Phobia of Healthcare Facilities: Community Health Volunteers, Shielding Clinically Vulnerable Families from COVID-19



Overcrowded populatiuon at Kibera slums with everybody going on with  their daily activities

The informal settlement of Kibera based in Nairobi the Kenya’s capital is the largest urban slum in Africa. The shanty has a varying population numbers but the United Nations Human Settlements Programme estimates that 500,000 to 700,000 people reside in the sprawling, densely populated community.

Residents of Kibera are from various walks of life with majority living below $2 a day. The low-income families can rarely afford three consecutive meals a day. Many people live from hand-to-mouth with very little savings if any. Most dwellings have mud walls and tin roofs ,indoor plumbing and electricity are scarce.

Life in Kibera comes with a range of challenges that mean government-recommended preventative measures are difficult to enforce. Filthy environment, poor housing, family congestion, lack of piped water and sanitation contributes largely to many health problems experienced.

The congestion of structures in Kibera slums, Nairobi Kenya

Health experts attribute some of the health problems to weak body immune system due to poor nutrition and diet among dwellers thereby exposing them to various diseases.

Marceline Ochieng, Nutritionist at Kibera South Health Centre (KSHC) says common diseases are mainly water borne, sexually transmitted infections (STIs)especially HIV/AIDS. Tuberculosis (TB) is also very common. The other are chronic ailments such as diabetes,kidney disease, blood pressure or heart diseases among the elderly.

Mrs Ochieng reveals many young families also experience domestic violence leaving wives or husbands with serious sustained injuries. Such violence mostly emanates from suspicion of extra-marital affairs indulgence from either partner, harsh economic times following closure of businesses as pandemic persists among many reasons.

“We teach community to wash hands regularly and to avoid congested areas and handshakes to prevent spreading or contracting coronavirus,” says Mrs Ochieng. “Social distancing remains a big challenge here: most families, often of five or more people live in a small single room. Neighbours often share a wall and live less than 2cm from each other.”

Marceline Ochieng, health nutritionist addressing some of the elderly men during community free medical services.

Lack of access to piped water is also a challenge. Most Kibera residents buy water for their families and increasingly find themselves having to choose between washing their hands and using the water to do some laundry, cook or drink.

“Harsh economic times are to blame for persisted violence as many people have lost jobs hence stay together in the house for long. Abrupt change of lifestyles among other essential needs could lead to misunderstanding too. So, COVID-19 has led to disintegration of families as well,” Mrs Ochieng observes.

“However, we normally organize for open day forums and conduct free medical camp where residents are treated.  We counsel them on gender-based violence issues, advised on basic foods with nutritional values, endurance among other Christian values. The information in such forums are usually helpful in minimizing some of social and health problems including domestic violence,” Mrs Ochieng asserts.

Generally speaking, the advent of COVID-19 pandemic on the other hand, especially in Africa’s largest slum, Kibera, is said to have caused jitters among top scientists globally. The anxiety was about containment measures owing to congestion, poor hygiene, Africa weak health systems just to mention but a few.

Some residents of Kibera risk using any moving stream water for laundry hence jeopardize their health

Kibera is among the estates which had been mapped out to lead in infection rates and deaths following its poor housing structures in terms of ventilation, spacing and small single rooms. Residents are assumed to be ignorant for overcrowded households that makes it almost impossible for physical distancing. Lack of readily available piped water forces many to stream mixed up with sewer-lines in many cases escalating stomach infections to say the least.

Teaching community COVID-19 prevention

Nonetheless, the anticipated high projection rates of coronavirus cases in Kibera turned out to be blessings in disguise. It motivated slum dwellers to work extra hard by adhering to World Health Organization (WHO) COVID-19 Prevention Protocols.

Community Health Volunteers (CHVs) who initially offered free public healthcare services to residents were hired by various NGOs. According to Margaret Kilonzo, CHV at Amref, a total of 800 CHVs were deployed in Kibera hence entitled to some remuneration.

Margaret Kilonzo in red dress educating  some families on how to prevent spread of coronavirus

Kilonzo said CHVs became fully in charge of educating the community on COVID-19 containment measures. Hand-washing points and facilities stationed strategically in every public premise. For instance, market, shops, hotels, bus-parks, clinics, Chief Camps and any meeting grounds sponsored by numerous NGOs.

