Walking to Save Lives – Meet Charles Ekale Community Health Promoter in Turkana

By Ida Maritim Communications and Media Manager SCI Kenya and Madagascar

In the rocky plains of Turkana, northern Kenya, where the roads are few and far between and the health facilities even fewer, a child's life can depend on a single person. That person is Charles Ekale – a Community Health Promoter. He walks for hours daily over long, unforgiving terrain and distances, in sweltering heat armed with his health kit and an unbreakable spirit to save children's lives.

His day starts at the break of dawn, and as a pastoralist, his first order of business is to help his family with the goats ensuring they are out of their pen to graze. He then takes a bath, picks up his health kit, and depending on his schedule begins his trek to households or walks to his drop-in clinic location. 

On the first day we meet Charles, he sets up a drop-in clinic under the shade of a large tree outside his home.  Here he sets up his tools – a weighing scale from a branch, opens his box of ‘simple tools’, checks his equipment and gathers his notebooks for record keeping. The clinic happens every week and word has spread about it through his community, through his visits outside the community, and by word of mouth. On some days there is a queue of people waiting for him. On this day, however, there is just one family with their 18-month-old baby girl *Ereng, who Charles has been treating for malnutrition. 

This make-shift drop-in clinic serves locals who brave the challenging terrain, long distances, and scorching temperatures to bring their children to see the "Doctor." Although Charles lacks formal medical qualifications, his training by Save the Children in basic healthcare for common childhood illnesses and malnutrition and his unwavering dedication has earned him this respected title within the village. 

Lomanat a mother of six has brought her 18-month baby Ereng to see Charles. 

As we meet the family, Lomanat narrates how drought wiped out the only livestock her family had forcing her to invest in a charcoal-burning business to feed her family.  However, this business was not profitable as she had no means of transport to reach potential buyers. 

This is why my baby got sick; we didn’t have enough food.  Because I had been trained on how to use the Family MUAC tape in a previous outreach, I measured Ereng, and I knew she was in bad shape and this is when I brought her to Charles” adds Lomanat

On their first visit, Charles screened Ereng and found that her upper arm circumference fell on the yellow part of the measuring tape. This meant that she had moderate acute malnutrition.  With this diagnosis, Charles put her on Plumpynut – a fortified peanut butter paste packed with all the vitamins, minerals and calories for treating acute malnutrition in children and told Lomanat to bring her back after two weeks.   

For over two months, Charles has been treating Ereng and Lomanat has been coming for peanut paste rations according to the date indicated in Ereng’s medical book.   

“Ereng has been in the yellow MUAC zone until recently. In the last two weeks, her MUAC indicated green which means healthy weight. She is here today, and upon screening, I have found that her MUAC lies in the green part of the band, and I have crossed her out of the register and discharged her from the programme. She came in weighing 7.2kg and has left the programme at 9.6kg” explains Charles. 

A "Family MUAC tape" is a simple, colour-coded tape used by mothers, caregivers, and other family members to screen children for acute malnutrition by measuring their mid-upper arm circumference (MUAC).  It is mostly used among communities who live far away from health facilities. 

 According to the guidelines, once a child falls in a green MUAC zone twice they are discharged from the programme. 

“That’s the reason I have crossed lines in my book. Before I discharged her, I first started by ticking two green boxes. When the child on two consecutive visits indicates green, you discharged them. I marked and crossed the lines in my book to indicate that the child is cured” says Charles.

The joy on the faces of Ereng’s family is palpable. 

“The doctor helped by giving her chocolate-fortified peanut paste. Since then, she has started gaining weight, gaining weight, gaining weight until I saw her come alive again” says Lomanat with a wide grin on her face. 

On the second day, we travel over seven kilometres to visit Selina.  Selina lives about 7 km away from Charles's home.  We travel most of the distance by car - four-by-four vehicle but end up completing the trip on foot. On the final section of the journey, the bushland was tough even for the vehicle to navigate- the ground too sandy, rocky or hilly to drive on. After crossing a sandy, dried-up riverbed, we all walked the final, short stretch, dodging small rocks and acacia thorns, arriving at Selina’s home hot and a little breathless.

We find Selina sitting calmly outside her home with her children, in the shade of a woven palm fence. Her small one-roomed home made from palm leaves and sticks is cooler inside than outside. 

Charles quickly does a basic health check for Selina, baby Kevina and her other children including Daudi. He added written notes in Selina’s government-issued mother and baby book and referred Kevina to the nearest clinic on a special Ministry of Health portal on his phone. He then assessed Daudi, who had fast breathing but no coughing and was warm to the touch. He suspected malaria and was able to correctly diagnose this with a rapid diagnostic test before giving him treatment.  

Selina knows that Charles is her best hope for keeping her children healthy. So much so, that we learned that she had spent hours travelling to Charles' village the previous day with her baby, looking for help for Daudi just 9 days after she had given birth. 

Like many in the region, this family has been badly affected by recent drought, made worse by climate change. Most of Selina’s animals died, leaving her with little options for food or income. When her children get sick, she lives too far from the nearest clinic to take them there.

The increasingly frequent droughts caused by climate change are making common, preventable diseases even more deadly for children. Community Health Promoters like Charles, and their supporting mentors, are reaching children most at risk, but they cannot do this alone. 

Save the Children has been working with other partners to train community health promoters in basic healthcare for common childhood illnesses and the electronic Community Health Information System (e-CHIS).  Community health promoters serve 100 households spread over a vast area and cover these distances on foot, especially in the arid and semi-arid counties where health facilities are few and far between. Charles mentions that sometimes he can take him over four hours on foot to get to the next household.  This can be very tiring carrying the health kit. 

“If I had a motorbike, it would be so much easier to visit the households and immediately get refills from the nearest health facility” 

The work by CHPs in Kenya is part of Kenya's Community Health Strategy (CHS) which aims to improve community health by bringing services closer to households. CHPs are trained community members acting as a vital link between the community and formal health facilities, delivering essential health services. 

The increasingly frequent droughts caused by climate change are making common, preventable diseases even more deadly for children. CHPs like Charles, and their supporting mentors, are reaching children most at risk, but they cannot do this alone.