community health workers

This week I was able to walk with community health workers (CHWs) as they did their rounds. Each one has about 200 households (all officially identified, by the way, with the male head of household) and visits them all in a three month period. Some families, e.g. those with children less than 5, a pregnant woman, or a child with a fever, are seen much more frequently. For those of us struggling in the US health care system with tracking indicators and follow-up, the system here utilizing the CHWs is great and getting tighter. They work for several hours six days a week. They walk from household to household during afternoon hours because mornings for them and the other villagers are spent in their gardens (translate that to matoke plots), especially during rainy season. So on each afternoon, I met one of the CHWs at the nearby health center and we started off on foot down steep hills along barely perceptible paths in the matoke plantations until we reached a house. Until this week the houses all looked roughly the same to me- small houses built of mud-ash-dung on a wood frame with corrugated iron roofs. I am now seeing the details- those people who have planted avocado and peppers or flowering plants, those whose houses are pristine despite packed dirt yards and packed dirt floors, those who have plastered the walls with a clay-lime mixture. Most of the houses have a main building with a small living/eating area (as small as 4 X 6 feet) with either wooden benches or seats with cushions and sleeping areas. Light comes from the open door and sometimes from small windows. Other buildings include the kitchen, which has gaps along the upper walls but without a chimney to let out the smoke from the wood or charcoal fire, a latrine, and an enclosure made of matoke leaves for bathing. Once inside the house, the women and children were welcoming and hospitable (of course laughing at my limited Runyankole and the presence of an omuzungo in their house). The CHWs know their families well and had preplanned what topic to discuss- child growth, family planning, or fever (they carry malaria kits). I'm currently helping to organize a project in which Ugandan Christian University community health interns, CHWs, and clinicians will visit every one of the 1050 households in the Ruhiira parish (1 of 8 parishes in the project area) starting Monday to test as many people as possible for HIV, promote family planning (to include bringing and implanting a 5 year contraceptive), encourage deliveries in the health centers, provide bed nets for anyone who lacks them, and reinforce the many other public health messages of the project- so I'm sure I will have ample opportunity to do more visits. The pictures are of Edward, a senior CHW, measuring a child's arm to monitor growth with Josephine, one of the interns, and Edward in front of the kitchen.