Nate Cohen was Project Bumwalukani's amazing FIMRC Ambassador last Fall. He has shared his experience working with FIMRC's Community Health Educators Program as well as the Program's success in empowering the community at Bumwalukani! Enjoy!
FIMRC CHE PROGRAM
The first thing you notice is mud. Mud is everywhere in Bududa district. The combination of heavy rainfall, clay-like soil, and high elevation makes it a daily fact of life in this remote corner of Uganda. Though they seem to be locked in an almost Sisyphus-ian struggle against the mud, the heat, and the ever-encroaching jungle, the roughly 150,000 people who live in the foothills of Bududa manage to scratch a living out of the mountainsides. The Foundation for International Medical Relief of Children (FIMRC)’s Project Bumwalukani is nestled on one of these mountainsides overlooking the Manafwa river. The clinic is small, less than 1,000 square feet, yet sees about 1,200 patients a month, more than any of the local government facilities save the district hospital about 15 kilometers away. Four clinicians, three staff assistants and two lab technicians manage this patient flow, providing both pediatric and adult services. In attempting to address the vast health needs of the communities where they work, FIMRC uses a two-part approach, one component of which is the actual hands on medical care provided by clinic staff. The other element of FIMRC’s approach is based on community outreach and education.
To this end, Project Bumwalukani has created a network of health volunteers. This program, the Community Health Educator (CHE) program, has been expanding and growing in Bududa district since 2009. There are now 24 CHEs based out of FIMRC’s clinic. These CHE’s are each responsible for their own individual catchment areas, usually incorporating 3-4 small villages (about 600-1000 people). While this only scratches the surface of the districts needs, it has had a vast impact on FIMRC’s ability to engage with the community and address its health needs and concerns. The CHEs are a diverse group, about equal split between men and women, varying in age from 19 to 74. The group includes 3 teachers, 4 pastors, 2 village elders and a taxi driver.
The CHEs are trained on a wide variety of health topics, primarily nutrition, sanitation, maternity and child health issues, malaria,immunizations, and wound care. This training allows them to serve as a first-line of treatment and evaluation for many of the members of the community, and about ¼ of the patients seen by FIMRC’s clinic on a monthly basis are referred by CHEs. FIMRC’s CHEs are equipped with basic first aid supplies, as well as low-level painkillers like paracetamol and ibuprofen and deworming medications like Albenazole. As the name would suggest, the CHEs also frequently participate in outreach and education efforts in their communities and at local schools and churches.
The day-to-day working of one of FIMRC’s CHEs involves an impressive amount of walking. CHEs are frequently sought out for medical assistance, but the most substantial part of their job involves home visits and health check-ups in their catchement areas. Given the lack of digital and cellular communication options, sending a CHE on a follow-up visit is often the only way for clinic staff to get updates on a patient’s condition. This can sometimes involve upwards of 20 km of walking up hillsides between 1500 and 2500 meters of elevation. I once hiked 12 km to do a follow-up on a child we’d seen at the clinic a few days before with one of our CHEs named Penina, who was 32 weeks pregnant at the time. Many of the CHEs also lead community groups sponsored by the clinic.
The idea of the CHE program is to empower members of the community FIMRC works in to address as many of the health needs of their families and neighbors as possible, while at the same time reaching an ever-increasing number of people in need of care. I had to cancel a training session with the CHEs in late November because of an emergency at the clinic, and they decided to meet anyway so they could discuss how their communities were doing. This is demonstrative of the most compelling and sustainable aspect of this model: the dedication with which the CHEs approach their work. Despite being unpaid volunteers, many CHEs frequently put in 30-40 hours a week of work, and their commitment to their communities is absolute. By creating an environment of ownership and investment, FIMRC has been able to engage the local community in a way that would be impossible for international workers to accomplish.