Time for a rant...

Against corrupt government health systems. Not all government health systems are corrupt, I’m sure that some work quite well, but here, working with the government health system provides absolutely endless frustrations, and I can only imagine how hard it is for the Myhre’s, actual doctors who have been working in this system for 15 years. And I’m not talking about annoyances, though those are also plentiful; I’m talking about “people-are-dying-because-we-have-no-drugs” level of frustrations. For instance, there continue to be no gloves in the government health system in the entire district. Those little latex gloves that are used for absolutely everything – drawing blood, inserting IVs, running labs – there are none of them in the district health system, and there haven’t been for about two months. Take a second to think about what that does to health care. Very understandably, lab staff and nurses refuse to draw blood without gloves (HIV is common, and Ebola is still fresh in people’s minds).The gloves we use at the health center come from the Myhre’s personal supply, and we give them to patients who need lab work done. Otherwise, the lab tells them that they need to buy them at a pharmacy, something that is prohibitively expensive for some, difficult for others, and just seems wrong to me. It’s like saying “here’s a government sponsored health center, but you can’t access almost any care without paying.”

Next, there are no ARVs either. ARVs (antiretrovirals) are the drugs that are used to treat AIDS patients and can be very effective, extending life expectancy for years and drastically increasing quality of life. Every Wednesday we have a clinic where we distribute ARVs to hundreds of people living with AIDS. The only problem is that, for weeks, there have been essentially no ARVs in the district – not at the health center, not at the hospital. The money for them got siphoned off somewhere along the line, and despite constant promises that the drugs are “on their way,” they seem to remain on their way without ever arriving.

Next we have health worker accountability. Since health workers are government employees they are assured their salary, and they receive it whether or not they actually do any of the work they are being paid for. So, naturally, they often don’t show up for work. Sometimes not a single person in the lab comes to work, so no one can get malaria smears, TB tests, hemoglobin counts, or HIV tests, all of which are quite important in deciding how to treat a patient. Sometimes not a single nurse shows up in the paediatric ward. And some people don’t show up for weeks on end. Weeks. But they continued to get paid. Someone at the health center was talking to Heidi about the problem of health workers missing shifts and ways that the issue could be addressed, to which Heidi replied that she didn’t know the answer, because in the hospitals she worked at in the States, they would simply lose their jobs. The response was muffled laughter, saying that that is impossible here. It’s a very different paradigm.

Of course, the issues are more complicated than just that. One reason that there are no gloves is that a large shipment was rejected by the Ministry of Health because they didn’t meet quality standards. Quality standards are good, and I’m sure it’s necessary for the health system to improve, but in the meantime there’s no backup plan and it leaves us with no gloves at all, not even ones of low quality, so patients can’t get the tests or procedures that they need. The health worker situation is also complex. It’s very possible for a co-worker or superior to report these absences to the district health office, who could presumably take action, but this essentially never happens. The reason, so far as I can tell, is that people are afraid that, if they report someone, that person will place a curse on their family. Witchcraft is a big deal here, and this fear prevents people from holding each other accountable or exposing corruption. And when I think about it, the logic makes perfect sense. If I felt that a very real curse could be placed on my family, would I report someone for missing work? How would that be worth it? And so the cycle continues.