Four themes emerged including: students’ understanding and appreciation of One Health concept, students’ experiences and gains from the field attachment, students’ contributions to the communities and challenges faced.
Students understanding and appreciation of One Health concept
When asked about their understanding of One Health approach, all the students had good knowledge about the concept. They explained that it is how different disciplines work in a collaborative manner to address complex challenges. They recognized and emphasized that health cannot be achieved by one discipline or sector , due to the interdependence between human, animal and the environment. Thus the need for collaboration and combined efforts as the corner stone to address the current health challenges.
“My view about One Health is that it addresses human, animal and environment challenges, and this cannot be addressed by only one discipline, so knowledge cannot come from only one area. There is need to bring together ideas, knowledge and skills of different aspects and from different academic backgrounds to be able to solve these problems effectively.” (IDI Student leader)
‘…..usually in reference to health and environment it is hard for one discipline, ok I have seen it, and now I can say that it is hard for one discipline to get a solution, it is more important to get ideas or approaches from different people so that you can get a good solution for that problem, either to get rid of it for once and for all or to stop it for some good time because as you can see some of these problems keep on coming back but getting a good solution deserve so many ideas from so many disciplines”. (FGD Art students)
Students mentioned that sustainable health solutions can be best developed and implemented through multidisciplinary efforts of various stakeholders at different levels, including communities where public health challenges exist.
“..., there should also be some bit of collaboration and partnership not only from people of the different disciplines but also from different leaders and different levels from within the community to ensure that you can be able to address those challenges in such a way that there is some bit of sustainability.” (FGD Science Students)
In addition, students noted that One Health approach is different from the tradition way of solving health challenges, because it involves every discipline/sector which is critical for sustainable health. Recognizing lack of awareness about the concept and its importance in many settings, students highlighted a need for sensitization to raise awareness among stakeholders across various sectors for it to be embraced.
“Well, One Health is not a traditional approach, it is a new system and handling that has been developed, it is an innovation that has come up to create a collective responsibility in problem solving. Traditionally we have been relying on the medical personnel only in case of an outbreak. Anthrax has occurred,…, brucellosis has occurred, and you look at a veterinary officer only, but now with One Health, we look at …what is the role of a farmer, what is the role of a market vender, then a vet who is coming to inspect meat at the slaughter house so it requires everyone’s input. This approach seems to be effective; we must market it, sensitize people about it, to get everyone on board and the system will be effective.” (FGD Science Students)
Some students viewed the One Health approach as being an efficient method of solving challenges by creating a sense of responsibility and saving time for example in responding to an outbreak.
“It is also another way of getting things done in the field within the shortest time possible because I am imagining he is a wildlife professional at the protected area which is faced with issues of social challenges. I see it can really be hard for him [wildlife professional ]to think of social matters, related economics . But now if you integrate and bring in all those other people [social workers] concerned especially with people, work can be done in a very simple way and in a short time. (IDI Student Leader)
Students’ experiences and gains were described in a number of ways as shown in the following categories; a) appreciation of the concept of team work, b) appreciation of the role of community involvement and c) innovative use of available resources.
a) Students’ appreciation of the concept of team work
Students appreciated the different disciplines working together to develop solutions to the challenges they identified in the communities. This was reported to be critical due to the complex nature of the interconnectedness of human, animal and the environment, and through team work they recognized that each discipline contributes importantly in achieving community health
“You realize when humans are affected, most times it is connected with either the environment they stay in or the animals they stay with, and the reverse can be true, when the animals are affected, sometimes it is connected to the humans with those diseases…so going in depth in knowing all these causes, teasing out relationships, is one good reason for bringing in multi- disciplinary teams because when you collect ideas from different people, you can come up with one good reason as to why something is happening then you can figure out how to solve that problem.” (FGD Arts Students)
“These challenges are complex in nature... If you look at the general community, you will see that there are different aspects that are also being affected indirectly. If you concentrate at the health part of it you will affect the environmental part of it, the economical bit of it, the social being of the people living in that community will also be affected so if you try to bring in different groups of people on one table, and you ensure that all those different aspects are captured, it will help you to come up with an intervention or a solution whereby each group of people is more comfortable with and you know that once you take this direction this challenge will be worked upon.” (FGD Science Students)
Other skills that were reportedly learnt included negotiation, stakeholder engagement, conflict resolution, and respect of other people’s opinions in order to foster effective team work and enhance integrated approaches. They noted that engagement with people of different background, social standards and professions requires collaborative efforts focused on respect of other people’s views.
