Community Changes

Submitted by Michaela Sholes

It is such an encouragement to me to be able to spend time with the health reps, whether in person during the trainings or via phone conversations! I thoroughly enjoy working with them to address any questions or concerns, but also just to hear from them and learn how they are making an impact in their homes. A recent blog addressed some ETCHE-related numbers, including the number of people impacted simply through attending health talks in their own communities by the health volunteers. I'd like to take this blog in a slightly different direction and talk about some of the changes reported as a result of what they are learning:

One of the health volunteers (who is also a teacher at the local primary school) recently shared with me how he had taught his students the "Hand-Washing Song" and as a result, has seen a marked increase in the number of children practicing good hand-washing habits. He also noticed that fewer children were missing school as a result of diarrheal disease. An observation shared by several of the Queen Mothers across communities, as they shared at the training how they have seen for themselves that there have been fewer bouts of diarrheal disease, despite it being the rainy season...a time when the communities typically see a spike in diarrhea.

In addition to increased hand-washing, several communities also reported mobilization efforts by the people to reduce urination and defecation in or near the river or lake in order to help reduce the transmission of schistosomiasis and other illnesses. The support of community authorities like the chiefs and elders in a community is critical in order to affect that level of reach, and we are glad to hear that they actively support the information they've received with the ETCHE drops!

We consider ourselves privileged to work with these communities and individuals who are working so hard to see positive change in their own homes!

A few Numbers

Submitted by Michaela Sholes

In the 6 bag drop flights made thus far in the ETCHE program, nearly 100 bags were delivered to isolated lakeside communities..and that's with plenty of storage space left to spare! Roughly 3/4th of those drops included materials that were directly health education related (such as health posters and messages), while the remaining drops were made up of logistics like the initial “ping” drop forms and invitations to trainings. Hard to believe we’ve come all this way on only 6 drops!

Community feed back

Submitted by Michaela Sholes

I felt like a kid at Christmas following the last training session from the plethora of evaluation forms provided by the communities! It was our first opportunity to begin putting some numbers to what we've done and get an idea of the community-level impact. In each health education drop, we included an attendance and feedback form for the local health volunteer to complete and bring to the next training session. So, in an ideal situation, we would have had 3 completed forms for each of the communities. As in any program however, we hit a few snags, but overall we had a good response rate. Not all the communities completed all 3 of the forms, but the available attendance and feedback reports were positive! Over 2,000 individuals across the communities were reached through meetings initiated by the local health volunteers and the Queen Mothers! Over the course of the diarrhea, schistosomiasis, and malaria bag drops, attendance at the meetings ranged from 2100-2500!

ETCHE can make a difference

Submitted by Michaela Sholes

Parts of Ghana, including our own Eastern region, have been affected over the past few months with outbreaks of Cholera. This disease, transmitted by contaminated water, is particularly devastating in areas where sanitation is a challenge or where there are few water sources. Its sudden onset of heavy diarrhoea (described as "rice-water") can quickly result in life-threatening dehydration, especially when combined with vomiting. Transmission can also occur if stool particles from a person infected with cholera contaminates water sources used by others. Children are at a higher risk for complications from cholera. Cholera infections can usually be managed successfully through rehydration efforts and basic antibiotics, as long as the disease is reported early to a health facility.

 

While MoM has not specifically addressed cholera in our health education messages, sanitation and clean water have been a major topic for some time now and many of the principles are the same. We emphasize

-Thorough, frequent, and appropriate hand-washing practices using soap and water:\

-Before and after eating

-After using the toilet

-Heat your food thoroughly before eating

-Store your food properly and heat food thoroughly when reheating

-All water used for drinking and cooking should be purified through boiling or methods such as SODIS

With particular relation to cholera, however, additional efforts should be used to prevent transmission of the disease:

-Ensure effective disposal and treatment of any fecal waste from cholera patients and any contaminated materials to prevent further transmission

-Any materials that come into contact with cholera patients should be treated by washing them thoroughly in hot water and chlorine bleach if possible.

-Wear gloves when touching cholera patients or their clothing/bedding and make sure to thoroughly clean and disinfect hands which have come into contact

As always, MoM encourages community members to quickly report any incidence of cholera to the nearest health facility, to ensure prompt management of the disease.

