One of the unique aspects of the model of Lwala Community Alliance, is that while there is a clinic, the program is multi-dimensional, there is also a strong water, sanitation, and hygiene program (WASH), a education initiative that partners with schools and helps to provide secondary school scholarships based on academic merit and need, Umama Salama, an initiative to train community members on basic lifesaving skills to reduce maternal and infant mortality, and a sewing cooperative. The clinic staff goes on school outreaches at local primary schools which includes health education and free preventive care.
I've had the chance to participate in the training-of trainers in the WASH program, wrote the malaria curriculum and have attended the roll-out trainings for the Umama Salama initiative, and have attended two school outreaches with the clinic staff. I've loved the opportunity to interact with individuals outside of the context of the formal clinic setting. Community members often have more candid discussions about community issues and health-related questions they have than they may when they visit as a patient. This week, I was at an Umama Salama (safe motherhood) training attended by men and women ranging from late high school to grandmothers, some were pregnant or with young kids, some were leaders in their community. One of the attendees came with some powerful persuasion from neighbors essentially because they wanted her to get medical care. They asked me to talk with her. She was cachectic with a rattling cough and became short-of-breath with talking. I learned that she'd been sick for months but had resisted going to the hospital for multiple reasons, including fear, stigma, as well as financial and family burdens. While we don't provide medical services at trainings, we were able to build enough trust to get her to come to clinic and overcome the practical barriers with the help of her friends mobilize a motorcycle ride to the health center since she was too weak to walk the 30 minutes. While this was happening, the training continued; participants first learn the lessons through verbal teaching and drawings, and then the messages are reinforced with role-play, which they really get into.
The community work at Lwala, both in terms of educating and empowering people to prevent disease as well as enabling them to be informed advocates who can capably identify illness and assist in bringing patients to appropriate care will ultimately have the greatest impact on the health of this community.