Kenya has only confirmed a handful of cases of COVID-19, however the country is clearly taking the threat of it’s spread seriously, and it needs to. Like other poor nations around the world with ill equipped health systems, Kenya is extremely vulnerable to the menace of COVID-19. President Kenyatta has closed schools and churches, and barred entry to the country from anyone travelling from a country with a confirmed COVID-19 case. There is a distinct sense of anxiety throughout Kenya, with many people staying at home to avoid contact (BBC 16-3-20).
Time and time again, our Community Health Workers (CHWs) shine through in tough times. Already at the front line in the fight against HIV/AIDS and other communicable diseases, our CHWs are standing strong and helping their communities to protect themselves against COVID-19. The Kenyan Ministry of Health is actually partnering with our project in order to share information at the grass roots level, through our CHWs.
And our usual work continues – albeit impacted, and creatively transformed in some cases. In response to social distancing recommendations from the Kenyan government, CHWs are no longer able to meet with whole families of HIV clients – instead they’re working one on one with the sick, whilst trying to share information with their family members in different rooms and tackle the stigma that grows when the sick are more isolated. Our Maternal, Newborn and Child Health (MNCH) program has been quite affected as these activities are based around large group meetings. In response, our workers have been able to arrange some smaller gatherings to reach pregnant women and new mothers, and are still able to visit them at home in times of need. Microscope outreaches that teach people about water and sanitation and disease prevention have also become smaller in size, and many are being conducted under the shade of trees to avoid confined indoor areas. These sessions are particularly important amid COVID-19, as they empower people with awareness about hand washing and other hygiene practices.
I would like to take this opportunity to thank our Positive Aid supporters – it is a really hard time for us all in Australia and throughout the world. The outbreak of COVID-19 has given us a unique insight into how people must work together globally to eradicate disease. As we try to protect ourselves and our families from the risks of COVID-19, we would like to sincerely thank you for continuing to support the health of communities in Kenya.
In remote villages – where resources are limited and local people rely on traditional medicine – ‘health literacy’ arms people with information to prevent disease, make healthy choices and improve their quality of life.
We use microscopes and other tools to teach communities about germs, water and sanitation, and the advantages of mosquito nets. The basics of western medicine are shared using local language, in ways that everyone can engage with, and enjoy.
For the last few years, Positive Aid has supported a Health Literacy program in Uranga. It has been a small but important part of our health project there, and we have trained more than 1,000 ‘Ambassadors’ to share vital information with their communities. Alice Mitchell, Vice President of Positive Aid with a PhD in public health, and has led the training of Community Health Workers (CHWs) and the overall design of the microscopy sessions. When in Kenya recently, she had the opportunity to build on the program, by refreshing all of our CHWs on the use of microscopes and doing more intensive training with several key workers who are responsible for facilitating the sessions. She also delivered and set up a new microscope, as we are putting things in place to expand the health literacy program to Boro division, to bring insight and information to people there.
Through advocacy outreaches and microscopy sessions, the faces of young and old alike brighten as they learn the basics that can change their lives. And every day more and more people are building latrines, hand-washing facilities and implementing mozzie nets to prevent malaria – life saving measures in poor rural villages prone to a host of preventable diseases.
World AIDS Day is held every year on 1st December. It aims to raise awareness in communities and around the world about HIV/AIDS. It is a day for people to show their support for those living with HIV, and to remember all those who have passed away from AIDS. HIV/AIDS has had a massive impact in Kenya, and it is naturally close to our hearts. Almost all of our Community Health Workers (CHWs) are HIV positive – they are not however victims; instead they are triumphant in their health and pillars of strength in their villages.
Positive Aid supported a team of our CHWs to travel to World AIDS Day celebrations in a nearby town – to give our project presence and strengthen their connections with other like-minded organisations. And of course to celebrate! Since we started our project twelve years ago, our CHWs have supported over 12,000 HIV-positive clients. Through our work they empower the most marginalised people living with HIV/AIDS, so that they can lead full and healthy lives, and their children can be born free of HIV. We salute these amazing CHWs!
Story by Alice Mitchell
It’s December 2019 and I am currently in Kenya, strengthening our health literacy program. Living in Kenya always involves a lot of walking. It’s good exercise; I don’t do enough of this in Australia. One benefit of walking is seeing things that you wouldn’t notice if you were getting a ride on a motorbike. One thing I noticed this visit is the prevalence of ‘gweno’- chooks in local Dholuo language, and their chicks. They seem to be everywhere. Not in great numbers but just ‘around’. You get used to them turning up in unexpected places.
So, when I walk from my accommodation for meals in the main house, there is always a chook or two around the steps. They pick up grain or small pieces of food that may have been dropped by the cook. As I walk along the road to our office each day, I always see a few chooks scratching in the maize fields or among brush on the side of the road. It’s not clear who owns them.
When I drop in to a local ‘hotel’ (we would call it a café) for lunch, I have become used to seeing a chook or two under the table, or just pecking about. Yesterday I noticed two chooks sitting on eggs in a basin in a corner of the café.
Chooks are always pecking about at the daily markets too. And of course, there is the odd rooster.
