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Storytellers bring a touch of magic to health promotion in Afghanistan

24-08-2009 Feature

Ensuring that families know about simple basic health care is an important part of the ICRC's water and habitat programme in Afghanistan. Jessica Barry joined a team of hygiene promoters on their daily round.

  ©ICRC/J. Barry    
Storytelling helps Malalai (right) and Nasira to put their messages across    
  ©ICRC/J. Barry    
The women use a loose-leaf book of pictures drawn by a local artist    
  ©ICRC/J. Barry    
Nasrin takes down family details before the session starts. Fozela looks on    
  ©ICRC/J. Barry    
Hygiene promotion is an integral part of the overall water and habitat programme    

 One recent morning, I visited homes on the edge of Kabul with a team of hygiene promoters from the International Committee of the Red Cross. Their work involved giving mothers tips on basic health care, and encouraging them to be diligent about keeping their homes and compounds clean. What struck me was how the four women -- Fozela, Nasira, Nasrin and Malalai -- conducted the sessions as if they were story telling. It had their audiences entranced.

All the women are of a certain age. Sitting there on red floor cushions in a curtained room, watching them settle into their routine -- the children and their mothers listening, absorbed -- was to be reminded of the power of the spoken word. And how, when you have the gift, mere words can be filled with magic, and even dry, prosaic terms such as'oral rehydration salts, and'keep food covered', can sparkle.

Every weekday morning, Fozela, Nasira, Nasrin and Malalai set off to the poorer quarters of Kabul city to speak with families about how to stay healthy without incurring costly doctors'fees. Their message is simple: Adopt good hygiene practices and use common sense, and you can create a healthy environment for your loved ones.

The women's arrival usually draws a crowd of excited children, clamouring to know if the team has come'to do vaccinations'or'to make a survey'. " No, we are health educators, " the women explain, leading the youngsters pied piper-like into the nearest house where their mothers are waiting.

In a country such as Afghanistan where most of the female population is illiterate, there would be little use in handing ou t brochures or guidelines with information on healthy living. Instead, the women illustrate their storytelling with a loose-leaf book of drawings commissioned from a local artist.

Each house in the chosen district is visited up to three times over several months, the better to monitor change.

" One of the best things about the work is seeing the family's adjustment over time, " remarks Nasira. *The children are cleaner, they don't get sick, and their mothers are pleased. "

The ICRC's hygiene promotion programme started back in 1997, but only with male hygiene promoters. A women's team was created in 2002, after the departure of the Taliban from Kabul. In addition to the four women in the Afghan capital, there are all-women teams in Mazar-i-Sharif, Herat and Jalalabad. The male hygiene promoters visit madrassas, mosques, and schools to talk about the importance of clean water, and other environmental health issues. They are particularly active in Kandahar and Kabul where the ICRC has ongoing water and sanitation programmes. 

Both the men and women hygiene promoters have been trained by the ICRC. 

When choosing female recruits preference is given to those who are their family’s breadwinner, or who have otherwise fallen on hard times.

After thirty years of conflict, few Afghan families remain unscathed. But for war widows, and women who are the head of the family because their husbands, fathers or brothers are absent or sick, life is particularly hard. Added to that, when taking into consideration how, in much of Afghanistan, a women’s place is in the home, then it is possible to see just how dim the chances are for a woman to earn an independent living and support her family.

Nasira and Malalai have been part of the programme from the start. Initially there were 11 lad ies on the books, many of them war widows. Later the team expanded to 17. Today, with so much accomplished, in Kabul at least, the team has shrunk to four. Working in such close harmony, it is hardly surprising that the women have become friends. 

Fozela, whose husband is an invalid, is putting her son through university. Nasrin, (35) who is single, looks after her bedridden, 82-year-old mother and a16-year-old niece. The child's mother, Nasrin's sister, died during the war, as did one of her brothers. Another brother is jobless, and lives at home. She provides for her whole 12-member extended family.

Forty-seven year old Malalai is no stranger to hardship either. Her husband disappeared in the nineteen nineties when the Taliban were in power, leaving her alone to bring up their five children. Despite enormous efforts to try and find him, no trace has ever been found. 

The women's work has been so successful that next year they plan to extend their hygiene promotion sessions to the rural areas, outside Kabul.

" There are lots of other organisations working in the city, " explains Mr Aziz, the hygiene promotion programme manager. " So we feel we need to reach out into other locations that are conflict affected. "

In the places where it will be difficult for the ladies to go in safety, they will instead meet with local shura (council) members, who will help them select community volunteers for the ladies to train. They will then carry on the work out in the villages where the team cannot go.

It will be quite a challenge for the four women, but one they are looking forward to.

" We may have to adapt the messages, as life in the rural areas is different from the city " observes Nasira. " So we will do a survey first. "

" In the city, people know about the Red Cross, " comments Malalai. " but it might not be the same out in the countryside. There will be stories on many subjects to tell. "