Action For Health : Empowering Communities in Mali

Kalabambougou is not far from the bustling streets of Bamako’s city center, but after leaving the paved roads behind, drivers go from dodging the moto bikes that weave in and out of traffic to skirting the car-sized pot holes formed by the deluge of the rainy season. The pot holes have recently been filled with large boulders that will be smashed into smaller pieces with sledgehammers – daunting work, made more intolerable by the relentless heat and humidity. Maintenance of these dirt roads throughout the year is vital to the community because it is their access to Bamako, the markets, and to the nearby community health center.
 
It is late afternoon and the women begin arriving at the meeting location for their weekly savings group, in the shade of an old moringa tree. Korotoumou, 25, is there with two of her six children and she is steeping the first round of sweetened green tea for the group’s members. There are freshly roasted peanuts for sale and another woman is selling chunks of juicy watermelons. One group member braids another’s hair, and a young girl is hanging brightly colored clothes on the line to dry. This is where the members of Ben Kadi and Yelen (one group with two names, translating to “Mutual Understanding” and “Light”) meet to give themselves and their families the opportunity to save for their future needs. The group has two names because there are two things the women save money for: healthcare and small business activities.
 
Korotoumou is the group’s treasurer, and when she isn’t meeting with the other women, she is busy with her small business, selling vegetables at the nearby market, or doing the never-ending work to keep her home functioning (cooking, cleaning, minding the kids). Her oldest child is eleven and her youngest is the nine-month-old girl in her lap commanding her fullest attention. She thinks education is important, so her five school-aged children are all enrolled at the nearby public school. Korotoumou and her husband, a local brick mason, had limited education when they were younger. He was schooled for eight years at a traditional Islamic school, or Madrassa, studying the Koran, and she has a fifth-grade level education from a public school.

Korotoumou was in a savings group before Mali Health introduced the idea of adding a health savings aspect. She says that contributing members feel a new sense of ownership for their family’s health needs. Before the health savings group, when one of her children fell ill and required a visit to the doctor, there was concern about how she would be able to pay for the visit and any needed prescriptions. She did not like having to ask family or friends for a loan because it made her and her husband feel embarrassed. Now, with the option of being able to take a health loan from the savings group, they feel a sense of pride in being able to do for themselves what so often they had to rely on others for.
 
There was a health center built in Kalabambougou a few years ago, but it never opened. There is a solar-powered water tower that is empty and beginning to rust, a maternity ward with gurneys and delivery areas that are collecting dust and cobwebs. The grounds are serving as a temporary farm field for the family tasked with caring for the vacant health center until whatever local political dispute preventing its opening is resolved. Korotoumou shakes her head and laughs when she talks about why the health center hasn’t ever been opened because she believes there isn’t anything she can do about it. It would be convenient to have a closer health center; the closest one with which Mali Health partners is more than three miles away, so she and her family use the one in the next town over because it is a shorter distance.

When one of Korotoumou’s children falls ill, she knows it immediately because instead of running around playing with friends, she says they remain at home asking to sleep and lay down. This is a telltale sign and she can now go to the health center with confidence that she will be able to afford the visit and any treatment. She and her husband will wait at least 24 hours after feeling ill to see if the symptoms will clear up on their own, but she doesn’t wait that long for her children because she knows they are at greater risk and require timely treatment. The most frequent illness the family encounters is malaria, which is especially prevalent during the rainy season as the mosquito population booms. She and her husband still use traditional herbal medicine to treat less severe cases of malaria because it is cheaper than western medicine, and in their opinion, just as effective.
 
The institutions that Korotoumou and her family rely on are fragile and it is difficult for her to feel secure in their future. She said what used to keep her awake at night was the fear of not being able to care for their children’s health needs, but with the Savings for Health program, she can now rest a little easier. The collective nature of the savings group gives her confidence that her community cares, and instills in Korotoumou a feeling of agency in being able to contribute to the better health of not just her children, but many other children in Kalabambougou.