Back in May, we shared the experience of Kadidiatou, one of our community health worker leaders, as she worked hard to keep her family and the families she serves as a community health worker (CHW) safe from COVID-19. As a CHW and supervisor for the other Mali Health CHWs serving Lafiabougou, Kadidiatou always knows what is happening in her community.
Kadidiatou is proud to share that Awa, the mother she told us was very reticent about going to the health center, did find her way back there, as did almost all of the families in Lafiabougou who had stopped seeking care due to rumors and concerns about COVID-19. After Kadidiatou talked Awa through her concerns and let her know that the visits would be safe, Awa returned to the health center for her prenatal care, and gave birth in August without any trouble.
You may also remember that Kadidiatou had a niece who was infected with the coronavirus, which was a scary time for her family. Her niece recovered, and Kadidiatou went to see her in June to hear about her experience, which encouraged her to work harder to prevent others from going through the same thing.
Kadidiatou reports that she has been able to share the messages of preventing COVID-19 more widely. She has been able to convince her neighbors to adopt prevention measures, including installing hand washing kits at the entry of their homes. She reports that more people in her community are limiting their movements and wearing masks regularly.
Kadidiatou also noted that the training that Mali Health was able to do with community leaders about how to combat misinformation and to encourage preventive measures and behaviors made a noticeable difference in improving the knowledge and awareness of members of her community. With these precautions and the progress she has observed, Kadidiatou is confident that Lafiabougou is prepared and will stay safe :
I believe that today, my community is strong enough to avoid COVID-19.
Kadidiatou, Mali Health community health supervisor
Learn more about the work of Kadidiatou and our community health workers here.
When COVID-19 arrived in Mali, it quickly interrupted lives and livelihoods in the peri-urban communities we serve. Most families with whom we work make their livings in the informal sector. The first COVID-19 prevention measures put into place in Mali significantly restricted their work.
But since 2018, we have worked with women to develop more accessible livelihoods through activities which they can control and are closer to their homes. With resources in their hands, women can make decisions that improve the health and wellbeing of their children and families. They can purchase nutritious food, buy soap and other prevention measures, seek healthcare, and enroll their children in school.
While our savings groups could not meet safely at this critical moment, the cooperatives, already equipped with PPE and operating in open outdoor spaces, could. Now, they are not only operating, they are growing.
In those early days as COVID-19 began to spread globally, we encouraged the soap-producing cooperatives to begin making as much soap as they could. Whatever they did not sell to their neighbors, we purchased and provided to our partner health centers and distributed to families most in need.
As the threat of COVID became clear, we decided to help women start sewing masks, using local cotton fabric. Our team quickly identified 30 women who already had basic sewing skills. We helped them to incorporate their cooperative and secure 5 sewing machines, along with the materials they would need. A very big thanks to Women International Leaders of Greater Philadelphia for the funds to purchase the equipment and materials.
The cooperative got started quickly and set the prices of adult masks at about $2 (1000 FCFA) and child masks at about $1 (600 FCFA). Mali Health was one of their first order; we purchased more masks for the staff at our CSCom partners in Bamako and Sikasso. As with the other cooperatives we have supported, the sewing cooperative not only provides much-needed revenue to families during the pandemic, they are also making very valuable resources available and accessible to peri-urban communities were resources are extremely limited.
We are even taking steps forward in helping the women who will lead a new union to support the cooperatives. In collaboration with the Direction Régionale du Développement Social et de l’Economie Solidaire du District de Bamako, women will receive training in leadership and management skills to help them develop and lead a resource of their own. Creating an association allows them to support and grow their cooperatives, while helping more women in peri-urban communities to launch cooperatives of their own. Stay tuned for more details!
As the COVID-19 pandemic slows in some parts of the world, the road ahead for the families we serve in Mali is still uncertain. What is clear is the impact the pandemic is having on the wellbeing of families who already faced many challenges. The health and economic impact of this disease will last for a very long time in the peri-urban communities we serve.
As we communicate with and support our partners each day, we wanted to share some of what they are experiencing with you. Since Mother’s Day will soon be here in the US, we particularly wanted to share how the moms we serve are doing.
Dr. Thiéro is the DTC (Directeur technique du centre, or health center technical director) at our partner health center in Sabalibougou (where our WomenConnect project is located). He noted that in April of this year, antenatal care visits fell by 35%, from 289 last April to 189 this year. Postnatal care visits have fallen by 15%. Visits for other curative services have dropped off even more.
Dr. Thiéro reports they have never seen such rapid declines like this before, not even during Ebola. He attributes the change to all the rumors and fears about COVID-19: that you will contract it at the health center, be diagnosed with it if you go, or simply accused of having it if you have any of the symptoms.
