Terveyspalvelut ulkomailla: Äitiys- ja lastenneuvola kokemuksia Keniasta

Terveyspalvelut ulkomailla-sarjassa ajatuksena on avata teille lukijoille meidän matkailijoiden kokemuksia terveyspalveluista maailmalla. Ensimmäisenä kerrottakoon teille omakohtaisia kokemuksia opiskeluajoiltani, kun olin työharjoittelussa Keniassa, Kisumun kaupungissa keväällä 2016. Olen aiheesta jo kirjoitellut matkablogiini, mutta halusin vielä täällä kertoa asiasta, jotta meidän kaikkien olisi ehkä helpompi ymmärtää, kuinka etuoikeutettuja olemmekaan Suomen palveluiden ääressä. En itse siis tällä reissulla ollut asiakkaana neuvolassa, eikä varmasti länsimaalainen Kisumussa asuva ihminen asioisi tällä klinikalla tarvitessaan äitiys- tai lastenneuvolapalveluita, vaan suuntaisi jollekkin lukuisista yksityisklinikoista. Tavalliselle kenialaiselle tuo klinikka oli mahdollisesti kuitenkin se ainoa vaihtoehto. Myöhemmin tässä sarjassa kuulemme blogissa myös muiden matkailijoiden ja minunkin asiakaskokemuksia ympäri maailmaa varsin erikoisten terveyspalveluidenkin äärestä, joten pysykää linjoilla!

Äitiysneuvolan arkea

Keniassa raskauden ajan seurantaan kuuluu neljä noin viidentoista minuutin käyntiä äitiysneuvolassa, mikä on hurjan vähän verrattuna Suomen vähintäänkin melkein kymmeneen käyntiin, joista osa on myös lääkärille. Harva käy noita kaikkia käyntejä neuvolassa, koska matka neuvolaan voi olla pitkä ja harvalla on varaa hoitaa ongelmia, jos niitä neuvolassa tulisi ilmi. Peruskäyntiin kuuluu asiakkaan verenpaineen, hemoglobiinin ja painon mittaus, sikiön sydänäänten kuuntelu sikiöstetoskoopilla ja hiv-testi kolmen kuukauden välein. Malariaa ehkäiseviä lääkkeitä odottavat äidit saavat raskausviikolta 16 eteenpäin neljän viikon välein ilmaisen hyttysverkon lisäksi, koska malariatartunta raskausaikana voi olla kohtalokas sekä sikiölle, että äidille.

Täällä äidit myös rokotetaan raskausaikana vastasyntyneen jäykkäkouristusta vastaan. Ensimmäistä lasta odottava äiti saa raskausaikana kaksi rokotetta ja 2.-4. lapsen kohdalla rokotuksia annetaan yksi ja kun lapsia on yli viisi, ei rokotusta enää anneta. Vastasyntyneen jäykkäkouristustartunta tapahtuu siis yleensä synnytyksen tapahtuessa epähygieenisissä oloissa, erityisesti jos napanuora leikataan likaisilla välineillä. Vastasyntyneelle (kuten usein myös aikuisille) jäykkäkouristus on hyvästäkin hoidosta huolimatta useimmiten tappava sairaus, puhumattakaan siitä, jos hoitoa ei ole saatavilla. Suomessa tuo vastasyntyneiden jäykkäkouristus on saatu kuriin jo pitkä tovi sitten.

Erityisen mielenkiintoista oli mielestäni perehtyä äitiysneuvolatyön paikallisiin painopisteisiin. Viiden kohdan listalla oli listattu naisten saaminen palaamaan neuvolaan myös ensikäynnin jälkeen, naisten informoiminen siitä, että poikalasten ympärileikkaukset voidaan tehdä sairaalassa, kaikkien naisten HIV-testaaminen, miesten osallistuminen neuvolakäynneille ja sairaalasynnytykseen kannustaminen. Aika erilainen lista kun Suomessa, eikä tuolla juuri varhaisesta vuorovaikutuksesta tai vaikkapa raskausajan elintapaohjauksesta puhuttu. Ainoa selkeä yhteinen haaste on tuo miesten saaminen mukaan neuvolaan.

