By Maureen Cherongis*
Many say that the shortage of health staff is the biggest threat for better health in Africa. The availability of professionally-trained health personnel is poor. In Malawi for instance, with only 300 doctors for a population of more than 17 million, and a nursing vacancy rate that is at 75%, the severe shortage of human resources for health is a major contributor to the high number of deaths. Addressing this shortage – throughout Africa – remains crucial.
Realistically though, it will take decades to train enough doctors, nurses and midwives to serve communities, while action is needed now. A possible answer? Training (voluntary) Community Health Workers! When trained, they help to fill the health worker gap, providing basic health care and education to their communities, families and children. With this article, we honour the men and women who commit themselves effortlessly to their community.
The story of Beatrice
She walks from house to house visiting families in Kenya in order to educate members on malaria prevention and, at the same time, identify people with malaria symptoms and refer them to the nearest health facility. With the training she has received in one of the projects of Amref Health Africa, Beatrice Muguoke (commonly known in her village as ‘Nyar Kisumu’ meaning a lady from Kisumu) has been able to contribute to the reduction of malaria cases in her community. This is after she became a Community Health Volunteer in 1990, something she never regrets.
The 62-year-old mother of four has served her community for more than 20 years and is in charge of Omia Malo community unit that has a total of 103 households in Siaya County in Kenya. This means she visits 80 homes each month offering basic health care in Community Case Management of malaria, issuing mosquito nets and providing basic malaria education. “I have been trained by Amref Health Africa in Kenya to use rapid diagnostic tests, which test for the presence of malarial parasites in blood samples. I also educate families on proper use of nets,” she says. The training on Community Health Strategy has greatly improved the Community Health Volunteers’ knowledge and skills needed to work at the community level. The training in proper case management of malaria provided them with the skills needed to assess the condition of the patient, look for danger signs and symptoms of severe disease and take appropriate action.
“I am not allowed to test and treat pregnant mothers. Instead, I refer them to the public health facility which is Ongielo Health Centre. When you visit my house, you will think it is a clinic. I have artemether lumefantrine (AL) drugs for malaria, antibiotics and the Rapid Diagnostic test. I am always on alert and my phone has to be on, since people call me even at midnight for testing and treatment,” Beatrice adds. “Some of the children I attend to have symptoms such as fever, vomiting, diarrhea and headaches. Sometimes the symptoms are side effects of the artemether lumefantrine (AL) drug that I give them but even then they need to be managed properly,” Beatrice continues. “I let them know they can call me anytime to their houses.”
As a Community Health Volunteer, she also has to fight myths and tradition towards malaria that plague her community. Some people in the county still use herbs to treat malaria. However, with the help of community health volunteers like Beatrice, villagers are being educated on the need to seek medical expertise at their nearest facility. “Sometimes it’s difficult for us, Community Health Volunteers. I can find myself using my own money to help some of the members of my community who are in dire need and cannot get to the hospital due to lack of transport money.”
“I am not retiring soon!” she says while laughing. “I will put down my tools when Omia Malo is declared malaria free,” she adds.
“Beatrice has brought a lot of happiness to my family ever since I knew her,” says Evelyne, one of the mothers who has felt the impact of the work of Beatrice. Evelyne Owour is a 26-year-old mother of five who hails from Omia Malo Village. For her and her family, malaria has been a great burden. She now knows too well the risks of children becoming ill with malaria, the danger of not treating it quickly and effectively, and the aftermath of failing to use preventative measures to keep malaria at bay. Evelyne talks about the agony her friend went through after she lost her child, who was just six years old. “The child was vomiting and had a fever, so the parents took the child to the health centre, but on arrival she was diagnosed with malaria. Since they had taken a long time to go to hospital, the baby, unfortunately, died.”
Evelyne says that Beatrice has taught her how to stay healthy and prevent the prevalent diseases in the region with special focus on malaria. Beatrice advises her on preventative measures, as well as practical tips, such as how to cover her bed and her children’s bed using a treated mosquito net.
