17 December 2007

Mali: Mothers Form Long Lines For Children's Health

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Bamako — The latest instalment in the reflections of Dr. Steven Phillips, ExxonMobil's Medical Director for Global Issues and Projects, on the huge campaign to reach millions of children and adults in Mali with life-saving health interventions. Click here for the complete series.  

Day 3: "The Power of "Political Will"

Under the merciless rays of an insistent sun which pierces a perennially brown dust-laden sky, we take our positions as international VIPs in a huge dirt schoolyard on the outskirts of Bamako. We are here for the official launch ceremony for the country's integrated health campaign week, and awaiting Mali's president.

The yard is festooned with banners urging parents to bring their children to vaccination posts. It is packed with hundreds of strategically-placed school children sitting in the dirt-layered rows around the perimeter. Scores of Malian guests are bedecked in rainbow-colored flowing robes with matching hats. Westerners are in formal business attire. The VIPs sit in overstuffed lounge-chairs planted in the dust and mercifully shaded under tent enclosures. The stage is set for the arrival of President Amadou Touré.

The audience warm-up includes a half-dozen speakers and animated folklore theatre with actors speaking Bambara playing parts of villagers. The Mali audience laughs uproariously. Prancing children kick up more dust.

The mayor of the commune and the health commune and the health minister speak from a makeshift podium in the middle of the schoolyard. ExxonMobil is mentioned along with several other contributors as a vital partner in the campaign. Then, flanked by generals in splendid military regalia, the president takes the podium. Along the way he stops to receive an impromptu gift from a Major League Soccer player in our delegation—a Houston Dynamo jersey, which he holds up to the cheers of a gleeful crowd.

The speech is brief, but the president makes his point. This is an opportunity for the entire country to support critical government health and child survival goals. The international community is here to help, and now the mothers and fathers of Mali must do their part by bringing their children to community health posts.

As he concludes, the president takes deliberate strides to navigate his way across the yard to a bed net distribution post. A huge crush of humanity rapidly encloses him. Dozens of mothers with flocks of young children attempt to squeeze through a phalanx of VIPs, reporters, and cameramen to receive free bed nets from the hands of their president. I decide to hang back thinking that personal safety trumps a brief exposure to local press.

A few hours later, we are in a caravan of three SUVs making our way to the town of Segou, about 250 kilometers southeast of Bamako on the inland Niger Delta. We are spending two days in the district to have a first-hand view of campaign mechanics at the village level. On the way to Segou we pass several roadside villages comprised of a few dozen randomly scattered mud huts, with no signs of commercial activity, except for long snaking rows of women and children outside a central hut. This seems a very incongruous sight until the riders in our vehicle finally put it together. Yes, these must be mothers already queuing for the campaign.

The following day we see campaign sites in three small villages, all looking strikingly similar. A rectangular set of tables with health aides and assistants staffing three stations: the first station provides oral interventions (polio vaccine, vitamin A, and a de-worming pill). The second a measles shot. And the third, two long-lasting nets for each household. In addition the fingernails of each child and the mother are marked with indelible ink to discourage repeat visits.

But for our visiting delegation the shock is the queue. Starting as early as 7:00 am, two hours before the health posts even open, mothers begin forming long lines holding and tugging their children behind. The lines are far less than ordinary, but far more disciplined than outright chaos. They wait standing patiently for hours until their children are served. Before the campaign is concluded in four days, it is expected that fully 95 percent of all children under the age of five in the entire country will have received their package of interventions.

What accounts for this level of social cohesiveness (public health professionals call this social mobilization)? In our villages the chef du village received word of the campaign from their district health officer weeks ago. With their endorsement, the village health and women's committees were recruited to help.

Another key form of mobilization is by griots. These are families within a village with a minstrel-like tradition of singing or chanting the local news. As they walk through the village on their daily rounds they are the human news kiosks of the village. The griots and the women's committee made their rounds through each village as early as 4 am on the day of the campaign to stimulate the turnout. As this phenomenon repeats itself throughout Mali's 15,000 villages, some 2.8 million children are brought to campaign posts.

In the African development world we hear much about the importance of political will. This typically refers to an African head of state demonstrating leadership through direct involvement in a social issue. It is assumed that only a president's will can truly mobilize broad grassroots national action.

This integrated campaign strikingly reinforced the validity of this perspective. President Touré 's few words had a monumental impact on his people. Griots chanted up and down every village alley, women elders knocked on hut doors at 4:00 am and colorful-robed women lined up in the hot dust...

Tomorrow: U.S. athletic stars suit up to help "send a net and save a life."

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