Dr Ceri Gallivan, UK RCGP volunteer at Bwindi Community Hospital reports on the latest USHAPE activities in the Kanungu District
This month we have had 4 days of VHT teaching in the community. VHTs are volunteer village health workers. There are several VHTs in each village and they are each assigned to a certain number of households (usually around fifteen). Their work is entirely voluntary apart from the occasional t-shirt or small amount of money given for attending workshops or teaching sessions. The VHT’s role is to educate the community, to report births and deaths and to liaise with other health workers. The system of village health teams operates across all of Uganda. I’m told it is not functioning so successfully in other parts of the country. One reason for the success in this area may be that the VHTs are supported by the community nurse team from the hospital. One nurses visits every village in the hospital catchment area once a month on the same day each month. They liaise with the VHTs and visit all neonates, postpartum mothers and pregnant women in the village.
Part of the USHAPE work is to support the VHTs through regular teaching sessions. The previous VHT teaching was in April 2014 and focussed on good qualities of a VHT, presentation and communication skills, cervical cancer screening, family planning methods and myths.
The teaching sessions were planned to cover all the hospital catchment area. The hospital covers three sub-districts. There are around 500 VHTs in total. We invited the lead VHT and the family planning lead from each village. On the first day of training we went to the most remote district of Mpungu. We squeezed 8 people into the hospital ambulance along with 3 crates of soda, doughnuts, VCT equipment and a spare tyre. We sped along red dusty roads up, down and along hillsides. We drove by the rainforest and through banana and tea plantations. We stopped in a small village along the way to drop off a team to do VCT outreach (voluntary counselling and testing for HIV). Eventually we reached Mpungu where we stopped at a health clinic on a hilltop. The clinic has an amazing view of the neighbouring villages, fields and a new large catholic church built on a hill looking rather out of place next to the small houses and farms.
We gathered in the small waiting room of the clinic. To begin the session we played a few videos on related subjects. We fashioned curtains out of women’s wraps to cover the windows and used a small handheld projector plugged into a large speaker.
The first session was on adolescent health. They split into five groups and discussed different questions such as describing common problems for adolescents, how to communicate with them, issues that you might face when working with adolescents and how to approach them. Each group then presented their discussion back to the group. This lead to some interesting discussions, about topics such as teenage pregnancy and early marriage. Some of the VHTs said that some of the challenge is that adolescents feel that they are more educated that the VHTs so don’t respect their teaching which is a difficult problem to address.
The second session was on confidentiality. We discussed some scenarios such as a man presenting with symptoms of a STI, a women requesting contraception whose partner doesn’t want her to have any, a teenage girl with a older man ‘sugar daddy’ who pays her school fees in return for sexual intercourse, a teenage girl tested positive for HIV who doesn’t want to tell her parents and a women who is HIV positive who doesn’t wish to tell her husband and wants the VHT to keep her medication for her. We had many interesting debates about these situations, especially about the ‘sugar daddy’ which caused some differing opinions amongst the VHTs. We emphasised that the main reason for confidentiality is so the patient and community can trust the VHTs which they all seemed to agreed with.
We then discussed different myths surrounding family planning. There are many things that I wouldn’t have known that people thought such as family planning methods causing fibroids and high blood pressure.
Between 30 and 50 VHTs attended each day depending on the population of the area. They were all very enthusiastic and motivated and indicated on the feedback forms that they’d like more training sessions in the future.
These sessions ran very well and were mostly facilitated by local staff. They didn’t really require the input the UK GP volunteers as they were all conducted in Rukiga. We were able to help with the planning and preparing materials though and we have some ideas for future sessions and things that could be improved. A few of the hospital staff that have attended the level two USHAPE training earlier in the year came along and delivered some of the sessions. It was really great to see them applying their knowledge and growing in confidence. We’re hoping to train some people to be trainers on the USHAPE courses over the year so that the project becomes more sustainable and is not relying on much input from UK volunteers.
Overall it was a really enjoyable experience. The VHTs are an inspirational group of people. They are working to improve their communities and the health of their populations without being paid a salary. They were enthusiastic and motivated and all had interesting input into the discussions. They showed empathy towards people’s problems and genuine care for the communities. I think communities in the UK could learn a lot from this structure of village health teams, perhaps it’d be one way to take pressure off increasingly busy GP practices!