Monday, November 2, 2009

Maternal and Child Health Workshop

First, thanks for the comments. I enjoy sharing the experiences that I've had in Morocco and I'm glad that other people enjoy reading about them.

On the 28th, 29th, and 30th of October, I hosted a Maternal and Child Workshop for 25 local women in my souq town. I'm going to write up a long report of it at some point and post that report here, but in the mean time, here is an account of the workshop.

I started thinking about this workshop one year ago, when Mara Hansen, another volunteer, hosted a similar one that I was involved in. In June and July of this year, I started recruiting women for the workshop. This involved riding my bike a lot to different villages, trying to find interested women. Luckily I had built up relationships in these villages in the past year. Early in the summer I also started talking with the doctors and midwives about the curriculum for the training and when we ought to host it. Simultaneously, I was working with the Ministry of Health in my provincial capital to make sure that we had there support.

After some miscommunication and scheduling difficulties with the Ministry, the training was officially scheduled for October 28, 29, 30. So I had to go back to each village to tell the women the details. Then, a week before the stage, I had to start working on logistical details for the women.

Tuesday afternoon (27th), there were some 10 women in Tounfite. We had dinner with them at a family's house who was hosting the women for the week. They were in a good mood. I was feeling very nervous. There were still 15 women missing! I knew that some of them would be staying with family in Tounfite and that others would be coming early tomorrow morning, but, throughout the training, I was often worried about things that I could not control.

Wednesday morning we met at the health clinic. Two Ministry midwives were supposed to be leading the training, but just that morning one had been called away to Khenifra for a Ministry meeting. The one who had been called away (named Wafa) was at last year's training, so she was going to be taking the lead; this was a disappointing development. The other midwife (Rachida), although inexperienced, spoke Tamazight, which is a big help because it means that the training can move more quickly and fluidly without waiting for translations. The other headache of that day was that the Ministry of Health officials (who were giving introductory remarks)coming from Khenifra were 45 minutes late. They also didn't bring the right number of booklets for the women. Besides these two difficulties, I think the first day went really well. At dinner that night, women who had attended last year's training told me that they liked Rachida a lot because she was a Tamazight speaker. The main lessons for that day were pre natale care and birthing.

Thursday was filled with more complications. Today, Wafa was in Tounfite, but Rachida was called away to Khenifra. After 30 minutes of Wafa leading the session, there was a minor emergency. A woman came into the health clinic: she was in labor! Wafa obviously had to go take care of the situation, so me and the other volunteers quickly talked about what we were going to do to fill the time. We didn't know how long Wafa would be gone. We decided to break the women up into small groups and have each volunteer lead a small review session. The session with my small group went really well; the women were engaged and on top of the material. My group happened to have my host mom in it; she was ashamed at times to be talking about birthing stuff in front of me.

The woman in labor ended up needing more attention than the Tounfite health clinic could provide her, so she was driven to Midelt in an ambulance, with Wafa staying behind. (I was relieved that the woman was having complications and needed to be driven away - how awful is that?) Wafa returned to the training room and got things going again. The rest of that morning went well.

Thursday afternoon, the doctor from my village came and did basic hygiene and first aid lessons with the women. She was visibly impatient with their lack of focus, but on the other hand, she did a good job of calling women out and making sure that they understood the lessons. Later in the afternoon, myself and other volunteers led two health lessons. In the first lesson, we did a skit where a man (me) coming back from the bathroom doesn't wash his hands with soap and he gets sick. When we asked the women why he was sick, they were quick to say that he hadn't washed the microbes off of his hands. This was a great confirmation that they had understood the doctor's lesson from earlier that afternoon. (Throughout the training, at meals, the women consistently washed their hands with soap. This doesn't sound like much, but it's a huge deal. And if a woman didn't wash with soap, the others would yell at her.) The other lesson was about making oral rehydration liquid, which is for people with diarrhea. I had been nervous about having volunteers lead lessons, but I think we did a really good job of it. Our lessons were more interactive than the ministry's lessons and I think the women enjoyed seeing us up there.

Friday morning, the women covered post natale care and family planning. I wasn't present in the actual training room, but female volunteers who were there told me that a condom was passed around (a big deal). Family planning is a critical lesson because lots of women don't understand how to take birth control correctly, resulting in unwanted pregnancies. In my opinion, the best way to reduce maternal and infant mortality is to prevent unwanted pregnancies.

