June 21, 2010

by Beth O'Connell
East Tennessee State University
College of Public Health
Cygera, Rwanda

beth_rwanda photo_family

Health Education            

Health education has been quite a success at the local high school. The Senior 3 class was very interested in and had many questions about the previous HIV/AIDS education. I based the next class on their questions. The following week I chose malaria as the topic because of its prevalence in the area. The students were misinformed about transmission of malaria. They thought that it was transmitted through unsafe drinking water, as so many of the other common diseases. I think that this may have been a communication error in previous education about removing stagnant water which breeds mosquitoes.  I continued health education in the general paper (essay) classes which I mentioned in my last update.   Students have turned in the required information on their selected health topics. The topics they could choose from were as follows: malaria, food contamination, safe water, community safety, and HIV/AIDS .  The students’ personal experience stories are educational for me and very eye-opening to the severity of these community health problems. The quality of their work varies widely. Ensuring that each student learns has involved individual study sessions after school hours. The students know where I am staying and come to visit me for help, sometimes voluntarily, sometimes by my request. I am in the process of grading the papers and discussing the topics with them. It has been helpful to the students to spend so much time discussing major health concerns in their community. This education has served a total of 112 students. Teachers also learn and ask questions.

Hand Washing and Water Treatment

My hand washing campaign has transitioned from group audiences at the school and church to individual homes in the village.  Each home visit has involved education through a translator and giving of written instructions in the local language and providing soap. I have also been providing each home I visit with a water treatment liquid produced by U.S. Aid. This treatment kills many of the biological contaminants in the local water. Some people are familiar with the product and its use, but are unable to afford it; others have not seen the product before.  I have provided an amount which should treat drinking water for an average family for one month.  This is only an estimate, because the bottle does not say how much water it will treat.  The instructions only say how much to use one cap-full for twenty liters of water.  Also, family sizes vary largely.   The education at each home includes information about boiling water as a method of killing contaminants.   They do not have a word for boiling, so I have explained that they must cook it until bubbles cover the surface for several minutes. This outreach into the community required the permission of the village elder, Anastasie Mukabashanana. We met and discussed my plan, after which she gave her blessing for the home visits. I then began the campaign with the village leader, giving her the items and education. She or one of her aids has been accompanying me on the home visits. The people in the village have been very receptive and thankful and this has been a rewarding experience.  A day of visits involve several hours of hiking at a time in significant heat; the terrain is hilly and the footpaths are rough.  The living conditions and lack of education are staggering and these visits have been incredibly educational for me.  We have visited 72 homes, which housed 332 people.   The local church congregation was also given this water treatment product.  There were 115 participants at the church, many of whom will share the liquid with families at home. This is a total of 554 participants in the safe water education. There have been a total of 706 participants in hand washing education to date. The difference in the two numbers is 112 high school students.  They are benefiting from bio-sand filters, and therefore were not given the water treatment liquid.

Bio-sand Water Filtration

Following up on the bio-sand filter installation project, I have overseen the “feeding “ of the bio-layers daily.  The Rwandese Health and Environment Project Initiative (RHEPI) that originally installed the filters has been helpful in continued maintenance. On Tuesday June 8, a RHEPI representative returned at my request to investigate slow flow rates of four of the filters. Other minor maintenance has been required, which I have performed with guidance from RHEPI.   Four of the filters are currently working well, with flow rates of about 0.7 liters per minute.  RHEPI will be returning soon to replace the sand in the one that is still flowing poorly.  After I leave, the school secretary has promised to maintain the two located at the school. The administrator at the children’s home will maintain the three there. The major maintenance is required during the initial setup, and further maintenance should be as simple as using the filters daily. Should there be problems, the school and children’s home have my contact information and the contact information of RHEPI.  On Friday, June 18, I travelled to Kigali to visit the RHEPI office to investigate options for future projects through partnership with them.

