Aichatou, nurse and community health -Niger
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Aichatou Daouda, 39 years old and a mother of a son, is a nurse by profession. She had training in 2010 on how to follow-up on mothers and newborns in the community (suivi de la mère et du nouveau-né au niveau communautaire), and has been, for the last two years, a community health worker and head of the Health Facility (Case de Santé) in Koulou Koira, a village which is located 16 kilometres away from Niamey, the Niger capital.
The Health Facilities are implemented in villages without health centres and so are essential for providing health care close to the people. To begin with, Aichatou carried out a survey of all the women of reproductive ages (15-45 years); then registered all the pregnant women so as to create a calendar of “home visits (HV): three visits for pregnant women and three for women who have given birth, which allows us to do the pre and post natal monitoring of these women”. These records also allow her to control the number of women who are expected to give birth at the Health Facility, and the number of newborns.
Unlike many of her patients, Aichatou does not have her face covered with a veil; instead she is wearing a type of turban that matches the vegetable pattern she wears underneath the white coat. As a community health worker, Aichatou takes advantage of the home visits to “detect different danger signs (symptoms of diseases), advise mothers about health care and hygiene (theirs and the babies’), and promote key family practices (KFP)”.
“The community health worker came to see me two days after I gave birth”, says Latifa, 17, Aichatou’s patient. “She gave us our first health care, informed me on key family practices, and gave me advice on how to take care of my baby, how to breastfeed, and how to take care of our hygiene (mine and my baby’s).”
Informing the people on the key family practices (KFP) is one of the strategic priorities of the French Muskoka Fund (FMF) in Niger. There are eight points and they include breastfeeding exclusively, a vaccination plan, the use of mosquito nets impregnated with insecticide to prevent malaria, the identification of symptoms of three diseases (malaria, diarrhoea, and pneumonia), hand washing at critical moments, the spacing of pregnancies, among others.
The aim is to contribute towards the improvement of maternal and child health in the country with the highest fertility rate in the world (7.6 children per woman). The strategy is to reduce home births and promote the use of health services – particularly in rural areas where fertility rates are higher and the beliefs and socio-cultural norms limit access to health.
Latifa does not know how many more times she will be visited by Aichatou, but she has already received two home visits since the caesarean section that brought the baby she is holding in her arms into the world – a privilege in a country where only 2% of births are performed using this childbirth technique. “I advise all mothers to follow the advice she gives us, for our own well-being and that of our children. This prevents us from having to always go to the health centre”, she argues.
In addition to reducing morbidity and mortality, following KFPs prevents many trips to the health centre, a factor to be taken into account in an extremely hot and desert climate, where eight out of ten people live in rural areas. There is also the issue of migration and threats such as terrorism and arms trafficking to deal with on the precarious road networks.
Recently, and to help health workers to reach the most remote communities, the French Muskoka Fund gave motorbikes to 13 Health Facilities in the health districts of the country’s southwest. In a context of enormous needs, the motorbikes can seem almost frivolous, but the expansion of health care has a domino effect on the indicators. Indeed, the combination of the various measures contributed to Niger reaching, in 2015, the 4th of the Millennium Development Goals (MDGs): the reduction of two-thirds or more of child mortality (under 5s) between 1990 and 2015.
With a look of “mission accomplished” Aichatou puts the scarf back on and gives a little smile. She thanks the partners for the training and the resources given, but hopes to get more help for travelling to visit the patients in the future. “With our low income, it is difficult to travel 5-8 kilometres to get fuel to carry out home visits to see these women”, she protests.
The vision of this nurse who has been converted into a local health worker goes even further. “The message I wish to give to the authorities is the need to promote scaling up”, she proposes. “This will allow other health workers to take care of mothers and newborns, as we do, and reduce the mortality rate, which is what we are trying to do in Niger”.