As I’ve mentioned in previous posts, my village is 11K away from the nearest paved road. To be fair, there are only 2 main paved roads in the whole country: the South Bank Highway and the North Bank Highway, with a few more in the capital region. So being 11K away from the North Bank Highway, access to health care is a problem in our area. Thankfully, we have a Health Post in Njawara with several skilled medical workers.
There are three different levels of health care facilities in this country: Major Health Center, Minor Health Center, and Health Post. We have a Health Post, and the village on the road 11K away has a Minor Health Center (Kerewan). We are situated about equidistant between two Major Health Centers in FarraFenni and Barra (also the major ports for crossing the River Gambia).
As a Health Post, we have almost all of the capabilities of a Minor Health Center, just with less staff and resources. There are a few full-time staff members and a few that are part-time. The main health care providers are the Officer-In-Charge (OIC), who is a trained CHM (Community Health Midwife), two CNAs (Certified Nurse Assistants), and the Village Health Worker (VHW). The Community Health Nurse (CHN) lives in Njawara and can assist at the clinic, but also serves 6 other surrounding villages.
Daily, there are a wide range of patients at the clinic, from family planning appointments to hypertensive patient check ups to even (this has happened twice in the past week) kids falling out of mango trees. The OIC and CNAs handle most cases like these, and the VHW takes care of wounds and wound dressing. There are beds available in the event of inpatients, but usually there are only outpatient cases. Thanks to a long legacy of Peace Corps volunteers, there are several health education murals around the Clinic.
The exception to this is that there is a maternity ward available for deliveries. In the past, Traditional Birth Attendants (TBAs) were designated in each village to assist with home deliveries and health care before, during, and after the birth. Over the past few years, the Ministry of Health has been pushing for deliveries in health facilities, and therefore changed the name of TBAs to Community Birth Companions (CBCs), designating their role to escort the delivering mother to a clinic. The OIC, CNA, and CHN at the Njawara Clinic are all trained for deliveries.
In the event of complications that require higher technology, there is an ambulance to take the patient to the Kerewan Minor Health Center. The brakes on the ambulance rarely work, so it’s only used in extreme circumstances.
Lastly, let’s talk about cost. That’s usually the first issue in the US when it comes to health care. On the whole, access to health care (physically) is not a problem in the US, but access to adequate and proper health care (financially) is usually the problem. It could not be more different here. The cost for a visit to the clinic (including all medications) is 25 Dhalasis (50 cents). However, sometimes pregnant women have to walk over 5K to get to the clinic itself. There’s a new program that even pays pregnant women for attending RCH (Reproductive and Child Health) Clinics each month and for delivering at a health facility. The government actually pays people for their proactive, health seeking behaviors… and it works! The RCH Clinics are packed with pregnant mothers and children under 5 every month.