Poste de Santé Liberté 4

Interning at a health clinic in Dakar, Senegal

by Lena Stern

Background

My internship was at the fourth poste santé in the neighborhood Sicap-Liberté in the Sanitaire Ouest district of Dakar, Senegal. A poste de santé is a health clinic that offers services such as prenatal consultations, immunizations, nutritional recovery, and family planning. Within the Senegalese health system, the poste de santé is located in the peripheral level. The health system in Senegal is organized in a 3-level pyramid scheme. The first is the peripheral level, the second is the intermediate level, and the third is the central level. The central level has the ministerial departments, the university hospital centers, and the private health structures. The intermediate level includes regional social action services and regional hygiene brigades. Then, at the peripheral level at the base of the pyramid, there are the departmental social action services and the health districts in which the postes de santé (health posts), the centres de santé (health centers), and the cases de santé (health huts) are located. Some of the broader health issues that the poste de santé aims to combat include reducing malaria cases by distributing oral medication and reducing maternal mortality by seeing women throughout their pregnancies and educating them on how to take care of themselves.

A page from the Carnet de Santé de la Mere et de l'Enfant (the Notebook of the Mother and Child) which every pregnant woman who comes to the poste de santé recieves. This page shows warning signs that a pregnant woman should visit the poste de santé for help.

This image shows the organization of the Senegalese health system.

The stamps of the sage-femmes that they use for approval of documents and prescriptions.

Role of Sage-Femme

The poste de santé is particularly interesting because it is the first contact citizens have with the health structure. The poste de santé is generally managed by the sage-femme, which directly translates to a midwife, but they more often play the role of a nurse since they are not usually present during a birth. The sage-femme usually has a state diploma and uses a technical platform that allows them to provide basic care. There are multiple rooms in the poste de santé for children, vaccinations, and the general public. In the room with the sage-femmes, there are only female patients that usually request a consultation having to do with reproductive health. There are usually multiple sage-femme working together as a team with patients. Common reasons for patients to visit the sage-femmes include pregnancy check-ups, picking up birth control, or concern around irregular menstruation. Often, sage-femmes write referrals, for example an ultrasound, or prescription for medications such as Aldomet Tablets to help lower blood pressure.

The office of the sage-femme

My Experience

During my fall 2021 semester abroad in Dakar, Senegal, I worked with a sage-femme at the poste de santé. I observed a majority of the appointments, but also helped out by taking patients' blood pressure, temperature, height, and weight. Sometimes I would conduct an urinalysis or a pregnancy test. I would retrieve medications from the pharmacy or medical tools such as the blood pressure monitor from another room. I observed the sage-femme do pregnancy examinations, educate younger women on birth control options and record patient information. I experienced barriers to providing care for patients because of my lack of prior medical experience and the majority of the time conversations were in Wolof, a language I do not know well. Still, I was able to learn a lot through observations and my own data collection and analysis.

Since every patient needs to have their blood pressure taken and recorded, I thought it would be interesting to record my own data on hypertension and its prevalence in Dakar. I had read a previous study that found a high prevalence of hypertension in Dakar and a high prevalence of obesity among women–particularly among older women. The American Heart Association (AHA) defines hypertension stage 1 as blood pressure consistently ranging from 130-139 systolic. The AHA says a systolic number above 140 is considered hypertension stage 2, which is more serious. When blood pressure is higher than 180/120 mm Hg, it is considered a hypertension crisis. The sage-femme was concerned when a patient had a systolic number approaching or over 140. With this information, I was able to evaluate the data I found from taking a patient's blood pressure. This previous study found that around 25% of the women in the study had hypertension, while my findings were significantly less with 12.4% of women with hypertension.

Medical tools used for each patient by the sage-femme

Reflections

This was a very fulfilling experience where I learned more about women’s health, which is an area I would like to focus on in my career. The poste de santé is successfully run where even though it operates as a walk-in clinic, everyone gets served each day. As for my recommendations, I would say that making the check-in for appointments where patients purchase their ticket for their appointment could be in a more clear area. Often patients would enter the office of the sage-femme without a ticket and we would have to wait for them to go get it which wasted some time, especially when there were lots of other people waiting. Another recommendation is having a room with adult supervision for women to keep their children during their appointment. Women would usually bring their children to the office of the sage-femme and the child would be distracting and cause the mother stress. I would help entertain the children sometimes, but having a more permanent solution would improve the patient experience. Although this was a positive experience, I experienced challenges around patients and the sage-femme mostly speaking in Wolof, which I had only been studying for 6 weeks prior to the internship. Also, during birth control injections and implant operations I often felt ill from the sight of blood. Although this hindered me from engaging more deeply with this work, it did help to further reassure me that I should not pursue a career in medicine and instead focus on population and public health.

References

American Heart Association. Understanding Blood Pressure Readings.

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-reading

Macia, E., Gueye, L., & Duboz, P. (2016). Hypertension and Obesity in Dakar, Senegal. PloS one, 11(9), e0161544. https://doi.org/10.1371/journal.pone.0161544

Touré, F. (2014). L’accès aux soins de santé au Sénégal: étude descriptive et exploratrice. https://libstore.ugent.be/fulltxt/RUG01/002/214/028/RUG01-002214028_2015_0001_AC.pdf

Lena Stern

Hello, my name is Lena (she/her) and I am an International Studies major with a concentration in CGH and a minor in French. I was born and raised in Seattle, WA. During my time at Macalester, I ran for the cross country and track teams. After graduating, I hope to work in the field of public health and eventually get my MPH. I am interested in reproductive health, health equity, and health policy.

Image Credits:

Stratégique Santé Digitale (PSSD) 2018-2023 du Sénégal. Ministère de la Santé et de l'Action Sociale. https://www.sante.gouv.sn/sites/default/files/Plan%20Stratégique%20Santé%20Digitale%202018-2023.pdf

All other images are my own

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