In Mali, one out of four 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 a factor also.
In 2005 Medicine for Mali made a five year 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.
MFM has trained “midwives” or 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. These women are monitored in how they are using the new techniques.
Village health volunteers or Relais are trained in the vital importance of prenatal visits and postnatal care. The relais give educational talks to the villagers about the potential life saving importance of having timely prenatal visits and postnatal care.
Volunteers or Relais
MFM Public Health programs work through a system of trained volunteers. These consist of two women and one man chosen by each village chief. These volunteers have been trained in malaria prevention and treatment, prenatal care, diarrhea, upper respiratory disease, family planning, and how to conduct village educational meetings on these topics. In turn, they educate their villages in malaria prevention, nutrition, immunizations, and what to do when sick, i.e., going to the health center.
The volunteers act as the main village educators and liaisons for MFM. They are a vital part of our work.
MFM has had Bambara literacy classes for these volunteers. The volunteers then write in Bambara to keep records for MFM and the villages.
Village vital statistics notebooks -SIS- System d’Information de la Santé
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 will become evident by looking at the notebooks. Then solutions can be found.
Refresher courses on improving the collection and use of this data are held.
Quarterly health worker meetings
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 time is given.
Malaria prevention with bednets
MFM has trained women’s associations to sell bednets on credit and to retreat them. We have also distributed free long lasting insecticide treated bednets. The emphasis was to families with children under 5. This program protects the villagers from the mosquitoes that carry malaria, as they mainly bite at night.
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. These nutrition programs find 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. These programs 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 had the district health officials work with us and we have used their expertise throughout the years.
Latrines and well surrounds
MFM has financed the construction of improved latrines and well surrounds. The men provided the labor to dig their own pits and collect materials, and MFM provided the cement to cover them.
Tractors and farmland
These tractors are for the use of the villagers. Three drivers have been trained. A management committee governs the use of the tractors. The profits from the use of the tractors go to help the Health Center function. Farmland given to MFM by a village has been cleared and plowed. A crop of maize (corn) is growing there.