By: The Club des Amis Damien
The Club des Amis Damien (CAD) is a Congolese non-governmental organization made up of community-based volunteer members. CAD’s members are former tuberculosis (TB) patients who work as community health workers for the organization. Rebecca Furth (RF) from Initiatives Inc. sat down with CAD’s National Secretary, Maxime Lunga (ML), to learn more about CAD and how its CHW members contribute to the fight against TB in the Democratic Republic of Congo.
RF: What motivated you to start CAD?
ML: The impetus to start Club des Amis Damien was given to us by a nurse; the same one who treated me when I had TB. The nurse asked us to form a group to save the health center; it was performing badly and w
as going to be shut down. Although not health facility personnel, our contribution made the center successful. Case detection and cure rates increased and treatment defaulter rates declined. The health center and TB leadership at MOHSW said this was due to us.
RF: Can you describe CAD’s model?
ML: CAD’s model is very unique. Our CHWs are volunteers first, meaning that we work of our own accord and contribute with our time, knowledge, and energy, and with the little we have. But it is also a unique model because CAD is a special community. CAD is composed of people who have suffered from TB. As a result, our experience helps us understand tuberculosis and tuberculosis treatment well and effectively accompany people who are undergoing treatment.
RF: Specifically, what is the work of a CAD member in health facilities and in the community?
ML: In the community, a CAD member has two responsibilities: first, to refer all people suspected of having tuberculosis to the health center, and second, to inform the community about TB. In health facilities, the CAD member accompanies patients for psycho-social and medical treatment and provides health education to TB patients before they start medication. Patients need to know that their treatment is free, that care is free and that they have a right to benefit from all that other TB patients get.
But a CAD member is also charged with helping the facility to correctly care for patients during the course of treatment. He has to follow-up on patients that miss their appointments or DOTS, and bring them back to the facility. He has to motivate patients who are not providing samples for their periodic sputum tests, and to bring medications to bedridden patients who do not have family members to help them. Members also transport sputum samples from bedridden patients for their routine examinations.
RF: Why did you decide to work with community health workers, in your case “members”?
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Just the Facts: Club Des Amis Damien
2013 results:
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ML: It was not a choice, it is our model. Even I, as the national secretary today, started as a member of an antenna. Activities emanate from that level; you can’t accompany a patient from the national or provincial level. You have to be at the community level to accompany patients. Members have to live in the catchment area of the health facility where they work. Each person is responsible for working in the area around him. In the end, when we add it all up, we are surprised [by what we have achieved]. We can only work at the community level with those who live where the problems exist.
RF: How are community health workers important for CAD?
ML: Without our members, CAD would simply no longer exist. CAD is first the community and then other levels. We have an inverse pyramid; the base is on top and the rest supports the community level. CAD exists because there are antennae, composed of CHWs who are former TB patients. If the antennas disappear, so will CAD.
RF: Does CAD provide any incentives to its community health workers?
ML: Yes, we have three types of motivation. The first is morale boosting. We do supportive supervision and we do it in a way that all stakeholders and partners recognize our members. Having all partners recognize the work of our members makes us feel appreciated; whether it is a minister or a zonal medical officer or a doctor in charge of a clinic, they respect the Club des Amis Damien.
The second incentive is tangible: if we have t-shirts or other materials for our activities, things that we receive from our partners, we distribute them.
Training is also an incentive. When we train members, we involve the National TB and Leprosy Program (NTLP) and at the end [trainees] get a certificate signed by us and the NTLP program. In rare cases we get financial motivation; for example, we received TB 2015 project funds for travel expenses for the MDR-TB recuperateur and NTLP transport funds for World TB Day.
RF: What are some of the greatest challenges CAD CHWs have faced?
ML: There are a lot: there is no rose without thorns! Some partners starting community-based activities try to take over the CAD members who we have trained. Another challenge is: when the nurse in charge of the TB clinic is not present in the health centers where we operate, other nurses do not want to get near our members. They are afraid of us. Discrimination and stigmatization still follow us, even though we have to help those that are under treatment. This is not a great difficulty, but it is a challenge. When a new nurse comes, they have a tendency to guard themselves; in time they approach us because they see that we are useful.
With TB patients themselves, we have to work hard to sensitize and educate them so they understand that we are there to help. To be CAD is to accompany a TB patient–and the TB patients have to accept that you do so. So this is a day-to-day challenge. But we see that this is going well; TB patients are starting to have confidence in us.
RCF: How is CAD financed?
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CAD member and Chef d’Antenne (Head of a section) Mumy Bolatangeli Why he became a member: “A CAD member came to my home to bring me my sputum container. I asked him why he brought it to me and he told me he was a CAD member and this is what they do; this got me interested in CAD.” |
ML: We have benefited from the support of USAID through two projects. The first was the TB CAP Project managed by the Union and the second, the TB 2015 project managed by PATH. That has enabled us to reach 7 provinces. We also received, not long ago, support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, managed by Caritas Congo, and this added another province. In Kinshasa, where we started, we are self-financed.
RF: How will CAD sustain its model?
ML: We want to maintain our model by sustaining our volunteerism. We also have to continue supervision and do regular refresher training to reinforce capacity [of members]. When we do training, we train on tuberculosis, but also on the qualities of a CAD member, and this enables us to maintain our model. But to continue to function, CAD obviously has to seek funding because we can’t continue supervision and training without funds.
RF: What do you hope to achieve through CAD?
ML: Our vision is to have a Democratic Republic of Congo without TB in the future. And we think that our work can contribute to this vision. Already, in the facilities where we work, 40% of [TB] cases detected have been attributed to the work of CAD. So we think we have a significant added value in the fight against TB and we hope that between now and 2050, if we can raise the bar a bit, tuberculosis will no longer be a public health problem in our country.
RF: Thank you, do you have anything to add?
ML: Yes, in relation to TB treatment, CAD is concerned that our country has experienced drug stock outs. We want to launch a call to global leaders to not give up: we want an end to drug supply shortages because it is worthless to accompany a TB patient if he has no medication.
Maxime Lunga is National Secretary of Club des Amis Damien (CAD), a non-profit organization based in Kinshasa, Democratic Republic of Congo. Mr. Lunga has been with CAD since its start in 1999 and has helped lead the organizations from a small group of cured TB patients into a nationally recognized network of volunteers contributing to the fight against TB. To contact CAD, write to maxilunga@yahoo.fr or call +243815190773.
Rebecca Furth, Initiatives Inc. conducted the interview and photographed Maxime Lunga for this feature.
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