Mothers know best

Amar, Keegan, Becca, Sabrina, Lisa and Iulia with some of the women from the first mothers’ group we visited.

One of our roles while in Dang was to meet with various local Mothers’ Groups to facilitate the delivery of educational modules about sickle cell disease (SCD). Mothers’ Groups are preformed groups supported by Her International and CP Nepal. This network of women serves to not only empower women, but also strengthen the communities and households that they come from. There are currently 32 groups consisting of 980 mothers from the Dang region of Nepal. These monthly meetings teach women skills to become self-reliant on a personal and financial level. The mothers’ groups facilitate microcredit loans, which give these women the previously impossible opportunity to start their own businesses. Furthermore, these meetings serve as a place for public awareness sessions on various topics, such as domestic abuse, mental health, how to vote, and since our team’s inception, sickle cell disease (SCD).

A mothers’ group listening to female community health volunteers delivering an educational module on sickle cell disease. Photo courtesy of CP Nepal.

The first Mothers’ Group meeting was located in a small village about an hour away from our hotel in Lamahi. We arrived at the meeting place early, and had the chance to get a tour of a few nearby homes. We learned that the walls were constructed from a hardy mixture of dung, rice husks, and mud, with bamboo beams lining the inside, serving as supports. The roofs of the homes were either tin, or made from a similar mud-mixture, with straw coating on the outside. The former is the cheaper and more readily available option, while the latter provides much needed insulation against the sweltering heat of Dang.

While the homes were modest in size, every inch of space was utilized. The home we spent the most time in was composed of a bedroom and a cooking room. Upon walking into the cooking room, we were immediately confronted with two human-height clay pots, used for storing rice and other grains. Continuing further into the room, we saw various cooking utensils and gadgets lining the walls. The fire burning “stove” was set against the far wall. While wood and other plants are the preferable fuel of choice, when supplies are low, human dung becomes a cheap and plentiful option. The walls of the room were stained with soot all the way up to the ceiling, after years of withstanding the smoke produced as a byproduct of cooking meals for the family to enjoy. 

After the tour of the homes was complete, most of the mothers had arrived. We were warmly greeted in the classic Nepalese manner, with red dye smeared on our foreheads and garlands. The women had also crafted beautiful clay pots, creatively decorated with beads, corn, and other colourful crops. Some of the pots spelled out messages, such as “welcome”, while others had purely artistic designs. The women carried these clay pots on their heads, without the aid of their hands or other supports. They encouraged us to try the same, but as we learned, this carrying method is NOT as easy as it looks. Shockingly, there were no clay pot casualties on the day, despite a few shaAaAaky balancing attempts.

After our elaborate welcome, and all ~40 of the mothers had arrived, it was time to deliver the educational modules. We were accompanied by Female Community Health Volunteers (FCHV) and CP staff, both of whom had been trained in the delivery of these SCD modules. These volunteers reach out to various communities in the Dang district to promote health education. In providing this service, they are role models for women in their communities, and will likely inspire women to effect positive change. We brought a number of posters we had created to aid the presentation, as well as educational pamphlets on SCD to hand out to the women afterwards.

Before the presentation began, each woman filled out a pre-module survey assessing their understanding of SCD and potential screening history. This process was slightly chaotic, but with the help of CP staff, instructions were clearly delivered, and each woman completed the survey. 

Members of a mothers’ group filling out pre-module surveys. Photo courtesy of CP Nepal.

The FCHVs and CP staff then went on to deliver an enticing, interactive module we had created on SCD in Tharu. The mothers appeared engaged, and asked plenty of questions.

Female community health volunteers delivering the SCD module to a mother’s group. Photo courtesy of CP Nepal.

After the module was complete, we administered similar post-module surveys to each mother. It was great seeing them critically think and apply what they had just learned. Once everyone was finished, we gathered all the forms, thanked the women profusely for taking the time to learn about SCD, uttered innumerable “Namaste’s”, and hopped into our tuk tuks to head back to Unako House.

At Unako House, our team went to work, compiling and coding all the data we had just gathered. We were all extremely encouraged by the improvement the women showed on their surveys, and their indicated newfound willingness to get themselves and their families screened! Based on our first glance at the data, the mothers showed great improvements in their understanding of SCD after hearing the module. We look forward to further analyzing the data to assess the effectiveness of our knowledge translation. We hope that this analysis will help us to optimize the consistency and effectiveness of our module delivery going forward.

All in all, it was a joy to see these women take ownership of their own education and health. We were humbled by how welcoming and appreciative they were, and inspired to continue to advocating for the health and well-being of their communities.

– Nepal Sickle Cell Team 2019

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