Case Study: Health Assistants's Experience

Nigma Dolma Bomzan works at the Laya Primary Health Centre (PHC) in Gasa Dzongkhag. Laya PHC was built some years ago in early 90s with mud and stones with wooden floorings. At present, electricity and 4G internet connection are in place. Laya, being the remotest place of Bhutan situated at western part of Bhutan at the altitude of 3824 meters, where the maximum people are illiterate.  

 My daily duties at the PHC starts at 9am-3pm from Monday till Friday and on Saturdays till 1pm and for any emergency cases and out calls, I work for indefinite hours for the benefits of patient’s wellbeing.My work includes OPD patients screening to medication supply and in-patient management and referral, Lab investigation, ANC, PNC, Immunization, Family Planning, HPV Screening, Breast Cancer Screening, H. Pyloric Screening, PEN Heart Screening, VCT Screening, NCDs Screening and Conducting C4CD Plus session play and P2P Screening etc. with recording and reporting. 

I always conduct C4CD Plus and P2P Screening on clinic days because on this day many caregivers come with their babies for weighing and vaccinations where I can grab the opportunity to advocate and conduct the session although it takes me a whole day.  

After the implementation of C4CD Plus at Laya PHC and ORC, many caregivers are aware that the interaction play with their children and responsive care are important for their child’s healthy brain development. They are also aware that they are the best role model and the best teacher to their children as I always advocate them during the session that education starts from the day a baby is conceived. They also came to know that their children enjoy playing even with the household items and also with the natural environmental items.  

From the very beginning, mothers or caregivers who come to attend are enrolled and added in different social media platforms like Facebook and WeChat group where the caregivers can upload their videos and pictures of playing with their children and many mothers do upload their play game videos too where I praised them in the group chat and get encourage to upload more by others too. One of the caregivers told me that her granddaughter who is 2.5 years old never eats anything without washing her hands as she along with her mother were taught song “Chu ChuCherai Lab Chu” and told them to sing always while washing hands before and after eating with their child. 

At Lungo, on ORC session day, if it falls on Saturdays and Govt. holidays, many pre-school going students always come to attend C4CD Plus session and they enjoy to be part of the session. 

At the same time, many caregivers do not turn up to attend the monthly regular C4CD plus session due to their unavoidable circumstances like during cordyceps and herbs collection timing for 4 months in summer. Many caregivers, they take their children with them and in winter, maximum Layaps migrate to Central Bhutan like in Phunakha in December – March. But to cover up the missed session, I take individual session too as long as they are at Laya. During winter, I personally do phone calls to the caregivers and request them to go to the nearest health centre with their child to attend the session. 

Fathers' involvement has also decreased comparing to the first session as they being the lone bread earner in the family, many of them go out of station to do field works. Nevertheless, I am encouraging the mothers to bring their husband too to attend the session and know the meaning of play and interaction which will be very helpful for their babies’ brain development to be healthy, happy and smart and do better in the school performances.