Africa
Deou Safe Motherhood Project, Burkina Faso
Our partnership with the health department in Burkina Faso to train
village midwives and combat maternal mortality completed its sixth
year at the end of 2007. It also sees the end of three years of
funding from NORAD/Fokus Kvinner through AMURT Norway. Our Norwegian
donors require a thorough evaluation of the program by an independent
party. We contacted APAIB (Associacion pour le Promotion de Alimentation
Infantile au Burkina) and they agreed to be our evaluators. While
we felt good about the program, we were anxious to see how an independent
and strictly objective party would asses our work and its impact.
Left: To work as a village midwife in a remote community requires character and courage. Salamata from Boula Est is a fine example; Right: Mariam, the village midwife from Ajafari, shares an intimate moment with her baby during a break in the training sessions in Deou
Our task, to educate the tribal women in the remote desert communities, is a monumental and complex undertaking. We are very aware that the project has a long way to go before we can declare 'mission accomplished.' Consider some factors: the project area has no roads, no electricity, very little water and food. Solar powered fixed-line phones were introduced last year, still no cellphone coverage. The population is divided between three tribes, each with their own languages. French is understood by very few, English not at all. Illiteracy is close to 100 percent among the women and only in single digits amongst the men. The logistical challenges are considerable: 7-8 hours from Ouagadougou, last four hours on dirt roads and through the bush. The project area covers close to 40 communities, some as far as two to three hours by four-wheel drive from our base in Deou.
Left: The Peuhl are nomads and their tents are easily disassembled
and moved every season; Right: The Bellas are not nomads and live
in larger grass huts
The evaluation team included a health department administrator,
two midwives, two nurses and a journalist. The team also added drivers,
translators and guides from the local clinics. We were 13 staying
at the AMURT compound in Deou. The team divided itself in two and
for eight days visited all the forty communities touched by the
Safe Motherhood program. Interviews were conducted, questionnaires
filled up, and in village meetings the population got the chance
to express their opinions about AMURT's work in general and the
Safe Motherhood program in particular. It was touching to see how
many of the communities had not forgotten Dada Rudreshvarananda
and his great efforts over many years.
To be frank, we had been a bit uncertain about how this evaluation would turn out. Our worries proved unfounded as right from the beginning the response was overwhelmingly positive. The people were eager to talk about the changes the program had brought in their lives. They confirmed that the village midwives had actively shared what they had learnt from their training sessions in Deou. An old chief talked about how most families had now stopped the practice of female circumcision (female genital mutilation). In other communities they spoke of how the women were no longer hesitant to visit the clinics for pre-natal counseling, and how the village midwives organized and accompanied the pregnant mothers to the clinics. The village midwives acquitted themselves very well in the interviews. They expressed their eagerness to learn more. All in all the evaluation process confirmed the importance and continued relevance for the program. The meetings with the population and all the brave village midwives strengthened our determination to continue the work.
In the evaluation report, the authors used selected quotes from their interviews to give a picture of the impact the Safe Motherhood project has had on the population:
"The approach is innovative in the sense that it is in line with the policy of decentralization and social contracts that is the order of the day, which promotes a greater participation and responsibility of the communities at the grassroots."
"The project permits us to acquire capacities so that today we feel capable to take charge of our health."
"Even if the project stops, we feel a sense of power to continue the activities. In short, the project has been very useful."
"The [village] midwives have clarified for us many things about
our health and about womens' pregnancy that we didn't know before.
Now, thanks to them, we know the importance of going for check-up
with the health agents at the clinic we are pregnant."
The evaluation report points out areas in our administration where we need to improve. We humbly accept these points, and will strive to improve in 2008. They were also kind to offer very concrete recommendations to make the program more effective. By the end of the year we will meet with our partners and advisors to agree on a plan. We will be seeking grants to continue the program.