“Before I knew Beatrice, we had a very hard time fighting malaria. Even my children almost died from the disease. The nearest health facility is far away, and I hadn’t realized how dangerous malaria could be,” she says. “I am more at peace now and we can sleep better at night as I know how to cover my family with treated mosquito nets.”
“I really thank Beatrice as she is always available anytime I call her. When my children are sick, especially at night, I call her and she immediately comes and treats them,” Evelyne says.
The story of Selemani
“I work every day, for at least half of the day. Despite the long hours, being a Community Health Worker means that I’m a volunteer. Some NGOs have given us a small stipend over the years but that never lasted long. People ask me why are I’m still doing this work now that it’s unpaid. They tell me
I should be out there making money. But I’ve felt indebted to my community for a long time – I need to help them.”
“I used to work away from home in the mines – far from my family. When I came back to my village it had been devastated by a measles outbreak. People had died and many were ill for the rest of their lives. My family had all received good medical treatment and they all survived. I was so thankful. Since then I’ve understood the value of medical care and want to help others understand it too.”
Selemani continues: “It’s been hard to keep motivated at times. I’ve been doing this since 1993 and seen some difficult things. Above all I’ve learned how important it is to ensure health education is well-coordinated. It’s all very well giving people information, but if you don’t follow-up with them, some take myths not truths forwards. There needs to be a way of ensuring the right information gets to everyone.”
“I also believe these projects will only succeed if they involve men. Previously there was a focus on women and child health and so organisations reached out to women only. Then women didn’t attend the services because their partners didn’t understand the importance of them. They were refusing to pay for transport and sometimes they would stop their wives from taking themselves or their babies to the clinic. Now that we are working with Amref Health Africa we reach out to men too and it’s working. They accompany their wives to the clinic, they tell them to get the antenatal screening and sometimes they even address their own health issues. They are getting themselves tested for HIV. I’m excited to see the progress now. I won’t stop doing this work.”
The story of Pamela
Malaria infection during pregnancy is a significant public health concern, with substantial health risks for the pregnant woman and her foetus. Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity to the disease, making her more susceptible to the infection and increasing her risk of illness, severe anaemia and death. For the foetus, maternal malaria increases the risk of miscarriage, still birth, premature delivery, as well as low birth weight.
In Siaya County, Kenya, malaria has greatly affected the economic growth and development of most families perpetuating the vicious cycle of poverty.
Belinda vividly remembers when she was pregnant with her last born, now nine months old. She fell very sick from malaria but with the intervention of Pamela, her Community Health Volunteer, she was referred to Onyieng Health Facility and was able to receive prompt treatment. “Malaria nearly killed me when I was pregnant as I couldn’t walk or eat. It was at midnight when I called Pamela and explained to her my symptoms. She advised me to go to the health facility. While there, I was treated and given a lasting insecticide treated mosquito net. I don’t know where I would be without Pamela, perhaps dead,” she adds.
Belinda, who is a tailor by profession, could not go work as a result of the sickness. Her sewing machine, which is at the corner of her house, is now used as a table as she is yet to resume her job. Through her sewing business, she would earn at least 2,500 Kenya Shillings per month. Now, she has to depend on her husband who works at construction sites at Bondo town, 10 kilometres from where they live. “Whenever I visit pregnant mothers, I talk to them about the risk of having malaria during pregnancy and educate them on the importance of antenatal care,” says Pamela.
Community Health Volunteers like Pamela are trained and equipped in close collaboration with community based organizations on the preventive messages, surveillance and how to advocate for early testing and treatment in communities. The health volunteers are also encouraged to refer pregnant mothers with symptoms of malaria for fast testing and treatment at nearest health facilities. Achieving a malaria-free generation starts with women like Pamela, who as a community health volunteer provides door-to-door visits. The engagement of health volunteers in the communities has helped enhance the progress, especially in reducing the mortality rate of malaria related complications.
*Maureen Cherongis works for Amref Health Africa.