A day in the life of a Medic Mobile Field Manager

Meet Jane Katanu, a public health professional with a zeal for improving the health and wellbeing of communities and particularly that of two most vulnerable groups: the children and mothers.

“My day as the project manager for the Kilifikids project involves constant and active interaction with a number of partners which all play crucial roles that have contributed to the success achieved with this project.

The community are the direct beneficiaries of this project. The purpose of this project is to meet a need that was felt within the community to improve the health of mothers and children through increasing utilization of antenatal and child welfare services. Talking with the community gives me a realistic evaluation of this project’s impact.

The Community Health Workers, CHEWS and Facility based health officials and district and county level based MOH officials are the consumers of the system. The project is designed to provide these users with mobile and information technology based tools that facilitate their work that is aimed at improving both maternal and child health. These users give us the feedback on whether the system is meeting their user needs. They help us to evaluate the effectiveness of the project. They give me insight on what they need and want to be done to help them improve the quality of the services they offer. Unless we perceive and understand the user needs we are bound to produce and implement an ineffective system.

The donor/sponsoring partners-Kilifikids and Rotary club. This important partner needs to be kept abreast with the progress of the project. I keep him informed of the ongoing implementation activities, targets met so far, challenges encountered and efforts made to overcome the challenges.

We work hand in hand in planning for future scale up and monitoring current activities.

Medic Mobile provides the technical specialty for this project. I working hand in hand with Medic Mobile’s software designers and developers to ensure that the mobile tools produced meet the user and donor specifications and that they are both effective and cost efficient.

In summary, integrative planning, organization, co-ordination, implementation and monitoring of this Kilifi based project working hand in hand with all the parties involved takes up my day.Thank you.”

A closer look!

WONDERS BEHIND THE SMS NOTIFICATIONS FOR ANTENATAL CARE AND IMMUNIZATION

Meet Lillian, a nurse at Ganze Health Facility. It is exactly 8:30 in the morning at the Mother and Child Health (MCH) wing. The room is very noisy with the cries of the infants and small children who are waiting for immunizations. Lillian starts by arranging for the women with varied concerns to sit on their respective benches to avoid overcrowding. The mothers and their children far outnumber the Antenatal mothers (ANC), so most of them have to stand in line for available seating.
“Before we begin, make sure you have your MCH Booklet every time you visit a health facility and show it to the Health Worker. We do appreciate your cooperation and understanding of the importance of coming for the clinic appointments. Keep the good spirit and make sure you continue coming for the rest of the appointments,” Lillian announced. The whole crowd cheered and clapped heavily. Lillian took the opportunity to introduce me to the crowd. “

Our Community Health Workers (CHWS) make house visits, keep us informed, and make sure we go for our appointments”, explained Kanze, one of the mothers. I noticed more CHWs in the crowd who had accompanied 8 pregnant mothers who had come for deliveries at the facility. This indicated to me that the CHWS was doing well with the follow-ups and monthly feedback. I wished to be with the mothers longer and talk to Lillian more about the program but she was very busy and could only give me a little summary. “What do you think about the program so far compared to the ANC and Immunization uptake in Ganze?” I asked. ”Honestly, it has really increased the attendance in the Antenatal Care and Immunization uptake. The number of home deliveries has declined as more mothers are now educated and see the need to come to the facility. Our workload has increased with the new traffic; more women come every day, at all hours. Eve, your project in Ganze District and Kilifi District has really created wonders and we are glad for the improvement,“ answered Lillian.
Thank you so much Lillian and keep the good work! Congratulations! Kwaherini na muendelee kuja clinic—-goodbye and keep on coming for the clinic appointments.

Post-Natal Care

INTERVIEW WITH DR. MLEWA, MINISTER OF HEALTH

INTERVIEW:  FORMER MINISTER OF HEALTH (MOH)

It is 10:45 in the morning through the phone with Dr. Mlewa.

EVA:   Hello, Good morning.

Dr.Mlewa:  Good morning, how are you?

Eva: I am very fine and how is work in the new environment?

Dr. Mlewa:  Honestly it’s somewhat challenging because it’s a new area for me but hopefully I will cope with the situation and put my effort on the ground.

Eva: O.K. glad to have this opportunity to share with you on our ongoing mHealth project in the entire Kilifi District. If you don’t mind can you please start by telling me more of your background?

Dr. Mlewa: Alright. To start with I am a married man with 2 children and a beautiful wife. I am a graduate in medicine and I have substantial experience in medicine and in public health. I was the Minister of health in Kilifi district but am now transferred in Lamu District. My work has not changed; I  am still doing the same work that I used to do in Killifi, but this time I have to put more effort in reinforcing good health in the communities at large.

Eva: That’s wonderful, and to add on, what role do you play as the MOH?

Dr.Mlewa: I am responsible for coordinating all the activities that are supposed to be conducted in the district, including training, workshops, and outreach in the communities. I also do assessment of all the activities conducted in the region. I make calls to all the facilities in the district and arrange meetings with the heads of departments to see our way forward. I am also entitled to attend meetings and represent the District on the National level. Lastly, I do supervision quarterly in all the facilities in the entire district.