The evaluation process was full of adventure; even with four-wheel-drive
vehicles and experienced drivers, we lost count of the times we
got stuck in the deep sand. At Loukoudou we had to conduct the interviews
in the midst of biting sandstorm. We drove through all impossible
terrains to locate the village midwives who had gone to farm or
to gather fire wood. Several days we returned only after dark. It
was tough navigating in the dark, with no roads, few landmarks,
and no lights other than the vehicle's headlights. The communities
received us very well, and offered us the only thing they have,
milk and millet. The evaluation team from Ouagadougou was excited
to visit a corner of their country that they had never seen before.
They were charmed by the colorful culture of the Bella and the Peuhl
tribes, and touched by their sweetness and inspired by the strength
they demonstrated by surviving in this inhospitable environment.
It's their home, and we did not hear anyone express desire to leave
their land for the city. Their determination and longing for a development
and a better future for their children was clear. The three main
needs: healthcare, water and education. Many mothers expressed their
dream that their daughters will learn to read and write.
 
Left:
The staple food is millet; Right: Pounded into a meal for cooking
Left: The stapl
This girl from Liila showed us how the Peuhl spin thread from straw
(left) and use it to weave the mats (right) they use to make the
tents they live in
The women in Petel were very vocal in expressing
their appreciation
for the work of the village midwife
Training of village midwives is the
heart of the Safe Motherhood project
With the addition of experienced midwives from Ouagadougou to the
team of instructors, the training programs for the village midwives
improved this year. In June eight new midwives were trained. We
added several items to the midwife kit on their recommendations
of the new teachers: plastic spread, more bowls for washing hands,
and laminated illustrated displays that help new midwives to teach
the women in their villages.
  Left:
F
Left: Fanta from Boulekessi practicing the delivery techniques under the supervision of the trainer; Right: Madame Oubda uses diagrams to explain the dangers of female mutilation
At the "recyclage" training in October, 36 out of a total of 37 village midwives participated. The program was held simultaneously in the three participating government health clinics, with everyone coming together for the last three days. Madame Oubda returned to take charge of the last three days and did a wonderful job. She uses a relaxed and engaging approach, her interactive and humorous style making the women feel very comfortable. The classroom was filled with laughter and fun, with games and exercises for the women to practice what they had learnt. She also gave personal attention to the AVs that needed more clarification. Everyone got the opportunity to come up front and demonstrate for the others. Madame Oubda has given many valuable recommendations that will be part of our plans for 2008. One example: to adopt a more decentralized approach for the training sessions, with smaller numbers and only one language group at a time.
 
Left: At the closing ceremony all 36 village midwives and 12 village health agents posed for a photo with their trainers; Right: At 22, Fatimata of Tontrou Pouli is the youngest of all the village midwives, here taking care of her sick child during a break in the training
Donkey cart ambulances for each village
During the evaluation, the village midwives all mentioned means
of transportation as a priority among all their needs. Some of the
villages are two to three hours drive by car from the nearest clinic.
If a woman should develop complications during the delivery there
are no means of transport available. There are no vehicles in the
villages, and a pregnant woman is in no position to walk or ride
a bicycle or donkey, what to speak of climbing a camel! The best
solution: a donkey cart in each village especially to transport
sick people and pregnant women to the clinic. Donkeys are plentiful
but flat carts are very scarce. On the recommendation of the evaluation
team, backed up by the health department staff, AMURT has taken
up the task of providing a "Donkey Cart Ambulance" to
each village. If you want to help with this, AMURT US's Christmas
Gifts from the Heart webpage offers an opportunity: www.amurt.us/gifts/africa.htm
Mafi-Seva Community Clinic, Ghana
Women of the Kekeli Movement: "Women
together for health and development"
Kekeli means "brightness", and it is the name
given to the latest initiative in our grassroots community health
education program in in the Volta Region. Kekeli symbolizes the
light of knowledge dispelling the darkness of ignorance and superstition
to bring health and wellbeing to the remote villages in the project
area. Ever since we started the community health education programs
in 2005, it had been our intentions to structure the activities
so as to be less dependant on outsiders. The key component is the
training of Kekeli women to be village health promoters.
