Giving mothers and babies a better chance

Moses William, a community health worker in Kasia, and Marsela Rafa, a midwife, talk about how putting an end to open defecation has given their village a new lease of life.

Sitting in the concrete shell of Kasia's clinic, Moses William says that the hardest thing about his job used to be his powerlessness as children died of diarrhoea because of the lack of medicines. “I felt so sad, and I would even run to the town to see if any NGOs or governments could rescue the situation,” but often with little effect, he says. “I used to give them Oral Rehydration Salts (ORS), but when that wasn't there, it was just advice. Some of the children were so sick.”

Cases of diarrhoea have plummeted

The clinic is empty but for a side table with a few pill pots, a delivery bed and weighing scales. William says that the supply of medicines hasn't improved, but thanks to the Community Approaches to Total Sanitation (CATS) project, cases of diarrhoea have plummeted. “In a month I used to get between 20 and 30 cases, and most of them were children. Now it’s eight,” he says.

Kasia beat nine other villages in a competition to become Open Defecation Free (ODF) by making sure each household and public building had their own latrine and hand washing station. Aside from increased productivity and wealth in this farming community, mother and child health has been CATS’ greatest success.


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And general health has improved too

“The pregnant mothers even complained of diarrhoea and it could lead to them losing the child or making it premature,” says local midwife Marsela Rafa. She says that greater awareness about basic sanitation has also improved general health. “When I used to get called to the pregnant women’s houses, sometimes I would see soap but they only had one and a special towel to be used for the birth,” she says.

Now, mothers are realizing that washing hands with soap and not going to the bush to defecate is both more cost-effective and can save lives in some of South Sudan’s most remote villages.

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