April 27

Today started much the same way the previous days did; going to fetch water in a cloud of children laughing and grasping our hands, washing the previous days dishes and washing our laundry. Ellen and I decided to go for a walk down the road. As usual we were stopped frequently to greet everyone we met on the road. I believe I successfully did not call anyone relish today although I did mess up the customary hand shake and clap. We walked about five kilometers and I did not see any wildlife besides butterflies and flies. Apparently the villagers will kill any animals that are in the area and eat them so there are literally no birds or monkeys or rodents around.

Ellen, Leanne (another PeaceCorps volunteer), and I visited the clinic this afternoon. The clinic is staffed by a single nurse. She is expected to work 6 days a week for 8 hours a day. Her house is located directly behind the clinic so if the clinic is not open and the villagers have an emergency they will knock on her door. This particular day she had been up all night with a laboring mother and is now taking care of a patient with bacterial meningitis and malaria. The blatant differences between health care in the US and in Africa were expected but are still shocking.  The nurse assesses, diagnoses, and treats patients completely independently; she will determine whether she can manage the patient in town or if they need to be shipped the 80km to the Boma for further treatment. I witnessed a patient come into the clinic describe several symptoms then leave with several pills in hand; no medical tests or physical examination were completed. The patient was in and out in 10 minutes.

The nurse and I discussed at the length the biggest challenges in providing healthcare in the village. The main one being that there is no accountability among the villagers to take responsibility for their own health.  Villagers will only seek out help once there is already a problem they will not take the appropriate measures to prevent disease or illness. For example surrounding the village is very tall grass which encourages the reproduction of mosquitos. The village has been educated over and over again that by slashing the grass it will reduce the mosquito levels and therefore reduce the incidence of malaria, but the grass is still there and villagers are still getting malaria.

 Secondly there is very little prenatal/antenatal care offered and perused by the villagers. Ideality pregnant women would come to the clinic to have their blood sugar monitored, blood pressure checked, weighed, obtain prenatal vitamins, screened for anemia,  and height of fundus measured. In reality the clinic has no blood pressure cuff (I did bring one with me), no measuring tape, no glucometer, no ability to measure hemoglobin, and rarely have a consistent supply of prenatal vitamins. The lack of supplies and ability to perform the necessary tests instills a sense of doubt and mistrust among the villagers with the clinics ability to provide effective care.  Furthermore there is very little record keeping or documentation of care given. The nurse, who has only be stationed for 3 months, has no record of women’s past medical history, how many pregnancies, miscarriages, and live births a women has had, or who is pregnant in the village. My tentative goal at the moment is to gather this information for the nurse so that she can submit the demographics to the government to hopefully receive funding for better prenatal care. Although I am not sure how to make this sustainable; I am afraid that once I leave there will be no one to gather this information and it is highly unlikely the culture among the women will change and they will miraculous become forthcoming with this information.  Any ideas or suggestions on this would be greatly appreciated.