From the start, we knew that our success in reducing the under-five mortality rate in our area hinges on the community viewing Nuru’s CHWs as health experts and welcoming them into their homes. Unfortunately this had proven to be difficult. Initial reactions to the CHWs were lukewarm. Many households turned CHWs away.
To counteract this we have conducted trainings on how to do a good household visit and focused our energy on individually coaching the CHWs to improve their home visits. Seven field officers spend two days each week visiting homes with CHWs, debriefing after each visit to coach the CHW on what they can do better in the next home. I’m happy to report that our hard work is paying off. It is a rare occasion when a CHW is turned away from a household. In addition to welcoming them into their homes, community members are eager to learn about health topics from the CHWs. When I went along on one home visit, as soon as we sat down the mama turned to the CHW and asked, “What are you going to teach me about this month?”
We’ve now had multiple instances like the one I wrote about a couple of months ago where community members have notified the CHW when a pregnant mother went into labor so that they could help the mother get to the health center for the delivery. On one occasion a CHW accompanied a pregnant woman to the hospital in Migori, about a 30-45 minute drive away, and was told he was not allowed to enter the hospital with her since it was outside of visiting hours. When he showed his Nuru CHW badge, the hospital let him in to be with the patient through a difficult delivery.
During home visits I’ve watched mothers present their children with fungal infections, vision problems, and a myriad of unknown illnesses to the CHWs and field officers to ask their opinion on how to treat the child and make them healthy again. Community members are even notifying the CHWs when their children are sick and following their advice. Just this past week Stephen, one of our field officers, told me a story about a CHW who was doing a routine home visit when he was notified of a sick 15-year-old boy. This boy had been sick for the past two months and was so weak that he was unable to walk. The family had already taken him to the local clinic and an area hospital. He had been diagnosed with pneumonia and yellow fever and treated accordingly, but did not improve. The CHW called Stephen to come to the house and help him make a recommendation for the boy. Based on the boy’s symptoms, Stephen and the CHW suspected tuberculosis (TB) and urged the family to take the boy to the hospital in Migori for a TB test. They boy’s family complied and he tested positive for TB. He recently began the six month long TB treatment and the CHW is following up regularly to ensure that he is taking the medication as prescribed.
These anecdotes demonstrate a transformation in the community mindset. There’s still a lot of work to be done to increase the CHWs’ disease knowledge and improve their home visits before we can truly say that they are the best health resources in the community, but we’ve made a major shift in that direction since the CHWs were first trained almost a year ago. I am certain that continuing this focus will continue to improve the community acceptance of the CHWs.