Report of my internship with PeP sans frontiers

From September to December 2018

“Insights into the sector of public health in Cameroun”

PSF/PEP SANS FRONTIERÉS

Pairs ÉducateursetPromoteurs sans Frontierés

Bp: 5085 Douala Cameroun

Tel bureau: 243 800608

Tel portable: +237694043818

Email: pairseducateursetpromoteurs@gmail.com

Julius Rosenhan

653672556

julius.ro@web.de

Preface

When I arrived at the airport in Douala, Cameroun, I tried not to have any expectations about the

time I would spend in this country but my aim was clear, to work and get experiences as an

intern in the sector of public health. I am definitely not saying you cannot expect anything from

Cameroun but time spent in Africa, normally I do not like to generalize a continent but I will

apply it here instead of naming all the different countries I have been to, showed me that it is

better to expect the unexpected or nothing at all. It all started with finishing university when after

I actually applied to another organization for an internship called Global Medicare Foundation

but in the taxi from the airport in Douala to the place I would spend the next months at plans

already changed. I was supposed to do my internship in Buea with GMF but since a conflict was

roaming in the area and security could not be ensured they linked me with one of their partner

organizations in Douala, namely PeP sans frontiers. My approach already turned out to be the

right one and do not get me wrong I enjoyed working there and learned a lot even when it was

kind of improvised.

Before I start with the report let me introduce myself shortly: My name is Julius Rosenhan and I

am a cultural and social anthropologist whose main interest lies in the cultural and social

dimensions of the medical domain. I am writing this report to share and reflect about my

experiences and observations I have made during working with a local organization in the public

health sector in Cameroun. By saying in advance that the report builds on my personal

experiences which are of course biased until a certain degree I want to distance me from an

objective and generalizing approach. Other people might have had different experiences about

the public health system in Cameroon but in this report I am trying to build an argument through

telling stories and situations I encountered. I hope it can be at the foot of a broader discussion

with the aim to improve on the health system and provide affordable, accessible and qualitative

healthcare to all Cameroonians.

Julius Rosenhan, intern at PeP sans frontiers

Table of Contents

1. Introduction__________________________________________________1

2. Objectives____________________________________________________2

3. Context of the public health system in Cameroun____________________3

3.1 Delegation of Public Health_________________________________3

3.2 Public Hospitals__________________________________________5

3.3 Private Clinics___________________________________________9

3.4 Cameroonians in the sector of public health____________________11

4. Cash money payment in the public health sector_____________________13

5. Conclusion________________________________________________17

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1. Introduction

The first step of my internship was to get introduced to the team of PeP sans frontiers and the

locality of their working space. I met the team of four people in an office in the district of Cité

des palmiers, Douala. The team consisted of a person responsible for cleaning, one for finances,

a secretary and my boss who was leading and guiding the projects. The first couple of weeks we

were also having another intern from the University of Douala who was studying “International

Law” and working on human rights. The office was a small place located on the first level of a

house with a small terrace facing the street. From the outside you could see a poster announcing

the organization and one of their focuses which ishuman rights. The other topic they are working

on is all around reproductive health. After we sat down and I introduced myself as well as my

main interests and objectives they obviously put me formally in their working sector of

reproductive health.The first three weeks I workedin the office not only to get an overview of the

work of the organization did but also to get a picture of the health system in Cameroun.I was

reading through different articles and papers I found on the internet for example the current

National Health Development Program and the Health Sector Strategy of Cameroun.

But the most exciting work started when they helped me to get introduced into different health

facilities and organizations in the area and when I started visiting thoseas well as participating in

different programs which aimed at improving the health situation. In the next chapter of my

report I willstate the objectives of my internship and clarify on the goals which I set during my

time in Cameroun. Furthermore and after giving an overview on how the health system is

structured through my visit to the Regional Delegation, I will draw a picture of the healthcare

provided by putting my experiencesin different public and private health institutions as an

example. Since to write a report on every activity and aspect I encountered during my time

would be far more than this report could contain I will focus in detail on the role of money,

especially cash payment, in the health sector and its influence on the healthcare provided. Finally

I summit the main points and conclude with a personal statement of experience and opinion.

