Campaign Season (no, not that one)

As things in France cool down (Hollande won) and things in the US heat up (will Obama get a second term?) it has stayed ridiculously hot here in Burkina Faso.

Also, on the health side of things, we’ve been doing a variety of campaigns against various health related things.

We did nutrition: going door to door to find out how many kids are malnourished in Poa (my village).

We did Polio: going door to door to give polio vaccinations to kids.

We did Mebendazol and Vitamin A: going door to door to give kids a deparasiting agent and vitamin A.

Now, we’re handing out albendazol and mictazine. Albendazol is a deparasiting agent (chemically the same as mebendazol but it’s a higher concentration and thus, for adults. Mictazine is a drug against filariose and hydrocele, more commonly known as elephantitis.

Next week looks like it’ll be trachoma but we’ll see what happens.

My role in all this is relatively simple. I plan. I divide the community health agents into teams, and help divide the village into manageable areas for each team. I then divide the medicines into which group gets how many pills, then I help explain how to give the medication and explain that if someone refuses to call the Major or myself and we’ll come out and figure out what the issue is (side note: this is where the color of my skin is actually a benefit).

Anyway, not the hardest job ever. Important? Kinda. Fairly straightforward? Absolutely.

The people who do all of the actual labor are the community health agents who are easily overlooked in the healthcare system here and play one of the most important roles. So they most definitely win the unsung hero award. I’m a foreigner. The nurses and doctors are civil servants so while we’re both here and they’re actually Burkinabe none of us really belong. This is where the community health agents come in. They belong. They live in the village, they were (more often than not) born in the village, and they’re well known in the village. Some can speak French, some can’t- but it’s really no big deal. People in the village know the community health agents and because they are actually part of the community (not just integrated into it) people invite them into their houses and they don’t feel self conscious or anything like that.

The thing about this though, is that these community health agents are just normal people. Some went to school, some didn’t. And all of them have other things to do. Most people in Burkina farm. Some people raise animals, some do both. All of which can be a full time job, so where do they find the time and energy to help out the health center?

So these people are a huge resource but with almost five weeks now of consistent campaigns each weekend (lasting for four or five days), I’ve got to wonder, is there a line where there are just too many campaigns and the people that help us out so much just say, “sorry, we’ve gotta plant our fields, or take care of our animals”?

Or is the sense of doing things for the greater good and that giving up a couple hours each day to hand out medications for the betterment of all is totally worth it really that strong here?

Of course, everyone who helps out is paid for their work but in a village of subsistence agriculture time doesn’t necessarily equal money.

I guess what I’m trying to say comes down to this:

1) The fact that we have campaigns like this every week is awesome. I’m not quite sure who donates everything we give out but I think if they came to visit they’d see that, in Poa at least, their resources have been well used.

2) The fact that there are people who rain or shine (usually shine) show up and do what needs to be done is a standard that more people all over the world should try and emulate.

3) When you have a resource of people who will give up their time to go door to door to hand out medications, don’t take it for granted- and don’t overuse it.

4) The little things count. I’m not rich. I probably will never be rich. And, that’s okay. But it’s not like I can give everyone who helps a ton of money to say thank you. But what I can do is go and buy water for everyone to give out when we visit people as they hand out medication. I can smile and say you’re doing awesome, thank you for helping us out, and give some moral support.

We don’t do vaccination campaigns like this in the United States but, I can’t help wondering if we did: would we find people like this to help out? I certainly hope so. 

All it takes is One

I’ve had a lot of interesting conversations over the past few weeks- and they’ve all revolved around what it means to be a leader, what it means to set an example, and how much good all of that can actually accomplish.

Let’s backtrack a bit. I was watching the French election with a few people here and we discussed politics, what a democracy was, and the relationship between Burkina Faso and France. Needless to say, it’s interesting to see what the perception is versus what I imagine versus what probably is the actual relationship.

When we first started talking a democracy was used interchangeably with utopia which, while that would be awesome, isn’t quite right. But, it certainly contained interesting ideas such as: while a democracy is fair and just for everyone- who decides what is fair and just? For example- a conservative Islamic leadership style might be exactly what a country wants, and is it necessarily bad just because it’s not what we have? And no, someone who is not Islamic is not by definition a member of the Taliban, although that was something I did have to clear up.

So this talk about democracy brought us to France/Burkina Faso relations which, admittedly I know very little about; and, is also an incredibly grey area. Our conversation reflected that we didn’t know for sure how much influence France has over Burkina Faso and how often it is wielded. But, if Burkina Faso as a whole is unsatisfied with the status quo, then it’s the responsibility of the country to change it. It’s one thing to talk about changing something, it’s quite another to get off your butt and actively change it.

Fast forward a few days and we had a staff meeting talking about practices that work at our health center, and things that we could do better, that kind of stuff. And the point that I brought up concerned that ambulance and, more specifically, how we (and other health centers use it). As it stands now, the ambulance is like a giant taxi- with a cool flashing light, the ability to speed (though speed limits seem optional here), and the word ambulance on the side.  So when the ambulance takes people out, there’s no one actually giving care. I tried to point out that this probably wasn’t the most prudent idea ever- and, they just laughed at me. Not the response I was looking for but, that’s life. The doctor and the Major actually did step in and say stop laughing, he’s right- but, that didn’t help anyone take the idea any more seriously.

I decided that I was right about this so kept pushing. I said that sometimes there’s hours between when someone refers a sick person to the hospital and if there was someone in the ambulance they can track changes in vital signs and even perform CPR if needed (I have to train them in CPR first but that’s coming).

The response to the idea was something along these lines: it’s the sick person that pays for the gas of the ambulance. And the gas is: from Poa to the village, from the village to the hospital in Koudougou, and then back to Poa. This means that if any village to the east of Poa (Koudougou is to the west) refers a sick person and if they send a nurse with the ambulance the nurse will only get as far as Poa on the way home unless they pay for the rest of the gas. So, then it became a question of, why should we put extra work on ourselves when other villages don’t. My response to this was simple: it’s your job. You have a responsibility to the sick people- it doesn’t matter where they come from. This isn’t my American imperialness speaking- some of the medical professionals that I’ve met in Burkina have expressed this outlook on more than one occasion.

It was starting to get late and we had a lot of other things to discuss so I let the subject go, decided to let it ruminate in people’s minds and then wait for the opportune moment.

A couple of weeks later, the opportune moment came- and I brought up the subject again, this time coupling it with the argument that all it takes is one person to change the status quo. And, somewhat surprisingly the Major and the Doctor looked at each other and said, let’s do it. So now, whenever our ambulance goes out- no matter whether it goes to the east, west, north, or south to pick up a sick person someone always goes with it. It’s not much. But, it’s a start. And, with a little luck the hospital will notice that when our ambulance comes in, there’s always someone who knows what’s up with the patient and that will then become standard practice.

Because, really, it only takes one to set an example for others to follow.