“We have been providing hand sanitizers, soaps, masks, pales, educative fliers, food stuff and fumigate premises. Our aim is to slow down the spread of coronavirus considering majority of residents here are vulnerable,” Kilonzo explains.

Group of local youth use their talents and prowess in graffiti art works by painting informative and educative messages on walls and other surfaces throughout the community. It has helped reminding residents to wear masks, socially distance, wash hands with water and soap frequently and discouraged  hugging or hand-shakes.

“Josphat Ndemo, an artist from Nairobi art collective, says painting mural reminds people to wear masks and to follow other government directive measures. “Even children, when they see this they know what it means,” he says.

Ndemo has since been co-opted in these public health initiatives as a CHV reaching out to thousands of people through painting mural. He draws graffiti on public vehicles that are responsible for transportation, a lifeline for Kibera residents most of who can’t afford personal cars and with his team, sprays the vehicles daily.

kibera artists paints murals to help remind residents on COVID-19 preventive measures.

“We appreciate the CHVs services here in Kibera. When first case of coronavirus was confirmed in Kibera, they sanitized the surrounding area and provided sanitizers and masks to immediate neighbors,” Risper Ojow affirms. The CHVs  initiatives have helped in reducing infections rates unlike earlier anticipated and hyped by international media.” Ojow adds.

Government and Red Cross Kenya also organized for some token via mobile money transfer, hand sanitizers and foodstuff to selected poor families and elderly. This cushioned many families especially those who lost jobs  through retrenchment.

Raphael Radol, aged 60 is a beneficiary of food-stuff which he admits was very helpful in such times of crisis. He appreciates the government initiative to award senior citizens Ksh 3000 every month. All these were made possible under supervision of the CHVs.

“That money was enough if well planned for and used well. Though it lasted for three months only, it assisted my family in many ways and the food-stuff voucher also sealed several household essential gaps,” Radol admits. The voucher entitled purchase of goods worth Ksh1,500 in specified supermarkets,” he adds.

 Extremely clinically vulnerable residents

However, there is a section of the residents who had been forgotten despite the excellent COVID preventive measures put in place. These are people who are extremely clinically vulnerable from COVID-19. Majority have underlying health conditions (comorbidities) whose lives largely depend on certain medicines.

Mrs Ogos the CHV explaining her role as patients support health services provider.

Shielding and protecting these vulnerable individuals is key for saving lives. Others living in a household with someone who is clinically extremely vulnerable are instead advised to follow the general regulations set out by Ministry of Health.

According to Lilian Aoko Ogos, a CHV under Amref based in Kibera, there are about 5000 residents with pre-existing health conditions whose lives depends entirely on medicines. They are very vulnerable to COVID-19 compared to the rest of the population.

“Quite a good number of these patients are living with HIV and AIDS, while a few suffer from tuberculosis, diabetes, kidney disease, and blood pressure among other chronic diseases,” Mrs Ogos the CHV explains.

“We came to realize these groups of residents when first two people from Kibera were diagnosed with COVID-19 at Mbagathi hospital. She was a lady in her late 40s and the other man aged 56, which totally changed community perception towards COVID,” Aoko disclosed.

Community health volunteer sanitizing and distributing masks to young people in Kibera as myths and misconception on COVID-19 escalates.

Residents were perturbed by the information which spread like bush fire in every corner of Kibera and beyond. Mrs Ogos explained at this point none wanted to be identified as having been very close to the two COVID patients for fear of compulsory quarantine.

Mrs Ogos affirmed it later emerged the lady had depleted her diabetes medicines while the man ran out of ARVs drugs. Despite the health status diagnosis confirmation, the immediate family members had been discriminated upon by residents, stigma notwithstanding.

“Neighbors went underground arguing government policy of contact tracing will force them into quarantine for 14 days as first step of preventive measure to transmission. This is how fear of health facilities developed in Kibera among residents,” Mrs Ogos explains.

So, Kibera residents turned their back to any healthcare facilities claiming they(hospitals) were breeding grounds for the deadly virus. Currently, any residents visiting health facilities are discriminated or forced to vacate mainly because they stand high chances of contracting the virus.  Again in case they do contract it, neighbors would be traced for mandatory 14 days quarantine.

At seventh month pregnant mother has never visited pre-natal healthcare services for fear contracting coronavirus.Such families are also assisted by the community health volunteers in Kibera.

