and partly because it forms part of a list I'm compiling entitled 'Things I'
ve said that seem perfectly normal here, but would seem crazy anywhere else'
Other notables include 'just come and hypnotise this chicken whilst I tie it
to the gas bottle', 'For how many days did you put the piece of cow bone in
the childs ear before coming to see us?' and 'It's really very simple, put
the gun down and THEN come into the clinic.'
So this week was a trip to a much-neglected clinic. So neglected in fact
that this was only my third visit in nine months. In many ways we have
failed them. There have been some fairly large extenuating circumstances,
the meningitis outbreak predominantly, but it still doesn't feel very good.
That the clinic is operating at all is miraculous however the lack of
supervision is evident here more than anywhere.
The drugs were being given out a little like party bags at the end of a
childrens party (i.e. everybody gets one) and the first morning we were
there we had to sack one of the staff for being drunk. It was a shame in
many ways as you are not only sacking an individual but also making life
much more difficult for his wife and children. But you can't really think
about that, after all drunk workers are not exactly good for patient safety.
Not a good start. It was to get worse.
In the afternoon I was sitting with the health worker in the consultation
room. In came an old woman with a basket. In the basket was a five-week old
baby wrapped in a blanket, I instinctively reached into the basket and
picked the baby up. The child was cold and dead. The grandmother said she
thought the child had died an hour or so ago but she had brought him in
anyway because she had heard we could bring people back to life. I think
this gives some indication of the general publics perception of what we can
do. I have to admit I was a little lost for words.
I stepped outside into the dazzling afternoon sun, it was still hot, but
dark clouds were gathering at the edge of the horizon. Dark clouds were soon
gathering in my head, my outreach buddy beckoned me over to the waiting
area. "Mate, I think this kid's got measles."
It's pretty difficult to describe how I felt; measles (thankfully now very
rare in the west) is still a huge problem here. One in every 250 cases is
fatal. If you score enough cases in a small village, (and 'enough' can be
less than twenty) you have to vaccinate.
I went through a bit of a cycle of thoughts. Firstly I tried to deny it "It
can't be, the rash isn't".this thought juddered to a halt as I found a
koplick spot (definitive proof it was measles) in the childs mouth. "Ok, ok
fine, perhaps it's an isolated case" I said glancing at the other children
around, and my eye being caught by one with puffy eyes and a very
distinctive rash. The faint sound of straws being clutched could be heard,
so I shut up.
As the week progressed we found progressively more and more cases. Most hadn
't come to the clinic at all and were merrily sitting at home. We went out
to a few of the surrounding villages and found more measles riddled infants
including one very sick child who hadn't been to the clinic and was in sight
of the health centres gate. The long and wordy public health books label
this sort of thing health seeking behaviour or (in intelligible English) why
sick people don't come to the clinics.
When I first arrived here I got the impression that people here were
actually very good at getting help if they were sick. People even seemed to
come when they weren't sick. The high numbers of patients pitching up with
nothing more lethal than a snotty nose seemed to support this theory.
However as time has gone on I've come to realise that actually we only
really scratch the surface.
If you were where I am now we could stand on the airstrip and look out at
the hundreds of huts and settlements across the flat savannah and I couldn't
tell you if the people living there were alive and well or all dying of
measles, meningitis or anything else.
So a week of measles investigation and general support ended with the
appointment of two new staff (always nice) and a vigorous game of football
on the airstrip. The plan was to return to base, pick up the stuff for
vaccination, come back out again and vaccinate. I was dreading it. The
logistical problems, keeping the vaccines cold, long days and nights and the
associated stress was not high on my wish list. Been there, seen that, very
much got the t-shirt.
On return to base we sat down and had a team meeting with all the staff from
the base. One of the nurses in the base said she had never done a
vaccination campaign and would love to come along too; objections were
raised about medical cover in the base. "You could always replace me???" I
offered, I tried (and probably failed) to make it sound like I was doing
them a favour, but in honesty, I think it was the other way around. So at
silly o'clock in the morning I watched as they bounced off along a dirt
track. I got to sit in clinic all morning and actually see some
patients.joyous!
I feel very much on the home stretch, a bit like a marathon runner rounding
the last corner, the end is in sight (two weekends left!) but there is still
work to do before I get there. In many ways I'm trying to pace out the last
few weeks. Increasingly I'm referring decisions about how the clinics are
running and focusing much more on the clinical stuff, which is the bit I
enjoy the most. The long and tedious human resource, logistical and program
planning problems aren't going to be solved in one visit and that's the most
I have to any of my outreach sites. Last week I said goodbye to two clinics
and their staff and this week I say goodbye to one of the two base sites.
At the first clinic I said my farewells to one of the staff said "I am very
happy, because you were there when there were many problems and things were
bad (the clinic was looted and destroyed and I was newly arrived for the
reopening) and now you have seen the clinic when it is good." I couldn't put
it more eloquently than that.