“… I learnt that it was good to engage people of different backgrounds, different levels of standards of living and people of different careers to ensure that you have the same goals. Another skill is on vision integration, because everyone comes with his/her own ideas and goals… so you try to bring all of them together. I also learnt diplomacy of solving conflicts within the groups, some of these conflicts you can’t avoid them. (FGD Science Students)
b) Appreciated the role of community involvement
During the community attachment process, the students were introduced to the community leaders and other relevant structures upon entry into the community. In their daily community activities, students worked hand in hand with the communities in identifying, prioritizing and addressing community challenges. Students reported that community involvement was critical in solving their health challenges and brought about their participation and ownership which is important for sustainability.
“We realized that in working with communities it is very crucial to involve the community, you look at what the community considers as a problem so you begin developing an idea to intervene where the community recognizes that it is really a problem affecting them. So you discuss with them the potential interventions, they tell you their suggestions and you improve their suggestions into something very important, otherwise the intervention will die out; we really appreciated that.” (FGD Science Students)
c) Innovative use of available resources
In their attachment, students did not have funds for the interventions to address identified challenges, but were expected to use the available local resources in the community. Students were able to come up with useful innovations.
“We went with nothing, with only our heads, and with prior information that OHCEA does not fund anything, I mean whatever intervention that we were going to do, you must use available local resources. At the beginning it was really hard to come up with any intervention without fund. Traditionally when you think of any intervention you first put funds on table, but we were able to put interventions that were really fundamental to the communities without any funds. By doing this, we used what the community would sustain, even without our presence” (FGD Students Science)
Come up with some useful innovations.
“…like one time there was a classroom they visited and when they reached that classroom it was full of bats….. They told us the bats do carry germs that cause diseases like marburg. The students using local herbs, came up with a concoction that was able to repel bats when it was smeared in the ceiling of the houses rather than using chemicals (which are eco-unfriendly) to kill them.” (IDI DVO Kasese)
Students’ contributions to communities
In all the community interviews, students were appreciated for being very instrumental in addressing community challenges. Community members’ views on the students’ contributions have been categorized into; a) participation in health promotion activities such as health education, sanitation and hygiene, b) enhanced interaction between the communities and their leaders, c) stimulated One Health practice in the communities, d) Committed, caring and compassion
a) Participation in health promotion activities
The students were widely recognized and appreciated by the communities for their engagement in health promotion activities in homes, schools, markets and other communal places, creating awareness among the communities on how to prevent various diseases. They conducted health education sessions which covered various topics including the interconnectedness of animal, human and environmental health.
“We benefited. We came to learn that there are diseases that can affect both animals and the human beings. These disease can kill both the animals and human beings.” (FGD Hima Slaughter Slab operators)
In addition, students were reported to implement sanitation interventions in schools and markets including hand washing facilities, clearing bushes, burning rubbishes, improving drainage systems, cleaning markets and abattoirs, thus improving sanitation standards.
“The students helped us a lot, they health educated us on health matters, they also participate in cleaning the area, there is a pit at the abattoir they found when it had blocked and they worked with us to dig another pit and filled it with stones, we are generally clean when the students are here. They also gave us advice with regards to good hygiene of the place” (IDI Tender owner Hima Slaughter Slab)
“They dug two pits down there [at the slaughter slab], they slashed here around the slab and around the toilet, and also cleaned the market. They went to Kisongola primary school and made a water tippy-tap for them,… you know the cows were drinking from the tap but they fenced the tap.” (FGD Slaughter Slab operators)
Also students participated in improving waste management in the markets, by teaching the vendors on how to recycle the waste into briquette’s. Recycling waste into briquettes offered the communities with a number of benefits; improving environmental sanitation, environmental protection and creating an income generating activity for the vendors.
Through their work, the communities reported that students challenged communities and caused visible change and impact in the community for instance in promoting positive attitude towards sanitation. For instance while a cholera outbreak affected one Kasese district, respondents reported that students work was believed to have contributed in controlling outbreaks in one of the town councils where they were attached.
