A realized dream, 20 years in the making

Tonight at a dinner party (held to greet our Executive Director, who arrived today for a brief visit) I had the great honor of sitting next to one of the oldest and most highly regarded of our chief partner organization. Thra Hser Nay Moo has for over forty years traveled throughout the jungles of eastern Burma providing health care and health education. He has led countless trainings for community health workers, trained dozens of medics, helped to design health services for Karen State, and co-founded the Backpack Health Worker Team. 25 years ago he built one of the first and only public hospitals in Karen State (which was destroyed by SLORC forces during the fighting leading up to the fall of Manerplaw).

I actually know him quite well, and work with him frequently, but it is always a pleasure to spend time with him (and always entertaining). Over the past months I have been working closely with him to develop a Village Health Worker program. Very simply, the idea is that there are many villages that have no ready access to a health clinic or skilled health workers. Even when a clinic is available, it is not the first place villagers turn for medical assitance. By training members of each village as village health workers, we can create a new first line for health care. These 'VHWs' can provide basic care where there are no other health services, and help families decided when it is important to seek help elsewhere. Additionally, by using trusted members of the community, we can help redirect the traditional course of seeking medical care. Very often, villagers first try to treat at home, then go to a pharmacy to self treat, then a traditional healer, and only then to a health clinic. By that time the patient is often quite sick, so medical clinics become disproportionately associated with the sickest patients and the cases that die, and therefore become distrusted. VHWs in the community can help identify cases early, and help families get proper treatment early, or get early referral. Hser Nay Moo's motto is "see early, help early, refer early".

To begin the program, we will only train VHWs on the most basic skills. They will begin by educating the community, and visiting individual houses to teach, about diarrhea transmission, prevention, and treatment, specifically, handwashing and the preparation and use of oral rehydration therapy. Diarrhea is the number one cause of death for children under five, yet is totally preventable, and generally treatable. The next phase of the program includes education on, prevention of, and early diagnosis and treatment of malaria and acute respiratory infections (the next two chief causes of death for children). Later phases include community organizing to galvanize water and sanitation projects, and education and treatment of lymphatic filiariasis, TB, and other health concerns.

I have been extremely excited to work on the development of this program, because I believe in its utility and importance so throughly, and because its development has been completely driven by the local organization. Often, they come to us with need, but rely on us heavily to develop the actual interventions and program implementation plan (a pattern found in many local CBO/ international NGO relationahips). This program, however, has been completely led by our partners, and so the process of developing it has also greatly increased the capacity of the staff working on it to plan other programs as well. Which is, of course, the goal of capacity building in the first place, and a large part of why we are really here. The role of my organization has been to provide information about which interventions have achieved the most impact when tested in other international settings, and to provide technical guidance on how to collect data to monitor and evaluate the program. They have identified the needs and priorities, determined the parameters of the program, written the VHW handbook and developed the other materials, and will conduct the trainings.

We started working on this because it has long been a dream of Hser Nay Moo's to start such a program. Tonight at dinner, he told me that he recognized the need for it, and began to plan for such a program 20 years ago. He has started several small projects, and has tried to launch it several times before, but the pieces were never all there for it to take off.

At dinner tonight, he told me that he feels in his heart that he is now seeing the realization of his dream. He said that he feels that it is due to an excellent partnership between an older generation of thinkers, and a younger generation of doers. He also marveled that people who are not Karen, and have not even ever been to Karen State, would come so far from their home to help his people, and help to make his dream real. He thanked me for helping make it possible. I could only insist that it is my honor to be a part of it, as indeed it is, and make whatever small contributions I can.

In the next couple of months, a baseline survey will be conducted to assess baseline knowledge, attitudes, and practices regarding program elements in program villages and 20 VHW supervisors will be trained in two locations. Subsequently, 247 VHWs will be trained and begin providing basic health education and services to 8,217 households, encompassing 49,195 people in 192 villages. I think this is truly remarkable.

Thank you, Hser Nay Moo, for your vision, and for letting me play a small part in its realization.