Health education and disease prevention programs are essential elements in every health care system. We normally envision community health programs in urban and rural settings across Canada. However, health education and disease prevention have also become a fundamental part of the health care system for refugee communities around the world.
PIP: This news article describes typical life and health conditions in Rwandan refugee camps and a community health program that now is considered an essential part of emergency relief in any refugee camp. The massive exodus of 650,000 people from Rwanda into Tanzania resulted in land degradation and the struggle for survival in camps. Refugees were confronted with morbidity and dehydration. They experienced water supplies that were insufficient to maintain oral hydration and personal hygiene, irregularly distributed and insufficient food supplies, limited living space, and shortages of fuel that required walking long distances. Food was cooked once a day, which meant food was contaminated by flies throughout the day. Shelters offered little protection from the elements and were located so close together that communicable diseases were spread easily. Medecins Sans Frontieres (MSF) was the first relief agency to set up operations. The health care system in the refugee camp was modeled after the one in Rwanda. Rwandan community health workers (CHWs) were trained. The CHWs identified the very sick and referred them for treatment in outpatient hospitals and clinics in the camp. CHWs distributed oral rehydration packets to refugees suffering from dehydration. The active cholera epidemic in the camp at the end of 1994 forced a shift in the program strategy to mass education and to early detection of new cholera cases. This timely and appropriate strategy resulted in swift isolation of cholera cases, less severe cases, and greater survival. Mass health education involved targeting groups at risk, teaching about hand washing for prevention of cholera, and training of other community members. The epidemic lasted only 3 months as a result of these efforts. CHWs also taught about personal hygiene, condom use, and the importance of immunization.