Zero child mortality in Baoulé
“My name is Aoufobara Dagui, I’m 27 years old and I am a community health worker (CHW) in Baoulé. I have had four children, but only two are alive. Two have passed away. And there is a fifth in my belly”, said Aoufobara while looking tenderly at her belly, patting it with her hand. She talks with us in her home, sitting on a mat on the floor, with her back against a sky-blue wall. To her left, also seated, are her husband and their two children who are playing silently.
Aoufobara has neither studied medicine nor nursing. Both she and her husband work in the fields; they are farmers just like most of the Togolese population (65%). Before becoming a community health worker, Aoufobara lost a baby during a caesarean delivery and another due to malaria – a major cause of child mortality on a national scale.
“If I had been a community health worker at that time, my son would probably not have died. This is what led me to become a CHW” says Aoufobara, who after having had specific training (integrated management of childhood illnesses and family planning) is able to identify symptoms of malaria, malnutrition, pneumonia, and other life-threatening diseases which have a high incidence in Togo.
Pregnancy does not prevent Aoufobara from continuing her mission as a community health worker, visiting the families in her village and the surrounding villages, providing child health care.
During home visits, Aoufobara listens carefully to the description of the symptoms, checks the children, carries out the diagnosis, and provides the appropriate treatment. In more severe situations, she refers the patients to the nearest health centre. In the case of Baoulé, a farming village where Aoufobara lives, the closest health centre is 7 km away.
During her visits and as part of her mission as a CHW, Aoufobara also brings awareness to women and families on the importance of family planning – a decisive method in the fate of her own family, as she explained: “Before, I had a baby in my belly and a child on my back, I could not work, I could not help my husband in the fields, the children would cry left, right, and centre”, she remembers. “Today, our home is full of pride”.
Her husband, Kokou Kossikan, is a farmer and a tractor driver. A little more reserved than Aoufobara, but equally dedicated to the cause of reducing maternal and child mortality in their village, Kokou supports his wife in many ways. “If she’s busy, I give the kids a wash, I cook, and we all eat together. If she has to go to another village, I sometimes go with her; we go by motorbike”. In other situations, Kokou takes the children to the health centre on his motorbike – “they do not have any other way of getting there, so I take them by motorbike to the health centre”. “The children’s health is essential to me“, Kokou adds while peeling the berries gathered from the field.
He wishes to point out that he not only supports his wife’s role as a community health worker, but he also helped to convince her to take on the challenge. “She did not agree when the villagers chose her. After I gave her my advice and talked it out with her, she finally agreed to it and began working as a CHW”, he says.
The work of the first community health worker in Baoulé is changing this village in the Savanna, the northernmost region of Togo. “Now, there are less deaths. Before, we lost count. But this year, there was not even a single death in my village”, says the satisfied Aoufobara.
The drastic reduction of infant mortality in Baoulé has had almost miraculous outlines, but the reality has nothing to do with the supernatural: it is the result of an initiative implemented by the French Muskoka Fund in Togo. Aoufobara is part of a group of about 1300 CHW who, like her, have been trained and now get a salary, a mobile phone, and other resources that are vital for the provision of quality health care, such as medication, rapid diagnostic tests, therapeutic food, among others.
“I use my instruments, just like I was taught to do in training. I use the thermometer to see if the child has a fever. I carry out the malaria test, and if the test is positive, I know he has malaria and I give him the medication”, Aoufobara explains.
Community health workers, like Aoufobara, play a key role in reducing child morbidity and mortality, ensuring the provision of health care in a timely manner to the families and communities who are far from the health units.
The year 2014 saw the work of these agents in Togo result in the treatment of about 70,000 cases of malaria, 17, 500 cases of diarrhoea, 8,000 cases of pneumonia – the leading causes of child mortality in Togo – and also 2,000 cases of severe acute malnutrition.
Together, Aoufobara and Kokou are helping to wipe out child mortality in Baoulé – and at the same time, doing away with some preconceptions. “There are people who criticize us a lot, but I pay no attention to them. So, I get on with what I have done so far – and I know I have been helping my village”, Aoufobara’s husband admits.