Community Health and local healing

Andy, a graduate student, and I have been working with the Community Health Department at KCMC to help prepare their MD1's (first year medical students) for their longitudinal community health experience. It is a great idea, and I wish my medical school had offered such an experience....years ago.
The MD1's spend 1 Thursday every week in their 1st 2 years of medical school with the Community Health department. Students are placed in groups and paired with villages in the Kilimanjaro region. Initially, they are required to do a community assessment of their village- interviewing the village health leaders, some families, and the health facility- and form recommendations based on their evaluations. Last week, the students presented their findings, and it was a great way to hear about the villages bordering KCMC hospital. Andy and I had each gone with a group to a specific village, so we had a chance to see 1 village closely.
My village was on the road to Kibosho, a rather large village with 12,000 inhabitants, it contained 7 primary schools, 123 local bars and 2 health dispensaries. We went to visit one dispensary. Dispensaries are the most basic level of health facility, and are ubiquitous. Tanzania has a goal of having 1 dispensary every 5 kilometers. This dispensary was privately run by a church, and contained all the essential parts: outpatient area, pharmacy, lab, 6 inpatient/maternity beds and 1 delivery bed. The dispensary was very clean, but it was also very quiet. The entire hour we were there, we only saw 2 patients come through. The villagers say that private dispensaries are not popular because they charge money for medications and services. Usually it is quite minimal- $1 for medications, $5 for a delivery. But this amount is enough to keep people away. We see this at KCMC hospital, where people don't want to pay the $12 fee for a regular delivery and try to stay at Mawenzie hospital (where it is free).
This village also has a local healer, and we were lucky enough to interview him. He practiced from his home, a nice house with a very nicely manicured lawn and driveway. His entire waiting room was filled, and we (the 4 medical students and I) squeezed into his treatment room the size of a closet with 2 babies, 1 child and their anxious mothers. Local healers practice in different ways- some are herbalists, some are spiritualists and a few are quite frightful (see the recent news of albinos afraid for their lives given the high value of their body parts http://www.timesonline.co.uk/tol/news/world/africa/article6901688.ece ). This local healer used to be an engineer until about 15 years ago when he had a vision, literally. He was driving down a lonely road in central Tanzania when he was forced to pull over by a vision in the sky. This vision told him to start healing people in his village, and he continues to get his treatments through visions. As he was talking with us, he was creating suspensions in bottles (he wouldn't tell us what it was) to give to the babies and child. He gave 1 teaspoon to each, and waited 5 minutes. Then he gave the suspensions to the mothers to take home. I admit I was rather conflicted- especially seeing infants given suspensions of unknown yellow liquids, when it sounded like they had some colic. Should I have offered to evaluate the infants with my western medical background and provided my allopathic-based diagnosis and treatment? Who am I to say that my treatment would work better? It definitely would be less mysterious and more standardized. I was surprised to see the mothers willing to pay $1 to the local healer, but not to the dispensary. The healer was not surprised, and he gave us a few stories of people who failed to be healed despite weeks of therapy at the hospital and who were only cured after visiting him. Of course, this conflict of therapies occurs in the U.S. all the time. My patients would tell me about how their Homeopathic doctor, or their Naturalist finally treated their problem after countless visits to my colleagues had failed. I wonder how many of my patients had similar experiences. I assumed that this local healer would be cheaper, or offer services at nights/weekends, or spend a long time with his patients- none of these were true. But he was definitely a popular alternative to the dispensary, or to the long journey to a larger health facility. With so many health facilities lacking basic medicines, laboratory tests, or essential supplies (like blood pressure cuffs or delivery kits), local healers can be an attractive alternative in health care. As we were leaving at the same time as the patients, we heard the mothers thank the "doctor" for his help.

Sumera

Brief trip to Rwanda

Jeff had a quick visit to Rwanda recently. It's always helpful to get some perspective on suffering. Here is a brief email received from him:

"I made a quick. somewhat last minute trip to Rwanda with Nathan Thielman to help him with a project on emergency obstetrics teaching here. Yesterday, we visited a few hospitals and also had the oportunity to visit two genocide memorials here in Kigali and in a town close by called Nyamata. I had read of many accounts of the Genocide in 1994, and the smaller ones over the past 40 years that lead up to it. It was something else to ride through the beautiful landscapes here and imagine it strewn with corpses. The world sat by and watched as 1 million people were systematically killed. It was sobering to say the least. We are going to Gisenyi today which is on the border with Congo. We are visiting one of the district hospitals there that has a particularly high maternal mortality rate."

More details to come....