Health Education Illustrations

The artists have completed 3 of the 6 sets of health education illustrations. It has been a lot of fun working with them as it has provided for an excellent opportunity to teach them about disease etiology, disease transmission, preventative techniques, and different therapies available. I sit down with the artists and review the pertinent information for each health topic and then we brainstorm different ways in which we can convey the important information using illustrations. I try to provide the artists with as much creative freedom as possible. I have been very impressed with their work and am pleased with how the project has worked out. Here are a few example of the illustrations they created for the malaria prevention flip chart.

And here are a couple from the HIV/AIDS series:

Time really passes fast here. It is hard to believe that I only have 4 weeks left! I feel lucky that I have had the opportunity to do both clinical and public health work as this work has kept me very busy and has provided for some very different experiences. Things have been extremely busy and I just took a long overdue day off yesterday. I spent most of the day in Lambarene, walking around the market and just watching (African) life go by. I think it was just what I needed.

There have been some bumps in the road regarding the health education training program. Last week, the director / moderator of the training decided that she would no longer participate. The real unfortunate thing is that she didn’t tell me until the night before she was to give the presentation on family planning. I ended up working through the night and put together the presentation myself and then gave the presentation. I broke the talk up into two 50 min long presentations and I learned that it is exhausting to speak in French for 2 hours straight. For some reason I had difficulty pronouncing one of the technical words in French. I tried about 5-6 times to get the correct pronunciation much to the amusement of the group. When I finally got it right, I got a standing ovation. It really made me smile.

In the end I think everything went well and we have had some excellent discussions. So far we have covered malnutrition and family planning. I think the highlight of the training sessions are the case studies/ role playing exercises. The nurses and midwives that I am working with are quite talented. They are so incredibly animated and I have been impressed with their creativity.

There is some concern in my eyes about the sustainability of this program now that our leader has stepped down. I am in the process of talking to an epidemiologist that works with the Ministry of Health in Lambarene. She has expressed interest in helping out with the training so I am hopeful that she can replace our previous moderator. In addition, I am working with "Mamma SIDA" a local woman who organizes community health education session on HIV prevention. She has a strong presence, is knowledgeable and has a booming voice. She is scheduled to present the HIV talk next Monday and I am hopeful that she will continue to assist with future health sessions.

Ultimately the goal is to have someone continue to lead these health education sessions on a monthly basis. We can eventually expand the training to include the nursing assistants that work in the rural health posts throughout the region.

In other news, the health illustrations that the artists have created are incredible. I am extremely pleased with their work. The two artists that I am working with are very motivated and talented. The illustrations really capture the important points concerning the selected health topics. We are hoping to have the illustrations for 4 of the 6 subjects completed by the end of next week.

We will be able to use the Malaria education illustrations for this week's presentation. I will eventually scan all of the images onto my computer before my departure on March 14th. I then plan to have the illustrations enlarged and printed in a flip chart format. After looking into prices here in Gabon, I think it will be less expensive to do the printing in the US. Future Schweitzer Fellows and other staff can hand deliver the charts once they are completed.

The pediatric work continues to be a highlight of my time here. I really look forward to the trips out to the villages. Not only is the clinical work exciting and challenging but traveling out to the villages provides for a rich cultural experience. Recently there seems to be an increase in malaria cases. After speaking with the malaria research center here I think that can mainly be attributed to the seasonal rains. It really can be challenging working in
the rural villages without any lab/ diagnostic tests to support a diagnosis. On one hand, it is challenging to make the diagnoses without the myriad of tests that we have at our finger tips back at home but on the other I truly feel that my clinical skills have been tested and as a result have improved significantly. You really only have the patient history, a stethoscope, otoscope / opthalmoscope and your brain to rely on. I have medical reference books that have also provided some useful information.

Over the past few weeks, some of the cases I have seen include malaria, upper and lower respiratory infections, shingles, buruli ulcers, gastrointestinal infections, fungal skin infections, malnutrition, dehydration and conjunctivitis. Some of the children are very sick when they arrive at the health clinics. The health team can help transport the very sick to the hospital with their truck and over the past 2 weeks we have brought back 5 children (2 with cerebral malaria and the other 3 extremely dehydrated and malnourished/ failure to thrive).

Thanks again for following the blog. I will continue to post photos as often as possible.

Here are a few more random photos I thought I would share......a cobra, killed about 20 yards from my house.

Dinner out on the town:

Additional Photos

Here are some more photos from my time here. I will continue to do my best to provide updates. Thank you for taking the time to follow my work here.


