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Guinea-Bissau: the ICRC helps strengthen the capacity of the national health system

10-03-2010 Feature

Guinea-Bissau’s health system is crippled by a lack of drugs and medical materials and equipment, compounded by the departure of medical professionals seeking greener pastures. As a result, few people, including those injured by weapons and mines, have access to adequate medical care.

" Despite being a national benchmark the hospital has only six major departments: medicine, surgery, maternity, paediatrics, ophthalmology and orthopaedics. In these departments, as in other, smaller ones, there are one or two specialists for each area, which is not enough for solving the problems,” laments the surgeon.
 
" In addition to scarce materials and equipment, the health system in Guinea is faced with a lack of human resources and a drain of professionals, who are leaving the country. This can be seen in the fact that there are currently only six surgeons working in our surgical departments,” he says.
 
“Furthermore, space in the surgical block is very tight. It was built for a city of 200,000 people, but the city is growing and now it has over 400,000 inhabitants. Which means that it’s not adequate,” he adds.
 
This is a situation similar to the one faced in other departments, such as the intensive care unit, paediatrics and maternity, which are struggling with shortages – lack of oxygen apparatus, life-support apparatus and aspirators, and not enough room for inpatients. There are times, especially during outbreaks of epidemics, when two patients share the same bed.
 
Meanwhile the government, with the support of its partners, is committed to boosting and improving the health system. In terms of infrastructure, the African Development Bank (ADB) recently financed the construction of new facilities at the Simão Mendes National Hospital and the renovation of the old buildings, which were falling into disrepair.
 
The International Committee of the Red Cross (ICRC), which opened an office in Bissau in 1998, has lent timely support to the government, and especially to the victims of the armed conflict s and the problems currently besetting the country.
 
As a result of the armed conflicts and the internal problems in Guinea-Bissau, many Guineans have suffered and are still suffering from trauma caused by injuries from firearms and mines.
 
The situation of Samba Djau, 45, who survived an exploding mine, is now almost desperate. “Even with the different kinds of surgery after the accident, my life is paralyzed for ever. Since I was wounded I haven’t been able work in the barracks any more, because only men who are fit and well work there.”
 
With the support of the ICRC, in November 2009 the Ministry of Health held a seminar entitled “The treatment of firearm and mine injuries” for some 30 doctors and nurses, both civilian and military. The seminar demonstrated simple, reliable techniques for saving lives and reducing the effects of traumas caused by firearms and mines. In parallel, the ICRC donated medicines and some equipment to the surgical departments at the Simão Mendes National Hospital.
 
In addition to the topics presented during the seminar, such as " War injuries involving fractures, " " Open craniocephalic wounds, " Infections and antibiotics in war surgery, " Nardini, an experienced ICRC surgeon who ran the course, exchanged experiences with Guinean colleagues, discussing concrete cases with them.
 
“A mine injury bleeds in the first few minutes, but then it gradually stops, because the explosion immediately burns the blood vessels and neutralizes them,” said Dr Lassana Indjai, recounting what he experienced in 2006 during the armed conflict in São Domingos, on the border between Guinea-Bissau and Senegal, with the wounded who arrived at the largest military hospital. Indjai is a surgeon at this hospital, and its director.
 
According to this military doctor, who trained as a general medical practitioner and now has a great deal of surgical exp erience, professionals are almost always forced to act because they can’t leave the wounded bleeding. “African doctors have to be well rounded, in other words, they have to know a bit about every area,” he maintained.
 
In fact, as these are not subjects taught in the universities, almost all the doctors/surgeons who received this training (most of whom had basic training as general practitioners) were unfamiliar with the techniques of war surgery.
 
During the seminar, participants received information about the rights and duties of a health team as enshrined in International Humanitarian Law, and first-aid techniques.