By: Raphaël Rivière
My name is Raphaël Rivière and I am a fourth-year medical student at uOttawa , and the 2018 recipient of the DFM Global Health Travel Bursary. I recently did a month-long global health elective in Bénin, a francophone country in West Africa. I rotated for two weeks through two urban hospitals in the capital, Cotonou, spent one week in a remote village with a big team of medical personnel, and an additional week in a suburban hospital in Zinvié, founded by private missionaries. Most of my time was spent in anesthesiology, critical care and emergency medicine.
Overall, I am very glad I went to Bénin. I learned an immense amount about the discrepancy between our health system, culture, and epidemiology of disease. It made me very grateful to have what we have in place: it may not be perfect, but it is something worth preserving and perfecting. In Bénin, most patients pay for everything, including the syringe and needle used to deliver their drugs. Here in Canada, that is definitely not the case, and I do not feel like we (both healthcare providers and recipients) fully appreciate the blessings of social medicine. It has given me renewed optimism of how far we have come, and what more we can achieve.
During my third week, we went to Colli, a village 20 minutes by car from Allada. We set up our own clinic with the limited equipment we had. We saw more than 1000 patients over the five days. It felt rewarding to be able to diagnose and treat so many children for malaria. Other common complaints included osteoarthritis, parasites, STIs, ‘sexual fatigue’, haemorrhoids, and cataracts. Overall, given our limited resources and sometimes very sick patients, the entire experience certainly consisted of a lot of ethical dilemmas and difficult decisions. Many times, we had to rely on clinical instinct. We had no laboratory or radiological investigations we could perform to corroborate our clinical impressions. We had algorithms we could follow to address generic complaints but it always felt like we could do more. In reality, the circumstances were very different. The infrastructure to provide the comprehensive care we have in the West simply was not available. In many of their eyes, it seemed as though we were a dispensary of medications and this was their chance to get some for a reduced cost. We were happy to provide the medications, especially to the children, pregnant women and elderly, who we knew we could more tangibly support by treating their malaria, providing prenatal medications, or pain relief for osteoarthritis. It was more care than many of these people could afford. This was the best we could do within our time and scope. It was difficult to know that some of these patients had cataracts or other diseases that required surgery, sooner rather than later.
Regarding technical skills, through my ICU and anesthesia electives, I had the chance to practice my IVs as well as neuraxial anesthesia. I was offered the privilege of naming a baby of a mother undergoing a C-section following a spinal I performed. In Cotonou, I had the chance to resuscitate a 30-week neonate born to an eclamptic mother. It was a great experience for me to be able to put into practice what I learned during my NRP training by one of my mentors, Dr. Patricia Moussette, a Family Practice Anesthetist in Winchester.
My trip to Bénin has also opened up a new world for me: Africa. I have always been curious about the continent, and although being to one country certainly does not mean I have an appreciation for the entire continent, it has opened up a door for me to explore it, both through a cultural and health systems perspective. There is so much more we can do for healthcare. Aside from the huge gaps in infrastructure and funding to create advanced healthcare facilities, the very basics, such as trained personnel, are also missing. There have been many moments where I have seen personnel with adequate equipment, but without knowledge of how to use it. The reverse has also been true. One can then presume that these same people would likely lose their technical skills over time even if they had prior training, should they continue to practice in an environment where they are unable to utilize these skills. Very basic things like oximeters, blood pressure cuffs, clean temperature probes and ECG lead stickers were a rarity, even in acute care settings. Many resource interventions could make a huge difference for very little cost. Clearly, I am not the first one to have identified this, however, seeing it upfront has given me a much better understanding of just how large the discrepancy is and how very little could go a long way. I am actively thinking now, how I could tailor my career to have an impact on health systems in resource-poor settings? There is a great deal we need to do for this world, both at home and abroad, and this experience has helped me recognize that with more clarity than ever before.