In Indonesia’s Central Southern Timor region, families have long lacked access to good health care, and 6 percent of children die before the age of 5. ChildFund and UNICEF are working to provide health care services to this population.
Reporting by Zoe Hogan, ChildFund Timor-Leste
Around the world, little brothers regard their older siblings with a mixture of awe and admiration. In a small town in Timor-Leste, 6-year-old Silvino looks up to his 25-year-old brother, Marcolino, but for a special reason.
A few months ago, Marcolino became a ChildFund Community Health Volunteer, and his new role is to share important health information with his community. He has learned about malaria and dengue prevention, hygiene and the importance of encouraging parents to use the local health clinic.
His training is just one part of a comprehensive maternal and child health project funded by ChildFund Australia and the Australian Agency for International Development. ChildFund is working with local communities and government to enhance health care and knowledge in order to improve the health of children and mothers. In addition to 410 Community Health Volunteers, ChildFund has trained 84 professional health workers and 36 midwives, distributed 6,000 mosquito nets to families and provided vital health training to 312 schoolchildren and more than 21,000 community members.
“What I like most [about being a volunteer] is that I can learn new ideas,” he says. “Before, I didn’t have knowledge about health, but today I do. And I can share it with others who need it.”
Marcolino and Silvino live with their parents and two sisters, Umbelina and Abita, on a small farm near a dry riverbed and a collapsed bridge. Last year, a flood destroyed their house and washed away precious topsoil. Marcolino’s father, Jose, could plant only enough to feed his family. Like others in the area, they simply cannot afford to deal with expensive and debilitating health problems.
So, when Silvino developed a fever, headache and persistent cough in February, Marcolino’s training proved essential. Recognizing that Silvino’s symptoms were potentially serious, Marcolino and his mother took the boy to the nearby government health clinic. With timely access to proper treatment, Silvino recovered quickly and is now back at school. Two mosquito nets from ChildFund are also helping the family to reduce their vulnerability to malaria.
“I worry about my siblings getting sick,” Marcolino says. “It makes me sad.”
His concern is understandable. In 1999, when Marcolino was 12, the conflict preceding Timor-Leste’s independence destroyed many homes and most of the country’s public infrastructure. Without access to health care or basic services, four of Marcolino’s siblings died from respiratory illnesses that year. The youngest was a month old.
“I feel responsible for the children around here and their health,” he says. “They are the same as my brother.”
To date, Marcolino has spoken to 15 local families about how they can prevent common diseases, and he has plans to walk up into the nearby mountains to share the information with another 30 families. Marcolino has also referred about 20 people to the health clinic after identifying symptoms of malaria and dengue. “It’s not too hard to convince people to go to the clinic once they understand [the significance of their symptoms],” he says.
As an older brother, Marcolino looks out for his younger siblings. As a Community Health Volunteer, he’s now helping protect them — and all of the children in the area — from preventable diseases. And it’s obvious that Silvino is pretty impressed with that.
by Anne Lynam Goddard, ChildFund president and CEO, and Brig. Gen. Ron Sconyers (USAF, Ret.), president and CEO of Physicians for Peace
“If you want to go fast, travel alone. If you want to go far, travel together.” —African proverb
In the Artibonite Valley of Haiti, on the grounds of Albert Schweitzer Hospital in Deschapelles, you’ll find an unassuming clinic dedicated to prosthetic and rehabilitation services for amputees. Patients make the 60-mile trip from Port-au-Prince to the Hanger Clinic balanced aboard vans, mopeds and tap taps, those colorful buses and pick-ups that ferry travelers along Haiti’s famously uneven roads. Many of these patients lost a limb in the earthquake of January 2010; others have been waiting for a prosthesis for years. Even before the earthquake, Haiti, the western hemisphere’s poorest country, was not equipped to provide adequate healthcare services to its disabled population. When the earthquake struck, need for these services increased dramatically.
Hanger Clinic is just one site that is benefitting from a new partnership between ChildFund International and Physicians for Peace. The clinic is actually a product of the Haitian Amputee Coalition, a confederation of organizations including Physicians for Peace, Albert Schweitzer Hospital, the Hanger Ivan R. Sabel Foundation, the Catholic Medical Mission Board, the Harold and Kayrita Anderson Foundation and the Shepherd Center, among other groups. Because of these strong partnerships, the clinic today is a place where patients receive proper medical and rehabilitative care, along with art therapy, meals, lodging, a sense of community and a reason for hope. The clinic also is a training ground for Haitian technicians, who learn valuable professional skills alongside both U.S. prosthetists from Hanger Orthopedic Group and volunteer physical therapists from Physicians for Peace.
