Rural Health Team

Rural health team

In the Dhofar area o'f Omari, every effort is being made to recruit bright youngsters with some schooling behind them who, after basic training, can return to their own villages as primary health workers

by Lies I G raz

Jibjaat, in the Qarra Moun more serious disease, with tuberculosis tant before being sent out on their own. tains of Southern Oman. leading the field. They are then carefully monitored by the There is cloud cover on the In Jibjaat, as in two dozen other clinics mobile teams as they visit the villages. mountains this end-of-man scattered over the southern Dhofar area The plan for the future is for the best of soon morning and the pilot of the Sultanate of Oman, there is a resi the health assistants to be sent on for fur of our little six-passenger Defender has a dent primary health worker on the spot, ther training, to the Sudan, for example. bit of trouble finding the airstrip, barely dispensing simple medicines, dressing Some clinics come to life only when 300 yards long on the top of the high wounds, following up his flock. Some of the mobile team arrives. They may be in plateau. But by the time we land, the air these health assistants are expatriates; as such out-of-the-way places that even for craft engines have been heard and the often as possible they are Omanis. De the dedicated members of the RHS staff, pick-up truck is there, waiting to take the spite the difficulties in an area where a some of whom live in extraordinarily dif Rural Health Service team into "town". decade ago not even primary schools ficult conditions, life there is untenable ; Town means a mosque, a school and a existed, every effort is being made to others may serve only a very small, rural clinic- all built since 1976- and a recruit bright youngsters with some scattered population. few score of round, stone-built houses, schooling behind them who, after a basic hacked out of the windswept hills. Every training course, can return to their own The desert blooms week the RHS team sweeps in from the villages as primary health workers. One such is Khahil, over 250 kilome sky and the roar of the plane is enough to The RHS runs its own four-month tres from the regional capital, Salalah, bring some 50 people to the clinic. Lots course, and the new graduates serve an on the desert's rim. There is no town, of simple aches and pains, but also much internship with a qualified health assis- only a small water-hole that the nomadic

22 . Case~finding and follow-up- essential steps in the camp was some distance away. assistant; a third was expected to arrive tuberculosis control for Oman 's Rural Health Doctor and nurses piled out again and shortly. One of the doctors usually Service team- present their own problems in held their surgery on the spot, men on remains in the office-cum-consulting the dark stone houses of Dhofar. the right and women in the shade of room in Salalah to deal with the steady (Photo L. Graz ©) the wing. stream of patients coming to the central Whenever possible, the mobile teams out-patient department. The director is bedu know well , no road, no track. The go by Land Rover, and four out of five also responsible for administering what one-room clinic is the only building. On are in the field every day. A team con is, in fact, an integrated service with re Thursday, when the RHS team comes in, sists, ideally, of a doctor plus two fully sponsibility for the health of the whole the effect is rather like that of winter rain qualified nurses, one male and one population outside the town of Salalah. in the desert: a sudden blooming-'-in this female, . working closely with the local Every morning at 7.15 the mobile case, of human beings. The day I was health assistant when there is one. There teams leave the RHS office. Before that there with the team, our stop in Khahil is also a driver and, in the mountains, the team leader and the second nurse will was short. There were some 20 patients usually an interpreter; the Jabali moun have prepared the bags and boxes of to be seen and little time for small talk tain tribes speak a Himyaritic language medicines and instruments, as well as the air charter time is expensive. Then, as we related to Amharic, not Arabic. That is records that cover the region to be vis were already in the plane ready for the ideal, but in reality the ideal is rarely ited. Before they return, between 2 and 4 takeoff, two shiny new pickup trucks attained. At the time of my visit there in the afternoon or sometimes later, they (the modern bedus' camels) came roaring were only two qualified doctors in the will have stopped at least three or four up to the strip. We had been spotted, but RHS, the director and a French medical times. And there is no break for lunch.

23 Sometimes the "consulting room" is Omani villages where the bedu come to another woman), but the doctor can simply a cluster of mats spread out under down to the sea to fetch the sardines only place his stethoscope by blind feel, a tree; sometimes nothing more than which they feed to their camels- it has behind an extra screen formed by the the fugitive shade of the Land Rover. very little to do with the procedures head-cloth. The face masks are intimi Bronchitis, extraordinarily prevalent taught iQ modern medical or nursing dating for conversation, with their dark . in the dank, stone-built houses of the schools. The health assistant here had his indigo surface only relieved by two mountains, has to be distinguished from two rooms spick and span, his stock of almond-shaped slits for the eyes. They something more serious ; pains, every basic medicines carefully lined up on the also make it difficult to identify the where, have to be sorted out. Every new shelves. That day the RHS director, patients, who sometimes become indig born baby that the local health worker or Dr Asif Ali al-Mansuri, was with the nant when doctor or nurse cannot the travelling team hears of is given BCG team. While the two nurses and the remember them from the last visit. vaccination against tuberculosis. Im health assistant were screening the crowd There are approximately 750 active munizations are arranged. "Next week" , in the outer room, he concentrated on cases of tuberculosis among the rural the team leader will say to the village the TB patients in the inner room where population of Dhofar, according to head man,l " have all the children here there was an examining table. At first he Dr Asif (who himself hails from Pakis when we come." And usually he can rely tried to have one patient in at a time, tan). Of these, 180 are now under treat on them being there. When medicines are together with perhaps a single family ment and about 500 are registered or dispensed, the doses are marked by one member. Imperceptibly, the room filled known, while more than 300 cases have stroke for each pill so many times a day. up until there was no more room to turn. been considered cured during the three Thus II I I I I means 2 tablets, 3 times a Everyone was ushered out, and the scene years that the RHS has been working. day. Liquids, cough syrups for instance, began all over again. One of the chief jobs of the mobile have so many spoons drawn on them and The men cheerfully remove their dish teams is the painstaking follow-up of a plastic spoon is given along with each dashas (the long Arab shirts), keeping T13 patients. bottle. only their underskirts. With the women, Follow-up, which requires record Examining patients is not a simple things are more difficult. Not only will keeping, is no mean task. All the patients matter. Even in the most favourable set they not remove their face masks (some themselves know is their name: they tings such as the rural health centre times they will lift them to show a sore have no idea of age, and even the names m Suqrah- one of those remarkable throat, for example, but preferably only are confusing when almost every man is

24 Rural health team

Left: Even though air charter time is expensive, the helicopter enables the medical personnel of the Rural Health Service to reach tiny settlements ofnomadsfar away on the desert's rim.

