Malaria – “the biggest problem in Senegal”

Every once and a while, I’ll sit next to Seck to observe a consultation. But for the first time, I sat in the patients’ seat, facing the ominous head nurse. Fortunately for me, I was only sitting there for an interview, and not for health reasons.

“My last question. What is the biggest problem in Senegal?”

“Malaria,” he responded without hesitation.

I hadn’t been in Senegal for very long when that question was first asked. And I really didn’t understand why malaria was the biggest medical problem in Senegal. I mean, so we get some people with malaria every once and a while. What’s the big deal? They just get an IV and they get better, right? It’s just like getting the flu.

The first time I saw somebody with malaria was back during the first month of being in Sangalkam. This girl walked through the cast-iron gate and she looked like death. Her eyes were bloodshot and where they weren’t red, they were yellow. The girl’s lips were flakey from her body losing moisture. Her skin was pale, even though she must’ve been over 104 degrees. She walked slowly and wobbly, as if she was a 10-month-old baby just beginning to stand on two feet. Halfway to the pharmacy, she bent over and vomited in the sand, though it was mostly water; a sure sign that she hadn’t been eating. Malaria isn’t like getting the flu. It might be like getting the flu if the flu was jacked up on steroids.

From that moment on, I began to see malaria everywhere. The hospitalization room was constantly filled with infected patients. They laid there for hours and hours with an IV in their arms. They stared up into the air, captivated by some world that only malaria patients can see. Often times I thought they were dead. Most of the time I was wrong. The only time I’ve ever seen a person die right in front of me was at the Poste. And as one would expect, it was from malaria. Though this woman was extremely old, it’s incredibly heart breaking to see a daughter run out into the street, crying at the top of her lungs. It was even more disturbing when they carried the body out in a small truck, the ones they use in the morning to deliver the cardboard-like bread to all the boutiques.

Living in the United States all my life, I’ve never had to worry about malaria. Malaria was eradicated long before I was a born. And even here, I still don’t have to worry too much about malaria. I have my prophylaxis to protect me, and if that fails, I have the comfort of knowing that I’d be rushed to the hospital for treatment, all paid by my health insurance. And in the worst-case scenario, I would be airlifted out of Senegal. But nevertheless, coming here I got to see malaria firsthand. Yes, it is true that it’s preventable. And yes it’s very treatable. Then why do so many people die from it? I really don’t know.

After seven months, I have seen my fair share of malaria patients and malaria is definitely pretty bad. What’s amazing is that I didn’t even see close to the worst. My whole in-country experience was during the dry season. The three wettest months are July, August, and September. The roads flood with human waste and any open container, any stray tire fills with water, breeding mosquitoes. During those three months, the Poste is filled beyond its capacity. Seck is a good guy and I know if he could do anything to help anybody at all, he would in a heartbeat. But even during the wet season, the Poste gets so packed that Seck has no choice but to deny treatment to people. › Continue reading

Tags: malaria, public health

Sakho at Valda Pharmaceuticals

Rachel would be so proud. Mat, being incredibly lucky and sociable, met this man named Sakho at the bank in Rufisique. It was serendipitous. It turns out that Sakho is the head pharmacist of Valda, a very large pharmaceutical company that actually has its headquarters in Rufisque. And so Mat, Ananda and I made our very own contact.

Mat brought us to the Valda headquarters to meet Sakho. Walking in, I was shocked. It was a gated complex that was more official than anything I’ve ever seen in Senegal. We got to the gate, and the security guard had to phone Sakho to make sure we were authorized to enter. I know in the US, that would be completely normal, but I guess I’m just really not use to that anymore. The security guard had to escort us to Sakho’s office, which was on the far side of the complex. As we walked in, the smell of chemicals just completely overwhelmed us. It was AWESOME. I miss the smell of chemicals. It smelled so clean, so official, so scientific. I could smell the chlorine in the air, along with other various chemicals. But walking into Sakho’s office was really surprising. It was so incredibly nice, and so western. He had a massive computer monitor, loaded with all the latest software, including Windows 7, which nobody uses in Senegal. He even had his own air conditioning unit. But once we sat down, we immediately started talking about Valda.

Valda is an incredibly fascinating company to me. The founder, a Swiss man, started the company right after World War II. Valda has been owned by the same family until about a few years ago, when the director of Pfizer in West Africa (yes Pfizer! My sister works at Pfizer in the States), decided to buy it. But, it’s not owned by Pfizer. It’s privately owned by the director, and has no affiliation with Pfizer. I find that a little weird, not just because the owner for this pharmaceutical works two jobs, but how in the world did he make enough to buy a company? But anyways, today, Valda Afrique services every country in Africa except South Africa (South Africa is always the weird one; they have their own pharmaceutical market there). How incredible is that? I’ve never even heard of this company and it’s a continent-wide company. And on top of that, there’s a Valda in Brazil. The Valda in Brazil services all of South America. In fact, the Valda has a much wider market in South America. Sakho said it’s mainly because the countries there are more developed and therefore have the purchasing power. But that’s incredible. Valda Afrique has this one location in Rufisque, and the entire complex can’t be more than five buildings. They have a total of around 65 employees. 65 employees for the all of Africa?! In comparison, Valda Brazil has a total of 20,000 employees. What? I don’t understand the huge discrepancy.

