Census Update

The last two weeks have been incredibly busy with the final preparations for the census.  We spent one week in Santa Lucia training the six enumerators that will be out in the field collecting our data and then spent the following week field testing the survey instruments in four communities (Concepcion Centro, Guachipilincito, San Marcos Centro, and San Jose).  Both the training and the field testing went well; we're still tweaking minor aspects of the forms, but the bulk of our questions are working and the enumerators are capturing the information fairly well during the interviews.

Currently, I am working on the final revisions to the forms and also collaborating with the enumerators on the exploration and socialization phase of the census.  We have two main goals during this phase:  1) to gain the trust and support of community leaders in our target areas, and 2) to create maps of those target communities.  We began by holding a general community meeting at the new clinic in Concepcion last Sunday.  About 30 people attended and the event went smoothly.  The enumerators and I have been having follow-up meetings with the key people in Concepcion this week:  the vice-mayor, members of the health committee, prominent teachers, members of the water committee, health volunteers, and others.  This process is relatively informal; we generally just show up at these peoples' homes or track them down in town.  Additionally, the enumerators have started collecting gps coordinates for each structure in each community and sketching corresponding maps.  The mapping process enables us to personally introduce a large percentage of the population to our work, and these lists of houses and maps will be used when the enumerators return to implement the census questionnaires.

Work, Work, Work

Shoulder to Shoulder is a private non-profit organization based in the United States that works in tandem with a Honduran sister organization, Hombro a Hombro. In the organization's own words, they strive "to develop educational and health programs to help poor, rural communities in Honduras achieve sustainable development and improve the overall health and well being of residents." Shoulder to Shoulder has been present in Santa Lucia and surrounding communities in the department of Intibuca for almost twenty years. In practice, the majority of the work here revolves around running one "major" health/dental clinic and managing a growing network of smaller health centers. Outside of the health arena, the organization also runs several additional interventions: an after-school/library program, a scholarship program for local students, a nutrition program targeting young children, a girls empowerment/entrepreneurship program, a water filter project, and a stove ventilation project. Moreover, one central component of the organization's mission is to expose young doctors to international public health work, so they maintain partnerships with several medical schools and groups of students routinely come down for two week service trips.

A little over a year ago, Shoulder to Shoulder was approached by the Honduran government and asked whether they would be interested in overseeing the health care services in this area of Intibuca. So, under a formal government contract, Shoulder to Shoulder now has the responsibility for managing and improving a decentralized network of local health centers, running its own major clinic in Santa Lucia, and is opening a second major clinic in Concepcion early in the new year. As I learn more about the decentralized system and have the chance to visit some of the small health centers I'll be able to provide a clearer picture of healthcare in this part of Honduras.

The existence of the government contract is the primary reason I currently have a job here. Under that contract, Shoulder to Shoulder is required to conduct a full household census of the main catchment area for its new clinic in Concepcion, comprising the municipalities of Concepcion and San Marcos de la Sierra. With oversight from the national director, I will be implementing and managing that census. The main study plan for the census was developed with input from researchers at the University of Cincinnati before I arrived. Posts have been slow this last week because I spent a good deal of time revising the survey instruments and study protocols and preparing for our upcoming training. I have heard varying and unreliable population estimates for our target area - one of the main reasons we are doing a census - but conservatively we expect between 12,000 and 25,000 people. We are slated to start the census on November 2nd and expect to have staff out in field for about 6 months; we begin training those enumerators on Monday and will be field testing the instruments the following week.