Medair News 2017 - Community Comes First by Medair

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Community Comes First Medairâ&#x20AC;&#x2122;s Innovative Approach to Health and Nutrition

2017

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WELCOME

Dear reader, In this edition of the Medair News, we’ll focus on people and communities in crisis and on the work that Medair is doing to respond to their suffering. In South Sudan, the United Nations has declared famine. Humanitarian needs these days are more than urgent! However, bringing humanitarian aid is not our only objective. We are careful to ensure that our efforts don’t lead to a situation of dependency. Instead, we want to strengthen the autonomy and capacity of every man and woman we help, which is the only way to produce real change that improves the lives of people in the long term. As part of our community-based approach, we train women on a variety of topics such as disease prevention and infant feeding. Once trained, these women organise discussion groups in which they share their new knowledge with other women. Women are thus empowered to become effective agents of community behaviour change. As the report presented here on the Yusuf Batil camp in South Sudan shows, the good news is that, even in the most difficult situations, change is possible! When people are treated with respect and as equals, their motivation and courage to overcome crises can flourish remarkably. This hope is not only for the displaced of South Sudan, but for us all in whatever challenges we may encounter in our own lives. A big thank you for your support! Warmly, David Farner Manager, Medair Zürich Office

S O U T H S U D A N

I've Seen a Lot of Change

7 I R A Q

The Courage to Hope

H E A L T H & N U T R I T I O N

When Emergencies Threaten Lives S O U T H S U D A N

An Unorthodox Approach to Saving Lives

H E A L T H & N U T R I T I O N

Community Comes First

B U I L D I N G C A P A C I T Y

We Have Hope That Never Dies

Sources: 1. Reproductive, maternal, newborn, and child health: Key messages from Disease Control Priorities, 3rd Edition. 2016. Black, R.E., Levin, C., Walker, N., Chou, D., Liu, L., Temmerman, M. World Bank. 2. Building on the Current Evidence to Strengthen Community-Based Service Delivery Strategies for Promoting Child Survival. 2009. USAID. Programme Funders Afghanistan: Global Affairs Canada, Common Humanitarian Fund, Canton of Zurich DR Congo: Swiss Agency for Development and Cooperation, US Agency for International Development, European Union, Medicor Foundation (LI), UN Children’s Fund, Common Humanitarian Fund, Gertrude Hirzel Foundation (CH), and Migros (CH) Iraq: US Agency for International Development, Swiss Solidarity, European Union, German Federal Enterprise for International Cooperation, UN Office for the Coordination of Humanitarian Affairs, Medicor (LI), Transform Aid International (AU), Fondation Famille Sandoz, Fondation Resurgens Lebanon: Global Affairs Canada (through World Relief Canada), European Union, UN High Commissioner for Refugees, All We Can (UK), UN Office for the Coordination of Humanitarian Affairs Somalia: Dutch Ministry of Foreign Affairs, through the Dutch Relief Alliance Joint Response, in partnership with Dorcas Aid International (NL), TEAR (AU), US Agency for International Development, Ferster Foundation (CH), Resurgens Foundation (CH), Gertrude Hirzel Foundation (CH) South Sudan: European Union, US Agency for International Development, UK Government, South Sudan Humanitarian Fund, Swiss Agency for Development and Cooperation, US Department of State, Dutch Ministry of Foreign Affairs, in partnership with Tear NL, and through the Dutch Relief Alliance Joint Response for South Sudan Cover Photo: Women gather in Yusuf Batil camp, South Sudan, for the celebratory launch of new Care Groups that promote good health, hygiene, and nutrition. © Medair /Diana Gorter

6 A F G H A N I S T A N

ood News from G Kandahar Province

S O U T H S U D A N

Thank you

MEDAIR

Chemin du Croset 9 1024 Ecublens Switzerland Tél: 021 694 35 00 suisse@medair.org medair.org

SOUTH SUDAN

I’ve Seen a Lot of Change In 2012, tens of thousands of desperate Sudanese refugees ﬂed across the border to Maban County, South Sudan. They overwhelmed the community’s capacity to shelter or care for them, and many struggled to survive. Medair sent an emergency health team to Yusuf Batil camp, where we responded to a deadly outbreak of Hepatitis E.

