Southwest nonprofit reaches out to families in Tanzania
In the highlands of northern Tanzania, just one paved road runs through Karatu District. The rest of the district, a sprawling 2,500 square kilometers, relies on dirt roads and foot paths — dusty in the dry season, muddy in the rainy season and rocky year-round.
I last reported on the activities of WellShare International three years ago in the Southwest Journal (“A banana tree with a few stalks is stronger,” Oct. 22, 2007).
Formerly known as Minnesota International Health Volunteers, this Stevens Square-based nonprofit has changed its name to greater represent its mission of improving the health of women, children and their communities around the world.
In rural Tanzania, a woman dies during childbirth every 21 minutes. Approximately 8,500 mothers die annually, which is 86 times the rate in the United States. There are many factors that contribute to the crisis, but most come down to women giving birth alone or with an untrained attendant and far from a health facility. One out of two Tanzanian women still deliver their babies at home without a trained attendant. When complications arise, women simply cannot reach a health facility in time.
WellShare’s team of 23 Tanzanians execute a U.S. government-funded child survival project that focuses on maternal care and prevention and treatment of the most common childhood diseases, including malaria, pneumonia and diarrheal disease.
Veronica Mariray, nursing officer for WellShare International, explains, “We are training traditional birth attendants about safe delivery [and] prevention of infection during delivery and teaching young women about antenatal care, intra-partum care, post-natal care, exclusive breast feeding and early vaccinations.”
In a place where staffed health clinics are few and far between, traditional birth attendants, often older village women who have been trained by WellShare in collaboration with the district’s health management team, play a crucial role in providing health education, basic medical care, home-based life saving skills and referrals to professional care.
“There’s a shortage of health services, so we are training traditional birth attendants about danger signs in pregnant women — swelling of the legs, swelling of the face, a migraine headache — and now, when they see these signs, they can get a woman to a health facility right away,” continues Mairiay.
When that determination is made, there is still the challenge of reaching a healthcare facility. In Laja village, the nearest health facility is 17 kilometers away, and women in labor are carried in a makeshift stretcher. In good weather, the journey takes 10 hours by foot. In bad weather, the roads are impassable.
WellShare has devised a donkey ambulance (dawa donkey in Swahili) as a sustainable and affordable solution to this crisis of emergency transport. The dawa donkey is a cart pulled by a team of one or two donkeys. The cart uses an innovative, animal-friendly design so that the weight is born by the animal’s back muscles (rather than neck muscles in the traditional yolk model used on oxen). The cart has a removable canvas cover to protect women from the elements, is padded, includes a mattress for a mother to lie on and has space for her traditional birth attendant and a family member to sit next to her on the journey.
When not needed for emergency transport, the dawa donkey can be used to help villages transport food, agricultural supplies and water.
Once a baby is safely delivered, Survive and Thrive groups — also created by WellShare — educate and support young single mothers, who are often stigmatized in their communities, to have healthy pregnancies and healthy children. Survive and Thrive groups incorporate both health education and income generation: the women have planted vegetable gardens and are learning to sew bags and bake and decorate cakes to sell in their communities. The profits are then used to ensure that women can afford school fees for their children and pay for health services when needed.
WellShare takes a holistic approach and works closely with the community to craft solutions that are appropriate, acceptable and sustainable.
“We are definitely at the community level, the place where change needs to occur,” explains Jolene Mullins, WellShare’s country director in Tanzania. “To achieve our overall goal of decreasing maternal and child morbidity and mortality, we must improve health status and provide lifesaving services at the household level — mother, child, father, family. Our project works closely with Tanzania’s Ministry of Health and Social Welfare and the local government to build capacity among health professionals and community health workers.”
The approach has been remarkably successful. The project’s mid-term evaluation, conducted in 2009, reported, among other things, that people were now much more likely to access health services in a timely manner.
Women receiving post-partum care within 72 hours of delivery had increased by 72.4 percent in the two years of project implementation. Likewise, children who were taken to a health facility when experiencing danger signs for serious and potentially fatal childhood diseases increased by 51.1 percent.
Ultimately, WellShare is fostering healthy communities by encouraging communities to be their own advocates. “Most importantly, we want the people we serve to understand that healthcare is their right. Access to health services is not a luxury; it is a basic human right. Raising awareness and increasing education motivates people to no longer accept that there is nothing that can be done when a child is sick or that there are no services for pregnant women. We have given the communities we work with important information and knowledge to advocate for these services,” said Mullins.
Founded in 1979 as Minnesota International Health Volunteers, the nonprofit initially sent Minnesota doctors to provide medical care in post-war Vietnamese refugee camps in Thailand. Since then, WellShare has shifted its focus from crisis intervention to providing health education to women and children; the organization has trained some 4,000 community health workers in seven countries. Since 2000, WellShare International has brought lessons learned from international health home and started programs working with Minneapolis’ Somali resident community.
WellShare International appreciates the support of the Minneapolis community. For more information on domestic and international programs and opportunities to get involved, please visit wellshareinternational.org.