21 December 2015
Helping mothers escape malaria this winter
Malaria is Africa's biggest killer. Pregnant women and children are particularly at risk. In many countries across the continent, including Kenya, people are dying because they don't have a mosquito net to sleep under. Kisumu County, which is a five-hour drive north west of the capital Nairobi, has some of the highest rates of the disease in the country, so churches joined together to respond, through a charity funded and supported by Christian Aid. Amaris Cole visited the area, learning just how easy it is to save many of the lives being lost.
After driving for two hours from the nearest city, Kisumu, we began the slow ascent up a steep track that even our 4x4, lovingly called "The Beast" by our team, struggled to climb. It wasn't a road, it was a rockery that happened to be wide enough for our vehicle. While I clung on, I noticed up ahead a lady walking with a water tank on her head. I was finding the drive enough of an ordeal; what would it be like to live at the top of this valley, having to tackle the path each time food or water was needed?
At the top we met David Oyuga. He is a 65-year-old community health volunteer (CHV). This means he visits 80 homes each month, offering basic healthcare and educating the community of Upper Kokumu about issues such as hygiene, HIV and malaria. It's a gruelling job, but without his help and advice, "my children would not be healthy and life would be very hard," one patient said. The only payment these volunteers receive is an occasional monthly allowance of around 1,000 Kenya Shillings from NGO partners, who in turn require the workers to submit reports on numbers of people reached.
The first patient on his morning round was Monica Achieng, a 32-year-old who is pregnant with her third child. Her sons, aged 10 and 8, were at school when we visited. She told us about her experience with malaria, which she said she "always has bouts of". She's already had it once this
In the past, people used herbs from the witchdoctor to treat malaria. With the help of these community health volunteers, villages are being educated about the need to seek medical expertise at their nearest facility. So, does Monica go to be tested when she has malaria symptoms? "I do now, but the facility is far away. It takes me three hours to reach the facility. It makes me feel tired – exhausted – and it also increases my illness and dizziness."
And it's not just Monica who suffers. "My children have had malaria. They vomit and their whole body has pain. Their head aches." The trouble is, her children don't sleep under a treated malaria net. The family only has one.
Malaria during pregnancy can be fatal: pregnant women who catch the disease are at risk of miscarrying, premature delivery or stillbirth, putting the life of both the mother and the baby on the line. David has now taught her that the first priority for nets must be pregnant women.
"If I was not pregnant I would automatically give my children the net. I'm aware of the risks. I fear for them so much. I'm afraid that they will contract malaria." Instead, they must sleep in a hut used as the kitchen, with mats rolled out to cover the ground. Her grandmother told her that smoke from
lighting a fire next to where they laid would discourage the mosquitos from entering the space. It doesn't, but Monica has to feel that she's doing something to protect them. We went to look at the area, and couldn't enter because of the smell and smoke – even the chicken wondering around the area stayed out of the hut.
Monica knows too well the risks of children becoming ill with this disease, and the danger of not treating it quickly. In 2005 her next door neighbour lost her little girl, at 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 they tried to give the child medicine and it was too late. The child died."
David teaches her how to stay healthy and avoid the number of diseases prevalent in this region. He advises her on preventative measures, as well as practical tips, such as how to boil and treat the pond water the family drink.
"It's difficult for us CHVs," he said, talking about the number of people he sees without a net. "It's hard that we have no solution to it all. Sometimes I find myself using my own money where I find the situation is desperate." To do this, he has to "slash his household budget".
David is retired. The only income he has comes from selling vegetables, the seeds of which were donated by ADS Nyanza, Christian Aid's partner in the region. He grows onions.
"I'm praying. If God gives me money from somewhere, I have to go and get a net for Monica. It's very tough to see this." It's our Christian duty to help, said David.
The government gives treated nets every three years, which people are expected to pick up from their local health facility. Being three hours away, though, Monica has found they're usually all gone by the time she arrives. Now, she just doesn't bother.
The fact is, Monica isn't alone in her struggles. Half of pregnant women in Kenya face the same challenge of deciding who should sleep under a net each night. A government survey is 2014 showed 49 per cent of women didn't sleep under a treated net the night before the research was carried out, along with 48 per cent of children. And some officials we spoke to suggested that even this figure might be inflated – with some people knowing they should sleep under a net, making them answer positively, despite nets actually being kept in case visitors arrived, or in some places by the coast, used as makeshift fishing nets.
So why aren't the government doing more? The director of health for Kisumu County, Dr Dickens, painted a fairly hopeless picture.
"We do still have some challenges," he admitted. "First, devolution came abruptly (in 2010, the Kenyan constitution was updated, which mandated the devolution of power to 47 counties), we did not adequately prepare for the process. Second, some drugs have run out – mainly prophylactic drugs for pregnant women. It's now the responsibility of the county government to provide and we weren't prepared.
"Malaria in pregnant women is a big worry for us."
ADS Nyanza, the charity that looks after the hundreds of community health volunteers that serve the rural villages, are equipping the volunteers, giving them supplies to make their crucial job a little easier. Thanks to funding and support from Christian Aid, the charity has trained the volunteers
to give life-saving health advice, donated motorbikes to help them transport patients to hospital, and given them the resources to monitor health levels in the community and record patient information, making it easier to refer sick people to the relevant health facilities.
ADS Nyanza is part of a national NGO, Anglican Development Services, which has regional hubs across Kenya made up of local dioceses. Samuel Omondi, director for ADS Nyanza, explains the vision: "The main object of this organisation is to work towards the vision of a dignified and responsible humanity.
"The region is bedevilled with a lot of problems. It's one of the poorest regions in this country – 60 per cent of the population live below the poverty line, and burdened with disease, particularly HIV and Aids and malaria."
Monica hopes her children's lives will be better – and healthier – than her own.
"When I pray to God I ask him to give them long life, opportunities and hope for the future." When it's simple things that could make this dream come true, including mosquito nets that cost a couple of pounds and the education that one community health volunteer brings to more than 80 families each, it's easy for all of us our bit and make sure it's achieved.
If you would like information about how to donate to Christian Aid's malaria project, call 0845 7000 300, or visit their website here.