While the fields of public health and medicine (among others) often invoke compassion as a grounding principle, its application to our training and practice as professionals is still developing. We recently had the chance to reflect on compassion and its role in our work, and we realize it a conversation that we want to continue. And we’d love for you to be a part of it. Share your thoughts with us on social media, or send us an email.
In mid-June, we attended the IZUMI Partners Meeting in Boston. We are so fortunate to work with IZUMI and they have been a strong, steady partner as we have developed our approach to improve healthcare quality, governance, and community participation at community health centers.
IZUMI Foundation supports global health around the world and is part of a group of foundations originating in the Shinnyo-en order. Shinnyo-en is a Buddhist denomination originally established in Japan that is grounded in values such as kindness, compassion, and caring for others. In fact, one translation for the Japanese word izumi is “heart of compassion” and in the Shinnyo-en tradition, that is represented by a deep commitment to social awareness and justice.
IZUMI Foundation is driven by the principles of hope, health and compassion and we are delighted that the one thing that stayed with us the most from their meeting was not something we learned about global health or nonprofit leadership, but something far more universal: the role of compassion.
The keynote speaker at IZUMI’s meeting was Dr. David Addiss, an advocate for compassion in global health, and he spoke about its necessity in our sector. Compassion is a familiar value for most of us, but Dr. Addiss differentiated compassion from other values and grounded it clearly in our field. Compassion is not rooted in sympathy or pity – those connote differences in power, even superiority. Instead, compassion is rooted in solidarity and an acceptance of our interconnectedness.
Though some may view it as an unscientific discourse, he noted that compassion is a skill that can be practiced and there is a growing field of neuroscience devoted to understanding it. Compassion can be taught, and learned. Dr. Addiss asked us to consider and interrogate compassion – as the desire to alleviate suffering – as the inspiration and motivation for many of us and as the ground in which our field is rooted.
Though we are now back in the busy day-to-day of our roles, the idea of compassion has remained with us. It has encouraged us to reflect on the role it plays in our organization – and in our partnerships with communities in the US, and in Mali. As a small community organization, we often think of Mali Health as generating so much of our identity from the communities we serve in Mali – the proximity of our team within them and our service to them – and the community in the US who chooses to support that work. But if we take a step back and ask ourselves why that identity has meaning for us – the answer looks much like compassion.
At its best, compassion is about solidarity, about making connections across difference out of a recognition that we are linked. While compassion might stem from conditions of inequality, those we serve are not the objects or recipients of our charity. They are equal partners in eliminating suffering and improving the wellbeing of all.
But sometimes, that distinction isn’t always clear in our sector. There can be a downside to compassion, especially when it comes to examining our motivations and choices as individuals. Helpers of all kinds can burn out and people make poor choices in the name of serving others. At its worst, those operating in the name of compassion insist on maintaining power and agency over others – blind to their own biases and the oppression they perpetuate. And we still watch with concern as the power that exists in our sector not only can allow poor leadership or poor development work, but can incentivize it. Compassion alone is not enough to solve these challenges, nor is it the only value that should direct us. But we wonder if it might not be the kind of guiding, and grounding, principle from which global health as a field, and we as practitioners within it, could benefit.
In Mali, we see many applications for compassion in our daily work. The idea of “compassionate care” in a clinical or medical setting is not a new idea, but compassion is not a term we often use in public health. Our work and the way we train our team is grounded in principles of respect and care, but compassion still seems distinct.
Yet we see it in our community health workers going out each day to tend to their neighbors – doing so out of a sense of improving their communities and protecting the most vulnerable within them. We see it in our office staff, who have a strong sense of service to others and have dedicated themselves to our mission and values.
But perhaps where the idea of compassion resonates most for us is in our work to improve the quality of primary healthcare for the most vulnerable. Within quality improvement, there is a well-defined emphasis on the delivery of respectful maternal care that ensures all mothers are treated with equity and dignity. Interestingly, compassion does not often accompany these principles in the literature. But with its insistence on recognizing the human connection between a provider and a patient, compassion seems inherent in the current quality, equity and dignity (QED) framework in maternal and child health.
