Contributor: Laura Peer

Kamran's doing OK. At seven years old, he has healthfully made it through the critical first five years of life in his village. The youngest of six children, he is already learning to take on the duties that his family will expect of him as a young man. But his newborn nephew and his newlywed sister may not have it so good.

Kamran lives with his large family in Yelagaj, a small village located high on top of a rocky mountain in the Masalli district of southeastern Azerbaijan. In addition to its geographical isolation, the village suffers from lack of employment, poor infrastructure and schools, and a deteriorated health care system -- all legacies of the former Soviet Union and of independent Azerbaijan's lack of support for the much-needed repairs and reforms. Because of the bad conditions, many young people who manage to attend university in the capital, Baku, or another city, do not return to Yelagaj. The scarcity of newly trained teachers and health workers retuning home directly affects the amount of new information reaching the people that live there. The result: poor health Ð especially for the youngest children and their mothers.

But the people of Yelagaj have something to hope for.

In recognition of its commitment to delivering sustainable community health solutions to severely underserved populations, the United States Agency for International Development awarded Mercy Corps a five-year, $1.3 million grant to implement the Azerbaijan Child Survival project. Utilizing the same innovative spirit that defines Mercy Corps' approach to humanitarian umbrella grant management in Azerbaijan, and drawing on the successes of our Child Survival project in Central America, Mercy Corps launched this program at the end of 2001 in three remote regions of Azerbaijan: Yardimli, Lerik and Masalli.

These areas have the highest maternal and infant morbidity and mortality rates in the country. Until now, they have been largely neglected by the government and international development and relief efforts due to the concentration of efforts on people affected by the Nogorno-Karabakh conflict in western Azerbaijan.

Working in partnership with the Ministry of Health, the project aims to reduce infant and maternal illness and death and improve the quality and increase utilization of basic village-level health care in the targeted areas. The Child Survival project will directly benefit 20,000 children under five years old and 30,000 women of reproductive age, including the women, infants and young children in Kamran's family.

Because of the lack of health information and access to care, many women in the project area, like Kamran's sister-in-law, suffer from complications during pregnancy and birth such as hemorrhaging and breech deliveries. The women who beat the odds and survive these often-deadly complications, will most likely suffer from problems related to their reproductive systems well after their reproductive years.

Women, usually midwives, traditionally attend all births. But Yelagaj has no midwife, so women deliver at home with the help of their mothers, sisters, and neighbors. Newborn Elmaddin, Kamran's nephew, came into the world breech, and he and his mother almost didn't make it. "It was a very dangerous delivery. We were all very worried. We don't have a good diagnostic system in place here. It may not have been such a close call if we had detected the problem in time or had access to better care before the delivery," says Pari, mother to Kamran and grandmother to Elmaddin. "Many women in the village need treatment for problems during pregnancy and delivery but can't afford the trip into the district center, let alone the doctor and hospital fees."

Mercy Corps is training community leaders to be community educators so they can pass their knowledge on to women and families like Kamran's, giving them more access to information on topics that include healthy pregnancy, women's health and safe family planning.

Mercy Corps also provides medical training to village-level feldschers (physician's assistants) and midwives to increase their ability to treat women and children close to home thereby increasing the utilization of village clinics and establishing a prevention-based primary healthcare system.

At the heart of the Child Survival project is the work done directly with community members and leaders to provide health education and training in community participation, and to create a health information system that allows health care providers to share information. This gives a voice to families like Kamran's in deciding the health needs of the village and how to address them in a way that will have a lasting impact.

"We need a lot of things in Yelagaj. I am ready to work with Mercy Corps and my community to see what I can do to help meet our needs so that when it's time for my recently-married daughter to start a family, she and her children will have the information and access to health care they need for a healthy, long life," Pari says.

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Arvana is a tiny green village hidden in the rocky Talysh Mountains in the Yardimli district of southeastern Azerbaijan. Hundreds of years ago it served as a resting point for caravans traveling between the Caucasus and Asia, with traders and travelers coming and going en route between Europe and Asia.

