Always Late

13 April 2010 Comments

Hello Everyone! My last entry has been a few weeks ago and I feel like I haven’t been so consistent to all my readers back home. Sorry about that…but it is definitely not from a lack of things to write about. Quite the opposite as my last few weeks have been absolutely action packed and I have either been on the road, too busy or simply too exhausted to go back to my computer after dinner and to organize my thoughts into a blog entry!

Highlights include a 3 day road trip to Kilwa to meet the “Medecin Chef du Zone”. As the Ministry of Health doctor responsible for all of the medical activities in the health zone where we work, he is my direct counterpart and one of the most important contacts/relationships I need to maintain. The meeting was good…but the road trip in itself was incredible.

I was also busy hosting community meetings in 5 of the villages where we currently support the local Ministry of Health clinic. In principle, this is a ‘town hall’ meeting where MSF explains our reasons for leaving, describes what the actual handover process will look like and gives the village leaders a chance to ask questions. In practice, this has me sitting in a sweaty classroom for 3 hours telling 50 people that they are losing their free health care and that now is the time to step up and to start working with the Ministry of Health to take responsibly for the health care in their community. Interesting. Important. Draining.

Finally, as we have less then 2 months before the actual handover date, I have also been busy giving notice letters to many of my staff. I have done about half…which means that I have had individual meetings with over 50 staff members where I give them their pink slip, explain their final payment details and discuss their plans for ‘after MSF’. I’ve had some interesting responses that I thought I could share.

After 20 straight days on the go, I was finally able to take my Sunday off! Over this next week, my schedule is a bit less hectic so I plan on writing about each of the topics above. However, for today, I want to leave you with a description of my visit last week to see a traditional healer in action…

They Are Only Roots

Witch doctor? Fetisheur? Shaman? Traditional healer? I suppose all of these would be an acceptable way to describe the man to which I was currently being introduced. Although barefoot, he was wearing a green and black striped golf shirt with grey slacks and was quite presentable. His eyes were shinning and he seemed genuinely impressed to receive a Mazungo as he invited me to join him in the shade of one of the huts that were scattered around his yard.

Here I am, sitting in my white MSF T-shirt and representing all forms of western medicine. Not only does this contradict his beliefs and those that he tries to install in his clients, it also represents a direct competition to his business of healing.

So, as you can imagine, this conversation was going to be a bit awkward and an invitation to sit with him in the shade was a good start. We (I was here with the expat nurse in charge of the outreach team and one of her Congolese staff) were not just dropping in either…we had heard that there were a few patients in pretty bad shape that really needed to be transferred to the Ministry of Health clinic and we were hoping to take a look.

The Pharmacy?

After introductions, I started by asking about his patients and how things were going. He confirmed that he had a couple of difficult cases with fevers but that his treatment seemed to be helping. Curious, I asked what, exactly, was his treatment for a fever. A bit surprised, he asked if I wanted to see his pharmacy. Of course...so off we go.

Rounding the corner of one of the small huts, we arrive. There is an axe, a few small piles of roots and various chunks of wood obviously from different trees. Oh…this is the pharmacy!? It really looked more like an empty wood chopping pile. He then proceeded to pass me different pieces of wood explaining that this one is for fever, this is in case a woman cannot get pregnant, this one is for worms. You just boil them for a bit and sometimes you drink it or sometimes it has to be injected. It depends.

And your patients with fever? Sure…come take a look.

We walk over to another small hut and the outreach nurse ducks her head and enters to examine a one year old boy that is clearly in the late stages of severe malaria. His eyes were rolled back, he was clearly anemic and he was in desperate need of a blood transfusion…not more of the root concoction.

Now the negotiations start. If we aren’t able to convince the traditional healer that this boy needs to go to the health center, there isn’t much we can do. If he tells the parents to go, they go. If he tells them to stay, they stay. If he tells them that their son has offended the evil spirits and will die, they accept. That is the kind of power he holds.

Follow up

In this case, we were successful. The parents quickly collect their things – a pot, blanket and a few pieces of manioc – and carry their son to the waiting landcruiser. It is hard to know why the traditional healer accepted. Maybe he was trying to put on a good show for the foreigners. Maybe he knew that the boy was going to die anyway. Maybe he honestly cares about the health of his patients…

We arrive a few minutes later at the health center, quickly confirm that it is malaria and give some medication to try to stabilize him. You need a fully function lab to do blood transfusions so the outreach team prepares to transfer him to the hospital. The parents pick up their child, climb back in the car and are joined by a Congolese nurse who will do what she can during the painful 3 hour trip back to the hospital.

He died halfway there.

Always too late

Although we are pretty good at saving lives, it is certainly not always the case. One of the main reasons patients die in our health centers is that they simply show up too late. There was really nothing that we could have done for the boy. If he had arrived a few hours earlier, he would probably still be alive.

Sometimes, they don’t even realize that their child is sick until it is too late. Sometimes they have to walk for hours – or even days – to reach the health center. Sometimes they simply think that there is nothing we can anyway and don’t bother.

However, more often then not, they simply trust their traditional healer and his pile of roots. We do what we can to educate and sensitize, but we are going up against hundreds of years of tradition and that is not easy. MSF does not pretend to address sorcery or think that all of these traditional remedies are useless; while there really is a time and a place for these beliefs, it is just NOT when a child is suffering from severe malaria.

Sometimes the realities in the field are pretty hard to take.