For several weeks, Lamin Ceesay had trouble getting out of bed. He came down with an unexplained illness after coming back from a trip that took him to 5 villages up country. At first, his family thought he was just exhausted from a long journey but when days of resting in bed wouldn’t ease the pain and fatigue, his family decided he should start taking Paracetamol. After several days of pill taking and without improvement, his wife, Amie decided to consult a marabout. She was told Lamin picked up the illness in one of the villages he visited during his trip and one short dark skin frail looking old lady is to blame – she cast a spell on him. Amie was asked to cook 7 meals of beef stew with white rice and distribute it among 11 kids who are not from the same parents. She obliged and carried out the instructions hurriedly.
After several days without feeling any improvement, Lamin decided to try his luck at the Edward Francis Small Teaching Hospital in Banjul with the hope that what home and supernatural readies couldn’t take care of, the main Referral Hospital in the country would easily deal with. So without reservation and with much optimism, he asked the wife to arrange a taxi for him to go to the hospital. We will come back to Lamin’s fate in a little bit.
The Gambia’s Health Infrastructure
The Gambia has 5 major hospitals namely: Edward Francis Small Teaching Hospital AKA RVTH, Sulayman Junkung in Bwiam, AFPRC Hospital in Fara Fenni, Bansang Hospital, and Serekunda General Hospital. The Main Referal that handles critical cases is RVTH.
Below the major hospitals are the Major Health Centers (Soma, Faji Kunda, Essau, Basse, Kuntaur, Brikama). The lowest rank are the Minor Health Centers (e.g Kwinella, Bakau, Yoro Baol). Registered Nurses run Minor Health Centers, while Doctors run the Major ones.
Health Care Budget
The budget allocated for health in 2014 for the whole country was D596,000,000 ($14,900,000). This represented 6% of the entire national budget.
Medications for the entire country are procured and delivered to the Central Medical Store in Kotu. Central Medical distributes to regional stores (Brikama, Mansakonko, Bansang, Basse, etc), who inturn allocate to all major hospitals in the region. Some supplies are delivered when requisitions are made from regional stores.
The most needed medications in the country are: adrenaline (for cardiac resuscitation), dopamine (for renal failure patients), dobutamine (for cardiac resuscitation), anti-coagulant/anti-platelets (for people with diabetes, heart attack, and those with other cardiovascular risk factors), thombolitics (needed immediately for patients showing signs of severe heart attack), broad spectrum anti-biotics (eg. vancomicine, ceftrisone) for patients who are resistant to other anti-biotics like peniciline – these are neumonia, gonorhia, syphilis, septic wounds, etc. , statins (for those with high cholesterol level , etc.) anti-hypertensives (for blood pressure lowering), anti-arrhythmic (intravenous amiodarone – for heart rate and rhythm control), anti-diabetic medications like insulin.
Routine machines and procedures most needed at the hospitals
-Machines for blood sugar monitoring
-Urine dip sticks for urine analysis
-Blood Pressure machines and thermometers
-Oxygen Saturation machines in times when patients are gasping for air
-Suction machines for patient resuscitation
-Bandages for wounds and surgeries
-Chemical re-agents to run samples and lab equipments
-Dialysis machines for hepitis B and C patients
-Catheters for patients going for dialysis (for intravenous access)
-Papers for ECG (Electronic Cardio Gram). Monitoring of patients needing reading of their vital signs
-Scanning by qualified Doctors
Compensation for Medical Doctors and Nurses
Starting salary for Doctors graduating from The Gambia’s own medical school is pegged at Grade 8.1 which is D3,500 with on-called allowances amounting to D4,500 a month. Everything totals to around D11,000 ($275) when you add car allowances, residential allowances, risk allowances, and transport allowances. Counterparts in Liberia are getting $1000.
Registered Nurses make on average salary of D4000 (including everything) a month, and D8,000 for those working double shift. Their transport allowance is only D500 a month.
The state of healthcare in The Gambia
Recently, 18 children died in the Maternity Wing of the RVTH because, according to reliable sources, there were no qualified medical staff to attend to them. They all succumbed to preventable situations. The question that begs to be answered is: how could the death of 18 innocent children under such callous circumstances not have generated the kind of firestorm we see in other nations? The virtual dictatorship in that country has not just been a case of physical tortures, disappearances, killings, illegal arrests and firings being meted out against an innocent citizenry, it has also severely affected the economy, agriculture, healthcare, education, and all other essentials for a viable nation. The case of these children, as catastrophic as it is, is just a symptom of a problem of biblical proportions – 1,000 other faceless victims lost their lives on the same day this tragedy unfolded due to preventable illnesses, malnutrition, poverty, and lack of basic education – all thanks to policies of the current regime.
So what’s wrong with the healthcare system?
