How We Care for Each Other

Elias Estabrook - Senegal

May 2, 2012

In mid-October, the second week in my village, I caught the flu. Fatigued and dehydrated, I arrived at the local clinic, accompanied by my host father. After laying down, I proceeded to doze off.  Still, I remember precisely how every few minutes, the blurriness cleared to reveal the distinct faces of members of the village who passed and peeked in to greet and comfort me, just with smiles and presence alone. I had never met most of these people, but here they were, introducing themselves and providing much needed moral support. At the time I was too weak to adequately acknowledge my “new” community members. Their words in Pulaar — a language I didn’t yet speak or understand — remained enigmatic, though the emotion in their gesture was clear, no translations needed. It was my first visit to the local Poste de Sante, the site of my future apprenticeship.

Over the last six months, occasions have frequently arisen where I’ve made similar visits to sick community members. Clearly, in Senegalese communities, this sort of psychological support for  people who are ill (even when not gravely so) is normal, it’s expected.  Rather than giving the ill people complete privacy and leaving them to recover, friends and cousins are welcomed at their side, asking them if they’re feeling better and saying prayers on their behalf. Occasionally, my brothers and parents will suggest a certain medication they’ve taken; however, currently, their extent of their aid doesn’t go beyond that. Within a population that is under-educated, particularly when it comes to health, and is only now benefitting from information campaigns about topics from malaria to maternal care, patients and their families aren’t yet qualified to make informed judgements nor administer treatment without the aid of a nurse.

Nontheless, this profound instinct and custom to care for each other is invaluable. It provides an opportunity to combat illnesses and expand the network of care that a small clinic alone can’t provide. The challenge is to reform people’s habits when it comes to preventing and reacting to illness. And this is where the efforts of Community Health Workers (CHWs), called relais (literally, “relays”) in Senegal, becomes particularly important. Immersed into the community during their household to household visits, they can observe and advise. They are trained enough to refer community members with “danger signs,” making critical decisions that can get malaria patients, malnourished children, and pregnant mothers to the closest clinic in the nick of time.  In addition, over the past few years, CHWs have pursued an ambitious campaign of registering all head-of-households, pregnant women, and children under five years old in a computer database via SMS forms sent from the field. Within communities, communication channels are already well established and efficient, yet the pivotal step of linking the health system to the community and comprehensively monitoring individuals is thus being realised.

As with most initiatives, the system is still a work-in-progress and gaps in coverage persist. Looking forward, clinic personnel will need to enlist the community in keeping watch and caring for itself. Nurses and project leaders have voiced concerns about the sustainability of the initiatives and services in the health sector, in particular the array of medications that are still prescribed (and often excessively) at no cost to patients. Moreover, the rural health system is not robust enough to adequately take on non-transmittable illnesses, such as cardiovascular conditions (anemia, hypertension, etc) and respiratory infections; some conditions simply can’t be addressed since diseases like tuberculosis and malaria have been the priority.  Indeed, funds and medications aren’t unlimited, so extensive public health efforts are the most critical frontier: to confront and prevent sicknesses before they send people in critical condition to the overwhelmed wards of a regional hospital, to increasingly pinpoint and address causes rather than just treat symptoms.

Elias Estabrook