Pay for Education, Not Drugs

Max Siragusa - Senegal

January 25, 2013

My nephew was kicked by a horse several days ago. I should say “clipped”, because the hoof caught his face only as it was about halfway into the air. He’s short enough that the hoof didn’t hit his leg or his chest. He’s only five and so the blow caught his face. The horse had no shoes, but whether or not the hoof was pegged with iron is not something that matters too much. It incised his face in a curve, with the cut slicing open his chin, his lower lip, the inside of the upper lip, and part of his right cheek. It also tore out five teeth, kind of. It really just shattered five teeth on the right side of his mouth. They were only torn out when he got to the doctor’s office.

He came in, and he was brought to the surgery. We cleaned off his face, a painkiller was given, and before waiting for it to take effect, we began to stitch up his chin and yank out the shards of teeth too embedded in the gum to fall out themselves. His mouth and gums were cleaned with some betadine and a saline cleanser. The cut on his face, even the parts that weren’t stitched, were cleaned. Only his chin was covered. There was dirty cotton and blood all over the table by the time he finally quit kicking and flailing and we were finished.

He was given prescriptions for a couple of different antibiotics and a painkiller, but the only medicine he ever received was the painkiller. And, really, he only got that when he began to cry the morning after the incident. The antibiotics, one a medicated mouthwash and the other a pill, were opened, analyzed, and then only given to him for two days. The doses were for a full week’s course.

His chin somehow healed without getting infected, despite the fact that he always removed his bandages (or had help doing so from various neighborhood kids) and managed to smear his chin and other wounds with rice, boiled vegetables, sugary tea, milk, chocolate powder, sand. The list I kept of what I wiped off his face is actually longer but there’s no need to write it all here. I make my point, I think. Sand especially is what the antibiotics were there to fight. Not the sand itself, but what it carried: the endless amounts of human and animal waste mingled in with the rotting food and dirty plastic tidbits and the innumerable, quasi-toxic garbage articles that exist here unmanaged in such quantity beneath our feet that you wonder why the grainy mixture on the ground is still in some places defined as “sand”. Yet, amazingly, his body repelled the microbial bodies and bacteria and viruses that rolling around in sand no doubt introduced into his wounds.

The stitches on his chin aside, most of the injury basically closed up without much trouble. However, it took about two and a half weeks for that to happen. And it’s scarred some. That doesn’t matter, that will fade. At this moment, the biggest infection risks are the incision inside his upper lip (which has surpassed the level of mere ‘risk’ and is actually infected) and his gums where the teeth were destroyed.

Asking his mother why the medications wouldn’t just be given to my nephew since all they can do is good for him, I am told he doesn’t need them and that he’s healing up fine. Looking at his injuries, and having been able to watch his recovery for over a week and a half, I’ll admit she’s right to a point. The gash inside his lip says otherwise. It’s been cleaned regularly with dirty water, usually before lunch (when the person cleaning it has just finished handling raw fish and meat and hasn’t washed their hands) and after lunch, where although a disinfectant is being used, oil and sand on the adult’s hands are introduced into his mouth. It’s not a major injury and it doesn’t require anything near what we’d define in the United States as “trained medical care”. You don’t need to have attended med school to know that dirty hands are a pathogenic conveyance risk.

Looking at the way my host nephew’s injuries have been cared for once out of the doctor’s office, I wonder if there is a word for “bacteria” or for “germs” in Wolof.

It is essential to bear in mind that this is not Africa as we see it in 1960s back-issues of National Geographic, where dying Biafran children crowd around U.N. aid trucks fighting for rice and water. This is not Africa as we see in CNN and Fox clips, where heroine-pumped adolescents massacre churches and clinics with Sierra Leonine AK-47s. This is not the Africa of Joseph Kony. This is an Africa where a kid can go to a doctor with a gash, cut, malady or deep wound and have it treated properly. This is an Africa where drugs are available to aid in the healing of wounds like the ones my nephew suffered from. And that availability is increasing as more drugs and those of a wider variety, too, become available. It’s an Africa with the means for someone to wash an injury with potable water. This is an Africa with the resources to fight germs and negative microbial entities. The resources exist to promote, at the very least, basic cleanliness. It’s scary, because that lack of “basic cleanliness” is often what can, does, and will maim or kill someone.

Despite this, people rarely if ever worry about sterility, minimal hygiene or preventing infections and illnesses of a bacterial sort. I can see now that when someone becomes seriously ill, or dies, from a small infection or what ought to have a been a passing sickness, it wasn’t due to lack of care. It wasn’t even necessarily lack of medicines or resources needed for treatment, although sometimes that is the problem. That person is victim to a lack of knowledge, a deep lack of understanding, that we in the West have about bodily care, first aid, and especially Germ Theory.

You can throw all the subsidized drugs and funding and nurse training you want at a growing nation. But if you can’t teach people the worth of not playing with wounds until they’ve washed their hands; if you can’t get people to understand the threat bacterial diseases pose for them if they aren’t careful when handling raw meat and fish; if you can teach people basic sterilization and cleanliness habits, no amount of aid money or supplies will make a difference. Clinic donations become utterly meaningless in a setting where a mother cleans the gaping slice in her child’s mouth because her hands “look clean”. Forget the muddy goats she was carrying around earlier, why wash your hands after handling dirty livestock? If wiping them on your chicken-blood-and-gut-covered apron makes them appear clean, then they must be. Right? For the record, these habits and practices I’m talking about aren’t financially unfeasible. Having a spare baggie of detergent or bottle of Madar Dish Cleanser in the house is not something impossible for many families to imagine. Cleanliness in many instances is only a bar of soap away. And soap is not terribly costly.

I’m certain for the most part that my nephew will be okay. But this incident opened my eyes to the realization that right now, Senegal and countries similar to it developmentally don’t necessarily need more hospital subsidies and more drug funding and more sponsored MD and midwife training. That stuff’s awesome. Really. But it doesn’t matter if it isn’t supplemented by an attitude that gives it all some kind of priority. What I’m beginning to realize Senegal needs is help in educating the population about the little things. The really, really minor things that make a world of difference, like washing hands. Or like ensuring you use a prescription as directed and don’t play doctor, stopping it after a day or two, or not getting it filled at all. Or about how just covering a cut on your foot and keeping dirt off of it will ensure you don’t need to go see the doc a month later when it’s expanded into a feverish abscess.

In a culture largely without any awareness in this area, healthcare becomes moot if people aren’t willing to go the extra step beyond just attaining more developed and comprehensive healthcare at their local doctor’s outpost. That step includes adopting simple preventative health practices and basic, non-intensive sanitation habits that are essential to making such healthcare effective in any long- or short-term measure.

Antibiotic creams and pills are no cure for preventable ignorance. The cure for many things at this point is not more resources. It’s basic education.

Max Siragusa