Date: October 24, 2013
Author: Michael Charles
Organization of the healthcare in Senegal: http://en.wikipedia.org/wiki/Healthcare_in_Senegal#Organization_of_the_health_care_system
Matrone: Elected woman in each village who is responsible for rallying inhabitants for health related events.
Agent de santé (health agent): The latter receives 4-6 weeks of training and is able to take care of 5 common medical pathologies: Leprosy, TB, malaria, acute respiratory infections, vomiting/diarrhea.
Today we kick off Day 2 of the screenings in 3 districts, spanning multiple villages around the region. The local health workers, Andrew, Anne, Patrick, and I are covering the Saraya district and surrounding areas. As planned, we reported to the hospital at 7:30a in order to prepare for today’s 2 villages: Kondokho, Dallafing, both located at approximately 20 minutes from Saraya. The sun had just risen, so the heat had yet to take its tool on our level of energy. We moved swiftly, with purpose, as we gathered and loaded the car with the equipment needed for the screenings. “Today we’re going to rock!” I remember thinking. Our midwives were well accustomed to the screening process; we had all our equipment handy; the villagers were aware of our program… I was not sure what could go wrong at that point!
En route to Kondokho, we appreciated some of the farmlands flanking the dirt road. Kondokho closely resembles Badioula, the city were screened the day prior. Multiple compounds of 4-5 huts arranged in circular fashion around a common ground, where it was typical to find wooden chairs, a kitchen, or structure from which corn was hung to be dried in the sun. As usual upon our arrival, the team met the chief of the village and the agent de santé. The latter walked us to the village health post a few hundred yards off the main road. We were very encouraged by the fact that the villagers seemed aware of the screening.
The health post was a stand-alone two-room building. A door connected both room from the inside. It seems like no one had the rooms in years. The truth of the matter is that they were not regularly maintained and cleaned. So we quickly swept the floors and opened the windows. We moved one of the dusty beds on the empty room next door. The matrone was kind enough to bring us a drape and some buckets of water. We even placed some benches outside of the room. Moments later, the women were coming in. A couple at first… then a few more. Then they stopped coming. We had screened 6 women at that point, most of whom were eligible for the study. Anne volunteered to walk back to the village to find out where they all were. Her investigation revealed that most of the town women left to another village for a wedding. Well, we were definitely not going hit our screening target of at least 15.
We kept our heads up and moved on to Dallafing. There, the health post looked even move abandoned. The classroom was significantly dusty, which is reflected of its lack of usage. The desks were facing away from the blackboard, dated “Mardi, 8 Octobre 2013.” The school-age children have been out since July. The school year isn’t expected to start till next month. An agent de santé welcomed us to his village. By the time we were done setting up, he had rallied many women by a tree near the health post. Again we got a rhythm going. Yet again, after about 10, no one else came.
This tale of our time in those two cities informed my views of global health in various ways. First I learned that patience and flexibility are key in this line of work and setting. Andrew stated: “If this were easy, someone would have already done it long before us.” Hence, setbacks are expected. Regardless of our best efforts for anticipate daily obstacles, new ones never fail to arise. It has been interesting watching the behavior of some of the folks that I have been working on this project from the start. Anne and Andrew have continued to demonstrate steadfast sangfroid, as they use their creativity to keep the screenings going.
Next, I learned that this patience stems from the profound belief in the potential of the project. The project will succeed; it has to! There is some much need in this region of Senegal. With a clear understanding of the gravity of the work needed, the innumerable impediments become opportunities to get even more invested in the project. The picture above illustrates such determination.
Lastly, I learned that a good support system on the ground is essential to any project. For the slightest chance of success in low-resources settings, highly dependable local workforce is needed. Across my journey in Senegal, I have met and worked alongside very talented people. The Peace Corps Volunteers embody altruism at its best. The nurses, midwives, and matrones care very much about their compatriots. The agents de santé have very dependable at going door to door to spread the word about our program.
There is no magic formulation to get things done when resources are limited. Things will certainly go wrong in unexpected ways. However, patience, determination, and hard work are a few indispensable items in order to keep pushing through. Lives depend on it.
Picture: Anne Linn, PCV, being a rockstar and getting things done!