PHR Student Blog

We’re about 3 weeks away from the 2010 Global Health Week of Action (GHWA). To help you plan a great week, PHR has posted some resources about the health workforce crisis, including a video spotlight of four Kenyan health workers and details about the Global HEALTH Act, which would provide $2 billion dollars for developing countries in Africa to build their health workforce capacity..

Still not sure what to do for your chapter’s Week of Action? Consider setting up an in-district meeting with your Congressperson’s local office to advocate for the Global HEALTH Act or any other key health and human rights issue your chapter is passionate about. That is what I am doing. In April, I will meet with staff from Congressman Michael Capuano’s office in Cambridge, Massachusetts, to talk about the health workforce crisis in Africa, and to encourage him to co-sponsor the Global HEALTH Act. If you are in Boston, join me for the meeting! Email me at hobrien[at]phrusa[dot]org and we can go together.

No matter where you live, holding a meeting with your Represenative’s office is easy, fun, empowering, and effective. PHR can help. Email Barbara at bcastro[at]phrusa[dot]org and she will help you set up a meeting and provide talking points so you will feel confident going in and have the tools to come away from the meeting with a new Global HEALTH Act co-sponsor.

Want to do something different during GHWA? Check out the GHWA Toolkit for more ideas and resources to help you plan.

In my previous posts, Happiness and Neema, I wrote about the tragic state of health care in Tanzania, where I am currently working in a clinic, telling the stories of two young girls I helped treat. I believe many students and health professionals desiring to work within majority nations such as Tanzania struggle to identify what they believe is an appropriate context of care: “Should I work in a clinic putting my specialized medical skills to work, or should I focus on capacity-building programs aimed at training and educating local health care workers? Which will have the greatest impact? Which will be the most sustainable? Given the limited time that I am able to spend here, how can my skills best complement and contribute to the existing health care infrastructure?” These are all tough questions, but my service this summer has shown me they are beside the point.

In the medical field we are constantly driven to maximize utility and impact of service and thus are forced to ask ourselves these questions before we begin any sort of health service. This obsession can easily lead to paralysis if we try to apply these principles within existing health systems because it forces us to ask ourselves, “Where do we begin?” It is important to realize that the work has already begun and is unfolding within a vastly different cultural, economic, and social context than the health system that we are used to. I urge you to shake off the rational paralysis that stems from your perception of the hugeness of the health problems at home and abroad. Take simple and practical steps that allow you to simply work where there is need with an open heart. Recognize that your skills as a medical student or health professional are valuable and will have positive impact regardless of whether you decide to work in health education, research, or a clinic.

In An Imperfect Offering: Humanitarian Action in for the Twenty-First Century, Dr. James Orbinski, past international President of Médecins Sans Fontiés, reflects:

“In being with the [sick], one refuses to accept what is an unacceptable assault on the dignity of the other, and thus on the self…Solidarity implies a willingness to confront the causes and condition of suffering that persist in destroying dignity, and to demand a minimum respect for human life.”

Many of you are hoping to rotate abroad, thinking about how to integrate international work into your career, but are bothered by the quandary of not knowing what exactly this will look like, or where you should go and what type of medicine you will be doing here. In my view it is not important what you do or how you are involved. What is important is, firstly, that you do it, and secondly, that within whatever you choose to do you be present enough to not only treat the immediate needs of your patients, but to also confront the root causes of their illness and disease. People get sick with specific illnesses for specific and, more often-than-not, very complex reasons. Wherever you train or practice, especially if it is in a country or culture foreign to you, discover what those reasons are and seek to understand their social, economic, and cultural undertones. In doing so, I believe that you are able to stand closer in solidarity with your patients and peers, and are not as likely to be bothered and blinded by a myriad of bureaucratic obstacles and resource limitations to the point that you loose sight of these true ‘causes and conditions of suffering.’

Neema will always need someone who knows how to dress her wound and Happiness’ mother can always benefit from increased education on preventing diarrheal disease and dehydration. But even more pressing than treating these wounds and addressing these immediate concerns is the even greater need for simple acts of solidarity, for us to be a unifying and consistently present voice against that which destroys dignity by practically working towards improving access to health care around the world in every way we are able.

