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The Peer Health Educator Group CHAKUNIMU

The Peer Health Educator Group CHAKUNIMU

Nyumba nitu, Njombe, Tanzania

McGill MSc student Andra Leimanis is currently in Tanzania as part of the Highlands Hope - McGill University School of Nursing project. She sends this update.

Home-Based Care with Peer Health Educators:
Report from the Villages

Who is CHAKUNIMU?

CHAKUNIMU is a group of Peer Health Educators (PHEs) who are actively involved in caring for their sick villagers through home-based care (HBC) and the promotion of HIV/AIDS education and prevention. The group was founded by nurse Betty Liduke at the end of 2004 with 63 PHEs in total and 20 PHEs providing HBC in the 6 villages surrounding the Tanganyika Wattle Company (Tanwat).

This grass-roots organization is very dedicated to their work as volunteers during their time-off from working in the fields cultivating crops and selling their produce. Since April of this year, "PIUTA", a support group for persons living with HIV/AIDS has been started in Nyumbanitu village with 12 members meeting every Sunday. They are also promoting the start of similar new support groups in each of the other villages as well.

A Typical Day

As part of my student project I am spending my weekends working along-side the PHEs to observe and support the current practice of HBC in these rural villages. The overall purpose is to see what home-based activities are occurring in this region and to identify the challenges and strengths of this work to help the PHEs in developing and strengthening their capacity to provide care and support to the chronically ill at home.

Typically we arrive in one of the neighbouring villages in the morning after a bicycle ride from Nyumbanitu to be greeted by the village major/chairman, we introduce ourselves, explain our purpose for visiting, and sign a guestbook. Our home visits are spread out during the entire day with each home visit lasting on average 20-30 minutes.

The distances between homes can be quite large as we leisurely walk on little paths through forests, corn fields, across streams, through gardens, up and down many hills. We take a break at some point in the day to either eat a snack called "Mandaaz"(a big doughnut), drink sodas or eat a complete meal at a small restaurant or at the home of one of the PHEs.

"Wagonjwa" - The Sick Individuals

I have spent six full days working with the PHEs up to this point. We visited with 18 patients in Nyumbanitu village September 20th-21st, 16 home visits in Mlevela village October 4th-5th, and 14 home visits in Itulike village October 6th and 7th.

I work very closely in particular with three of the administrative leaders of CHAKUNIMU, Laurence, Amon and Vumilia, who visit a different village every weekend together with the local PHEs from that specific village.

The diseases/illnesses that I have been seeing are primarily chronic conditions such as HIV, cancers, arthritis, diabetes, tuberculosis in the past, and many respiratory complaints. One of the most frequent complaints is a cough, often a result of smoky home environments from cooking on fires in small enclosed rooms.

Long-term paralysis or weakness on one side of the body is another common problem occurring as a result of accidents, falls, and in one instance a snake bite. We also visit orphan-run homes, where the eldest teenage child is caring for five to six younger siblings since the passing of their parents from AIDS.

A large number of the villagers are HIV+, taking antiretroviral therapy and attending CTCs (care and treatment centres) on a monthly or bimonthly basis.

On a Personal Note

The work I have been doing with the PHEs has been very interesting but at times challenging to see the reality of some of these villagers with limited money for medicines and resources, and family losses due to untimely deaths. Other challenges for me have included language comprehension as all communication is in Swahili with additional greetings in the local language of Kibena.

My basic Swahili ability is growing "pole pole" (slowly) with a dictionary and phrase book always at hand! The PHEs have been very eager to learn English as I am to learn Swahili, so we teach one another new phrases and words as we walk and talk throughout the day. I have been warmly welcomed into the household of Vumilia (a 25 year-old PHE) with her 5 younger siblings, her parents and all their extended family in the village.

We eat dinner by lantern light, eating traditional ugali (maize) or rice, beans, vegetables, boiled and sweetened milk from their cow, and meat from a freshly plucked chicken. I have helped to fetch water from the nearby stream, but have not yet learned the graceful skill of carrying the bucket on my head as all the women do here!

I have attended Lutheran church services where I have been deeply moved by the beautiful voices singing hymns and have visited a family in mourning over a loss of their one-year old infant to malaria.

The sense of community and family togetherness is very palpable in this setting, where everyone greets one another passing by on the streets, by homes and workers in the fields. The sincerity of the villagers is very special especially the smiles and laughter of the children, and the young infants bundled in a traditional African cloth on their mothers' backs.

Words of Gratitude

The PHEs have asked me to express their gratitude for the instrumental support from Royal Orr in Montreal, Canada who has helped to fund the cost of a bicycle for CHAKUNIMU. They now have a total of two bicycles which permits them to travel some distances along roads and paths to gain access to neighbouring villages.

Lia Sanzone completed her undergraduate and graduate studies in Nursing at McGill University and has obtained a graduate certificate in health care management from Université Laval.

She has been involved in teaching at both the undergraduate and graduate levels of study in nursing since 2001. Prior to taking on a full time position at McGill and becoming Associate Director of the B.Sc.(N.) program, she worked in various clinical and administrative positions in community health. She has held several leadership roles in multiple committees at different organizational levels and actively participated in the development of the MUHC Pediatric Think Tank and the RUIS McGill Nursing Working Group as co-chair.