But there’s more we’d like to do.
Ethiopia’s Health Systems Transformation Plan discusses the creation of a compassionate, respectful, caring (CRC) health workforce, embedding compassion not only in quality, but also a building block of health systems strengthening (HSS). HSS can be one of the “nameless, faceless” areas of global health that the call for compassion is seeking to humanize – and we’re watching closely.
We are imagining how we might facilitate conversations with our team and our partners about the role of compassion not only for their motivations as individuals, but also within their daily work. We are thinking about what connections we might make between our emphasis on the patient experience in our quality improvement work, and how compassion might further improve our partners’ ability to provide more patient-centered care. Might we help our partners build a compassionate, respectful, caring (CRC) workforce?
Our ideas for how we might integrate compassion into our work are just beginning…
We also know that members of the Mali Health community are motivated from a place of compassion. You have told us time and again that you see solidarity at the heart of our work, and that is why you support us. You share your compassion with women and children in Mali, and us, because you believe that no one should suffer because they don’t have access to quality healthcare. Beyond your participation in our community, many of you are physicians, educators, or helpers of some kind. Your compassion, your desire to alleviate suffering, emerges in all areas of your life.
For us both, reflecting on compassion has led us to some rich and thought-provoking places. We are thinking about its role in our motivations as leaders, in the organization and team we support, and in our field. We wonder if you might have similar insights?
We want to open up the conversation about compassion in our communities – both in the US and in Mali – and we invite you to be a part of it. Let us know your thoughts about the role of compassion in your life – personal and professional. We’d love to hear from you. Send us an email, or leave us a note on social media.
On Wednesday 10 July, Mali Health was honored by the Sotuba community in recognition of our partnership, and the impact it has had on improving community health. While we were the ones being recognized, for us, this event was actually a chance to celebrate the strong leadership in Sotuba, and the community’s investment and ownership of their health, and health system.
Sotuba is a peri-urban community on the eastern side of Bamako and Mali Health collaborates with the health center (CSCom) to improve healthcare quality and governance, as well as supporting community health workers and women’s health savings groups there.
The celebration featured staff from Mali Health, members of the community, and the president of Sotuba’s ASACO (Association de Santé Communautaire), the organization made of community members that oversees the health center. The ASACO serves as a bridge between the health center and the surrounding community, linking the organization and the people.
The ASACO has a key role in helping to improve the health of the community. When a community has an organized and efficient ASACO, the CSCom’s work is tailored to the specific needs of the people it serves, the CSCom becomes more responsive, and the amount of women and children seeking care at the health center increases.
Sotuba is one of the smallest communities with whom Mali Health collaborates. When the partnership began, the ASACO had no structure or organization and it was unclear to the community and the health center what exactly the role of the ASACO was. Unfortunately, most low-resource communities in Mali face the same challenge and one of the most important pillars of the community health system often is not able to fulfill its role of ensuring strong management, accountability and community participation in health centers.
Today, Sotuba’s ASACO is an active group of community members who are fulfilling that essential role – and they are seeing impressive results. On a measurement scale we use for transparency and accountability, Sotuba went from being one of the lowest-scoring partners to one of the highest. Sotuba’s patient satisfaction scores are consistently among the highest, over 95%, and the rates of pregnant women returning to deliver at the CSCom are the highest of any of our partners – sometimes reaching 100%.
As one of Mali Health’s first partners to implement, test, and refine our participatory quality improvement (QI) approach, their hard work speaks for itself. For several years, a QI coach has provided technical support and coaching to a QI team at the Sotuba CSCom and we are now in the process of turning the QI program over to that team, so that they can continue serving their community at this high level.
