Programs partnered with Mass General in Uganda and South Africa are using volunteer health workers to extend their reach to people in need of care.

Fueled by the tenets of local empowerment, volunteerism and self-sustainability, a new wave of volunteer projects across the developing world is seeing pioneering drive ripple far beyond its origins. From the rain forests of Uganda to the Zulu heartland of South Africa, two Mass General-partnered programs are showcasing how volunteer health workers and grassroots innovation are delivering far-impacting, positive change.

Dr. Raquel Reyes with three volunteer health workers from Ihani and Bugoye villages in Uganda | Volunteer Health Workers Bolster MGH Africa Programs
Dr. Raquel Reyes (second from left) with three volunteer health workers from Ihani and Bugoye villages in Uganda.

Bugoye Integrated Community Case Management Initiative (BIMI), Uganda

“What first strikes you about the place is its beauty,” reveals Raquel Reyes MD, site director of Mass General’s Global Primary Care Program in Bugoye, Uganda. The remote region of lush rain forests and meadows sits on the scenic foothills of the Rwenzori Mountains, flanking the country’s border with neighboring Congo. However, deep within this African postcard lie some of Uganda’s most isolated and impoverished villages: remote mud-hut communities, living life on the fringes – and an existence on the edge.

Thanks to a collaboration with Uganda’s Mbarara University of Science and Technology, Dr. Reyes and her Mass General colleagues are now offering a lifeline to these settlements, many of which lie hours from the nearest clinic. BIMI is building upon the deployment of volunteer health workers (VHW) in the region, enabling communities to provide primary care to their peers at the ultimate grassroots level. “Volunteers are provided with basic public health and medical training,” explains Dr. Reyes. “They follow pictorial aids and algorithms to treat their fellow villagers.” The BIMI pilot is currently targeting children under five with a focus on treating and detecting malaria, diarrhea and pneumonia.

A Volunteer Spirit Gathers Steam

The volunteer health workers, while coming from all walks of life within their communities, all share one crucial commonality among their peers: trust. “We are the connection between the community and the health unit,” explains Adreda Begenda, a 52-year-old field worker and volunteer health worker from the village of Kanyamugo. “We treat things that people can otherwise keep private. They trust us.”

It’s a trust bearing fruit. Though only one year into the project involving volunteer health workers, early outcomes are positive. Along with children getting timely, effective treatment in their villages, providers at Bugoye’s main clinic are seeing a decrease in malaria from the intervention villages. Now, with appropriate funding, the hope is to roll out the project from the current five-village pilot scheme to all of Bugoye’s 32 settlements.

“It’s really not until you have actually walked those goat trails up and down the mountains to those remote villages that you can see the value of these projects.”

For Dr. Reyes, however, BIMI’s worth also goes beyond statistics. “It’s really not until you have actually walked those goat trails up and down the mountains to those remote villages that you can see the value of these projects,” she says. “It’s then you can say, that distance was spared to a mother carrying a sick kid on her back. And it’s pretty hard to put that value into words.”

Integration of TB in Education and Care for HIV/AIDS (iTEACH), South Africa

Two thousand miles south in the Zulu heartland of South Africa, grassroots health care is receiving a lifeline thanks to another volunteer branch of the community: “sangomas” or traditional African healers. While historically dismissed by Western practitioners, sangomas represent the first medical go-to for 80% of black South Africans – a cultural reality seen as an opportunity, rather than an obstacle, by Krista Dong, MD, director of iTEACH, a Mass General-partnered nongovernmental organization.

“I found such a dichotomy surrounding sangomas and Western practitioners as society here viewed them as mutually exclusive when it comes to healthcare delivery,” she explains. “I decided to address this by recognizing sangomas, not as this great black-box of unknown, but rather as abundant, potential allies who iTEACH could work with all within a holistic community chain.”

Recent volunteer health worker graduates acting out a home visit in from of a crowd at graduation | Volunteer Health Workers Bolster MGH Africa Programs
Recent volunteer health worker graduates acting out a home visit in front of a crowd at graduation.

Groundbreaking Meeting of Minds

After calling a gathering near Durban in 2006 to liaise with hundreds of sangomas, the consensus, according to Dr. Dong, was clear: “The healers expressed that they felt sidelined by Western practitioners and that they wanted more respect, but above all – they wanted to help.” Working together, Dong and the sangomas then devised a medium where the healers could make a profound impact in their communities. In a province ravaged by HIV/AIDS and where only 5 percent of the population knew their status, awarding the sangomas with a HIV testing qualification seemed like the pioneering way forward.

After the program’s initial hurdles surrounding language and literacy, (most sangomas can’t speak English or read or write in their native Zulu tongue), the South African government gave iTEACH the green light to pilot their scheme by offering practical exams in Zulu. Twenty healers graduated from its first class in 2009. Today, the graduates total 170.

iTEACH didn’t want to simply meet standard government requirements for certification, according to Dr. Dong, they wanted them to exceed them. “We decided to extend our training course from ten days to one month which requires sangomas to observe at least 50 HIV tests before qualification,” she explains. “This way, they are totally beyond criticism and offer unparalleled care.”

“We’re doing something pretty phenomenal here – we’re treating people in their own culture.”

Wider Outlook – Unprecedented Result

For iTEACH, the ethos doesn’t stop at training. In a climate where programs come and go, Dr. Dong and her sangomas were mutually adamant that graduates’ roles should have long-lasting, tangible consequences. “Many sangomas told me they could wallpaper their homes with certificates they’d received over the years,” says Dr. Dong. “They’d seen a lot of programs come and go.” With iTEACH, however, sangomas are equipped with goal-orientated skill-sets: from being able to identify symptoms of tuberculosis in their patients and serving as their patients’ gateway into care, to also creating outreach programs for HIV testing within their communities.

Today, iTEACH has become the number one go-to for HIV test drives across KwaZulu-Natal; from university campuses to its provincial rural outposts. “Our mission here is not to create something which is funding dependent,” says Dr. Dong, “but rather a sustainable model which can be normalized into people’s own traditional practices. We’re doing something pretty phenomenal here – we’re treating people in their own culture.”

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