Since May 2011, the 10 members of the Bandiagara Coura Action Group have been hard at work making their hill-side community healthier. Bandiagara Coura is named after the famous Dogon escarpment, and its steep hills and rock-homes evoke Mali's famous tourist destination. Given the difficulty residents have accessing water, electricity, roads and schools, it is also one the most underprivileged parts of the Sikoro neighborhood.
After an intensive training on community activism by Mali Health’s Mobilization Coordinator Dramane Diarra, the Action Group members went to work developing programs to improve the health and well-being of their neighbors. One of their first activities was to conduct a census of the population of Bandiagara Coura. The members of the Action Group realized that without a clear picture of who resided in the neighborhood, and the number of people living there, they would be unable to plan and execute activities. The Action Group surveyed over 1200 families living in Bandiagara Coura and gathered valuable information about the population (such as the fact that certain households essentially as dormitories for people who work in downtown Bamako) and community relations (for example, some residents have a negative view of the sector chief, dating to the time when the land was divided). All of this information will allow the group to effectively plan and implement activities.
Following the census, the Action Group began work on their first community improvement program: paving the three main roads in Bandiagara Coura. Ama, the Action Group president said, "Paving the roads will make it easier to leave Bandiagara Coura. Today, if someone falls ill, they have to climb down the hill, or someone has to carry them down the hill, to the main road before they can find a car or bus, as these vehicles cannot drive up the hill.” In addition to reducing access to health care, the poor road quality means that women and children have limited access to piped water, which is only located in the valley. More than 5 years ago, the sector chief had directed an activity to pave some of the roads, but others remain unfinished. In order to improve access between Bandiagara Coura and the rest of the neighborhood, the Action Group plans to pave 3 roads. In order to make these roads usable for motor vehicles, they have to do everything from dynamiting rock to make the road wider, building retaining walls, and filling in sunken land. To achieve their goal, the Action Group has solicited donations from community members to pay for cement and sand, and youth have contributed labor to the project. This is an ongoing project, but the start has been very fruitful and close to 70% of Action for Health families have participated in the project. The sector chief says: "It has been a dream of mine to see public transport in Bandiagara Coura, and we need good roads for this to become a reality." (Bamia, chef de secteur).
Over 18 months ago, Action for Health launched to address child health by providing free services for children, health education, and opportunities for families to engage in local health projects. Today we’re excited to announce the start of our expanded maternal health initiative, designed to empower women with critical health knowledge and services to ensure a safe pregnancy, delivery, and postpartum recovery.
1 in 22 women in Mali die of maternal health complications (UNICEF). Most of these deaths are caused by preventable and treatable conditions, like hemorrhaging, infections, high blood pressure, and obstructed labor. Under our new maternal health initiative, we are excited to offer enrolled mothers expanded health education, free prenatal consultations, accompaniment, and follow up to connect them with medical providers. The heart of the initiative is our Community Health Worker team, composed of local residents (most of them mothers themselves) with training in health promotion.
Our Community Health Workers work one-on-one with women in their homes, reviewing lessons such as maternal nutritional needs, birth spacing, the purpose of prenatal visits, and recommended breastfeeding practices. Under the new initiative, Health Workers also accompany mothers on prenatal consultations (now free of charge), work with them and their husbands to plan for transportation and logistics of the birth, and are on-call for deliveries. An emergency fund is now available for complex pregnancies requiring specialized services. Executive Director Anna Ninan states: “Health knowledge and agency are infectious: when one women learns to safeguard her health she shares that information with her family and friends, empowering others around her. At the same time, we have to recognize the critical role of health services, especially for those who might not be able to afford them as is the case for much of Sikoro. We’re excited to be breaking down those financial barriers to care by providing free services.”
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While reviewing the patient charts for Action for Health members, Mali Health Community Health Worker Djibril Traore noticed something – the number of cases of diarrhea was increasing sharply. At the Sikoro-Sourkabougou public clinic, the Medical Director, Dr. Diarra, noticed the same pattern. Together, Djibril, Dr. Diarra and other members of the Action for Health team decided they needed to do something to address the increased number of cases – diarrhea is one of leading killers of children under-5 in Mali.
The Action for Health team worked with Dr. Diarra to plan a two-phase response, including education and community action.
On Sunday August 14 over 100 women assembled in the public square of the part of Sikoro known as Bandiagara Coura, one of Action for Health's primary target zones, to take part in an information session on diarrheal diseases. Dr. Diarra led a discussion of the causes, symptoms, preventive measures and curative actions for diarrheal diseases. Women benefited from learning about the need to maintain clean water sources, and to provide lifesaving liquid to their children even before taking them to the clinic. According to Djbril: “The day was a huge success. The population really appreciated the information, and some of our Community Health Workers even asked that we do this sort of education program every month. I think it was really important as well, because of the impact of diarrheal diseases - in Mali we are even being threatened with cholera epidemics in Mopti and Timbuktu, so it is really important to teach people about how to care for diarrhea."
