Continental Drift

December 15, 2009

Theories of Relativity

Filed under: Uncategorized — unaleona @ 6:10 pm

Back in South Africa, I wrote about my trip to Mtubatuba and the clinics that I saw there.  The post was called Elbow Taps, and some of you pointed out that I neglected to explain what the title referenced.  This oversight was possibly due to my own original confusion about the term.  In several of the clinics we visited, when we asked about things that were needed in order for the nurses to do their jobs, they mentioned elbow taps. At first we presumed that they were referring to the rubber tapping device that doctors always use to check your reflexes.  Finally, a nurse motioned to a sink and pointed out that this sink had elbow taps, but that all the other consulting rooms did not.

Elbow taps: the ubiquitous tall handles on faucets in medical settings that enable you to turn off the tap with your elbows after you finish using it, allowing you to maintain the cleanliness of your hands post-washing.

All this explanation is to say that all the nurses and all the members of our scouting party were concerned that almost none of the sinks in the consulting rooms at any of the clinics had elbow taps.  The South African department of health had promised them, deeming them necessary to proper healthcare, but had not produced them.  Elbow taps went onto the list of USAID financed improvements, because it was considered a real problem that nurses wouldn’t be able to maintain sanitary conditions.

Of course, this seemed a bit problematic in light of the fact that some of the clinics didn’t have running water at all, while some had running water in certain rooms but not in all the consulting rooms.  In those clinics, we did not discuss elbow taps, we just discussed getting water to flow into the sinks with normal taps.  So are elbow taps necessary? Important?

There was the clinic we saw with the horrible bathroom situation.  My USAID colleague described what served as the bathroom as “Basically just a room with a hole in the ground.  We have got to do something about this, this is awful.” Of course, when the clinic construction crew put the finishing touches on the Sourakabougou clinic site, they showed us the completed nyegen.  We all oo’d and aah’d about how fancy and new it was.

The nice new nyegen:

However, it does distinctly resemble a hole in the ground, doesn’t it?

In the developing country context, good enough is never as shiny and sterile and new as it would be in your doctor’s office in Anytown, USA.  But in a situation where you are the provider of limited resources, how do you set standards to identify the bare necessities?

MHOP has been fighting hard for years to build this clinic, because people here in Sikoro-Sourakabougou told us that they did not have access to the existing clinic.  I believe that the farthest reaches of Sourakabougou are 5km from the Sikoro clinic.  5km between a rural village and a clinic would be considered close.  To a pregnant woman without access to a car, 5km is very far.  On an unpaved road consisting basically of rocks and dust, even in any vehicle, 5km is very far for someone in seriously poor health.  To ask someone to go to the clinic for preventative care, 5km seems like it would always be too far.  While investigating what was happening to our governmental request for clinic funding, we discovered that when our file was languishing in the city health department, someone took the time to write, “Why don’t we just build a good road from Sourakabougou to the Sikoro clinic instead?” (before they threw the folder to the bottom of the pile and forgot about it).   The members of our Community Health Action Group thought that a clinic was necessary, which is how we got started in the first place, and we certainly aren’t going to change course now.  But what if they had originally proposed a road? Would paving a road be good enough? Or is a clinic a bare necessity?

Who gave us the right to decide such things? Simply the access we have to American donors who can provide us with the funds for us to provide the necessities.  But what is basic in America isn’t required in South Africa, and the minimum in the South African context isn’t so bad at all in the Malian. If we’re supposed to be discussing the lowest possible common denominator for health, don’t we need to get rid of all our theories of relativity?


1 Comment »

  1. Plesepost a phot of you in your bazin.

    Comment by Paul — December 16, 2009 @ 3:53 pm | Reply

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