It is easy to feel overwhelmed in Haiti, but efforts at the clinic are making a difference. Since the earthquake, Physicians for Peace volunteers have worked with more than 785 patients. Put another way, because of the clinic, more than 785 Haitian amputees can now return to the daily work of their lives, and the Haitian technicians working on-site have the opportunity to earn a living, without leaving behind their country and their families.
These are important milestones; yet these “good news” stories can sometimes be lost. That’s a shame. Because while complicated issues of health, politics, infrastructure and accountability remain in Haiti, our experiences have only reinforced the belief that strategic nongovernmental organization (NGO) partnerships can play a leadership role in paving the road for sustainable, replicable solutions, in Haiti and beyond.
As Physicians for Peace and ChildFund International mark World Health Day on April 7, we are focused on crafting exactly those kinds of partnerships and solutions. Our efforts already are bringing about results. Four months ago, ChildFund International presented a $500,000 grant to Physicians for Peace to support and expand standing efforts at the Hanger Clinic, including volunteer physical therapy missions, and facilitate new initiatives, such as a summer camp for disabled children and tuition support toward a national prosthetics and orthotics training and certification program for Haitian technicians. By combining our resources, we are able to take on additional projects, reduce inefficiencies and help to eliminate redundancies in services and programs. In doing so, we can respond more effectively to our in-country partners’ needs, and we can more efficiently steward our donors’ investments.
Coming together to work in Haiti has been a natural fit for Physicians for Peace and ChildFund International. Our initial approaches may be different, but they are also complementary: ChildFund International works toward a future where all children have the potential to become leaders who bring positive change for those around them. Physicians for Peace envisions a future in which men, women and children around the world have full and equal access to quality healthcare services. In the end, we are both working toward a healthier world, a place where people are afforded the opportunity to live with dignity, respect and good health. When we come together for that purpose, everyone benefits.
As we celebrate World Health Day – from our offices in Norfolk and Richmond, Va., and through field offices and volunteer teams in Asia, Africa, Central America, South America and the Caribbean – we’ll keep close to our hearts a Haitian expression often repeated to Physicians for Peace volunteers at the Hanger Clinic: “piti, piti, zwazo fe nich.” Little by little, the bird builds its nest. Through collaboration and partnerships that prioritize need over ego, we can work together to build a world that is better, safer and healthier.
Guest post by Henry B. Perry
Henry Perry, M.D., Ph.D., MPH, is a senior associate in the Department of International Health at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore, Md.
During the past half-century, there has been a growing recognition that community-based workers can make an important contribution to the health of communities, especially in resource-constrained settings. These workers are known by many names, but most commonly Community Health Workers (CHWs). With initial training of usually 6 weeks or less, they can effectively provide different types of services from community mobilization to health education to preventive screening to family planning education to identifying persons with symptoms of leprosy or tuberculosis to diagnosis and treatment of life-threatening childhood illness, and many more. These persons may work as volunteers or for modest incentives or salaries.
Based on early projects that utilized CHWs effectively in a number of developing countries, the seminal International Conference on Primary Health Care — sponsored by the World Health Organization and UNICEF in 1978 and attended by high-level representatives of almost every country in the world — recognized that in many settings where facilities and highly trained health workers are scarce, CHWs can become an important part of a primary health care system.
The Declaration of Alma Ata, adopted at the conference, called for basic health services — promotive, preventive, curative and rehabilitative — to be provided by “health workers, including physicians, nurses, midwives, auxiliaries and community workers [italics added] as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.” The Declaration also recognized the importance of providing health services “as close as possible to where people live and work.”
