Public Health, Public Health

Public health messages are very important here. There are billboards everywhere, and magazines devoted specifically to the subject can be found on most nurses' station desks. As you would expect, most of these messages concentrate on HIV and AIDS. My favourite billboard is a picture denoting Abstinence, Condoms and Faithfulness as "life-saving boats in an AIDS flood". Most patients are sent for VCT (voluntary testing and counselling) so that they know their status (HIV negative or positive). There are centres for male circumcision, although the message still hasn't come across that circumcision won't PREVENT HIV infection; it merely decreases the risk.

Unfortunately, with most messages concentrating on HIV, a few things have fallen by the wayside. Rubbish is everywhere. At the bus station, people will buy plastic bottles of soft drink and then throw the bottle out the window, so there is a layer of plastic over the entire area.

Basic hygiene such as handwashing, and covering one's mouth when coughing, generally does not occur. I find this especially disturbing when half the adult population is infected with TB, and my friend and I are convinced we'll have TB when we get home.

Whilst women's rights are improving, women's health is not widely promoted and I have seen two cases of advanced breast cancer so far. Both women had noticed a lump in their breast growing over about a year, and both had cancers eroding through the skin. They had huge axillary lymph nodes and one even had arm pain from brachial plexus involvement. We sent them to the surgeons who would tell them that their prognosis was not good, as both cases were beyond surgery. You might wonder how they let themselves get that far, but these women genuinely had no idea what was wrong with them.

It's hard to say whether the public health message should be broadened, or perhaps if they should try and get the HIV message across and that epidemic under control before concentrating on other health care promotions. Either way, it's opened my eyes to public health.