10 October 2012

Namibia: Extension Workers Take Health to Kunene Communities

IT TAKES no less than a five-hour drive over rough terrain with 4x4s to reach the outlying cattle post Ozondombo, about 100 kilometres from Opuwo town in the Kunene Region.

The cattle post is right in the middle of a sandy riverbed where a community of Ovahimba dug out waterholes more than a metre deep to draw preciously scarce water for their livestock in the dry season.

It is here where the semi-nomadic community of subsistence farmers have trekked for easier access to water sources.

It was also here where newly graduated community health extension worker (HEW) Vemapomambo Tjivinda started his day by first making a quick census of the demographics of the community and identifying those in need of health assistance.

Armed with a small health kit containing, among other things, oral rehydration solution (ORS), bandages, gloves, and Panado tablets, Tjivinda crouched down to a mother with a three-month-old baby sitting under a shade tree to examine the infant.

From his brief examination, Tjivinda established that the baby, although fit and healthy with motor skills remarkably well developed, has not yet received any vaccinations and was not registered at birth.

At birth, infants are supposed to receive the Bacillus Calmette-Guérim (BCG) tuberculosis vaccine and polio drops. At six weeks, infants are immunised against diphtheria, tetanus and whooping cough.

Negligible immunisation coverage is common in the far-flung outreaches of the Kunene among the communal subsistence farming communities of the Ovahimba, Ovatwa and Ovazemba.

This is partly because these communities can only reach health facilities after days of trekking on foot or by donkey through rough mountainous terrain, which they do only in cases of health emergencies.

For the most part, these communities do not access the State health facilities scattered across the region, primarily because of their insulated and often dangerous cultural practices, as well as widespread ignorance of the benefits modern medicine can offer.

According to an enrolled nurse at the Etanga clinic, Kaura Koruhama, the most prominent health challenges of these communities include diarrhoea and vomiting due to the use of open water sources and handling of food, common colds and flu, and worryingly, a high rate of sexually transmitted infections (STIs), presumably because of multi-partnering and because they generally do not use condoms. But the prevalence of HIV-AIDS among these communities remains negligible, possibly as a result of their isolation.

During the dry season, the communities also complain of muscle aches brought on by the heavy work they do.

A big concern for the health authorities, however, is maternal and newborn health in these communities.

Ovahimba women prefer to give birth at their mothers' homesteads. This practice worries health professionals, as the Ovahimba do not tie off a newborn baby's umbilical cord, which can lead to infections and, in worst-case scenarios, even death.

The Ovatwa on the other hand put cow dung on the umbilicus of a newborn, which can have similar adverse consequences.

Dr Stephanie van der Walt of Communications for Change (C-Change), which is involved with the training of the HEWs, also related a story that the Ovahimba pull a finger from the mouth in the belief that this will stop bleeding.

The HEWs were identified by their communities for primary healthcare training, and deployed back into these communities and are thus considered to act as bridges between the deeply traditional communities and State health facilities.

But the head of continuous education in the health training network of the Ministry of Health and Social Services, Sofia Black, pointed out that the intention of the HEW programme is not to supplant positive cultural healthcare practices, but to strengthen healthcare services to the communities.

The HEW programme was developed by the ministry with development partners like Unicef, the United States Agency for International Development (USAID), and C-Change, taken from lessons from Ethiopia, Malawi, and Eritrea where significant progress has been made in improving equity in primary healthcare services.

The programme was first rolled out in the Kunene Region, which is in most need of primary healthcare.

The 34 graduates of the HEW programme will serve communities in the Etanga catchment area.

The 26-year-old Tjivinda will be responsible for a catchment area where he will visit as many as 314 people a week, whom he has to reach by crossing mountains and plains, often covering 10 to 20 kilometres per day.

They have to visit pregnant women at least four times during their pregnancies.

The impact of these HEWs is huge, considering that on average there are 1 134 patients for each nurse in the Kunene Region.

More importantly, the HEWs seem to foster understanding of the value of preventive, promotive, curative and rehabilitative primary healthcare interventions.

They greatly assist in the dissemination of health and social welfare information, conduct home visits where outreach nurses rarely reach, promote hygiene and are able to identify common childhood illnesses and outbreaks.

Also important for the isolated communities is that the HEWs, who come from these communities, make the linkage between services and the communities easier.

Although the HEWs were only deployed at the beginning of this month, Koruhama has already noticed a change in attitude of the communities.

More people are now visiting clinics with reference forms, and families are now more likely to take their children to be screened and immunised.

Another positive development is that women are prepared to walk 100 to 180 kilometres to reach a clinic for ante-natal care, something they would previously not have done.

The health ministry is using the Kunene HEW rollout as a pilot case, and if it proves successful in Kunene, which many feel it will because of the levels of commitment so far showed by the young HEWs, the programme will be implemented in other parts of the country.

The HEWs are currently being sponsored by Unicef and the USAID, but health minister Richard Kamwi said Government will assume the financial support of the HEW due to the centrality of these extension workers in the well-being of marginal communities.

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