Health Staff
The Project Team
Ò[In 2006 the project trained 36 traditional midwives and] 21 community health information volunteers (they collect data about births and deaths, weigh babies and give nutritional counselling, and teach their communities about health issues). The health volunteers vary significantly in their ability. About six of them demonstrate a lot of potential and have a very good manner in relating to patients. I would love it if they could be trained to become officially recognised nurses but sadly it won't be possible as their level of formal education is too low and there's virtually no opportunity for them to increase it.Ó
Health Post Volunteer Course
Now 10 members of the health facilitation team work
full-time alongside Peg and many more volunteers have been trained.
ÒThis week the doctor from the District Health Department is coming up to Cobue from Metangula to evaluate some of the 30 volunteers we've been training who work in the government and community health posts. Most of them are already qualified and allowed to prescribe a few basic drugs, but these tests are to qualify them to work with first-line antibiotics and oral contraceptive pills. Four are new health workers and if some of them qualify then we can open another community health post in Chia, in the south of the project area.Ó Nov 2007
Exam invigilation and child care
ÒWorking with the health team these past two weeks has made me quite optimistic that IÕll be able to hand over the project management to them in about 12 months time and just help out intermittently during 2009. They seem enthusiastic about taking on the challenge and eager to accept the extra responsibilities IÕm dealing out to them. It helps a lot that they believe in the value of what theyÕre doing Ð that theyÕre making a real contribution to peopleÕs lives rather than just earning a salary. I canÕt remember if I told you that the health data weÕve got from over the past two and a half years suggests weÕve reduced child mortality by about 30%.Ó Feb 2008
ÒThe team, as usual, has worked hard and well while IÕve been away [on holiday]. IÕm encouraged at the rate with which theyÕre taking on new responsibilities and how enthusiastic they are about the methodology of our work. They seem to have genuinely bought in to the concept that if local people want their communities to develop and improve then itÕs appropriate for them to contribute to that themselves by working on a voluntary basis, rather than expecting all the inputs to come from outside aid.Ó Jun 08
Traditional Midwives giving health education
ÒI'm sitting in the MSF (Doctors without Borders) office
in Lichinga using their colour printer for making out certificates. The
certificates are for the training we're doing during August and part
of September for 60 of the traditional midwives and other health
volunteers on family planning and antenatal care (which might seem a
strange combination but I like to have a back-up plan). MSF help run the
ARV treatment programme in the province.Ó Aug 08
Medicines
The medicine
is supplied, erratically, by the official health system of Mozambique and
prescribed from the health posts by the trained volunteers.
ÒI used to be afraid that communities would be disappointed and annoyed when they realised the limited range of medicines the health volunteers are allowed to use, and the prohibition to them giving injections. It's been a big relief to discover that, although people would like more, they're still tremendously pleased to have access to paracetamol, anti-malarials, antibiotic eye ointment, worm medicine and simple treatments for scabies, fungal skin infections and wounds. The health volunteers are longing to be able to prescribe antibiotics and I'm hoping very much this will be possible next year if I can train them in the Ministry of Health recognised WHO guidelines for IMCD (integrated management of childhood diseases) which includes the use of antibiotics for treatment of pneumonia and ear infections. The Provincial Health Department have already given me verbal approval to do this.Ó
Malaria
Malaria is a major problem on the Lakeshore.
ÒEach
year, there are approximately 515 million cases of malaria, killing between one
and three million people, the majority of whom are young children in Sub-Saharan Africa. Malaria is commonly
associated with poverty, but is also a cause of poverty and a major hindrance
to economic development.Ó Wikipedia
The health
volunteers are trained to use Fansidar with Artesunate for the first line
treatment of malaria. Mosquito nets can also be used to help reduce infection,
but this can create other problems.
ÒIn Malawi, on the opposite side of the lake, several
NGOs are distributing bed nets free to women attending antenatal or under-fives
clinics. Small scale traders wait
outside these clinics and offer the women money for the nets they have just
been given. Frequently these nets
are then cut up and converted into fishing nets. Many such fishing nets, some of them exceeding 50 metres in
length, are now being used along the Mozambican lakeshore where they are contributing to the serious decline in
the fish population.[The fine mesh captures immature fish].
