CHWs, You're the Ones I Love

Rulindo, Rwanda
February 20, 2010
















Photo caption:
Four Community Health Workers (CHW) in Rulindo; from left to right: Beatha, Josephine, Marie Rose, and Florida. What are they holding, you might ask? Well, curious SHE-er, those are our monitoring and evaluation forms that our CHWs will fill out every time they carry out a health and hygiene training, or make a pad sale. These reports will complement our field visits where we will work with each CHW directly. This is at the conclusion of our three-hour meeting, by which time we all were comfortable enough with each other to make jokes, and say “salaaaaad” (pronounce sah-laaaaahd) together to get our teeth showing for this picture.


CHWs, you're the ones I love.

Maramutso, Miriweh, Uraho…these are some of the many greetings I heard and learned this week. I’ve also become accustomed to the common handshake here (this one is mostly used when meeting someone for the first time)– a kind of loose informal hand-slap with one hand, with the other hand resting on the extended arm’s elbow.

I spent time with quiet Esperance and young active community member Aloys in Nyamata, leader Marthe, reserved Marie Claire, and opinionated Azela in Karongi, sweet Marie Rose, quiet Florida, giggly Josephine and leader Beatha in Rulindo, and many others in Nyamagabe. They told me everything – about the health and hygiene trainings, the pad sales, and the changes they see in their communities.

The communities we work with vary from those who live hours from the city centre, to those who live in the centre of the rural district. Sensitizing everyone to the issues around menstruation has been key, but has definitely been more important for those who live in farther out rural areas. For many (especially those farther from the city centre), it is their first time hearing about menstrual health and hygiene, and seeing that there are pads to help them manage their menstruation. The trained has helped to break the silence and embarrassment of menstruation, as our CHWs explained that before, women and girls would have to hide that they were menstruating and hide their fabrics during washing, but now they are free and it is not a matter of shame for them.

Let me clarify – what the CHWs said: before, some girls and women were using fabric that they would cut from their clothes. But this was ineffective because women and girls still could not go places freely when they were menstruating. Now, women are able to go to church freely because they know how to manage their period and have the pads to do it, and girls don’t have to stay home from school because they are ashamed or afraid their fabric won’t protect them all day – they can put on a pad in the morning, and it can last the whole day or they can take another one in their backpack with them. The CHWs said they see the difference starting in their homes - with their sisters, mothers - and extending to their neighbors and to their communities.

One thing that is interesting is that the CHWs train men in the health and hygiene education curriculum as well. They said it is important to train the men also because they have to understand the need to buy pads, and they are very supportive of it now that they have had trainings. Men are very happy because it is the first time that they are understanding this, and now it is easy for them to buy pads for their sisters or wives.

As they were explaining the differences they see, they also said that girls and women do not get “illnesses of hygiene” anymore. I kept probing on the illnesses that they used to get, and they described pain and yeast infections. These have decreased dramatically.

So what are we doing with this feedback and what do we need to work on? I think Azela put it well when she said a phrase in kinyarwanda in this proud kind of way, and everyone laughed; when I turned to Delphine (Rwandese intern, currently a student at KIST), she tried to explain that it was hard to directly translate, but it was along the lines of “I’m the best sales-woman: when I have something to sell, people come to me.” She proceeded by saying she wanted more pads to sell. Beatha said it in a heartbreaking way: “Poverty is everywhere, money will always be an issue, what can you do but try to find work and help your family and neighbor.”

Our CHWs are incredible people who want to have more impact on their neighbors, want every girl to have enough pads so she doesn’t miss school, and want to meet more women in the market who tell them that now they are free and comfortable. I walked away from each field visit with a satisfying exploding headache, knowing that these CHWs want more pads to sell, more information on health and hygiene, and training on how to make pads. There is much to be done on addressing and incorporating all of this feedback, and that is what we are now working on.

As always, please comment and write with any ideas.

Fatima, SHE Fellow

fatima@sheinnovates.com