Sunday, June 17, 2012

Community Health Program in Action

Yesterday I had the opportunity to go out to Hattikot, one of the communities that the Bayalpata Hospital serves. The work week here is Sun-Fri and every Sat, the community health department hikes to one of the nine communities it serves (yes, people here at Nyaya commonly work 7 days a week – there’s a lot to be done and Nyaya has a very dedicated staff). These communities range in distance from 45 minutes to 3 hours each way through beautiful mountains, fields, and along streams. I was enjoying the hike quite a lot until I realized that the pregnant women in the maternity ward, the 40 lb 12 year old with a severe heart condition, and the elderly and sick patients we see every day also have to make the hike – and it’s not an easy one. The mountains were steep and rocky, a path along a stream was precarious, and the sun was very hot. Even after drinking 1.2 gallons of water yesterday, I was dehydrated enough I needed an oral rehydrating salt solution.

On route: Ranju and Ashma - two of the Nyaya staff members
The people we have met here are unfailingly kind and generous people. People greet you with a friendly smile and ‘Namaste.’ Along our hike, I was given glimpses into everyday life here. This isn’t ideal farming time unless you’re by the river because the monsoons haven’t started yet so it’s too dry for much to grow. However, we saw many people working hard in their fields. The youngest children were carried in baskets on their mother’s backs while older children were helping carry water or sticks to their families. In Sanfe, the community at the base of the mountain where the hospital is, we stopped by a small store run by two young girls about 9 and 11 years old. Along our hike, we were offered homemade yoghurt and sugar by a woman with a few adorable children. She didn’t know us – she is just that hospitable. The women who serve as community health workers are a very sociable group who clearly care that their neighbors and friends are well taken of. In the hospital, I’ve never seen patients show impatience with long, hot waits, despite the fact that many of them do have to wait hours to be seen after walking great distances just to get here.

Seems to be a fairly typical farmer's house
Once in Hattikot, we were greeted by many members of the community. We went to the sub-health post. Women can deliver in this facility and very basic health services are offered by auxiliary health workers (individuals who have 18 months of training after 10th grade). The female community health volunteers (the women who serve in the government community worker program) for this region meet every Saturday with a community health worker leader (a Nyaya staff member). The community health worker leaders come to the hospital every Monday and Friday to receive trainings and work with the community health department. Every Saturday, they check in with the female community health volunteers to compile information about which community members were seen, what services were offered, what recommendations/referrals were made, and to lead a discussion about a relevant health topic. Right now, this information is compiled by hand, but part of our work here this summer will be piloting the transition to digitized data collection. Services offered by the community health workers include patient follow up (for a wide variety of chronic and acute diseases – they ensure medication schedules are followed, malnourished kids are getting the supplemental food they need, patients are either feeling better or are referred back to the hospital/health posts), general check-in/health surveillance of community members, and health education. They have recently started offering menstrual hygiene workshops for school-age girls. Elsewhere in Nepal, studies have shown that the practice of isolating women as untouchables in separate sheds during menstruation is widespread. 

A community health worker leader collecting data from the female community heath volunteers
While the community health program provides patients with a much better standard of care and the hospital with a means to check in on the health status of people in its catchment area, there are still many ways this program should expand. Friday, there was a discussion about which patients should be followed-up by community health workers. Ideally, all patients with chronic conditions would be followed for about 3 months but it’s simply not feasible to do this with every condition (e.g. there are 50 or 60 hypertensive patients and there just isn’t the woman-power to do that so these patients will have to be followed for a shorter time period). Additionally, the hospital would like to expand the community health worker program into new communities, be able to provide universal screening for childhood malnutrition, improve data collection and analysis procedures, finalize the curriculum used in trainings, and provide more health education/outreach programs. Expansion requires resources and resources are limited. Last year, over 13,000 patients (over 5% of the catchment area) were directly served by this program on a total budget of about $30,000 (you can check for yourself on Nyaya’s public wiki/drop box that details all of Nyaya’s operational information). Our GlobeMed chapter raised $6440 last year - just think about how far another $6466 (or $12,932) could go. 

Pictures can't quite capture the beauty

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