Africa vs the NHS

Yesterday Karen took me to see her clinic. It is located just over the road from her compound. It has taken me a while to get used to the idea of Karen living in a compound. The term sounds so isolationist and sectarian, as though the missionaries are segregated from the rest of Gambia and living in their own little Mini-Europe. Actually, everybody lives in a compound here. A compound is a family group of houses, maybe an animal shed, a yard, farming/gardening area in the style of “The Good Life” although far harder. They are all fenced off from one another in a variety of ways: sheets of corrugated iron, fence posts, wire fencing, anything to keep the livestock in at night and the wilder animals out. Crime is rarely an issue fortunately. Karen's compound is shared with another missionary family who are currently away. We are having to feed their cat who is my Sleep Nemesis as it wakes me up every morning climbing up the mosquito netting outside my window shouting to be fed. It is only a couple of months old, very sweet but also demanding of attention in the way that small children usually are.

Back to the clinic. The clinic consists of three areas, one where there is an AIDS/HIV clinic; a drop in centre and a general hospital. The drop in centre is open three mornings a week and has differing specialities of each day. On Monday there is a general adult clinic; on Tuesdays pre-natal and Wednesdays is Infant Welfare. There is a large number of patients, some come from miles around either walking, taking a bus, donkey cart. In fact, any way they can. The team of in-house trained nurses assess the patients, dispense medicine if needed and pass on all cases they are unsure of to the Doctor on duty. All women are offered an AIDS test when pregnant and then passed on to the appropriate clinic if the results demand it. Interestingly I think many of us assume that AIDS is passed around by promiscuity. I was interested to hear that in Gambia it is a problem because of the number of wives a man may have, multiplied by the divorce and remarriage rate. So, if you have three wives, divorce one, she marries someone else, he already has two other wives and then divorces one of them who then marries another man, etc. Can you see how it spreads without any infidelity at all?

The facilities at the hospital are basic but adequate. Drugs are available, and not stolen unlike some other hospitals, sterilisation equipment is used, the ward has been redecorated to be more cheerful. There are two isolation rooms as well if needed. The delivery suite would make most western women run in terror but is still far better than the alternatives. At least Karen's midwives don't beat the women in labour if they make a noise contrary to the local custom. Records are well kept for future treatment. So all in all, basic, efficient*, and a place where the patients are cared for.

*Karen has just added that efficient is a very good adjective: the hospital spends about £2 per patient/consultation. The entire hospital costs about £70 000 per year to treat 35 000 patients.

So, next time I feel inclined to complain about the NHS, I will be very grateful indeed. Karen's clinic is good by African standards, and the staff very caring, but would still be happier to be ill back home.

This is the maternity delivery room. The hospital has just been rearranged to give women more privacy.

The operating theatre. There are only a few surgeries carried out here every year, there used to be more. As Karen says, "Basic, but most of what I would need is here."

The waiting room. There are scales on the right to weigh patients before the they see the nurses; the consulting rooms and dispensary are behind in this picture. Can you see the scarves tied around the women on this side of the wall? They are carrying their babies.

Karen's new office. The AIDS/HIV block, the Care Centre, is new and well equipped with computerised records, well stocked with drugs and trying very hard with counselling to change patterns of behaviour and beliefs to ones that are more helpful.

Karen said that I had to show you this. It's her new incinerator and only finished at the weekend to a design she found online. Finally the hospital has a safe way to dispose of clinical waste instead of the open fires or pits that they had previously. She was very pleased to see the finished result.