Tajikistan Maternal and Child Health Program

Quarterly Report #10 Reporting Period: January 1, 2011 - March 31, 2011

Cooperative Agreement # 119-A-00-08-00025-00 Submitted by: Mercy Corps –

TABLE OF CONTENTS 1 Acronyms and Abbreviation…………………………………………...………………. 3 2 Project Overview and Progress towards Objectives….………………………….….... 4 3 Status of Activities………………………………………………………………...……..7 3.1 Community Development…………………………………………...………...... 7 3.2 Behavior Change Communication (BCC)………………………..…………....8 3.3 Child-to-Child (CtC)………………………………………………...…………..9 3.4 Safe Motherhood…………………………………………………..………….…9 3.5 Integrated Management of Childhood Illness (IMCI)……………………….10 3.6 Water, Sanitation and Hygiene………………………………………….…….11 3.7 Monitoring & Evaluation activity……………………………………………..12 4 Planned vs. Actual Status of Activities………………………………………………..13 5 Constraints/Challenges…………………………………………………...……………14 6 Technical Assistance…………………………………………………...……………....14 7 Conferences/Workshops……………………………………………………………….14 8 Success Story: The man of the time………………………………………..………….15

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ACRONYMS & ABBREVIATIONS

ARI Acute Respiratory Infection BCC Behavior Change Communication CHE Community Health Educator CHL Centers for Promotion of Healthy Lifestyles C-IMCI Community Integrated Management of Childhood Illness CtC Child-to-Child DIP Detailed Implementation Plan DOH Department of Health – Sughd Oblast & District levels EPC Essential Prenatal Care ETS Emergency Transport System Feldsher Lowest level of healthcare worker, a medic FGD Focus Group Discussion Hukumat District-level government head IMCI Integrated Management of Childhood Illness Jamoat Local sub-district government structure (several villages per jamoat) MCH Maternal Child Health MOE Ministry of Education MOH Ministry of Health of Tajikistan – national level OB/GYN Obstetrics & Gynecology Specialist PPD Post Partum Depression RCHL Republic Centre for Healthy Lifestyle RRS Regions of Republican Subordination SBA Skilled Birth Attendant STPHCO Strengthening Tajikistan Primary Health Care & Outreach SIDA Swedish International Development Agency TB Tuberculosis TJS Tajikistan Somoni TOT Training of Trainers USAID United States Agency for International Development VDC Village Development Committee WHO World Health Organization

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This is the tenth quarterly performance report for the third year of the Mercy Corps and USAID Tajikistan Maternal and Child Health (MCH) project, covering the period of January 1, 2011 through March 31, 2011 under Cooperative Agreement #119-A-00-08-00025-00.

2. PROJECT OVERVIEW AND PROGRESS TOWARDS OBJECTIVES

Project Overview: Over the five-year implementation period, the MCH project aims to reduce infant and maternal mortality by improving the health of women and of children under the age of five years. Mortality rates in some districts of the Sughd Oblast in northern Tajikistan are among the worst in the country. The project is in its third year of implementation in the Asht, , Spitamen and (old) and , Taboshar, Gonchi (new) districts of Sughd Oblast and in the Hissor district of the RRS Oblast. As the target districts are considered to be underserved areas, the MCH Project encourages greater government engagement regarding the issues of mother and child health and promotes the adoption of healthy behaviors and key interventions. The project expects to benefit 220,068 people (127,231 women of reproductive age and 92,837 children under five). The goals and objectives are to be achieved by building the capacity of district level Department of Health (DoH) while addressing the challenges of sustainable and quality service delivery, and promoting behavior change and community mobilization. The main objectives of the project are as follows: 1. Increase the percentage of mothers of children under two years who practice improved feeding, caring and health-seeking practices. 2. Increase the percentage of women who receive adequate maternal and newborn care. 3. Increase the capacity of the DoH facilities to deliver quality maternal and child health services.

Progress towards Project objectives: Progress has been made towards the all above mentioned objectives as well regarding all project activities as per the project plan, especially, in the area of capacity development of health workers and communities to deliver quality maternal and child health services.

