Spotlight on Global Health
¡Salud Total!: Community Health Clubs are Started in the Dominican Republic
¡Bienvenidos Clubs de Salud Comunitario a la Republica Dominicana! In March 2012, the Center for Medical Humanities & Ethics (CMHE) at the University of Texas Health Science Center at San Antonio’s (UTHSCSA), in collaboration with the Children of the Nations (COTN) organization and the Universidad Iberoamericana (UNIBE), trained the first 6 CHC facilitators from 5 communities in the Barahona Province to start the first Community Health Clubs (CHC) in Latin America and the Caribbean. The goal of this program, which is supported by the Christ is Our Salvation Foundation, is to contribute to a reduction in water, sanitation and hygiene related conditions and demonstrate the effectiveness of this methodology in laying a sustainable foundation for community-based health and development. With cholera poised to pose a continuous threat from across the border in Haiti for the foreseeable future, it is hoped that this small pilot project will be the impetus for a rapid expansion along the remaining bordering provinces of the Dominican Republic and ultimately across the border into Haiti.
Since 2010, the CMHE has been operating mobile clinics in Independencia Province, providing free medical care to some of the most vulnerable communities in the Dominican Republic. While providing health care services to residents of bateyes (unincorporated settlements of low-wage Haitian and Dominican laborers and displaced Haitian migrants), students and faculty realized that to truly make a positive health impact in these communities, a long term, ustainable approach would better address the underlying causes of locally prevalent diseases. At the same time, the cholera epidemic that began in the Artibonite Province of Haiti in October 2010 rapidly spread, resulting in over 531,000 confirmed cases and over 7,000 deaths in Haiti1, and almost 20,000 cases (predominantly border provinces) in the Dominican Republic2. In response, the CMHE began partnering with COTN to pilot the CHC approach in the five communities where COTN has been operating since 1997.
The CHC Approach is a community-based, participatory methodology first developed by the Zimbabwe AHEAD organization that has had great success throughout Sub-Saharan Africa over the past 10 years. This approach is considered ‘best practice’ for community-based participatory health education in Sub- Saharan Africa because it not only encourages the buy-in and participation of entire communities, but also achieves measurable water, sanitation and hygiene (WASH) behavior change. By combining time-tested adult education activities and culturally adapted educational materials with weekly health promotion sessions for a dedicated group of learners, this approach catalyzes sustainable behavior change through social pressure and alters community WASH norms. Where implemented, the ‘Common-Unity’ this approach engenders establishes a sustainable culture of health that communities leverage beyond the immediate goals of WASH programs, such as the prevention and management of vector-borne diseases like malaria, infectious diseases like HIV and tuberculosis and chronic diseases like diabetes.
After 1 year of research, material development and planning, residents of the communities of Altagracia, Algodon, Los Robles, Don Bosco and Pueblo Nuevo are set to join the international network of Health Club members who have used health education as an entry point to holistic community health and development. Over the past year, baseline data has been collected from almost 300 households across the 5 communities to demonstrate the impact of the program and its adaptability to local contexts outside of Africa. The first phase of this research was completed in June 2011 when 3 MD/MPH students from UTHSCSA collected data from 88 households in Altagracia. The results of this research were instrumental in identifying the need for a CHC program, in advocating for the required resources for this pilot project and have been published in the Journal of Global Health by the student researchers who conducted the work. These students were also vital in the development of the CHC Membership Card the health education toolkit, which has been contextualized for bateyes in the Dominican Republic. In March 2012, the remainder of the baseline data was collected by 8 MD students from UNIBE, with supervision from CMHE staff member Jason Rosenfeld.
At the same time this research and program development was being completed, Mr. Rosenfeld was introducing the program to the 5 communities and mobilizing them to join their local Health Club using the time-tested participatory activity, Nurse Ana (more commonly known as Nurse Tanaka in Africa). In this activity, community members act out a role play at their local clinic, with one person acting as Nurse Ana and the rest as community members. Patients visit the clinic with common conditions from their community, Nurse Ana diagnoses the condition and shares his/her thoughts about the causes of the condition. The purpose of this activity is learn about each communities perceived health issues, while also to demonstrate that the majority of the conditions can be prevented through improved water, sanitation and hygiene practices. The response from each of the 5 communities was overwhelmingly positive so the decision was taken to move ahead with implementation. 
Therefore, from March 12-15 six community-based facilitators, two nurses from COTN, and 3 guests from Haiti participated in the first of two training workshops for this project. During this four day workshop, participants were trained in the CHC methodology, best practices in how to mobilize their community and start a CHC, and how to use the CHC Toolkit and participatory activities to conduct the first 2 months of health education. Currently, these facilitators are mobilizing their communities and registering the first ever Health Club members in Latin America and the Caribbean.
Over the course of the next year, Health Club members in these 5 communities will participate in weekly health education sessions and will begin making incremental improvements to their households and communities. The goal of this program is to prevent the transmission of preventable conditions such as intestinal parasites, skin diseases, malaria/dengue, and diarrhea, most importantly cholera. Stay tuned as this exciting new program grows. ¡Salud Total!
1 Ministry of Public Health and Population, Pan American Health Organization, Mar 2012.
2 Weekly Epidemiological Bulletin: Oct 30 – Nov 5, 2011. Ministry of Public Health, Department of Epidemiology, National Epidemiological Surveillance System. Week 44, 2011.