Famous Mbagathi and Kenyatta National hospitals were temporarily converted into isolation centres to accommodate COVID-19 patients. The KSHC which could have become alternative to Kibera residents in such a situation also was turned into quarantine facility.

Mrs Ogos argues Kibera residents are presently left without public hospitals worsening situation. People with chronic illnesses are suffering the most as their lives depend on special medications. Many are living with HIV and AIDS, and silently suffering from stigma, discrimination from neighbors. They fear of healthcare facilities claiming chances of contracting the virus is very high and considering their age factor is another reason.

Keeping families safe from pandemic  

It is at this point that services of community health volunteers came in handy. Amref Kibera Community Health Centre (KCHC) had to recall back CHVs and train them for about two weeks for the duty ahead. At least 100 CHVs were deployed in various Units on Kibera to reach out to these patients with chronic illness in their homes.

Paints murals in strategic surfaces to help remind residents of Kibera to wear masks in public places

Mrs Ogos who previously offered public healthcare services to the community, has been identified as champion for this new initiative. Her recall rejuvenates residents especially these groups of clinically vulnerable families. She however, admits the role requires more skills, attention and love for the work since it is tasking.

As I accompanied Mrs Ogos, the CHV to a small mudbrick and tin-roof house at Katwekera village in Kibera, a mother of four Jecinter Adhiambo aged 35, welcome us to her house.I hesitated to enter and she beckons Mrs Ogos, the CHV to walk inside as I followed in her single small house.

“Welcome to my home,” Adhiambo says with a smile. “I am sorry I can’t welcome you the way I’m supposed to. “No hugs, no hand-shakes due to COVID-19 but please, feel free.” She said humbly.

As Adhiambo sits on her bed, with a rose-embroidered curtain separating her sleeping and sitting quarters, I looked around and saw bags hang on nails in wall, containing her few possessions. She thanks the CHV for visiting her together with a guest(journalist)which to her, it signalizes blessings for the day.

After introducing myself and my mission, Adhiambo smiles and glanced at the CHV and permits me to carry on with interview claiming days of privacy and confidentiality is long gone. She first took a deep breath then smiled and continued narrating her situation.

According to Adhiambo, COVID-19 has made her life miserable in terms of medication and job opportunities. She used to pick her AVRs drugs at Mbagathi County hospital which she cannot as it operates as COVID-19 Isolation Centre.

(Left)Jecinter Adhiambo is receiving her medicines from (right) Lilian Aoko community health volunteer.

“I ran out of my medicines on Tuesday, 12 May, 2020 exactly two months after the first case of COVID in the country. I wanted to travel to upcountry in Siaya County but could not due to lockdown imposed in Nairobi County, so I got stranded, ”Adhiambo explains.

“Luckily enough, God always has His own ways of doing things. I received a strange phone call from Lilian here, who is community health volunteer asking if we could meet and talk,” Adhiambo discloses. I never minced my words because I knew she must have known my health status and could have alternative way out hence my rescue at the moment,” she attests.

“In fact the phone call came on Saturday, 16 May, 2020 at round 2:30pm. I had completely lost hope for any health services provision. I had contemplated being among COVID-19 patients if my situation could deteriorate.” She revealed.  The rest is history but I thanked God for everything as you can see for yourself, I am looking very healthy,” Adhiambo explains while admiring her body physique.

“My savior to date I would boldly say are these CHVs team who brings these essential medicines at my door step.  I could have died long ago not of COVID-19 but of underlying health condition and be counted as part of COVID death statistics.” She claimed.

Impacts of COVID-19 to community

Rashid Obonyo aged 53 has lived in Kibera since 1984, a blacksmith by profession making jikos, boxes, windows, steel doors among others. He has 6 grown up children is but a frustrated man for close to one year now.

Obonyo said he grew weak due to frustrations after Kibera South Health Centre (KSHC) was turned into coronavirus quarantine facility. This has obstructed him from accessing healthcare services and again losing his part-time job as welder at the facility is frustrating. He explained he had to stay in the house for six months (May –October, 2020) to avoid rumors about his health condition peddled by neighbors.


“I was extremely stressed up by residents’ sarcastic questions” Obonyo posed. “I had no drugs to take, no money, could not work, hospitals occupied by coronavirus patients or turned into quarantine, roads closed by lockdowns, curfews, stigma and discrimination became order of the day here in Kibera,” Obonyo narrated angrily.

