Anita Dohn, MD, MSc
Michael N. Dohn, MD, MSc
Anita & Michael Dohn are physicians who are serving as missionaries with SAMS (Society of Anglican Missionaries & Senders).
Anita is a Family Practitioner.
Michael is an Internist.
The Community Health Program Staff
Community Health: The Beginning
Over the years, Community Health has run various programs and projects. More has been accomplished than can be described well here. The main ongoing activities have included volunteer community health promoters, chosen by the community councils in their neighborhoods, trained by us, and remaining a community resource. (You can download copies of the health promoter manuals.)
The first community health promoters began working in 2001. Since then, more than 400 community health promoters have been formally trained, and about 150 are still formally associated with health promoter groups in their communities, including women from the original 2001 health promoter group. The majority of those trained are still promoting health in some way - for example, working with other NGO's, working for public health, or (as is the case with many of the teenage health promoters over the years) working as nurses, physicians, or as other health professionals.
The original 2001 health promoter project achieved good results and demonstrated better health effects when health and micro-economic programs were undertaken simultaneously (view Abstract of this article).
Originally, the community health promoter program focused on the causes of excess child deaths (diarrhea and dehydration, acute respiratory illness, vaccine preventable diseases, and malnutrition), women's health (cervical and breast cancer detection), HIV/AIDS and sexual health, among other topics (view a summary of the 2008-2012 health promoter program).
Premisies for Christian Community Health
The original 2001 health promoter project also illustrates two premises that we use in our community health work (1).
1. Community health ministries should actually improve people's health.
It is not enough to simply go through the motions or count the numbers of people enrolled. It is important that health ministry produces real improvements in health status or conditions for people. It is also good
stewardship of resources. Evaluation of the effects of community health programs and projects is important to us.
"If you aren't keeping score, you're just playing around."
2. The process of improving health is as important as the health outcomes.
We must have a process through which individuals, families, and communities can grow in self-esteem, autonomy, and self-efficacy. It should be a process that helps them to grow into their full stature in Christ.
When teaching a young mother point-of-use water purification and hygiene techniques, we are not just trying to prevent diarrhea in her children, we are also empowering her to have a positive impact on her family's health and economy. As she has more control and is able to contribute more to her family's well-being, she may feel more self-worth and self-confidence. She may take a greater part in the making of family decisions. While we say "may feel" and "may take", the research indicates these effects are consistently observed.
An additional consideration is that just putting "community" into a program title does not make it a community program. We prefer to do Asset-Based Community Development (ABCD) to encourage community ownership and better long-term sustainability. Equity is another consideration for our programming. We have materials about "ABC-Health-D" and "Equity" on the "Other mission materials" page of this website.
Domestic and Gender-Based Violence
In 2011, the health promoters identified violence as a focus for their future work. While the original health topics listed above involved persuading people to make individual behavioral changes, progress on reducing violence requires changes in attitudes, customs, and paradigms on a community level.
We began with workshops about domestic and gender-based violence in combination with additional instruction on theories and models of community change. The health promoters began consciousness raising activities through community presentations, church presentations, and school programs.
Beginning in 2013, the health promoters are working with community leaders and churches to develop plans to respond to domestic violence in their neighborhoods. The violent situations are often delicate to address, challenge the boundaries between privacy and public concern, and may be dangerous for anyone else getting involved.
As we proceed with the anti-violence program, Community Health is working as part of a network that includes other NGO's, the Ministry for Women, the Ministry of Public Health, the National Police, the local Public Prosecutor's Office, the Court for Children and Adolescents, and the Public Ministry's local Domestic Violence and Sex Crimes Victims' Unit, among others. One of our contributions to the network is our community contacts, our other network of health workers and leaders in more than 30 communities in the province.
A life skills course for pre-adolescents that focuses on reducing their risk for experiencing domestic violence is another part of the program. Working with communities and schools, the 10 session program for 7th and 8th graders covers topics such as: communication, negotiation, & conflict resolution; human rights; gender; recognizing & evaluating influences; and values clarification. All of these areas are related to domestic violence prevention. We hope to motivate the young people to become more than bystanders and take an active role in their communities.
We are talking about 7th and 8th graders, so the program is more about games and simulations and doing things than about instruction. By using the young people's understandings, observations, and thoughts on how to deal with problems they see, the program will be relevant to their lives.
In preparation for this student program, we surveyed over 500 public high school students to establish what their thinking was as far as gender roles and expectations, peer pressure, personal agency, and women's rights, among other themes. 'Machismo' may be on the way out, according to our results. (If you would like to see a summary of the results, let us know by using the Contact Form on the Contact Us page.)
Future Directions: Alcohol and other factors contributing to violence
To be written within a few days!
(Meanwhile, read our open-access article "Alcohol Use and Church Attendance Among Seventh Through Twelfth Grade Students, Dominican Republic, 2011")
Funding for the community health program has come from various sources. The program began with a generous grant from Summit Alliance Global Health in cooperation with Esperanza Internacional to examine the health and micro-credit interactions on a community level. Subsequent funders have included USAID, the Foundation for AIDS Research (amfAR), the Caribbean Treatment Action Group, Christ Church Cathedral (Cincinnati, OH), The William Cooper Procter Fund, and Trinity Grants (Trinity Episcopal Church, Wall Street), among others.
The major funder over the years has been Episcopal Relief & Development.
1. Mosley WH. Principles of Community Health. In: Ewert DM (editor). A New Agenda for Medical Missions. 1990. Brunswick, GA: MAP International. Pp 33-44.