Our health programs are driven by a simple but very powerful idea: the health of Gorongosa National Park is directly linked to the health of the people living near the Park. And vice-versa.
It's the idea behind ECOHEALTH, an initiative funded by the US government (USAID and PEPFAR), and our program logo says it all:
This program is made possible by the generous support of the American people through the United States Agency for International Development (USAID) through cooperative agreement number 656-A-00-11-00075-00.
The program is based on a "PHE model". Put simply, it means the security of the environment is directly linked to the population and health of its people.
Here are some of the things we do to improve the health of the thousands of people living around Gorongosa:
Mobile Medical Clinics
Through mobile medical clinics, we reach some of the most vulnerable families in some of the remotest areas of the Gorongosa region. For many people, this is their first contact ever with a medical professional. The demand can sometimes be overwhelming, with hundreds of people showing up for care. But it's deeply fulfilling work because there is no doubt about it: these clinics save a lot of lives.
The mobile clinics are a critical first-point-of-contact where we can identify and care for high-risk and vulnerable patients such as pregnant women and children. We provide pre-natal care, referrals for facility-based births as opposed to home-based births, and post-natal care including the basics of child nutrition and sanitation. We also offer family planning services to families who wish to postpone pregnancy and enjoy the economic and social benefits of smaller family sizes.
The clinics also give us a chance to meet and begin caring for vulnerable children, particularly orphans and malnourished infants. We provide vaccinations, growth monitoring, and hygiene and sanitation advice to parents. All these measures dramatically increase a child's chances of survival. For others, we provide a range of vital medical services for a broad range of health problems such as malaria-related symptoms, diarrhea and respiratory infections.
We also use the opportunity of engagement to teach people the fundamental basics about disease prevention (e.g. mosquito nets, clean water treatments, HIV/Aids counseling and testing), disease management (including malaria and HIV/Aids), and better nutrition and sanitation principles and practices.
We also communicate the powerful economic and social benefits of family planning, the liberating effects of prolonging the education of girls, and inform women of their legal rights to help prevent gender-based violence.
Traditional Birth Attendants
Our research shows that 84% percent of women in Gorongosa delivered their last baby at home. By training and supporting traditional birth attendants (TBAs) who live and work in the communities, we ensure that our focus on reproductive health continues and that maternal and infant mortality rates fall.
Profile of a TBA - Laurinha Paulino
Laurinha Paulino has been a traditional birth attendant in the Nhankuco community on Mount Gorongosa since July 2011. She is 22 years old and has 4 children, aged 8, 6, 4, and 2 years old. The term traditional birth attendant is a misnomer because Laurinha and her peers are not trained in home deliveries, as their mandate is actually to accompany pregnant women to a facility to assure a safe birth with a skilled attendant. In Portuguese, TBAs are knows as matronas or literally mother’s helpers.
"I like to be a matrona because I provide a very important service to my community, because I am helping a lot of people."
Laurinha says that the most valuable thing that she has learned through participating in this program is to recognize danger signs for both pregnant women and newborns,
"I never knew about the specific danger signs and I believe this knowledge is helping many of my community members."
In the last three months Laurinha has counseled women through 9 deliveries and of these, 6 were at the facility. This represents a huge jump to 66% of safe births in comparison to our baseline data of only 16% safe births. Some of the biggest barriers preventing women from delivering at a facility include distance (it takes nearly 4 hours to walk from Nhankuco to the nearest health facility in Canda), lack of information about the dangers of delivering at home and the importance of traditional ceremonies that are carried out at home after delivery. But TBAs are proving to be effective champions for this message and in the first year of work they have already increased the average amount of safe deliveries at facilities to 44%.
Community Health Workers
By training and supporting groups of community health workers (CHWs), we vastly expand our ability to provide constant and consistent care for the people of Gorongosa. All of the community health workers are members of the communities we serve and were selected by the communities themselves. They receive 5 months of training and return to their villages with the knowledge and tools required to dramatically improve the lives of their friends and families.
In its first year, in 2012, twenty-three community health workers returned to fourteen different communities, fully trained on the basics of health promotion and disease prevention and are now equipped to diagnose and treat malaria, diarrhea and respiratory infections. In addition, they are trained on environmental conservation topics and can even act as informal Park rangers in their community. More health workers are being trained and this program will continue and expand.
Profile of a CHW - Carlos Félix Melo
Carlos Félix Melo graduated from the community health worker (CHW) training program in July, 2012. He is 25 years old, married and has two children aged 3 and 1 years old. He comes from the buffer zone community of Murombodzi, which has a population of about 3,500 people.
"The most valuable thing that I have learned from becoming a community health worker is how to prevent the most common diseases in my community such as how to eliminate mosquito breeding grounds to reduce malaria, and how to manage household waste to improve hygiene and sanitation to prevent diarrhea."
Since becoming a CHW he has built a latrine and garbage pit in his own home following guidelines learned during the course. Another change that Carlos has implemented is using conservation agriculture techniques to prepare his fields, as taught in an environmental education workshop at the CEC. This year Carlos employed those methods in his fields by not burning to prepare the soil for crops, therefore preserving soil quality by providing natural fertilizer.
Since becoming a CHW, Carlos has treated or transferred many patients in the community suffering from malaria, diarrhea or respiratory infections. Carlos also carries out about 150 home visits per month where he tailors health education messages to the members of households. For instance, if there is a pregnant woman, he promotes pre-natal care and facility based births, and if there are children under 5, he promotes vaccinations and water treatment. Carlos also carries out weekly health education talks to groups that include the church, sellers at the market, women pumping at the well or at the mill grinding corn. During these health talks, or palestras, Carlos teaches folks about how to prevent HIV/AIDS, the importance of having an HIV test, the meaning of gender based violence and laws that protect victims. Since becoming a CHW Carlos feels like he is better known and respected by members of the Murombodzi community. He is committed to continuing to improve the health of families in his community and dreams of one day continuing his training to become a certified nurse.
Improving food security
We strive to improve the food security of people in the Gorongosa area (particularly the most vulnerable people like orphans and their caregivers) by introducing household vegetable gardens, teaching animal husbandry, providing nutrition education and promoting conservation farming techniques to increase crop yields.