After a year in site, I realized I haven’t shared much with you about the health system and the people that I work with to improve our community’s health. Senegal’s national health care system can be broken down into several layers: regional hospitals, district health centers, health posts, health huts and community health workers.
My town is home to the District Sanitaire, or district health center. It is responsible for providing medicines, supplies and training for health workers at the seventeen health posts in our department and the numerous health huts in the more distant areas. The health center is managed by the Medecin Chef, a doctor who spends most of his time on administrative, financial and program planning duties rather than treatment. He is in charge of organizing all of the health campaigns in the department, such as house-to-house polio vaccinations and vitamin A supplementation and HIV testing. The health center is also home to several nurses, nurse assistants, midwives, traditional birth attendants, community health agents, a lab tech and a pharmacist. There is a lab that can take care of pretty much all blood and urine work and the doctor can take sonograms, as long as the electricity is working. For major traumas like broken bones, pregnancy complications and severe injuries, people are referred to the regional hospital in Kaffrine. Luckily for us, we have two full-time chaffeurs on staff that can transport people in a well-maintained ambulance.
On a typical day, the nurses take turns consulting with patients and writing prescriptions. The community health agents do a lot of the basic treatment: treating wounds, giving shots. Every morning the midwives and birth attendants provide prenatal and postnatal consultations, family planning and births. Sometimes they will give short talks to the women waiting on topics like preventing tuberculosis or the importance of attending all of your prenatal visits. Our health center is one of the pilot centers for a USAID Severe Acute Malnutrition (SAM) Program. A nurse who specializes in treating malnutrition consults with women and their children. If the child is diagnosed with SAM they are admitted to the health center and provided with medicine and Plump’y Nut (a peanut based food developed specifically to treat severe malnutrition), usually for a minimum of two weeks. Once the child has improved, they are sent home and monitored over several weeks to ensure that they continue to progress.
Khathya, a nurse assistant, measuring a child as part of the malnutrition screening program
My host mom Fatou, a traditional midwife, giving a woman a birth control shot
The activity that I have been most involved with at the health center is child vaccinations. Every Friday morning we weigh and vaccinate babies, usually under twelve months old, for tuberculosis, polio, measles, mumps, rubella, diphtheria-pertussis-tetanus (DTP), hepatitis B, Haemophilus influenzae type B, pneumococcal infections, and yellow fever. I don’t do the actual vaccinations-that part is for the trained health workers-but I help weigh the babies and enter all of their information into the various records that have to be kept. Every woman who attends the vaccinations is given a yellow WHO card that includes information for their child’s weight and all of their vaccinations-in an ideal world, that is. Unfortunately we’ve been out of these cards for a couple of months now so if a woman doesn’t already have one, we have to enter the data into their prenatal consultation cards, which also include space for vaccinations. This can get confusing when women have both cards but may forget to bring one or the other to the visits. That’s what we have the other books for, where we record the information that stays at the health center. It’s not a perfect system but considering the circumstances it works fairly well.
The head nurse, Maimouna, weighing a baby before the vaccinations
Maimouna giving the oral polio vaccine to an infant
These mornings can get pretty chaotic, not to mention loud, with all the screaming infants, but it is something I look forward to every week. I know there is a lot of controversy at the moment in the US and UK over childhood vaccinations, but I am grateful that the women here in Senegal happily comply with the recommendations and show up month after month to get their kids vaccinated. The likelihood of contracting diseases like tuberculosis, pneumonia, yellow fever and measles here are very high and life-threatening to children under five and the vaccines save millions of lives every year.
The health facilities here are understaffed and undersupplied, and I don’t always agree with how they treat patients, but I have so much respect for the health workers. They work incredibly long hours in difficult conditions for very little pay, and yet they still show up to work everyday and do their best to keep their community healthy.