Conversation Club May 8, 2009: HEALTH
Health problems in Senegal
The conversation opened by, “What comes to mind when you think of health in Senegal.” The conversation was quickly directed to the prominent diseases found in the country. Malaria is one of the biggest problems in Senegal and according to the participants, the one that kills the most people[1]. The high number of malaria cases was attributed to the poor living conditions and the lack of government policies regarding health and healthcare.
Furthermore, the environment is a major factor, since people throw their garbage in the streets and it collects in decomposing heaps. These heaps, as well as stagnant water creates a breeding ground for mosquitoes. As mentioned in our first conversation club about the environment, people take care of their own houses but not the outside.
Disease prevention and attention
The group talked about disease prevention techniques that are not adhered to in Senegal, such as not shaking peoples’ hands. Since, in Senegal, it is customary and polite to shake people’s hands, the thought of doctors advising to abstain from this practice seemed ludicrous. A Senegalese participant mentioned that when people cough or sneeze in public, they do not cover their mouth or nose, which rapidly spreads disease.
A Senegalese participant noted that there is a lack of education regarding paying attention to one’s health and going to the doctor or hospital if something is amiss. The general sentiment among the group is that people wait until too late to seek treatment. They suffer at home until the pain or condition becomes unbearable.
A participant from Sierra Leone mentioned that in Western countries people are encouraged to go to the doctor with their illness. An American participant countered that by stating that many Americans do not have health insurance and therefore are stuck waiting until their condition becomes dire before seeking medical assistance. She also noted that healthcare in Dakar is relatively comparable to healthcare in the United States in terms of care and quality. Other participants seemed skeptical.
Swine flu
There was much debate about whether swine flu could make it and flourish in Senegal. The Senegalese government called a meeting last week to address the flu, but nothing concrete has emerged. Some participants alluded that swine flu won’t survive in hot countries, however, the American participant pointed out that Mexico is a relatively hot country and it is thriving there.
The interior versus the capital
There are many more doctors and health centers in Dakar than in other parts of Senegal. The South of Senegal was indicted as a location that is in particular need of more health professionals and clinics. The government is addressing this issue by supporting a financial incentive which pays for doctors’ relocation and housing.
The group stated that Dakar has higher incidences of disease than the interior regions. The speculation made on the reasons behind the higher rates pointed to the pollution, garbage, overcrowded neighborhoods, and the conditions created by the rainy season. These conditions breed health related problems like malaria, malnutrition, and air or water born diseases like cholera and tuberculosis.
In the interior the group spoke about the major problems concerning health being maternal health, malaria, malnutrition, unwanted pregnancies, and the lack of health clinics. A participant from the Matam region said that there are only one or two doctors for the entire region and that people must walk many kilometers to visit a health clinic.
A participant chastised the ministers in the ministry of health for the widespread health problems. He said that many of the ministers in the health cabinet come from the interior of the country and recognize the problems, but do not do anything to ameliorate the situation.
The group felt that Dakar has enough health structures but that more emphasis should be placed on care and the kind of care provided. There aren’t enough beds in some hospitals and they lack many important materials. For example, Hospital Fass, outside of Dakar, was the biggest hospital in the area. Now it is described as one of the worst. The government is blamed for not developing the healthcare structures more. Additionally, healthcare is seen as very expensive in Dakar especially in private clinics. Health insurance isn’t popular and so people pay for their care out of pocket.
Traditional doctors
A participant from Sierra Leone brought up the importance of respecting traditional doctors who offer their services and medicine for a lower price than “modern” doctors. He insisted that traditional medicine is a good solution to people’s health problems, especially in Sierra Leone where health care is expensive.
In Senegal, traditional medicine is viewed as the antithesis of “modern” medicine. Senegalese participants made a distinction between drugs (pharmaceuticals) and plant-based medicine administered by traditional doctors. Drugs are seen as the first step in treatment in Dakar. However, if the don’t work then people seek out traditional medicine.
Traditional doctors come from families who have been in practice for many generations. These doctors are well known in their communities. Yoff, which is seen as a more traditional community, has traditional doctors who oversee “ndeups” which are ritual healing ceremonies whose details are kept relatively secret from the outside community.
A Senegalese participant spoke about his personal experience with traditional medicine after suffering from chronic stomach pain. He went to a “modern” doctor and purchased the prescribed drugs. After taking these drugs for several weeks without relief, he went to a traditional doctor. The traditional doctor told him to drink a concoction before every meal for several weeks. This worked for him and he has been without pain for six months.
Medicine
Several participants called “modern” doctors businessmen who are in cahoots with the pharmacies. They alluded to doctor’s prescribing a bunch of drugs, some of which were unneeded.
The underground world of prescription drug seems to be flourishing. There is a pharmacy in Dakar that sells prescription drugs for less, Keur Serigne Bi, which is very well known. The Senegalese participants said that the medicine is real and is just cheaper than in other pharmacies. A Senegalese participant stated that fake drugs sometimes make it into legitimate pharmacies. The American participant said that this happens in her country as well.
We touched on the people who sell “fake” and expired drugs on the streets but did not go further into the subject. A participant from Sierra Leone said that a few years ago Nigerians were selling “fake” drugs in Sierra Leone. These drugs had a sugar coating but and filled with chalk.
A Senegalese participant made the point that pharmaceuticals are made from plants and therefore without nature, the basis of traditional medicine, there wouldn’t be any drugs.
Wrapping Up
The group expressed how expensive healthcare can be in Dakar and that the government does not subsidize medication. Instead, in hospitals they ask people to pay for their treatment before being seen by the doctor. This would disadvantage people who can’t afford being treated and leaves them with few options.
There was a general consensus that something needs to be done to encourage people to have regular check-ups. The need for more health centers and hospitals is also very apparent and is a pressing need that was reiterated several times.
Everyone mentioned the need for blending traditional and “modern” doctors as a more holistic approach to medicine and healthcare. The fear is that some traditional doctors are charlatans and since there isn’t any regulation on what they can and cannot do, some cross these invisible lines.
More Information
http://allafrica.com/stories/200904280004.html
http://en.wikipedia.org/wiki/Health_care_in_Senegal
http://www.cafebabel.com/fre/article/25092/Healthcare-Senegal-Poverty-The-Third-World.html
In French
http://fr.wikipedia.org/wiki/Sant%C3%A9_au_S%C3%A9n%C3%A9gal
[1] Apparently, this is not true. Pneumonia kills more people in Senegal than malaria. http://www.nytimes.com/2009/05/10/opinion/10kristof.html?adxnnl=1&adxnnlx=1241957127-/JShU4Z3GsyR/i94xFMppg
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