Eva: Oh my, that’s challenging and great work. More over, what role do you play in the mHealth project?

Dr.Mlewa :   I am mainly responsible for coordinating all the training activities, prevention and healthcare of disease and  assessment of current projects. Initially you have piloted the mHealth project in Ganze District; my team and I do not yet know if you will implement the project in the entire District. The project is really doing well as we have seen the impacts so far and these indicate a positive pathway. Honestly you are doing a good job.

Eva: Thank you so much and God bless you. We are looking forward to expand our projects because all we want is to see that the entire community benefits and improve the health care of the communities at large.

Dr. Mlewa:  That’s wonderful and will  keep up the spirit of reliable and efficient healthcare.

Eva: If you don’t mind can you please tell me something about a day in your life.

Dr. Mlewa: Great, my day starts at 6:00 in the morning and I take my breakfast as it has already been prepared by my beautiful wife. At 7:30 I am off to my office. I check my planner to see if I have any appointments. I Get briefs from the head of departments who give me some information concerning the day’s meetings. I make calls to officers to come for the meetings scheduled, and also am entitled to make calls to some of the facilities. Most of the days are spent outside in the workshops, seminars, meetings, and sometimes outreaches. I am sometimes unable to leave the office before 9:00pm because of the workload.

Eva: wow……that’s amazing but challenging too. Alright then it was nice talking to you. Thank you so much for your time and I wish you well in the new District, Lamu.

Dr.Mlewa: you are always welcome, good day.

Eva: Good day, thank you so much.

The Ziwani visit

REAL IMPACT

Our team has grown rapidly in the last year, from just our pilot Community Unit in Petanguo, Ganze District we now hold 4 other Community Units (CU) across the District. With the support of our product roadmap, we are able to build tools that health workers and patients need. Partnerships with the Rotary Club Kilifi, Medic Mobile and the Ministry Of Health (MOH) enable us to implement at scale.

It is 2pm in the afternoon when we decide to visit Sofia, a CHW at her home. Sofia is surprised to see us but she welcomes us- the Medic Mobile team and some Community Health Extension Workers (CHEWS) from the facility. She introduces herself to us and we are excited about her competency as she explains her role as a CHW. “Whenever I meet a pregnant woman”, Sofia says, “I start by asking her full name, LMP and by doing this I am able to register the pregnant woman by a text message by sending it to Ganze Health Facility.  The facility communicates back to me by sending me reminders on the pregnant woman’s next appointments. These reminders enable me to alert the pregnant woman making sure that she attends her next appointments. The same happens in registering the child for immunization.”

The loop never got complete as she took us to one of the households that she had a registered pregnant woman. We met the woman namely Grace who also really impressed us. Grace has 6 children and the youngest is 9 month old. What makes the story interesting is that she never took the first 4 children for immunization and she also never attended clinic schedules for the 4 children until Sofia came to her home and brought the good news of CHWs. “Honestly, I have seen great improvement in my young child’s growth and development”, states the pregnant mother, “and I too feel strong and well educated about my pregnancy thanks to Sofia, my CHW, I am fully encouraged and I now see the importance and need to go for the antenatal care and immunizations.”

Thanks, for the wings to fly!

It is a Tuesday morning in the quiet village of Kanamai in Mtwapa, Mombasa. The village hall, which evidently is still under construction, is filled with a group of about 50 men and women dressed in the local buibuis. They are cheerfully chatting and murmuring together with an occasional high pitched laughter from one corner. I approach them and casually greet them in the local Kiswahili language, and they heartily respond.

It is not long before we are deeply engaged in a very exciting and insightful discussion with this group. These are the community health workers ‘Madaktari wa nyanjani’ as they are commonly known- loosely translated as ‘the field doctors’ from the Community Unit (CU) of Kanamai B. They are gathered here courtesy of Ministry of Health (Kenya), Kilifi Kids, and Medic Mobile.

Community health workers (CHWs) are volunteers with little or no knowledge on health. They are democratically elected by the community during barazas’, the community’s official meetings with its leaders, to act as their health representatives. They are trained by the government and other health related organisation on varied basic health preservative and promotive activities that range from ensuring proper sanitation in the area, handling gender based violence,  to encouraging pregnant women and children to seek health services. The community health workers thus educate their fellow community members and encourage them to make and maintain healthy choices. They form the extreme front line ‘health care providers’ in the health system.

Each community health worker is in charge of 20 households, i.e. 100 people are assigned to him depending on accessibility and convenience and they work hand in hand with Community Health Extension workers (CHEW) who are government employees in charge of 25 CHWs. The CHEWs link the health facilities and the communities. A cohort of 50 CHWs, 1000 households make a Community Unit (CU), which is directly headed by a highly trained health personnel based at the nearest health facility.

