Saturday, March 12, 2011

Some Health Issues

More about babies
I am still going to the maternity center two mornings a week, when I don’t have other things scheduled at the time, to help with weighting the babies. Since January they have changed the routine a bit, and I also understand things a bit better, so here is the story. When a woman comes to the maternity center for pre-natal consultation she gets a little blue book which she brings with her each time. It contains a record of all the consultations before the birth. After the birth there are sections that get filled out about the baby: name, birth date, birth weight, date of polio vaccine, and so on. Babies get the polio vaccine shortly after they are born.

Mothers are supposed to bring the babies in once a month, especially the first, second and third month, in order to get the series of baby shots. I am not sure what all is in the mix, but I expect diphtheria, tetanus, measles, and so on, just as in the states. The problem is that most of the mothers are illiterate and don’t know how to read their appointment date. They also may not have a calendar or know what day it is. This results in mothers showing up too soon for the second or third shot, or, on the other hand, not coming back for 3 or 4 months. On the baby days the mothers arrive with babies on their backs and sit around on wood benches in the waiting area until the staff finally get there and get set up (West Africa International Time, WAIT). There are often mothers there by 8:00 and we often do not get started until 9 or 9:30. Last week the vaccine did not arrive until 10:00.

The baby weighing routine
In theory I could do this alone, but most of the mothers do not speak French and I don’t speak enough Moore to be able to explain things to them, so there is always another woman there with me. The mother comes into the room and hands her book to me or the other woman working there. We check to see if it is time for the baby to be there and, if it is, we find the baby in a record book and find his or her record card. Mother strips off the clothes and puts the baby on the baby scale. In taking the baby off her back and stripping off the clothes, most of the time she holds the baby up in the air by one arm, just the way we were taught NOT to do it for fear of dislocating the baby’s shoulder. At first I found it alarming, and I still cringe when I see it, but the babies seem to do just fine. After we record the weight, we measure the length by having the mother hold the baby’s head at the top of a plastic gizmo that is about 3 feet long. The baby is lying on her back with her mother holding her chin to keep her head at the top of the gizmo, and I grab the poor little thing’s feet and slide a plastic plate up against the soles of her feet. Most of the babies don’t like this too much, although if I am quick we can sometimes measure the length before the baby starts to scream.

We then check a chart to see how the baby is doing. The options are better that 100%, 85%, 80%, 75% and so on. I think the 100% means how much a child that length should weigh. When you get a baby at less that 75% the nurse I am helping explains to the mother that there is a problem and refers her to the head nurse for a consultation. I assume in really bad cases they refer the family to the center for malnourished children, up the road. On average we see 25 to 45 babies each day, and there are usually two or three who need consultation. Sometimes it is clear as soon as you see the baby on the mother’s back that there is a problem. Other times the baby looks OK until his clothes are off, and then you see the skinny little arms and legs and know the child is not getting proper nutrition.

Kick Polio out of Africa
I mentioned the polio vaccine. It turns out that polio it is still a problem in this country and I believe in all of Africa. In November there was a big campaign to get all kids vaccinated, with the slogan “Kick Polio out of Africa.” There is another one coming up this month. They want to vaccinate every child under 5, and I think there are plenty who do not ever come in for immunizations. The other day I met one of the women from the maternity center and a man from the health service on the road wearing vests with the Kick Polio out of Africa slogan, complete with a soccer player kicking a soccer ball. They were doing a door to door (or courtyard to courtyard) trek around the village, looking for unvaccinated kids.

Evidence of polio
Everywhere I have been in Burkina you see people riding adult sized tricycle-type carts that they peddle by hand. The chain to move the bike is attached to peddles that are in front of the rider as he or she sits in the three wheeled cart. You see people in them on the busy streets and even going down the highway. There are homes for handicapped where people are trained in handicrafts and in my town there is a gift shop that is operated by the handicapped association where they sell their products. When the Pershings were here they bought some of their souvenirs there and I have bought a couple of wall hangings from them to decorate my living room.

Sex Ed for 6th graders
When I started to ask people why girls do not finish high school, one of the common responses was unplanned pregnancy. I have learned that Burkinabè do not talk about sex, even with their spouses. There is no sex education in the schools and the first encounter student have with sexual information is 10th grade biology. That apparently is too late for many girls. In a meeting I had with officers from the parent’s association and the mothers association, one of the suggestions from the mothers was to have a program for mothers and girls about sex and how to avoid unwanted pregnancy. I thought it was a great idea. At our in-service training we received a sex education kit from the Peace Corps. It is designed as an HIV prevention kit, but you can use it to cover any aspect of sexuality. Because of my connections at the maternity center it was easy to find the perfect person to help me with this project. She is a retired mid-wife who has seen too many young girls having babies and is very enthusiastic about this project.

We will first of all explain what menstruation is. Apparently many girls begin to have their periods without having any idea of what is happening to them, and they are terrified. Next we will explain how to avoid unplanned pregnancy. Abstinence, of course is the first method we will discuss, and it is the only sure fire way of course. We will do a demonstration of condoms and how to use them, using a wooden model of the male sex organ, and then explain other forms of contraception. Finally we will talk about HIV infection and how the use of a condom can prevent transmission. My counterpart, the retired mid wife, is fluent in French and in Moore and I expect I will not get to say much, which is fine with me. It is better coming from a Burkinabè than from me! We shall see how it goes. I hope this will become a tradition that continues in these schools after I leave the country.

1 comment:

  1. Jan -

    I am consulting on a project in South Africa, Uganda, and Tanzania focusing on HIV and relationship violence education. There are wonderful interventions in Kenya where traditions about not talking about sex are the same. My journal also recently published some papers specifically on how girls deal with menstruation.

    Would they be helpful?