All the hens seem to have a few chicks with them and occasionally I see some half-grown hens. They all free-range. But there must be predators around. I was told that, every now and then, people nick other people’s chooks. I guess if you are hungry, it is tempting with chooks roaming freely about the place.
Last week I joined one of our Maternal, Newborn and Child Health workers at a ‘pregnancy club’ within a local clinic. She adeptly taught the mums about how to stay healthy, and especially how to prevent mother to child transmission of HIV in pregnancy. It is so important to be tested for the HIV virus so that mothers can take the daily medications that prevent the baby acquiring HIV. Other topics she taught about included family planning and the importance of birthing in a facility with skilled birth attendants rather than birthing at home. The inevitable chook walked into the group of seated mothers. Of course, no one took notice of it. There’s always a chook.
Story by Alice Mitchell
One of the strengths of the project in Kenya is the intentional building of cohesive teams of lay Community Health Workers (CHWs). It’s one thing that makes the two local projects that Positive Aid supports stand out and be successful.
Each CHW is allocated to a group in their area that meets monthly at one of their homes to share and report on how their work is going. This is a time to talk about challenges and successes in the work. There is formal data reporting on the number of people visited for home-based HIV care, and reporting on clients who have been unable to adhere to their HIV medications. Afterwards, sharing a meal together at the meetings provides opportunity to talk with and listen to each other more closely. It is a heart-warming job at times, and at other times a heart-wrenching one.
Reaching out to local villagers who have HIV/AIDS and connecting them with a health facility to start treatment means a life saved and stabilisation of a family’s wellbeing. Endeavouring to connect with local villagers who have declined to continue daily anti-retroviral drugs to prevent AIDS, and further spread of HIV, naturally means a critical understanding of human nature is needed. This client group (named ‘defaulters’) have most often not been provided with adequate information when first diagnosed and counselled for HIV, or have felt pressure to stop their treatment. These particular clients may not welcome the CHWs, and the dynamic can be edgy. The CHWs’ message to re-start the drugs and continue with them for the rest of life is a hard one. Yet it is dangerous to continue life without these drugs, so a CHW’s capacity to engage and persuade is paramount.
Sharing a meal together, enables CHWs to feel part of a supportive team with a collaborative mission. In fact, they ‘own’ the project. They are the hands and feet on the ground, working to halt the HIV epidemic in their location. CHWs never quit. In fact, our local manager often receives requests from local people to let them know if a vacancy becomes available.
This year we were fortunate to have three volunteer representatives travel to Kenya. Long-term committee members Alice Mitchell and myself, Jess Alvarez, presented a strong partnership, complementing each other’s strengths across many areas. We were joined by Briege Young – a midwife from New Zealand – who came to assist in maternal and child health: areas in which she possesses wonderful experience and passion.
Our trip spanned around three weeks and we were based in Uranga – spending evenings at a local parish and walking to the project offices each day. We carried out a number of important checks to ensure activities and finances are being properly managed, and spent much time connecting with stakeholders at different levels to attain feedback on progress being made in the project overall. We met with community health workers, clients, management and board members, as well as other key people from the Kenya Ministry of Health and local organisations.
The three of us gained a great deal of insight into current issues in the project, and devised various ways to tackle challenges and seize opportunities. We strengthened the important relationships already in place with our partner organisations, and returned to Australia motivated to continue supporting the amazing things happening on the ground in Kenya. Thanks to Alice and Briege for their input and for volunteering their time to accompany me on this trip.
Positive Aid is now piloting new activities targeting women – providing them with reusable sanitary pads. We are initially giving the ‘kits’ to new mothers, right after they give birth when there is a specific and real need. Commercial pads are not an option for most women due to poverty, so this intervention has the power to make a significant impact. Not only will the pads help women manage lochia; they will also reduce dangerous infections, as women will not have to resort to unhygienic alternatives.
Briege has led a new collaboration between Positive Aid, Days for Girls, and Stitch – NGOs involved in the production and distribution of the reusable pads. The pads are easy to use, wash and dry. They are environmentally friendly and sustainable, and –as an added bonus – are beautifully hand-sewn in African fabrics. Initial feedback from the women who have used them has been exciting and positive!
Future possibilities include providing the pads to girls too – with the aim of empowering them to remain independent and improve their school attendance throughout every month. Special thanks go to Briege and the people at Days for Girls, and Stitch.
After starting off under the umbrella and mentorship of URDI CBO, Boro Rural Development Initiative (BRDI) CBO is now independently partnering with Positive Aid. Peter is the full time manager in Boro and has led his team over the last few years, supporting and guiding workers and volunteers alike to develop a strong work ethic and commitment to the cause. We rent a small office in Boro town, where meetings are conducted and records kept. Peter works alongside a part-time employee, Elizabeth, who assists with administration.
During our recent trip to Kenya, we attended BRDI’s first ever board meeting. Five members were selected to represent the organisation, each bringing unique strengths and experience to the board:
Moses Ochiel – Chairperson and NGO expert
Ingrid Moraa – Nurse with the Kenyan Ministry of Health
Peter Yuya – Local Chief
Peter Ouma – BRDI Manager
Charles Onyango – Community Health Volunteer, BRDI
It was an honour to participate in the meeting, and to witness these important leaders come together with the shared vision of leading BRDI and its work to empower their community in Boro.
