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Expanding healthcare to the most vulnerable and hardest-to-reach

© UNICEF Uzbekistan/2011/Pirozzi
Gulmira Uzakova holds her 8-month-old daughter, Hurmiza, as they are weighed by a nurse in their home in Karakalpakstan.

By Rob McBride

KARAKALPAKSTAN, Uzbekistan, 20 January 2012 – In the remote Khujayli District of Karakalpakstan, the Saparova family can often be found in a traditional yurt at the back of the house, escaping the worst of the summer heat.

This was where a visiting medical team headed to find Gulmira Uzakova and her newborn baby. After removing their shoes and performing traditional greetings, the visitors were invited inside to see smiling 8-month-old Hurmiza.

As they weighed and measured Hurmiza, they chatted with her grandmother, Bibizada Saparova. In traditional families, the grandmother is a key decision maker, and the medical team knows that influencing her will be crucial to spreading positive child-care practices.

The elderly Ms. Saparova was impressed by the level of attention her daughter and granddaughter were receiving. “They measure the growth of the child regularly,” she said approvingly. “And depending on how the child is doing, they give advice on feeding and so on.

It is a very different level of service than Ms. Saparova is used to. Expanding quality health care Karakalpakstan is blighted by the environmental and health hazards of the shrinking Aral Sea, including worsening water quality, declining food security, threatened livelihoods and persistent poverty. These conditions are reflected in high rates of pneumonia, diarrhoea, anaemia and malnutrition among children; in fact, child health and nutritional indicators in the western region are among the worst in the country. And given the area’s remoteness, extra effort is required to reach the most vulnerable children here.

Medical visits like those at the Saparova household are part of a new, ambitious, UNICEF-supported government plan to expand quality health care and improve child health.

In a rural clinic in the village of Tara-Baz, Dr. Shakhnoza Djumaniyazova performs similar evaluations on babies brought by their mothers. “The main problem here has been children who are underweight and below normal height,” she said. “But now, we are taking regular checks on growth development and counselling the mothers on giving proper nutrition.”

Like many other doctors and nurses, Dr. Djumaniyazova has received UNICEF-supported training on improved child health care, making her a more effective physician and counsellor.

What is important is reaching the household level so that all children benefit,” said Dr. Hari Krishna Banskota, a UNICEF health specialist. “Not a single child is left.”

© UNICEF Uzbekistan/2011/Pirozzi
Dr. Shakhnoza Djumaniyazova, who has received UNICEF-supported training, measures a girl’s height in Taza Baz Village, Karakalpakstan.

Radical changes in health care quality

In her 29 years as an obstetrician at the District Hospital’s maternity ward, Dr. Bibihadicha Isakova has seen radical changes in the delivery and quality of health care. “Our hospital has been through several programmes,” she recalled, “including breastfeeding promotion and a baby-friendly initiative.” As a result, child morbidity has declined.

The hospital also embraced baby- and mother-friendly techniques, such as allowing husbands or other family members to be present during delivery and not immediately taking the baby away from the mother, as had previously been the practice.

One of Dr. Isakova’s patients, Gulnur Bekbosinova, has seen those changes first-hand between the delivery of her first baby six years ago, and her youngest child the day before. “The first time, my child was taken from me straight away,” she said, nursing day-old Arman. “But this time, they gave the child to me, and I felt much happier.”

Little Arman has been born into a region facing a variety of hardships – but with changes like those he and his mother are experiencing, they, and their community, have cause for hope.



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