A Borneo Connection
International hepatitis C education
Friends of mine have been managing a national park in Borneo for a number of years and I had been wanting to visit them and the local communities for some time. Finally, in April 2009, I was able to spend five weeks in Borneo on annual leave, travelling with a dear friend, Sandy Dekker.
I asked if there might be some projects we could be involved in when we came over. Maybe plant some trees or cut back noxious weeds? Or teach belly-dancing (which Sandy did, to the delight of the local women). To my surprise, they asked if we could facilitate some workshops on hepatitis C for staff and community members.
They stated that intravenous drug use had been an issue in the communities and, given their geographical isolation, there is very limited knowledge of ways people can remain healthy and minimise the spread of the virus. Both Sandy and my own backgrounds as social workers have focused on working in the areas of violence and abuse, and with survivors of childhood sexual abuse. Hepatitis C was a bit out of our area of expertise!
Expanding our knowledge of hepatitis C
I had a conversation with the nurses Denise Pratt and Margaret Grohs, who work with me at the Playford Primary Health Care Service. They helped me search some websites which included the Hepatitis C Council of SA. From there, I contacted John McKiernan. John was extremely helpful, meeting with Sandy and me, going through information and providing us with lots of resources.
I met with Enaam Oudih, from PEACE, Relationships Australia of SA (RASA), to discuss multi-cultural aspects of working with different population groups. I also met with Cathy Healey (RASA) to talk about working with indigenous communities. Both women were very helpful and giving of their time. Other people who generously shared their knowledge and resources included: SAVIVE staff Carol and Patrick; Lucia from the Communicable Disease Control Branch, SA Health; and Megan Camfferman, dietician from Playford Primary Health Care Services, providing information on diet and the importance of eating well, especially when dealing with a health issue like hepatitis C.
Everyone whom I contacted was so helpful.
Sandy and I also have training in Narrative Therapy, so we drew on our knowledge of that practice, and the experiences of Yvonne Sliep, recorded in her articles about her community work with people in Malawi (who are addressing the impacts of HIV-AIDS on local communities), and Barb Wingard, writing on her experiences of addressing the effects of diabetes within Aboriginal communities in South Australia.
The Workshops
I ran the draft of the workshops past my friends to ensure there were no glaring cultural issues which needed to be addressed. This proved to be invaluable as they know the communities very well, and I was able to make relevant changes. Sandy assisted, especially with information on diet and nutrition and with the role-plays (indicating that the virus is spread only via blood).
To say that I was a bit nervous with the first workshop is a bit of an understatement. Working in a different culture, with population groups whom I didn’t know, using an interpreter, discussing quite a sensitive topic: it all had me feeling quite apprehensive. However, the audience, comprised of park staff, was genuinely interested in the topic. They were relieved to hear that hepatitis C was blood-borne only and could not be caught through sharing meals together, or through sharing of bathrooms, toilets or swimming areas.
They were surprised to learn, however, that sharing of toothbrushes, razors and hairbrushes (common practices) could be possible sources of transmission. We had some in-depth discussions about ways in which they could educate the local barber (used regularly by many of the men) by taking information to him about hepatitis C and asking him to use their own personal razors and combs rather than using communal items.
The interpreter was very interested in the topic as his two sons and his daughter-in-law have all been diagnosed with hepatitis C. He indicated that his family had been subject to discrimination from community members due to the fear of hepatitis C. He told us that his new wife had left when she found out that his children had hepatitis C, as she was frightened of contracting the virus and he was obviously very sad about this.
He attended all but one of the workshops (a total of six in all, with about 85 people attending) as he was keen to get accurate information. He is an Elder in the local Church (a powerful group within the community) so he will continue to spread this information. He knew the content of the workshops so well that by the last workshop, he could have facilitated this himself. When we told him this, he was quietly proud.
People asked lots of questions, including whether mosquitos could carry the virus and were not convinced when I said that the research indicated this was not the case! They were curious to know where the virus had come from, how long it had been around and whether it was safe to have sex if one or both partners have hepatitis C. They were relieved to learn that, unless blood was present, this was safe. (Several smiles and embarrassed laughter spread around the room at this discussion!).
We had some interesting discussions when we talked about the importance of eating well (and cutting down on eating the fat from wild boar which they view as a delicacy) and decreasing cigarette and alcohol consumption. These particular discussions were not so warmly received!
After the first workshop, we heard that people thought that I had said that tattooing should be stopped. This was a concern as tattooing is an important part of cultural practices within the communities. This was a lesson in me needing to be very clear about what I was saying. After that, I took greater care to acknowledge the importance of tattooing, but emphasised the need not to be sharing implements.
Some tender outcomes
Sandy and I met with the young couple who both have hepatitis C and talked through some very intimate details with them about ways of keeping healthy and not passing on the disease to their little daughter. They said that they had received medical help from the nearby hospital, but that no-one had actually explained the implications of hepatitis C, ways in which to minimise its spread, the importance of diet, and ways of keeping healthy generally.
The day we left, the young man told us that he had given up smoking and drinking alcohol and that his intention was to abstain forever as he wanted to live a long and healthy life with his wife and child. They also wished to have more children and would now consider this.
The interpreter asked if I could run a workshop for community members. At the end of that session, he brought his wife over to meet us. After hearing the information from the workshops via her husband, she had returned that day to hear the information first-hand. She had decided to live again with the family. That really touched our hearts.
We really enjoyed doing the workshops. It felt good to be able to do something, even in a small way, to help to diminish fears about hepatitis C and hopefully, pass on information which will enable community members to live a healthier life.
We encouraged people to view this as a community issue and to work together to decrease the likelihood of hepatitis C spreading throughout the area, to create healthy communities where issues like this can be openly discussed and acted on.
I can see a huge need for community education and health promotion in areas like Borneo. I reflect on how lucky we are in Australia to have the dedication of staff and the resources from agencies like the Hepatitis C Council, RASA and SA Health.
My friends contacted me recently to say that there continue to be comments made by community members indicating that the workshops were helpful. There have been no new reported cases in recent months. This is so good to hear!
While I was surprised when my friends asked me to do the hepatitis C workshops, I am now pleased to have had the opportunity to offer them and that the communities were eager to take up the information discussed.
Thank you to all the people who helped me gather the relevant information on hepatitis C and provide the resources which could then be shared with the communities in Borneo. A special thanks to John McKiernan and the Hepatitis C Council of SA. Without the help of the people named above, the workshops would not have happened.
Note: In order to respect the privacy of the communities in Borneo, the names of the specific park and area have been omitted.
Jussey Verco
Jussey Verco is the senior social worker with Central Northern Adelaide Health Service, Ambulatory and Primary Health Care Services, Playford site, Davoren Park.
References:
Sliep, Y., 1996: A spirit on its own is easily broken but together we will not break: communitites respond to HIV/AIDS, diabetes and grief. Dulwich Centre Newsletter, No 3., Dulwich Centre Publications, 1997.
Wingard, B., 1996: Bringing the Work Home: the work of Barb Wingard and the Aboriginal Women’s Health and Healing Project of South Australia. Dulwich Centre Newsletter, No 3., Dulwich Centre Publications, 1997.