OCTOBER 15, 2004

Canadian docs, Ugandan villagers harmonize for kids' health

Children performing health skits in costumes, medical scales hanging from trees � and people singing songs about diarrhea. A bad dream after too long a shift on the peds ward? Actually, it's pediatrician Dr Jenn Brenner's idea of a nice break from the office. Dr Brenner, of the Alberta Children's Hospital, is the Canadian Project Coordinator of a joint effort between the Canadian Paediatric Society (CPS) and Mbarara University of Science and Technology (MUST) called the CPS-MUST Child Health Project, Uganda.

It all started back in 2000 when MUST approached the CPS and proposed they work together on a community-based educational project aimed at the health of local children from birth to five years of age. The project has been up and running for a year. Twenty-five Canadian doctors have all done tours of duty of at least a month, and with the help of CPS volunteers, the locally driven program is now improving child health conditions in 60 villages, with a total population of 25,000, throughout southwestern Uganda. "This is a happy story about Africa," says Dr Brenner, "and we'd like to share it with Canadians."

With seven years of volunteer experience with a medical school in rural southwestern Uganda, Dr Brenner knows a lot about the joys and difficulties of working in a country where one in five children die before they turn five. "One of the most frustrating things," she says, "is when kids come in so sick that they often die within a day, from a preventable illness."

The project uses three strategies to create long-term solutions. First, it emphasizes health promotion and prevention. Second, putting the emphasis on a community-based approach. Third and, according to Dr Brenner, most important, is the goal of building the local skills needed to keep the program going.

The role of Canadian doctors is to provide consulting for the project and to train twelve educators at MUST. Each of the 60 villages selects two leaders; these 120 leaders are trained by the MUST educators using materials provided by the CPS. The local leaders, also called community-based healthcare facilitators, are all parents (71% are mothers) and often have to make long journeys to deliver health education. They do all the day-to-day work on the ground, explains Dr Brenner. They hold workshops to train other parents about breastfeeding, sanitation, nutrition and family planning, and train villagers in malaria prevention by cutting down bushes and using bed-nets. To create long-term health promotion, the healthcare facilitators organize communal activities like building latrines and planting co-op gardens for growing nutritional foods.

The key to the project's success, according to Dr Brenner, is that it uses a bottom-up approach to community-based learning. Essential to the process are community action plans, where villages define their own needs, priorities and solutions. One village recognized that their children's health problems were primarily created by poverty. The solution? The villagers initiated a plan to start a pig farm and put the profits into a healthcare fund.

The present phase of the project is funded by the Canadian International Development Agency (CIDA) and ends in January 2005. But Dr Brenner foresees the project continuing in Mbarara, and hopefully elsewhere. "The community-based approach to child health has been very successful in Uganda," she says. "We're hoping this model can be developed and used in other countries."

CREATIVE methods
The most successful project initiative has been the hugely popular Child Health Days, which attract 500 to 1000 kids each time. Twice a year in each of six parishes, children are dewormed, immunized, given vitamin A and weighed on decorated scales that hang from tree branches. But beyond practical matters, the days are creative festivals for the kids, with children performing skits about health issues, and parents singing songs about boiling water to prevent diarrhea.

So what's the most rewarding part of the work for Dr Brenner? "The enormous community response to the program," she says without hesitation. "People will walk 10km with three children and babies strapped on their backs and fronts. Seeing that was what kept me going. They face so many challenges, but they're motivated, inventive and resourceful � they keep going."

More info: contact the CPS at 613-526-9397 or [email protected]



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