This article originally appeared in Field Notes, the MSF Canada print newsletter.
When Prosper Ndumuraro brought his Médecins Sans Frontières/Doctors Without Borders (MSF) health education team to Ngamaye, a small village in southeastern Chad, he was immediately met with a challenge.
“The village elders told us that many other people had come there,” Ndumuraro recalls, “but that nothing had ever come of it. How would we be any different?”
MSF may not have been the first organization to send health workers to Ngamaye, but Ndumuraro was resolved that its impact would indeed be different. As an MSF Information, Education and Communication Officer, it was his job to bring basic health information to communities where there was little access to medical care. But he had a responsibility to listen as well as to teach. “We told the village elders that we wanted to hear from the people of the village, to understand their difficulties,” Ndumuraro says. “In this way, we could connect with the people, so they could receive our message.”
One of the highest maternal mortality rates in the world
The message was one of reproductive health. Chad has one of the highest maternal mortality rates in the world. In the area near Am Timan, where Ndumuraro’s MSF team was based, girls between the ages of 10 and 15 often receive traditional genital cutting, which can create serious complications for reproductive health. Girls will often marry soon after, creating the expectation that they will begin bearing children.
It was successful.The nurse there told me he had never seen anyone from this village visit. Suddenly, he said, there were not only many people coming from Ngamaye for treatment, but they were telling this nurse how to do his work, because they had learned so much.
In rural villages such as Ngamaye, it can be difficult to talk frankly on topics such as women’s health without offending traditional sensibilities. Ndumuraro, who worked as an MSF national staff member in his home country of Burundi for many years before moving to Canada in 2011, made the following pitch to village elders: He and his team would meet with villagers twice a week to discuss topics in reproductive health. In return, villagers would be free to ask their own questions about healthcare topics that concerned them.
“It was successful,” Ndumuraro says. “Ngamaye was located 23 kilometres from the nearest health centre. The nurse there told me he had never seen anyone from this village visit. Suddenly, he said, there were not only many people coming from Ngamaye for treatment, but they were telling this nurse how to do his work, because they had learned so much.”
'It's like a kind of magic you have'
The nurse was so impressed by the results of MSF’s outreach, he suggested that Ndumuraro’s team must have had extra help. “He said ‘It’s like a kind of magic you have,’ ” Ndumuraro recalls with a laugh.
In fact, the MSF team relies on other forms of engagement: In addition to talking with community members, teams will often use performance, storytelling or even songs. “One of our team members created a song about the risks of female genital cutting,” Ndumuraro says. “It was very popular. People would sing it everywhere.”
After several visits to Ngamaye, villagers gave Ndumuraro an indication of how welcome his team and its messages had become in the community. They surprised their guests with a special feast, which villagers had organized in order to give thanks for MSF’s help and instruction.
“I do not cry very easily,” Ndumuraro says, “but in that moment I had to find a place behind a tree to cry just a little bit.”