Fifteen new Kekeli women start their work
The second group of Kekeli women graduated on 18 October. The training was led by volunteers Jennifer, a public health graduate, and Olivia, a registered nurse, both from California, USA, who were assisted by Bernice from Seva Clinic. Organizing and logistics was taken care of by Emperor from Seva Clinic. They all did a fantastic job in every way. The course ran for one month, with classes Tuesdays, Wednesdays and Thursdays. The trainees, who were selected by the women in their communities, walked from their villages to centrally located Somekpe village. From the fifteen participating communities nine come within the northern sector of Mafi-Zongo Water Project, and the remaining six communities lie to the north and east of the project area. Some of the women had to cross rivers and walk as far as seven kilometres each way to participate in the program. Jennifer and Olivia skilfully made the classes fun and engaging with a very dynamic and participatory format, without dry lectures. Right from the beginning, the women, many meeting for the first time, created unity and an affectionate bond between each other. It was inspiring to see. During the training the women were given homework, like to prepare talks, or to talk to their headmen about health issues. They responded very well, and the work in many villages started even before the course was over.
The topics taught as part of the Kekeli training are roles of a village health promoter, malaria, hygiene and sanitation, first aid, sexual health, nutrition, and diarrhoea and dehydration. Three more subjects were added in the session that just finished; high blood pressure, maternal health, and reporting symptoms of illness. Jennifer and Olivia also added many new teaching tips and appendices to help the Kekeli women learn and also to give them ideas on how to pass on the knowledge to their communities.
The graduation program opened with the Kekeli Song, recently composed
by one of the Kekeli women, Charity from Mankukope. It's a soaring
anthem that starts with ‘"We are the Kekeli women",
and ends with ‘"if we put into to practice we will have
a healthy life". The program included short talks by invited
dignitaries, and representatives from AMURT and the Seva Clinic. The
highlight was a drama about the importance of sex education and
the danger of HIV/AIDS. The one-hour drama was written acted out
by the Kekeli women and had the audience roaring with laughter,
which then turned to reflection and contemplation at the end. It
gave food for thought, particularly to the men in the audience.
At the close of the drama, the Kekeli women danced in a circle chanting
"Condoms are many, waiting for the men".
 
Left: Enionam from Kpokope played Uncle George, the unfaithful husband, here with one of his illicit lovers, played by Selassie from Kpelebe; Right: The happy and healthy family was played by Charity from Mankukope and Happy from Adanu. Here they are showing how to use a condom
After the graduation all received their certificate, the 100-page illustrated manual which has been translated into the local Eve language, a thermometer and a box of 100 condoms to help them promoter safe sex and family planning in their communities.
 
Left:
The second batch of Kekeli women after the graduation ceremony with Jennifer and Olivia; Right: Happy from Adanu village gets her certificate from Bernice and the trainers
By facilitating the development of women as leaders and providing new role models for girls and young women, the Kekeli program has a tremendous potential. It takes a lot of thought and sensitivity to get things right. Subtle dynamics and locally specified strategies are required. We are still feeling our way, navigating through this process. Presently we are deciding whether to train more women in 2008, or concentrate on consolidating and strengthening the group that has already been trained.
We are happy to see some of the Kekeli women taking initiatives on their own and the reception from the communities has been encouraging. The women have formed small groups; Kekeli women from three or four neighbouring villages teach together, taking confidence and support from each other. Improvised comical role plays are a part of the teaching session. In early 2008 we will concentrate on developing the use of drama in health education with the Kekeli women.
Throughout the period about thirty health education programs were held in the villages in the water project area and beyond. Some programs were help for the general community, some for the women only, other times we presented in churches, or in the schools. Topics included hygiene and sanitation, sex education, blood pressure, (with testing), abuse of alcohol and medication, etc.
Kekeli Song
We are the Kekeli women
We have brought you knowledge
We have taught you
For everybody to have a healthy life.
