Written by Djibril Traore, Community Health Workers Coordinator
It happened some months ago, during a routine visit to one of my families. Someone reported that there was a problem that required urgent action. A child named SK had been badly burned in an accident at home. SK’s mother is a young woman named Oumou; she is raising SK alone, and she has very little to eat. She washes clothes for other people to make ends meet. When my colleague told me about the incident, I was deeply worried about the boy, and I quickly took my bike and rode as fast as possible to family’s home.
When I reached the house, I walked inside to see SK lying on a cloth next to Oumou. He was unable to stand because of his injuries. I could not hold back my tears. Oumou was distraught and desperate; she didn’t know what to do for her child. Her eyes were filled with anguish and sorrow as if she were saying goodbye forever, expecting that she would soon lose her son. I got a taxi and told the young woman to prepare to go to ASACOSISOU, the nearest health facility, built by Mali Health. We struggled to carry the boy into the taxi. Once we pulled up to the clinic and the doctor saw us with the child, he rushed out to help get him safely inside and immediately started treating his wounds. After some time, I called my superiors and explained the details of the situation.
That day, the clinic staff changed this family’s life, and Mali Health was part of that effort. We helped SK access the care he needed. After his wounds were dressed, we returned to the house and Oumou fed her son. A health worker continued to provide follow-up care and monitoring after that day to ensure that SK would make a full recovery. Oumou’s face was radiant, so happy and so lively as she fed and talked to her son; she thought she had lost the most precious thing in her life, but then had it returned to her.
Some time into his recovery, the mother and child came to our office, SK walking on his own at his mother’s side. She blessed Mali Health for what it had done for her and her son. I was very happy to see the child standing strong and improving, and we were all happy that he would fully recover.
I am very proud of Mali Health for its bravery, its tenacity, and the support and guidance it provides to people, as exemplified by this case with SK and Oumou. I want to say thank you to Mali Health, to my colleagues, and to our generous donors, who make our work possible. I am proud to be a part of this wonderful organization. Our mission motivates me and gives me the strength to continue on this path.
Written by Dr. Diakardia Traoré, Medical Advisor
It is August 17, 2013. It is 6:30 in the morning when I get in my car in Sebenicoro under a cloudy sky. I smile to myself; I feel I’ve accomplished a lot to help the people of Sikoro-Sourakabougou. Today is the opening of the maternity ward at CSCOMSISOU, the clinic Mali Health helped to build in Sikoro.
After a 45-minute drive, I pull up to the clinic gates. I lift my eyes to the sky and say “Thank you” with a heart full of satisfaction. The president of the ASACO (the local community health committee) Mr. N’faly Dembélé comes over to meet me and tells me, “Doctor, from my heart I thank you, I thank you for your help. What we are doing today, it is important to me not only as president of the ASACO, but as a resident of this area and as a father.”
As we approach the building, we meet Ms. Adam Traore, the matron of the CSCOM; she says to me, “Thank you, Doctor. This building will give us much better conditions in which to work. Women will no longer wait in pain because this new delivery room is much bigger; they will not fear for their privacy because this building is set apart from the others; and they’ll no longer have to rest with their newborn baby in the same room as the sick. As a woman, this maternity ward warms my heart and makes me even more proud to work here at the clinic.”
An old woman then approaches us. She had been looking for someone from Mali Health when she was told I was one of the people who built the maternity ward. In her soft voice, she began, “Dr. Traoré, thank you for your work. I accompanied my beautiful daughters here, just like the other women around us. Four years ago, I lost my grandson when my daughter gave birth at home. It was 3am and there was no clinic here to come to. It was a dangerous area, and we couldn’t find a taxi to take us to the hospital, so my daughter gave birth at home with no professional help. They were atrocious conditions in which to bring a baby into the world, and he didn’t survive. Now, only three months ago, my daughter gave birth again, this time here in the clinic; there were no problems, but she had no privacy either. With this new ward, our daughters are happy that they can give birth safely and privately, and we are just as happy for them. So I say thank you to everyone who made this possible. God bless you.”
