Our Health Programme in the district of Dawasamu on the Fijian Island of Tailevu began in January 2018. The long-term objective as it stands is to assist the District Nurse Lavenia Merekula Raivono with the health issues concerning the District of Dawasamu in accordance with the Ministry of Health’s annual objectives.
Initially, District Nurse Lavenia and I established three sub-objectives so we could implement specific projects that target three key health areas identified for Dawasamu District. These sub-objectives were:
(1) the safe disposal of non-recyclable waste;
(2) educating women to prevent the malnutrition of children aged 0-5yrs and the importance of nutrition for breastfeeding mothers;
(3) education on preventative health measures and first aid.
The first task for the GVI healthcare program participants was to create a more efficient working environment for District Nurse Lavenia. The government-run nursing stations were severely damaged during Cyclone Winston in 2016.
While the government made sure the station received the essentials to get it back up and functioning, the building was placed on a waiting list for a complete refurbishment. Understandably, the waiting list was very long as the whole of Fiji had been affected by the cyclone.
At the time, GVI had been working with the communities of Dawasamu for over five years and saw an opportunity to work with local community members to contribute to the project of refurbishing the damaged nursing station. Between January and March of 2017, a total of 15 GVI staff and participants worked on improving the working space for the District Nurse.
Together, we identified she needed two things. The first being that she needed a separate working space to see her more vulnerable patients – babies and children. This separate area would help ensure that diseases weren’t easily transmitted between sick patients and babies attending the clinic. The space would also offer mothers and their babies an area to relax and wait for their appointment.
Another need we identified was an inviting, spacious area to host community members. The purpose of this area was to display posters and other educational material produced by the government. This material would be used in conjunction with the clinics/workshops on preventive health measures to help keep members of the communities healthy.
I asked District Nurse Lavenia how she feels about her revamped workspace, and she had this to say: “The new mother and babies’ room helps me do my job so much more efficiently, I no longer have to worry about the babies I see on clinic day being in the same area as patients who are unwell, who come for treatment on those days. My surgery is amazing.”
A health education room for the mother and baby clinic
As soon as the refurbishment work was completed, in January 2017, the GVI Health Programme started to focus on its first key objective: to assist the District Nurse in educating mothers and expectant mothers in her catchment area (which consists of 15 villages, with a population of approximately 2,000 people) about how to prevent malnutrition in children of 0-5 years, and the importance of nutrition for breastfeeding mothers.
During this time, the Ministry of Health in conjunction with the National Food Nutritional Centre produced ten key messages in the form of pamphlets containing information. These key messages educated on things like breastfeeding, starting other foods, vitamin A sources, and protein sources.
So, GVI created workshops and displays that were centred around these ten key messages. Workshops are carried out every Wednesday at the mother and baby clinic.
Before their babies’ check-up, mothers attend the workshops that are applicable to their baby’s age. Resources and activities have been created to accompany the workshop, and the activities were designed to be visual and to encourage mothers to participate.
The collaboration between the GVI and the District Nurse means that the important information that mothers need to understand can be shared in a conducive learning environment at the pace set by the mothers.
On average, the District Nurse will see 40-55 babies every Wednesday, between 09:00 and 13:00. With this limited time, she was not able to discuss each key message in detail. And now, with GVI conducting the workshops, mothers are educated by the team, allowing the District Nurse to discuss any areas of concern with a mother during the checkup.
The Key Message One workshops highlighted the importance of breastfeeding and encouraged mothers to exclusively breastfeed for the first six months. GVI started the Key Message One workshops in January 2018. So far, a year to date, 422 mothers have attended the workshop, which includes mothers with babies over six months, plus mothers attending more than once.
Breaking down attendance, 111 mothers attended between January and March, and 311 between April and December. Comparing 2017 and 2018, there has been an increase of 18% of mothers exclusively breastfeeding for the first six months.
Before facilitating the workshops, participants receive training from the Community Project Leader, which involves practising the workshop. Participants are also given the opportunity to ask any questions.
The feedback from mothers has been very positive and they enjoy the interactive part of the workshops. Some mothers have attended the workshops several times, as they enjoy listening and taking part in the activities. This helps when new mothers join, as the mothers who have attended before can help translate.
The District Nurse is extremely happy about the way the workshops encourage mothers to discuss what they have learnt with each other. This prompts them to ask her questions about their children’s health and about how nutrition plays a key part.
Reducing malnutrition in the district of Dawasamu
The workshops are designed to target mothers by educating them about the value of nutrition and the benefits. In Fiji, malnutrition is much more prevalent than it should be, considering it’s a land filled with nutritious fruits, vegetables and root crops, and an ocean full of fish.
This project targets the United Nations’ Sustainable Development Goal (UN SDG) 2: Zero Hunger, addressing the nutritional needs of adolescent girls, pregnant and lactating women, and older persons (Target 2.2).
Over 90 million children under the age of five are dangerously underweight. Undernutrition is the leading cause of mortality in children in this age group. But those most at risk of malnutrition are children being introduced to complementary feeding at around 5-7 months of age.
Furthermore, this project contributes to the United Nations Sustainable Development Goal 3: Good Health and Wellbeing. More specifically, Target 3.1 aims to end preventable deaths of newborns and children under five years of age; and Target 3.13 aims to aim to strengthen the capacity of all countries for early warning, risk reduction and management of national and global health risks.
The District Nurse has reported that between February 2018 and October 2018 there was a decrease in malnutrition in children under the age of five. The District Nurse believes that the workshops are giving mothers a better understanding of nutrition and are a contributing factor in the decrease of malnutrition cases.
The success of mother and baby workshops has given us the template to be able to start work on the preventive health measures objective. By working in partnership with the District Nurse and the community health workers the overall main goal is definitely achievable. Our goal is to ensure that these projects are sustainable, through education and upskilling.
This story comes from GVI’s 2018 Impact and Ethics report. To celebrate 20 years of work in sustainable development, we reflect on and showcase our impactful stories and data. Read the report in full.