Dear Neil,
Here is one concrete example from my recent mission.
Best regards,
Sanja
During my recent deployment in South Sudan we had one young male patient who was referred to our clinic due to minor gun shout wound. He was coming from very remote village, where access is difficult, with only poorly functional PHC that is facing severe shortages in skilled staff, medicines and basic diagnostic tools.
Several days after admission he had one episode of tonic-clonic seizures. He didn’t not mention on arrival any previous medical condition. After talking to his caretaker and with patient itself about this event he said that he had similar episodes over last years. They just accepted it, minimizing the importance of need for treatment. Partially to avoid stigma, but also as the healthcare facility in his village can offer very limited support.
This is just one of the examples and there are many similar in the country remains complex and volatile context from humanitarian prospectives. South Sudan’s fragile public health system is almost entirely dependent on humanitarians/donors. Due to the protracted conflict, the health system is characterized by widespread damage to health structures, closure of many health facilities, low levels of qualified staff, lack of remuneration for health staff and lack of medical materials and drugs. Access to quality health care remains difficult due to insecurity and logistical challenges as communities live isolated, often impossible to reach by road and airlift is the only possibility. With poorly functional primary health care facilities across the country, delay in treatment and secondary health care hardly available. This dire situation is reflecting high levels of avoidable morbidity and mortality from communicable and non communicable conditions. In parallel, ahumanitarian assistance and development funding continue to shrink for South Sudan, due to global crises and increase of overall growing humanitarian needs.
Going back to this patient that was started on treatment but the main concerns were around follow up and access to medications. We involved the caretaker in explaining what is epilepsy, the importance of treatment and how to link with local facility for follow up. The other possibilities was to use of phone for follow up, though in that area phone coverage is limited too.
Indeed, patient follow-up can be particularly challenging in humanitarian situations, due to access constraints, lack of functional strucutres, language barriers and sometimes cultural belives, health unliterarcy and overall adherence to treatment. Soultion that might seems obvious and easy to apply in most of the context here might not be applicable.
HIFA profile: Sanja Janjanin is an Anaesthetist with the ICRC, Italy. Professional interests: Patient safety and anaesthesia in LMIC, Global & Environmental health, Conflict & Health. smizlica AT yahoo.com