Community Health Worker Training 19.09.2011
By Talitha Calder
On my final day in Kenya, the various staff members and volunteers from the Piave Health Centre, the Umoja Support Group, the Society for Women and AIDS in Kenya, and the Dispensary Committee encircled me in a tearful final good-bye hug at the end of what had been an indescribable journey volunteering with ROTH in Kenya. Since arriving back home in Canada, I have been surrounded by my friends and family sharing pictures, stories, laughter, and tears. However, what has been most difficult about my return to Canada has been trying to put the story of my past three months spent in Kenya into words.
For how can I possibly articulate to my friends and family the graciousness and selflessness of Esther (the Chairlady of SWAK) in her care over the OVCs? How Bernard, the Public Health Officer, exemplifies everything that is diligence, patience, and dedication in all that he does? How Monica, a member of the cleaning staff, and Miriam, a member of the Dispensary Committee, despite economic hardship always manage to begin and end each day with the biggest smiles and the most uproarious laughs? The past three months have felt like a dream, but the work that I completed alongside the committed community members of Piave has hopefully led to long-lasting results in improving the accessibility of health care services at the Piave Health Centre.
My journey began May 10th at the Jomo Kenyatta International Airport where I was warmly welcomed to my new home by my host father and long-time friend of ROTH, Nicodemus Nyamumbo. Upon my arrival, I was uplifted by the warm summer air and was astonished at the large buildings and sky-scrapers that dot the Nairobi sky-line. From there, I was taken to my home for the next three months, an apartment building located just on the outskirts of Nakuru Town. With not even a day spent in my new home, I was introduced to Esther who would be my partner in my project over the next three months.
The first four days of my volunteer placement with ROTH were spent meeting with various stakeholders such as community and political leaders, the health staff at the Maternity Ward and Dispensary and members of the dispensary committee, SWAK, and the Umoja Support Group. I held group discussions and meetings with all of the stakeholders in order to properly understand the political and community dynamics of Piave, the health needs that were still pertinent within the area, and the difficulties the health centre continued to face in their community out-reach programs. After much discussion, a running theme emerged which was the importance of Community Health Workers (community members who are trained to provide basic health and medical care) in addressing Piave’s specific health needs whilst alleviating informal and formal barriers of receiving health care services.
In coordination with SWAK and the Piave Health Centre, our ambitious project would entail training an additional fifty Community Health Workers in the sub-location of Migaa while increasing the capacity of Community Health Workers in Subuku through a training session held on Orphans and Vulnerable Children’s health care needs. After the training sessions, an inventory of the health care needs of OVCs was conducted by all of the Community Health Workers. This inventory is then translated to a database for the Health Care Centre which will be updated, upon visits to the health centre from the OVCs. The overarching goal of the project was to increase the number of Community Health Workers and their capacity to complete their work. More specifically, the project was designed to help alleviate some of the work of SWAK, by having the CHWs monitor the health care needs of the OVCs and to have the database serve as a tool for SWAK to better program their activities to address the OVC’s specific needs. Moreover, by recruiting and training Community Health Workers in Piave, the Health Care Centre can now better provide outreach to areas which were previously deemed “unreachable”.
Bernard, Esther, Festus (CACC-HIV/AIDS Coordinator) and I held a meeting with the key stakeholders to discuss the implementation and the objectives of the project. The stakeholders meeting was held May 16th on the grounds of the Maternity Ward with community members, representatives from civil society organizations, members from the Ministry of Health, and the area chiefs, among other local political figures. Round-table discussions were held on the topics of poverty, education, and health care all within a children’s rights framework. Festus clearly indicated to the group of stakeholders that they were more than just stakeholders of the project, but stake-owners. In other words, this project is intrinsically of benefit to the “stake-owners”, and as such the “stake-owners” should put forth their best opinions and criticisms to ensure that the project will be run as efficiently as possible. After many flip chart sheets were filled, we now had a clear idea as to what were the key problems for the OVCs in Piave, and from there we could start the next step.