My goal on that day was to facilitate training on antenatal care (ANC) and immunisation and how mobile phones will help the CHWs to carry out their duties more efficiently and effectively. But before then, let us get back to our discussion with the CHWs about the joys and challenges of a CHW.I lose myself to the joy that these CHWs exhibit as they share their rich experiences in the group. It is clear that they derive deep pleasure and satisfaction from their work. They are excited about the positive effects attributable to their work, like fewer reported deaths of children which were earlier associated to dysentery secondary to poor sanitation, increased number of pregnant women and children seeking health care services at the health facilities and a community better informed in matters of their health.

However they cite a number of areas that they have not been able to address appropriately because of a number of challenges and hindrances. Some of the areas that they felt they could do better were to prevent deaths of mothers and their children that occur during delivery by encouraging mothers to deliver their babies at the health facilities and to take their children for immunisation. Most women in this community still give birth at home, under the help of the traditional birth attendants (TBA) who cannot handle the life threatening emergencies that occur during deliveries. Children die of preventable diseases like pneumonia, measles and malnutrition.

In a very interactive session the participants highlighted ignorance as the main cause of this and unanimously agreed that as ‘Madaktari wa nyanjani’ education and constant insistence to the community members on the importance of attending ANC clinics, delivery at health facility and immunisation is the way to go, and is to continue for as long as it takes to bring about a positive behaviour change!

By the time my colleagues Mativo of Medic Mobile, Lydia of Ministry Of Health, and I started the actual training we were confident this particular training and project had come at the most optimal time and also convinced beyond doubt that it will meet the highest priority need for the users. The CHWs were certainly ready.

‘It feels like being given wings to soar to heights that would otherwise have taken a really long time to attain,’ one of the CHEWs present remarked. I am glad that Kilifi kids found this community ‘need’ and Medic mobile provided the tool that will lead to undeniably positive and great health impact to the local communities of Kenya.

Nurture the Nurturer

I am seated at the consultation room of one of the busiest health centres at Kilifi district  cheerfully attending to pregnant women who have come for ANC (Antenatal Clinic). There are slightly over 10 of them in the waiting bay. So far, I have seen 5 of them, and am happy with the number that has attended the clinic today. I am a nurse and this is what we love doing. There is no greater joy than the one of seeing a happy mother holding her healthy newborn baby. I clearly understand the pivotal role of effective ANC. Just next door is a queue of about 30 women with their children waiting at the Child welfare Clinic (CWC) room for immunisation and growth monitoring of the children. A few metres away is a young man with a large register book on the table, surrounded by about 20 people waiting to be served.

Sister Chaka, nurses in Kilifi are called sisters, walks in. She is visibly happy as she greets the woman I am attending to then turns her attention to me for the report: Mwanawali Mwadzuma is 29 years of age. She is 5 months pregnant, her blood level (HB) results are out and reading 5.0g/dl. This is her eighth pregnancy; she lost the last 2 babies at around 28 weeks of pregnancy, and was admitted once in the hospital because of severe anaemia .She has delivered all her babies at home. Her current weight is 46kg, blood pressure is relatively low, no bacteria, sugar or protein in urine. She neither has syphilis nor HIV/AIDS. Sister Chaka chuckles and lovingly pats Mwadzuma’s back as she says ‘Mwadzuma, am glad you came.’ She goes on to explain how most pregnant women in this region do not attend ANC. They prefer to deliver their children at home with the help of traditional birth attendants (TBA). She states that ‘The women do not understand the importance of medical checkups during pregnancy, actually, they do not appreciate the importance of taking precaution against diseases, to them, hospitals are for the sick!’

Maternal mortality is the worst nightmare in any clinicians mind. Research has shown that with effective antenatal clinic visits, 99% of all the risks that lead to death of a pregnant woman are prevented. If she delivers at a health facility under the supervision of qualified health professional the risk is reduced further by over 0.8%. Maternal deaths are therefore almost completely preventable through simple cost effective approaches that are incorporated in effective ANC visits. It is unbearably painful when women die of poorly monitored pregnancy that would instead have brought pure joy and bliss. Majority of the pregnant women who seek ANC services are referred by community health workers (CHWs), who consistently encourage them to attend these clinics and follow them up for revisits. ‘These women need constant reminders and follow up for them to come for the clinics, a role that the CHWs are playing excellently.’ The CHW identifies the pregnant women, sends a short message text (sms) with a mobile phone to the health facility for registration and refers the woman to the health facility for ANC.

The clinician sees the client, and schedules the appointment date for review. Just before the appointment day, the computerised system at the health facility sends a text message asking the CHW to go and remind that particular woman to attend her antenatal clinic appointment. This tool has not only increased the number of women attending ANC but more importantly has led to increased number of revisits for ANC that the women make per pregnancy.

Women are natural carers; they are more concerned about the welfare of everyone else in the family and in the society than of their own. They have a multitude of tasks that they perform and thus need to be constantly reminded to attend their clinics. It is a great gesture to them that we are genuinely concerned about their health and that their health is of paramount importance. This woman who has constantly been followed will most likely come to the health facility to delivery her baby. And as mother walks out of the health facility all smiles, the joy reflected on her face as she holds her healthy baby in her arms, is what keeps the Sisters zealous in their work.