By Kasha Patel
BU News Service

More information at pamojatogether.com

Imagine you must visit 100 houses a month in your town. At each house, you spend time with the residents, asking how they are feeling and addressing any of their health issues. Then, you notice that their living conditions are very unhygienic. So, you teach them to wash their hands with clean water before eating and after using the bathroom. You teach them to wash and hang their clothing. You play a critical role in maintaining your residents’ health. Without you, the healthcare system will falter. But, you are not getting paid anything for doing this job.

That is the life of a community health worker in western Kenya.

Kenya is largely affected by HIV and malaria, but also struggles with getting people to go to hospitals and practice good hygiene in their homes. Six years ago, the Kenyan Ministry of Public Health and Sanitation implemented a new healthcare plan called the Community Health Strategy in order to improve the country’s healthcare outcomes. One of the changes from the new health strategy was the implementation of community health workers, which the Kenyans refer to as CHWs.

AUDIO: Jackie Atieno is a community health worker in the Butere district in western Kenya. After finding out she was HIV positive, she decided to publicly announce her status, but did not initially receive a lot of support from her peers. When her CD4 count went down, Atieno began antiretroviral therapies (ARVs) to help suppress the HIV virus. Now, Atieno helps other members of her community in revealing their HIV status to the public, motivating them to keep hope, and encouraging them to get proper treatment.

This past summer, I traveled to a rural town in western Kenya called Bondo and reported on the lives of a few community health workers. The reporting expedition was through a program called PamojaTogether with the Boston University Program on Crisis Response and Reporting. The reporting opportunity was great because it allowed me to actually experience what I learned about community health workers in my class at the BU School of Public Health. The literature told me that the community health workers are overworked, sometimes unhappy with their workload, and are not regularly paid, if paid at all. But I didn’t understand the number, gravity, or importance of their duties until I followed community health worker Millicent Akinyi Odhiambo around for few days.

Millicent is a community health worker in the Ting Wangi district in Kenya. She visits 99 houses a month and takes care of 454 people. She provides a myriad of services including checking the health of her residents, installing water sanitation systems by the bathrooms, and encouraging mothers to give birth in a clinic rather than the unsanitary conditions at home. On one day that I followed her around, she and two other health workers visited elementary schools in the area to administer Vitamin A supplements to pre-school aged children.

They walked to and from each school, which were kilometers apart. Because I was with them, they offered to get a bike to take us from each school. Wanting to experience an authentic day as a community health worker, I said no and walked with them for kilometers, in the blazing sun, with my long pants, for several hours, with no water. I could barely talk because I was tired and wanted to save my energy, but Millicent and her coworkers were walking, laughing, and enjoying the day. When we arrived at one school, the principal informed us that the elementary school children were not there because their teacher is out on maternity leave. They couldn’t find a replacement so they just told the kids to stay at home. We nodded, turned around, and walked back through the hilly, dirt roads for a few more kilometers.

After she completes her community health worker duties at 4:00pm every day, Millicent opens up her cloth store— her only source of revenue. Most community health workers are not paid for their duties as a community health worker. Sometimes, another country will provide foreign aid in the form of a small stipend to the workers, but it’s not consistent. For instance, Millicent is supposed to receive $2,000 a month from USAID (which is not enough to cover her expenses), but hasn’t received any money for months. But she still continue her duties because being a community health worker is an honor bestowed by the community.

Community health workers are either elected or appointed to the position and are members of the community they serve. After they are elected, they receive training and supplies from other countries such as USA, Norway, and Japan to help them carry out their duties. Community health workers are usually people that the community respects and can feel comfortable talking to about sensitive situations, such as their HIV status. For Millicent, as well as many other community health workers, the honor of being a community health worker and a genuine desire to help members of their community is their primary motivation.

And it’s working. In the Ashirembe area in the Butere district, community health workers have motivated eighteen out of twenty two mothers to give birth in hospitals in this past year. The Siaya district has also had measurable success with more mothers attending antenatal clinics (see picture to the right). When I talked to the community members, many were happy with their community health workers. Millicent loves working as a health worker. When she was asked to be a health worker, she was so excited because she’s always wanted to be a nurse.

It’s amazing to me that these community health workers do so much work and expect no pay, but I understand how it works after my brief but valuable time in Kenya. That is the culture in Kenya, at least in the area that I was in. Millicent and her fellow community health workers do the work because it’s an honor in their community. And to have an entire portion of the Kenyan healthcare system be based on volunteerism, well, to me, that’s impressive.

For more in-depth health reporting stories from the PamojaTogether program, visit www.pamojatogether.com

By Sony Salzman
BU News Service

At a Red Cross facility in downtown Boston, centrifuge machines churn in a low hum while nurses tend to paperwork and volunteers fight nausea.

Volunteers are here for more than just a typical blood donation. A needle in each donor’s left arm removes blood, which is then stripped of platelets and plasma and returned to the body through a needle in the right arm. The plasma will later be used later to help patients with hemophilia, compromised immune systems and other disorders. But for the time being, it collected into a bag that hangs like an IV drip over the donor’s left shoulder.

The whole assembly looks like so:

On this particular autumn day at the Red Cross Donation Center, four volunteers sit along the south wall as their plasma slowly drips into respective plastic bags hanging over the left shoulder. Each person’s plasma is a thin yellow color. That is, every person except one: a young woman in the last chair on the right, whose plasma is a mysterious Hulk-green color.

Typical plasma: 

Hulk plasma: 

Is there something wrong with this woman? Is she an alien? Is she part-squid? Is she maybe suffering from some kind of weird bacterial infection?

It turns out she’s just on birth control. Oral contraceptive pills create a harmless chemical reaction with certain proteins in plasma that turn the yellow liquid to green. Moreover, the green plasma is completely normal. Even plasma that looks orange or “milky,” instead of the typical yellow color is safe to donate.

Plasma is the watery part of every person’s blood, and makes up about half the total volume of blood. Swimming around in plasma are proteins, blood clotting factors and hormones. Plasma surrounds red blood cells, helping transport waste, nutrients and immune cells in case of infections.

This woman’s plasma is actually green because of increased levels of copper – just like the copper Statue of Liberty is green. Inside her body, the birth control hormones trick her liver into producing more of an enzyme called Ceruloplasmin (the same thing happens when women are actually pregnant). This enzyme has six copper atoms in its chemical structure. The boosted presence of this enzyme is enough to turn the plasma green.

There are a variety of chemical reactions that can have a benign effect on blood plasma. For example, if you eat a ton of carrots (and therefore a lot of vitamin A), your plasma will look kind of like SunnyD. If you eat a really high-fat diet, your plasma is going to look like butternut squash soup.

However, even though green or milky plasma is totally safe to donate, technicians are trained to watch out for more nefarious variations in plasma. For example, little particles inside the plasma baggie might indicate a blood-borne infection, and these donations have to be tossed in the garbage.

But despite the suspicious-looking green plasma bag in a room full of yellow bags, this woman’s donation is A-OK. The grateful recipients care much more about the generosity of this woman’s donation than the color of her plasma.