On Wednesday we spent the afternoon with Erick, who has been a Community Health Volunteer for 15 years in Nairobi. He was trained by the Ministry but is employed and paid by AMREF. He oversees 800 houses in Kibera informal settlement, where a million people live. He manages to see all of them once a quarter. People living in this area suffer from some of the worst poverty and living conditions, and Erick is an important primary care touchpoint for them. He supports people emotionally (is well liked and welcomed) as well as helping to guide them to the right medical care when they need it. He does not carry or dispense antibiotics, unlike the CHW we met in Kisumu.
Here are some of the most inspiring things we learned:
Campaigning with simple health messages works
"I will go around the area with a megaphone and spread messages such as 'My health, My responsibility". We're trying to get people to take care of themselves while they are still young. We also use ghetto radio."
The CHV's role was originally created to educate people around HIV.
People have more immediate issues than AMR
When 1/8 people have HIV in this community, and many others are trying to avoid Cholera, Typhoid and TB on a daily basis, the idea of educating around AMR is not top of mind. However, he is trying to inform people not to take antibiotics automatically when they're ill, and encourages people to see a doctor before taking any drugs. He uses very simple messages about what will and won't work for patients, and the idea of wasting money on drugs that won't treat them.
"I tell people not to go straight to the pharmacy when they're sick. I say “those who are selling drugs in the slums are trying to cheat people”'
He says that to create better health behaviours, you need to present guidance as lifestyle advice. This goes back to the advice we were given by Karen Mah early on about humanising the issue rather than keeping it medical. If we can talk about resistance in relation to lifestyle factors that they care about, then we may have a chance of cutting through.
"I tell people a story about a man who got 'Steve Johnson' syndrome because went to a quack and was given medication without them knowing he was on HIV medication. He had a terrible skin reaction, he was in hospital for 3 months and lost half his tongue"
"Cheap is expensive. Quacks buy drugs wholesale and then make a 300% profit in the slums”
Connecting the dangers of drug misuse to stories people can relate to and are scared by seems a good approach and supports our 'Serious stories' campaign concept.
He recently completed an AMREF M-Learning course which lasted a year. Each week he would be sent audio case studies and then would answer around 25 questions. The first CHV in the area to complete accurately each week would win 1000 shillings in their M-PESA account.
One thing I learned about was how to help people Disclose to their loved ones that they have HIV. I now run 3 support groups in the area to share this knowledge. It's 3 simple things - choosing 'Who', knowing 'When' and 'Why' you're telling them.
We showed him our Top Doc concept, which would train health professionals with the latest knowledge around AB usage.
"I would want to use this, it's very good. It's clearer than the M-Learning and you can see the different modules you've learned"
HMW design a learning platform that not only gives healthcare professionals the right knowledge but teaches them in a way that's highly applicable in their jobs? That they can put to use with patients and share easily?