Miss Lydia .. Healthcare educator

Submitted by Rachelle Milam

One of the best parts of the training this past Friday was watching the AvTech girls step up and take a part in teaching and demonstrating first aid techniques to the communities. Juliet assisted Michaela to talk about how to treat a burn, Emanuella assisted a visiting nurse to give a demonstration of stabalizing a fractured limb, and Lydia assisted Audrey, one of our long term volunteers, with showing how to treat a wound. They all did an amazing job and worked very hard with the rest of us to make Friday a success. The greatest impact, however, came when Lydia stood in front of the community reps and Queen Mothers and told the story of how her arm was disfigured. She explained that when she was very young, she'd been bitten by an insect. Because her parents had no knowledge of first aid, they relied on traditional healing methods, like mixing herbs and applying them to the wound. Sadly, because of these methods, her arm became infected and ended up becoming disfigured. While the communities were interested in all the demonstrations, it was easy to see that Lydia's story was what they really connected with. They related to it because they all had children who'd been hurt. It drove home how important these steps could be, because it's not a matter of loving their child or wanting to see them well; it's about being aware of the necessary steps to make sure that their child will be effectively treated if something happens. Lydia did such a wonderful job, and we hope that her story inspired the people to learn ways to prevent such a tragedy occuring with their own families.

ETCHE training 2

Submitted by Michaela Sholes

While I’ll be the first to acknowledge that training events are expensive and take a great deal of energy and effort, they are also hugely rewarding!

The second ETCHE training saw a total of 43 visitors attend, not including the 3 presenters, the AvTech girls, and our wonderful volunteers! Although we were a little disappointed that there were fewer community Queen Mothers present than at the first training, we were pleased to see that all 17 of the original communities as well as the 2 new communities were represented by their health volunteers or as in one case, a community-elected stand-in. It was wonderful to recognize familiar faces from the last training and put faces to names for the new communities.

In true Ghanaian fashion, we began roughly an hour later than expected, but the sessions themselves ran fairly smoothly. Audrey and Lydia facilitated a brilliant wound management session, with hands-down the most moving presentation as Lydia touched a personal chord with each individual as she shared with them the evident high cost of improper care for wounds. Prior to her talk, many in the audience had been unconvinced about the dangers of herbal treatments which Audrey had previously been discussing…but Lydia’s frank dialogue left no questions about the darker side of those herbs which are commonly used by many and the fact that her point hit home was clear. Afterward, Lydia employed the help of Mr. Kofi Wisdom (health rep from Asekesu Ada and dedicated teacher) to assist her in a demonstration of how to properly clean and dress a wound.

We were pleased to have with us Nurse Stella from GHS to help with the session on fracture management. She and Emmanuella did an excellent job discussing types of fractures, stabilization techniques, and evacuation options (i.e. backboards and local transportation). Nurse Stella provided a relevant frame of reference regarding locally available materials such as a clean headscarf in place of a splint-tie or sling. Manye Makutsu volunteered to help during the demonstration about how to stabilize a broken arm, getting more than a few chuckles out of the crowd with her exaggerated groans over her “injury”.

Juliet and I facilitated the last session regarding burn management and really enjoyed the discussion session with community members regarding their experiences with burns, prevention, and treatment. Mr. Prosper (the health volunteer from Akokoman Sisi) shared with the group about the time his wife had been holding their child while preparing the evening meal when she had accidentally spilled the pot all over herself and the child. Juliet did a great job walking the group through the way to cool and clean a burn as well as prevention behaviors.

We are so appreciative to Manye Esther, Manye Makutsu, and Manye Obukie for lending their support to the event and assisting with the coordination of catering for the trainees. Manye Makutsu provided translation for the first session as well as enthusiastic participation during the sessions. A big “Thank you” as well to the community members like Noah and Alexander who helped translate for us at different points of the day!

One of the things I enjoyed most about this particular training session was the ability to hold an evaluation-type of discussion with the group to gather feedback from them regarding successes and challenges they had experienced over the past 2 months of the program. Their honesty regarding what had or had not worked for them has really helped to frame our understanding of future directions, even when it means that on more than one occasion we’ve made mistakes. For example, although the SODIS demonstration was a huge hit at the last training, we came to understand that adoption among the communities was less than low…in fact, it hadn’t really been implemented at all. It’s not that individuals were opposed to it, but we realized afterwards that repeated demonstration and further explanation of the benefits would be needed to encourage adoption. On the flip side, communities reported not only widespread adoption of community sanitation practices and hand-washing, but also visible disease reduction in their homes!"

