MISA-Swaziland e-Forum article
November 26, 2013
Georgina-Kate Adams is a British writer and founder of The Seed Africa, a crowdfunding NGO helping to educate girls. She is currently living in Swaziland, where, among other things, she encountered the country’s healthcare system.
What can be said of a medical system where you are prescribed drugs without diagnosis? The first time I can take as an anomaly, but the second? This is clearly engrained in Swazi hospital culture.
I had managed to avoid going to the doctor at all during my first nine months in Swaziland (except briefly when a Scottish doctor signed a form to certify I was not an idiot. True story.)
In the last two weeks however, I darted once to a private clinic during a malaria scare and today went to a public hospital for a routine sexual health check. In the West, both would be standard procedure and neither cause for antibiotics. Here, both were.
There were advantages and disadvantages of both experiences. At the private clinic I was seen immediately by a real doctor. Then served a disproportionately large bill. (E500 for a 10 minute appointment and malaria test.) At the public hospital, I spent three hours being prodded and passed around, without ever once seeing an actual doctor. But (spare a E20 registration fee), it didn’t cost me a cent.
The consistent factor in both experiences was being served a lengthy list of prescriptions (three a piece) before my test results were sent out – let alone had come back – nor anyone had any real clue what was up. In both cases, doxycycline (a ferociously unpleasant drug by all accounts) was prescribed with great insistence.
I could go on. I could talk about that, in a country suffering from a sexual disease pandemic and with streets littered with posters urging individuals to “get tested”, it is almost impossible to get a full sexual health check. I could talk about how they test for “organisms” not diseases and match the drugs to those organisms, without ever making an actual diagnosis. (This is after the drugs they’ve prescribed you pre-diagnosis of course).
I could talk about the inexperience with which my blood was extracted, leaving me 24 hours later with an arm which is still purple, green and throbbing.
But let’s ponder this point for a second: What is the motivation for prescribing serious drugs to patients who have no diagnosed ailment? And who is motivating it? Okay, if a makeshift hospital which provides complimentary healthcare to those who need it relies on their dispensary as a source of income, I can understand (although not condone). But what of the private clinic? Pure greed? And who is bearing the cost of these medications if they are so profitable to sell? The sceptic in me points a finger at external organisations which trade aid for other privileges, or dump their drug excess on Africa whether we want it or not.
Don’t get me wrong, everyone should have access to medical sanctuary. And these hospitals provide a fair service in a challenging economic and public health environment. Encouragingly, the HIV testing process was simple and efficient. Both hospitals had several energetic and committed staff, and I would be proud if one of the young girls I mentor went on to train as a nurse and serve their people.
But it is important that we teach them to do a better job than the current generation. Medical aid is not a business venture. It is a human right. And where there is prevalent disease, there should be access to relevant and thorough diagnosis and treatment. That means, as with a friend’s husband, malaria shouldn’t be a death sentence simply because we don’t have sophisticated or efficient enough systems to diagnose and treat it. And when we test for HIV, we should test for all other STIs besides. Because, though we may be preventing the spread of some cells, we are letting others slip through the net. And when it comes to medical care, nothing should slip through the net.
Follow Georgina on Twitter @Georgina_KateA