There is always a flurry of activity when the outreach team is preparing to head out. Someone is busy collecting vaccines from the refrigerator and putting them into a small cold box loaded with ice packs. Someone else is packing folding camp beds, mosquito nets and cooking pots into the car as the driver does his daily checks and fires up his Land cruiser. Another member is busy signing out the satellite phone and getting MSF vests for the team. Last minute instructions are quickly passed to those staying in the base and off they go.
Outreach is a major component of our project here in Shamwana, as MSF supports a network of five rural health centers where the Ministry of Health (MoH) is providing basic health care to the population. While these clinics are operated and staffed by the Ministry of Health, MSF provides support in the form of free medicine and technical support. MSF also provides a ‘prime’ or monthly bonus to all MoH staff to ensure that all of these health providers receive a fair wage.
Although each health center is a bit different, they all have an outpatient department and a maternity. Staffed by a registrar, pharmacist, consultation nurse, mid-wife and a cleaner, they provide frontline care in a classic primary health care setting. Supplies are limited, the clinics are absolutely isolated and staff experience varies. All serious or complicated cases are referred to the MSF hospital here in Shamwana and, as crazy as it may seem, it is not uncommon for someone to ride a bicycle through the night to inform MSF of an emergency in a health center.
The Outreach Team
The MSF Outreach team consists mostly of national staff and is made up of 2 nurses, 2 community mobilizers, a health educator and a mid-wife. Supervised by a dynamic Expat nurse (also Canadian!), they enforce MSF protocols, give training sessions, raise awareness and, in general, monitor and supervise the operations in all the health centers. Spending approximately 4 days a week in the field, they also help out with consultations, vaccinations for newborns and reporting.
The relationship between MSF and the Ministry of Health is delicate and just maintaining this dialogue is a never-ending struggle. Here in Shamwana, the success of the project largely depends on the MoH’s ability to take over from MSF so there is a huge emphasis on capacity building within this existing Congolese system.
This afternoon, the team just came back from 3 days in Kyango where we are running a bi-weekly mobile clinic to see if the needs are high enough to justify the support of the MoH clinic in the area. They saw over 200 patients and brought 3 serious cases back with them for further treatment in the hospital. Tomorrow, they are off in the other direction to supervise the activities in one of the standing clinics and to collect their monthly medical order. With 5 different centers to support, there is always more then enough work to keep them moving!