To support the efforts of the health center and extend the impact of improvements in quality, Mali Health has provided community health workers and free or subsidized healthcare to children and pregnant women with the least access. We also help women in Sotuba access more financial resources that can help them improve their family’s health. By addressing preventive healthcare, hygiene, and budgeting, these strategies aim to advance health in Sotuba by helping women gain more knowledge about their children’s health and increase their ability to act on it.
A mother and savings group member who attended the celebration shared her experience:
Two times a month, Mali Health makes contact with us parents, to see the evolution of the state of health of the children. They are really there for us; we are really grateful. They educate us about the nutrition of our children and hygiene. The savings funds that Mali Health helped us set up helps us a lot to provide hygiene products such as our soaps and other cleaners. I’m so grateful that I have tears in my eyes about Mali Health.
Mali Health’s overarching goal is to support the Sotuba community to improve access to healthcare; the partnership is rooted in the community’s desire for change. Although there is more work to be done, this celebration represented an important milestone and the core of what makes Mali Health’s approach different. While Mali Health can give support to the health center, mothers and community members to improve health and to make change, it is up to them to decide whether to adopt strategies, act on information, and to take ownership of those strategies to sustain that change in the long term.
As the president of the ASACO described it, to the community, Mali Health represents the idea that a different future is possible, and within their reach. During his acknowledgement, the president reflected:
I remember a story that was told to me by one of my teachers: a little boy from a small village became a doctor and became a source of hope for his entire community. This little boy reminds me of Mali Health which has become the source of hope for our community.
Members of the Sotuba community have seen the change they are able to make to improve the health of mothers and children. While Mali Health remains so grateful for their partnership, and their gracious efforts to recognize what our partnership has achieved, we are most excited by the real steps forward that community members in Sotuba are taking to actively participate and take ownership of their health system and its future.
Every community with whom we work will always have our support, but our role is to strengthen their ability to manage and improve health in their communities, so that they can take the lead.
When they are the ones who start giving us the certificates and the chiwaras – then we know we’re all doing something right.
Joe (board member) and Tara (US Director) visited Mali in February 2019 and were honored to host a few American guests for an eventful week, including the celebration of our team of community health workers, and their amazing accomplishment of not having lost a single mother or child in their care since January 2014 (read more on that here). Below is another special experience from that trip, written by Tara.
Getting to Lassa requires a bit of a climb. Like Sikoro, it is north of Bamako, where the hills turn into cliffs. It is a different landscape.
On our way to visit a savings group, we started with a call on the village elders. Traveling with more Americans than usual, they received our small delegation graciously in a thatched-roof building that is surely often occupied by important community meetings and discussions.
Seated on the ground on an animal skin, the eldest offered very warm and customary greetings. We offered a traditional gift of kola nuts. Interpreting the exchange for our guests – Bambara, French, English – English, French Bambara – makes it feel more profound and ceremonial. Receptions like these are an honor and a social performance of respect – and I will never tire of them. I’m unsure if Mariam (our Mali Director), or the rest of our team, share my enthusiasm and awe. They always represent Mali Health with the immense Malian graciousness that is gratifying to this Southerner to watch.
Accompanied by two of the elders, we continued a bit farther up the slope. Noting very large piles of firewood (and suddenly realizing the lack of trees), they inform us that the production of charcoal was the primary revenue-generating activity. The informal economy is how most of those living in peri-urban communities, especially women, get by. They tell us that Lassa used to be like a rainforest – a small oasis above the city – but the dust the characterizes the rest of Bamako now seems to dominate here, too.
But as we continued, mango trees began to appear and grow in size. When we turned the corner to where the group was seated, we encountered one of the largest mango trees I’ve seen in Bamako. Mango trees provide very welcome shade here along the edge of the Sahel; thousands of women’s groups meet beneath them across the continent every day. They are amazing trees – thriving in even the harshest of conditions.
Again our small delegation is welcomed graciously, this time with song. We observe the opening ritual of the meeting – the diligent taking of attendance, reporting, counting, and recounting of the amounts saved in their two accounts: one for health expenses and one for income-generating activities.
