By Madeleine Logan
TAMALE, Ghana, 9 May 2012 - One morning about 10 years ago, Afakiba Azure's daughter, Ndepoka, started vomiting. She did not stop for three days. On the fourth day, Ms. Azure strapped the 10-year-old girl to her back and walked 10 hours to the nearest hospital. But in spite of the nurses' efforts, Ndepoka died.
This was not Ms. Azure's first loss. Her two sons, Ndego and Abugri, had both died when they were 2 years old - Ndego from diarrhoea and Abugri after complaining that he had a headache. There was no clinic near their home in Kpalsako, and the closest nurse was a day's walk away.
In those days, herbal remedies were the only option for parents of sick children. Ms. Azure treated all three of her sick children with traditional brews of boiled leaves. "All I could do was pray and give them the herbs," she said.
When the herbs did nothing, villagers would carry their children, as Ms. Azure did, for 10 hours to Zebilla hospital. In later years, they could travel for two hours to the new Binaba Health Centre.
"But even then, children would get sicker and sicker during the walk. At times, you would get there and the child is dead," Ms. Azure said.
Community-based care
Mothers were relieved when nurses from the Ghana Health Service visited Kpalsako in 2008, offering to train two local volunteers to treat children sick with malaria and diarrhoea. The UNICEF-funded Community Case Management program meant that children would be treated without having to leave the village.
Paulina Ndego was chosen as one of two Community-Based Agents (CBA). She received training and medication to treat children between 6 months and 5 years old. She was also tasked with educating the community about positive health and hygiene practices. In 2010, she also started to treat pneumonia.
Susannah Alariba said the community voted for Ms. Ndego because she was hardworking and patient.
"She is always there," Ms. Alariba said. "We can run to her in the middle of the night, or wake her up early in the morning."
Ms. Ngedo's wooden medical box is filled with malaria medication, amoxicillin syrup for pneumonia, and zinc tablets and oral rehydration salts to treat diarrhoea. If the child does not improve, Ms. Ngedo refers them to the closest health centre, which is now a one-hour walk away, in Zongoire.
Even before she became a CBA, community members would come to Ms. Ngedo for advice on how to treat their sick children. She told them everything she had learned from her aunt, who was a nurse. Ms. Ngedo herself would have loved to become a nurse, but she never learned to read or write.
A lifeline in an emergency situation
Martha Asam said her two children were rarely sick after Ms. Ngedo convinced her that they should sleep under a mosquito net. The cases of malaria in the community have dropped from 15 children per month when Ms. Ngedo started to five children per month.
Ghana Health Service National Child Health Coordinator Isabella Sagoe-Moses said CBAs have brought health care to those most in need. In 2010, community volunteers treated approximately 83,000 cases of malaria and 17,000 cases of diarrhoea in the three northern regions, which were among the first to implement Community Case Management in Ghana.
"Today, Community Case Management is firmly part of our formal Child Health Policy and Strategy," Ms. Sagoe-Moses said.
"When I started working with UNICEF in Uganda in 2004, Community Case Management was my first project, a lifeline in an emergency situation," said UNICEF Ghana Health and Nutrition Specialist Geoffrey Acaye, who has overseen the programme's rollout in northern Ghana. "It took a lot of advocacy to convince people to entrust the use of antibiotics at the community level."
Ms. Azure believes that her three children would not have died if there had been a CBA in the community. Her focus now is helping her three grandchildren - Monica, Comfort and Awiniman - will survive to adulthood.
These days, when they are sick, she takes them to Ms. Ngedo and gets prompt treatment.
"Now I am confident that they will live, if God blesses us," Ms. Azure said.
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