The Bolo Health Center south of Gbadolite, Nord-Ubangi Territory. Villagers built this hut as the temporary health center. They have plans for a more adequate permanent building, but cement and roofing is very expensive.
Young woman nurse of the Kawadje Health Center (right in blue shirt.) Full of compassion and commitment to serve. She recognizes the willingness of her community to support the her and the health center.
A whole crowd of people from Tshitesa accompanied us to their field - 2 acres of peanuts just breaking through the surface.
Christophe, the Bena Leka Health Zone community mobilization agent. In the opening months of the program he has proven to be energetic, resourceful and inordinately respectful of community groups.
The Bolo Health Center is a perfect example. Local villagers built it from the red clay soil of northern Equateur province. It is dark inside; hardly enough light to read a microscope slide on a bright sunny day. Behind it is a newly-built house for the nurse. It is the community’s way to attract and encourage the nurse. A trained nurse and some basic medicine and supplies can mean the difference between life and death. Poverty may limit what people are able to provide, but even desperately poor communities aspire to better health care and are willing to contribute what they have to get it.
A little further down the road from Bolo is the village of Kawadje. The nurse is humble young woman with simple grace and dignity. I asked her how the local community supports her. She looked a little embarrassed and explained that people in the area are very poor. Sometimes they can’t pay for her services. “But what can I do?” she asked. “They need my help and we all do what we can.”
We talked in front of a large, solid, well-constructed traditional building. The walls were plastered with mud and whitewashed to increase the light. The yard was clean. The nurse explained how the health center was built. “People here have a good heart. The health center committee asked village leaders to help. Everyone pitched in. They brought robust sticks and palm ribs for the walls and thatch for the roof. They dug clay to fill in the lattice work and plaster the walls. Whenever we need something people are willing to help.”
These are communities managing to take small steps to secure reliable basic health care. They are handicapped by poor education, distance from good markets, a predatory government officials, and policies that discourage economic development. But they work together, using what they know and what they have at hand to bring the most basic health services to the community. It is far from perfect, but it is a step in the right direction.
Much of my time these days is devoted to helping local health zones develop a way for cash-poor communities to turn their knowledge and resources into support for their local health center. In many rural areas, people are underemployed have abundant land. When invited to contribute, community groups are very open to producing and selling a crop in order to pay the nurse and improve the health center. What they often lack is good agricultural advice, good crop varieties and good seed. This reduces the potential benefit and increases the risk of discouraging failure. But if these were widely available, farmers in many regions of Congo could double their production, the well-being of rural households would improve dramatically, AND contributing to a local health center would be more satisfying.
Our strategy is to provoke thousands of communities to go beyond the occasional building campaign for their local health center. Over 400 community groups have joined the experiment. They agree to give half of what they produce to support the health center. In return they will get a 40% reduction in health service fees.
We have worked with 17 health zones to train community volunteers to share information on best agricultural practices with these groups. Participating community groups have received nearly 9 tons of improved seed and about 180,000 meters of improved manioc seed cuttings, promising a bigger production bang for the buck. The health zones encourage the program by regular visits to enrolled community groups.
A couple of weeks ago I spent a week visiting Community Health Endowment groups in Kasai Occidental and seeing health centers they want to support. The Tshipanga Health Center is four small rooms, wattle and mud construction. Another hut serves as the local maternity center (for mid-wife assisted births.) The day we visited, the nurse’s wife had just given birth there to their fourth child. The child’s healthy cries could be heard in the background as we talked.
Our guide was Christophe, the energetic community mobilization agent for the Bena Leka health zone. Two villages in the Tshipanga health center’s service area have agreed to participate in the program. In Tshitesha, from the first few minutes after getting out of the truck it was obvious that the community was enthused. One of the village elders led us a half mile into the forest, with dozens of excited villagers trailing along. We came to a 2 acre field with newly planted peanuts just poking up through the soil. A beautiful field. In the discussion back in the village, I asked about why they wanted to plant the field. One of the elders replied, “Because our health center is very important to our people.” Heads nodded and murmurs of agreement rippled through the people pressing in around us.
We are hoping that Tshitesa and villages like it are early adopters, people who demonstrate to others that a new idea really can work – in this case that poverty is not destiny and that the local community can mobilize to provide better primary health care. I believe that people often don’t realize the power they have. God has given us so much. The challenge is to see beyond our feelings of helplessness, hopelessness to a different reality. Many Christians know this. If the people of Tshitesa succeed, others will brave the experiment, and possibly discover the power that God gives us all to change, transform the world around us for the good.