Abas, 9 months, is no longer malnourished, thanks to community-based health and nutrition. “If Medair were not here, people would die,” says Abas’ mother Noti.

Five years have now passed and we’re still there, but things have changed immensely for the better. We’ve seen the incredible impact of community-based health and nutrition interventions during times of emergency.

Refugees in Yusuf Batil camp celebrate the opening of a 24-hour delivery clinic last year. “That’s a big change. This enables more women to seek out skilled assistance and deliver their babies safely.” – Jillian, Medair relief worker

I M PAC T I N Y U S U F B AT I L C A M P Medair’s approach to health and nutrition has cut mortality rates and kept them below emergency levels since 2012.

(birth–6 months)

99%

Up from 55.1% 1

Measles Vaccinations

(mothers)

96%

74%

Up from 49.9% 1

I’ve seen a lot of change in my community since we started with the Care Groups. In my group, the women are very interested. It’s now rare to find people lacking vaccinations. In the beginning, there were lots of diseases. Now, there are not so many. – Asja, 34, Care Group volunteer 1

Safe Handwashing Practices

Up from 47% 1

Exclusive Breastfeeding

Y U S U F B AT I L C A M P (population: 41,280) 1 primary health care centre (with a 24-hour delivery ward) and 1 nutrition clinic Water treatment and distribution for the whole camp A thriving Care Group network that reaches most of the camp’s households and teaches families how to improve health, hygiene, and nutrition Training that builds the capacity of local staff to deliver health and nutrition services

Latest data assessed in January 2017; earlier data were from a June 2014 survey. medair.org

May 2017

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H E A LT H & NUTRITION

When Emergencies Threaten Lives

Medair’s life-saving health and nutrition teams treat illnesses, prevent diseases, and nourish children back to health.

SOMALIA Ayan carried her crying and malnourished son, Adan, into a health clinic in south-central Somalia. “I am worried I might lose him,” she said.

In Somalia, Medair works with community volunteers to break down these kinds of negative attitudes towards health providers and clinics because they undermine public health.

After careful treatment, Adan recovered from his illness. Ayan is so grateful that she was told about Medair’s clinic—and that she had the courage to ignore her neighbours. It saved her son’s life.

Thankfully, Ayan refused to listen to the people who feared the health clinics. She travelled for

seven hours from her village to reach the Medairsupported facility. “I was welcomed warmly,” she recalled. “I was given medicine and told to come back the next day.”

Ayan once believed that only prayers would heal her child, but his condition worsened. A relative told her about the health facilities supported by Medair, which offer services at no cost. Yet her neighbours warned her not to go. They feared the health facility and cautioned her not to trust the people there. “They scolded me,” said Ayan. “They told me I would come back with a dead child.”

LEBANON Ikram promotes healthy behaviours to patients and their families at a Medair-supported clinic.

DR CONGO Kavira rejoices at the health of her newborn twins. Kavira had lost a child during childbirth twice before. She was overjoyed this time to have a successful delivery at a Medair-supported clinic in Beni Territory. “I had a Caesarean. The nurse had told me that I was expecting twins but I didn’t believe him!” laughs Kavira. 4

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“A few years ago, the clinic was nothing like it is today,” says Samia, a mother and Syrian refugee. “It wasn’t easy to find a doctor, and if there was one, there wasn’t any good equipment or medication. The clinic has changed a lot. Now there are more doctors, better services, and free medication. I really want to thank Medair and their donors.”

