Community Health Workers – The Power of Listening

The roof was tin, but I could not see it because of the newspapers cut into snowflakes hanging from it. The walls were of mud, but veiled with advertisements and colorful newspaper front pages. The floors also were of mud, but clean, compacted swept mud; you could walk barefoot and not get dirty. We talked with the matriarch of a family. I made out what I could, but barely understood; my Swahili is quite bad. I could understand her face, her tone of voice.

The healthcare team has been starting to focus on Community Health Workers. This means that low-trained community members regularly visit their neighbors and give advice and minimal medical treatments (bandaging wounds, simple drugs). We have been struggling to figure out how to win the trust of our members. It’s not much easier to go to win the trust of a complete stranger here than it is in the US.

In the past, we were survey-based. To make it easier, I gave them a series of questions to provoke discussion. But, after months of problems and a few weeks of supervision, I discovered that rather than an inspiration, these questions were a crutch. No matter how much I cajoled, I could not get them to converse. Rather than having a friendly conversation, the workers were robotically asking the questions from the list. So this week I tried something new: no questions. Or rather, just one question: “Who did you talk to?” No more bright orange arm floaties; it was time to sink or swim.

And yesterday, they swam. The woman we talked to had problems. Members of her family had problems. She worried about them, and had no one to share her worries with. When we asked her about her problems, she told us. Though I only found out afterwards what the problems were, I could understand her distress in sharing, and relief when it was through.

We had no knowledge of the difficult medical questions for her family (in the future, we will have the ability to refer hard questions to local practitioners). But the biggest thing for this old woman was the conversation itself. It was like we had taken a heavy burden from off her back (or to fit local custom, from off her head).

Why didn’t I think of this earlier? Isn’t it obvious? We want compassionate doctors who actually listen. We pay psychiatrists to listen. We love friends who listen. Why wouldn’t the poor, also? Are they creatures so different that things true of Americans aren’t true of them? I feel bad for not realizing this earlier. I also am disappointed in the field of Global Health. With all my reading and research, I have not read about this effect of Community Health Workers. Maybe it has and it’s so obvious that nobody needs to talk about it.

In any case, we have a new strategy to win trust: listen to people. It seems too simple. But it’s certainly a lot better than our old one: gather data on people.

I suppose I should not have ignored my teachers. Dale Carnegie, the management guru from the ‘20s, told me this: “Become genuinely interested in other people…Be a good listener. Encourage others to talk about themselves.” My other teacher, Francis Bacon (who is even deader than Carnegie), said, “For there is no man that imparteth his joys to his friend, but he joyeth the more ; and no man that imparteth his griefs to his friend, but he grieveth the less.” I should have listened.

 

About David Carreon

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