AMURT started in Nigeria late in 2010. Nigeria has the largest population of all African countries. The indicators for maternal and child mortality are among the highest in the world. The need being so great, it was imperative that AMURT start operations in Nigeria.
EBONYI STATE – THE BATTLE AGAINST MATERNAL MORTALITY
Ebonyi state was created from the neglected areas of Enugu and Abia state in 1996 and is the poorest state in the south of Nigeria. According to the state web-site, for every 100 live births, one Ebonyi woman dies of peri-natal causes, thus giving Ebonyi one of the highest maternal mortality rates in the world. The state health department is overwhelmed and unable to provide operational health facilities to the population in rural areas.
Immunization at Obegu Omege.
LOCAL WOMEN TAKEN INITIATIVE TO OPEN HEALTH CENTERS
AMURT was invited to join a primary healthcare initiative in Ekumenyi Development Center, Abakaliki Local Government, where the communities were close to completing construction of three new health centers. ActionAid Nigeria provided the construction materials, and mobilized the communities, who in turn paid the artisans.
AMURT committed to provide furniture, medical equipment, supplies and drugs and the construction of bathrooms and latrines. Initiated many years ago, the local women’s association members levied themselves 10 naira each to start the work on the foundation of what would become the health centers. From the beginning, the vision was one of community management and ownership, thus fitting well into AMURT’s strategy in community development and primary healthcare.
The Epheniyum Women's Association
In July 2010, along with our partners, we started intensive advocacy to pressurize the government to assume responsibility. We had a difficult start, but as soon as we got the local head of the health department on board, things started moving fast. Finally the local government agreed to post health workers to the facilities and the state health department also soon gave support to the project.
Family Planning Training 8-10 March 2011
THREE COMMUNITY OWNED HEALTH CENTERS OPEN THEIR DOORS
24th of November saw a grand ‘public presentation’ of three new health centers. Her Excellency, the First Lady of Ebonyi State, Mrs. Josephine Elechi, presided and a large contingent of government officials were present. Omege Health Center had already opened on 21st September. Ephenium and Offia Oji Health Centers opened on the day of the presentation. The program was well covered in the local and national media.
Immunization at Offia Oji Health Center
The population has been patronizing the health centers, as evidenced by women coming for delivery at the clinics, the big attendance at ante-natal day, and the number of adults taking advantage of the outpatient and inpatient services, including surgery days with visiting doctors from the Federal Medical Center. AMURT’s first responsibility is to give support to ensure a high standard in the new health centers. We are modeling our approach after WHO’s ‘Continuum of Care’ packages: starting from family planning before pregnancy, pregnancy care, delivery care, post-natal care, infant care and childhood care. The activities include supplementary training for the health workers, health education in the thirty-four villages in the project area and outreach programs.
Testing blood pressure on opening day at Omege Health Center
THREE YEAR PROGRAM FOR PRIMARY HEALTH
We have committed to a three year program for Ebonyi State. Our first task is to define and establish a model in the first three health centers. Secondly we plan to scale up and replicate the model in ten more health rural health centers in Ebonyi State before the end of 2013. AMURT will also extend assistance to rural water supply and sanitation initiatives.
Many villages in Ebonyi do not have access to safe water
PARTNERSHIP FOR PROGRESS – THE WAY FORWARD
It has been wonderful to learn firsthand the potential that working in partnership offers for community development. For the first time in West Africa we are working closely with government and NGO partners, in addition to the community base we are so used to from Ghana and Burkina Faso. To assist and help build the capacity of the local authorities makes sense in a development context. The problems are so great that no NGO can carry this task alone. Working in a tri-partial partnership instills a new kind of humility that creates the right framework and mindset for successful projects. The work on the projects always comes first, as any ambition towards credit, control or ownership is held back by the common desire to serve and get the job done. It’s overwhelmingly clear that through partnership we can accomplish things that we could never achieve working separately.
Towards a brighter tomorrow. Joyfully!
To donate for AMURT’s Maternal and Child Health program in Nigeria, click here.
