Health in the field

The last weeks we were regularly in the field, visiting hospitals and health centres to take interviews from pregnant women, women with children, health workers and authorities for a baseline survey. Not an easy task, because of the limited number of cars for the different projects, the distances to the villages, and the state of the road! And also the interviews themselves are quite challenging. Most women have little knowledge of French. When I take an interview, regularly one of my colleagues has to translate into yacouba, malinké, baoulé or another local language, so that they understand the questions.

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06-Bangolo interview
In the survey, lots of questions are focused on nutrition. Poverty is of course the most important reason for child malnutrition, but also certain taboos and local habits and beliefs play a substantial role. For different ethnicities, the first mother milk after the baby is born (colostrum), which looks a bit yellowish, but is important because it increases the defences of the baby in the first months, is dirty and is thrown away. For others, you should not give eggs to babies, because they might develop wings. If you then know that eggs are one of the easiest sources of proteins for these people, this belief does not really help a young child. In a lot of cases of malnutrition, people do not see the relation with nutrition, and they will attribute it to witchcraft or to somebody who wishes them bad luck. Another reason of malnutrition is that lots of women have their babies short after each other, and the lack of variation in the food, although it is available and not necessarily expensive. What is also very clear is the fact that malnutrition follows the seasons. After the rains (between June and September) there are different crops available and malnutrition rate decreases. Once the dry season is more advanced (from March onwards), less food is available and the malnutrition rate increases again. This results in more malnourished children in the nutrition centers.

A few words about the health system here in Côte d’Ivoire. On a regional level, the country is divided in sanitary districts, headed by a DD (Directeur Départemental). In each sanitary district, there is a reference hospital, and there are a number of health centers (Centres de Santé), headed by a nurse, or urban health centers (Centres de Santé Urbaine), headed by a physician. In our project, we are working with 53 of those health centers in 5 different sanitary districts. The interaction with the health authorities (the DDs) is very important. This assures access to the health centers and the cooperation of the health staff. But this helps also for the long-term implementation of the project activities. Do not expect high quality infrastructure. Even in the reference hospitals, equipment is pretty basic, and a big part of the services are covered by unpaid volunteers (aide soignante) with a limited training. Also in the health centers, an important part of the work is done by community health workers (Agents de Santé Communautaire). As these people are not regularly paid, their motivation is not always very high.

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01-Hospital Man

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In our health and nutrition project, one of the goals is to increase the identification and selection of malnourished children under 5 years of age. This will be done via the community health workers. Therefore, an important part of the project is the training of these health workers. Once this is done, they will focus on the identification of malnourished children, via the organisation of screening days. This will increase the amount of malnourished children supported. However, mothers are not always motivated to take their child to the nutrition center, because it involves costs. Therefore, the project foresees a budget to pay for their transport to and food at the nutrition center.

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01-Mother with  2 year old malnourished child

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