Hygiene, Condoms & a Preventable Death

Last month, as the doctor’s time here came to its end, we finally got to what I had been very much looking forward to: the workshops. On the schedule were two community workshops in Ba’aka villages, and a workshop for health personnel from nearby clinics and health centers.

It is a universal law of nature that the back of a classroom always fills first, as demonstrated by these attendees in Yandoumbe. Also, you might be able to tell from the hysterical laughter in the room that at the time the subject of the lesson was yes, sex (and the various diseases one can get during it).

One grizzled woman was adamant that a condom, if used near a woman’s period, or if broken inside a woman, would cause her death. Amazingly, a workshop attendee had a condom on him and so the doctor got a volunteer to help demonstrate that condoms are actually quite strong and can even fit around a water bottle.

Here are the kids demonstrating how one should cough or sneeze: into one’s elbow! This also applies to all of you reading this. I’m serious. As you can see this workshop, held at Mossapoula, consisted primarily of children. This is because only a handful of people showed up despite many notifications in advance and the village chief going from hut to hut to ask people to come. After a few hours of waiting around, I commandeered a nearby classroom where kids were attending regular school and took over for an hour.

Some of you may already know how I’m obsessed with proper hand-washing technique, and that was a vital part of my curriculum. A few weeks later one of the gorilla trackers, who apparently attended one of my workshops during his time off, showed me how I taught him to wash his hands. That alone validated my whole month with the doctor (click here if you missed that post).

I thought our time spent treating individual patients was over, but the day before our last workshop and my departure for Bai Hokou, there was an emergency case regarding a tracker’s daughter. She was pregnant with her first child, but had been in painful labor for days. Her strong-willed mother—over a head shorter than me, with no toes on her left foot but terrifying nonetheless, and not least because of her bulging muscles— refused to let her seek medical care as she did not trust Western medicine.

We tracked the woman down and after a yelling match between other community members, her husband and her mother, we finally got her mother to agree to let her go.

 The woman’s husband and his first wife, who was to accompany her to the private Baptist clinic, helped her onto the moto.

The motorcycle ambulance convoy. She’s not visible in this picture, but the doctor is between the driver and I. 

After we arrived at the clinic, the doctor soon discovered that the fetus was dead, but for how long she could not say. Her husband (who as I mentioned earlier, has two wives) had untreated syphilis, which may have been the cause of the baby’s death. Though it was too late to save the baby, the mother’s life was still at stake as there was a severe infection inside of her. The only option was to evacuate the woman to the nearest actual hospital in Nola, 100 km away. The woman’s mother refused again, but was eventually convinced.

The doctor and I then had to frantically jump through several bureaucratic hoops; time was of the essence if this woman were to be saved. One was a visit to the woman who was in charge of the local public health center during the night shift. Her husband happens to be the local “sub-prefect”, who went on a long (drunken) rant about how the local government should not help a private clinic to evacuate a patient despite the fact that it was the official protocol that all evacuations must be authorized by the head of the health center. He continued to say that the couple in charge of the private clinic were unqualified and uneducated, unlike the staff at the public health center. It was very, very difficult to hold my tongue. The two individuals who run the clinic are in fact lovely, caring and competent health workers while just a few days ago, one of his government health staff—the only one present at the center at the time—had been completely drunk and acted completely inappropriately while a woman was in labor. He asked for bribes, offered to get her stung by a scorpion he claimed would hasten the delivery and sexually assaulted her. And there I was, nodding my head as the sous-prefet went on and on about how incompetent the private clinic staff were compared to his staff.

At one point, I had to rush to the WWF office to get some paperwork copied and some cocky eco-guard (armed guards whose job it is to protect the park) stopped me and refused to let me through because I was being “impolite”. No matter that a woman was dying. I am so incredibly sick of African men on power trips—they are arguably the single most significant hindrance to development on this continent.

Here, some of the woman’s relatives are packing food for the journey to Nola. 

Sadly, we found out the following morning that she died soon after her arrival at the hospital. Though the doctor felt like she failed, the woman would have had a much better chance if she had sought proper medical care days earlier. That can be traced back to the lack of education, the lack of access and the discrimination against the Ba’Aka—all problems that obviously started way before the doctor came here.

A picture we used during the presentation. 

The following morning, we had our last workshop. The aim was to teach health personnel how they can improve based on what the doctor and I witnessed over the past few weeks. The major problems in the local health system are the overprescription of antibiotics and the misuse of drugs. Antibiotics are prescribed for every single ailment—whether it’s a cold, malaria or a bruise. One example of drug used carelessly is  dexamethasone, which is prescribed highly frequently for a host of complaints ranging from fatigue to comas. According to the doctor, in reality it should only be used in cases of severe allergic reactions or pulmonary crises when the patient is unable to breathe, such as during an asthma attack. A very potent drug, it should not be used lightly and can even cause death if improperly taken.

The local health center’s lab tech, who had been the most stubborn and frustrating person to work with those few weeks, declared during the workshop that “there was no discussion” regarding the way they use their drugs: he said he could only explain to us why they were forced to use such drugs because he insisted, as he had many times before, that the Czech doctor simply could not understand the circumstances and diseases the local population had to deal with. I personally believe that he just did not want to listen to two young foreign women. There is no quick solution to all of the issues leading to poor healthcare in this area. But a new doctor has just arrived a few days ago, and we are hoping that some leadership and proper medical expertise will do this place some good.

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