Negotiations in the Ministry, crisis talks in the national office of the World Health Organization (WHO), control visit of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), discussions with a prospective donor, exchange of experience in the German Embassy: every 20 minutes the telephone rings, somebody needs some help or advice – quite a normal day for Franz Wiedemann, the Representative of the German Leprosy and TB Relief Association (DAHW) in Togo.
At the same time, Issoyo Touakawa, Health Control Officer from Sotouboua, is on his way to Tindjassé and Tchatchako in the North of the country. The distance between the capital Lomé and these remote places is “only” 350 km, but the trip takes two days. Streets which are worthy of the name hardly exist in Togo. The gravel roads and cart tracks are very difficult to pass by car and they are completely impassable in the rainy season. But Touakawa is travelling by cross-country motorcycle and on his way he is testing the new model for the mobile health services.
DAHW Representative Wiedemann’s telephone is ringing once more: Health Control Officer Touakawa informs him that in all probability he will still arrive today. The new motorcycle is more reliable and so is shortening travel time. Wiedemann is pleased about this news; “I want to do everything I can to ensure that everything is functioning in the field so that our doctors, nurses and medical assistants can take as much care as possible of the patients.”
Thus he is also away from Lomé, “At least every second week I have to go to the field. I do not want to lose contact and our partners in the field must feel that they are important to us.” Above all, however, he wants to see the work which can be done thanks to donations from Germany – and a bit of control can’t be harmful.
His way leads him to Atchanvé approximately 40 km distant – around three hours in the off-road car. Health Control Officer Kome Hegnion and a colleague are waiting for him. With their motorcycles they needed only half of the time. “Sometimes I am even forced to stop for days,” Hegnion reports almost wearily, „The motorcycle is no cross-country motorcycle and more than 10 years old, therefore there have been more breakdowns recently.”
Today, however, he is in good time for the screening campaign in the school of Mimivakpo which is situated in a river area. He received a friendly welcome from the village elders – it is very seldom that they get to welcome medical doctors in their village. That is why they have seen many of their neighbours die: children in the first years of their lives, mothers after having given birth, or people of every age who have died of diseases which would have been easy to treat.
But there is no doctor in the village and to travel to the next hospital is expensive and time-consuming. Certainly, there is a Government Health Post in the vicinity which cares for the health problems of the people as well as possible, but there is a permanent lack of materials and drugs. So the average life expectancy in Togo is only 58 years; in the remote villages in the countryside it is much lower.
Through its commitment DAHW tries to fight these dangerous problems: 35 health workers go to the most remote regions. With their motorcycles they are able to reach every village to examine and treat the people there. This is made possible through a programme against the diseases of leprosy, tuberculosis and Buruli ulcer which is run by DAHW together with the Government services.
“It is not easy, it needs good staff, means of transport and good connections with the people in the health system. But we are making progress,” DAHW Representative Wiedemann tells us and he is not only talking about the journey to the remote village: “There was so much resistance, because here we lack so many basic things, which Europeans take for granted.” A special problem here is the lack of medical doctors. “For example in France there are more doctors and nurses from Togo than here in the country itself. Drugs are relatively expensive and hardly available in the countryside, and even the most basic food stuffs have become rare and expensive over the past few years.”
In Togo there is one doctor per 8,000 inhabitants – in Germany there are 30 times more doctors. The prices for basic food stuffs such as potatoes, rice or beans have almost tripled in the past two years: one and a half kilos of corn cost 53 cents in 2007. Today, in May 2009, it costs almost 1.50 Euros. And the price for a litre of peanut oil has increased from 65 cents to 1.50 Euros in the same period. Although the harvest was good this year, the prices for food have hardly decreased. And despite the high prices the farmers do not get more money for their products.
The higher prices do not only lead to malnourishment and, as a consequence, to more diseases among the poor people. They also make it more difficult to keep qualified medical experts in Togo: the salaries have not been increased for years. If a nurse in Togo wants to buy one litre of milk, she has to work for almost four days – in Germany or France it takes only six minutes. “How could I blame someone for accepting an offer from one of the rich countries? At the end of the day, all people want a better life for themselves and their family,” Wiedemann says. “I am all the more pleased about everybody who does stay here in their place of birth, convinced of the necessity of fighting diseases of poverty with us.”
It has never occurred to Franz Wiedemann to give up. On the contrary: “We have had a leprosy and tuberculosis programme for many years. Last year the new treatment centre for Buruli ulcer was opened by the German Minister of Foreign Affairs Frank-Walter Steinmeier. And now we want to make it accessible to as many people as possible.” The mobile health services will be vital to achieving this aim – it will enable poor people from remote places, away from paved roads, to have access to medical treatment for the first time.
He has hardly finished saying this and he already is on his way back to Lomé again. He is bringing two children from the village to the new hospital in Tsevié – they are suspected of having been infected by Buruli ulcer. They will be examined thoroughly in Tsevié. Without the mobile health services, these children would have become crippled and their paralysed limbs would have become a “burden” for their families one day - unfortunately rather common in one of the poorest countries in the world. But the 48-year-old development worker does not want to think about this now, at this very moment when he is bringing the children for the treatment that will save them.
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