Now and then in the villages of Uranga or Boro, you might glimpse someone walking or cycling to a homestead in a green polo shirt with the word Nyamrerwa printed on the back – Community Health Worker, in the local mother tongue. The Nyamrerwas are trained and practiced in caring for people with HIV/AIDS. They themselves are HIV positive, which adds crucial understanding and experience to their role. These Nyamrerwas have the great responsibility of finding clients who have defaulted from their HIV treatment, and bringing them back step-by-step to the psychological and physical condition to resume that life-saving treatment.
It is challenging and exhausting, as clients are often gripped by stigma and fear, poverty, and a lack of support from their families, churches and communities. Clients cannot bear adhering to their treatment, yet they need it urgently. And so the Nyamrerwa’s work begins – it demands sensitivity, patience, strength and vision. The challenge of this work, ‘defaulter tracing’, is so great that most NGOs have left it in the ‘too hard basket’. Yet our project is making a palpable impact.
The things that motivate our health workers and keep them volunteering, year after year, are intangible and seemingly unique to our project. Is it the ongoing support they receive from management and from each other through group meetings and debriefings? Is it the praise and respect they earn from local Chiefs and other leaders? Or is it the simple desire to help others out of a position they were once in themselves?
During our recent trip to Kenya, we encouraged and thanked our Nyamrerwas for their vital work. And, through discussions, we came up with an extra way of supporting them – a semi-regular excursion away from their duties and all the associated stresses; a kind of retreat aimed at refreshing and re-building morale. We hope that this activity will further strengthen the individuals who form the backbone of our project into the future.
Positive Aid recently supported an expedition to the offices of NGO ‘Management Sciences for Health’, in Kakamega, Western Kenya. They are doing some great work in Maternal and Child Health and we took the opportunity to connect – sharing experiences and the lessons learned in best practices are invaluable in the NGO world, as they help to boost all organisations’ work for the benefit of the people they serve.
We sponsored our two Maternal and Child Health officers Connie and Hellen, along with three of our local management, Mordecai, Martin and Peter to take part. The trip gave them the chance to discover and be motivated to continue striving in their activities. In response to what was shared, we plan to produce some new picture-based materials to use in empowering pregnant women in our project throughout Uranga and Boro.
‘Jiggers’ (tunga penetrans) are a kind of flea common to Central and South America as well as Sub-Saharan Africa. They commonly infect the soles of peoples’ feet in our project area, where animals can live in close quarters to villagers – jiggers can cause terrible discomfort and affect people’s ability to go about their daily work and lives. Unsafe village practices of removing the jiggers without proper sterilization also pose serious risks of infection.
Positive Aid supported Boro Project Manager Peter, to lead a jigger campaign in his Division. With the help of our Boro Community Health Workers, Peter mobilised a large part of the population including Chiefs and other key leaders. The aim was to treat local kids and adults who were infected with jiggers, and also teach people about how to avoid infection in future. The day was a great success and we congratulate Peter and the Health Workers for their efforts in helping their community.
Committee member and long term supporter Kellie Woiwod visited our project in Kenya in March. She set out to represent Positive Aid on a range of tasks, including assessing how we’re progressing with our health objectives, building local management’s capacity, and looking for ways to further improve activities on the ground. We were fortunate Kellie was able to volunteer her time, as she has a strong background in the monitoring and evaluation of similar projects in developing countries – after an intensive trip she returned to Australia with a number of new ideas and praise for the way the project is being run. Thanks to Kellie for all of her inputs and energy in keeping our project thriving!
Our Maternal and Child Health (MCH) Officer Connie is a local woman from Uranga. She is passionate about helping women and children, and has four kids herself. Starting out as a community health worker in our project ten years ago, Connie quickly displayed great leadership qualities, eye for detail and a drive to make positive change. In 2012 when we introduced our MCH program, we naturally put Connie in charge of activities. Since then she has worked tirelessly with children, parents and carers, pregnant women and new mothers – facilitating small and large groups, connecting people in health care settings, visiting needy clients at home, and reporting on the successes and challenges in the field. We have supported Connie through several trainings to build her capacity and confidence in her role, including sending her to Uganda for a specialised course, and more recently to Kisumu for training by the Kenyan Ministry of Health. Thanks to our project and Connie’s dedication, hundreds of women have given birth safely in health facilities, and countless babies have been able to thrive.
Peter, our Manager in Boro, is soon to be trained in Home-Based Counselling and Testing (HBCT) of people for HIV. To date, Project Manager Mordecai has provided all of the testing and counselling in our project, however new activities are increasingly demanding his time and Peter has shown enthusiasm and commitment to the idea of adding counselling to his role. He is particularly familiar with Boro Division where he’s worked for years now, and understands the important role HBCT plays in helping people with HIV get treatment. We wish him the best for a successful training and experience in his new responsibilities.