Let me get this straight

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.