The Remote Village Project
The Remote Village Project of the Virginia Hospital Center Medical Brigade began in 2005 with a series of strategic planning discussions at the Board level. The strategic aim was to extend the impact of primary care services offered during the annual high impact trip. Using the knowledge, skills and experience of Brigade members who had previously worked with NGOs in developing nations, a plan for implementation of this project was made and the first village clinics opened in 2006. Presently there are three clinic sites in remote mountain villages in Honduras. Nine fully trained lay health workers staff these clinics where over 3000 patients visit annually.
Implementation began with a two phase community needs assessment. First was an analysis of 700 children and their families seen during the high impact trip in 2006. It was determined that there were specific health problems that could be categorized into four basic areas- respiratory complaints, gastrointestinal disease, skin infections and infestations, and malnutrition. These illnesses are both easily recognizable and respond well to discrete treatments. The potential to revert to a previously used model where lay health workers supplement an existing health system was apparent and on site needs assessment continued in two villages using a tool developed by this group.
Once the villages agreed to participate, health committees were formed and tasked with specific assignments within the villages. These tasks took place over a period of time to allow the group to develop as a leadership body within the village; they are designed to promote planning skills as well as recognition of public health issues within the village. The village health committee selects health workers for training using a set of guidelines that we have developed. Initial training consists of one week of didactic instruction with interspersed clinical experiences under the guidance and supervision of members of the project. The curriculum was developed to address the common illness patterns previously identified. A simple formulary of eight medicines is provided for each clinic. The health workers are visited every 3 months by project representatives; observation of clinical skills, reinforcement of didactic education, review of patient records and completion of a site visit tool are all done during these quarterly visits. Data collected is maintained in a database so that the impact of various interventions can be measured over time. The first and most obvious impact was resolution of the access issue which began very early in the implementation phase. The second, observed anecdotally, is substantial interest in health matters and a desire to improve living conditions. In our experience it became obvious early on that the most significant impact that we could make in these villages quickly would be to get them potable sources of drinking water. As a result, we began a corollary water project. Our data tell us that as clean water comes into use, the incidence of diarrheal illnesses is decreasing as would be expected with a consistent seasonal pattern. While respiratory illnesses remain at a consistent level, treatment is sought earlier. Nutrition is being addressed with supplemental vitamins at this point while community garden projects are being considered by the village health committees for implementation following completion of their work on the water project.
The annual budget for this project is approximately $6000 per village. This includes the cost of medicine, travel for US based project representatives quarterly, materials for clinics, salary for an onsite project manager and educational materials for the health workers. The text for the health workers is Where There Is No Doctor which is available in many languages and used throughout the world. Clinic materials include scales, stethoscopes, thermometers, medicine storage shelves, desks, and cots, and paper supplies. This cost can potentially be driven down with wider implementation and in-country project staff who can provide the supportive presence needed for success of the health workers. The model is more fully described in Rennert W and Koop E "Primary Health Care for Remote Village Communities in Honduras: A Model for Training and Support of Community Health Workers" JFamMed Oct 09. Finally, it should be noted that this model is the recipient of a $100,000 grant from Ronald McDonald House Charities.
Community Health Workers
San Antonio de la Libertad - return to top
Daniel is a lifelong resident of San Antonio where much of his extended family still lives. He is a coffee farmer with a large independent farm. He lives in the village center with his wife and two children. Daniel's daughter suffers from a kidney ailment which has intensified his interest in providing health care and education in his community. Daniel served on the Village Health Committee, along with four other coffee farmers, which initiated this project for his village. Daniel takes an intense interest in his studies as a CHW and is often found reading his health text when the clinic is not busy. He is also very active in the local Catholic Church, and each week uses the opportunity of these large local gatherings to provide basic health education at the conclusion of services.
