Comprehensive Health Service-CHS
Health (Comprehensive Health Service-CHS, Reproductive & Sexual Health Rights-Initiative for Health Development-IHDP and Disability Rehabilitation Project-DRP, Reflect and Lokokendra)
Comprehensive Health Service (CHS)
SUS is providing services two ways i.e. preventative service through awareness rising and curative service through static and satellite clinic and different types of test are being completed by SUS hospital. During this time, SUS has established static clinic where 2 MBBS doctors as full time, midwives and health assistants are involved. Increase Women’s Empowerment and Reproductive Health Services Program has been strategically developed in the year 2001 with home-based safe delivery, family planning, vaccination for pregnant mother and children, nutrition education, safe drinking water and sanitation and disability rehabilitation.
The project is running among 52 villages of 6 unions under Netrakona sadar upazila. Reproductive Health Service Project has been running with 8159 eligible couples those who are getting benefits from the project directly and 42153 (Male: 7981, Female: 6251, Children (0-5 years): 346, Boy: 14191 and Adolescent: 13384) community people are getting benefits indirectly through the technical and financial support since 2002.
In the 2008, SUS has developed a strategy for establishing people’s rights to community leaders, government health related workers, mothers-in-laws, adolescents and eligible couples by raising their awareness regarding reproductive health. On the other hand, SUS has formed 10 permanent satellite clinics for ensuring mother and child health care and reducing general diseases in 10 villages with the spontaneous assistance of villagers. SUS is providing necessary materials for ensuring smooth services of satellite clinic. By this time, voluntary health committee has been formed by the elite persons of the villages for strengthening satellite clinic. It is remarkable that the voluntary health committee members and elite persons are motivating the extreme poor family for accumulating savings and they have arranged rickshaw-van for bringing pregnant mothers to hospital for safe delivery. During the reporting period, SUS has provided delivery kit box among TBAs. By the by, SUS is providing package treatment among the pregnant mother. The pregnant mothers are coming to SUS hospital with husband for taking pregnancy card, urine and blood test, regular check up, iron capsule and delivery kit box at an amount of tk.40.00 as whole. Each month, SUS arranges satellite clinic in selective villages by the cooperation of health worker and midwives. After delivery, midwives and TBAs visit their houses (door to door) for providing necessary information and suggestions.
12 participants have made aware on leadership development. Different program of SUS is smoothly running by their leadership. 1084 participants (women, adolescents, disabled and pregnant mothers) attended the community meetings for raising awareness on primary health care. 85% participants are aware on health related issues. 80% participants are using water-salted latrine and fulfilling nutritional demand. 52% eligible couple is using family planning method. Community people are concern about natal and post-natal care and are practicing accordingly. Water-borne diseases have been reduced from 25%-20%. Health camp helped the community to response in time for any health problems and these are under practice. 105 children have taken vaccination of hepatitis B virus. Community people are responding towards these issues. 2200 community people celebrated safe motherhood day and world health day. 20% community people have realized the importance of observed days. They discussed on importance of safe delivery and ANC & PNC. They have identified different general and sexual diseases through health camp in different areas and are providing necessary treatment among 1188 (women: 986, male: 28, Children: 108 and adolescent 66) patient. 54 untrained TBAs have been trained up through training conducted by doctors and midwives. A TBA forum has been formed with 20 trained TBAs. 04 midwives have received training on copper-T utilization. During reporting period, 51 community meeting, 12 pregnant mothers and mother-in-laws’ meeting and 293 permanent satellite clinics with voluntary health committee were held in the working area. 95 EPI sessions, 278-satellite clinic and 293 static clinics were completed. The community people observed world health day and safe motherhood day. Health team is making linkage with other like-minded organizations such as: government and non-government organizations, local and national/international groups. SUS is providing preventative service through community meeting and personal contact and curative service is being ensured through static and satellite clinic.
Health team is making linkage with other like-minded organizations such as: government and non-government organizations, local and national/international groups. SUS is providing preventative service through community meeting and personal contact and curative service is being ensured through static and satellite clinic.
Initiative for Health Development (Reproductive & Sexual Health Rights)
The project ``Initiative for Health development’’ has been started from February 2008. At first SUS completed a baseline survey among the villages under 18 unions of 6 Upazillas (Atpara, Madan, Kendua, Mohongonj, Barhatta & Purbodhala). According to the survey report, 48 villages of 16 unions were selected for this project. To implement this project, SUS established 48 health centers with 1200 participants. Every participant is eligible mother. 16 health workers gave advice & services to the participants twice in a week.
