Wednesday, January 19, 2011

Confrontation vs. Indirect Action

10 December – Romongo, 9:50pm

Today was interesting - we had a session on corruption. It sounds like the answer is always to cool down your anger and call Dr. Claude for advice since she knows the health care system and can help iron out anything that is actually a misunderstanding on our part, or can give us advice on how to diplomatically respond to things. I'm glad we had this session because when we started analyzing the “scenario” story and how we should respond, my immediate response was pretty direct and confrontational, which just doesn't work here (even though the American in me stubbornly maintains that it should).

Basically, the story was that a woman recognizes that her child has early symptoms of malaria (good!), but because the CSPS is far away she uses traditional cures of eucalyptus and neem first (bad). The child gets worse, so her mom takes her to the CSPS after borrowing money from the neighbors to pay for the consultation (needs options for saving money for health emergencies). The medicine costs more than she brought, so the mother leaves her daughter to go get more money. She returns to find that the pharmacy doesn't have the medication on hand (not acceptable pharmacy management), and goes and cries to the head nurse. He offers her the medications out of his “private stock” (not kosher, and where did the meds come from?) but at a much higher price than the government dictates for the sale of that drug (absolutely not acceptable) and she can't afford it. You, the volunteer, show up and greet the patients. The head nurse sees you taking an interest in this particular girl and discretely tells you that it's the fault of the CoGES for poor pharmacy management that this girl will probably die without treatment. You hop on your bike to the nearest other CSPS, buy the medications, and give it to the grateful mother, whose daughter lives (we're big on happy endings in our scenarios). But now what do you do?

Even my most diplomatic attempts to address the situation fell flat, mostly because I couldn't think of any response that didn't involve going to someone higher in the health care system. As Volunteers we work very hard to convince people that we aren't spies for the government. Thus, even if we see blatant corruption, even resulting in awful patient care, we can't go to the higher-ups of the corrupt person because it will make everyone see us as spies there to rat them out to the district. Although it's tempting to call up the supervisor of the head nurse and get him transferred or fired, it then would taint our interactions with other health agents who would worry that we were watching them to get them fired as well, which would obviously make it very hard to work on health issues without the support of the health clinic. We also discussed trying to convince the pharmacist and the CoGES to keep better records, to make sure medications were stocked and not stolen or lost, and that all the money was accounted for. While it still sounds like a good idea to me, Rob said that it was only a little effective as there are ways around any system if the head nurse still wanted to buy black-market meds and sell them on the side for more. Similar to in the US, there's a pretty strong notion that if it costs more (or if it costs anything if the alternative is free), then it must be better in some way. Thus, you find people selling “free” vaccinations and people will willingly pay for what they could easily access for free because they feel like if there's a price it must be important and thus worth it.

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