I cannot continue on my way because I am stopped at all turns by people who want to greet me and express their thanks. A sense of pride rushes through me. I sit on a bench for a moment, and I start to think about all of the people who made this event possible: our staff, our partners, and the donors from all over the world who contributed to this project, especially the family of Rita Camardo, after whom the ward is named. Without them, I would not be here today receiving all of this gratitude. But I am, so I do it on their behalf; this gratitude is for all of us. Today, August 17, 2013, will forever live in my memory.
It was the last Friday of August 2013. In the meeting room, the health team was in a training on the implementation of mobile health. My office was open. From my desk, I saw the feet of the Chief of the Department of Communication and Public Relations. He has long legs, so while I could’t see his head, I had a good view of his shoes because his office faces mine from across the terrace.
Suddenly, I saw a woman step onto the terrace, a baby on her back, looking for someone to talk to. She had a big gleam in her eyes. It was just after noon. I walked over and invited her to come into my office and sit down. As she did, she took her baby off her back and handed the child to me with a smile on her face, saying, “I have to show you your baby!” It was like she was handing me a trophy. She seemed to have won a battle.
The woman’s name was Djelika Sogore. She had a cheerful air, which I quickly mirrored, as I took the baby from her. “What is our baby’s name?,” I asked. She told me his name is Kassim Coulibaly and he is 18 months old. She added,
I'm not the baby’s mother. I'm his grandmother. His mother died giving birth after a cesarean section, leaving Kassim to me. He is all I have left of my daughter. But he became very ill and very thin and had trouble breathing normally. I thought that misfortune was still knocking on my door and that I would lose what was left of my daughter. That's when officers from Sigida Keneyali (Mali Health’s local name) arrived. They drove my grandson to CSREF (a near-by health center) to be hospitalized, and he received intensive care for a month. I was told that my grandson was suffering from malnutrition and a severe respiratory disease.
After helping us get my grandson the immediate care he needed, Mali Health workers have often visited us to follow-up on his recovery and growth. On Friday, when I took him in my arms, he looked at me with eyes that remind me of my daughter; that look flooded my heart with joy. I thought to myself that I had to share this my happiness with the people who are behind this miracle, the officers of Sigida Keneyali. That's why I'm here!
I looked at the small child, and I too felt the joy deep within me, being a mother, a grandmother (my son has a 5-year-old son of his own), and having also lost my daughter (who would have been 30 years old now). What can I say? That joy, delivered through the eyes of this child, is indescribable and takes your whole being. I couldn't help myself, and I started crying. I invited the Chief of Public Relations from across the terrace to come and also experience the joy of a grandmother who has seen her grandson win the fight against child mortality.
After that day, I really understood why God led me towards Mali Health to be part of this team that is working tirelessly, and in conditions that are never ideal, to do what is vital: saving lives, providing dignity and empowerment, and giving hope to people forgotten by the health system.
This past weekend, the Rita Camardo Maternity Ward opened its doors for the first time, and – literally before the paint was dry – hosted its first delivery, a healthy baby girl, hours before the official inauguration.
The moment – and the whole new maternity ward – was made possible through extensive collaboration. Seattle foundation One Day's Wages and Mali Health's network of committed partners put forward much of the financing necessary. Moreover, local community members orchestrated a successful fundraising drive, the community clinic itself added support, and the government health system and the Malian Red Cross provided equipment.
Certainly, a building is just a building. It alone can't save lives. But the new facility will allow more room for prenatal care and family planning, and offer delivery and recovery space separate from the general ward, where newborns spent their first hours – the most vulnerable – on beds next to the infirm. Given that clinic births have increased nearly 300% since 2010 in Sikoro (one of the fastest growing areas in one of the world's fastest growing cities) we hold high hopes about the immediate and longterm impact of the dedicated maternity ward.
So far, it has paid off. Baby Diakité was born to Safiatou Ba this last Friday – just couldn't wait until the official opening.