No longer an international crossroads, today's Arvana is a sleepy village notable for its isolation from the rest of Azerbaijan, reachable only by four-wheel drive vehicles during the dry summer months. This isolation has led to a vacuum in information, training, and resources, particularly in health care, and the result for the people of Arvana is disproportionately high rates of infant and maternal mortality and morbidity. A great number of these illnesses and deaths are due in large part to diseases and complications that are preventable or treatable given the proper knowledge and equipment at the most local level. Infants, young children and women are living with illness or dying needlessly. But something can be done about it.

In recognition of its commitment to delivering sustainable community health solutions to severely underserved populations, the United States Agency for International Development awarded Mercy Corps a five-year, $1.3 million grant to implement the Azerbaijan Child Survival project. Utilizing the same innovative spirit that defines Mercy CorpsÕ approach to humanitarian umbrella grant management in Azerbaijan, and drawing on the successes of our Child Survival project in Central America, Mercy Corps launched this program at the end of 2001 in three remote regions of Azerbaijan: Yardimli, Lerik and Masalli.

These areas have the highest maternal and infant morbidity and mortality rates in the country. Until now, they have been largely neglected by the government and international development and relief efforts due to the concentration of efforts on people affected by the Nogorno-Karabakh conflict in western Azerbaijan. Mercy Corps' work in these areas has resulted in the government of Azerbaijan's awareness of the health problems for women and children, and in their participation in creating lasting solutions.

The project aims to reduce infant, child and maternal death and illness in the targeted area. This will be accomplished through providing community-based health education and training, improving the quality and increasing the utilization of village-level health care, and leading the movement towards a primary, prevention-based health care system. Throughout its five-year duration, the Child Survival project will benefit more than 20,000 children under five years old and 30,000 women of reproductive age.

Rahila Safarova is a Child Survival community educator in Arvana. She is proud of her community and its ability to survive under such isolated, difficult conditions. But when her community is in need of health care, she says the people of Arvana have had little hope for getting the help they need.

"We have a feldscher (physicianÕs assistant) who provides the most basic care for our children. But when there is an emergency, our only option is to hire a car to a hospital more than three hours away. Unless the roads are passable and you have the money to hire a car, there is no hope for getting treatment. When a mother or child is in need of emergency care, they are left with no options and the results are often tragic. We need the information to prevent or detect illnesses before they become an emergency," Rahila said.

The Child Survival project works with community leaders like Rahila to provide education for behavior change in mothers and caretakers in order to take measures to prevent maternal and child illnesses. Rahila and her brother Jamal work with women and men to encourage families to seek primary care for infants and young children at the first sign of an illness from their community-based health facilities.

To improve and increase the level of service provided by midwives and feldschers as the first-line community health care providers, Mercy Corps provides technical training that equips these providers with the skills to better handle maternal and child illnesses. The program began with a thorough community health assessment in partnership with local and district-level health care workers and the Ministry of Health. By summer 2002, Child Survival staff trained first-level health care providers in treating and preventing childhood diarrheal diseases; trained and monitored providers in rational use of medications; and distributed essential medicines and supplies. Also, the foundations were laid for establishing a health information system on all levels of care from village clinic to district hospital and for establishing, in cooperation with the Ministry of Health, a comprehensive plan of action for managing childhood illnesses.

The Child Survival project also aims to empower communities to take control of their families' health by strengthening their participation in identifying their own maternal and child health needs and identifying measures to address them. In 2002, Mercy Corps led trainings for community leaders and health care providers on community mobilization, empowerment and leadership. With Mercy Corps' technical assistance and community mobilization expertise, the Azerbaijan Child Survival project is working to improve the health and well being of AzerbaijanÕs most needy children and communities.

"I am very excited to be working with Mercy Corps,Ó Rahila said. ÒI want to learn as much as I can so that I can inform my community and help improve the lives of children, mothers, and everyone in my village

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