http://allafrica.com/stories/201504091230.html
I am in pain. Like seriously in severe pain. The death of
that baby that died in the arms of a 14 years old while the mother was trying
to get money to pay for health care services has touched me too much. I mean
what have (we) in the public health sector being doing. That death case is
preventable.
Fist let me try to analyse what could be the real cause of
that innocent baby’s death.
1.
Does anyone know the mother’s educational
status??? And you are wondering why I am asking right??? It is very simple.
Educated women are more likely to understand health related issues. They are
even more likely to know their rights in terms of reproductive rights, spacing
and accessing health services etc. Education allow women to build healthier
families, stronger communities and bright future. In simple words – the mother
of that deceased baby that passed away at Nampost could have a more chance of
surviving if the mother has a secondary education and even a more survival
chance if she had a tertiary education. Education could help the mother decide
to take the sick child to the hospital earlier and even understand the danger
signs of illness in childhood that should make one run to the hospital whether
you have money or not. Have you ever head of the “Let the Girls Learn”
initiative?? Check out the insert and the link below so that you can understand
why education plays a big roles in relation to accessing health services.
Why Educate Girls
Education is one of the most critical areas of empowerment for women.
When girls are educated, they lead healthier and more productive lives. They
gain the skills, knowledge and self-confidence to escape the cycle of poverty.
They become better citizens, parents and breadwinners. An educated girl has a
positive ripple effect on her health, family, community and society as a whole
( USAID, http://www.usaid.gov/news-information/fact-sheets/let-girls-learn)
I must mentioned that we are real
hopeful when it comes to educating women and girls in Namibia, because the
government has introduced free primary education about a year ago and will soon
also introduce free secondary education.
2.
Is our health care system meeting the community
needs … or should I say that poor woman and her family’s needs??? Now don’t get
me wrong here. I am not criticizing neither do I want to praise our Namibian
health care system but the truth shall be told. And I would like to look at our
health care system taking into consideration the universal standards that would
help us understand the situation.
The world Health Organization (WHO) member
states endorsed a resolution to provide universal coverage of health care to
all in 2005. Universal coverage of health is defined as access for all to
appropriate promotive, preventive, curative and rehabilitative services at an
affordable cost. And then there are common terms used in health promotion that
I believe all healthcare workers must know by hard … accessibility,
affordability, acceptability, and appropriateness. Is the health care system
universal to all in terms of affordability here in Namibia??? If yes – then why
did the mother delay taking the child to hospital??? Obviously because she did
not have money at the time and had to get assistance from the neighbour who she
had to pay and that is why the baby died in her sister’s arms while the mother
is in the queue trying to get money. And all those factors delayed the chance
of the baby to access health services and for his or her life to be saved. And let us talk about the geographic
accessibility??? – can the mother access comprehensive health care at the
nearest clinic. And that is the Kaukamasheshe clinic??? Maybe yes and maybe
not. But one would conclude that she could not get comprehensive health care
services at Okaukamasheshe, because she opted to travel some few kilometres to
Oshakati Hospital. I cannot even remember the acceptable distance from a
household to health facility. But given the geographic situation in Namibia I
can imagine that it could even go to over 20km or even 100km for some
communities. And this discussion bring us to the building blocks of the health
care systems under the WHO Health System Framework. They are: Leadership and governance; Health
Care Financing; Health Work Force; Medical Products and Technologies;
Information Systems and Services Delivery.
We seems to have all those building block here in Namibia right? But
perhaps they are not fully functional or need to be strengthen. Let us look at
the service delivery block. WHO defines the service deliver block as “Good
health services are those which
deliver effective, safe, quality personal and non-personal health interventions
to those who need them, when and where needed, with minimum waste of resources.”
Perhaps the services delivery is there but not reaching those who need it.
E.g. why couldn’t that woman call or sms an ambulance to come help take her severely
ill child to the hospital. Why couldn’t the community leaders or anyone out
there just not easily accessible to assist this poor woman and her very sick
baby. I recently visited omaheke region and learned that a certain community
has a focal person who community members from farms could go to and ask for an
ambulance to pick up the sick people in the farms. Now why is this not being
practiced in Oshana region? Could it be the difference in governing
styles?? I could go on writing and
writing under this point ….. and I could ask thousand and million questions
right but will not have an answer.
But there is one last question that I should
be allowed to ask…. Is there a health extension worker in that community????
Could she have made a difference if she could work with her community and make
them understand the danger signs of children illnesses or perhaps be there
24hours to provide basic support and link such critical cases to health facilities???
Of course it could.
3.
Where is the general community support??? I
remember that my father was one of the few people who had cars in the villages
back then. And I remember neighbours and people from our communities waking us
up at night requesting my dad to assist take them to hospitals. I don’t
remember how or whether they paid but my dad always assisted. One women even
delivered her baby in my dad’s Toyota bakkie on the way to hospital. I know
there is a lot of people who are helping others, but the community seems to be
changing. I once fell down in front of a health centre here in Windhoek and
nobody even bothered to help or assist me. The driver of the vehicle could not
see me and only came after I started moaning of pain. Meanwhile the community
was standing in a line with folded arms staring at me in pain. A toddle was
moving towards me and the mother picked him up and told him not to move close
to me. With that said….. Do I need to say more? No! Our fellow people will
stand by and watch others in pain and in suffering. Or how would you explain
why that poor woman had to go in the line to get money to pay the neighbour. Could
the neighbour not notice that the baby was severely ill and advise the woman to
go straight to the hospital and pay later?? Do you think the people working in
the post office could let that woman skip the line and attend to her
immediately so that she could take her very sick child to the hospital? Maybe
but then the fellow community members in the line would be so angry.
4.
For how long was that baby ill? Just imagine….
You are poor you don’t have money and start coughing. Will you go to the
hospital immediately? No …. You would hang on hoping the cough will get better
or even try home remedies because you do not have fees to pay for the hospital
or transport. So perhaps that baby has been sick for days. And the mother
contemplated for some days….. hours….. and minutes before she finally decided
to go to the clinic. And maybe the nurse advised the woman to take the child to
Oshakati hospital but the mother contemplated for hours and minutes again
before she finally decided to approach the neighbour to assist. So it is simple - you cannot improve health issue alone. We need
to consider poverty because it is strongly related to poor health.
Have you ever heard of the relationship
between equity and health care??? Let me quote Paul Farmer, a physician and anthropologist,
and a founded Partners in Health an organizations that has been helping
developing countries so that you can get an insight: “. Poor health outcomes are
associated with poverty and inequality. Relieving health inequalities depends
ultimately on addressing basic social ills. We can address the lack of basic
tools, from diagnostics to therapeutics; the lack of healthcare workers; and
the absence of community-based models of care in locations lacking
laboratories, doctors, or nurses. And we can also tackle broader obstacles to
well-being, such as no roads and cultural and linguistic barriers. In so doing,
we hope also to contribute to the basic goal of alleviating poverty.”
In simple terms we need to address health
care issues from a social point of view. Addressing health issues in isolation
will never help us reach our ultimate goal. But we have hope in Namibia ….
Thanks to the new administration that has created a new ministry addressing
poverty issues in Namibia. We are counting on the poverty ministry to make a
difference.
I have so many questions. I wish the MoHSS could do a case
assessment on that incidents to help us improve our health care system. And as
usual…. This are my own word and writing based on my understanding of public
health. Thank you!