Since last year, Mali Health has been working with professors of health economics at Brown University to launch a randomized control evaluation of Action for Health. The multi-year study aims to clarify the impact of free care and community health worker visits on the health of our target children, and provide analysis on health behaviors in similar communities. For us, it’s as much an opportunity to analyze our own impact as it is a chance to contribute to the greater field of international health and development.
The first step in this evaluation was a baseline survey, conducted last August 2012 with over 1,000 families, to measure indicators and conditions before any intervention had taken place. For Mali Health, the results of the baseline offer a clear picture of the financial and health status of our target families. With a focus on income, expenditures and assets, the survey showed that members of our program spend an average of $1.25 per person per day, living directly on the World Bank-defined poverty line.
During the 6-week survey, less than one in five children received care in a facility when sick. The tendency to avoid medical facilities may be related to cost, as families in the survey paid an average of $2.71 for care, whereas the care for a child enrolled in Action for Health costs about $7.00 at a public clinic, indicating a significant gap in what is financially needed and what is financially accessible.
A lack of accessible and timely medical care is one of the primary causes of Mali’s high rate of child mortality and this survey indicates that children are not receiving care when they need it most. But those children enrolled in Action for Health are able to access care; they are much more likely to visit a doctor when needed and much less likely to die from treatable diseases.
The information that Mali Health gained from the baseline will allow us to better plan our programs. But this is just the start. Moving forward, this evaluation will allow us to truly understand the difference our program – and others like it – can make. The families surveyed last August began receiving services through Action for Health in December. Today, we are preparing for the “Year-1” round of surveying in August, with the continued support of Brown University and new partners at the Aga Khan Development Network. As valued partners in our efforts to improve child survival in our own geographic footprint and beyond it, we invite you to stay tuned over the summer and into the fall as we share and build on these important lessons in global health.
To read the full article, click here.
By Devon Golaszewski. Special thanks to Anja Sautmann and Mark Dean, Professors of Economics at Brown University and co-Primary Investigators, and Samuel Brown, Research Assistant.
In the Global South, health systems and health seekers face an unavoidable and constant tension – how to provide quality and accessible care for the poor and how to pay for it. Common and preventable infirmities remain the world’s largest killers, while financial, geographic and knowledge-based barriers keep the indigent from seeking – and receiving – proper and affordable basic care. Simultaneously, health systems in the Global South are under-financed, poorly equipped and inadequately staffed. Where facilities do exist, patients endure long waits, are hospitalized in unhygienic conditions and receive hasty assessments and hurried follow-up directives.
This is a challenge that, while daunting, we hope to shed light on over the next two years. With generous support provided by the Izumi Foundation, a Boston and Japanese institution well versed in tackling some of the greatest global health challenges, Mali Health is developing an expanded health system-strengthening program. Our intent is to increase demand, improve services, and increase affordability at the primary care level.
Mali Health operates in one of the most decentralized countries in the world (one board member called it ‘A libertarian’s dream’), where community adoption and participation is vital to achieving any degree of lasting impact. Given this environment, the project intends to pilot and identify best practices that can be implemented without significant cost or significant long-term support. Working in 5 major areas – patient behavior, operational efficiency, transparency and goal setting, standardization, and financial strategies – the “model clinic” will be a partnership with an existing primary care center. Together, we will aim to achieve the following:
1. Institute a “Goal for Zero” child mortality target objective and culture at identified clinic(s)
2. Improve patient/maternal access to prompt and appropriate care and service delivery satisfaction
3. Strengthen a peri-urban health system’s efficiency, capacity and sustainability
Only now in its beginning stages, the office is busy with brainstorming meetings and planning sessions. We’re grateful to Izumi for the opportunity to collaborate on such an important project, and we look forward to sharing updates in this space as the program develops.
I'm thrilled to announce the hire of Mariam Fofana Diallo to Mali Health's team as the organization's new Programs' Director! The position will oversee all of Mali Health's current and future efforts on the ground.
