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Think of the dentist, the drill, the dentist chair and most of us cringe. However, we all know dental care is an important part of general healthcare for all people.

Let us take you on a journey to Operation Mercy’s work in western Azerbaijan.

Dr Liu is Operation Mercy’s dentist who visits schools in different parts of the country to provide dental care amongst the school children. His work is supported and organized by his fellow Operation Mercy co-workers who partner with Dr Liu.  They set up his dental visits to the towns where they are based.  In the couple of days that he would spend visiting a school he would examine and clean the children’s teeth and arrange to come back and do fillings where necessary.  His mobile clinic, with generator powered, portable equipment is set up to do all of this. The Operation Mercy teams see to it that dental hygiene teaching is given at each school visited, usually handing out tooth brushes and tooth paste. Preventing dental cavities is always the best solution.

How do the children like the dentist? ‘I can tell you that, yes, many children are very nervous the first time they come but our team and Dr Liu explain everything to the children and what they will experience.  When they're done they usually say it was easy! Then the next time they hop right into the dentist chair and they encourage their classmates to do the same’.

"They loved the pictures of the baby developing in the womb and had many questions about a baby’s formation.”

This was the response heard time and again throughout a successful year distributing the Miracle of Life pregnancy calendar in the GBAO region around Khorog. 

Khorog is the main medical center for the entire GBAO region. The team introduced the important maternal health material to relevant medical professionals and expectant mothers through trainings conducted at the Oblast General Hospital and Khorog Polyclinic from March through to September. Both of these medical centers handle many patients and have become partners in this project, along with the GBAO Ministry of Health.  

During the summer, pregnancy calendars were delivered to 180 villages across GBAO. Later in the year, the team returned to these villages to conduct day-long participatory trainings based on the pregnancy calendar. A survey was taken at the beginning and end of the training to measure how much was learned during the day. The overwhelming conclusion was that participants’ knowledge increased significantly in this area.

The autumn was a time for follow-up and evaluation, revisiting the villages to assess how much the calendar was being used and how useful it was proving to be.  Workers at village clinics consistently responded with enthusiasm and, among other things, highlighted the value of the section on communicating with husbands and mothers-in-law. These evaluations also allowed the team to distribute the newly developed anaemia poster aimed at helping the 99 percent of women affected in GBAO.

To make the project sustainable, the team involved medical staff from across the region including doctors, nurses of maternity and neonatal departments, midwives, interns and trained and volunteer village health workers. This way they could pass on their knowledge and skills to new medical staff and patients.

Where There Is No Doctor (WTIND) is a health handbook first written in Spanish for farm people in the mountains of Mexico many years ago when the author helped form a health care network now run by the workers themselves. The first English edition was published in 1977.  WTIND has now been translated into more than 70 languages and is used by village health workers in over 100 countries. It is now available in three neighboring languages: Uzbek, Dari (Northern Afghanistan) and Kyrgyz.

Recently we translated portions of WTIND into the local Tajik language. We aim to provide nurses and community health workers with this information in pamphlet form with topics on eyes, nutrition, maternal health, and health and sickness in children.

In a country where poverty is a significant problem and adequate health care is limited our Tajik edition of WTIND information will be a valuable resource to complement our Miracle of Life Pregnancy Calendar.

The following stories are from participants of our maternal health lessons in Khujand. We base our lessons on the Miracle of Life pregnancy calendar, which gives women important information during each month of pregnancy and during their children’s infancy.

Story #1:
I am a gynaecologist and I am pregnant. I really like the pregnancy calendar. I use it every day in my work. It is very easy to read. Sometimes I even read it with my husband. I am so happy you came here to teach preventative measures for our women. I want to say thank you to the staff for providing us with this information.

Story #2:
One of the mother’s group participants, who is currently pregnant, told us she is reading the pregnancy calendar every day and has learned many new things. She has been reading it together with her neighbour and studying the pictures. Recently she was admitted to the hospital for several days and brought the calendar with her so she could read it together with the other women in her room. The sections she liked most were the ones about good nutrition, how to raise your children, and exercises for pregnant women. She is doing these exercises at home and finds them helpful.  

Many women in Afghanistan deliver their babies in their own homes. Only 16 percent of women have one or more antenatal visits from a trained health care attendant and during their lifetime, they have a one in eight chance of dying during pregnancy (UNICEF, 2008).

BLiSS (Birth Life Saving Skills) is a health education program about pregnancy, birth and new born care.

BLiSS trainers facilitate learner-centred, participatory lessons that guide illiterate women in the community through the process of recognizing maternal-child health issues, identifying health related problems and coming to a consensual decision about appropriate solutions.

Operation Mercy is committed to training midwives, nurses and health educators in Afghanistan and has done so since 2005. In 2010 in Kabul and Mazar-e Sharif combined, we were able to train over 1200 women and 300 men in the BLiSS approach.

When health surveys were completed in the Wakhan valley a number of years ago, the team discovered that no health care was found available in this area that lies in the far north east corner of Afghanistan high in the Pamir Mountains.

32% of children in the Wakhan valley died before the age of 5, while maternal mortality was very high, between 2000-4000 per 100.000 women.

