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Côte d'Ivoire: hospital reprieves lifeline

11-08-2008 Feature

The Korhogo hospital has few resources and scores of indigent patients. But once in a while its dedicated staff, working together with the ICRC, manage to save a life – like that of Amandine.* Report by Iolanda Jaquemet.

Amandine arrived at the obstetrics department of the Korhogo regional hospital in northern Côte d'Ivoire on 13 May 2007 at 9 a.m. She was uncertain about her age but appeared to be about 16 or 17 years old. What was certain was that she was about to give birth. And the doctor on duty noticed that her pelvis was too narrow.

But Amandine had no money at all, let alone the fee for a caesarean section – 100,000 CFA francs (about 250 US dollars). Nor did Sékou Soumahoro, the hospital's social worker, have enough cash on hand to help her out. And yet, it was clearly a case of life or death. " I filled up the tank of my motorbike, paying out of my own pocket, and started making the rounds, " he said.

 Social safety net  

Amandine's relatives in Korhogo – the teenager was from western Côte d’Ivoire – were less than enthusiastic about chipping in. The baby's father, a high-school student, admitted his responsibility but his own father refused to pay for the operation. After several fruitless attempts to raise the money, Sékou Soumahoro knocked on the door of Élise Bjerkrheim, head of the ICRC's local office.

" It was clear that we had to do everything in our power to save the young woman’s life, " said the delegate. A few phone calls and several consultations later, a solution came from the Korhogo hospital itself – one of four supported by the ICRC in northern Côte d'Ivoire since 2003.

" In June 2007, we started donating medicines to the hospital on a monthly basis, " explained Amadou Fadiga, an ICRC doctor worki ng in the region. " Some of the medicines are sold and the proceeds (between 300 and 500 thousand CFA francs) are spent on care for indigent patients. We stipulated that priority must be given to maternity and paediatric cases, and of course to life-threatening ones. "

Amandine fulfilled all the criteria for financial aid. However, on that particular day, there were insufficient funds in the till. By dint of persuasion, Élise Bjerkrheim and Dr Fadiga finally struck a deal with the hospital: the facility agreed to reduce the fee for the operation and the pharmacy would provide an advance on its earnings.

At 10 that evening, Amandine gave birth by caesarean section to a healthy baby girl. Exhausted but happy, Sékou Soumahoro was finally able to go home.

" We used to be the referral hospital for northern Côte d'Ivoire, " said the hospital’s director, Dr Jules Kra Yao, sighing heavily. " But ever since the crisis began in 2002, there has been a mass exodus of medical staff and our services have gone downhill. Luckily, the ICRC is now helping to boost our medical capacity. "

By way of example, he mentioned the ICRC's donation of two autoclaves for the sterilization of medical equipment. Previously, the rate of post-operative infections had been close to 100 per cent. According to a study carried out within the obstetrics department, which received one of the autoclaves, the infections had now been practically eliminated. The surgery department received the other autoclave.

Another priority was to combat the high maternal and neonatal mortality rates (over two and a half times those of neighbouring Mali, for the former). " We've trained 58 nurses and midwives from the Korhogo region and about 20 from Katiola, and interest in the programme has been enormous, " said ICRC Dr Amadou Fadiga. The ICRC had also donated a large quanti ty of medical supplies and equipment to the obstetrics and surgical departments, drawn up medical follow-up protocols and provided administrative support.

 No water, no hospital  

Water and sanitation problems had to be addressed as well. " Two weeks ago, our one remaining water pump, which was on its last leg, broke down completely " explained the director. Without water, no hospital can function. Within 48 hours the ICRC water and sanitation delegate in Korhogo, Michel Vouilloz, had ordered a new pump, which was being installed under his supervision.

Michel Vouilloz, an engineer, was also completing various feasibility studies. " Our first priority is to install a new septic tank, " he said. " The current one is insalubrious and presents a risk for the entire neighbourhood. " The engineer was making further plans to rehabilitate the hospital's incinerator, which had been shut down owing to a lack of fuel. " It could easily provide a centralized service for all the medical facilities in the region, " he said.

Summing up the situation, Sékou Soumahoro explained: " The funds available to help poor patients depend entirely on the sale of medicines by the pharmacy. Each day I receive an average of 30 pleas for aid, some of which concern serious conditions, and each month I can only finance 10 relatively minor cases or two major ones. " Even though it would not resolve all the problems, Sékou Soumahoro was nevertheless happy to hear that the ICRC planned to considerably increase the amount of medicines it donated to the pharmacy, as that would clearly inject needed money into the social-welfare fund.

In the recovery room for caesarean patients, Amandine was now resting. After a chat with Sékou Soumahoro, she had decided to call her baby girl, who was sleeping peacefull y by her side, Élise.

* Name changed