The importance of prevention...

From: http://blogs.bmj.com/bmj/2010/10/26/sandra-lako-on-the-importance-of-prevention/

A few weeks ago a child came to the hospital with classic signs of tetanus: a locked jaw, rigidity of the muscles, and jerking of the body. The diagnosis was obvious. The doctors and nurses tried to cure the child, but in reality they had little to offer. The children’s hospital is not set up to manage these cases effectively. And so, a few days after admission, the child passed away and a preventable disease took the life of yet another child. Unfortunately the child was not immunised. This time it was tetanus next time it might be malaria.

Preventable diseases still make up a large portion of morbidity and mortality in Sierra Leone. Diseases like malaria, diarrheal disease, and malnutrition are rampant. Even tetanus is not uncommon. Although these diseases can be prevented, each one of them still takes an unnecessary toll on the children of Sierra Leone.

To win this battle a two-fold approach is needed. Curative services must be improved including adequate access to care, proper diagnosis, and appropriate treatment. Secondly, but arguably more importantly, preventive measures must be intensified.

Since the launch of Free Health Care in April, the number of patients seen at the hospital has increased. There are currently 8 medical officers and 2 house officers dealing with 1000 admissions a month plus outpatients. Add to this the inadequate diagnostic facilities, other staff constraints and a limited assortment of drugs and the challenge is obvious. Unfortunately cases that are easily treated in the developed world are difficult to deal with under such circumstances. However, progress is being made; a lab development project is underway, the radiology department is improving and there are significant steps being made in the area of staff training. All of these advances will aid in improving curative care. This is of course essential, since everyone wants sick children to be healthy again. However, although both approaches are crucial, prevention will have the greatest impact on lessening the burden of disease. Decreasing mortality is good, but reducing morbidity altogether is the key. Less illness means fewer hospital admissions, which in turn means that patients who are admitted can receive better care. And of course, less sick children should mean fewer children die. How can morbidity be reduced? The answer is clear: prevention.

Prevention is an integral part of public health in which health is seen as a basic right and should be maintained. Time and money spent keeping people healthy will have a huge impact on families, communities, and ultimately the country. The question is how to roll out prevention programs effectively in a developing country?

Examples of preventive measures include: hand washing, sleeping under mosquito nets, clean water for drinking, receiving immunisations, use of oral rehydration solution, use of latrines, ensuring good nutrition. It seems simple: make sure health messages reach the public and ensure that programs are delivered. However, implementation is where part of the problem lies. Simple measures can be difficult in a country like Sierra Leone where resources are limited. How does one promote hand washing, when water is not available? How can one expect a mother to walk for one hour to the nearest health post for immunisations when she has three other children to look after? These are the types of obstacles that stand in the way of effective programs. And, like anywhere else in the world, the biggest challenge is bringing about behavioral change. People need to be convinced that these measures will benefit them or they will not buy into them. In a society where traditional/religious beliefs are intertwined in daily life, behavioral change does not come quickly. This calls for perseverance from those delivering preventive programs.

Personally, I’m hoping that at the Ola During Children’s Hospital we will be able to focus more on prevention as well as continue to improve curative services. It would be great if the caretakers can be educated and in turn teach in their communities. One way in which this can be done is by showing health education videos in Krio as well as group sessions and one-on-one talks. Hopefully by taking the health messages onboard and implementing preventive measures in their homes, they will see that they can play a role in keeping their children healthy and happy. Hopefully an attempt will be made at all levels (ministry of health, hospitals, primary healthcare units, schools, religious places, etc.) to deliver high-quality, deliverable, and sustainable preventive programs. Sierra Leone, let’s make prevention a part of daily life.

Sandra Lako is a doctor from the Netherlands who previously spent four and a half years in Sierra Leone setting up and managing a pediatric outpatient clinic with an organisation called Mercy Ships. After a year at home, she returned to Sierra Leone to volunteer as medical coordinator with the Welbodi Partnership, a UK based charity supporting the only government-run children’s hospital in a country where 1 in 5 children do not reach the age of five.