Please Just Get in the Basket: A Tricky Health Activity is Ultimately Successful

I recently went with Sarath and Roth from the TGF Health Programme to Salar village in Kok Tlok Leu Commune to monitor village health workers as they led a growth monitoring assessment of children in the community.  During the assessment the volunteers are aiming to weigh all the children under 5 years old in the village to see if they are healthy or undernourished.  Those children that are undernourished will be encouraged to continue attending (accompanied by their parents) malnutrition rehabilitation meetings sponsored by TGF.

 

In most villages these assessments are run successfully by volunteers without TGF staff present.  But in this instance extra help was needed in Salar-the most competent of the two village health volunteers recently stepped down from her post to give birth in October.  A new untrained village health volunteer had just been appointed by villagers, and was planning to manage the assessment in cooperation with the remaining village health volunteer, even though neither were used to managing these activities.  Given this case the TGF Health Programme team felt it necessary to come and lend support this time so the assessment would run smoothly.  The hope is that after some initial guidance these two village health volunteers will be able to run other health activities themselves in the future.

 

In theory the assessment shouldn’t be that hard to conduct.  Basically during the assessment children under 5 years old, escorted by their parents, are placed in a plastic laundry hamper hanging from a heavy duty pull scale.  The scale gives a measure of the child’s weight, which is then recorded by one of the volunteers next to their name and signed by their parents.  In this way TGF and village health volunteers know which children are still malnourished and which children have reached a healthy weight.  If children are still malnourished they and their parents will be invited to come to the next scheduled malnutrition rehabilitation, where they receive a healthy meal and their parents learn how to provide a more balanced diet to children from locally available, affordable foods.  If the children have reached a healthy weight, they and their parents become (unofficially) proud “graduates” of the TGF Cambodia Malnutrition Project.

However in practice and with one new and one not so skilled health volunteer, the assessment was quite tricky to pull off this time.  The first problem was that a few kids at the start of the assessment were reluctant to get in the basket and began crying.  This led to a chain reaction; all other children waiting their turn began crying too in fearful anticipation of “The Basket”: for example in the picture on the left, its hard to even see the child because they are scrambling to escape the basket!

Eventually the village health volunteers and TGF staff got this child as well as the others attending calmed down enough to be weighed.  Sarath said that volunteers in other villages know how to manage this better so it doesn’t become a scary activity for the children.

The second difficulty was the data recording.  Literacy is not strong among adults in our area of rural Cambodia.  It may seem easy enough to write down each child’s name, their age and weight, but the village health volunteer was new and writing slowly.  Soon the number of parents and their children getting weighed outpaced her record keeping.  Parents whose children had been weighed encircled her, yelling out their data to be written down.  After a few minutes Roth (TGF Health Programme Assistant) stepped in and politely explained to everyone the obvious-if they don’t go one by one, the new volunteer won’t be able to get any information down accurately.  The group calmed down and people started giving their information one at a time to the volunteer rather than all at once.

 

Eventually all names and weights were recorded accurately.  Near the end of the session the former health volunteer came to check on results, carrying her newborn baby with her (only twenty days old!).  She carefully weighed her child for the first time, and had the results recorded.  It was understandable why she could not help with the assessment-she was quite visibly tired from taking care of her newborn.  However she did say that in a few months’ time she would like to help again to manage health activities, time allowing.

 

By the end of the session 53 children out of 82 in the village had been weighed.  This was better than anticipated, even though 100% would be the ideal attendance rate.  Despite the popularity of health activities, daily attendance is lower during the rainy season than at other times of year because families are busy with rice planting and harvesting.  To compensate, TGF Cambodia advises village health volunteers to schedule time several days in a row for any health activity-usually when parents and children can’t come one day, they instead come the following day.  In this way participation remains close to 100%.

 

This particular assessment in Salar was possibly one of the most disorganized ever supported by TGF Cambodia, but that’s understandable given the lack of training and organizing abilities of the health volunteers managing.  Still a majority of children were weighed and their data accurately recorded.  Possibly more importantly for the future, the village health volunteers learnt a great deal about managing the assessment by organizing it themselves.  The TGF Cambodia Health Programme has had a lot of success working this way, providing advisement and encouragement to village health volunteers but leaving it to the volunteers themselves to lead the health activities in their own villages.  As a result their ability usually grows quickly, and everything they learn to do with their own community they can put to use later with or without further support from TGF Cambodia.  While in this instance the village health volunteers needed TGF Cambodia there for some help in person, they came away from this assessment with a basic understanding of how to conduct another assessment next time on their own, and this means a great deal of progress was made despite the setbacks during this health activity.