INDANAN, MA. CHARIS ANNE M.

BSN 3A – G3

Case Study: Safe Water in Barangay X

Community health workers are responsible for a small supply of essential drugs which enable
them to provide treatment for simple health problems.

CASE STUDY: SAFE WATER FOR BARANGAY X

The community comprises a number of barangays. In all of them, people suffer from guinea-
worm infection, a waterborne disease. If people drink contaminated water, nine months or a
year later they may find that a long, thick white worm has grown in their bodies. The worm
usually grows in a part of the body that comes into contact with water (often the legs). The
adult worm will cause an ulcer in the skin and push itself through so it can deposit its eggs in
the water. This painful disease is responsible for many absences from work and school, and the
ulcers can become infected with tetanus.

After discussing the problem with the staff at the local health center, the residents of Barangay
X decided to organize a primary health care project to deal with guinea-worm and other local
problems.
Word about the primary health care project was sent to every barangay area. Each barangay
was asked to send at least one volunteer to the health center to be trained as a community
health worker.

The health center staff drew up a training program that took the problems mentioned by the
community leaders into account, covering subjects like:

 Clean water supply, including how to build wells, protected springs, and simple filtering,
with emphasis on self-help;
 First aid for cuts and wounds;
 Treatment of simple problems like fever and diarrhea; and
 Health and nutrition of children.

Barangay X is a small barangay about 10 kilometers from the health center. When the barangay
people heard the news about the primary health care program, they were very happy. Out of
the 75 people living in Barangay X, 40 were suffering from guinea-worm infection. They wanted
someone to go to the health center to learn how to rid the barangay of the disease.

When the chief of Barangay X heard the news, he asked his two brothers to come and discuss
the idea. They decided that the son of one of the brothers would be sent to the health center
for training. This son, Amos, had finished primary school several years earlier. The three men
thought that the boy was bright and thus a suitable choice. They also thought that the training
might help him in the future.

When the decision to send Amos was announced in the barangay, people were not happy.
Some had wanted to send members of their own families. They also thought that the boy was
too young and might eventually run away to the city. He would be of no use to them then. A
few people voiced their opposition, but the chief's mind was set. His nephew was sent for the
training.

When Amos returned, the first thing he did was to call a meeting of the barangay elders. He
said that the community should build a small hut or room for him next to his father's house.
This room would be his 'clinic'. It was the planting season and everyone was busy, but they
agreed to do as Amos asked. They hoped that the clinic would help him work better.

Amos enjoyed treating sick people. He had been given a small supply of drugs in health center
to use in his barangay. He had been told that he should charge a small amount of money for the
drugs in order to be able to pay for replacements. Amos decided to charge more for the drugs
and keep the extra money. The people did not complain at first, because they did not know
how community health workers were acting in the other barangays.

Amos tried to use up his drugs quickly. He would then go to the health center to buy more. He
would sometimes stay in health center, or even go to the city, for up to a week, enjoying
himself with the extra money he had made from selling the drugs.
After a few months, the Barangay X people learned from friends what the community health
workers in other Barangays were doing. Most of these workers had already started self-help
efforts to dig wells and protect springs. None of them had asked their barangays to build them
a clinic. All were selling their drugs cheaply. The health workers in other barangays were never
away for a long time. When they went to collect new drug supplies, they usually returned on
the same day.

The people of Barangay X were unhappy because they had not benefited from the primary
health care program.

Learning from the case study

A case study like this could be used with barangay leaders to help them learn how to select and
use community health workers. It could be discussed with the community health workers
themselves to help them learn how best to behave and work in their communities.

ACTIVITY #1

Please discussed each.

- What went wrong with the program?

- What could the chief of Barangay X have done differently?

- What should those barangays who did not agree with his choice have done in the beginning?

- What is the best way of choosing a community health worker?

- What should be the qualifications of a community health worker?

- What should the people of Barangay X do now?

1. The chosen community health worker is too young for the duties and responsibilities of
a community health worker. Efforts to build a clinic, instead of digging wells and
protecting springs, were made. Drugs were also being sold expensively. The extra
money made from these drugs were used for self-enjoyment instead for the
improvements of the barangay.
2. The chief of Barangay X could have chosen a more qualified community health worker.
3. Protest for voting or communicate with the health center staffs.
4. Ideally, the CHW recruitment process will cover the following steps: “establishing
criteria, communicating CHW opportunities to identify candidates, interviewing and
selecting CHWs from candidates, and hiring selected CHWs.” Commonly, this can look
like the following: the CHW program advertises a position in local media, communities
 nominate candidates via civil society organizations or public gatherings, and finally the
program makes hiring decisions based on internal criteria like literacy and attitude.
5. A CHW should have the ability to listen and respond to clients and communities with
compassion and kindness, trustworthiness and maturity, honesty, allowing others to
confide in you, maintaining confidentiality, and upholding professional ethics. Aside
from that, a community health worker (CHW) should also undergo initial and continuing
trainings.
6. Meet with their fellow barangay X community members and communicate with the
chief of the barangay and with the health center staffs about the situation and agree to
make good changes.

