Joan: The backpack nurse who changed lives of Kajiado women

Joan Kasaine’s whirring motorcycle sound fades as she draws close to the Fountain Church in Lowua village, Kajiado South. She parks it under an acacia tree, where about 30 women are seated on plastic chairs waiting for her. She takes off her helmet, gloves, knee pads and a heavy leather jacket. The midday sun is out and the sky is bare, with a tinge of grey clouds struggling to gather from afar, signalling impending rain later that evening.

The women, all from different age groups, left their homes early in the morning to attend a community health dialogue that Joan is about to give.

She is a community health promoter cum backpack nurse. When her motorcycle roars around the village, there is hope that health messages will reach people in the nooks and crannies of Kajiado South.

The topics for the day include family planning, antenatal care, immunisation and the need for skilled delivery.

She greets them all in the Maa language and they respond enthusiastically. Joan then asks the mothers general questions about their families and wellbeing to help in creating a rapport. As they open up, she ingeniously introduces her agenda for the day and the conversation flows, with the women showing the gusto of a curious teenager.

Joan notices that there are fewer younger women attending the talk and so she asks why that is the case. The present women respond but there is no definitive answer as to why they were conspicuously absent. They move on.

“Why do you think antenatal care (ANC) visits are necessary?” She asks.

Three women raise their hands to answer the question.

“To check on our HIV status,” one woman says.

“We go to the clinics to ensure that our babies are healthy during pregnancy,” another responds.

The last woman echoes the first lady’s answer, adding that women need to be checked to know how much they weigh and whether they have any underlying conditions.

They dissect a topic after the other, speaking in their local language as they freely learn and unlearn different aspects of maternal and child health.

Joan asks why some of the women in the community miss out on ANC visits, especially during the first trimester. “We don’t want people to know that we are pregnant. We are sometimes shy,” responds one young woman.

“But now that we know, let us tell our friends to attend clinics,” Joan responds.

A conversation on Maasai culture comes up. In the olden days for instance, a goat could be slaughtered every week after a woman gives birth to ensure that the woman is in good health. This has since changed because of climate change and hard economic times. Joan now tells them the need for spacing because if they give birth all the time, their health will deteriorate because there is no ‘good’ diet in plenty as it used to be the case.
She also implores them to embrace family planning because their children need to be educated and to give them good education, they have to have enough resources.

“You have to choose with your partner, with the help of a clinician ,the best family planning method,” she tells them.

About an hour later, Joan wraps up the health talk and the women take tea and bread as they talk about the things they had learnt that day.

We meet Ruth Simon, one of the women who was part of the talk. She is a mother of four.

“We learn a lot from these talks. Before this was introduced, most of us were clueless about basic things like family planning. The first time I ever heard about it was at a clinic but I did not get more details,” she tells Healthy Nation.

“I had never used any family planning method until after I was introduced to these talks,” she adds.

This community health dialogues are organised by community health promoters from the Ministry of Health in collaboration with some NGOs working in the area.

Joel Lekeni, a community health project officer working with the Big Life Foundation, tells us that the project was introduced in 2018, with an aim to link conservation efforts to people’s health, especially maternal health.

“The impact we have seen so far is that the health facilities supported by the Ministry of Health are not so many and most of them are situated quite far from each other. By taking the nurses to the communities to do skilled delivery and offer talks, we not only save the mothers but also the cost they would have incurred to get to the nearest health facility,” explains Joel.

“As of 2018 when we started the project, women who were embracing modern family planning methods were about 130. By 2022, we had 4,500 families who had taken up family planning,” he adds.

Boniface Wachira, a nurse at the Imbirikani Level IV Hospital, tells Healthy Nation that using people from the community as community health promoters and nurse backpackers has helped in breaking taboos.

“There was a time when family planning commodities could expire because of the myths and misconceptions. Out of these community dialogues, even the men are part of the conversation. You can get a man coming with their wife inquiring about a certain family planning method,” he explains.

“More people are also coming for antenatal clinics and that is also a plus for testing couples when they come together,” he says.

Older men are also not left out. We meet Gideon Kiberenge outside his home.

He tells us that talks on family planning were unheard of in the Maasai community. In fact, when a woman delays giving birth, it used to be a big issue. But now we know better,” he says.

The community health promoters work with older people like Saaasaa Anna, a traditional birth attendant who encourages women in the community to go for skilled delivery in hospitals.

Younger women like 24-year-old Evelyne Moses say they are glad to have been born at a time when there is positive change in terms of maternal health in their community.

The 2022 Kenya Demographic and Health Survey (KDHS) shows that the knowledge of contraceptive methods in Kajiado County for both men and women was 99 and 100 per cent, respectively. The same report shows that the county is among the top counties whose women embrace contraceptive use. About 63.0 per cent of women in Kajiado use at least one method of contraceptives to help in family planning. The data also shows that in the two year preceding 2022, Kajiado County had 85 per cent of their live births and skilled delivery happening at a health facility. All the women sampled in the KDHS survey received antenatal care from a skilled care provider.

Even as Joan’s impact will be felt by her community members, she unfortunately died a few weeks after this interview. This story honours Joan, posthumously, for the work she did for women in Kajiado County. 

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