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learning from the refugee experience

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  • learning from the refugee experience

    Good evening,

    So far, in most readings concerning a concerted community response to pandemic influenza, the focus appears to be either on public health programs or on individual education and preparedness. In seeking to learn by analogy from other situations, we might heed some words from Médecins Sans Frontières (Doctors Without Borders) about a novel yet very important category of staff person: the Home Visitors. This is indeed one area which, if planned for in advance, could cast a vast and effective safety net over our communities. It is one very concrete way in which community groups, such as faith-based groups, could play a crucial role in bridging the span between pandemic response leadership and the common citizen.

    Tim Foggin,
    Oct 29, 2006


    from : REFUGEE HEALTH—An approach to emergency situations by Médecins Sans Frontières (1997) ISBN 0-333-72210-8


    page 42:
    Home-visitors are a particularly important category of staff required to ensure the link between the refugee community and assistance programmes. They should be chosen from among the refugee or displaced population. Particular attention must be paid to both their training, and to that of other local health staff.


    pages 219-220:
    REFUGEE-SPECIFIC CATEGORY OF STAFF : HOME-VISITORS

    Home-visitors are an essential component of any refugee programme ensuring the link between refugees and the services offered to them and conducting outreach activities in the settlement. Home-visitors should berecruited rapidly at the start of programmes (within the first few weeks) and function as a network covering the whole refugee population.

    Home-visitors (HVs) should be distinguished from community health workers (CHWs) or village health workers (VHWs): CHWs are an essential aspect of (long-term) primary health care programmes in stable countries, aimed at extending health services to all communities and supporting them in solving their own health problems. CHWs are members of the community, who have received a short training on health-related matters and are already integrated into the public health system of their country. HVs are also selected from the community, but only in response to a refugee crisis. Their tasks differ from those of the CHWs, and it is preferable that they do not provide curative health care. The CHWs already present in the refugee community will generally be assigned to health services (e.g. health posts) because of the health knowledge they have already acquired.

    The characteristics of home-visiting programmes include the following:

    Home visitors should be selected from among the sections of the population they will care for; initially there should be 1 HV for every 500-1,000 refugees. The most important selection criteria is that they are accepted and recognized by their community, whether or not they have previous skills or are literate. Difficulties in the HV selection process arise when refugee leaders try to unduly influence it, or designate friends or relatives who may not be suitable. Care should be taken that women are among those recruited (see above, Staff recruitment). The number of HVs can be increased depending on how events and activities evolve.

    The main tasks to be performed by HVs are listed below (see also 6. Health Care in the Emergency Phase).

    - Data collection: HVs ensure the regular collection of population figures (census, new arrivals and departures, births, etc.) and mortality figures (number and causes of deaths in the population).

    - Active screening: they make regular visits to shelters to screen for sick persons, malnourished children and those not immunized against measles, and refer these to health or nutritional facilities. They may also be required to screen for other problems: defaulters from particular programmes (e.g. feeding centre), vulnerable groups with specific problems, etc. In the case of disease outbreaks, this screening task will have to be reinforced.

    - Informing the population: they are responsible for transmitting necessary messages in regard to, for example, the availability of services, distributions that are to take place, the need to bring children for measles immunization etc. They should also conduct health education, for instance, on the use of latrines, the importance of personal hygiene, etc.

    - Assistance to other programmes: HVs can assist in many activities: mass immunization, health posts, feeding programmes, conducting surveys, etc. However, this should not be at the expense of making home visits.

    A main role of HVs is thus to facilitate the flow of information by informing refugees about relief services and informing relief agencies on refugee needs and problems.

    · Supervision and training of home-visitors: A few HVs who demonstrate superior skills should be assigned a supervisory role; one supervisor for ten HVs. Overall supervision of the home-visiting programme should be ensured by a health professional (for instance, an experienced nurse). Frequent and regular meetings between HVs and their supervisors must be instituted from the start, on a daily basis in the initial stages. This allows HVs to make a daily report, hand over data collected, exchange information about refugee needs, etc. It also provides an opportunity for training: an initial and basic training session should be organized on the first tasks to be performed (mainly data collection, possibly active screening), and is continued through these regular meetings to cover other tasks and specific issues related to refugee programmes. The general guidelines for training in a refugee context are given above under Training.

    · Contact with other refugee activities: HVs should maintain close contacts with staff working on other programmes. Collaboration with health services is particularly important: HVs should be linked to the health post to which they refer patients; the person in charge of the health post may also supervise their work and provide them with support.

  • #2
    Re: learning from the refugee experience

    Welcome to the forum tmf.

    It's great to see the MSF has deliniated the "Home-Visitor" tasks so well.
    Is this information available online?

    AnneZ said in her read of "Black November" that folks did something similar to the MSF Home Visitor and it worked well in 1918. They even sometimes communicated with waving cloth of various colors.

    .
    "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

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    • #3
      Re: learning from the refugee experience

      Welcome at Flu Trackers tmf and thank you for your contribution.

      Comment


      • #4
        Re: learning from the refugee experience

        This looks promising. I am aware of similiar programs in San Antonio and elsewhere that were developed to help increase access to preventive care for HIV, substance abuse and injuries. Will look for details and post tonight.
        JT
        Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

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        • #5
          Re: learning from the refugee experience

          See this thread for more responses to this concept.

          http://www.flutrackers.com/forum/sho...ed=1#post43735
          "May the long time sun
          Shine upon you,
          All love surround you,
          And the pure light within you
          Guide your way on."

          "Where your talents and the needs of the world cross, lies your calling."
          Aristotle

          “In a gentle way, you can shake the world.”
          Mohandas Gandhi

          Be the light that is within.

          Comment


          • #6
            Re: learning from the refugee experience

            Brief comment here in the Neighborhood thread. In reading the first post I see the clear distinction is made between Health Care Worker (what I know as La Promotres from San Antonio) and the Home Visitor. However, I am not familiar with that category of worker in USA. I wrote to a member of the board of the Health Care Worker National Network Association to invite conversation about pandemic preparedness from this important group. Additional information on the group can be found at their web site
            Community Health Worker National Network Association
            http://www.chwnna.org/index.htm
            JT
            Thought has a dual purpose in ethics: to affirm life, and to lead from ethical impulses to a rational course of action - Teaching Reverence for Life -Albert Schweitzer. JT

            Comment


            • #7
              Re: learning from the refugee experience

              Oh I h ope that Community Health Worker National Network Association will join in this conversation for I believe that they will have a great insight to contribute to this ongoing consideration.

              Also want to remind people that we are having a 'party line' sort of conversation with this thread in this forum as well as the ongoing discussion in the faith based community forum also. I would offer a site location but I am not that talented to do such. http://www.flutrackers.com/forum/showthread.php?t=12246 (FL1)
              Can some one remind everyone of the mutual discussions going on. Sorry computers and I are only so friendly!
              TM

              Originally posted by Thornton
              Brief comment here in the Neighborhood thread. In reading the first post I see the clear distinction is made between Health Care Worker (what I know as La Promotres from San Antonio) and the Home Visitor. However, I am not familiar with that category of worker in USA. I wrote to a member of the board of the Health Care Worker National Network Association to invite conversation about pandemic preparedness from this important group. Additional information on the group can be found at their web site
              Community Health Worker National Network Association
              http://www.chwnna.org/index.htm
              JT
              Last edited by sharon sanders; November 1st, 2006, 09:23 PM. Reason: added link

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