The sun isn’t up yet but Hawa Coulibaly is already sweeping away the dust from her modest front yard. Smoke billows from a saucepan of porridge bu
The sun isn’t up yet but Hawa Coulibaly is already sweeping away the dust from her modest front yard.
Smoke billows from a saucepan of porridge bubbling on the outdoor fire while inside the mud home, her two eldest children noisily get ready for school. Soon the dawn prayer will ring out across the remote village of Kourougue, tucked away in the corn and sorghum fields of rural Mali.
And after that, worried young mothers will begin to line up to see Hawa, whose no-nonsense approach to child health comes with a warm smile.
The West African country of Mali is in the grip of a hunger crisis. Shockingly, in Mali a child will die every five minutes and half of those deaths are down to malnutrition.
In Kourouge, around 200 miles from the capital Bamako, community health worker Hawa works tirelessly to help change the grim statistics. It may seem a world away from here but it is the British public making her life-saving project possible. Next to Hawa’s surgery, three chickens squark as exuberant youngsters chase them along dirt paths.
The chaos disturbs a meeting of male village elders, who are seeking shade from the blazing sun underneath a wooden hut in the market place. Hawa gently, but firmly, admonishes the group of children before breaking out into laughter.
There’s a good chance one of those chickens will soon become a gift from villagers for the 30-year-old mother-of-three.
With no electricity or running water, life hasn’t changed in the village for decades. Women with babies strapped to their backs collect water from the streams and carry it for miles balanced perfectly on their heads. Other mothers are sharing a joke as they wade through the rice fields.
It’s currently rainy season, during which time cases of malnutrition spike. Mosquitoes buzz around the clinic and the stagnant water surrounding the village only aids killer diseases such as malaria, dysentery and cholera.
Education levels are low and before Hawa’s arrival villagers didn’t know how to prevent a child getting sick. Even if they did, the nearest health centre was several days’ walk away.
Malnutrition was often thought of as a sign of the devil and out of desperation, many families would turn to ineffective traditional remedies.
Her first patient of the day is Simbo, whose name means strong hunter is the local Bambara language. The two year old is an inquisitive boy who causes chaos by trying to eat his medical notes while Hawa assesses him. His mother Mamisa Jakite is so relieved this mischievous side is back.
Just three weeks earlier, her youngest son couldn’t even hold his head up because he was so malnourished. As the flies buzz overhead, Hawa, 30, begins her examination by placing Simbo on the scales and then taking his temperature.
He lets out a small wail as she pricks his finger to draw blood for a malaria test but is soon soothed by his mother’s milk. At this point, Hawa’s four-year-old daughter Habibatu wanders out of the two-roomed home and into the clinic, which is set up in the front yard.
She sits herself down on the single rattan bed, reserved for patients, and intently watches and copies her mother’s every move. Hawa’s next task is the MUAC – or mid-upper arm circumference – test. She wraps a band around Simbo’s arm at the midpoint between his shoulder and elbow to measure the circumference and determine if he is too thin.
The test works as a traffic light system and the little boy is now firmly back in the green zone. There are peels of laughter from the two women as the little boy promptly attempts to chew that too.
After school, Hawa trained as a midwife but moved into community health work seven years ago. Last year she moved from the town of Balandougou to set up this clinic. It’s only ten miles away but the dirt tracks become rivers during rainy season and the journey is impassable for months.
Her teacher husband Abdoulaye remained behind and visits Hawa and their three daughters when term time allows. Hawa said: ‘I do this work to help the men, women and children in the village. Because before I came here the population was suffering. ‘Many children died.
But since I came here there are fewer deaths and less disease. My job is to care for the children and I talk to the mothers. ‘We talk about family planning, malaria and other diseases, hygiene and the importance of vaccinations. Before I came here there was not much knowledge about health or nutrition.’
Kourouge’s economy, like most of Mali, is based on agriculture. After Mamisa and Simbo leave the clinic, the young boy will be left in the care of family while his mother picks up her hoe and goes to the fields to plant tomatoes, yams and onions. The rains failed last year and food prices have soared.
Climate change and population displacement caused by violence means living off the land is extremely precarious. Mali has a rate of chronic malnutrition among the under-fives of 38%. Just last month, the United Nations announced 850,000 children are at risk. Hawa explained: ‘During the rainy season, life is not easy here. In some families children have nothing to eat.
‘Some people do eat but not necessarily healthy or nutritious food. And then there is the poverty; people have no money. ‘Parents don’t have the money to get their children to hospital or pay for medicine.’
Hawa, who is supported by the British charity Action Against Hunger, is on hand with a peanut-based paste called Plumpy’Nut, that is high in nutrients and calories.
