A tale of three villages
A new approach bringing together malaria and pneumonia treatment by community volunteers that could reduce childhood deaths in Africa
In Djalakoro: a clock that tells pneumonia
Inoussa Sawadogo, a community health worker in Djalakoro, tests a child for pneumonia by counting the number of breaths per minute. Sory Awa, the child's mother, looks on
Inoussa Sawadogo, 42, is a community health worker in Dialakoro, a village of about 3 000 where residents earn their living raising goats and growing vegetables and mangoes. On a hot day in mid-March, Sawadogo was sitting under a straw awning examining the infant child of a young, agitated-looking mother in her early twenties. Speaking in Dioula, the only language spoken by many village residents, he chatted amiably with Awa Sory and asked about her child's symptoms:
"Is he coughing?"
"Yes, a lot."
He gently places one hand on the belly of Sory's ten-month old child and begins to count the child's breaths. In his other hand he holds a large alarm clock with prominent minute and second hands.
After observing the number of the child's breaths to be more than 50 per minute, he turns to the mother.
"I can tell you that he has pneumonia and I will show you how to mix the medicine," says Sawadogo, pointing to pictures of a mother putting a tablet in a glass of water and a child drinking the mixture to the last drop. The clearly-illustrated images printed on the drug packaging reinforce the instructions for Sory, who, like seventy percent of Burkina Faso's adult population, is illiterate.
Sorry is now visibly relieved. She hands over a 50 CFA coin (equivalent to ten US cents) to Sawadogo to pay for the medication. When she is asked what she thinks about having a community health worker in her village, her face lights up. She says she is glad that she doesn't have to travel, sometimes by foot, a distance of 17 kilometers to the health centre in Sidéradougou. "And it is good that the drugs are cheap," she adds, referring to the 50 CFA fee for the pneumonia drug, comparable to the price of a loaf of bread, and the 100 CFA charge for the malaria drug, equal to the going rate for 250 grams of rice.
The fact that the drugs are not completely free, however, enables the community health workers to earn a small stipend. Asked if the financial gain was an incentive to take the position, Sawadogo smiles and replies that the income only barely covers the cost of motorcycle fuel for journeys to pick up the drugs.
"The main thing is feeling good about helping the community," he says in a soft-spoken way as he walks through the village and is warmly greeted by people passing by. A farmer by trade and the father of six children, Sawadogo comes across as a natural leader, a quality sought after when the community health workers are selected in each community.
Sawadogo adds that he was also motivated by another reason. "I know what it is like to lose a child because of malaria," he says, his face growing serious as he describes what happened when his seven-month old daughter had a high fever prior to the implementation of the community case management programme.
"Because the health centre is so far away we tried to treat her with traditional herbal medicine," he recalls. When he did finally take her there it was too late. "I feel for certain that if the health initiative had been operating then, she would be alive today."