These last few weeks have flown by. The final evaluation of the newborn health program has now started! 2 weeks ago, I joined two Save the Children staff members in a week-long field visit to Chitipa, the northernmost district of Malawi. Malawi’s a small country, but it still took two full days of driving to get to this district! It may have had something to do with the fact that some of the roads looked like this:
I really enjoyed getting to see more of the countryside; while the area around Lilongwe is flat and dry, the area we drove through the first day had huge outcroppings of rock and pine trees!
The first day we stopped in Mzimba district, at the Ekwedeni hospital in the city of Mzuzu (aren’t these names fun to say? 🙂 ). In Ekwedeni, Save the Children had helped pilot a project called the Agogo Approach. Agogo means “grandparent” in Tumbuka, the language spoken in this part of the country. In addition to training facility health workers and community health workers in proper newborn care, this project was based on the realization that grandparents here are the “custodians of tradition”: it is them that a young mother often gets advice from about practices surrounding pregnancy and childbirth. So a few years ago, this project trained over 8,000 grandparents in basic maternal and newborn health messages, figuring that if they could disseminate positive practices to young mothers, their voice would complement the messages from the health facility. Apparently the grandparents were so happy that they were finally being involved in a health project (so many projects focus just on the mother and children), and that their status as elders was being acknowledged.
We spoke with the program coordinators and some of the agogos themselves, and what struck me was the strong relationship the agogos had with the mothers in their community. Elsewhere, our program was struggling to get mothers to come for antenatal care at the beginning of their pregnancy (people generally don’t like to announce their pregnancy till they’re really showing), to tell the community health workers that they’d given birth, and for those health workers to actually make a post-birth visit. Here, though, I was amazed as the agogos matter-of-factly described how the mothers came for antenatal care in their first three months; how as soon as they gave birth, they immediately let the agogos know; and how those agogos would tell the community health worker and make sure he/she came for the visit! It highlighted the importance of motivation: though some of the agogos had been trained 5 years ago, they’re excited to be involved in this work, and have a personal connection with the young women in their community, so they’re still actively involved with very little supervision and no pay! I was amazed at these quiet but staunch leaders of their community.
I can only imagine the courage of their generation: while the provision of more HIV/AIDS drugs has decreased the disease’s death rate in Malawi, up till just a few years ago people were apparently dying from the disease left and right. It’s still common to see coffin shops on the side of the road. So these grandparents have probably seen a great deal of suffering and may be caring for grandchildren whose parent(s) died from the disease. Yet they press on, helping the younger generation address this additional challenge of maternal and newborn health.