Cainan is a coffee farmer and lifelong resident of San Antonio where he lives with his wife and children. Cainan is the quiet presence of the San Antonio clinic where he spends many hours each week seeing patients from San Antonio and the surrounding villages. Cainan also served on the Village Health Committee which initiated this project. Both Daniel and Cainan are also involved in the water, sanitation, and public health project, which will bring sources of potable water to the village in the near future.
Valle Bonito - return to top
Irene is a Sister of San Geronimo, an Italian order whose mother house is located in El Salvador. Sister Irene runs the Santa Maria del Valle Orphanage, which houses approximately 20 children - infants through high-schoolers - along with several other Sisters of the same order. She holds a certificate for initial nursing training and she grew up in Valle Bonito. The orphanage has been a valued partner and supporter of the water, sanitation, and public health team, regularly affording lodging, meals, and construction material storage to the efforts.
Elisa is also Sister Irene's blood sister and a lifelong resident of Valle Bonito, where she currently lives with her family. Elisa served on the Village Health Committee which initiated this project. Elisa has long been active in community health issues, maintaining community immunization records, running a women's support group, and providing health education to the villagers.
Clean Water Project
The Virginia Hospital Center Medical Brigade
June 24, 2010
In addition to treating symptoms, the Remote Village Project (RVP) also seeks to address the root cause of the majority of health conditions in the villages by empowering communities to develop their own gravity-fed potable water and sanitation systems, as defined by the United Nations Millennium Development Goals.
The Medical Brigade has joined forces with several in-country organizations to advocate for villages in these development efforts. These in-country organizations are Agua Para el Pueblo, a Honduran engineering firm in Tegucigalpa which provides Honduran engineers for design and construction inspections; the Peace Corps, which provides volunteer water and sanitation engineers who provide both interpretation services and technical expertise to the Brigade inspection team; and Agua y Dessarrollo Comunitario, a Honduran non-profit organization which contributes technical consulting advice.
In the RVPís water model the Medical Brigade provides funding, project management, and technical training for operations, maintenance, and small business administration. Inasmuch as each village homeowner pays a monthly water tariff to cover the cost of chlorine and maintenance, these projects have the added benefit of increasing the capacity of community leaders by running the small business of the water systems. The community provides man days of manual, unskilled labor, raw materials (wood, gravel, and rock), and transportation of purchased construction materials to the villages if necessary. The Mayor of the governing Municipality provides a portion of the building materials, transportation of materials, and assistance in mobilizing the community.
There is a specific sequence of events in the project. First, each homeowner must remediate the trash around his home. Then he is provided the materials and training to build his own washable (pour-flush) latrine. When the latrine is complete, homeowners are provided their tap for clean water.
Two water and sanitation projects have been completed to date, providing sustainable access to safe drinking water and improved sanitation facilities to 3,900 people in 627 homes in nine villages. In October 2008, the potable water and sanitation projects were completed in the RVP village of Valle Bonito, serving approximately 1,800 people in 290 homes. In May 2010, these projects were completed in the two RVP villages of San Antonio de la Libertad and Planes de Nueva Esperanza. Six other nearby small villages asked to be part of the project as well, and the resulting systems serve about 2,100 people in 337 homes.
The systems are engineered to serve growing populations for economic useful lives of 25 years. As such, over time these two systems will serve over 8,000 people. The total development cost of these systems was $525,000, with $285,000 of cash (54%) provided by the Medical Brigade, $193,000 of labor and raw materials (37%) provided by the communities, and $47,000 of materials and transportation (9%) provided by the governing Municipalities. This sharing of cost and effort is absolutely critical to the long term sustainability of the systems.
These infrastructure projects will be followed by the introduction of specifically tailored public health intervention plans for the communities to raise awareness of the link between proper hygiene and disease prevention by educating and encouraging new healthy behaviors surrounding personal hygiene, food preparation, and water storage. Detailed patient records from the RVPís Community Health Workersí first years of service to the communities will serve as benchmarks against which can be measured.