Chasing the devil out of health care

Despite our community health project, children in the villages are still dying at home without ever having had a medical consultation.

MAGARIA, NIGER

Despite our community health project, children in the villages are still dying at home without ever having had a medical consultation.

My final two weeks in Niger were filled with some of the most exceptional times of my life as we actively searched out why this is happening and how it can be stopped.

After using a number of fairly ineffective tactics to try and better understand this phenomena, we decided to use the very direct approach and just ask the community, “Why are your children still dying?”

Community workshops were planned in each village with a health post in order to discuss this question, as well as to investigate other health problems present in the villages.

There are often eight to 10 villages associated to each health post, and from each of these villages the village chief, the Imam, the woman of influence and the young person of influence were invited to the workshop. This meant that some of the workshops were attended by 80 people.

As a means to show collaboration and to collectively express our concerns regarding the deaths of children at home, the workshops were co-facilitated by the chief of war, myself, the chief Imam of the region, and the representative of the king (I suspect that never again will I have the chance to be put in such a lineup).

I had been concerned about potential disorder with such large groups at each workshop; however, I had apparently never co-facilitated a workshop with the chief of war.

One can be assured that no disorder takes place in his presence.

These workshops redefined for me the potential of community collaboration.

Without doubt, there were tense times – great answers do not come easily. There were ethnic tensions and accusations. Problems were posed, and eventually solutions were collectively created. The workshops lasted all day, and the evolution of thought was fascinating as the participants realized their role in the health of their population.

By the end of every workshop, all of the villages in attendance were demanding that no meeting ever occur at the health post without their presence. No workshop ever ended without the participants planning to build latrines at the health post, or to build shelters outside the health post so that woman can have shade while they wait for their consultations.

In every workshop, the population was frank with us. We heard of traditional health practices. We heard that people thought they were excluded from the health post because of their ethnicity. People shared that they had believed their village wasn’t welcome at the health post. We heard a number of reasons why people weren’t accessing treatment, but the reason given at one of the final workshops was the most fascinating.

The devil was in the health post.

People were refusing to take their child to the health post because the devil took the form of the nurse. This meant one could not discern if they were being consulted by the nurse or the devil.

There was even the accusation our nurse supervisor who provides on-the-job training to the health-post nurses had been unknowingly training the devil (I still haven’t figured out whether, as his supervisor, I should have given him a warning about this).

I was, as so often happens here, at a complete loss for where to go from there. Thankfully this was my co-facilitators’ area of expertise – The chief of war and the chief Imam stepped up to the plate. Plans were made, exorcisms organized and community prayers prepared. I imagine that the devil did not last long in that health post.

And hopefully, soon, the number of children dying at home will diminish.

My time in Niger has come to an end. Leaving Magaria was more emotional for me than my departures from previous missions. I learned about limitations during this mission. Without access to basic human rights, the benefits of medication and access to health care are limited. Niger is a country of incredibly welcoming people in a horribly hostile environment. Life is not easy there, and despite all of the humanitarian organizations in place in the country, I fear that in 10 years time there will be little positive change.

I so hope that I am wrong.

Trish Newport is a Whitehorse nurse who works for Medecins Sans Frontiers/ Doctors Without Borders. The article was written between November 2010 and May 2011, during a mission in Niger.

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