Interview: Antonella Leakono, Nurse at Longewan Dispensary

Antonella Leakono is a nurse at Longewan Dispensary. Sarah Manyeki (M&E Officer for the project in Kenya) spoke to her about the changes she has noticed since the Community Health Workers (CHWs) were trained, and some of the challenges she faces in her work at the dispensary.

When was the community health unit formed?

The unit was launched on 7 December 2013 although the CHWs had started being functional in August 2013.

In your opinion, how many CHWs are active?

Out of the 25 CHWs, only eight of them are active. They are active in terms of referrals, identifying and referring immunisation defaulters, bringing expectant mothers to the clinic and following up on the referrals. Other services that they offer include escorting women to the facility to seek family planning services and growth monitoring for children.

What changes have you noted since the CHWs started doing their work?

Antonella said that hospital delivery before the CHWs started doing their work was at zero but currently, an average of seven women are delivering at the facility per month. The number of women seeking antenatal care services has also increased from 15 to 45 per month, children going to the clinic for growth monitoring has also increased from 0 to 100 and those seeking family planning services have increased from 10 to 40.

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Interview: Evalyne Ngise, Nurse at Arjijo Dispensary

Evalyne Ngise works at the Arjijo Dispensary, she was deployed there in 2010. Sarah Manyeki (M&E Officer for the project in Kenya) had a short interview with her on the 26 June 2014

How many CHWs were trained and of those how many are active?

“The only person who can answer that question precisely is the CHEW, but I think 25 CHWs were trained. Out of this number, I have only noted 1 CHW who is outstandingly active and her name is Mama Faith (Rosemary)”

Asked why she said that the CHW is outstandingly active, she based it on the number of referrals by the CHW and the follow up calls that she makes.

What changes have you noted since the CHWs were trained?

“Since the CHWs were trained, there has been a big improvement. The number of outpatients seeking services has increased from 40 people per month to a minimum of 98 people and an average of over 100. Number of women seeking antenatal services has increased from 1-2 per month to 9-10 per month. The CHWs have also been trained on assessing malnutrition (using the MUAC provided by the MoH) and are therefore referring the children to the facility. They are also following up on immunization and once they identify that a child does not have a scar, then they refer them to the clinic, so far we have received 2 from Katunga village this month and another one who is scheduled to come next week from Sepeyo village (they can not immunize all the time, have scheduled immunization days to avoid wastage)”

“It is now more common to see men coming to the clinic to request for a HIV test. In the last month, we witnessed an upsurge in the number of women seeking Family Planning services. Very many women had a Norplant implanted on them. In the past, there were misconceptions on Family Planning. Many women however prefer depo because it has privacy and not many husbands will allow their wives to practice Family Planning in this community although some men have embraced the change.”

On skilled birth deliveries she said “from 2010 when I was deployed here to late last year, only 2 deliveries had been conducted at the dispensary. Currently, I conduct between 2-3 deliveries per month” She however said that she does not encourage women to give birth at the dispensary. “I prefer visiting the women at the comfort of their homes to assist them from there because the facility’s maternity is not well equipped, there is no delivery bed, beddings and the beds there are not in good shape” She was however quick to note that the County Government of Laikipia has pledged to assist the dispensary with Kshs. 240,000 from their development kitty and this money will be used to equip maternity. “I have ordered for a delivery bed, 4 beds, blankets and pipes for installing piped water system inside the dispensary”. This will be a great relieve for her and for the women. I came to learn later that she had been called to assist 4 more women during the month but could not attend them due to distance and lack of transportation.

According to Evalyne, the community is now more aware of the health issues, “it is now a common occurrence for community members to walk in to the clinic and request for water treatment tablets” she noted. This she attributed to the sessions being offered by CHWs.

What are the challenges experienced?

Despite all these there are a few challenges and the major one is staffing. “As you must have noted, I work alone at this dispensary. Sometimes I am invited for workshops or I have to go out for training which can be as long as fourteen days and there is none to relieve me. This is very disappointed for those community members seeking services during my absence, some walk as far as from Lariokorok Village only to find there is no one and then walk back. I am forced to work through out without having off days and this is very tedious.” She said. Lariokorok after enquiry, I learnt that its 24 kilometers to and fro.

