I was starting a health promotion programme deep in the rural areas of Guinea Bissau, a country which is one of the poorest in Africa. The village was far from the main road, merely a collection of mud huts under a groove of palm trees. The enthusiasm of the lively crowd of women each holding up their baby to be photographed, was delightful. I took beautiful pictures of this idyllic rural scene, and the colorful women beneath the tropical sun.
Then I saw a sad young girl of about 15 staring at me quietly on the edge of the crowd, her eyes large and full of tears. As I was leaving she came up to me and took my hand and dragged me through the villages, to see her baby. I had to stoop to get in the little door and inside the dark mud hut, I waited while she picked up a bundle of rags, and held it out to me. Inside was what seemed to be a little bird, skin and bones – except it wasn’t – it was a tiny baby, emaciated beyond belief. She told me the story. Her own father was away in town and she and her mother were trying to help the baby, which was born less than a month ago. The father of the baby was a young boy from the next village, who had run away when he heard his girlfriend was pregnant. The 15 year old girl was in disgrace with her family and her mother was ashamed of her. The baby was born in the hut, delivered with minimal support by the local midwife, and they called her Segni. Within a day, Segni had fever and diarrhoea and no one knew what to do. She stopped sucking and began to waste away. The teenager’s mother took her to the traditional healer, who chanted prayers, invoked the ancestral spirits, rubbed special mud on the umbilical chord, tied amulets round the baby and sent them away. The family didn’t even try to go the clinic to get medicine, as it was too far. By the time we got her to the nearest Health Centre, it was too late. Little Segni died that night of neo-natal tetanus and dehydration due to diarrhoea. This little tragedy is one of many that happened all over Africa that same night. Diarrhoeal disease is responsible for the death of 800,000 children under the age of five who die every year in Africa.
The tragic thing is that many of these deaths need not have happened. Diarrhoea is entirely preventable if only mothers would practiced safe hygiene. Diarrhoea can be treated and children can survive. It is not the diarrhoea (amount of excreta) that kills them but dehydration (lack of fluid in the body). I remember my own mother believe the ‘old wives tales’ that if a person has diarrhoea they must stop eating and drinking, so as to give the stomach a rest. This dehydrates a person to the point their bodies literally dry up, like a plant that is not watered. If that person is a tiny one week old child, the baby will have no resistance and will die within a couple of days. The tragedy is, that it is so easy to prevent a death from dehydration, if only one knows how, and with very simple ingredients. Every mother can prevent a child dying from diarrhoea but the knowledge is lacking.
A few months later there was a Community Health Club started in Segni’s village. Women sat together every week and discussed how to improve their homes. They learnt how to prevent children dying from diarrhoea by using sugar-salt solution to rehydrate a child. They discussed how to deliver a child in safety and how using a razor blade to cut the umbilical chord could result in neo-natal tetanus. They understood how important it was to have a baby delivered in hygienic environment and that young girls were specially vulnerable to complications in child birth. They learnt about birth control and how to manage their husband’s objections and they shared their stories. They were taught how to wean their babies properly and feed them supplementary food which would ensure the toddlers remained strong.
If the village had had a Community Health Club when Segni was born, the baby would never have died. Neighbours would have been able to support the teenager and provided sound advice as to why the baby was ill. They would have clubbed together and raised the bus fare to take the baby to the health center.
We had come too late with our programme. Segni was one of many that died that day in Guinea Bissau. For every 1,000 babies born in Guinea Bissau, 62 will die before their 1st birthday. There is a horrifying difference between the survival rates of babies born in the industrialized world compared to those who have the misfortune to be conceived in poverty in Africa. For every child born in Europe, there are 16 babies who are born in Africa who will die before their 5th birthday.
Because mothers expect that their children will die young, they have many children to ensure that at least some will survive. It is pointless to try and control birth before mothers are sure all their children will live. Before we try and tackle the massive challenge of population explosion in Africa, we have to find ways to address the wastage of life through unnecessary child deaths.
A Community Health Club is a practical means to enable a safety net for women who need help and for children who go untreated. Once the whole community is aware how to prevent disease they will naturally help each other. Social Capital is built up within the village so that even those who are not health club members will benefit from the activities of the health club. Water Sources will be maintained so that people do not have to drink polluted water. Sanitation will improve as the dangers of open defecation are understood, and the community starts to use hygienic latrines. Food will be properly stored and handled so that it is not contaminated by dirty fingers or filthy containers. People will learn to wash hands with soap before eating so as to prevent their own hands contaminating their food. All these small practical steps will lead to a decrease in diarrheal diseases.
We all know the maxim, ‘Prevention is better than Cure’, and this is even more important in countries that have limited resources for Health Centers. If all mothers know how to prevent common diseases the burden of treating disease would be reduced, and this can in fact be achieved through adult education programme such as the activities done in Community Health Clubs.
Waterkeyn. J. (2010) Hygiene Behaviour Change through the Community Health Club Approach: a cost-effective strategy to achieve the Millennium Development Goals for improved sanitation in Africa. Lambert Academic Publishing.
For more information: www.africaahead.org
Juliet Waterkeyn is a social psychologist who has been working in Africa for the past 35 years. She is the architect of the Community Health Club Approach and co-founder / CEO of Africa AHEAD, an organisation started to scale up this model of development.