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How Can A Burden Be A Joy? Ask A Community Health Worker

Consolata Agunga goes door-to-door as a community health worker, a demanding volunteer job. "It is God who gives me the strength," she says. She is also a small-scale farmer, growing vegetables for her family.
Marc Silver/NPR
Consolata Agunga goes door-to-door as a community health worker, a demanding volunteer job. "It is God who gives me the strength," she says. She is also a small-scale farmer, growing vegetables for her family.

If someone were to tell you their job was a burden, you might feel sorry for that person.

So when Consolata Agunga told me, "I feel good because I have the burden of serving my people," I was puzzled.

How can a burden make you feel good?

Consolata, a 55-year-old mother of three (and grandmother of three), is a community health worker in Kenya. Her "burden" is to go door-to-door in her village of Ramba Pundo, keeping tabs on the health of 673 community members. Among the things she might want to know: Have pregnant women had their checkups? Are children being vaccinated? Does a couple need information on family planning? And what's up with that fever — flu or malaria?

She spends many hours a week as a volunteer, receiving only a stipend of $30 a month and health-care coverage. So, in a way, it is a burden. But she's been doing it for 7 years and loves it: "God gives the burden but it is God who gives me the strength," she says. "I have the zeal and the desire to serve. I have my people at heart."

I met Consolata at the Skoll World Forum this year. She was on a panel entitled "Leveraging Technology to Close the Distance in Global Health Access." And technology has been a boon in her job. Community health workers now use an app on their mobile phones to record information. "I used to carry big, heavy registries," she says.

But the technology can't do anything by itself. And no technology can speak up as Consolata did, looking at the audience at Skoll and forthrightly stating: "I don't expect mothers to die when they are expectant. It is a crime for a mother to die when expecting."

I wanted to learn from her what it's like to be one of Kenya's approximately 100,000 community health workers.

Joining us for the conversation were Kennedy Oruenjo, the county focal person for community health services in Siaya County, where Consolata lives, and Caroline Mbindyo, the director of technology and innovation for a nonprofit called , which seeks to provide technology to community health workers. She is based in Kenya. The conversation has been edited for length and clarity.

How does someone become a community health worker in Kenya?

Consolata: I used to do volunteer work in a community-based organization. So when the opportunity came, I decided to be one of the community health workers.

So that's it — someone decides to be a community health worker?

Caroline: You are elected. You may have the desire but if the community doesn't trust you, you can't do it. Some people want to but are not capable, they don't understand the illnesses. And not all of them are in it to provide quality services.

What's the motivation for people who aren't in it for the right reason?

Caroline: Because community health work is a prestigious thing in the community. It's a thing of trust. They are valued by the community. People call them "daktari" — doctor in Swahili.

Consolata: I feel important.

Yet in most parts of Kenya they do not even receive a stipend.

Caroline: They are valued in theory but not in actuality. Most counties in Kenya don't pay them. I would say about five counties of the 47 pay.

Why does Siaya county pay?

Kennedy: Our governor's interest was to get to each and every household with key messages about health.

Caroline: He institutionalized payments so if he left office, the stipend would still be paid.

I've read that the living wage in Kenya is about $250 a month. So $30 isn't much.

Consolata: The stipend cannot do much for a person but we have no say.

Kennedy: It is just a token.

Caroline: I think the majority of them have other jobs.

Does it helps with retention?

Kennedy: Yes. Before the stipend, the dropout rate was so high — 60 percent in a year.

What kind of hours do they work?

Caroline: Some days they might work a full day and some days not at all.

So they have other jobs?

Caroline: They might work in the market, they might wash clothes, they might own businesses in the community.

Consolata, what do you do when you're not doing your health work?

Consolata: I do farm work — maize, beans and vegetables, like white and sweet potatoes, on a small scale for my family.

How are the health workers trained?

Kennedy: We train them on signs and symptoms of illness. And some treatment, like doing a prick test and analyzing results, giving treatments to manage fever. They can do minimal care and refer people to the nearest health-care services.

Give me an example of what might happen on a home visit.

Consolata: Making sure people have their malaria nets hung correctly.

If the person says their malaria net is in place, is that enough?

Consolata: No, I have to see it. I have to see it hanged and hanged correctly. Some are hung very high so they cannot be inserted into the bed.

People don't mind you coming into their bedroom to check it out?

Consolata: They're used to me.

Do people ever resist — they don't want to be seen by a doctor, maybe, because they're afraid to go?

Consolata: No. Sometimes they come to us.

I understand that a key task is checking to see if kids have been vaccinated.

Caroline: Some people don't believe in immunization, they believe it causes barrenness or have religious beliefs against immunization.

How do you convince people to go for the vaccines?

Consolata: I talk about it all the time, all the time.

What's the male/female breakdown?

Caroline: There are more women than men.

Why is that?

Kennedy: In Kenya, the man should be the breadwinner, that is the thinking. If you are a volunteer, at the end of the day the children won't eat.

Consolata: Some community members feel safer when attended to by a woman compared to a man.

Caroline: Another man coming into a man's house, the man is asking, "What is that man coming to do in my house?"

Speaking of houses ... Consolata, what is your village like?

There are no tarmac roads. During rainy season the area is muddy and I need a raincoat, umbrella and gumboots. During dry season it's windy and dusty. The majority of houses are single rooms. I live in an old, unfinished house. It has a kitchen, a single bedroom and a small sitting room.

Is there running water?

No. I buy water daily. I use an outside latrine.

And electricity?

Yes. I have electricity but frequent blackouts so a good battery is needed. I have a battery, but it does not retain power so using the phone becomes a challenge.

It sounds like you have a lot to deal with on a daily basis. And yet you have this commitment to volunteer. Where does that come from?


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Marc Silver
Marc Silver, who edits NPR's global health blog, has been a reporter and editor for the Baltimore Jewish Times, U.S. News & World Report and National Geographic. He is the author of Breast Cancer Husband: How to Help Your Wife (and Yourself) During Diagnosis, Treatment and Beyond and co-author, with his daughter, Maya Silver, of My Parent Has Cancer and It Really Sucks: Real-Life Advice From Real-Life Teens. The NPR story he co-wrote with Rebecca Davis and Viola Kosome -- 'No Sex For Fish' — won a Sigma Delta Chi award for online reporting from the Society of Professional Journalists.
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