H E A LT H & NUTRITION

Community Comes First Medair responds to disease outbreaks, acute malnutrition, alarming spikes in illness or death, or families fleeing their homes who face health risks. We support existing health clinics when possible, and we provide life-saving health and nutrition services ourselves. What makes us distinct is the way we blend community-based programming with our health and nutrition services. Medair is at the forefront of adapting proven, evidence-based techniques from development settings to emergency relief situations. The results to date have been remarkably effective.

M E D A I R ’ S I N N O VAT I V E A P P R O A C H T O H E A LT H A N D N U T R I T I O N CARE FOR PEOPLE WHERE THEY LIVE

Mobile health and nutrition clinics Vaccination outreach Home visits Integrated community case management (iCCM) iCCM trains people in the community to deliver door-to-door testing and first-line treatment for the most deadly diseases in the neighbourhood.

CHANGE FROM WITHIN

TREAT EVERYONE WITH DIGNITY

Professional training and supervision of local health and nutrition staff Community health workers Peer-to-peer Care Groups

Inclusive, welcoming approach Listen to individual concerns Psychological first aid

A Care Group is made up of volunteers, mostly women, who learn about lifesaving health, nutrition, and hygiene behaviours, and share what they’ve learned with their neighbours.

Psychological first aid addresses the impact of trauma during emergencies. We listen, assess needs, offer support and comfort, link to services, and protect people from harm.

HOLISTIC

SUSTAINABLE

In emergencies, there’s always more than one public health problem to tackle. A community-based focus looks at the ways public health problems overlap, so that we can address urgent needs and respond to the underlying causes.

Knowledge and changed behaviours stay in a community long after Medair leaves. INNOVATIVE

We have the flexibility to adapt our health and nutrition programming rapidly in response to unexpected circumstances.

CLOSER TO HOME

Studies have shown that delivering basic health and nutrition services where people live saves more lives than having a perfectly equipped hospital that people must travel far to reach.

COMMUNITY-DRIVEN

We treat people with respect and empower them to become agents of change.

AFFORDABLE

Our training helps prevent future cases of disease, often saving us from returning to communities at high cost.

See page 2, citation 1

1600 1400 Lives saved (in thousands)

A 2016 Lancet study1 concluded that the deaths of 1.44 million children (1-59 months) each year could be averted through an essential child-health package— delivered mostly via community care (93%) plus primary health centres and hospitals.

1200 1000

Hospital Primary health centre

800 600

Community

400 200 0

Essential Child-Health Package

The communitybased approach makes a massive life-saving difference for children!

AFG HANI STAN

Good News from Kandahar Province

That’s all true. But Medair has been working in Kandahar province for three years now, and we want to share the good news that we’ve seen over that time. Our community-based nutritional services began with eight mobile nutrition sites near urban areas. We nurtured strong community relations and extended our services to 27 rural nutrition sites— reaching families who could not safely or easily travel to clinics. “When they ﬁrst did an assessment in our area, we didn’t believe they would actually come,” said a community elder. “For 10 years, no organisation had come to our area. But now, Medair comes regularly, setting up the clinic, spending time with us, and treating us and our children with respect.” We treat children under ﬁve for acute malnutrition, while also training mothers on basic hygiene and nutrition. Our nutrition extension workers go from home to home screening children for malnutrition. Khambira was one of those children—diagnosed as severely malnourished, she was transformed to good health during her treatment at the nutrition clinic. “Whenever one of our relatives comes to see Khambira, they don’t believe she is the same child they saw before, she has changed so much,” said her mother. Our Nutrition Manager is convinced that the programme succeeds because Medair focuses on 6

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working closely with the community: “I spend a lot of time talking to community leaders and explaining why the messages about health, nutrition, and hygiene are important. Now, they even give the messages through loudspeakers in town and the religious leaders are sharing them as well. They tell everyone to embrace the project and the lessons. This is really special!” Medair uses a Care Group approach in Kandahar province. More than 500 volunteers teach groups of men and women about how to improve the health of their families, including how to curb malnutrition in their children. “I have noticed a lot of changes where we first started with Care Groups,” said a Medair relief worker. “The biggest changes were seen when we gave lessons about safe water, handwashing, and breastfeeding. "Before, there were a lot of children with diarrhoea. In Kandahar, a lot of people think if you have diarrhoea, you shouldn’t drink… but it is very important to drink. We taught the mothers, and they taught their neighbours, and now children are healthier."