The objective of the project to decrease the common disease, mother and child death and activate the local health related institutes.
In the year of 2008, 700 eligible mother received family planning methods after coming the health centers. But only 240 women were using these methods before. There are 834 participants made compost in their homestead. Now they are using compost regularly in their vegetable gardens. 741 parsons made homestead garden properly. 77 mothers gave birth of newborn baby safely. Another 189 mothers took services from local institutes by the assistance of TBA for safe delivery. 48 TBA received training from expatriates. They take care & give advice to the pregnant mothers regularly. 10 tub-well & 960 sanitary latrines were installed by the own initiative of the participants. 17 women took treatment from specialist doctors for uterus problem. 14 meeting were held with the gov’t service providers & UP standing committee of health. As a result, the participants of the project can communicate with theme easily. 778 participants planted different trees in their homes.
This project also achieved some unplanned achievements. For example: 960 children completed the courses of vitamin A. 8 man received permanent method of family planning. The gov’t family planning workers participated in the group discussion of health center 34 times. 1200 participants take advice from
EPI & satellite services.
Overall changes happened
Most of the SUS participants are now aware on health issues. They now use safe drinking water, sanitary latrines and practice hygiene at family level. They are aware of arsenic hazards and negative impact of open defecation. Previously many used to hide diseases due to lack of consciousness but presently they do not do so; they go to visit at least local village doctors for treatment. Almost every program participants installed tube-wells and sanitary latrines in their houses and all of them use safe water for all purposes. The program participants are now aware on importance of necessary nutrition intake for health concerns.
SUS participants’ now practice cleanliness everywhere at family level. Due to their knowledge development in primary health care, they are now able to understand the measures to be taken during health hazards. Moreover, they are now advising others in the society to practice primary health care at family level through disseminating knowledge in this regard. About 75% of the people of the area use sanitary latrines and incidences of water borne diseases have been decreased significantly in the area.
Due to mass awareness development, SUS program participating families are increasing adopting family planning process. The most positive effect is males are now adopting family planning processes.
SUS participants now know about necessary care required during pregnancy. They take balanced diet and follow the advices of TBAs. No SUS participant now takes help from non-trained birth attendant. TBAs regularly advise the pregnant women on pre and post delivery care, counsel at family level to provide the pregnant mothers with necessary nutrition, take the pregnant women to hospital for check-up and send the delivery patients to hospital not keeping under their control for more than 12 hours after the pain. They also go to hospital to receive TT vaccines as well as to receive iron tablets. Due to huge awareness development through family level counseling, the family members’ of the pregnant women now take care of them with keen attention.
All the SUS group members are now aware of their children’s health concerns and go for vaccination of their children in time. This has become possible due to mass awareness development of the program participants.
SUS participants now do not go to local kabiraj (Quark) for treatment. They are now very much concerned about their health and they either go to hospital or local village doctors to receive treatment.
Previously the poor patients had to suffer in the govt. hospital to receive treatment due to negligence of the doctors as well as of the hospital staff members. But at present the situation is completely opposite. Due to advocacy and rapport development of the GOB doctors and the staff members the poor patients are now receiving prior attention in the hospital. Doctors in the hospital now check-up patients well, perform pathological tests and provide them with medicinal support. The participants showed their utmost satisfaction in this regard.
Doctors of the govt. hospital now attend SUS program regularly. Doctors are providing services in the health camps. Most times a doctor visits 2-3 villages and examines about 50 patients, as the participants viewed. This has become possible due to increased GO-NGO coordination. Govt. family planning workers now visit the area regularly and deliver services like providing necessary advices and family planning materials like tablets and condoms.
The SUS participants now share health related issues with their neighbors and the neighboring families are now becoming well aware of health concerns. Program implementation with assistance of VHC helped in mass awareness development in the community and now the community people are aware of health, nutrition, sanitation, hygiene practice and safe water use. Community people now send complex delivery and other cases to hospital for treatment.
The respondents viewed somehow negative impacts of health program in some areas as described in the following bullets.
Lack of technical staff members in the program has made it difficult for SUS to work according to the increased expectation of the patients. People are learning about complex diseases but they are not receiving treatment facilities, as there is absence of sufficient physicians as well as lack of test facilities.
SUS participants find it difficult to allocate time in the definite predetermined date, as most of them are to work during that specific time.
As SUS is working in the area to establish human rights, the organization is developing awareness of the pregnant mothers to undergo operation in necessary cares, but cannot provide them with any support without information. Due to huge awareness development in the community, expectation of people on SUS has also developed simultaneously.
