Today, July 31, was the last day of training. The morning was spent on a wrap-up session. The focus was documentation. The Lay Community Health Workers must document carefully their contacts with families and individuals. The family files must reflect the discussions and actions that take place. Often documentation is downplayed by practitioners, due to their focus on providing service. Also during this morning session, the health workers were given a map of the community that is divided into zones. These workers will be assigned a zone as the basis of their respective caseloads.
In the afternoon, after lunch, the emphasis shifted to the focus group. Crystal Adams took the lead at this juncture. The propose of this group was to grasp the opinions of the Lay Community Health Workers on a variety of issues. What we did right and wrong is important feedback in terms of future planning. The health workers were somewhat talkative and gave us some significant insights.
Saying goodbye was sad for everyone. Not only did the workers bond together, but we also bonded with them. But we accomplished our task: a group of skilled and confident lay community health workers has been created. These persons will have real and sustained impact on the general and breast health of Coast Guard and Grenada. We couldn’t have expected more.
Rebecca, one of the new health workers, brought a friend with a guitar to the school. He accompanied her as she sang a couple of songs. Good-byes were said and pictures taken. Valda, another new health worker, made a poignant point when she said that their community is not poor but rich with talent that this sort of training helps to realize. The final prayer, offered by Sister DeSilva, gave thanks for this training and the trainers, and blessed this and any future projects.
On July 30th, Wednesday, the 5th annual Mango Festival was held inside of the National Stadium. The rain fell all day but the event was not dampened. Persons came from throughout the island to exhibit their goods. Most everything on display was made from mangos, including muffins, cakes, ice cream, soap, and bread. After all, the theme this yeas is: “Showcasing Value-added Opportunities of Mango through Innovation for a Sustainable Economy and a Healthier Nation.” The set-up reminded me of a county fair.
The project team was invited to the opening ceremony, which began at roughly 10am and lasted for one hour. The Governor General of Grenada, Dame Cecile De La Grenada, declared the festival open. Additionally, speeches were given about the economy of Grenada and the importance of the mango crop to economic and social development. A highlight were the Tivoli Drummers who were excellent drummers. The project team was also recognized by the Chair of the ceremony.
Immediately following this ceremony, the project team began to work. Without a lot of advertising, more than fifty women showed up at the room where they could receive free breast exams. In fact, the response was overwhelming. Examinations were supposed to stop at 2:00 but continued to be given until after 3:00. At the end, everyone was exhausted. The Lay Community Health Workers, however, received invaluable experience and increased their confidence immensely.
Tomorrow will be the last training session with the health workers. The focus will be on the assignment of caseloads, care of their caseload files, and a focus group designed to elicit their views of the training that they received thus far. This phase constitutes a vital, but only one facet of the project evaluation process. Based on this information, changes will be made with regard to any future training.
As the project team prepares to leave Grenada, the week of the 28th is devoted to completing some important tasks. Monday morning, for example, was dedicated to making home visits, particularly focusing on conducting breast exams. As anyone might imagine, this exercise is quite an experience for the Lay Community Health Workers. This practice provides a valuable “learning moment” for these workers, especially if an abnormality is found.
The afternoon was spent talking to Sister DeSilva about her role as the project liaison when the team has departed. She is a very experienced nurse, and thus the project is in very capable hands.
Tuesday morning was spent completing the community mapping and dividing the community into manageable zones. The Lay Community Health Workers, as mentioned in an earlier blog, will have a caseload of approximately ten families. The decision was made, after consulting with the health workers and Sister DeSilva, to have the caseloads mimic clusters of houses. And as the caseloads develop, adjustments and further refinements can be made.
Wednesday, July 30th, the Lay Community Health Workers will be practicing their craft at Mango Fest. This event is held at the National Stadium, and a room will be provided for conducting breast exams. The health workers will get the opportunity to administer exams to women, and possibly some men, who are in attendance. The Lay Community Health Workers will thus have another chance to enhance their skills.
Everything seems to be moving quickly right now. Final touches are being made. Our initial work is almost complete, although the project team will continue to provide advice, monitor events, and evaluate outcomes. But this stage could not have gone any better.
