World Health Day

The Enormous Toll of Vector-Borne Diseases

By Meg Carter, ChildFund Sponsorship Communication Specialist 

One in a series this week for World Health Day (April 7)  

One bright morning, I was administering the English language section of a four-hour exam in a high school in Saint-Louis, Senegal. About halfway through the test, which divides high school graduates who go on to university from those who return to their villages to farm, I felt dizzy and feverish. 

malaria in Senegal

A malaria clinic in Senegal.

By noon, I was walking slowly across a quarter-mile-long cantilever bridge, clinging to the handrail. The bridge connects the island portion of the town to the mainland, where I lived. It felt as if a vise was crushing my head; I could barely see. 

Reaching the mainland, I sat down on a pile of rocks on the bank of the Senegal River, shaking uncontrollably in the intense sunlight. Eventually, a cool hand grazed my forehead. I heard a sharp intake of breath, then a familiar voice saying, in French, “malaria.” 

I stared at the child in front of me, unable to move or speak. 

“Miss Meg, it’s me, Amadou N’Diaye. I’m taking you home now.” 

He ran back to the street and flagged down a taxi. Together, Amadou and the driver lifted me inside. When we arrived at our apartment block, Amadou ran first to my Peace Corps colleagues, who carried me up the stairs and into bed. Then he found my French friend. “Bring your medicines, quick,” he told Christian. 

Christian’s cocktails of anti-malarial and tetracycline drugs worked. Three days later, I came out from under my mosquito net, no longer wanting to die. 

I’d slept under that net for nearly two years. And I’d taken tonic water daily for its quinine benefit, lit a mosquito coil in my bedroom each evening at sunset, and swallowed my weekly pills. But despite these precautions, on restless nights when I bumped up against my net, mosquitos feasted on my arms and legs. Anti-malarial drugs don’t entirely destroy plasmodium parasites, which carry malaria; they merely keep them under control. In those days, the West African breeds were increasingly drug-resistant. 

Now imagine what it’s like for children without bed nets or medication who are bitten every night of every rainy season by hundreds of mosquitos. 

mosquito bed net

A Gambian girl’s bed net helps protect her from malaria.

This year, World Health Day is turning its focus toward vector-borne infections; its motto is “small bite, big threat.” Epidemiologists refer to insects and snails as the vectors for parasites and viruses they transmit to our bloodstreams. 

Malaria is the world’s most prevalent vector-borne infection, but dengue fever, a mosquito-borne virus, is the fastest growing. In the countries where ChildFund serves, other parasitic diseases such as Chagas, from kissing bugs, and trypanosomiasis, from tsetse flies, threaten children’s health. Viral illnesses, including chikungunya (mosquitos), schistosomiasis (freshwater snails), and the hemorrhagic fevers — Yellow Fever (mosquitos), Rift Valley Fever (mosquitos) and Crimean-Congo Fever (ticks) — are less widespread but still deadly.

Urbanization, deforestation and damaging agricultural practices all contribute to the spread of malaria. Deforestation and urbanization also led to resurgences of Yellow Fever and the sudden emergence of dengue and chikungunya. 

Mosquitos breed in stagnant water, hiding in tall grass during the day and tracking their human targets nightly by the carbon dioxide we exhale. Although we can’t yet eradicate malaria, giving families access to medicated bed nets is a step in the right direction.

Uphill Climb to Provide Health Care to Rural Indian Families

By Saroj Pattnaik, ChildFund India

One in a series this week for World Health Day (April 7) 

Saraswathi

Saraswathi and her baby at a parenting workshop in southern India.

On a hot afternoon in southern India, the atmosphere inside the small community center  was unbearably sultry. But for a group of women, the heat was not terribly bothersome, as they were in the middle of an informative and eye-opening session on child care and parenting skills. 

Led by Beula Ruth of the Kalaiselvi Karunalaya Social Welfare Society, one of ChildFund’s local partner organizations in the state of Tamil Nadu, the workshop was aimed at educating pregnant and lactating mothers about prenatal and postnatal care. 

“I had no idea about exclusive breastfeeding. I didn’t know that a child needs only breast milk for six long months,” says Saraswathi, a first-time mother of a 5-month-old baby. “This is something that I am hearing for the very first time.” 

Beula agrees and adds, “Every time, we come across some women who don’t have the basic knowledge on child care. This is why we continuously conduct such awareness sessions in our project area.” 

There has been substantial improvement to government health services in India, but a majority of people living in rural areas still don’t have access to health care.  And that’s where ChildFund comes into the picture, by working with the government and local partners to bring public health services to underserved communities.  

