Serving as health promoter in a slum

Tuesday December 20 2016

Christine Namakula (R) with one of the women

Christine Namakula (R) with one of the women she counsels in her community. To ease her work, she has installed a health app on her phone. PHOTO BY LILIAN NAMAGEMBE 


About ten minutes’ drive off the Kampala-Gulu Highway, we arrive in a small village located in Kawempe Division, a Kampala suburb.
After minutes of jumping one drainage after the other, we are at last able to penetrate into the jammed dilapidated small houses. They are predominantly residential rentals dotted with lodges and bars.
Mulnourished, potbellied, dry skinned with straw-like appearance children are playing around most compounds of the ramshackled houses.
Other youthful residents are either expectant or breastfeeding mothers. This is what constitutes the Kanyanya village slum population.
We particularly move around Lutunda, one of the village zones where Christine Namakula, 53, has volunteered for the last three years as a community health promoter and a resident.
The single mother of three started teaching good health living behaviours to the slum dwellers after realising the poor health conditions that led to rampant deaths, especially among expectant mothers, newborns and children under five in the area.
Due to the poor drainage system, the area is infested with mosquitoes and residents are prone to malaria and typhoid while children are predisposed to dirt-related diseases including dysentery, Namakula tells us.
Instead, she adds that, the situation is taken advantage of by the ever mushrooming clinic and pharmacies mostly run by unqualified health workers without the necessary equipment to carry out diagnosis.
“I was always concerned and had the passion to serve my community that I chose to become the health change agent in my zone,” says Nalwanga, who is also the women secretary on the Lutunda zone council.
Her passion was steered when she attended an event in 2013 that was organised by Living Goods, a non-governmental organisation which among others, works to reduce child mortality across the country through community sensitisation.
Having openly appreciated the arrangement and showed interest in community service, Namakula says: “it is from there that I was picked out together with other women who could volunteer as community health promoters.”
The role involved taking up a one month training with medical doctors on diagnosis of malaria and other common infections and diseases like diarrhea and dysentery among mothers and children.
“I was trained to use Malaria rapid diagnostic tests (RDTs) which assist in the diagnosis of malaria by detecting evidence of malaria parasites (antigens) in human blood,” she adds.

What she does
As one of the tools, Namakula was equipped with a smart phone which has a diagnosis App which provides a menu of the likely signs and symptoms the child or mother could be suffering after which it gives a prescription.
“I am furnished with malaria drugs and other tablets for minor infections by Living Goods which I sell to patients at a subsidised price,” she explains, adding that it is from there that she gets a commission at the end of the day.

For those patients that Namakula diagnoses with diseases such as typhoid and those in worse conditions, she helps to refer them to hospitals and ensure they do not go to clinics or carry out self- medication in their homes.
As a community health promoter, Namakula, moves door-to-door identifying both expectant mothers and children in the community whom she sentsitises on good medication and where they should seek treatment whenever they fall sick.
“We discourage families from going to clinics and just buy tablets for their children without proper diagnosis from qualified doctors,” she says of the common vice among communities in Uganda.

Indeed, her guess becomes evident as we move to one of the homesteads a few metres away from her house where she goes to check on a five year old boy with fever.
The boy’s mother reveals that the boy had been given Coartem, a renowned malaria drug, bought from a clinic without proper diagnosis.
“They (clinic) just applied a clinical thermometer on him before prescribing the drugs,” the boy’s mother who never wanted to disclose her name said.
Meanwhile through her registration system, she is able to check on expectant mothers every trimester, sensitise them on the early signs of pregnancy complications and cautions them to go and seek timely treatment from gynaecologists in government health centres but not clinics.

Zai Nabbagala, one of the programme beneficiaries is all smiles on seeing Namakula at her home to check on her seven months pregnancy.
“It has helped us to reduce on the costs since she brings the services near to us without incurring transport costs to go to the hospital for simple sicknesses like malaria,” Nabaggala lauds the health promoter.
Namakula says, the challenge she has however faced as a community health promoter is being rejected by some of the patients who do not trust her services while other mothers mistake her for a tradition birth attendant and want her to deliver them.


Maternal mortality. A recent report by Ministry of Health cited a retarded progress in reducing maternal mortality rate currently at 438 per 100,000 live births while malaria remains the number one cause of death despite the 21 million mosquito nets distributed across the country this year.