A Day in Muhoroni

RoselineRoseline, a community health promoter in Muhoroni sub-district health facility, is a tall woman with a wide smile and boisterous personality. She also has a nunlike presence – with patience and kindness for everyone she meets. As she awaits pregnant women for their antenatal care visits, she naturally engages them in conversation and makes them smile and feel at ease. She is perfect for the job. Her task today is to lead a group of women in a discussion about pregnancy as they await their clinic appointment. The women wait in nervous anticipation along a bench in the open-air waiting area - for some this is their first pregnancy, and first visit to the health facility.





To begin, Roseline calls the maternal health nurse, Rael, to begin the discussion with medical facts. Neatly dressed in a nursing uniform and Femiplan red apron, she begins a discussion about the importance of malaria prophylaxis during pregnancy. Rael describes the dangers of malaria in pregnancy and the importance of prevention. She even brings the tablets for them to inspect. In Muhoroni the prevalence of malaria is high, she continues, and preventing malaria can have additional health benefits such as anemia prevention.

Rael asks the women about their birth plans next. She describes how real vs. false labor pains feel and encourages the women to prepare to travel to a health facility early in labor. She also emphasizes the benefits of delivering in the hospital, including the items they will receive from SWAP if they deliver in a facility – a lesso (a baby blanket), and a 100 ksh voucher for health products of their choice. The nurse then asks the women if they have any questions. Most are shy and look away, but one brave woman asks why the malaria pills make her feel more ill. She graciously explains that eating prior to taking the pills helps, while emphasizing their importance. The discussion continues until the women have no more questions for the nurse.

Roseline returns to the group with a large grin as she encourages the women to talk to each other. At first, nobody moves, but once one woman starts talking to her neighbor, the others gently introduce themselves to the pregnant stranger beside them. The formal feeling of the discussion begins to change as the CHP jokes about anger, moodiness, and overwhelming frustration with your husband during pregnancy. The environment feels open and safe, and the women discuss labor pains, exhaustion, sex, and food choices. Mostly, the questions are asked and answered by the pregnant women in the group, with the CHP guiding them and encouraging the shy women to engage.

Then, Roseline begins singing and clapping. At first the women laugh at her, averting their eyes in embarrassment. Before long, though, the women are out of their seats clapping, singing and laughing at themselves.  

Group-based appointment

As the session ends, one of the women asks why they have never had a group before. She wishes she had a group like this for her first pregnancy because there was so much she didn’t know about pregnancy and labor that she could have learned from experienced mothers. The women continue chatting as if they are old friends as they wait for their appointments and vouchers – the mood has palpably changed. Before leaving, another woman insists that she is invited to the next meeting as she walks away with her soap and Waterguard she received with her voucher, a large smile covering her face.