CONTACT AMURT NIGERIA: Tel: +234-81-3306-7130 E-mail: nigeria AT amurt.net
AMURT’s involvement in the North Tongu District of Ghana’s Volta Region started in 1990 in Mafi-Dekpoe with an educational campaign to combat the Guinea Worm menace. After employing meetings, house visits and theatre, the AMURT team soon realized that the best way to help the people would be to provide safe drinking water. A dam built by the Russians in the 1960’s for agricultural purposes held enough water for a project to serve the ten villages. AMURT was able to build a water treatment plant using the slow sand filter technology to purify the dam water. DANIDA paid for the piping and distribution. The work took years, but in August 1998, the water finally started flowing.
MOVING ON TO MAFI-ZONGO
Before the Mafi-Dekpoe project was completed, AMURT was approached by the assembly man from Mafi-Zongo. The were also badly affected by Guinea Worm. They needed a similar project. AMURT got a grant from the UNDP and constructed a dam, and the water treatment plant was constructed with help from AMURT chapters in the US and Europe. Committees were organized with representatives from the communities, and these committees took the lead in organizing the communal labor and various aspects of the project planning.
COMMUNITIES COMING TOGETHER TO COMPLETE THE RESERVOIR
After building the dam, and the water treatment plant; at the end of 2002 we were looking at the daunting task of constructing a reservoir or water tower on the top of Kpokope Hill. The project design calls for the treated water to be pumped from the water treatment plant to the tower, from where it will flow by gravity to the communities. The logistical problems were considerable. How to convey heavy construction materials to the top of the mountain? The community organizers, Emperor and Kudjo, along with AMURT coordinator, Brohim, worked hard to mobilize the communities. Fifteen truck loads of sand, along with 600 bags of cement, and hundreds of iron bars and planks of wood reached the summit and the construction was completed in July. The capacity of the tank is 100 cubic meter, or 100,000 liters.
Pulling up the pipes was a dangerous and difficult job
Here are the Kpokope Mountain Heroes the local boys lifted and secured heavy iron pipes on the steep mountain side
The women of Kpokope took up the task of providing rocks and stone chips for the construction. They climbed and chipped the rocks with hammers straight off the mountain near the construction site–more than 1500 head-pans. The communities take great pride in the construction of the water tower. The Zongo water project is community owned and community managed. The participation of the communities through labor, sand and rocks, is a key component to instill the spirit necessary to make the project sustainable.
THE WATER REACHES THE VILLAGES
2005 was a pivotal year for the project. By summer the difficult and dangerous installations of iron pipes on the Kpokope hill was completed. The pumps, generators and filter media were installed, well tuned and tested at the water treatment plant. Fifteen kilometers of pipes were laid and 21 pipes stands constructed to deliver the water to the first ten communities.
The water treatment plant produced water of a clarity and quality that had not been seen in the communities before.
NETWORK EXTENDED TO 26 COMMUNITIES
With funding from Italy, the communities and AMURT set out to bring water to more communities. Phase 2 was completed in 2006, as thirteen more communities were connected. In 2008 three more communities were added. The community leaders worked hard to mobilize the people for the grueling task of digging the trenches. At the end of 2008 the network at Mafi Zongo Water Project has extended to more than 52 kilometers, with 45 standpipes serving 26 communities with a population close to 9,000.
MAINTAINING THE DAM
In May 2006, the heaviest rains in memory caused the flood waters to rise until the dam overflowed. The dike was damaged, and the communities piled sandbags to avert a disaster. The dam held and in 2007 AMURT brought bulldozers to make the repairs. The spillway was redesigned and relocated to the southern end of the dike. To make the dam safer and increase the storage capacity, the spillway level was raised by close to 3 feet. Additional bulldozer work to improve the spillway and the dike is planned for 2009.
Since the opening in 2005, the project has been able to function satisfactorily during the dry season. During the rainy seasons we have experienced higher turbidity and problems with clogging filters that has led to interruptions in service. The Engineers Without Borders chapter of the University of Arizona at Tucson made several research trips and concluded that our roughing filters (pre-treatment filters) were unable to handle the additional silt in the dam water due to heavy run-off into the dam during heavy rains. EWB has designed new filters that will solve this problem. After much hard work, with the help of EWB, Rotary USA and the Lanesra Foundation funds are now ready for this work. The construction is scheduled to be completed by the spring 2009.
