Challenge of typhoid in Benin
By Sister Nkeiru Edochie
It was January and an epidemic of typhoid had us run off our feet. People were dying in great numbers in the Republic of Benin. Our little health centre is not adequately equipped to handle a crisis of this nature, but in the spirit of MMM we stretched beyond our limitations and reached out to as many people as we could.
The Ministry of Health mandated the use of a drug called ciprofloxacine to fight the epidemic, but this was an expensive antibiotic, well beyond the resources of most people.
Monique, aged eight, from our village of Zaffé, was brought to us by her stepmother. She was feverish, weak and dehydrated. We suspected she had typhoid fever and commenced supportive treatment. The only laboratory that could confirm the diagnosis was 30 km away.
We asked the stepmother to go away and buy ciprofloxacine and we kept Monique for observation all day, but because ours is not a bedded health centre, we had to let her go home in the evening.
The next day was Friday. Monique was a little better, but the drug had not been purchased. Her father was away farming and there was no money at home. On Friday evening she went home again.
On Monday, both parents arrived with Monique at 9 a.m. Still no drug had been bought. The little girl was in a bad state, bent over double in pain, dehydrated, very febrile and looking really miserable. She now had a typhoid intestinal perforation, one of the dreaded complications of this deadly disease. She had to be got to hospital.
We drove her the 24 km to the referral hospital in Dassa- Zoumé, but they could not accept her because the surgeon was away. We continued another 30 km to the hospital in Savalou. Again they would not accept her because their surgical wards were full to overflowing. At least one in three were cases of complications from typhoid.
It would be a 4 1/2 hour journey to the bigger hospital. At this, the parents despaired. They said they would prefer to take her home and treat her with traditional medicine. By now we did not think that Monique would even survive the journey home.
We managed to see the Medical Director who was very understanding. He put her in a non-surgical ward under the care of the surgeons.
Nine days later Monique came home to Zaffé. Only later did we realise that her parents had taken her home without waiting for her to be discharged. They had run out of funds and saw that Monique was no longer in a critical condition.
We encouraged them to return, but they were not keen. They tried the traditional method, but Monique only got worse. We visited her home regularly. She was very emaciated and could neither sit nor stand. We feared she would die and continued to try to persuade her parents to return to hospital with her. In the end they gave in.
It was a busy morning for us in the Health Centre a few weeks later when Monique walked in with her parents, carrying a bag of yams to say ‘thank you’! All the staff were very excited and hugged her when she made her speech thanking us for keeping her alive. We then discovered that Monique had never been to school because her parents did not have the funds to pay her school fees. Friends of our have now accepted to sponsor her through primary school. She is looking forward now to this new opportunity in her life.