From Hot Spots to Holy Places: Group sales of health products contribute to women’s empowerment and better health in Mali

Togo Kadiatou Malle, president of Muso Yiriwa Ton in Mali, is now an ardent proponent of condoms and contraceptives.

This was originally published on the Knowledge4Health Blog on July 1, 2019.

The first five times the sales manager of Keneya Jemu Kan came looking for Madame Togo Kadiatou Mallé to talk about her women’s association selling condoms and other health products, she ran away and hid, so terrified was she of the prospect of having to work with condoms. 

But the sales manager’s persistence paid off. Eventually, they talked, and Madame Togo has become such an enthusiastic condom promoter, she is known as Mama Condom. She laughs about her fear of condoms. 

Madame Togo is president of Muso Yiriwa Ton (MYT), which means “women-empowering group” in the Bambara language, a women’s association based in the very poor Sabalibougou neighbourhood of Bamako, Mali. Her association – as well as other women’s associations – are a major reason for the success of Keneya Jemu Kan (“Communication Around Health”), or KJK, a project funded by the U.S. Agency for International Development and led by the Johns Hopkins Center for Communication Programs that seeks to reduce maternal, infant, and child mortality in Mali. Palladium leads the social marketing component of KJK.

MYT has more than 400 members, and roughly half of them sell the KJK’s male and female condoms, as well as Aquatabs (water purification tablets), Orasel Zinc (zinc tablets and oral rehydration solution to treat diarrhoea), and CycleBeads (a natural family planning method). MYT members sell an average of 107 cartons of Protector Plus condoms per month. That’s 64,200 condoms. The partnership helps to enhance economic prospects of its members. 

“It has become a source of life for many families,” said Madame Togo. “And it is improving health of the areas where they sell, in Commune 5 and beyond.”

Health workers, facilities under attack in 23 nations; UN accused of inaction

This hospital was damaged by clashes during a 79-day curfew from late 2015 to early 2016 in the city of Cizre in southeastern Turkey. Photo: Physicians for Human Rights.

This was originally published on Global Health TV on May 23, 2017.

In 2012, two Pakistani health workers were out vaccinating children against polio when they were both shot by extremists. One of them died. The other, shot in the leg, had 11 metal rods inserted into his leg and was hospitalized for three months.

In November, I met this remarkable man named Latif (his surname is withheld to protect his security). He is now fully recovered and back to work on the polio vaccination campaign. He told me he never considered giving up. Pakistan reported only two cases of wild poliovirus in 2017 as of May 17 and Latif is determined to see the polio campaign through to the end.

The attack on Latif is only one example of a tragic phenomenon that is not getting better – violence against heath workers and health facilities. In 2016, the extent and intensity of such violence “remained alarmingly high,” according to a new report released by the Safeguarding Health in Conflict Coalition.” The report also found that accountability for committing these attacks remains inadequate or non-existent.

The violence isn’t always perpetrated by terrorists. Sometimes it is committed by the police or the country’s military — institutions that should be ensuring tranquility.

Tremendous progress against malaria seen but challenges remain

Twins Dorcas and Deborah Bendak, 7, under their mosquito net at their home in Musoma, Tanzania. Insecticide-treated bednets have become the cornerstone of malaria prevention efforts. Photo: Riccardo Gangale/VictorWorks, Courtesy of Photosphere

This was originally published on Global Health TV on April 25, 2017.

When I was a young development worker, I engaged in high risk behavior one night in a village in Mali: I slept without a mosquito net. A week or so later I contracted malaria.

Of all the diseases I have written about here, malaria is the only one with which I have personal and intimate experience. And it was not pleasant. It was so debilitating, so sapping of my energy, I remember not caring whether I lived or died.

Fortunately, I was an otherwise healthy young male and bounced back briskly after a week or so of misery. In fact, I have lived long enough to see the beginning of the end (or at least the decline) of this global killer: In December, the World Health Organization (WHO) released the World Malaria Report 2016 in which it estimated that 1.3 billion fewer malaria cases and 6.8 million fewer malaria deaths occurred between 2001 and 2015 than would have occurred had incidence and mortality remained the same. About 97% of those deaths averted were for children under five years (who are most vulnerable to the disease, along with pregnant women).

