Buddy Home Care Project

1. Background

Health And Share Foundation (HSF.) is working in rural area on primary health care and HIV/AIDS along the border Thai-Laos, Ubon Ratchathani Province. In the rural area the family structure has been changing, many families moved to the big city for working. They have left children at home with aging people. Those aging people sometimes don’t know how to raise and communicate with the children who would rather favor of playing internet and phone. They would just blame it. The absence of fostering circumstance has affected children’s behavior both in physical and mental health. Moreover, children are facing with many problems. In the year 2015, the HSF surveyed and identified 344 disadvantaged children in Khemarat and Huana Sub-district who are in difficult situations such as, 1) homeless 2) orphan 3) live in risky situations (drug, domestic violence, sexual violence, etc) 4) poor family (family income less than US$45 per month, 5) health problem 6) parent in prison 7) sing parent due to divorce, 8) disable children 9) discrimination and injustice problem, and 10) stateless or No ID number/non Thai.

2. Stakeholders

Recently, the Family Care Team (FCT) has been set up for taking care of households which have health problems in the whole country under the policy of Ministry of Public Health. The FCT works at three different levels, namely district, sub3district and community. The HSF has already experienced to work with the health staff at the sub-district level and with the village Health Volunteers (VHVs) in our project area. Some of the VHVs have been trained as a community caregiver and they visited home of the aging persons along with the health center staff. Because the FCT has not focused on capacity building of those disadvantaged children, HSF came up with an idea to work with them to join the home care project. The buddy is pairing a Village Health Volunteer or VHV and a disadvantaged child. They make home visits to the aging people. Through the activities of Buddy Home Care, VHVs play a key role in observing and supporting the disadvantaged children and their families. VHVs share information on how to access to social welfare and health services with the children’s family.

Apart from VHVs, we are also working on the project in collaboration with the Community Action Group (CAG) who represented five sectors in the community such as the 1) local government, 2) school 3) hospital and health promoting hospital or health center, 4) community based organizations and 5) administration. CAG have worked for the disadvantaged children in the community.

3. Working Process

Meetings were held by the VHVs and CAG to study the problems of the disadvantaged children and

screen them as project participants. We selected 20 children out of the target group (aged 10-15 years old), who are living in the community and available to join the project. Then, coordination among these children was initiated for them to attend the Buddy Home Care activity together with CAG. Meetings and capability building activities for children and VHVs are organized such as:

• Self-empowerment workshop. The purpose of which is to know each other and raise their self-confidence in order to be more capable in facing other people in their own community.
• Community analysis. At this point, children and VHVs analyze community health problems through community mapping and screening cases. They also learn about their roles as buddy home care. For instance, what they should do when they work as buddies for home care in the community
• Basic health skills training. They learn the concepts and acquire skills on basic health care and home care during the training. They are trained how to sponge bath the body to reduce the patient’s temperature, to turn over the body position, to change fresh clothes, and to do exercise and rehabilitation.

4. Plan and Prepare Materials for Home Visits

The Buddy team has to perform two main activities as follows:

• The Buddy team of a disadvantaged child and a VHV carry out home visits for the aging people in their community together with the hospital staff and CAG members;
• The Buddy team summarizes their activity and refers information to the hospital staff or to the social welfare office staff when they find a serious case that needs financial support, medical equipment and the likes.

 5.Achievements

Most of the aging people stay in bed all the time. Children’s visits made them smile and eased their stress caused by loneliness at home. The disadvantaged children raised their self-confidence and self-esteem as a result of doing home visits. They felt proud of themselves that they could work for others in the community.

The VHVs could directly support the disadvantaged children. They taught other children some life skills such as negotiation and bargaining skills, self-protection skills (to prevent them from being in a risky situation), problem solving skills (scenario making to draw concrete solutions in response to problems identified), and referral skills (for health and/or social welfare), and so on.

6. Lesson Learned and Next Steps
7. There are some challenges related to sustainability of the project. Some of the disadvantaged children cannot join the activities continuously because of family problems. Others have to take care of other family members while the parents work outdoor. VHVs want to invite other community people to understand the situation of the disadvantaged children and join the activity. They especially aimed for the village chief, hospital staff and others who are interested on volunteer work so that the project would take root in the community.
8. Screening the aging persons as the subject for home visit was mostly decided by the VHVs. They tell the children what to do, when they both do home visits. Because the VHVs mostly chose severe cases like dying, it affected the children’s mind. Some children were scared and did not know what to do while they were visiting. The children as they reflected realized that they want to join the succeeding home visits but doing something more appropriate for their young age. For instance, demonstrating how to exercise, helping to clean the rooms of the aging people, and other lighter tasks. The buddies need to be more motivated to stimulate discussion and decision making on whatever activities they have to do. In this leaning, each of the buddies might value their team even more.
9. For the home visits, environmental cleanliness and hygiene management is a big challenge. These include room cleaning, safe environment, and rehabilitation. It may also entail rail support for stand and walk signals.
10. The VHVs and the disadvantaged children still lack the skills of taking care aging people. In response to this discrepancy, we plan to prepare the handout on the basic health care and the typical diseases such as diabetes, hypertension and stroke. They are more prevalent among the aging people.
11. The aging people themselves or caretakers cannot manage to dose and /or administer medicine. The buddy team discusses with the aging people and the caretaker to prepare some medicine boxes. These boxes are more efficient for the aging people to get their medicine easily following the right dose, and the right time regularly.
12. For food, the children and the VHVs could give suggestions on what food is appropriate to eat for each patient at home.
13. Regarding exercise and rehabilitation, children could help to show how to exercise at home or encourage the patient and caretaker by teaching them how to do it with the help of a physical therapist.

Ms.Siriwan Arsasri
Health And Share Foundation (HSF.)