“Apart from getting money, are we not also blessed?” [Kola on the “noble” profession of nursing]

Kola’s turns of phrase when he’s lecturing have been delighting Jo and I all day.  The title of this and the previous posts are good examples of the fervour with which he plays his role as MCAI’s on the ground neonatal trainer.  And he is not alone.  Gertrude, Agnes and Christina are equally dedicated to their patients and their unit, totally committed to the patients they look after.  And totally engaged in their roles today as instructor candidates on the Newborn Care Course.

Gertrude doing Stage 2 of the 4-stage procedure in how to tie a kalafong wrap for the baby to be skin-to-skin with its mother.
Christina overseeing resuscitation skills training.
Agnes (gesticulating with her hands) running an animated discussion workshop on pain in babies and how to manage the baby who won’t live long.

United Nations Convention on the Rights of the Child

The rights of children across the world are enshrined in the United Nations Convention on the Rights of the Child, or UNCRC, signed by all UN members except the USA.  The Convention has 54 articles that cover all aspects of a child’s life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights, whatever their ethnicity, gender, religion, language, abilities or any other status.

You can read more about it at https://www.unicef.org.uk/what-we-do/un-convention-child-rights/.

The UN rights of the child are often violated when families are in situations of conflict.  In particular articles 19 (protection from violence, abuse and neglect) and article 38 (war and armed conflicts) from the UN Convention, are relevant in this regard.

Over the last 2 years, while NICHE has been working in Cameroon, West Africa, we have seen how civil unrest there has affected patients, and indeed, hear firsthand from health professionals who continue to try to care for them.

A young doctor who attended one of our Newborn Care training courses earlier this year in Cameroon, has recently written about the direct effects on children’s health that she has witnessed.

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Over the past three years, the English-speaking North West and South West Regions of Cameroon have been affected by civil unrest.  Since the crisis started in October 2016 following a strike action by teacher and lawyer unions, it has escalated to an armed conflict. There has been heavy military deployment to the regions and violent attacks by the opposing forces in urban and rural areas, leading to disruption of activities in communities, displacement from homes, and loss of property and lives. Education, business and healthcare are some of the most directly hit activities in the different communities affected by the conflict. Its adverse effects are numerous, including difficulty in providing and accessing proper health care facilities, causing diseases, which had been under control, to regain grounds, become virulent and lead to increasing levels of disability and death.

Working in the Pediatric Unit of the Bamenda Regional Hospital over the past months, we have witnessed this centre, which is the only very accessible reference centre of the North West Region, struggle to manage the current challenges despite the continuing conflict. We have seen a rise in the severity of epidemic diseases like Malaria and Dysenteric illnesses, seen by the 198 cases of malaria treated from January to August 2019 as to the 168 treated in the same duration in 2018. In 2018 alone, 119 cases of meningitis were managed in our health facility.  Added to these, are diseases which are now poorly managed due to lack of health facilities and personnel in the surrounding villages, notably Tuberculosis, HIV/AIDS, Sickle cell Disease, Pneumonia, and  Severe Malnutrition.

Children are the most affected, with two out of every five inhabitants of our Region being under the age of 15 years old. As the conflict continues, access to hospitals and other health centres from surrounding villages remains very difficult for these populations notably the children. By the time they successfully arrive at facilities like ours, it is either too late and they expire, or they end up disabled.

The lack of adequate health infrastructure and personnel especially in the periphery of Bamenda and surrounding villages has also adversely affected vaccination coverage for children in these areas. We are therefore exposed to a high risk that vaccine-preventable diseases may resurface, with catastrophic effects on the children. We have unfortunately had cases of children as old as 1 year who haven’t received any vaccines since they were born in the bushes to displaced mothers.

On a final note, we have been witnessing an alarming rise in cases of sexual abuse on children. The numbers are on the rise, thereby increasing the risk of sexually transmitted disease infections as well as additional psychological trauma, which would both have disastrous consequences.

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The current crisis in Cameroon is complicated.  Good resources to look at if you want to know the timeline of the conflict are:

https://africanarguments.org/2019/08/13/cameroon-crisis-three-deepening-divides/ and

https://www.bbc.co.uk/news/av/world-africa-44459488/cameroon-crisis-explained which has links to up to date information like the recent release of the opposition leader from prison and the current peace plan.

Childhood mortality in Liberia

I’ve been thinking about what I wrote yesterday about the drop in percentage of population who are over 15 compared to the under 15s.  Liberia has a very high under 5s mortality rate and it is probably that that skews the chart so heavily.  In the UK, our under 5s mortality rate (expressed as the number of children under 5 dying per 1000 live births) is very similar to our infant mortality rate (number of under 1s dying per 1000 live births).  ie. if you survive till your first birthday in the UK, the likelihood is that you will survive till your 5th.  Not so in countries like Liberia and Cameroon.  Take a look at the table below (2017 data from UNICEF).  All forms of childhood mortality are expressed as the number dying per 1000 live births:

COUNTRY NEONATAL MORTALITY
INFANT MORTALITY  

UNDER 5 MORTALITY

 

UK 2.6 3.7 4.3
CAMEROON 25.5 55.1 84
LIBERIA 25.1 55.9 74.7

 

Many children die between the ages of 1 and 5 in low income (eg. Liberia) and lower middle income (eg. Cameroon) countries (World Bank classification according to GNI (more on this tomorrow I think)).  Actually, according to UNICEF statistics (https://www.unicef.org/liberia/children.html), Liberia has done rather well recently in reducing under-five child deaths, from 241 to 78 per 1,000 live births between 1990 and 2011.  This is great but still means there’s a long way to go before the UN’s sustainable development goal (SDG) of 25 per 1,000 by 2030 is achieved (https://www.un.org/sustainabledevelopment/health/). 

The SDG neonatal mortality goal which is what NICHE International is all about is “at least as low as 12 per 1,000 live births” worldwide.  Take a look at my table above again.  We have some work to do.