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Paul D. Coverdell World Wise Schools

Paul D. Coverdell World Wise Schools

Road to Lamesen

The following is the transcript of the film 'Road to Lamesen'
This film was made possible by:
U.S. Peace Corps,
Ministry of Health, Togo,
National Health Education Service of Togo,
U.S. Agency for International Development,
Centers for Disease Control and Prevention, and
Africa Child Survival Initiative/Combating
Child Communicable Diseases.

Narrator
Togo is rich in culture and tradition. A kaleidoscope of color, a nation of natural beauty. Located on the Atlantic coast, Togo is bordered by Ghana to the west and Benin to the east. Some 3.5 million people who represent 40 ethnic groups live here. They speak more than 50 different dialects, but French is Togo's official language. Togo has been independent, after periods of French and German rule, since 1960. Its roads are comparatively good, and it's proud of a healthcare system that includes small dispensaries in communities throughout the country. But the majority of the Togolese live in small communal villages which are often miles from the nearest dispensary, and it is here that health information was needed most. Information on how to treat malaria, a disease that currently affects one out of every five Africans, and claims the lives of thousands of Togolese children every year. Information about the importance of immunization to prevent such childhood diseases as polio, measles, diphtheria, tetanus, and whooping cough, and information that could help prevent the deaths of children and babies from the dehydration that accompanies diarrhea. So in 1985 the Togolese Ministry of Health began a five-year planet project aimed at improving the availability of health information to the people of Togo. A project that Peace Corps, USAID and UNICEF helped design.

Dr. Etshi Akolly
French writer said that a well conceived idea is easily implemented. It was this idea that formed the base from which the American Peace Corps and the Togolese came together for this project.

Narrator
30 health education teams were formed, each made up of two Togolese health workers and one Peace Corps Volunteer. The teams were sent to different villages where they worked with residents on special health issues. The projects' two main goals were to train local health service professionals in health education skills, and to ensure project sustainability. This model can be used in any community to empower people to improve their own lives.

In the Kotokoli dialect, lamesen means help, and the key step on the road to help for Togos children was the Community Health Education for Child Survival Project. This project was designed by two Peace Corps Volunteers and representatives from the National Health Education Services of Togo. The project supported the international initiative to combat child-communicable diseases. The plan was to train members of village development committees in health education. Each village level community would then carry these health messages to the community as a whole. For the project, behaviors to be changed were identified by the National Health Education Service staff. Specific goals, objectives, and methods of implementation were then developed. After more than two months of planning, the project was presented by the Minister of Health to the chief medical officer of each prefecture, whose staff would be responsible for carrying it out. Initially, the project concentrated on oral rehydration therapy, the treatment of malaria, and the importance of immunization. Long-term, it would enable the village development committees to identify their own health problems and seek their own solutions. But the success of any project like this depends on the willingness of the community to help plan and then implement it.

Tchao Bamaze
My role in this project is to plan with the Ministry of Health the different steps of the project and to coordinate communication at the village level.

Narrator
The village chief was fully informed about the project long before it began. As both the spiritual and social leader of the community, his blessing was essential to the project's future success.

Virginia Swezy
I think one of the great things about this project is it's not just outsiders coming in and implementing a project into an area, but the real beauty of the project is that the way it works is that it comes from the community itself. After we've introduced the project to the Chief, we then ask that we have a team of village, I guess village volunteers if you will, to actually work with us on this project so that they are communicating to their own community.

Narrator
The Chief, who fully appreciated the value of the project for his people, called a meeting of the village elders, the community's most revered leaders. At this meeting he briefed the elders on the goals of the project. They in turn agreed to nominate people to serve on the new Village Development Committee. It was this process that ensured ownership of the project by its beneficiaries, a critical element in any development plan.

Tchao Bamaze
The most important goal of the project is to organize communities so that they are able to take charge and address some of their own problems and needs.

Narrator
Later, the Village Development Committee nominees were presented at a special village celebration. Each nominee was called in front of the community and introduced. They were enthusiastically elected by applause from the audience. Their election was considered a high honor, and the committee members were proud to carry their new responsibilities. As these events took place in the village of Koumoniade, they were being duplicated in the other pilot villages throughout Togo. The first priority was to assess the level of health information in the village. Through a systematic door-to-door survey, the team developed the baseline data that would be used to tailor the project to the unique needs of each village; data that also will be used at the end of the project to determine its overall success. Careful questioning revealed what mothers believed about disease. Sometimes they said the harmattan , the dust clouds that blow in form the Sahara, were the cause.

