With a mask in one hand and sanitizer in the other, Grace Akinyi moves from door-to-door in the shanties of Kawangawre in Nairobi, Kenya, teaching residents the importance of both.
It’s a task she has been undertaking since the first case of coronavirus was reported in the country on March 13, 2020. Grace is not a doctor or nurse, neither does she have any medical training but rather a health volunteer who took it upon herself to create awareness after seeing how the disease scared the hell out of her community.
The 65-year-old widow is no stranger to such tasks, having played a crucial role in ending stigma when HIV/AIDS ravaged her community in the late 80s and early 90s. But even with her experience, nothing prepared her for what Covid-19 brought.
“It was a new disease, people were scared and did not know what to do. Most of the time, they would hide and only talk about it in hushed tones,” Grace tells this writer at her one-roomed house in Kawangware.
With the community scared, the government didn’t help matters. The Health Ministry’s reminders looked more like threats, restrictions of movement in and out of the two largest cities Nairobi and Mombasa plus a 5am-7pm (now revised to 4am-10pm) curfew enforced in brutal fashion by the police made people more scared of the state than the virus.
“People were only wearing masks when they saw police then put them below their chin once they are past them. People were also crowding at bus stations to get home early before the curfew hours,” Grace remembers.
These, coupled with the fact that hand washing in the slums is a luxury due to lack of running water while the cramped corrugated houses, where up to seven family members can stay in one room, make social distancing impossible, provided a perfect environment for the virus to thrive.
It was no surprise therefore, at least to Grace, when Kawangware became an epicentre for the disease in early May, recording and average of 10 cases per day.
“Most of the people who live here do domestic work in the neighbuoring suburbs such as Lavington, Kileleshwa and Westlands. Most of those people travel a lot and some of them contracted the virus and passed it to these women unknowingly. That is how it was brought to the community,” says Grace.
At the time, the Kenyan Health Ministry traced 12 of the cases to one person, showing just how easy it was to spread the disease in the densely populated informal settlement. With the government struggling to contain the virus in the slum, Grace was just what the doctor ordered.
To check the runaway numbers, the state rolled out mass testing in the area but medical personnel spent most of their time scrolling through their phones than testing people, many shying away due to some beliefs and myths about the infectious disease. Grace played a crucial role in changing perception.
“They believed this disease is for the rich, those who travel by plane. I had a hard time trying to convince them that coronavirus does not choose. For a community like this, your approach matters. You don’t impose yourself, you sit with them, mingle and tell them why they should get tested.”
“What helps them buy the message is that I’m not a stranger but one of them. That is how they started going to testing centers.”
With the increased testing, the positive cases also surged, adding onto Grace’s workload. Her understanding of the area and its people would come in handy when it came to contact tracing.
“There was a challenge when medical personnel came to pick those who had turned positive. Most of them did not want to come out for fear of stigmatization while some have other diseases they do not want to reveal. But I told them ‘look, I’m 65, diabetic and with high blood pressure, you will not die’ that is how they started getting out and going to isolation centres,” says Grace.
Since then, Grace has stuck to the message. She moves door-to-door, risking her life to dole out health advice to families living in the informal settlement, showing residents how to wash their hands and use a face mask.
The fact that she is 65, diabetic and with high blood pressure, clustered as Covid-19 high risk group, does not bother her. “The Bible says you give. Since I do not have money, I give my time. Isiah 54:17 says no weapon formed against me shall prosper, so why should I be scared?” she poses.
“When those who tested positive recover and come back, the community is normally not receptive but I’m always the first to welcome them. I give them hugs, visit them and tell them the importance of staying safe. When the rest see, they realise it’s normal. This has helped end stigma.”
Grace is not alone. In Dagoretti North Constituency, where Kawangware is situated, there are 628 community health volunteers with each visiting 100 marked households in the five wards.
As Grace and her peers fight the virus in Kawangware, Alice Ndungu is leading the war in Mathare, another slum in Nairobi with close to 500,000 inhabitants.
While Mathare did not have a surge in cases like Kawangware, Ndungu was instrumental in ensuring the numbers are low after the first case was reported in April.
“I do not want to see my community suffer. I have been with them through difficult times especially those that have chronic diseases whom we give advice to and those that experience domestic violence. When this disease came, it was just a continuation. It helps if you are one of them,” says Alice, after talking to a gathering of about 10 largely elderly women on the importance of mask wearing.
Grace and Alice’s work has not gone unnoticed. Kenya’s Ministry of Health acknowledge that it is due to the feedback received from the community health volunteers that they changed their messaging.
“They are a resource that was already existing because they have been helping in awareness campaigns for other terminals illnesses and when coronavirus came, we just added the Covid-19 module to what they were doing,” says Dr Mercy Mwangangi, the Chief Administrative Secretary in the Ministry of Health.
“At the start, we were only giving figures of new infections in various counties but after the feedback we got from them, we started narrowing it down to constituencies so that people in those particular areas know the diseases is there with them instead of assuming it’s for the rich,” she adds.
Due to the risks they are exposed to, the Ministry, through the help of a number of partners such as Amref Africa, Red Cross and St Jones helped offer lessons on Covid-19 with a few getting masks to protect themselves.
The volunteers’ work was also boosted by a number of aid organisations who donated masks, sanitizers and soap while others installed handwashing stations and mobile toilets in the slum to enhance sanitation.
“We have limited soap and sanitizers so we give priority to breastfeeding mothers and the elderly. This does not only fight the virus but also boosts relations because most of these people get tired of seeing me empty handed with only messages to deliver,” says Grace.
Alice echoed her sentiments, saying: “These aid organisations not only provided soap, water and masks but also relief food which has helped cushion these people since most of them have lost their jobs.”
The Health Ministry cannot quantify the impact of these volunteers but believes it has been huge since the engagement started.
“They have helped flatten the curve in the slums because it was them who convinced members of their community to wear masks, handwash, soap distribution and fumigation,” acknowledges Dr Mwangangi.
In an area where two meals a day is a luxury, Grace and Alice spend all their time on a job that does not pay as the ministry has no budget for them. Their satisfaction comes from saving lives while living by faith.
“I have six adopted children and as we speak, I don’t know what we will eat for dinner or how I will pay rent at the end of the month. But I’m not worried, I have never slept hungry or failed to pay rent. God always comes through for his people,” says Grace.
With the number of new infections having gone down since they began this assignment, these soldiers of mostly ordinary women seem to be winning the war on Covid-19 without any fanfare.