At home
Our health savings groups cannot meet normally right now, but we are still finding ways to share health information. We spent the weeks before COVID-19 arrived in Mali training our team to share information with all groups and to help them prepare for its arrival. We were able to reach all 5058 women in our savings groups, and all 180 women in our cooperatives.
Korotoumou is a member of one of our savings groups in Boulkassoumbougou. At the end of March, she had a cold that was making her very tired. She did not want to go to the health center because it is said that if you go with a cold, the staff will automatically isolate you, and your family, which would lead to stigma in your community.
So Korotoumou decided not to go, until the day her group facilitator came and shared information on COVID-19 and encouraged everyone to continue seeking care as normal. The following day, she changed her mind, and went to the health center to get the care she needed, and she recovered. Just last week, she attended her scheduled antenatal checkup at the health center. Korotoumou told us:
I think it is very important to share the right information with members of the community so that families can avoid very difficult situations either due to delaying care or to stigma from COVID-19.
Fortunately, like Korotoumou, all the women in our savings program for pregnant women (SHARE) continue to complete all of their antenatal and postnatal visits as scheduled. All 10 of the women who gave birth in March or April did so at their health center.
Community health workers
Our team of 41 health workers continues to safely visit or check on the families in their care, which include 1812 mothers, 167 of whom are pregnant, and their 2701 children. You already know how hard our CHW team works to take care of families, but you may not know that most of them are mothers themselves.
Kadidiatou is a community health worker in Lafiabougou, and the supervisor for the other CHWs working in her community. She has two sons; one is 3 years old and the second is 3 months old. Like everyone in her community, she had some doubts when she first heard about COVID-19. But as soon as she attended our initial team trainings, she understood the threat posed by this disease and was able to get answers to all her questions, which she now shares with all the families she cares for.
As a mother, she is also taking as many precautions as she can to protect her family, by not visiting friends and neighbors and by closing the gate to her home so others do not stop by for a visit. Unfortunately, her niece tested positive for COVID-19, which was a difficult time for her family. Thankfully her niece has recovered, but Kadidiatou uses her experience as a way to convince others to take COVID-19 very seriously.
Last Saturday, she was checking on a pregnant mother, Sanata, to remind her that she had an antenatal visit coming up this week. But as they talked, she realized Sanata did not intend to go. When Kadidiatou pressed her, Sanata shared that she had heard it said that if someone goes to the health center, she will return with COVID-19, noting that it was only recently that health centers had any preventive measures in place, like handwashing stations. She told Kadidiatou,
I do not want to go to seek care, only to catch this illness and bring it home to my family.
Mothers like Sanata and Kadidiatou are not alone. Our team is talking with worried mothers across Bamako. As long as COVID-19 is a threat to their families, our team will continue to help mothers navigate and overcome all the challenges that prevent them from accessing healthcare in their communities. Now more than ever, it is clear that all mothers and children deserve access to quality healthcare – and just how far we still have to go.
The limited resources available in Mali make it extremely vulnerable to COVID-19. The best chance that Mali has is to prevent an outbreak before it begins, so that is our focus. If you can, we hope you will contribute, or buy a bar of soap, and together we will help make sure families and health centers have the essential resources they need, like soap, to stay safe.
Like us, you are probably receiving daily emails about the global pandemic confronting our world.
While there are no confirmed cases in Mali, we do not yet know what impact COVID-19 will have on the communities we serve.
Mali is extremely vulnerable to an outbreak like COVID-19. There are perhaps only 20 ventilators available and the health system simply does not have the capacity to manage the number of patients who would need care. In the peri-urban communities we serve, limited access to running water and soap, as well as dense populations, make many preventive measures difficult or impossible to adopt.
But we are holding on to hope. The countries surrounding Mali have several cases, including the continent’s first confirmed death to the disease, a woman in Burkina Faso. The fact that there are no confirmed cases in Mali is an incredible achievement. We are doing everything we can to support both the government and communities to prevent any cases.
Here are a few reasons why we are hopeful that we can:
The people of Mali are resilient.
The past several years have been some of the most challenging in Mali’s history. If there is anything we can say about the challenges Malians have faced since 2012, it has contributed to their strength and resilience. Malians repeatedly demonstrate their commitment to their communities and to one another; social cohesion is extremely valued and it is worked towards every day in large and small ways. Since we began our work, the people of Mali have faced a political crisis, the Ebola outbreak, and a worsening security situation. Through it all, Malians are working together to support one another and their communities. Resilience is one of the greatest strengths Mali has to get through this pandemic.
We are ready.
