PallCHASE Impact Story, World Refugee Day, 20th June 2023.
Written by Hannah Ikong.
Moses Bida is a member of the Village Health Team (VHT) as well as a VHT Mentor in Budri, a rural village in Obongi district in Northern Uganda. Like several other VHTs, he had been trained to identify, manage, and refer patients with palliative care needs through organisations such as Cairdeas International Palliative Care Trust (Cairdeas IPCT) and Peace Hospice. He has also received some trainings in Photovoice research.
I have had the pleasure to work with Moses on multiple occasions this year. Moses brings a wealth of experience to coordinating the VHTs, patients to be screened, and their families. He knows Budri and the surrounding villages so well, and his heart and mind are centred on the patients and their families. We talked only about his patients and palliative care, so I did not realise until much later that I knew very little about Moses! Moses, I came to learn, spent most of his life in South Sudan and only came to this area of Uganda during a time a war in 2017. Then our conversations quickly went back to his community and the role of a VHT.
Holistic care is everything
“VHT work has no borders, we need to work hand-in-hand with other colleagues …” Moses began to relate his work within the Village Health Teams and other stakeholders in the community. He gives health education and counselling, and he especially spends time with the family on how to take care of someone with chronic illness. For the caregivers, he told me, we tell them to take good care of your patient and not to speak badly to someone who is ill. Whenever there are spiritual issues and questions, Moses involves the local faith leaders and church. The holistic care is everything, says Moses. “If death comes, you’ll now die peacefully, that is what we are trying to tell the patients.”
Recently, Moses worked with a young patient whose chronic illness was quite a mental burden for her, causing her to hide herself in her room and refuse medication. “I have been telling her to feel free,” Moses shared, “Because she is not the only person who may be living with chronic illness; there are so many people. So let her not isolate herself inside, let her come and associate with the community freely, from there, she will be okay.” During his visits, he counselled her and asked her to consider doing small activities, as she was able. In Moses’ last visit, he was encouraged to find her outside and with others and even making her own porridge. She says she is feeling better and not as helpless. With the counselling and support the patient’s mental state is better too, Moses added. “Now the caregiver can even go to the field and do other work. Before the caregiver was not able to even do this, because she feared to leave the patient alone as the patient could commit suicide.”
Additional challenges and difficulties
There are other challenges, Moses said, and the work can be difficult. Living as a refugee has its complications on several levels, including the basics of food rations and farming (or attempting to farm) for one’s own food. Moses then relayed a story of a different patient struggling with mental health. She can get quite aggressive in a crisis, and one time as they tried to assist her to get medical attention, she pulled and tore Moses’ shirt. Yet he continues to provide support to her and her family, citing that the VHTs and VHT Mentors need to be there and do more than simply bring a patient to the health centre. “The health centres are not in a good condition, carpets and sleeping mats are not sufficient, even the food is not there. Even the system of storing and distributing medication is not to date,” he said.
Let me end this essay on Moses Bida and his work as a VHT Mentor with one of our chats about Photovoice research. That day, Moses shared his insights in allowing the patient and their family to choose the picture and explain its message. Let’s practice Photovoice, I suggested, where shall we take your photo? Moses took a quick look around our surrounds. About 20 metres off the dusty road, we were in a cleared area, by a few palm trees and the community homes in the distance. Right by our feet was a pile of baked clay bricks, and Moses suddenly went down and posed. “Here! You get lower too, take the picture here, by the bricks, waiting to be built.” With a calm look, he posed for the picture, asking later, “What do you think the message is here?”