The end of trachoma, world's leading cause of preventable blindness, is in sight

This woman, who was examined by a health worker at a clinic in Ressa Kebele, Kallo District, Amhara, Ethiopia, will receive trichiasis surgery. The arrow indicates which eye will be operated on. Credit: The Carter Center.

This was originally published on Global Health TV on December 13, 2016.

In 1988, as a young development worker for Lutheran World Relief in Mali, I was showing a group of American Lutherans our development projects in Dogon Country, when we came across a tragic situation —a young boy with a severely inflected eye, where he had lost his sight, with menacing flies hovering around the other, still good eye.

It was a heart-wrenching scene for these people, most of whom were on their first trip to Africa. One woman took pity on the boy and, after returning to the U.S., raised money for his treatment. I took the boy to the best hospital in the country in the capital Bamako. Doctors removed his infected eye, and replaced it with a glass eye. Without treatment, he surely would have gone completely blind.

That was my first exposure to trachoma, the world’s leading infectious cause of blindness in the world. Trachoma — a bacterial eye infection found in poor, isolated communities lacking basic hygiene, clean water and sanitation – continues to plague Mali and 40 or so other countries.

In West Africa, progress on family planning but millions not treated for HIV

Women gather for the launch of the national family planning campaign in a low-income neighborhood of Bamako, Mali in April.

This was originally published on Global Health TV on April 26, 2016.

BAMAKO, Mali — Last year, there were several reports of how West Africa, after decades of seriously lagging behind the rest of the world (and Africa) in family planning, was finally starting to embrace it. IntraHealth International covered this topic extensively on its Vital blog, and I wrote about my own views of family planning in Mali here at Global Health TV.

Senegal, in particular, emerged as a family planning leader in West Africa and provided hope for the rest of the region. The three main reasons for Senegal’s success were strong political will, better coordination and collaboration and innovative approaches, according to Babacar Gueye, IntraHealth country director in Senegal.

New programs here in Mali, like Keneya Jemu Kan (USAID Communications et Promotion de la Santé, in the Bambara language), are making a major push to increase health indicators beyond the anemic progress of the past three decades. For example, the percentage of married women using any modern method of family planning in Mali has only increased from 1.3% in 1987 to 9.9% in 2013, and Keneya Jemu Kan is working to bend that rate upwards. (Full disclosure: I work as a consultant for Keneya Jemu Kan).

But a disturbing new report from Médecins Sans Frontières (MSF), or Doctors Without Borders, claims that similar progress is not being made in HIV/AIDS. On the contrary, MSF claims that millions of people in West and Central Africa are being left out of the global HIV response despite globally agreed goals to curb HIV by 2020, and is calling on the international community to develop and implement an urgent plan to scale up antiretroviral treatment for countries where critical medicines reach fewer than one-third of the population in need.

Can polio and Guinea worm both be eliminated in 2016?

Nuru Ziblim, a Guinea worm health volunteer in Ghana, educates children on how to use pipe filters to avoid the parasite when they go to the fields with their families. Credit: The Carter Center

This was originally published on Global Health TV on January 14, 2016.

Only once in history has a human disease has been eliminated from the face of the earth. That was smallpox, eradicated in 1980.

There is a reasonable chance that in 2016 two diseases could be eliminated  — polio and guinea worm.

We won’t eradicate either disease this year. Eradication requires that several years pass with no new cases being detected. But it does look like 2016 is the year we could eliminate both diseases.

To be sure, we have been close before with polio, and then lost ground. The World Health Organization (WHO) says that “failure to stop polio in these last remaining areas could result in as many as 200,000 new cases every year, within 10 years, all over the world.” So there is little room for error.

Women trying to regain dignity by ending fistula

Djantou

This blog was originally published on Global Health TV on May 27, 2015.