Jännittävintä tuolla oli näin silloisen terveydenhoitajaopiskelijan näkökulmasta luonnollisesti se, että ultraääniä tai dopplereita ei tuolla vielä ollut. Raskausviikot, sikiön koko, lapsiveden määrä, syke ja kaikki muu tarvittava tutkittiin siis manuaalisesti käsikopelolla ja sikiöstetoskoopin avulla. Ainakin täytyy sanoa, että kädentaidot kehittyivät kohisten, mutta melko epävarmaahan tuo on noin kokeneemmankin terveydenhoitajan kohdalla ja jos sikiö todettiin esimerkiksi oletettuja viikkoja pienemmäksi tai isommaksi, ainoa toimenpide joka tehtiin, oli arvioitujen viikkojen muuttaminen kirjoihin ja kansiin.

Huutavia lapsia ja helteistä jonotusta lastenneuvolaan

Suomessahan lastenneuvola lienee tunnettu siitä, että siellä lapsen kasvua ja kehitystä seurataan usein ja melkoisen monesta aspektista. Keniassakin seurantaa kyllä on, mutta se rajoittuu tasan pituuteen, painoon ja rokotuksien antamiseen. Onneksi vanhemmat sentään saavat kaikki kattavan opaslehtisen, jossa edes vähän puhutaan lapsen kasvun ja kehityksen tukemisesta ja turvaamisesta, mutta eipä tuostakaan paljon ole iloa, jos vanhemmat eivät osaa lukea…

Rokotusohjelma Keniassa on hyvin samanlainen kuin Suomessakin ja rokotukset samaantapaan ilmaisia perheille. Eroina on lähinnä se, että kaikki lapset saavat BCG-rokotteen tuberkuloosia vastaan, poliorokote annetaan suunkautta ja kaikille annetaan osana paikallista viitosrokotetta hepatiitti-B-rokote.  Neuvoloiden lisäksi Keniassa toimi myös ns. kotirokotustiimi, joka kiersi kylissä ja slummeissa rokottamassa lapsia, jotka eivät syystä tai toisesta käy klinikalla. Pienten lasten rokotukset ainakin terveyskeskuksen tilastojen mukaan ovat ihan hyvin hoidossa, mutta huolestuttavaa oli mielestäni se, kuinka monelta rokotusohjelma jää kokonaan kesken.

Vauvat saavat myös puolen vuoden iästä a-vitamiinitippoja neuvolassa kouluikään asti ja yleinen mato- ja loislääkitys puolen vuoden välein. Kuten äitiysneuvolankin puolella, myös lastenneuvolassa jaetaan perheille malariaverkko, jota kannustetaan käyttämään. Melko erilaista tuo meno kuitenkin kokonaisuudessaan molemmissa neuvolan osa-alueissa tuolla oli.  Ja voi sitä itkua lapsissa, kun tämmöinen valkonaama koitti rokottaa tai päästä tutkimaan, siinä harvaa lasta enää nauratti…

Hämmentävintä oli kuitenkin sekä äitiys- että lastenneuvolassa jonotussysteemi. Ajanvarauksia ei ollut ja asiakkaille kerrottiin vain, kuinka monen viikon päästä suunnilleen olisi syytä tulla uudestaan vastaanotolle. Jonotus tapahtui sitten ekana paikalla – ekana vastaanotolla periaatteella, eli paikalle saavuttiin aamutuimaan jonottamaan ja siitä sitten hoitajat ottivat asiakkaita vastaan saapumisjärjestyksessä ja osa perheistä saattoi jonottaa pihapuun alla +35C helteessä hyvinkin puoli päivää pienen vastasyntyneen tai valtavan raskausmahan kanssa, aikamoista….


Millaista oli lukea näitä kokemuksia? Yllättikö tai ihmetyttikö joku erityisesti? Haluaisitko kuulla lisää kokemuksiani ulkomailta tai lukea muiden matkailijoiden kokemuksia potilaan roolista ulkomailla? 

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