“Another challenge is that the CHWs have no kits. This means that even for the simple cases like headaches, they (CHWs) have to refer” Evalyne added. She felt that if the CHWs are provided with kits, then her workload could be reduced. She also said that the facility is not well equipped. “we have no laboratory and this means that even the simplest cases like the ANC test profiles have to be referred to Doldol Hospital, most of the clients end up not going (to Doldol for tests) because they do not find it as an emergency”, she said.

Referrals are another headache because of the transportation issues. Asked about the sub county ambulance, “Most of the time the ambulance is not available. Most of the time we are forced to transport the referral cases using motorbikes which is very uncomfortable for me and for the patients,” she said.

Recommendations and closing remarks

Asked on what she would recommend, she was fast to point out that there is need for more staff, equip the maternity which is on the pipeline and provide the CHWs with kits. She also highlighted the issue of a gas cylinder used to refrigerates the immunization drugs. “We only have one cylinder in this facility. We are therefore forced to skip immunizations sometimes when the gas is finished and have to wait for an extra cylinder from the Doldol sub county Hospital” She said that a second cylinder would be of great help.

On her closing remarks, she said that “the CHWs are doing a commendable job in referring cases and making up follow up calls, enquiring whether the nurse is available before referring and consulting on what to do for the simple cases as well as finding out the clinic and immunization days on behalf of the community” She however said that the CHWs need to do the household visits more often especially to the women with small children to identify cases of malnutrition.

If these hands could talk

I remember gazing at the hands of a traditional birth attendant in pastoralist Laikipia, Kenya, and wondering about the stories they might hold. How many newborns had these hands supported into the world? What challenges had been faced by the women they helped through childbirth, in their remote rural homes far from any health clinic? Beneath the rough and wrinkled surface, how much loss had they absorbed through these experiences?

The hands of a traditional birth attendant in Laikipia County, Kenya.  Image: Hannah Ford / AVI

The hands of a traditional birth attendant in Laikipia County, Kenya. Image: Hannah Ford / AVI

Sub-Saharan Africa has the highest maternal mortality rate, bearing the burden of more than 50 per cent of the world’s maternal deaths. One in 39 women in this region faces the risk of dying in childbirth in their lifetime.

Yet less than half of all mothers in sub-Saharan Africa have the support of a trained midwife, nurse or doctor during childbirth. Even fewer mothers from the marginalised nomadic pastoralist communities of Kenya and Ethiopia have access to skilled birth attendants. While evidence has shown that access to skilled care during pregnancy, birth and post-delivery, is key to saving lives, many women don’t have an option.

For the past two years, I’ve had the privilege of working on The Road Less Travelled project and coordinating this blog. I have learnt so much during this time. As I reflect on my experiences, what stands out to me most is the strength and resilience of the pastoralist communities at the heart of the project – and especially that of the mothers. They want what all women want for their children: the chance to survive and thrive.

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Photo exhibition: Motherhood Matters

Image: Kate Holt / Anglican Overseas Aid

Image: Kate Holt / Anglican Overseas Aid

Take a journey along the road to safe motherhood in sub-Saharan Africa with ‘Motherhood Matters’, a stunning exhibition of photographs on display at Federation Square in Melbourne in the lead-up to Mother’s Day in May.

Where: The Atrium at Fed Square
When: 5 – 13 May, 24 hours
Price: Free

Download the exhibition poster and help us spread the word

Gain an insight into the experience of mothers in rural African communities, learn about some of the challenges they face and find out about the vital work being done to improve maternal health in Kenya, Ethiopia, Uganda, Tanzania and Rwanda.

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Delivering a better start in life

Sunday 5th May marked the International Day of the Midwife, an opportunity to recognise and reflect on the crucial role midwives and birth attendants play in supporting mothers through pregnancy and making childbirth safer.

With Mothers’ Day coming up this Sunday 12th May, there is no better time to pay tribute to all the amazing, dedicated people who work tirelessly to improve maternal health for all women, all over the world.

Honor a midwife or a mother: send a free e-card today.

Most maternal deaths (99%) occur in developing countries, and more than half of these deaths occur in sub-Saharan Africa, according to World Health Organization statistics.

Working in this region, we are all too familiar with the disparities that exist in terms of access to basic health services. The nomadic pastoralist communities who live in sparsely-populated areas of Ethiopia and Kenya are among those often excluded – they are marginalised as a result of their remote location and way of life.

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