Just joking around:










Community Health Team:
Marie Benoite, Mamma Sophie, and
Hortance











Vaccinations:

Overlooking Zile:

Rainy day:

Pet monkey:

Mamma Sophie at Albert Schweitzer Hospital:

Peds consultations:

X-ray of pediatric patient with miliary tuberculosis:

ER equipment










With Veronique during rainstorm:

In the OR at the Albert Schweitzer Hospital:

Hospital in Fougamou:

Community Health Visits:

The following is a list of some of the villages the community health team visited over the past couple weeks:

1/15: Massika , 1/16: Oulianga , 1/21: Issinga and Nambakele , 1/22: Paris- Bifoun , 1/23: Noumbakele , 1/28: Oyenano , 1/29: Fougamou .

I have enjoyed this aspect of my experience here in Gabon. It is during these days that I gain experience in clinical pediatrics. On a typical day do approximately 10-15 pediatric consultations and will assist with the vaccination of approximately 40-60 children. For the consultations, I have two pediatricians at the Albert Schweitzer Hospital and a nurse practitioner with whom I can consult for complicated cases. A majority of the cases have been respiratory infections, gastro-intestinal infections, malaria, skin rashes and abscesses. As I mentioned previously, we have a limited supply of medication with which to treat but most of the antibiotics we do have access to have a broad spectrum of therapy.

It is saddening and frustrating at times to witness the poor healthcare infrastructure here. These people basically have limited access to medical care. The only time they can be seen by trained professionals is when the community health team visits. The remainder of the month the only option would be to go to the hospital (which transportation itself makes it cost-prohibitive) or visit one of the traditional medicine men located in the village. The Schweitzer Hospital serves as a model for the country in serving remote villages. There is only so much they can do though. Our team visits approximately 15 of the 31 health posts located throughout the region. In theory the health posts are to be manned by nursing assistants but my experience is that these health professionals either leave their posts or do not work.

Marchella, the girlfriend of the German physician working at the hospital, joined the health team on one of our visits a couple weeks ago. She was working for the hospital taking photos to be used on their new website (still under construction) and she was nice enough to share some of her photos with me.

Public Health Work

It is hard to believe that a month and a half has already passed. My experience thus far has truly been rewarding. I am thoroughly enjoying both the clinical and public health work. I have run into a few challenges along the way but most are related to logistical problems (nothing a little persistence can’t fix). One of my Schweitzer mentors sent me the following quote:

"Anyone who proposes to do good must not expect people to roll stones out of his way, but must accept his lot calmly if they even roll a few more upon it. A strength which becomes clearer and stronger through its experience of such obstacles is the only strength that can conquer them." ~Albert Schweitzer

It has been challenging to attempt to create this extensive health education program but I appreciate the process of planning and implementing this project. I have met some extremely motivated individuals with altruistic commitments. In addition I have learned a tremendous amount about how the Albert Schweitzer Hospital and the General Hospital in Lambarene are run and have come to understand some of the needs of the community.

One of the greatest challenges that I face though is the brevity of my stay and the possibility of implementing such a large project in this timeframe. It would be naïve to think that I could fully understand the intricacies of the health system and the numerous barriers that exist to implementing different programs. I do have the advantage of accessing a needs assessment that has been conducted at the hospital prior to my arrival. This assessment had identified health education as one of the major areas that needed improvement, hence the development of this training program.

I have proposed the idea of implementing a health education program to the administration at the Schweitzer Hospital, General Hospital and Ministry of Health and all are in complete support of our program. We will begin by conducting a training of trainers. We have identified health care workers at the two hospitals and will begin health education teaching sessions next week. Our goal is to address 6 health related topics (malaria, tuberculosis, malnutrition, buruli ulcers, HIV/AIDS and family planning) and provide the staff with basic information on the etiology and epidemiology of these illnesses, propose preventative measures, and treatment options. Those trained will in turn be able to hold teaching sessions for other health staff and patients in their respective services.

We are in the process of developing questionnaires which will be used to assess the quality and content of our health education sessions. As part of this program, I am also working with 2 local artists in developing illustrations that will be used in the patient education sessions. I have secured funding for the artist’s work and am currently looking into options for printing the illustrations in a flip-chart format. The long term goal is to provide a training conference for all health care workers in the region. Each health post located within the region will then be provided with a copy of the health illustration flip charts to be used in the teaching sessions.

We are planning on beginning the training on Monday February 9th. Teaching sessions will be held every Monday and Friday afternoon for the following 4 weeks. Teaching sessions will be conducted by hospital staff and public health professionals working in Gabon.