Home-based care in village settings; working with CHAKUNIMU

McGill MSc student Andra Leimanis is currently in Tanzania as part of the Highlands Hope - McGill University School of Nursing project. She sends this update.

Home-Based Care with Peer Health Educators:
Report from the Villages


CHAKUNIMU is a group of Peer Health Educators (PHEs) who are actively involved in caring for their sick villagers through home-based care (HBC) and the promotion of HIV/AIDS education and prevention. The group was founded by nurse Betty Liduke at the end of 2004 with 63 PHEs in total and 20 PHEs providing HBC in the 6 villages surrounding the Tanganyika Wattle Company (Tanwat).

This grass-roots organization is very dedicated to their work as volunteers during their time-off from working in the fields cultivating crops and selling their produce. Since April of this year, "PIUTA", a support group for persons living with HIV/AIDS has been started in Nyumbanitu village with 12 members meeting every Sunday. They are also promoting the start of similar new support groups in each of the other villages as well.

A Typical Day

As part of my student project I am spending my weekends working along-side the PHEs to observe and support the current practice of HBC in these rural villages. The overall purpose is to see what home-based activities are occurring in this region and to identify the challenges and strengths of this work to help the PHEs in developing and strengthening their capacity to provide care and support to the chronically ill at home.

Typically we arrive in one of the neighbouring villages in the morning after a bicycle ride from Nyumbanitu to be greeted by the village major/chairman, we introduce ourselves, explain our purpose for visiting, and sign a guestbook. Our home visits are spread out during the entire day with each home visit lasting on average 20-30 minutes.

The distances between homes can be quite large as we leisurely walk on little paths through forests, corn fields, across streams, through gardens, up and down many hills. We take a break at some point in the day to either eat a snack called "Mandaaz"(a big doughnut), drink sodas or eat a complete meal at a small restaurant or at the home of one of the PHEs.

"Wagonjwa" - The Sick Individuals

I have spent six full days working with the PHEs up to this point. We visited with 18 patients in Nyumbanitu village September 20th-21st, 16 home visits in Mlevela village October 4th-5th, and 14 home visits in Itulike village October 6th and 7th.

I work very closely in particular with three of the administrative leaders of CHAKUNIMU, Laurence, Amon and Vumilia, who visit a different village every weekend together with the local PHEs from that specific village.

The diseases/illnesses that I have been seeing are primarily chronic conditions such as HIV, cancers, arthritis, diabetes, tuberculosis in the past, and many respiratory complaints. One of the most frequent complaints is a cough, often a result of smoky home environments from cooking on fires in small enclosed rooms.

Long-term paralysis or weakness on one side of the body is another common problem occurring as a result of accidents, falls, and in one instance a snake bite. We also visit orphan-run homes, where the eldest teenage child is caring for five to six younger siblings since the passing of their parents from AIDS.

A large number of the villagers are HIV+, taking antiretroviral therapy and attending CTCs (care and treatment centres) on a monthly or bimonthly basis.

On a Personal Note

The work I have been doing with the PHEs has been very interesting but at times challenging to see the reality of some of these villagers with limited money for medicines and resources, and family losses due to untimely deaths. Other challenges for me have included language comprehension as all communication is in Swahili with additional greetings in the local language of Kibena.

My basic Swahili ability is growing "pole pole" (slowly) with a dictionary and phrase book always at hand! The PHEs have been very eager to learn English as I am to learn Swahili, so we teach one another new phrases and words as we walk and talk throughout the day. I have been warmly welcomed into the household of Vumilia (a 25 year-old PHE) with her 5 younger siblings, her parents and all their extended family in the village.

We eat dinner by lantern light, eating traditional ugali (maize) or rice, beans, vegetables, boiled and sweetened milk from their cow, and meat from a freshly plucked chicken. I have helped to fetch water from the nearby stream, but have not yet learned the graceful skill of carrying the bucket on my head as all the women do here!

I have attended Lutheran church services where I have been deeply moved by the beautiful voices singing hymns and have visited a family in mourning over a loss of their one-year old infant to malaria.

The sense of community and family togetherness is very palpable in this setting, where everyone greets one another passing by on the streets, by homes and workers in the fields. The sincerity of the villagers is very special especially the smiles and laughter of the children, and the young infants bundled in a traditional African cloth on their mothers' backs.

Words of Gratitude

The PHEs have asked me to express their gratitude for the instrumental support from Royal Orr in Montreal, Canada who has helped to fund the cost of a bicycle for CHAKUNIMU. They now have a total of two bicycles which permits them to travel some distances along roads and paths to gain access to neighbouring villages.