Project proceeded further towards the first objective of increasing the percentage of mothers of children less than two years who practice improved feeding, caring and health-seeking practices at the household a multi-media based Behavior Change strategy has been followed in this quarter as well. Behavior Change Communication (BCC) activities engaged particularly local media in the dissemination of health messages. Mass media such as Mastchoh TV and Gonchi Radio was engaged to deliver messages about the mission of the project and the education session on HIV/AIDS. These messages reach to the deep pockets of population even in the hard to reach area. Mercy Corps began collaboration with the Mastcho District Newspaper office and published a special article providing basic information about the project’s goals and objectives. The use of mass media along with the interpersonal communication and support group interactive communication is a proven strategy to have more synergy for behavior change.

The Child-to-Child component, compliments strongly, the first two objectives of the MCH project as proven under the Sugdh Child Survival Program. The CtC model involves training a teacher in each school, who then recruits or selects a group of 10th and 11th graders with

4 | P a g e leadership skills. These students become “student-trainers,” transmitting key messages to very young students or peers through age-appropriate activities such as songs, plays, and games. Under CtC project, staff conducted education sessions for Student-Trainers on Hygiene and Sanitation in twenty-six schools and on Pure Water in twenty-three schools of Hisor district. Student-Trainers also conducted an assessment for Hygiene and Sanitation among school children in the target schools. While some messages focus on behaviors the young children control themselves, such as personal hygiene and sanitation, there are also activities which inspire the children to promote certain healthy behaviors with their families such as use of purified water, handwashing, or other health issues. The student-trainers become engaged in health promotion outside of school as well. They remind families about immunizations, visit households to invite women to participate in educational sessions, assist the VDCs with clean-up campaigns, or notify health workers of sick children needing medical care which is a form of referral.

There has been sustained progress regarding the third objective of the MCH project in regards to the increased capacity of the DoH health facilities’ staff. Under the Safe Motherhood component a series of monitoring visits to maternity facilities in remote areas of Gonchi and Mastcho districts were conducted. A series of training on Community Integrated Management of Childhood Illnesses (C-IMCI) was conducted with support from the regional IMCI center. The trainings consisted of theoretical and practical sessions focusing on households and provided advices and recommendations to be given mothers on childcare. The main focus was tracking the results of training with joint visits with specialists from the regional and district centers to monitor and support the practices of trained health providers on Safe Motherhood. It was reported that in some remote areas, the maternity houses (Mujum village of Gonchi and Zarafshon community of Mascho district) were closed due to lack of basic conditions for Safe Motherhood: the facilities were cold; the emergency kits were not in place and there was no water available. Mercy Corps MCH project has prepared a list of such facilities in the program area with the needs for the repairs and refurbishments to explore any additional resources.

To complement the improved knowledge and behavior change the MCH project has a small component of budget allocated for priority improvements in the public water and sanitation facilities such as toilets in the health facilities and restoration of dysfunctional water supply system etc. The engage of community through VDCs, Jamoat, School administration and health staff at the facilities as well their full participation contribution in constructing/improving these facilities is central to this component. All water and sanitation related activities were coordinated with the USAID Environmental Compliance division and pass the compliance criteria for mitigation of impact. Water and Sanitation activities progressed successfully within the four Maternal and Child Health districts this quarter. The project handed over the construction of fifteen latrines and rehabilitation of one health center to the Health Centers of target districts. The reconstruction of a drinking water pump line has started in two targeted districts of MCH. For example in the Jamoat of Dalyoni Bolo a two-hole latrine was constructed and handed over to local Health Center authorities with the participation of VDC members and Jamoat representatives and almost 100 health facility visitors would be benefitting from this project.

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Improving access to information is one the most effective ways of promoting adoption of healthy practices. The project encouraged the publication of informative article on HIV/AIDS in the local newspaper of Gonchi district about preventive ways of HIV/AIDs, importance of having test after returning from migration for men and how the infected person should be treated by others. This newspaper is available to almost everyone within the community.

Monitoring activities: During this reporting period, focus group discussions (FGD) were conducted to asses the Impact of Activity Planning training among Village Development Committee (VDC) members in all MCH districts. Findings show that VDCs played a key role regarding social activities such as Hashar, anti-natural disaster activity, cleaning of irrigation canals and hygiene and sanitation issues in the process of community development. For example, one of the participants said that “After a natural disaster, in which the main bridge of the community was totally destroyed by the mudslide, it was very difficult for the schoolchildren to go to the school. Fortunately the bridge was reconstructed by the initiative of VDC and contributions from community members.” Project also conducted FGDs with school children 3rd to 6th grades within the Child-to-Child project in to assess the school children’s knowledge, attitudes and practices on certain topics concerning health such as, Safe drinking water, Diarrhea, Worms, Hygiene & Sanitation.

