It’s a little before six in the morning. Outside, the sounds of frogs calling and crickets chirping fill the predawn air; interrupted with increasing frequency by the boisterous crowing of roosters no more than twenty feet away from my window. Over the next thirty minutes, or so, this cacophony will dissipate, slowly replaced by the gentle sound of songbirds singing as the Sun rises. This has become the normal, and rather welcome, start of my day here in rural western Kenya.

Wahfeld Lwala Kenya

Over the past few weeks I have been living at Lwala Community Alliance, a community-driven organization serving approximately 4000 households in the  North Kamagambo region of Migori County. Situated nearly an hour southeast of Homa Bay, a small town on the southern shore of Lake Victoria’s eastern expanse, Lwala’s immediate surroundings are the definition of a bucolic setting. Lush green fields of maize and sugarcane border the ruddy dirt roads leading to and from the nearest paved road, which lies almost five miles away.

The vast, open skies extend for miles before meeting the horizon. Clusters of small homes and buildings, the majority of which have corrugated metal roofs, dot the rolling countryside. Domesticated animals are abundant. It’s quite common to see chickens, often with their chicks following closely behind, roaming freely. Zebu (local cattle recognizable by a fatty hump between their shoulder blades) and goats may be seen, tied by rope to short wooden posts, by the roadside or nearby homes. Dogs, and the occasional cat, are also a part of the mix

My first few weeks here have been spent getting acquainted with the community and Lwala’s approach to promoting health and well-being in the region. Recognizing that health (and life) does not occur in a vacuum, Lwala has four distinct, though highly interwoven, programmatic arms: clinical health, public health, education, and economic development. In addition, Lwala has formed an on-site partnership with Development in Gardening (DIG) to train local famers in sustainable gardening techniques and to promote overall nutrition. With health as a central focus, these arms work in tandem to support Lwala’s vision of providing “wholeness of life in Lwala and beyond.”

Wahfeld Lwala Kenya

This integrated approach to community health is seen in all aspects of daily life at Lwala, and has been especially evident to me as I gain increasing exposure to Lwala’s Thrive Thru Five initiative, and their HAWI program. The acronym HAWI stands for HIV/AIDS WASH Integration, and has the benefit of sounding similar to a phrase in the local, Dholuo language which means “having good luck.” WASH, a component of HAWI, refers to water, sanitation, and hygiene. Providing education to individuals on proper handwashing practices, the use of treated drinking water, and the building and use of latrines, WASH training programs are fundamental to the prevention of diarrheal illness and disease for all members of a community. However, WASH becomes increasingly important to individuals living with HIV, as individuals with a weakened immune systems are more susceptible to opportunistic illnesses.

Although there is no cure, proper adherence to antiretroviral therapy (ART) can help individuals living with HIV have longer and healthier lives. In turn, by preventing HIV cells from reproducing, ARTs help to reduce the risk of transmitting HIV to others. With the goal of reaching all HIV affected households within the catchment, Lwala’s HAWI program targets the health and well-being of HIV positive individuals, seeking to increase knowledge, treatment adherence, and WASH compliance, while reducing the stigma surrounding HIV.

The Thrive Thru Five initiative is part of Lwala’s commitment to maternal and child health. In an area where the mortality rate for children age five and under has been reported as 150/1000, Lwala’s Thrive Thru Five initiative seeks to reduce the under-five mortality in North Kamagambo by 50% of the county average by the end of 2016. This reduction in mortality is only one component of the initiative. The first five years of life are a crucial stage in human development. As such, promoting the health and well-being of mothers and children from conception through the child’s fifth birthday is part of Lwala’s core focus and involves sustained input by all four of Lwala’s programmatic arms.

Wahfeld Lwala Kenya

Though HAWI and Thrive Thru Five focus on different, yet potentially overlapping, subsets of the population, they share a common asset: community health workers (CHWs). Over the years, Lwala has trained a team of nearly 80 individuals to become community health workers. Divided into 10 village sections each area of North Kamagambo has between 7 and 9 CHWs. Importantly, all of Lwala’s community health workers are established members of their communities, as opposed to coming from outside the village they serve.

Primarily women, including many who were previously serving as traditional birth attendants (Umama Salamas), community health workers act as a conduit linking Lwala’s services to the community, and communicating household level health information to Lwala. Acting as role models within their community, these women and men support their neighbors by visiting homes, providing health education (including family planning) and counseling services.

CHWs enroll individuals into Lwala’s prevention and health management programs, and refer community members to Lwala Community Hospital and other local health facilities as needed. Community health workers also act as integral players in larger community outreach and education sessions, mobilizing members of their community and participating in mobile health clinics. In short, community health workers are the foundation of Lwala’s community-led efforts to promote health and well-being in North Kamagambo.

Wahfeld Lwala KenyaAttending several meetings these past weeks, I have been impressed by the level of self-supervision displayed by community health workers, especially related to data collection in their community. Led by a head community health worker (MCHW), each group of CHWs meet weekly to discuss the health of their community. Included in these discussions, CHWS report how many new pregnancies have been identified, the number of these women who have been enrolled into antenatal care, and the number of births occurring in the community over the past week. The number of under-five deaths, if any, are also recorded, and any challenges faced by the CHWs discussed.

The final weekly CHW meeting of the month is attended by staff members from Lwala’s community health office. Over a three-day period, I had the opportunity to join these staff members as they met with each team of community health workers in all 10 areas that Lwala serves. A similar format to the weekly meetings, these monthly check-ins provide CHWs an opportunity to share their findings with Lwala staff, and to gain feedback on best practices.

At the end of the month, all active community health workers meet at Lwala to present monthly data from each of their respective communities. These meetings also provide a forum for a discussion of any challenges that arose during the previous month. This past month, the meeting included a discussion of the seasonal uptick of lab confirmed malaria cases in children under-five. Led by members of Lwala’s community health team and MCHWs, the discussion provided insight into the times when children under-five are most vulnerable, and potential opportunities to reduce the number of cases in each area. Action days have been planned over the coming weeks.

Wahfeld Lwala Kenya

It’s an exciting time to be at Lwala. Over the next two months I will be based out of the community health office. I have recently begun attending training sessions on community case management of malaria (CCMM), and look forward to learning best practices from Lwala staff as they move forward with their malaria intervention and continued work with the Thrive Thru Five initiative. Lwala will also be rolling out a tablet-based mobile data collection platform for HAWI in the very near future. In recent weeks I have helped to train members of the Lwala staff on the new software, and will be part of the team training HAWI CHWs. I look forward to sharing my thoughts, questions, and new experiences with you in the weeks to come.