This daunting yet fulfilling responsibility defines the daily lives of mentor mothers at Mtwapa Subcounty Hospital in Kilifi county and other health facilities across Kenya.
Through innovative programmes, dedicated healthcare workers and community collaboration, the hospital has achieved monumental success in reducing HIV cases among infants.
At the heart of the hospital's success in reducing mother-to-child transmission of HIV is the role of mentor mothers, women living with HIV who guide pregnant women and mothers through the journey of prevention and treatment.
On a Thursday morning, we meet Francisca Adhiambo, affectionately known as ‘Nyako’ by her clients, attending to patients at Mtwapa Subcounty Hospital.
Adhiambo, a mentor mother, says her role begins on the first day an expectant mother visits the hospital and continues even after the baby is born.
"It is my responsibility to ensure the child is HIV-free and that the mother is also well cared for,” she said.
She said that after the nine months of pregnancy period, the journey does not stop; she has the responsibility of ensuring that the infant is well taken care of until the time the baby is confirmed to be negative.
Her day begins at 8am, welcoming expectant women and breastfeeding mothers to the hospital. She starts with a health talk, providing vital information on how to care of themselves and their children.
“As a mentor mother who has a life at hand to save, health talks are critical to my patients because many mothers lack the knowledge they need to manage their health and prevent transmission to their children,” she said.
In addition to counselling, mentor mothers like Adhiambo ensure women are screened, educated about family planning and referred for antiretroviral treatment (ART) as needed.
They also promote HIV prevention strategies, such as the use of Pre-Exposure Prophylaxis (PrEP) for discordant couples.
MILESTONES ACHIEVED
In 2020, when the country was hit by Covid-19, the hospital recorded seven infants born with HIV. However, the numbers dropped to one in 2021 and zero cases in 2022.
In 2023, they recorded one case but according to Hellen Tunje, a nursing officer and maternal and child health (MCH) in charge, the case was a seroconversion.
“The mother of this one baby who turned positive in 2023 was negative. She attended a clinic at our facility where we did the HIV testing but found negative results throughout her pregnancy journey,” Tunje said.
“But after delivery, we did not do the testing because we did not have HIV kits at that time. The little one became our baby at one year when the mother requested to do a test due to a work trip.”
At that time, she said, “We started putting more emphasis on Prep so to ensure seroconversion will not happen.”
From seven cases to one, this is a great achievement. Currently, the facility has up to 230 mothers getting services at the facility, and this includes those starting Antenatal Clinic when they are pregnant and infected with HIV, those who turn to be HIV positive during their antenatal clinic, and those who turn positive during breastfeeding and any other time.
“We manage them and feel happy when they are doing well because we monitor their viral load and do health education on nutrition, their health and rule out diseases like the non-communicable diseases — diabetes, hypertension and STIs,” she said.
This is thanks to the many organisations partnering with the facility to support the women. They include USAid under their Stawisha Programme and the Kenya Medical Research Institute.
“USAid has really been of great help to our facility, especially when it comes to drug supply,” Tunje said.
“They also support us with testing kits, which have helped us test the children and their mothers.”
Before, Tunje said that they did not have health talks as a facility but through the support of Stawisha programme, they are able to give patients information, especially the discordant couples who get educated on the importance of PrEP.
In the past, she said, children used to breastfeed for three months. This was adjusted to six months then one year but today, children can breastfeed for two years and as long as there is NVP, a mother is likely to get a negative baby.
CHALLENGES FACED
Despite the remarkable progress and milestones achieved, the hospital has also faced challenges in achieving their goal of protecting children.
These include stockouts of testing kits, lack of viral load monitoring equipment and staff shortages, which occasionally hinder their efforts.
They sometimes run out of vital supplies, such as HIV test kits or nevirapine syrup for infants.
“It’s heartbreaking when we can’t provide the services mothers and children need,” Tunje said.
“I always feel bad when a mother comes for testing and you tell her that there are no testing kits.”