Sunday, July 27th, was graduation day for the Lay Community Health Workers. This ceremony took place at the same school where training occurs. The health workers organized the entire affair. They planned the program and selected the decorations. They even decided to wear a similar outfit: a pink shirt and a dark skirt. Local persons supplied the snacks and refreshments.
The Lay Community Health Workers entered via a procession down the center aisle and took their seats on the stage. The Mistress of Ceremony was Dr. Delpech. The health workers opened the program by singing the Grenadian National Anthem, followed by the invocation by Precious Ezeamama, one of the students who are part of the project team.
Rebecca Jerome, Krystal Forsyth, and Shamel Julien, all health workers, contributed a special song, a poem, and the class speech respectively. Dr. Clarice Modeste gave the Congratulatory Speech. Her talk focused on the importance of this event in Grenada. She believes that these health workers will have a positive impact on health care, both in Grenada and possibly throughout the Caribbean.
Following the address by Dr. Modeste, the Lay Community Health Workers were presented with their Certificates of Completion by Karen Callaghan. After receiving their certificates, each worker had a picture taken with Drs. Modeste
and Delpech. Then Sister Shelia DeSilva, the community liaison for this project,
led the health workers in the pledge that they wrote for this occasion. The thrust of this pledge is that they should be faithful to the ideals of community work and their community.
The ceremony concluded with a group song selected by the Lay Community Health Workers. Concluding remarks were offered by Judy Ann Andall, a new lay community health worker. At the completion of the event, the health workers were presented with their uniforms, a set of “scrubs.”
The health workers came together as a group through the planning of this affair. They have bonded and exhibit great collective maturity. As a result, they appear to be ready to face the challenges of community work. I cannot imagine that ten better persons could have been chosen. Now the members of Coast Guard have a group of very dedicated women to look after their health.
Thursday and Friday (July 24-25) of this week were spent in the classroom and making home visits. Although some of the Lay Community Health Workers conducted health assessments, others engaged neighborhood women in breast health education or conducted breast exams. Again, the health workers were amazing. They were in the homes educating women, a focal point of primary health care, or instructing these persons to do breast self-exams. These visits will continue into the coming week.
A couple of other activities took place on Friday. A meeting was held with Dr. Martin from the Health Minister’s Office, representatives of the District Health Council, and the project team. The thrust of this meeting was how to integrate the health workers into the prevailing health system, while gradually introducing a move toward primary care. Basic to this model is the idea that health providers do not wait for patients to appear at their offices, but intervene actively in a community to inaugurate early identification, prevention, and education. According to the Alma Ata Conference, held in 1978, primary care is the only method that will improve health care in developing countries. This meeting was very productive. Specifically, everyone present seemed to value the role of community health workers and their potentially positive impact on the health of persons in Grenada.
Friday afternoon was devoted to training the Lay Community Health Workers in primary health care and the function and operation of a community health committee. John Murphy and Karen Callaghan took the lead at this time. As part of this instruction, the health workers conducted their first meeting. Their styles of communication and interaction, for example, were examined and critiqued. The purpose of this feedback is to improve their ability to organize a meeting.
In terms of primary health care, this health committee is essential. With the Lay Community Health Workers as the primary point of entry to the health system, the committee becomes the way to interface with other health professionals. In addition to a vital means of mutual support and information sharing, this committee becomes the collective voice of a community. Such a committee enables persons to have control over their health care, while promoting community solidarity.
During the coming week training continues, while a focus group is organized to assess the implementation of this project. This information will be used to shape future training. Additionally, Sunday, July 27th, the health workers will graduate. A ceremony is planned for Sunday afternoon around 4pm. A hundred persons might be present, including several dignitaries. With respect to health care, this day is quite significant. The first cohort of lay community health workers will begin to operate in Grenada.
Tuesday and Wednesday the breast health education continued, with Paula Delpech taking the lead. During these two days, the Lay Community Health Workers began to work with breast models, which allows them to visualize clearly lumps and actually locate these abnormalities. A video was also introduced to facilitate training. Palpitation, the word used to describe the physical inspection of the breasts, was prominent at this juncture.
Discussions were held on the symptoms of breast cancer, barriers to screening, and adopting a healthy lifestyle. The symptoms discussed included a lump or thickening in the breast, a change in size, and discharge from the nipple, while the lifestyle factors mentioned relate to smoking, proper diet, and exercise.
