How to summarize a month of travelling, meetings, learning and experiencing in just a few pages? Well, here’s my attempt, though I strongly advice going to see yourself:
Background. My name is Nicholas Kinnunen and I am 32 years old. I’m a registered nurse, currently working in a pulmonology/gastroenterology ward in a university hospital in Umeå, Sweden. I am interested in working in low and middle income countries in the future. I was interested in going and see for myself how health care functioned in a low income country. I contacted the Sweden-Cameroon Organisation ( SCO) as I thought Cameroon would be an interesting country for this trip. The organization helped organize internships for me at an health center and hospital during my one month long stay.
Yaounde. My stay in Cameroon started and ended in Yaounde, the political capital of Cameroon. I started off with doing an internship in a Catholic health centre in the district Nkol-Eton. There I observed primary health care; how it was given, what resources there were, common illnesses, etc. I got to see general, prenatal and cardiology consultations done both by nurses and doctors. I also saw minor surgeries and ultrasound examinations. Furthermore I got to visit a public hospital for a day.
When not at the health centre I usually was at the SCO office; watching the personnel instruct youth in diverse health questions, host discussions about health or life in general, help with schoolwork or assist with applications for higher studies (in Sweden, as a matter of fact).
My impression of Yaounde was that it was crowded, busy and never quiet. There seemed to be people selling everything from bananas to blood pressure cuffs at almost any time of the day. The traffic can best be described as functional chaos; cars, motorcycles and bicycles compete about the same roads, all with a healthy smattering of carts, wheelbarrows and pedestrians. My definite highlight in Cameroonian traffic was when I was sitting in a taxi locked in a queue and suddenly two horses made their way through the line of cars, each with a youth riding barebacked.
Bandja. After my two weeks in Yaounde I went to Bandja, a rural community in west Cameroon, for about a week and a half. There I primarily did an internship in the Protestant hospital of Bassou. There I got to observe (and sometimes assist with) consultations, vaccinations, wound dressing, larger surgeries, physiotherapy, etc. I also got to visit a public health center.
The SCO has an office in Bandja as well and there was where I usually spent time after finishing at the hospital. As in Yaounde, the office in Bandja aimed to discuss and inform youth about health topics, help them with schoolwork, etc.
Apart from the time in the hospital and with SCO, the main thing I will remember about Bandja is the humidity. Staying there in rain season means that you’ll probably feel slightly moist most of the time. This took some getting used to, but after a few days you grow accustomed to it. A definite plus with the rain and moisture is that you get to see some pretty lush vegetation and eat some terrific fruit and vegetables.
My reflections on Cameroonian health care. While doing internships, traveling and talking I got a lot of impressions of Cameroonian health care and how it differed from the work I did back home. Below is a list of my impressions from the trip. Bear in mind that these are only my own impressions, gathered during a month from only two internships and a few visits in a country where most people speak French, a language that I do not speak. Both of my internships were in private facilities, this could have affected my impressions as in Cameroon the private health care is better staffed and have access to more material compared to public health care. The bottom line is that the reflections are not objective, thorough or even accurate. They are just my own and the only ones I have to offer. When I use terms like “more” or “less” without further specification I am comparing to Swedish health care.
Lack of personnel. In Cameroon there is a clear lack of educated health professionals in comparison to the population size. For example there is only one physician per 12500 inhabitants (Amani, 2020), in comparison to Sweden’s one physician per 300 inhabitants (World bank, 2012). This affects health care in many ways, some of which I relate below.
Lack of material and medicine. In all the facilities I visited there was a clear lack of many things that are taken for granted in Swedish health care. This was everything from basic supplies like bandages and sphygmometers to more advanced things like lab equipment to analyze blood samples. As you will see below this, in combination with the lack of personnel, affect many areas of Cameroonian health care (at least in my view). I was thoroughly impressed by how health professional worked to minimize wastage of material and medicine and how creative thinking could solve certain shortages with minimal means (like building an incubator out of a box and a lamp).
