5 April 2013: UNICEF correspondent Alex Duval Smith reports on the important role of community health workers in rural Mali.
By Alex Duval Smith
BAIMA, Mali, 21 May 2013 – “When the war came, I was very scared,” says 20-year-old Soumaila Coulibaly. “But I have never stopped work or run away. I just adapt to the situation.”
Mr. Coulibaly is a community health worker in this rural village 20 kilometres from Sevare in northeastern Mali’s Mopti region. The war he is talking about is the struggle during the past year for control of northern Mali by an alliance of separatists and Islamist groups, in which hundreds of thousands of residents fled south or to neighbouring countries. Schools, health centres and anything else associated with the Malian state were targets for rebel attacks.
UNICEF-supported community health agents like Mr. Coulibaly have emerged as unsung heroes of the recent conflict in Mali, playing a front-line role in saving children's lives as rebels targeted the country's formal health system. The health agents’ low-key but widespread coverage of rural Mali kept up a minimum level of health provision.
Continuing crisis
This past January, the rebels moved further into Mopti region – within a day’s drive of the capital, Bamako – prompting the Government to request immediate military assistance. France sent an intervention force of 4,500 troops to defend its former colony and re-establish Government control of the north.
In July, a 12,600-strong United Nations peacekeeping operation will be deployed to help stabilize the country. But nearly 500,000 civilians are estimated to have fled the north since last year – including civil servants, teachers and health staff – and they are still largely reluctant to return home, where insecurity and an ongoing food crisis remain serious obstacles.
All along, Mr. Coulibaly has carried on with his work.
Back to basics
UNICEF Mali has supported 1,700 community health agents in rural settlements five kilometres or more from a public clinic or hospital. The programme pays for their training, salaries and starter kits.
Mr. Coulibaly arrived in Baima from his native Sevare in June 2012. He lives with his wife, Mariam, in a mud-brick house with a straw roof, just like everyone else’s. The only difference between him and the local livestock farmers of the village is that he earns a salary – 40,000 CFA (US$80) per month – and has a solar panel to charge his mobile phone. “Of course, coming from a city, living in the darkness of a community without electricity takes some getting used to,” he says.
“I mainly see cases of malaria, diarrhoea and respiratory disease in under-fives.” He says. “Another concern is malnutrition. My training has taught me to know when cases should be referred.”
Mr. Coulibaly’s home was built for him by the community and includes a self-contained ‘surgery’ – a separate small house where a locked cupboard holds a range of basic medicines: water purification tablets, zinc suspension, rehydration salts, malaria treatments and antibiotics.
Along with Baima, which has a population of just over 1,000 people, Mr. Coulibaly also covers two smaller communities, which he visits once a week, one of them an hour’s bicycle ride away.
A gentle approach
“During April [this year], when the fighting got really close, I had to cancel my visits to Bougue and Dongoro. I could not go to Sevare to stock up on medicines,” he says. That fighting pitted French and Malian forces against the retreating rebels and Islamists.
“That is also the time when I shaved my beard, stopped wearing a djellaba [traditional robe] and started dressing like a youth,” he says, pointing to his Western attire of blue trousers and white polo shirt. “We were afraid the army is going to mistake us for Islamists.”
Mr. Coulibaly has had to tread respectfully in this village where the wisdom of age, the religious calendar and the vagaries of the rains are guiding forces. He was training to be an electrician when the opportunity arose to become a community health agent. He says he loves his work.
“Every morning after I have prayed, I pay a courtesy visit to the chief and elders and look around for children that might need attention. If I see a case of suspected malnutrition, for instance, I find the mother and suggest she speaks to her husband about bringing the child to me,” he says.
Being the closest Baima has to a professional medical practitioner, he is addressed as ‘doctor’. “But I try to take a gentle approach, because people here are used to going to the traditional doctor,” he explains. “It is important to respect that.”
His sensitivity has paid off. “I feel totally safe here. The community has taken me in like a son of their own.”