Village Mother
Our mothers told us that the harmattan caused several coughing diseases.
Ouro-Gouni Alassane
In Koumoniade, we are 2,000, and a large percentage of the population is children. A health program for the children is our concern. Before the project, people thought that the measles were caused by the harmattan. Before the program we believed that the malaria is caused by exposure to the sun and antasenal parasites were a common disease that we didn't know how to prevent.

Narrator
It was clear that entrenched beliefs passed down through the centuries would be difficult to dislodge. There was no question that the Health Education Team and the Village Development Committee had their work cut out for them. The Peace Corps facility at Pagala, 300 kilometers north of Lomé, was the training center for the project. The facility can house up to 90 people at a time in eight dormitory buildings. Classes are held in 14 small, open-air structures called pilotes and in several indoor classrooms. It's here that the Peace Corps Volunteers and their Togolese counterparts were trained before and during the project.

Dr. Etshi Akolly
The Volunteers and their counterparts come to the training center at our invitation, the invitation of the National Health Education Service. They are invited to this training for a period of five days, and for each of the training period they could be there for any of a number of themes.

Narrator
In this case the themes related directly to the health problems of the children in the pilot villages.

Virginia Sweezy
I was placed in the village, or at the village level, so that I could actually work on a day-to-day basis with the community that I lived with. During the two years that I was actually at my post, I also was part of an in-service training which was to prepare myself and also my counterparts for particular health campaigns or focus areas that we worked on. Those were one-week training periods and they focused on three areas at the Ministry of Health considered as problem areas for Togo. That was immunization, oral rehydration therapy, and malaria.

Narrator
After each in-service training period, the Peace Corps Volunteers and their counterparts returned to their pilot villages. There they taught the Village Development Committee how to prevent the diseases that were killing their children, and how to communicate what they learned to others in the village. This was an important step in achieving the project's objectives.

Virginia Swezy
My counterparts and I begin, for example, by training our village committee on how we're going to carry out the campaign. For example, with oral rehydration therapy we'll actually conduct training sessions on what exactly does oral rehydration therapy involve and how do we pass these messages along to the community. For instance, the mixing of the actual solution itself.

Narrator
After the demonstration, everyone got to taste the fluid and everyone thought it was good. Now they all understood how to make it and how to use it to treat children suffering from dehydration. The Village Development Committees were also taught how to mobilize their communities behind a particular health issue. They learned what causes malaria, how to help prevent it and how to treat it, and they learned about a variety of communicable childhood diseases that could be prevented through immunization. Each training session lasted three months, and each was followed by a community education campaign. One community education method took advantage of Togo's public school system. The Togolese counterparts visited classrooms where they helped teachers devise lesson plans in various aspects of health education. The teachers then used the lessons to teach their students fundamentals, like the importance of clean hands for the prevention of diarrhea. Through homework assignments, each child was required to carry the lesson home to their parents and siblings. This kind of child-to-child activity makes the classroom the center of the ripple effect that reaches throughout the community.

At the same time, members of the Development Committee would conduct one-on-one training sessions in the village. In one session, mothers learned how to mix the oral rehydration fluid. The village volunteer eagerly communicated the recipe in her native language just as she had learned it in her training session. And each mother was given the opportunity to make the fluid herself. The ingredients were readily available: one liter of water, eight cubes of sugar, the juice of half a lemon, and a bottle cap of salt. Now when her children suffer from the severe dehydration that accompanies diarrhea, she'll be able to treat the problem herself and instruct others on how to do it as well.

Malaria required a different approach. Pictures were used that graphically explained how malaria is contracted and how to help prevent it. The symptoms, primarily high fever, were pointed out and the mothers were advised about treatment. A chart depicted the correct dose of chloroquine for the age and weight of the patient so that mothers would know how much of the medicine to give their children. The session concluded with a discussion period. The mothers' answers to the volunteer's questions indicated whether the key messages had been understood and if mothers had changed their beliefs.