Signs of Success One day, a Care Group volunteer approached a Medair supervisor and said a recent training had helped save her boy's life. The woman explained that her baby had a cough which one night got much worse. She remembered the danger signs of pneumonia from the past week’s Care Group lesson. She removed his shirt and saw that his chest looked the same as the drawing she had seen. She woke up her husband and neighbours and they went to the hospital right away. The baby was diagnosed with severe pneumonia and stayed in hospital for treatment. “But now, he is playing again!”

If you have heard of Kandahar province, it is likely for all the wrong reasons: decades of conﬂict, displaced families, malnourished children, and limited access to health care, water, or food.

IRAQ

The Courage to Hope Overcoming trauma on Mount Sinjar, Iraq Baseema was 13 when the crisis began. In August 2014, armed groups attacked Sinjar, thousands were killed in their homes, and tens of thousands fled to Mt. Sinjar without shelter, food, or water. Their way out was blocked by gunmen and they became trapped on the mountain. Baseema has struggled with mental illness ever since. She cannot remember anything about that time, but talks about being unable to leave her bed for months. “I couldn’t see, and I couldn’t move my hands,” says the shy teenager. “For many months I couldn’t walk, and when I did, I would fall unconscious.” Baseema saw visions and heard voices in her head. People dressed in black and white told her she had to obey them. A doctor diagnosed Baseema with schizophrenia and gave her medication, but her symptoms didn’t improve. In September 2016, she began weekly visits with Firas, Medair's psychosocial counsellor.

I can stand up to them myself. Now I tell them I am only listening to my doctor,” said Baseema with a smile, looking up from the floor. “My life has changed completely. I can go out of the house now, and my family is so relieved.” Firas leans forward and claps his hands in encouragement. “She still has a long way to go,” says Firas, clearly so happy for Baseema and her progress. “But she has hope now. She has experienced that she can get better, and she can help herself. She is working hard.”

Talk-based psychosocial treatment is still new in this culture, where asking for help can carry deep stigma. Yet there is no judgement to be found among the survivors of the August 2014 events. “We all need help,” says the village leader. “I need it, my wife needs it, and my children need it. It is obvious; I see it every day. Anytime there is a loud noise or a plane, people look around in fear, thinking that someone is coming for them again.”

“At first I just talked with her, to let her begin to trust me,” says Firas, who was also impacted by the events of August 2014. “I gave her freedom to open up so I could better understand her symptoms. With any new patient, we talk first about what she is experiencing, and as we find ways to deal with those things, we get closer to the actual trauma. My job is to open doors for her.”

“This is a very good team,” he says of the Medair staff. “They respect people and are doing everything they can to help. They always greet people with smiles and everyone can access the medicine they need. We are very grateful they are here.”

With Firas’ support, Baseema went back to her doctor, who revised the diagnosis to post-traumatic stress disorder and adjusted her medication. “Firas told me I can refuse to listen to the visions in my mind.

Baseema’s name means “with a smile,” and when she talks about her life today, her smile even reaches her eyes. Everyone has noticed the changes in her. She is ﬁ nding her way. She has the courage to hope.

Throughout northern Iraq, Medair provides health care, cash transfer programming, water and sanitation projects, and emergency response. In the Sinjar region, mobile medical clinics visit underserved communities on a weekly basis. medair.org

May 2017

Medair

SOUTH SUDAN

An Unorthodox Approach to Saving Lives

In 2015, Medair heard reports that children under ﬁve were dying at emergency levels in a crowded UN displacement camp in Bentiu, South Sudan. Malaria rates were escalating to very high levels. Our emergency health team responded to the crisis, but in one week, 50 people died—30 died before they could even be treated at a crowded health facility.

