Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

More documents

Recommendations

Info

AppendicesAppendix 1 – Diarrhoea narrativeThe following diarrhoea narrative illustrates multiple health care seeking actions, belief in custom ascause, and delay in getting to a health facility. The first action taken by the mother is to prepare atraditional remedy at home because the closest health facility is far. By implication, if the facility hadbeen closer she may have taken the child there first. The next action is to take the child to a healthfacility and here we learn about delay due to distance from health facility, and the cost of transport –during the three days she approaches relatives to borrow money and tries to sell chickens, but she isunsuccessful. Another action potentially taken involves custom. The mother explains if the medicineprescribed by the doctor had not been effective this would signify that another cause was at play i.e.,unsettled matter of custom. The father would carry out the ritual to settle custom at home while themother would return to the CHC to get medicine. We learn that after the custom matter has beensettled, the mother again seeks hospital medicine which is now effective, and the child gets better.This reinforces belief in the importance of settling adat matters.Timor-Leste Health Care Seeking Behaviour Study | 2009In this community, what symptoms are considered to indicate diarrhoea that is problematic?At 8 months old [my daughter] was quite healthy but suddenly she got diarrhoea with vomiting.On the first day I looked at the child’s poo. I didn’t know why the child’s poo was like this. Thesecond day I wondered why is there still diarrhoea. The third day I saw the child was very weak.The community health centre was very far so I made a herbal cure.Then I went to the CHC … When I arrived there the nurse asked me how long had the child beensick and I answered three days. She said [with angry tone – nada siak]: “why didn’t you bring thischild with diarrhoea quickly?” I replied: “I wanted to bring the child quickly but there was notransport and no money [to pay for transport]” … We asked our relatives for money to bring thechild to hospital but they could not help. Even though our child had been sick for three days wecould not go. What could we do? I asked relatives for money but they did not give me any, so wewaited, but if we wait then our child will die. My husband has no job, he is a farmer, so we have nomoney. I tried to sell chickens [to raise money for transport] but no-one bought them. [At theCHC] I asked the ‘doctor’ for medicine to give to the child. I gave the medicine to the child. Afterthree days the child’s poo was already dry. So this was the way the child was affected.However if I saw the child was still not well [after CHC visit] I would return again and ask myhusband and the family: “how is it that this child still has diarrhoea - I have taken the child tohospital. I have tried herbs. Something may have happened, something may have caused this childto get diarrhoea.” So our family comes together and thinks about this thing. Maybe somethinghas caused it. We try to think about whether custom (adat) might be the cause. The child’sdiarrhoea is not because of sickness but because custom caused it. They speak, they kill a smallrooster, and try and identify the cause of the sickness. The sickness is like this or that – this is whythe child is like this. I cannot wait any longer at home – I have to go to the hospital to collect themedicine to cure the diarrhoea. At home they must continue to carry out the ritual. When thecustom cause is settled, the child then drinks the medicine and becomes well. This is myexperience.Married woman, Focus Group Discussion, Lautem District61
Appendix 2 – Birth spacing narrativeThis narrative illustrates several aspects in relation to using a spacing method. This includesdisagreement between husband and wife over using (unusually, husband wants to use, wife doesnot), receiving information about spacing during immunisation, switching methods resulting fromside effects, conception/pregnancy occurring while following the calendar method, and expressedsatisfaction with using a method due to economic reasons: being able to assist her husband withagricultural work in order to sell surplus produce to raise income.Where and to whom did you visit for birth spacing method or information?Mine is [like this] with my second child my husband obliged [me], you should follow familyplanning, I refused, if I use it may cause me to be infertile, you must [said husband], then when mybaby reached two months and I attended immunization, he obliged [again], I was not convinced,after vaccination I took my baby outside [husband asked] ‘did you get family planning or not?’. Ireplied ‘not yet’. He asked me to return, no problem because you [husband] want me to use sothen I used the pill, I received pill then they explained to me [how to take it] take like this, and likethis. I followed it [instruction], I took it for two days only and had bleeding for two weeks,excessive bleeding that made my face pale, and made me very weak, very weak. Then I returned[to CHC] I blamed my husband ‘it is because of your attitude that this has happened. The child isstill little, now what is going to happen, you take me back to hospital [CHC]. [Then they] took me tohospital [CHC]. [Health staff said] no problem, take medicine to stop the bleeding. One week afterthe bleeding has stopped, return again. I took the medicine and the bleeding stopped. After oneweek I returned and was given an injection, the injection suited [me] but I was like a man, my bodywas very big, why I am as big as this. After the fourth child I refused [to use injection any more]. He[husband] obliged me but I refused to follow family planning, I used calendar [method] and why, Idon’t know, suddenly I fell pregnant [respondent laughs]. I said after delivery I will try to go back tothe clinic. People said even bleeding might occur but if you are careful it will be fine. So afterdelivery I intended to go to [health facility] to use family planning again. But my younger child isnow 2 years and 3 months and I am 3 months pregnant [again]. I’m not feeling very happy about it- my husband is a farmer, how are we going to survive? We live from agriculture, if he [husband]goes to the garden [if we don’t have young children] we can help him in the garden to plant andthen buy soap, kerosene. If we are pregnant and nursing children continuously it is a problem. Ithink family planning is good for us. We like it.Married woman, Focus Group Discussion, Lautem DistrictTimor-Leste Health Care Seeking Behaviour Study | 200962
Page 3 and 4:
AcknowledgementsWe acknowledge the
Page 5:
ForewordHonourable Minister of Heal
Page 12 and 13: Recommendations for the Ministry of
Page 14 and 15: Section 1 - Introduction1.1 Backgro
Page 16 and 17: 1.3.2 Timor-Leste Survey of Living
Page 18 and 19: Satisfaction with services was diff
Page 20 and 21: households. Within each household,
Page 22 and 23: Once the final set of questions was
Page 24 and 25: for all FGDs as well as for all use
Page 26 and 27: Treatment for the illness was sough
Page 28 and 29: mothers carrying infants the journe
Page 30 and 31: (tau todan) should something go wro
Page 32 and 33: Box 2: Midwife demonstrates care of
Page 34 and 35: 4.2.7 MedicationIn relation to trea
Page 36 and 37: esponsibility may be partly mitigat
Page 38 and 39: with bloody diarrhoea (tee raan) to
Page 40: push, preventing premature pushing
Page 43 and 44: In the previous 12 months, 43.3% of
Page 45 and 46: Most informants referred to the nor
Page 47 and 48: The HCSBS survey investigated proce
Page 49 and 50: antenatal care: weighing pregnant w
Page 51 and 52: drug compliance. 27 Some providers
Page 53 and 54: survey activity with little discern
Page 55 and 56: Figure 7 - Improving access, qualit
Page 57 and 58: Education of women is a particularl
Page 59 and 60: 5.4.4 Recommendations for developme
Page 61: 27. Beiersmann C, Sanou A, Wladarsc
Page 65 and 66: Appendix 4 - User-provider interact
Page 67 and 68: Appendix 5 - User blame of provider
Page 70: TIMOR-LESTE HEALTH CARE SEEKING BEH
show all

Timor-Leste Health Care Seeking Behaviour Study - Secretaria de ...

Create successful ePaper yourself

Delete template?

Save as template?