Here are some of the stark facts about the lives of rural Indians:

  • 66 percent of the rural population in India lacks access to preventive medicines
  • 31 percent of the rural population has to travel more than  18 miles for medical treatment
  • 10 percent of all babies die before their first birthday
  • 56 of every 1,000 Indian children will die before they turn 5
  • Only 35 percent of all Indians have access to improved sanitation facilities
  • Just 3.9 percent of India’s 2011 GDP was spent on public health

(Sources:  National Rural Health Mission, Government of India; WHO; Indiafacts.in) 

health camp in India

A doctor sees patients during a health camp organized by Pride India in the district of Raigad.

As part of our Early Childhood Development program, ChildFund and its partners in India conduct training sessions for mothers, discussing good nutrition (both for themselves during pregnancy and for their children under the age of 5), developmental benchmarks and preventive health care, among other issues.  

Last year, there were more than 9,000 training sessions across India, with more than 180,000 parents and other caregivers participating. As a result, more than 86 percent of births  occurred in hospitals or other health institutions, and more than 68,000 children have been fully immunized. 

“We make sure that all the communities have the access to government health facilities and if they don’t we bring those services to their doorsteps,” Beula says. “Our ECD workers and volunteers continuously monitor the health of children, pregnant women and new mothers and refer them to nearby hospitals whenever necessary.”   

Like Beula, Anita Ghalekar in Chochinde Kond — a remote village in Maharashtra State’s Raigad district — is a busy woman. Even after her retirement from ChildFund’s local partner Pride India, she is committed to maintaining access to health services for local families.     

health care in home

Anita Ghalekar monitors a boy’s growth in his home in the Raigad district.

Besides overseeing ChildFund’s home-based ECD intervention activities in her region, Anita leads 15 health camps, which provide workshops and care in individual villages. 

“We make sure that all the villages in and around our program area are covered under our programs designed to ensure basic health care of the people, especially children, new mothers and adolescent girls,” says Virendra Kulkarni, manager of Pride India. 

“And we implement these programs in such a way that the communities take ownership of them,” he adds. “For example, when we conduct health camps, villagers provide us accommodation, beds and other logistic support required. And this has helped us reach out to a wider population and implement our program successfully.”  

Dr. Vijay Kumar Singh, who led a health camp in Uttar Pradesh recently, says, “ChildFund is doing a great work. They are reaching out to people in those places where the government health service has not yet reached.”

ChildFund Assists Health Care Efforts in Mozambique

By ChildFund Mozambique Staff

One in a series this week for World Health Day (April 7)

Olga Jeje

Dr. Olga Jeje of Gondola, Mozambique.

Olga Jeje has worked in Gondola as a doctor since 2009, and she’s experienced firsthand the partnership between ChildFund and Mozambique’s health department, a collaboration that helps provide basic health services for children and families.

“At the health services department, we work in close coordination with ChildFund, which supports vaccination campaigns against polio and measles, and also in reaching children with supplements of vitamin A,” Olga notes.

ChildFund has supported doctors and other medical personnel with transportation and by facilitating their moves from one clinic to another. As a result, about 8,000 children have benefited in Gondola.

Another result of the partnership between ChildFund and the District Office of Health Gondola has been the distribution of insecticide-treated mosquito nets purchased by ChildFund supporters, benefiting more than 100 children who now have a better chance of avoiding malaria.

Talking to community members, many say that ChildFund’s contribution to local health services has meant a lot.  

“The presence of community health activists in the area, trained by ChildFund through the Community Caring for Children Programme, has been a great opportunity for us, because we now understand the benefits of taking our children to the health centers at the first signs of sickness,” says Julio Domingos, a community leader in Mazicuera. “We now know the importance of managing waste to avoid diseases, such as diarrhea, and we now know how important is to use a mosquito net in order to prevent malaria. We are now aware of the methods of how to prevent HIV and AIDS. We also see community activists paying visits to people living with HIV and AIDS, and we know that this gesture is very important for all of us.”

vaccination campaign

A vaccination campaign in a Gondola clinic.

On World Health Day: A Caring Brother in the Community

Reporting by Zoe Hogan, ChildFund Timor-Leste

Around the world, little brothers regard their older siblings with a mixture of awe and admiration. In a small town in Timor-Leste, 6-year-old Silvino looks up to his 25-year-old brother, Marcolino, but for a special reason.

Older brother and younger brother

Marcolino, 25, recently became a ChildFund Community Health Volunteer. He is using his new knowledge to help protect his family and community from preventable diseases.