To succeed, we needed to quickly fi nd and train capable people from within the camp. One of them was Kuach, who had made it to the camp with his family after trekking four nights through the bush. As a Medair CBD, Kuach would walk through the UN camp, calling out greetings to everyone, young and old. He treated everyone he visited with great care, and took time for them, despite the pressure of the work. “The iCCM programme is the best,” said Kuach, his eyes lighting up. “Many organisations appreciate it. Medair has reduced a lot of cases of pneumonia and malaria.” With a team of 20 CBDs and three supervisors, Medair was soon treating 2,000 people a week. This kind of community care made a real difference to mothers like Angeline. “Two of my children were treated this morning and two more were treated when the Medair people were going house to house,” she said. “If Medair had not done that, the children could have lost their lives.” Although some people were skeptical at first about iCCM, the results soon won them over. “We saw and treated so many people who may never have reached a clinic. It really helped bring the numbers of illnesses down and helped control the deadly situation,” said Wendy. “It helped convince people about the benefits of this type of approach.”

Our plan was simple: Instead of waiting for patients to come to an overcrowded clinic, we would train community members to go to them. These “community-based distributers” (CBDs) would walk door to door, assessing for a few of the most common diseases (mainly malaria), providing medicine and treatment, and referring those with more complicated symptoms to seek treatment at a clinic.

Today, Medair provides iCCM in Somalia, South Sudan, and DR Congo. In South Sudan, our team helps hundreds of thousands of people in need each year with a wide range of life-saving health and nutrition services.

We needed to try something diﬀerent. With more than 120,000 people in the camp, all the clinics were overwhelmed with patients. We decided to try “integrated community case management” (iCCM), a method used mostly in developmental contexts but rarely tried for emergency responses. “No one thought it was a good idea at ﬁ rst,” recalled Wendy Dyment, Medair physician. “I remember the health cluster and other agencies on the ground weren’t convinced, but they still allowed us to try our approach.”

BUILDING CAPACIT Y

In November 2016, Medair held a health and nutrition training workshop in South Africa for senior staﬀ from 14 countries.

We Have Hope That Never Dies Taban* is a South Sudanese health professional who works for Medair in Kandahar province, Afghanistan. Words alone are never enough for me to describe how helpful Medair has been in my career. In 2013, I began working with Medair in Yusuf Batil refugee camp in South Sudan. Every three months, I was given a short leave to continue my studies. This is something I will never forget in my life. Medair realised and recognised what I was capable of. My line manager started trusting me with roles and allowing me to grow. One year later, I was promoted to the clinic officer in-charge, then after completion of my studies, Medair offered me a position as a health manager. All of that helped me to develop and become a resourceful person.

I still miss home, especially my Medair team in Maban. I miss our strong culture full of love and dances, hard work, determination, and respect for one another. It pains me a lot when some people describe the South Sudanese as different from who we are. We are bigger and better than the culture of war inflicted on us. We are the most hospitable people you will ever find. We like visitors, we love parties, we love sharing the little we have. We have hope that never dies and that is our strength.

I dreamed about doing humanitarian aid outside of South Sudan. My managers supported my dream with one heart, and here I am today, making that difference, and continuing to learn and grow as a nutrition manager in Afghanistan. Medair is a unique organisation, with strong values—practical values that can be applied by staff everywhere in the world. Medair has an ability to transform their staff from nobody to somebody. I am a testimony to that. I think I will have a lot of knowledge and experience to carry home by the end of my period in Afghanistan, and that really is my dream.

Taban, wearing the Medair vest, works with his Afghan colleagues.

* name changed and face not shown for security reasons medair.org

May 2017

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YOUR GIFT

A community-based approach to health and nutrition makes a massive life-saving difference for children.

B E C O M E A M O N T H LY S U P P O R T E R T O D AY AT D O N AT E . M E D A I R .O R G

CHF 30/month Support for 3 Care Groups in South Sudan

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Your gift today saves lives tomorrow.

