IWD 2019: Advocating for better neurological care in East Africa

In the first of our International Women's Day 2019 blogs, Dr Marieke Dekker discusses her inspirations as a doctor and  what drives her as an advocate for better neurological care in East Africa. 

I was inspired by an article about Professor Fiona Wood, an Australian/British burns surgeon with six children, which made me realise I wasn’t alone in combining a large family and medicine. She cares for patients who suffer stigma due to their injuries and goes out of her way to help improve their lives. Somehow, her story stayed in the back of my mind, assuring me that I could do this. 

All six of my children had home births thanks to an amazing Dutch obstetric and midwifery system. I have been lucky with being in the right place at the right time. But the chances of an average African child making it through birth as smoothly are not the same - two thirds of my neuropediatric clinic children have cerebral palsy, three quarters of which is due to perinatal asphyxia.

In theory, much of this perinatal asphyxia is preventable damage. Every single child I treat reminds me of this. 

Who are the ones who drive me to go on with my work and to be an advocate for better neurological care? Their mothers and grandmothers. They keep inspiring and driving me. These women may be the only breadwinner, abandoned by husband or family and uninsured.

Having a disabled child often confers stigma and isolation, requiring endless endurance. We have mothers in their sixties, walking to our epilepsy clinic with their disabled, adult child in a cloth strapped across their backs. No money for wheelchairs. My colleagues and I may wait to see them until the hospital is quiet or in a back room, because there is no money for a patient file. I have deep respect for those ladies, their lifelong struggle and the loving care for their sick child.

Difficult and saddening circumstances also keep driving me to reach out to the multidisciplinary Spinal Cord Unit. It is populated by young men and women facing a life paraplegic or quadriplegic. The unit is only one of two in the Eastern African region, and we are keeping a detailed database of our patients which tells the story of Africa in a nutshell.

The main trauma mechanism for spinal cord injury is fall from tree, illustrative of how rural society still is here. When a woman falls from a tree, it often implies there is little money in the household. The daily food had to be sought on branches high above the ground, possibly in a situation where her body is already weakened by hunger.

Needless to say that these patients will be unable to pay their hospital bills, scans or a wheelchair. Our doctors bend over backwards with creative and cunning solutions to provide comprehensive and feasible care, but also to soothe the stigma that disability continues to have in the community. And every individual patient we can discharge like this feels like a victory. We make a small difference, but it matters.

Dr Marieke Dekker has worked at the Kilimanjaro Christian Medical Centre, Tanzania since 2012, training local neurologists and looking after neurological patients of all ages. Recently she was elected vice president for Eastern Africa for the African Academy of Neurology. 

This blog is part of a week-long series celebrating women in medicine and their inspirations, as part of International Women's Day.