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2. Objectives

� To know how the Cameroonian public health sector is structured and organized

� To get an overview on how the Cameroonian public health system functions

� To find out how Cameroonians view and deal with disease, illness and sickness

I set those objectives in cooperation and discussion with PeP sans frontierésas well as regarding

my personal goal to continue my education with a Master in “Medical Anthropology”. By

applying the two methods of observation and participation in different health settings the first

two of my objectives can be achieved. The third one requires a close contact to people looking

for healthcare and to engage in conversations and discussions with them as well as to ask

information from health personal and to find out their point of view. I am aware that the public

health sector is quite diverse, complex and too big to get to know every aspect in just a couple of

months but I tried to find a representative small sample of different health institutions to get an

overview on it. Since PeP sans frontierés was already collaborating with the Ministry of Public

Health and the Regional Delegation on Public Health in Littoral I was able to step into the public

health system without many complications. I was reporting every of my visits to PeP sans

frontierés and we were discussing my observations and impressions together to identify

challenges and dysfunctions in the public health sector what would be a possible starting point to

work on.

In summery I was doing a small kind of research and the organizations used their contacts to link

me with the different people in the public health sector which allowed me to visit different

hospitals, clinics and other agents.

In the following chapter I will give an overview and more detailed description on the different

programs I worked on and participated in during the internship.

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3. Context of the public health system in Cameroun

3.1 Regional Delegation of Public Health

One of the first things I decided todo was to pay a visit to the Regional Delegation of Public

Health and not only introduce myself to the officials but also ask questions about the structures

and organization of the public health system in Cameroun. I was warmly welcomed and after a

short introduction one of the responsible started explaining the organization of the health sector

to me. He started giving me an overview by dividing the sector in two main areas, namely an

administrative and a medical system. The Delegation is for example part of the administrative

system and has the task to implement, supervise, evaluate and organize the health system by

developing different programs and introducing policies. In the other area are for example

medical institutions like hospitals situated which can be seen as part of the medical system since

to provide healthcare is their main goal.

Furthermore there are three kind of vertical levels which divide the health system into different

areas. The first level is Central, the second Intermediate and the third Peripheral. Those differ in

the administrative structures, their competencesas well as in the healthcare institutions. On the

Central Level Ministries and Departments are locatedwho are responsible do develop policies

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and coordinate, regulate and supervise on a national level. Healthcare structures on this level are

for example General Hospitals and University Teaching Hospitals. The Intermediate Level is

built by the 10 Regional Delegations such as the one I visited for the Littoral Region. Their

responsibility is to provide technical support, coordinate, regulate as well as supervise on a

regional level. In the health sector the level is represented by the different regional hospitals. The

Peripheral Level consists of 189 Health Districts. Inside those district hospitals, clinics and

medical health centers are providing healthcare as well as regulation and coordination to the

district. I was further told that there are 7 levels in a system of healthcare provision which range

from the big General Hospital in Yaoundé to a small health center in some local village. They

provide different kinds of healthcare to different populations but are all part of a system which

tries to provide healthcare to everyone.

My colleague (left) and I (right) at the

Delegation of Public Health

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After I asked about the role of the private sector I was told that it is of course part of the public

health system, same as the traditional medicine, but operating separately. I found out that there is

no health insurance available for the majority of the population but only to a few privileged

persons who can afford the costs. The rest of the people bring cash money to every hospital visit

which shapes the whole health system, but also healthcare provision in a remarkable way which I

found out during my time spent in public and private health institutions. Before I target the issues

regarding money I want to present the public and private sector as I have seen and observed it by

using my visits to different hospitals and clinics as example.

3.2 Public Hospitals

During the time of my internship in Douala I visited in total 4 public hospitals on a district level.

At one of which I was able to work on a weekly basis and observed as well as participated in

various hospital programs. The others I visited only daily to be shown around the campus or to

evaluate on a specific problem with one of the programs. Those public hospitals I could get an

insight in were mostly structured and organized in a similar way. Different unit houses were built

around a small area where grass or small trees were planted.