The conveying of the pipes to the trenches was done by the women
After laying the pipes, the trenches must be filled immediately
The women did most of the work to prepare the filter media at the Water Treatment Plant
CONNECTING MORE VILLAGES TO MAFI-KUMASE WATER PROJECT
The oldest water project in the area is Mafi-Kumase Water project. Using the same basic technology and set up as Mafi-Zongo Water Project, they serve a network of more than 15 communities. In 2008, with the help of AMURT Italy and ScanCad International, we were able to extend water to the Adalekpoe community. Other communities have applied, and AMURT Italy and their partners are sponsoring more communities to be connected to the Mafi-Kumase Water Project.
A MODEL IN COMMUNITY DEVELOPMENT
The Mafii-Zongo Water Project is huge in scope and technically complex. We are facing challenges to establish the project financially, technically and managerially. The local government is doing their best to extend the electrical grid to the area. Until now the pumps are powered by generators. Electrical power will help ease the operating costs as diesel prices have gone up by 300 percent since the project started. We are also seeking a closer cooperation with the government’s Community Water and Sanitation Agency for the long term interest of the project. The communities remain determined and have assumed the management of the project. Because of the vast area, the daily administration is divided into two zones, North and South. Monthly meetings are held to give the communities opportunities give input and keep themselves informed about the developments of the project. We have a long way to go, but AMURT will remain until the project is well established. Our goal is to create a model for other community development projects in Africa and beyond.
The water is distributed on a pay and fetch basis. Here the meter reader comes to collect the weekly revenue from the standpipe attendant at Adiekpe
The water projects of North Tongu District are the result of hard work by the communities and strong determination by the local dedicated AMURT staff. However, we remain reliant on contributions from individuals and funding agencies to complete the project. We are still looking for sponsors for the finishing stages of the project, most significantly the distribution and piping.
– communities come together and open their own clinic –
As the communities realized their potential through the Mafi-Zongo Water Project, they decided to open a clinic. The preparations took a year, as the locals prepared an abandoned building, sent candidates for training, and secured the necessary permission from the health department. AMURT assisted with furniture, equipment and supplies, and staff from the AMURTEL clinic in Domeabra helped out in the first months of the clinic. The Mafi-Seva Community Clinic finally opened on 1st May, 2003. The clinic staff is sustained by the income from the patient fees.
During the first year, AMURT Italy, with the help of a grant from Jolly Casa, enabled the clinic to construct a staff quarters, install solar energy for light and purchase a Landrover truck for outreach work and to take patients to the hospital.
The clinic has an outpatient department, two small wards and a maternity ward. On average the clinic has 150 patients and 4 deliveries per month. Malaria and diarrhoea are the most common complaints, along with infections and injuries from accidents, followed by a long list of other complaints.
More than fifty percent of the patients at Seva are babies and children. Here Bernice is checking a baby at the maternity ward
The staff at Seva Clinic with Dada Daneshananda from AMURT
The staff is composed of people from the project area with little or no formal qualifications. Since 2005 AMURT’s role has brought in qualified medical volunteers to give training to the local staff and improve the standard of care at the clinic. Many of the volunteers have come through the Kids WorldwideVolunteer Network – www.kidsworldwide.org. The volunteers have also played a key role in health education outreach programs that have reached more than forty villages.
Volunteers nurses from Canada; Chloe and Mandy, admire newborn twins in Alavanyo village.
Homeopathy at Seva Clinic
After a 2005 visit from Linda of the Ghana Homeopathy Project www.ghanahomeopathy.org, Emperor, the director at Seva, started learning and following regular teaching visits from Sheila Ryan, homeopathy is now integrated into the treatment on offer at Seva Clinic. Staff members, Gideon and Christopher are also learning. The response has above all expectations. Patients now come specifically for homeopathy as a result of the word of mouth news of the effectiveness of the new treatment.