QUARTERLY DATA FOR USAID PRIORITY MCH INDICATORS

(Indicates progress in quantitative terms towards the objective two of MCH: Increase the percentage of women who receive adequate maternal and newborn care)

Health Facility based data: 2011 Indicators January February March Total

1 Number of 1173 1127 1219 3519 deliveries with a SBA 2 Number of 1135 1089 1181 3405 women receiving AMSTL 3 Number of 1155 1109 1203 3467 newborns receiving essential newborn care 4 # cases of child pneumonia treated with 392 354 245 991 antibiotics by trained facility staff

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5 # cases of child diarrhea treated 67 39 68 174

Community and health facility based data: 2011 People received January February March Total training under the program 6 Maternal/newborn - - 9951 9951 health 7 Child health and 10588 10683 2587 23858 nutrition

3. STATUS OF ACTIVITIES

3.1 Community Development During the first quarter of 2011, education sessions on Acute Respiratory Infection, HIV\AIDS, and Care and feeding for pregnant woman were conducted in the MCH districts. All trainings was based on cascade methods (Program staff to field staff and field staff to CHEs and medical workers) The community members have welcomed the new information on proper care and nutrition practices important for pregnant women. Local medical staff and VDC members help CHEs to conduct these sessions among the community.

Training of trainers on Birth Planning was conducted for MCH staff in the four newly targeted districts. As part of the training, participants learned how and why to prepare a birth plan. MCH field staff subsequently taught birth planning to 467 VDC members. As a follow-up, each VDC has taken up the responsibility to organize emergency transport as per the need and assist pregnant women and their families to complete a birth-planning matrix. The purpose of increasing knowledge in these key areas for the target population is intended to promote better care for pregnant woman, to change behaviors regarding pre-natal care visits, and provide important information regarding danger signs during pregnancy and after delivery. Each committee depends on population will be organize number of emergency transport for delivery pregnant women and children with dangers signs to the health facilities.

Highlights of Community Based Activities:

Health education sessions in the program reached a total of population of 41 097.

CHEs made an average of 1 045 home visits per month and referred an average of 228 persons per month to health facilities for

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3.2 Behavior Change Communication

Identity and ever improving self-esteem are key drivers for sustained motivation among the Community Health Educators. Program banners for Community Health Educators were distributed among CHEs in Tajik and Uzbek languages for display during the educational sessions. The banner indicates the name of the project, the donor’s name, project goals and objectives. The process of installing Community Sign Boards with information about the project in each community is ongoing. The Community Sign Boards will include information about project goals and objectives, description of donors of the program, accomplishments within the community, and CHEs and VDCs accomplished activities. Approximately, 23,000 brochures on Danger Signs for Mothers and Newborns were also distributed among the target population.

Action against Tuberculosis was conducted in all 8 Maternal and Child Health target districts. The action devoted to the TB prevention day is organized every year on the 24th of March all over the world. Participants of this action were community members, youth, the Village Development Committee members and Community Health Educators. Different competitions, including questions and answers and quizzes were organized with the winners receiving gifts. The presenters used banners and posters prepared by the Healthy Life Style centre.

3.3 Child-to-Child The Child-to-Child project has conducted education sessions for Student-Trainers on Sanitation and Hygiene in twenty-six schools of Hisor district. In total, 390 Student-Trainers and 47 teachers were trained. There were also classes conducted for Student–Trainers on Safe Drinking Water in twenty-three schools of Hisor district. In total, three hundred fifty two Student-Trainers and forty-two responsible teachers were trained in these areas. The main purpose of conducting education session for Student-Trainers is to teach younger schoolchildren on the health issues and prepare future Student-Trainers out of schoolchildren. In addition, this project organized monitoring assessments in target schools of Hisor and Taboshar districts with the help of Student-Trainers. The main purpose of monitoring was to assess behavioral attitudes of the students concerning ‘Hygiene and Sanitation’. During this reporting period the CtC component with the support of the Sugd Department of Education, Mercy Corps conducted Focus Group Discussions among school children 3rd to 6th grades within the Child-to-Child project in Asht district. The main purpose of carrying out the FGD was to assess the school children’s knowledge, attitudes and practices on certain topics concerning health such as, Safe drinking water, Diarrhea, Worms, and Hygiene & Sanitation. The Mercy Corps is planning to cover 65 schools of Asht district under the CtC project.

