The Community Health Workers: Meet the Kenyan Women on the Front Lines of Disease Prevention
On Saturdays there are only weddings. Brides dressed in white spill out of churches with a full wedding party behind. Funerals; allowed every day of the week are prohibited today. This rule came during the time when the Kenya’s death toll from HIV/AIDS was reaching its peak and decimating communities. In a country where death and funerals are as much a communal event as birthdays and weddings, the high death toll put a pressure on religious organizations and clerics who officiate the ceremonies, as well as the finances of the deceased’s family, who had to afford to organize a funeral and proper burial. The AIDS epidemic also took a toll on the community’s health, everyday people were dying and every day there was a new funeral, new coffins to be put into the ground and new widows and orphans to console. Something had to be done to stop the near constant mourning. The government soon realized this and declared Saturdays a day of celebrations. Weddings and other celebratory religious events could be held on this day and funerals were prohibited, at least for twenty-four hours. This gave the community time to relax and celebrate, in a time of so many deaths.
On this celebration Saturday I found myself not at a wedding but at a meeting. About twenty women were gathered in a sturdy, cool building in the Hope Kenya Community Center. They sat quietly in a row of chairs facing a chalkboard. The women ranged in age from twenty to fifty, each sat quietly and attentively, their hands clasped in their laps as their children play outside the building. On the chalkboard was a series of lists that kept track of the number of pregnancies, cases of HIV, quality of housing and disease risk factors and various other aspects of health. These are the community health workers, and they have been on the front line of infectious disease monitoring and prevention. The program was first created by the Kenyan Department of Health in Nairobi, but it ran into funding troubles when it came to reaching the more remote areas of Kenya. Partners of Hope Kenya applied for and funded the program, and since then Hope Kenya has been a part of the program in the growing town of Machakos, Kenya.
The women each have caseloads of up to twenty families who they are required to visit every month and document any illnesses, risk factors and the environmental issues effecting the families. Every four months the women meet to train and retrain members how to provide basic health care and document the required health indicators. They learn how to measure blood pressure, how to take blood samples, and how to handle people who have infectious diseases safely. One of the biggest problems is that people with HIV begin taking medicine but do not continue to take it and become sick and contagious again, the women are militant when it comes to making the families in their charge be vigilant about staying on medication regimens. This simple training puts them ahead of many of their peers when it comes to basic health knowledge. Most of the women and their families live below the poverty line. Some are victims of the high unemployment rate, others are stay at moms and several are small farmers. During training they receive a small stipend of about five dollars, but otherwise they are unpaid. They have taken their celebration Saturday to meet and report their findings. They are serious but not sad, they are peaceful and determined. The meeting is quiet and orderly; someone’s phone rings. The person officiating the meeting says “Whoever’s phone goes off next has to come up front and sing a song”. A murmur of laughter travels through the room, and the women turn to silence their tiny flip phones. They take their work seriously and it has paid off, the rate of HIV and other diseases in their community have gone down significantly since the program started. After the numbers are reported and totaled everyone goes outside. Someone has cooked pilaf and meat, sodas are being passed around, the women are having a celebration of their own. They talk and sing while the children play on the playground. Most of the women do it for their own families they say, volunteering gives them a way to learn about how to best care for sick children, husbands and parents. It empowers them with knowledge of how to be healthy and how to avoid disease. It gives them hope for the future, for their families and most of all for their community. Helping other families helps them, they tell me.
The community is still heavily effected by death from HIV/AIDS some of the grimmer statistics on the chalkboard will tell you just how many are still sick and dying from it and other infectious diseases, but outside the room the women eat, sing, talk and spread hope. They are not discouraged by the statistics, on this celebration Saturday they commend each other and the work they do. As I look around me, for the women on the front lines of the fight against HIV/AIDS, today is not a day for sadness but a day for celebration.