What does a chemistry major do in Togo?

On the way up to my host family in northern Togo, Dr. Piot asked all of us students to tell him of our majors. Madeline: cultural antrhopology, Alex: Political science/government. So far, so good. Dr. Piot nodded his head as he could see why these humanity majors would come to Togo to work on their respective projects. Then it my turn. "Chemistry," I said. He literally turned around and said "WHAT are you doing in Africa?"

So I am here trying to answer that question. As I have already said in my profile, I want to learn about how doctors heal patients in an environment where health is understood as a physical and spiritual matter. I am also here to give my service to best help the need of the organzation. My time here in split between working in a decent size clinic in the bigger village of Farendé, interviewing local healers, and developing a feasible action plan for the local insurance system that they want to implement in a small village up the moutain, called Kuwdé.

The clinic in Farendé is called Centre Medicale Sociale, or CMS for short. It is a part of the Evangelic Church, but it serves as the local health institute. It is responsible for everything ranging from primary care and birthing to vaccination and public health education. However, like many of the health institutions in Togo, they are understaffed and underfunded. For example, there are three nurses and one l'assistant mediacal (almost, but not quite a doctor) who have to manage consultation room, injection room, wound dressing room and the two hospital rooms. The nurses each take a 24 hour rotation to take care of the patients, so there's actually only one to two people who can monitor the entire facility at one time. In addition, out of 10 people who comes to the clinic, about only 4 can actually pay for their medecine and consultation fees. Sometimes, I wonder how this instituion is even able to stay in business at all with their limited revenue. There is no government aid or any outside help except for the once-a-year medicine donation from Doctor without boarders. In order to help the clinic, they have used all extra space at the center to plant peanuts to support the staff. Right now, my goal is to work with the education programs that they have at the center to better the curriculum and to find people to teach them about how to prevent infectious diseases.

My other big project is working with the assurance system for the little village of Kuwdé. Tara, a student who came up with this idea last year, wanted to start an insurance system so that the people in the region do not have to pay very much when they come to the clinic. The problem in this village is that people cannot pay in full for their medicines. This is partly due to the poverty in this region as well as the way of life here. Most people do not practice saving money because they have never experienced what it means to have a steady income. The only way of life that they understand is the subsistance living where they toil all day to make just enough for that day. Thus, there is never the occasion to save, and they hardly ever have a sum of money set aside for rainy days. When they have to come up with a large sum of money for pay for things like medical expenses, their instinct is to sell something in their house, like a goat, chicken, or grains, to pay for the expenses. This practice, however, puts people at the mercy of the market. They can only make however much the market dictates. Thus, these people can never be sure of whether they can pay for the medicine or not. This chain of events ultimately affects the health insititute because the health worker cannot turn a sick person away due to his/her ability to pay. Thus, it is the health institution that ends up going into debt, and the personnels are not paid. This insurance system is here to provide some security.