Where is the missing link?

Apparently, malaria is the major disease burden in Kyangwali refugee settlement accounting for close to 50% of the morbidity. There have been various preventive and curative interventions that are widely implemented by Action Africa Help and other implementing partners- something that really raises hopes among health workers, sympathizers and some of the residents.

However, the reality is a bitter one that nearly rubbishes the efforts and time spent in the preventive approaches, specifically the supply of Insecticide treated mosquito bed nets. One of the facts that the refugees have come to learn with time is the “insect-cidal” effect of the chemicals these nets are treated with. As opposed to utilizing this “insect-cidal” effect by sleeping under them for the control of mosquito infestation, majority have adamantly used the mosquito nets as termite resistant building materials. The closer one gets to most of the grass thatched houses in the settlement, you notice strips of blue or white thick netted thread joining up reeds or sticks used for the superstructure and as well firmly fixing the grass thatched conical roof tops.  As though this is not enough, I saw animals tethered by twisted but netted blue and white ropes that clearly turned out to be mosquito nets. I was exasperated and sick of this unhealthy practice among people who indeed are in dire need of rescue for their lives. They are causing a great disservice to themselves, health service providers plus inhabiting and surrounding communities by averting the efforts towards a malaria free community. My worst scene had not come yet until I coincidently moved to the back yard of one of the houses that we visited during the intensive nutrition assessment exercise for the refugee settlement. A brand new mosquito bed net, without a single puncture was hanging over firmly fixed sticks forming a chicken pen that restrained 2 cocks and a hen just like one would use a wire mesh!

Chicken restrained by a mosquito net as a chicken house

Mosquito net used as building material

A grass thatched roof fixed with strips of mosquito nets

  

                                                                                                           

As I reflect on these observations that seem to be happening in many homes in the refugee settlement, I can’t stop asking myself what exactly the missing link is. Why would a pregnant mother, a recovered client or a vulnerable person who has received instructions and sensitizations on the value and usage of such an effective item go back home only to use it as a chicken house or a tether rope? Could it be that the health communication is not effective or that the paradigms in behavior change among such populations are rather complex?  

Participatory Learning: A case of the training of community health workers on Infant and Young Feeding Practices (IYFP) in Kyangwali refugee settlement

Training community health workers can turn out to be a sluggish and boring activity if participation of the trainees in under looked. This 3 day training (27^th to 29^th September) was a great experience to test how participatory learning can make training fun and much more beneficial to the trainees and the trainer.

At the end of the second day, we decided to introduce what we called “problem based learning”. This is a scenario where you formulate a problem statement close to real life encompassing the topics that you already discussed with the trainees. You then let them divide in groups and tackle the problem while jotting down the solutions and then pick a group member from them to present on behalf of the entire group.

Trainees tackling the scenario in their group

The group representative discussing their solution

Lessons drawn from the “problem based learning”:

The participants become more active and you will not see any of them dozing off be it after lunch hours.

It greatly imparts communication skills to the trainees

The trainees feel valued and thus will better own the training and its objectives

This makes the assessment of whether the trainees have understood the training content easier for the trainer.

Norms, beliefs and customs of the community are easily spelt out when one of the members is given opportunity to solve a scenario.

It creates opportunity for the trainer to build on local or available knowledge and skills of the community

It emphasizes creativity in problem solving

It creates opportunity for the facilitator to re-emphasize messages or to communicate what was forgotten or accidentally left out.

The training ended on a good note but more importantly, we were generally satisfied that the trainees had widely benefited and that they are capable of putting what they had learnt in appropriate practice. We concluded by asking them how we could improve the trainings and they listed a number of things that we too had identified along the way:

·         They demanded for the use of audio-visual training materials from which they will watch what the trainers are emphasizing as opposed to just imagining.

·         They demanded for some incentives that could motivate them to carry on with this voluntary role that they play in the community. Such include; T-shirts with health messages, gum boots, certificates etc.

·         They however pointed out that at times they are over ridden by various trainings and other roles by various implementing partners and therefore proper timing and prior communication are key in mobilizing them for the training.

From our own view, we noticed that the trainings will be much beneficial if other influential people capable of determining and promoting health in the community take part. We thus decided that during other trainings, we shall invite some community leaders to attend.