Working WITH the community.. the only way

Submitted by Rachelle Milam

In the early 1960’s, a young man named Bruce Olson decided that he wanted to work with the people of South America, and without the support of any agency, any money, or even any solid plans, he went. Through a series of events that spanned several years, he eventually ended up with the Motilone Indians in Columbia, a tribe that was, at the time, known only for their ability to kill anyone who came near their lands. Bruce, or “Bruchko” as the Indians named him, stayed with the Indians for many many years, and in his time he saw changes in the tribe that had never before been witnessed in a people so removed from “civilization”. They established agricultural centers, public health works, schools, newspapers, and many other amazing feats during the years that Olson worked with them. To many, this would seem just another story where a white man came in and saved the savages from themselves - however, this is not the case. The most impressive part of this story is the fact that the remarkable changes the tribe made were not through Olson’s coming in and taking charge of everything - it was through the Motilone Indians seeing a need for change and changing it themselves in their own way, with their own people.

My favorite part of his story is when he talks about how he first tried to introduce the idea of modern medicine to the Motilones during an outbreak of pinkeye. At the time, the tribe relied on a traditional healer to sing songs to the spirits and give out treatments of her own. After trying and failing to get the people to try the ointments that would heal the pinkeye, Olson got himself infected, then went to the healer and asked her to sing her spirit songs while rubbing the ointment in his eye. He was healed in just a few days. When the tribe saw that they did not have to change their whole way of doing things, but just implement new ideas and treatments, they were much more open to the idea of new medicines. That healer became a great help to Olson’s work, and he found that through education and allowing the people to learn from a healer they knew and trusted, community health was greatly improved.

Here at MoM, we could take the approach of riding (or flying) to acommunity and standing on a box in front of the whole village and telling them exactly what they’re doing wrong and why they must change. If we did things that way, I don’t imagine many people would want to listen to us. We have chosen, much like Bruce Olson did, to work in a different way. When the drops were first started, each community’s health representative or Queen Mother was asked to contact us. In the communities that had no health representative, the people were asked to get together and nominate someone that they trusted to be their health representative. Most of the contact we have with the communities is through these men and women, and it is they, not us, that communicate the information we give them for the betterment of their communities. This is so important because people are much more likely to believe someone they know and see regularly in their communities. If we were to go in and do it, people might nod their heads and pretend to listen, but likely we would not see any significant change. This way, the community can learn from people they respect, act together to change their environment, they can “own” their own health and the health of their families, and they have a much better chance of seeing the changes new health practices can bring.

Burn care part two

Submitted by Michaela Sholes

When discussing general burn care with communities, we emphasize these actions as a first response to stabilize the wound and prevent infection prior to arrival at a health facility:

• Separate the person from the source of the burn if possible, without subjecting yourself to injury.
• Flood the burned area for at least 10 minutes with clean water which is cool/lukewarm in temperature. This cools the area to prevent further injury, removes burning chemicals (if present), and controls pain. Water which is warm or very cold may further damage tissue.
• Remove clothing, rings, watches, belts, shoes, etc., from the area surrounding the burn. Tissue will begin swelling soon after the injury, so these articles may become too tight for blood to flow properly.
• Keep the burn as clean as possible, applying a loose bandage until medical attention is received. Never remove items which are melted or stuck in the skin, as this can cause further damage, pain, and possible infections if not done properly by a health professional.
• Never squeeze or break blisters. When blisters are broken open, bacteria enter the skin. Warmth and moisture encourage the growth of bacteria, so infections can become serious in open blisters.
• Medical care should always be found for burns involving children, hands, feet, face, genital areas, or burns that go all the way around the arm or leg. Burns that go deeper than the first layer of skin or blisters over 5% of the body should also be immediately brought to the clinic or hospital.

In “The Calling”, there was an image of a little boy in the Fulani camp who had stepped on live coals while walking around the family’s courtyard. In the film, you can see his mother pouring cool water from a bucket over the burned bare little foot as Matthew waits, hands gloved, to apply a clean dressing to prevent infection until the family is able to get to the clinic.

Injuries like burns are common in many places, but are further complicated in rural areas due to the distance to the health center as well as a lack of sterile equipment and environment. These are their everyday challenges which can quickly get out of hand if infection control is not understood and applied quickly.

 

 

Burn care

Submitted by Michaela Sholes

One of the most common injuries in rural communities is a burn. Whether as a result of children being too close to the cooking pot/fire, acid being thrown at someone during a fight, or during dry season when there is a lot of brush fires, burns can quickly become life-threatening if not addressed quickly and effectively. As with wound management in general, there are a number of local or home remedies that are used when this happen, which can include anything from putting gel from the aloe plant (good for treatment, but only following proper cleaning and medical care for the burn) to putting sand (NOT a sterile or effective method) on the burn.

Just a few weeks ago, a friend of ours called me in a minor panic as a family member had just spilled boiling water all over her hands and needed information about how to properly manage her injury. Ironically enough, not 3 days later, her daughter was also burned by boiling water, but this time, because she had had the previous experience, she was able to handle it quickly and effectively.