This part of the training is definitely the most challenging and sensitive. The health workers, however, seemed focused and intent on learning how to train women to perform breast self-examinations. Toward the end of this segment, the emphasis shifted to documenting the results of exams. For example, they were instructed on how to describe the location, size, and texture of an abnormality. Stress was placed on noticing and documenting any changes in the breasts.
Tomorrow, in the morning, classroom instruction continues. In the afternoon more home visits are scheduled. These visitations are exciting and very productive. After all, the more visible a health worker is in the community, the stronger the bonds that are developed.
On Monday, July 21st the Lay Community Health Workers entered the second phase of their training, that is, breast health. The first module dealt mostly with cell (abnormal) growth, types of tumors, and the risk factors for breast cancer, while the second focused on breast physiology. Paula Delpech conducted these sessions. In addition to lecture material, discussion and role play were also involved.
Although a lot of this material is complex, especially the part on breast physiology, the health workers seemed relaxed and confident that they could master this information. In fact, they learned very quickly. But this finding should not be a surprise. The research literature testifies to the ability of lay community health workers to learn very difficult material. Our group seems to be no different.
Soon the health workers will be making their second round of home visits. They will be using this information to educate neighborhood women about breast health and their risks of developing breast cancer. In this regard, these workers have to be familiar with their own physiology and talking to other women about their breasts. After all, some of this interaction is somewhat sensitive. But these health workers seem to be up for the task.
On Saturday, July 19th the project team participated in a health fair organized by Barry University and the Ministry of Health. This event took place in Munich at the Tuileries Pentecostal Church. The fair ran from 10:00-2:00. This church was located at the top of a hill that provided a great view of the Atlantic Ocean and the City of Grenville.
The height and weight, blood pressure, and glucose were recorded for every local person who came in and registered. Women, who chose to do so, were able to receive a breast exam. An education table was also available, where the results of these tests were interpreted and additional information on a range of topics–such as healthy diet, prostate cancer, and high blood pressure–could be obtained. The men were also encouraged to go to a local clinic in the near future to have a prostate exam.
Approximately twenty five persons came to be tested. The fair was well organized and ran very smoothly. Members of the church provided lunch for the health fair workers. In general, the local persons seemed to like the event and even expressed the hope that these fairs would be held in the future.
The Lay Community Health Workers have been in the field for two days visiting households and administering the health assessment. Yesterday was hot and sunny, while today was rainy and blustery. The rumor is that a tropical storm was passing over Grenada Friday.
Yesterday the health workers were a little apprehensive, but today they performed like pros. The mentors introduced the workers to the persons interviewed. But once the dialogue began, one health worker took the lead in asking questions, while the other recorded the responses. In this way, both workers were engaged in the process.
Most interesting is how the workers have begun to support one another. They seem to recognize each other’s strengths during the assessment process and make the necessary adjustments. Someone who is better at interviewing allows others to record. But both ask follow-up questions and encourage the household members to discuss issues.
The breast health facet of the training will begin this coming week. Hopefully the interviewing skills the health workers learned this week will transfer to the next phase. But following the completion of each assessment, the household members were told that the workers would be returning next week to discuss women’s breast health. The Lay Community Health Workers have made great strides both in terms of learning to conduct a home health assessment and bonding as a cohesive unit.
Today the lay community health workers finished the classroom work related to conducting the health survey. But more classroom time is on tap in terms of breath health education. During the past three days the health workers were exposed to the theory behind community-based work, reviewed and modified the survey instrument, and practiced their interviewing skills. Some role playing was also involved. They are enthusiastic and anxious to get into the field. In general, they have been great learners.
This afternoon the health workers as a group walked through Coast Guard. During this so-called walk about, using the mapping that is almost finished, they were animated and excited. Additionally, they began to use their new skills of observation, sometimes called a “Windshield” assessment, in order to identify health hazards and community strengths.
The homes have been selected that they will visit tomorrow. This contact will be their first with the members of Coast Guard. Tomorrow, five teams, consisting of two health workers and a project mentor, will begin the surveys. These mentors will take the lead and gradually ease the workers into this process.
Tomorrow is another big day in the project. The Lay Community Health Workers will begin establishing a long-term relationship with the members of Coast Guard. Although excited, apprehension is also expected. But these workers are smart and well trained, and we are sure that they will perform with few problems.