The public health tragedy

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By Modou Lamin Jammeh
BSc Public & Environmental Health
Student University of The Gambia

With a heart full of sorrow – over the melancholic realities that have beclouded The Gambia – what I will coyly consider as a public health tragedy, I write in respect to the above caption. Excuse my impertinence for not extending my solemn greetings, perhaps I have been quickly consumed by my emotions already.

Sir, it is approximately four months since you left the shores of The Gambia for your pursuit of a master’s degree in Public Health, however, forgive my curiosity, I bet you have not heard any rumor of a looming sit-down strike by the Public Health Cadre at the time of your departure? If otherwise, well, I suppose the media have already transmitted the news for your consideration. Has it ever occurred to you that one day, the Public Health Officers will grow nerves to press the strike button – that’s too bold of them? All along, my conviction has always been that, they are too timid or shy to sound their voices. 

One would ask why do I even hold such a quasi-disrespectful opinion of these revered and well-mannered lads in the field. It is nothing bizarre of course, I guess I am just exercising my right to freedom of opinion


(whatever that means). But I can’t seem to find a reference point to hold a firm grasp on the issue, suffice to say that the Public Health cadre have never ever in their history gone for a strike. Well maybe! I have not searched enough.

Enough of the trolling I guess, now adays in this country everyone is angry, is it due to the high cost of living, unemployment, politics, diet, climatic conditions, anyways I can only guess – I have not read any empirical research published on it yet. Public Health Tragedy – sounds weird right? Well, I can’t find a better title. Maybe the succeeding paragraphs will qualify what that means and entails.

Firstly sir, I have observed inequalities in pay and treatment among healthcare workers; there is a huge disparity and a disproportionate distribution of healthcare resources. While each of the cadre in the healthcare domain represents a strand in the healthcare web, the respective cadres are unequally treated – attaching unequal values to them. We cannot lose sight of the fact that the ultimate goal of all these cadres is to build a healthy population while keeping all other health determinants intact. Well, how they achieve this goal may grossly differ. Now, you will agree with me that you cannot achieve the “healthy population goal” in light of a conspicuous marginalization or discrimination of a particular cadre – it would just be a strenuous and wasteful exercise in futility. 

This inequality has led to the diminishing of quality healthcare service delivery. Most often than not, consumers would express dissatisfaction over these poor services. Who is to be blamed? I supposed in Ghana, such partial treatments are rare – non-existing will be so impeccable of them. Healthcare workers have a family to feed. The least they deserve is a dignified pay and a non-discriminatory treatment. Afterall, if your employees are happy, they make the job well done. Not too much to ask for, isn’t it? 

Secondly sir, the sit-down strike of the public health cadre will mean an abrupt disruption of essential health services like: immunization, surveillance (at points of entry, community, health facilities), inspection, birth and death registrations, antenatal services, treks, health education and promotion activities, food handlers and clearance certifications, covid-19 testing, contact tracing, risk communication, community engagements… Any further delay in resuming work will just exacerbate the existing risk of multiple disease outbreaks or an upheaval of service utilizers. You may be aware that there is an ongoing measles outbreak in the country, given the fact that measles is highly contagious and is deadlier among the under-five populations with no existing cure, it is very unwise to allow this strike to continue. What a continuation of the strike will mean is that we are giving more room for the rate of infections to proliferate among the at-risk populations. The oldest measles patient I have encountered so far about eight weeks ago is aged 23 years. The good news is, that this patient is lucky, he cannot be reinfected as he has already been conferred with a natural immunity. But who is next?

Thirdly, moving away from the strike issue sir, we have a pervasive problem of waste management in this country – poor waste management is a recipe to the growth of communicable diseases and environmental health problems as you might already know. Who is regulating dump sites? Here, just turn right or left, you will be slapped in the face with a dump site – whether a legal or illegal one, just take notice. 

Some few weeks back, I have read a circulating online petition requesting for the relocation of the Bakoteh dump site, residents have been complaining of the smoke coming from the site which is inimical to health. The waste is just burnt as they come in. who controls the smoke? Isn’t that a call for concern? Maybe you need to know that, we have people with chronic conditions like asthma, chronic obstructive pulmonary diseases and other respiratory conditions living around that end. Aren’t their plights worrisome? It just occurred to me that I should equally inform you that the SOS Children’s Village and the clinic are right opposite the dumpsite. Drivers often complain bitterly of the smoke that makes the road misty. A lot of people have lost their lives around that end while others got disabled due to road traffic accidents. Inasmuch as the word accident and crash are interchanged, in this case, accident is more appropriate since it is inevitable in such harsh weather conditions. Speaking of accident or crashes, hmm…! that will be a subject of my subsequent writ to you.

Sir, while the above revelations may not bewilder you as much as I would want them to, it is about time the Gambian populace is awakened to see the ongoing tragedies. Public Health needs more cogent interventions to arrest the undesirable happenings. At least, the dumpsite issues, the sit-down strike, and the inequalities are major problems we should not shy away from as a country. We need a vibrant health ministry that is, first of, considerate of the plights of its staff; secondly, that will hold the bull by its horns and drag the pestilence out of them; and thirdly, that will establish and run programs that sought to systematically surmount the forementioned economic, cultural and anthropogenic barriers. Sir, I wish you well in your pursuit. And I must confess that I am a great admirer.

Best regards.