| Home visits are a vital part of the Building a Caring Community (BCC) program, Mosaic International’s work in Tanzania. Half of the children in our program receive in-home services. This is based on a number of factors. Some of the children have behavioral or health concerns that make it easier for them to receive services at home. Others live too far away from a center to realistically have their parents get them there, especially in a place where they have no access to a vehicle and have to walk with their child on dirt roads or no roads at all.
In some cases, children would benefit from center services, but the current centers do not have space to accommodate all the children in that area who want to attend. In these cases, children receive in-home service until a space opens up in the center. In a perfect world, all children who could benefit from center services would be able to attend, and those living far away could have transportation services. However, budget and logistical realities in Tanzania are not perfect, so we make the most of what is available to meet the needs of the children and families we serve, while constantly working to improve upon all services.
The in-home service program includes visits from outreach workers trained to work with children with disabilities and their families or other caregivers. They regularly visit each family, talking to the parents or other caregivers about the situation, and finally make recommendations about therapeutic exercises to do with the children at home. In the case of more mobile and independent children and young adults, they may also recommend ways to develop life-skills such as personal hygiene and money management.
While it serves as a very important part of BCC, the in-home service program is a challenge. After several weeks of joining Gertrude, the local BCC staff member who oversees centers and service provision, I can better appreciate why. On our first day of home visits Gertrude, Doroth (one of the outreach workers) and I walked over 10 kilometers, uphill, on rough dirt roads in the sweltering heat and humidity. It’s one thing to hear the outreach workers report that they are having trouble reaching all the families because of distance, but it’s quite another to walk that distance yourself. Taking a bodaboda (motorcycle taxi) could cut down on the trek, but the cost of those rides would add up quickly.
Another challenge to providing in-home services in Moshi is keeping close track of the families. Families sometimes move without informing the program. Rental agreements and housing arrangements look a lot different for people living in such extreme poverty. Sometimes people are evicted on short notice or have to move for other financial reasons and can’t be located by the outreach worker.
Sometimes visits are not as productive because the parents aren’t home. Again, with more limited communications and sometimes more remote locations, pre-planning visits is more difficult in this environment. This was the case when we visited Kevy, one of the little boys who lives on a remote hilltop with his family. When we arrived for our visit, we found that his parents, both subsistence farmers, had gone to Arusha (a larger city nearby) for the day. He was home with his older sister, who couldn’t have been more than 10. Young children watching siblings is not uncommon, both in Tanzania and in special needs families around the world. I can speak from experience!
Although she was young, it was clear that Kevy’s sister was mature and responsible and that he was well cared for. We saw the homemade equipment the family had for him, including a special chair, standing frame and fence used for walking. We also talked to the neighbor, who was helping to keep an eye on the kids. They showed us Kevy’s wheelchair in need of repair. These neighbors were very knowledgeable about Kevy’s situation and very supportive. In a society that has traditionally shunned those with disabilities, this is a very positive sign.
As we plan for the next six months at BCC in Moshi, our goals include some things to meet these challenges and continue improvements to our in-home services program. We’re focused on increasing the frequency of the visits, tailoring their content to needs that the families and children we serve express, as well as bolstering our documentation system. All children in the in-home services program are also part of the PROMOT Health preventative healthcare program as well, something that little Kevy and his family have benefited from greatly. Strengthening and growing our partnerships with health organizations that could give our families more professional services is another area of focus for us. We dream of a day when not only outreach workers, but teams of nurses could visit our families in more remote areas, too.
Over the next couple of months, I’ll be joining the BCC team as we continue our assessment visits to the centers and families in the in-home services program. Seeing the conditions some of our families live in is a motivating and sobering reminder of how important the work Mosaic International is doing in Tanzania, and how much work is still left to do.