News and Events: Projects

Pilot Project Report: Youth Health Promoters - Salacat

NOTE: Also available in a Word format.

Introduction

Salacat, a Centro Poblado of Sorochuco with about 400 families, is located northeast of Cajamarca City, the capital of the department of Cajamarca. It is accessible by poorly maintained dirt roads with a four to nine hour journey, depending upon the time of year. There exists a kindergarten, grade and high school, and a health post which is currently attended by a nurse. About half of the population has access to electricity, and the majority have access to water from a pipe during the rainy season. The community has an active parents' group (APAFA), a water committee, a mayor, governor's representative, and local judge, among other small government authorities. The nearest health post manned by a doctor is about an hour's walk away, or thirty minutes by car, while the nearest hospital is a two and a half hour drive from the community. The majority of the population survive on subsistence farming, while a few have small businesses of making and selling cheese, maintaining a small local store, or buying and selling livestock.

The largest health concerns in Salacat include malnutrition in all ages, especially those of school age, poor hygiene, bronchial infections, and work-related injuries. Due to malnutrition combined with poor hygiene other ailments occur, including diarreah, flu, common cold, and bronchial infections. Bronchial infections are largely caused by poor ventilation in kitchens where fires are used to cook. However the bronchial infections are exacerbated by the poor nutrition and hygiene habits of the community.

Lack of knowledge about these important issues is due not to ignorance of the inhabitants, but a mix of poor education, lack of government programs, difficulty in changing habits, and lack of resources.

The Plan

What

To fill the niche of health education in rural towns such as Salacat in an efficient and sustainable manner, Youth Health Promoters would learn the basics about health, especially focusing on issues important to teenagers. They would be required to help spread the general information to the rest of the community by their own designs of formal education techniques, which they would learn. On top of the duty of helping diffuse information, they would act as peer counselors to fellow community members, especially other teens, acting as leaders in the community. Therefore this pilot project's main goal is to provide classes to train Youth Health Promoters in the community.

Goals

1. Youth will have a basic knowledge of health themes, especially in the areas of sex education, puberty, self-esteem, nutrition, hygiene, pregnancy, basic illnesses, environment and first aid.
2. Youth will feel comfortable with and spread the health knowledge to the rest of the community.
3. Youth will make personal behavioral changes in their own lives in accordance with what they have learned in the classes, reducing incidence of disease and teenage pregnancy.

Who

MEJORC hopes to enlist 20 students in the Youth Health Promoter (YHP) classes between the ages of 14 and 18.

When

Consent from parents will be gained during the first week of classes which begin May 31. Classes are held Wednesday and Thursday 6-8pm and Fridays 3-5pm. The exam will be taken on the 6th of July and the Graduation Ceremony, during which certificates will be rewarded, takes place the 7th of July.

Where

Classes will be held in two of the school classrooms depending on availability each day. Permission was received by the director of the grade school, as were keys to one of the classrooms.

What

Topics covered will be:

• Integral Health
• Education
• Communication and Counseling
• Self-esteem
• Puberty
• Alcohol and Drugs
• Basic Illnesses
• Sex, Gender and Sexuality
• High-risk Pregnancy
• Healthy Pregnancy
• Nutrition
• Hygiene
• First Aid
• The Environment

Among these topics, students will learn to speak in front of a group, critical thinking skills, leadership, and self-esteem. They will graduate comfortable with spreading their new knowledge to others. They will, in fact, have homework of preparing parts of the class and presenting topics, in turn.

How

The classes will be carried out mainly by Katie Masferrer and Lucio Correa Camacho, a local graduate of the last series of Youth Health Promoter Classes held in Salacat. However, the help of the local health post, the House of Promoters, and members of CARE Peru will be solicited. Also, the last class of health promoters trained in Salacat in 2006 will be asked to come help present classes and encourage the students by talking about their experiences.

Projected Costs

We hope to not have to charge students anything for their entry into the classes. This will of course depend on MEJORC funds.

The breakdown of costs for this project are:

Item: Cost: Preparation-----------------------2 days= 60 1 teachers copy of book= 10 1 notebook= 5 SUBTOTAL= S/.75 Personnel-------------------------6 weeks x 3days/week at 30 soles a day = 540, x 2 people= 1080 + 2 people x 6 trips to and from Cajamarca at 20 soles a trip = 240 Help from locals in clases, 10 soles/day x 7 days = 70 SUBTOTAL= S/.1390 Books-------------------------------67 pages x .10 soles = 6.7 soles per book Also an extra 3soles for binding per book 9.7 soles per book x 20 books = SUBTOTAL= S/.194 Pens---------------------------------1 pen x 20 students x .50 soles per pen = 10 soles + 5 dry erase markers at 1 sol each = 5 soles + 10 soles of misc. markers/pens SUBTOTAL=S/.25 Paper--------------------------------20 cartulinas at 1.50 soles each =30 soles + 20 papelotes at 1 sol each = 20 soles SUBTOTAL= S/. 50 Misc material----------------------Eggs = 5 soles Paint = 10 soles Whiteboard = 10 soles Balloons = 1 sol Trash Bags = 5 soles Prizes = 50 soles Props = 10 soles SUBTOTAL= S/. 91 Evaluation-----------------------3 days= 90 1 travel= 20 SUBTOTAL= S/.110 TOTAL = S/. 1935 = $552.86 (using $1= S/.3.5)

Conclusion

After training 20 students in basic youth health topics, we hope that they will in turn teach others what they know and encourage them to practice better health habits, which will subsequently lead to healthier communities. The youth health promoters will also offer the community youth someone to talk to about problems, as the YHP will be trained in Peer Counseling. The youth will receive certificates proving the validity of their knowledge once they pass the exam, which will give them more authority in their community.

