What began as an endeavor to provide Community Health Workers with a screening kit has become a wonderful tool for Home Based Care nurses at St. Gabriel’s. The backpack is not practical for use by CHWs for several reasons. First, CHWs are trained heavily in patient counseling and follow-up, but are not trained to use medical equipment such as blood-pressure cuffs and glucometers. Second, Community Health Worker has a different meaning in almost every region of the world. Often times, like at St. Gabriel’s Hospital, CHWs are involved in specific programs (HIV/AIDS, TB, PMTCT, HBPC) that might or might not involve utilization of the tools in the screening kit. Their responsibilities vary widely, making it difficult to create a uniform screening kit for all CHWs.

I have discovered that almost all of the outreach at St. Gabriel’s Hospital is done by the HBPC team. Twice a week, two Home Based Care nurses (Alex and Matilda) spend the day travelling to communities in the catchment area, providing basic treatment, monitoring vital signs, and doing simple tests (such as checking glucose and hemoglobin levels).

I have been able to travel with both Alex and Matilda over the past few weeks. We travel by motorbike from one community to the next, sometimes spending an hour with a patient. So far, we have used the kit to provide every single patient with some form of care. Some of my favorite cases include:

1. The second patient to benefit from the kit was a 62 year old man who had just lost four of the toes on his left foot to an infection. We used the kit to sterilize the amputation and dress the wound.

2. Soon after, we used the kit to monitor the vital signs and glucose levels of a 100+ year old grandmother. The family said they had stopped keeping track of her age at 100, several years ago. This woman was alive before the benefits of penicillin were known, before we monitored glucose levels, and long before St. Gabriel’s Hospital was in existence. Needless to say, I can’t imagine that, even in her wildest dreams, she ever thought that she would benefit from the use of this screening kit.

3. I was lucky enough to spend the day at the Antenatal and Under Five outreach clinic. We used the hanging scale from the kit to weigh 30+ babies in less than five minutes. The mothers were eager to place their newborns fearlessly in the trust of the cloth sling, laughing as their babies screamed and wiggled.

4. The kit has several compartments that can be used to bring drugs along. Alex and I were proud to provide ibuprofen and multivitamins to a patient who had been incarcerated for seven years after illegally selling 500g of tobacco.

5. Matilda and I visited a textbook end-stage cervical cancer patient, dehydrated with a severe protein deficiency. We sat with her and her ten guardians in her hut as the HBC CHW explained to them how to prepare Oral Rehydration Solution, using the cards from the CHW screening kit.

After presenting the backpack to the matron of the hospital, we discovered that St. Gabriel’s has been given funding to pay for ten more outreach nurses to join Alex and Matilda for, at least, the next three years. Hopefully, we will be able to provide them each with an “Outreach Kit”. With feedback from Alex and Matilda on the first three months of the pilot, we will be able to scale the project up, and provide the hospital with tailor-made outreach packs, designed specifically for their outreach needs.