A few months ago, Marcolino became a ChildFund Community Health Volunteer, and his new role is to share important health information with his community. He has learned about malaria and dengue prevention, hygiene and the importance of encouraging parents to use the local health clinic.

His training is just one part of a comprehensive maternal and child health project funded by ChildFund Australia and the Australian Agency for International Development. ChildFund is working with local communities and government to enhance health care and knowledge in order to improve the health of children and mothers. In addition to 410 Community Health Volunteers, ChildFund has trained 84 professional health workers and 36 midwives, distributed 6,000 mosquito nets to families and provided vital health training to 312 schoolchildren and more than 21,000 community members.

“What I like most [about being a volunteer] is that I can learn new ideas,” he says. “Before, I didn’t have knowledge about health, but today I do. And I can share it with others who need it.”

Marcolino and Silvino live with their parents and two sisters, Umbelina and Abita, on a small farm near a dry riverbed and a collapsed bridge. Last year, a flood destroyed their house and washed away precious topsoil. Marcolino’s father, Jose, could plant only enough to feed his family. Like others in the area, they simply cannot afford to deal with expensive and debilitating health problems.

So, when Silvino developed a fever, headache and persistent cough in February, Marcolino’s training proved essential. Recognizing that Silvino’s symptoms were potentially serious, Marcolino and his mother took the boy to the nearby government health clinic. With timely access to proper treatment, Silvino recovered quickly and is now back at school. Two mosquito nets from ChildFund are also helping the family to reduce their vulnerability to malaria.

“I worry about my siblings getting sick,” Marcolino says. “It makes me sad.”

His concern is understandable. In 1999, when Marcolino was 12, the conflict preceding Timor-Leste’s independence destroyed many homes and most of the country’s public infrastructure. Without access to health care or basic services, four of Marcolino’s siblings died from respiratory illnesses that year. The youngest was a month old.

“I feel responsible for the children around here and their health,” he says. “They are the same as my brother.”

To date, Marcolino has spoken to 15 local families about how they can prevent common diseases, and he has plans to walk up into the nearby mountains to share the information with another 30 families. Marcolino has also referred about 20 people to the health clinic after identifying symptoms of malaria and dengue. “It’s not too hard to convince people to go to the clinic once they understand [the significance of their symptoms],” he says.

As an older brother, Marcolino looks out for his younger siblings. As a Community Health Volunteer, he’s now helping protect them — and all of the children in the area — from preventable diseases. And it’s obvious that Silvino is pretty impressed with that.

The Power of Partnerships

by Anne Lynam Goddard, ChildFund president and CEO, and Brig. Gen. Ron Sconyers (USAF, Ret.), president and CEO of Physicians for Peace

“If you want to go fast, travel alone. If you want to go far, travel together.” —African proverb

In the Artibonite Valley of Haiti, on the grounds of Albert Schweitzer Hospital in Deschapelles, you’ll find an unassuming clinic dedicated to prosthetic and rehabilitation services for amputees. Patients make the 60-mile trip from Port-au-Prince to the Hanger Clinic balanced aboard vans, mopeds and tap taps, those colorful buses and pick-ups that ferry travelers along Haiti’s famously uneven roads. Many of these patients lost a limb in the earthquake of January 2010; others have been waiting for a prosthesis for years. Even before the earthquake, Haiti, the western hemisphere’s poorest country, was not equipped to provide adequate healthcare services to its disabled population. When the earthquake struck, need for these services increased dramatically.

Haiti child

A child at Hanger clinic learns to play again. Photo: Roberto Westbrook, Physicians for Peace

Hanger Clinic is just one site that is benefitting from a new partnership between ChildFund International and Physicians for Peace. The clinic is actually a product of the Haitian Amputee Coalition, a confederation of organizations including Physicians for Peace, Albert Schweitzer Hospital, the Hanger Ivan R. Sabel Foundation, the Catholic Medical Mission Board, the Harold and Kayrita Anderson Foundation and the Shepherd Center, among other groups. Because of these strong partnerships, the clinic today is a place where patients receive proper medical and rehabilitative care, along with art therapy, meals, lodging, a sense of community and a reason for hope. The clinic also is a training ground for Haitian technicians, who learn valuable professional skills alongside both U.S. prosthetists from Hanger Orthopedic Group and volunteer physical therapists from Physicians for Peace.