The health teams

What is a team?

A team is a special type of group. Like other groups, the team has a purpose or goal. In a team
each member has special skills or responsibilities. It is necessary for every member of the team
to work together and to cooperate if the team is going to succeed in its tasks.

A football (soccer) team is an example. Each of the eleven players has responsibility. for a
particular part of the football field. If each team member does not handle his or her
responsibility well, the team will probably score no goals. No one team member is more
important than another.

It may be true that only one person kicks the ball into the goal, but if the other members of the
team had not been doing their job, this one person would never have had the chance of
scoring.

Members of the health team

The goal or purpose of the health team is to improve and maintain the health of the community
it serves. In order to achieve that goal, the health team is made up of different members who
have been trained in special skills. Think of the staff at your local health center, dispensary, or
clinic. There may be nurses, public health inspectors, health aides, records clerks, dispensers,
midwives, medical assistants, and maintenance staff.

All of these people must work together to make sure that health care reaches people in the
community.

Of course, the physician is a member of the health team, but not every health center or clinic
will have a doctor present all the time. Many have doctors who visit once a week or once a
month. Sick people who cannot be treated at a health center are referred to the nearest
hospital where the health team is much larger and ma, include doctors, nurses, midwives,
laboratory technicians, X-ray technicians, and hospital aides.
The larger hospitals may also have dentists, physical therapists, pharmacists, health educators,
administrators, and social workers.

Responsibilities of team members

Let us look at the example of a child health program in a local health center. The nursing staff
examine both well and ill children to see how they are growing. They treat some sick children
and refer others to the doctors. They provide preventive services such as immunization. The
dispensers provide medicaments for sick children and keep a supply of vaccines for prevention.

The midwives try to see that healthy babies enter the world by providing antenatal care and a
safe delivery. Then midwives follow the children up as they begin to grow. The records clerks
maintain records in good order so that the history and progress of all the children can be seen
easily.

The environment in which the children live must be healthy. Through home visits and
community projects, the public health inspector works towards a healthy community
environment. The maintenance staff at the center or clinic guarantee that the place will be
clean and welcoming.

These are just a few of the responsibilities of each team member. All are important for
promoting child health. The situation will be similar in any health program.

Team leadership and cooperation

Like formal groups, teams have leaders. The leaders, however, are not elected' neither do they
inherit their positions. In fact, the leaders may change from time to time depending on the
project.

For the normal administrative work of the team, it is often the most senior or experienced
member of the nursing or environmental health staff who organizes the team's activities at a
health center. When a doctor is present, she or he usually takes on that responsibility.

The leadership of a specific project will depend on what the project is about. If the project is
mostly concerned with the health of pregnant women, the midwife or the nurse will naturally
give leadership and direction to team efforts. Should the project deal with environmental
hygiene, the sanitarian, health inspectors, or health superintendent will assume leadership.

What we have said so far about sharing responsibilities and cooperation belongs to the domain
of the ideal. Teams do not always work so well together. While a football team practices
together regularly, members of a health team sometimes tend to work on their own. It is sad
when they do not share their experience and do not ask other team members for help.
Health education methods and skills can be used to encourage better team work. Each member
should try to promote good relationships and communication among all team members. When
there are projects to work on, ways should be found for everyone to participate and contribute
their particular expertise.

Discussion groups and meetings (see the next section on conducting meetings) are useful tools
for helping the team plan and evaluate program. It is. through regular meetings that progress
can be evaluated, relationships can grow among members, and new problems can be identified
and solved. When the team does meet, observe the behavior of the members, including
yourself. Do they make for a healthy and successful group?

If a health team works in the same way as the Unity committee, it will never achieve its goal of
improving community health. Health education skills can encourage mature group behavior like
that of the members of the Progress Committee.

Health education duties of team members

The health team is a place where members can work together to improve their health
education skills. These skills can serve to improve the quality of the team-work. They should
also be used when the team carries out any program. During team meetings, members can
decide who will be responsible for which types of health education.

In the child health program, the nurses can arrange program for informal groups of mothers at
the clinic. They can also give individual counselling to mothers and children with problems. The
environmental health staff can organize community meetings and projects. The dispensers can
educate patients about their drugs, so that they will be able to take them correctly.

ACTIVITY #2

Think of other educational activities that would be appropriate for each team member.

Suppose you are organizing health program for (a) the teenagers, (b) the elderly, and (c)
the farmers in your community. What would be the responsibility of each health team
member in each of these programs? What would be the health education duties of each
member? How should other community workers be involved in such programs?

