Its funny, I have so much training and so many degrees & diplomas now… but even though I can easily talk theoretically about many of these problems that we are seeing – for example, the various causes and contributors to child malnutrition, how it should be managed in theory, etc – I feel somewhat overwhelmed when thinking about what to do practically to help ameliorate this system that often just doesn’t work. Part of why I have so much education is that I always think I don’t know enough to actually start… yet, here we are. So, where do you start? What can you do that is going to have a lasting impact? How do you make changes & suggestions without sounding imperialistic? Where do you find sustainable funds to pay for necessary medicines and treatments? These are the questions I’ve been wrestling with, how to take all this theory I now know so well and transfer it to action.
We are starting with an 8 week orientation of sorts. A series of rotations through the peripheral clinics, the pediatric service and the adult (maternity & internal medicine) services so that we can get a handle on the way the health system functions. Or doesn’t.
I’ve been in the peripheral clinics and Thursday and Friday I spent visiting the CSPS Accart-Ville, where I got to see nutrition interventions – the monthly weighing of well kids (with checks of their vaccine records) and the CREN (Centre de Rehabilitation et Education Nutritionnel) where they provide food supplements and education to mothers of kids who are malnourished. Severely malnourished kids are referred to the main hospital, but mild-moderate ones are treated locally. The kids receive vitamin A on admission to the program, and their mothers come every day and are taught how to make a number of different “bouilles” or gruels, with rice or milk or eggs. The mothers are responsible for cooking the bouille, with supervision of the nurse / nutritionist. In the process, they learn about different public health interventions, like hand washing & hygiene, vaccinations, home management of diarrhea, signs of severe malnutrition and other topics chosen by the mothers. At this CREN, it costs the families 25 CFA / day; nearly everyone can scrape together that much and it would cost more to buy the nutritious food that is provided. The kids are weighed once weekly, and referred to see the nurse if they aren’t gaining weight appropriately.
Friday I did consultations with two of the nurses – there are not enough doctors, so nurses provide the primary care. At first they seemed displeased that I was there, but over the course of the morning they warmed to me, and I did a few teaching things. (Like, recommended that they use Tylenol instead of aspirin for kids who may have viral infections because of the risk of Reye’s syndrome, which they’d never heard of). Most of the kids had fever, and they were all given a diagnosis of malaria and prescribed oral quinine. No smears are done at the CSPS level (or in the hospital for that matter but that’s for another day). It was interesting to see how things work. I asked about their PMTCT (Prevention of Mother to Child Transmission of HIV) program – the person who was trained in that left, so they don’t do it any more. They do recommend HIV testing and if the mothers accept testing, and are positive, they are referred on to a center that can follow them.
This coming week, I’ll be spending time at another CSPS that does lots of maternity and even PMTCT. It will be interesting to learn more about the barriers to care, and the strengths too of the decentralized system.
The other big news was my moto. I’ve been thinking about purchasing it since shortly after arrival and the only reason it took this long was procrastination. Bobo has more motorcycles / mopeds / scooters per capita than any other city I’ve ever seen. Even the hospital parking lot is mostly for motos. There are relatively few cars on the road here (1 car for every 5-10 motos!) and many of the streets are wide although rutted & potholed. However, until a few weeks ago, I had never driven any two wheeled motorized vehicle… so its still a little terrifying. But I have to say that it is SO much nicer to have my own transport and not have to depend on finding a taxi willing to take me to my house. All 4 of us now have motos – Dana bought hers yesterday, the last to go. Sunday, I was able to go visit Dana for a while, a feat nearly impossible without wheels as no taxis go from my house to hers.
Anyhow, I hope everyone at home had a lovely Thanksgiving. (OK, well, all those Canadians for whom it was Thanksgiving this weekend). Its odd to think of you at home, the leaves turning, the weather cold, tucked inside and having turkey feasts… while I am sitting here sweating in a tank top & shorts, and struggling to think of where we’re going to find refeeding formula to give to the malnourished kids in the hospital.
1 comment:
Congratulations on your independent transportation! I know that will make a huge difference to you as you can now get yourself around.
From what you've said over the last few posts, it seems to me that a big problem health care providers experience there is a lack of continuity. People with training do a job until they leave and then there is a gap left behind. Programs run until funding sources dry up and then there is another gap. It must be a huge challenge even to keep lines of communication going among professionals with all the changes and losses along the way.
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