July 8 2015
Wellbody Hero of the Week:
Mabel Koroma - Community Health Worker
Seijiro Takahashi - 17 June 2015
Mabel Koroma is one of Wellbody Alliance's Community Health Workers (CHWs). She is a 32 year old from Kabala Town, and is a single parent with three children – 14, 12, and 2.5 year old girls.
Why her job is heroic:
As a CHW, Mabel plays a crucial role in connecting Wellbody's life-saving resources to individuals within Kono, especially to those living in hard-to-access rural areas. Mabel's job goes far beyond making sure that HIV-positive patients take their medication – Mabel views her patients as family, and accompanies them in all aspects of their daily lives. Being responsible for nearly fifty patients, Mabel skillfully supports all of her patients, allotting her time with them depending on who needs the most attention. In this week's edition of, “Wellbody Heroes,” Mabel shares with us an inspiring personal story of empowerment, in which she uses her life-changing challenges as a means to propel herself forward in her career to help others. Mabel describes her duties as a CHW, and explains how she contributes to a larger movement towards healthcare equity, and towards diminishing the stigma and discrimination that HIV-positive patients, particularly women and girls, face within society.
Mabel Koroma - a Wellbody Community Health Worker (CHW)
How did you become a community health worker (CHW)?
During pregnancy, I was diagnosed with a chronic health condition. After three days, I told my husband about this, who then started to mistreat me. I explained my situation to my counselor, who linked me to Fodei Daboh, the CHW Supervisor at Wellbody. It was through this meeting that I learned about Wellbody. At that time, I was eight months pregnant, and was given psychosocial counseling, free medication, and visitations. Six months later, I returned to Wellbody, and explained to Daboh how I was struggling with my baby.
Daboh then asked me if I wanted to work with Wellbody, and informed me about the application procedures. One year later, I brought records of my credentials and qualifications to Daboh, and I was asked to write up my application to become a CHW.
So this is how I became a CHW – through my heath complications – and I have been one since September 12, 2012.
What is a typical day at work like?
I'm responsible for close to fifty patients in total, so I usually design a weekly activity plan that targets a certain amount of patients, day-by-day. There is no chance that I could visit all of my patients in one day, but I typically visit five patients per day.
I work from 7 am to 1 pm, when I eat lunch. I have free time from 1 pm to 7 pm, during which I rest for one or two hours. I must take the time to rest each day because of my condition. At 7 pm, I visit patients to remind them to take their second daily dose of HIV medication. Some patients, especially new ones, forget to take their medication if they are not reminded. Some won't take their medication even if you remind them to over the phone. So I must encourage them in-person, sitting next to them, putting my arm around them, and telling them, “You have already done well by taking one pill this morning – now, you must continue to do well by taking the second dose in the evening.” In this way, I must coax some patients.
07:00:00 AM ~ 01:00:00 PM
Visit HIV-positive patients within community – remind them to take medication
01:00:00 PM ~ 03:00:00 PM
Lunch and rest
03:00:00 PM ~ 07:00:00 PM
Meet with HIV-positive social group; dinner
Return to work – visit patients/bring patients to Wellbody Clinic – remind them to take 2nd dose of medication; return patients from Wellbody Clinic to homes
In a very terrible situation, unfortunately, I must give priority to patients who are more sick and vulnerable than other patients. There are categories of patients, and I must pay attention to those who are more sick and vulnerable. I link them to health facilities or visit them to be by their sides, especially those who are new to the system. I must cajole them and make them feel like they belong to the community. I must enthuse them, and make sure that they get their medication on time. Later, I convey them from the clinic to their respective houses, because some patients cannot walk by themselves. For other patients, I bring them to the clinic from home on an okada (motorbike) for medication, and sit next to them during the ride. After that, I take them back home.
I build an attachment with them, and make them my close friend and relative, because we share the same blood.
Edna asks me, “Are you in doubt about that, Seiji?” and they both look at me.
In doubt about what?
They say, “In doubt about Mabel sharing the same blood as her patients.”
We share the same blood because we are all experiencing health challenges. I feel for my HIV-positive patients, because he who knows it, feels it. This is how I overcame my own terrible situation – through work.
