Public Health Project

After meeting with hospital and public health officials in Lambarene, I now have the support to begin a health education program. The ultimate goal is to provide comprehensive health education/ disease prevention for patients in the Lambarene region (Middle Ooguee Region). This will be done by training nurses and community health care workers posted in their designated villages. In addition, we intend to use local artists to create health education materials such as poster animations.

The first step in this process is identifying key members of the health care community who are going to be the major players in the implementation of this project. It is extremely important that these individuals have ownership of the program as my time here is limited to 3 months. I am also in the process of developing a survey/ questionnaire which will be used to assess the level of knowledge of the nursing staff at the hospital. This will aid us in addressing appropriate health education topics and will also serve as an evaluation tool when the training is complete. Once the nurses have been trained, they will be responsible for conducting health education sessions with their patients.

Weekend boat trip up the Ooguee River

We spent last Saturday on a boat ride up the Ooguee rive. We traveled for approximately 3 hours up the river. It was a beautiful ride winding through the jungle. We were searching for hippos or any signs of wildlife along the river bank but had no such luck. Our guide, Ya-ya , informed us that the river level was still too high to spot any hippos. Maybe in another month or two. One of the islands we stopped at had a monastery. Here are some photos from the trip:

Surgery/ Internal Medicine Service

I have included some photos of my time here and wanted to provide a warning before you proceed: Some of the photos may be quite graphic.

In addition to the public health and community health clinic work, I spent a few days working in the surgery and internal medicine wards. The chest x-rays shown are actually a success story. The patient was a 35 year old female diagnosed with tuberculosis. The x-ray on the L is the one taken on her first visit approximately 6 months ago. Notice the L side of her chest (your R) is completely white. This infection has spread throughout her L lung field. The patient initially presented with the typical symptoms…weight loss, anorexia, fever, and night sweats. The patient was placed on multi-drug therapy for 6 months. Upon return to the clinic for her 6 month check-up the patient had the x-ray on the R taken. The infection had completely resolved and the patient had a healthy recovery.

Working on the surgery ward was one of the most eye opening experiences I have had in medicine. The patients were of various ages but almost all had severely debilitating diseases. What was most unsettling was the fact that many of the patients had come to the hospital long after their disease process began. One of the most impressive diseases commonly found in tropical hospitals is the buruli ulcer. Buruli ulcers are chronic necrotizing skin infections caused by the bacteria Mycobacterium ulcerans. The ulcers usually begin as painless nodules that can sometimes itch. Some spontaneously resolve but many times the ulcers will grow in size and begin to spread rapidly. They can become quite large and disfiguring. The best way to treat these ulcers is by early detection and surgical excision of the ulcer. Without treatment or with a late diagnosis the lesion may slowly heal after a few years.

Community Health Visits to Chad and Belle Vue

I had an opportunity to join the community health group twice last week. On Wednesday we went to Chad, a village approximately 40 km away from Lambarene, along the road to Libreville. The ride out was beautiful as they are cut right out of the jungle. The roads in Gabon are fairly well maintained and are some of the safest I have traveled on in Africa.

As we pulled into the village, Mamma Sophie began her ritual yelling out the window of the pick-up. I have to wonder if there is an easier way to inform the people that the health team has arrived but this system seems to work, plus it has provided for some amusing moments. Mamma Sophie will call out to any mother she sees with an infant and insist that the mother bring her child to the health clinic for vaccinations. The two usually have a friendly shouting match; defending their own position and going back and forth, as we slowly drive by.

Chad is a relatively large village and we had roughly 50 children show up, of which approximately 15 were sick visits. I assisted with the meticulous vaccination process. As we immunize the children, records are kept of all new children seen and of all updated vaccinations. Well child checks are simultaneously conducted, which include weighing the children (which has to be one of my favorite photo opportunities), plotting their weight on growth charts, and conducting brief physicals on every child. Added on top of this patient load are the 15 other pediatric consultations making for a busy day.

There have been a relatively wide variety of cases that I have seen in the community health visits. A majority of the cases are similar to pediatric outpatient clinics in the US…upper respiratory and lower respiratory infections, gastrointestinal problems, skin rashes, etc. Out of the remaining cases, we get a relatively high number of malnourished children, and then a mix of tropical and sometimes bizarre cases…malaria, buruli ulcers, and a woman presenting with a fishhook in her finger(which she somehow managed to endure for 5 days).

On Thursday we traveled by boat to Belle Vue, a small village of approximately 200 people. The village reminded me of villages I encountered as a Peace Corps volunteer. It was remote in location, about 30 miles down the Ooguee River. The village has no electricity, no running water and the people support themselves by fishing and farming. There is something completely calming about working and living in this type of village. While the landscape differed from the village where I lived in Mauritania, it still had a similar ambiance. Just walking around the village and talking to the people gave me a sense of the strong community ties and family bonds that exist in such a tight knit community. The air smells of firewood cooking today’s lunch and sandy paths bisect the thick jungle, connecting one family compound to another. It was a wonderful experience to work here and I am enjoying getting to know the different members of the community health team.

Weekend Activities

Arts and Crafts day, designing masks that will be displayed throughout the hospital:

Meeting the neighbor's pet chimp:

At the entrance to the hospital:

Public Health Project

I spent most of last week orienting myself to the daily operations of the pediatric ward and the hospital in general. As mentioned in a previous posting I also spent some time with the community health group doing pediatric consultations. After observing patient care and working with the hospital staff for approximately 1 and 1/2 weeks there appears to be an opportunity to improve the health education/ disease prevention conducted at the hospital.

Schweitzer pediatric ward:

Currently, the community health clinic is the sole source of health education on the hospital's campus. The visual aides they use are a bit outdated and weathered to say the least. On Friday I met with the regional public health director (Dr. Diallo) at Lambarene's General Hospital. Dr. Diallo appears to be an extremely motivated individual and identified disease prevention education as the region's primary health care concern. Subsequent to our meeting I met with a young artist who lives on the Albert Schweitzer Hospital campus and spoke with him about possible collaboration in creating health animations. I intend to meet with the hospital director this week to discuss the possibility of developing a health education program.

Lambarene General Hospital:

New Year Celebration

W/ Caroline (a French Pharmacy PhD student):

Aude (a French Pediatric Nursing Student) w/ Henry (Hospital technician):

Natalie (a French Pharmacist), Caroline and Aude:

Paul (a Pediatrician from Germany) and his girlfriend Marchella (a Graphic Designer taking photos of the hospital during her month vacation here):