Sara (to the right in the picture above) shares a story in our group forum today. To this community, sharing stories is sharing life.
Sara receives a call in the middle of the night. Her HIV patient, who has been bedridden for months, has slowed his breathing and will soon pass. She willingly rises from her bed and leaves her family to go to his bedside. When she arrives where he lay, she comforts his family. He passes in the early hours of the morning. It is her job to coordinate the transfer of the body to the hospital. She soon learns that there are no ambulances available. Sara uses her own money to pay for someone to drive the body to the hospital.
The first thing for me to acknowledge in this story is the stark contrast this story has to my experience as a nurse. It is beyond foreign, it is uncomfortable to think about. I am obligated to consider this as a reality on this earth. I am amazed at this women when she talks...something pulling her to work that isn't related to money or status. It is palpable, I see it, I respect it. She has no white coat, no letters after her name. She doesn't even have a badge. Next disturbing thought..How the hell there isn't an ambulance? I picture the dying being transferred to hospitals in a dangerous bus-taxi-like vehicle. Finally, I settle my mind on the complexity of this story. It suggests problems that are so deeply dug into their society. Money can't fix all this. There is no clear solution.
I feel confident in this thought...the empowerment of the 'nurse' or Community Health Worker in this society will fundamentally change their baseline health status. I know this because I know what nurses do, how they think and how they impact change. I know that the women I sit with are powerful. How do they realize their power?
Sara is not paid for her work. Who should pay? The community? The government?
A basic tenant of any job/profession is the ability to earn money. The concept of the village health worker was established during the 50’s. Different countries have handled the proposition differently. For example, Indonesia implemented CHWs in 1982 that were paid by the community themselves. They had favorable outcomes including an infant mortality rate that dropped by 30%. A review of the literature done by the World Health Report (2007) http://www.who.int/hrh/documents/community_health_workers.pdf suggests that CHW programs that are implemented by the community with funding have a higher likelihood of sustainability.
What role does data play here? What impact does Sara have on the Ngando community? Is her value reflected in data? What if she could speak to that data and advocate for herself?
There is no better place to look to than the Crimean War when discussing the power of data. Florence Nightingale and roughly 40 volunteer nurses were sent to solve the issue of the dying soldiers. When they got there they believed that the sanitation practices were contributing to the death rate. Florence was unwavering in her commitment to gathering, interpreting and visually reflecting data to prove her theory. She would bring statistical graphs to British parliament realizing she could bring data to life. This is how she would impact change, and get the government aligned with her priorities.
The story of how data impacted the outcomes in the Crimean War has profound implications for the CHWs and their slums. There are undeniable similarities. The CHWs have powerful data all around them and it reflects their intrinsic value. If they find a way to organize themselves, collect their data and bring it to life they will find themselves in a powerful position in the community they serve.