Friday January 21, 2011
Blog entry written by Andrew Dykens
Bonjour, tout le monde, heera siita, an wali jam, naka wa suuba
One of our hosts, Dr Isaac Manga, ended the day for us yesterday on a
high note. He gave an extremely interesting and informative lecture
on malaria, including the clinical diagnosis and management as well as
discussions surrounding the epidemiology and health system approach.
We were quite intrigued and very impressed at the system that is in
place here, in Senegal. The treatment of malaria is quite well
decentralized such that community health workers are able to not only
diagnose but provide medications, as well. This is critically
important in low resource areas where the ability for patients to
travel can be quite restricted. In many countries patients must
travel to the regional hospital to get medications for malaria. There
has been some thought in the past that providing this form of
decentralized management could result in resistance to the medication
because of problems such as patients not completing regimens.
However, the community health workers are taught and directed to
observe all therapy (similarly to tuberculosis management) so that the
risk of developing resistance is very minimal. In addition, I was
reassured and encouraged to learn that there is no problem with
corruption (in terms of selling medications that should be freely
available – in some places this is done to supplement income to health
workers that may not be well paid, or not paid at all at times). The
degree to which the population at large is educated on the freely
available medications discourages this practice and, at the same time,
encourages early health system utilization. It was a terrific
lecture, and we learned a great deal.
Today, we are back to it. As I currently write this, a portion of the
team and several of the trainers being trained are performing a VIA,
cervical cancer screening. From my perspective, it is quite exciting
to see this training occur and today is the last day of the training
of trainers. We will be discussing, with the trainers, their
perspective of incorporating this methodology into the current health
system, to ensure sustainability. We were able to have many
discussions of this sort prior to arrival with the Peace Corps
volunteers as well as with Dr. N’diaye, the lead physician here, but
we are continuing the conversation as it is critically important to
find the manner in which the integration of the new screening process
into daily practice and data collection will be the most likely to be
maintained. We will, as well, take up the challenging conversation of
management of positive findings. Undoubtedly we will (during our time
here, or after the UIC team leaves) find precancers and overt cancers.
The difficulties of working through the system in place will be
discussed and we will ensure that every woman’s welfare will be
considered thoroughly. In addition, we hope to ensure that there does
not develop any type of stigma around the diagnosis within the
community. We will be discussing this with those being trained, as
As I am now getting back to this writing, these discussion were,
indeed, quite lively, and very encouraging. We have full buy-in from
those participating and we will in all likelihood not have significant
difficulty ensuring sustainability in consideration of implementation
into the health system. Of course, our Peace Corps volunteers will
greatly assist us with the oversight of this component after our
departure, through the coming months, and we may need to adjust the
details of the plan somewhat from time to time. These “growing pains”
will be inevitable, but it is comforting to know that our philosophy
is in line with theirs.
Well, we have, as well, been quite honored today, in another sense.
This morning the United States Ambassador to Senegal, Marcia Bernicat
came to visit us at our training site, along with the Peace Corps
Country Director, Chris Hedrick! Wow! What an honor and surprise.
She took the time to thoroughly listen to the details of our project
and model of collaboration with the Peace Corps. She expressed that
she was impressed with our approach and wished us the best of luck in
moving forward. She mentioned that she hoped to discuss our project
and model with others, as well. She took the time to meet the
hospital staff and posed for several photos. It was terrific, as
well, to see Chris again. I was honored to be able to stay with his
family during my site visit in May 2010. He has been an incredible
support for the project and organization overall and, today, once
again, reiterated his support. His openness to our project and
encouragement has been extraordinary, and I really can’t overstate the
degree to which Peace Corps’ infrastructure, integration, and trust
has been invaluable to the progression of the project.
Today ended our teaching sessions for the training of training
component. I am proud and appreciative of our team. Tracy Irwin’s
experience has been invaluable in teaching this topic and my
residents, Melody and Paulette, as well as Nora have really been
involved in the educational component. Their advancement over the
past few days of relating information in creative ways and through
translation has been quite impressive, from my perspective. I am
looking forward to seeing the newly trained trainers take the lead
role next week. I am looking forward to learning from them, as to
their manner of relaying information effectively.
Well, I will end by announcing Peace Care’s One Year Anniversary.
Happy Birthday, Peace Care! Founded January 20, 2010. It has been
quite a year and I am looking forward to what is to come.
Of course, I want to tell my wife and daughter how much I miss them.
Lauren and Sevi, I’ll be home soon.