Malaria Prevention

I continue to work toward protecting the children and caretakers of the Faith and Hope Children’s Home from the hazards associated with mosquitoes and other insects.  I again sprayed the homes again with insecticide one month following the initial treatment as recommended by the manufacturer.  Also, I paid for and arranged the replacement of two broken windows to avoid insect entry into the homes. Communicating with a technician for such a project to specify exactly what needs to be done and how much it will cost can take several hours. I will spray the homes again in one month and have instructed the home administrator about using the insecticide after I leave. Also, to make the screening over the windows more permanent, I have hired a local technician to put wooden frames around the screening. Spiders have become more prominent with the change of seasons, so the efforts to avoid mosquitoes have also been useful in avoiding the spiders.


In doing all this, I have educated myself as well. The interventions and education that I have done in the last two weeks have been predominantly beyond what I have learned in classes at the College of Public Health at East Tennessee State University. I have used my skills on how to find information, which I learned in various classes while doing papers and projects. The World Health Organization and Centers for Disease Control and Prevention websites have been excellent resources for lesson plans at the school. I just happened to notice the water treatment liquid at a store one day and then looked into it. Communication has continued to be a necessary and difficult skill to use. This includes communication with the people I am educating with community gatekeepers and people all helping me.  I have learned that attitude and creativity is very important in accomplishing a task.  Many times, it has been up to me to come up with ideas and find a way to make them happen.  Motivational skills and a positive attitude have been necessary to do this.

My field experience has been very busy and successful so far. I look forward to seeing the results of some of the interventions that will produce tangible results soon. For example, the bio-sand filters will be producing drinkable water beginning July 4. I also look forward to continuing health education at the school. Despite challenges, this experience has been very educational and rewarding. I am excited to see what the rest of the internship holds in store for me and for the village of Cyegera


June 21, 2010

by Brittany Latimer
Lipscomb College of Pharmacy
Namwianga, Zambia

brittany latimer_zambia 1

Day One: The Clinic

This is my first time traveling to Africa, so for me it is a very exciting time.  I wanted to have a very open mind, but I had no idea what to expect.  In only a week I have discovered so many cultural differences.  The main differences I noticed were time, transportation, and friendliness.  In Zambia the people are not concerned about being punctual.  The people are never in a rush and they don’t mind waiting.  As compared to a pharmacy in the US where people want their prescription filled in fifteen minutes or less.  Mostly everyone walks to where ever they need to go since gas is about $9 a gallon here.  Also you have to be a great visual learner and use a lot of landmarks to remember where you’re going because there are no street signs.  There are just a lot of dirt paths that start to look the same.  The Tonga people are so friendly and peaceful.  Zambia is very peaceful, and the people greet you wherever you go.  Here everyone looks out for one another and it feels very much like a community. 

One of the biggest differences that I have noticed is healthcare.  I saw this first hand when I went to the healthcare clinic in Namwianga.  The clinic opens at 9 am, after the workers morning devotional, closes for lunch from 12:30-2 pm and then closes for the day at 4 pm.  They are open from 9-12 on Saturday and only open for emergencies on Sunday.  My first day there I worked in the pharmacy with another Lipscomb pharmacy student, John Deason, and the dispenser, Michelle.  They don’t even have a pharmacist, just a dispenser which is the equivalent to a pharmacy technician.  A dispenser has to school for two extra years after high school and has a general knowledge of the medications.  Once a patient sees the clinical officer they go straight to the pharmacy with their prescription and the dispenser fills the prescription.  They don’t collect any payment. 

Recently there was a new law made that any patients that come to the clinic do not have to pay.  They do not pay for medicine or to see the “doctor”.  This has made things quite difficult because the clinic basically runs off donations since they do not receive that much money from the government.  Therefore the pharmacy is very under stocked since they only receive one shipment at the beginning of the month.  They have less medicine than two shelves of medicine in a pharmacy in the United States.  Once they run out of medicine they have to do their best to substitute it with something else or the patient is out of luck.  They only had a couple of antibiotics.  For example if a prescription is written for Amoxil (because most of the prescriptions are in brand name, not generic) and the medication is not in stock, it will be substituted with Chloramphenicol.  Sadly, chloramphenicol is only reserved for very serious infections and is more of a last line agent because of its toxicity.  However since it is so cheap it is used a lot in third world countries.  Since they have so few resources they can’t take a lot of factors into consideration when choosing an antibiotic.  Although it may not be the optimal treatment, I am just thankful that at least the people here are getting some form of treatment. 

