Next stop was Kusitia – a small village a fair distance off the main road, following a dirt track. In between what looked like outhouses, was the village ‘square’, where a health education class was underway. There was a group of about 6 women sitting on woven mats, an instructor and another lady with a box of some basic over the counter medications. The topic for the class was hygiene – a reminder class for some and a new topic for others, including a newly pregnant mother.
For some background, here is how the health ‘system’ works under the BRAC program. The role of SS: essentially a health worker – a volunteer women selected from the village, who is generally regarded as an influencer. The neighbours trust and respect her, and she can translate any medical questions they may have in the comfort of their own home. She undergoes 15 days training plus 1 day refresher training per month to assist her in identifying the most common of ailments – diarrhea, stomach upsets, common colds, headaches etc. She treats these ailments with over the counter medications.
She also monitors pregnant women 4 times throughout their term and administers daily medication to patients who have TB and such like. This ensures the medications are taken when they are supposed to be taken, and are not sold on the black market.
The SS is responsible for the general health of the 3 villages she is responsible for. There are a total of 30 SS in a district. The role of the SK: a semi-professional health worker who has completed her SSC (senior school certificate) plus received health professional training with BRAC.
The SK is responsible for the health of approx. 10 villages, and works closely with the three SS who work in those villages, overseeing their work and validating their diagnosis. The SK will also review patients the SS is unsure about, and makes the decision of the patient should be referred to a hospital or not. She runs three health care meetings per day, using simple methods of instruction such as pictures, diagrams and storytelling. The SK will also keep an eye on trends of ailments, and report to the Program Organizer.
The role of the Program Organizer: this is an oversight role with management of 3 SKs, approx. 30 SSs and 90 villages – phew, that’s a big district! Tthe PO manages the budget, does all the reporting to regional and head office, and works to manage communicable diseases. TB is significant in the Manikganj district. This is primarily because of poverty levels, lack of understanding on how not to infect others, and the local tobacco processing plants don’t help much either.
There are about 30 TB patients on this district’s list, all receiving daily medication in accordance with the DOTS method – directly observed treatment shortcourse. I do not pretend to be a medical expert so check out this link for more info on DOTS. The PO proudly tells me this treatment is effective in his district, with the SSs playing a key role in ensuring the patients take their medication consistently. The instances of TB have decreased over the years, he’s been in this PO role for 10 years. Not being a medical person, I was just there as an observer, but learned a lot. And became convinced of the huge importance of the role of the SS. It was clear the women deferred to her if they did not understand something the SK had said. It was also clear they had learned much about hygiene from the SK.
My presence gathered about a dozen kids to also come and watch the training session, and some of them learned too. I mentioned it to the PO, that it would be a good idea to include the kids, who generally put pressure on their parents to change behaviour. He agreed, so the kids might be included the next time!