Communities tune in for Child Health Weeks
By Skye Wheeler, UNICEF writer.
Droub, Blue Nile State, 29 April 2009 – The tune is from a traditional folk song and is old, older even than grandparents. It was recorded in a dusty village using only one microphone and the singing voices sound a little distant, as if from the past.
But the message, part of a community radio series released on Blue Nile’s government station, is very much of the time. In fact, it was specially made for one week in late April.
“Polio is coming,” sings an adult male voice, clearly much practiced in the arts of folksong, “Bring your child for vaccination,” answer a group of children. This is repeated a few times, to the beat of a drum and the twanging guitar-like rababa instrument. “If your child has vaccine …” the deeper voice continues; “He will never suffer polio,” is the reply.
“The radio messages help a lot,” explained Tijany Abdalla Mohammed, a team leader for about ten volunteer vaccinators covering six villages in Blue Nile State. “It means when we arrive we are expected. We save time because we don’t have to explain.”
House-to-house polio campaigns have taken place in Blue Nile State since the 1990s. But this time it’s more than just polio vaccine that volunteers like Mohammed’s team, all gently perspiring in the 42° Celsius afternoon, are giving to children.
If over six months old, children will also receive vitamin A – crucial for the immune system and preventing night blindness – and de-worming medicine. Volunteers also gave folic acid and iron to all pregnant women and provided health messages on their importance and on hand washing and sanitation to families, crucial in an area where 153 out of every 1,000 under-five children die, often from diarrhea.
This ‘Child Health Week’ package is piggy-backing on the structure of the twice-yearly polio campaigns. Backed with supplies and financial and technical support from UNICEF, it is a central part of a broader Sudan Accelerated Child Survival Initiative that aims to rapidly reduce child mortality across the country.
“We realized that we will not reach the 2015 Millennium Development Goals if we don’t do many interventions in each campaign,” explained Deputy Director-General of the State Ministry of Health Dr. Ali Sayed.
Building new systems in a complex environment
Development has come only slowly to Blue Nile State, an area that bore the brunt of much fighting during Sudan’s civil war that ended in 2005.
Blue Nile’s infant mortality rate is easily the worst in northern Sudan with 99 out of every 1,000 babies dying before they’re one year old. The under-five mortality rate is the second worst in the country, worse than much of the war-ravaged southern states.Blue Nile’s infant mortality rate is easily the worst in northern Sudan with 99 out of every 1,000 babies dying before they’re one year old. The under-five mortality rate is the second worst in the country, worse than much of the war-ravaged southern states.
Since a 2005 north-south peace deal, the area’s administration is shared between the Government of National Unity and the Government of Southern Sudan. Despite the political restructuring, there remain considerable disparities between communities, and it is only this year that medical interventions have become fully integrated.
State-wide efforts to bring peace dividends like the Child Health Week have an important message of unity, of things that do actually work. “It’s only now that we’ve reached the level of synchronizing everything,” Sayed explained.
"I am very happy about this service"
It is the dry season, dust keeps the sky close over Droub village, the earth is brown and Zainab Mohammed’s husband is away working somewhere as a casual laborer.
“I am very happy about this service,” she says simply. “We worry about polio.” She has a pretty girlish face but already has five children, including three-year-old Zachariah who has just been vaccinated together with his baby sister Ibtisam.
Polio affects only children, often crippling them for life and sometimes causing death. Experts believe it can be eradicated. But hopes for a polio-free Sudan were dashed when the virus cropped up again last year. Blue Nile, bordering Southern Sudan as well as Ethiopia is especially vulnerable, Sayed explained.
“We heard about the new cases on the radio,” another woman Hannan Hamdun said. “That is one of the reasons we know this vaccination is important. The virus can move fast.”
Last year’s de-worming made a clear difference to Zainab. “The children became better than before, more healthy and no diarrhea,” she explained. Worms in younger children can be serious, weakening them as the parasites absorb precious nutrients.
“We’d not really been able to address de-worming adequately before Child Health Week,” Sayed said.
Zachariah’s grandmother snorts dramatically when asked her opinion. She is thin, her stance and rheumy eyes show the years living in this harsh environment. “It is always the same. Men die. Children die,” she says with such ferocious arm gestures that Zainab and her neighbours sitting with her start laughing. Mortality – whether man-made or natural – has become almost accepted by some.Mortality – whether man-made or natural – has become almost accepted by some.
But for Zainab, things are changing. She didn’t have a chance to go to school but her older girls are now learning. Electricity is more common and television aerials stick out from behind neatly woven grass fences.
A collective approach to delivering healthcare
The pride the people of Droub have in their home is reflected in the efforts they make together to ensure that every family is reached.
Abd Rahim, the chief’s son, was a volunteer vaccinator in one of the past campaigns and has spent today moving with the teams, making sure things are going well. He was there when the cold boxes filled with glass capsules of polio vaccine arrived in the morning from the state capital Damazine.
Mothers were alerted by community leaders like Bashir Suleiman, head of the local health committee. There are no health services in Droub except for a community health worker who keeps a few boxes of malaria drugs in his hut. They try to make up for this by promoting sanitation and the use of mosquito nets and making sure everyone knows about Child Health Week.
In another village Khor Muganza the chief sent out youths with microphones and made sure the small village mosque minaret relayed news of the vaccinators.
As a backdrop to local advocacy, the radio is crucial, Suleiman said.
UNICEF is currently working with the state Ministry of Social Affairs to set up child-friendly radio, with programmes made by children for child listening groups.
Perhaps then the children will be more likely to get information about polio directly from the radio. But for now, Suleiman says with a sigh that echoes others of his generation far beyond the borders of Droub; “it is mainly the mothers who receive. Children don’t listen to the radio. Children just watch television.”