In 2018, the Village Health Team (VHT) system was set up by the Ugandan government. Essentially, each village has a few people who volunteer themselves to become the first point of contact for healthcare for all the people within the village. This was done to tackle the lack of access to healthcare for many remote villages, which proved to be a pressing issue as I’ve realised after visiting the remote village, Bihehe village, 2 days ago to run a mobile clinic. I worked together with KFSP alongside other Laidlaw scholars to provide healthcare services to 162 patients in the village and its neighbouring regions. I was positioned at the check-up station to help with initial vital checks (blood pressure and temperature). The visit gave me a much clearer picture of the difficulties in the logistics of the act of realistically providing healthcare to these regions or even to reach these regions at all, even when putting aside the issue of cost. It took us about an hour of main road from Kasiisi, then another 45 km of bumpy, dirt roads, with lots of holes, where half of the road wasn't even detectable on Google Maps; a journey that was capable of damaging a donated ambulance to an irreparable state within a year.
Initially, the idea of a VHT system sounded like the ideal solution to this healthcare access problem as it seems that without one, these villages would not have any means of healthcare access, especially due to how expensive transport costs would be and their mere distance from the closest healthcare centre. However, it's almost as if the government created this idea and policy with no intention of executing it properly as the current system is clearly unsustainable. The volunteers who decide to become VHTs don't have any medical training and, in some cases, the furthest they've gone in their education is to finish primary school. The government didn't give them any training or learning resources. The VHTs are also left with no medications to use to even treat patients. Furthermore, the VHTs are non-paid volunteers, which also means that in emergencies when someone needs to be referredd to a doctor in a health centre, they would pay for the patient's transport and not get reimbursed. All this while still having to work to make a living to themselves. It's quite shocking how much they actually do for their community as well. I was surprised to find that out after speaking with a few VHTs because the job they described already sounded like a full-time job to me! (visiting schools, doing home visits, public health talks, and seeing up to 30 individual patients a week). The government created this hope, with no means of translating the idea into a realistic, working, sustainable system.
The project my team (the health team) is working on is to continue and finalise a handbook and training plan for VHTs that previous Laidlaw scholars have started to help VHTs with their work. After meeting a few VHTs, it twas nice to know that all of them expressed deep interest and eagerness to continue to study and learn as much as they can, which has really put what we’re doing into perspective. I've been very lucky to be able to work with a team of dedicated Ugandans who have been guiding us on the cultural sensitivities, what things we should be careful with, and speaking with VHTs has helped us understand what they want from the manual to really specify the content of the manual into something that the VHTs would find most useful.
Alongside the VHT manual project, we have been working on culturally-sensitive and specific content for the children health curriculum for schools surrounding Kibale National Park. Specifically, we have worked on presentations and lesson plans for the topics of drug abuse, child safety, and gender-based violence. Yesterday, we were able to visit a school to teach the health club members of the school about puberty, with the hope that these few interested students will pass on the information to their peers, which has proven to be far more effective in increasing transference of information between children in previous KFSP initiatives. This especially with the topics like puberty that children might feel safer to talk about with a friend they trust, rather than an adult. KFSP has recently started this curriculum as a public health initiative to improve public health and safety for children in schools and have extended the teaching to parents as well, to help them protect themselves and better help their children as their role models and as an adult they trust.
Outside of work, we have also been exploring Uganda and its culture, as well as talking to the children at the Kasiisi Primary School, which has helped us understand the community we aim to work with and what it is they need. Last week, we attended an Empaako naming ceremony, which seems to be a prevalent piece of the Tooro culture. It is even thought to be more respectful to call someone by their Empaako as compared to their given name, so being given one was an honour to us and meant that we were recognised as people in their society.
We look forward to continuing our work this week and to understand more of the Tooro culture and its influence on health. More to come next week!