Health Education Activities

So I haven’t been doing nothing but sitting and drinking tea for 2 months. Yes, that is a large part of what I do every day, but I have also participated in CSCOM activities. Here’s an overview of what I’ve done:

1. Polio Vaccination Campaign
My second week at site coincided with Mali’s polio vaccination campaign. A friend explained to me today that Malians are extremely proactive when it comes to polio vaccinations. In the two months I’ve been at site, we participated in the campaign twice. During the campaign, CSCOM (health center) staff as well as relays (local volunteers who are trained in basic health education outreach) go out into all of the villages in our commune (28 in total) and administer the polio vaccine to every child under the age of 5. It takes my commune 2 days to complete the campaign.

Many children and their parents don’t know exactly how old the children are, so for kids who look like they’re on the borderline, we have them stretch their arm over top of their head and try to touch their ear on the opposite side. If they cannot touch, they are considered under 5 and eligible for the vaccine. Sometimes we vaccinate anyway just to be on the safe side.

The vaccine is in oral liquid form, so it’s an easy process. In groups of 2-3 people, we walk from compound to compound, and at each home identify the children under 5. Each child is given 2 drops of the vaccine, their left pinky nail is colored with a purple marker, and we record how many children have been vaccinated on a sheet of paper. As we leave, a worker will mark a chalk symbol on the outside wall of the house. The different symbols indicate which campaign it is, if eligible kids are present, and whether or not the kids were vaccinated. Most of the kids are totally used to the process, and immediately tip back their heads and then stick out their left pinky. Some are thrown off by the presence of the white girl and get a little nervous and/or completely terrified. The babies are the cutest. The vaccinator squeezes their little mouths into a fishy mouth (the babies are often still asleep on their mom’s backs when this process starts) and squeezes in the drops. Sometimes the babies continue to sleep. Sometimes they wake up and blink sleepily. Sometimes they start howling. And every now and then they immediately throw up. That part is not so cute, especially since I’m usually the one trying to find their tiny pinky nail amidst all the cloth they are wrapped in, and therefore I’m in prime projectile range. So far I’ve escaped being a target (knock on wood!).

It’s a long process to go from house to house, and it takes all day with a short lunch break. Especially when it’s 100°+ outside. But it’s a good chance for me to go out into the community in a health setting, see people’s homes, and try to get the community used to the idea that I am here as a health worker. I think it’s also helpful that I’m with health workers not doctors and that I’m never the one administering the vaccine, just marking fingernails or recording on the paper. Sometimes people think I’m a doctor, and it’s important that I make the distinction.

2. Prenatal Consultations
I briefly mentioned these in another post. Although women can come in any day for a PNC, Tuesdays are PNC day and that’s when we get the majority of our women. One by one, women come into the consultation room where they sit down and talk with the matrone (head women’s doctor) and health workers. Basic health information is gathered as well as height, weight, and blood pressure. I can help with the first two. Then the women lay down on a examining chair and the matrone measures the growth of the belly and listens for the baby’s heartbeat. If a need is determined, the matrone can do a more thorough pelvic exam. Women are given malaria medication twice during their 4th and 8th months of pregnancies and also receive tetanus shots.

One thing I’ve noticed is just how small most of the women are. You don’t always notice it under all of their clothing, but I’ve weighed women who are 8 months pregnant who way several kilos less than I do, which is a result of poor nutrition. You also just don’t really see fat people in Mali; only very rarely. Most people – women especially – do so much manual labor that there isn’t much extra fat on their bodies.

3. Baby Weighing
The same day as PNCs is also Baby Weighing/Vaccination day. This is where I prefer to be – bring on the babies!! I already talked about baby weighing in a previous post, so I won’t repeat myself. I did mention that we’d been low on babies because we were out of a vaccine. It turns out it’s a combined vaccine for diphtheria, tetanus, hepatitis, meningitis, and whooping cough. We got a supply in late May and had more than 90 women show up with their babies. The week before, with no vaccine, we had 5 babies. A week later we were out of the vaccine again, and down to very few babies. It’s a shame that we have so many women willing to come the distance to the CSCOM and vaccinate their children, and such a low supply of the vaccine.

4. Health Animations
Animations are something that all Health PCVs are trained in, and often a good place to start for Volunteers. My CSCOM actually already does animations, so right now I’ve been on the sidelines, watching and listening.

An animation is anything from a talk about a topic to a skit. We do talks. Every Tuesday morning the matrone does a PNC animation and the vaccinator does a vaccination animation. Additionally, the CSCOM women go out into the nearby villages to give talks on the importance of PNCs and delivering at the CSCOM. I’ve gone with them on several occasions. Anywhere from 12-30 women show up at each village, and the matrone speaks for about an hour on the topic. She brings along a few picture posters to aid her talks but she honestly doesn’t need them. She has a great personality for public speaking. Even I can tell that, and I can’t understand much of what she’s saying! I’m hoping eventually I can help expand the animation topics into other areas such as nutrition, breast feeding and weaning, HIV/AIDS, etc.

I like having the experience of going to other villages, despite the sometimes struggle to get there (See my post on Stating the Obvious, #4). Some of the villages are off the main road in the bush and very, very small. It’s interesting to see how they compare to my own village. In places like these, it’s easy to tell that many of the children have never seen a white person before. They stare at me in the same way you would stare if you suddenly saw a 7 foot giant with 3 heads standing in front of you. What is this thing?! Why is it here?! What is it going to do?! I must be pretty disappointing; I don’t do much!

These kids have a tendency to gather around me in an increasingly tighter circle until I’m surrounded on all sides within a 6 inch radius. It wouldn’t be so bad if they would talk to me, but instead they just stare, no matter how much I smile and greet them in whatever language I can manage. Every now and then a brave one will come forward and shake or high-5 my offered hand, to which everyone nervously giggles. I’ve taken to openly staring back at them. It’s funny to watch their reactions. Some continue to stand and stoically stare but many will immediately try to make themselves as small and invisible as possible. For some that means hiding their face behind a tree or a friend; for large groups it means immediately tightening into a small cluster. It’s quite an effect!

5. Baseline Survey
The only PC related project I was required – or even expected – to do during my first two months was my Baseline Survey. The survey is meant to give us a general idea of where our community stands regarding health knowledge and practice, and where we can fit into the picture. I first wrote my survey in English and then translated it into Bambara. Then I read it out loud to my homologue and the other CSCOM women and they helped me correct my Bambara and phrase the questions in an appropriate way. On two different days, my homologue and I went out into the community, from house to house, and administered the survey.

My survey included questions on Family Info, Education, Nutrition, Wat/San, Illnesses, Maternal Health, Vaccinations, Malaria, and Sex Ed. I tried to be as well rounded as possible and touch, if only briefly, on as many topics as I could. I was hoping this would give me a “big-picture view” of what my community knows, wants, and needs, generally speaking.

Like the polio vaccination campaign, I enjoyed going out into the community in a health setting. With my homologue accompanying me, I was immediately given more credibility in my role, and she was able to help correct any language misunderstandings. I’m not really sure yet how I’ll use the results of my survey, but if nothing else, it was a good community integration and language experience.

These are the kinds of things I’ll continue to focus on for several months, and possibly continue through the length of my service. It’s still too early for me to be starting any big projects. First I need to continue working on my language skills and integrating into the community. It’s normal for PCVs to wait until they are a year into their service to start bigger projects. This is why it’s so important for us to be here for 2 years. It takes awhile to become integrated into a new culture, and 2 years gives us an appropriate amount of time to do that before starting major development work. So babies, here I come!!