When it rains in Emusala village, a person sick with a fever can find it hard to get to the nearest health center, which requires a trip along the slippery footpaths that lead to the nearest main road some 10km (6 miles) away, in the heart of Western Kenya's Kakamega County.
But if the fever spells the onset of malaria, rapid diagnosis and treatment are essential.
That's where Nicholas Akhonya comes in. With the aid of a simple medical kit and his mobile phone, Akhonya, a trained community health volunteer, is able to diagnose villagers with malaria in their own homes, offer treatment, and refer acute cases and pregnant women to health facilities for specialized care.
Malaria cases are on the increase in Kenya, and experts attribute the upsurge to changes in the climate.
According to Dr. James Emisiko, coordinator for the Division of Vector Borne and Neglected Tropical Diseases in Kakamega County, mosquitoes breed particularly well in stagnant water in warm temperatures.
The females feed on human blood in order to produce eggs, and if a mosquito carrying the malaria-causing plasmodium parasite bites a person, it is likely to infect them.
Kenya's recent drought — the harshest in East Africa since 2011— followed by sporadic rainfall in the middle of this year has created a perfect breeding environment for mosquitoes, Emisiko told Thomson Reuters Foundation.
The result is an upsurge of malaria cases, especially in the Western Kenya region and around Lake Victoria.
"The only way to control deaths from this life-threatening disease is to ensure that all fever cases are tested wherever the patients are, malaria-positive cases [are] treated and all complicated cases referred to nearby health centers," the doctor said.
He said that parents in rural areas often initially give painkillers to children with fever. When families finally seek proper medical attention, it is often too late for those who have malaria to respond to simple anti-malarial drugs, and they require expensive hospitalization instead.
Calling in the Volunteers
To tackle the problem, for the past two years county governments in malaria-prone areas have worked with non-governmental organizations to train community health volunteers to diagnose the disease in patients' homes, using rapid diagnostic kits.
The volunteers then treat those who test positive, and refer complicated cases to the nearest health center.
"In case of any complication, all I need is to have power on my mobile phone so that I can communicate with medical experts using the toll-free number for further advice," said Akhonya, one of the volunteers.
The U.S.-based Centers for Disease Control and Prevention estimate that there are 6.7 million new clinical cases of malaria in Kenya each year and 4,000 deaths, most of them in Western Kenya.
According to Moses Makokha, clinical officer in charge of the Bumala-A sub-county health center in Busia County, some malaria cases can be fatal little more than 24 hours after symptoms occur, especially in children below the age of five years and pregnant women.
In pregnant women, malaria can lead to miscarriage or other serious complications, Makokha said.
"It is always an easy disease to manage - but only if it is identified at the onset of the fever and treated immediately using the correct medication," Makokha said.
Kakamega County's government has trained 4,200 community health volunteers to manage simple malaria, working with Community Asset Building and Development (CABDA), a local NGO, and with support from Amref Health Africa, an international Kenyan medical charity headquartered in Nairobi.
The volunteers are supplied with test kits and basic drugs to treat the disease at no cost to patients.
Treating malaria at the village level, among other interventions, has helped reduce the prevalence of the disease in Kakamega County from 38 percent in 2013 to 27 percent in 2016, according to County Health Executive Peninah Mukabane.
"This is one of the success stories that we are all proud of," Ephy Imbali, CABDA's executive director, told the Thomson Reuters Foundation.
Cash - and Status
Refresher questions from trainers keep the volunteers on their toes, and ongoing training helps to keep their skills sharp, said Imbali. Experts from county health departments visit frequently to monitor the program.
Each volunteer receives a monthly motivational stipend of 2,000 Kenyan shillings ($20).
"Apart from the stipend, I have learned so many things in terms of health interventions which are not just important for my immediate family but also to the community where I live," said Miriam Opechi, one community health volunteer and a mother of three children.
"I feel very happy whenever a patient gets well after my intervention. It gives me a complete satisfaction, and makes me feel a valuable member of the society, commanding a lot of respect from the villagers," she said.
According to Imbali, the program makes it possible for residents of rural areas to get access to medicines even on weekends and holidays when public health facilities are usually closed.
Emisiko, Kakamega County's health official, said the volunteers' efforts reduce crowding at local health facilities, making it easier for health providers to attend to other important ailments.
But the work of community health volunteers is not always limited to malaria.
Simon Ondeyo, who hails from Emusala, said in a telephone interview that community health volunteers had treated his children for malaria a number of times.
But Ondeyo is himself is a tuberculosis patient who had given up on an arduous treatment regimen until community health volunteers began visiting him daily to ensure that he took his drugs.
Today he feels fully recovered — though is still completing his course of treatment.
"Without the volunteers, I do not know if I would be alive today," he said.