The most used prescription was paracetamol (which is also known as acetaminophen) because most people carry packages on their head or back if they’re not carrying their babies.  Some diseases don’t even seem realistic to treat here in Namwianga since it is a very rural area.  HIV/AIDS patients seem almost impossible to treat at an optimal level.  They send workers from the clinic out into the villages to try and get people to come into to get their medicines.  Also it’s hard to keep medicines in stock, because they have little money to work with.  Most people don’t have refrigerators.  After a suspension is mixed up for a child it is supposed to be stored in a refrigerator, but what do you do if you don’t have one?  We are just so blessed here in the United States.  Yes we may spend the most money on healthcare than any other country and still not have the best outcomes, but we have so many more resources and are so blessed.   

Day Two: The Patients 

The second day at I was at the clinic I observed the clinical officer working.  You may be asking yourself what is a clinical officer?  A clinical officer is equivalent to a physician’s assistant in the United States.  They don’t have many doctors here, so clinical officers serve as doctors and are at the highest end of the spectrum.  There are normally two clinical officers on duty but since one here at Namwianga is on leave, we are left with only one.  As soon as the clinic opens there is already a line of about five to ten people long.  Each patient has an exercise book where the clinical officer and nurses chart.  They keep all the patients vital signs in there along with their diagnosis, prescriptions, and any notes that they may have.  Once the patient has seen the doctor and/or gone to the pharmacy they turn their books back into the record room where they are kept. 

The clinical officer’s door is always open so patients don’t receive much privacy unless it is a highly sensitive issue.  One major difference is that an entire family will come in to see the clinical officer as opposed to parents seeing their personal doctors and their children going to a pediatrician in the United States.  It’s much easier for the family but it can be somewhat of an inconvenience

There were a lot of patients coming needing wound care or complaining of previous wounds.  There were three very memorable experiences that stuck out in my mind.  The first experience involved a man’s two young sons.  The younger son was less than 10 years old and had an inguinal hernia.  He was referred to a hospital in order to have surgery to repair the hernia.  The older son had a form of warts that started all the way in his left armpit, migrated up his shoulder onto his neck, onto the left then right side of his face and onto his chest.  He has had the warts since birth, but it has been spreading over the years.  The second experience included a lady who was in so much pain that she was doubled over and had to be carried out of the car to a wheelchair into the office.  She looked very emaciated and it was very unnerving to see her in so much pain.  She was HIV positive and possibly even had AIDS.  She had not yet started on her antiretroviral drugs and since she was in such critical condition she was referred to the closest hospital for treatment.  One woman came in with a prolapsed uterus and had to also be referred to a hospital for surgery.  There are so few resources that after the clinical officer examined the woman on the examination table he wasn’t able to change the sheets. 

The line of patients seemed to be never ending.  No matter how many people the clinical officer managed to see, the line only seemed to get longer.  The dentist had to take ten to fifteen patients in order for them to be able to get through all the patients in time.  The Clinical Officer had no reference materials in order to double check his initial diagnosis or to check the dosing of a medication.  He totally relied on his memory for everything.  He also didn’t have a peer that he could consult.  He was pretty much on his own.  It was quite an interesting experience to see firsthand.  The staff at the clinic has very few resources to work with, but they make do with what they have and try to do their job to the best of their ability. 