For starters, when procurement for medication is made, the supply just simply doesn’t meet the demand. The yearly supply doesn’t last past the first three months. This is happening when the budget allocated to the President’s Office (almost 7% excluding other Departments brought under this office to snatch more funds for the President) is more than what is allocated to entire healthcare needs of the country.
According to our sources, the other problem aggravating the medication problem is that those procuring don’t have a clue what kind of medications are needed, especially the essential ones. This, in addition to the fact that wrong medications are ordered routinely. We already listed for you the essential machines and medications badly needed in The Gambia because of the prevalence of the ailments those facilities are needed for, here is what obtains with regards to that situation: machines for blood sugar monitoring are not available – sometimes only one for the entire hospital. Urine dip sticks for urine analysis are not available. Oxygen machines not available. Blood Pressure machines not available. Nurses are supposed to take the vital signs all the time, this is routine in any hospital around the world. Even thermometers are lacking. Oxygen Saturation machines in times when patients are gasping for air are not available. Suction machines for patient resuscitation are not available. The only one available is a manual, not useful in times of emergencies which is when this is usually needed in the first place. Sometimes bandages for wounds and surgeries are not available. Operation after operation is cancelled because of this. Routine analysis cannot be run in the labs because of lack of chemical re-agents to run samples, and lack of maintenance of lab equipments. No Dialysis machines allocated to hepitis B and C patients. Under normal circumstances, HIV patients should not share the same machine with hepatitis B and C patients but unfortunately this general precaution is not adhered to in The Gambia because of this problem. The only machine working is being used for healthy patients. No Catheters for patients going for dialysis (for intravenous access). The kits needed for dialysis are not available when people with kidney failure have to be on dialysis. Many die because of this. As if these preventable issues are not outrageous enough, we were baffled to discover that even ECG (Electronic Cardio Gram) machines have no papers available to do the reading of cardiac activity. This is now discontinued. So monitoring of patients needing reading of their vital signs has been stopped. We are talking about paper here! X-Ray films are also not available. So X-Rays have been discontinued. Scanning has also been discontinued because only the Cuban Doctors can do that and they are currently on vacation and haven’t returned. They were supposed to return on October 9 but due to unavailability of flights, they are stuck in Cuba. No Blood Bank In the entire hospital system, so when patients need blood transfusion, the hospitals generally make appeals to soldiers and private citizens to help out. Patients in the meantime have to wait until donated blood is available, if they are lucky to be alive till then.
Doctors and Nurses go all around the hospital looking for just one of these items in emergencies without success. Hundreds of patients die weekly due to these problems. Staff morale is at an all-time low due to the stress associated with this.
There is currently one urologist and one neurologist in the whole country. No dermatologist in the entire country. No oncologists (for treatment of cancers, etc).
To control the consumption of essential drugs, due to the shortage, the government came up with a lame attempt – a memo has recently been issued instructing Doctors not to prescribe anti-biotics. That roll has now been assigned to Consultants (Specialists in each department).
It must be noted that contrary to popular belief, most Doctors in the Gambia did not specialize. They all just happen to attach themselves to a particular field and end up being known for practicing in that field but they don’t have the certificates to practice in those areas. The Medical Board unfortunately is dominated by these Doctors and they are just self-policing. Dr. Mbowe, for example, is a General Physician, not a gynecologist. He did no post graduate training in that field even though that is the practice he is known for. Most of the Doctors working in the hospitals also have their own private clinics where they perform the same services. Those who can afford it, therefore seek help from those clinics. The care is still below standard but it is an improvement over what one gets in the public hospitals since you get more attention from the Doctors.
So it is no accident that the disaster unfolding in The Gambia’s healthcare system is a boon for Senegalese private hospitals – most Gambians who can afford it, prefer to go to Senegal instead of going to hospitals in The gambia. Each year, this medical travels inject millions of dollars into the Senegalese economy and healthcare business since these trips are mostly financed by The Gambian Diaspora who have completely lost faith in the system.
Back to Lamin Ceesay. Lamin died at the hospital because he was discovered to have a kidney failure and needed Dialysis. The Dialysis procedure could not be done because there was no Catheter (sells for less than $3) avaible. In the meantime time the President, Yahya Jammeh is spending D80,000,000 ($2,000,000) on birthday celebrations while his wife spends more than D8,000,000 ($200,000) on each shopping trip (about 5 a year) she takes to the United States. Their daughter Mariam’s tuition at the private High School she is attending in Manhattan, New York City is D2,880,000 ($72,000) a year. None of the members of the First Family seek medical help from hospitals in that country, Jammeh’s own mother goes to see her Doctor in Belgium each time she needs to consult regarding her diabetes. Government Ministers make every effort to send their wives to the United States to deliver their babies. Who is left in that God forsaken healthcare system? Go figure.