Sometimes they are unable to carry out the viral load and the Polymerase Chain Reaction (PCR) test, whereby they investigate to find out if the baby has been infected due to stockouts.
“This really affects us because you go home with a disturbed mind and feeling like something needs to be done,” the nursing officer said.
Workload is also an issue because there are more clients but few health providers.
The system of having mentor mothers in all health facilities across the country has helped because they communicate to each other, making it easy to get defaulters.
Having worked as a mentor mother for many years, Adhiambo said it has its ups and downs.
“Walking through the journey with an expectant mother and at the end she gets a negative child is one of my proudest moments,” she said.
On the flip side, it hurts her the most when the outcome is the opposite.
“It is so devastating to see a child test positive. So many questions run through your mind on where you went wrong or where the mother made a mistake,” she said.
As treatment buddies, the mentor mothers have the capacity to administer treatment services to their patients at home. This has helped them create a good rapport with the community and have an easy time when tracing a straying patient.
The most worrying moment is when a mother has not done disclosed their status to their partner.
“Disclosure is a delicate issue. We can only guide mothers and help them understand the importance of disclosure, but we cannot force them to do it,” she said.
“This is a challenge because lack of disclosure can lead to high viral loads and put the partner at risk.”
She said they have inter-communication with other facilities, a programme that has helped them trace their patients who relocate without their knowledge. They also work with private hospitals because their aim is to build a negative community.
INNOVATIONS AND INTERVENTIONS
The hospital’s success in reducing HIV transmission rates has been supported by innovative solutions.
These include the introduction of electronic medical records (EMR), which help in tracking patients more effectively, preventing missed appointments and enabling better follow-up.
Tunje, who also coordinates Prevention of
Mother-To-Child Transmission (PMTCT) and PrEP services, said that the seven
cases were like an eye opener to them because they started working as a team
and brainstorming on how they can protect both the mother and the child.
“Initially, we did not have phones to call patients prior to their clinics and to default trace,” she said.
“But with the help of the Stawisha programme, we have phones that are used for contact tracing, and mentor mothers who frequently do supervision visits and support the patients and their children. These have helped us identify and address our challenges.”
Tunje called on partners and the government to support the facility with staffing by hiring more people and ensuring that there are enough kits and equipment to support their work.
“The big issue has been on the testing and tracking kits, the viral tubes and the pipette because that is the way to monitor, and our main fear is the transmission of viruses to the baby,” she said.
She loves it when a mother leaves the facility happy and satisfied with the services.
“Sometimes I get young mothers, so walking through the journey with them and ensuring they give birth to a negative child due to my help and education gives me joy,” she said.
The hospital’s medical superintendent Samia Mabruk said that at the PMTCT clinic, there is a specific day set for each client, a move which has really helped in providing quality services.
Through their partnership with USAid, the facility has been able to reach out to more clients in terms of mobilisation and defaulter tracing.
“Since I started working at this facility in 2019, we have seen a lot of improvement and big milestones in terms of PMTCT services,” Mabruk said.
“This is due to the great support we get from USAid in all aspects. We have additional nurses and mentor mothers who are also supported by the organisation, and this has helped a lot in terms of improving access to the quality of services that we give.”
She said there is a gap in private hospitals in terms of capacity building, which has made them record seroconversion cases from the clients coming from private hospitals to their facility for delivery.
“These clients end up in our facility and hence these babies that seroconverse, they become our babies, they become our data,” Mabruk said.
She called for sensitisation and training of healthcare workers in the private facilities.
“As much as I want to be generous and share the support because we are all one, we are all here and our purpose is to serve the community of Kilifi at large,” she said.
Reaching out to the private sector and training them will be a huge milestone, she said.
“We need to capacity build them and ensure that they are giving the same quality service that we are also offering in our facility.”
As Adhiambo puts it, “Being a mentor mother is not just a job, it is a calling. “Every healthy baby reminds me why I do this. We are building a future free from HIV, one baby at a time.”
