The Long Walk toward Community Health

written by: Robert Greathouse
posted in: 2010, Sudan

My colleague Gideon and I were exhausted. We had travelled one hour from the CHESS project’s headquarters in Duk Payuel—on a road peppered with pools of water and mud, courtesy of Sudan’s rainy season, which could bring the strongest off-road vehicle to its knees—to Mareeng, a nearby village that normally would take 15 minutes to reach. Just as we reached the outskirts of Mareeng, our vehicle finally succumbed to the condition of the roads and became stranded in a mixture of mud and clay that could easily be mistaken for quicksand.

Determined not to let our travel conditions get the best of us, Gideon and I decided to complete the fifteen minute journey in blazing heat to the County Administrator’s office on foot, so that we could introduce ourselves and inform the government officials of our scheduled activities in Mareeng, before getting to work.  Battling the wave of exhaustion that washed over us as we settled into the office chairs in the Administrator’s office, Gideon and I made our requisite introductions and set out to begin the interviews that had brought us to Mareeng in the first place.

On this particular day, Gideon and I were engaged in our third and final day of data collection for a Knowledge, Attitudes, and Practices (KAP) survey on the major health components of CHESS. This survey was designed to assist the project management in evaluating the effectiveness of the training, outreach, and direct service provision elements of CHESS, such as communal sanitation and hygiene trainings conducted by the project on the importance of hand washing and proper waste disposal, distribution of insecticide-treated bednets to households to prevent malaria, childhood immunization campaigns, and the quality of services offered by the CHESS project’s sub-partner, the Duk Lost Boys Clinic operated by the John Dau Foundation.

The questions included in the survey served three primary purposes: measuring the level of knowledge among individuals surveyed on selected health topics; gauging community attitudes on recently introduced (and controversial) health initiatives such as childhood vaccinations, HIV/AIDS, water treatment; and attempting to measure the level of adherence to prescribed preventive health measures advocated by CHESS, such as routine childhood immunizations, use of malaria-preventing bednets, and use of trained health personnel (midwives or traditional birth attendants) during childbirth. This survey would also aid IRD in planning for future projects by identifying villages and communities with the lowest coverage of health services, such as primary healthcare clinics, safe water services, and low levels of child vaccination.

As I walked with Gideon that day, going house to house conducting the interviews for the survey, two things struck me as unique: the first was the zeal respondents showed during the exercise, and the second was CHESS, and by extension, IRD’s impact on the community members of Duk Payuel. When preparing to conduct a survey, it is common practice to enter the targeted communities unannounced, in an effort to obtain responses that are honest and truly representative of that particular community. For example, if Gideon and I had announced earlier that day that we were going around asking people about hand washing and were interested in seeing whether households had soap available to wash their hands, it is likely that local shopkeepers would have seen a marked increase in the sale of soap for that particular day (whether or not a family would actually use that soap is another matter). However, in spite of the unannounced nature of our visit, the residents of Mareeng were all too happy to temporarily stop cooking, cleaning, feeding their children, or tending to their crops or animals to answer the questions Gideon asked of them. These respondents were also extremely enthusiastic to search their homes for bars of soap, tubs of detergent, or child health cards (a card given to parents by health clinics to document a child’s birth data, growth and development measurements, and instances of immunizations) and, upon finding these items, would present them with pride to both Gideon and me. The survey seemed to be so popular among the inhabitants of Mareeng that, although our survey sample only included approximately 30 people from Mareeng, those we did not interview requested that Gideon and I return to interview them the following day!

This request served as a pleasant surprise to me, as oftentimes local community members are wary of participating in such exercises, fearing that the NGO will collect their answers, use them to request funds from donors, and then “disappear,” never returning to reinvest the dividends of the process into the communities that served as the impetus for such efforts. Some commentators of this phenomenon have called this “NGO fatigue.” However, I was elated to find that the only fatigue I had at the end of the day was from walking for over 4 hours to complete the KAP survey data collection in Mareeng. This, to me, was the highest form of flattery that CHESS/IRD could receive from the local community. Nearly everyone we interviewed that day expressed sincere gratitude for the efforts IRD had undertaken to improve the health of their community.  For me, this was confirmation in the flesh of IRD’s mission statement: “Improving Lives, Building Livelihoods.”

KAP Survey Pictures

Peter Goch, a CHESS staff member, notes the presence of soap in response to one of the KAP survey’s questions on hand washing behavior, while a crowd of enthusiastic onlookers observes the interview.

Peter observing a child health card during a KAP survey interview, while the child in the background smiles for the camera.

Gideon Duot, another CHESS staff member, conducting an interview with one of the (few) male respondents in Mareeng.

A resident of Mareeng takes a break from tilling his crops to respond to the KAP questionnaire administered by Gideon.

Me crosschecking a completed KAP survey questionnaire for completion and accuracy in the homestead of the respondent standing above me in Mareeng.

Me and one of our respondents in Mareeng striking a pose in front of her traditionally-constructed home, called a “tukul” in Sudan.

Me (standing on my tip-toes to equal Gideon’s height) and Gideon after finishing data collection in Mareeng.

This entry was posted on July 12, 2010 at 9:16 am and is filed under 2010, Sudan. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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