This is the first in a series of posts about implementing health projects in a developing country. It is meant to introduce a reader to the inner workings of public health training and action, especially the collection of baseline information, and share with the world data, stories, and personal thoughts about the ongoing challenges of global health in Mozambique.
Public health is complicated.
The area of study and practice, focused more on the prevention and detection of disease rather than the actual treatment of it, is underfunded, underreported, and largely misunderstood (case in point). The area isn’t without its controversy, but each day public health workers are attempting to diminish the burden from diseases for millions of people across the globe through epidemiology, monitoring & evaluation, and education (although, as we’ve seen in the states, even education can be somewhat ineffective against an individual’s personal beliefs).
Public health in a developing country is more complicated.
When you first arrive in your host country for Peace Corps service, you spend two months living with a host family, learning about the language and culture, and receiving a mountain of information about health statistics throughout the country. This training often leaves one feeling overwhelmed, living and working in the constant shadow of statistics, findings, recommendations for future research and programs. The voices heard during training are many, and the statistics forced into a volunteer’s conscious are intimidating.
The trick isn’t lowering the mountain, but looking at it from the right angle.
While many volunteers arrive at site ready to destroy (or slightly reduce) this mountain of information with absolute force, strength, and ideas passed along from experts, the public health practitioner first takes a step back, looking at the larger community, researching the entire story, before taking a step forward toward public health practice. One of the main tools used during this analysis is a community needs assessment (CNA). AKA my baby.
The CNA asks you to collect all the necessary information relevant to your site, speak with as many people within the community (leaders, business owners, members of the community), and identify any gaps in service, or areas of health that aren’t already being addressed by other organizations, community groups, or available resources. Instead of doing a cannonball into the deep end of the pool, the CNA both eases you into the pool and helps you find an open area to swim. (There must be an analogy for urine in the pool, but I can’t yet place it). And as we all know, it’s better to (ideally) have a swimming buddy.
Collection of information & sharing the experience with a counterpart
In terms of sustainability (especially in developing countries), it’s important to share your research methods with a host-country national, or in non-Peace-Corps-speech, someone from the country in which you are serving. I arrived at my site with a supervisor but no counterpart, so I first sought out an interested mind in the ways of health. This came in the form of a young man who was new to the area and wanted to keep busy. His name is Flex.
Flex and I eased our way into the water. The Internet is overflowing with information regarding health around the world. With the right sites (here, here, here, yes also here) or even a quick Google Scholar search, you’re able to paint a pretty vivid portrait of the current health culture in any given area of the world. Here is a small sample of what we found on Mozambique, simply by huddling around a computer:
- The country is home to about 25 million people with a life expectancy of 52 years
- Low United Nations Human Development Index classification of 184/186 countries
- The national prevalence of HIV, the primary cause of death among adults and tertiary cause among children, is 11.5% with a province (Nampula) prevalence of 4.8%
- HIV testing in Mozambique is low with 34% women and 17% men receiving treatment, and testing is less prevalent in the north (23%) than the south (50%)
While the Internet will provide nation-wide statistics on health, it’s more difficult to find information on (in order from hard to solid diamond) the province, district, town, or neighborhoods in which you are serving. In order to build a complete case for whatever decision you decide to do for projects, you need to also collect your own information.
A lesson in language & early morning drunkenness
Since we have already decided to take a broad look at our community, we need to first start broad with our information collection. Would it be very helpful to full aside someone from the community and start to ask them about their sexual health habits if we haven’t yet heard from the community that sexually transmitted infections are an issue? On a first date, would you jump to asking your date about his or her divorced parents or first start by asking about family? Both situations are bound to end in a frustrated party (maybe a slap).
I decided that I first wanted to collect information demographics (sex, age, if they live in Namapa, speak Portuguese, speak the local language), the general population’s ideas about major health concerns in the community, and where people are receiving their health information. Using the survey above, I spoke with 100 members of my community over the course of one day. By walking down our main street with a clipboard and an inquisitive expression, people were curious and interested to share their thoughts. The problem is always with language (attempting the survey after a few weeks at site) and attracting unwanted attention.
A common habit of many people in Mozambique is to drink at every hour of the day. Because of joblessness and a lack of understanding about the health effects of drinking, it is very common to see someone with a beer at 9:00 a.m. It makes for great business for local stores and bars, but the environment is often difficult to navigate with constant distractions from conversations with people who have had one too many cold beverages.
During my survey, a young man grabbed my wrist, pulled me into a dark, smoky bar, and sat me in front of a heavy-set man sitting down in a chair facing the front door. I looked around and saw many faces staring in my direction as I was placed in the chair. With a smile on my face, I greet the man. He tells me he is the chefe (boss) of the neighborhood and wanted to know what I was doing on his street. The tension soon faded when I told him my role as a health volunteer. Tension turned to absurdity as they laughed, shook my hand, and led me out the front door with the original young man by my side. He vowed to help me with my survey, but instead he stumbled about, yelled at passerby’s, and was eventually dismissed by me to head back to the bar.
Distraction alluded, I was able to finish the survey and collected the following results: (1) information about the perceived health problems in Namapa, and (2) where people obtain information about health in the community.
Moving forward slowly
The information provided important details about the direction of my service; however, I still wasn’t satisfied with the information and knew that the collection of information would need to continue with more personal, detailed, and qualitative information, mainly in the form of in-depth interviews with key members from the community and focus groups with community support organizations around Namapa.
Questions? Comments? Contact me!