Health Care in Rural Senegal

Abstract

Slowly modern medicine is making its way into Taiba MDayene a farming village deep in the Senegalese bush. THe village is involved with 400 other villages in the region of Sine Saloum in a major experiment in public health financed and administered in part by the US Agency for International Development (USAID). The program objective modest by US standards but potentially revolutionary in rural Senegal is to make the most rudimentary most basic type of health care available to the Senegalese population who live in villages like Taiba MDayene. Specifically the program works to establish a Case de Sante (health hut) in each village staffed by a Village Health Worker (VHW). In effect a first aid worker the VHW administers a few simple drugs for malaria intestinal worms and ophthalmia; disinfects and dresses simple wounds; and refers patients with more serious health problems to a district health center where possibly more sophisticated treatment will be available. The VHW also helps educate other villagers in elementary preventive medicine i.e. sanitation immunization and isolation of infectious diseases. Rural Senegal is fairly typical of the rural regions in most 3rd world countries and few Americans have a clear concept of how they live there. The nutritional deficiencies evident in Senegal amplify the impact of such endemic diseases as malaria tuberculosis measles and various gastrointestinal infections. Gastrointestinal infections and malaria are also most prevalent during the "hard times" of the rainy season. To cope with its daunting health problems Senegal has some 420 doctors. More than 70% of the doctors are concentrated in Dakar and adjacent towns. Hospital facilities are somewhat better distributed. The appalling health care picture reflects Senegals poverty. In Senegal public health programs are viewed as essential. But getting primary health care to rural Senegal is not in the picture for the foreseeable future for neither the money nor the personnel is or will be available. The USAID program got underway in 1977 when village health committees were asked to select village residents for training. Initially the program seemed to be working but within a year or so it was in trouble due to extraordinarily high (up to 80%) attrition among the VHWs. The program was reorganized and the village committees were urged to pick only people rooted in the community to replace the missing VHWs. The new VHWs almost invariably stayed put. Their basic responsibility is to be available in case of sickness or injury. In the quantitative sense the program is really working. THe VHWs are seeking patients. There seems little question that drugs particularly chloroquine are actually being given out although whether they are being dispensed or taken in adequate quantitites is more problematic. Future reductions in infant and adult mortality can result from elementary health education. Further progress will come through improvement in the nutritional status of the rural population. A family planning program has been identified as essential.