“In fact, I had made up my mind to take away my life. What stopped me is persuasion from CHVs,” he added.

Obonyo stated that his main problem was medicines which are given free in government hospitals.  Antiretroviral (ARVs) drugs are not sold over the counter because doctors have to approve the patients’ health status. So, provision is under restricted prescription and regulations.

“Because of all these humiliations I was facing, my chances of dying were extremely high compared to contracting coronavirus,” Obonyo said trembling.

“My health status requires proper diet and medicines without which the body immune system becomes weak. That way, I can easily get opportunistic diseases as prevalence of COVID continues making it even worse considering my age,” Obonyo regrets.

Mrs Ogos, the community health volunteer delivers medicines to Rashid Obonyo at his house. These are clinically vulnerable families who either fear visiting healthcare facilities or turned into COVID-19 cases centre.

“Just a few months ago before Madam Lilian, the CHV reached out to me, I had developed scabies all over my body with persisted headache and diarrhea. However, when she brought me these drugs in November last year, my situation has been improving since then,” Obonyo testifies.

Obonyo is currently stronger compared to six months ago after the CHV guided and counseled him to re-accept the medicine prescription. As Obonyo narrates and tears rolling down his cheeks, he says “CHVs are saving more lives than ever before and giving hope to many people particularly in Kibera informal settlement at this time of COVID-19 pandemic.”

“I can testify that before God and even Court of Law and this is despite many challenges they are experiencing.” He argues.

As hospitals continue to remain deserted or a no-going zone except for COVID-19 patients and health personnel, CHVs are getting recognition and being honored by residents of their exemplary health services provision.

Impacts of CHVs to residents

As we walked to the next house for more media interviews, residents kept on stopping Mrs Ogos, the CHV to appreciate her for the good work. One would think she is an aspirant vying for a political seat but their health services heroine. We hardly walked ten metres away without residents’ interception to talk to her, inform her about a patient health situation or ask for hand sanitizers.

Patrick Nyamenya, 48 years old, and a father of four attests to the statement as factual. He argues CHVs are also critical during nurses and doctors strike not just during COVID-19 pandemic. When it comes to emergency at night, it is CHVs who assists citizens anywhere within residence.

Patrick Nyamenya receives his monthly medicines for the underlying health condition from the community health volunteer.

“My daughter-in-law was assisted to deliver a bouncing baby boy at night by CHV. She feared going to deliver in hospital owing to coronavirus and again neighbors could not accept her back here. Therefore, this pandemic has brought many problems not economic, social, health but discrimination too.”  Nyamenya explains while appreciating Mrs Ogos was her health services.

“I default my medicines not because I wanted to but hospital to pick another dose was not accesible. I became sicker and weak until none wanted to associate with me to a point even my relatives and even wife disowned me,” Nyamenya recalls.

“I remember when CHV came in my house one morning; she found I had messed up on my bedding. She never looked down upon me neither the stench from inside the house but washed me and cleaned up everything,” Nyamenya appreciates.

CHVs entreaty

A Ministry of Health official from Nairobi City County Government trains community health volunteers before embarking on COVID19 outreach campaign in their various units.

The CHVs are calling upon Nairobi County Government to register them as part of healthcare services providers, put on payroll, medical cover scheme with house and risk allowances. Many have been trained by Ministry of Health, Red Cross, Amref, Unicef, UN Habitat, among other NGOs and experienced but need money for daily upkeep.

Grace Apondi from Tembea Kibera said CHVs are key in teaching community how to prevent COVID-19, provide medicines to chronic patients, offer care to pregnant mothers, make follow-ups, deliver behavior change messages, keep children safe from violence and abuse just to mention a few programs. She argues where there is an outbreak and impact is severe, or when nurses and doctors strike it is CHVs who are always reachable.

“We are very vital in educating families about modes of transmission, prevention measures, deliver medicines on time at patients’ door step among other essential healthcare services,” Apondi explains.

These community health volunteers are important fellows, acting as first line of defense before a patient is hospitalized. If they are adequately trained and supported, it have proven effectiveness in increasing access, acceptability and affordability to home based cares services. More so to vulnerable groups and key populations who bear a disproportionate weight of HIV infection among other various illnesses.