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Keeping Vigil on Villagers’ Health and Hygiene

© UNICEF/PAKA02006D/Zaidi
Firdaus and a fellow Community Health Worker on their afternoon round of checking on the health of families in Chela Bandi camp on the outskirts of Muzaffarabad. The scars of violent landslides triggered can be seen in the background

By Bronwyn Curran

MUZAFFARABAD - Firdaus, a student, stoops to enter the tented home of the Akhtar family –an igloo-shaped canvas and aluminium shelter in the ruins of Chela Bandi village in Pakistan-Administered Kashmir.

Sunset burns the chalky cliff opposite, where an entire mountain slope was sheared off by the October 8 earthquake, and Firdaus begins her daily round of monitoring 30 families’ health and hygiene behaviours.

“Are you using soap to wash your hands?” she checks.
“When preserving cooked food, always cover it with a lid.”

On a mattress opposite Akhtar Bibi, her daughter Nusrat and Akhtar’s father, Firdaus pulls out a data book and launches into her newfound duty of recording the health of each member of the family and imparting basic hygiene tips.

Firdaus is part of the new army of community-based outreach workers on the frontline of UNICEF plans to bring health care and hygiene promotion to earthquake-affected rural areas. 

“Community health workers are the lynchpin of our efforts to bring quality health care to people in rural and remote areas, and to change their health and hygiene habits,” said UNICEF Health Officer Dr Tamur Mueenuddin.

“This calamity has given us a window to raise the bar in health monitoring. Living in a remote village should no longer be a reason for people to miss out on proper treatment”, said UNICEF's Health Officer

Around 3,300 community health workers have already been trained by UNICEF and local partners in basic first aid, health monitoring, and the provision of essential health services in the home, such as vaccine and antibiotic administration, and newborn care. 

They’ve also been trained to encourage pregnant women to engage skilled birth attendants for home deliveries.

They are the vanguard. Over the next two years, UNICEF plans to train approximately 4,000 community-based health workers to work in tent villages and isolated areas in earthquake-ravaged parts of Pakistan-Administered Kashmir and North West Frontier Province.

It is hoped that some 400,000 families will be reached by the trained community health workers – around 80 percent of families living in areas targeted under UNICEF’s two-year recovery plan.
“Each day I usually see two families. On busy days I see four or five. I go back to each family again and again to check on them,” Firdaus says.

“Before the earthquake the people here weren’t in the habit of washing their hands with soap before preparing meals.”

Firdaus says the new health workers have already made an impact in Chela Bandi.

“I’ve seen the level of illness drop. Before there were many cases of diarrhea and worms. Both problems are less frequent now, especially worms and scabies.”

Another 28 women are monitoring families in Chela Bandi. They’re all college students who divide their days between morning classes and afternoon check-ups on the families under their charge.
“When I go to them, I ask if anyone is sick and what type of sickness they have. I tell them about health and hygiene, like what kind of safety measures they should take to avoid diseases,” says Shaheen, 17.

“I encourage them to boil water before drinking. After latrine-use they should wash their hands with soap. They listen to me carefully and try to follow the instructions. It’s the first time they’re hearing these messages”, adds Shaheen

© UNICEF/PAKA02007D/Zaidi
Community Health Worker Firdaus shares hygiene tips with Akhtar Bibi and her daughter Nusrat in the Chela Bandi camp

Tehmina, 18, has already treated a three-year-old boy suffering from diarrhea by administering Oral Rehydration Salts.

“The boy’s mother told me that he’d had bowel motions for several days. I felt confident administering the ORS. I knew everything well from my training.” 

The women spend about three hours each day visiting families, who each average about eight members.

“We check their records, we check on every member of the family, from old men to young girls,” says Tehmina.

UNICEF has paid for the training, medical supplies, salaries and the data books used by the community health workers to record health information.

“We have one data sheet per family on which we record the number of family members, their ages, gender, marital status, occupation and education,” explains Firdaus.
The most common illnesses they encounter are colds, rashes, malaria, jaundice, diarrhea and dysentery.
“Before the earthquake we had no idea about our people’s health status, what illnesses or diseases they had, or what their health and hygiene practices were,” says Tehmina.
“Now we go to them, we give them information, we see what their deficiencies are. Things are getting better”, adds TehminaFirdaus says increased awareness is making people healthier.

“People are learning what the causes of their illnesses are, whether it’s diarrhea, worms, or dysentery. They know that dysentery is because of contaminated water, so now they boil the water. They are becoming aware and they are changing their behaviours.”

The women health workers in Chela Bandi have become empowered through their engagement with the health of their community – an added benefit to the training program.

“This has been very good for the girls’ confidence,” said Doctor Gulshan Rasheed, a Pakistani woman who is UNICEF’s Assistant Project Officer for Health in Muzaffarabad.

“Looking at them now, you can see they’ve gained confidence and a sense of purpose. Also the earnings they receive can help them with their own college education.”

In their cosy tent, Akhtar Bibi’s family huddle around Firdaus.

“Do you boil water before drinking?” asks the college student-turned health worker
“Before we didn’t, but now we do,” the mother replies.
“How do you wash your vegetables?” Firdaus checks.
“With (treated) water from the plant,” Akhtar Bibi answers.
“Remember to put all your garbage in one bag and always close from the top. And don’t forget to cut your nails.”

Firdaus closes her book, takes her leave, and steps out of the igloo shelter into the dusk.

“I really enjoy this work. We go and interact with the people, we learn about their problems and how they are living. It’s very eye-opening for us.”



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