BEYOND THE TICK BOX

Senegal is a Western African country, home to 12 million people.  It also happens to be where a good friend and doctor from university now lives and works. I was lucky enough to visit this friend in 2009 and help her with running medical clinics in the local area in and around her adopted hometown of Ziguinchor, in the south eastern region of Senegal, Casamance.  My journey started with a long flight from London to Banjul, where I met my friend and then onwards to Ziguinchor in a ‘luxurious’ battered old van. The roads were precarious; unfinished surfaces and massive potholes made for a very bumpy, dusty ride! After several hours of exhausting travelling, we finally arrived at our destination. Before settling into our accommodation, we called at the town hall to meet the councillor for a passport check before we were granted permission to stay in the town for two weeks.

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On the first day, I attended the Ziguinchor medical clinic, which was run by a medical officer who trained as a nurse and now manages the clinic. It was here that my friend and another British doctor assisted in clinics alongside the resident medical officer. The medical centre consisted of two consulting rooms, a medicine dispensing room where the clinic’s pharmacist was based, a sparsely equipped treatment room and a few rooms for inpatients.

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Medication supplies were limited and there had been no formal medical records in the past; however the volunteers working in the clinic had begun to introduce the use of note-keeping in addition to providing teaching for the permanent medical and nursing staff. Patients were seen on a first come first served basis, and each day the waiting room was full, with no room to maintain any privacy.  It was an interesting insight into the working of a Senegalese medical centre.

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Next, I travelled to Guinea Bissau, a small country to the south of Senegal and one of the poorest in Africa, to set up a temporary outreach clinic.  Our party included four medics and two members of staff from the local clinic, who acted as our translators.  We had a few packed boxes of medicines and our own small bag of supplies. On our journey there, we had to make several stops to present our passports to both border police and guards and accumulated numerous passport stamps throughout our road trip. There was one particularly daunting crossing when the border-guards demanded some of our medicines, but thankfully it was settled amicably and we crossed the border with all our supplies in tow.

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Our base was in a community not far from the border, which consisted of a collection of houses along the main road, a school and a newly built hall.  We set up our clinic in this hall, dividing the room into two consulting areas with sheets tied from the walls to provide some privacy. Word had spread that we were providing a clinic for a few days so a queue formed early in the morning. Many families had travelled long distances on foot, and queued patiently for several hours to be seen, and more people came over the next two days. The nearest hospital was many miles away, so people wanted to take this rare opportunity to have a medical check-up.

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The patients presented with a wide variety of pathologies. Skin conditions were a common problem in both adults and children, although these were difficult to diagnose. There were many children with fevers. There was a baby who was particularly unwell, who presented with a history of vomiting and was dehydrated. Unfortunately we only had one cannula; we tried to obtain venous access to give intravenous fluids but were unsuccessful. We offered to drive the family to the nearest hospital, but they declined, choosing to travel there themselves. We later heard that they had made it to the regional hospital; and the baby was recovering well. I also observed the consequences of some of the indigenous beliefs practiced, most noticeable, was the disfiguring scars on some of the children’s faces. These were the result of acts performed in infancy and believed to ward off evil spirits.

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It was a tiring but extraordinary few days. Despite sleeping in a cashew nut store room with one mosquito net covering three of us, we slept well, even with the trepidation of using the eco-friendly insect-infested toilet! The local children were very friendly and at the end of the day they would be waiting to play. The community school was not open during our visit because of lack of funding for a teacher. After three days, we headed back to Senegal, negotiating many passport check points along the way, and persuading the border-guards that they really did not need antibiotics!

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After a rest day in Ziguinchor, we made our way to a small island off the coast of Senegal for one more remote clinic. It began with a car ride along unsurfaced bumpy roads, four of us squashed in the back and three up front with all our supplies, followed by a drive through the wet rice fields. Ending with an amazing scenic trip down the river in a wooden canoe, we stopped along the river to buy fresh fish from local fishermen.

On the remote island was a hamlet of mud huts and a few donated solar powered street lights! The clinic was set up in the school hall and the queue was once again vast. The children appeared in better health than some of the children we had seen previously. Many of the adults presented with chronic musculoskeletal pain and eye conditions, which severely impaired their sight. The clinic took most of the day, but we were warmly welcomed by the community who showed their appreciation by preparing a communal dish of rice and fish for our lunch. The trip back to the mainland on the canoe was unforgettable, as the sun was setting.

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Before we left Ziguinchor we were invited to visit a drop-in centre for the street boys. The centre was a sanctuary for the orphan boys to go for a free meal, to rest, have school lessons and to enjoy playing football. These boys each have a bowl that they use for begging. These are their most important possessions. The centre houses a room full of shelves specifically designated to keep these bowls safe whilst the boys are visiting. Their livelihoods and survival are dependent on those bowls.

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Soon, it was time to say our goodbyes to those at the medical centre who had allowed us to assist in the clinics and be a part of their community for this short time and for giving me the opportunity to visit Senegal, especially the bustling markets in Ziguinchor and the charming white sandy beaches on the west coast at Cap Skiring.

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This was an extraordinary experience and I feel privileged to have worked and travelled in Senegal and Guinea Bissau

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