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The first step for a patient to enter one of the hospitals was to walk through a guarded gate and

inform the guard about the purpose of the visit. Afterwards and close to the entrance you could

always easily find a kind of reception where patients need to identify themselves and present

their patient books.

Those small books are essential during the process of healthcare and I want to explain shortly

why. First of all the books need to be bought by the patients themselves and without them they

would net get a consultation or treatment. The books were not only a way do document the

history, parameters, diagnosis, treatment and medication but also representing the person himself

in a medical domain. I observed many situations when not the person seeking treatment was

addressed but only the book requested and studied. The person was left aside as passive and

without a voice whereas the book was seen as containing all the essential and necessary

information. I will add to this perception in chapter 3.4 Cameroonians in the sector of public

health.

After the reception the person, who is most of the time accompanied by a family member or a

friend, would be referred to the unit where he or she can find the care he or she was looking for.

Most of the time patients are already expected to know and request what kind of doctor they

want to see for example a Generalist, a Gynecologist or a Pediatrician. The costs for the different

consultations already differ since a general consultation is cheaper than to see a specialist. The

process to get a consultation takes most of the time at least 30 minutes.From there on now the

circle of the patient starts as it can be seen in the following picture.

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The hospitals I visited also divided the male from the female patients. The hospitals were not

only having units for males, females and kids but also special units such as radiology, a unit for

HIV/AIDS patients, a family planning unit, a chirurgic department and a pre-, neo- and postnatal

unit which were most of the time the largest. The surgery unit was sometimes very small and

only able to do minor work or not working at all due to a lack of doctors or appropriate

equipment. The nurses responsible for the different departments dress in different colors such as

green for surgery, white for general, pink for pre-, neo- and postnatal and blue for HIV/AIDS.

The doctors are wearing white clothes. Even when it seemed to be quite differentiated my

observations showed that the different departments are working in close collaboration in

referring and treating the patients.

The public hospitals I have seen had from 30 to 60 beds to hospitalize patients whereby the

rooms are different in amount of patients, equipment and comfort because of which the prize for

a night also varies. Water and electricity supply was generally good and all of the hospitals not

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only gave mineral water to the patients and had access to running water but also owned a

generator for if electricity would be cut.

Every hospital was having a pharmacy where the patients could buy the necessary products but

those were sometimes either not appropriately stored or equipped as I saw in a surveillance

program on medication management and organization I participated in. Another program I

worked with focused on epidemiological diseases and after talking to responsible doctors it was

clear that not in every facility the necessary structures and policies were implemented to report

on cases of highly infectious and contagious diseases. Those two programs gave me an insight

into the surveillance in the public health system. The program itself was always well structured

and organized on a policy level as well as implemented into the different health facilities. The

two goals targeted by those programs and which I mentioned before were clearly not sufficiently

fulfilled at the different health institutions and at the end of the surveillance recommendations

were made.

There are also general governmental programs existing which focus on vulnerable groups such

as children under 5, pregnant women and patients with HIV/ AIDS. Another program was a

nationwide immunization campaign free of charge. I experienced those kinds of programs as

strongly executed and carefully submitted at every health institution I went to.

Some hospitals also tried to reach the community through educational and sensitizing campaigns

but those I only heard of whereas I participated in one in the private sector.

As far as I can evaluate and I am not a medical person the technological level was basic but

sufficient for the cases treated on a district level. More complicated cases would be referred to

higher levels and bigger hospitals in the regional health sector.

The main disease I identified during speaking to doctors and nurses or just spending time at the

different hospitals is Malaria which is put a lot of focus on. Every patient with fever will be

tested and Malaria is suspected in most of the patients. It is followed by gastrointestinal diseases,

respiratory diseases and HIV/AIDS. This overview is not based on quantitative data but personal

experience and observation.