More generalist care. As there is such a shortage of personnel the people working in health care have to care for a wider spectrum of patients. As a doctor or nurse in a small hospital you have to be ready to treat patients ranging from small children to elderly and of both genders. You will have to be ready to deliver babies, assist in operations, do physical therapy, etc. According to the health professional I talked to this is anticipated already during the education which tries to very generalist for this purpose. In my eyes, the most marked indicator of this was the thorough pharmacological education that nurses received as the situation often is such that nurses have to prescribe medicine to patients. Apparently the university hospitals are built for more specialized care (as the one I am used to in Sweden), but I never visited one of them myself.
More authoritative. Prescriptions and treatment were given to patients in a commanding manner. Doctors and nurses were basically telling patients what to do. We certainly use a fair amount of authority in Swedish health care, but my experience is that we have more of a dialogue with our patients in Sweden. I’m guessing that this depends mostly on the lack of personnel; the time for each patient is limited and there’s no time for reasoning back and forth. Another reason could relate to education; many Cameroonians only have basic school education (if even that) as school is only free through 14 years of age. By saying “Do this and this” a patient gets a clear picture of treatment. A more informative and in depth discussion tailored to the patient’s understanding of health would of course be preferable, but that would certainly take more time and as I’ve already mentioned the personnel resources don’t allow for more time.
Quicker diagnosis. Many diagnoses are done in a few minutes. Treatments are prescribed in the same time frame. An obvious reason for this is the previously mentioned lack of health professionals; there is no time to start ruling out a lot of differential diagnoses. Another reason is a lack of materials, there are no resources to do bacterial cultures, advanced blood testing or other tests that could confirm a diagnosis. Physicians and nurses have to use a lot of clinical findings while diagnosing. This does not mean that they will always have an answer, if they cannot diagnose a patient they will remit to a specialist.
More dependent on the patient’s economy. There are some differences concerning consumption of health care between people in different income classes in Sweden, but those differences are very small compared to Cameroon. There you have to pay when coming to the hospital and if you get admitted you pay for the stay there. You also pay for the medications, infusions, syringes, bandages and other material that you consume during your stay or visit. It quickly becomes apparent that the poorest part of the population will have no or only spurious contact with health care in such a system. Some things who are deemed important from a public health aspect, like many vaccinations, are free though.
Most everyday care given by proxies. If a patient had to stay in hospital the bedding, food and help with other mundane activities were handled by relatives or friends (mostly female). Proxies also handled the dispensing of medicines according to schedules given by the health personnel. This of course put strain on families as family members have to spend a lot of time in the hospital which interferes with work, both domestic and for income. On a positive note it provided a lot of opportunities for education of proxies in medication, specific care or rehabilitation for the patient, for example physical therapy after a cerebrovascular event.
Less use of analgesics. The use of analgesics (painkillers) was markedly less than in Sweden, something I saw mostly in minor surgeries. An obvious reason is again the lack of medicine; the supply and cost of medicine resulted in it only being used when there was a great need for analgesia. The lack personnel probably contributed to a lesser part; strong analgesics can have negative effects on patients which can lead to a need for observation for a time after administering the medicine. Another reason was beliefs about analgesics. For example, I was told that circumcision performed with analgesics was somehow “worth less”. Although with older children (8-10 years and above) analgesics were often used to lessen the pain and simplify the procedure. Another belief I heard relating to analgesics was that “Cameroonians are traumatized almost daily, so why would they not be able to endure some pain during a medical procedure?”.
Summary. There are many areas in which Cameroonian and Swedish health care differ. As I have described above, I think a lot of the differences are due to the different levels of resources in the two countries. I also believe that culture, demographics and regional differences in disease burden contribute to the difference. I actually have more impressions from my visit, but I only included the major ones as the format does not allow me to fit it all in. I hope I have managed to shed some light on how health care in Cameroon is given. Personally I have gotten many impressions, learned much and also seen areas where I have to learn more. My greatest thanks to the people in the SCO, at the health centers and hospitals who organized, explained and answered questions so that I could gain these insights.
References:
Amani, A. (2010). The Health Workers Crises In Cameroon. Public Health Theses. Paper 139.
http://digitalarchive.gsu.edu/iph_theses/139
World bank website, downloaded 16/7/2012: http://data.worldbank.org/indicator/SH.MED.PHYS.ZS
Originally published August 14, 2012 by admin.