Given that there is another group (or “stage” as they call them here) of Health PCVs entering Morocco in less than a month I decided that it would be good to update my blog and begin again. This is for a few different reasons. First, it allows incoming volunteers (and anyone else interested) to see inside the life and mind of a health PCV serving here in Morocco. Second, it allows me to center my work and mind in what needs to be done each week. So here goes.
To begin to get an understanding of the health work that needs to be done here and in order to figure it out myself it would be good to take a look at how the health system is run in my area. It centers mainly around the local clinic (called a “sbitar”). If you are sick you can come to the sbitar in the morning, talk to the local doctor, get a diagnosis and medicine all for free. If the problem is serious or medication is not available, there is a larger medical center and pharmacy located in a larger town 50km down the mountain. Inside the larger medical center, people are able to do sonograms and other small screenings, however, in order to get major procedures (x-rays, tuberculosis and AIDS/HIV testing) you must go to the city of Middlt, about another 200km away. But for today our focus is mainly on the local sbitar.
Free diagnosis and medicine seem like a miracle in the land of poverty compared to the large sums that must be paid in America to receive that sort of treatment. Unfortunately, this free healthcare comes with its disadvantages. One of the biggest problems is the lack of medicine in the area (and most of the province for that matter). We have a constant shortage of medicine such as penicillin, metrozol, and other antibiotics. This is in addition to good syringes, low amounts of sterilizing fluid which are a necessity for administering much of the medication and care required to help these people.
Lack of medicine stems from a series of problems. First, people have the idea that eating a pill will solve any or all of the medical problems they face. I’ve been asked for medicine that will heal people’s arthritis, years of back pain from hard labor in the fields, tuberculosis, the common cold, and even bad hearing. These are all diseases that can be treated but not necessarily cured. But like all people, rather than improving preventive measures these villagers scramble for a quick fix pill. Thus, every time someone doesn’t brush their teeth and begin to have a toothache more aspirine or antibiotics are used and the supply diminishes.
The second reason for lack of supplies is the poor diagnostics that the doctors are given. There are no culture labs to identify a bacterial infection from a virus, no x-rays or TB tests to determine if someone is carrying a cold or the next epedemic of tuberculosis. Therefore the doctor is left to shoot blindly by administering a slurry of antibiotics to people (which is dangerous in itself by promoting resistance to medicine in the communal diseases). So what can be done about this?
Last week, the men in my village asked me to sit with them in one of the local qHowa’s (cafes). As we sat they brought up the problem of no medicine to me and asked me to set up a health association (with me as president) to address the problem. As there were two existing and inactive associations sitting in the café with me, I politely declined the invitation, although I did recommend a solution to them. I told them that there were two things we could do to increase supply of medicine. The local hospitals located in Middlt and Khunifera (provincial capitals) may have old but non-expired medicine that will not be used but could be used immediately in our village. This would require one of the association presidents going to the hospitals and talking with staff members to create such a plan. Second, each week I could teach lessons on preventive methods to avoid many of the major health problems that require medicine. This way, less people need to use medicine and the strain on resources will be much less. We all agreed to the plan, however, much of it is yet to be done.
Lack of medicine is not the only problem in the area. On of the biggest causes of death that I have observed in my village and the surrounding area is maternal death. Much of the problem I believe is simply getting women to do regular checkups at the sbitar in order to get forewarnings about pregnancy complications. If the women knew there would be a problem, they could go down to the local health care center 50km away and have the problem addressed by professionals. Unfortunately, there is another problem. Transportation is not always readily available and everyone is reluctant to take the ambulance because it is so expensive (130DH to take the ambulance down instead of the 10DH for the usual transport ride). I of course have my suspicions that the ambulance is not entirely an honest system and am hoping to see where the 130 DHs is going for each ride.
If someone was to go to the larger health center there is the question of where they will stay while waiting to give birth and who will take care of the women while they recover. This used to scare women but recently a free maternity house opened up that allows women to sleep, eat, and wait for (and after) labour all free of charge. Although, this is a great deal, many of the women in the outer duars where I live do not know about the house or trust it. The women simply want to sit in their warm safe houses and wait for pregnancy to come. But this leaves them unprepared in greater danger than they could ever suspect.
So what can be done about the pregnancy problem? Right now, I can try and find a way to make the ambulance service more affordable but it may still be of no hope the days roads are shut down and no doctor is available. It is also useless to people in extremely isolated villages that can be reached only by foot. The best solution is to educate these women on the risks of pregnancy and the affordable option available to them; go to the sbitar once every three months for a check up, and go to the larger health center down the mountain the last week of pregnancy to give birth. By thinking ahead and proper planning, lives and much money can be saved.