Mariam is an accomplished leader in the field of global health and international development, having spent the last 10 years directing and growing programs for Population Services, International, as a Project Manager and specialist of strategy and behavior change communication in several posts across West Africa. Before that, Mariam served for several years as Peace Corp's Training Director in Côte D'Ivoire.
Mariam brings incredible experience, energy, and passion to Mali Health. Together with our Medical Director, Dr. Diak Traoré, and the rest of our local team, she will help to expand our programs and deepen our impact over the next several years.
Undoubtedly, she has some large shoes to fill, as current director Devon Golaszewski moves on to pursue a PhD after many years with Mali Health, the last two in this current role.
Thank you, Devon, and welcome, Mariam. And to our closest friends, partners, and longtime supporters to Mali Health, I couldn't be more thrilled to share our news with you.
With excitement and appreciation,
by Jeff Fessler, Grade 4 & 5 Teacher, American International School of Bamako
Last fall, my class of Grade 4 and 5 students from the American International School of Bamako took part in a field trip that was very different from trips they had taken in the past. Our school is always interested in community service projects, and we were fortunate to be introduced to Devon Golaszewski at Mali Health Organizing Project.
Our collaboration began when Devon organized a field trip for my students in the Sikoro community. We began at the Mali Health office, watching a PowerPoint about the dangers of malaria. Next we took a walk through the local community, which was an eye-opening experience for my students. They saw firsthand the homes with no electricity, running water, or coverings over the windows, along with the streams of wastewater running down the bumpy, dirt roads. We hiked higher and higher up the hill, where the elevation gave us amazing views of the surrounding area.
Finally we arrived at Bandiagara Coura Elementary School where we had the opportunity to speak with the teachers and visit classrooms. My students were stunned into silence when they sat inside the classrooms. Our own classroom at AISB is very large, air conditioned, and is full of books and posters. These classrooms were very small and crowded with 30 or 40 children. The floors were dirt and there was no glass in the single window. The chalkboard was a simple piece of wood painted black. It was the first time my students experienced this kind of reality in person.
Our final hike took us to a local clinic, a basic concrete block structure with small rooms for patients to see the doctor. The doctor explained to us that many people in the community suffer and even die from treatable illnesses because they don’t have the money to pay the doctor or buy the appropriate medicine. On the ride home, I heard more than one student say they didn’t realize how lucky they were until today. When we were back in our classroom, I asked the students if they were interested in helping Mali Health’s cause, and they answered with a resounding “YES!”
After consulting with Devon, we decided that we would create an informational piece on malaria prevention, something that could be copied and distributed to the children in Sikoro. The students brainstormed many ideas, including a poster, pamphlet, booklet, and a graphic novel (the fancy version of a comic book). The graphic novel was their final choice, and we started to work.
As a class they created the rough outline of a plot, keeping in mind that the story had to teach important facts about malaria but still be entertaining to children. They decided the main character would be Anti-Malaria Man, and he would challenge the evil Dr. Plasmodium. Four teams of students each wrote a chapter, making sure to include the basics on malaria such as transmission, symptoms, treatment, prevention, and the details of what exactly happens in the body once it is infected with malaria. Since I incorporated the study of disease into science class, the students were able to incorporate much of what they learned into the story. They also applied many skills from their writing classes, incorporating all the parts of a plot (e.g. rising action, climax, falling action), using figurative language, and creating believable dialogue. Once the story was completed our French teacher, Barbara Alonso, translated it into French (the version we would provide for the Sikoro students).
Next the students created storyboards that showed each illustration and its associated text, including dialogue. To create the illustrations the students created a tableau (frozen pose) of each scene they wanted to show in the graphic novel. I photographed these tableaus and printed them out. Students overlaid paper on the photos and traced the figures, later adding different clothing (such as Anti-Malaria Man’s superhero costume) and different backgrounds. For scenes where our hero flew, a student lay across a chair and the tracer would leave out the chair. For scenes where Dr. Plasmodium rides a giant mosquito, a student posed on a beanbag chair, riding it like a horse. This method gave the illustrations—more than 50–a realistic touch.
