|© UNICEF/Yousri Akl 2008|
|A community outreach worker during one of the house-to-house visits|
FAYOUM, Egypt, 3 April, 2009 - In Fayoum, a bustling and fertile region some fifty miles southeast of Cairo that is home to hundreds of villages and close-knit communities, 33-year-old Hala (Ahmed Abdel Khalek) starts her day early.
After checking in with her supervisor, Hala carefully surveys the list of families she will visit over the next several hours, collects the educational flipchart and register book she’ll need for house-to-house visits, and sets off on Fayoum’s dusty roads to begin her work.
Hala is one of approximately 13,000 community health workers—or raedat reefiat, as they are locally known—who have been put into place since the arrival, in 2006, of bird flu in Egypt. Well-trained and technically supported through a tight monitoring and supervision system, Hala and her colleagues typically visit 280-290 households per month. Because they are recruited from the very villages they work in, raedat reefiat are readily accepted, and trust often grows quickly.
The work of Hala and her fellow raedate reefiat is a vital component of a community-based education program launched by the Egyptian Ministry of Health and Population in collaboration with UNICEF and the government of Japan in August 2007. The program is designed to reach out to more than 4.8 million families in the rural areas of the country’s seventeen most affected governornates.
Poultry breeding is a widespread activity in rural Egypt, and as many as five million households in the country depend on it as a main source of food and income. Because household flocks are often kept in close proximity, humans are in constant contact with chickens, ducks, geese and turkeys.
Usually, it is the duty of women and children to take care of the birds, feed them and clean the backyards. Figures indicate that 60% of those infected with bird flu to date have been children and 68% have been women.
“I always ask to talk to all the women and the children, because they are the ones who are most exposed to the virus,” explains Hala, whose duties, like other raedat reefiats, include providing guidance on family planning and general health care support.
During the house-to-house visits, members of the families responsible for the breeding of poultry learn about measures to best protect themselves and the means through which to avoid AI infection among birds or humans. Key messages are: “Wash; cover up your nose and mouth; separate poultry from living areas; and report.”
“I remind families that clothes and slippers worn inside the chicken enclosure should never be taken back in the house,” Hala emphasizes.
It is a centuries-old habit of people in the villages to slaughter and de-feather their poultry. Taking advice to amend this process can only occur over time and incrementally.
Persistence, persuasion, and gentle determination on behalf of the raedat reefiats are key.
“What we are doing is giving people a helping hand,” notes Hala. “But we should be assertive and help them to clearly understand that this is for their own benefit and for the benefit of their families, their poultry, and the entire community.”
And while the avian flu campaign is still its infancy, the work of the community health workers on its behalf appears to be bearing fruit.
41-year-old Manga, for example, acknowledges that in the aftermath of the daily visits of the raedat reefieat, some of her habits can changed.
She still rises early each morning to prepare breakfast for her family, and still heads up to rooftop after family members have departed for the day to feed the chickens.
But now, the stairs leading to the roof where Manga’s hen house is kept are clear of feathers and chicken droppings. A gallabeya (long rural dress) and a scarf are hanging on a door, and tucked into a corner are a pair of well-warn pajama bottoms.
“I use these only when I go inside the hen house,” says Manga, “and when I finish feeding the chickens and cleaning the yard, I take them off and leave them here.” “If we take all these precautions and follow the advice of the raeda, our poultry will be healthy, our children will be healthy and we will not catch any disease,” Manga says proudly.
Manga has come to understand, with the careful explanation of her community health worker, that sick chickens should be immediately reported to her village health clinic, and then killed, placed in a plastic bag, doused in chlorine and dropped in a garbage bin.
“If we take all these precautions and follow the advice of the raeda, our poultry will be healthy, our children will be healthy and we will not catch any disease,” she says proudly.
At yet another household in Fayoum, Hala turns towards Umm Hashem and asks whether she washes her hands after feeding her birds and before going back into her home.
Umm Hashem nods. “How can I disobey you, Abla Hala (teacher, in colloquial Arabic)?” she adds, with a cheeky smile.
Umm Hashem then kisses Hala on the cheek.
“I know we gave you some trouble at the beginning, Abla Hala,” Umm Hashem says. “But thanks to you we are now looking after our chicken in the proper way and are no more at the mercy of this treacherous bird flu. We will continue to do what we’ve learned from you, I promise.”
Hala cannot suppress a smile.
“Oh, I love my job,” she answers, “and would not change it for anything else.”