CHAPTER 1
Introduction to The GRIP Guide
Injuries are a leading cause of death and disability for all age groups, among all people, in all parts of the world. Yet injuries are one of the most preventable health conditions we face. Grass Roots Injury Prevention: A Guide for Field Workers has been written for field workers who want to help make their communities safer. The GRIP Guide translates the principles of injury prevention into everyday practice. It helps you understand what causes injuries and what can be done to prevent them.
Keywords: injury prevention, guide, manual, field workers
Who it will help
If you are working to prevent injuries and promote safety at individual, family, and village levels in lower- and middle-income countries, The GRIP Guide is for you!
Community health workers are looking for simple, effective ways to prevent injuries and promote safety. This is a practical manual to help you make a difference, without the need to wade through the theory of individual, social, and environmental change that underpins injury prevention and safety promotion.
How to use it
The GRIP Guide is designed to help translate the principles of injury prevention into everyday practice. It will help readers understand what causes injuries and what can be done to prevent them. It takes into account the human, social, environmental, and financial challenges in many communities. The book focuses on preventing the causes of injury (primary prevention).
The GRIP Guide provides a series of approaches community health workers can use to help ordinary people create safer homes, villages and communities. The explanation of these approaches is based on the experiences of a fictional field worker named Dula and a group of community members in the fictional village of Dingly. The exercises provide community health workers with tools they can use to bring community leaders and members together to identify the main causes of injury and propose lasting solutions that will work in their community.
Readers can select the modules (sections) that reflect the types of injuries in their communities. Each module provides the information that community members and leaders need to help them take action.
The GRIP Guide does not provide a blueprint for you to simply copy. Instead, it provides a process to help you guide the community in developing the answers for themselves. The GRIP Guide helps you 'learn by doing', not 'do by copying'.
We recommend you read the whole manual carefully to enable you to understand the purpose, content, and approach taken. To help others to learn and to act in their own communities, you must be familiar with the key information provided in each exercise.
The guide will help you help others – such as community members and leaders or key decision-makers in schools, workplaces, and government departments – to understand the major causes of injuries, and what they can do to build and maintain safe places for people to live, work, and play.
At the end of each exercise, the guide encourages you to think of other possibilities and alternative ways to address the problem under discussion.
How it is structured
The GRIP Guide contains seven modules following the introductory chapters.
Chapter 2 gives an overview of the principles of injury prevention and safety promotion. Modules 1 to 5 describe how to address the five main types of unintentional injuries (burns, falls, drowning, transport injuries, poisoning). Module 6 describes an approach to preventing intentional injuries (violence). Module 7 provides a generic approach to reducing the risk of other unintentional injuries.
These modules can be used flexibly; you do not need to follow the sequence from 1 through to 7. The authors encourage you to read all modules as each provides information of value to you in working toward lasting change. However, you can choose to focus on the module about the injury of most concern to your community. The GRIP Guide is there to support you and your community to learn through doing.
Each module is designed to help build confidence and skills in:
• Grasping the problem;
• Risk factor identification;
• Intervention development and implementation;
• Progress monitoring.
Making The GRIP Guide work for you
To improve the local relevance of the exercises provided, you may wish to use local names and local stories. Carefully consider any cultural and religious issues that are important to your community when adapting the exercises. You also need to think about the financial, physical, or geographic restrictions that may make an exercise difficult in your community.
One person cannot have all the knowledge, skills and authority to change many of the factors that cause injury. We recommend you seek the assistance and support of local officials and community members each step of the way, from gathering information about the problem through to putting lasting solutions in place.
How to form a group
To get the most out of The GRIP Guide, you will need to work with a wide range of people. Bringing them together in a group will enable you to build on their experience and skills. Forming a group involves getting together people who share an interest in an area (such as injury prevention) or who have responsibility for the things found to be causing injuries, and who are prepared to work with others to achieve the community's goals.
Begin by identifying the most senior members of the community, such as elders, the chief priest, political leaders, business owners, aid organization representatives, police, and medical and nursing professions in the village. Arrange to visit each of these people to talk about the problem of injury in your community. Ask them to support your plan to establish a group to work on ways to reduce injuries in the community. Present them with a summary of the problem of injury in your community and some of the ways the community could be made safer. Explain how improved safety would be good for the community, the government, and businesses.
When arranging meetings find a time when most people will be available, considering work, family and community commitments, and then provide everyone with details of where and when the first meeting will be held. At that first meeting, you can help those present discuss how the group will function in the future.
Learning exercises
Group exercises and various activities are used to encourage community members and leaders to take part. The following pages describe these activities.
Brainstorming
Brainstorming helps people work together to build a solution to a problem. The group members' experiences, skills, and knowledge of their own community can lead to new approaches to removing a problem.
Steps
• Write the problem on a flipchart or blackboard. For example: what can we do to prevent burn injuries in the village?
• Ask group members to think about the problem for a few minutes.
• Encourage them to put forward their ideas.
• Write all the ideas on the board as they are mentioned. Do not interrupt or argue; let the ideas flow freely. It is important to record all the ideas – no matter how unusual or unlikely to work they may seem to you. If there appear to be any areas of confusion, encourage everyone to explain their ideas a bit more.
• Work with the group members to allocate the ideas to themes such as 'in the home'; 'in the workplace'; 'in the village'.
• With the group members, consider how often the injury happens and its severity. Prioritize the ideas within each group according to the urgency for action. Ask the questions: What must we do now? What can we do over the next three months? What do we need to do in the future?
Case study
A case study is a detailed story – real or made up – about an event that led to one or more injuries. It enables group members to realize that their families and community members may be at risk of similar injuries. Encourage the group members to think about what was happening when the injury took place, what caused the injury, and what action could have prevented the injury from happening.
