What do you do when you’re a young health prevention champion speaking to rural communities during a cholera epidemic on safety measures and the beaming woman of the house hands you a glass of water from her well, similar to one you had just inspected and found of questionable security?

“We were told not to reject it,” 27-year-old Grace Hyeladi Durkwa says, with huge laughter. Diversion is the trick. “We get them talking and after studying their environment, we just bid goodbye and go, as if we forgot to drink the water!”

When she says questionable security, she means cows and other animals lingering near the water supply, flies around kitchen utensils or faeces found outside near the kitchen or house entrance.

Durkwa, who lives in Adamawa State in North-East Nigeria, volunteered for training as a health champion during the cholera epidemic in 2018, partly because she was idle. But she was also a just-graduated-mass-communication specialist not yet employed in communicating and this seemed unique. “I love communications, and you’re speaking in a language they understand,” she recalls a year later. “And there’s a joy in letting them know how to prevent themselves and their children from getting sick. It was joyful!”

In 2018, multiple cholera outbreaks occurred in the north-eastern states of Adamawa, Borno and Yobe, affecting nearly 11 000 people, including 175 deaths, across 28 Local Government Areas (LGA).

Durkwa and around a hundred other young women in her state were trained specifically on the nature of cholera and how to prevent it. Over nearly a three-week period, she travelled about two hours each day to Mubi North LGA and back to Mubi town where she lives. In Mubi North, she and her group of about nine other young women travelled another hour to villages known to be at risk and where most women are illiterate. Typically walking or bicycling in due to the lack of a road, they reached out to them house by house.

The World Health Organization (WHO) trained and engaged more than 500 “community health champions” between May 2018 and February 2019 as part of its emergency response to the cholera outbreak, of which 454 were women. 

Working in teams for a few weeks as volunteers, the women fanned out in Adamawa and Borno states to reach into some of the dustiest and remotest corners of North-East Nigeria to forge new paths to the doors of households at risk of many diseases. In some of the communities, the purdah system that secludes women is practised, making it difficult to educate them on health issues of relevance to them and their children.

The few such women in purdah whom she met, known as matan kul’le to Durkwa, seemed welcoming of the flip charts and posters that reminded them to keep their sick children away from where they wash and cook the family meals. “They opened up, especially when we talked about keeping the environment clean,” she says.

Female health champions are not only helping to break down the barriers of female seclusion, they are providing important information about immunization and other health-related interventions available at the health facilities during their interactions with caregivers in each household.

“It is much easier for a female health worker than a man to come to your home for a house-to-house vaccination or to sensitize you on a disease outbreak. Women are also generally more trusted with handling children than men,” says Dr Christopher Ugboko, Director of the Gender Adolescent School Health and Elderly Care Division within the Federal Ministry of Health.

Training only women to reach out to communities Durkwa believes has been a successful strategy: “People really responded to our lectures, and we were welcomed. We talked about awareness. We gave them tablets to purify the water. We gave them other options.”

In Borno State, 138 of the 150 trained community health champions were recent female public health graduates also targeting internally displaced persons in temporary camps. 

“We believe that through these gender-sensitive interventions, we can ensure a balance and accuracy in the collection of data, investigation of cases and dispensation of health services,” says Dr Clement Peter, WHO Officer in Charge. 

Durkwa says the learning wasn’t only one way. In reaching out to other women with valuable information, she realized, “When I sanitize my environment, I’m not doing it for my own good but for the benefit of people around me. If something happens to me, it can affect other people.”