Wednesday, March 25, 2009

Health in General

if interested in earlier posts either look at "blog archive" to the right and click on topic, or scroll down and find "older posts" [it is a very small sign below] and double click on this. Older topics cover rambling thoughts of mine on our Peace Corps Days in up-country Sierra Leone. Please pass on this site to others who might find it interesting. 

As Volunteers we were given a so-called medical kit just prior to dispersing to our posts. The kit had some first-aid like material that were to be used for the minor things that we might run into. There were bandages, bandaids, dressing, topical creams, etc to be used for skin problems. We also were supplied with our antimalarial called Aralen phosphate which we took every Sunday. The Peace Corps also gave us regular mosquito netting for our beds, and there were directions provided for emergencies, problems that we might run in to.  We had been lectured in health issues on arrival in Sierra Leone. Most of us were not very worried about what we might be confronted with. We all knew to boil our water before drinking, be careful about working in the swamps, iron our clothing before wearing (the so called "tumbu" flies would lay their eggs in moist clothing and if not ironed these could burrow into your skin and leave huge welts).  We also knew that you had to be careful what you ate, you had to make sure the food was well-cooked.  The key was not to be obsessive about our new environment - the key was just to be careful and smart.  Emergencies were another thing. Each province had a Peace Corps director - we had Jim Alrutz. If there was a health issue - a message needed to be sent to Jim and he would come by and see to it that you were taken care of. This might include scheduling a visit with a local doctor (there was one UK doc in Kenema), or if you were really in trouble, he might see to it that you got flown down to Freetown to see the Peace Corps doc. We, as volunteers were also required every 6 months to get to Freetown and get gammaglobulin shots thought at that time to help ward off hepatitis. During our time there I did learn of a few volunteers who under the stress of it all had mental health issues and had to emergently be flown out of the country. If this happened it was usually to Germany where we apparently had some upscale health triage and care. As volunteers - for the most part we were a pretty healthy group.  Sierra Leoneans were certainly not as fortunate as we were at least in their ability to access health care easily. The government hospitals in those days were very limited. Their supplies were often low, their staffing was often variable, their sophistication was often limited by the lack of support and money.  People tended to use local methods to treat themselves - some of the concoctions probably worked. There may have been some that were less helpful. Many villages had someone who was experienced in native medicine to help out in a pinch.  People seemed to rely on the government hospitals when things looked dire, often times when things were too late. Immunization programs did exist through the United Nations (Measles-smallpox eradication; I think polio) but simple stuff like tetanus immunization was uncommon).  Very few people took antimalarials as these were just too expensive; very few people used mosquito netting; antibiotics were expensive and hard to come by.  Simple injuries often turned into infectious disasters as the climate fostered infection and early and appropriate cleansing of wounds was often not done.  The one aspect of health care that I was acutely aware of was how limited the delivery of modern health care is in a developing country.  Infant mortality was incredibly high, and this just added to the overall stress.  It was never that people didn't want better.  The combination of limited resources, limited support by the government, limited numbers of health care providers, and the limits of a population who had done without for generations - all added up to a very challenged health care system.  But, for the most part we, as Peace Corps Volunteers were very peripheral to it all. We did our stuff, helped out when we could (Susan and I worked at a Leprasarium for two months during our summer holiday) but generally speaking, unless we were specifically assigned to work in health care (few of use were) we had little to do with the health care system in-country.  I guess we were lucky.  

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