If you use a real story, change the names of people and the community described in the story to protect their privacy. It is important to make sure that no hurt can be done through the telling of a story in which a loved one might be easily identified.
Steps
• Divide your group into smaller teams of three or four members. Bigger teams can make it difficult for everyone to be heard.
• Give each team a copy of the case study (e.g. a detailed story about an event resulting in burns to a three-year-old child).
• Ask team members to read and discuss the case study. You may need to prompt the discussion with some questions, such as: What are the main things you think contributed to the injury? What could have been done differently? What must happen to prevent a similar injury in our village?
• Bring the small teams back together to discuss all the ideas put forward.
• Write down the ideas on the board as they are mentioned.
• Work with the members to put the ideas into logical themes around the type of injury described in the case study, such as 'in the home'; 'in the workplace'; 'in the village'.
• Work with the group members to prioritize each idea under headings, such as 'What must we do now?'; 'What can we do over the next three months?'; 'What do we need to do in the future?'
Community mapping
Community mapping can be used to assess the potential risks to safety in places where the community members live, work, and play. Features mapped might include:
• natural landmarks, such as rivers, channels, wells, jungle, wild animal crossings;
• human-built structures, such as cooking areas, roads, livestock pens, and playing areas;
• common activities, such as farming, washing, and building.
Steps
• Have group members draw a map of their area on a large sheet of paper.
• Ask them to mark features that are important in relation to the problem being discussed. For example, if you are discussing drowning, mark all the wells and bodies of water.
• Ask them to describe any injuries that are related to these features.
• Discuss the relationships between the features on the map and the injuries that have occurred.
• Encourage group members to share their ideas about what could be done to reduce the risk of injuries in these areas in the future.
Daily activity schedule
Ask the group members to record their daily activities to help them identify behaviour that could place them or their loved ones at risk of an injury. Use this exercise when helping people understand that individual behaviour is an important factor in preventing injury.
Demonstrations
Demonstrations are a good way to give people a strong message. For example, setting alight a flammable item of children's clothing or seeing the damage done by falling building material will be more effective and leave a longer-lasting message than just describing it.
Steps
• Explain the purpose of the demonstration.
• Encourage group members to ask questions.
• Demonstrate the behaviour or other factors that could cause an injury.
• Ask group members to role-play (see below) the event.
• Discuss the feasibility, advantages, and disadvantages of reducing exposure to the things shown to be the causes of an injury.
• With the group members, explore how they could overcome any potential barriers to reducing these causes in their community.
• Encourage group members to make a list of actions under each of the headings: 'What must we do now?'; 'What can we do over the next three months?'; 'What do we need to do in the future?'
Event calendars and charts
Keeping event calendars and charts can provide information about the size of the injury problem in a community. They also help monitor the success of activities designed to reduce the risk or severity of injuries. Group members can be encouraged to record the details of injuries that occur in their village over several months or seasons. This will provide valuable information about the frequency, severity, and seasonal variation of injuries.
Group discussions
Group discussions encourage members to share their ideas and experiences. Open discussions help group members realize that they are better able to find ways to reduce the risk of injury in their village if they work together.
Steps
• Group discussions can be in small teams of three or four people or as a large group.
• Start by agreeing on the rules of the group discussion. Group rules might include:
– listen to each other without interrupting;
– respect each other's ideas, values, and beliefs;
– do not insult or cause intentional hurt through negative comments, looks or gestures;
– give views briefly, clearly, and keep discussions on the topic.
• To help give everyone an opportunity to join the discussion, you might use a 'talking stick' to identify the person who is speaking. This is a stick or similar object that is passed to each group member in turn to encourage them to share their ideas while everyone else listens.
• Select one person in the group to lead the discussion and, if necessary, to remind group members of the agreed rules.
• If the discussion is in smaller teams, ask each team to choose a member to present the summary of their discussion to the whole group. Encourage all group members to be involved in discussing each summary.
Field visits
Field visits provide group members with first-hand experience of where injuries happen.
Steps
• Decide on a place to visit that is relevant to the injury the group is focused on.
• If needed, plan safe transport and access to clean water, and organize meals for the day of the field visit.
• Think about the observations and activities that will increase the group's knowledge.
• Prepare a checklist for each group member, drawing attention to injury risk factors. The checklist should encourage them to look at the physical features, such as the layout of the site; the natural landmarks; the activities taking place; and who is involved in them.
• After the field visit, bring the group together to discuss their observations and experiences. Use the checklist to guide discussions about the site's features and people's behaviour that increased or decreased the risk of injury.
Folk media
Folk media (lullabies, nursery rhymes, folk songs, and puppets) can be used to convey important information about ways to stay safe and to prevent injuries among people of all ages and backgrounds.
Games
Games specific to a group's culture and community can support learning and help people to work together.
If the group members are not well known to each other, you might need to think of ways to 'break the ice' before people will join in or share their ideas. Group games specific to their culture may help everyone relax and be a more confident member of the group.
Presentations
Presentations by experts in a subject area can raise awareness within a community and increase knowledge about preventive actions.
Experts can come from many different places and backgrounds. They might include the local baby health nurse presenting practical ways to keep a baby safe; an officer from the Department of Agriculture demonstrating how to use farm chemicals safely; or the local doctor talking about what to do to reduce the skin damage if someone is scalded by hot water.
Presenters need to select information that will be meaningful to the group members, taking into account their level of education and any cultural issues that may influence their reactions.
Role play
Role play is an unrehearsed, unscripted drama in which group members act out an event. Role plays of injuries can motivate group members to change their behaviour to avoid injuries.
Steps
Choose a situation: for example, a fire caused by an overloaded power board breaks out in a home while the family is gathered to watch TV or an elderly grandmother is severely burnt while preparing the evening meal.