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Public hospitals seemed to me sometimes overwhelmed by the amount of patients they were

confronted with but into my eyes treating and providingthe needed healthcare to the population

who was looking for treatment. Nonetheless I was shocked by the difference between the public

and private sector after I went to a private clinic for the first time which I want to describe in the

next chapter.

3.3 Private Clinics

I remember the first impression after I entered a private clinic for the first time. To me and

compared to the public hospitals where people would wait outside and hygiene definitely needs

to be improved the private clinics looked like hotels. I visited 5 private clinics in total which

differ in size and in the provision of healthcare but in general have had an increased standard of

healthcare to what I had seen so far. Especially at two of them I was able to build a close contact

not only to the nurses and doctors but also to the administrative stuff which got me some insights

into the functioning and organization.

I was warmly welcomed everywhere and most of the times got a tour around the facilities. I saw

clean and comfortable patient rooms, fully equipped theatres, consultations rooms for every kind

of specialist and more. The private clinics were having beds available from about 50 to almost

100. The clinical stuff could not only speak French but most of the time English as well which

was different to public places where I only heard French and English was spoken rarely.

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Now even though the private clinics seemed a little like a different world the general

organization was not so different from the public places. The personal details of the patients are

also taken at a reception just after the entrance. You can sit afterwards in a waiting area until

someone calls you to take the parameters. The next step will be a consultation and from there

decisions are made what treatment is needed and if a hospitalization is necessary. Instead of the

small school books which are used in public hospitals as patient files in private clinics there is a

higher chance of getting a more detailed file with different specified documents. Patients do not

need to go and buy a book.

Compared to public hospitals the private places I have visited seemed almost empty or at least

not very busy. During my time I found out that there are truly not many patients coming to the

private clinics. At one private clinic it was about 6-10 patients a day. The medical stuff looked

most of the rime relaxed and I rarely saw any stress or hectic. I mean it is no surprise that private

clinics have a higher standard in healthcare than public hospitals but the gap between the two of

them was, at least to me, frightening. It was the first time when I realized the impact of a missing

health insurances and the obvious influence of money on the quality of healthcare. There were

apparently not many patients going to private clinics because they could not effort the place and

the healthcare. Only the wealthy and socioeconomic successful people were able to profit from

the private clinics, which could supply healthcare up to a European level. The only deciding

factor was if you can afford it.

Like I mentioned in the previous chapter I was able to participate in a community outreach

program with one of the private clinics. A qualified nurse would visit a specified area in the

neighboring community once a week. The area changes every week so that different households

can be reached. The goal was to educate and sensibilize the population about different health

topics like water, sanitation, hygiene, litter and family planning as well as ask for any health

problems. People would invite us into their homes and listen to what we had to say. To me it was

a very good approach but we could only visit about 10 households a day and the impact is

therefore not very far reaching.

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The next chapter focuses on the people in Cameroun and how they view and deal with sickness,

disease and illness.

3.4 Cameroonians in the sector of public health

Because of countless conversations and discussions with not only professionals but also patients

and Cameroonian citizens I was able to identify some aspects of how Cameroonians engage in

the sector of public health once they get sick and how they view disease.

First of all there is kind of a distance towards hospitalization whereby not only hospitals and

clinics but foremost pharmacies can be found at any corner. But the people I talked to preferred

to medicate themselves than to make a step into a health facility. One of the reasons is probably

the lack of knowledge about the medical and many stories and experiences about people dying in

hospitals. Another also deciding factor might be money which I will focus on in the following

chapter.

But let us go back to the self-medication first because I think it is pretty interesting since it was

surprising to me at first how many people from a very young age on know the names of different

My colleague (left), I (right) and the responsible nurse after a visit to the community.

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drugs and for how much to buy or when to take them. The pharmacies on the streets are playing

an important role in that context but are sometimes in a very bad shape and the storage is not

appropriate at all. One the other hand what makes them attractive is that the prize is cheap.If one

of my friends would get sick he or she would not go and look for a doctor at first but send

someone to buy medicine on the streets. For me that behavior was a little strange at first but can

be interpreted as a kind of taking agency to prevent high costs and financial expenses. Another

aspect that was mentioned a few times to me is distrust towards medical personal and the claim

that they work not in the interest of the patient but for their own profit. I will explain the different

dimensions of this way of thinking in the next chapter because money is involved and plays an

obvious role.

