Transforming Health in Impoverished Communities

Poverty and discrimination will frequently lead to poor levels of community health. Impoverished populations will suffer from both acute and chronic illness; children failing to thrive; and severe mental health issues leading to alcoholism, drug abuse, domestic abuse, and increased incidence of suicide. Nurses Christian Fellowship International works collaboratively with Partnerships in International Medical Education, whose aim is improving standards of healthcare education worldwide. Our current project is a pilot to demonstrate the impact that parish community health visitors can have on impoverished communities while supporting the work of the church. In 2016, a local priest from an impoverished city parish in Northern Pakistan approached me. He explained that it is impossible for a priest to meet all the needs of this poor, vulnerable, and demoralized community, where residents live in fear of discrimination and intermittent persecution because they are Christians. He wanted help in the parish similar to support provided by faith community nurses (FCNs). In this situation, FCNs would not have the option to work as volunteers. So, we proposed a project where young people from the community could be trained as healthcare workers. We call them parish community health visitors (PCHVs). This specific parish has approximately 30,000 people; our focus is on 400 homes in the poorest sector of the community. We selected 10 young adults—4 men and 6 women—and with donated funds, we supported them for 1 year of training as nurse assistants. Next, we identified a core team in Pakistan, including our program leader, a missionary nurse, a young male nurse with extensive experience and a master's degree in public health to act as the supervisor/field work instructor, and a Pakistani Christian nurse educator who assisted with the training program. The 10 trainees completed their nurse assistant course in February 2018. Because of the COVID epidemic, we were unable to deploy them immediately; however, we embarked on the PCHV training program using Zoom. This course consists of 100 hours of community education—the core knowledge needed to deliver basic health education and promotion in the community with a spiritual, holistic perspective. The theoretical teaching is followed up over 2 years by supervised practice where the nurse supervisor supports the trainees in providing health education and health promotion and continues to supplement their knowledge base. This is essential for when the PCHVs are faced with new situations or to reinforce the application of knowledge in practice. The parish community health workers served in mixed male and female groups. Their first task was to create home profiles for every household in their patch. These homes are visited monthly to follow up on health issues, give advice and support, and monitor health status. Blood glucose levels, body mass index (BMI), and blood pressures are taken as required. Mental health support is provided; any family member needing professional help is referred to the parish priest. Group sessions are held for patients with diabetes, encouraging self-care. Nutritional monitoring of children is carried out and dietary advice is given to parents; 60% of children are 2 years below their expected height/weight percentile. The home profile details are entered into a database, along with follow-up visits, actions taken, and outcomes identified by the PCHVs. These data are immediately transferred to a central database where the data are being analyzed by our researcher. In addition, the PCHVs maintain written accounts of their visits, recounting stories of successes and challenges in their work. This program is now expanding to a second diocese targeting 10 impoverished villages. Twenty-five young people will be supported to complete their nurse assistant course that began in September 2023. Our aim is to approach people holistically, as spiritual beings in the context of a community, not as isolated individuals. This is what we bring to the care of the people in our community and what we pass on to the young people who are carrying out their role as parish community health visitors.