Today’s adventure provided the most exciting news yet. A year and a after they were sent to Malawi, I’ve finally had a chance to follow up on the 12 Community Health Outreach backpacks. This was a project than began two years ago in a sophomore design class at Rice. The backpack struggled through several design iterations, and finally ended up in the field at St. Gabriel’s Hospital for the summer. The original intended end user was a group of trained community health volunteers, known officially as Community Health Workers (CHWs). After a summer of using the backpack in the communities surrounding St. Gabriel’s Hospital, the backpack was redesigned to accommodate the feedback. Twelve new and improved backpacks were sent to be used at St. Gabs:
Several teams spent months trying to identify the appropriate end user for these backpacks. Little did we know, the end user would find the backpacks. The backpack was originally designed for use by Community Health Workers. It was quickly assumed that these volunteer members of the community (sometimes with no more than a middle school level education) would not be able to use some of the more technical items in the backpack. We thought that perhaps the backpack would be most useful in the hands of an outreach nurse with professional training and a nursing degree.
When I arrived at St. Gabs this summer, I was surprised to find that the backpacks had made it into the hands of 12 of the hospital’s most trusted Community Health Workers. Alex, the hospital’s chief Home Based and Palliative Care nurse, used Frontline:SMS to call 12 of his most reliable CHWs to the hospital to be trained to use the backpacks in their community. Each of the 12 CHWs was trained in palliative care (an approach that includes both the family and the community in end-of-life chronic disease care, and take a holistic approach to medicine). They were then designated as leaders of teams of 15-20 CHWs in neighboring communities as a Palliative Care Team. So, each Community Health Outreach backpack is shared by a team of 15-20 CHWs, and they travel as a team with the backpack to care for patients in their communities.
I’ve been able to visit several of these teams of CHWs, spread as far as 100 km from the hospital. They are using the backpack 2-4 times per week, to visit an average of 10 patients per week. They’re keeping detailed records of every item they use (including every time they open the snapware boxes!), and store the backpacks in the village chief’s house for safekeeping. I won’t bore you with the details of the data collection, but some of the results and suggestions were absolutely fascinating. Several teams highly suggested the inclusion a tooth brush and toothpaste, to increase the appetite in some of their patients, and to promote oral hygiene. This suggestion hasn’t come up once in 2 years of tens of university students studying the possibilities for this backpack.
Besides the fact that hundreds of CHWs and hundreds of patients are benefiting from these 12 backpacks, by far the most encouraging discussion was how the backpacks were affecting the CHW’s roles in their communities:
“Before we had these packs, we used to travel with our drugs and tools in plastic bags. If I fell, the drugs would be scattered. In this bag, they will be protected.”
“These bags have given us an identity. The tools and drugs are now secured. We are well honored in our community.”
“Patients are feeling well cared for because the tools are well arranged. When they see that they are being well cared for, they get their appetites back.”
“This should just be the beginning. We need more packs.”
“These backpacks have given us an identity. Before, members of the community were not recognizing that we are legitimate workers for the hospital. With these bags, we are well recognized.”
“Our patients will see us coming with the packs, and they will say ‘Oh yes, our doctor is here.’”
“The bag has brought unity and transparency among the volunteers. We are now working as a team to treat our patients. Volunteers who were previously inactive are motivated by the hospital’s willingness to support us with the tools we need, and have now become active again.”