3.4 Safe Motherhood The Safe Motherhood component focused on tracking the results of training with organized joint visits with specialists from the regional and district centers to monitor and support the practices of trained health providers on Safe Motherhood. A series of visits were made to maternity houses in remote areas. It was reported that in some remote areas, the maternity houses (Mujum village of Gonchi and Zarafshon community of Mascho district) were closed due to lack of basic

8 | P a g e conditions for Safe Motherhood: the facilities were cold; the emergency kits were not in place and there was no water available.

During this quarter, two discussions were organized concerning two cases of maternal death that occurred in January 2011 in Mastchoh and Gonchi districts. In connection with these cases Mercy Corps together with Sughd Department of Health organized working groups to investigate the causes of these deaths. The working group consisted of experts from the Regional Center for Reproductive Health, an obstetrician-gynecologist, an anesthesiologist, specialists from intensive care and transfusion units, a laboratory physician, and an infectious disease specialist of the district centers. The study found that both cases were preventable; 1) if the family members knew about the danger signs of pre-eclampsia, 2) timely hospitalization and availability of transportation 3) availability of qualitative medical care (Gonchi). 1) Not being registered in any village committees or hospitals. 2) If covered by the contraception method 3) Lack of qualitative medical care. The main reason for two death cases are: in Mastcho is due to sepsis and in Gonchi eclampsia . There were a number of shortcomings at all three levels in the death cases (family, community and health facility). Lack of laboratory test equipment and trained professional also came out as potential barriers to the care. In addition, the age of the district laboratory equipment dates 35-40 years. Monitoring activities were conducted in Gonchi, Mastcho and Hisor district in order to track the introduction of Safe Motherhood on management of Post Partum Hemairage (PPH) hypertensive problems, physical deliveries and antenatal care. During the next quarter, the introducton of training on Standards during critical obstetric situations for doctors and trainings for midwives on pre-birth preparation and provision of counseling are planned.

3.5 Integrated Management and Childhood Illnesses The third component (the third component of IMCI which is called Community IMCI (C-IMCI) is working with community mothers with children under five years. Aims to provide consultations feed and care the baby. The third component of IMCI prepare trainers (4-days trainings, TOT) and conduct education sessions in the community on the topics like diarrhea, exclusive breastfeeding, complementary foods and care and development of baby) of IMCI has been further rolled out with trainings conducted in Gonchi district. The total number of participants included 15 people, including mid-level health workers and mothers. Trainings on the third component of IMCI were prepared and conducted by trainers including the supervisor from the Sughd IMCI Center. The training consists of both theoretical and practical segments. The theoretical section included training information in 2 manuals and booklets; 1.Manuals for teachers, 2.Module to consult the mothers, Booklets for preparing complementary feeding. The practical component took place at households where participants learned how to offer advice and recommendations for mothers or other caregivers of childcare. The results show that the post test materials were distributed by all participants who were very active. The program schedule was well prepared and at the end of the training all participants received certificates. Each participant was provided with a complete set of training manuals and copies of records for further work at these sites.

The course includes key preventive measures: ➢ Advising mothers on feeding and care for development.

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➢ Support on breastfeeding, including the correct techniques of breastfeeding and timely complementary feeding management. ➢ Care for development ➢ How to give fluids ➢ Identifying danger signs - Consults on child health Impact: After completing the training, the trainees will be able to quickly assess the existing danger signs in a child and how to fill the sick child forms. The participants will be able to accurately advise mothers and other caregivers about nutrition and care of the child. This activity is intended for the purpose of improving people's knowledge and bringing about positive changes in behavior of beneficiaries. During February and March 2011, monitoring visits were conducted in Hisor and Mastchoh districts by the district IMCI monitors and directors. In total, 7 health facilities and 13 health care providers were monitored.

3.6 Hygiene, Water and Sanitation During this quarter, the following projects were accomplished under the Hygiene, Water and Sanitation component in four MCH districts and handed over to Health Centers authorities with the participation of VDC members and Jamoat representatives. The projects were supported by MCH project as well as by community member’s contributions and heath points approximate 50- 60 visitors would benefit from these projects:

Gonchi district: The construction of latrines has been completed in the health centers and medical points of seven villages in Gonchi district. Also, the project completed the reconstruction of the health center in the village of Khujaho in Gonchi district.

