Africa's unsung army of women wage war on COVID-19

Community health workers are the foot soldiers – mostly female – who are known in the neighbourhood and trusted to save lives

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By Nita Bhalla and Emeline Wuilbercq

NAIROBI/ADDIS ABABA, June 26 (Thomson Reuters Foundation) - Armed with a face mask, notebook and pen, Everlyne Akinyi Omondi sets out each morning from her one-room home in Nairobi's informal settlement of Kawangware to do a job few others would contemplate in a pandemic.

As cases of the new coronavirus climb and Kenyans are told to stay home and avoid human contact, 38-year-old Omondi moves house to house through Kawangware's maze of narrow lanes.

Standing at the doorways of the cramped, corrugated houses, she talks about COVID-19, shows residents how to wash hands or don a mask, patiently answering their questions.

"I know there are risks of contracting the virus, but I don't feel so scared. I have made a pledge to keep my community safe," said Omondi, turning to reprimand a group of children crowded around her for not maintaining social distancing rules.

"You see how small and close together the places where we live are. We have to make sure people understand how they can stop corona from spreading. Here, if one person gets it, everyone can."

The mother of three is not a doctor, nurse or medic of any sort - just one of tens of thousands of ordinary African women who, without fanfare, battle the virus in their communities.

Poorly paid or not at all, these unsung armies of mostly female community health workers have for years doled out advice and health services to families living in remote villages and urban slums who lack formal support.

Recruited and trained by government and charities - they are found from Kenya to Tanzania, Ethiopia to Malawi, Liberia to South Africa - the women go door to door, dispensing advice on everything from family planning to immunisations.

Now, as transmission of the new coronavirus spreads, women like Omondi are essential foot soldiers in the war on COVID-19.

Charities such as Catholic Relief Services, which is supporting coronavirus training for about 5,000 community health volunteers in Kenya, say this workforce is key.

"Community health volunteers are not given the recognition they deserve, but they are important frontline workers. They have a wide range of knowledge and experience from dealing with cholera outbreaks to malaria prevention," said Moses Orinda, CRS's senior project officer in Kenya.

"For COVID-19, they have the ability to contact trace, provide support to home-based patients and conduct essential prevention and control activities," Orinda said.

COMMUNITY TRANSMISSION

The COVID-19 virus has infected close to 10 million people and killed almost half a million worldwide, according to Johns Hopkins University.

Initially the virus multiplied more slowly in Africa than in Asia or Europe, but all 54 nations on the continent are now infected, with more than 330,000 cases and over 8,800 deaths combined, says the African Union's Centre for Disease Control.

South Africa, Egypt and Nigeria have recorded most cases, but experts say true numbers may be much higher as many nations lack reliable diagnostic or testing capabilities.

With densely-packed slums, poor access to water, widespread disease and weak health systems, many countries will struggle to control the fast-spreading virus, they add.

"For now, Africa still only accounts for a small fraction of cases worldwide," said Matshidiso Moeti, the World Health Organization (WHO) Africa director, earlier this month.

"But the pace of the spread is quickening. Swift and early action by African countries has helped to keep numbers low, but constant vigilance is needed to stop COVID-19 from overwhelming health facilities."

More than half of African countries have witnessed community transmission - cases where patients have no travel history or known contact with infected people - suggesting the virus is moving undetected in the population, says WHO.

This is not hard to believe.

Many cities are home to sprawling, overcrowded settlements, housing tens of thousands of people, where the key to containing the spread - hand-washing and social distancing - are a luxury.

In Kawangware, there is scant access to water or the space for self-isolation. Families of five live in one-room shacks. There is no piped water and households share toilets.

According to the United Nations, only 14% of Kenyans have the facilities to wash their hands at home with soap and water.

The warning from WHO is stark: up to 190,000 Africans could die if containment measures such as contact tracing, isolation, personal hygiene and distancing are not improved.

'INVISIBLE' ARMIES

Already known and respected, community health workers are a perfect first-line response to a pandemic, say health experts.

Raj Panjabi, of Harvard Medical School and CEO of Last Mile Health, said community health workers showed their value when another deadly virus hit in Liberia.

"When Ebola threatened to bring humanity to its knees, informal community providers stepped up to learn the signs and symptoms of Ebola, to team up with nurses and doctors, to go door to door to find the sick and get them into care," he said.

"You couldn't have stopped the epidemic without a ground force of these community members."

One of their key jobs is busting myths and slaying stigmas.

A belief that only whites get the virus or that it can be cured with hot, sweet tea is rampant, while mass testing is elusive due to the stigma a positive result can carry.

Government health officials say the women have built up trust through years of contact so locals are happy to pay heed.

"We know that they can pass messages on which sometimes the government cannot. They live in the same communities and have good social standing, so it is much easier for them to do provide information," said Catherine Mugo, a sub-county community strategy coordinator at Kenya's ministry of health.

Mugo isn't far wrong.

As Omondi wends through the knot of narrow alleys that make up Kawangware, residents rush out to greet her, children give chase, and women break off from hanging washing for her advice.

What to do if there is no money for soap?

Borrowing a bucket, water and bleach, she shows them how to make a safe chlorine solution strong enough to kill the virus.

Some can't afford to buy face masks for running errands. Stay home, she orders; send out somebody who does own one.

"Everlyne is good. She has brought us new information," said resident Patrick Gitonga. "She has shown us new ways."

Health professionals and charity workers say governments need to value this workforce - to give them a living wage as well as the personal protective equipment needed to work safely.

Omondi, who has been working as a community health volunteer for 10 years without pay and is responsible for 100 households in her neighbourhood, would welcome some recognition.

"Having a salary or some stipend would be really useful," said Omondi, whose five-strong family struggles to get by.

"But you know, most of us are doing this work because we have something in (our) heart that tells us that we cannot let our neighbour suffer."

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(Reporting by Nita Bhalla @nitabhalla and Emeline Wuilbercq, Editing by Lyndsay Griffiths. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)

This story is one in a series supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria. www.theglobalfund.org

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