By Kamayani Bali Mahabal
20 December, 2012
The team of health activists that is working in post-conflict South Sudan. Dr Hiba Salih (in the pink head cover) is a physician from North Sudan who has worked for three years in post-conflict sites in South Sudan.
Thunderbay, Canada (Women’s Feature Service) – South Sudan has one of the highest maternal mortality rates in the world; a young girl in South Sudan is three times more likely to die during pregnancy or childbirth than to reach Grade Eight. So how can change be ushered in under such adverse circumstances?
This was one of the themes at a recent international public health conference, held in Thunderbay, Canada, which was hosted by the Women Health Task Force (WHTF) and focused generally on the theme of reducing maternal and newborn mortality. It was attended by 850 delegates from 50 countries.
WHTF, incidentally, has a very interesting history. According to WHTF founder member, Professor Judy Lewis, who is Director, Global Health Education and Professor, Departments of Community Medicine and Pediatrics, University of Connecticut School of Medicine, it was formed in 2002 with support of Global Health Education, Training and Service as a part of an international health network. Its significance lay in south-south collaboration to improve education and health outcomes for women. The group unites experts working on women’s health and higher education with members from different regions and countries around the world. The WHTF is also an active and growing forum for the exchange of ideas and the development of strategies and resources for women’s health.
The recent conference showcased the impact of this exchange of ideas very clearly, especially with regard to the situation in South Sudan. It brought to the fore voices like that of Dr Khalifa Elmusharaf, Head of the Reproductive and Child Health Research Unit at the University of Medical Sciences & Technology, Khartoum, the capital of Sudan. “I started to work in South Sudan in 2010 with motivated and inspired post-graduates students. Together, we launched ‘Rebuilding Reproductive & Child Health System in Post Conflict Settings Initiative’, an intervention that aimed to rebuild reproductive and child health systems in a post-conflict setting by getting a better understanding of local contexts and cultures. This helped us design culture oriented interventions that improved the demand side of health delivery and empowered women to stay healthy, make the right health decisions and act on those decisions,” elaborated Dr Elmusharaf.
Sudan is a country that witnessed a bloody civil war that has raged for the past 50 years, with the more developed north of the country pitted against the south. This was a war that affected eight million with an estimated two million killed and about four million displaced from their homes.
In was against this background that Dr Hiba Salih, a physician from North Sudan, who actually worked for three years in post-conflict sites in South Sudan, could make a difference. “In the past, Sudan’s health interventions had a top to bottom approach. They did not involve local communities. What made the situation even more difficult was that the traditional modes and methods prevalent in North Sudan were completely different from those existing in the south. We inverted the pyramid and adopted a bottom-up strategy,” revealed Dr Salih.
This posed a communications challenge. The task before Dr Salih was to take local traditions and use them in untraditional ways in the advocacy for health. She pointed to a poster she had brought, “It doesn’t matter if you cannot speak Arabic. The fact is 62 per cent of the population in South Sudan is in any case illiterate, so posters like this one has had to cross the literacy divide. The central message of this poster is: ‘We are strong and united, let’s work together for primary health care of women and encourage the husband to take care of his wife and child’.”
Working in post-conflict areas with very limited resources forced Dr Salih and her team to keep their minds open. “The idea was really to connect with the community in order to empower them. So you are forced to think untraditionally and adopt local ways. The people will help you understand their context; they will share their indigenous knowledge with you. But it is ultimately up to you to choose the ways you can identify and utilise local resources for maximum impact. When you do this, you have better chances of creating sustainable solutions, which is always a big challenge in post-conflict areas,” she observed.
So what did Dr Salih and her team do? They started by empowering 15 illiterate women in 15 different villages through simple games. “Women were lined up and told to hold on to one rope. Each woman was then asked to pull a part of the rope and in this way the rest of the group moved closer to her. This was to demonstrate that networks mattered within the community. Anything that happened to any one of them affected not just the whole family but the community,” Dr Salih explained.
Since the team also wanted to understand the daily realities of these women’s lives, it came up with a novel way of getting women to document their own lives. Each woman was handed over a disposable camera for a week and asked them to take photographs relevant to their lives. Later they had to explain why they took a particular picture. Said Dr Salih, “In this way, we got a deeper understanding of their beliefs and attitudes, as well as their lives.”
Slowly, through this process the women were able to identify the important issues in their community which were adversely affecting their health. Over time, they were able to help in designing tools to address the issues that had affected them.
“It was amazing. Not only did we train them they taught us something as well. I remember this song they composed, ‘La la la ya baba yoo, ma tadogo mama yoo, Mama heya hamlana, shelo mashakil betaaki dah (no, no daddy, don’t hit mommy/ Mommy is pregnant, please don’t fight with her)’. These illiterate women had identified domestic violence as a health issue. They wanted to change their community, and even neighbouring villages, through songs,” revealed Dr Salih.
The sustainability aspect also came through. When the team first started, it comprised seven physicians who trained 15 women. Within less than a year, after about six visits, more than 55 men and women wanted to be trained. Remarked Dr Salih, “We trained the trainers and that was how we were able to have a multiple impact.”
Lewis of WHTF saw this as a good example of how participatory research as well as the development of songs and other communication tools for low literacy communities could be used to improve women’s health all over the world – including in the global north.
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