As for the products, Valda make an incredible range of things. They make Yotox, which is the insecticide that everybody uses in Senegal. They make tetracycline, which is used for skin and eye infections. They make so many types of antiseptics, more than I even knew existed. They make elixirs and oils that help things from indigestion to infections. They also produce huge amounts of condoms. But the funny thing is, when he told us how many they produce (which was like 2 million or something), I was like, that’s it?? For the all of Africa?? I assume there has to be other producers of condoms, or people just have a lot of unprotected sex here. Which is possible considering the high birthrates and venereal diseases. But you also have to remember, more people here have sex to have kids. However, their biggest product are mints. The mints fight bad breath and they act as cough drops too. Though that’s the biggest product, I think the best product is AquaTabs. They’re tablets that clean water. And it costs about two cents in US currency. Each tablet purifies 10 gallons. That’s amazing, and hopefully people will actually use them. Overall, it’s incredible the amount of things they produce considering how small the complex is. I can only assume that, though they service the whole of Africa, minus South Africa, they don’t produce HUGE amounts. Or maybe they do and they’re just incredibly efficient. That’s possible. › Continue reading

Tags: globalization, pharmaceuticals, public health

A Poignant Morning at the Maternite

Vaccinating infants, examining pregnant women, giving birth control, checking up on prostitutes and other activities related to reproductive health make up a usual day at the Sebikotane Maternite, where I have been an apprentice for the past four months. As I am not a medical student, my jobs are relatively simple: taking blood pressure, weighing pregnant women, and fetching things for the midwives. While I don’t feel like I physically do much there is usually something interesting going on and I am always learning. Working there after volunteering at a hospital in the U.S. I also see the great difference in the quality of health care between the two countries. However, after living here for four months and getting used to what I see every day I some times forget what is lacking here. At the same time there are still things that surprise me and remind me there is much potential for improvement.

Probably the most impactful event since beginning work here happened about a month ago. One morning, soon after I arrived, a woman came in with an extremely tiny baby all wrapped up. I thought the baby had just been born until I noticed its pierced ears and the large black eye brows painted on its weirdly shrunken face. The woman was explaining something  I could not understand as one of the midwives unwrapped the little bundle. I immediatly knew something was wrong but did not realize how wrong until its fral ribs and caved in stomach were revieled. With horror I thought the baby must be dead. The mid wife gasped and began chastisizing the woman. The child was starving. We rushed to put her under heat lights and spooned water little by little into her mouth, waiting for the woman to return from the pharmacy with formula. The midwife explained to me that the mother was very young and had not begun to produce milk yet. I asked if another woman who had just had a baby could feed her but she said they would not do that in Senegal. As more mid wives began coming in for work, they were all upset by the state of the baby. › Continue reading

Tags: apprenticeship, public health

Playing Pharmacy Boss

Today was a big leap at the Poste. I don’t think I have been that productive since the beginning of my experience at the Poste. I was running the pharmacy like a pro today! Not really. I was a pretty big n00b but still. I thought I was rockin’ it. I was never flying solo, but when somebody handed me their prescription, I knew exactly what to do. I was even able to read most of the handwriting. Unless Sakho was the person doing the consultation. He seriously needs to go to a calligraphy class or something. And for the most part, I got all the prices right. There were a few mess-ups here and there, but nothing bad. I always had Madame Salle or Candi there, watching over me. No pressure or anything. Both of them thought the entire thing was pretty funny. You know, a toubab running the pharmacy at a Senegalese Poste de Santé.

What I also discovered was that most people who come to the Poste don’t use French. They only speak Wolof. Some of them can speak French, but with the combination of my horrible accent and my limited vocabulary, French clearly wasn’t the right language to use. Not only did I sell the medicine, but I also had to tell each patient how to take each medicine. The directions on the package are always in either French or English. And that’s when there are packages. We sell most of the drugs by parts. A box of ibuprofen has 50 tablets, organized in 10 tablets per a sheet of those plastic and foil pop-out wrappers. So we sell each sheet separately. Thus, no written directions. So what I had to do was learn how to give the directions in Wolof. Wow did everybody find that hilarious. Every time I told a patient the directions, they’d start laughing. Nobody could take me seriously. I mean, I can understand. It’s like when a white person speaks Mandarin. That stuff is funny. And Madame Salle and Candi were another story. Every time I said things correctly, they’d celebrate and give me high-fives. The thing with Wolof for me is that the sounds that the language uses are sounds that I’ve never produced. I mean, throughout my life, I have spoken English and Mandarin. I’ve learned Spanish for god knows how long (through a pretty lousy Spanish department). And I’ve recently been learning French. Yet with the four languages that I’m familiar with, Wolof still uses sounds I’ve never used. And if you guys don’t know, I’m really bad with accents.

But I did eventually learn how to give the directions in Wolof. So if you ever need me to tell you the directions for ibuprofen in Wolof, I’m your guy. › Continue reading

Tags: apprenticeship, public health

La journée mondiale du diabète

My host family’s house here in Sebikotane is made up of three separate buildings enclosing an open concrete-floored space shaded by a single fruit tree (never seen this particular fruit before) and hanging laundry; it is usually empty except for me, my notebook, my nalgene, lots of little kids and a few buckets full of dishes and laundry to one side. But throughout this past week I would come home at one o’clock for lunch from the elementary school where I started my apprenticeship to find this space full of large colorful bodies, mostly women, sitting on stools and mats, bending over large bowls of fish guts or white rice, or stirring a cauldron sized pot of sizzling oil. I would go around and shake each of their hands with a little curtsy to show respect, and inevitably be commanded to sit down, after which would follow a fairly predictable series of questions starting out with where are you from? and proceeding quickly to why don’t you have a husband? › Continue reading

Tags: public health