BAMAKO, Mali — Djantou came here from Fangala, her village northwest of Bamako, to repair her fistula, a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labor without adequate treatment. Djantou’s fistula occurred while she was in labor during her first pregnancy. Her child was stillborn. She wants to have children in the future but she is afraid — both of the operation and of childbirth. Djantou is 15 years old.

Rokia

Rokia is from the village of Tarasso, near the border with Burkina Faso. Twenty years ago, she also developed fistula during her first pregnancy. The baby was stillborn. “The urine would not stop,” she said. Rokia has had two operations but both failed. She is now awaiting her third operation. Although she is 40 years old, she still very much wants to have children.

Fistula is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation — either self-imposed or by their sometimes unforgiving communities.

How Mali conquered Ebola

These signs — which say “Stop the Ebola virus: Wash your hands regularly with soap” are still ubiquitous around Bamako three months after WHO declared Mali Ebola-free.

This blog originally appeared on Global Health TV on April 28, 2015.

BAMAKO, Mali — In the year-old Ebola epidemic, most of the attention has justifiably been focused on Guinea, Liberia and Sierra Leone, where the vast majority of the cases (26,044) and deaths (10,808) have taken place. But what about those countries that have successfully controlled Ebola — Mali, Nigeria, Senegal, Spain, the UK and the US — which account for only 35 cases and 15 deaths? 

I am spending two months in one of those countries and wondered how Mali conquered Ebola. Even though the World Health Organization (WHO) had declared Mali Ebola-free in January, I had barely stepped off my airplane at Bamako–Sénou International Airport on March 14 when I encountered Ebola control: I was scanned for a fever and offered hand sanitizer before entering the airport terminal.

Mali went on high alert after confirming its first case of Ebola in late October of last year, when a 2-year-old girl who had traveled from Guinea to Mali died. The country moved quickly in what the government considered an emergency situation. The child, who was symptomatic upon her arrival in Mali, had traveled extensively in the country using public transportation. Aggressive contact tracing was undertaken but none of the contacts showed symptoms.

It looked like the country had dodged a bullet, with only one death. But then an imam from Guinea was admitted to Bamako’s prestigious Pasteur Clinic with a diagnosis of acute kidney failure, and died on Oct. 27. That case set off a chain of transmission that led to seven additional Ebola cases and five deaths, including a doctor and nurse who had treated the imam. He was buried with full traditional rites, including washing of his highly contagious body, which may have exposed mourners to the virus.

West Africa finally starting to embrace family planning

A health worker counsels a client in rural Senegal on family planning options. Photo courtesy of IntraHealth International, © 2014 by Jonathan Torgovnik/Reportage by Getty Images

This blog originally appeared on Global Health TV on March 24, 2015.

BAMAKO, Mali — When my wife and I lived here in the late 1980s and early 1990s, our housekeeper, Korotumu, hid her birth control pills on the top shelf in our kitchen, so her husband would not find out she was using contraception. He was unemployed and they had two children. Koro figured that two was enough, at least as long as her husband was not working.

I didn’t realize it then, but Koro was in a progressive minority of Malian women at that time. The 1987 Demographic and Health Survey of Mali revealed only 1.3% of married women were using modern contraception and the fertility rate (the average number of children a woman has in her lifetime) was 7.1. Koro was part of that 1.3%.

Flash forward a quarter of a century and what has happened in Mali? Use of modern contraception has increased to 9.9% and the fertility rate has dropped from 7.1 to 6.1.

The top 10 in contraceptive social marketing

Two salesmen from DKT India make a pitch for contraceptives to the owner of a pharmacy in the Mumbai slums. In 2013, DKT India was the ninth biggest contraceptive social marketing program in the world. 
Photo: David J. Olson

This was originally published on the Knowledge4Health Blog on Dec. 23, 2014.

Social marketing organizations around the world delivered more impact than ever before in 2013 —70 million couple years of protection (CYPs), an increase of 6.8% from the 65.5 million CYPs produced in 2012, according to the 2013 Contraceptive Social Marketing Statistics just published by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article for more details).

The report provides details on 93 contraceptive social marketing programs in 66 countries, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries.