Wound management

Submitted by Michaela Sholes

When discussing general wound management with the communities, we encourage the following actions to prevent infection and promote healing in a wound:

· Control any bleeding through elevating the limb and apply direct pressure with your fingers. Wear gloves and use a sterile dressing if possible, or ask the victim to apply pressure himself.

· Clean around the wound with soap and clean water or disinfectant (e.g., alcohol, peroxide). Clean all skin within 2 inches (50 mm) of wound, starting at the edges and spiraling away from the wound. Note: these liquids shouldn’t be poured into the wound, but instead are used to clean the outside of the wound.

· Flush the wound with clean, drinkable water (bottled, boiled, or cleaned by SODIS method). Use a Pure Water sachet or a small clean plastic bottle with a hole in the cap to squeeze water through the hole to create gentle pressure. Use at least ½ liter of water, or more for larger wounds.

· Do not remove large objects that are firmly embedded.

· Cover the wound with sterile gauze and a clean dressing.

·Change the dressings at least once every day or whenever the bandage becomes wet or visibly dirty.

Many of these steps are easier said than done…it IS a challenge to get clean water and to find items like sterile gauze. But it WILL make a difference between spending a little money/time now and spending much more money/time at the clinic later once an infection has set in.

Many of these steps are easier said than done…it IS a challenge to get clean water and to find items like sterile gauze. But it WILL make a difference between spending a little money/time now and spending much more money/time at the clinic later once an infection has set in.

Effective wound management

Submitted by Michaela Sholes

Effective wound management is one of the main things we will be discussing in the coming ETCHE training session. Injuries happen everywhere in the world, but in the rural areas things can get complicated quickly due to a variety of factors. A small cut or insect bite can quickly turn into a raging infection, causing pain and additional challenges that could often have been avoided in the event that effective and maintained cleaning were present.

In addition to Lydia’s experience, we have seen the effects of these challenges time and time again. Last year in the Fulani camp, Asamau developed a severe infection which affected the nerves in her hand, all because a stick had punctured her small hand. Even though her family did take her to the hospital, she still faced challenges related to environment and health literacy.


It is for this reason that we feel it is necessary to provide our community volunteers with training in basic first aid, to be able to quickly and effectively manage and stabilize injuries when they occur.

Hands on Demonstration

Submitted by Michaela Sholes

The AvTech girls practiced their demonstrations for the upcoming training and I am so excited to have their help!  Each girl spent time reviewing the layout of each of their sections and enjoyed a hands-on review of the material.  Juliet had some excellent ideas about how to effectively explain the various levels of burns to the communities, while Emmanuella really enjoyed creating make-shift sling/swathe arm splints and traction splint using locally available items.  I thoroughly enjoyed my conversation with Lydia regarding her desire to educate others about proper wound management and the high costs of doing otherwise...in her words, "a dream coming true.

The Next Training session

Submitted by Michaela Sholes

One of the things we’ll be sharing with the communities in the upcoming training session is the concept of effective wound management. There are a number of perspectives around the world about the best ways to clean a wound and keep away infections. Some of these perspectives are driven by scientific proof (i.e. using clean water to irrigate a wound will help avoid infections as it will clear the vulnerable wound of foreign bacteria) and others are driven by tradition/home remedies (i.e. putting cow dung or brake fluid on a wound as treatment - which are clearly not appropriate treatments and need addressed).

Now, we should specify that we are not condemning the use of all herbal/alternative medicines any more than we want to portray modern medicine as the only thing that will ever work…they must work hand in hand, with those that employ their uses being educated about what is valid to use, what might in fact end up doing more harm than good, and how to best utilize the local clinics. A big part of effective wound management is keeping the wound clean and free of potential infections by ensuring that hands and bandages are kept clean AND introducing the concept of using low cost, readily available anti-septic creams/liquids. Controlling bleeding, fully irrigating/cleaning a wound, applying clean bandages for stabilization, and avoiding the introduction of any foreign contaminant on the wound before bringing a person to the clinic increases their chances of avoiding infection.

No ops in the rain .....

Submitted by Michaela Sholes

Rainy season is in full swing, bringing with it the need to adjust activities when a storm system blows in. Our plans for the weekly session in the Fulani camp had to be rescheduled as the roads both on the airfield and at the camp are essentially undriveable. The last time we tried to drive in to visit the camp right after a storm, we spent nearly 30 minutes trying to drive the quarter of a mile on dirt road from the junction to the camp because the mud was so thick. We will attempt to reschedule for Wednesday or Thursday if possible. 

