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In promoting public health, compassion is Margaret Asewe's best medicine

By Coco McCabe

Margaret Asewe is tall and thin. To get into her small hut, she bends her long frame nearly in half and scoots through the low door. It's quiet inside, the thick, circular walls and thatched roof buffering the blare of a TV from the far end of the Oxfam compound.

This is where Asewe stays when she's in Goz Beida, a small town in eastern Chad whose outskirts are now flooded with about 52,000 people forced from their villages by factional fighting. But when it's safe, her home is a tent at Kerfi, one of several sites in the area that the displaced Chadians have temporarily settled.

"That's what my beneficiaries are using," says Asewe about her tent. "It's good to use what my beneficiaries are using."

It's there, at Kerfi, that Asewe likes to be best—in the midst of the people she has come to help. A registered nurse and trained midwife, she is a public health promoter for Oxfam, leading a team of three staffers and a committee of 15. Her job is to work closely with families, showing them how to prevent the spread of waterborne diseases. A musical voice, a warm smile, and an untempered passion are her tools.

Asewe came to this region of Chad in mid-July 2007—at the height of the rainy season—her second posting to the country in a long humanitarian career that has carried her around the world from the tsunami-ravaged coast of Indonesia to Afghanistan, Pakistan, Sierra Leone, Ethiopia and back to Chad. It was raining that first time here, too, back in 2004 when refugees from the Darfur region of Sudan were streaming across the border, many of them having walked for days to reach safety.

Sorrows in Bredjing

She was assigned to Bredjing, a camp that now has a population of close to 30,000 people. But back then, it was just beginning to grow, a chaotic sprawl of families, ragged and tired, desperate for food, water, and shelter.

"It was a very difficult situation. Every morning we would come and we would find at least 100 people, towards the wadi, just squatting around," recalls Asewe. "Some would come with small plastic sheets. Some would have traditional mats, but some would have literally nothing. It would be raining the whole night. The children would have literally nothing on top of their heads."

Many of them didn't survive.

"They put in their own graveyard. Every morning organizations like Doctors Without Borders had outreach people just to count how many graves. Yes. So it was very very painful when they first came."

For nine months, Asewe worked with Oxfam, and alongside other organizations, to bring some order to the camp.

"I left happy, though," she says, "because I had seen the beginning and I saw all the changes—everybody putting in a lot of effort." Besides getting water and sanitation services in place, aid groups had even managed to set up activities for children. And the overcrowding was relieved a bit when some of the refugees moved to a new camp—one that was planned for them in advance, so water systems and latrines were already in place.

Coming to Kerfi

For the first few weeks of her posting to Kerfi, about 45 kilometers south of Goz Beida, Asewe couldn't even get there. The heavy seasonal rain had swollen the seasonal river, or wadi, swamping parts of the village, and making it impossible for trucks to cross. The short drive from Goz Beida to Kerfi took six or seven hours through the rain, as drivers struggled to negotiate the mud and gushing streams.

Doctors Without Borders was the only aid organization working in Kerfi at the time, said Asewe and it had managed to get there before the rains began to fall. It had parked two of its trucks on the far side of the wadi rushing by the village.

Eventually, workers built a small raft from old drums. An Oxfam driver would deliver Asew to the wadi's edge, and she would float across, her feet dangling in the water, to catch a ride on the other side in a Doctors Without Borders truck.

"We did that until September," Asewe said. "We were not able to get a driver across until October so that delayed all the possibilities."

But once she was able to set foot in Kerfi, Asewe wasted no time in laying the groundwork for her program.

Dangers of Overcrowding

In crowded situations, where there is little room for people and their animals to live as they are accustomed, the spread of waterborne diseases poses a major threat. In December Kerfi was home home to more than 3,000 displaced people—on top of the 4,200 who were already living there.

"The major issue was there was a lot of wadi water, but no clean water," said Asewe, noting that Doctors Without Borders was treating numerous cases of diarrhea. "It was pathetic. The host community, having been completely surrounded, also lost the area they would use for extra space. Their main complaint was they hardly had any place to get their animals to graze." Nor did they have any place left to use as a bathroom.

"Hence the demand for latrines and water," says Asewe.

In convincing people to adopt new ways of doing things, it's important to make them part of the process—so they own it, too. But first, Asewe has to find out what they know, and in this case, it quickly became clear that people were not making the link between the dirty wadi water they were relying on the diarrhea they were suffering from.

"That gives you a key basis where to start," says Asewe.

She organized a development committee of nine women and eight men from Kerfi who would eventually help her with the big task of public education. After some training, together they settled on three main messages they needed to convey to the community.

The messages may sound simple to western ears, but for the residents and displaced people of Kerfi, they could mean the difference between life and death.

Three messages

Here is what the health promotion committee and Asewe want the people of Kerfi to do:

  • Dispose of excreta safely. Don't use the wadis as a latrine.
  • Make sure your water stays clean once you've drawn it from the bore hole.
  • Wash your hands, especially at critical times: after touching feces, changing babies, and before cooking.

Part of Asewe's public education program also includes granting families ownership of community latrines—along with cleaning and maintenance duties. About 20 people share each latrine. When a cluster of three or four have been built for people who are under the care of one chief, Asewe arranges for a handover ceremony, with plans made for who's going to keep the latrines clean and how they'll close them down when they're full. And with each latrine, Oxfam provides a latrine kit—a brush and bucket for cleaning.

Some people get the messages very quickly; others are slower to change.

"The best people to target are the children," says Asewe. They learn quickly and adapt readily. "For adults, they may be able to understand, but changing habits may not be so easy."

But whatever the frustrations may be—wadis overflowing with water, insecurity that keeps her tied to Goz Beida, the slow pace of people's adaptation—Asewe says none of that is enough to snuff out the enthusiasm she has for this work.

"I'm still so happy to be the public health promoter who goes to that little house and finds the child and plays around with them and see how you could improve their little lives," says Asewe. "That makes me more happy. It's quite an opportunity and a blessing."