International Women's Day 2019
International Women’s Day has special significance for everyone at Helen Keller International. Our co-founder, Helen Keller, was a fearless trailblazer and champion for social justice and women’s rights. She is one of the world’s most indelible examples of the power of the human spirit to overcome seemingly insurmountable obstacles.
Today, we join the international community in celebrating the potential of women and girls all over the world. But we know that is not enough. As Helen herself did so fiercely, we must also take action to remove the barriers that threaten the opportunities, health, safety, and status of women and girls in their homes and communities.
In Africa and Asia, Helen Keller International works to empower women through integrated programs that improve their economic capacity; strengthen their livelihoods and access to healthy foods; and equip them with the knowledge and services they need to prevent malnutrition and maintain good health for their infants and young children. In the United States, we provide vision care to under-resourced communities to help schoolchildren and young girls see and succeed.
Today, we celebrate three exceptional women and agents of change from Senegal. Brigitte Malou, Madelene Sadio, and Maryama Kouyaté are health workers and leaders who give their time, energy, and service—with all their hearts—to improving life for women and children and building stronger communities.
The USAID-funded Neema project works to ensure that communities in Senegal have sustainable access to high-quality, routine health and nutrition care, even in the most remote villages. All the women we celebrate in this story received training through the Neema project (which Helen Keller International implements in collaboration with partners), and Project Neema supports their work.
Nurse Brigitte Malou’s office at the health post in Sinbandi Balante may as well have a revolving door – the moment one mother and child leaves, another pair enters. The nurse welcomes them all with an unflagging and 100% genuine smile.
“Some women travel here from very far away, even all the way from outside the district – some even come from Guinea-Bissau,” she said. “Regardless of where they come from, we take them into our care.”
Many of the women are worried because their children are sick, while others are here for routine immunizations or check-ups. The nurse attends to the immediate health needs – testing a feverish infant for malaria, for example, and giving another one anti-diarrheal medicine. She also diligently works through a check-list of protocols to determine whether the children are well-nourished and up-to-date on their immunizations, deworming pills, and Vitamin A supplements.
She starts each visit by asking the mothers for the children’s health registers, in which height, weight, arm circumference, previous medical visits, and treatments are tracked. Then she takes the child’s measurements and temperature and inputs them into the register, confirming whether the child is appropriately nourished. She administers vaccines and drugs, gives medical advice, and refers acute cases of malnutrition and complicated illnesses to the health center in Goudomp, a slightly larger town nearby.
In between, she takes every opportunity to create teaching moments. With one mother after another, she flips patiently through the pages of her illustrated nutrition guide, tirelessly delivering advice on how to feed children local foods rich in vitamins and minerals. She points to posters on the wall that offer advice on hygiene. She reminds mothers about the importance of bringing sick children to health centers.
Malou’s compassion, like her smile, is ever-present and second nature. While a mother was listening to a doctor’s instructions on how to make enriched porridge for her malnourished child, the little boy started crying in her arms. The mother tried nursing and lightly bouncing him while concentrating on the doctor’s words, to no avail. Malou gently and wordlessly took the fussing child out of his mother’s arms and rocked him until the doctor was finished. Later that afternoon, a mother came in with an infant the nurse recognized, and her face lit up. “Who is this person?!” she cooed at the delighted little girl.
Though she clearly has a way with children, it’s not the kids who most appreciate Malou and her colleagues. In this part of Senegal – rural and underserved – quality healthcare is not taken for granted. One young woman who came in with her mother – each carried one of the daughter’s four month-old twins wrapped to her back – said they had walked past six health posts to get to the one in Sinbandi Balante, because they knew they would receive kind, compassionate care from the nurses here.
“When the women come in, we give them a warm welcome,” Malou said. “We tell them to take a seat, we ask them if everything is going well at home, we put them at ease. Then we move on to the children.” It’s her rapport with the mothers that helps Malou convince them of the need to bring in their children for regular care. And she says it’s working, little by little. “The mothers are starting to understand. It will take time, but it will happen.”
In the verdant Casamance area of Senegal, the March nights can be cool but the days are decidedly hot. Still, from 8:30 in the morning until 2:00 in the afternoon, a steady stream of mothers and their children arrived at the health hut in Kolane, a village of about 1,400 people, and waited in the shade of a tree for their turn to see a contingent of community health workers. The workers visit Kolane once a month to weigh the children, assess them for malnutrition, and give them Vitamin A supplementation and deworming pills as needed.
