Wednesday, August 27, 2014

Aug 27. 2014. 7-Eleven

When you see the word “7-11” for the first time, how would you read it? July 11th? November 7th? Seven dash eleven? Or 7-Eleven?

It is a World Vision’s Health and Nutrition (H/N) 7-11 strategy; it pursues a behavior change communication (BCC) approach to have a positive impact on individual, community and environment level by 360 Degrees of Support. Among the 8 Millennium Development Goals (MDGs) that were established by the United Nations in 2000, MDG4 is to reduce child mortality by two thirds, and MDG5 is to improve maternal health by three quarters by 2015. The 7-11 strategy is to improve Maternal, Newborn and Child Health (MNCH) to achieve MDG4 & 5. This year is 2014, so we have only 1 more year to achieve those goals by 2015. Unfortunately, only 9 out of the 137 countries have achieved MDG 4 & 5 so far, so World Vision launched Child Health Now (CHN) campaign in 2009 to boost up the speed of reaching our global goals. In align with this effort, AIM-Health [Access: Infant and Maternal Health] Programme has been implemented in 10 Area Development Programmes (ADPs) of five African countries: Kenya(1), Mauritania(2), Sierra Leone(2), Tanzania(2) and Uganda(3).

In the “7-11,” “7” means the number of intervention for the mother (adequate diet; iron/folate supplements; tetanus toxoid immunization; malaria prevention, treatment access and intermittent preventive treatment; birth preparedness, healthy timing and spacing of delivery; de-worming; access to maternal health service: ANC, PNC, SBAs, PMTCT, TB/STI screening), and “11” means the number of intervention for children under 2 (appropriate breast-feeding; essential newborn care; hand washing with soap; appropriate complementary feeding; adequate iron; vitamin A supplementation; ORT/zinc; prevention and care seeking for malaria; full immunization for age; prevention and care seeking for ARI; de-worming). So we are saying “Seven Eleven Strategy.”

When I first heard “7-11,” I suspected that why it must be “7-11.” I mean, it reminded me of the convenient store, “7-Eleven.” There must be so many other interventions for mothers and children, so it could also have been “11-11,” “9-11,” or “10-10.” I wanted to ask about the origin of this name to Erin, but I did not because the question sounded so silly. :-) So I do not know the history how this name was created. Probably, World Vision staff made this name as “7-11” deliberately to make it familiar and rememberable. Anyway, I can pronounce it easily and nicely. “Seven Eleven!” During this week, I have been reviewing World Vision’s all basic concepts and strategies to strengthen my background about 7-11 conceptual framework. And I tried to find the hidden meaning of 7-11, beyond just memorizing what interventions World Vision are dealing with.

Every year, 8.8 million children under the age of 5 die of preventable disease: pneumonia, diarrhea, malaria and undernutrition. To me, diarrhea was temporary one night troublesome phenomenon. How diarrhea kills children? I was so surprised. However, for malnourished children, diarrhea is life-threatening disease because it leads to severe dehydration. Every year, up to 500,000 women die during pregnancy or from childbirth-related complications. 99% of cases have been occurred in sub-Saharan Africa and South Asia.

To achieve the goal of improving MNCH, World Vision focuses on 3 Child well-being outcomes (CWBO).
1. Mothers and children are well-nourished.
2. Mothers and children are protected from infection and disease.
3. Mothers and children access essential health services.

It looks good. All of them make sense. Everyone will be happy if we reach those outcomes. But if we think these in a different way, we realize that mothers and children in developing countries are not nourished well, are exposed to all kinds of infection and disease defenselessly, and they have no access to essential health services.

If your friend is sick, you may advise him/her, “You’d better to go to hospital.” So, we can go to hospital, receive medical treatments from doctors and nurses if necessary, go to pharmacy to get some medicine. You may be hospitalized or you go back home to take some good rest. All activities seem to be normal. (Of course, we also have to have medical insurance…) Anyway, the point is that we take it for granted that we can go to hospital 24/7 whenever we have an emergency and give birth to babies.

But, this normality that we considered it as a common behavior never applies to sub-Saharan Africa. For example, whole number of populations is 28,791 in Sherbro Island, Sierra Leone. There is only one hospital that surgery is possible, named Bonthe Government Hospital. In that hospital, there is only one medical doctor who can perform a surgery. That means, 1 surgeon is taking responsibility for 28,791 populations’ health. To make it matters worse, no one wants to go and work there as a nurse or doctor because people think living in the island is like being in prison and feel isolated. Although there are 10 peripheral health units (PHUs) and 110 community health workers (CHWs) for Sherbro people, no one can save their lives when they are in danger of medical emergency except a medical doctor. If pregnant women who need immediate help but that only one medical doctor is not available, they have to be referred to Mattru Jong Hospital located in the mainland right away. It takes 1 hour for taking speedboat, and 1 another hour to reach that hospital, but more seriously, they do not have money to purchase fuel for a speedboat. Referring to the hospital is delayed for one reason or another; even if they finally succeed in reaching the hospital, after that is too late. Prolonged or obstructed labour caused death of a baby inside of the womb, and mothers’ lives fall into in hazard.

We can see 7-Eleven anywhere. Even if you do not know where it is, you can ask a passenger “Where is 7-Eleven?” and find it within 10 minutes. You are so thirsty and famished, so you buy a Coke and bread. After quenching your thirst and hunger, and you buy some vitamin and soap to improve quality of your life. This would be normal to you. But somewhere in Africa, this is not normal. They even never know what 7-Eleven is. They have no hospital, no ambulance, no water, no essential drug, no electricity, no vitamin, no soap, and no bread. They do not even notice their children are dying because they have never heard of the symptoms of diseases. Mothers are also dying of anemia, tetanus, HIV/AIDs, tuberculosis, STIs, and neglected tropical diseases. All of diseases are preventable, but they are still suffering from those only because they have no “7-Eleven” near to their home. That is why. To me, World Vision’s “7-11” tells me that it sounds familiar but it is something that I should not take that for granted. Food, iron/folate, TT, malarial pill, vitamin A, medicine, soap, and hospital… All of them seemed to be a matter of course, but they were actually life-saving tools that should be an indispensable part of our lives. So, I would like to see that 7-11 should also be in sub-Saharan Africa and South Asia, just like U.S. people easily see it, then everyone in the world would enjoy life-saving benefits and take it for granted in the near future.


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