One of the main dimensions worth mentioning on how Cameroonians view disease, sickness and

illness though is clearly faith. I was observing three main groups in Cameroun which are

Christians, Muslims and Animists.

On the one hand the first two explain the cause of a disease in the disobedience towards god. On

the other hand animism puts an important role on the ancestors and following their tradition. If

someone is not living according to the family values and causing trouble animists would think of

disease as a consequence which follows.

Besides faith another important aspect is ethnicity. There are more than 250 different ethnic

groups in Cameroun. It might not have an impact at first sight from which group you come from

and how you deal with disease but I just want to retell a story which I heard from a nurse. The

nurse is working in a private clinic and we talked about the importance of taking the personal

details, patient history and parameters when he told me one of his experiences towards culture.

He explained how they give three meals every day to the patients but there is a variety of foods

in Cameroun and every ethnic group has its own traditional food. He was mentioning one patient

from a tribe far north which was not feeling good and did not eat much of the food in Douala and

was having a slow healing process until that point. The nurse identified the ethnic background as

a factor influencing the healing process and ordered for the traditional food of that person. When

he brought it there was an obvious change in the behavior of the person and the patient ate

everything and after a couple of days left the hospital. The story shows that the ethnic

background is also playing a role in the healthcare system and needs to be considered.

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In the beginning I mentioned that Cameroonians are distanced towards hospitals and try to avoid

a visit until the very end. One of the reasons is like already mentioned money but in my opinion

there is more to it. I was able to observe many consultations and different doctor-patient

interactions in which I was surprised by how little communication was brought to the patient.

When a person is coming to the hospital and is looking for treatment the doctors and nurses look

at the patient without any agency or knowledge. If the patient is not asking about the diagnosis

he or she might not even know what is happening but just be sent to the pharmacy to buy a load

of drugs. One of the doctors I was working with and who studied in Germany told me that for

him the main difference between patients in Cameroun and Germany is that Germans would look

the diagnosis up in some way and ask all kinds of questions whereas Cameroonians would accept

everything the doctors says without questioning.

Besides all of the points mentioned there is a trend towards more familiarity and knowledge

about medical care and hospitals which leads to more people looking for help in those kinds of

settings not in traditional medicine or self-medication. This is to me due to improving healthcare

and closer contact with the western medical system.

The overview I gained is shaped by various challenges for the population of Cameroun.First of

all to find access to appropriate health care is not easy and equal to the population. One of the

biggest and most deciding factors are the financial expenses like transport costs, buying the

book, consultation, hospitalization or just for drugs and continued treatment. Which role money

plays and how it influences the healthcare situation is topic of the next chapter where I want to

use it as an example of one of the most, at least to me, interesting aspects I could observe in

many situations in the Cameroonian Health System.

4. Cash money payment in the public health sector

One of the reasons why I choose to discuss this topic in detail is definitely my own background

and the comparison to the health system I know in Germany. What was most surprising to me is

that every visit to the hospital in Cameroun needs to be accompanied by thoughtful planning on

how much cash money needs to be taken with. Sometimes it is therefore necessary to include

family members or friends to help out the patient with the costs which needs to be covered even

before entering the health setting. In Germany it seems to me like even I know money is

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involved it is like invisible and not playing a primary role since insurances are involved. But in

Cameroonian hospitals money will change one hand to the other in so many situations that it is

hard not to question or at least discuss this aspect.

Before I analyze and discuss different situations I want to give an example of my own experience

because me myself I was hospitalized two times during my time and spent time in two very

different hospitals as a patient. Both times it was because of an infection in the gastrointestinal

region accompanied by fever. The treatment was both times almost the same and I spent twice 3

days in hospital. But the main difference was that I spent almost exactly twice the amount at the

private clinic where I was the first time as at the public health center where I was a patient the

second time.

