In Gulf Province, MSF is in charge of three tuberculosis (TB) treatment units, one of which is located in a health centre in Ihu, a village two hours away from our base.
A local team is based in Ihu year-round, while we go there one to two weeks a month to provide support.
The only way…
The health centre is located on the bank of a river along which communities are settled, some of which are more than three hours away by boat.
To reach the patients and the health centres the team must travel by river. It’s the only practical way.
Because the ocean is nearby, the water level goes up and down during the day, according to the tides. This means our work is tied to the natural world around us, which is true for all everyday tasks here!
Each month is organised in the same way: the first and third weeks, we go to meet patients, to provide their treatment for the coming month, or find those who missed their last appointment.
The second week, it’s the patients who come to the treatment unit to see the doctor, thanks to the transport network put in place.
We travel in a motorized canoe, and people wave their arms to greet us, punctuating our journey with “hello”s. The reception is really warm.
At the edge of the first village, the river becomes narrower. The vegetation reaching from both sides of the bank almost covers us.
We meet fishermen, women washing dishes, children playing Tarzan.
Some villages are completely flooded, in part because of the tidal coefficients, but also because of the heavy rain that fell in recent days. We sail between the houses on stilts in search of our patients!
Once we’ve seen all the patients along the river, we resume our journey.
Other communities are not based right on the riverbank. We have to walk through what people call the bush, or access the villages via the beach, when the level of the tide allows it.
After an hour and a half of walking in the sun, we finally arrive in a hamlet of houses on stilts. As usual, the consultations take place under one of these houses, under the curious eyes of the villagers.
One of our patients is the mother of several young children and could not bring them to the health centre because of the distance to travel. However, all under-fives who have been in close contact with someone with pulmonary tuberculosis should be put on prophylaxis (preventative medicine) for six months.
For this family, our goal is to carry out the first part of the consultation here in the village and then to find a solution facilitating transport to the health centre in order to start the treatment.
It is not uncommon for parents to have difficulty understanding the value of prophylatic treatment even when their child is in good health.
The role of our colleagues in charge of health promotion is crucial: using visual aids, they explain what pushes us to offer this treatment, respond to people’s concerns and work to resolve their doubts about the relevance of this care.
Indeed, if the geographical challenge is important, it is not usually the only barrier to care that we see with our patients: the lack of information, training or psycho-social difficulties are all problems that can create a lack adherence to the treatment programme, or even cause people to stop the treatment all together.
All this is why our community health workers work in tandem with a health education advisor when they go out into the field.
We continue our journey up the river for nearly two hours and arrive in a relatively large village of thirty houses. A table and chairs are already waiting for us under the big tree!
The children are very numerous, malnourished for the most part, as evidenced by the inflated belly of some while their limbs appear fine as chopsticks. They come to the consultation and kick up a racket.
The children who are sick or under prophylaxis benefit from Plumpy’Nut. This is a therapeutic food based on peanuts which helps with moderate malnutrition. However, Plumpy’Nut is not enough for severe malnutrition, which is initially treated in a medical centre.
Many people come to us for symptoms that have nothing to do with tuberculosis. The nearest health centre is an hour and a half away by boat and the community here has little opportunity to consult with a medic.
After two hours of one consultation after another, the whole village has joined us. The children laugh out loud when I take off my face mask with a grimace, and the dads get us a dozen coconuts for the rest of our trip. We don’t refuse - the sun hits hard and the day is still long!
The last village
One hour later, we arrive at the last village on our route.
The village is actually just three houses: about twenty people live here.
One of our patients has just given birth. She is introduced as the baby’s “number one mother”. Indeed, the father has two wives and nine children, so we say “mum one” and “mum two”.
Here too, the children seem malnourished and again, none of them are under prophylaxis ... Before we can get this fixed, we gather everyone under the coconut tree to explain again how important preventative treatment is.
It will take us another 30 minutes to leave because the village chief gives a touching address thanking us for coming to them, where there is no transportation, no health centre, and fewer strangers!
Then he runs to get us the fish of the day, and bananas!
It takes us three hours by boat to get back, it is already late. The rest of the team remained in the village worried and even took a boat to meet us. But everything is fine, apart from feeling like I’m developing bedsores after almost six hours sat on the canoe’s wooden bench!