Haitian child

Photo: Roberto Westbrook, Physicians for Peace

It is easy to feel overwhelmed in Haiti, but efforts at the clinic are making a difference. Since the earthquake, Physicians for Peace volunteers have worked with more than 785 patients. Put another way, because of the clinic, more than 785 Haitian amputees can now return to the daily work of their lives, and the Haitian technicians working on-site have the opportunity to earn a living, without leaving behind their country and their families.

These are important milestones; yet these “good news” stories can sometimes be lost. That’s a shame. Because while complicated issues of health, politics, infrastructure and accountability remain in Haiti, our experiences have only reinforced the belief that strategic nongovernmental organization (NGO) partnerships can play a leadership role in paving the road for sustainable, replicable solutions, in Haiti and beyond.

As Physicians for Peace and ChildFund International mark World Health Day on April 7, we are focused on crafting exactly those kinds of partnerships and solutions. Our efforts already are bringing about results. Four months ago, ChildFund International presented a $500,000 grant to Physicians for Peace to support and expand standing efforts at the Hanger Clinic, including volunteer physical therapy missions, and facilitate new initiatives, such as a summer camp for disabled children and tuition support toward a national prosthetics and orthotics training and certification program for Haitian technicians. By combining our resources, we are able to take on additional projects, reduce inefficiencies and help to eliminate redundancies in services and programs. In doing so, we can respond more effectively to our in-country partners’ needs, and we can more efficiently steward our donors’ investments.

Coming together to work in Haiti has been a natural fit for Physicians for Peace and ChildFund International. Our initial approaches may be different, but they are also complementary: ChildFund International works toward a future where all children have the potential to become leaders who bring positive change for those around them. Physicians for Peace envisions a future in which men, women and children around the world have full and equal access to quality healthcare services. In the end, we are both working toward a healthier world, a place where people are afforded the opportunity to live with dignity, respect and good health. When we come together for that purpose, everyone benefits.

As we celebrate World Health Day – from our offices in Norfolk and Richmond, Va., and through field offices and volunteer teams in Asia, Africa, Central America, South America and the Caribbean – we’ll keep close to our hearts a Haitian expression often repeated to Physicians for Peace volunteers at the Hanger Clinic: “piti, piti, zwazo fe nich.” Little by little, the bird builds its nest. Through collaboration and partnerships that prioritize need over ego, we can work together to build a world that is better, safer and healthier.

Community Health Workers: Key Agents for Reducing Child Mortality

Guest post by Henry B. Perry

author photo

Henry Perry, M.D., Ph.D., MPH, is a senior associate in the Department of International Health at Johns Hopkins University’s Bloomberg School of Public Health in Baltimore, Md.

During the past half-century, there has been a growing recognition that community-based workers can make an important contribution to the health of communities, especially in resource-constrained settings. These workers are known by many names, but most commonly Community Health Workers (CHWs). With initial training of usually 6 weeks or less, they can effectively provide different types of services from community mobilization to health education to preventive screening to family planning education to identifying persons with symptoms of leprosy or tuberculosis to diagnosis and treatment of life-threatening childhood illness, and many more. These persons may work as volunteers or for modest incentives or salaries.

Based on early projects that utilized CHWs effectively in a number of developing countries, the seminal International Conference on Primary Health Care — sponsored by the World Health Organization and UNICEF in 1978 and attended by high-level representatives of almost every country in the world — recognized that in many settings where facilities and highly trained health workers are scarce, CHWs can become an important part of a primary health care system.

The Declaration of Alma Ata, adopted at the conference, called for basic health services — promotive, preventive, curative and rehabilitative — to be provided by “health workers, including physicians, nurses, midwives, auxiliaries and community workers [italics added] as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.” The Declaration also recognized the importance of providing health services “as close as possible to where people live and work.”

Community health volunteer photo

A ChildFund community health worker in Honduras.

Progress in incorporating CHWs into the formal health systems of resource-constrained settings has been only gradual, often moving in fits and starts and sometimes in reverse (in response to disappointing results from poorly designed and inadequately implemented large-scale CHW programs in the 1980s). However, evidence and experience during the past decade have led to a renewed interest in CHWs as a key agent for reducing child mortality as well as addressing other health priorities.