One of the health workers, Madelene Sadio, lives in the village; the women assembled at the health hut are her friends and neighbors. Though her own children are now grown, she recalled being a young mother in need of the same health care services these women now seek. Because she grew up in the bigger community of Sinbandi Balante and profited from a more extensive education than most women here ever receive, she learned the importance of immunizations and check-ups. She does this work to help the women in Kolane gain the same knowledge and access the same care that she had.
“I saw that women in this village were giving birth at home and the children were not getting their immunizations,” Sadio said. “I received training so that I can sensitize women to the importance of giving birth in health facilities and getting pre- and post-natal consultations, as well as the need to bring children to be weighed and vaccinated.”
Sadio’s role during the S.P.C. visit (Suivi et Promotion de la Croissance, or Tracking and Promotion of Growth) was to administer deworming tablets, as well as Vitamin A drops to any child from six months to five years of age who hadn’t received a dose of this critical immunity-strengthening vitamin for at least six months. While the mothers held their sometimes squirming, sometimes crying children, Sadio gently squeezed the children’s cheeks and expertly dropped a dose of the liquid supplement into each child’s mouth.
Out of thirty-seven children who were seen by the workers, two were found to be suffering from moderate or acute malnutrition and were referred for follow-up care. While this is still two children too many, Sadio has noticed an improvement both in the health of the children and in the engagement of their mothers since she was trained as a community health worker five years ago. She believes that her outreach efforts in the community have started to make an impact, and she gives an example. “Women used to leave their sick children at home,” she said. “But now as soon as a child falls ill they hurry to the health hut. It makes me very happy. And I have gained a lot of respect from the women in the community. That makes me happy, too.”
Once you turn off the highway connecting Casamance’s two biggest cities, Ziguinchor and Kolda, the roads become narrow and sandy. They weave their way through small towns consisting of little more than a cluster of houses, an open market, a mosque, a church, a school, and a health post. Turn onto an even smaller dirt road – one so rugged and bumpy that you can drive no faster than a few miles an hour on it – and you’ll come to tiny, dusty settlements with only a handful of residents.
The daily routine here rotates around agriculture: the women pick hibiscus leaves and grow vegetables and rice; the men raise cows, goats, and sheep; and the children, when not at school or helping their parents, climb towering baobab trees or play in the shade of the painted concrete houses.
In these communities, when an infant gets sick, going to the doctor can be a matter of walking several miles with the child strapped to one’s back. Overworked mothers –who not only garden but also cook, clean, go to the market as vendors and buyers, draw well water, and do almost all of the childcare in the household – will drop everything to travel to the health post only in emergencies.
So, Mariama Kouyaté comes to them. For seven years, she has been a DESDOM (dispensateur de soin à domicile, or home-care giver), a voluntary health worker chosen by the community council who makes house calls to administer vaccinations, diagnose and treat basic illnesses, and refer more complicated ones for treatment. “It was a great honor to be chosen,” she said. “But I also made the choice to do it. I wanted to wake up every morning and go into the community and help sick people.”
When she receives a message about a child who has fallen ill, she grabs her suitcase of medical tools and supplies and leaves her own six children behind to make a house call.
On the day we visited Kouyaté, she walked to a compound about a kilometer away to attend to a one year-old who was running a fever along with diarrhea and vomiting. In this part of the world, those symptoms are quite likely to be caused by malaria, which is particularly dangerous for children under five.
So, the first thing Kouyaté did after taking the infant’s temperature was to give him a malaria prick test. While she waited the requisite fifteen minutes for the results, she asked the mother about the boy’s symptoms and checked his health register to make sure he was up-to-date on his immunizations, deworming pills, and Vitamin A supplements. She also measured his arm circumference to check for malnutrition. As at the regional, district, and municipal levels, Kouyaté integrates this full package of health interventions into every visit, so that no child’s routine healthcare falls through the cracks.
The malaria test turned out to be negative, thankfully. Kouyaté gave the worried mother pills to relieve the child’s diarrhea and vomiting, along with detailed instructions on how and when to administer them. She wrote out a referral for a visit to the health post, so that the mother could take her child to see a doctor about the fever. And perhaps most importantly, she reassured the mother that her child would be just fine with the proper care.
“When my children are sick, I have the same fears that other mothers with sick children have. We share the same worries,” she said. “When there is a sick child who I give medicine or refer to the health post, and then I see him one or two days later in good health, that makes me happy. What I want to do is to wake up every day and see that people are in good health.”
Mariama Kouyaté: mother of six, and caregiver to countless others.