28-year-old Olive Mujawamariya first felt mildly sick five days ago. The expectant mother of one says that at first, she felt some general body weakness but brushed it off as part of pregnancy fatigue. However, with time, her joints started aching and in 24 hours, she was having chills and mild fever in the evening. Upon diagnosis, Mujawamariya was found Covid-19 positive. The unexpected news sent the heavily pregnant mother into a sudden panic. “The first thing that came to mind was that I was going to lose my unborn baby. I went into a panic. I started crying and calling everyone I know,” she says. In its clinical management guidelines, the Rwanda Biomedical Centre (RBC) says that there is no evidence that pregnant women are more likely to get seriously ill from coronavirus. However, they are considered vulnerable and a keener eye is kept on them on a regular basis. Although Mujawamariya was looked at by the doctors and sent home, like all the other patients who have mild to no symptoms, she is being followed up at home by community health workers. The Rwanda Community Health Workers’ Program was established in 1995 to increase uptake of essential maternal and child clinical services through education of pregnant women, promotion of healthy behaviours, and follow-up and linkages to health services. 48 year old Jeanne Umuhoza, who has been a community health worker in Kicukiro district’s Rubirizi cell, Kanombe Sector for the past three years says that upon receiving a positive diagnosis, the first step is to offer counselling. “Most people worry a lot but for pregnant women, it is worse. They suddenly start thinking that they are going to die but our job is to give them counselling and to ensure that the mother stays focused on keeping herself and the baby strong,” she said. In the following days, Umuhoza says that the community health worker is obliged to check on the patient more times than they do for other Covid-19 patients to ensure that both mother and child are safe. “We take the mother’s temperature every day and monitor her closely. Should a serious symptom arise, we immediately call an ambulance to take her to hospital for more expert attention, she said. Mental health support Jerome Nkusi Niyonsaba has been a community health worker based in Kibagabaga Cell, Kimironko Sector for the last two years. He says that with the increase in the number of Covid-19 infections, pregnant mothers are dealing with anxiety in addition to the pressures that come with pregnancy. He said that he spends many of these communal rounds providing hope and information in equal measure. “Everyone is worried about the Covid-19 Delta variant but for pregnant women, it is worse. I spend most of the time calming their anxieties down and also reminding them that should they contract the virus, they will still be taken care of until they have their babies,” he said. The RBC Maternal, Child and Community Health Division Manager, Dr. Felix Sayinzoga told The New Times in a telephone interview that community health workers have training that allows them to tell when an expectant woman is at risk and when to seek help. “They already know what to look out for and the instructions are specific. Some they can manage, others are considered red flags and must immediately be reported to the nearest hospital where the expectant mother is quickly taken for further support,” he said. Sayinzoga agrees that counselling is a big part of the community health worker’s responsibility since the expectant mother’s mental stability plays a big role in whatever comes next. “Many lose hope when they test positive. It is important that they are counselled so that they take the precautions going forward more seriously. Actually, we are now even counselling those who are not infected to know what to expect in case they get infected,” he said. He reminded that a pregnant woman with Covid-19 cannot pass the virus to the foetus or to a baby through breastfeeding. Dr Kenneth Ruzindana, a consultant at University Teaching Hospital Kigali (CHUK), told this publication that although most infected pregnant mothers recover without undergoing hospitalisation, rapid clinical deterioration can occur. “Obviously symptomatic pregnant patients are at increased risk of death compared to symptomatic non-pregnant females of reproductive age. However, a big number (over 90 per cent) of the infected ones can recover without giving birth prematurely,” he said. A total of 58,467 community health workers are currently operating all over the country where they provide the first line of health service delivery. 60 per cent of these are women. There are four in each village: a male-female pair providing basic care and integrated community case management of childhood illness, and another two in charge of maternal health.