First of all it needs to be said that I know that not every family could even effort such a hospital

visit. The amount you need to pay of course depends on the treatment but it can easily become as

much as a family would spend to buy food for a month. Secondly the healthcare was so different

that it was almost funny to me but since I knew the stuff because of my work even before going

there for treatment I always felt in good hands. But compared to the first time where I was

having a clean, big room with air-conditioning and three meals a day the second time I was

finding myself in a small room without any of the things mentioned before. The doctors in the

private clinic looked after me every morning and evening whereas the second time almost no one

even told me what the diagnosis and treatment was. I remember a feeling of being lost and

without any power while I was lying in my bed and just waiting for someone to tell me what is

happening until the very point when I got up from bed and asked. Furthermore the nurses in the

first place where having an education in the field but some of the nurses who were treating me in

the health center did not have training but learned by them or were told what they had to know. I

was even lucky there was a doctor around who normally would work in a different clinic but was

a friend of one of the nurses. Even though I could continue the list I will stop here because I

think it is clear how much money influences and what role it plays regarding not only the quality

but also the possibility of healthcare.

During my visit to the Delegation of Public Health I was told that health care is provided and

accessible to everyone. What is already questionable especially in rural areas but most

importantly what is not mentioned is affordability. Or at least the huge differences of healthcare

15

provided depending on the amount of money you can pay. The poorer part of the population is

not having a lot of choices where to look for healthcare or even if they can do so. I observed

many consultations where before treatment was given the patient was asked if he or she can

afford and pay for the treatment. Sometimes people would be sent back home to bring the money

to be treated. This leadsto a development of different coping behaviors to deal with the pressure

of disease in different ways rather than visiting a hospital.

Because money is such a deciding factor people will also wait as long as possible to avoid a visit

to a hospital. That leads to the problem that many cases which come to the hospital can be

already very or even too serious to treat successfully. Furthermore it affects the behavior towards

the treatment recommended by the doctor. I had many situations where patients asked several

times if it is really necessary to buy that kind of drug, do such a test or even go to see a

radiologist after an accident. I can imagine that many patients are sent home after consultation

with instructions which are not followed up because of the costs. For example I already

mentioned the street pharmacies which not only carry the risk of buying expired but also

inefficient drugs due to wrong storage. In addition I observed people buying not the

recommended amount of pills but only half or they would mix different cheaper ones they heard

of because they believe it would improve on the impact.

I already mentioned the distrust towards medical doctors and I heard the story many times how

doctors are money-orientated and exploit patients through providing healthcare. I want to discuss

this aspect with a thought which I had during my time in a small health center where every

evening the accounting was done. Healthcare in Cameroun is having in many situations more the

character of a business than a universal human right. For example in front of bigger hospitals you

will find small shops selling coffins, flowers and everything related to death. It felt odd to me to

pass these shops when I entered a hospital since it gave me a feeling of entering a place where

people mostly die and not a place where people are cured. The business aspect also comes into

play when I look at the many different small health institutions which seriously compete against

each other for patients. I was participating a meeting of stuff in a medical center when people

were discussing how they could differ their healthcare from other places around them to get

more patients. They ended up focusing on pregnant women and childbirth. And it is true that

sometimes I am puzzled about the many signs to any kind of health facility next to the round.

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Another aspect is healthcare itself and how the prize of any kind of treatment, drug and

consultation not only differ between public and private but in the private sector itself as well.

And we are talking up to four or five times the amount.

Let us be honest people die or at least take a risk because they cannot afford necessary treatment.