Babita tells about the merits of discussion regarding
reproductive health:
Babita Akter
Participant of the center
Initiative for health development project
North Jagadispur village
"It was the secret problem of women. Now we know about the source of the problem, how to keep us safe from the problem and what are its remedies. We share the issue with members of the family and other relatives and neighbors. It is needed to work more regarding the issue".
Jharna tells about govt. health service
Jharna Rani
Participant
Chuchaura health center
We had no idea about the govt. services such as: EPI, Satellite, Source of getting materials of Family planning method, service of govt. TBA etc. After knowing these, we are taking services from these places regularly and we are also advising other people to go there".
Observation of midwives Hosneara on fixed satellite
A fixed satellite is organized in the community by the assistance of health worker. Fixed satellite is 10-15 kilometer from Netrakona sadar hospital. If a patient wants to take treatment from this hospital, they have to spend in average Tk.50-Tk.60 only for transport purpose. SUS is running 10 satellites in 10 villages in Netrakona sadar upazila. In average 5-6 patients come to the each satellite centre for taking proper treatment. A heath worker goes to the villages and informs and provides satellite date to the community people through community meeting and home visit. The fixed satellite centre is being run by MBBS doctor and trained midwives. MBBS doctor and trained midwives provide proper treatment and necessary medicine without money. All community people are getting different types of services and the pregnant mothers get special treatment. The pregnant mothers engage with package program, which is being run by SUS hospital. The pregnant mothers are getting different types of treatments like urine test, blood test, pressure checkup and ultrasongraphy. If any patient is affected by harmful disease, he/she is transferred to govt. hospital. One of the fixed satellite centre is being run by the assistance of SUS at Abdul Mannan’s house of Mougati village under Mougati union of Netrakona sadar upazila. According to plan, Midwives Hosnera went to conduct satellite on November 2008. She was informed from satellite centre that a delivery was completed in their neighbor house but child didn’t response properly. A woman told to midwives Hosneara to go to the house for observing the situation. Hosneara went to this house and she saw the child was kept on banana leaf. She was confirmed about his pulse as positive through diagnosis. She separated his placenta immediately. She pushed saline and washed saliva. Thereafter, the child started to breath out spontaneously. In addition, midwives Hosneara injected injection Oradox and referred to Netrakona sadar hospital for getting better treatment. The child was stayed at hospital for 7 days. After taking treatment, he was saved from death and was brought back to his house. Now, he is well.
3.2.3.3. Disability Rehabilitation Project (DRP)
Bangladesh is a developing country of south Asia. According to World Health Organization (WHO), 10% of our total population is disabled. Due to complexity during pregnancy period and delivery, a newborn baby becomes the victim of disability. Disability is not a disease but a problem. The people are not aware on this issue. Superstitions and ignorance make this problem hazard. In this context, SUS incepted a project named by "Disability Rehabilitation Project" during June 1998 with a little space at Netrakona sadar . By this time this project has been extended in other 6 (Atpara, Modon, Kendua, Purbodhalla, Mohanganj and Barhatta) Upazila of Netrakona district for ensuring the rights of disable and determine their social position . This project is being run among 348 villages in 47 unions. Whole activities have been carried out through three parts: Awareness, Operation, Skill development.
At present, total number of registered disable clients is 2040. Out of them, physical 1459, mental 142, hearing and speech 218 and blind 221. Total 133 disable Clint has received operation facility up to 2007.
Its objectives are to raise awareness on the causes of disability, to rehabilitate disabled clients, to establish their rights and to change people’s negative attitude towards disabled persons.
In 2008, 288 disables have been enlisted under Disability Rehabilitation Project. Disability related issues such as: what is disability, causes of disability along with remedies have been discussed in 65 community meeting, 1934 courtyard meeting and 131 parents meeting in NFPE school and 10 in circles. People are becoming aware on causes behind disability. 84 static clinics were arranged where 1429 persons received services. The conditions of clients have been improved. 19 disables have been enlisted with inclusive education and they are now going to school with their classmates. 11 disables have been involved with IGA and accessibility has been increased within the family.82 disables have been referred to another places for getting better treatment. 22 disables have gotten operation scope and 59 have received assistive devices. 02 volunteers’ orientation, 01 parent’s orientations were held with 72 participants on disability and they are performing their activities at field level. The volunteers have been informed on definition of disability, its kinds and causes, they have identified the disable and sent to SUS, they have disseminated the information on disability in their area. 07 dramas on disability issues were held where 1419 viewers attended and infirmed what is disability, cause behind disability and remedy. As a result, changing the negative attitude of people towards disable such as disability is not course of Allah; it is one kind of disease.
