By: Ellie Kealey, UNICEF South Sudan
AJUONG THOK, South Sudan, October 24, 2017 – “That child could have been dead by morning,” UNICEF health officer Christopher Otti Ajumara tells me. “If we hadn’t come here today, he could have died.”
We are in Ajuong Thok in northern South Sudan, having just visited the home of Lina, a 20 year old mother of three. Her nine-month old son, Mapir, became ill with malaria five days ago and is exhibiting danger signs. Our visit is the first time he has seen a health professional for his condition. “I kept thinking, when tomorrow comes, the child will be ok,” Lina said when asked why she had delayed seeking treatment for her son.
Ajuong Thok, which hosts a refugee camp for people who have fled fighting in neighbouring Sudan, is also the site of a pilot programmeme – the first of its kind in South Sudan – to prevent and treat common childhood illnesses, which if untreated are often deadly.
The Integrated Community Case Management (ICCM) programme has been running since 2016 by UNICEF in partnership with African Humanitarian Action (AHA) and has so far treated 26,000 children.
Mortality among under-fives in South Sudan is extremely high at 93 per 1000 live births which translates into about 850 young children aged under five dying every week. The three main killers of children are malaria, diarrhoea, and pneumonia – with widespread malnutrition making children even more vulnerable. Most of these deaths are preventable, but often children do not receive timely and correct treatment. Distance combined with a lack of primary health care services, trust and education on the part of mothers are the main barriers to accessing healthcare. And it is these barriers that the integrated community case management programme seeks to address by ensuring children have local and timely access to treatment.
As part of the initiative, in Ajuong Thok, AHA has trained 70 people taken from both the refugee camp and the host community in diagnosing and treating these illnesses with the most severe cases, as well as screening for those children suffering from severe malnutrition before being referred to local clinics.
They work within the community, treating patients at home and teaching families how to avoid preventable diseases. The target of the programme is to treat every child within the critical window of 24 hours after the onset of symptoms; which has been 98 per cent achieved so far. Christopher says it is “one of the most successful programmes I’ve ever been involved in.” Patients do not have to visit over-burdened health facilities, he says, and instead are seen at home. “The health worker treats the patient in the environment where the disease is caught. They can see why the person is sick; maybe there is stagnant water, maybe there are holes in [mosquito] nets. At the clinic the person only comes with the sickness.”
Parents are often reluctant to take children to clinics due to the need to travel long distances to reach facilities and the long queues they face when they get there. Ashi Kaka, a lone mother of eight, who fled fighting in Sudan, says she is unable to care for her children when she walks to a clinic. “Now, thank God, we have the health workers. They come to my home if a child is sick, even in the night, and I can get medicine. And it has given me time take care of the house and raise money for food.”
With approximately 60 per cent of patients at local clinics presenting with the three diseases targeted by the ICCM, the burden on scarcely available health centres has also been much reduced.
In the Ajuong Thok camp, home to over 37,000 refugees, I meet Maria Chichi, who has been working for the ICCM programme since late 2016. Having won the trust of mothers in the refugee community she is now the first person they go to with a sick child. “I am often woken several times a night by mothers seeking help for their children,” she tells me. “Education and treatment, the two things go together,” she explains when questioned on the success of the programme. “If you take a microphone and speak through it people won’t understand you. The best solution is to go house to house, to speak directly to people so that they can understand how to improve their health.”
Mariam Ezikial, a 35 year old mother of six, is part of the second stage of the ICCM programme. Her family, along with 50 others, were trained in health promotion and disease prevention such as hand-washing, proper sanitation practices and immunization. They now educate and mobilize their communities on how to live healthier lives, through one-to-one interactions and routine meetings with friends and neighbours. “When we sit down for coffee I tell my friends and neighbours about how to stay clean and healthy,” Mariam explains. “In the beginning people were asking ‘Why should we do this? We don’t wash our hands where we come from.’ But as I kept telling them every day, they have realized that it can make a difference.”
As a result of the pilot project, there has been a 40 per cent reduction in the number of under-fives admitted with severe pneumonia, malaria and diarrhoea. UNICEF’s health officer Christopher credits much of the success of the initiative to the commitment and passion that the community health volunteers bring to their work. “This is the work that I accept inside my heart,” says Maria. “And I do it freely, to save the lives of the people.”