Arthur Mwai, Amref Health Africa in Kenya
Some stories begin in the middle or at the end and then roll back to the beginning, with the audience on edge, waiting to see how it all ties up.
The Coca-Cola Foundation COVID-19 Response project in Kenya is one such story. Hatched in the most unexpected of circumstances, set in the weirdest of years in human history and unfolding through the selflessness of a new type of heroes and heroines in the frontlines.
Where it Started
The partnership between Amref Health Africa in Kenya and the Coca-Cola Foundation in response to COVID-19 in the Coast region of the country started with what was available at hand given the scramble for scarce medical commodities globally and set amidst rising cases.
In July, we launched the project with the County Public Health Department.
At the height of the pandemic back in April when daily death counts in Europe shocked the world and much less was understood about the virus, face masks were so scarce that some health workers in Mvita sub-county in Kenya had to do with a single disposable surgical mask for a whole week, while most had to buy varied types of masks. A few got infected with COVID-19, prompting the Mvita health clinic to shut down for a while.
Wangui (left) and fellow CHV Priscilla wear masks donated by the Coca Cola Foundation
The face mask is the most common piece of personal protective equipment (PPE), seemingly basic, yet so critical in enabling health workers to safely do their jobs – both at the clinic and in the informal settlements where Community Health Volunteers (CHVs) carry out door-to-door preventive health interventions.
Face masks and hand sanitisers are not stored in the general store along with other medical commodities in the Mvita sub-county health clinic. Instead, they are kept under lock and key near the boardroom, under the watchful eye of ever-busy but friendly Sumeya. Every request must go through her, and she is held accountable for each medical commodity issued out of the store.
The thirteen thermal guns that we donated in early June were not even stored for a single day under Sumeya’s watch. Instead, they went straight into action to fill a critical gap for COVID-19 response teams in the field.
Magdalene Radier, a seasoned Community Health Volunteer from Mburukenge in Kenya who was wearing a surgical mask that told tales of being washed, re-washed and washed again, carefully packed away the new set of masks that we issued them for use during the week’s door-to-door education campaign.
She did not want to wear one just yet – they are too precious to use and dispose of. Instead, the utility of a surgical mask, which is designed for use over eight hours only, must be stretched as much as possible. Wearing a new mask has to be postponed, avoided – because a CHV never knows when they will be issued with face masks again.
A Different Kind of Messaging
Weeks turned into months, with the fear of getting infected with COVID-19 that turned into indifference and many unanswered questions. Sensitization posters had started to yellow from the beating sun, and the wet patter of rain after cars fitted with blaring loudspeakers and intermittent music made their rounds blaring out COVID-19 messages to disinterested people going about their business.
We sat down and crafted a different approach, bold and difficult, but formidable and engaging. We were going to engage CHVs in a door-to-door education campaign, where residents of Muoroto, Tudor Mwisho and Mburukenge informal settlements, within Mvita sub-county, would get a chance to pose questions about COVID-19 to the health workers and generally have an interactive session.
CHV Riziki (left), showing a woman how and when to use the issued hand sanitizers
As acknowledgement of their time, and to reinforce proper hand hygiene where washing hands with soap and water is not feasible, targeted households would receive two small bottles of hand sanitizer.CHVs have a difficult job of dealing with the blowback and serving as the de facto customer service between residents of the informal settlements and project implementers – from the government to NGOs.
“Sometimes you get to a household to do your intervention and find that they have not eaten in days, especially the TB and HIV patients. So the humane thing to do is to dip into your pocket and help. Remember that we are not paid a salary or stipend; we are just volunteers.” –Teresia Okeyo, Community Health Volunteer
From welcoming mothers, to hostile residents who insisted that COVID-19 was a government ploy, to water-poor households that washed their hands several times using the same water in a basin. To teenage mums who respect and look up to the health advice given by the CHV, to neighbours who complained that the CHV did not come to share the message with them. The team of eight CHVs managed to reach 800 households over five days, across three sections of the Tudor informal settlements in Mvita sub-County.
A Simple Long-Lasting Message: Talking Walls
A set of simple COVID-19 messages on a community wall beats posters and cars fitted with loudspeakers.
Mutisya, also known as “Coach” or “Coaches” lives in a tiny house next to the mural, above CHV Wangui’s tiny apartment. Parents adore him for keeping their kids engaged through sports in morning and afternoon shifts; he is much respected and loved.
Coach (fore left on the bike) with a group of young footballers from the neighbourhood
“As a community, we feel proud of this message that you have put on this wall. This wall art, in a way, signifies to us that we have not been forgotten in the fight against COVID-19. Some people still care about our lives and health. As a coach and mentor to many young people, I am proud to have this talking wall in this key community space. The family living inside the house feels very happy and proud to host such an important message to the community.” — Mutisya, also known as ‘Coach.’
As work on the mural was still ongoing, youths came to pose for a photo, while some took a selfie. The messages on four other strategically located walls will reinforce the information passed during the door-to-door campaign and serve as a reminder to many unreached residents that COVID-19 is real and of the preventive measures that need to become a habit, for many months to come.
Adopt a Handwashing Station
In our first field briefing with the CHVs before starting the education campaign, we met under the elusive shade of a tree at the Assistant Chief’s office, between two buildings. A nice handwashing frame branded with the donor name was strategically placed at the entrance, but it looked sad without a water tank and soap and the ground below was dry and cracked – tell-tale signs that no handwashing had happened in a long time.
Big branded tanks with rows of taps greet everybody entering Muoroto Simitini, Mburukenge and Tudor Mwisho informal settlements. But they all do not have soap.
Soap, in conjunction with flowing water, helps wash away the COVID-19 virus when hands are washed properly. But washing hands without soap is pointless in the fight against COVID-19.
So for the 14 handwashing stations that we distributed across the three informal settlements, each was adopted by a CHV who would ensure that the station always had soap and water and that it was safe in a strategic community space for maximum impact.
Proper handwashing with soap and water is not as obvious as it may appear, but when done correctly, it is a highly effective prevention strategy for most diseases.
CHV Teresia Okeyo (right) and ‘Coach’ (far left) supervise kids at a handwashing station
Why the Basics Matter
In most of the developing world countries like Kenya, maintaining physical distance is impossible in the informal sector where a majority of Kenyans live and conduct their daily business.
So proper wearing of facemasks, sneeze and cough etiquette, frequent handwashing with soap and water or using a hand sanitizer in place of soap and water will be pivotal in suppressing and consequent flattening of the COVID-19 curve.
The Strength of Partnership
The partnership between Amref Health Africa and the Coca-Cola Foundation has left an indelible mark in the lives of youths, CHVs and members of women groups trained to make soap and their lives forever changed. We have walked hand-in-hand with Mvita sub-county Clinic – one of Kenya’s worst-hit COVID-19 epicentres, which needed all the help they could get.
We have run the race and amplified the little help that we could offer by ensuring quality where quantity was not feasible. We have worked in the field, shoulder-to-shoulder with CHVs and shared our COVID-19 dreams and fears with selfless health workers at the Mvita Clinic who show up every day, ready to serve.
The basics matter, the health and lives of marginalized communities living at the fringe of our society matters, every partnership that we can make in the ongoing and multi-faceted fight against COVID-19 matters.