Providing women’s preventative health education and medical clinic services in Margibi County.
Describe the need affecting community
Following the devastating civil war in Liberia, people were without health care, as health facilities all over the country had been destroyed. The first attempts by relief agencies to begin providing health care again were in Monrovia and on the rubber plantations. Communities like those in Margibi County were left without local care. People died of things that would have been easily treatable in the USA. This was especially tragic as the women, who so bravely organized to stop the civil war and bring democracy and peace to Liberia, were dying at a time when they were needed to keep families together, plant gardens, open markets and schools, and to care for their children and husbands. Even 8 years after the end of the war, there was no safe, sanitary, effective, reliable health care in Margibi County for the residents of Kakata and the 36 surrounding villages of the Kakata District. Since 2012, Healthy Women, Healthy Liberia, HWHL, has been helping heal the sick in the name of Jesus. Organizing women’s groups, providing health education, operating a temporary medical clinic and training Community Health Workers in Kakata. When the Ebola virus hit the community and the government shutdown, along with the hospital, and the schools closed. HWHL continued working in the communities every day, setting up hand-washing stations, holding Ebola awareness sessions, and calming fears. Helping people cope with losing loved ones, and not being able to hold ”proper” funerals. Using funds provided by Global Giving, we doubled the number of Community Health Workers (CHWs), both men and women, to expand our services in the rural communities. These workers provide immediate care to community members when they are hurt or sick, lead health education, track community and individuals’ health status, and support local vaccination and immunization campaigns. At least once every week the CHWs make home visits to mothers or families with young children in the home, as well as other individuals with special health needs. They encourage pregnant women to seek health care and new mothers to seek postnatal care. They are the first responders and work as full-time advocates for the women in their communities. Kakata, being centrally located, lies at a crossroads between the capital, and distant rural, farming communities, 43 miles northwest of Monrovia, the capital of Liberia. It is a place of commerce, markets and distribution centers. It is where many “good roads” end. When the hospital and other clinics closed during the Ebola crisis, the HWHL clinic was overrun with patients, many were new to the community. The population of the Kakata district swelled from 135,000 to over 210,000. The only referral hospital in Margibi County, C.H.Rennie, heavily impacted by Ebola, continues to operate with critical shortages in both staffing and supplies. Many birthing centers and clinics have still not reopened. The shortage of trained medical staff is critical.
How will this Advance project help to address the need?
In response to the total breakdown of the healthcare system, we have accelerated our capacity building efforts in Kakata. We have hired and are training additional Community Health Workers to improve our reach into the communities and have constructed a new purpose-built facility. Once operational our new facility will provide the basic infrastructure to provide all comprehensive basic services, including eye and dental care. This facility will fill a major gap in health infrastructure in the community that had existed long before the Ebola crisis. With lab and ultrasound imaging services onsite we will have faster, more accurate diagnoses. We will be able to offer space for overnight, short stays during the long, 8 month rainy season for birthing or hospital aftercare. Medical outcomes will be substantially improved.
Describe the primary goal of the project
The Vision of Healthy Women, Healthy Liberia is to transform communities using community based healthcare models for medical and dental care through education and services, especially to women and children. To be successful community based healthcare programs require community leaders to understand issues that impact health and take responsible action. To promote the changes necessary to improve the health of every community member. It requires leadership and investment of time and resources by both leaders and community members. HWHL provides support and medical resources. The Ebola crisis focused discussions and solutions at a community level with immediacy and in some ways moved the process forward. Our objective now is to continue the discussion, to leverage the same sense of urgency for other critical community health issues. In 2016, we expect the number of community health workers (CHWs) to remain the same and community participation to continue at just under 15,000. The four CHWs in training in Ghana will be replaced, as when they return they will assume new roles. Community health education and home care programs will change only with the normal addition of new education topics identified during the year. In the past two years we have expanded services for young mothers pre and post natal care, infant care, child spacing, sexual and reproductive health. We would like to expand these programs further and include young fathers or young couples. Although abortion is illegal we are seeing more post abortion cases. In fact, sudden death from an infected abortion is a leading cause of female teen deaths. Child marriage is still an issue leading to a wide variety of health related issues in young girls. All of the growth in HWHL services and staff will be in the new Medical Center clinic medical and dental services, pharmacy, laboratory and ultrasound services. The clinic staff will more than double with a number of new, higher level positions. When the Medical Center opens and is fully operational, we expect the number of patient contacts to double to nearly 30,000 annually. As we prepare to open the new Medical Center hiring and training staff is the highest priority. In the next few months we will be adding a physician, dentist, nurses, lab technicians, pharmacists and supporting staff, 23 new positions have been identified to be filled as funding allows. The wage cost of this expanded staff is estimated at $5,700 per month, which reflects the costs under “normal conditions”, but the challenge is finding trained staff to fill these positions. The school closings have worsened the already critical shortage of available medical personnel with few new graduates in 2015. We believe that the advantage of having a new, modern facility will help in attracting new staff, but we may need to rely on contract labor initially. Liberia has for many years published National Therapeutic Guidelines and an Essential Medicines List, which provide guidance in care for all medical practitioners and pharmacy dispensers. For the HWHL pharmacy in addition to ample shelving and good lighting, we need a computer(s) with a battery backup power source since the solar power system may be intermittent during the long rainy season. Pharmacy software systems are available from several sources. The pharmacist we hire will have input into the software purchase after consultation with the National Pharmacy Board. A printer and Rx label printer are required, as well as counting trays and spatulas, various liquid measuring devices, vials and bottles, an ointment slab, a digital electronic scale, a glass mortar and pestle to compound pediatric doses from adult meds, storage bins, paper bags and a stapler, and small and large zip lock bags. We need to invest in a a small medical library of medical and pharmacy reference materials at a minimum a current Physician’s Desk Reference (PDR for the Docs) and Facts and Comparisons (for the pharmacists). While this sort of information is available on line, the reliability of the intermittent internet in Liberia is not adequate for day to day use in our clinic. All of our systems and data needs to be available within our clinic with a server, backed up with uninterruptable power supplies. The cash economy in Liberia makes all financial processes more complex. Essentially there are two processes for every one transaction, one to get the cash and the second to make the actual purchase or payment. Automating the cash management and inventory management processes in Liberia will substantially improve our ability to track shortages and plan and schedule donations and purchases, but will required administrative staff trained in computer skills. Our primary goal is to engage everyone in the community in improving their health, while supporting those with health issues with medical services. We would like every woman and girl to be empowered with the knowledge to manage her own health and to access care when appropriate to keep herself and her family healthy. We recruit workers from the communities in which they serve, generally they are selected by their Community Leaders or elders, who have an interest in their success. Our very long term goal is to find partner ngos, government agencies, churches or schools, and transfer successful programs, so we can focus on solving the next problem. The long term impact will be a healthier, more productive community. To our knowledge ours is the only program focused on preventative healthcare for women and girls in Liberia. We believe this clinic will be a worthy model for other new clinics to open in Liberia in the future to meet the health goals of the nation.
Describe the change you would like to see in the community as a result of this Advance project
1. Evidence of God and Christ’s community in action every day at HWHL. 2. Active participation in HWHL health programs by all community leaders and community members in every Margibi County community with open discussion, prioritization and resolution of critical community health issues. 3. Improved health and life expectancy for every person in Margibi County. 4. Young mothers/couples knowledgeable of how to care properly for their children and each other. 5. Women empowered to manage their own health.