Kalofonos Ippolytos
a Department of Psychiatry and Behavioral Sciences , University of Washington Medical Center , Seattle , WA , USA.
Glob Public Health. 2014;9(1-2):7-24. doi: 10.1080/17441692.2014.881527. Epub 2014 Feb 6.
This paper tracks the intertwined biographies of a community home-based care (CHBC) volunteer, Arminda, the community-based organisation she worked for, Mufudzi, and the HIV scale-up in Mozambique. The focus is on Arminda--the experiences, aspirations, skills, and values she brought to her work as a volunteer, and the ways her own life converged with the rise and fall of the organisation that pioneered CHBC in this region. CHBC began in Mozambique in the mid-1990s as a community-level response to the AIDS epidemic at a time when there were few such organised efforts. The rapid pace and technical orientation of the scale-up as well as the influx of funding altered the practice of CHBC by expanding the scope of the work to become more technically comprehensive, but at the same time more narrowly defining 'care' as clinically-oriented work. Over the course of the scale-up, Arminda and her colleagues felt exploited and ultimately abandoned, despite their work having served as the vanguard and national model for CHBC. This paper considers how this happened and raises questions about the communities constituted by global health interventions and about the role of and the voice of community health workers in large-scale interventions such as the HIV scale-up.
本文追溯了社区居家护理(CHBC)志愿者阿明达、她工作的社区组织穆富齐以及莫桑比克扩大抗逆转录病毒治疗规模这三者相互交织的经历。重点是阿明达——她作为志愿者为工作带来的经历、抱负、技能和价值观,以及她自己的生活与该地区率先开展社区居家护理的组织的兴衰如何交织在一起。社区居家护理于20世纪90年代中期在莫桑比克兴起,当时针对艾滋病疫情的社区层面应对措施很少。扩大规模的快速步伐和技术导向,以及资金的涌入,改变了社区居家护理的实践,将工作范围扩大,使其在技术上更加全面,但同时将“护理”更狭义地定义为以临床为导向的工作。在扩大规模的过程中,阿明达和她的同事们感到受到了剥削,最终被抛弃,尽管他们的工作曾是社区居家护理的先锋和国家典范。本文探讨了这一情况是如何发生的,并对全球卫生干预所构成的社区,以及社区卫生工作者在扩大抗逆转录病毒治疗规模等大规模干预中的作用和声音提出了疑问。