Overall changes happened
Due to counseling at family level, the family members now do not consider disability as a curse. Family members are now soft 4o the handicapped members and extending full support to them to be self-dependant. As the handicapped children are getting opportunity to go to schools under the continuous education program, the family members of them have now become very conscious to send them to schools. Further, the family members are now proactive to help the handicapped member getting out of disability. Now the handicapped family members do not feel helpless.
Counseling at society and institution level helped towards increasing acceptance of the handicapped to society people as well as to different institutions. Now superstition on disability has been decreased significantly in the society. Handicapped people are now getting works at different institutions and earning through IGAs. Thus their status at society level has been improved.
Due to mass awareness through the program people are now aware of removing disability in possible cases. They are now receiving regular services rendered by SUS. The parents are also providing their handicapped children with physiotherapy treatment at home level as they have been trained by SUS. Thus disability has been reduced in the community.
Inclusion of the handicapped in the MF&ME program opened opportunity for them to earn through different IGAs. As they are earning now, they are contributing in increasing their family earnings. The mothers of the handicapped children are also receiving credit from SUS being group members and they are also contributing in their family income increasing through
different IGAs.
The respondents viewed somehow negative impacts of disability rehabilitation programme in some areas as described in the following bullets.
Only the physical handicapped are receiving facilities from SUS. Due to limited scope SUS cannot extend its services to blind, deaf and dumb.
Lack of adequate materials for the handicapped children makes it difficult for them to learn.
Now Rafi can walk slowly
Rafi is a lovely and affectionate child of his parents. He is 5+ years old. His mother is Robina and she is a housewife. His father is Saiful Islam and he is involved with electrical work. They are the inhabitants of Hosenpur moholla (Area) under Netrakona municipality of Netrakona district. Robina said that during 9 months pregnancy; I was affected suddenly by convulsion. She suffered from convulsion for one day and one night. Next day, her relatives brought her to maternity hospital of Netrakona. The doctor examined and referred her to Netrakona Model sadar hospital for better treatment. Rafi was born there. After born, Rafi did not cry like normal baby. After providing oxygen, he cried out. His mother suffered from convulsion due to lack of oxygen. Rafi was hurt on his brain resulting cerebral palsy. After came back from hospital, he was affected by Jondish. He took treatment from doctor and overcame this. All hope for normal children but parents fall in an unstable situation if something happens in growing stage. The parents went for treatment for returning back him to normal life. When he was one year old, he could not sit alone. His parents took treatment from doctor and heeler but didn’t get any types of progress. Old aged family members told that many children sit and walk in late. When he was 2 and ½ years old, then he could not sit, move and walk. After few time, his parents knew about disability service of SUS. His parents communicated with disability project and enlisted his name under the project. By this time, disability worker was providing physiotherapy through static clinic. From 2007, SUS staff has been providing home-based physiotherapy. At present, he is using different types of assistive devices like standing table, parallel bar. During this time, his mother has been trained up on physiotherapy. 3 times physiotherapy is being conducted in a day by the assistance of her mother. Starting 2008, he could sit, stand up and walk by the assistance of other person. He can take food by his own hands; he can tell Bengali words slowly. Now, he walks slowly by the help of other person. His parents hope that their Rafi will come back to normal life within short time. They are grateful to SUS.
SUS believes that health is a major component. Increase comprehensive family health care was regarded as one of the major objectives of SUS. To address the situation of Netrakona, SUS started to provide both curative and preventive services since inception. During this time, SUS has established static clinic where MBBS doctors as full time, midwives and health assistants are involved
Dulal tells about the role of SUS regarding disability services
Dulal Mian
Inhabitant of Mohonganj municipality
"I have brought my son to many doctors and quarks. But I didn’t get proper treatment from them. My son can walk now by the service of SUS. He goes to school now. There is no scope of treatment for disable persons in our govt. hospital. Many families like me are getting opportunities from SUS. We expect that SUS will establish a hospital for the disable persons in Netrakona".
Halima tells about the role of SUS regarding disability service
Halima Akter
Pregnant mother of Jaoyani village
"Only SUS is working with the prevention of disability during pregnancy and rehabilitation of disables. There is no scope of treatment in govt. hospital for disable persons. Many families are getting benefits for running this project by SUS. One of my sons is disable. Now I am pregnant. I participate in disability related community meeting for preventing disability of my next baby. I obey the advices of the meeting. I also share with my relatives. I think, this project should be expanded".
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