With the illustration and story finished, students used a comic software program to format the novel and produce a digital, camera-ready copy for the local printer. Our PTO (Parent Teacher Organization) funded the printing of about 300 copies for distribution.
During the last week of school our class returned to the Mali Health office where we met students from three local schools who were all members of their school’s health club, another amazing initiative started by Mali Health. The Malian students performed a skit about Malaria while our students described the making of the graphic novels and presented each student with a copy. The AISB elementary student council also presented a donation to Mali Health as a token of our appreciation of the good work they do. It was heartening to see my students interact with the local students, especially as they tried to figure out which student posed for which character.
We are grateful that Mali Health provided the opportunity for this meaningful collaboration. My students practically applied their science, writing, and reading skills to a real world project. But more importantly, they learned more about the realities of life in Mali and how they can make a difference.
One of Mali Health’s goals is to mobilize citizens at the community level to plan and execute projects that improve health outcomes in Sikoro. Since 2011, Mali Health has trained a local women’s group to plan, organize, and execute local development projects. The women of this Action Training Group chose to undertake a well improvement project. Sourakabougou, a sub-section of Sikoro, is infamous for its lack of access to clean water, as the high altitude, rocky soil, and poor road conditions makes digging wells extremely difficult. This makes the task of getting water for the family to drink, bathe, and cook with an everyday hassle for women and girls, as the closest source of water is over three and a half miles away over rocky and treacherous terrain.
Mali Health’s Action Training group made it a priority to improve their neighborhood’s access to water. Over 15 years ago, another NGO had begun digging 5 wells in Sourakabougou, but failed to complete even one. The wells had lain unused – and without water – for 15 years, while local women struggled to gather water for their daily needs. Before the work even began, the Action Training group developed an action plan, a technical plan to excavate the remaining depth to reach water, and a budget, and then began soliciting the funds and donations from the surrounding community. Community members also offered in-kind services such as labor, food for the laborers, and materials, making this project truly community-based. In February and March the Action Training group successfully completed digging their first well and they plan to finish the remaining four. Now that the work is finished, the well improvement project will increase access to water for 103 households, or about 700 men, women, and children.
Mali Health may have given this Action Training the tools and knowledge they needed to succeed, but it was the motivation and determination of these women that has made their lives just a little bit easier.
Written by Matt Schinske
Mali has a decentralized health system, which means that the responsibility of health care facilities to the community resides with locally elected associations and an engaged population holding those associations accountable. These local health associations are known as ASACOs.
Radio Sigida Joli (RSJ) and Mali Health sponsored an awareness campaign for the local citizens of Sikoro (the community we work in, just outside of Bamako). The goal of this campaign was to stress the importance of community participation in the management of ASACOs through home visits and selling ASACO membership cards. These cards are vital to the community because they allow the cardholder to vote in ASACO elections. This means that they have a voice as to how their local health association is run and by whom. Another benefit to purchasing an ASACO membership card is that it offers discounts at local health clinics for doctor consultations.
This campaign was planned, developed, and implemented by one of RSJ’s listening groups, with technical and financial assistance provided by the RSJ team. The membership cards were sold over the weekend of the 23rd and 24th of February with the help of 20 volunteers from the listening group. The goal was to visit 250 families and share information about the roles of the ASACO, stress why community engagement with local health institutions is vital, and to sell as many membership cards as possible.
Overall this locally run health campaign was a great success with 260 families reached and 50 ASACO membership cards sold! The price of membership card is about $2, which is not cheap when you consider that the majority of residents are living on less than $1 a day. It is also exciting to see a local clinic enthusiastic about selling these cards. Although it is every citizens’ right to purchase one, the majority of clinics are reluctant to sell them, and offer any number of excuses as to why they are not available. It sometimes feels like we are fighting an uphill battle trying to increase community engagement and ownership of local health institutions while those same institutions sometimes push back to maintain control, power, and an apathetic constituency. Mali health and our partners are focused on the climb and we continue to fight for a more conscientious, engaged, and healthy Sikoro.← Older posts