Difficult start in establishing preventative health care at Gussoro
Gussoro, Nigeria, in 1996
Prevention can be a more difficult idea to sell to people than cure. That was the conclusion of MMM pioneers at Gussoro, in Niger State, Nigeria.
In June 1981, Sisters Pauline Connolly and Therese Jane Ogu opened a health education programme at Gussoro. For the first six months they lived in a mobile home. During this time they helped to supervise and draw up a list of materials to complete the building of our present house.
Here is how an early report described the difficulties and the progress.
"We began to meet with the chiefs, elders, and people of Gussoro. We had discussions and sought their opinions. They said they needed help with their health problems and would appreciate any way we could help them. A community-based preventative health education way was agreed, starting with what they knew and building from there. A programme outline had been drawn up in December 1980.
"We made visits to families and compounds trying to share their lifestyle, hopes and fears and see the causes and kinds of illnesses from which people suffered.
"Arrangements were made with the villagers to gather and hold regular meetings. During these sessions, through talks, discussions, visual aids, story, song and demonstration, people were helped to become more aware of causes of some of their community diseases and health hazards. Taking initiative and responsibility was encouraged as well as forming health communities and training health workers. Much emphasis was put on helping the people to realize how they could promote health by carrying out simple preventative measures.
"Along with these, a literacy programme was offered. We were open and hoped to promote pastoral care in any way we could, encouraging and organizing interested groups to hold prayer services and give classes.
"Initially, chiefs, elders and large groups of villagers came and participated, but many opted out after a number of meetings because of the challenge of the task and because we did not offer hand-outs. The men saw responsibility for health care as women's role. Yet they continued to assure us of their gratefulness for showing them the way to better health and village improvements!
"Change of attitude was a very slow process hence any action was greatly impeded. Even though meetings invariably ended with a resolution to act, action seldom followed.
"Some impacts were made:
- Use of improved diet to regain weight loss in children
- Early treatment of diarrhoea with oral rehydration, resulting in better control and quicker recovery from gastroenteritis
- Mothers beginning to teach and help each other to make and give rehydration solution.
- Steps in safer home delivery: new razor, soap, etc.
- Two villages organized to dig and line wells.
- Three groups built latrines; others began to follow.
- A number of soakaways were built.
- A few local tables for keeping eating utensils were made.
- Four villages built a place for worship and began instruction.
- Some began literacy. Some opted out; others struggled on. Eventually a few readers emerged.
"Efforts to set up village health committees were unsuccessful. The community chose not to select them and no suitable persons emerged. Inability to overcome differences and pull together for the common good was reflected in lack of commitment to carry out suggested action. There was fluctuating interest in the programme. We could see that a programme of prevention was harder to implement than one of cure. Traditional medicine posed a problem because sickness was often thought of as a curse or evil spell.
"In July 1983, we commenced a child welfare and immunization programme and antenatal care. These have continued, with an estimated 3000 children registered in the vaccination programme.
"In November 1983, one of the villagers, who is a part-time health worker, opened a medicine store. Here simple treatments are available under supervision. It is an effort to help people learn to buy sensible medicines and know why and when to use them.
"In December 1983, we celebrated a health festival. Groups came together in the village to display in dance and drama a health problem that was of concern to them. It challenged them to look critically at their situation and motivated them to change."
"In December 1984, we began tidy compound activities. Compounds were inspected and judged. Villagers were praised for their efforts and on what they had accomplished in health and hygiene practices. The men were further challenged to build better houses and make things easier for the women.
"Most of the homes in the locality now have basic health essentials such as latrines, soakaways, and refuse pits. The general environmental sanitation has improved. Six wells have been completed. There is progress in controlling malaria, anaemia, worm infestations, and other common sicknesses.
"The women and men often say, 'Our children are stronger and they are not dying as before.' The women have become more aware of the importance of antenatal care. The traditional birth attendants continue their practical training slowly. Now the women can recognize problems early and know when to call for help. Of the sixty-four cases the Sisters were called to attend when a woman got into difficulties, all except one delivered safely. That woman had already delivered and was moribund from loss of blood when they arrived. Ten other women were unable to deliver and were referred to hospital.
"Community orientation in health care continues to develop. Acceptance of the message is catching. There is a growing realization among the women to understand and control some of the factors affecting their health and to break down some of the feelings of fatalism and helplessness. Meetings and discussions on health topics and visits continue. After discussions, the women now pay a small contribution as members of the group. Nevertheless, the struggle to hold and carry out instructions poses problems. There is still apathy on the part of the men to become more involved."
MMM handed over our programmes in Gussoro in 2006.