Survivors of FGM facilitate discussions to end the practice

By Martha Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure.

Chifra, Afar, 23 January 2018 – “I had severe period pain, and my labour was a life and death situation,” says Fatuma Abdu, 28, who had undergone Type III FGM/C as a child. Fatuma has two daughters, a 4–year-old and a 20-months-old.

She recalls her first pregnancy experience saying, “I was very weak during my first pregnancy. I was in labour for 24 hours before they took me to the hospital. I gave birth at the hospital. However, because of our tradition, I have stitched again. My menstrual cycle pain was agonizing. I got pregnant again, and it was worse than my first experience. I was in labour for three days until I was unconscious and found myself at Mille Maternity hospital.

The doctor told me I would have suffered from fistula had I stayed home longer than that. I had a stillbirth.  I was physically and emotionally hurt. My third pregnancy was much better because of the surgery at the hospital.”

Zahara Mohammod, 28 discusses about FGM/C with “Unmarried Adolescent Girls’ Club” at Mille Woreda, Afar. © UNICEF Ethiopia /2018/Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure. She explains how it was difficult to convince her husband on her decision saying, because “The day I went through all that because of my FGM/C procedure was the same day I made that decision. My husband disagreed because we had always thought we were right to practice FGM/C. Mind you, even though he knew how much I have suffered, he still could not make up his mind. I told him I would sue anyone who would touch my daughters and that was it.”

The UNFPA-UNICEF Joint Programme has been working in collaboration with Bureau of Women and Children Affairs (BoWCA) to accelerate the abandonment of FGM/C in Afar region since November 2008. During the implementation of its first phase that ended in 2013, the programme targeted six districts out of the 32 districts in the region, which have declared abandonment of FGM/C presently.

According to the assessment made at the end of this first phase, the programme has resulted in substantial changes in belief and practice of FGM/C in target districts, with a practice decline from 90 per cent in 2008 to 39 per cent after five years of intervention. The second phase of the programme is currently implementing social mobilization interventions in three districts with the aim of improving community knowledge, attitude and practice. The programme heavily focuses on the engagement of community and religious leaders who are the most influential persons in the community. Additionally, the programme promotes community conversations through various discussion groups to create awareness and empower community members for a lasting change.

Fatuma is among the trainers who have been selected to facilitate discussion groups in their communities. The UNFPA-UNICEF Joint Programme has trained 176 facilitators for community conversation and dialogue from 3 districts on FGM/C and early marriage. This community conversation and dialogue on FGM/C is inclusive of girls, boys, men, women, and the youth in the community.

“I hope everyone listens to our suffering and refuses to undergo the FGM/C procedure.”

Sharing her experiences with the training, Fatuma states, “The training was such an eye-opener. I was challenged regarding my wrong beliefs, and it helped me speak up for others.”

According to Sheikh Mohammod Dersa, President of the Islamic Affairs Supreme Council in Afar, the FGM/C intervention by UNFPA-UNICEF has brought a behavioural change in the community.

He states, “We are grateful for what UNFPA and UNICEF have done in our region. We have been working with them hand in hand. But, we still need to work harder, because the issue is deeply rooted in social and religious norms. Social norms are powerful. We need to know that this is a generational issue, as well. It takes a lot of effort and collaboration to challenge communities and achieve the goal of ending FGM/C. We are always ready to teach our community, and we hope the programme continues and expands to other districts.”

Healthy mothers, healthy children, making healthy communities in Ethiopia

Dugem, Tigray REGION, Ethiopia, 21 December 2017 – In the health post at Dugem village, in Ethiopia’s Tigray region, Berhan Zebraruk, 25, gently strokes her child’s cheek and then gives him a sweet tickle on the tummy. Her first born, Awot Kaleab, is quick to respond to her touch. He cracks a beautiful smile displaying his toothless gums and looks his mother right in the eye for the play to continue. The little boy is restless. He grabs his mother’s cell phone and when that is taken away from him, he turns his attention to the baby next to him.

“My boy likes to play with everything he holds,” says Berhan. “I have to keep an eye on him, otherwise he put things in his mouth.”

Awot is now 9-months-old and it is time for his measles vaccination, which would complete his set of basic vaccinations for children under the age of 1, as recommended by WHO and the Ethiopia National Expanded Program on Immunization.

