Getting some perspective on Public Health

The importance of a nation’s infrastructure for health has really hit home this week. After five days in Kenya which has an acclaimed mobile network, I have only just managed to post my second blog due to the variance of the internet. So it’s not surprising that delivering healthcare is a huge undertaking, and that like the UK, Kenya’s NGOs are looking to mobiles to deliver timely messages to patients. However the challenges of patients taking medicines once they have been prescribed has led to a growing army of health support volunteers working one to one with patients whose compliance is essential to not only their personal health but also to wider public health.

I met Lovelance yesterday and her two-year old Hope. Hope was born with TB but it took until Hope was 7 months old and dying before her mother took her to a clinic. Hope’s father and neighbours had prior to this been advocating various herbal and traditional remedies. But to ensure Hope got her daily medicine and nutrition, Carol was assigned to the family as a support worker. Experience has shown that without this support, as health seems to improve, patients stop taking their medication until things seem to worsen again, thus beginning an on-off cycle that enables the bacteria to evolve resistance and endangers the wider public.

Volunteer Health Visitor Carol with Lovelance and her baby Hope

Carol herself is a TB survivor, as are most of her co-workers. They are trained by the US Centres for Disease Control based in Kisumu and get the equivalent of £3.50 a week, half a litre of milk and a loaf of bread a week for being involved in the work. They were so pleased at having a visit from us (the IRP group I am with) that they put on a special welcome dance! Compliance with medication is a huge problem in every country, and this is a labour intensive way of ensuring it. However the stakes are higher with diseases that can progress rapidly and cause fatality, and which will become more resistant if medicines are not taken regularly. Add to this the lack of running water, electricity and sewerage and staying healthy becomes a major challenge.

The resources we have in the west dwarf what are available to those in the developing world. The choices open to providers and patients are beyond imagination. But there is an urgency and attitude here from which we should learn – looking for low-cost solutions, using neighbourhood networks, engaging those who have experienced illness to support those who become sick. The NHS will ony be sustainable if we expect less to be done by the professionals.