It’s 30 degrees Celsius in the sweltering heat of Njigoni village in Tharaka Nithi; The wind blowing more hot air on your skin doesn’t give much refreshment, but a different wind of change has hit this county. One that has changed the lives of many- both young and old, and upcoming generations (yet to be born children). To understand this, would be to understand the history of the county and such villages as it pertains to health.
In 2018, Tharaka Nithi witnessed one of the worst cases of Cholera outbreak, this was largely due to the lack of knowledge on how to establish and maintain basic forms of hygiene and various forms of disease awareness. This ranged from animal-human diseases such as anthrax to strong religious beliefs and parents who did not believe in their children getting vaccinated. Other impediments are more culturally centred, as greater trust is put in traditional healers and local practices of opening dead animal carcasses to try and diagnose the cause of death for the highly treasured animals.
In mid-2019, when the CP3 program was started in the county, it brought with it a sense of hope but also a great change in the way things were done. According to County Coordinator from the Health Ministry in the County government, “The project funded by IFRC greatly helped in the detection and response of cases that were reported by the community health volunteer through alerts sent to the county disease surveillance unit.”
The program which had a highly devolved structure saw to it that residences in the furthest areas and villages were reached by the support of the community health volunteers. These able men and women were people who stepped in from their usual roles as farmers, teachers, pastors and took time to be trained by the Society on epidemic control for volunteers and community-based surveillance. Essential tools to enable them to train the members of the community on the importance of hygiene, vaccination, disease monitoring, reporting, and control.
The one health program, with support from the county government, has had a great impact. Since its inception, the community has seen a rise in strengthened community surveillance, disease reduction- especially in Tharaka North that had recurrent diarrhoea cases and has not reported any since- and the mobilization of community members has been made easier through community health volunteers (CHVs).
General improvement of the health status in the communities was recorded, including a rise in hospital visits attributed to CHVs referrals from their household visits. According to the Nurse in charge at the Karungwaru dispensary, there has been an improvement of 4 and above visits (the recommended ones) of Anti-natal care mothers, post-natal care of delivered mothers, and an increase in immunization of children under 5-years. This was a stark difference from 2 years before; where there were more home deliveries and high child mortality rates (under 5) due to malnutrition and abdominal infections. The radical transformation did not just stop at basic hygiene sensitization, but also saw the transformation from staunch religious practices.
A religious group locally known as the Kabonokia, posed a great challenge since they did not believe in medical intervention. According to Ruth Gachoka, a former convert of the group in Ikuu unit in Tharaka South, they believed that God only helped and was against medical interventions, taking their children to get vaccinated, and did not believe in taking their children to school either.
“We were not allowed to even treat our livestock or get them to vaccinate. When we get milk, we believed in not boiling it which I later learned, puts us at a higher risk of getting diseases.” Ruth said.
Since her conversion, her health and that of her family improved. She took her 6- and 12-year children to get vaccinated after she left the Kabonokia group and implemented that which she had been trained on by the CHVs.
Before the start of the program, the challenge that the public health officials had was that of communication and tracing of reported diseases.
“It would be hard for us to move from one area to another without knowing what we are responding to given the distance between the villages and various areas. But since 2019, when we started using the USSD code by the CHVs for reporting, it makes it easier to know the cases reported and how to best respond.” Dr. Mugambi Mwamba, the Public Health Office in Tharaka North sub-county said.
The CHVs use the USSD code *384*60# for community-based surveillance alerts which are centralized and received by the public health officials as the sub-county surveillance officer. The community also has access to a direct reporting line, 1513, which gets them through to the county and allows them to report any case.