I, Seema Punjani Nurse case manager at AKUH Pakistan have done lot of work on improving quality of neonatal care, specially for low birth weight infants. We found tremendous improvement in decreasing the mortality and morbidity related to sepsis among this population. The most important strategy I used was mother education. If anyone interested I can share some of the important measures and pictures as well.
Regarding the health education and smoking project, it was a project with primary school children of standards 3 & 4, i.e children aged between 7 & 8. It dates back as far as 1990. The title of the project was "Prevention of onset of smoking in school children". It was a joint project between the Ministry of Health and the Ministry of Education in 1990. Several schools were selected for that purpose. Audiovisual and print materials including a Teacher's handbook were produced for use in the implementation of the project.
What you say about teachers has been the experience of my colleagues in setting up Child-to-Child programmes, In the workshops they run they found it was important to have at least 2 participants from each school to support each other. Teachers are comfortable in a school but are concerned to move more into the community.
I have more than 30 yrs in the field of community health promotion at national, regional and grass root/community level. I totally agree that we have to reach everybody in our health education/health promotion interventions, especially the less privileged and child to child education is a very good strategy. I have sufficient experience in it when I worked out a child-to-child education programme in an informational & educational campaign against cigarette smoking with primary school children in the context of World No Tobacco Day several years ago.
We have a health program at the university called health teaching and health education whereby nurses, community health workers, midwives and medical asistants come to train to become teachers and health promoters. We have access to our local primary school and high school and we have found that the child to child education can only work if the following are in place:
In what context will the major communicators of health messages such as nurses, midwives and medical assistants, spread health messages? If it is just to clinic attendees they will fail to reach the least 'privileged' in any community who suffer more sickness and have the higher mortality.
To me the most promising channel is through children attending primary school. In most societies the majority of even less privileged families now send their children to school. The schools master and the schools are greatly respected.
Thank you for the response on the discussion on the pope's statements on condom use. What you pointed out is very important, don't JUST promote condoms. Though I think all colleagues who have been responding do not just promote condoms. The general used way to educate on STD/HIV prevention in Africa (and I believe in other regions of the world too) is the ABC method. Abstinence and Being faithful come first and are very important, a lot of focus is given to that. If people can not stick to A and B, then go to C: the condom use.
I agree that promoting the use of condoms and allowing access to these is important. However, to think that this is THE solution is surely risky. When saying that safe sex is the only way, we forget that individuals are not dichotomous in their actions. They do not either practice safe sex or not 100% of the time, and even those with the best intentions and the highest degree of motivation make mistakes from time to time. The UK government thought that increasing sex education in schools and promoting condom use would reduce teenage pregnancy rates and they were wrong. Why?
It is so sad for Africa. I know our folks in Africa relatively well and you will be surprised what such a message can do to our God-fearing faith communities. They treat the Pope as a small god and will not be swayed by "...little doctors who were born yesterday" about condom use, as I have been told several times by elderly folks who believe that "...condoms are for prostitutes" and that "...AIDS affects worldly people. There is no AIDS in my church!" This is said by so many faith community leaders in Africa.
The term "promiscuity" is not a medical definition, it is a value-loaded opinion. I don't believe that it has any use in health care circles. Its important to be specific - is the person having sexual relations with multiple partners, is the person a sex worker, is the person engaged in serial monogamy? Some cultures define "promiscuity" as dating more than one person even though intercourse never occurs. The pope is wrong. The use of condoms has decreased the spread of HIV/AIDs.