A Typical Day at the Tallinding Children’s Health Centre – TCHC
The gates are opened every morning at 6 am by Mr Ibrima Badjie, the caretaker. Patients arrive between 6-8 a.m. and many will have travelled quite some distance. Remember, The Gambia is not blessed with many such centres available to the general public. In the municipality of Kanifing, where the Centre is located, there are 7or 8 such centres and they are serving the largest population of any of the administrative districts in The Gambia. Numbers increase significantly during the malaria season June to September. This is when the medicine bill shoots up.
Once the patients are in the Centre, they are issued with a ticket by Mr. Ibrima BADJIE. He organises the queues and the waiting room – not an easy task. He gives out tickets as and when people arrive and in that order they go to Reception where Mariama KAMBI, the receptionist, writes down details of each patient in the Register….Name, Age, Fee to pay and time of registration. At this point any fees are paid. A green card with these details is also filled in and this is dispatched to the nurse. Then the patients have to sit and wait their turn until they are called by Mr Badjie….an important man Mr Ibrima Badjie.
The consultation with the nurse is charged at 50 dalasi (£1) but children 1-5 pay only 10 dalasi (20p) and 0-1 go free. This means that children are heavily subsidised as these fees do not cover costs. The nurse asks a series of questions for 5-10 minutes to identify symptoms and if appropriate, to take samples for testing. There is a flat rate charge for tests – 50 dalasi (£1). The patient then has another wait for the results. If malaria is the diagnosis, the standard treatment is Paracetemol -24 dalasi for 10 tablets (50p), Multivite – 180 dalasi (£3.75), Vitamin Beco 180 dil (£3.75) and the key malaria medicine, Coartem which costs 300 dalasi (£6) per treatment per adult and 150 dalasi (£3) per child).The other common illnesses are worms that often runs in tandem with malaria, and diarrhoea, treated with oral rehydration salts. The medicine required for both adults and children is Mebendazole. The Centre can issue all of these medicines but not Coartem. This must be bought at the state pharmacies so the Centre can only write a prescription. At this point, the nurse will write down the medicinal information down on a clinic form. The patient hands this in to pharmacy through a shutter in the wall in the waiting room. Then the patient sits down and waits… again for the pharmacy team to dispense the medicine.
In theory the whole process should break down as:
- Diagnosis with nurse – 10 minutes
- Test process – 10 minutes
- Test results with nurse – 5 minutes
- Wait for medicines from Pharmacy – 5 minutes …..
But what should be a 35 minute process often turns out to be a lot longer! It is not a happy sight to witness a waiting room of mothers and children sitting around in the Gambian heat. Everyone has a drawn expression and lifeless eyes. Malaria is truly life sapping and energy seems to desert the human body. The most striking sensation is the silence. Despite the number of people and particularly children, there is little noise in the heated rooms. People are sapped of all energy.
When we visited in November 2016 we took some random dates from the reception register and the numbers were:
- 27/11/2014 = 85 27/11/2015 =79 15/09/2016 = 109
- 28/11/2014 = 74 28/11/2015 = 59 19/09/2016 = 125
- 01/12/2014 = 113 01/12/2015 = 54 28/09/2016 = 96
You can see how referrals fall away as the rainy season ends