Mabel Koroma and her patient Tejan inside Tejan's house
In another scenario, some patients cannot afford their own meals. When I visit these patients, I ask them, “Have you taken your medication?” If not, I will ask them why they haven't. If they say that it's because they have not eaten all day, then I will go to the nearest local restaurant, and buy them food, paying for it out of my own pocket and salary, just to encourage them to take the medication.
So I spend more of my time with particularly vulnerable patients, especially women and girls, but I still see other patients. In any epidemic, women and girls are the most exposed to infection.
During my free time from 1 to 7 pm, I only rest for one or two hours. For the remainder of the time, I meet with HIV-positive individuals. There is a small social group of people including those with HIV, who meet and visit each other to see how things are going. We do this on a weekly basis, or even on a day-to-day basis. It helps to unify us, to bring oneness, love, and togetherness.
I only cook on the weekends to prepare meals for myself. I don't cook on weekdays because of my tight schedule. My auntie cooks for my children on the weekdays.
What is the most rewarding part of your work?
Wellbody preaches social justice, and social justice is the most rewarding part of my work. As a CHW, I link patients to health facilities. That means that we are extending social justice to them. Our mission is to establish healthcare as a human right.
We provide free medical care, especially to people with HIV and tuberculosis (TB).
Some districts don't have medical facilities, such as Kwendadu. HIV-positive individuals in these areas are so skinny. With Wellbody, in Kono, I can't tell if someone is HIV-positive unless we take a virus count, because of the care that is provided to patients – the medicine, social support, and psychosocial counseling. We are working hand-in-glove to save the last HIV patient's life, and we believe that healthcare is a human right.
What changes have you noticed since you have started working with Wellbody?
Those living with HIV and TB, those that visit the antenatal clinic (ANC), children under 5 years of age – Wellbody has made a great change for people in these categories, from what I have personally witnessed and experienced.
In your opinion, what does Kono need the most right now?
There is still more work to be done in Kono. We need to break the failure of imagination, because many people in their minds think that any woman who is HIV-positive must be a call girl or a prostitute. Since HIV has affected Sierra Leone, and Kono in specific, women and girls have suffered the most, because we are more vulnerable and exposed. In order for us to overcome these challenges, we make sure to empower more women and girls to build capacity. We have conducted a survey to count the number of HIV-positive girls and women who have not received formal education. We need to provide more health facilities. We need to pay total attention to vulnerable women and girls with HIV by providing soft grants – food and nonfood items to improve their lives, such as clothes, toothpaste, lotions, shoes, and blankets – things to make them look and feel nice. Most of these women and girls have no opportunity for formal schooling. We need to provide education for them, to help them engage in their own small businesses, so that they are able to provide food for themselves, to eat well, and to take their medication. Then they will be able to pay their children's school fees and can deal with other family issues, land issues, and violation issues.
What advice do you have for those who want to help individuals in Kono?
Wellbody and Partners In Health are doing very well to improve the health system in Kono, as an umbrella body for AIDS issues. If anybody wants to contribute to the cause, they should collaborate with other like-minded donors to embrace the issue of health in Kono. Education is also a big challenge. Most of my colleagues are illiterate. When building a city or district, one must focus on two main issues – health and education. When people are healthy and educated, they are able to fight poverty.
Do you have any particular photos that you'd like to share with the readers?
I personally recommend one of my patients, Tejan, because he is more vulnerable than most of the patients in my domain. There is a saying that, “even in the place of wealth, you need to give preference to the poor.” As a CHW, Tejan has a special moral claim on me and the organization, so we need to come to his aid in a difficult situation like this. His photograph can speak on his behalf. He has a very big ulcer on his leg, not even a proper place to sleep, and faces challenges with his upkeep. Everyone - the readers of this blog, me, like-minded donors - are of the world. So we must open up to excluded vulnerable patients, especially people like Tejan, to help them attain a sustainable livelihood.
This photo is from one of my couselling visits at Tejan's house. I sit very close to him in his untidy cubicle that is fit only for our local chickens to roost in.
What do you enjoy doing for fun?
I'm very gamesome. I like playing and watching games. For indoor games, I like Lodo; for outdoor games, I like football. I like to coordinate events, like football matches.
