Welcome to the primary health care centre in Cha Kunda, in the heart of the Gambia’s Central River region. Almamo Fatty is the village’s voluntary health care worker. We sit down on boxes and he shows us his diagnosis manuals. They’re simple, pictorial guides to the common symptoms for illnesses like malaria – a big threat to children here – and they enable volunteers without formal education, like Almamo, to provide a vital service for families.
He looks tired. As an unpaid health worker, what are his working hours? “I work whenever I’m needed,” he says.
Almamo sometimes travels long distances at his own cost to collect drugs; it’s an unbelievable level of commitment from a volunteer. So what keeps him motivated? “This community trusts me,” he says.
It’s hard to overstate the importance of individuals like Almamo in a country where ‘one in every 10 children still doesnt reach the age of five.
One big barrier to child survival in the Gambia is the distance that mothers and children often have to travel to reach medical help in an emergency. Yet in Cha Kunda, families have a committed health worker living in the village. And they’re not the only ones. Cha Kunda’s just one of almost 550 UNICEF-supported Baby Friendly Communities here.
As the village health worker, Almamo is part of a larger village support group that promotes potentially life-saving practices like exclusive breastfeeding and handwashing. These groups, made up of five women and three men, are at the centre of each Baby Friendly Community.
Over time, and with thorough training, these groups become trusted one-stop-shops for all kinds of mother and child health issues, from checking for malnutrition to ensuring that mums know when mobile vaccination clinics are happening. In one village, Tambasansang, in the remote Upper River region, support group members told us that they’d become experts in spotting early signs of anaemia in pregnant women. They’d even created their own community vegetable garden to enable mums to supplement their regular food with iron-rich greens.
During our visit there, one of the women members of the support group introduced us to her one-year-old grandson. You couldn’t hope to see a healthier, chubbier little boy. She proudly holds him up in the village as a living example of an exclusively breastfed child.
But what happens when a child does fall ill in one of these Baby Friendly Communities?
The next day, we stop at the village of Bakadagi, again in the Upper River region. The community health worker arrives on his motorbike and takes us to meet 20-month-old baby Abdullah and his mum.
Just two weeks ago, Abdullah was weak and listless, with no appetite or energy to play. When his mum gave up breastfeeding him at six months, he stopped getting the right nutrients in his diet and as a result became severely malnourished. The village health worker noticed the signs, and Abdullah was quickly diagnosed, and given a course of high-energy peanut paste. When we meet him, Abdullah is impatiently sorting through the sachets of peanut paste on his mum’s lap and greedily tucks into one as soon as she opens it. This little boy is clearly on the mend, thanks to rapid care at village level.
But the village support group is about improving children’s health in the long-term. Since Abdullah’s diagnosis, they’ve helped his mum to understand how to keep vital nutrients in food when she cooks. She’s now expecting another child, and has joined a local antenatal programme to help prepare her.
As we talk with Abdullah’s mum, her mother in-law appears, along with other members of her extended family. That’s when the real benefit of this community-based health care becomes clear: at no point has Abdullah been admitted to hospital in order to receive treatment; the care has all happened in his home. As a result, the whole family knows more about nutrition, breastfeeding and handwashing.
Driving along the dusty, uneven roads of the Gambia’s two poorest regions, we passed dozens of Baby Friendly Community signs. The children in these regions are some of the most disadvantaged in the country, in no small part because on these roads they’re so hard to get to.
At the moment just over a quarter of communities in the Gambia are accredited Baby Friendly, so there’s still a huge challenge ahead to ensure that every mother and child has health care and support where they live. But it’s a massive privilege to meet just a few of the people who are making this aim a reality for some of the Gambia’s hardest-to-reach children.
Author: Isabelle Andrews
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