Where the Kiddos Go

I have an affinity for loosely organized chaos.  I also have an affinity for attempting to loosely organize said chaos.  There is a wonderful event here that allows me to participate in both—Under-5 Clinics.

Under-5 Clinics are monthly clinics held at designated sites throughout a Rural Health Clinic’s catchment area.  Fimpulu has 10 zones with an U-5 occurring once monthly in each zone (well, roughly—a couple of the zones are combined into one meeting place for simplicity’s sake). Depending on how you get there, our furthest zone is 35km away from the clinic.

U-5 Clinics serve the primary purpose of growth monitoring and vaccine administration.  Ideally, family planning and antenatal services should also happen then.  For our furthest zones, this is often the only time people are seen by a “clinic worker” (because do YOU want to tie your sick 5-year-old on your back and walk or bike 10 or 20 or 30 kilometers to the nearest health facility? Um me neither). With that in mind, there is obvious potential to expand the services offered at U-5s, manpower and resources providing.

So a couple of weeks ago, Meg the Wimpy White Girl (that’s my superhero name) hopped on her bicycle and pedaled all the relatively short way to Fitobolo. It’s mostly tarmac the whole way there, which puts it in the “easy” category as far as bike rides go, but Meg is super duper out of shape. Holy thigh cramps, Batman! I arrived at a completely deserted shelter, inhabited only by a hanging UNICEF baby scale which convinced me I was in fact in the right place.  30 minutes passed.  Then an hour.  When my clinic colleague finally arrived on his motorbike, everyone heard the engine coming and popped out of the bush grass like children of the corn, but cuter and less creepy.

Then we got started.

First, we collect everyone’s U-5 cards.  I taped back together the ones that were falling apart.  Everyone gets weighed and charted. Cards are then sorted into 4 piles:

Needs vaccination, growing well

Needs vaccination, not growing

No vaccination, growing well

No vaccination, not growing well

The Needs Vacc group line up and get poked. Much wailing and gnashing of teeth ensues. The Not Growing families are, theoretically and ideally, identified, interviewed, and an appropriate intervention put in place. I say “theoretically” because sadly, this group usually consists of repeat offenders.  Nutrition intervention is not as simple as just telling people to eat better, or even giving them food.  But that’s for a different blogpost. 

In order to encourage a change in the normal way of handling patients here, which seems to be based around public verbal bludgeoning and punishment, I also make a point of calling out to mothers whose kids are doing particularly well-- children who have started gaining weight after a drop, or who have started retaining U-5s after a few months absence-- and profusely praising and encouraging them in front of their peers.

Then all the preggo mommies line up for antenatal (palpation, exam if necessary, distribution of vitamins, screening for complications), followed by all the moms who don’t want another baby right now for family planning.  Most women opt for DepoProvera here, which is an injection they get once every 3 months. It doesn’t require the daily vigilance of the pill or the visible evidence (scar) of the implant. Recently, I’ve asked each zone’s Community Health Worker (individuals trained to provide very basic diagnoses and treatment on the community level) to come and set up shop in the corner, testing for and treating uncomplicated malaria and/or pneumonia. The CHW’s attend their zone’s U-5s anyway, so it’s a logical service to provide.

I weave my way through the crowd cooing at babies and looking for any problems that might have been missed. I carry basic supplies with me (like sterile dressings, burn cream, antibiotic ointment, etc.) to deal with the inevitable owies I come across. It's not uncommon to find a child with a half-healed injury that was never treated at the clinic and needs some serious attention.

While all of this is going on, every blessed thing we do has to be charted on a tallysheet or in a register.

I know that all of that sounds relatively simple and systematic.

But it’s not.

It’s a giant cluster of screaming, hungry babies and tired, hot mommas.  It’s chronically sick and underweight kids whose vaccination records are all over the place.  It’s a beautiful churning mass of persistent, unquenchable humanity.

For the moms and kids of Fimpulu, it is life-protecting and health-encouraging.

For me, it is soul-filling and God-honoring.

I’m gonna just call that a win-win.