If we put it into practice,
we will all have a healthy life
Three months with the Kekeli women
Jennifer Kotlewski, a Public Health graduate from California,
who worked with the Kekeli program for three months, wrote this
report:
Palm fronds, mud huts, and a crowd of inquisitive villagers:
the scene had become a familiar one during my three months working
as a health promoter in Ghana. An education session on hygiene and
sanitation had just ended and I prepared myself for the barrage
of questions that was sure to follow. A man with a child on each
knee shouted a query that I had heard before: "You keep telling
us to make sure our kids are wearing shoes. What's the point?”
Just as I opened my mouth to reply, I heard a response from a confident
voice to my left. "Dirt carries germs, which cause disease.
When children run around barefoot, and then enter the house, those
germs can get on your clothes and in your food, making you and your
family very sick. When your family wears shoes, they can be left
outside, and with them, the dirt and germs.” The voice belonged
to Kafui, one of the three newly-initiated Kekeli women who organized
and taught the entire session.
After hearing her words translated from Ewe to English, I beamed
with pride. The ability to give such a clear, concise explanation
about a concept unfamiliar to most of her peers is the result of
a month of health education and leadership training, completed in
October by 15 women. For three days a week, my fellow volunteer
Olivia and I did our best to chip away at a cultural belief system
about disease which is hundreds of years old. We used role play,
games, lecture, and round-table discussion to introduce new ideas
while dismissing local superstitions and serious health-related
misconceptions. It seemed a nearly impossible task, but in the weeks
following their graduation, I was able to witness the fruits of
their labour as well as my own. Traversing from village to village
to observe their first teachings, I couldn't believe my eyes. Using
the same tools that I had used only a few weeks before, the women
were conveying the same complex concepts and commanding respect
from their once-sceptical audiences. Not only could I say with pride
that I helped them to develop those skills, but I could see that
they improved upon what I had given them, adapting my methods to
reach the ears of their neighbours. The simple lessons I taught
them paled in comparison to the true gift of the Kekeli program:
the confidence-inspiring truth that they are able to make a change
for their communities, families, children, and futures.
A week after Kafui's health session, I found myself in another
familiar scene as I stood facing a group of strong, beautiful women
in bright blue Kekeli T-shirts. Only this time, I wasn't teaching,
but addressing them as equals, as fellow health promoters, and as
my dear sisters and friends. It was the last time I would see most
of them, the final meeting before my departure back to the United
States. Since I arrived in Ghana, the program has expanded by leaps
and bounds. It has more than doubled in membership and has been
dramatically strengthened in terms of training and sustainability.
I am so proud to have been a part of a program that does more than
just advertise "empowerment;” it truly delivers on its
promise to instil real capability and confidence.
At the end of the day, I watched the clinic's old Land Rover
drive away to drop off an incredible group of women at the villages
that they call home, and that are so much better off since the Kekeli
program began. I have nothing but great expectations for the present
and future Kekeli women, for they have shown me the possibilities
that sprout from a passion for change. In this case, the possibilities
are endless.
 
Left: Jennifer with Kafui at Feda village; Right: Traditional birth attendants trained at the Seva Clinic studying the illustrations about pre-natal examinations. They had three training sessions with volunteer Olivia
Homeopathy: the experience at Seva Clinic proves homeopathy a viable alternative for rural healthcare
When Radha Linda Shannon first brought Homeopathy to Seva in April 2006, we had no idea that it would catch on to the extent it has. Today homeopathy has become known in the area, and many come to Seva Clinic for homeopathic care through word of mouth. The work is lead by Emperor under the guidance of Sheila from the Ghana Homeopathy Project in the UK. Over the last months we had visits by five homeopath volunteers, Linda, Grace, Mel, Angie and Bill, helped at Seva Clinic and conducted homeopathy outreach camps in communities. A special homeopathy room has been prepared at Seva, well stocked with remedies and books.