While [the elderly lady] talks, and Chissano interprets to Spanish, her great-grand
child, a young girl about 5 years old, starts climbing up my back. Her
movements are spastic and she cannot walk without clinging to something. She is unable to talk. Later Peg
explains to me that her disabilities are probably the result of meningitis or
malaria having damaged her brain at a very young age. ÒYou see so many of these
cases; children who were born perfectly healthy but later became severely
mentally and physically retarded because of an infection that was treated too
late or inappropriately Ð itÕs tragic as itÕs so avoidable.Ó Gšran
Holmqvist[1]
Bilharzia
Shistosomiasis (Bilharzia) is a problem on the lakeshore. Over 80% of
the children in Chigoma (one of the lakeshore villages) are effected.
ÒSchistosomiasis (also known
as bilharzia, bilharziosis or snail
fever) is a parasitic
disease caused by several species of fluke
of the genus Schistosoma. It is most commonly found in Asia, Africa, and South America,
especially in areas with water that is contaminated with freshwater
snails,
which may carry the parasite. The disease affects many people in developing
countries, particularly children who may acquire the disease by swimming or
playing in infected water.
Although it has a low mortality
rate, schistosomiasis often is a chronic
illness that can damage internal organs and, in children, impair
growth and cognitive development. The urinary
form of schistosomiasis is associated with increased risks for bladder
cancer in adults. Schistosomiasis is the second-most
socioeconomically devastating disease after malaria.
Ò Wikipedia
Bilharzia lifecycle education sheet
The treatment for Bilharzia is cheap and easy Ð a single tablet that
costs less than £1. The problem is that the whole community has to be treated
otherwise the patient is re-infected. The Lago project has provided the health
infrastructure that enables whole communities to be treated. In January 2007
10,000 tablets of praziquantel were used to treat a large area of the lakeshore
and the treatment was repeated in July 2008.
Adriano running a Bilharzia study
Mental Health
There's a 40 year old shizophrenic man who lives a couple of hours walk south of Cobue, close to Nkwichi. When I discovered him a couple of years ago he was in a really bad way, living tied up to a tree a lot of the time as it was the only way the village had found to ensure he got enough to eat and didn't get lost in the bush during one of his long, agitated walks.
With the
help of Likoma Health Centre I started him on treatment and he was doing very
well until about 3 months ago when he deteriorated again. He's currently
eating very little, not washing, and walking around collecting huge bundles of
firewood which he's filling his elderly mother's hut with, making her terribly
afraid that he's soon going to burn it down. I increased the dose of his
medication up to the maximum recommended for outpatients but so
far it doesn't appear to have helped. His mum (a wonderfully caring
woman) is at the end of her tether and would very much like me to get John
admitted to a psychiatric hospital.
I agree with her it's an appropriate move but the
nearest unit that would take him is in Lilongue. Likoma would refer
him there but we'd have to cover the transport costs. I said I'd pay
for fuel for the ambulance but when I discovered I'd also have to pay for the
nurse to accompany him (3 days allowance) and the driver (2 days
allowance) and make sure there was provision for the return journey I
decided we needed to look at alternatives first.
I phoned the
psychiatric hospital and they suggest I put up the medication dose to
about twice what he's currently taking, so this morning I talked to his mum and
that's what we've done. It's a bit anxiety inducing as the medication can
have very nasty, long-lasting side effects of causing muscle spasms, strange
writhing movements and distressing facial contortions, so ideally he
should be having very close monitoring in a unit where they can administer the
antidote quickly in the event that such problems occur. All I can do is
advise his mum that if he does start making odd moverments she should get him
to Likoma and ask them to stick him on the Ilala ferry to Nkhata Bay (once a
week schedule) and hopefully he'll be given the antidote there if it's in
stock. Not ideal but the alternative prescription of tying him to a
tree trunk again doesn't seem any better. Ò