Date of Defense:
October 5, 2018
For my Field Experience, I traveled to Senegal to complete a medical and public health mission – with Medical Mission Senegal. There were several medical issues and public health issues that we aimed to address. The trip did not proceed as I had envisioned or planned. I envisioned more exotic diseases like malaria, Drunculosis and the bot fly; instead, among adults (both male and female), we saw high rates of hypertension, diabetes, and malnutrition. Specific to maternal and child health there were breastfeeding concerns, lack of routine preventive reproductive care (STI screening, well woman care), diarrhea in infants, and lack of consistent prenatal care. HIV/AIDS was not highly prevalent in the areas we were working. Additionally, it was the dry season, so malaria was not of high concern. Several experiences made this Field Experience worthwhile from a public health perspective.
Our group spent time in Dakar (urban capital on the Western side) and Kanel (rural town on the Eastern border). In Kanel, we organized and worked out of a makeshift clinic/pharmacy (providing general outpatient care) that was an abandoned clinic and saw roughly 1,000 patients. The overall goal of this Field Experience was to gain exposure to global rural health care and use skills learned in fundamental MCH courses in the field, such as data collection, evaluation, and women/child specific education. I was able to observe all members of the team. I also was involved in educating groups on mosquito nets and female hygiene kits. No data was collected though we charted all patients seen in clinic with a brief history, physical exam, and assessment/plan. From these charts it was evident hypertension and diabetes were likely very prevalent in Kanel.
This was the first year this group and the organization traveled together. The group was composed of employees from Hennepin County Medical Center and included a wide array of caregivers and providers – two physicians (one of which was an MD/MPH), one nurse practitioner, two nurses, and a social worker. The nurse practitioner, who was also my preceptor, immigrated from Kanel almost 15 years ago. The purpose of the overall effort was to provide outpatient care to the residents of Kanel and the surrounding area, learn more about the ongoing medical and public health issues, and potentially help create a focused plan regarding the specific needs of the area to improve future missions back to Kanel. My specific role was to gain a better understanding of the intersection between public health needs (i.e. clean water, sanitation, nutrition, etc.) and prevalence of medical illnesses.
My overall experience was eye-opening. It was made abundantly clear the importance of public health, especially in a rural setting with an underprivileged population. The basics we take for granted living in the United States make a huge difference in quality of life, morbidity and sometimes mortality. In addition, it was evident working with different providers that each had a different awareness of the relationship between medical illness and public health. For example, several patients presented with poorly controlled high blood pressure to which a provider would prescribe a 10-day course of amlodipine. There was no education or long-term plan provided afterwards regarding appropriate diet, physical activity, or other ways to prevent or lower high blood pressure. Nor was it taken into consideration whether or not the patient had the ability to continue this medication when the samples ran out. This was extremely frustrating given one of the members of my team was an MD/MPH and I felt we should have been far more prepared to provide sustainable care through a more holistic approach.
It was difficult to narrow down any one fundamental cause of the health issues that presented. It was clear the issues are multifaceted, many of them likely driven by (or at least complicated by) social/environmental causes on top of genetics. This made all the patients we saw an interwoven blend of medical illnesses and complicated public health issues – clean water, food insecurity, socioeconomic status and access to medical care.
We were able to meet with USAID in Dakar at which time I was able to discuss various maternal child health issues prevalent in Senegal. Though we did not witness any emergent acute cases firsthand, USAID informed us that neonatal asphyxia, upper respiratory infection, and diarrhea are the primary causes of infant mortality in Senegal.
I saw a primary case of syphilis, something which is rarely seen in the United States except in textbooks, which led to a discussion with a local outreach coordinator in Kanel working with the LGBTQ community. Senegal’s primary religion is Islam, and within this religion, LGBTQ persons and sexual relations outside of marriage are highly frowned upon. The outreach coordinator assured us they are working to decrease the stigma associated with LGBTQ and sensitively educate, however, cultural changes like this take a long time.
It was our group’s first time traveling together and first time Kanel has had a medical and public health mission provide care in their area. There were many things to be learned. Regarding activities and programs in Kanel – there needs to be more general public health education to support the medical care provided. The two go hand-in-hand and without a larger emphasis on programs to promulgate sustainable preventative public health, medical care delivery will have no long-term success. Hopefully this first year served as a foundation for future years for this organization to continue.