A Day in the Life of an IMC Field Worker

The People Who Make IMC Great
A monthly glimpse at the individuals who work tirelessly each day to help IMC save lives around the globe

South Sudan: Elizabeth Apopo, Trainer
By Miranda Bryant

Elizabeth Apopo is in a jeep, bouncing along on a rutted dirt road filled with deep watery potholes, halfway into a three-hour journey to the western corner of South Sudan. Only she is not thinking of the possibility that the vehicle could get hopelessly stuck, but rather about the rampant water-borne diseases like diarrhea and guinea worm that International Medical Corps is working hard to fight.

Photo: Miranda Bryant

Elizabeth Apopo assesses community health worker Samuel Appolo's knowledge of diarrhea prevention on a supervisory visit to the village of Ndoromo in South Sudan.

Elizabeth is paying a supervisory visit to a Primary Health Care Unit (PHCU) in the village of Ndoromo in South Sudan, located ten miles north of the border of the Democratic Republic of Congo. As IMC’s training and capacity building officer, Elizabeth is tasked with teaching and encouraging the 40 medical employees working at the 20 health care centers IMC operates in Yambio County. The task is Herculean. The county’s education system was rendered all but defunct during the country’s 21-year war. Community health workers have limited reading, writing and arithmetic skills, and on average, they have received only nine months of medical training. To ensure that they are up to the job, IMC is constantly upgrading their skills through a combination of workshops, on-the-job training and guidance from supervisors such as Elizabeth, who assesses whether staff members are absorbing and implementing their education. In leading her team, Elizabeth draws on her 14 years of experience as a community health nurse, much of it spent treating women and youth in rural Kenya.

Elizabeth’s visits are part inspection, part instruction.

“You have no aspirin? Why do you have no aspirin? Did you not request it the last time you came to the office?” The 40-year-old Kenyan nurse has a no-nonsense demeanor tempered with humor and genuine concern for the health workers’ performance. The facility did indeed receive aspirin, but the health worker neglected to record it in the books. “When you receive an order, you must enter it,” Elizabeth explains.

Twice a week, weather and security allowing, she is on the road. “Me, I cannot just sit in the office. It’s not enough for me to read reports from the field, I want to share with my team and be part of their work.”

Elizabeth continues the inspection, with Samuel Appolo, a community health worker, at her side. The sink should be cleaned more regularly, she says; the sterilized medical tools must be covered, and soap is needed for hand-washing among the medical staff. She inspects the cleanliness of the pit latrines, scrutinizes the drug consumption and patient registers, and quizzes Samuel on his knowledge of diarrhea prevention. The 28-year-old father of six says he teaches the community to consume properly cooked food and clean water. His answer prompts Elizabeth to examine the community water source.

“So this is what you’re using at the clinic to wash hands?” she says, peering down into a stagnant, turbid pool of water in a clearing about half a mile from the clinic. The village of Ndoromo lacks a well or borehole, forcing its residents to use this pothole during the rainy season and to hike to a distant river during the dry season for drinking water.

Photo: Miranda Bryant

Accompanied by two IMC staffers, Esto Kornelio and Samuel Appolo, Elizabeth inspects the stagnant pool that serves as the community’s source for drinking, bathing and cooking water.

Upon further questioning, Elizabeth discovers that the facility in fact does have the means to collect clean water. A large plastic water tank is on hand, an elevated concrete platform has been built for it, and rain gutters have been acquired. All that’s missing is a simple piece of timber and a skilled carpenter to erect the gutters to collect rainwater from the building’s roof. The water tank is meant for use by the clinic, but it will be overflowing due to the plentiful rains this time of year, allowing the community to partake. Clean drinking water would help reduce diarrhea, which, following malaria, is the most common disease in this part of Africa, particularly among children under five.

Initially, health workers were nervous about Elizabeth’s visits, assuming their abilities would be criticized. However, they now realize that she is there to support them and help them do their jobs better. Improvements have been noted: particularly in the area of staff attendance, patient registration, diagnosis and treatment, and drug inventory management.

Elizabeth knows full well what would happen if she were unable to visit field sites like Yambio. “First and foremost the health workers would feel abandoned,” she says. “They would lose morale, and they wouldn’t open the facility. We wouldn’t know if they had pharmaceuticals on hand. We would not be able to assess their needs, or the needs of the community.” Due to their limited education levels, health care workers would likely misdiagnose diseases in the absence of supervisory visits and other capacity building efforts. Malaria may be mistaken for meningitis, and vice versa. Providing the incorrect treatment could be fatal.

Today, with one visit, Elizabeth has not only demonstrated to the community health worker how to improve his performance, but has identified a simple, effective method of preventing water-borne diseases.

“I feel satisfied leaving today, knowing that this community will soon have safe, clean drinking water,” says Elizabeth, as she climbs back into the car to start her long, bumpy journey back to the office.