Up to this point, we have been using repeatedly the term success. But the initial day of training can only be called successful. Because of a slight schedule change, the first session began at 2:00pm and ended at 6:00pm. The community health workers were energetic, attentive, and asked a lot of questions. Ten (10) workers were present. Karen Callaghan and John Murphy took the lead of this session.
Yesterday’s session consisted of an overview of the entire training, the role, history, and tasks of lay community health workers, and the ethics of community work. A lot of time was spent on the importance of building a positive reputation in the community. So, confidentiality was a very significant topic. After all, these workers must be trusted and establish a strong relationship with the community in general and the specific families on their respective caseloads. Caseload was a prominent idea this day.
While this training was going on, several others of our team began mapping the community. In other words, they began to identify the number and location of the households. This mapping is crucial in order to assign households to the worker’s caseloads. Based on yesterday’s preliminary count, each community health worker should have a caseload of eight to ten families.
The focus of tomorrow’s training will be the health assessment. Based on today’s performance, we anticipate that tomorrow will go smoothly. Tomorrow’s session will also begin at 2:00pm, but we expect that our usual schedule will run from 10-12am and 2-4 in the afternoon.
The fundraiser organized by the Grenadinas, most notably Ann Hopkin and Claudia Simon, began at approximately 7:00pm Sunday evening. This concert consisted of local persons who sang and played a mixture of Gospel and classic pop music. The event was held at the Annex of the International Trade Center in St. George’s. The MC was also entertaining and kept the evening moving right along.
The entertainment was wonderful. Additionally, Miss Simon was given an award for her invaluable support of The St. Mark Community Health Project. A local caterer provided the food for the buffet. Everyone seemed to think that this event was a complete success, including the Minister of a Health, who was also in attendance. Like always, she gave a very supportive talk. Although an official count is not available at this moment, a lot of persons were present.
This event was truly a community-based affair. Local persons came together to support a community project. Everyone volunteered their time and talents, and the result was a triumph of the spirit and, hopefully, the improvement of health care.
Today the project team made an appearance on the TV program Health Matters. This program is on Channel 22, which is operated by the Grenadian Government. The taping took place at 9:00 this morning. The first airing should be sometime tomorrow.
Four persons from the project appeared on the program. Paula Delpech gave an overview of the project, including the history. John Murphy talked about the philosophy that sustains the project and the three stages of training. And Crystal Adams addressed primary health care and the creation of the health committee. After the first segment, Kellina Langaigne, a recent graduate of Barry University, a native Grenadian, and member of the project team, replaced John Murphy on the set. She talked about her role in the project, her background, and her take on how this project will help Grenada.
After the taping, the team went to a copy center to make copies of the program of today’s orientation, which will be held at the local Government school in Coast Guard.
The Minister of Health will be in attendance. A meeting was held with the first cohort of lay community health workers at 4:00pm. 11 of the 12 in this cohort were present. Dr. Modeste, the Minister of Health, arrived toward the end of the meeting and gave a rousing talk about the rewards of being a community health worker. She commented on the personal satisfaction that is gained, in addition to the contribution they make to their communities. She remarked also on how this model has been successful in other parts of the world, and she believed that Grenada will not be an exception. Her commitment to our project is unflagging.
Glen Haynes-Smith, a member of the nursing faculty at St. George’s University, a member of the team that collected some of the original data on breast health in Grenada, and a part of this project, welcomed everyone. Precious Ezeamama, a Barry university student and participant in this project, gave the Invocation. Many of the health workers are religious and appreciated this prayer.
Karen Callaghan then introduced the members of our project to the health workers. Following this introduction, John Murphy welcomed the health workers. He reminded them that they are joining a venerable tradition of volunteers who are becoming the centerpiece of health care delivery around the world. Due to their involvement, Murphy pointed out to them, health care is beginning to reach many poor communities and improve the lives of these persons.
Paula Delpech took over after Murphy and proceeded to describe the basic elements of the training. The health workers were told at this time about the training materials that they would be given. Additionally, there was a discussion of the stipends. Although the workers were happy to receive stipends, they voiced their belief that most important to them is the opportunity to learn and contribute to their community.
As noted above, Dr. Modeste then gave her talk. She is quite a motivational speaker. Several members of the project team stated that if they were not already committed to this project, they would be signing up as volunteers.
In the opinion of everyone on our team, this initial session with the lay community health workers was incredibly successful. There are certain crucial moments in these projects, when everything seems to be going in the correct direction, and this meeting was one. We are now convinced that we are on the correct track.
On the way home, we stopped in Gouyave, a city in St. John’s Parish, along the coast, to participate in Fish Friday. Every Friday venders line several streets to sell food, but mostly various types of fish. As usual, the food was great and inexpensive.