Then, one at a time, every woman rises and brings her contribution, 100 FCFA, or about $0.18. The status of loans is reported. The funds are counted, recounted, and reported to the group to be held in the collective memory. At the beginning of their next meeting, the group will be asked how much should be in the accounts. The funds will be counted and the numbers will agree.
At the conclusion of their savings activities, the visitors are welcomed to ask questions. This Director, eager to report back to our wonderful supporters, asks a few (rather standard) questions:
How many of you have used the health fund for yourself or one of your family members? About 80% of hands go up.
What kind of things do you take the non-health loans for? Women share that here in Lassa, they are gardeners. They buy inputs and tools for their gardens with the loans. Things like fertilizer, small tools, or seeds they don’t save themselves.
What can we as Mali Health do to better support your group? They want support to form a cooperative too… word travels fast. Though we are testing the cooperatives in only two communities – not at all close to Lassa – the other 5,000 women in Mali Health savings groups are watching closely.
Great – we would love to help you do that. If you had a cooperative, what would you like use the funds for? To send our children to school, they say.
Hmm… no mention of health. I say as much to Mariam and she nods – but she’s already two steps ahead of me. I ask her if I might ask about the health center, how do they find the service there? How is the quality of care? We have worked with the health center here as an advisor to another community project, but we just added the CSCom in Lassa as a full quality improvement partner a few months ago.
Thanks to our partnership with OSIWA, we are expanding our participatory quality improvement approach – this time with a particular emphasis on women’s participation at all levels. These are some of the very women who we will be relying on to provide their feedback and leadership – to participate actively in the improvement of the health center. Mariam knows what is coming, but gives me the go-ahead.
Could you tell me about your health center here in Lassa? What has your experience been like? What do you think of the quality of the care you receive there? A few women weigh in, saying they are satisfied with the care. Many have taken their children there and have received effective treatment.
I turned to Mariam – are they just telling us what we want to hear? Do they know we want to hear their real experiences? Mariam smiles at me, knowingly, as if my understanding finally catches up to hers. We discuss that the time is late and I say that we can just let it go. But, it would be nice to encourage them to share more. Their experiences are essential for us and the health center to hear and understand. We want them to know how important they are, but is now the best time to have this discussion?
As I discuss with Mariam, the group becomes restless. We have already taken up too much time – they have households to manage, children to mind, and meals to prepare. Having stopped interpreting our side discussions, I’m worried I’m boring our guests who are not accustomed to the dryness and heat.
But then Mariam turns to Gaoussou, the dynamic Director of our Community Capacity Building department, and says a few things in Bambara. Though her Bambara is excellent, she usually prefers to speak in French and have Gaoussou interpret for her – another process I enjoy. This time, she speaks directly and deliberately to the women in Bambara.
Mariam tells them she knows there are issues at their health center. She explains why they are so important, not only to us, but to their health center and community. She describes our strategies for sharing feedback from women with the health centers and that we need more women to become leaders in the community association that manages the CSCom to help advocate for better care.
Though we have just taken them on as a full quality improvement partner, Mariam knows the center well. She gives the names of all the personnel – including the new director. She conveys to the group that she knows what happens there – she knows what they know.
One of the visiting elders weighs in.
Listen to her words, she knows your health center perhaps better than you – why don’t you share your experiences?
After a brief pause, one woman starts pouring out her story – sounding more urgent and frustrated with every word. After hearing about the importance of delivering at the health center from her savings group, she was finally able to convince her brother to let her take his wife to deliver at the health center. Despite going into labor in the center, her sister-in-law was never attended to. She delivered, without being touched by a single provider. She vows to never return to the health center.
Other women weigh in with similar stories of neglect, lack of respect, or poor-quality care. They say that when they take loans from their group, they take extra so they can pay for the transportation to take their children to another CSCom nearby. They avoid their own health center if they can.