A rapidly growing number of studies demonstrate that CHWs make it possible to expand access and improve coverage of essential services, particularly in remote and poorly served populations, thereby improving equity. CHWs have been shown to play critical roles in interventions to
- reduce child mortality, including distribution of vitamin A capsules and other critical micronutrients
- promote water and sanitation education (hand washing, point-of-use water treatment and safe water storage, latrine construction and promotion of latrine use)
- distribute mosquito nets and assist communities in draining stagnant water to eliminate breeding grounds for mosquitoes
- diagnose and treat childhood pneumonia, diarrhea, malaria, newborn sepsis and severe malnutrition
- promote healthy behaviors such as appropriate breastfeeding (exclusive breastfeeding during the first six months of life and continued breastfeeding until at least one year of age)
- provide hygiene and cleanliness education
- ensure appropriate care of newborns
- promote and facilitate immunizations for mothers and children.
Many countries can benefit by scaling up integrated community case management of pneumonia, diarrhea, malaria and newborn sepsis and promotion of healthy behaviors that can save the lives of millions of children who are dying from preventable causes.
CHWs are one of the essential ingredients for making this possible — along with political commitment, professional leadership, long-term sustainable training, support and supervision from the health system and reliable logistical support of basic medicines and supplies. A strong commitment by the world community to these activities, which are some of the most cost-effective approaches to promoting global equity in health, is a moral imperative for today and tomorrow.
James Grant, the renowned executive director of UNICEF from 1980 to 1995 and champion of what is often referred to as the First Child Survival Revolution, repeatedly reminded us that “morality must march with capacity.”
We now know that CHWs can have the capacity to make a difference between life and death for millions of children. The moral imperative for the world community is to ensure that health systems and underserved communities support CHWs in attaining this capacity.
Berman, P. A., D. R. Gwatkin, et al. (1987). “Community-based health workers: head start or false start towards health for all?” Soc Sci Med 25(5): 443-459.
Haines, A., D. Sanders, et al. (2007). “Achieving child survival goals: potential contribution of community health workers.” Lancet 369(9579): 2121-2131.
Lassi, Z. S., B. A. Haider, et al. (2010). “Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.” Cochrane Database Syst Rev 11: CD007754.
Newell, K. W., Ed. (1975). Health by the People. Geneva, Switzerland, World Health Organization.
Perry, H., P. Freeman, et al. (2009). How Effective Is Community-based Primary Health Care in Improving the Health of Children? Summary Findings and Report to the Expert Review Panel, American Public Health Association.
Sazawal, S. and R. E. Black (2003). “Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.” Lancet Infect Dis 3(9): 547-556.
World Health Organization and UNICEF (1978). Declaration of Alma-Ata: International Conference on Primary Health Care. International Conference on Primary Health Care. Alma-Ata, USSR.
by Virginia Sowers
ChildFund Community Manager
As we mark World Health Day, cities and communities across the world are participating in this World Health Organization effort to improve individual and collective health globally.
Having just returned from a ChildFund Study Tour in Kenya, I was pleased to learn that Nairobi is one of 13,000 cities participating in this year’s World Health Day events, with an emphasis on urban health.
This week, Nairobi is closing a major street to traffic and setting up a health fair. Fun activities including music, dance, acrobats and a carnival procession will advocate and educate the public on healthy lifestyles in cities.
As we learned on a project visit to the Karai Pamoja HIV/AIDS support group in Kenya, education is absolutely critical to improved health. When this community was struck with the AIDS epidemic several years ago, the majority of the population feared the disease and lacked adequate knowledge about transmission and prevention. Those who became ill did not receive adequate care or nutrition. Children struggled to survive as their parents became bedridden or died.
In September 2005, ChildFund Kenya’s Weaving the Safety Net program “came to the rescue of the Karai community in the Kikuyu District,” explains Gad Son Thiru, chair of the community-based organization. ChildFund trained home-based care workers to support the bedridden and refer them to health facilities for antiretroviral therapy.
Next came the formation of the Karai Pamoja support group for people living with HIV/AIDS. It started with 15 members who tested positive and grew to 86 members. “Karai Pamoja support group became the only hope and savior of the people living with HIV/AIDS in this area because it was here members felt safe and secure,” Gad explains. Members felt safe to share personal worries, fears and hopes for the future.
As the members regained their health through good nutrition and access to medication, ChildFund helped them develop income-generating activities. The group has opened a community bank account, and the money is used to buy food, improve housing and support their children’s education.
ChildFund also helped sustain the community’s children by providing school uniforms, books, deworming, vitamin A supplements, mosquito nets and psychosocial support.
“As you can see,” Gad says, “you cannot tell our HIV status because we are now strong and back to our feet.”