“That child could have been dead by morning,” UNICEF Health Officer Christopher Otti Ajumara tells me. “If we hadn’t come here today, he could have died.”
We are in Ajuong Thok in northern South Sudan, having just visited the home of Lina, 20, a mother of three. Her nine month old son, Mapir, became ill with malaria five days ago and is exhibiting danger signs. This is the first time he has been treated. “I kept thinking, when tomorrow comes, the child will be okay,” Lina said.
Ajuong Thok, which hosts a refugee camp for people who have fled fighting in neighbouring Sudan, is also the site of a pilot programme to prevent and treat common childhood illnesses.
UNICEF has been running the Integrated Community Case Management (ICCM) programme since 2016, in partnership with African Humanitarian Action (AHA). It has treated 26,000 children.
Mortality among under-fives in South Sudan is extremely high at 93 per 1000 live births – about 850 young children die every week. The three main killers are malaria, diarrhoea, and pneumonia. Widespread malnutrition makes children even more vulnerable.
Most of these deaths are preventable, but often children do not receive timely and correct treatment. Distance, combined with a lack of primary health care services, trust, and education amongst mothers are the main barriers. And it is these barriers that the integrated community case management programme seeks to address.
In Ajuong Thok, AHA has trained 70 people from both the refugee camp and the host community in diagnosing and treating these illnesses, as well as how to screen children suffering from severe malnutrition.
They treat patients at home, and teach families how to avoid diseases. The target of the programme is to treat every child within the critical window of 24 hours after the onset of symptoms; which has been 98 percent achieved so far. “It is one of the most successful programmes I’ve ever been involved in,” Ajumara says. Being treated at home means patients do not have to visit over-burdened health facilities. “The health worker treats the patient in the environment where the disease is caught. They can see why the person is sick; maybe there is stagnant water, maybe there are holes in [mosquito] nets. At the clinic the person only comes with the sickness,” he says.
Parents are often reluctant to take children to clinics because of the distances involved and the long queues they face when they get there. Ashi Kaka, a single mother of eight, who fled fighting in Sudan, says she is unable to care for her children when she walks to a clinic. “Now, thank God, we have the health workers. They come to my home if a child is sick, even in the night, and I can get medicine. And it has given me time to take care of the house and raise money for food.”
With approximately 60 percent of patients at local clinics presenting with the three diseases targeted by the ICCM, the burden on health centres has also been much reduced.
In Ajuong Thok camp, home to over 37,000 refugees, I meet Maria Chichi, who has been working for the ICCM programme since late 2016. Having won the trust of mothers in the refugee community, she is now the first person they go to with a sick child. “I am often woken several times a night by mothers seeking help for their children,” she tells me. “Education and treatment, the two things go together,” she explains. “If you take a microphone and speak through it, people won’t understand you. The best solution is to go house to house, to speak directly to people, so that they can understand how to improve their health.”
Mariam Ezikial, 35 and a mother of six, is part of the second stage of the ICCM programme. Her family, along with 50 others, were trained in health promotion and disease prevention such as hand-washing, proper sanitation, and immunization. They now educate their communities on how to live healthier lives, through one-to-one interactions and meetings with friends and neighbours. “When we sit down for coffee I tell my friends and neighbours about how to stay clean and healthy,” Mariam explains. “In the beginning, people were asking ‘Why should we do this? We don’t wash our hands where we come from.’ But as I kept telling them every day, they have realized that it can make a difference.”
As a result of the pilot project, there has been a 40 percent reduction in the number of under-fives admitted with severe pneumonia, malaria and diarrhoea. Christopher Otti Ajumara credits much of the success of the initiative to the commitment and passion that the community health volunteers bring to their work. “This is the work that I accept inside my heart,” says Maria. “And I do it freely, to save the lives of the people.”
The Integrated Community Case Management Programme has been made possible through the generous support of ECHO – European Civil Protection and Humanitarian Aid.
Ellie Kealey is a digital producer for UNICEF South Sudan