Throughout their testimonies, Mariam nods, again knowingly. Their experiences are why we started our quality improvement work in the first place. What is the use of helping women overcome the barriers to accessing care if the care they receive does not help them? This is why our approach of addressing both access and quality is so important.
Mariam thanks them for sharing their stories. She says it is because of their experiences that we are now working with their health center to improve. She reinforces once again that they are a very necessary part of the process and that we will continue to support them and the health center until they are truly satisfied.
We close our meeting with exchanges of gratitude all around. We take a group photo under a branch of the grand mango tree.
Des Bonnes Mamans savings group in Lassa, with visitors
Though very aware of the time we have consumed, but not wanting to leave them after such an enlightening visit, I very timidly ask Gaoussou if I might just see one of the gardens they mentioned? Maybe take a photograph of one of the cultivators in her element?
We are again graciously ushered up a hill, through the barriers that keep out renegade goats, chickens and children and into beautiful, lush gardens. Yams, peppers, tomatoes – as far as the eye can see. I’m told that nearly every woman in the savings group has a garden and they sell their excess produce in the markets. No more charcoal.
While many families we serve come from rural areas where cultivation is the mainstay, there isn’t much room for gardens in densely-packed peri-urban communities. Lassa, situated along the ridges above town, has a bit more room – so the women are growing.
After more thanks and farewells, I’m still processing the lessons this group taught us, but mostly feeling very proud of our team and their dedication to ensuring women are heard and can lead. As we descend from the gardens, the elders share that instead of cutting trees, the community is now working on replanting them. Between the trees and the gardens, they have already noticed a difference in their climate.
They say the rains, which started to pass over Lassa into the next valley when the trees were all cut, have returned.
In November 2018, Mali Health officially became a partner in the WomenConnect Challenge (WCC) – a USAID initiative intended to “bridge the digital gender divide.”
For so many reasons, this was an unlikely place to find ourselves; it was not something we had planned. Partnership, collaboration, and learning can be funny in that sense – they often lead to unexpected places. The journey to become one of nine WCC partners has been enlightening, challenging, and meaningful. It’s a journey that we are fortunate to be on. This is new territory for Mali Health.
Perhaps you are now wondering: what is a digital divide? and what does that have to do with mothers and children, or health? Confusion, and even skepticism, are rational responses. We would be the first to admit that the connections between our community health work, this opportunity in particular, and the fascination with technology/innovation/social entrepreneurship in general, could seem tenuous. This project could be a distraction from our mission.
But, we’re learning so much on this journey – and those concerns do not keep us up at night. Here are four reasons why:
1. We’re focused on women.
Women are the heart of what we do. They are the focus of our daily work because they are at the core of our mission and strategy. Women are the key to improving maternal and child health in Mali because they are the ones who are most affected by access to and quality of care. You’ll remember that access and quality are our two top priorities in community-level maternal and child health. Women are the care-providers to children and the care-seekers for their families. They are the ones who determine where, when and how their family needs to seek healthcare.
As you may have guessed, WomenConnect is also completely focused on women. We all know that women do not have the same opportunities to reach their full potential, but have you thought about what it means for them not to have access to the same technologies? As the world becomes more digital, what does it mean for women to not have equal access to the internet? Could that impact their health and wellbeing? WomenConnect thinks these are questions worth asking and answering (so do we).
And we’re in good company. In their 2019 Annual Letter, Bill and Melinda Gates described nine of their top surprises as they have pursued their philanthropy and work. Guess what #9 was?
“Mobile phones are most powerful in the hands of the poorest women.”
– 2019 Annual Letter, Bill and Melinda Gates
Say that again? We start a project to learn if and how cell phones using a voice-based technology can help the poorest women in Bamako better meet their health needs… and two of the most towering figures in global health are talking about poor women and cell phones?! On the Colbert Late Show?!
If it makes sense to Bill and Melinda Gates, that works for us.
2.This project allows us to use technology and engage in innovation and social entrepreneurship in an appropriate, measured way.