Clockwise: Pascal, Daniel, Abdullha, Dorcas, and little Peter, my young friends from Babati, Tanzania.

Neema, laying in bed in our critical care room after having her wound dressed, with two of her brothers and Hannah Godfrey, a fifth year medical student from the University of Newcastle.

In my last post, I wrote about Happiness, a young girl I treated while working in a Tanzanian clinic. My second story is of Neema, another young girl I helped treat there. Neema, a beautiful five-year old, timidly approached me at the triage table with her mother and four young siblings. Her head was wrapped in a colorfully printed yellow, burnt orange, and red kanga, a commonly worn traditional fabric in this part of the world. When her mother motioned to her, Neema unwrapped her kanga revealing a severely infected burn-wound that covered the whole left side of her face. She looked me in the eyes for a reaction as I knelt down. I gave her a big, cheery smile, asked her name, and said some silly muzungu phrases to make her laugh. Upon examining the wound more closely, I immediately thought, “skin graph”. I worked hard to keep my smile from turning into an empathetic grimace; I could see that her wound was covered with a tough scab, colored red not by blood but by the ubiquitous rust-colored dust that covers everything here during the dry season.

Burns are all too common here, especially among children, as firewood is the primary source of fuel for cooking and heat. They are often a result of people suffering seizures and falling into fires, and are occasionally the primary presentation of epilepsy, which has a curiously higher rate in regions with high prevalence of malaria. Neema’s mother told us she had burned herself while trying to eat scalding porridge directly from the pot, and hadn’t been able to eat since. I wondered why she wasn’t brought to a clinic earlier, and asked the mother if she had ever been treated for the burn. The mother said she had pulverized some old penicillin tablets and sprinkled the dust onto the wound, in the hopes that it would heal it. An interesting combination of western medicine and traditional practices, I thought.

We ushered Neema and her family into our ‘critical care’ room, where we dressed wounds and saw our sickest patients. I entertained the kids with bubbles and coloring books while the doctors formulated a plan to clean the wound and coordinated with the regional hospital in Arusha for surgery the following week. The lead doctor in our team was trained as an anesthesiologist and was able to sedate her for what would otherwise be an unbearably painful procedure. Another doctor did an excellent job of clearing the wound and dressed it with sterile, silver-embedded dressing to fight off infection for the week she would have to wait for plastic surgery.

While Neema was being treated, Neema’s mother asked if we could also see her other children. Their labs came back and assessments were made: Joseph, who was four, had malaria, James had pneumonia, and Pascal had shilingy (ring worm) on his arms and back. I wondered at the difficulties that the mother faced daily, managing this playful and rambunctious crew, all clearly struggling with these nagging and potentially devastating diseases. And to think, she came to the clinic only for Neema.

Neema, laying in bed in our critical care room after having her wound dressed, with two of her brothers and Hannah Godfrey, a fifth year medical student from the University of Newcastle.

Previously, Triage in Tanzania (part 1): Happiness
Next, Triage in Tanzania (part 3): Tough Questions

In the early morning sun, under the forgiving shade of a lone acacia tree, I sat behind our intake/triage table with my fellow health outreach workers. We faced a crowd of over one hundred patients, many of whom had journeyed dozens upon dozens of kilometers through the rugged rural northern Tanzanian countryside, on foot or perched precariously on the back of rickety, old bicycles, with the hopes of being seen by our physicians. Over the course of the ensuing week, our mobile clinic team, consisting of four physicians, five nurses, ten medical students and two physical therapists, would see nearly 700 patients. Due to resource and time limitations, we would be forced to turn at least as many away.

Every morning before our team began to take patients, two nurses would walk through the lines of patients gathered outside the gates of the farm compound that was hosting the clinic, looking for the sickest infants and young children to be seen first. On the third day, a very young mother waved down one of our nurses asking her to look at her 10-month daughter, Happiness, who was strapped to her back. She was unconscious and had deeply sunken eyes and fontanelles carrying an ashen pallor — all signs of severe dehydration. She was immediately rushed inside for assessment.

