Today is the first official workday in the field. The day began at 6 am before sunrise, as we awoke from our cots, mosquito nets, and got ready for the day. I packed a few essentials, then headed to the patio for breakfast. We munched on fruit cocktail and scrambled eggs. Everyone wore some black rain boots, carried their bags and water bottles, and ventured out!
The goal this week is to visit homes monitoring community health and water quality. By the end of the week, data from home visits will be collected, analyzed, and presented to everyone in the community. This is part of the job of a health promoter, a trusted and a trained member of the community.
The job is accomplishable, yet health promoters are faced with many challenges. Homes are isolated and located far away from the clinic. With long travel distances and many homes to visit, the health promoters are short of staff to achieve this. Though driving to all the homes would be ideal, some of the roads are not suitable for driving: It rains frequently leaving them very muddy and wire fences barricade certain areas. Thus, hiking is the way to go. This is where we as AMOS interns play a role in assisting the community.
Prior to hiking, we split into teams of six people each. Each group had a health promoter, an AMOS staff member, and 4 volunteers. Each group was assigned to visit five homes collecting water samples, examining water filters, observing yard conditions, and sharing Zika information. At 9, we began the hike.
The hike was simple at the beginning: The trail was flat and dirt with some downhills. It was hot and humid, yet it felt good to be out in open space. At some areas, we could see just grassland everywhere, mountains in the distance, and even some farm animals. Everything was just, well, simple.
At some point, the path split into two and the hike then became more challenging. We crossed rivers, climbed rocks, and squeezed through tight wire fences. Without a doubt the fence was the most difficult part: The health promoter had to open the wires wide enough for us to pass through. While holding the wires, one-by-one we passed with one leg, the head, body, then another leg.
Soon, we arrived at the patio of the first home waiting for the homeowner. Then, the homeowner’s wife appeared. Pablo (an AMOS staff member) asked her permission to enter and if she had time to do a survey. She obliged and allowed us inside her kitchen.
Inside was a covered firewood stove heating a cauldron. Smoke rose and escaped through gaps of darkened wooden walls and ceiling. The wife stood at a table by the stove while we sat across the room.
Pablo surveyed her to demonstrate the home visit. He began by asking a series of questions. Both Pablo and the wife spoke Spanish very fast and I understood bits of it. From what I gathered, he asked questions such as how many people lived in the home and the condition of the filters. After about 20 minutes doing the survey, we moved onto the next part; filter checking and taking water samples.
A majority if not all locals in San Jose own a BioSand filter; It’s a covered yellow/green bucket with the AMOS logo on it, its date of installation, layers of sand inside, and a nozzle at the bottom. To examine how well the filter functioned, someone grabbed a timer to measure how much time it took the water to fill a bottle of water. If the water filled the bottle within 2 minutes, then the filter was in great condition. A flashlight was also used to see how clear the water looked inside.
(pictured above is a home where a mother and children live, with a green biosand filter in the back)
Meanwhile, Pablo brought out some sandwich bags with strings to put samples in. He filled a sandwich bag with the filtered water, labeled it, then tied it up. After checking the filters, the next part was checking the yard conditions.
Then, we went into the last part of the visit; Zika education. Pablo asked the wife what she knew about Zika, discussed its symptoms, modes of transmissions, and treatments. He was also holding a flyer with all that information. With the wife’s permission, he posted it on a wall. This part lasted perhaps another 5-10 minutes.
The home visit ended after the Zika information and we hiked right to the next home. Each home was isolated and took at least an hour to hike to.
By the third house, it was our turn to conduct the visit and we split tasks; I was in charge of water samples. Obtaining water samples was a bit tricky. After filling a sandwich bag with filtered water, I had to flip it at least a few times, tie the bag by its ends, then turn it upside down. If the bag leaked, then that meant that the bag wasn’t tight enough. Thankfully, none of the bags that I filled leaked over.
After doing this for the remaining homes, we finished home visits for the day. Rather than hiking back, the truck we rode to San Jose was parked right down a hill! Then, we rode up some steep hills back to the clinic. Seeing how steep the road was, it would be a nightmare to hike back.
I enjoyed doing home visits for the first time. Hiking in boots for 3+ hours (with water breaks and resting at homes) made for a balanced workout. I also didn’t mind collecting water samples, though I was jealous that I didn’t do Zika education.
The health promoter in my team even taught me new animal words at some of the visits:
Misingo pronounced me-sing-o (cat),
cachorro pronounced cah-cho-ro with rolling of the r. (dog)
choqoyo pronounced cho-cuy-o (parrot/bird).