Bandiagara Coura is located on a hillside overlooking the rest of the neighborhood. Although public taps exist in other parts of Sikoro, no taps have been installed in Bandiagara Coura, and women who live here must walk up and down the steep hill to collect water. Given this challenge, many choose to drink well water instead. The months of June-September coincide with the rainy season in Mali and open latrines and other sources of dirty water can easily contaminate these wells. In light of this reality, education about diarrheal diseases is not enough. Our Action for Health team researched the different options, and decided that the most effective response would be to distribute Aquatabs to families in the Action for Health program. Aquatabs, which are similar to the water-purification tablets used while camping (or traveling abroad), disinfect up to 20 liters of water with one pill, providing a source of clean drinking water for children and family members. The distribution of Aquatabs, in conjunction with the education provided on the prevention and treatment of diarrhea, will lead to a decrease in the number cases of diarrhea in Sikoro– a potentially lifesaving intervention for children.
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With the support of our Community Health Worker team, Action for Health recently expanded to two new neighborhoods, nearly doubling program enrollment. We are excited to announce that our twelve fulltime Community Health Workers now provide in-home education and case management for nearly 800 poor children!
The newest neighborhood to be added to the program’s catchment is Bandiagara Coura, a peripheral area of Sikoroni where houses climb the base of a nearby cliff. Residents here have no access to running water or sanitation services. Over 170 of the poorest families in the neighborhood have been enrolled, allowing much needed access to health care and opening the door for residents to work together to address root causes of health problems.
Action for Health uses a peer education model, encouraging program participants to become health advocates among friends and neighbors. Community Health Workers are chosen from the neighborhoods that the program serves. This means that Health Workers’ patients are also their friends and neighbors, allowing them an invaluable insider’s perspective and ensuring that they are near the families they serve in case of urgent needs. Sanata Cissoko and Ami Tangara are two of the newest additions to our team of Community Health Workers.
Sanata and Ami exemplify the diversity across the team of Health Workers and the unique strengths that each individual brings to the group. Sanata Cissoko is a 24-year-old new mother who moved to Sikoro just four years ago. She was recently certified by the Red Cross as a nurse’s assistant after a six month training in which she learned to recognize danger signs of serious illness in children, administer dressings and bandages, giving injections, and understand pathologies of diseases like malaria and respiratory infections. Santa is especially excited to work to educate and serve other young mothers like herself, saying, “I want to do my work well.”
In contrast, Ami Tangara has been living in Sikoro for over twenty years. She has raised her own four children here, selling meat at the local market to support her family. Today she is an active leader in local women’s groups, including a savings group through which women pool their money to support each other. Upon meeting Ami, one is immediately struck by her sense of humor, as well as the wisdom and experience of an older woman who has already shepherded many children into the world. Ami is excited about serving the community as a Health Worker, saying: “We can teach families; help them understand what's important for their child's health. It's our job to make sure they get care and follow up with the child to make sure they get better." We look forward to keeping you updated on the dynamic leadership of Ami, Sanata, and the rest of our Community Health Worker team. Read more updates on Mali Health programs at www.malihealth.org, and as always don't hesitate to email us with questions at firstname.lastname@example.org.
On March 1st, Action for Health celebrated its one-year anniversary. Over the last twelve months, our community health worker team has made over 13,000 preventive home visits and supervised nearly 800 clinic visits to treat sick children. With half a dozen health actions, families have contributed over 1,000 hours of community service to improving the health of Sikoro as a whole.
Beyond the numbers, the impact can be seen by the families themselves. Oumou Niare, a 38 year old Sikoro community member, sells condiments on the side of the road while her husband works as a carpenter. Customers are scarce, and neither job provides a reliable income for the family. Last year Oumou enrolled her two children in Action for Health because she didn’t have the financial means to take care of their health.
Since joining, Oumou has learned a lot about preventive care from the community health workers, who have worked with her one on one to cover topics ranging from vaccinations to mosquito nets that can protect her children. Thanks to these health lessons she has learned, Oumou says her children now have fewer problems with diarrhea and vomiting.
At the same time she’s thankful to know that when her children do fall ill, can get the medical care they need. In her own words “Now I don’t have to leave my sick baby at home because of lack of money. The program helps me to cure my babies and I can also give back to the community.” Knowing that the cost of care is covered, Oumou now takes her children to the clinic when they first become sick, rather than have to spend several days scraping together funds for the visit from friends and family.
Oumou also feels the program is innovative because of the health actions. From malnutrition awareness days to community clean-ups, Oumou is proud to know that she is participating in activities that benefit the community as a whole, helping to prevent illness among other families and create a healthy environment for children across Sikoro. She hopes to see the program expand to include more families in the years to come.
As we prepare to double the number of children enrolled in Action for Health, it is heartening to move beyond the numbers and hear stories of change like Oumou’s. This coming year we look forward to not only supporting more families, but also deepening the community service impact with our new action training curriculum. We look forward to keeping you up to date as the program progresses!
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