I want to describe one case of a mature woman who came for consultation because she was in

her, I believe, 7th month pregnant. The doctor examined her and because of an abnormality

advised her to do a caesarian section. The woman looked not only scared but mostly concerned

about the doctor’s diagnosis. First of all an operation is always a frightening procedure especially

in Cameroun where little is known by the population and horror stories are being told between

each other. It is true that good anesthetists are rarely found but caesarians are done quite often. I

even heard about a governmental program to reduce the costs but as I was told there is again a

difference in the quality of healthcare involved. Now when I was with that woman and after the

doctor explained very well why it was necessary she still did not seem like she would take it as

an option. Besides the fear of an operation money comes into play. There are many situations

when patients weight for themselves the risk of not following the advised treatment in

comparison to the money which would be spent. But it is clear that they cannot fully evaluate the

medical situation and even if it might be sometimes for prevention or to stay on the safe side I

was puzzled at first encountering those behaviors. I could not understand how people could take

their chances by putting their health and furthermore lives at risk until I looked at the money

involved. Finding a job in Cameroun is not easy and one that is paid good even harder. The

informal sector is large and most of the people are working in small business they started

themselves selling some kind of goods. When disease enters into life it can threaten the very own

existence not only by the worsened health condition but also by the possible expenses due to

looking for treatment and healing. Truly governmental institutions are trying to lower the costs to

make healthcare affordable and there are many good programs to target vulnerable groups by

providing free healthcare like vaccinations but the quality of healthcare is mostly not ensured

sufficiently.

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5. Conclusion

Before I give my personal opinion on the issue discussed I want to summarize the main points

which I made earlier in the different chapters.

By describing the visit to the Delegation of Public Health I was able to draw a picture of how the

public health system in Cameroun is structures. The several divisions into an administrative and

medical area, the three different levels of Central, Intermediate and Peripheral as well as the big

sectors of public and private health institutions plus the traditional medicine represent not only

the organization but also complexity of the national health system. The division goes hand in

hand with several different functions, responsibilities and competences of the health facilities

inside.

I described public and private health facilities from my own perspective and tried to compare to

two of them on different aspects. Public health facilities are having a lower standard in providing

healthcare but trying their best to provide affordable and accessible healthcare to the population.

But those facilities are facing different challenges like an overwhelming amount of patients or

insufficient equipment and facilities. In opposition private health facilities provide very good

healthcare but are too expensive for the majority of the people.

In the chapter about Cameroonians and their way of seeing disease I was able to identify a

general perception towards western medicine and different behaviors to deal with the challenges

of being sick. Cameroonians are distanced towards hospitals and when they become sick it is not

only their own health they have to deal with but also the question how to pay for the treatment.

Because of this aspect sometimes medical advice is not followed, drugs are bought but not like

recommended or people try to delay the visit to the hospital as long as possible.

Since money is such an important factor which needs to be considered especially in my point of

view because health insurances are not affordable I discussed the issue in the previous chapter.

The amount of money you are able to spend when looking for healthcare influences directly on

the quality of care you will receive. It is not very surprising if therewould not be such a huge gap

between the healthcare provided on lower governmental levels and big private clinics. I already

stated how the financial expanses affect the people’s behavior as well. But not only individual

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lives are at stake but also the whole health system seems to be trending towards healthcare as a

kind of business. Such a characteristic challenges a human rights approach and manifests itself

not only in different institutions but influences how people interact in situations regarding health

as well as the quality and the way healthcare is provided.

Personally I feel like as soon as money is becoming more important than the patient as a person

something in the health system is not going the right way. I understand it is not that simple but

from my experience in Cameroun it is what is at stake and the core of many challenges public

health is facing. Of course the system is working in some way and since the government is not

having a lot of money to put into the sector other agents are trying to fill the gap but if the

majority of the population is excluded in the very end other solutions need to be find. I am aware

that it might sound a little dark but there is also a lot of light in the Cameroonian Health System.

I have encountered a lot of great, engaging and motivated as well as hard working health

professionals who try everyday with sometimes little to provide the best possible healthcare. I

have met doctors who will get up in the night if they receive a call and saw people being picked

up with a private car by health personal because no transport was available to them and being

escorted to their appointment at some hospital. There is a lot of good care just next to the daily

challenges people are facing.

What I would like to see in the future is some kind of public health insurance implemented

which covers at least basic treatment for all the population. I know it is not an easy thing to do

but it would be a huge step for Cameroun and for many people it could mean life over death.

Since health is a human righteveryone should have the possibility to get affordable, accessible

and qualitative healthcare!