Margaret Kilonzo, CHW

Margaret was interviewed by Onome Ako, then-Executive Director of Amref Health Africa in Canada, and together they discussed the triumphs and challenges of being an unpaid Community Health Worker in Kibera, both before and during the COVID-19 pandemic. In case you missed it, catch up on their conversation below – and be sure to sign up to our mailing list at the bottom of this page so that you never miss an invitation again!

TORONTO / NAIROBI, Friday 5th March 2021

ONOME: Thanks for being with us today, Margaret. Why don’t you tell us a little bit about yourself – where did you grow up, what was your childhood like, and what do you do now?

MARGARET: Thank you so much. My name is Margaret Kilonzo. I am a Community Health Worker from Kibera, Nairobi, Kenya. I was born in Kibera, raised in Kibera, and I stayed in Kibera: this is my community. Growing up, it was not easy being in a girl in a population where there is so many people; where girls are not given any chances; and where boys are given more opportunities than girls. But I survived those challenges. Now I have been a Community Health Worker for over 20 years in the same community, because these are my people.

O: Thank you, Margaret. A lot of people on this call today may not have been to Kibera, or to Kenya for that matter, so could you help us understand what Kibera is like? What would people see and hear if they were to visit Kibera?

M: Kibera is the largest [informal settlement] in Africa. It consists of different people are from many different parts of Kenya. It consists of so many people – so many tribes – but they all share the same resources. The community is very congested, so there are some issues with sanitation, but people there are so friendly and social. Now, women are beginning to become empowered within the community, and gender equality is improving because of the work of Community Health Workers. But still, there is a lot to be done in Kibera, because of that congestion, especially now that there is COVID-19. There is still a lack of basic sanitation facilities, so we are still trying to get support from the government.

O: How many people live in a household in Kibera? Can you give us a flavour of life there?

M: I visit around 100 households as a Community Health Worker. In each household you might find four to six people living in a one-room shack. You might even find two families sharing the same shack. There is a big issue with congestion. There are so many people that the housing conditions are bad, and people are surviving just that way. The population is too high – I think it is now over two million – because so many people have relocated to Kibera.

O: Thanks, Margaret. So, you’ve been in Kibera all your life, and you’ve started talking a little bit about some of the changes you’ve seen there. Can you tell us a little bit more about that – has Kibera changed a lot since your childhood?

M: One thing I can say is about empowerment. Before, there was great inequality between men and women. There was the issue of girls not going to school, but if you visit now, you find that girls are in school. There was also the issue of female genital mutilation or cutting (FGM/C), but now that is very rare: you won’t find it here anymore.

Now, there are so many more health clinics, including Amref’s, so women’s reproductive health is catered for. Women are now delivering their babies in hospitals or clinics instead of at home. Back then, there were no Community Health Workers, but now there are lots of resourced, empowered Community Health Workers who go from door to door to educate and empower these women on issues like family planning and sexual health. Because of that, people have changed, and now they are seeking health services from the right people with the right skills. Before, women used to go to Traditional Birth Attendants (TBAs) to give birth, but now the TBAs are escorting women to the clinic to give birth safely.

During my childhood, there wasn’t even sanitary towels for girls. It was very hard to ask for them because those kinds of topics weren’t talked about. But now we talk about them openly, and girls can use the products without feeling embarrassed. This helps girls stay in school, whereas before, girls would stay at home when they were on their period due to a lack of sanitary towels.

O: Thank you so much, Margaret. It is really amazing to hear that so much has changed since your childhood, but I know there’s still lots to be done. I wanted to come back to the work you do as a Community Health Worker. Could you tell us what a typical day at work looks like for you and other Community Health Workers like yourself?

M: OK, when I wake up in the morning, the first thing I do is go to the clinic to give health talks. Then after that I go to the community, where I give priority to pregnant women and girls; women who have chronic illnesses; or those who experience other issues like gender-based violence. Then after that, I visit other clients in the household to give health talks. I take around two to three hours in the community, then I go to my actual job. As you know, Community Health Workers are just volunteers; we are not paid anything. So, I have to look after my family by working casual jobs in the evening.

O: Thank you, Margaret, that gives us a really good sense of what it’s like to volunteer as a Community Health Worker who doesn’t get paid. We all thank you for your service. Amref is doing a lot of work around advocating for Community Health Workers to be recognised and compensated for your work. So, I want to move this conversation forward in two parts. One: life before COVID-19. We know the first case of COVID-19 was detected in Kenya on 12th March 2020, so we’re about a year to that date. And Kenya, like the rest of the world, has been dealing with the virus and finding solutions. So, before COVID-19, what was the biggest challenge you faced as a health worker in Kibera?

M: A huge challenge was over-expectations from the community. When we visit them, they think we are paid, so they expect a lot from us. We were expected to be called upon any time to go and transport those women to the clinic. Sometimes there is the issue of security: we don’t have any cover or protection, so it can be dangerous. Sometimes, you visit the household, and you find that they don’t have anything to eat. You end up sharing whatever you have in the house with these people, because they are your people, but we don’t have much either, because we are just volunteers.

O: Thank you so much for expressing that. I’d like now to touch on some of the challenges that you’ve faced as a result of COVID-19. How has it impacted your work as a Community Health Worker?

M: Things have become very hard because of COVID-19. Social distancing is very difficult in Kibera because of over-crowding, and the Community Health Workers are not provided with PPE when making household visits. There is a big issue of water shortage: we are telling these people to wash their hands regularly with soap and water, and in Kibera, this is very hard, because even getting water is a problem for people here, since it is not free so they must buy it. When there is no shortage, it costs five shillings for one jerrycan, and when there is a shortage, it is 10 shillings. These people cannot afford that. So, when we are there as Community Health Workers telling people to wash their hands, they ask, will you provide the water? Because of that, visiting these households is very hard. We must not tell people where there is congestion to social distance or wash their hands.

You also find that people are relocating because of COVID-19. So, you might have a client, a pregnant woman, and the next minute you realise she is no longer around because she has left Kibera. You wonder where these women went, and you have to follow them until you find them again. This makes our work very hard.

There is also the issue of gender-based violence. This has increased in the community due to COVID-19. Many girls are dropping out of school because they can’t afford the resources for online learning, and we find that they’re falling pregnant now that they’re no longer in school. Some of them are going to the backstreets to carry out very high risk abortions on themselves. There is also a high infection rate of HIV, even higher than COVID-19 itself.

O: Well, Margaret, you’ve laid out a range of challenges that you face as a result of COVID-19. Lack of PPE, water shortages, unsafe abortions, lack of access to technology to access education, and gender-based violence. Has there been a moment in your work as a CHW when you’ve felt complete despair; when you’ve felt you can’t do it any longer?

M: Yes, I reached that moment due to food shortages in Kibera. Because of COVID-19, a lot of people don’t have jobs. So, when we go to home visits, they are expecting us to give them food, and they are very angry when we go there without food. At that moment, I thought to myself, this is enough, I’m giving up. But then I thought: these are my people, I will not give up on them. So, I continue to work with my community.

O: Thanks, Margaret. To finish, I have one final question for you. What gives you hope, despite all these challenges?

M: I am passionate about seeing women empowered in my community – to see women stand on their own. I am passionate about seeing a community where there is equality for women. I am passionate about seeing a community where there is positive change: where there is no more poverty, where people have their own business and are not dependent on well-wishers. That’s what drives me: to see a place where girls are educated, where they don’t drop out of school. That is why I do what I do.

This interview has been edited for length and clarity.