08.53, 26 May 2010
Last week marked the half-way point of my Vodafone World of Difference
year working with Health Poverty Action
and the competition has just been launched again for this year. As I write this, we have just said goodbye to the team of 12 community health volunteers who have been working as researchers on our fistula project baseline survey. We have been working together for the last two weeks, with three days spent training the researchers on research skills, pre-testing the interview questionnaires and focus group discussions, nine days of fieldwork and then a debriefing and evaluation. It has been an intense, but rewarding two weeks.
We have been working across all five of the Chiefdoms of Northern Bombali that Health Poverty Action is operational in. This baseline survey will enable us to measure the impact of our two-year project to prevent fistula and also identify and refer women for repair surgery. The researchers are conducting interviews in 30 villages with men, women and community leaders, which will give us an idea of the community knowledge, perception and attitude towards fistula. In addition to the household surveys, we have interviewed traditional birth attendants (TBAs) (who currently provide the vast majority of care for women during labour and birth in this area), health workers in all 27 of the rural health centres in our operational area, exploring knowledge, routine practices, referral systems and working relationships between the TBAs and health workers.
All of this information is useful not only to assess the impact of the two-year project, but also to identify training needs for health workers and areas for development, in order to improve collaboration between health workers and TBAs.
Being able to go to all the rural health posts we work in has been really useful for me – I have now been able to meet nearly all the maternal and child health aides who will come for training next month, as well as collecting information on the free healthcare initiative in the first weeks after the launch.
I was lucky to be able to attend the launch of the initiative by President Dr Ernest Bai Koroma in Freetown last month. Health Poverty Action is the lead non-governmental organisation for supporting the implementation of the initiative in Bombali District. Utilisation of health services by pregnant/lactating women and under-fives appears to have increased hugely, which is good, but does mean that many of the health workers are having to manage a huge increase in workload and large numbers of clients arriving for clinics – in one health post, we met around 150 women and children. Generally the supplies of drugs seem to be getting through, apart from some exceptions, although stock is quickly diminishing due to the high volume of women and under-fives coming for treatment. Health workers have been told that they will receive more stock soon. Initial reports from the field appear that although there are some issues to resolve, the implementation is generally going well.
During our nine days of fieldwork, we have covered large distances on some of the poorest roads in the country. The discomfort has been worth it though, as the landscape is incredible. We have passed through lush jungle, with mountains rising out of the early morning mist as the dew sparkles in the sunlight all around – travelled through the rocky gold mining areas, through national parkland and through the customs and immigration post at Sanya as we reached our last village, which is almost on the Guinea border. Everywhere people have been working on their farms, as it is planting season with pepper, tobacco, cassava and cocoa all being nursed or planted out. Some of these remote villages could only be reached on foot. They sadly lack even basic sanitation facilities including clean water and the challenges that some health workers face in areas with poor road networks, no mobile phone coverage and long distances to the referral hospital are many.
The most vivid memory I will have of this work will be, without doubt, the hospitality and generosity of the people we have met and stayed with. In every village, we were given either fruit or chickens to take away or rice and plassus (sauce) to eat. Staying with health workers in the rural clinics, we were given beds to sleep in (often their own, which feels like an imposition, but I was assured is the custom), food to eat (whatever time of the day or evening we arrived) and welcomed as if we were part of their own family.
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