Mali: Young nurses go against the tide
International staff: 7
National staff: 45
In March 2000, five students began their nursing studies at the nursing school in Gao, a small city along the Niger River in north-central Mali. This would be nothing unusual in most countries. Yet here these student nurses are among a very small number of health practitioners going against a general "brain-drain" south.
This movement to work and live in the more developed south has left poorer northerners with even less access to adequate health care than their southern compatriots. And the need for adequate access to care is urgent in Mali, one of the poorest countries in the world: 70% of the population lives below the poverty line, and only 1% of rural inhabitants and 16% of city-dwellers have access to drinkable water.
The nursing students in Gao have been given scholarships by MSF, and they are being mentored by an expatriate nurse. After they graduate, they are committed to spending five years working in the north, in the Circle (District) of Ansongo. The area is home to about 400,000 people, a quarter of whom are nomadic or semi-nomadic. In addition to supporting the nursing school and nursing students, MSF runs a wider district health program in Ansongo, working to promote a health system that corresponds to the special circumstances of the area's nomadic people.
Promoting healthy eyes
In summer 1999, MSF launched a program focusing on ocular health in central Mali, in the region of Mopti. The area has a high rate of eye diseases such as trachoma; MSF estimates that 75% of the cases could be avoided by simple measures, including better hygiene. The goal is to integrate a basic approach to eye health into the area's primary care structure.
Local health workers have been trained to intervene and to educate local communities about eye diseases, and to raise awareness of basic hygiene techniques. At the international level, MSF is pushing for better access to one of the key trachoma drugs, azithromycine, prohibitively expensive for most Malians.
MSF supports four health centers in Selingué, in the Circle of Yanfolilia. In addition, MSF is working in the city of Kangari to improve overall management and performance of the district hospital. Employees have been asked to sign new contracts outlining specific responsibilities as well as consequences for failing to carry out these duties. This somewhat radical approach invites greater involvement on the part of the employees in the management of the hospital and a greater investment in welcoming patients and giving good care.
Mali is regularly hit by epidemics, notably yellow fever, meningitis, cholera and measles. MSF worked from 1997 through early 2000 to revise the national epidemic response plan, develop a written guidebook for managing outbreaks and monitor the country's epidemic surveillance system.
MSF first intervened in Mali in 1984.