Somalia: “Health promotion is vital”

Fatumazahra Khalif is a senior health promotion manager with MSF Somalia. She explains the impact health promotion can have and why working alongside local communities is key when it comes to saving lives.

Since I was a young kid, my mum has always put a real emphasis on education. She’s a nurse, and she is always giving back to the community. She really inspires me. She worked for MSF a long time ago, in the 90s.

Now 30 years on, I’m part of the team too.

I work across three MSF projects in Somalia, mainly in Mudug, Sool and Baidoa. Our projects focus on maternity and paediatric care, nutrition programmes, and clinics for people living in and around camps for displaced people. The health sector in Somalia is in a critical condition, with rates of maternal and neonatal mortality among some of the worst in the world.

For me, there are two main aspects to health promotion: sharing information and advice with the community and then learning from them about the challenges they face, the needs they have and how MSF can improve the health services we offer.

For example, lots of women here give birth at home. For some, that’s because they have always relied on traditional birth attendants, who haven’t had access to medical training and may not be able to assist if there are complications with the birth. So, we make women aware of MSF’s free maternity services.

But even mothers who want to come to the health facilities may not be able to. In our focus groups at one project, women told us that they don’t have the money to pay for transport, so we now provide an ambulance that means mothers in labour can reach the hospital, even at night. These insights are key to helping us understand how we can design our services to have the greatest impact.

We also find that when communities don’t have access to all the information they need about health, dangerous rumours can start to spread. That’s when health promoters are vital.

Recently, a huge cholera outbreak was tearing through one of the regions where we work. Cholera spreads through contaminated water or food. It causes severe diarrhoea and vomiting, leading people to become so dehydrated that the disease can quickly become fatal, especially in children or the elderly.

We can treat cholera, but during this outbreak, we saw that people were not coming to medical facilities until it was too late. Our team talked to different community members and learned that many people had misinformation, believing that cholera is just a fever but that if you went to the hospital, you would die. Because people were putting off coming to the hospital until they were in critical condition, the doctors weren’t always able to save them, so we could see how this rumour was being believed.

So, we worked with the Ministry of Health to do a mass awareness campaign. Using radio ads and teams with loudspeakers, we explained that if people came to medical facilities promptly, they would receive treatment that could actually be life-saving. It worked. People started coming, and as a result, we were able to save lives and reduce the spread of the outbreak.

That cholera outbreak was not an isolated incident. The health situation in Somalia is dire. Hundreds of thousands of people have been displaced because of armed conflict and violence, overwhelming limited health facilities.

Meanwhile, years of drought have meant failed harvests, leaving many communities with limited access to both clean water and food. Rates of malnutrition are high, and outbreaks of water-borne diseases and measles have hit some regions hard.

Challenges like inaccessible roads, fuel and electricity shortages mean transporting medicines and medical equipment is extremely difficult, and these supplies are limited or non-existent in many areas. And there are security problems which can make life dangerous, both for the communities we serve and for anyone trying to reach them.

But MSF’s principles of impartiality and neutrality are really important to me: we work to offer healthcare to the people most in need, whatever their different cultural beliefs and norms. So I try to remember something a colleague said recently: despite the difficulties, we must never give up on what we are doing.

I often think about a little girl I met at an eye camp supported by MSF. These ‘camps’ travel to different areas, working intensively over several weeks to provide vision-related healthcare. Frequently, a camp will be the first time these services have been available in an area for years, so as health promoters, it’s our job to work with community leaders to ensure people know when and how they can access this care.

This little girl was around eight years old and had been partially blind throughout her life. However, the community helped spread the word about the camp, and her parents decided to bring her. The surgical team were able to operate and restore her sight.

I met her after her surgery – she was so happy. When I need encouragement, I think about her. People in the areas where we work are often living in very tough conditions, and there’s so much more that must be done to ensure they have access to the care they need. But I remind myself that by working alongside communities, it is sometimes possible to have a real impact. Before, this girl was partially blind, but now she can see.