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On the Front Lines of Public Health:
Family-Centered Strategies To Improve Child Survival

Originally from Fergus Falls, MN, Mary Skarie has been working in public health for more than thirty years. An undergraduate experience in India, working with women and children in primary health care settings, sparked Skarie’s interest in public health. Inspired, she went on to graduate from Antioch College with a BA in philosophy, receive nursing degrees from Cornell and the University of Arizona, and earn a Master’s of Public Health from Johns Hopkins University.

Today, Skarie manages a program for the US Agency for International Development (USAID) that is helping to strengthen primary health care and restructure the health care systems in Central Asia. Most countries in the region are poor with high child mortality rates. While American children typically do not die from respiratory infections or diarrhea, in Turkmenistan, for instance, these illnesses are often fatal.

“In this part of the world, people are not expected to know much about self care, so they are surprised when nurses provide health information and expect them to understand and apply these lessons in caring for their families,” explains Skarie.

Skarie was part of an innovative new program sponsored by USAID—the Keeping Children Healthy Campaign—which was launched in Serdar, Turkmenistan during Winter 2002. The campaign created a competition among local clinic nurses who were each tasked with educating families about recognizing the symptoms of and getting treatment for signs of acute respiratory infection. These nurses helped to brighten up the lives of these families by bringing colorful posters and brochures, and showing a genuine interest in the lives of each family.

Mary Skarie, RN (2nd row, 4th from left) with primary health clinic staff in Khatlon Oblast, Tajikistan

The nurses with the best overall results (number of families reached, quality of materials) were recognized in a public ceremony and awarded useful prizes for their clinics, such as video cassette players or televisions to use in public education.

In its first year, this campaign touched the lives of 8,000 people, including 5,000 pregnant women and mothers of young children and 2,000 children. The initiative has had a tremendous impact on helping people realize their own power in improving the health of children in their communities. It has also saved lives: one child died of respiratory infection last winter, compared to five children in 2001 and 12 children in the year 2000. Families in Serdar now know that, armed with health information, they can help to prevent illness among their children.

One participating nurse explained, “In the past, we waited for illness to happen, and then we tried to cure it. Now we know that we can prevent sickness too, and our people are healthier.”

The work that Mary Skarie is doing in Central Asia is even more extraordinary when you look at the political situation that exists there today. Turkmenistan is a strained and fearful environment where it is nearly impossible for people to take action on their own to better their lives or make a contribution to their community. It is forbidden to organize in any way – even around a health issue – and such groups immediately fall under government scrutiny.

“USAID has been able to fill a niche in an environment that is acceptable to the country’s authoritarian government and makes a real difference in the lives of the children and families there,” she reflects. “It is successful in Turkmenistan because we don’t focus on giving equipment. We teach people to take new approaches to health care and provide the training and expertise that enables them to do things for themselves.”

Mary Skarie has been stationed in Central Asia for the last 3 years, working with USAID and the Turkmenistan Ministry of Health, on programs like Keeping Children Healthy to improve the nation’s child survival rate. Health officials attribute the reduction in respiratory infection to the work of local nurses who worked with so many families toward this important goal.

“I absolutely love my work here. As a public health nurse I can think of nothing I would rather be doing. Education works. Prevention works. It’s so wonderful to see it have an impact.”

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Mary Skarie, MPH, RN manages USAID’s program to strengthen primary health care and restructure the health care systems of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. This health program takes an integrated approach that will help the health care system to be more responsive, user-friendly, and provide better care, as well as reform the health finance system to run more efficiently.

The US Agency for International Development has provided economic and humanitarian assistance worldwide for more than 40 years.

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