June 21, 2010

by John Deason
Lipscomb College of Pharmacy
Namwianga, Zambia

John Deason_pharmacy in zambia

           This is my first blog posting on my trip in Zambia.  I’ve been in one week so far but it has seemed much more.  Things operate so differently from how they do in the states, especially if you have never left the country!  My first taste of Zambia was really on Sunday since much of my first day here was just spent traveling.  We traveled to a small village called Kasibi where we attended church.  It was one of the most humbling services I have ever attended.  The church was no larger than the den at my parents’ house (and we don’t have a huge house).  On the walls were either tacked or duct taped posters depicting Jesus or various biblical events.  Most looked like they were thirty-plus years old and were very weather worn.  The roof was tin and full of holes.  I doubt very seriously that it kept the congregation dry during the wet season.  The benches were small and old with no backings and were only long enough to truly fit four grown men tightly. 

            Despite the meager appearance of this place, the verse “that where three or more have gathered there [God] shall be” never rang truer.  I cannot describe the absolute joy I felt the entire time I was there, from the time I was greeted in Tongan (their local language) song, to our dismissal by circling the church and having all members in attendance shake each others hand in Zambian style (which is much easier to show rather than describe).  What delighted me most was that we somehow fit 100 or so individuals in this place!  There was no room to even breathe!  I could only think how wonderful it was that so many craved the word of God. 

            Afterwards we traveled back to the village where they had prepared a traditional meal (rice, chicken, and cabbage) and had their village band play us some beautiful music on their makeshift instruments.  All of the local children gathered around the band and danced in a circle.  It’s amazing how even the children of this country have more rhythm than those that get paid to teach it in our country…

            My first taste of the clinic came on Tuesday.  All I can say is I’m not in the States anymore.  I was taken back how much they can do with absolutely nothing!  The people having a prescription for Amoxil (a very common antibiotic) had to be dispensed Chloramphenachol instead!!! For those that don’t know, in the U.S. this has been reserved as a last line drug for serious infections where there is nothing else you can give due to it being so difficult to tolerate.  In essence, we have such a richer health system we can afford drugs with much better side affects while the people in Zambia have to take whatever they can get just for a sinus infection.  It was heartbreaking…

            I wish I could say the pharmacy was the only department in need, but it didn’t stop there.  The triage station (that they called the OPD, or Out Patient Department) took the vital signs of each patient wanting to see the clinical officer (Zambia’s version of a PA).  The ear-thermometers they used to get the temperature didn’t operate that well in the cold and had to be kept in the nurse’s pocket to keep it warm enough to work.  In addition, they were out of disposable covers so the tips were caked with earwax because they didn’t have enough alcohol pads to clean them in between patients.  They had only one size needle for all injections (23 gauge) which could be a little painful even to the tough patients. 

            God has certainly led me to a country of his people great in need.  I can only pray that I can be his humble servant and give back the blessing that God has bestowed me to his children he so dearly loves.


June 17, 2010

by Katie Skelton
East Tennessee State University
College of Public Health

All is going well here in Urubamba, Peru where my day begins at 4:45 am each morning. I wake up, get dressed, grab a quick bite to eat and head to the local bus station to catch an early bus to the local villages. By the time I arrive in the communities, it is 6:30 am. It is imperative for us to arrive in the villages as early as possible as the village families work in the fields in the morning so we must arrive before they set out for their daily routines.

For the past few weeks we have gone house-to-house to gather as much information as possible from the local communities. The purpose of our survey has been to determine the main health problems in the area. Our surveys are now complete and after many grueling mornings, the results have been analyzed. The problems are vast: nutrition, diarrhea, intense cough, lack of health education, and more. We have determined that the most pressing issue in the area surrounds none-other-than water in terms of both availability and quality.

The Sacred Valley is affected by water in every imaginable way. It impacts every area of their lives from health to their daily activities and jobs. Sadly water here is rationed and is turned off at different times of the day for various parts of Urubamba. I personally have experienced the effects of the lack of water; there have been stretches of days when I have been unable to bathe because water has not been provided to my home. As you might expect, I am unable to drink the water or eat anything that has been washed with it. Regrettably a number of my co-workers have become sick due to infections from drinking the water.

Although life here in Urubamba is impacted by water, the effects in communities fifteen minutes away are even more devastating. The majority of these families rely upon agriculture for their sustenance. Without water their crops will not flourish, they cannot give water to their animals, nor can they cook, clean, or do normal daily activities.

To obtain clean water these families must purchase water from a truck that makes trips to the area and of course, this is not enough water for all of the families. Aside from the shortage, this water is expense and families must also carry the water home.

From our surveys, we pinpointed many of the recurring health issues of the approximately 180 families in our target communities. Many of their problems are related to fecal-oral contamination, giardia, and other parasitic infections. People are treated for their illnesses but quickly experience re-infection as a result of drinking dirty water. To help solve many of these issues, I am currently working on a proposal to provide water filters to each of the families in our target population. These filters will allow families to have clean water free of parasitic infections. Through focusing on water we are hopeful we can help improve the health status and quality of life for the residents of the Sacred Valley communities.


June 15, 2010

by Jenny Eaton Dyer, Ph.D.

frist at global health gathering 6.14

Last night, Hope Through Healing Hands hosted a meeting for local, Tennessee global health nonprofit institutions, universities such as East Tennessee State University, Vanderbilt University, and Lipscomb University, and faith communities to gather for an authentic sharing of stories, interest, and work.

Senator Bill Frist, M.D. keynoted the event, discussing the unique city of Nashville, as a hub for health care, music, and faith, and how these 50 organizations might intersect especially with the faith communities given a shared global interest in caring for the widow, protecting the orphan, and over all – loving our neighbors – even if across oceans.

Jars of Clay, an amazing group of men who have been longtime activists in the movement against the HIV/AIDS pandemic, shared the stage with Senator Frist. They sang an apropos song for the evening, Two Hands. Dan Haseltine, the lead singer, spoke eloquently about his longtime vision of a unified front of global health advocates in Tennessee who might work together, hand in hand, to face the issues of global proportion. Their experiences and work have led them to found Blood:Water Mission, a Nashville-based nonprofit focused on building wells in Africa. In terms of raising awareness and advocacy in the United States, together we are stronger.

The goal of the evening was to allow a space for the coalition representatives to genuinely get to know their fellow colleagues better. Hope Through Healing Hands’ hosted small group sessions for a sharing of goals, missions, and work as a beginning for deeper relationships beyond the meeting. We want to encourage a robust network of friendships and partnerships among the global health community, especially for those times of global crisis and emergency relief.  

We wish to offer a special thanks to Brentwood Baptist Church for kindly offering us a facility, gratis, to host the event. We look forward to the inclusion of more faith communities and their involvement in the global health coalition in the future.

jars of clay 6.14global health gathering small group 

June 14, 2010

by Brande Jackson

We were greeted by enthusiastic fans and volunteers in Detroit, which made for a great night! We talked to lots of people, including several who were interested in volunteering and becoming involved with the campaign on a local level and on their campuses, something we always like to hear.

Our volunteers consisted of two ‘teams’ of people: Stephanie and Nicole, sisters on their summer break (from college and high school) and our team of enthusiastic high school girls: Erica, Emmy, Betsy and Marissa. Our crew did a great job, talking to lots of people and getting them excited about bringing clean water to people around the world. We were a bit limited in what we could do in Detroit due to the way the venue was set up, but our volunteer crew were true troopers, making the most of it and getting a record number of fans to take part in our text message fundraising campaign.

We loaded up our stuff and got on the tour bus bound for Pittsburgh the next day. Saturday morning we were greeted by the tour crew worried about thunderstorms that never actually materialized (we seemed to be blessed by the weather fairies this tour, knock on wood!) so we set up somewhat concerned, but forged ahead. Unfortunately, we didn’t have any volunteers joining us that night (Pittsburgh - we need some people, sign up and join! www.waterequalshope.com/volunteer) but we made the most of it, signing up lots of new supporters and raising money to bring a needing community a well. Fans are really excited about this idea, really responding to the notion of the Paisley & country music fan base being able to create clean water for those that need it through the combined small actions of many over the course of the tour. While walking the lawn before the show, I talked to lots and lots of people who were really excited about what Water = Hope is doing, so we are eager to get community efforts moving in Pittsburgh as well!

After loading out once Brad was finished Saturday night, we were surprised to find Josh Thompson and some of his band setting up for an impromptu midnight bluegrass session next to our bus! Josh is a big supporter of Water = Hope, not only taking part in our PSA but always ‘re-tweeting’ our Twitter posts and helping to spread the word on Facebook, and he’s a great musician and all around nice guy. It was a great way to end a wonderful weekend!

We’ll be back out again this weekend before we take a break while the tour goes to Europe. We will be in Darien Center (Buffalo and Rochester regions of NY) and Philly on Friday and Saturday  - as always, we’d love to have you sign up and volunteer!


5 New Frist Global Health Leaders: Summer '10

Honduras, Peru, Rwanda, and the Appalachia Region

We are excited to report that 5 new Frist Global Health Leaders have traveled this summer and are beginning to report back their great work from around the globe. This includes public health education for hand washing, dental hygiene, HIV/AIDS prevention, and clean water.

Three students from ETSU College of Public Health are currently in foreign countries, and two students from ETSU College of Public Health are at home, in the United States, Appalachia Region.

We invite you to learn more about them in our NEW Frist Global Health Leaders Program section on our website. We have included photos, biographies, and links to their current blogs we are posting daily. Simply go to the continent where they are located and  click on their country. You can learn a little bit about the country they are in as well!

We will have 2 more Frist Global Health Leaders from Lipscomb University leave within the month for Zambia. Stay tuned.  

Here are some sample blogs from students around the world:

Donate Today: We would be honored if you would consider donating to our Frist Global Health Leaders Fund today. Consider a contribution to fund students, residents, and fellows to practice health diplomacy in underserved communities around the world.

Thanks for your support,

JED signature 

Jenny Eaton Dyer, Ph.D.
Executive Director

June 8, 2010

by Brande Jackson

Cincinnati Water=Hope vol crew 

Photo: The Cincinnati Volunteer Crew!

Toledo proved to be a small but mighty show; though at one of the smaller venues on the tour, fans came out in force to support Water = Hope! We signed up hundreds of new supporters while also collecting donations for our very popular Water = Hope tee-shirts (you can soon buy them online as well - watch for updates!). We also got nice mentions in the local press, the Toledo Blade, and we were even featured on a local country radio station as well. 

After the show friday night, we headed out on the tour buses bound for Indianapolis, our Saturday show. Cloudy skies hung around all day in Indy, threatening to open up, but we set up our booth and moved forward with fingers crossed. We were joined by a great volunteer crew; Lea, Justin, Matt, Kayla and Chelsea all work together and came to the show together. It was one of their first volunteer experiences, and they did great, signing up lots of people AND getting a chance to meet and talk to Josh Thompson, one of the artists performing on the tour. 

Cincinnati turned out to be the best night we’ve had on the tour yet. Our amazing volunteer crew helped us sign up close to 800 new supporters for Water = Hope! Aaron, Andrea and Kaitlyn are all high school students, Michael and Ashlynn are college students, Karen and her husband David are local Cincinnati residents, and Gayenell brought her entire family to volunteer! The team did an incredible job, even engaging in some friendly competition (for a prized Water = Hope hoodie!)  to see who could sign up the most supporters; we were very amused of their ‘tracking method’ which involved marking off completed sheets on their arms! Ashlynn proved to be the final winner of the night, signing up an amazing 160 new Water = Hope supporters, though Michael was a close second with 135. All of our volunteers worked incredibly hard to make our evening in Cincinnati a huge success. 

Talking to the fans each night is always inspiring; the Paisley and country music community is eager to lend their voice and to invest in clean water initiatives. One of our favorite groups of people were the ladies of the “Waters of Dillsboro Retirment Home”; they all work together at the retirement community outside of Cincinnati and were super excited about the Water = Hope campaign, insisting several times that we promise to email them about volunteer opportunities they can do as a group! 

This week we’ll be in Detroit and Pittsburgh and are looking forward to talking to fans there. We already have some great volunteers signed up for those shows that we can’t wait to meet, but we do still have room for more volunteers to join us, visit our volunteer page to learn more: http://www.waterequalshope.com/volunteer/


June 7, 2010

by Brittany Cannon
Roatan, Honduras
East Tennessee State University: College of Public Health

brittany cannon 3

Since my last report I wrapped up the dental health screening data collection and educational project because I simply ran out toothbrushes.   By the end of this process 508 children were educated on the importance of dental health and 600 toothbrushes were given out.  I have compiled my findings and the results are significant and should validate the request for funding continuation of this program. The local dentist’s hope is to receive funding to make it possible for him to put sealants on the children’s six year molar so they will be less likely to decay, which in turn, would prevent the extraction of this adult tooth. I will now be assisting him with the grant writing process.   Hopefully, future screenings will reveal a positive change in the dental health of the children of Roatan.

My next project involves HIV/AIDS education and I will be traveling throughout the island with doctors who are doing HIV/AIDS screenings and I will be involved in the educational aspect of these programs.  There is barely a basic knowledge of the disease or how it is spread and a huge stigma surrounds those with the disease. The people of Roatan place considerable importance on family and community. However, if a family member has HIV/AIDS and the family finds out about it,  that member is banished from the household and the family unit. Because of fear of losing one’s family, many people do not get screened for HIV/AIDS leading the doctors I am working with to believe the prevalence of HIV/AIDS on the island is much higher than is evident.  Also, commercial sex is quite a problem here which contributes to an even bigger HIV/AIDS issue.  It is my hope that through this education program we can reduce the prevalence of HIV/AIDS on the island and also mitigate the stigma that surrounds those with this disease.

Once again, I want to thank the Hope Through Healing Hands Foundation and the Niswonger Foundation; this is truly an experience of a lifetime.

June 7, 2010

by Beth O'Connell
Cygera, Rwanda
East Tennessee State University: College of Public Health

Beth Oconnell 1

Hand Washing and Community Health Education

The hand washing campaign has continued with 78 high school students participating.

I was given a very challenging task of educating high school students at the local Kiruhura Christian College on health topics. This proved to be a challenge because of the language barrier and lack of resources- the students had no text books and there is a very limited supply of pens, paper, and chalk.   Nonetheless, the task was accomplished successfully and  I was asked to teach during Biology for the Senior 3, Senior 4A, Senior 4B, and Senior 5 classes.   In these classes students range in age from 15 to 38 years of age.   Biology class meets for two hours per week, one hour on Tuesdays, and one on Wednesdays. I chose to teach the Germ Theory of Disease with hand washing during the first two classes.  To evaluate understanding and effectiveness, they took a quiz whereby six of the eight students scored perfectly, and two answered three out of five questions correctly.   I believe that the students understood the topic well and their incorrect answers were due to language barrier.  

The second week, I taught the same students about HIV/AIDS. This discussion included general information including how HIV is transmitted  and ways to prevent transmission.

Because of attending an organizational meeting in Kigali on June 2, I have not given the HIV quiz yet. I plan to do so during next week’s class. I was pleased that the students asked many questions and I plan to continue teaching about HIV/ AIDS next week.  Handouts and quizzes were kept simple due to language and cultural barriers.   Also, printing resources are limited so materials were limited to one page or less.  

For the General Paper classes, I asked each student to choose from a list of health concerns in the community, or to propose a health related topic of their own.   The list provided included Malaria; HIV/AIDS; hand washing and hygiene; clean water; food contamination, and community safety. They were to include definition of the problem, causes of the problem, importance, how to prevent the problem, and any personal experience they have had with the problem.   These classes meet for two hours per week, but it is common in Rwanda for students to be absent frequently.   I left materials with the teacher of each class to give to absent students. These students were required to take quizzes and turn in assignments the following class.

Despite these challenges, I  anticipate excellent results from these classes.  These students are the future of Rwanda  and educating them on health will improve the health of the community for years to come.  I also expect a ripple effect as the student share their knowledge with their family and friends outside of school. I have no means of assessing this ripple effect, only the assessments of the individual student’s knowledge after each education session. These assessments are the quizzes given in the biology class and the essays written in the general paper class. I plan to continue teaching on health topics in the school.

Bio-sand Water Filtration

On June 4, the Rwandese Health and Environment Project Initiative (RHEPI), installed five bio-sand water filters and educated those who would be using it on proper use. At the advice of RHEPI representative James Rubakisibo, three filters were installed at the Faith and Hope Children’s Home, one at the girls boarding quarters at the Kiruhura Christian College, and one in the school cafeteria. 

There are currently thirty girls and no boys at the school’s boarding quarters.    I am happy to report that all the students will now be able to drink clean water at lunch due to these filter systems.  Installation of these filters is the product of my research, contacting filter providers and on-going communication since December 2009.  This began with researching types of filters with  Bio-sand filters removing 95-99% of bacterial, viral, and protozoan contaminants. If you are interested,  you can learn more at http://www.biosandfilter.org/biosandfilter/index.php/item/301.

While bio-sand filtration is not very effective in removing chemical contaminants, the primary concern in the community of Cyegera is microbes.  Bio-sand filters are very simple to use and require little maintenance and for these reasons seemed the best choice for this community.  I then began contacting organizations that build bio-sand filters; CAWST of Canada responded to my request for information with clarification to determine if bio-sand filters were truly the best option for Cyegera.

Once they were satisfied, they referred me to RHEPI and  James Rubakisibo. James and I discussed pricing, when the filters would be available for the instillation, education, and other details of a contract.

The filters require one month of daily feeding before the bio-layer is completely functioning. RHEPI provided education about bio-sand filters prior to installation to those who would use them.  Staff of both the school and children’s home assisted in the installation so that they have an understanding of how the filters function.  Unsafe water has been a serious problem in this area, and I look forward to seeing a reduction in water-related illness at the school and children’s home.

Other  activities

In addition to the health education and water filtration, I have been busy with community and organizational events.   As mentioned, I went with the site administrator, to a meeting in Kigali. The meeting was a strategy and information-sharing meeting among administrators of various sites. I also participated in a government mandated community work day.  These work days occur the last Saturday of every month. This work day was spent breaking ground for an additional building at the local school. 


I have reached 259 participants in my hand washing education campaign; my original goal was 300 participants so I am well on my way to meeting this objective.  I met my objective concerning environmental analysis and interventions during the first week and described in my May 25 report. I have also educated a total of 112 students on several of the major health concerns of the community.

I have met the objective of installing five bio-sand water filters and will continue to look for opportunities to expand these objectives as most have already been achived.  

Please view the chart below for a  summary of the work the Hope Through Healing Hands Foundation and the Niswonger Foundation are helping make possible in Rwanda.




Intervention/ Education



# of participants or people affected 

May 25-26



Germ Theory Education






May 26



Hand washing






May 26



Topics of Concern in Community Health






May 27



Topics of Concern in Community Health






May 29



Community work day






May 30



Prenatal vitamin education






May 31



Topics of Concern in Community Health






May 31



Hand washing education


(class S4A)







June 1



HIV/AIDS Education






June 2



Organizational meeting






June 3



Hand washing education


(class S5)







June 4



Bio-sand Water Filter Installation and Education (Children’s Home)






June 4



Bio-sand Education (Girl Boarding Students)






June 4



Bio-sand Water Filter Installation and Education (School Cafeteria)






June 7



Topics of Concern in Community Health






Daily since June 4



Bio-sand Water Filter Feeding






Daily since May 19



Meal logs for future analysis







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