We risk our safety to serve our community: experiences as a Community Health Promoter in Mathare, Nairobi

In this blog Emily Wangari recounts her experiences of being a Community Health Promoter (CHP) in Mathare informal settlement, Nairobi to Rosie Steege. Emily discusses the threats to her safety and security, the mental strain of being a CHP in her community and the importance of being involved as a community researcher through ARISE. This contains stories of abuse that some audiences may find triggering.

I’ve been a Community Health Promoter (CHP) for five years now. Before this, I was a community leader, and I was doing everything, referring people, attending to the sick – so I thought, let me take the training to become a Community Health Volunteer (as called at the time) so I can continue caring for my community as I enjoyed this aspect of my work.

As a CHP, I am responsible for 140 households and each month I have to report on 33 households. This is higher than the 100 houses outlined by the government because the area is very densely populated and this is the number allocated to my unit.

I live in Mathare, an informal settlement in Nairobi. What makes us vulnerable is the housing and the insecurity of tenure. If the government can release the land to us, we would able to change our area through our savings and through our unit. It is a mixed area, which brings challenges – we have children who don’t go to school and are looked after by other siblings, and people who visit private chemists known as ‘quacks’ (retail shops), rather than formal hospitals. The perceived benefit of the quack is that it is a ‘credit’ facility, so you can clear your debt later – it is viewed as more affordable, but it is more dangerous. For example, people will go for contraceptives and instead be injected with water and end up pregnant.

On a day to day, I wake up, prepare my children for school and I might hear about a matter that has arisen in the community, so I go to follow up. Mostly, for the issues related to health, I like to do this in the evening – around 5-8pm – as the community are not around in the day. If you miss them, you can try again at the weekend but often people living in my community are working on Saturdays too. So preferably, Sunday afternoon. In the urban context, many people work away from home, in the rural, you might find people in their neighbouring gardens, farming – so this is a challenge more unique to urban areas.  This affects us as CHPs so much, as we are not free to walk at night. Some households have men, and as women, we fear they will take advantage of us, so we tend to go out in a team of two women. One will stand outside the house to keep watch, and one will go inside to collect the data. We are worried about being raped; it has been attempted before.

If you don’t find your partner is available you might not attend to your community in their house, you will just ask some questions outside the house. Many try to welcome you and we don’t want there to be a gap in service delivery, so sometimes we just risk it. We risk our safety to serve our community. This worry can affect our motivation, we still attend the community, but not wholeheartedly.

What we would advocate for is to be allocated a household that we are familiar with, but it doesn’t always work like that as the unit leaders are the ones who allocate the houses we serve, based on our unit. If they allocate you a house you are unfamiliar with, you won’t have a choice but to attend. My unit for example is not where I live, I have been allocated to look after the permanent houses – if I was serving where I live, I could walk around at midnight without worry, but this is not the case in somewhere new.

During COVID-19, we lost two CHPs due to COVID-19 because they had other conditions. This really brought us down, we thought ‘this job will claim our lives’ it was so hard. We were not being paid at this time. Since the 2022 election we have started to be paid, it has been less than a year. This has motivated us a little, but the stipend has come with an added responsibility. We now have devices for measuring blood pressure, blood sugar so we now attend at the level 1. This is a motivating factor, but it adds pressure to us. The CHAs now pressure us with the reports.

I also offer free services, such as taking children to safehouses in cases of abuse or negligence. One case was when a child took some meat that was intended for supper and the mother placed a knife on an electric coil, and then placed it on the child. The landlord identified the abuse and by the time we found out, it was a week later, and the child had been in pain. When I found them, I said the child must be taken to hospital. This was challenging for me. The mother bit me when I tried to intervene, the community came and beat the woman, and then I tried to stop them beating her. It was hectic. It was mentally hard, the child was crying so much in the hospital, I stayed with the child the whole time. I told the child, you were beaten because of meat, and I bought the child meat to eat together. Now the child is in the safehouse and is happy to see me when I visit. So much so, people ask what our connection is.

How are you involved in ARISE?

Through ARISE and SDI Kenya, I have been involved in Mathare’s physical address system. The physical address system is very helpful and we are advocating when unit heads are dividing the households, they are using the physical address system. ARISE worked with the CHPs as stakeholders and CHPs are some of the main beneficiaries of the physical address system. ARISE has done mapping with CHPs, vulnerability mapping with CHPs, we have done so many activities with CHPs.

We were also trained on mental health through ARISE with LVCT Health. There are so many challenges in Kenya and people are suffering in silence. Right now, we have had two suicides among men in my community. We are the people who attend these people but there is no one who attends to us. The training was very helpful. Before the mental health training, we didn’t know we were suffering. After the sessions, we knew that something was wrong. A good example is when we consult somebody after they had lost a family member – we used to confuse them with the words we use ‘it is God’s will’ for example, but now we know how to support someone through bereavement. We are there physically, helping in the house, bringing food, receiving the visitors, washing dishes, and not saying anything – let them cry it’s a healing process, if you try to stop it, it will haunt them later. It is a healing, don’t stop it. Later, they will come and tell you thank you, but I was feeling down and I couldn’t appreciate you at that time.

It is very important to involve CHPs and communities in research projects. ARISE has actually helped us to know more people in the community. When you are doing CHP work you are not doing it in your area – so when the community now sees you doing different activities in the area, they get to know you. So, they come to you if they have a problem. They’ll see me with the chief, with the CHPs, so it’s easier for them to tell me if there is a child suffering in the house, it’s easier for them to come to me. Then I find time to follow them up – so the feedback is there. You report it and I follow up. The project was very inclusive, we owned the project, and we did it with our community, engaging with the community and telling them what we were doing.

For more information on ARISE and the work of SDI Kenya and Emily Wangari’s role in  Muungano wa wanavijiji please see:

https://www.muungano.net/emily-wangari

https://www.ariseconsortium.org/

https://sdinet.org/