A supervisory team from the state came to visit our CSPS the
other day.
They came to check out how we deal with suspected cases of
malaria first and foremost. We started off talking about simple malaria cases:
we told them that we took vital signs, evaluated signs and symptoms, and then
kept eliminating other potential maladies until we arrived at malaria. Awesome,
one point for the Poa staff. They then asked us if we used the TDRs (rapid
diagnostic tests) to which the answer is both yes and no. When we have them, we
use them, but when we don’t we can’t. The supervisory team didn’t really like
that answer especially the “run out” part. Then we had to explain that for most
of 2011 we didn’t have the test because we couldn’t get any (from the state).
The new malaria directive is this: you have to do the TDR
(makes sense), if you get a positive result you treat malaria (makes sense), if
you get a negative result you do not treat malaria (again, makes sense). If the
TDR is negative- you’re supposed to research other possibilities for the signs
of malaria (fever, vomiting, diarrhea, etc). If you find something, you treat
that, if you don’t find anything treat the symptoms, have them come back in a
few days and see what happens. Once again- this makes a lot of sense on many
different levels. There are lots of times in Burkina Faso when a person will
come into the CSPS (health center) and say I have a fever. The nurse will then
say alright, you’ve got malaria, and they’ll give the medication for malaria,
along with an antibiotic (just in case there was something bacterial) and say
come back in a few days. The flaw with that plan is this: currently the
government here subsidizes the malaria treatment medication- so if people are
being diagnosed with malaria just because they might have a fever- then this
drives up the cost that the government has to pay. Also, the parasite will
develop a resistance to the medication and that’s not a good thing. Same thing
with the antibiotic- if you give it and isn’t needed it will become less
effective overtime.
Example: today a guy came into the CSPS and said, “I have
malaria.” We asked him why and he said that his body hurt. So we took his
temperature (it was normal), asked if he vomited, had diarrhea, a headache, anything
like that and he said no to all of them. So we ascertained that the guy did not
have malaria. So then I asked him what he had been doing yesterday and he said
he was building a school yesterday. In the hot sun. All day. So clearly, the guy
was worn out- and did not have malaria. So, we prescribed him some rest, and
some vitamins as well- but I was proud of our ability to follow a new
directive.
So this new malaria directive makes sense- financially,
medically, logically- all over the place really.
Here’s what really gets me:
There are these agents called PECADO (deal with malaria
cases and aren’t nurses but are authorized to sell malaria medication). And
they’re basically tasked with: if someone comes to you and says that they kind
of, maybe, sort of, potentially have a fever- then they sell them malaria
medication. No diagnostic tests, no assessment of any type- just selling
malaria medication. It seems to me that this is somewhat at odds with the new
directive (having two groups of caregivers operating in the same general area
but following different directives) but then again, maybe there’s something I’m
missing.
Not everything makes sense all the time but, hopefully, this
will…at some point in time. And I’m still super psyched by our CSPS- and our
ability to set an example and treat what’s there…and not what’s easiest. Go
team.
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