Day: October 23, 2012

Wednesday started off a 3-day nationwide Maternal and Infant Health campaign in Rwanda. This campaign is repeated twice annually and provides free vaccinations, de-worming medications, vitamin supplements, health lessons and more, specifically targeting pregnant women and children through the end of secondary education. Every Health Center in the country prepares and hosts multiple sites in their Sector where women and children are able to come and benefit from the services.

It was a great site to see so many people show up for the services and listen to the various lectures on health, with this campaign’s tagline being “Real Men Support Family Planning.” Love it. The campaign was well timed for The Access Project Musanze team, since this past week we wrapped up a two-month informal look at Maternal and Infant health in Musanze District. The results of which have been put together into a concise report highlighting the major best practices and gaps to adequate health care for pregnant women and infants in the area.

Our team placed 5 skilled nurses at various health facilities around the district where they observed and followed specific cases of maternal and infant patients. The nurses interviewed patients, verified patient charts, talked with staff, and simply observed the care given to each patient. My coworkers and I met twice a week with the nurses to review the issues illustrated by each case that they were able to present.

This informal look into the maternal and infant health of the district showed gaps at all levels of care, including community-based knowledge gaps, traditional beliefs and customs, transportation issues related to distance or availability of ambulance services as well as gaps at the health facility level revolving around limited staff, training or equipment available at the health facility. We were also privy to some great practices showing initiative and creativity on the part of Community Health Workers, mothers in the community and health providers. These findings are now going to be used to develop strategies that The Access Project will begin implementing to improve overall health for mothers and infants in the district, with the hope that Musanze can serve as a model for the country for maternal and infant health indicators.

It has been great being a part of the project from the beginning, and we are now at an exciting phase in the program where the development of health interventions will begin, as well as a more comprehensive look into the health indicators of mothers and infants in the district.

In other exciting news, as part of The Access Project’s emphasis on improving maternal and infant health in the district, one of my favorite projects I’m working on involves the further development and effectiveness of the nation’s RapidSMS program, a text-message-based technology allowing Community Health Workers to report in real-time updates on maternal and infant health, including the ability to request immediate ambulance services via text messages! That program, however, will have to come in another post, in the meantime, be excited about it!

As much as I want to tell a story about how my first three months of the fellowship year has been exciting, enlightening and rewarding with inspiring experiences, I will defer that and tell a startling tale.

Coming to America,  as a physician trained in Africa, I would literally assume the healthcare system is void of a lot of discrepancies that we face in my home country Nigeria. As fate would have it, I happened to be my own case study.

My ordeal with the healthcare system started when I found out I needed to get health screening to work at one of my programs site but my insurance would not pay for preventive services and I needed to be ill to use the insurance I was provided. I sought a solution, but obviously this was a situation beyond me or anyone that may have tried to intervene. It was a societal menace. It is one of the ills the average American has to deal with whenever such medical needs are warranted. This is one of the wrongs of the health system I as an American fellow was supposed to identify and work with others to alleviate.

As awkward as I felt at that time, I decided to press on and get through that part of my requirements. Little did I know that I just went through the first stage of my case study of the health system!

Once I found a practice, my tests were ordered and as expected, since I live in America now, the results came in quicker than what I was used to and I scheduled an appointment to see my new physician. On review, one of the tests was of concern and I was told I needed treatment for the condition to my utter surprise! I had just taken the test less than a year ago and I got cleared for it. It was not a condition I needed to be tested yearly or regularly for but because this was a new job and I am African, it was necessary. I looked at the report but doubted what was documented by the reporting laboratory and requested for further evaluation or another clinician’s opinion since I don’t have signs or symptoms of the diagnosis. My physician decided that I needed to be treated still, but I maintained I won’t get treated for a condition I don’t have. The laboratory clinician declined further review and made it clear the result was final and the test she reported from would not be provided as it will seem normal if anybody else looked at it. This is the same hospital that my demographics were erroneously recorded as a 66year old man on the same day despite been there physically. My physician sensed some foul play and decided I should take a repeat test which I may have to pay for out of pocket because my insurance may question the request. I was given a prescription to another practice for a repeat test for comparison.  The comparison test came out negative and with evidence for a third review of the result which also was negative.

First lesson from this is, to never think any system is perfect! There are a lot of holes and issues in the American health system that needs to be identified and require a multilevel collaboration to mend. Secondly, when I looked at my circumstance and the challenges I encountered while navigating the system, it brings to light the predicament of the underserved and minority populations whom we serve, who are uninsured or under-insured, homeless, can’t afford healthcare, not equipped with health information, not able to challenge the status quo and are constantly at the mercy of the system.Thirdly, the financial burden and psychological effect of the laxity and inefficiencies in the health system to the population is immense.

This drives home the reason the work my co-fellow and I are doing with the Children’s health fund is necessary. Our organization provides comprehensive health care to the nation’s most medically underserved children through the  promotion of guaranteed access to “appropriate health care” for all children and homeless youths through mobile medical units and collaboration of medical doctors, nurses, psychologists, social workers, IT specialist, managers and communications specialists. We also serve as advocates for our population through research and advocacy  to stakeholders.

The true definition of health inequities is revealed to me on a daily basis and clarity of purpose as a  Global health corp fellow is being gained continually. I am also delighted to be a part of a movement to foster equity and mitigate the manifestation of inequities. It seems a lot to do, but I know we can do it! With collaborations and a vision for change “Little drops of water, little grains of sand, make the mighty ocean and the beauteous land.”   Yes we can!