Nigeria, 1996

Prevention can be a more difficult idea to sell to than Cure, was the conclusion of MMM Pioneers at Gussoro, in Niger State, Nigeria.

In June 1981 Sister Pauline Connolly and Sister Therese Jane Ogu opened a health education programme at Gussoro. The first six months were lived in a mobile home. During this time they helped to supervise and draw up a list of materials, to complete the building of our present home.

Here is how an early Report described the difficulties and the progress:

We began to meet with chief, elders, and people of Gussoro. We had discussions, sought their opinions. They said they needed help with their health problems and would appreciate any way we could help them. A community based preventative health education way was agreed, starting with what they know and building from there. A Programme Outline had been drawn up in December 1980.

We made visits to families and compounds trying to share their lifestyle, hopes and fears and see causes and kinds of illnesses people suffered from.

Arrangements were made with the villagers to gather and hold regular meetings. During these sessions through talks, discussions, visual aids, story, song and demonstration, people were helped to become more aware of causes of some of their community disease and health hazards. Taking initiative and responsibility was encouraged as well as trying to form health communities and train health workers. Much emphasis was put on helping the people to realise how they can promote helth by carrying out simple preventative measures.

Side by side with above, a literacy programme was offered for those interested. We were open and hoped to promote pastoral care in any way we could, encouraging and organising interested groups to hold prayer serices and give instruction classes.

Initially, chief, elders and large groups of villgers came and participated, however, many opted out after a number of meetings because of the challenge of the task and no hand outs were offered. The men became less interested seeing responsibility of health care as woman's role. Yet they continued to assure us of their gratefulness for our help in showing them the way to better health and villge improvements!

Change of attitude was a very slow process hence any action was greatly impeded. Even though meetings invariably ended with a resolution to act, action seldom followed.

Some impact was made:

• use of improved diet to regain weight loss in children;
• early treatment of diarrhoea with oral rehydration resulting in better control and quicker recovery from gastro-enteritis;
• mothers beginning to teach and help each other to make and give rehydration solution;
• steps in more safe home delivery, new razor, soap, etc.
• two villages organised themselves and dug and lined wells;
• three groups built latrines, others began to follow;
• a number of soakaways were built;
• a few native tables for keeping eating utensils were made;
• four villages built a place for worship and began instruction;
• some began literacy, some opted out, others struggled on, eventually a few readers emerged.

Efforts to set up village health committees were unsuccessful, the community did not choose to select them and no suitable persons evolved. Inability to overcome differences and pull together for the common good reflected in lack of commitment to carry out suggested action. There was fluctuating interest in the programme, and we could see that a programme of prevention was harder to implement than cure. Traditionl medicine posed a problem, sickness often thought of as a curse or evil spell.

In July 1983, we commenced Child Welfare/Immunisation Programme also Ante Natal care. Following reflection this was decided as a further step in health promotion and to interest the mothers and again instil the value of prevention and early recognition of illness.

Since then these have continued with an estimated 3000 children registered on vaccination programme.

In November 1983, one of the villagers who is a part time health worker opened a medicine store. Here simple treatments are available under supervision. It is an effort to help people to learn to buy sensible medicines and know why and when to use them.

In December 1983, a Health Festival was celebrated - here groups came together in the village to display in dance and drama a health problem that was of concern to them. It challenged them to look critically at their situation and motivate them to change.

In December 1984, tidy compound activities were begun. Compounds were inspected and judged and praised for their efforts and what they had accomplished in health and hygiene practices. The men were further challenged to build better houses and make things easier for the women.

Maintaining community orientation of health care continues as a developing process. Acceptance of the message is catching. Meetings, discussions on health topics and visitation are kept up. The ability and capacity of the people to grasp and retain different ways and ideas is very limited. The struggle to hold and carry out instructions poses problems. All in all there is a growing realisation among the women to understand and control some of the factors affecting their health and break down some of the feelings of fatalism and helplessness. There is still apathy on the part of the men to become more involved.

Most of the homes in the locality now have basic health essentials such as latrines, soakaways, refuse pits, and the general environmental sanitation has improved. Six wells have been completed. There is progress in controlling malaria, anaemia, worm infestation and such common recurrent sicknesses.

The women and men continually say 'our children are stronger and they are not dying as before'. The women have become more aware of the importance of ante natal care. The traditional birth attendants continue their practical training at a very slow pace. Another breakthrough is the fact that now the women can recognise problems early and know when to call for help. Of the sixty four cases the Sisters were called to attend when a woman got into difficulties, all except one delivered safely. That one case had already delivered and was moribund from loss of blood on arrival. Of other cases, ten were unable to deliver and were referred to hospital.

The groups are showing initial signs of assuming responsibility for their own health. After discussion, the women now pay a small contribution as members of the group.

Altogether there are twenty five village groups now (1986) involved in the programme. There are another twenty more remote villages on the other side of the river requesting more help and attention. These are more Christian orientated people and working with them might take on a different style.

There is still a great need to continue to encourage and promote training in leadership and development skills.