The following week, a Memorandum of Understanding was signed with the Minister of Health-Rongai District, Representatives from the Dispensary Committee, and Frederique Vallieres, the President of ROTH. After the signing of the MOU, the project could now officially begin. Bernard and Susan Otieno (Public Health Officer) facilitated an open information session on community health work for interested Migaa citizens. We amassed a huge crowd of interested community members to which we then explained the project and the roles and responsibilities of a CHW in the community. The following week, Bernard, Susan, and I held a three day training session specifically on the health care needs of OVCs for the previously trained Subuku CHWs. The Subuku CHWs were trained on the topics of water based/related diseases, nutrition and healthy diets, reproductive and sexual health, HIV/AIDS, Malaria, and TB prevention, identifying child disability, and bereavement counselling. At the end of the training session, we heard many positive comments from the CHWs, since they were now trained on topics they had not been previously trained on, but now felt equipped to handle in their everyday work.
Unfortunately, both the training sessions and the conduction of the inventory were delayed due to a lengthy political dispute in the community over the ownership of a borehole which had been sunk by ROTH in 2007. The issue of the borehole had threatened the sustainability of all of the projects in place at the health centre and all future projects. Subsequently, the issue needed to be resolved expediently so that the work of ROTH could continue. During the first week of the training sessions, meetings were held to resolve the issue with various community leaders from Piave and local government authorities such as the Provincial Commissioner, the District Commissioner, and the Minister of Health. A resolution was reached and the projects initiated by ROTH for the summer of 2011 could resume.
Training sessions were held the following week with the newly recruited members of Migaa. Since the people of Migaa had not received previous training, five days of training sessions were held, instead of three, in order to teach them the basics in Community Health Work such as community strategy and governance, community mapping, administering referrals, developing village registers, and leadership skills. The CHWs were then briefed on how to conduct the inventory and were also trained on how to address pertinent health issues in the area and national priority diseases. At the end of the training session, the members of the Community Health Worker training team handed out certificates to all the newly trained CHWs.
After the training sessions had concluded, the next phase of the project could begin. The following three weeks were spent conducting an inventory of all of the orphans and vulnerable children in Piave. As a result of the inventory, a myriad of health issues emerged, particularly the alarming lack of mosquito nets in Piave. Moreover, it was found that many of the OVCs in Piave have never received education in their schools on drug abuse and addiction nor sexual and reproductive health. Consequently, future programmes designed for the OVCs can now better address the OVC’s needs, since there is a database at the Health Care Centre indicating the health care needs of every child.
After my project had concluded, many other projects developed at the health centre from the community members themselves. Daniel Mbugua, has undertaken a highly ambitious project in partnership with the Community Development Foundation. Daniel is the chair of the Community Health Workers for Subuku, a member of the Dispensary Committee, and is a Community Health Worker himself. He has initiated an income generating activity for the CHWs of Subuku. Many CHW programs suffer from high attrition rates due to its demanding voluntary commitment. Subsequently, many CHW programs are now incorporating an “income generating activity” so as to ensure that CHWs once trained will have a steady stream of revenue to support their work. At the beginning of July, the Community Health Workers dug a deep hole for a pond. The pond will later be filled so that the CHWs can then sell the fish. Esther Nyokabi, has also purchased a small plot of land to grow a shamba (a small farm) in order to continually support the livelihoods of the orphans and vulnerable children of Piave.
From my summer spent with ROTH in Piave, I have observed the hard work of community members in their efforts to create a better life for themselves and for their neighbours. I am grateful for the opportunity to have interacted with and developed a project alongside the beautiful people of Piave. Other development projects can benefit from ROTH’s mission. Since, it is only by “reaching out to humanity” that the harmful dynamic of “donor” and “recipient” can be eradicated and that sustainable community owned development can take shape.
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