“Generally there is a bit of change of attitude by the community members in as far as sanitation is concerned, because where they found no toilets they encouraged those people to construct to ensure that they have latrines and so at least sanitation has improved and this has led to reduced episodes infections like cholera and others. For example when the district was hit by cholera recently, Hima town council was safe. We didn’t have any occurrence of cholera infection. ” (IDI Town Clerk Hima Town Council)
b) Enhanced interaction between the communities and their leaders
“The students had an opportunity to present their work they had done in the community to an audience consisting of the district officials, town clerk, staff and members of councils. They presented what they found in the community, what was done and what is expected of the town council/district, so that the community/town council/district owns it.” ( IDI Animal Husbandry Hima-Field Mentor)
Students also created awareness regarding potential stakeholders and corporate social responsibility. Students were reported to consult and involve organizations and companies, and reminded them of their role in the community.
“…. if we have Hima Cement factory in Hima town council, how do they help the community? Do they put there anything, do they give them water, do they open up some roads, how do they contribute to the people, how could people gain from them.’ (IDI Animal Husbandary Hima-Field Mentor)
c) Stimulated appreciation of One Health practice in the community
The students’ work ethic challenged community members including the district officials by demonstrating potential efficiency and effectiveness in collaborative efforts. Communities appreciated the One Health approach based on what the students’ way of work, where they exhibited collaboration, team work and respect for each discipline, unlike where they work in siloes. They said that lessons from experiences with students in the communities guided a multi-sectoral response against a cholera outbreak in the district.
“When we had the recent cholera outbreak, here we had to awaken people, basing on the concept we had from OHCEA, and the fight of cholera it was everyone on board, the LCs were on board, the business community we called them that the strategic market is going to be affected and our business is going to be affected, an outbreak is going to affect the economic activity , so we had to sit with them and agreed on how they were going to improve and we saw things working out, unlike the previous days when it was for the health workers alone.” (IDI District Health Officer-Field Mentor)
Communities also realized that there are things they should do for themselves, than relying on government.
“One of the things was that they realized that certain things can be addressed using the available resources other than relying on the government, thinking that it is the government which is going to do everything, they realized that we can address certain things using the resources that are available within us.” IDI Laboratory-Field Mentor)
d) Students were committed, caring and compassionate
“... I witnessed that they were doing very good work. They talked about protection of rivers or water bodies and you could see that they are educating people with a lot of care and love and showing them that it is all about them (community), it is for their benefit that they must do this.” IDI Town Clerk Hima Town council
Challenges faced by students
One of the major challenges reported was related to inadequate funding. While students were encouraged to be innovative and use available resources, they noted that lack of funding limited the extent of the appropriate and sustainable interventions they could implement in the communities. The students felt that if some funds were available, they would have come up with strong and more meaningful solutions more so than using inferior materials.
“…We are looking at sustainability and we are just digging up something, no concrete, I think if we were provided with some little cement and you construct a very nice pit, permanent because it will rain and the whole thing is filled with sand, so what next? But if it’s well constructed with concrete, it can create an impact on the whole community and they even make an effort to keep it clean” (IDI Science Student)
Lack of community ownership of interventions was also a concern. It was reported that some community members refused to participate because they wanted to be paid. Such lack of community participation indicates less or no ownership of interventions. The need for payment by some community members before they could to engage in their own community solutions threatens sustainability mechanisms of any interventions the students implemented. Relatedly, community respondents were concerned about the sustainability of the interventions given the short period of attachment because students would leave the communities immediately after implementing the interventions. This raised concerns regarding limited lessons and follow up with some interventions which communities wouldn’t maintain on their own in the long run.
“…, like issue of sustainability, something has been done, how is the follow up going to be done to ensure sustainability , to show that this is what we are doing and there after what happens? But we need an intervention to be done and people learn from that intervention and people take on that intervention continuity to see that at least there is a change in life, or in the lives of the community, but now the challenge is, after making all this how do we ensure continuity of these services when you leave” (IDI District Veterinary Officer/Field Mentor)
There was also a challenge of language barrier, with some students and community members failing to communicate which compromised the community engagement process to some extent.
The issue of culture was also raised as a factor affecting assimilation of what the students sensitized the communities about in terms of preventing diseases. Some cultural practices promote transmission of diseases. For example it was reported that the Balalo (cattle keepers) love their animals so much that they don’t believe they can be of risk to their health. They find it normal to share a house with their animals or drink uncooked milk from them.
“Ok for the Balalo they got annoyed because for them you cannot separate them with their animals, they wouldn’t mind seeing an animal sharing with them a saucepan. Some of them were not happy with the changes as a result of the interventions of these students” (FGD Hima Town Council)