Health center revitalization and changes, changes

Apart from the usual forays into Manantali for visits to the market and a few small PCV get togethers, I have been mostly holed up in village since late July. And for good reason: a lot is changing over here! A few months ago, the ASACO in my village (the managing committee of my health center) started the process of “re-lauching” the CSCom, in hopes of revitalizing it and making it a place that villagers actually trust for health care provision.

Over the past several years, the Marena CSCom has largely fallen into disrepair and neglect. The place is rarely cleaned, the roof leaks, and we are perpetually out of absolutely everything, from a working blood pressure meter (sort of essential for any type of pre natal care) to essential medicines like antimalarials, painkillers, and antibiotics. Not to mention the lack of a clear, organized budget system, and the practice of giving care or medicine to villagers on credit (I’d been here almost a year and still had no idea what things are “supposed” to cost since no one ever seemed to pay a uniform amount for anything).

So, the ASACO got together, sent out mobile teams to all of the 10 villages served by the center, and collected the equivalent of a little more than $2 from every family. This may not seem like a gigantic undertaking, but getting people to cough over a not-insignificant amount of money is not as easy as it sounds. In addition, my host dad copied over 200 letters soliciting donations from anyone of even minor importance in the Bafing area, from the mayor’s assistant to the dam worker’s association to local business owners. And when all this money had been collected, a team from the hospital in Bafoulabe (the district capital) came out for a week to help Marena CSCom with its renewal process.

Alas, changes. Here are some of the most important ones:

–A new midwife. Kandiafing (I just call her Kandia) finished her formal training and officially started her work in Marena in September. She is fabulous. We are around the same age, and she is married with one daughter, but her husband lives and works far away. While the previous midwife had not actually received the formal clinical training required to run the maternity, Kandia actually seems to know her stuff, and since she also moved into one of the houses closest to mine we became fast friends. Since she’s been here more women have been coming in for consultation, and she’s been helpful to me with some of the malnutrition cases even though that’s not typically the midwife’s responsibility. She came during a time when the previous midwife had already left and the director was out of town, and so it was kind of nice to feel like I was able to show her around and orient her a bit to the center.

–A pharmacy and a awesome new female pharmacist. One of the biggest frustrations at my CSCom was the constant lack of medicine. Villagers literally told me they wouldn’t even bother coming in for consultation in Marena, since they would just have to go to Manantali to get their prescriptions anyway. It was really becoming detrimental to the overall functioning of the center, not to mention making staff feel pretty, uh, useless (yeah, we know your kid has cerebral malaria, but sorry, we’re out of quinine right now…..). But no more! We now have a basic pharmacy stocked with essential medicines and–more importantly, i think–a pharmacist trained and ready to manage it all, so that we can be sure to keep stock in and not run into constant shortages. The pharmacist is named Toombi, another local young woman whose husband works far away, and she’s been keeping things organized so far, so good.

–A new “chef du poste” or technical director of the center. My supervisor Komby, who has been the CDP since the center opened in 2004, has moved on to work at a center closer to his home village. He didn’t exactly go out of his way to explain any of these personnel changes to me, which I was a little annoyed about, especially since he is my official PC supervisor and the one responsible for explaining my role and projects to his successor. Alas, he has left the building, and in his place is a new CDP, Issa. I have yet to formulate an opinion on this man, as he has been present at approximately two of the last ten or so days. It doesn’t matter too much since I won’t really be working with him anyway, but at least with Komby, who had supervised two previous health volunteers, he understood what PC volunteers are supposed to be doing and could be helpful when he needed to be. Issa and I might have gotten off to a bit of a rocky start–he simply could not remember my name and continually referred to me as the “tubabu muso”–but I’m trying to give him a chance.

–Reorganization of the center. The Bafoulabe team came bearing loads of equipment and material. A team of women came in armed with detergent, water buckets and brooms and scrubbed layers upon layers of dirt out of the outrageously dirty and previously unused back room, until it became a reasonably clean and organized, if not quite sparkling, pre natal consultation space and post-delivery rest area. We have new scales, a new delivery table, and they are building a shade structure behind the maternity so the women won’t have to sit in the hot sun waiting for pre natal consultations. The team also let loose on the piles and piles of old files haphazardly thrown into random file cabinets, archiving some, throwing many away, and generally getting a system going, hallelujah.

–A new work plan for the center, including monthly visits to each of the villages served by a mobile personnel team, plus visits to some of the farther off farming hamlets where small numbers of villagers stay for extended periods of time. This is supposed to help us reach with essential services and vaccines those who would otherwise probably not have access. Theoretically it could be a good opportunity for me to incorporate some education and sensitization activities. Also an increased focus on malnutrition and growth monitoring activities, which I’ve been trying really hard to regularize on my own and hope that the other staff will now recognize as important.

These are just a few highlights of the massive overhaul that has taken place. And while many of the problems the center faces will not be fixed overnight, I am at least encouraged and energized by the presence of new staff and the potential to work with them, particularly Kandia. While I had found myself drifting away from working every day at the CSCom during rainy season, I’m now back to a daily presence there, and I hope that as long as we keep the ball rolling there will be new opportunities to expand my efforts. I still have a year left in Marena, and I want to really make the most of it.