With this in mind the field team started a community health and development programme, with a focus on building trust in the communities and on setting up a basic health care system. From the start, the focus was on community participation, capacity building and sustainable help. Since then a Wakhi man has been supported financially to become a nurse. He now works for the project as a community nurse while continuing to receive further training from expatriate medical doctors on the team.

Training was given for 7 men and 7 women from different villages as community health workers. These health workers completed subjects on diagnosing and treating the most common diseases, malnutrition, and performing clean deliveries. Operation Mercy will continue to provide refresher training and supply needed medicines.

Two local men and two local women received Birth Life Saving skills (BLiSS) training enabling them to teach other local groups. This training continues to be tremendously effective in providing safer environments for pregnant mothers and infants both during and after childbirth. Both men and women groups are taught through simple, participatory educational training by these local BLiSS-trainers and supervised by the expatriate team.

When starting the first BLiSS course we ask about the participants children. There were many who have between 3 and 6 children and many have lost some children. Two men stood out with their life stories. The first man had 8 children but all of them died as babies or in young age. The other man has eight living children but also lost 8 children. Sometimes during the courses women start to cry when they realise that with the knowledge provided by the course some of their babies might have survived ... if only they would have known earlier.

Through training and enabling local Wakhi people health care is now available to these village people living in the Wakhan valley.

'Talibe' is a Wolof word meaning 'follower' or 'disciple'. In Mauritania under the Talibe system, village boys, sometimes as young as 4 years old, are sent by their families to study the Qur'an with a marabout, a folk Islamic teacher. In return for a basic education of the Qur'an and minimal board and lodging, the boys are required to make a daily contribution to the marabout. The boys must earn this money themselves by begging on the streets or from house to house, selling small items in the market or theft. Thus the boys spend much of their lives on the streets. There are estimated to be as many as 1,000 Talibe boys roaming the streets of the capital Nouakchott.

The 'Talibe Boys' Project is currently operating 2 centres in the city and more than 100 boys are involved in the programs. Here the boys are shown love in action. They are given nutritious meals, a place to shower and some clothes. Twenty five of the boys are sponsored to go to local schools. There are also opportunities given in the centres for literacy classes teaching Pulaar, one of the local languages. Most of the boys cannot read or write and these literacy classes have helped many of them become literate. The older boys are also taught vocational skills in carpentry, hairdressing and tailoring to provide life skills. Several boys have gone on to apprenticeships with local craftsmen. Fun activities that all boys enjoy are also found in the centres. Football and art and craft classes are attended enthusiastically!

Our project demonstrates to the Talibe boys that they are loved and their lives have value. With opportunities of education and vocational skills these boys can have hope in the future. The project also gives the centre staff opportunity to have regular contact with the Marabouts, and to visit the boys' home villages and have contact with their parents, helping us to understand the conditions and beliefs that undergird the Talibe system. Through such visits, we are able to help people envision transformation, and to fight the poverty that allows such a system to persist.

Nouakchott in Mauritania is a young and very poor city with a population of around 1 million. The majority of its inhabitants are first or second generation migrants who have left rural areas because of economic pressures and who now live in urban ghettos surrounding the city.

The key question arises, how to help the poor in Mauritania?

What we have learned through many years living amongst the people we serve, learning the local language and sharing our lives with shanty town dwellers, is that the BEST way to tackle the root causes of their poverty is to empower and equip the local people to build effective community structures.

By focusing on the identification and promotion of key strengths inherent within the communities, rather than on the elimination of weaknesses and problems, we build with an asset based community development and self help approach.

This year we will be promoting our self help groups and establishing these in new areas of the city, training community health volunteers, developing the current kindergarten programs, continuing with literacy programs, micro-business training and training in worldview. Our aim is to build on the strong foundations which have been laid, help families identify new opportunities and encourage a deeper and broader ownership of the program by the communities themselves.

Previous and ongoing surveys undertaken at the centres clearly show a marked improvement in the welfare of the participants themselves and their families over time. Beneficiaries show increases in income-generating activity, increased ownership of poultry, sheep and goats, better school attendance among children and greatly increased functional literacy, whilst a decrease in severe malnutrition among preschool children. We were greatly encouraged!

We are confident and optimistic that our eight community development centres and self help groups will have a positive impact amongst the poor we serve in Nouakchott.

 Good health is worth more than money.  A Tajik Proverb

Operation Mercy, Khujand takes weekly health lessons to Sartukai, Navobod and Kuyuktol villages to support the work of local medical institutions and raise health awareness.  In cooperation with village medical staff, women attend presentations using the Miracle of Life pregnancy calendars, where they learn about the development of the fetus, nutrition, anemia, exercises for pregnant women, nursing the baby, family planning, caring for sick children, and immunizations.

Upon request from the Endocrinology Center in Khujand, Operation Mercy participated in a children’s diabetes camp last summer.  The team invited an international specialist to help children with diabetes learn about their condition, about good nutrition and maintaining healthy glucose levels.    

The official grand opening of the Navobod village medical clinic was held in April 2010.  Operation Mercy provided materials for the clinic’s construction and the community provided the labor. 

This project is held in cooperation with the Sughd Region Department of Health, the mayor and administration of Yova Subdistrict, village leaders and medical staff, and the staff at the Endocrinology Center and Health Centers in the City of Khujand.