The social marketing program producing the most CYPs in 2013 was DKT Indonesia, delivering 6.7 million CYPs, consisting of contraceptives sold through social marketing channels such as pharmacies, convenience stores and medical wholesalers. The second biggest program was the Government of India, with 5.8 million CYPs (although over 40% of these CYPs were for products given out for free, which was not the case with other programs in the Top 10). Here is the Top 10 list in contraceptive social marketing in 2013:

1. DKT Indonesia, 6.7 million CYPs

2. Government of India, 5.8 million CYPs

3. Social Marketing Company (SMC), Bangladesh, 4.44 million CYPs

4. Greenstar Social Marketing, Pakistan, 4.42

5. PSI India, 3.8 million CYPs

6. Society for Family Health, Nigeria, 3.4 million CYPs

7. Population Health Services India, 3.3 million CYPs

8. DKT Ethiopia, 3.1 million CYPs

9. DKT India, 2.89 million CYPs

10. Profamilia, Colombia, 2.87 million CYPs

Mali: One of many African malaria success stories

This blog was published on The Huffington Post on April 25, 2011.
 
One night, as a young development worker in Mali 20 years ago, I engaged in high-risk behavior in a village west of Bamako -- I slept without a mosquito net in the middle of the rainy season.

I came to regret my lapse: I was struck down with a severe case of malaria a week later in Morocco, a country where malaria is not endemic, and the doctor I consulted in Casablanca could not diagnose it. Initially, I thought it was some form of flu, but soon realized it was much worse, and that I had carried it with me from Mali.

David as a young development worker in Africa.

Malaria was the most debilitating illness I had ever experienced. Usually when I am sick, I enjoy reading, or at least watching TV. But malaria made me feel more awful, more lethargic than I ever had in my life and I felt like doing nothing except staring at the ceiling.

In those days, mosquito nets were hard to come by for anyone, but especially if you were a poor, rural Malian. And most Malians were poor and rural.

Much has changed. A 2010 Roll Back Malaria report shows that Mali is part of a pan-African malaria success story: In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, more than any of the 34 malaria endemic countries in Africa studied in the report.

In malaria prevention, positive change in Mali, and elsewhere

WASHINGTON, DC — As a young development worker for Lutheran World Relief in Mali 20 years ago, I engaged in high-risk behavior occasionally. In my extended journeys around the country, I slept in villages from the Sahara Desert in the north to the Niger River Delta and Dogon Country in the center to the southern savanna, but rarely with a mosquito net hanging over me, and certainly not an insecticide-treated one.

I paid for my sins: I was struck down by malaria after an overnight stay in a southern Mali village in the middle of the rainy season. Malaria made me feel so awful, so lethargic, that I thought I might die and worse, I didn’t much care. In those days, mosquito nets were hard to come by, especially if you were a poor, rural Malian. And most Malians are poor and rural.

But a lot has changed in 20 years. Today, a new report unveiled at the National Press Club shows that Mali is an important part of a pan-African malaria success story. In 2000, there were an estimated 22,663 malaria deaths among children 1 to 59 months in Mali. From 2001 to 2010, the global investment in malaria control prevented 65,065 malaria deaths, the most of any of the 34 malaria endemic countries in Africa.

And Mali is only one piece of an even bigger story: The new report "Saving Lives with Malaria Control: Counting Down to the Millennium Development Goals" — authored by Tulane University, Johns Hopkins University, the World Health Organization and PATH and published today by Roll Back Malaria — reveals that the lives of almost three quarters of a million children in these 34 countries were saved in the last 10 years through the use of insecticide-treated mosquito nets and other preventive measures.

Most importantly, the report estimates that an additional 3 million lives could be saved by 2015 if the world continues to increase investment in tackling the disease.

This should provide a clarion call for world leaders who gather in New York next week for the UN Summit on the Millennium Development Goals as they seek ways to meet the eight goals in the five years remaining in the 15-year timeline of the MDGs.

The report shows clearly what is required: U.S. and other international donors should just keep investing in malaria control the way they have been doing the last few years, and 3 million more lives could be saved in the next five years.

Here is the press release on the report.