If this project goes well, another class of 20 students will begin and run through August, with appropriate changes made through gained knowledge and experience. Possibly the second group could be from another zone. The costs would likely remain quite similar.

Evaluation

Classes were not held in Sorochuco because of lack of participation in that town, and therefore Salacat was given the opportunity to provide the numbers necessary to hold classes there. Although the numbers dwindled with time, the ultimate desire to learn in a community like Salacat makes project development much more likely, as well as continued participation from the students.

Only 15 students originally signed up for the classes and of those only 8 graduated, 4 of whom were female. Participation by other groups was not solicited due to lack of time and availability.

Scores on the preliminary exams arrived at an average of 33.7%, with the highest score being only 69%. The most difficult topics for the students were education, healthy pregnancy, nutrition, and appropriate treatment of diarreah. After the classes, the average for the exams was 74.2%, a 120.5% increase in scores. In the second round the most difficult topics were recognizing affects of different drugs, education, and diarreah treatment, although both latter topics did improve dramatically over the preliminary exam. In turn, the best topics ended up being self-esteem, nutrition, hygiene and healthy pregnancy.

The budget for this project was more than enough to cover costs mostly because less than the projected 20 students were found to complete the program. With the lowered costs, some extra was used to bring in the new coordinator so that he could gain experience in this type of project. However, $88.25 was still leftover.

1. Youth will have a basic knowledge of health themes, especially in the areas of sex education, puberty, self-esteem, nutrition, hygiene, pregnancy, basic illnesses, environment and first aid.

Results: basic knowledge of the above themes from the beginning to the end of classes increased 120.5% based off of the exams given. All students who finished classes passed the final exam.

2. Youth will feel comfortable with and spread the health knowledge to the rest of the community.

Results: When asked, the youth felt very confident in at least a few of the major themes, to be able to spread the knowledge they gained in those areas to others in their own family if not in formal education methods to the entire community. Future interviews will be given to determine if this goal is met fully.

3. Youth will make personal behavioral changes in their own lives in accordance with what they have learned in the classes, reducing incidence of disease and teenage pregnancy.

Results: Although not enough time has passed nor sufficient information gathered to adequately answer the question of whether this goal was fulfilled, some basic changes were seen in the daily life of many students, especially in the areas of leadership, self-esteem, and hygiene.

Student feedback

The students thanked MEJORC for the opportunity to learn health themes that are important to them. Although they learned a lot of these topics in high school, all but one student affirmed that learning these topics in a fun and comfortable environment led them to learn the topics more easily and with more detail. The students expressed gratitude for the opportunity to learn these topics, especially that of sex education and puberty, which is rarely talked about in the campo, and often remains a mystery to both girls and boys leading to more experimentation or fear of intimacy.

A suggestion was made to divide the group into age groups, so that the topics covered would be more appropriate for the age group. For example, it was suggested that the topics covered were more appropriate for between 12 and 16 year-olds, whereas another class of more technical disease prevention and treatment would be greatly appreciated by all members of the community for members ages 16 and up.

Personal Reflection

The strongest suggestion for future Youth Health Promoter projects is to take more time to assure strong participation not only by the community, but by other organizations, and to be sure that the classes do not coincide with local festivals. Without the help of other organizations, and the fact that I, as one of the teachers was busy with so many things each week and missed a number of the classes myself, resulted in the classes feeling more disjointed, unorganized as well as less enjoyable. Confusion about class times, the rules about missing classes and trying to squeeze in a lot of information to make up for lost classes made the learning environment less conducive to integrated understanding of each topic, although the more motivated youth did a fantastic job of sticking with it.

Although the idea of having two separate age groups and technical levels of health education is a great idea, having basic knowledge first is important. Further classes for general community health promoters would require much more attention to detail and would not be able to cover basics. In the future community health promoter classes could be held for those youth which have already completed the youth health promoter classes and have had a few years to demonstrate their level of activity in the community in that capacity. In the meantime, the age group is still important for up to 18 years of age, which was reflected in the primary exam results.

In the future, having two local teachers should be hired instead of my trying to be a part of the classes too much, because I was not able to be present for many of them due to illness and traveling difficulties. Also, the teachers should be chosen not just on knowledge of the subjects, but also based on their leadership position within the community, the respect the other youth have for them, and their ability to make the youth feel comfortable. A sense of humor, being motivated by the desire to make a difference in the youths' lives, as well as the ability to make strict decisions, are extremely important qualities.

Recruitment for the classes should also be conducted in a more responsible way, making sure that everyone and their parents are aware of the requirements, rules, and expectations of students before they sign up. This would help lower the attrition rate, which was 47% during this pilot project.

A permanent and dependable location for classes is a must in the future so as to avoid confusion with the students as to whether or not classes are being held. The classes should not coincide with local festivities or participation will drop off significantly, and having classes during school breaks is even more desirable.

Also, in future youth health promoter projects, more preliminary data should be collected so that comparisons can be made within the community as a whole over time, such as teenage pregnancies, disease, malnutrition, and stability of emergency patients when they arrive at the health post.

In general the project was successful in spreading key information to students who finished the classes and graduated. Although mastery of the subjects was rarely attained, the amount of knowledge in the key topics increased dramatically. With further support by MEJORC coordinators and the local teacher, they should continue to work together toward the goal of spreading that knowledge to the rest of the community.