Right: The sparse shade ofa tree is all that is required to hold a "clinic". The notes carefully record ed by the male nurse will enable the team to keep a permanent check on the health of this woman and her family. (Photos L. Graz ©)

named M uhammad, Ali or Salim and fishing hamlet on the main island of the part of the Office of the Wali (Governor) there are no family names as such. The Kuria Muria archipelago, just off the of Dhofar. only way to keep things straight is to coast. Today, just four patients still come Until 1976, there was nothing here record the name, the father's name and every morning to the local clinic, where no roads, no schools, and of course no grandfather's name, plus the name of the the health assistant sees to it that they health care at all. The RHS was formally tribe- then hope for the best. Addresses take their tablets. Kuria Muria, a tiny founded in the autumn of 1977, and last are just as much of a problem : most of closed environment, is a rather special October it celebrated its birthday with a the inhabitants of Dhofar are at least example of success in the fight against TB. " picnic" attended by a good part of the semi-nomadic, so each patient is listed Now that tuberculosis is considered to local population. with one principal and two or three sub be at least " under control", the same The RHS is, on paper, not an inexpen sidiary " residences". Since there is usual case-finding and follow-up methods are sive service to run. Its total personnel ly a roughly fixed annual circuit, eventu being extended to other chronic diseases. roster, from the local health workers in ally patients should be trackable. All of First among them are leprosy, which the villages to the drivers and interpret this is recorded on a large blue card, with is not very common but does ex ist, ers, the nurses, the tiny administrative cross-registration in the RHS files . On ar diabetes, and a surprising number of staff and the doctors, comes to about rival in a village, the team brings out the mental disorders. It is very difficult to 100, working in an area with an estimat TB cards and asks the whereabouts of ev have the villagers attribute these to ed population of I 00,000. Transport, in ery single patient. On one card I picked anything but the actions of the jinni, the cluding air charter, costs nearly as much up at random, with 11 notations in the demons. The jinni are also held respon as salaries, and other expenses include space of one year, there were five dif sible for other illness, such as that of the the cost of medicines. But this health ser ferent place names- including an admis old man lying in a stone hut, in whom vice is probably one of the strongest ram sion to Qaboos Hospital in Salalah, fol the doctor strongly suspected advanced parts of peace in what was for long a lowed the next day by a laconic note : cancer. volatile area of the Arabian Peninsula. " discharged against medical advice". The RHS does not function in a A great deal remains to be done. If the In some villages, the incidence of TB vacuum. Interaction with other govern RHS has so far concentrated its efforts on was estimated at almost 40 per cent when ment agencies forms an integral part of the most pressing problems, it is now the RHS began working systematically ·its working method, especially with the beginning to go beyond the fire-fighting three years ago. One of these is the Civilian Aid Department (CAD), now stage. There is something touching about

Above: Another open-air clinic is improvised munity just behind the Qarra mountains, mountains meet the desert and the desert in the shade of the team's vehicle. at least half the visible stock is made up meets the sea. Left : The Rural Health Service team consists of milk powders, and the shopkeeper has A lovely girl of about 12, back home ideally of a doctor plus one female and one a big store of free sample bottles to dis after three months in Qaboos hospitals male nurse, working closely with the loci:zl tribute. Every second child suffers from where she was treated for tuberculosis, health assistant. (Photos L. Graz ©) diarrhoea and, despite the best efforts of sits there, her eyes hollow and infinitely persuasion by the health teams, the feed sad. " Have you been taking your pills ev going into a village dispensary and seeing ing bottle as a first symbol of "moder ery day, absolutely every day?" Hardly a sign " Ante-natal clinic: Wednesday" . nism" is almost impossible to root out. understanding Arabic, she just looks The women are coming in increasing The Civilian Aid Department is mak blankly: no answer. The doctor asks numbers for weighing, auscultation, the ing impressive efforts to dig wells, tap someone to fetch her parents. When the taking of blood and urine specimens springs and bring water supplies over father comes, he is given a serious talk and for reassurance. Very few women distances of several kilometres to the vil ing-to. Then the doctor sees old Salim give birth away from their homes, but a lages, or to supply water by tanker. Sani the village's prize patient. "Just look at few cases of pregnancy corn plications are tary facilities remain practically non Salim; you remember how sick he was? brought to the hospital in Salalah. Fertil existent; there are no toilets other than Now he takes his tablets every day." ity is very high ; so, still, is infant mortali the bush or the nearest dune. Fortunately, Salim, an old man by desert standards, ty. In the remotest hamlets, one can see the population is not very concentrated. beams with health. The girl's father infant feeding bottles being rolled in the For me, the spirit of the Rural Health solemnly promises that he will see to dust, played with by an older child, car Service can be summed up in a scene that it that she takes her medicine every ried around all day in the heat. In the I witnessed during a trip to the northern day too- and we all hope that Salim's general store at_ Thamrait, an oasis corn- most strip of RHS territory, where the example will suffice. •