Sunday, July 29, 2007

The Health Post

The Health Post

Every Thursday is vaccination day at my town’s health post. It coincides with the weekly market so that everyone knows what day it is happening. This is very effective and I have been consistently impressed with the turnout. At my first vaccination day 64 women showed up to vaccinate their babies! Women come from all over the region, not just from my town. They come in from nearby villages, and towns nextdoor.

I have recently started attending the vaccination days, not to vaccinate any babies of course, but to hang out and speak with the women, to practice my Pulaar, and to have a chance to talk to them a bit about their health concerns (in my broken Pulaar). All the while I have my PCV observation goggles on. I take in every site, sound, concern, and emotion I can until my head is swimming with ideas and of course, frustrations and disappointments.

As I said, 64 women showed up several weeks ago. Most of them arrived between 8-9am. The last ones did not leave until 2pm. They waited to be seen for 6 hours, in the heat, with their infants. There are only 2 benches, which means there is room for about 4 women on each. The rest sprawl out on the cement floor and when that is full the others wait outside in the sand or on mats. When the power goes out, so does the running water and on this day, the power was out, so no one had any water to drink.

But despite all that, these women persevere. They pay the money to travel by cart or van, they brave the heat and the thirst, all to come and vaccinate their babies. I am always inspired by their drive. None of them speak any French which means that they have not been to school and I am consistently impressed that it is now common knowledge for babies to even be vaccinated in the first place.

All that aside, my days at the health post are exhausting. The first vaccination day I had my first run in with really sick, tiny, skinny, malnourished, swollen-bellied newborn babies who will most likely not even live to 3 months. This is just devastating every time. My first day I had to leave because I couldn’t hold back the tears. Even thinking about it now brings tears to my eyes.

I try to single out the mommies with the sickest looking babies and talk to them about why they are so tiny and what they can do to make them well. Because it’s not as if they do not notice. And I can see all the other women with healthier babies glancing knowingly at the tiny ones. I spoke with one woman about her baby and I asked her if she was breast feeding exclusively-no water, no butter, no oily coffee dipped bread, breast milk only. She nodded at me sheepishly and then later of course I saw her giving her newborn tap water out of a filthy sippy cup. Sigh.

It’s these kind of interactions that have motivated me to start weekly health talks at the health post on vaccination days. I have already cleared it with the head midwife and she was very encouraging. I mean, I will have a captive audience of bored, hopefully interested women. I know it will not be ideal, because it will still be hot and uncomfortable, but it is the perfect opportunity to take advantage of a captive and idle audience. I will be giving talks on breastfeeding, diarrhea, explaining the vaccination cards (because they are in French), the importance of pre-natal visits, tracking their babies weight, first aid, malaria, you name it. I am eager to start as soon as I come back from IST. I know that the women will be appreciative because they are always very receptive to me when I am there. They just cannot believe that there is a toubak at the health post who not only speaks some Pulaar, but who wants to do nothing else but sit around and talk to them and hold their babies, and laugh, and make them feel at ease. (I will admit that these days are very good for my own ego because the women always tell me how good my Pulaar is. Not true, but nice to hear. And of course I get to hold adorable drooling, giggling, babies all day. Heaven!) I even had one woman give me a bin bin a few weeks ago just for talking to her. I was touched.

From hanging around at these vaccination days I now understand first hand the complexity of the health problems in my town.

For one thing, the quality of care is almost absolutely zero. Women are literally afraid of the nurses and midwives there. And I entirely understand why. If they are late vaccinating their babies, they get yelled at; when they get injections there is no forewarning, the nurses just stab them gossiping with their friends all the while; if they don’t jump up and run to the vaccinating room the instant they are called the midwives roll their eyes and sigh as if they have somewhere else they are supposed to be; the babies are thrown around like pillows and vaccinated on a cold hard slab of metal; and don’t even get me started about the birthing room…

Perhaps that needs to be reserved for a whole other entry?
But ultimately, there is no privacy. There are 5 “beds” (wire structures with old foam pads) all in one room and the door is left open at all times so that when the health post is crowded women can come in and sit in there. So women who are in labor are always surrounded by strangers. The midwives might check on them every once in awhile, but ultimately they are left to their own devices until the very last minute. Most bring a family member who fetches them water and whatever they need, but if they can’t, they are totally alone in a crowded, filthy, hot room with no bathroom facilities, and no medical facilities. There are no ultrasound machines, or heart monitors, or medicine for pain. Nope, it’s pretty much just a room and as far as I can tell every woman is indiscriminantly given an IV drip of glucose.

So there is little incentive to even get to the health post in the first place. As a result many women choose to give birth at home. I spoke with one woman recently who told me that when she was in labor, she trekked to the health post at midnight, got ahold of the midwife who told her to go back home because it was too late at night, and the woman most likely would not need to be there until morning. On her walk back sure enough, the baby arrived and she gave birth right there in the sand. In the sand, with animal shit and urine, and tires, and trash, and rotting food. And the stories don’t end there. Every week I hear new ones, each more horrifying than the last.

And on the other end, the midwives get jaded and frustrated because they repeatedly see women doing exactly the things they tell them not to, like not exclusively breastfeeding until six months, or not coming to the vaccination days on time, or not coming for prenatal visits. So there are frustrations all around and no one seems to be working to retrain the health workers to be more compassionate, and the women are not receiving the necessary education to help keep their babies healthy.

I suppose this is where I come in, as a middle person, to transfer simple health knowledge and to live by example.

But I am going to start this work off right. Namely, by gathering data. I can access any records I want (health post, mayor’s office) so I am first going to accumulate statistics on the number of deaths of children under 2 in my town and then after two years I will actually have something to compare to. Granted it is not ideal because reporting is not required and there is plenty of room for error, but I think that concrete results are important and unfortunately they are difficult to come by and overlooked in a lot of grassroots development work.
I am ready to start helping mommies keep their babies alive, healthy, and giggling…one vaccination day at a time.

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