Bill Rumble, a homeopath from Wales with 20 years experience visited Seva for a long weekend. He shares his experiences here:
When I heard about the Ananda Marga homoeopathy project I was
instantly excited as I have a life long fascination with African
music and traditional spirituality. I'd like to share my experiences
with you after my visit to Mafi Seva, a village in the Volta region
of Ghana close to the border with Togo, an area inhabited
by the Ewe (ayway) people. The clinic there is multidisciplinary
and resolutely patient centred with an emphasis on empowering the
local people to make their own choices about the kind of treatment
they need. It opened in May 2003 and has been self sustaining from
the beginning, apart from vehicles and solar power. The first homoeopath
arrived in April 2006 and a local man called Emperor was asked to
act as translator. The Organon of Medicine is the seminal
work on homoeopathy, it was written by the founder Samuel Hahnemann
in the late 18th century. It begins with these words: "The
physician's highest and only calling is to heal the sick.”
So Emperor heard the call: "I knew immediately I had discovered
my life's purpose; to practice homoeopathy." So Emperor was
my translator as we toured the neighboring villages in the clinic's
pickup truck. We saw patients suffering from snake bites, malaria,
typhoid, asthma, infertility and any number of injuries. We saw
traditional animists, Moslems and Christians. We saw fetish priests,
wild and sprightly old people, and pastors on motorcycles.
All of them were treated individually and with the highest standard
of care and the results of Emperor's prescribing under supervision
are truly impressive. The clinic now provides frontline treatment
at a fraction of the cost of many "top heavy" health care
projects. For myself it was one experience I will never forget;
to be in such a beautiful and soulful place as Mafi Seva and to
be involved in a community-led project who's members set such an
example of decisive and relaxed leadership was truly an education
for me. Thanks.
Mafi-Zongo Water Project, Ghana
Consolidating and strengthening the base
The work has continued to provide a lot of challenges. The size
and complexity of the project is such that difficulties can't be
avoided, but at least we can say that the communities, with support
from AMURT, have faced the difficulties bravely, with the confidence
that for every problem there is a solution. During the period we
had a series of breakdowns at the water treatment plant which caused
interruptions. The pumps, the generator, as well as the valves at
the treatment plant were repaired several times and we had several
leaks. In August, heavy road construction equipment damaged many
pipes causing leaks and interrupting service to three communities
for a long period.
In September and October, the whole management and financial management
of the project was revised through a lengthy three step process:
first the issues were discussed at the north zone and southern zone
monthly meetings. The proposals and suggestions were taken to an
executive meeting of the board, along with North and South chairmen
and the staff that reads the meters and take charge of the revenue
collection. Finally all the policy changes was sent in writing to
all the headmen in all the communities, who came together to finally
ratify the changes. All the standpipe vendors and headmen were trained
in the operation of the standpipes and financial system of the project.
The new system calls for a stronger involvement in the project
by the village headmen. It's encouraging to see the communities
take charge to address problems and make changes. It promises well
for the future sustainability of the program. There is still a lot
of work to be done to legally define and formally establish the
project. AMURT continue to provide technical and logistical assistance
to strengthen the project. We hope that it will not be long until
it can truly stand on its own feet.
In the next months, if things go well, we will be able to bring
piped water to two more communities, hopefully before the end of
the dry season. AMURT Italy has raised funds, and the surveying
has been completed. The engineers are studying the finer technical
details before giving the go ahead. We remain in touch with Engineers
Without Borders in Tucson, Arizona. With their assistance we hope
to construct an additional pre-treatment filter to ensure better
and more consistent water quality.
Kwaku at the Zongo water treatment plant has been busy planting under the guidance of Agryabuddhi from the AMURT board. In a few years we will have an orchard with grafter mango, avocado, orange, papaya and coconut. A natural fence of tight thorny bushes has been planted to protect the WTP and the new trees.
Donations are very welcome!
AMURT
6810 Tilden Lane, Rockville, MD 20852, USA
Or with credit card through PayPal at www.amurt.net/africa
Bank information:
GHANA
Ananda Marga Universal Relief Team
Acct # 3702602
Barclays Bank, Makola Branch Accra, Ghana
Swift Code: BARCGHAC
BURKINA FASO
AMURT Acct# 0124211071808501-73
Banque International de Burkina, B.P. 362, Ouagadougou, Burkino Faso
Swift Code: BIBUBFBF
For more info visit www.amurt.net
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