As a junior doctor, trained in Uganda, my lecturers emphasized the need to be trained and prepared to work in a resource limited setting which is the case for most African health workers. Indeed, they trained us well to serve such a purpose; at least I believed so until I recently came back to my country. What I found in the rural areas of Somalia is something I was not prepared for. I came to the conclusion that even the idea of health care in resource limited setting should not be an objective description rather a subjective one. Poor setting in Uganda means the best care in my country!
I would like to share with you a series of stories based on my own personal encounter as health care provider in the Sanaag Region of Somaliland to give you an insight into the reality of healthcare in Somalia. It is nothing but the reflection of a truly failed state!
Zaynab, 26 years old, shown in the photos below, was a G¬6P5+0(sixth pregnancy and has 5 children) unsure of her dates, brought to Hingalol District Hospital in a semiconscious state early this month (3 October 2015). Upon quick collateral history and examination, I found that she was in shock with an unrecordable Bp. We resuscitated as quickly as we could with intravenous fluids. We found that her Hb (Hemoglobin level) was 4.3 g/dl-extremely low hemoglobin level. Later, I made a diagnosis of decompensated heart failure secondary to severe anaemia in pregnancy. She also had septicemia. I made the decision to transfuse her with 2 units of whole blood but to do that I have to go about a series of obstacles.
To start with, there is no blood bank, no proper laboratory services and no one with technical know how on how to collect and store blood, no reliable electricity. Actually no one was transfused in the history of Hingalol District and local people have their doubts on the benefits of blood transfusion. It was very hard to convince them that blood transfusion is a life saving procedure if done properly and safely.
We only had a blood collection bag and our lab guy could do blood grouping but no screening for HIV or Hepatitis B or other infections, we didn’t have a blood giving set so at the end we have to use the giving set for other i.v fluids. I carefully explained to the husband of the wife, a nomadic camel rearer, what we found and what we are planning to do. Though he had no schooling, he was among the most intelligent and open-minded people I have ever seen. He told me since I am the doctor I should do whatever I think necessary to save her life but he requested he should be donating the blood as he only trusts his blood to be save and unspoiled. I told him it is ok if his blood matches her blood but we shall test both of them. Unfortunately, the patient was O+ while the generous caring husband was B+. Since I am 0+, I could not see any other option other than donating my own blood. I have to admit, it was not easy convincing the husband that a guy from a non-Wersangali clan could be of the same blood group to his wife while himself is not! I explained to him that even brothers and sisters could be of different blood group! Moreover, I am the only one, I guess, with enough Hb to donate blood; most people are anaemic and dehydrated because of the scorching heat and long march in search of pasture and water for their livestock. Remember cross-matching is not a luxury I have at this point in time and I will transfuse the blood as soon as I harvest my blood. I have to sit next to the patient and watch for any early transfusion reactions during the whole process. At the back of my mind, the basic hematologic fact that i am a universal donor reassured me.
The following day the patient could sit up and talk! However, the patient left before completion of treatment because the family and the livestock have moved to Sool region where it has been raining and she has to go because there is no other person to take care of her children, with a postransfusion Hb of 6.7g/dl-still seriously anaemic!
Anaemia in pregnancy coupled with the lack of antenatal care services and properly trained health workers and the fact that there is a severe drought in this region makes pregnancy a death sentence in this part of the world.
Mohamed Bobe, Hingalool.
#NomadicHealthCare #252HealthCare #Mypersonalexperience #Servicetomycountry.
Informative indeed...healthcare is my hobby and I was aware of malnutrition, anemia in women being widespread in particular, as a key factor in our sky high maternal and child mortality. It is said that much of the healthcare progress comes from better hygiene and nutrition as simple as clean water, handwashing during birth etc and I heard that local solutions such as the moringa tree are extremely valuable but there should be a prevention focused wider public health as well as primary care system. Our taxation system and civil service may be getting more competent but social sectors funding must be the priority alongside creative ways to address the needs of nomads...
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