Andrew Dykens, Trip Director
October 11, 2012
Today we share perspective. Just as we share our work. Just as we share our motivation. Just as we share a trip together.
We sent two teams to two villages today for a day of screenings. Our first effort at implementing the record keeping system developed by the local team, with books and a plan for patient registration, clinical records, and monthly reports to the district level. One team headed out to Samecouta at about 8 AM and I, being in the second team, climbed aboard the hospital car to head out to Sekhoto shortly thereafter.
We shared the car with a patient who was being discharged from the inpatient ward (an open air room with 7 beds filled mostly with kids three and under appearing half their stated age, malnourished, and miserably ill with malaria). This patient, several weeks previously, had sudden onset quadriplegia associated with pregnancy. She had had it once before (during a previous pregnancy) and it had resolved completely after a few weeks. This pregnancy brought this episode back, causing the loss of her child and complete limb paralysis lasting several weeks. She was being treated with low dose steroids, being, really, the only option. Within the last 2 weeks she had begun to improve and had regained most of her strength in the upper extremities though still without use of her legs. She was presented with the option of going to Dakar for further testing and advanced therapy for an illness as yet unnamed though narrowed to exclude life threatening causes related to the brain or spinal cord (by way of careful physical examination and history). Likely she will recover at home (having opted out of the ride to Dakar which would have been soon followed with expensive medical bills).
We dropped her off in her village. She was carried to her mud brick home by concerned family members and neighbors. No doubt she will receive loving care here, but she will definitely not receive physical / occupational therapy, social work, nutrition counseling, wound care specialty care (should bedsores develop), counseling to avoid future occurrences, definitive diagnostics, nor evidence based therapies for her condition. She was elated to be home. You could see it in her face and the faces of her family welcomed her back, as well.
We continued. Sekhoto is a beautiful village. So far from any road that there was discussion and second guessing as to the way to get there between our driver and the nurse, Diop, who covered the health care for the entire zone (we picked him up along the way). His health post was several hours walk for many of the patients in his zone, a task quite challenging during this time of year, especially, for the infirm and those who oftentimes are obliged to carry them along this path. Camara is the village Chief and his compound is warm and welcoming; Seven thatch-roofed, mud-brick huts surrounding an open area with traditional mortars and pistils lying about, a gorgeous baobab tree on one end and a kora in the middle (a traditional structure whereby one can lounge away the brutal heat of the afternoon).
After informing him of our work, we headed to the health hut, a structure in existence but with no one to carry the responsibility of working within it. The issue of the shortage of health workers is one of the most significant issues affecting many low income countries. Africa, the continent, as an example has about 10% of the world’s population, carries about 24% of the disease burden, yet has only 3% of the health care workforce. What a challenge.
Our intention today is to screen some women in this village for cervical cancer, the number one cancer killer among women in Senegal, currently. This illness is relatively easily treated if caught in the early stages. But, like many places, the absence of primary health care resources does not allow this type of preventive medicine to occur. Chronic diseases currently represent the largest cause of morbidity and mortality in low income countries and the rise is dramatic. Among many things, we can blame this on urbanization, nutrition transition, transnational corporations (read tobacco companies), not to mention other international policies favoring rich nations as well as the constant struggle for development (basic sanitation, roads, trained personnel). I digress.
Our other purpose is to observe and improve the process of the screenings in these small communities. We have been working hand in hand with a team of midwives in the region and extraordinary Peace Corps Volunteers to advance this work. Our next step will be a mass screening campaign around the region in early 2013 that will, in essence, kick start this service throughout the region. These unbelievable women (the midwife leadership team) have spent the last year and a half training individuals throughout the region with extraordinary logistical and coordination support from three generations of Peace Corps Volunteers on site. We need to assure that the process is efficient, effective, ethical, and responsible.
Our effort is initially being aimed at women between the ages of 30 and 50. Most women who showed up today were somewhere around the age of 20 to 25. We had several women who were likely in their early 30’s and the local traditional midwife (ALSO women’s group leader, ALSO primary health communicator, etc, etc) was the only person presenting an identification card revealing her specific age to be within the target age range. The others could only guess at their own age. All of the older women were in the fields tending to their peanuts. January will be better as harvest will have passed, but, generally speaking, women past childbearing age don’t receive medical care. Quite different from what I see on Chicago’s West side, to draw a comparison between two “underserved” communities, where women (and men) are very proud to show up soon after their 65th birthday because they can now afford a consultation (Medicare kicks in) only to find that their kidneys are holding on by a thread because of long standing hypertension that could have been very easily diagnosed and treated had they received basic services earlier. Hmmm, interesting comparison. But, again, I digress. (I tend to do that sort of thing)
After we wrapped up our work for the day, we did take a moment to play with the kids and leave them some distractions. A few kick balls, a jump rope, a flute. I need to take a moment here to recognize a very special girl, Kendall Platner, from Neosho, Missouri. She is 8 years old and has spent, literally, the last several months, little by little, collecting toys to give to someone, somewhere, who might need something to play with. Of her own accord, with no prompts, and, really, no specific plan, simply a desire to share. Beautiful. When I learned about her, I, of course, offered to bring these along as I knew these gifts would be highly appreciated. Now I need to give a bit of context for this. We, as a group, through our approach, generally do not bring things (though we do bring a few kickballs for the kids everytime we come). What I mean is we don’t come and give medical supplies nor do we see patients or practice clinical medicine while we are here. We take every opportunity to assure ourselves that we are working within the system in place to find, through extensive local leadership and participation, locally appropriate solutions that can be integrated into the service delivery system in existence. Our Peace Corps Volunteers provide us with extensive local experience and the local health leadership (within the Ministry System) guides the work. We merely offer the academic resources of our institution, training and public health expertise, and good will. That is our approach. However, Kendall’s beneficence is extraordinary, indeed. While she is too young to realize that gifts without consideration of context and careful assurance of sustainability don’t impact disparity, Gifts for the sake of sharing, thinking of others, increasing tolerance and understanding, opening communication between neighbors, and providing some old fashioned fun are incredibly important and beautiful. I have never met Kendall. I don’t know what prompted this motivation to share herself with others, but I, personally, have found her personal initiative inspiring.
Our ride back to Saraya was quiet and pensive. The team exhausted from the day, some of us nodded off briefly, but I did my best to watch the countryside pass by, with the women working in the fields, and the occasional traveler on bicycle seemingly burdened with too many sacks to guide a bike along an uneven route bordered with shoulder high weeds. Undoubtedly, the route we share is sometimes not what we had expected and the terrain is often rough, but forward progress continues. One more step forward that we have all shared together.