Mastcho district: The construction of a latrine project was also completed and handed over in three health centers of .

Taboshar district: In two health centers the construction of latrines has been completed and handed over in Taboshar district.

Hisor district: The construction of latrines has been completed in three village health centers of Mastchoh district. The Hygiene, Water and Sanitation project was also completed. In general, construction of fifteen latrines and reconstruction of one health center were handed over to the health centers.

Projects Underway: The construction of three latrines and garbage point re going on in the health centers of Gonchi, Mastchoh and Hisor districts. In these three mentioned districts, the construction work is almost complete and will be handed over next quarter.

Projects started:

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The construction of L=380m drinking water pump line has begun in the health center of Taboshar district. The same project with L=120m drinking water pump line has also started in the health center of Hujum village in Hisor district.

3.7 Monitoring and Evaluation activity Program monitoring and evaluation is an essential tool for strengthening and managing the projects. It is used for accountability, decision-making, program improvement and looking at the efficiency and effectiveness of projects. During this quarter, a Focus Group Discussion was conducted on the Impact of Planning activities among Village Development Committees in four Maternal and Child Health Program districts. The main purpose of conducting the FGD was to evaluate the impact of Activity Planning training that was provided by the local partner organization, ‘Ehiyo Farhang va Tarakiyot’. The findings showed that VDCs played a key role in regards with social activities such as Hashar, anti-natural disaster activity, cleaning of irrigation canals and hygiene and sanitation issues. For example, one of the participants said that ‘After the occurrence of a natural disaster, in which the main bridge of the community, was destroyed totally by the mudslide, big problems resulted for the schoolchildren to get to the school. Fortunately the bridge was reconstructed by the initiative of VDC and contributions of community members. The next step for developing capacity building of VDC member is to organize training sessions on Community Mobilization for VDC members as the findings show that apart from successes in working closely with community members the VDC member still face challenges and difficulties in mobilizing community members in the process of community development. With the support of the Sugd Department of Education, Mercy Corps conducted Focus Group Discussions among school children in the 3rd to 6th grades within the Child-to-Child project in Asht district to assess the school children’s knowledge, attitudes and practices on certain topics concerning health such as, Safe drinking water, Diarrhea, Worms, Hygiene & Sanitation. It also provided an opportunity to introduce the CtC program to the sixty-five schools of Asht district.

4. PLANNED VS. ACTUAL STATUS OF ACTIVITIES (January – March 2011) The Following table is from the DIP and lists all the planned activities for the last quarter with comments indicating the status of each activity.

Activity Comments

January February March

Technical and management training for paid staff x x x Ongoing Cascade training on Care & Nutrition of Pregnant x x Completed women & Birth Planning Monitoring activities continuation and new districts x x x On-Going FGD survey for VDC x Completed FGD survey for CtC project in continuation district x Completed

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(Asht)

Child-to-Child (CtC)

Comments

Feb Mar Activity Jan Develop brochures, modules, handouts by topic x x Completed Training for teachers in Hisor and Taboshar x x x Ongoing Training for high class student-trainers x x x Ongoing Training for school children x x x Ongoing Mid-term test for student-trainers x Completed M&E of project activities x x x This is a continuous activity Monthly meeting with partners x Ongoing meetings with DoE

Maternal Newborn Care

Activity Comments

Jan Feb Mar Follow up support visit x x x Ongoing

Safe Motherhood training based on national standards x x x Conducted in Mastcho & Gonchi Roundtable meeting with DOH trainers-monitors & x x Completed representatives from the government Joint Monitoring visit with MoH & DoH x x Completed

IMCI and Childhood Illnesses

Comments

Feb Mar Activity Jan Monitoring of medical workers x x Completed Roundtable meeting with MOH, DOH & trainer x Completed monitors C-IMCI training x Completed

Community Based Activities

Comments

Feb Mar Activity Jan Community mobilization x x x Ongoing Cross visits for CHEs, VDCs x x x Ongoing Creation of community sign boards x Completed Printing of danger signs brochures for beneficiaries x Completed Puppet show activity x Ongoing Visibility for CHE x Completed

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Mass media collaboration in district level x x x Ongoing

5. CONSTRAINTS/CHALLENGES Despite the achievements highlighted in this report, some challenges were faced by the project. For example, under the Child-to-Child component, authorities of some schools did not give permission to conduct sessions for Student–Trainers during school hours, and asked Mercy Corps to conduct the lessons after 1:00pm. The school authorities expressed concern that the CtC lessons may affect their schedule of other normal school lessons. School authorities and Mercy Corps are negotiating to find a creative solution. During monitoring visits to some remote villages, maternity houses in the Mujun village of Gonchi and Zarafshon community of Mastcho districts were found to be closed as they lacked basic conditions necessary to provide care for pregnant mothers, for deliveries and for newborn babies. The maternal facilities were cold; emergency kits were not in place and there was no water. These substandard conditions in the maternity houses might affect the project's outcome.