CHF 60/month Life-saving treatment for 1 malnourished child in Somalia each month

CHF 160/month Safe delivery for 1 woman and child in South Sudan each month

OTH ER WAYS TO HELP

Migros has been supporting development projects in Switzerland and many other countries since 1979. Each year, the company gives a total of 1 million Swiss francs to 20 recognised NGOs. In 2016, Medair benefited for the first time from Migros’ support. We would like to extend our warm thanks to Migros for their generosity! Their fi nancial support allowed us to continue our water and sanitation projects in DR Congo. Medair has been helping the people of this African country for almost 20 years. We work to ensure that the health centres have a safe supply of water and access to sanitation and hygiene. If you would like to know more about our work in DR Congo, please read the article "A Valuable Commitment" (in French and German), published in the April issue of Migros Magazine. You will hear from Yannick Sauter, Swiss project manager, who talks about the challenges he faces in his work in DR Congo, but also about the successes that encourage

Migros Supports Medair’s Water Project in DR Congo

Yannick Sauter, a Swiss national working with Medair in the Democratic Republic of Congo.

him. Along with our donors, we thank Migros once again for the conﬁdence and trust they give us and our work! Article link in French: https://www.migrosmagazine.ch/migros/infosmigros/article/le-fonds-de-soutien-migros-un-engagement-precieux Article link in German: https://issuu.com/m-magazin/docs/migrosmagazin-13-2017-d-vs

Swiss Cantons and Communes by our Side

Swiss cantons are known for their involvement in and ﬁ nancial contribution to cultural projects all over Switzerland. But did you know that they also support international relief projects run by recognised NGOs? For the past three years, Medair has been one of the organisations supported by various cantons. We’d like to thank the cantonal lottery funds of

A joyful harvest: seeds distributed by Medair have borne fruit.

Zürich, Aargau, Nidwalden, and Appenzell for their generous support! We would also like to thank the municipalities of Binningen, Bülach, Carouge, Chêne-Bougeries, Echandens, Ecublens, Erlenbach, Gy, Illnau-Effretikon, Lausanne, Presinge, Pully, Randogne, Rapperswil-Jona, Schlieren, Vandeouvres, Zollikon. The canton of Zürich has chosen to support our projects in Afghanistan where Medair provides safe water, installs sanitary latrines, and treats mothers and children suffering from malnutrition. We are pleased with the significant commitment of the cantons and communes who have come together to support these important aid projects. To gain public funds, we must raise a certain percentage of our financial needs from private funds. So we extend our thanks to you as well, dear donors, who have such an important role to play! medair.org

May 2017

Medair

Thank You! Abuk, 25, is doing all she can to feed her four children and keep them alive. "There is no food,” said Abuk. “Flooding and drought have affected the crops. Our children are malnourished.” When Abuk heard about Medair’s new nutrition clinic in Aweil, she rushed there with her daughter Achan. “I heard from people that Medair is helping malnourished children and that their condition will improve,” she said. On top of severe malnutrition, Achan had malaria as well, making her health that much worse. Her legs were stick-thin, her skin wrinkly and loose. There was no time to lose. Achan received her first dose of malaria treatment right away. Her mother learned how to administer the malaria drugs at home, and was given nutrient-rich supplements that help children recover quickly from malnutrition. “The Medair staff are treating me very nicely,” said Abuk. “They are able to help my child.” Abuk clings fiercely to a mother’s hope. The hope that her daughter will recover, that her future will look brighter, that one day all four of her children will go to school. Thank you for your gifts that are giving mothers like Abuk reasons to keep hoping. South Sudan is in the grips of a severe food and nutrition crisis, with famine declared in some areas. Your regular monthly support is a blessing that enables us to stay on the frontlines of this emergency. Your gifts save the lives of children like Achan every day.

MN1701-EN

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SOUTH SUDAN