Pre-natal counseling and check-ups is available at the Mafi-Seva Clinic
Prevention is better than cure – Health Education in the communities
Since 2005, AMURT, the Seva Clinic and volunteers have cooperated to bring health education to villages in the project area. More than forty villages have benefited from programs addressing a wide range of health issues. We started with malaria prevention, followed by hygiene and sanitation awareness. Teenage pregnancies and unsafe abortions pose a great risk. Volunteers from AMURT have conducted sexual health education in all the secondary schools in the area. Close to one third of women over 30 in the area have high blood pressure. There is little awareness of the dangers posed by high blood pressure, and AMURT and Seva Clinic have addressed this by offering blood pressure test and education throughout the communities. On Sundays, Seva Clinic staff and volunteers are invited to speak in churches about health issues.
AMURT volunteers conducted sexual health education for teenage girls in all the secondary schools
Teaching hygiene and sanitation at Horkpoe village
Participatory video made by the Kekkeli women themselves
Kekeli Women – women together for health and development.
In early 2007, AMURT and Seva Clinic introduced the Kekeli Woman Program. For true development, it’s essential that the local people are empowered to charge of the health education. Kekeli means ‘brightness’ and symbolized the light of knowledge dispelling the darkness of ignorance and superstition. The program trains women village health promoters. The candidates are special as they are chosen by the women in each community. After the training they go back as a health resource person in their communities. A 120 page illustrated manual summarizing all the topics covered in the course has been translated into Ewe and given to each of the Kekeli women.
Graduation of the 2nd batch of Kekeli women with volunteer trainers Olivia and Jennifer
Teaching through drama and fun
The 30 Kekeli women have divided themselves into six groups. In small groups the women come together to give health education programs in each other’s communities. To make the presentations more interesting and fun, they have abandoned dry lectures, and chosen present the topics through drama and role play. The women write the plays and act themselves, as they know very well the psychology and culture of their own people. Presentations on AIDS awareness, the dangers of alcohol abuse and superstition have been received very well.
At Dafur village the Kekeli women’s drama exposed the dangers of relying in magic and juju instead of going to the clinic to get help for health problems.
The Kekeli women’s hour long epic about the dangers of AIDS was performed at Somekpe and made deep impact.
Reproductive health in focus – combating the spread of STD’s and offering choices in family planning
During the summer of 2009, the health education effort focused on sexual health. We were shocked to find that the prevalence of STDs very high. In meetings throughout the project areas, the women expressed their interest and need for choices in family planning. In January we opened the Kekeli Reproductive Health Center in a new building at Seva Clinic. Clinic staff and volunteers teach sexual health in the secondary schools in the project area through the sexual health game.
Sexual health game at Zongo secondary school
Teenage boys after sexual health game at Wudzrlo
The reproductive health center brings awareness and choice
Maternal Health in focus – training of Traditional Birth Attendants
Starting in 2005, AMURT and Seva Clinic started to support the local TBAs with regular training programs led by Susan Crowther, an experienced UK midwife. Many women in the area don’t go for check ups during pregnancy, and often come to the TBA in the middle of the night. The TBA’s are not well prepared and all to often fail to identify the complications in time. The infant mortality remain high. AMURT, Seva Clinic and the Kekeli women are doing their best to promote the importance of pre-natal check ups. In the summer of 2008, Lisa Dalporto conducted a three month program for TBA’s. In all 25 TBA’s have received birth kits and completed the training. They have joined with the Kekeli women, and are known as Kekeli TBAs. Lisa facilitated the opening of dialog and communication between the midwives at the Adidome Hospital and the village TBA’s. We hope that this new coordination and improved mutual understanding will save lives and improve the health of mothers and infants in the area.
During the summer of 2008 the weekly all day sessions were attended by 20-30 TBAs. Here, Holali and Selassie from Seva demonstrates as Lisa explains about delivering the placenta.
Susan and Bernice instruct TBA Margaret about the use of the equipment in birth kit given to all the traditional birth attendants.
To contribute you can donate online here for the Kekeli Women and the Maternal Health Program.