6. TECHNICAL ASSISTANCE Mercy Corps’ Program Officer for Monitoring & Evaluation participated in the Mission Metrics (Mercy Corps Design Monitoring and Evaluation initiative to track data and progress crucial to its mission for its programs worldwide, including health programs) online training and completed the training successfully during this quarter. The training was organized by the Design, Monitoring and Evaluation section of Mercy Corps. Mission Metrics is an online data management system for M&E. Mission Metrics is an agency-wide framework for performance management against Mercy Corps mission. The purpose is also to improve and assure the relevance, credibility, and completeness of data being reviewed.

7. CONFERENCES/WORKSHOPS The Program Officer- Safe Motherhood for MCH participated in the process of Investigating Critical Obstetric Situations that took place in Sughd Maternity House. This project is being implemented by World Health Organization (WHO).

8. SUCCESS STORY

Success story: “The man of the time”

Can an ordinary man save people of his village from the “Plague of the 20th century” now? Yes, he can save it! Who is that man? What has been doing for his family and his village? A 61-year- old agricultural mechanic, was born in Basmanda village with a population of 9,500 people. It is a remote village in the northern part of Sughd province of Tajikistan, located on the way of the ancient Great Silk Road and surrounded by impressive mountains. It survived the invasions of Alexander Macedon, Genghis Khan and other challenges of history. Many years ago, this village was called Marsmanda, which means “a mountainous gateway”; this is the place where people gather for a big bazaar. Now the villagers are busy with cattle breeding, growing potatoes, carrots and weaving woolen carpets.

After the USSR collapsed, many people had to leave the village to earn a living. About 700 young laborers left each year from this village to travel to different cities of Russia. They stay there from 6 months to several years. They return with the money they earned in Russia to get married and buy necessary things

13 | P a g e for basic living. Some of them have degraded health due to unbearable conditions. Unfortunately, every year one death occurs.

This man worked very hard all his life. For many years he worked in the cotton fields in a Soviet kolkhoz in neighboring Zafarabad district. He has a big family with three sons and a daughter and now he has eleven grandchildren. Two of his sons go to Russia every year along with other young people. He gained respect and a good reputation in his community, and in 2006, he became a chief member of the Village Development Committee. During his work, he managed to find solutions for many problems in his village. For example, in 2008, VDC members collected 6,400 somoni (about 2000$) and renovated 2.5 km of irrigation water pipes from the mountains. Then, they cleaned and constructed three water reservoirs for domestic animals. They have also repaired the road from the village to the center of Gonchi. The local doctor asked this man to help conduct educational sessions about HIV\AIDS for young men who go to Russia for work.

“When I learned about the nature and consequences of this disease I strongly decided to conduct lessons for people before their departure to prevent spreading of the “Plague of the 20th century” in our peaceful and flourishing village. It is painful to be aware that people may die very young. This was my first step in improving health education in our community.” So these classes have regularly been conducted in his village from January till March when men regularly return back home for winter since 2006. Only four years later, the volunteers from Mercy Corps began their courses in this village. Five Community Health Educators now work with him. Now medical personnel join the CHE sessions and classes have become more informative. During the sessions, leaflets and condoms are distributed and instructions are given on how to use them. Demonstration and role-play games are a part of the program. “When I conduct classes for young people, I am not just talking about the dangers of HIV/AIDS but also tell how to avoid harmful habits in a foreign country, because alcohol and dissolute lifestyle will contribute to the spread of this disease. I care about all the young people of the village as my own children”. Now, the man says he would like to make a fundraising proposal to the community for travel arrangements to take people for HIV/AIDS tests, because it can be done in , which is about 110 km away from the village. Only then, I shall feel comfortable when I know that none of the young people are infected. At the end, he said, “I am proud that I have made a contribution in prevention of this disease.”

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