Conversations with my work partner

Alassane, my work partner, is the ASC at the Case de Santé in my village. The services provided by the Case de Santé are as follows: health causeries, baby weighings with CARE group, prenatal visits, post natal visits, regular physical examinations, optimal nutrition cooking demonstrations, and house visits. Alassane and an elderly matrone care for a great many people, who come from many neighboring villages, attracted by the Case de Santé’s excellent reputation. He is a tireless worker, but both his time and access to medicine are limited severely. Alassane is paid as a function of the amount of medicine sold, in addition to the number of consultations and the number of injections made. But he does not have a fixed salary, and he struggles to make ends meet.

Each month, Alassane has about 40,000 CFA to replenish the Case de Santé’s stock of medicine. The order goes to the pharmacy in Sokone, a large nearby town, and the medicine is delivered to the Post de Santé in Karang. From there, the Post de Santé is responsible for distributing medicine to all the Cases de Santé under its supervision. Usually, though, the amount he pays exceeds the amount allocated by upwards of 10,000 CFA; further, he often gets fewer units of medicine than expected.

Recently, there has been an outbreak of chicken pox in the area. Chicken pox is very contagious in children under 14. It manifests as itchy sores on the body and fever. I never thought chicken pox was a big deal, but according to Alassane, it can be very dangerous for babies and infants. As I sit and talk with my colleague Ben, Alassane prepares yet another batch of skin cream: ¼ liter of oil, 4 hand soaps, 2 liters of boiled acacia leaf water. He tells me that it is very effective in soothing rashes and relieving itching. The other day, a young girl of about 8 came in with her mother. It doesn’t take Alassane long to realize that she has an advanced case of chickenpox. He wishes that her mother had brought her in earlier; he might have given her a shot to make her less contagious to other children. However, he later tells me that, thanks to ongoing education and sensitization, the villagers have started seeking out medical care at the onset of illness rather than waiting too long or opting for traditional care.

However, other sources of frustration are ever-present. For instance, he tells me that fathers are usually far less invested in their children’s care than mothers are. My own visits to divers health structures have certainly confirmed this trend; I’ve noticed that those seeking care are overwhelmingly female, with infants and toddlers in tow. This is always problematic, because men often have control over family funds here. Basic hygiene and sanitations practices are also largely absent, despite repeated efforts to educate the population. Most families do not use soap to wash their hands before eating, changing babies, using the bathroom, or cooking. Most simply rinse their hands in communal bowls.