MSF brings personal contact to IDPs in precarious health conditions

Offering the simplest care to displaced can assure people they have not been forgotten.
Ingushetia - "Behind the facade of daily routine there is so much misery among the people that sometimes I'm ashamed to tell them about germs and the importance of keeping a clean environment" says Raya Edelbieva. "But as we have survived, life goes on and we go on living. But so do germs, and these days there are lots of them". "It's common knowledge that, when you're far from home and living in difficult conditions, attention and kind words help you feel that you haven't been forgotten."
Ã?â??Ã?  MSF - Ingushetia Raya is fully aware of the health problems linked to precarious living conditions. She is part of a new network of 16 community health workers set up by MSF in Malgobeck, the northwestern district of Ingushetia. About 40,000 persons who fled from the war in Chechnya have settled in collective centers, tents and host families in this district. Each community health worker visits the settlements and is in charge of a population of 1,000 internally displaced persons. Their job is to get to know the IDPs personally, understand their urgent needs, refer medical cases to doctors, and promote primary and reproductive health care as well as hygiene and sanitation. "The IDPs have lost their homes and all their belongings" explains Dr. Sylvie Moinié of MSF's medical coordinators for Ingushetia. "They are traumatized by the war; they are strangers in this land and these surroundings; they feel excluded; they are wary of persons they don't know; and distrust systems they're unfamiliar with. "Under these circumstances the displaced are less likely to seek assistance, and a child's bronchitis may develop into pneumonia, or a woman may have a stillbirth that could have been prevented. The community health workers are there to increase communication and provide crucial links between the displaced, the local community, and the medical staff." MSF nurse Roza Sukaeva, who coordinates the new program, describes the team members as "very active displaced persons who are particularly interested in improving the community's health conditions. They are responsible, sympathetic, and they feel like helping others". These character traits - as well as the ability to communicate effectively, organize activities and mobilize others to act - were used to select the community health workers. MSF then trained the team in conducting first aid, improving basic hygiene and sanitation, and recognizing symptoms of infectious diseases to promptly refer them to medical facilities. The workers refer all serious cases of disease or trauma to hospitals, advise sick persons to seek medical assistance and pregnant women to attend pre and post natal consultations, and encourage mothers to vaccinate their children. They also identify particularly vulnerable individuals who may need special assistance from local agencies or foreign NGOs. They also collect data, such as the number of invalids, chronic patients, births, deaths and pregnancies. Moreover, by addressing minor health problem they lighten the case loads for overburdened doctors and nurses working in the MSF mobile clinics or the Ingush health structures, while increasing the likelihood that those who wait in consultation lines are the most needy. "Yesterday, one of the community health workers reported 40 cases of diarrhea in a collective centre" said Dr. Sylvie Moinié "An MSF nurse immediately went to the site to check on the situation and then called on the local department of infectious diseases to respond. Without such early detections we can be faced with hundreds of cases and a potential epidemic." In other collective centers in Malgobeck district community health workers have discovered cases of lice. Working with an MSF nurse, they rounded up all the infected individuals and members of their households, explained the problem and showed them how to wash themselves to get rid of the parasite. The anti-lice campaign is on-going in collective centers and in the tent camp of Aki Yurt. Information sessions on basic hygiene and sanitation are organized regularly, sometimes for more than a hundred people. During these sessions, the workers give practical advice: always boil water before drinking it, wash your hands before meals, protect food from flies and other insects, keep latrines clean, notify us about mice, rats and cockroaches. They also organize mass cleaning-up operations during which persons work together to collect and dispose of garbage. As a result, the sanitary conditions in the collective centres have improved. The change is most notable in the Aki Yurt camp. And finally, there are the invisible results, which seem to be the most rewarding to the community health workers themselves. "Many refugees thank me," says Malika Djabayeva, "and ask me to thank MSF, for having visited them, for caring about their health, and for giving them advice. It's common knowledge that, when you're far from home and living in difficult conditions, attention and kind words help you feel that you haven't been forgotten.".