At the local dispensary, still another group learned about immunization and its importance to their children's health. Because the mothers feared vaccinations, health workers explained the reactions that might occur and assured the mothers that these reactions would not paralyze their children nor threaten their lives. Over time, as the information was passed from one person to another, more and more mothers came to the dispensary for vaccinations and the number of children who are protected from disease began to increase.

Village Mother
I came from a village which is about a three hour walk from here. I came because I know the importance of vaccination. That's why we are not tired after walking a 10 kilometers.

Narrator
Meetings of the whole village, an important aspect of the Togolese social fabric, were also used to reinforce health messages. Using local communication traditions is another key component of the successful development project.

Tchao Bamaze
The principal means of communication in the project at the village level are theater, songs, stories, and child-to-child activities. We use these means because they are the means of communication that people already use at the village level. These are things that they are familiar with. Ways that they get ideas across to one another. We use these methods for passing health messages along.

(Song)
Open your eyes, open your ears. Listen and see how many people are dying. We need vaccinations…you must be aware…

Narrator
Traditional songs were given new lyrics, and serious plays with a comic twist featured people from the village as actors. Dressed in costumes of their own making, each actor represented a different disease. The character Tetanus wore a bird's feather in his hat. Measles was made up to be clearly infected, and Tuberculosis could hardly say a word without having to spit in her cup. Though serious, the plays also provided great amusement. No one minded watching them over and over again. A variety of plays communicated a wide range of health ideas. They were highly effective vehicles for communicating virtually any message to young and old alike. So over time, a project that began with careful planning and highly specific goals had become a community based effort. The messages were getting across. The people were now taking action for themselves.

Village Mother
Now, people understand the importance of immunization, and mothers come to the dispensary with their children. Also, before the vaccination campaign we would see that deaths were high, and now that we are getting vaccinations the incidence of disease like tetanus, polio and measles has decreased a lot and we are glad.

Aman Tchion
Now that people know the importance of preventing disease they come to the dispensary in great numbers. I am quite satisfied with my job now.

Ouro-Gouni Alassane
The changes I've noticed are these: everybody uses latrines now in my village And talking about vaccinations, every mother with small children listens to the vaccinations campaign. And in the case of diarrhea, mothers know now how to treat their children when they get diarrhea.

Dr. Komina Aflaga
The project was a success because it was very well conceived. Up to this time, in the primary healthcare in Togo, there hasn't been an appropriate approach to these problems. That is, there hasn't been a project of this type whereby there is participation from the community.

Narrator
The CHAPs project in Togo was successful because it had clear goals from the beginning. It involved its beneficiaries during all phases of development and implementation. It enabled Togolese health education coordinators to assume a new role, the role of the enabler who can assist others in the village to solve new health problems as they arise. And even more important, to help them prevent disease in the first place. This project can and is being replicated. Several of the Togolese Health Education Teams have expanded the project's activities to other villages and Village Development Committees are taking an active role in identifying new health issues to address. Training two health workers per team helped ensure the project sustainability so when Peace Corps Volunteers left Togo, the health education project continued. Deep concern for children and family has mobilized communities to fight disease through preventive action. Many have begun to build wells and latrines. Others have started family planning campaigns. Still others are reaching out to the villages that surround them, all on their own initiative.

Today a new play is ready for the people of Koumoniade, a play in which the traditional healers and revered ancestors communicate new health messages in a time-honored way. It's a play of their own creation, a testament to their determination and assurance that they will succeed. With setting clear goals and objectives, ownership of the project, and effective communication techniques, the Togolese are now prepared to meet new health challenges as they arise. From health workers to village volunteers, from village volunteers to their neighbors, from teachers to children, from children to their families, the lives of the people of Togo have continued to improve in the years since the project began. Plays, songs, and stories of their own not only provide enjoyment for everyone, they carry life-giving messages that will save these children and their children's children from unnecessary suffering and death. This is a project that has far exceeded its original goals. A health-giving project that today is growing and expanding throughout Togo on the initiative of the people themselves. A project that reaffirms Peace Corp's central philosophy of helping people help themselves. A project that started here, a program that continues to expand, and a process that can work anywhere in the world.