Preventing Malaria with Music
By Kasha Patel and Faith Chesire

About a dozen spectators sit under the shade of a mango tree. There is no stage, no curtains or orchestra. The only spotlight is the blazing midday sun. Farm animals moo and cluck nearby but no one seems distracted. The actors and audience are focused; the message is clear.

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The lead actress, a heavy-set woman wrapped in a kanga, grabs her back in pain. Soon, she is groaning, and falls to the ground. She is taken a few feet away to the doctor and diagnosed with malaria, a serious complication in pregnancy. She should be hospitalized but her husband refuses and takes her home. Soon, the woman has a miscarriage. The small audience of village elders and surrounding neighbors follow the play closely. A few audience members could probably relate to the actors through first-hand experience. After watching the performance, the audience gains a greater understanding of the risks of malaria in pregnancy.

In the Ashirembe area in Butere District in Western Kenya, community health workers perform skits that educate their villagers about concerns in the area: malaria, HIV, dropping out of school, safe water use, and discouraging abortion. The skits also try to instill positive messages about income- generating activities and empowerment of women.

“After presentations, sometimes, the community members will come to us and tell us that [a certain situation] is happening in the community,” said Annette Amukuba, a community health worker in Ashirembe.

“You reach your own people and they understand you so well.”

The theater productions do not have many props or costumes, but the awareness and behavior change in the community have been noticeable. Amukuba reports that eighteen out of twenty-two pregnant mothers gave birth in a facility last year. Three years ago before the skits were implemented, less than half of the mothers were giving birth in a facility.

“Many people have commented, saying that the message is easily communicated,” said Moses Matete, who coordinates community health workers in Ashirembe. Many of the villagers, particularly the older, illiterate people are able to understand local issues through these visual presentations.

Matete introduces each play with a musical prelude about the theme. He can sing over a wide vocal range from soprano, baritone, bass, to tenor. “You have to make the play as interesting and exciting as possible and make sure the message gets right at home,” said Matete. The skits last about ten minutes and usually include elements of humor.

The theater productions were initiated when the national Community Health Strategy was implemented in 2009. The Kenyan Ministry of Health developed the community-based programs to help bridge the gap between the small villages and health services that are available in larger nearby communities with more resources to handle health problems. Some villagers are reluctant to seek medical attention. Community workers play a key role in encouraging local patients who have serious health concerns to seek help at the larger better-equipped facilities.

Each community health worker is assigned at least one hundred homes to visit per month. The workers do not get paid, although some receive a small stipend to visit households, educate the community, and perform basic medical procedures such as distributing nutritional supplements. However, foreign donors such as USAID (the US Agency for International Health and Development), Simavi from the Netherlands, and Livestrong sponsor training for the workers, explaining how to manage cases of malaria, typhoid, and diarrhea, as well as how to advocate for preventative health measures like using mosquito nets.

“When we go for the training, we come back and empower the community with the new knowledge we get there,” said Amukuba, who is a playwright of the skits. The plays are extra endeavors on top of the workers’ regular house visits and weekly duties. Every Friday, the community health workers meet for two hours to practice the plays. The skits are presented at barazas — village chief’s gatherings and public holidays which hundreds of people attend.

“In the future, we hope even the youth will engage and join the skit because maybe we can no longer be in the position to present because of age,” said Amukuba. “But [until then], we will continue.”