VHWs, CHWs, and Riders

(Be sure to scroll to the end of this one for a treat!)

In the course of my global health studies, we constantly learned about the importance of the village health worker.  In developing countries, since most people don’t have easy access to clinics or hospitals, members of the villages are trained to work as village or community health workers.  The responsibility of VHWs or CHWs is usually to educate other members of the community about basic hygiene and locally prevalent diseases, as well as screen children and adults in the community for malnourishment or sickness and refer them to clinics, hospitals, or local organizations as necessary.  Sometimes they even survey the community for baseline statistics on health in order to track trends in disease epidemics and transmit this information to governments and non-profits.  Essentially, their job is to promote health in areas where access to healthcare is limited.

Mahpolenang Health Clinic, run by the Red Cross.

The crowded clinic waiting room.

A few weeks ago, on a day I didn’t go on outreach, I got the opportunity to attend a VHW meeting at a clinic in Mahpolaneng, about one half hour outside of Mokhotlong.  The Red Cross of Lesotho is responsible for running this clinic.  I thought we were going to watch a training session, but it turns out they were actually waiting for us to give them information about TTL.  When we first entered the clinic, Jenn, Brad, and I were introduced to the nurses in charge of the clinic before being led through a crowd of waiting patients to a back room.  Sitting in the room was a group of mostly elderly women, wrapped in their Basotho blankets, staring intently at us.  The TTL outreach worker who planned this gathering and drove us to it introduced TTL and then made each of us stand up in front of everyone and introduce ourselves in Sesotho.  Needless to say, my heart was pounding as I stood up to say, “Lebitso la ka ke Annie.”  Luckily I didn’t butcher it, and all the women clapped and smiled as I sat down (I was quite embarrassed that they were clapping!).

M'e Mantja speaking to the VHWs

The next half hour was spent asking the women questions about their job responsibilities, their pay rate, and their roles in the community.  I found this really exciting because I was asking critical questions along with Jenn and Brad, finally applying what I learned in classes to a real-world situation.  We were trying to figure out exactly what the VHWs needed to do their job better, as TTL and PIH might work together soon to improve Lesotho’s government-run VHW program.  Eventually, after some prying, the VHWs in the room all agreed that they wanted more training, especially on HIV/AIDS, antiretroviral therapy, and tuberculosis treatment.  This prompted us to ask the last time they received any sort of formal training from a Ministry of Health official, which we soon found out was in 2009.  2009?!  For real?!  I know Mokhotlong is 5 hours from Maseru where the Ministry of Health is located, but not having someone come to train VHWs on the most recent advances in healthcare education in over 4 years is just simply unacceptable.  For a country where the HIV prevalence is through the roof, you would think that the VHWs would have the most up-to-date information to pass along in the villages.  Rather, you have a group of women who are supposed to be the most knowledgeable on health topics in each community wishing they knew more about the diseases affecting their families and friends.  I also have a hard time believing that these very elderly women are truly the best candidates for this job.  Lesotho has no age cap for their VHW program, so women like to keep the job for as long as possible since they receive a cash payment for their duties.  Yes, maybe older women get more respect from community members, but these women were frail and it didn’t look like walking from rondavel to rondavel would be an easy task.  As excited as I was to go to this VHW meeting at the beginning, I was equally disappointed in what I learned while I was there (I’m finding this to be a common theme in my experiences with healthcare in the developing world).

Some Basotho VHWs speaking out about their needs...

It wasn't all a let down, however.  When Brad, Jenn, and I got up to leave, we were quickly told to sit back down.  A bit confused, we followed orders and took our seats.  Before we knew it all the women were standing up swaying from side to side.  They were soon entertaining us with a song and dance (that was quite long!), led by one of the most talkative women in the group.  As she sang aloud, the other women echoed and followed her movements…somehow they were all singing in harmony!  After the first song was over, it was followed by another dance performed while kneeling (this one was shorter and kind of odd, but cool nonetheless).  I thought the first song might’ve been about health, since I saw some hand washing motions at one point, and this was confirmed by TTL’s outreach worker.  In fact, the song teaches mothers how to make homemade ORS (oral rehydration salts).  ORS can save a dehydrated child’s life, whether they are suffering from malnourishment or diarrheal disease, but can also kill a small child if made incorrectly.  Therefore, the dance moves that went along with the tune showed the exact amounts of water, salt, and sugar required to make ORS.  For example, they held up the thumb and pointer finger pinched together to demonstrate using only a “pinch” of one ingredient.  Having learned a lot about the importance of ORS in my grad program, I was elated to at least witness the promotion of making these salts with little to no cost in Lesotho’s villages.

The village health workers got moves! (Singing their ORS song.)

The knee dance.

We were finally ready to head back to TTL, but got distracted by a man on a red motorcycle outside of the clinic.  He was dressed in a jumpsuit, was wearing a silver helmet, and was carrying a backpack that read “Riders.org”.  Riders (also known as Riders for Health) is an organization that works in several countries of Sub-Saharan Africa.  They hire locals to work as nurses and community health workers who drive between many villages delivering healthcare services.  The cool part is that they teach the “riders” how to maintain and fix their vehicles because one of the greatest issues in developing countries is the delivery aspect of healthcare.  Here in Mokhotlong, the riders not only deliver ART medication to patients in the rural villages located far from the hospital, but they also draw blood from HIV positive patients to be brought back and tested at the hospital for CD4 counts (for the non-health folk, CD4 cells are white blood cells that fight disease, but are also the cells that HIV attacks and kills).  Sometimes they even get sputum samples from patients to test for TB and bring young children immunizations.  According to riders.org, their services have reduced the turnaround time for test results in rural Lesotho by 50%.  I think Riders for Health is an awesome organization that deserves more attention, support, and applause, and I was honored to be able to speak to one of their riders about his own work.  I saw this rider at a shop in town just the other day, and was pleased when he recognized me (although being one of the only white people here, I guess that shouldn’t have been so surprising).  He made me promise to stop by his laboratory at the hospital before I leave Mokhotlong for the summer with the picture that I took of him.  I get the feeling that the riders are very proud of their work!

Riders for Health!

I really hope that in the near future Lesotho’s VHW program is revamped and becomes more effective, hopefully as effective as Riders for Health has been (seriously you should check out their website…it’s riders.org if you haven’t already figured that out!).  It’s really amazing what some organizations do with business models that think a bit outside of the box.  I hope that one day as a physician I will be able to do the same as a physician and, in doing so, change the lives of thousands (maybe even millions!) of people around the world.