Favour Lowcost Health Care Foundation (FALCOH) First Trimester Activity Report
PURPOSE: The purpose of this document is to present a report of the community interventions carried out by this organization between December 2016 and March 2017.
BACKGROUND: The FALCOH Foundation has as objective to provide affordable, sustainable and context-oriented health care services to vulnerable communities and persons. To this effect the organization carried out a community diagnosis tour in the Bangem Health District from the 15th to the 25th of November 2016, in collaboration with the District Health Service Bangem. From this activity we found out that most of the inhabitants in the health district do not use the health facilities within and outside their communities principally because of high service charges, non availability of personnel and the poor geographical accessibility to some health facilities.
The District health service was charged to resolve the high charges for services and inadequate personnel situation in the district which all have a managerial scope. FALCOH foundation committed itself to carry health care closer to the communities and dampen the negative impact of the difficult geographical terrain to health seeking behavior of the inhabitants. This was realized via series of community outreach interventions to geographically vulnerable communities within 10-20km from the lone District Hospital in Bangem centre.
The community outreach activities were carried out from December 2016 to March 2017. A total of nine communities within five health areas benefited from this intervention namely Nkikoh, Nkack, Muaku, Muabi, Enyandong, Ndibse, Tente-Asome, Muambong and Ekanjoh-Bajoh which are 10km, 12km, 15km, 25km, 35km and 45km, respectively, from the District Hospital Bangem. The outreach activities included medical consultations, antenatal consultations, laboratory investigations, hospitalizations, circumcisions, hernia repairs, hydrocele repairs, appendectomies, health education and sensitization, surveillance of diseases with epidemiological potentials and referral of complicated cases to the District Hospital.
INDIVIDUAL COMMUNITY REPORTS
- Ekanjoh-Bajoh HA: This health area has a total of 08 communities of 3,566 inhabitants served by a single Integrated Health Centre (45km from the DH Bangem) with a lone Nurse Assistant as the Chief of Centre. The organization carried out outreach intervention at the Ekanjoh-Bajoh IHC on Wednesday the 07th of December 2016. Outpatient consultations started at about 10 am and we received a total of 301 patients hailing from 07 out of the 08 communities. We could attend to 200 clients only giving the human and material resources available. Following consultation, the patients were investigated in the laboratory for the following pathologies; malaria (Rapid Diagnostic Test), Typhoid fever (Widal serology), Syphilis (TPHA), Rheumatoid arthritis (ASLO serology), Hepatitis B infection (HBsAg), Urinary Tract Infections (COMBI kit), Diabetes (FBS/RBS), H.pylori gastritis (H.pylori serology), Early pregnancy (PT), Haemoglobin concentration (Haemoglobinometer) and HIV (Determine). The patients were treated for the following confirmed pathologies; simple malaria, Enteric fever, UTI, URTIs, Hypertension, Arthritis, H.pylori-induced gastritis, Inguinal hernias and acute appendicitis. Referrals were done to the DH Bangem for follow-up test and for surgeries. Essential medications were bought from the health centre pro-pharmacy.
- Ebamut HA: The Ebamut HA has a total of 12 communities served by two IHCs; Ndibse IHC serving about 1000 inhabitants and Enyandong IHC serving about 719 persons. FALCOH foundation carried out community outreach in Ndibse IHC on Monday 13th February and in Enyandong IHC on Tuesday 14th February 2017. The team attended to a total of 97 and 65 patients at Ndibse and Enyandong IHC, respectively. Following laboratory investigations the patients were managed for hypertension, Diabetes mellitus, Lipoma, Simple malaria, Degenerative Osteoarthritis, H.pylori gastritis, soft tissue infections and skin diseases (scabies, Tinea, Allergy). Health education was given and referrals were made for follow up.
- Muaku Community: This is one of the communities in the Nkack HA with a population of about 600 inhabitants. It is served by a well-furnished IHC manned by a single nurse assistant as the COC. The team carried out consultations in this IHC on Friday 17th February 2017 in which a total of 102 clients were received. The following diagnoses were made; simple malaria, acute appendicitis, PID, skin diseases, arthritis, hypertension, Bronchopneumonia and UTIs. Prescriptions were given and counseling done for patients with chronic diseases.
- Nkikoh Community: This community is found in the Bangem Health Area and is served by the Nkikoh IHC manned a single Nurse Assistant who is the Chief of Centre. This IHC serves a population of more than 2000 inhabitants and is about 10km from the DH Bangem. The FALCOH team consulted at this health unit on Thursday 23th February 2017 as from 09:30am. The team consulted a total of 203 patients with diverse complaints, out of the over 300 inhabitants who came for consultation. After clinical and paraclinical examinations the patients were prescribed medications for the following pathologies; simple malaria, malaria in pregnancy, Gastritis (H.pylori and non H.pylori-induced), Arthritis (Degenerative OA, RA), skin diseases, hypertension, diabetes mellitus, post term pregnancy, STIs (Genital syphilis, Chlamydia), hernias and intestinal colic. The post term pregnancy was referred to the DH for a Cesarean Section. Health education was also given on lifestyle modification and hygiene and sanitation. Sensitisation on disease surveillance was reinforced and the team promised to improve on its capacity in order to attend to all the participants during subsequent campaigns.
