A long wait on a hard bench: a personal take on disease burden

Photo courtesy of Angie Rowe

Photo courtesy of Angie Rowe

By Matt Boslego
PATH Communications Assistant

I woke up with a pounding headache, drenched in sweat. A quick temperature check confirmed that I had a fever well over 100°F. I was living at the time in Guinea-Bissau, a small, hot, and arrestingly beautiful country on Africa’s western coastline. Decades of instability had contributed to a lack of investment in the health sector and in general infrastructure, which meant that diseases such as cholera, typhoid, and malaria were shockingly common. I limped down the stairs of my apartment and had a friend hail a cab for me. It was still early in the morning; I hoped that I would be among the first in line at the clinic.

Supply and demand: few doctors in the country and a high disease burden meant a long wait. Despite arriving at 7:30 in the morning, 30 minutes before opening, there was already a crowd waiting to be signed in. The clinic was a simple concrete building run by a foreign nonprofit. Though basic, it was clean and well organized—highly necessary when there are over 100 people waiting to be seen. I took a number and sat down with them, spending a few hours on a hard bench. Though I would have loved a nap, I enjoyed the camaraderie of the other patients, many wishing me, “Forsa meninu” (“Be strong, kid”).

Photo courtesy of Kelsey Barrett

Photo courtesy of Kelsey Barrett

A consultation, blood drawn, and more waiting for the test result. Malaria on the tip of everyone’s tongue. Due to the history of treating every febrile illness as malaria, the word for it in the local language, “paludismo,” had come to mean “sick” in a more general sense. Now, when possible, a positive diagnosis is required before treating, ensuring that people get treatment for the diseases they actually have. That day, in the late afternoon, I was called to the counter (“Number 76!”) and received my diagnosis sheet: Malaria – Negativo; Typhoid – Positivo.

Though I didn’t have malaria that day, many waiting in line ahead of me did. Hundreds of thousands of people are affected by the disease in Guinea-Bissau each year, up to approximately 28 percent of the population. In 2012, the World Health Organization estimated that malaria was the cause of 18 percent of deaths of children under five years old in the country. Guinea-Bissau urgently needs to lessen the huge burden malaria places on its under-staffed health services to free up clinic space and hospital beds. In the end, the population pays the price—getting sick isn’t cheap. Even with subsidized health care, families must pay for transport to a health center and for the productivity lost while ill.

Fortunately, the situation has been steadily improving. A return to democracy in 2014, following the military coup d’état two years prior, has reopened the way for foreign aid, with health investments listed as a top priority. Insecticide-treated bed net coverage has steadily been increasing, now reaching nearly 70 percent of the population. Conceptually, reducing malaria’s burden on the population is not complicated: the standard package of bed nets, indoor residual spraying, and improved case management works; it is just a matter of securing the financial and material resources necessary to make it a reality.

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