A pact for public health

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In Mali, Helen Keller International (HKI) has developed a program to both treat and prevent malnutrition, an acute public health problem in this part of the world. HKI’s Senior Nutritionist in Mali, Vanessa Dickey, explains how a traditional healer and an HKI Community Health Agent found common ground to protect the health of malnourished children in the Koulikoro Region.

Women in Mali

Oumou Sangare, an HKI health worker, noticed a worrisome trend in the health district of Banamba; children diagnosed with acute malnutrition were not going to the local health center for the treatment they desperately needed. She was determined to find out the reason for this behavior.

During a regular visit to meet with local women and provide nutrition education, Oumou happened to bring her baby daughter, who was crying and fussing more than normal. The women suggested Oumou visit the village’s traditional healer, Fatoumata Kane, as she had special medicines that could cure any childhood illness.

Oumou was intrigued. Could it be that this influential traditional healer had something to do with the fact that families were not taking their children to the local health center? And more importantly, was there a way that these two women could work together to improve the health of the community?

Fatoumata Kane has been a respected healer within the community for 21 years. She has helped countless children and their parents and is known throughout the region for her healing powers.

When Oumou went to visit Madame Kane she immediately noticed that a few of the children gathered for treatment were visibly malnourished. Oumou introduced herself as a health worker with HKI, and respectfully asked the healer about her methods for treating malnourished children. Madame Kane explained that she sees 15 to 20 children per day and provides various herbal remedies depending on the condition. She treats malnourished children with a special combination of leaves from medicinal plants.

In turn, Oumou explained how HKI’s program, Community Management of Acute Malnutrition (CMAM), works. She described how CMAM community health workers identify children who are wasted (have extremely low weight for their height) and ensure they get correct medical and nutritional care. Children with severe acute malnutrition receive medicine and Plumpy’Nut  (a peanut-based fortified food that helps with rapid weight gain), and children with moderate acute malnutrition receive nutritionally enhanced food rations. To prevent future relapses, mothers are taught improved feeding practices, including frequent breastfeeding and complementing traditional porridges with nutritious and locally-sourced foods.

Madame Kane had no interest in this approach. Not only did she think her methods were sufficient to treat the children, but since she earns her living doing so, she viewed CMAM as a threat to her livelihood.

Undaunted, Oumou continued to visit the healer. Madame Kane had so much renown and influence in the community that she could potentially discourage women from seeking medical treatment at health centers. Mothers would be put in a difficult position, and in the end the children would suffer.

Oumou strongly believed that she and Madame Kane had the same goal in mind – to help the community – and that a compromise was possible. With each visit, she took the opportunity to explain the causes of certain diseases and the treatments offered at the health center.

Eventually, an agreement was reached. Madame Kane would examine the children using the same CMAM methods as community health workers, including measuring a child’s mid-upper arm circumference to determine the level of malnutrition. She would also continue to collect her usual fee allowing her to continue to earn her living, and the children who needed treatment would receive care. Since the healer knew everybody in the community, and the mothers trusted her, she was a powerful advocate for the CMAM program. It was a win-win situation!

Since January 2011, Fatoumata Kane has diagnosed six children with severe malnutrition and referred all six to the local health center for treatment. She also organized seven educational talks on nutrition using materials provided by HKI.

Helen Keller International (HKI)