Normandy helps Senegal / Brigitte Girault & Badara Samb

18 World Heolth • September-October 1992 Normandy helps Senegal Brigitte Girault & Badara Samb A n initiative backed by the Municipality of Caen, a city in Nonnandy, northern France, is helping a district of the West Af1ican state of Senegal to overcome disease and malnutrition. In 1988 we studied the health situation in the Department of Oussouye under the auspices of the · "Nonnandy Association for Social Aid to Senegal Villages". This showed that, despite seven years of health work, living standards in the district had scarcely changed, and people were still plagued by malnutrition and by diseases related to the environment, such as malaria, diarrhoea and parasites. An innovative strategy was needed to improve the situation, consisting of an approach based on the family and what the family reported about itself. Primary health care had to be viewed in a global context and not just selectively; only failure would follow if well-meaning health workers restricted their activity to setting up basic health units, fencing off water sources and vaccinating people. Yet to do more than this would take a great deal of courage, since the work is both enonnous and difficult. What became the Boucotte Primary Health Care project lasted 18 months and involved virtually redefining the word Health. Education for health In the preparatory phase, the project leaders studied the monthly reports from the health post in the village of Boucotte (population, 1500), made a census of the local population, visited every family to explain the aims of the project, observed the social and economic realities of everyday life, and tried to persuade everyone to participate. They drew up a record- card for each family starting with the This proiect, linking environmental health closely with health education in a mainly rural area of Senegal, won for the two authors a share in the 1992 Sasakawa Prize for outstanding innovative work in health development. including such items as the cleanliness of the home, how drinking-water was stored, whether there was a latrine, and whether people were receiving antimalaria drugs. The next phase involved making people better aware about what they could do to improve health. Young people were organized into "hygiene brigades," which undertook to clean up the village and cut down weeds, and also to educate people. They were given machetes, rakes and brooms to keep the villages clean, and wheelbarrows so they could collect and bum rubbish. We prepared a booklet called "The lesson of health" to serve as a basic teaching tool and to make every schoolchild a vehicle for information and health education in the family context. The Ministry of Education seconded a teacher to oversee this aspect. Women had special responsibility for keeping each house clean inside and out, for looking after the water storage, feeding the family, and keeping wells unpolluted. The men, as heads of households, had to give their agreement so this involved them in everything to do with improving the life of the family, including construction work on wells and latrines. The Nonnandy Association gave each family three sacks of cement for this purpose. In each family, people learnt about basic hygiene- washing hands, keeping water clean- and were taught how to use a simple first aid kit. Dietary advice included how to feed people who became ill. A second set of cards recorded the names and ages of children aged up to 14, pregnant women, and how much chloroquine to take each week to combat malaria, according to age. A family member names of father and mother, and Sharing know-haw far better health Brigitte Girault works among the villagers. World Health • September-October 1992 was made responsible for buying and distributing chloroquine on a weekly basis and keeping the record-card up-to-date. The success of these activities was easily measurable. There are now 90 wells to serve Ill families; 97% of the families have proper water storage and 90% use latrines. In terms of cases of disease there was a spectacular improvement, as the figures show: Malaria Diarrhoea Parasitic diseases 1990 1991 3362 460 267 772 Ill 98 So the diseases linked with the environment have clearly declined, thanks to a combination of hygiene measures, the building of latrines, water chlorination and the distribution of antimalarial drugs. All these steps, when backed up by a strong campaign of public awareness-raising and health education, have proved highly successful. The factors that have helped to boost this project include community participation, the willingness of young people to take part, and the community's readiness to apply time and labour in building latrines and health posts and maintaining the antimalaria record-cards. The negative factors included an unwillingness to change the traditional diet- for instance, a reluctance to eat eggs - or to distinguish between what is essential food and what is merely seasoning. Such attitudes will take a long time to change. The nurses working in this district have to change their ways of operating. They can no longer be content simply to treat the sick; they have to come out of their dispensary and become real activists in the domain of health education. In Africa, many disease-causing agents are intimately linked with the difficult living conditions, which in turn reflect the state of development. Faced with such pressing realities, it is a paradox to have health structures imposed by Western countries that have no relationship with what goes on in a village or in an over-populated township. Health does not reside in structures, in cures and in vaccinations, but rather in a whole complex where development and health education are the principal constituents. Today ' s goal is to ensure that health care- part of the strategy for global development - is not left solely to the "health technicians", but becomes a daily concern and daily practice for all societies which have adopted that strategy. • Young people launch a sanitation campaign in the village. A clean container will ensure safe storage of water. 19 Mrs Brigitte Girault is a founder member of the "Normandy Association for Social Aid to Senegal Villages" which promotes and finances the Boucotte Primary Health Care pro;ect. Her address is 20, rue Saint-Norbert, 14000 Caen, France. Mr Badara Samb is Head Nurse at Ziguinchor Hospital in the Department of Oussouye, Senegal.