In December 2006, Dana Shepherd, ARNP, CPNP spent a month in in western Africa. There, she joined two of our nurses, Lin Grey RN and Connie Kline RN, who attended a special school in Senegal to learn advanced medical skills for missionaries. Dana tells, in pictures and words, about her moving experience in this hurting nation:
While I was in Senegal, I provided pediatric consultations at a clinic and hospital in Thies, about one hour east of Dakar, and taught at the University of the Nations, an innovate missonary-focused school designed to teach advanced primary health care skills to African and international students without significant medical backgrounds. The goal of the school is to enable these students to effectively and efficiently fill a desperate need for primary health care in Africa, where the ratio of people in need to physicians is often no better than 200,000 to 1.
In the Barthimee Clinic and Hospital in Thies, a hospital bed frame and stray clothing sit on the unfinished 3rd floor. The building is four stories, of which only the first two are completed due to a lack of funds. It is a hospital by name, but functions mainly as an urgent care clinic and same-day surgery center, lacking enough staff to keep it open overnight.
The elevator is built but not functional, so in the height of malaria season when over 60 patients a day can be in need of intravenous fluids, be they large or small, the patients are physically carried up the steep flights of concrete stairs by family members or available staff. A nurse there told me that in the worst of it, patients would rest on this, as it was better than the floor.
Barthimee is an amazing place with dedicated individuals treating devastating illnesses with the best possible care that can be found there…always with tremendous compassion.
The following is a photo of an absolutely gorgeous mom and baby, taken at the clinic. Although impossible to tell from this photograph, this was one of the sickest children I cared for during my time in Africa.
Nine months old, this baby weighed only 4 kg (a bit over 8 pounds), suffering from typhoid, malaria, and chronic and severe malnutrition. Small though they are, my hands were able to completely encircle his upper chest, finger tips overlapping on his back, my thumbs touching over his heart. He belonged in an Intensive Care Unit. Aside from the fact that none was available, his mother could not afford even overnight observation for him at an outlying hospital. We gave him all the medications we had and sent him home with his mother with further medications and instructions.
By absolutely nothing other than the grace of God, she returned with him to the clinic several days later, and he was much, much improved. Hope is a fragile thing, but what an example of why we should have it. His mom was so kind to allow me to take this picture, and was very pleased to see it.
The prevalence of malnutrition is on the rise in Senegal, increasing the fastest in infants and toddlers, and affecting an estimated 20% of children under five in this country. The Senegalese government is working with many NGOs and relief organizations to establish programs to intervene and prevent the continued rise in these numbers.
It’s too overwhelming for me to think about the global scale of this issue…I found it more helpful to be in this village, even for a short time, and take the perspective of one child at a time, one village at a time. It helped to remove some of the feeling of helplessness and paralysis that can come along with looking at a problem of such enormous scale.
Countless on the streets of Senegal, boys, some as young as 4 years old, wander barefoot with plastic cups in their hands, dirty, clothes half missing or torn, begging for change in the darkest of places. They scurry alone across busy streets, small enough to be unseen below a driver’s dashboard, onto the next pitying glance and dismissive gesture.
They are orphans either by natural cause or by intentional circumstance, given by their parents to men who falsely call themselves imams, who promise parents money, schooling and safe boarding, but who put these children out on the streets to beg, only to take their earnings at the end of the day. They are truly the least of these and I never saw a smile from any of them.
There was tremendous noise and chaos all around this boy when I took his picture. Cars and motorcycles honking, engines gunning, street musicians playing, people yelling and pouring out of stores into busy streets as the siesta time began. He sat totally still, right in the thick of things but completely apart from it, empty bucket at his side, looking for all the world like he was fully somewhere else in his mind’s eye.
I have been asked several times, with a just glint of misgiving and disapproval, how I felt “comfortable” taking photographs of children like this. My answer is the same: I was not comfortable with anything about this situation, but the greatest exploitation of these children is a world of educated people ignorant of their plight, unaware of their existence. That’s why I took this picture.
I was kneeling in dirt and trash, taking random shots of kids playing outside the mobile health clinic we had set up. They were all having a blast, smiling and running around together. Then I saw this little girl leaning against her brother waiting to get checked in. She was fully surrounded by laughing children, but so lost and apart in her sickness. I remember feeling overwhelmed on this day, before I saw her: too many kids, not enough of us, not enough medicine, not enough time. Overwhelmed with walking the fine line of bringing help without breeding dependence, treating illness without changing the community flora in such a way that the parasitic infections would only return later with a vengeance. What was I doing here? Barely a drop in the ocean of repair that’s needed for the impoverishment that rages over this continent. Why only scratch the surface when it’s a mess too deep to ever see the bottom? Whe reminded me why — for one little life at a time. So very worth it. I took her picture to remember.
******* See Dana’s other gripping photos and stories from Senegal on http://www.flickr.com