today i will spew out random things i have seen and learned while at the health centres here in conakry. a mixed assortment of tidbits that have stuck in my brain and intrigue me:
(that is denise, my midwife partner in crime, feeding colostrum to a premature wee one)- the WHO recommends the distribution of mosquito nets to all pregnant women in countries where malaria is endemic; mass distributions of mosquito nets were done by various NGOs over the last decade here...2006, 2008, 2010. when our community health agents go door-to-door, we find there are almost none to be seen. MSF follows WHO recommendations, hence we are distributing nets to all our pregnant patients, despite many proven failures of mass distribution programs. after 6 months, we have found that about 8% of pregnant women are using the nets we distributed. they either bring them home and stack them neatly on a shelf (with pride), they sell them, they gift them, they use the threads as fishing line, or the net itself is used for shrimp fishing. they report that they smell bad, they inhibit air circulation (making it too hot to sleep), their husbands don't like them, or they didn't have a hook to hang it. each mosquito net costs about 5-10 dollars and over the years, i can't imagine how much well-intentioned NGO money has actually gone into shrimp fishing!
(isn't she the sweetest little shrimp!?!? guinean babies are sooooooo lovely!)- i watched our community health agents go door-to-door (figuratively, because there are rarely doors)...as they spread preventative health information to families, such as the importance of mosquito nets or proper waste management ideas. typically there is a group of 10ish people who gather to listen to the agents, and of those people, 3-4 pay moderate attention to what is being discussed, but most don't even pretend to be listening. then everyone claps and says thank you and they get on with their day. i wonder how many times each family has had some NGO-backed person come give a speech...i wish i could speak their language and ask them what it is like to be on the recipient side of international development programs. the concept is great and their are good outcomes sometimes, but my experience really made me feel how disengaged people seem to be when yet another aid organization comes to tell them what to do.
(two babes born to an HIV-pos mama, who have a 99% chance of not being infected :D)- i shook my head and laughed when i saw one of these same health workers (MSF employees who, i remind you, are spreading public health messages on our behalf) take a piss right outside the main entrance to the health care centre. we put in toilets, but they have decided they are so new and nice that it is better to keep them clean and pee around the health centre instead. furthermore, certain individuals have deemed themselves guardians of these toilets, and they charge people to come in, further encouraging their disuse. basic hygiene can feel impossible to attain sometimes!
(donations of medical supplies are lovely, but maintenance of these gifts is a whole other story...)- since our program started in 2009, the number of people coming to the health centres in which we work has gone through the roof. mostly because we are providing free health care to our target population (children under five and pregnant women). the most challenging side effect is that what were once appropriately sized structures are now disgustingly overcrowded, making quality healthcare provision nearly impossible. we have unintentionally worsened the conditions of the consultation spaces and we have seriously aggravated the staff who work there. it is trippy how we have created more needs by trying to meet existing needs. so to address this, we are doing renovations and improvements to the facilities, which is an expensive undertaking, only to wonder what will happen when the project is over. will these health centres be an addition to the many many beautiful but empty health care facilities all over africa?...facilities that are no longer frequented because people can't pay or because they have no more medications/supplies.
(our birth beds that MSF donated a couple years ago)- this is a good one! we were reviewing the names of staff members who are listed as paid employees by the Guinean government at one of the health care centres. we wanted to try to figure out who within the structure is actually supposed to be there (as the units are packed with various people in medical uniforms, some of whom are trained, some are volunteers, some are students, some are just people who have a medical coat and want to come make money...it can seriously be a feat to try to figure out who actually has some expertise). you can imagine how interesting it can be to try to improve quality of care when some of the midwives turn out to be cleaning ladies who inherited a lab coat! anyhow, we noticed that there were three pharmacists listed, but actually, there is only one pharmacist at the centre. the director informed us that the other two went to work in europe a few years ago. he went on to explain that many of the listed names are people who now work in europe, but the government hasn't updated the lists in a long time, and nobody enforces employee presence or absences. so while the government spends about 1% of its budget paying health care workers, who knows what percentage of that money is actually being paid to doctors overseas who don't even live here anymore. amazing! not to mention the rest of the list, which consists of people who come to work for a few hours a day, a few days here and there, etc. etc.
(a paediatrician from geneva teaching our staff about care for premature babies...a concept that is really new here. they tend to accept that strong babies live and weak ones die, and trying to engage them in newborn care is really asking for a huge paradigm shift it seems)- another lame side effect of our project is that we have made healthcare free; so women are told never to pay for any services or medications they receive. the cleaning ladies at the centre used to get tips or gifts of soap from the patients, but now nobody pays them anything. so we have chosen to give them a small stipend, but it isn't enough, and rumours suggest that they sometimes work as midwives in the community, attending births at home to get more money. the situation doesn't necessarily lead to improved outcomes for our target population. and despite being a big advocate for home birth in canada, home births with cleaning ladies in guinea aren't really something i want to encourage.
(this is one of my favourite wittle ones...)clearly there is a lot that needs to shift here in order for health care to really improve, but it is so damn complicated. so much disorder, lack of follow-up when it comes to medicine and administration, lack of hygiene, a medical culture that lacks compassion (not because people want to be mean but because they are overworked and need to make ends meet), no privacy, overcrowded conditions, theft, waste management concerns, no food for patients, little concern for sterilization, nothing is labelled, protocols don't exist or aren't followed, delays in every step along the chain of care. it is hard to know where to start. as per my last post, i am trying to just exhibit good habits and see if it catches. it seems like it does, if i am in the room watching, but when i leave for lunch or turn my back...not so much. but we have to keep our chins up and do the work that needs to be done, right? ;)
AND...seriously, all the little ones getting life-changing surgery because of our tin of change bring much light to my work here!
(i have never seen a newborn casted like this before and find it quite charming)
(a family that thanks you for your support!)