- Tente–Asome community: It is one of the communities in the Muambong HA with a population of about 1,565 inhabitants which is served by the Tente-Asome IHC. The latter is hosted in an old dilapidating wooden structure and is run by a lone Nurse Assistant without a pro-pharmacy. The FALCOH team consulted in this facility on Thursday 02nd March from 10am to 04pm. We received a total of 98 clients with various complaints. They were clerked, examined clinically and paraclinically after which the following diagnoses were made; simple malaria, arthritis, gastritis, hypertension, malaria in 2nd trimester pregnancy, hernias, lipomas, typhoid fever and skin diseases like tinea and scabies. Some patients were referred to the DH Bangem for continuity and a majority to nearby IHCs with pro-pharmacies to buy essential medications.
- Muabi HA: The Muabi community is about 15km from the DH Bangem and has an estimated population of 1,595 inhabitants. It embodies the Muanenguba villages which are located on the grassland slopes of the Muanenguba mountain range and twin lakes. The team carried out consultation at the Muabi IHC on Friday 10th March 2017. This was the most attended community outreach with an attendance of about 600 persons. The team consulted a total of 250 clients with diverse complaints. The following pathologies were diagnosed after clinical examination and laboratory investigations: simple malaria, severe malaria, arthritis, hypertension, UTI, Bronchopneumonia, acute appendicitis, Gastritis, skin diseases, Lumbago, eye diseases, hernias, hepatitis B infection and HIV infection. Essential medications were prescribed to be bought at the health centre pro-pharmacy, health education was given and appointments for follow up and surgery were also made. The team ended work at this facility at about 10:30pm.
- Nkack Community: The Nkack community is one of the communities in the Nkack HA and host the leading health facility, the Nkack IHC. The latter serves an estimated population of about 1,154 persons and is located about 12km from the referral hospital. The FALCOH team worked in this centre on Monday 17th April 2017 following 02 weeks of community sensitization. We received a total of 97 clients who were all consulted and investigated for various complaints. They were all managed for various tropical diseases and follow up visits were programed for reviews and surgeries at the DH Bangem.
- Muambong community: This is the second largest community in the Bangem HD with a population of about 5,289 inhabitants, after Bangem town. It has an IHC run by a State Registered Nurse, assisted by 02 temporal nurses. The FALCOH team visited this health facility on Thursday 20th April, after prior community mobilization. The team consulted a total of 155 clients and diagnosed various tropical pathologies among which were mainly surgical pathologies; 05 acute appendicitis, 01 ovarian cyst, 10 hernias (inguinal and peri-umbilical), 04 scrotal hydroceles (01 infant) and 06 lipomas. The surgical team took a day to prepare for these surgeries and operated 10 of the cases who were prepared on Saturday 22nd April 2017 at the Muambong IHC. We plan to continue these interventions as close to the patient’s localities as possible whenever the resources permit. The clients expressed immense satisfaction with our services because they feel more comfortable when attended to in their own vicinity, rather than travelling kilometers to be operated for a hernia with all the inconveniences (financial, nutritional, caregiver etc) that come with such displacement.
- Capacity building interventions: The Foundation organized a training session for all the Chief of Centres to build their capacity of basic laboratory techniques such as the use of Rapid Diagnostic Test strips. This activity was intended to temporary address the problem of lack of laboratory technicians in the health centres which has greatly reduce the trust of clients on their services. It was carried out on Monday 5th December 2017, with Mr. Mbu Cavin, a trained laboratory scientist, as the resource person.
Furthermore, the foundation assisted the Bangem council in the transportation of material and equipment supplied to the Ekanjoh-Bajoh IHC from Bangem town to Ekanjoh-Bajoh IHC. This activity was carried out on Tuesday 27th December 2017.
- There are a lot of sick people in many communities in the Bangem HD who cannot access the hospitals due to financial constraints, geographical barriers, and lack of trust in the capacity/efficiency of the health personnel at the peripheral health centres.
- Most of the Health Centres lack the basic equipment and manpower to enable them offer the minimum Package of care to the population.
- Most (60%) of the nurses heading the peripheral health canters lack the technical capacity to manage 80% of the pathologies presenting in their centres. They are mostly Assistant Nurses working in understaffed and unequipped health centres.
- The FALCOH team did not have sufficient financial and material resources to meet the health needs of most of the population which came for consultations in some communities. However, the technical strength was sufficient in quality but lacking in quantity.
- The communities appreciated the gesture and solicited subsequent sessions of medical consultations and, were applicable, surgical operations in their communities in the days ahead.
- The FALCOH Foundation is appealing to the stakeholders of health in Cameroon (Traditional & Municipal authorities, District Health Service Bangem, SW Regional Delegation of Public Health, Ministry of Public Health) to provide the necessary material, human and financial resources needed for the effective implementation of the MPA at the periphery within the context of Primary Health Care.
- The FALCOH team is appealing to all well-wishers, potential partners and donor organisations to assist the foundation in the realization of its goals via financial and material support. These will enhance capacity building workshops in the field and increase the scope of coverage of the team during subsequent campaigns.
Picture gallery of FALCOH Foundation community outreach activities in the Bangem HD
Fig 1&2: Demonstration on use of RDTs during capacity building workshop of COC.