The potential for innovation and solo social entrepreneurs to save the world is another topic for another day – but let’s just say this approach feels overrepresented in our field at the moment. Not every health problem (especially in community and/or maternal and child health) is a challenge just waiting to be hacked or solved by the right technology or business model, which can then be taken to scale to save the world.
However, there are some very amazing engineers and entrepreneurs out there who may very well revolutionize the way the world tackles certain problems. We’re not one of them, and we’re not trying to be one of them. The revolution we seek is to help communities in Mali have full ownership and control of their local health systems so that all mothers and children have access to quality care. But, that doesn’t mean we can’t partner with one of these visionaries (see #3 below) – and work together to find extraordinary solutions.
So we are. As a small community organization, everything Mali Health achieves is through partnerships. With donors, with communities, with mothers and families. This project allows us to build an exciting new partnership, which happens to include technology.
And perhaps it is through partnership – bringing together community expertise and resources, community builders and problem solvers like Mali Health, and the best of technology, innovation or social entrepreneurship like Lenali – that the real potential for transformative change using technology and innovation exists. Even social entrepreneurs need customers. Maybe it is none of these pieces alone, but working together in partnership with the others, that creates success? We’re excited to find out.
3. We are going to learn a lot. In fact, we already have.
Learning from others is very important to us. So important, in fact, that we made learning and data-based decision-making a pillar of our current strategic plan. It’s something we encourage within our team and within our organization everyday.
Participating in this process has already offered many lessons. Perhaps like me, skepticism about the appropriateness of technology to serve women living below the international poverty line, in some of the poorest peri-urban communities in the world, is still lingering in your mind. When we’re simply trying to help women and children prevent basic illness via handwashing with soap, or get to their community health center for prenatal care, malaria treatment, or to give birth – where is the role for technology? I had to learn.
My favorite line about the 9th surprise in Bill and Melinda’s letter is this: “connectivity is a solution to marginalization.” The most important part of that line is the smallest, the article: Connectivity is A solution, it is not THE solution. Perhaps the greatest lesson I have learned so far is that simply using technology should not ever be THE solution. In fact, it’s quite the opposite. Technology for its own sake almost never works. Technology is a tool, like soap or a mosquito net. And it is one that we should not overlook because the women and families we serve happen to be poor.
This lesson is also particularly evident in our baseline study, which was administered by our talented Research, Monitoring and Evaluation Department. Of the 300 women we surveyed in Sabalibougou, 100% reported owning a cell phone. Of those same women, 52% had no formal education and 37% had some primary school education. So, a full 89% of the women we surveyed had extremely limited or no formal education, meaning they are likely to have trouble with literacy and numeracy – but they all had a cell phone.
So, can connectivity be a solution to marginalization in this context? Absolutely, yes.
Our baseline study was full of other surprising results (so much learning!) but I will save those for another day. This project has already challenged my assumptions about technology – what it is, and how it can be used, it’s relevance to the poorest women – and I am ready for other assumptions to be challenged. That’s why learning is so important.
4. We’re part of a supportive WCC community.
In June last year, we had the opportunity to attend a workshop in DC as a part of the WCC application process. Mali Health was the only health organization to attend among the approximately 20 participants. Not only did we meet some fantastic people, we learned a great deal. We learned from the other projects and organizations who attended and collectively we learned together from a community of experts who shared their advice and work. There was a spirit of collegiality, not competition. For anyone who must attend professional workshops or conferences, or who have firsthand experience with USAID “co-creation” processes – you know what a rare experience that is, and can understand how much we appreciated it.
The person who is most responsible for this community is WCC Director Revi Sterling, whom we had the honor of hosting for the community launch of our project in Sabalibougou earlier this month. We are so fortunate that Revi and her vision for WomenConnect landed at USAID when she did – and we wouldn’t be participating in WomenConnect without her.
Mali Health is proud to be a part of WomenConnect – and we will be working very hard to make our colleagues in the WomenConnect community proud of us.
