A Hero’s Job: Malaria and the Village First Responders

Ryan Sandford
May 20 · 5 min read

Your child is sick — his fever is 39 C (102.2 F), and he is shaking and sweating profusely. At 4-years-old you know that he’s at a higher risk of contracting malaria. All the clinical signs point towards that conclusion. It’s rainy season, and after a particularly heavy downpour, the road is muddy. No motorcycle taxis are coming through this evening, as they have taken shelter underneath a far away tin roof nearer to the main road. Getting your child to the health center feels nearly impossible.

There are three people that immediately come to your mind as your best chance of early treatment: your local community health workers.

Community Health Workers (CHWs) are on the front lines of malaria prevention and treatment. Their job is not easy, and it is a volunteer position. So what role do they play in these 16,000+ communities in Rwanda, and why do they do it?

Community Health Workers take on a crucial and integral role in rural villages in Rwanda. The responsibility of this role is not lost on Valentina, who has been working as a community health worker in Rwanda’s Northern Province, in Rulindo district.

“Community Health Workers must carry themselves well in front of their community, and if you are going to do other activities, you must always be ready and available to help your community on the spot.” — Valentina, CHW

In Rwanda, May is World Malaria Month, a reminder that in 2017 the WHO reported 435,000 malaria deaths globally; and according to Rwanda’s Malaria Operational Plan, Rwanda recorded over 4.7 million malaria cases that year.

But bed-net distributions, indoor residual spraying (IRS), and even groundbreaking vaccines on the horizon leave us with a new level of hope that malaria burden in Rwanda can be reduced.

For community health workers in Rwanda, malaria is a part of their daily life and focus, and they rise to that challenge. They are on the front lines of malaria prevention and treatment programs.

They have a simple yet highly impactful task beyond testing and treatment: changing the community’s mindset regarding malaria prevention. Community health workers tirelessly implement discussions and activities to promote positive malaria preventive behaviors in their communities. Celestin teaches about many activities that help prevent malaria, but one specific habit immediately comes to his mind:

“There are a few major ways to fight against malaria: First and foremost is simply sleeping under mosquito nets.”

“Knowing that malaria is a very intense sickness that can end a person’s life after a very short period of time gives me the courage and drive to fight against it” — Celestin, CHW

Community health workers often partner closely with Peace Corps Volunteers (PCVs) in a plethora of ways to bring greater health equity to rural areas. Last year, PCVs in Nyagatare participated in an IRS sensitization campaign, helping communities understand the need for insecticide spraying, also visiting families and working alongside community health workers to encourage better net care and repair in rural areas.

Others partner with community health workers to conduct net care and repair demonstrations, or behavior change focused activities that empower communities to use their nets and seek early treatment.

The job is a volunteer position generally without pay and also very taxing. So why do they choose it?

We asked our friend Jean, who works with Peace Corps Volunteer Kerong Kelly in a health center in Rwanda’s Northern Province:

“I chose to be a community health worker because it is simply a good thing. When your neighbor has a problem and they come to you for help and support, it is an amazing thing if you are able to help them, and then subsequently you feel even more useful in your community…

The community health workers’ program is very important as it provides first aid to people with health services that are efficient and on time.”

On time is a key phrase in Jean’s answer. The earlier that community members seek treatment, the greater chance they have of escaping complications of malaria — complications that can include cerebral malaria and death.

But what does it entail to be a community health worker?

Community health workers test and treat for malaria, pneumonia and diarrhoeal-related diseases. When someone is too sick to reach the health center, a community health worker from the local binome (the pair of CHWs, one male and one female, who are responsible for the testing and treating at the community level) is the first responder, the trusted community member that supports them.

Community health workers are elected by their own community members and are an emblem of what public health systems should be: a mutual sense of trust and a personal bond between the patient and the health provider.

We had seen how community health workers are respected and how they are viewed by their communities, but we wondered how they viewed their own work. Marie Chantal had one inspiring answer for us.

“To be a community health worker is something I am proud of. I am able to get close with my community and also in general we are able to have discussions about health.”

Marie Chantal’s answer is simple and powerful. She should be proud. Countless children, women and men are healthier and safer because of community health workers, and we continue to learn from them and follow in their courageous footsteps.

Photos and Interviews by Kerong Kelly

Translation and Copy by Ryan Sandford and Denyse Muhawenimana

Ryan Sandford

Written by

Peace Corps Rwanda | Public Health Sector | Jhpiego Malaria Division

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