Any child found suffering from malnutrition is given the fortified food, which costs just 31p per child per day and has been hailed as a game changer in the fight against global childhood malnutrition. At the clinic, Simbo wolfs down the final dose of Plumpy’Nut. He is alert, his eyes are bright and he is now getting impatient because, like any two year old, he wants to head off and play.
Mother Mamisa, 32, said: ‘Simbo was really underweight. He didn’t breastfeed and he couldn’t sit. Hawa said Simbo was malnourished and she gave us Plumpy’Nut , which is full of vitamins.
He soon started sitting up, then began crawling and walking. He is so happy now because he eats and plays well. My dream for him would be to go to school and study.’
Head of the Action Against Hunger’s Malnutrition Project, Dr Clement Drabo, said the training up of health workers to live in villages was showing some ‘amazing results.’ Before the programme, 30% of children with malnutrition died.
For those who stay with the project, that figure plummets to less than 1%. Often they have other health complications. ‘This project is very important because it puts the community health workers at the heart of everything,’ Dr Drabo said.
‘They live in the communities with the people and can really reach more children. ‘Before these people would never have been able to reach a health centre if they or their child got sick. Now we are looking after lots and lots of children and these are really amazing results.’
After a simple lunch of jollof rice, Hawa takes her youngest daughter Habibatu to a neighbour’s home before setting off to do the village rounds. She will walk for miles and her brightly-patterned cloth dress adds a dash of colour to the surrounding green fields and brown mud tracks.
Her second patient of the day is Many Coulibaly and two year old daughter Fatumata. Before the community health team came to Kourougue village, the family almost lost their eldest child Musa to malnutrition. As he grew weaker, Many, 25, used traditional medicine and bathed him in a mixture of water, leaves and bark from the local tereninfu tree.
Eventually she borrowed money to get a motorbike taxi to the hospital in the nearest city Kita, where he made a full recovery. Many said: ‘I didn’t go to school and so didn’t learn anything about malnutrition. Before Hawa, it was very difficult here especially in the rainy season and the children were getting sick.
‘The hospital is far away and the roads are bad so it’s difficult to leave the village. But with Hawa, she treats us here and gives us advice on how to avoid sickness but also what to do if our child does get ill.
‘Before Hawa we were living in darkness. Since she has come here, children are healthier and mothers are happier. It’s like all our children have a second mother looking after them.’
Life in Kourougue is simple and it is a relatively safe part of the landlocked, arid nation of Mali. French, US and UN troops have been battling to stablize the country since 2012, when Islamic and allied Tuareg rebels seized swaths of territory, including the ancient city of Timbuktu.
The famous music and cultural scenes have been silenced and there is a terrible human cost. Around 70,000 people have been internally displaced while almost 140,000 have fled to neighbouring countries. Hawa’s life-saving work for Action Against Hunger was kick-started by a grant from the innocent foundation, the charitable arm of the smoothie and drinks company.
Their £1.35 million donation was joined by £300,000 from the People’s Postcode Lottery and £640,000 from the European Commission. People’s Postcode Lottery spokesman Callum Aitken, said: ‘With this funding, Action Against Hunger is able to ensure that children with severe malnutrition are getting access to health care in local villages, without the need for families to walk long distances to receive treatment.’
The community health worker project was a pilot scheme, which has now been deemed so successful that Action Against Hunger is rolling out in other countries. The US Government has also announced it will use the same model for their programmes in Niger and Mauritania. The innocent foundation’s Director, Kate Franks, said: ‘Our aim is to stop children dying from hunger. ‘Training community health workers to bring diagnosis and treatment into children’s homes has been a complete game changer in Mali. ‘Now we’re working with Action Against Hunger and other world experts to persuade more countries to adopt the same model, so that we can save hundreds of thousands of children’s lives.’
Behind every saved child is a hard working community health worker such as Hawa. By 4pm, her eldest children Bintu, nine, and Djeneba, seven, are back from school and immersed in French homework. Habibatu is again chasing animals with the neighbours but will occasionally run through the clinic compound to check on the progress of her mum’s couscous and chicken dinner.
Hawa’s dream is for her daughters to find work in the city, where there is more money and less disease. Gender inequality is rife in the villages and she hopes her children will finish school and get good office jobs, where their ability to eat is less reliant on the rains.
At nightfall, the three girls and Hawa will head through the small corrugated iron door into their house and their shared double bed. As the family home doubles as the clinic, Hawa is always on call for the men, women and children of Kourougue village.
‘Even if it is night or early in the morning and a patient comes, I will treat them,’ Hawa said. ‘Because if a child is healed then I am happy. ‘I could do another job but not like this. Why would I want to? I love this so much.’
Source: MSN News