I’m back in Tajikistan, six months after my first visit. This time, I’m here to support our field team with the midterm evaluation being conducted for our Maternal and Child Health program. Accompanying me is Donna Sillan, a consultant we have contracted to write the evaluation.
We spent our first two days in Khujand — in the country's northern Sughd region where most of Mercy Corps' Maternal and Child Health interventions are taking place — planning sessions with the Village District Coordinators on how to collect qualitative data to gain an understanding of the program’s impact on improving the health of women and children in the target areas, as well as other local capacity-building initiatives. The Village District Coordinators are a mix of Tajik men and women, many of them trained doctors from the Soviet era. These people are not only knowledgeable of health issues, but genuinely care about the work they are doing in the communities.
As I saw them conduct trainings, focus group discussions and various interviews with our beneficiaries, their support came across in such a kind and nurturing manner that made me think —even if I had never met them — I would feel immediately comfortable in speaking to them about my health!
During our field visits to the various districts targeted in the program, I met with women and children, including expectant mothers and mothers-in-law, men, health providers, school children and their student trainers participating in our Child-to-Child program, where older students teach younger students about health and hygiene. I participated and observed sessions conducted by our Village District Coordinators, Community Health Educators and Donna as well.
I have to add, that I did not leave a Tajik village without a meal. No one can. Once you meet with these people, you are invited into their homes where they will put everything in their kitchen out for you to eat: fruit, vegetables, candy, meat, yogurt and bread, just to name a few. And if you haven’t tried Tajik pilau (rice and meat dish), you cannot say you’ve been to Tajikistan. The Tajik hospitality is unaccounted for in my opinion. Their graciousness in just saying "hello" is something one has to see to understand.
During my field visits, two things struck me the most:
- The numbers of fathers/husbands away in Russia working while their wives look after their household, including their in-laws and children. Tajik families rely on remittances from male household members working abroad, mostly in Russia. I met expectant mothers whose husbands were away and could not be sure if their husband would return for the birth of their child or at all, as many men stay in Russia and start new families.
- The brightness and enthusiasm for learning that Tajik students ranging all the way from the 3rd to 10th grade show in our Child-to-Child training sessions.
When you walk into a Tajik classroom, you will be greeted by the entire classroom standing in almost military style with a hand to the heart as they enthusiastically say, “A-salamalikum!!” As I watched these kids display their new found knowledge about hand-washing, boiling water and their knowledge of disease prevention and why healthy practices are important for them and their families, it amazes me to see how much information they have absorbed.
Maybe it’s the complete lack of health education in the school curriculum, but they have taken interest in a way that I think our implementers did not even expect. Not only do they explain how making changes in their hygiene behavior at home has helped them get sick less often, they are inquisitive about other health problems such as tuberculosis, hepatitis and diabetes.
Unfortunately — once Donna and I discussed why they would ask about more adult-related illnesses — we realized they are most likely trying to understand why someone in their household is sick, most probably one or both of their parents. It breaks your heart, especially when we then ask them how many of them have both their mother and father living at home with them and find that 90 percent of them are in a single-parent household. There is going to be an entire generation of Tajik children growing up without their fathers.
As one man in a focus group discussion told us, “we leave when our children are this high,” lowering his hand to the ground, “and return to see them as tall as us. They cannot refer to us as ‘father’ and see us more as a relative or sibling because they cannot relate to us and lack an emotional connection.”
It makes me realize that I shouldn’t feel homesick being away from my family for a mere two weeks and instead, grateful that I am able to be with them at all.
It’s been difficult to see these issues in every household and at every school I’ve visited. What makes me take a positive outlook are again, two things: one, Mercy Corps’ Maternal and Child Health program is truly SAVING LIVES.
Together with our field staff, local participants like the Community Health Educators and Village District Coordinators, we are going into these communities and saving lives of mothers and children who before did not have a means to get to a health facility to give birth with a skilled birth attendant or doctor. Or the knowledge of how to care for their newborns and avoid preventable causes of death such as diarrhea and malnutrition. I’ve heard firsthand from women in these communities that our interventions have caused fewer deaths in their communities while also hearing from other women who wished they had this program when they were pregnant because it could have avoided the death of their child. Again, it does break your heart.
And the one last positive outlook I have is HOPE. I am confident in the ability of the children here to learn and pursue a successful future, especially when going around the classroom and seeing how many of them want to be health providers and artists when they grow up and do NOT want to go to Russia for work!
If this country could start investing in its people, provide jobs that would prevent fathers and husbands from leaving their families for nine months out of the year or longer, and improve and build the capacity of their education system and basic health services, what a different Tajikistan this could be.