Narrowing the gaps: a health surveillance assistant with a heart to serve

Village health worker Noah Chipeta has to travel 17km by bicycle to restock medication for his community clinic
 © UNICEF Malawi/2017/Guy Hubbard

By Joseph Scott, UNICEF Malawi

When Noah Chipeta arrived at his new posting as a health surveillance assistant (HSA) in Chanthunthu, situated in Malawi’s Kasungu District, he didn’t think he would be staying long in this isolated area. Chanthunthu is a small community of 11 villages, wedged between two rivers which cut the area off from the outside world during the rainy season.

“I arrived here in 2009,” says Noah. “Back then, there was no health facility or house for me to stay. Most of the time I was working under a tree. Although it was challenging to work with minimal resources, I saw the need for my presence in this community.”

At the time, the community was losing many children to preventable diseases due to lack of access to health services. The earth tracks that connect Chanthunthu to the main road are in bad shape. Years of deforestation has exposed the landscape to soil erosion and the roads were not spared. Running water has carved dips in the roads, making driving or cycling to this community difficult.

“Before I arrived, there was no one to advise people on how to prevent diseases such as diarrhea or malaria, which were killing many children in the area,” Noah explains. “I felt that leaving would be an injustice to this community in need.”

The nearest health centre to Chanthunthu is about 17 km away. But when it is raining, the journey becomes much longer as those seeking medical help have to avoid the swollen rivers by using another path through the rugged mountains. For parents seeking quick medical help for their ailing children, the mountain paths are not a good option.

“There were cases where parents would just give up,” says Noah. “The mountain paths are slippery during the rainy season and it puts the lives of both the parent and sick child at risk. So many would just stay home hoping that the sickness will go away.”

Noah prepares to prick the finger of three-year-old Trinity Banda, to test her for Malaria
 © UNICEF Malawi/2017/Guy Hubbard

UNICEF’s support

Noah’s posting at Chanthunthu coincided with the launch of the integrated community case management (ICCM) approach in the area. With UNICEF support, the district health office started training health workers in the district how to offer basic medical treatment to children in the villages. Noah received the training and for the first time in years, children in the community could access treatment quickly.

“After working here for some months, I was encouraged to stay despite the difficult conditions because the community really appreciated my services,” says Noah. “They had lost so many children to disease. My coming to the area was a big relief for them as they now could access health services closer to their homes.”

The village health clinic provides a ‘one stop shop’ for the local community. Now health services such as antenatal clinic, growth monitoring, immunization and screening for malnutrition are done under one roof. Children who are malnourished also receive ready-to-use therapeutic food (RUTF) at the rural clinic.

“The community has been very supportive of the clinic,” Noah says. “In fact, they contributed by molding bricks and even with the actual construction of the clinic building. UNICEF supported us with metal sheets for the roof.”

In addition to the training and clinic construction, UNICEF has provided essential drugs such as anti-malarials, antibiotics, zinc and oral rehydration, and bicycles for rural health workers to travel easily between the villages in their area.

Noah talks about health issues to mothers with young children from the local community
 © UNICEF Malawi/2017/Guy Hubbard

Relief for mothers

Catherine Chisale, 35, from the local community says that the coming of the health surveillance assistant to the area has helped reduce deaths, especially of children. “We face a lot of problems especially when it’s raining and a child is ill,” says the mother of six. “We have had cases of children either collapsing or dying on the way to the health centre as it is far. I have many examples of friends and relatives who lost children because they could not receive help in time.”

But challenges remain. “For minor illnesses, the village clinic can help. But when the illness is serious, we have to go either to the health centre or the main hospital in town,” Catherine adds.

Although it has been almost 18 years since Noah reported for duty in Chanthuntha, he does not see himself moving any time soon. “I am now part of this community,” he says. “The village chiefs and the people appreciate my work and I don’t see any reason to move to another place.”

Noah relaxes at home with with his family after a day of treating children under five for illnesses
 © UNICEF Malawi/2017/Guy Hubbard

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