Today we spoke with three community health officers (CHO) and a physician assistant located in and around Makeni. We traveled with the Ukweli and Safe Motherhood teams to the different clinics.
Our first stop was the Kagbaneh Community health post (CHP). While there, we spoke with Fatmata, a CHO in charge of 16 community health workers (CHW) and with 10 years of experience. She showed us a “Maternity Record Card” which the CHWs use to track a woman’s health during their antenatal care (ANC) visits. The government recommends that all women attend 4-8 ANC visits; however, the majority of women do not get the required care before birth because it is too hard for them to travel to the post. Despite that, most mothers do give birth in healthcare facilities, because there is a fine if you give birth at home. They do this because the maternal mortality rate is so high, therefore, they want people to go to the clinic to have a better chance of surviving. The ANC Maternity Record Card also included a question asking whether the mother had sickle cell. Although Fatmata said they had no way to know for sure if a woman had sickle cell, most people are able to determine their diagnosis based on family history and symptoms (especially the recurrent painful episodes). She told us that she had had one sickle cell patient in the past. The mother came to the health post to give birth; however, the health post does not have blood so they sent her to the Makeni hospital in an ambulance for the delivery. She ended up needing 2 liters of blood in order to survive.
After this meeting, we went to a larger community heath center (CHC) in Kamabai. There we spoke to Alusine, a CHO who used to work in the Makeni government hospital. When we asked Alusine what diagnostic tests he thought the clinic needed, he said hepatitis B, sickle cell, and hemoglobin levels (for anemia). He said that he has had approximately 8 patients with sickle cell, and that all he can do to help them is given them pain-medication or take them to the hospital in Makeni. We also spoke to him for a little about the services they offer at the CHC. The Kamabai CHC has the capability of performing lab tests to diagnose TB, but this is an uncommon service to be offered. They also provide free general medical care for under 5, antenatal care for pregnant women, postnatal care for lactating mothers, and family planning (including condoms), HIV testing and treatment, malaria testing and treatment, counseling services, and EPI immunizations for everyone.
Finally, we travelled to a CHC in Binkolo where we spoke to a CHO, Andrew. He said that his CHWs treat/test for 3 main conditions: diarrhea, malaria, and respiratory problems. When asked what other test he would like to run, he mentioned hepatitis B and Hb (hemoglobin levels). He had only ever worked with one woman with sickle cell disease, who was identified based on her family history and symptoms.
After the clinic visits, we returned to the World Hope International headquarters. There, we spoke with Solomon, a physician assistant from the regional hospital and a worker for CHAMPS (Childhood Health and Mortality Prevention Surveillance). He told us that it was difficult to deal with sickle cell patients, especially children and women during labor, since there can be many complications. When labor lasts too long, a sickle cell crisis can occur, which requires a blood transfusion to treat; however, there isn’t a stable supply of blood in Makeni to handle this effectively. All together, he has seen more than 20 people with sickle cell, all diagnosed based on family background and symptoms. Although many of the signs and symptoms are very similar to malaria, CHWs/CHOs can test for malaria first, and then if the test comes back negative, they continue to investigate sickle cell. For treatment, he usually encourages people to stay hydrated, eat more food, and to obtain IV fluids if they are in a crisis. He also prescribes them folic acid daily and makes sure to treat any side issues, such as worm infestations, as soon as possible in order to avoid complications. He said that they do sometimes give their patients antibiotics, but there are no specific penicillin prophylaxis treatment plans. When asked about the importance of our device, he said it could be important for family planning, expecting mothers, and for correct diagnosis and treatment of patients who may be going though a crisis.
We have been asking a number of CHOs what the life expectancy for sickle cell is and everyone has been spitting out the number 25, Soloman did too. He also added on the statement that a majority of people who know what sickle cell is believe that if you make it past 25, you “can’t die from sickle cell”. Soloman is a very interesting and busy man. He does rounds in the morning at the hospital, comes to World Hope during the day and then goes back to the hospital in the afternoon/night to preform basic surgeries and look after his patients. Soloman is our connection to Makeni hospital, so with his help we will hopefully have the opportunity to speak with a lab technician, a hematologist, and a pediatrician at the hospital in the coming week.