It is a special day for Berhan. Shortly after Awot received the vaccine, the health extension worker, Genet Desta, registered his name in the vaccine book. Then she called out Berhan’s name and handed her a certificate, a recognition that is given to mothers when their children complete taking the necessary vaccines.

Maternal and Child Health, TigrayBerhan is applauded by the other mothers in the health post for successfully vaccinating her child. She is also recognized as a role model for her best child feeding practices, including exclusively breastfeeding her son for his first six months.

Berhan attended school up to grade 10. Since she was a little girl, her dream was to become a doctor. Instead, she got married and became a housewife like many other women in her village. Yet, her education is considered an achievement in the eyes of fellow villagers.

“I wanted to become a doctor because I saw health workers treating people in my village,” says Berhan. “That wasn’t meant to happen for me, maybe it will for my son,” she added, gazing down at him.

Berhan understands that her child can only fulfil her unrealized dream if he grows up healthy and well. When she knew that she was pregnant with him, she started her pregnancy follow-up relatively earlier than other mothers.

‘’Berhan attended all of the four antenatal follow-ups and took the iron supplement properly,” says Genet, the health worker. “She was very conscious of her health and that’s why her child is very healthy.”

In Ethiopia, an increasing number of women are receiving care by skilled health workers both during pregnancy and childbirth. In the Tigray region, where Berhan lives, for instance, 90 percent of women receive antenatal care by skilled attendants, at least once, during their pregnancy, which is well over the national average of 62.4 percent.

In addition, 59 percent of the region’s mothers are giving birth in health facilities, instead of the old tradition of home delivery.

The country has seen significant improvement in immunization coverage over the past two decades. In 2000, it was only 14 per cent of Ethiopia’s children under the age of 2 who have received all the basic vaccinations, but in 2016, that number soared to almost 40 per cent.

Owing to its well-established community-based health service provision, Ethiopia is also enjoying a reduction in maternal and child deaths. Maternal mortality which was 871 deaths per 100,000 live births in 2000 has dropped to only 412 in 2016, a reduction by more than half in just 16 years. The same is also true when it comes to child mortality. More children in rural Ethiopia are celebrating their fifth birthday than ever before.

The nearly 40,000 female health workers, together with the women of the Health Development Army, easily access women and children in every household and provide much needed advice and services, including immunization to prevent the most debilitating child illnesses.

UNICEF is supporting the different components of the programme by providing both financial and technical assistance. UNICEF also supports the management of common childhood illnesses including malaria, pneumonia, diarrhoea and severe acute malnutrition at the health post level, contributing to a significant reduction in deaths.

Berhan’s task as a mother, caring and nurturing for Awot, symbolizes the bright future that lies ahead of children in rural Ethiopia. She is well equipped with skills and knowledge that will enable her to provide critical health and nutritional care for her son. Further help is also available since services, even for those in remote communities, are now more accessible.

አጣዳፊ ተቅማጥና እና ትውከት /አተት/ በሽታን እንከላከል

የአጣዳፊ ተቅማጥና ትውከት በሽታ በተለያዩ በጥቃቅን በዓይን በማይታዩ ተዋህሲያን አማካይነት አማካይነት የሚከሰት በሽታ ሲሆን ከንጽህና መጓደል በተለይም በተህዋሲያን በተበከሉ ምግቦች፣ የመጠጥ ውሃ እና በሌሎች መተላለፊያ መንገዶች ከሰው ወደ ሰው በከፍተኛ ፍጥነት የሚተላለፍ ነዉ፡፡

በሀገራችን ነባራዊ ሁኔታ በአንዳንድ አካባቢዎች የንጹህ መጠጥ ውሃ አቅርቦት በቂ ያለመሆንና በዓለም ላይ በተከሰተዉ የኢሊኖ አየር መዛባት ምክንያት የዉሃ እጥረትና በሌላዉ በኩል የጎርፍ ችግር መኖር እንዲሁም ፣ ከሕብረተሰቡ የአከባቢ፣ የግል፣ የውሃና የምግብ ንጽህና አያያዝና አጠቃቀም ልማድ አለመዳበር ጋር ተያይዞ የተቅማጥ በሽታዎች ስርጭት በየጊዜው እንዲከሰት አስተዋጽዖ አድርጓል፡፡ በተለይም በጎርፍ ምክንያት ምንጮች፣ ወንዞች፣ የውሃ ጉድጓዶች ስለሚበከሉ በአጣዳፊ ተቅማጥና ትውከት የሚያዙ ሰዎች ቁጥር ይጨምራል፡፡

የአተት ምልክቶች ምንድናቸው ?