Today was very productive. Particularly important is that the health workers appear to be very smart and committed. No one could ask for more. Today, therefore, represented a great step forward for this project.
We had a meeting today with the Minister of Health and other key members of the Health Ministry. The focus of this meeting was how to insure the sustainability of our project. The literature on the sustainability of community-based projects indicates that government support is essential for their long-term viability.
Paula Delpech started the presentation with an overview of the project, while John Murphy talked about the paradigm shift associated with a community-based model of health delivery. Karen Callaghan summed up everything with a discussion of the purpose and operation of a health committee and issues related to sustainability.
Following these presentations was a Q & A session. Questions were asked about future funding, problems associated with community-based projects, and the interface with the general health system. Even the Alma-Ata conference was mentioned.
The overall tone of the meeting was very positive. The Minister of Health remains committed to the project. In this regard, she appointed two members of her ministry to work directly with our team. The aim is to facilitate the inclusion of our project, and the associated model, into the general movement underway in Grenada toward primary health care. But some work needs to be done on our part with the District Wellness Councils, in order to eliminate any obstacles to implementing this community-based strategy.
The adoption of a community-based model represents a significant change away from the way in which health care has been traditionally offered. Although getting an entire health system on board may be difficult, this sort of work is necessary. This sort of social change is difficult but possible.
After the meeting, the team went to a buffet-style restaurant in St. George’s called Andell’s. We ate home-cooked Grenadian food. On the way home from the restaurant, we stopped at out favorite bakery–the Homemade Bakery. The fruitcake we bought will be our desert tonight.
Tomorrow we are supposed to make a presentation about our project at a local television station. Later in the day we travel to St. Mark to have an orientation with the lay community health workers. Tomorrow will be another important day.
This day was devoted to settling in to our new environment. Our first chore was to inventory the stock of food that we brought to Grenada. Then we went on group shopping trip to the local IGA to stock up on provisions for the coming week. Next we went to St. George’s to the open-air produce market and fish market. Along the way, we discovered a great bakery.
We returned home and ate a great meal prepared by Sharon, Ms. Hopkin’s housekeeper. Before and after dinner, the team discussed the next day’s meeting with the Minister of Health. This meeting is scheduled for 10:00 tomorrow morning. The focus of this meeting will likely be the long-term sustainability of the project. Sustainability, of course, is very important.
Everyone on the team is excited about our upcoming trip to Grenada. The group in Grenada
is also enthusiastic and awaiting our arrival. We are as prepared as possible at this juncture in the project.
The curriculum is prepared, and we have tried to anticipate any problems. But of course we will
have to be flexible and make adjustments when on the ground. A community-based intervention
requires these corrections.
We plan to provide almost daily accounts of our activities in Grenada. Pictures
will also be provided. We want our friends and supporters to have a fairly clear understanding of
our adventure in health care. We are convinced, however, that this strategy is necessary and
appropriate to upgrade health care in every part of the world, including the United States.
Community guidance will surely improve access to and the quality of services.
On a lighter note, we have many suitcases. Some of the team members feel as if they aremoving to Grenada. But remember that we are taking office and medical supplies, not to mention food and clothes, in order to live and work for almost a month. So, we have a lot of stuff to carry and check-in at the airport.
But our spirits are high and mission clear. We hope that everything goes smoothly, although
we know that glitches will occur. Our goal, however, is to enhance the health care in Grenada.
Wish us luck!
Our team is finishing up the final details to travel to Grenada tomorrow. The month of July will be dedicated to training Lay Community Health Workers, developing a community health committee, and meeting with national health officials to ensure the success of the project. We have been busy in the last few months with developing the curriculum for training and fundraising for the project. We are looking forward to arriving in Grenada and beginning this important phase of the project. We are going to try and provide updates throughout the next month in case you want to follow our progress.
We hope to continue the work that we’ve done in the past. Our strategy has always been to have community involvement. This project represents a continuation of the work that we’ve done in Colombia and Ecuador which seemed to benefit the communities greatly. For example, these projects related to building a health center in Ecuador and training students to engage various communities in terms of economic development in Colombia. The goal of this project is to train local people to assess their own health needs and develop breast literacy. This strategy has also worked in countries such as Haiti and Venezuela. So we believe this will also be effective in Grenada.
The project team has been working very hard to prepare for the upcoming trip to Grenada. During this March visit, the idea is to lay the groundwork for the initiation of the project in July, 2014. We believe that the focus of this initiative on breast health is very important. Additionally, the community-based philosophy that guides this project is crucial. Without community involvement in every phase, relevance and sustainability are difficult to achieve. But through community-based projects, communities can become self-directed and improve their health status.