Trying To Keep Up!

January 16, 2010 - Yako

As predicted in my last post, my focus was definitely improved after a night's rest. Still, the last two days have been overwhelming. Not only has it been busy, but there has been a great deal for me to try to comprehend in my first look at the health and medical services available for people in this region of Burkina Faso.

My mandate is to assess the activites of my host organization with respect to the management of care needs for people living with HIV, as well as their capacity to provide palliative care to those who are living with advancing disease. In order to do this, I must understand how the medical services that are available in the region are managed, how they are accessed by people in the community, the relationship between the state medical system and the community associations in providing care for people living with HIV, and how people manage their daily lives - all of this along with recommendations for developement, all before the end of the month. I try not to think too much about how I can possibly do all of this - I'm just going one day at a time.

I spent yesterday looking at the activities of the various departments of SEMUS, including their forestry and agricultural development programs. SEMUS is active in helping community organizations, cooperatives and associations in their capacity building by providing access to expertise, by bringing together different groups with simmilar goals, and by establishing linkages with international partners. With respect to care for people with HIV, they are active in prevention and screening for HIV, and have a clinic for follow up of individuals who have been diagnosed with HIV infections. Today, I began to tour the health care and medical facilities in the area. There is a local hospital (Centre Médical avec Antenne Chiurgicale or CMA) and several rural health centres (Centre Santé et de Promotion Sociale or CSPS). These are provided through the Ministry of Health and manage to function despite a severe lack of resources. The rural facilities have basic buildings with virtually no equipment and extremely limited medical supplies and medications. They are attended by a midwife and either a nurse or (more likely) an auxiliary nurse. They are in cell phone contact with the CMA in Yako and are able to keep patients overnight if required, but no longer than 2 nights. Serious problem (as far as I could tell, they were all serious problems - malaria, other infectious diseases, etc.) that could not be managed at the CSPS were transferred by ambulance to Yako. Ambulances are of course a scarce commodity in rural Burkina Faso, and they are dispached from Yako, which means a round trip of up to 80 km and considerable delay if they are dealing with a medical or obstetrical emergency.

Most of the CMA dates from the colonial era. Some of the buildings have been renovated somewhat, and the pediatric unit was recently built with funds provided by an international donor, but much of the hospital is falling apart, and resources are almost non-existant by western standards. I met a young woman who was brought to the hospital by ambulance with an obstructed labour. By the time she arrived, her uterus had ruptured and the baby was dead. She survived because of an emergency hysterectomy, but during her entire ordeal she had not received any medication to manage pain except for the general anaesthetic at the time of surgery, and some ibuprofen (Motrin or Advil) after the operation. She was now confronted with a dead baby, the loss of her fertility (which is devastating in a culture where family is everything), and her family now has to contend with a bill for her medical services that will likely drain their resources. When I saw her she was surrounded (and cared for, including nutrition) by her family who were very concerned for her, but she was withdrawn and clearly in severe psychological distress.

The images here are from the CMA in Yako. The bottom picture is the medical unit, with the doors to the patient room opening directly outside. The corridor is the emergency and urgent care clinic.

The dilapidated wall and gate lead in to the psychiatric unit. Inside, you see mothers caring for their children, doing the cooking over an open fire pit and the washing in buckets. The young woman is likely suffering from schizophrenia, and is chained to the tree by her right ankle in order to restrain her (her mother made certain that I saw this). There are virtually no medications available to adequately treat schizophrenia.