As Project Lead of the nursing undergraduate curriculum review, she continues in her role as B.Sc. (N.) U1 Advisor and Coordinator of the Nurse Peer Mentorship Program (NPMP).

She has been cited as a nursing leader in two of Dr. Gottlieb’s books: A Perspective on Health, Family, Learning and Collaborative Partnership and The Collaborative Partnership Approach to Care: A Delicate Balance (2005); and in her Strength Based Nursing Care book (2012).

B.Sc.(N.), M.Sc.(A.) (McGill University), Microprogramme de 2e cycle en développement des organisations  (Université Laval).

Areas of interest

  • Nurse Peer Mentorship Program
  • Global Health
  • Professional development of nursing practice
  • McGill Nurses for CHAKUNIMU Mentorship program to address the challenge of HIV/AIDS and related social problems in the Njombe region of the Southern Highlands of Tanzania

McGill Nurses for Highlands Hope was established in 2006 to provide education and practice opportunities between McGill University's School of Nursing and Chakunimu, a nongovernment organization that brings together community, professional, and volunteer networks to address the challenge of HIV/AIDS and related social problems in the Njombe region of the Southern Highlands of Tanzania.Nurse Neema using the Point-of-Care (PoC) CD4 Testing Program in rural Njombe, Tanzania. /photo M. Wilson

Program Objectives

  • Provide instrumental resources to support sustainable health promotion projects originating from the Highlands Hope Umbrella.
  • Provide educational and research opportunities for McGill University's School of Nursing students pursuing graduate studies in Global Health.
  • Support Highlands Hope Umbrella members, in particular CHAKUNIMU Peer Health Educators and Kibena Women Association, in addressing the needs of people, including orphaned and vulnerable children, living with HIV/AIDS and other health and social issues.
 
 

Edmund Munubi, Manager at Tanganyika Wattle (TANWAT) Company Hospital visits Faculty of Medicine at McGill (2012). Owen Egan

Program Highlights

McGill Nurses for Highlands Hope has supported fellowships, scholarships, visiting scholars and student projects. It has also provided instrumental support so that nurses and community health workers have materials and increased skills to use in their daily work.

Visiting Scholars

Edmund Munubi, Manager at Tanganyika Wattle (TANWAT) Company Hospital (2012)

Bathseba Liduke, RN, and Evangelista Kayombo, RN, Tanganyika Wattle (TANWAT) Company Hospital (2009)

Student projects

Andra Leimanis - Factors influencing implementation of home based care in Tanganyika Wattle Company Hospital villages (2008).

Jacquie Bocking – Factors affecting adherence to antiretroviral therapy in Tanganyika Wattle Company Hospital HIV Clinical Treatment Centre (2008).

Amy Low – Exploring the needs of clients using community home-based care in Njombe, Tanzania (2009).

Veronique Fraser – They test with their eyes: Rapid appraisal of barriers and facilitators to voluntary counseling and testing in Njombe, Tanzania (2009).

Kristin Gagnon – A home care kit training intervention for Peer Health Educators delivering community home-based care in rural Njombe, Tanzania (2010).

Ryan Lomenda – Primary school students’ knowledge, attitudes and practice regarding HIV/AIDS in Njombe, Tanzania (2010).

Joyce Ngabire - Sustainablility of peer health education in primary schools in a low-resourced setting - building on students' leadership skills (2012).

Maggie Wilson - Evaluating the implementation of Point-of-Care (PoC) CD4 Testing Program for the Monitoring and Management of HIV/AIDS in rural Njombe, Tanzania (2013).

Andrea Willett - Evaluating the sustainablility of a Point-of-Care (PoC) CD4 Testing Program for the Monitoring and Management of HIV/AIDS in rural Njombe, Tanzania (in progress).

Instrumental support

Support from our generous donors is vital to our continued success. Donations have enabled McGill Nurses for Highlands Hope to:

  • Support and evaluate the implementation of a Point-of-Care (PoC) CD4 Testing Program for the monitoring and management of HIV/AIDS in Njombe, Tanzania
  • Support, implement and evaluate Youth Peer Health Education about 'Ukimwi' (HIV/AIDS) in 6 primary schools
  • Print Mawazo na Nyenzo- Ukimwi (Tools and Ideas - AIDS) book to distribute to nurse educators and peer counselorsWho said 13 was unlucky? Here are the 13 Canadians who raised well over the target $13,000 for MNHH at Uhuru Peak, Jan. 13, 2014
  • Purchase Nursing and biomedical texts to update TANWAT Nursing library
  • Support computer purchase and training workshops
  • Purchase home based care kits for use in community home-based care programs
  • Provide instrumental support for school fees, books, uniforms for children under the care of Kibena Women Association

 

A group of generous (and fit)  Montrealers climbed Mt. Kilimanjaro as a fundraiser for Hope School in Iringa, Tanzania. The school’s “Let them Learn” program has been successful in reducing teen pregnancies, preventing abuse, and increasing the rate of successful school completion among its female students.

Thanks to the work of Kristin Gagnon (MSc(A) 2011) and creativity and printing by Origami Tactical Creativity and Branding, the home-based care resource manual Mwongozo Wa Haraka 1.0 was released in 2012!