Tuesday, September 25, 2007

The plight of a health volunteer

Sometimes being a health volunteer is utterly exhausting.

There are so many myths, beliefs, and practices about what to give people and how to treat them, or not treat them, that sometimes it’s hard to know how and where to start re-educating them.

In about an hour today I had two different “health volunteer moments” (as I’ve come to call them), both of which with just a little bit of proper education would make my job obsolete.

Case #1

I stopped by the house of one of the women from my new mommies group, Aminata, and found that her 2-year-old son is really ill. She said he had been vomiting and his fever had to be at least 104. I felt his head and it was burning hot. Of course she asked if I had medicine to get rid of the fever, but I have to say no. I told her that she should go to the health post, or to the pharmacy to buy some. Then she pulled out some child’s dissolvable aspirin and asked if it was appropriate.

I was thrilled because it was exactly what he needed for a fever reducer, but she wasn’t sure how to give it to him, or how to use it because the instructions were written in French (classic). And she knew enough to read the date on the back and didn’t know what “Aug” was, but it said ’07 so she figured it was expired. Which, it technically is, but only by a few weeks so I gave her the okay (figuring it couldn’t hurt anyway) and explained how he should take it.

Like any normal two year old, he saw the meds going in the cup and refused to drink it. He hit it out of her hand and spilled about half. So I tried to salvage the little bit of powder that was still in the packet. Then we added sugar and he still wouldn’t take it. So I had her switch cups and tell him it was water. Then of course he drank it right down.

It was clear that he was dehydrated and even though he did not feel well he was gladly accepting water. It was news to her to give it to him. It’s a common belief that if stuff is coming up through vomiting or diarrhea that you should withhold water because it will just make them expel more. So that was the very first thing that I told her, that he needs to be well hydrated. She responded well and ran to get water. She is a very eager mommy and wants to learn how to take care of her first baby.

I told her to give him another dose in the afternoon (around 5 o’clock prayer time because they don’t usually pay attention to hours, and the mosque call to prayer is a good time marker) and that I would be back to check on him that afternoon. I am going to teach her one-on-one how to make ORS (Oral Rehydration Salts) so that at least she can keep him hydrated. Hopefully the aspirin will work and this is just a passing flu, and not malaria. But if it continues (it has already been 4 days) then I am going to have to keep pushing her to go to the health post and have him tested.

Interactions like this are so scary. Panic sets in immediately. I get so anxious for these kids and these families. It’s sort of like having a town full of 10,000 children. I always feel so responsible. Especially for the ones that I actually do work with on a regular basis and am trying to teach better health practices.

If anything happened to any of the kids I’m close with I don’t know how I would recover. I worry about them every night when they are outside sleeping without mosquito nets, or sitting on the ground near animal feces and then eating, or climbing walls and scraping their hands on rusty nails.

Because at least at home in the states you know that you can take care of most illnesses on your own. We all have huge medicine cabinets and know how to wash out a cut. And if a situation ever becomes a real emergency, trained and reliable personnel are just moments away. And there are roads to get there, and ambulances, and telephones etc.

The anxiety and the fear build in the pit of my stomach and I constantly ask myself what else I can do. And I get so frustrated that my Pulaar still isn’t better and that I still struggle so much to actually explain things, especially related to health.

But then sometimes little kids surprise you and they bounce right back and you can’t believe that they pulled through. In a way I’m starting to understand why people are so fatalistic and believe that the choice of who lives and who dies is out of their hands. Because a lot of times it defies all explanation and logic.

For example, I am SO happy to report that the baby that I wrote about in May, Oumou, who is the baby of a sister in another villages (the one that was having trouble breast feeding), has somehow gone from a 1 kilo premature infant, to a fat, happy, normal 4 month old. And it’s thrilling. She is always all smiles and never cries. I just don’t get it. I just didn’t expect her to make it. She’s a fighter I guess and has been since she was born.

(Next Day)
I went back to Aminata’s house this morning to check on her son. His fever is almost gone as far as I can tell. When I asked her what she gave him she said that she went to the pharmacy and picked up malaria medication.* She had just given him the first dose that morning. Who knows if that really what it is, but at least he seems better and was sleeping.

*(This is one of the reasons that some strains of malaria in some regions of Africa have become resistant to certain drugs. Here during the rainy season, everything is immediately diagnosed as malaria. I am pretty sure that the health post does not have the resources or take the time to test people using malaria smears. They just prescribe the prophylaxis to anyone with symptoms of malaria (which are pretty general and apply to almost every other illness).

Though he still wasn’t drinking anything. I sat her down to talk about giving him ORS and I was pleasantly surprised that she already knew how because she learned how to make it from the previous volunteer. Again, knowledge is there, behavior change is slow. But she thought that the ORS could only be used for diarrhea, so I assured her that it would be good because he is very dehydrated. She said she would make it right away. Fingers crossed that she did. At least his fever is gone. Hopefully he’s on the mend.

Case #2

The second “health volunteer moment” of the day happened right when I came back from Aminata’s house. I walked in and there was my 15-year-old sister, Faama, (who goes to school by the way) about to put BRIGHT PINK NAIL POLISH on her friend’s infected blister beetle bite! Are you kidding me? Nail Polish? What??

(If I could make a movie of this moment it would be in slow motion.)

I basically yelled, “What are you doing?” and ripped the bottle out of her hand. She is always the first to argue with me and question my health knowledge and it took me a good 10 minutes to convince the two of them that nail polish was not going to do any good, has NO antiseptic, or beneficial properties, and would make the infected blister worse. I had to plead with them that all they needed to do was wash it with soap and water and keep it clean and dry and eventually it will heal and go away by itself.

(Clarification: Blister beetles are these horrible things that if they land on you they often pee and their urine leaves a huge blister that is painful and can get easily infected (mostly because people don’t keep them clean or know how). Luckily, all you have to do is keep it clean and dry. It is still a very annoying bug to deal with. And everyone seems to have one so I’m assuming it is the season for them. Yuck.)

Last night I saw someone with one on his neck and it was absolutely covered in flaky white junk. Of course I freaked out and told him to run to the health post immediately. But he laughed and just said that it was a blister beetle blister, but that he had put “cream” on it. God only knows what it was…toothpaste? Soap shavings? Lotion? I have no idea.

I have decided that my very first lesson for the kids at the schools will be a first aid lesson. The things people put on cuts and scrapes make me cringe: sand, leaves, toothpaste, dirt, nail polish (apparently), hair pomade, cologne, random lotions and creams. You name it.

Although these moments are scary, at least I know there is a lot of work to be done and that I am definitely needed here.

Now I just have to work on not making myself a nervous wreck every time I see a sick child. Because if I don’t, I’m never going to make it through this.

No comments: