REGALO DE DIOSCommunity Overview

OVERVIEW

• Community: Regalo de Dios

• A small community located in El Limón, Soyapango, just outside of the capitol

OVERVIEW

• The community is home to approximately 200 families, 800+ people

• Most families live on less than $3-5 a day

• Homes are three-room concrete block, steel reinforced homes, 600 sq. ft.

• RDD was founded after the earthquakes of 2001 and is made up of families from 7 different original communities

Temporary Housing/Refugee camp conditions• Families lived in

temporary shelters that measured 144ft2

• They were not so affectionately called “Microwaves”

• As the homes were being built, families shared these spaces as there was no where else to go

Divisions created challenges to setting up new community

• Community members were divided by the communities from which they originated

• Politics, as in almost everything in El Salvador, was and is a very strong cause of division in the community

Transformations Achieved

• Agents of Change– US Churches: Donors

and facilitator of community development

– Asociación A-BRAZO: Technical support and strategic alliances

– Mayor of Soyapango: Donor of land and basic services

Junta Directiva

• The community was able to establish one Junta Directiva (Community Board) which includes a legal representative and committees for community development

Permanent Homes and Community Participation

• Community members worked to build their houses and paid a small amount of the costs. Each family had a trained construction worker from A-BRAZO working with them

New Homes Completed

Elementary School

Community Center

Computer Center

Public Water Faucets: but water not always available

Families Line Up for Water During the Dry Season

Sewage Treatment Plant: Homes plumbed with indoor toilets/showers but no water to homes

Continuing Challenges

• Delinquency/Gangs• Drug and Alcohol

Addiction• Sexual & Domestic

Violence• Problems w/neighbors• Unemployment and

Poverty

Continuing Challenges

• Lack of education and health

• Disintegration of the family

• Immigration• Challenge to get

homes connected to municipal water

• Limited hours of water availability

Health Issues in the Community• Common health issues present in children in the

community include:• Respiratory Infections• Diarrhea• Dental Caries• Parasites; Scabies• Lead Exposure (adults work with lead)

• Anemia a concern of community• Diabetes/HPB in adults• Women’s Health Education

Access to Health Care

• The community has access to a Unidad de Salud that is approximately 2 km from the community

• There are 3 Unidades de Salud in Soyapango, a city of over 700,000 people

• The closest Unidad de Salud should serve 15,000 people, but in 2005 was responsible for 175,000 people

Access to Health Care

• Consultas are free, but medicine and exams done outside of the clinic are not

• Community members are often able to get to the Unidad de Salud but costs prohibit them from following up visits with medicine or further exams that have been prescribed

Current Projects by A-Brazo

• Other projects in the community include:• Tutoring and mentoring• Basic computer training for adults and youth,

including a leadership workshop and job preparation training

• An analysis of the strengths, weaknesses, and needs of the community (A-BRAZO) and development of a long-term development plan

• Ongoing work with the Junta Directiva

Future Projects

• Projects that are in the works:• Parenting Classes and Vocational Training for

youth by Pastor Alberto• Continued Computer Training, including Computer

Maintenance Training and further Job Prep• A scholarship program for high school and college

age youth• Recycling program/campaign by the community

youth• Composting and small-plot

gardening program

How had CHIMPS been a part of our transformation?

Partnership with CHIMPS

• 08/2007: Resident, Dr. Erica Freeman 1 month elective & screened for lead, Hb, ZPPH + health ed for lead abatement

• 01/2008: Resident, Dr. Katie Nielsen did nutrition education with community members; rescreened kids with Pb>10. (all had lower levels)

• CHIMPS screening for anemia and iron deficiency in Los Abelines, El Salvador

• Community concerns:– Anemia due to parasitic infection & poor

nutrition– Lead poisoning due to surrounding industry

• Highly-publicized closing of battery factory Record in La Libertad, El Salvador

• Point-of-care testing for ZPPH, hemoglobin and lead for 1-4 year olds

• Education for families of children with iron deficiency or elevated lead levels

• Iron therapy for children with anemia and/or iron deficiency

• Anti-parasitic therapy for those screened• Community-wide health ed. on parasitic

infection and nutrition• Direct collaboration with NGO/ community

• Took community census

• Scheduled all testing appointments

• Conducted all data collection and initial education with families using handouts

• Publicized community-wide health education slideshow

• Provided leadership & enthusiasm

• Testing results 55 children age 1-4 years – Seven children with hemoglobin < 11 (13%).– Six children with lead levels >10 µg/dL (11%,

range 10.5-20.2 µg/dL)– ZPPH greater than 80 in 3 children (5%)– Boys 2.3 times more likely to have a lead level

greater than 10 µg/dL (95% CI 0.31 to 4.5)– All children with elevated lead levels live with

adults who have occupational lead exposure

• Educational slideshows attended by over 100 community members

• Dr. Katie Nielsen returned to Regalo de Dios to undertake a health education project

• Taught “charlas” on health topics• Taught leaders how to use health charlas in

the community• Performed lead re-testing on all six kids who

had elevated BLL in September• All now had BLL less than 10 µg/dl

CHIMPS and A-Brazo

• Clarification of goals, desires, needs and capacity of each partner started 3/08

• Health is a new area of work for A-Brazo

• Systems and support structures related to health needed for A-brazo

• Amy Wagner, staff with A-Brazo, acts as on site CHIMPS Coordinator

November ‘08 Brigada Focus

• Groundwork for formation of an active Health Committee

• Education– Health Histories– Oral Health Charla– Nutrition Information– Screening for under/over wgt.

• Skills training

Health Committee Formation

• Idea Generation – What can a health committee do?

• Training of health committee – Charlas, health screening, community health needs assessment

Public Health Issues

• Women’s Health• Nutrition• Waste and

Sanitation issues• Water safety• Oral health

November ‘08 Brigada Focus

• Women’s Health Charlas– Menopause– Reproductive Health– Cervical, Uterine, and Breast

Cancer– Questions to ask the doctor– Etc.

• Youth Sex Education Charla

November 2008 Brigada

• Training for various members of the health committee on how to:– Take blood pressure– Measure height and weight– Calculate BMI– Take blood for glucose and

hemoglobin tests– Apply Fl varnish

Health Committee Members learn to give health history then take them

Learning to take vital signs

Measuring height accurately Calculating BMI

Oral Health Charla

Charla presentation Learning to floss teeth

Applying Fluoride Varnish

Learning to apply varnish Doing it on their own

Oral health interventions valuedHer own toothpaste tube! Who’s toothbrush is best?

Blood screening for glucose, hemoglobin, iron deficiencyYouth assist with testing Assistant applies bandaid

Meaning of test results explained to HC: they give health education

Test results reviewed HC learns results meaning

Nutrition health education follows blood testing

A-Brazo SWer does charla Learning about calcium

Women’s Health Group Shares Knowledge/Skills

The Pros Balance Water Yankee Docs Give a Try

Better Nutrition Options?Healthier offerings in local home stores (tiendas)

Utilizing small back yard plots for gardens

Results (Nov. 2008 Brigada)

• Screening of 191 community members (140 children, 51 adults)– Glucose– Hemoglobin– ZPPH

• 18 people with anemia

• 7 people iron deficient

• 2 people with diabetes

Results (Nov. 2008 Brigada)

• Good News– 87% Brush their teeth daily– 39% Do something to clean their water– 95% Use the bathrooms inside their house

• Bad News– 24% of children are malnourished– 43% of adults are overweight– 95% Have cavities

Supporting A-Brazo Staff in Health Screening/Counseling• Trained Staff to do BP, glucose, Hb• Set up medical record systems for Regalo de

Dios and Santa Elena families• Follow-up form /system for A-Brazo to do follow-

up testing and counseling• Connected A-Brazo with community pediatrician

& discussed plans to form local health advisory committee for A-Brazo

• Set-up Excel template for data entry by community teens in computer program

AwesomeTeen Super Stars

Plans for future work

• A-Brazo staff to help community continue screening of all 800 community members with screening clinics every 2 months

• Health committee starting planning of wellness activities they could conduct:– Walking/cooking clubs– Monitoring of weight/blood pressure

• F/U CHIMPS Brigadas 4/09 and 11/09

Thanks for all that you have already done for us!