This week’s session is scheduled to review the budget sheet Ben introduced to the men’s group 2 weeks ago, as well as the SODIS demonstration and literacy lessons with the women’s group. We have been reviewing basic phonics with the ladies, but will be increasing the pace soon. Based on the different working levels of the women, we may look into splitting the group into those who need more foundational work and those who are ready to work on word building. Real life applications will be incorporated where appropriate so they can practice letter/sound recognition in their everyday lives, whether that be medicine bottles, health posters, or their children’s workbooks from school. Audrey, Ben, Rachelle, and I look forward to continuing to work with the group to support their efforts, help address challenges, and cheer on their successes!"

Community participation

Submitted by Michaela Sholes

One of the things I love most about working with the communities is how different they all are and the various personalities we interact with. I had another encouraging call from a community today, this time from the community’s chief or “dademantse” (phonetically it is “DAH-day-MAHN-chay”). This fellow has been highly supportive of our efforts from the very start and we at MoM believe that is crucial to success. This time, he called to let me know (very enthusiastically!) that they had received the last ETCHE drop, had arranged the next community meeting to share the malaria information, and that the community would come together to help sponsor their Queen Mother and Health Volunteer to attend the upcoming training. It makes all the hardships worthwhile when you hear something like that, to know that they value this and want to do what they can to make the most of it.

The road side infomercial

Submitted by Michaela Sholes

Every part of the world has various angles from which to portray health issues, including the "infomercial" perspective on health. In the US, you'll see the latest vitamin trend which promises to regrow hair, give you "super energy" and various other promises which are tailored to appeal to what is important to us as a culture. It's no different in Ghana, as you can see from this advertisement located on a busy intersection, where the ailments range from spiritual in form (i.e. witchcraft), to cultural (sexual weakness), to actual health issues (Bilharzia, stroke, etc...) that may also go by local names. This is part of the challenge in health education as we want to be respectful to culture and perspectives that are not our own, but also to address these ideas that are very real to many.

VFR on-top

On Monday we pushed out on a tight schedule, dodging weather and working to a new drop route. Michaela added two more drops to the run. Climbing out, the only safe route was VFR On-Top to clear the ridge - the views magnificent, as was the turbulence. In this image we are barely at 2500', and the cloud formations are rapidly growing.

During the drops we achieved some of our most accurate deliveries, Patricia's flying improving on every run - so much so that she surprised me on one drop where the bag fouled and she appeared to almost reverse the aircraft with deft use of throttle and pitch, enabling a perfect targeted delivery.

We set out with extra fuel, planning for a deviation to Kumasi, in the event of weather breaking from the East. Fortunately for our day, on the way back we dodged weather and made a safe return.

The Drops continue

Submitted by Michaela Sholes

The MoM team was up early today as the pilots departed for the next round of ETCHE bag drops! Although the weather presented some challenges, the drops were 100% successful and we look forward to hearing from communities! This week's drop included information targeting malaria awareness as well as a malaria-targeted health poster and an invitation to the next training session, scheduled for Friday June 22.

Akosobo Dam

Submitted by Hallie Paige Arrigon

To celebrate the Ghanaian holiday on Friday, I ventured off the airfield to tour the dam at Akosombo. The dam was constructed during the 1960s to generate electricity for rural communities across the region. Lake Volta, the world’s largest artificial lake, formed as a result of this intervention in natural processes. Electricity from the dam certainly has a positive impact on the health and safety of some individuals and communities who have gained access to refrigeration, electric lighting, and similar luxuries. However, many of the communities that are situated along Lake Volta and served by MoM remain without electricity and have instead suffered health threats imposed by the dam. Transforming an active river into a massive lake created the perfect environment for the snails that carry the schistosomiasis parasite. Schistosomiasis (also known as bilharzia) can cause many unpleasant symptoms like blood in the urine and stool as well as a variety of long-term consequences, including impaired growth and development in children and infertility and cervical cancer in women. The disease remains alarmingly prevalent around Lake Volta. For this reason, MoM recently distributed health education materials targeting schistosomiasis to the communities participating in the ETCHE Project and remains active in the Bilharzia Control Forum Implementation Committee.

How do you say............ ?

Submitted by Michaela Sholes

As MoM works towards ensuring that all our materials are appropriate for community understanding and context, we rely on those who know Ghanaians best....Ghanaians themselves! During part of our class session today, the AvTech girls went through our most recent information sheet regarding Malaria and provided valuable insights to wording and perspectives. Although it might sound easy to do, it can be rather tricky to find simpler terms than "parasites" and "immune system" and even "unconscious"...especially when one attempts to find the local word for such things, much less the English word! Good work today, girls!