I'm just gearing up for my second week of work here, although I can't really say I'm "working" so much as "learning" at this point. There are so many complexities of how MSF works, who all the team members are, how we are to work effectively together and between ex-pat and national staff members, how we are to collaborate with the health care providers working here,... and then there's all the learning that is needed to understand things like the political context of the healthcare system and the community within which we work, and the many cultural pieces that must be understood. I'm also really cognizant that many humanitarian workers have come before me and rather than jumping into any action, lots of questions have to be asked and histories of what has been tried before must be considered. All the while I'm working hard to refine my French, adapt to the local accent and expand my medical vocabulary. I also have tonnes of learning to do about HIV and the prevention of mother-to-child transmission, as well as malaria in pregnancy/babies, etc. etc. I am taking it all in and trying to not get too overwhelmed!
The details of what I'm up to here are yet to be really understood, but the basic deal is that I'm working in a project in one of the poorer (but not poorest) neighbourhoods in Conakry, the capital city. I am involved in 3 health care centres that provide pregnancy, birth and children's health care. We refer to the big tertiary hospital if a case is particularly complicated, although the referral hospital has a mortality rate of 25% for children, so it's not the cosiest back-up option. They also functioned at an average of 150% capacity over the last few months, making the quality of care a big issue. That being said, we are working within the existing health care system and MSF wants to collaborate from within the system, rather than ignore the usual policies and referral processes...so that's the context. I am working with a local midwife who has been overseeing the centres, and we are providing free prenatal care and birth care, followed by free healthcare to all kids under the age of 5. It's incredibly complicated to offer free healthcare to this target population within a system that is usually fee-for-service, with staff memebers who are used to getting money from patients, and addressing the complexities of the boundaries that we have to draw ie) a dying 6 year old is not eligible for our care... My brain is swirling with issues that I'm learning about, but I'll be online all day if I start sharing too much.
So I'll just give a quick comparison of what I've seen so far, compared to my experience in Uganda. Much like last time, it's incredibly hot and humid and the air quality makes breathing undesirable. The city is overcrowded, very littered, poorly maintained and loud. Electricity is limited and water is scarce. Like I saw before, the amount of corruption within the hierarchy of the powers-that-be creates incredible challenges when it comes to making change; but at least in Uganda there was some government-funded care. From what I've been able to figure out, the healthcare budget was 5% of the annual federal budget in 2008 and was completely absent in the annual budget for 2010. The army takes up something like 50% of the budget, perhaps more. They use "cost recovery" to provide private healthcare and when the government has been approached for funding, they have encouraged health centres to seek international NGO funding instead. So we are working within the system but we aren't really collaborating towards any sustainable change it seems. In other similarities to Uganda, there is a general lack of supplies, overcrowding and delays in health care possibilities. And the culture here, like in East Africa moves at a much slower pace than I'm used to. This is lovely when you are having dinner at a restaurant, making for a very relaxed experience. However, when there is urgency or someone's life is on the line, it feels really uphill to provide help.
The differences compared to my experience last time is that I have physically been coping better; I am adjusting to the heat and humidity and different hygiene standards with greater ease, and knock on wood, I haven't gotten sick yet. In Uganda there were always real shortages in staff, leaving much work to be done by foreigners if they were so inclined. Here there are so many staff members at the centres, you can barely move through them. None of them are officially paid to be there, but they charge the patients themselves. There is no way to distinguish an educated midwife from an uneducated midwife or from a student or cleaning lady, which is pretty wild. (There are also tonnes of volunteer army men, police and traffic control dudes. It's quite hilarious actually; you never know who you're dealing with...could be an official army sargeant, could be the guy next door playing dress-up!) The midwives seem to be less violent than they were in Uganda, which is lovely. They are still quite abrupt with the women and aren't particularly sweet, but it's better. (But it can be shocking to see a midwife reem out a patient because she forgot her healthcare booklet; that wouldn't really fly back home!) There are no HIV programs in place here, whereas Uganda has a relatively a good one. There is no counselling, testing, treatment or prevention of mother-to-child transmission whatsoever! Nobody knows the actual prevalence here and nothing is currently in place to reduce the effects of the epidemic. With how much we know about HIV, it just seems so crazy that we're in 2011 and babies are being needlessly infected with HIV when we know how to make it otherwise. One of the most obvious differences is that most people here are Muslim. There is very little Christian missionary presence compared to Uganda, and the mosque sings sweetly all day near my house!
I could really go on and on...and I will another day... A-M
