In Mali, one out of five children will die before their fifth birthday. These deaths are largely preventable. They are caused by malaria, diarrhea, and upper respiratory disease. These are all underlain by malnutrition which weakens the body and makes the children more susceptible to infections.
One out of four of these children die in the first 28 days of life. The remoteness of the villages, the long distances to travel to health centers, the poverty of the people all contribute to the problem of seeking and receiving appropriate health care. Lack of knowledge about illness and modern treatment is an important factor also.
In 2005 Medicine for Mali made a plan for Public Health. The first goal is to improve the morbidity and mortality of children under five years old. The second is to improve the functioning of the existing health care system. Much work has gone into reaching these two goals. Both goals have seen improvements, which directly benefits the lives of the people. More work and more time are needed to make further advancements.
These vital activities were not being done prior to MFM’s involvement in the area.
Medicine for Mali (MFM) has brought university trained midwives to train our village birth attendants or Matrons on monthly visits to each of the 7 villages with maternities. MFM is emphasizing Prenatal visits and safe, hygienic delivery in the village maternities. Tools, such as blood pressure cuffs, gloves and scales have been donated to the matrons. Villages have worked to get containers of clean water, sterilizing equipment and bleach to aid in safe deliveries. Matrons have been trained on monitoring the delivery using a WHO document, the partogram. Many more women are coming for prenatal visits now because of the midwives’ active participation. MFM works to have immunizations for children on the same day as the midwife’s visit. this way many women are present and come for Prenatal visits too.
At the beginning of this project several years ago, MFM has trained matrons of each village in the district hospital in safe delivery and pre and postnatal care. A practical internship in the district hospital wards was included. Diarrhea, malnutrition for children, and the importance of prenatal visits were discussed.
MFM trains Village health volunteers or Relais in the vital importance of prenatal visits. The relais , in turn, give educational talks to the villagers about the potential life saving importance of having prenatal visits.
Volunteers or Relais
MFM Public Health programs work through a system of trained volunteers called relais. These consist of two women and one man chosen by each village chief. These volunteers atend yearly trainings on malaria prevention, prenatal visits, upper respiratory disease, family planning. They learn how to conduct village educational meetings on these topics. The relais then give talks to their villages on malaria prevention, nutrition, immunizations, and what to do when sick, i.e., go to the health center.
The native language is Bambara. MFM conducts Bambara literacy classes for these volunteers. The volunteers learn to read and write in Bambara and do math in order to keep Vital Statistics notebooks for MFM. Their villages can use the information in these notebooks to help solve health problems themselves.
The volunteers act as the main village educators and liaisons for MFM. They are a vital part of our work: our feet on the ground.
Village vital statistics notebooks
The MFM village volunteers or relais are trained to record health information for their village in a systematic way in notebooks. This information includes vaccinations, births and deaths of children under 5 yrs, weighing of children under 3 yrs, prenatal visits, and educational talks given by the relais. This is very important information to have for the health of the villagers. Written records have not been kept before. If these vital health issues are not being done or problems exist, it can be seen by looking at the notebooks. Then solutions can be found.
Refresher courses on improving the collection and use of this data are held yearly.
Quarterly health worker meetings
MFM organizes quarterly meetings for our volunteers, nurse, matrons, and health care management system. These include problem solving on immunizations, prenatal visits and other issues that surface in the health record books. Problem and solution discussion are discussed all together.
Malaria prevention with bednets
MFM works to educate and distribute free bednets: long-lasting, insecticide-treated bednets. The emphasis is on families with children under 5 and pregnant women. This program protects the villagers from the mosquitoes that carry malaria that bite at night. Malaria is endemic in Mali. It is a major cause of death for children under 5 and pregnant women.
Village volunteers or relais weigh children quarterly to find malnourished ones. The relais advise the mothers how to prepare more nutritious food. Severely malnourished kids are sent to the Health Center for Plumpy’Nut and other food supplements. All the children’s weights are recorded in the Vital Statistics notebooks by the relais.
In 2005, at the beginning our our nutrition program, MFM weighed all the children and found that 37% of the children under 3 years old were malnourished. We have trained these same volunteers to run nutrition programs in their villages using the Positive Deviance model. This program finds what poor mothers with well nourished children are doing and teaching this to the women of malnourished children. These programs have been successful and many women with well nourished children desire to come and learn too. This program saw the rate of malnutrition fall to under than 20%. This rate has been maintained in the years since this program was conducted. This is much lower than the Malian average of 30%.
Health center management
In order to get the health care system functioning, MFM has assisted in the formation of managing committees in the health care zone. We have trained volunteers in their roles and responsibilities of running health care system. We have worked with the district health officials in Kati. They have helped us; and we have used their expertise throughout the years.