The Gambia 2- Medical Facilities Banjul/Fajara

Our first introduction to the Gambian health care system was at the infamous Medical Research Unit (MRC). We heard much about this facility during our course, with much of the British research in west Africa coming from their facilities. In addition to research they provided limited health care to the local Gambian and toubabs. The service consists of a triage system, an outpatient facility and small impatient hospital. They take the first 250 presenting patients and provide service and medications for free. If you are a patient in a trial you and your family receive 24/7 access (mmmmm). We had the opportunity to see the triage system being performed by skilled nurses, 200 patients in a few hours between 3 nurses!

We visit 3 government health facilities including the Royal Victoria Hospital (RVH). This was an interesting visit where we split into two groups and saw the pediatric and adult wards. The place seem crowded even though it was the quiet/dry season. The doctors were predominately Cuban with a few Brits and other nationalities. The presentations in the kids ward mainly consisted of anemia, pneumonia and malnutrition with a few more exotic cases such as Burkett’s lymphoma. The services were limited and management seemed to be a process of elimination with treatment rather investigations at times. But despite this it was amazing what you can do with very little.

Campala was an experience. We were pepped up about this since leaving the UK. The facilities used use to be an old prison and in the 20 years it been used I am not sure if things have changed. The patients are there on a voluntary or involuntary basis and are provided with food, water and medications. But the are bars on windows, a certain smell on the air and the place was desperate. If we can’t fund psychic iatric services adequately in the west I guess you can imagine the budget in the Gambia.

TB Sanatoriuam was situated out the outskirts of town next to the prison and a burning waste dump?! It is used for non-responders mainly for compliance reasons. They are given the choice of going to this facilities or the one next door, all chose the sanitarium!. We were first shown the old facilities and the new ones which was a marked improvement. They had first line treatment and second line treatment available and access to sensitivity testing.

We also visited the headquarters of the Center for Initive Against Malaira (CIAM). These wer nice airconditioned, powerpoint equiped with coffee and biscuits for morning tea (thanks to Bill and Milinda!). They fosucs on the disemination of health messages through radio, plays and TV. But now the funding has ceased they are deperately seeking support to continue their good work.