Familie Kieviet in Senegal

“Don’t throw that away!” Christian – one of our nurses – calls out to a colleague. “This empty bottle of coke is too valuable for the trash!” In our clinic we recently started saving them for asthma patients. Asthma is a major health problem in this dusty metropolis. While in the Netherlands allergy is its common cause, the very dry and dusty air causes a hypersensitivity of the lungs resulting in airway constriction and shortness of breath. An asthma attack is a frightening experience. It has been compared to the feeling of breathing through a straw after going up and down the stairs twice. Asthma is often a chronic disease and no or inadequate treatment leads to more serious crises. A few months ago, a boy of 18 years died in our clinic due an asthma crisis!

Time for action. It is known that inhalation therapy is more effective in asthma than pills. We can buy the pumps here, practice shows that the powder usually ends up on the tongue rather than in the lungs. A small plastic bottle may well serve as a spacer. My colleague and I are writing a protocol for treatment and discuss this with the head nurses. Two teaching sessions for the entire team follow. Next step… collecting bottles and getting started! We cut the holes in the bottles; explain again and again the importance to the patients and the staff. We correct myths and drink lots and lots of coke. Many factors play along in this process of change. When the first patient comes back enthusiastically saying: “this pump-bottle works really well!” the staff starts to really believe in it. The proof: they are now even fishing out bottles from the trash! I am satisfied: the circle of change is complete.