Back from our weekend away, we were finished with our internship at the hospital in Boko and the next two weeks was our internship at the local health centres in Parakou. The first week we were at the centre in Ganou, a neighbourhood on the edge of Parakou in the north. The second week we were at the centre in Madina, a neighbourhood in the centre of the city.

The idea was to see how a centre on the “periphery” of the city functioned compared to one in the centre, and of course both in comparison to the hospital. In general, we found that the health centres functioned a lot like a miniature hospital. They had general consultations, a maternity ward with birthing centre and pre- and post-natal consultations, and a vaccination centre. The birthing centre was only for straightforward, natural births. Anything more complicated and the mothers would be sent to the hospital.

The vaccination centre

The vaccination centre is where we tended to start most of our days, because it is during these visits that other aspects of a child’s growth is also being checked. The mothers as a group receive an educational talk prior to the vaccines starting which focuses on proper nutrition for the age group that is being handled that day. In Ganou they also spoke about proper hygiene especially around the still present threat of Covid, as well as the importance of keeping an eye out in their neighbourhood for signs of children with polio. If a child comes in with polio, the treatment is free, and everyone is urged to report if they notice a suspected case in their community.

Starting from the vaccines at 6 weeks old, the children are also weighed before receiving the vaccine, so that the health care workers can keep track of their growth on the growth charts in each child’s file. In Madina they also measured the height/length of the children as well as used the armband measurement for children over 6 months to check for malnutrition. If any child was found to not be progressing in a positive way, the mother was pulled aside to receive nutritional advice from one of the health care workers. In general, both centres worked mainly with the UNICEF provided nutritional guideline books, using the images from this book to communicate the key takeaways to the mothers.

From 6 months old, the children also start receiving vitamin A supplements when they come in for their vaccines and weigh-ins, and they also receive a prescription for an iron supplement to be taken daily.

During these visits, the health care workers are also doing other tasks, such as checking for a tongue tie, and if necessary, snipping the tissue to free up the tongue and improve breastfeeding success. If requested, they will also pierce the newborn’s ears – a very common occurrence here. Most baby girls have their ears pierced within the first hour after being born!

The big difference between the two health centres was that in Ganou, all the vaccinations happened in a consultation room, so the mothers wait outside in an open area until they were called. It took a long time to get prepared to start receiving the children, but once they began there was certain amount of order to it all. In Madina, they used a large gazebo in the middle of the campus, where it was much more difficult to control the flow of people, so it felt very chaotic and at times overwhelming. The number of children received at each centre each day seemed quite similar to each other.

Consultations

Depending on the time we finished up with vaccinations, we would then head to the pre-natal consultations to follow with the midwives the sessions there. These were very similar to what we experienced working at the hospital. In Ganou, the women came into the consultation room one at a time, and you had the sense that they could ask questions if they were concerned about anything. In Madina, there were two examination tables next to each other (with privacy screens), where the midwife moved quickly between one and the other. We didn’t get the sense that the women had a lot of opportunity to ask questions, unless they really pushed and took the initiative to do so.

In Madina they also provided consultations about family planning, which in this case meant a consult on the best type of birth control the woman should use. Most of the woman we saw coming for these appointments already had a child or two and were looking for birth control in order to avoid falling pregnant again too soon. We saw two women fitted with the implant in their arm that provides contraception for up to 5 years.

We also followed the general consultations a few times. As the high season for malaria is slowly approaching, most of the patients we followed there were ill and were tested for malaria. When children were coming in for a consult there was then also a check to see whether or not the child was malnourished.

Enjoying some downtime

To finish off our weeks at the health centre, we headed out for our first restaurant meal in Parakou – more than a month into our stay here! We headed to Dody’s, well known among the expat crowd for its more European menu and indulged in some cheeseburgers to end the week. Then it was off to the Hotel Les Routieres for a few hours relaxing by the pool. Just the break that we needed after a long, hot week. It was also the prefect opportunity to introduce the newest intern in Parakou, Svea, to the life here. She arrived in the middle of March for an internship with the Foundation as well, although she is focusing on the agricultural businesses that the organisation is involved in. She’s living with us at the hospital in Boko, until at least the end of our stay here in Benin.