This year there is a major change at Jibhi- we are broadening our scope beyond outpatient clinics, emergency presentations and surgical camps into a formal community health programme.

Vision statement:A sustainable, ‘community owned’ programme consisting of community based, preventative and curative health developed in partnership with communities around Jibhi, Banjar District, Himachal Pradesh.

The community

History:In community health a community rather than an individual the patient is a community and treatment is at the community level. Just like clinical medicine though almost everything comes from the ‘history’. Taking a ‘history’ from a community to define its health problems however is a little more complicated than taking an individual patient’s history. So far we have spent six weeks walking to 13 villages surrounding our clinic and conducting meetings to discuss health problems as well as getting ourselves known in the valley. Though incidental meetings on tracks around the hills and endless cups of tea in people’s houses might be most relevant we have also formally introduced ourselves at the meetings of the panchayats (local administrative units) on both sides of the valley. We have worked hard to establish a relationship with doctors and administrators in the nearest hospital (civil hospital Banjaar), met local government health workers, school teachers and other significant players in the district. We have got to know Mr Payson Stevens an American with an interest in community health who lives locally as well as people from SAHARA, an NGO that works for people displaced in forming the Great Himalayan national park. This context analysis is interesting and exciting work which will continue throughout the life of this project.

Examination

As in clinical medicine examination as well as history is required to work out our patient’s health needs. Now that doctors live here we have increased primary care clinics (OPD) to twice a week and do minor procedures when necessary. This is all part of clinically examining our community.

Diagnosis

Putting together all the ideas, opinions and clinical/non clinical data gives us a picture of access barriers resulting in significant health problems for people who live around us. The access barriers are physical geography which makes it very difficult to get to medical care, lack of money which makes medical care unaffordable and educational/cultural blocks which mean that often people do not know when they should seek medical care and they know that Banjaar hospital much of the time can do less than what might be required. At our clinics we often see patients with advanced disease who should have come sooner and others who made a long and expensive trip which they could have done without. Our clinical information from screening, OPD and surgical camps shows us that there are significant levels of chronic malnutrition as well as TB, respiratory tract infections, dental caries and gastrointestinal parasites.

Strategy

We are now designing a strategy to approach these barriers and their results by working simultaneously at various levels of the medical spectrum from community based health to surgery. We will proceed iteratively- trying to consciously learn, reflect on what we have learned and feed those lessons back into an evolving programme. To be a sustainable, high quality health project we should change as we gain understanding of the local context and players rather than impose a pre-planned blueprint onto the community. An example of how we might work is immunisation which this year will be in villages rather than asking everyone to come to us. A further innovation is to combine this with street theatre (in partnership with SAHARA), oral hygiene dental checks, eye examinations and height/weight recording. Later this year we may train village based health workers who will be able to do health education, treat most things in their village, call us for advice when required and advise patients when they really need to come to our clinic. Our guiding principle is that our every activity should be developed in partnership with the community and should contribute towards a sustainable health system that empowers the people around Jibhi.

We have significant resources to start on this exciting and somewhat challenging proposal. Strongest is our human resource: Kanta and Padham as community health workers and support staff have a wealth of local knowledge and relationships after years in Jibhi. This year  Dr. Susan Passah will spearhead the project as Community Director. Dr. Kaaren will spend one month with the project before she travels to Spiti.

 This project team resident at Jibhi is supported by Pushpa Christopher in Manali. She is trained as a social worker and has experience in rural health projects. The Jibhi Community Health project is of course supported by the entire LWH team. People often come from Manali to help with medical and surgical work and phone advice is always available. On top of our human resource we have ‘social capital’ and organizational knowledge built up over ten years of providing health care in Jibhi and a clinic well equipped for medicine and surgery. From another perspective one also sees a geographical location, accommodation and other facilities ideal for a community based programme headquarters. Seeing a wider programme evolve here will be exciting.

Upcoming activities:

Ongoing training of the nutrition promoters and follow up of the kids on database

Family visits, village visits,

Kala jatha programs,

Health mela scheduled for May 2010

Continued fortnightly visits and clinics at the Jibhi centre by the team from Manali.