በበሽታው የተያዘ ሰው በተደጋጋሚ አጣዳፊ ተቅማጥና ትውከት ይኖረዋል፡፡ በዚህም የተነሳ የሰውነት ፈሳሽና ጠቃሚ የሆኑትን ንጥረ ነገሮች መጠን ያዛባል፡፡ በተጨማሪም

  • አጣዳፊ መጠነ ብዙ የሆነ ውኃማ ተቅማጥ
  • ትውከትና ቁርጥማት
  • የአይን መስርጐድ
  • የአፍና የምላስ መድረቅ
  • እንባ አልባ መሆን
  • የሽንት መጠን መቀነስ
  • የቆዳ ድርቀትና መሸብሸብ በመጨረሻም ከፍተኛ የሆነ የሰውነት ድርቀት በማስከተል ህመምተኛው በወቅቱ ካልታከመ ለሞት ሊያበቃው ይችላል፡፡

አጣዳፊ ተቅማጥና ትውከት የሚያስከትለው ችግር ምንድነው ?

በአተት የተያዘ ሰው ከሰውነቱ ብዙ ፈሳሽ ስለሚወጣ በሽተኛው የሰውነት ድርቀት /Dehydration/ ያስከትልበታል፡፡ ይህ ሁኔታ ደግሞ በአተት የተያዘው ሰው በአጭር ጊዜ ራሱን እንዲስት ያደርገዋል፡፡ ከዚህ በተጨማሪ አፋጣኝ የሕክምና ዕርዳታ ካላገኘ በበሽታው የመሞት አጋጣሚው ሃምሳ ከመቶ /5%/ ነው፡፡ ነገር ግን አስፈላጊው የሕክምና ዕርዳታ ከተደረገለት የመሞት አጋጣሚው ከአንድ ከመቶ /1%/ ወይም ከዚያ በታች ማድረግ ይቻላል፡፡

በሽታውን መለያ መንገዶች

1. ምልክቶቹን በማየት

2. በላብራቶሪ ሊረጋገጥ ይችላል፡፡

ህክምናው

  • የወጣውን ፈሳሽ መተካት ዋናውና ቅድሚያ የሚሰጠው ነው
  • እንደ ተዋህሲያኑ አይነት በባለሙያ የሚሰጥ ህክምናን ተግባራዊ ማድረግ

መከላከያና መቆጣጠሪያ መንገዶች

AWD message in Amharic

  • መፀዳጃ ቤት መገንባትና በአግባቡ መጠቀም
  • ምግብን በሚገባ አብስሎ መመገብ
  • በውኃ /መድሃኒት/ በውኃ አጋር/ የታከመ ውሃ ለመጠጥ መጠቀም ወይም ውኃ አፍልቶና አቀዝቅዞ መጠጣት
  • እጅን በውኃና በሳሙና /በአመድ በደንብ አጥርቶ መታጠብ
    • ከመጸዳጃ ቤት መልስ
    • ምግብ ከማዘጋጀት በፊት
    • ምግብ ከማቅረብ በፊት
    • ምግብ ከመመገብ በፊት
    • ሕጻናትን ካጸዳዱ በኋላ
    • ህጻናትን ጢት ከማጥባት በፊት
    • በበሽታዉ የተያዙ ሰዎችን እነክብካቤ ካደረጉ በኃላ

ማንኛውም ከቤት የሚወጣ ደረቅ ወይም ፈሳሽ ቆሻሻ አካባቢን ወይንም ውኃን እንዳይበክል በአግባቡ ማስወገድ፡፡ ምልክቱ የታየበት ህመምተኛ ፈጥኖ ወደ ህክምና ተቋም በመምጣት ሊታከም ይገባል፡፡

ይህንን መሰረት በማድረግ ሁሉም ህብረተሰብ በሽታዉን በመከላከል ዙሪያ የተሰጡ መልእክቶችን በመተግበር እያንዳንዱ ግለሰብ እራሱንና ቤተሰቡን እንዲሁም አካባቢዉን ሊከላከል ይገባል፡፡