In one of Dar es Salaam’s densely populated neighborhoods, community health workers Catherine Mselem and Japhet Mhando are on a vital mission: safeguarding expectant mothers during the pandemic.
Familiar with every corner, they navigate through the streets, preparing to meet the day’s first client. Next to a convenience store sits 26-year-old Aisha Hussein, who is eight months pregnant with her first child. She dutifully covers her face with a homemade mask as the two health workers approach.
She has been terrified to give birth during the pandemic, fearing that she will contract coronavirus while at the hospital. Catherine Mselem, whom she respectfully calls “mama,” has guided her through this extraordinary time.
“Mama has helped me with information to keep me safe; to wear a mask, wash hands regularly, and avoid crowds,” says Aisha.
Rumors that the local hospitals are unsafe during the pandemic are widespread among the local women, she adds, instilling fear and uncertainty among expectant mothers. “If we go to the hospital, we will get corona and die,” a pregnant woman told Aisha.
COVID’s impact on maternal health
Maternal and child mortality has been high on the list of concerns among scholars during the pandemic. According to estimates by global health experts published in The Lancet, the pandemic could cause more than 1.5 million additional child deaths and over 56,000 additional maternal deaths over six months in low- and middle-income countries if health systems are overwhelmed and access to food is limited.
Catherine has been worried that maternal and newborn deaths could increase significantly during the pandemic as a result of increased home births. Together with Japhet, she has urged pregnant women to continue with their medical check-ups at the local clinic and to give birth at the hospital.
“We tell women that our hospitals have safety measures put in place such as social distancing in order to reduce their fear,” Catherine says. And while there was a sense of panic initially during the outbreak, the fear of hospitals has now diminished, according to the community health workers.
Since the first cases of COVID-19 were reported in Tanzania in March, the two community health workers have visited approximately 300 homes and have not recorded a single corona-related death. According to the official figures, Tanzania has had 509 recorded coronavirus cases and 21 deaths. However, these numbers were last updated on 29 April.
As restrictions ease and life returns to normal in the often-chaotic city, face masks become a less frequent sight. The community health workers must confront community members who deliberately walk into a crowd without a face mask.
“You have to talk and try to make the person understand why a mask is important,” says Japhet Mhando. After six years as community health workers, Catherine and Japhet are experienced in resolving conflicts and detecting symptoms that require medical attention.
While they are not trained in attending births or permitted to administer medicine, they deal with a wide range of issues: referring patients with HIV or tuberculosis symptoms for testing, advising on family planning and detecting malaria.
The importance of community health workers
Back in the street, Catherine and Japhet meet 22-year-old Husna Adam, who is expecting her first child. She has been waiting for them on her doorstep and willingly extends her arm for Catherine to measure her temperature. Then she shyly answers Catherine’s questions; has she been coughing? Sneezing? When was her last visit to the doctor?
The answers are comforting. Husna has been following her schedule at the clinic and her temperature is normal. “I am going to give birth at the hospital. I am not scared,” says Husna, who met Catherine and Japhet in the street during one of their visits.
Although the feedback is generally positive, visiting community members every day from morning to afternoon, can be taxing at times. They face difficulties on a daily basis, and with very little pay from the municipality and occasional donations from charities.
Still, their service to the community is rewarding in its own way.
“At first, I did it because there was not much other work to get, but now it has gone to my heart,” says Catherine. “I like to help people and I will continue to do this job as long as I can,” she says.