Happiness had been stricken with diarrhea a week earlier and had since been unable to feed. We gave her oral re-hydration fluids using an uncapped 10 ml syringe as a bottle, which she suckled at in her near-comatose state, with only the white of her eyes showing between her delicate, twitching eyelids. When I came to see her a few hours later, she was still unresponsive. We worried that she wasn’t getting enough fluids and would be unable to get the antibiotics she needed soon enough. Luckily, a visiting ER doctor from New York was able to secure their delivery and by the end of our long and tense day, Happiness was a bubbly, smiling little baby again. She was amazingly alert and responsive, and I was shocked and relieved. However, I knew that for Happiness and her mother, this was perhaps only the first of many precarious situations they would encounter.

Anywhere in the US, this child would have been placed in the ICU, and I fear that had we not intervened, she would have died within the day. It was either luck or fate that our mobile team was near Happiness’ home that week. Our nurses worked closely with the mother to teach her how to feed her child the oral rehydration salts (ORS) to prevent future bouts of such severe diarrhea. She was given medicines and handfuls of ORS with a follow-up referral for later in the week; it was all we could do. Diarrheal diseases are easily preventable, and reflect the resource and education privations that many young mothers are faced with in this part of the world. How can we dissolve the wicked barriers against proper hygiene and healthcare imposed upon this family by the structural violence, in all its complexities, that lingers as a heavy shadow in this land of poverty? It was one of the many impossible questions that echoed in the back of my mind as I watched Happiness, her mother, and still hundreds more leave our clinic at the end of the day.

Clockwise: Pascal, Daniel, Abdullha, Dorcas, and little Peter, my young friends from Babati, Tanzania.

Next, Triage in Tanzania (part 2): Neema

Is healthcare a right? What is a human right? Why is this important in Africa? Wednesday was spent meeting people who offered different perspectives on these questions and elucidated new ideas for progress in Uganda.

This is a country rife with the denial of basic rights. From a lack of educational opportunities for  youth to food insecurity in the rural areas to widespread abductions of children by the Lord’s Resistance Army (LRA) in the north?—?denial of rights is widespread.

In America, we rarely think about human rights, and most of us don’t really even know what they are. But here, in Uganda, people are acutely aware of them. The lack of rights is so severe that it affects daily life. Access to food may be a human right, but if the soil is too poor to grow anything, then how can that right be assured? If water sources are running dry due to climate change, then how can the right to water be fulfilled? These are basic life necessities that are lacking in parts of Uganda, and the rights-based approach can empower the people to demand that they have access to these things. It is up to the governing powers, however, to build sustainable systems for delivery of basic rights.

As enshrined in the Universal Declaration of Human Rights of 1948, healthcare is one of those basic human rights. In Uganda, there are so few doctors being trained, and even fewer choose to stay on here after their schooling is over. Brain drain to industrialized nations has crippled this country’s ability to effectively respond to the healthcare needs of this country, from basic primary care and obstetrics to a burgeoning HIV/AIDS epidemic. It really falls on the government here to encourage doctors to stay; one way they could do so is by paying them more adequately.

Throwing money at the problem is not the most effective solution in a country that has serious problems with corruption, accountability and rule of law. Uganda has developed a bad reputation for mismanaging aid money, as evidenced by the recent withdrawal of Global Fund for AIDS, TB and Malaria. This has led to increased hesitancy by international donors to give money. As a consequence, there are no drugs left here to treat TB, and this country has the 15 highest disease burden in the world.

Before money can simply be channeled into the system, it must be ensured that an accountable and transparent government exists and is kept in check by the people. Civil society involvement is essential, and that is why all of these human rights groups who we visited on Wednesday exist. People need to know what their rights are and that they must exercise them by voting and holding the government accountable if they want anything to change.

(Cross-posted on Health Rights Advocate)