Even though we are a community organization, our team has experience responding to disease outbreaks and coordinating with national responses. Our community health workers continued to serve their communities during the Ebola outbreak, and have a strong desire to do so. Our team continues to reach thousands of families with the prevention information and resources they need to stay healthy. We are helping our community health center partners prepare and implement stronger prevention measures. Our dedicated team will continue serving their communities unless distancing measures are ordered by the government, or until it becomes unsafe for them to do their work. We do not know how big the task before us will be, but our team is prepared, and we are helping our partners and the communities we serve prepare, too.
Here are some of the steps we are taking:
Our health team did a refresher training for our entire team, including over 50 community-based health workers and group facilitators, on the signs of COVID-19 and the top prevention measures
In the homes and communities we serve, our team is emphasizing these messages in their daily visits, particularly handwashing with soap (which is always a big priority for us)
With our CSCom partners, we have re-implemented many Ebola prevention methods, such as ensuring our health workers are stationed at each CSCom to greet and share information with all visitors and making sure all visitors wash hands upon arrival and departure
We are making sure our partners have all the equipment they need to maintain proper prevention protocols, such as handwashing stations, and soap. Until the threat of COVID-19 has passed, all proceeds from the sales of our soap will go to equipping community partners with soap, which we will source from our cooperatives.
We are in the process of doing a small evaluation to assess where the needs might be at our partner CSComs (in terms of facility and preparation) as well as how best to help them with health promotion and making sure prevention messages reach all patients and visitors
We are also making plans, should the very worst occur. When the health system is stressed and its resources spread thin, access to primary care will suffer. We’re doing all we can to ensure that mothers and children will still have access to quality primary healthcare, during this pandemic, and after it.
We will get through this in the same way we accomplish everything we do – by working together.
Mali Health believes in building on a community’s existing resources. We do not want to replace them, because we want to enhance them. Often, a community’s greatest resource is its residents – people deeply committed to improving life for their families and neighbors.
A central tenet of our organization has always been to build deep connections to, and within, the communities we serve. We believe it is the only way we can develop local, long-term solutions.
That’s why we deploy a team of 50 community-based health agents who can sit across from mothers, listen to them, and answer their questions. They are an essential part of our strategies to improve community health. They are also an essential part of how Mali and the world will achieve universal health coverage, through improved community health.
One of the greatest examples of the local leadership that is changing the face of community health in Mali is our team’s new leader, Dramane Diarra.
Dramane has been a part of Mali Health for 10 years, having joined us in October 2009. He has held multiple roles over the past decade. Beginning as a health promoter, he rose to lead the entire Health Promotion team. Because of his leadership of his department and several other important projects, like our role in the Ebola response and the subsequent Global Health Security Agenda, Dramane became our most senior program leader at the beginning of this year.
Dramane has as much experience and knowledge of Mali Health as anyone, and perhaps more than anyone.
But it is not just his past roles in our organization that position Dramane well to lead our team. Dramane’s role in Sikoro (see more from Sokone below) and his belief in the power of communities to improve community health, make him the ideal leader for the hard work we will do going forward.
We are at a critical time. We want to from collaborating with our community partners to implement effective strategies, to helping them sustain them. We’ve made progress, as with our participatory quality improvement approach, but our goals are immense and long-term. To reach them, we need someone who understands the communities we serve from within. We need someone who knows how to motivate and support other community leaders to join him – and that is Dramane.
Here’s how Dramane sees his work:
” My commitment to community health comes from my firm belief that in every community, there is the power to improve health.
This power, at times, can be disjointed or poorly expressed, or even misunderstood and undervalued. But all it takes is to highlight it and to show communities how to use it; then the results will follow.
Everyone, whatever her level or his position, comes from a community; it is to this community that he or she returns at the end of every day. If every community understands the need to come together, every community can improve health.“
As our work to improve maternal and child health continues, we are recommitting ourselves to strengthening the resources and leaders on the ground – helping them to see and use their power, you might say. In order to build local and resilient community health systems in Mali, we will rely on leaders like the one Dramane was in Sikoro in 2006, and the one he is today.
The most powerful, dedicated, and impactful community health leaders come from within – and we are just getting started supporting them. Now, we are thrilled that our team is led by one.
Sokone is a community health worker in Sikoro. She’s known Dramane for many years, and here are her thoughts about our new team leader:
” I have known Dramane since he worked at the Sikoro Animation Center before joining Mali Health. He contributed greatly to the development of Sikoro as an educator and by helping families enroll their children in school. That is the work that helped him to become known, respected and solicited by the people of Sikoro. Since his arrival at Mali Health, this son of Sikoro has been steadfast in his commitment to help disadvantaged families have access to quality health information and healthcare.
Like all the community health workers, Dramane helped me a lot personally. He has helped us become knowledgeable, competent actors so that we can inform the families in our community. This constant support of our team has led to dramatic changes in the health of children and families in Sikoro.
Hard-working and courageous, Dramane has always been available for the cause of Sikoro, from his childhood to this day. “
