One of the main reasons for going to Sylhet was to see the Projahnmo 3 study site. This is the neonatal health project I was writing papers for this summer for those of you who know. The Stage 3 intervention is comprised of two parts: 1) testing the efficacy of chlorohexidine (CHX) application to the umbilicus in decreasing neonatal mortality and 2) operational research (OR) to see how much village woman would pay for and where they would get CHX and clean delivery kits.
CHX has been proven to decrease neonatal mortality in other areas (e.g. Nepal) so I think this study is just further confirming that. Right now, if you buy CHX from a pharmacy or a trained birth assistant it costs 45Tk (~$.65), but if you give birth in a government facility it's free. A clean delivery kit costs 18Tk (~$.25) in the same way. The intervention uses pamphlets, community meetings, posters, and songs to describe how to use the CHX and where to get it, etc.
The program manager set-up two field visits for us. On the first day, we went to an OR community meeting and the second day, we went to a neonatal home visits for the efficacy trial and a pre-birth community meeting.
The first day: From the office in Syhlet, we drove about 70km northwest, which took approximately 2.5 hours. We picked up some materials at a local field office and then attempted to make our way to the community meeting. We ended up getting massively lost among the miles of rice paddies and drove around for about an hour and a half asking random people on the side of the road for this community. When we finally found someone who said we were near, we decided to walk. After about 40 minutes walking through the sweltering heat with no cover, we arrived to about 15 women, waiting and upset. Apparently the meeting couldn't start without our evaluator and they had been waiting for more than an hour. I completely understand.
In addition to the 15-ish women who sat in the meeting, so did about 15 kids. A lot of the kids kept crying and fiddling, which I thought would disturb the meeting, but they pushed right through, even yelling at the kids sometimes. A group of men gathered at the window to stare at us because we were white (it was reaaaallly funny)! The community health assistant gave a brief demonstration on how to apply CHX to the cord and gave a handout to the women. Lots of the women asked questions, which I thought was good - it indicates they showed at least some interest in what was being said. Most of them also listened to the actual presentation and demonstration intensively. After the question period, the communications officer we were with asked a series of questions to evaluate what they had learned, but also how much they were willing to pay for the supplies, where they would get them, if they thought it would work, etc. So the data that's being collected is really useful and informative. Unfortunately though, the switch from the CHW to the communications director involved some re-shuffling, so there a lot of the women left during this time period.
Once we were done, we were supposed to go see a male community meeting and visit one of the satellite clinics, but the time we spent getting lost messed that up, so we just went home.
Impressions of the village: I'm not sure what the economic status of the community was, but their house was multi-roomed, had electricity with fans, and numerous cell phones. All the kids looked healthy and well-built and one of the men even talked to me in English (he asked me to take a picture of all the men together!). All the kids were great and were laughing and playing and having great fun! I took a couple of pictures of the women and kids, which they didn't realize. When I showed them the pictures from it, they were sooo excited and had me take a bunch of pictures in a little photo shoot! It was awesome.
The second day: Today we visited the main trial in a village about 70km from Sylhet from India. This community was located in the most AMAZING location - a perfect location in which to place a cottage.
The first visit we went to was for CHX application for a neonate that was 3 days old. A CHW first asked the mother a series of questions to assess the health of the baby and if there were any signs of infection, then provided a physical examination. The CHW comes on day 1, 3, and 7, I think to do the same thing. There is also a VHW (village health worker) that works in the group of households to apply the CHX every day. THe VHW also has communication with the CHW so that if there are signs of infection on the days that she doesn't come, she can be called. The whole process took about 20 minutes.
The second visit was a community meeting for a woman who was 7.5 months pregnant. The CHW encouraged her to go to a facility to deliver, but if she couldn't (cost, transport, etc), how to have a clean, safe birth, how to cut the umbilical cord, how to wash the baby and prop him/her up, how to breastfeed (positioning, attachment, timing, etc), and how to contact the VHW for CHX. In addition to the pregnant women, there was her mother, her mother-in-law, a TBA for the community, the VHW, and a couple other women. It was great to see that the woman and the VHW had so many women for support. We stayed for about 45 minutes and then left, but the women were free to ask questions and get advice. Total, the meetings last for about 2 hours.
Impressions of the village: According to the doctor we were with, this village was one of the lower economic-class communities. None of the houses had electricity, they were mainly one-roomed with a huge bed that multiple household members would sleep on, and the roofs were made of patched together rice-bags. You could definitely get the impression of the poorness, but all of a sudden this 12 year old girl pulls out a camera phone to take pictures of us (the white people)! It was sooo odd - I know that phone companies get around and that it's possible it was a community phone, it was just so odd to see such a poor community with a cell phone nicer than the one I owned in the States.
It's also amazing what a communal event birth is. Both the CHX visit and the pre-birth visit brought out about 15 women, even though the visit was targeted at one specific person. It's great that everyone pitches in to help and that multiple people benefit from the information provided at the meetings.
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