 

A rapidly growing number of studies demonstrate that CHWs make it possible to expand access and improve coverage of essential services, particularly in remote and poorly served populations, thereby improving equity. CHWs have been shown to play critical roles in interventions to

  • reduce child mortality, including distribution of vitamin A capsules and other critical micronutrients
  • promote water and sanitation education (hand washing, point-of-use water treatment and safe water storage, latrine construction and promotion of latrine use)
  • distribute mosquito nets and assist communities in draining stagnant water to eliminate breeding grounds for mosquitoes
  • diagnose and treat childhood pneumonia, diarrhea, malaria, newborn sepsis and severe malnutrition
  • promote healthy behaviors such as appropriate breastfeeding (exclusive breastfeeding during the first six months of life and continued breastfeeding until at least one year of age)
  • provide hygiene and cleanliness education
  • ensure appropriate care of newborns
  • promote and facilitate immunizations for mothers and children.

Many countries can benefit by scaling up integrated community case management of pneumonia, diarrhea, malaria and newborn sepsis and promotion of healthy behaviors that can save the lives of millions of children who are dying from preventable causes.

CHWs are one of the essential ingredients for making this possible — along with political commitment, professional leadership, long-term sustainable training, support and supervision from the health system and reliable logistical support of basic medicines and supplies. A strong commitment by the world community to these activities, which are some of the most cost-effective approaches to promoting global equity in health, is a moral imperative for today and tomorrow.

James Grant, the renowned executive director of UNICEF from 1980 to 1995 and champion of what is often referred to as the First Child Survival Revolution, repeatedly reminded us that “morality must march with capacity.”

We now know that CHWs can have the capacity to make a difference between life and death for millions of children. The moral imperative for the world community is to ensure that health systems and underserved communities support CHWs in attaining this capacity.

Community health workers are vital to the success of numerous ChildFund projects in countries such as Senegal, Kenya and Honduras.

Additional Reading

Berman, P. A., D. R. Gwatkin, et al. (1987). “Community-based health workers: head start or false start towards health for all?” Soc Sci Med 25(5): 443-459.

Haines, A., D. Sanders, et al. (2007). “Achieving child survival goals: potential contribution of community health workers.” Lancet 369(9579): 2121-2131.

Lassi, Z. S., B. A. Haider, et al. (2010). “Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.” Cochrane Database Syst Rev 11: CD007754.

Newell, K. W., Ed. (1975). Health by the People. Geneva, Switzerland, World Health Organization.

Perry, H., P. Freeman, et al. (2009). How Effective Is Community-based Primary Health Care in Improving the Health of Children? Summary Findings and Report to the Expert Review Panel, American Public Health Association.

Sazawal, S. and R. E. Black (2003). “Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials.” Lancet Infect Dis 3(9): 547-556.

World Health Organization and UNICEF (1978). Declaration of Alma-Ata: International Conference on Primary Health Care. International Conference on Primary Health Care. Alma-Ata, USSR.

Restoring Health and Hope to ChildFund Communities

by Virginia Sowers
ChildFund Community Manager

As we mark World Health Day, cities and communities across the world are participating in this World Health Organization effort to improve individual and collective health globally.

Having just returned from a ChildFund Study Tour in Kenya, I was pleased to learn that Nairobi is one of 13,000 cities participating in this year’s World Health Day events, with an emphasis on urban health.

This week, Nairobi is closing a major street to traffic and setting up a health fair. Fun activities including music, dance, acrobats and a carnival procession will advocate and educate the public on healthy lifestyles in cities.

As we learned on a project visit to the Karai Pamoja HIV/AIDS support group in Kenya, education is absolutely critical to improved health. When this community was struck with the AIDS epidemic several years ago, the majority of the population feared the disease and lacked adequate knowledge about transmission and prevention. Those who became ill did not receive adequate care or nutrition. Children struggled to survive as their parents became bedridden or died.

In September 2005, ChildFund Kenya’s Weaving the Safety Net program “came to the rescue of the Karai community in the Kikuyu District,” explains Gad Son Thiru, chair of the community-based organization. ChildFund trained home-based care workers to support the bedridden and refer them to health facilities for antiretroviral therapy.

Next came the formation of the Karai Pamoja support group for people living with HIV/AIDS. It started with 15 members who tested positive and grew to 86 members. “Karai Pamoja support group became the only hope and savior of the people living with HIV/AIDS in this area because it was here members felt safe and secure,” Gad explains. Members felt safe to share personal worries, fears and hopes for the future.

Members of Karai Pamoja support group

As the members regained their health through good nutrition and access to medication, ChildFund helped them develop income-generating activities. The group has opened a community bank account, and the money is used to buy food, improve housing and support their children’s education.

ChildFund also helped sustain the community’s children by providing school uniforms, books, deworming, vitamin A supplements, mosquito nets and psychosocial support.

“As you can see,” Gad says, “you cannot tell our HIV status because we are now strong and back to our feet.”

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