Dr Clement Diarga Basse is a clinician and deputy head of Senegal’s Ziguinchor region health district. In February, Dr Basse attended the first of 18 RCP/West African College of Physicians clinical training courses aimed at increasing access to highly trained physicians in West Africa.
In this short interview, part of our 'Voices on the ground' series, he gives an insight into the Senegalese health system and shares his hopes for the future.
What are the three most important improvements in healthcare that have occurred in Senegal in the past 10 years?
I think the introduction of rapid diagnostics for the detection of malaria has been incredibly important. When I first started practicing medicine, we mainly based a diagnosis of malaria on clinical symptoms. Following the government’s introduction of free rapid diagnostics, we found that sometimes we had been diagnosing patients with malaria when in fact it wasn’t malaria at all. The ability to quickly rule malaria out has been really helpful for us in treating patients.
Secondly, the decentralisation of treatment for HIV and TB patients. At the beginning, every patient that was diagnosed with HIV or TB had to go to the capital, Dakar. The government then decentralised care for these patients and gave all district hospitals the authority and the drugs they needed, and importantly, training for all the nurses. In the district I work in, there are three nurses that have been trained following the decentralisation, and people now know that they can go somewhere nearby to receive the treatment they need. It’s playing a big part in improving the health of local communities.
The third point is something that’s recent and new - the government’s universal health coverage system that enables all children under the age of 5 to receive medical care free of charge. This is working very well and will help reduce the high mortality rate of children under 5.
What barriers do you see to further improving healthcare in Senegal?
The main challenges are that the country does not have enough doctors for its population, and that almost all the doctors we have are based in Dakar.
Some of the population based in the more remote areas have limited access to a doctor. Often there is only one doctor working in an area and they may have family in the capital or elsewhere and have to attend training or workshops in the capital so they’re not always in the area they work in. There needs to be more done to encourage doctors to work outside the capital.
Second, I feel the way that health workers are treating patients is a growing problem. Often, I’m told that patients don’t want to go to hospital because they do not feel welcome there, which is obviously a big problem.
A simple example: A pregnant woman needs to have antenatal care and the WHO recommendations say that the woman should have at least 4 appointments before giving birth. If the woman is not treated well by the midwife on the first visit, then they will not attend the second or third appointment. This means that if there’s a problem towards the end of the pregnancy it will not be picked up, and this is a major cause of mortality for the mother or child. The way we are treating patients is therefore directly related to the health of the community.
What’s the most rewarding aspect of your role?
For me it’s the recognition from patients that you are doing your best for them.
I’m not working in private practice so the financial conditions can be difficult but I get my satisfaction from the way patients respond to treatment and the way they talk to me. That is enough for me.