Providing Unique Care within the Context of Crises

By: Elvis Akomoneh
Access Care Institute

Access Care Institute provides education, research, and clinical services in the Northwest and Southwest Regions in Cameroon, primarily serving internally displaced persons due to the seven-year long armed conflict in the region. The conflict began in November 2016 as an explosion of a long-term marginalization of citizens of the former British colony (English-speaking Cameroonians). It started as a civil protest by the English-speaking minority (Northwest and Southwest Regions) seeking greater representation in the predominantly French-cultured country. The protest quickly deteriorated into an armed conflict with young men, infamously referred to as separatist fighters seeking for a separate state called Ambazonia, taking up arms against government forces. The separatists instituted lockdowns taking place every Monday since January 2017, and sometimes weeklong lockdowns. They also close schools in the regions as a form of sit-in protest. Some schools and healthcare facilities were burned down and businesses and economic activities were paralyzed, with hundreds of thousands of residents displaced from their homes.

Access Care Institute has a humanitarian arm known as Access Care Foundation. The Foundation was created in August 2016 to provide basic home healthcare services to persons in especially hard to reach areas requiring prompt treatment of communicable diseases like malaria and diarrhea and other healthcare emergencies such as like child labor. The Foundation was also created in response to poor road networks in remote areas which discouraged persons from seeking healthcare promptly. The consequences were high infant mortality from treatable diseases (when diagnosed early) and maternal and neonatal deaths. Appalled with the situation, the Foundation undertook door-to-door home care activities to promptly diagnose and treat these diseases while offering antenatal and maternity services.

After barely three months in the field, the armed conflict in the region broke out and redefined the activities of the Foundation. Fleeing their homes because of the conflict and abandoning their sources of livelihood, these Cameroonians had their destiny taken out of their hands as only the higher income class could afford to move out of the affected region and receive basic healthcare services and access to education. Some had to flee into bushes and construction tents while others could only afford a single room in the suburbs (with about ten persons in a room). This exposed them to poor hygiene which perpetuated the spread of malaria, diarrhea, and respiratory tract infections including COVID 19 during the pandemic. The community where we operate is in a relatively safer zone and thus became host to internally displaced persons. Our number of patients increased by at least a factor of ten, as did their health and educational needs. Our objectives and strategies were redefined from serving people in difficult terrains to serving people in difficult terrain who could not afford to pay for basic healthcare due to loss of livelihood. This brought us closer to knowing that one could die not only from curable diseases that they were ignorant of but even of cases that they were aware of but could not afford to treat. This means even a simple condition such as malaria that can be cured with less than five dollars. To address this, the Foundation started partnering with higher education institutions, training medical students so these students can serve the displaced communities as part of their community base internships. This greatly increased the critically needed manpower.

As with every other armed conflict, the brunt of the burden is borne the most by young women. Displaced from their homes and in search for refuge, some of these young women are raped or forced into illicit sexual activities due to their vulnerable situation. The problem is exacerbated by the fact that these women, because they are unmarried, are not included in routine family planning campaigns provided by most healthcare establishments which serve mostly married women. While this is not a government policy, the delivery method does not take into consideration the specific needs of young unmarried women such as attitude, cost, accessibility, user friendliness, confidentiality, and respect of privacy. Most often, any adolescent who voluntarily seeks family planning services at these centres is believed to be having premarital sex, which young women never want to be identified with publicly due to social stigma. The resulting stigmatisation leaves the young women with no options or support, and often results in unwanted pregnancy, sexually transmitted infections, criminal abortion (which could lead to loss of reproductive health or death). If the young woman has the “courage” to take on single parenthood, this is usually accompanied by abrupt termination of schooling and traumatic experiences throughout life.

As if this was not critical enough, then came the COVID-19 pandemic. This marked another turning point in our activities in the communities as the already crowded living conditions lacked water. These two were the top predisposing factors for COVID-19. Our objectives were again redefined to containing the pandemic through educational programs, provision of face masks and installation of hand washing stations. This brought about a merger and transformation process that gave rise to Access Care Institute, an umbrella organization training medical students, running a healthcare clinic, and conducting research to properly address these challenges. The Institute engages medical students to work with staff at its clinic to undertake community homecare services as informed by its research center. The Institute also offers a hybrid educational environment on campus and online in efforts to ensure uninterrupted study by affected populations even during lockdowns and especially with the separatist fighters declaring war on government-owned schools.

Created within the context of the crises, Access Care Institute prides itself as an institute operating in a crisis milieu and being unique in its approach by providing different dimensions to existing endeavors. For example, our homecare services are new in Cameroon and could provide a new direction to primary healthcare service delivery in a country with poor access to limited healthcare facilities. Also, our family planning delivery method of using the young people to sensitize their peers at home could not only eliminate the current stigmatization but protect the lives and sexual and reproductive health of young women. Finally, our affordable online and on-campus hybrid training not only guarantees access to education to those in remote areas, but also ensures continuous learning even within Mondays or weeklong lockdowns.