Suppose I am organizing a health program for these groups, I think that a mini team building
would be appropriate. It doesn’t just make them more aware of their purpose, how to deal with
conflicts and problems within themselves and within their groups, but it would also build a
stronger bond and harmony between them. Say for example:
 a. For the teenagers, a charitable work such as a concert-for-a-cause about mental
health or importance of environmental cleanliness may be scheduled and organized.
This would be a good idea in showcasing their talents and confidence and in bringing
the message to the people.
b. For the elderly, social events may be possible. Being social would keep them
mentally engaged and help them feel less isolated. This social event may be a walk-
for-a-cause.
c. For the farmers, a workshop on how to maintain the environment clean and healthy
may be a good idea. Group games and activities that have learning points may be
included.

Before or after these programs, the nursing staff will examine both well and ill children and
teenagers, adults, and elderly to see how their health is. The records clerks maintain records in
good order so that the history and progress can be seen easily.

The environment must be healthy. Through these community programs, the public health
inspector works towards a healthy community environment. The maintenance guarantee that
the place will be clean and welcoming.

Depending on the goal of the program, persons concerned (nurses, physician, physical
therapists, health educators, pharmacists) may give a health education towards the people.

ACTIVITY #3

REFLECTIONS

1. What have you learned about your own community?

I learned that my community is not perfect but it is unique and beautiful. Although
conflicts and problems are inevitable, everyone has been doing their part to make the
situation better. Both the government and the community members are willing and are
cooperating to make improvements within and for the community.

2. Do you think the people in your community are unique? Why or why not?
I believe that each of the people in our community are unique. As the saying goes, “no
man is an island.” An individual doesn’t possess all characteristics needed to run the
community. And by that, I believe and I can see that we all complement each other’s
weaknesses and strengths.
3. What are some public policies do you involved and what are their implications? How
can they be improved?
PAMANA Program. The PAyapa at MAsaganang PamayaNAn (PAMANA) Program was
launched in 2011 as a priority program of the Government that supports the Peace
Negotiation Track and contributes to the goal of attaining Just and Lasting Peace. During
my high school years, we actively participated in all of the activities of this programs. We
even went to different provinces and made efforts to build a strong bond with them,
especially with some of their youth population. As for my experience, I suggest that
locals in faraway barrios or sitios, including some tribes, should also be reached by this
program. As they say, no one should be left behind.

4. Who determines what’s best for the community?

The community members and the government should work hand in hand for the best of
the community. The government cannot just work without listening to the voices of its
people. Likewise, the community members must also listen and cooperate.

5. Describe what a typical day might be like for someone who uses the service of any
organization where you lived?
You will be entertained but not as fast and comfortable as before, most especially now
that we are battling with the pandemic. The moment you use a certain service, you need
to wait and wait and make sure that you are also safe until you come home.

6. How would you do this differently if you were in charge?

I would work in making it more organized. Because sometimes, what the other team
member says is totally opposite with his/her team member’s. That would make the flow
disorganized and the person trying to use the service uncomfortable and unsatisfied.

7. What was the best/worst/most challenging thing that happened?

The worst thing that happened was when I was not able to use any service at all
because of their disorganization.

8. Did you feel like a part of the community in which you were living?
Yes. The groups which involve the youth population are what keeps me active in the
community. I’m able to participate not just in social gatherings but also in activities like
tree planting, reach outs, general cleaning, and many more.

9. How do you define community?

 A community is a social unit wherein there are different religions, organizations, culture
and values that are existing but unity and harmony are still present.

10. Discuss a social problem that you have come in contact with during your stay.
What bothers me a lot when I stay in our place, most specifically at home, is the
possibility of being stolen with something. In our home, we grow a lot of fruit bearing
trees and plants. Since my brother is working abroad and I’m studying in Cebu, and my
parents are busy working in school, people are used to assume that nobody’s home and
they can always sneak in and take away everything they can, especially our fruits (and
even our chickens when we still had our poultry and livestock farming at home).

11. What do you think are the root causes of this problem? Explain how you contribute to
its alleviation/ solution.
Poverty. There are people in our community who belong to the poor population. It is
sad that they just end up stealing from other people’s houses to have a food on their
tables. I cannot say that I really made efforts to completely solve this problem. But,
whenever I’m home and I can see some kids outside, I give them a good part of what we
have. And I also always tell them that they can ask if they want something (Rambutan,
Pomelo, Avocado, Coconut and Durian) as we can always give.

12. What could the leaders do to address the problems of your community?
They can conduct reach out programs within the community and/or provide work for
the adults of this population.

13. What could each member of the community do on his/her own?

Cooperate and help. Cooperate not just with the government but also with other
community members, poor or not, old or young. Cooperation and generosity would
make the community become even more peaceful and successful.

14. How can this experience apply to the situations in your life?
I interact with different people every day. These people have different stories and it
would feel fulfilling to be able to contribute in making their stories better even just in
my own little ways.

15. How can your solutions apply to the problem(s) of other groups?
When conflicts arise in groups, the first natural or usual reaction would be to judge
and/or hurt each other, which then worsens the situation. Instead, good communication
and being approachable could actually bulls eye what the problem is and how to
address it.