The medical situation in the village is by far the most depressing and troubling aspect of life in the village. If I functioned independently and didn’t interact with people, it would have little effect on my life as I am privileged enough to have medical insurance that includes MEDVAC and an organization that wouldn’t hesitate to send a truck up to me and get me to an adequate hospital in Calabar or Lagos. But indeed, I do interact with others and the medical situation affects both my personal and worklife.
To give you some perspective, my village is about one hour from the main highway. From the main highway it is about an hour to the capital city of our state, Calabar. The closest ‘big city’ is Ugep, about 20 minutes north from the highway. There is a somewhat decent medical facility in Akampa, about 30 minutes south from the highway. None of these, including Calabar, would I fully trust and if I am ever faced with any type of ailment, I would not hesitate to go to Lagos. Commenting on the national health scene is a whole different story but I will say that excellent care is available in Lagos and Abuja. I suppose that is one positive about having such an enormous gap between the rich and the poor; the rich will always attract good doctors, just as long as you can pay for them. But like I said, this makes me feel a little privileged and out of touch but its a reality.
Back to the village. In our village we have several “Dr’s” who are locally called chemists. They are like a Dr. and pharmacy all rolled into one, minus the qualifications, knowledge and experience of a real doctor or pharmacy. These “doctors” are no more than business men running shops. One of the most popular chemists is 19 years old and didn’t finish secondary school. Not that the quality of the secondary school is anything that would actually add to his medical knowledge but you get my point. Often times chemists are accused of prescribing certain types of medicine that are profitable (and often have little use) and almost certainly they are over prescribing antibiotics. And for those of you who don’t know, improper use of antibiotics encourages viruses to adapt and increases the risk that current antibiotics will be useless when viruses build resistance. People are constantly giving incorrect doses of various antibiotics for simple problems. And the worst part is, people in the village don’t know any better so they never question these chemists. Which leads me to how this all causes problems with work.
Our organization gives our employees basic medical insurance. Unfortunately for us, the lack of medical facilities in our area leaves us in a bit of a bind. Our biggest problem is people falling sick and claiming malaria. Okay, fine if you have malaria but then taking the wrong drugs (like mefloquine in a mefloquine resistant area) and wrong doses isn’t going to help. I don’t think that our employees have malaria every time they claim they do, rather it’s the term the use for being sick. I think most of the time the people are simply malnourished, exhausted and dehydrated. Perhaps they picked up a bug from contaminated water. But then again, if malaria goes untreated it can be fatal. So we’re stuck in a tricky situation. I seriously believe that the way people treat malaria in rural Nigeria is going to cause a huge problem in the future. It’s like someone came with a campaign about malaria but only did half the education that was necessary. The result will be a pretty nasty malaria that is resistant to all the drugs available locally.
One of the biggest arguments I got into with staff was when one of the staff reported to me with bruised ribs. The story was pretty simple; he was moving wood and he slipped and the gigantic log rammed into his chest. It was now painful to breath and caused a lot of discomfort. I told him that he had bruised ribs and explained that it would really hurt but there was nothing he could do, except take some ibuprofen. The next day he sees me with a medical bill for antibiotics, fish oil and ibuprofen. I ask him why he didn’t listen to me and he said, “Well, I just accept what the chemist gives me, I don’t know what it is”. So we go together to the chemist and the chemist tells me that he probably has an internal infection so antibiotics are necessary. I tell our staff that we are not paying for that and the chemist turns it into a “they don’t respect your welfare” kind of thing. At the end of a lot of talking, arguing, education, deaf ears and frustration, I ultimately ended up looking like an asshole who doesn’t care about infections caused by bruised rib. Sometimes it’s tough, you try to explain things the best that you can but people trust what they know, even if it’s incorrect. This incident was used as an example at our staff meeting and several people argued that they had always been using the local chemist and have been okay so why should they stop? It’s tough for me to answer those kinds of questions in a way they would understand.
Personally, it’s tough to watch my friends continually get poor treatment. One of our staff’s (who is also a friend, not all of them are) dad was very ill and they asked if I could do anything. I went to see the man and he looked extremely emaciated and complained of a chronic cough that occasionally has blood. He said he has been getting treatment for a year from the local chemist but nothing has improved, in fact he had gotten worse. I told my friend that he should take his father to the clinic to get him tested for TB. I said that it is something that can easily be cured but if left untreated can be fatal. The next few days he gathered money from his entire family so he could take him to a clinic in Akampa, and sure enough he was diagnosed with TB. The next week my friend complained of weakness and a cough. I said that he should also go get TB and lo and behold, he tested positive. They both are recovering quite nicely now and needless to say, he now trusts my medical opinion. The biggest problem is, I can only diagnose pretty minor ailments and I am better off just recommending proper treatment for minor ailments. I often get to the point where I say, “You know what, there’s stuff going on here where I recommend they go to a lab to get tested”. But most people in my village can’t afford to do that, and if they could they couldn’t afford the subsequent medication. The other day my best friends four year old baby was vomiting and feverish…I didn’t know what it was. It could have been anything from a minor stomach bug to possibly fatal typhoid. It’s extremely hard to be completely honest with them and say, “I don’t know what is wrong, they need to see a qualified doctor”, when I know they can’t afford it.
So I try my best. I use this awesome book, Where There Is No Doctor, that has taught me a lot and gives me some pretty basic knowledge. I do my best to not overstep my boundaries, though as I said, it can be a bit depressing at times.