Haven’t posted in a while, huh? I don’t even know where to begin….the last few weeks have been full of all kinds of ups and downs. I spent the beginning of last week observing at RUHSA and in the Low Cost Effective Care Unit at CMC. The time at RUHSA was pretty packed: Iwatched a video on the program nd got a chance to speak to the director of the program about the work they do, and then headed out into the field. First, I went along with a mobile clinic out to the rural areas they serve. Like CHAD, the program relies upon cooperation between the CMC staff and PCHWs, trained community members who are responsible for identifying individuals who could utilize the clinic services. Then, I went with one of the program members to visit a little rural community of people living in little thatched huts. There are several of these communities in which RUHSA runs Self Helf Groups that teaches the people of the communities how to manage money. Basically, RUHSA assists the groups is securing loans from banks, teaches them how to save money every week (each member of the group has to contribute dues to the group each week), how to invest this money and guides them in spending the money on their community, neighbors or investment ventures. The really exciting thing about this program is that it is self-sustainable and profitable for the groups: one group saved enough money to secure a loan to buy an ambulance that they leased out to nearby towns. As a result of their ventures, they made enough money to not only pay the driver and for the ambulance, but also had profit left over. It’s pretty incredible. The idea of these programs is that health care can only be improved if we can raise standards of living in these areas. In the end, the major difference between these and many other welfare type programs is that these programs are closely monitored to increase the likelihood of their efficacy. The people are free to do what they want with the money (three people out of the group have access to the money- any two of them have to sign a withdrawal slip from the bank in order to access the money. the idea is that spending the money is a group venture), but they are given guidance (not instruction) on investments. They are shown the benefits of investing the money in themselves rather than just spending it on, say, drink or food which are gone in a day without making any profit for the future. The other interesting thing is that these programs are run by women because the idea is that women see the needs of the community more clearly and because empowered women generally lead to men raising their standards of success. One of the med students I met while at RUHSA is studying to see the opinion of the men in these communities of this empowerment. I’d be very curious to see if (a) they actually feel threatened/left out and (b) the effect is making them step up and earn back respect or if they just condemn the program.
Spent the rest of the time visiting the vocational schools developed for the rural boys and the textiles programs developed for the women…and then touring the wards, where along with regular health services, they perform tubal ligations for women (the government has a program by which women are given financial incentives to have these done…and after having two children, can have them done without the consent of their husbands). Lastly, saw more of the community education efforts: pictures of street plays on HIV transmission, etc.
Overall, very impressed by a very round approach to healthcare…
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