The Unsung Heroes in Public Health
In life we meet a lot of people — sometimes we easily forget about certain ones and do not remember their names or faces if we see them again. However, there are others who we meet and never forget because of the impact they have made in our lives. And we rarely realize the impact these amazing individuals have had on our lives unless we look back and reflect. Not to mention, there are people that make sacrifices so that others can benefit, and we do not always realize the sacrifices they made and the services they provided. Often times, we do not understand people and the decisions they make unless we have walked a mile in their shoes. We rarely think about what someone had to go through to show up and serve others, sometimes getting more work done and helping others with less resources than the people who have all of the resources at their disposal.
This story is about the unspoken and often unappreciated heroes in public health — those who go an extra mile amidst all the challenges to show their selflessness. These heroes put the community’s needs above their own, serving diligently and compassionately. A hero can be defined as a person who is admired for their courage, outstanding achievements, or noble qualities; this is a person who, in the opinion of others, has special achievements, abilities, or personal qualities and is regarded as a role model.
In a recent assignment in my work as a Global Health Corps fellow at Population Council, I had the opportunity to meet and interact with health providers in rural areas of Zambia. One of the health providers I interacted with, whom we will call Joseph, lives in Nsonga village, which is located about 73 kilometers from the Mansa District Health Office in Luapula Province. Joseph is unmarried and lives with two of his brothers and his nephew in a house that is 500 meters from the health facility. Joseph has been working at Nsonga Rural Health Centre for the past two years now, and he was posted there just after obtaining his professional certification as a registered nurse. Despite possessing this degree and skill set, Joseph thought he would be there for a shorter period of time, after which he would be transferred from the village to a nearby town. When he began his assignment in this community, Joseph did not have access to water or electricity. He got access to solar power just a few months ago. As for water, he uses the communal hand pump from the nearby school. As a side business and hobby, Joseph rears poultry that he sometimes sells to the locals to support his insufficient income.
The health facility is open 24/7 and serves the entire community of almost 5000 people, including at least 25 outpatient cases per day. As Joseph is the only qualified health care provider — despite his great enthusiasm and positive energy — he is overburdened by this role. He was recently joined by an environmental health technician (EHT) whose role includes planning and implementing environmental health inspections, enforcing public health statutes, ensuring timely implementation of pest control activities, and conducting environmental health awareness activities. The EHT is supposed to spend 80% of his working hours in the community and 20% at the facility. Because there is inadequate personnel at this health facility, the EHT is also learning to do some other tasks to help out and ensure that the facility is running. It is also of great importance to note that some people have to walk for approximately 40 kilometers in order to get to the health facility.
Joseph has to be at the facility everyday at eight o’clock in the morning; however, he is also always on call, meaning that he has to be available all the time to see clients since he is the only qualified health provider. He has to provide health services to all community members in the health centre, which lacks an adequate amount of resources. As the only health provider, he gets tired from working long hours with limited time to rest. On numerous occasions, Joseph has stayed up late in the labour room helping women deliver, yet he always manages to attend to other patients in the morning. The quality of work can sometimes get compromised, as he may have to tend to people when he’s tired. He has even had to conduct certain procedures and advise on certain areas in which he was not initially trained, such as long term family planning methods that he has to learn on the spot. He refers the clients to other health centres with more skilled staff in cases where he’s unsure of what to do. There is also lack of career development on Joseph’s part due to lack of free time. However, he has somehow managed some of these problems that he faces everyday by scheduling some activities to be conducted only on specific days hence improving some quality of work.
Over time, the community has placed its trust and belief in Joseph, both acknowledging that he is their only health provider, and feeling safe and confident in his skills and abilities to offer these health services. This is one of those rare moments that defines someone as a hero as he puts others’ needs before his own needs and keeps making these sacrifices every day without any expectations.
Early last year while at the health centre, Joseph met a 17-year-old pregnant woman who was in the active phase of labour, meaning she was roughly eight centimeters dilated and ready to give birth. Her case was touching because two weeks prior, she had lost her husband in a road traffic accident. He was coming back from the bank in Mansa, where he went to get his money for the maize he sold to food reserve agency. They had been married for less than a year. An ambulance would have taken approximately four to five hours to arrive to take her to the nearest hospital, so Joseph decided to perform the delivery himself. She came in around 18:00 hours and she gave birth to a male infant, whose body weight was 2800 grams and Apgar score was 1/10, at 21:45 hours. The baby was not breathing or crying. He was not active, and his heartbeat rate was below 100. Joseph called this condition birth asphyxia. The chances of the baby surviving were below par.
As a result of his training in emergency obstetric and newborn care, Joseph successfully managed to resuscitate the baby. He said, “It was a wonderful experience and feeling. I remember all the people who brought her, when they saw the baby, they all lost hope until they saw the baby breathing after a few minutes.” Joseph commented that he had resuscitated many babies before, but the feeling was exceptional in this case. Even now, when they bring the baby for under-five check ups, Joseph’s heart is filled with joy. With these skills and medical training, he has helped more than 20 babies. Joseph says he has faced many challenges, but being alone at the facility is something that has pushed him to work harder and be exceptional. Even when the whole situation was happening, he was alone at the health facility. Both the baby and the mother needed emergency medical attention, and it was not easy for him to deal with such a difficult situation. There is not really anything that can prepare one for saving a mother and an infant alone — if not for a big heart and passion for humanity. And if this is not what makes one a hero, then I do not know what does.
Not many people in the health profession would go to work in a place like this, but Joseph made a choice to serve a community that needs these kinds of services. Without his constant dedication and effort, would that child have survived for a year? Probably not. But Joseph sacrificed without expecting anything from this family in return. All he wanted was for the child to get well. He is just one of the many unsung heroes who work to bring health services closer to the people. Joseph and many others use their creativity and energy daily, often sacrificing their personal resources for the communities they serve. They put career development on hold as they have no free time. They spend little or no time at all on vacations. They have limited time for their own families. They spend their time with eyes fixed ahead on the road leading to the health facility, knowing they have to be alert for any emergency. Public health requires these people — people with courage, commitment, and passion to keep serving their communities.
A big shout out to all the unsung heroes in public health!
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