Prologue
We aim for patient-centered healthcare, but the patient remains a passive recipient of care in that model. In malaria-endemic countries, lower-level facilities lack the human resources, equipment, supplies and structural arrangements needed to provide care. What if communities became stewards of their own health? What if they were actively informed about their community health profile, and were engaged to actively work collectively to improve health outcomes? In the scene below, we play out what such a community meeting might entail. Community-designated community health representatives in a given district are having their first monthly meeting with their District Health Officer and Health Center Nurse.
Scene 1
Present at this meeting are:
They each take their turn making their request/report.
Madame Nurse/Acting Midwife/Acting Youth Counselor
“Let’s get straight to it. Before I let you start Madame IAmARespectedElder, this week, please share with the women in the community what you have learned about how mosquitos spread and give us malaria. Please ask them to cover or empty and flip all water receptacles. Also, please let us know how many of them need mosquito nets. Especially families with pregnant women and young children.”
Madame IAmARespectedElder
“Yes, thank you for that, I have been speaking to the women one by one about this, but I will call them all to my house to discuss this so I can show them how I have done it. But the rainy season is coming and I will need you to come speak to us women again about the signs of malaria and when to come to the health center. You told me that if we come early, we can avoid serious malaria, but we don’t know when early is. Sometimes it starts with diarrhea, sometimes fever, sometimes stomach aches. We don’t know when it is malaria or when it is something small that will go away on its own. We need more information so we can help our families.”
Madame Nurse/Acting Midwife/Acting Youth Counselor
“Madame IAmARespectfulElder, this is good. I hear you. Mr ICareButAmTooBusy is here with us today. He will guide us. Madame OverwhelmedAndLoved, please remind all pregnant women to come to the health facility this week for their antimalarial treatment. If they all come together on the 15th, the doctor will be here and will check them one by one. I will try to organize a group session so we can speak about malaria, complication signs during labor and what to do when. If you bring them, I will do it. And if they want, they can even come with their husbands. I know these men are interested but sometimes feel shy. Chief ICareAboutMyPeople, if you can help us ask the husbands to come, this would be good. They can come after if they want.”
Mr Young Man
“Three girls stopped coming to school this semester because they are pregnant and ashamed of their big bellies. I want to ask someone kind and understanding from the health center to come speak to us youth in the village (boys and girls together) about how to avoid pregnancy if you are not ready to become a mother/father. Sometimes, it is an accident, but it still changes the girl’s life forever. Sometimes, her parents even chase her away. I don’t want this to happen to my sisters or any more girls in the village. We need this information. We know there is a way, but we don’t know what. And if there is something you can distribute, please come with it. If you agree and give me a date, I will make sure all the youth are together and ready to listen that day. But please, don’t come to shame us. We need information.”
Madame IAmARespectedElder
[Angrily to Mr Young Man]
“Tchrrrrrrrrr……You children today! You don’t listen! At your age we couldn’t even look at boys, and today, the girls throw themselves at boys! What more information can you possibly need!?”
Mr Young Man:
[Looks down, ashamed and annoyed.]
Madame Nurse/Acting Midwife/Acting Youth Counselor
“No Madame IAmARespectfulElder. This type of remark is what makes the youth hide and do what they want to do anyway. They need information and tools so they can make the right decision. Mr Young Man, thank you for having the courage to speak to us here about this. It is important. You are right, the youth need this information. Next Wednesday morning, please come to the health center with the youth. I will be prepared to talk to you, to share information and answer all your questions.”
Mr ICareButAmTooBusy:
“And before you leave today Madame Nurse, let me go over your pharmacy stock with you. I want to make sure you have what you need for Wednesday. I will also add condoms and birth control pills and some new pamphlets we just received. I will ask them to send you more. I know the Ministry received funding last year to work on this communication. Young man, thank you for your courage. I applaud you! We will make sure this information is always available at the health center. And to you Madame IAmARespectfulElder, we also have new bednets and new mosquito repellent soap an NGO is giving out. I’ll make sure there is enough.”
Chief ICareAboutMyPeople
This is good. This is good. Now Mr ICareButIamTooBusy, I will call you next week to make sure you were able to send us everything.
Mr Young Man, you raise a valid point. Well done! This is what we expect from you. Keep raising youth health issues, even if you think you will get scolded.
Now Mr ICareButIAmTooBusy, when will we have a midwife here? Madame Nurse is doing everything all the time. She needs someone else here with her who can help with the women.
Also, as you know, in this region, we now have mines. With them came the ‘night workers’ [sex workers] so how does this affect us? There is this disease, HIV you mentioned. We also need more information about it. How do you get it, protect and treat yourself. We need to have information. We are villagers but if you give us the information, we can improve our health.
End of Scene 1.