I also like to discuss women's issues, such as violence against girls and women. I channel these cases of violence to like-minded donors who have an interest in women's rights. These organizations include Action Aid, and Advocates for Social Justice and Development, because these groups deal with women's issues. When you have compassion for women and your colleagues, you are able to break the bridge of imagination. I also like to search for the sick. To crown it all, I like doing things on a voluntary basis.
What is Kono like?
Kono used to be known as the breadbasket of Sierra Leone. Now, Kono is in a very deplorable condition. However, unlike the other districts, the violence issue about women and girls is not taken lightly. Rape cases are especially dealt with seriously. Rape happens often in Kono – this year, there have been close to ninety cases in the last few months. Most victims are 0 months to 18 years old. In Kono, legal action is taken against perpetrators. This helps to reduce the level of stigma and discrimination against women and girls. Sierra Leone's government and likeminded donors like Wellbody Alliance, Advocates for Social Justice and Development, and Action Aid are addressing such issues. Wellbody is involved in addressing women's rights by participating in community sensitization efforts, in which people are visited door-to-door to raise awareness about such problems, and by providing psychosocial education. Other likeminded people are also providing support, especially those living in rural areas – rural chiefdoms in Kono are frowning against violence towards women and children.
Donors provide support for the poorest of the poor, which is Kono. Wellbody's new antenatal clinic (ANC) has so much equipment. Before, we were referring complicated cases to other hospitals. Now, the ANC has attracted many women, but we still have challenges.
For example, we have no general operating room, so if we encounter complicated medical cases, we must refer them to Koidu Government Hospital. But even that hospital is not well-equipped.
We also have a challenge with electricity in Kono. Electric power is not affordable or accessible – it is very, very expensive.
Road conditions are very deplorable, and it especially affects Wellbody's operational communities that are far away.
The crime rate in Kono is at a higher peak because of poverty, including theft and violence, and teen pregnancy is the order of day. Early marriage is killing the future of our girls, and the education system in Kono not of standard.
If it weren't for Wellbody and Partners In Health, the situation would be much worse.
What are your passions? What do you really care about?
I am passionate about fighting for gender equality. I care about employment for our colleagues, and I want there to be educational facilities for those without education, and especially for people living with HIV and TB.
Who are your heroes? Why do you admire them?
I have many heroes, but today I will mention two of them: Dr. Barrie (Wellbody's co-founder) and Raphi (Wellbody's Executive Director) are my heroes. They have passion for HIV patients, and are creative.
Dr. Barrie brought Wellbody to Kono because it was and is the poorest of the poor districts in Sierra Leone. Dr. Barrie's hands are open to receive people at any time, in any place, and no matter how. He is developmentally oriented, and has passion for HIV people.
Raphi is helping with the mobilization of phones to address issues of medication and social support for people living with HIV and TB, for vulnerable women and girls, and for other people.
What are your future plans and aspirations?
When I was younger, I wanted to become a doctor. Because of the rebel war, I became an early orphan after my parents were killed. Since I have lost my parents, I have had no caregivers, and no way to pursue an education. In the future, I would like to become a doctor who specializes in treating HIV and TB. I have been around HIV, I know it and how it attacks, and I know how to take care of HIV patients. So I will become a doctor, provided that I have the financial support.
I would also like to pay a visit to other HIV caregivers and patients of the world beyond Kono, to share and exchange ideas with them.
Osman Tolo Kamara, one of Mabel Koroma's patients
Do you have any personal advice for someone who is interested in a career in global health?
I recommend creating room for capacity building. We should provide more medical support, especially medication. We should train more nurses, train more quality doctors, improve mobility within Kono, and build bigger and better hospitals in Kono that can have more than one hundred patients. We should build a medical college in Kono here. Most people in Kono have aspirations, but cannot go to Freetown to attend medical school. If there were to be a medical school in Kono, they would be able to enroll smoothly. We should also organize an exchange program, in which you come to Kono, and I go to the US.
People in Kono love strangers, especially researchers. When Dr. Barrie and Dr. Kelly brought their idea for Wellbody to Kono, they were able to stay because of the welcoming nature of the people here.
Thank you for sharing your inspiring story today, Mabel!