Report on Community Health Worker program, al-Aida and al-Azza refugee camps
S. Komarovsky, JVP Health Advisory Council
al-Aida and al-Azza refugee camps in Bethlehem are two of the oldest refugee camps in the world. They began in 1950, and currently house about 7,500 individuals from 27 different villages. The camps were hit particularly hard by violence and suppression during the second intifada, which the communities still feel the effects of today. Health 4 Palestine’s Community Health Worker (CHW) program was developed after the findings of a focus group conducted in the camps concerning health, healthcare, and barriers to receiving care in early 2018. The focus groups found that the community’s major concerns for health were diabetes, hypertension, COPD/asthma, depression, and cancer – the major causes of mortality and morbidity in the region. Access to care for these non-communicable diseases was found to have a complicated web of barriers. The occupation of the West Bank, widespread poverty, distrust in the health systems and its providers, trauma, and lack of individual agency were found to obstruct access to adequate care. Poverty, psychological trauma, and unemployment are high due to the occupation and corruption within the Palestinian Authority. The health systems accessible to the camp are disjointed – the only UNRWA dedicated clinic in the area is 4.5 km away, which users describe as inadequate care with regular stock outs of essential medicines. Ministry of Health clinics are viewed as slightly better, though this creates financial barriers. Instead, many utilize both clinics in spite of the lack of integrated information systems between them. Many patients end up with conflicting diagnosis and treatments, often with issues of polypharmacy.
The CHW pilot program began in March of 2018, utilizing social accompaniment and social medicine models of health and health care. The pilot began with 6 CHWs (3 teams of 2) from the camps who were trained in testing and treatment for diabetes and hypertension, as well as social support and coaching on facilitating behavioral changes. The Lajee Center, a community center in al-Aida, houses the project. An international team consisting of doctors, activists, and CHWs from Harvard, Brigham and Women’s Hospital, and Boston University lend expertise and oversight in helping to steer the project. The hope was that by engaging individuals around two of the most prominent noncommunicable diseases, with straight forward treatment recommendations, the CHWs would begin to develop community agency and support for health and self-determination within the camp.
The program, which began in April, has recorded unbelievable success. Their caseload grew from 10 to 60, a direct result of the need, desire, and excitement for this project. CHWs were being sought out by members in the community for medical support on the streets. Many of their patients have begun to adhere to their medication prescriptions, have changed their diets, reduced smoking, and have sought treatment for other ailments due to their referrals and support. One family I witnessed saw a man with diabetes and high blood pressure drop from 90 kilos to 60 kilos, reduce smoking from 4 packs to 1 pack a day, and is figuring out a medication routine that works. The woman of the house’s blood sugar level has changed from poorly controlled diabetes (of 15 years) to under good control. They have developed medication charts, helped with medical translations in the clinic, and have, as I saw in one home, “brought good fortune” with a phone call from a participant’s son from administrative detention.
CHWs are not a new idea, though within the context of the occupation this program is unique. The ailments that patients describe are a direct result of the occupation – the high cost for fresh produce, stress from living under military rule (“Why do I have hypertension? Five of my six sons are in prison! One of them was released last week”), and a disjointed political health system that does as little as possible for refugees. The goals of the program are both to scale the project up (first to train more within al-Aida/Azza, then to other Palestinian refugee camps) and for the organizing for advocacy. By developing a program around health and self-determination within the camp, there is hope of generating a community base to help begin a new wave of resistance within the camp – run by those most affected by the occupation and consolidating collective power through the effects on their community’s health.
CHWs, managers, and international partners work to develop plans for care at a participant’s home.
The Aida an international team participated in the Social Medicine Conference at Berzeit University in the Summer of 2018. Ramallah, West Bank
Two of the CHWs advocating for their program at the Social Medicine Conference at Berzeit University in the Summer of 2018. Ramallah, West Bank.