Friday afternoon was the big finale. I had invited men from every village. The men I invited were those who had helped me recruit women from their village. We broke into 4 different groups, clustered by tribal relationships (Ait Moussa, Ait Fadouli, Ait Sliman, and Ait Tounfite). In the small groups, with the help of a volunteer facilitating the discussion, the women were supposed to quickly summarize the five most important lessons of the workshop (importance of seeking pre natale care, importance of birthing in the health clinic, hygiene, oral rehydration liquide, and family planning). Then, the men and women were supposed to discuss amongst themselves what the biggest health problems were in their village and which lesson best applied to that health problem. They were supposed to discuss the idiosyncrasies of their village (eg Ait Sliman is especially far from a health clinic) and what that meant for their ability to implement the lessons from the training. THEN, the group was supposed to decide what was the best course of action. Working first with the Ait Moussa group, our discussion went really well. One of the men took the lead (I'd asked him to do so beforehand) and did a great job of directing the conversation. We decided that we needed to have one meeting with men (mostly about importance of pre natale visits) and one meeting with women (about a range of lessons). The man would be in charge of inviting people. Our doctor will be invited and I will help her and the women communicate the lessons. After finishing with Ait Moussa, I helped Ait Sliman, which was (unsuprisingly) a little more difficult. However, in the end, they came to the same conclusion: that they needed to do community meetings and education with the help of me and their nurse. I was really nervous about this part of the workshop, but it could not have gone better. I believe it was the most important session and that it will be the catalyst to significant behavior change in my communities...we'll see.

After meeting in the small groups (and tea), we reconvened in a big group. A representative from each group had to explain their group's community plan. Tounfite, Ait Moussa, and Ait Sliman did a pretty good job of explaining to the others what they wanted to do. A woman from Tounfite did an excellent job; the work that will happen in Tounfite as a result of this training should be very good. Finally, was Ait Fadouli. No men from their villages had shown up, so it was mostly up to this 23 year old woman from a particuraly isolated village to lead the charge. She is unmarried and has worked in Rabat and Casablanca; clearly an anomaly in her village. She has a very strong personality.

She stood up and made the best speech that I have ever heard in person. The theme of her speech was that people in these villages need to help each other; the government is corrupt and sitting on its hands. Basically, it's up to us to help ourselves. She told the men that it was shameful for them sit not take care of their women; that the women were the heart and soul of the family and that they deserved proper care. She told the women that it was shameful for them to be witness to the oppression of their sisters, friends, and themselves and not stand up for themselves. She told the women that they had to be more assertive and less afraid. I'm so glad that my Tamazight has gotten to a level where I could understand what she said, because it was amazing. Sitting there in the room at the culmination of the training, I was fighting back tears.

It's hard not to feel really good about the training. I felt like I was taking a risk by inviting the men and asking them to engage with womens' problems, but they did. The whole time I was nervous because I had very little control over whether or not people were going to invest in the training. But I think that's a good sign that I'm doing development work: in the end, people have to help themselves.

But this is really just the beginning. I have 6 villages that are now asking me to come smaller, one day versions of this workshop in their community. That, ultimately, was what I wanted from the training, but it's going to be a lot of work. If those meetings happen, I think it will validate the training. Another way we have of measuring the impact of the training is that we gave each woman a "referral" card, which has a picture of a pregnant lady going to the health clinic. Each card has the name of the woman on it. The idea is that the woman will give the card to her pregnant woman to remind her to go to the health clinic, who will then give the card to the doctor at the clinic. That way we will be able to count a) if people are making referrals and b) which women are making those referrals. I'm a little unsure about whether people will buy into the idea of referral cards, but I think it's worth trying. Another way to measure the effectiveness of the training is to compare number of pre natal visits before and after the training, but that's not a great method of measuring

In conclusion, it was a great week. The women were happy all week long and I think they absorbed some valuable information. I want to thank: the volunteers who helped me run the training (Kristen, Eric, Jed, Falisha, Taryn, and Dan), the volunteers who built my capacity to do this (Mara, Dave, and Kristin), the Ministry of Health staff who helped run the training (Selua, Wafa, and Rachida), the Ministry of Health people in Khenifra who gave me the stamp of approval (mostly Sidi Aissa), my PC programming staff (Mostafa and Rachid), the family who housed and fed the women for the training (Mamaksu and Baha) and most importantly, the women and men who came, participated, and engaged.

I'm in Marrakech, leading sessions for IST (in-service training) for volunteers who have been in the country since March. I have a lot of free time here in between sessions and unlimited computer access (with Internet), so I'm going to be working on my grad school apps.


Kristin said...

Hey Dunc! Sounds like the training went really well, congrats!!! It's so great that the girl from ait foudouli gave such an amazing speech. It's women like that that really give me hope for the future of Morocco. And it's great that the men came and participated. Now you'll have plenty to do for the next few months!!

Franny said...

wow dunc that sounds awesome. good luck with grad school essays! you can do it!

Mara in Morocco said...

yeaaaaaaah!!!! wish i could have heard the speech. much love and celebration!!!!