Thoughts of How on earth did we get here? have ceded to thoughts like What an amazing opportunity for our team!
We cannot know if this project will work – it is a pilot, after all. But as we work alongside 400 women in Sabalibougou and listen to what they think of a brand new technology and its relevance to their lives, we do know that we, and our partners, will be learning a great deal along the way.
This post was written by Mali Health Board Chair Dr. Joe Camardo, after his recent visit to Mali.
At 8AM I walked out of the NIH guest house at Point G, which is settled on a hill above Bamako, into the heat of the Malian morning. The terrace provides a view of Bamako on the plain below; what a place. Just flat and sprawling as far as I can see, and from here it is just quiet. But, five minutes in the car and one joins the crowd of commuters. Cars, motorbikes, sotramas, pedestrians; courtesy and good judgement orchestrate this constant flow of movement, since there are few traffic lights. Bamako is rich in spirit and like Mandé music it seems to have a rhythm and a story.
So, we (Samba my driver and I) cross the town and arrive at the Mali Health office. This starts a week that allows me to see our team, the families we serve, and our health center partners. It also includes visits to some of the government officers who are tasked with the vision to lead the country to a place where the spirit of the people is matched by the services and material goods all of us have come to expect.
One of our concerns about Mali Health is whether we can convey to our supporters how much of a difference they make in a place so distant, so different, and somewhat obscure, not usually the subject of news stories, except for bad news. But there is some good news:
At CSCom SISSOU, our very first partner health center in Sikoro, there is much activity. They follow our quality improvement protocols and have improved their system for payment, their labs, their water and sanitation. In May, they delivered 100 babies. The team is motivated and they’re responding to an influx of new residents in the Sikoro area. The community health workers in Sikoro/Sourakabougou visit families on a planned schedule, with specific objectives. The health center is raising money to improve the laboratory so it can be certified for additional testing services.
In Sotuba, our community health worker spent over an hour with mothers explaining vaccination, malaria, handwashing, and other simple but important ways to keep their infants and toddlers healthy. They spent a long time in discussions and banter in a combination of French and Bambara (and some arguing with more vocal of the community). The women are illiterate. Since we cannot just provide information in writing, the discussion is one of the few ways to make an impact.
In Lafiabougou, I attended a quality improvement session (in French and Bambara with simultaneous translation by Mariam. Note to self: learn French before next visit). It was great discussion about vaccinations: why are families with newborns missing some of the later doses, how should we make sure the mothers know when to return, how do we make it easy for them to get back to the health center. Another lively discussion including the head physician, the sagefemme (midwife), and the staff of the health center, along with our quality improvement coaches.
In Sibiribougou, I met with a savings group. Of course, this is an opportunity to provide information to mothers. I noticed it’s also a chance to see the babies; though not a real pediatrician visit, even an out-of-practice doctor can see if the baby is thriving or not. This is a great event, lots of laughter, but also serious accountability for the contributions and their use. I contributed a very worn-out 1000 CFA note (about 2 dollars), which generated some applause and laughter and I suppose allows me the privilege of a loan if I need it. I find these sessions to be inspiring; it’s not just the money, (that is important) but it is the sense that these mothers really help each other. It is one of the activities that mothers manage themselves; our animateurs make sure they get together, but the mothers run the show.
Mariam and Joe visit the Ministry of Women, Children and Families
This visit we took the opportunity to visit the Ministry of Health and the Ministry of Women, Children, and Families. We also reminded them of our status as an INGO, recently granted. Though we are a US nonprofit organization, we are incorporated as an international NGO in Mali, under Mariam’s leadership. We visited the Minister of Defense, Honorable Tiene Coulibaly, who is a friend of Mali Health from his time as Mali’s Ambassador to the US. Though a courtesy visit, it was a reminder that one obstacle to progress in Mali is the continued threats to peace in the North, and in the Dogon region. All I could say was that, having visited Mali now three times, that I wish him the best of luck in the job, and told him that for sure the people of Mali deserve peace.
