the state of health...

for most of my life i had this uncontrollable fear of hospitals...when i was about 3 or 4 i remember my mother lying in her bed after a hospital visit, so weak from the procedure they did that i thought hospitals took in strong people and released them when they were weak...i saw my mother as the incredible hulk and when i saw her lying on the bed unable to move i made the immediate decision to never enter a hospital ever in my life...

well almost 20 years later, i too ended up in a hospital in ukraine for 3 days...for i came into the hospital dehydrated, delusional, and very weak but came out rested, hydrated, and the most part on the road to recovery...i never thought in a million years that i would some day work at one...ironically i have chosen a career that is somewhat connected to hospitals...public health...and i love every minute of it...which is what brought me to africa...currently i am a rural community health volunteer at a health center in a very small village in northern benin...everyday at 09.00 i head over to the maternity ward of the health center and do what i can to help...whether that be organizing inventory, taking blood pressure and temperature of patients, record-keeping, discussing health issues with pregnant women, or providing ideas for improving our health services, i do what i can...i usually hang out until noon where we lock up the center and go home for repos (siestas)...i'd cook lunch for myself and then take a nap for an hour before returning to the maternity at 15.00 (3pm)...i would hang around some more doing what i could until we would go home at 18.30 (6.30pm)...some days when the rains would not let up and no one would show up, Francoise, Agnes, Eliane and i would just talk about everything and anything from my "white" skin to my experiences in america, to sorcery, domestic violence, and health care in benin...i am very fortunate that i can on any day walk into a consultation, childbirth, sleeping area and ask as many questions as i want to anyone around, that i work with some very dedicated village health workers who are working within a system that is dysfunctional and sometimes harmful for the people...

my time so far has given me such perspective on the state of health in benin...where to being...benin is a very poor country who's transition to democracy has helped alleviate corruption but is still lacking in some of the basic health care we as americans take for granted...benin ranks near the bottom in the world...on average there is one doctor for every 7,000 people...in my area there is one doctor that serves a population of 47,000 people...life expectancy is around 57 years...5.4 children born/woman...maternal mortality is 500 out of 100,000 and infant mortality is 80 deaths/1,000 live births...1.2% of the population is HIV+ with some areas at 2% including my area...

what are the consequences?...for one thing there aren't enough qualified nurses or doctors to provide medical care to the population especially in remote villages like mine...my health center is split between 2 villages where the maternity, which takes care of maternal and child health, is in my village and the dispensary, which deals with accidents, injuries, etc, is about 5 km (3miles) away in another village...our village health center serves a population of about 5,000 people with half the population living several miles away...some people walk for hours to get to us...women have given birth right on the road cause they had no other means of getting to the maternity...but at the same time many of the villagers don't even use the health centers...traditional practices keep them from seeking treatment to very easily curable diseases like typhoid fever, malaria, gonorrhea, etc...

in africa there are 2 types of diseases: 1) western diseases that are cured by medicine found at the hospital and 2) african diseases that are caused by sorcery and can only be cured by sorcery...because africans believe that there are spirits all around and that at any time anyone can use them to cause diseases on someone they despise they first go to what they call in french a "charlatan", a kind of "witch doctor" who determines if the disease is of western or african origin...of course for the most part he will say that its an african disease and will provide the cure so long as you pay him 10,000FCFA (about $20USD) for the consultation plus the cost of treatment which is a good amount of money...because of these traditional beliefs, very few people seek out the health center...

since my arrival, i had been working with ismael, "major" or head nurse at my health center...we have become very good friends and work partners that he takes me every where...i had the opportunity to consult an HIV+ man, who had come to our health center in a terrible state...he was in the last stage of the disease: AIDS...he had multiple complications: fever, chronic coughing, head aches, vomitting, diarrhea...he wasn't eating, drinking, sleeping, he was practically dead when he arrived...we convinced him to get on the antiretroviral medications that are available in benin...within a month, the man health had improved drastically that he was able to return home...unfortunately while he was in the hospital, his wife and 3 young children b/w the ages of 7 and 1 years old sat with ismael and me...we spoke to her about the risk to her and her children, about the treatment plan for her husband, and asked her permission to test her and her children at that moment...it was frustrating to watch, i felt pity for this family, i felt angry for the fact that these children will be forever affected by this disease whether as orphans or succumbing to the disease themselves...i helped ismael gather all the test strips, needles, cotton balls, alcohol, everything needed to draw blood and do the test...we started with the wife and mother of his children...ismael with gloves on drew her blood and placed it on the test strip...he added several drops of the serom that will identify HIV antibodies in the blood...it takes a few minutes before you can read the test strip so we started to work on the kids...we took blood from the 1 year old first, then the girl who was about 4 years old and lastly the boy who was 7...during all this the wife's test strip turned positive...man, not the news we were hoping for...as for the children, its not automatic that they will be positive too but the outlook is not good...i had to brace for the fact that all the children could very well be positive and they would never grow up to be adults...i was holding the littliest one in my arms and playing with him...i looked into his eyes and saw nothing but pure joy and innocence...he has no idea of the destruction that has started to take place in his family...of the pain and suffering he and his siblings will endure...this little baby's fate was decided by his parents...

the little boys test was ready...ismael read my face and said: "are you ready rut?"..."yeah, i am"..."negative"...such relief but its not over...he would have to be tested every 3-6 months for the next year to prove for real that he is not HIV+...the 4 years old girl: undetermined...7 year old boy: undetermined...not the best news...we place their blood in a cooler to take to the district health center 25 km away...they will have to run further tests to determine serology...the fight continues...

while the man was recovering at home, ismael and i continued to do home visits...we provided counselling and support, nutritional advice, encouraged him to continue the drug therapy...we spoke to his mother who was taking care of him...that day i found out the hard way about africans and their beliefs...they told us that this disease was an african disease and that our medicine was not going to help...i asked the man if he had felt better after taking the medicine?...yes, he had...had his appetite returned?...yes...had he been able to sleep again?...yes...had he stopped vomitting?...yes...had he been able to walk again?...yes...hadn't his whole life seem to come back to him?...yes...what do you think brought you back to life?...i don't know...these traditional ways of thinking is what keeps benin from progressing in all aspects of life especially in healthcare...even the well-to-do, educated people believe in this stuff...it was hard to listen to this man when his children where running around the courtyard...i kept thinking that this whole family will be dead if we do not intervene...but its not up to me...its up to him and his family...i felt helpless for the first time...but it would not be the only time...