I Will Cross The Waters For You: The Weight on Emmanuel Malama, Zambia’s Community Health Worker

In this parts its to understand that for many families, the first line of care is also the thinnest line between life and death.

When you stand on the small hill, you will see it. The wetland in Chilubi, Zambia, wears its green reeds and clear water so well, almost like an earth beauty at a nature-fashion parade. It’s stunning to look at.

But that water rises almost to the thighs. It’s a swamp. And Emmanuel,a walking stick in hand, searches for ground that isn’t there. He pushes the stick forward. It sinks. He pulls. The mud grips back. His foot gets stuck, then smacks free as he levers himself out, jaw tight, breath measured. Emmanuel lives with a disability. You see, he lost a leg as a child. And still, he wades through dangerous wetlands, crosses swamps, and threads his way through thick, unstable ground to deliver health services in northern Zambia.

It is hard to imagine, until you see it. You have to see. You have to walk with Emmanuel.

Because once you do, you begin to understand the strength of the human spirit, how, despite what may seem like limitations, a person can keep showing up: for mothers, for children, for families living across the swamp.

This is life in Chilubi District, in northern Zambia, where water shapes everything. Villages lie far apart, cut off by wetlands and rivers. People wade across long stretches of swamp. Some push bicycles through water. Others climb into small canoes when the channels deepen. Movement is slow. And when sickness comes, that distance becomes dangerous.

Emmanuel, trained by Amref Health Africa, is a Community Health Assistant at Kasansa Rural Health Post in Chilubi, where he supervises Community Change Agents who support with information awareness on Malaria and other diseases. His work takes him from household to household, helping families make healthier choices. He encourages people to sleep under mosquito nets, use safe water, improve sanitation, seek treatment early, and ensure pregnant women book antenatal care in time and take preventive treatment for malaria. He also helps treat minor illnesses, supports disease surveillance, and compiles reports at the health facility.

In other places, these tasks might sound routine. In Chilubi, they are anything but.

The district is split between the island, the swamp and the mainland. Water determines everything: who can reach a clinic, who can collect medicines, who can survive a referral. Emmanuel explains that commodities are often left on the mainland, and for health workers like him, getting to them means crossing water, navigating broken routes, and spending energy they scarcely have. 

Referrals are worse. A pregnant woman in labour. A child with severe anaemia from critical Malaria. A patient who needs urgent higher-level care. “At times, maybe the pregnant mother might die in the process,” he says, “because of the bad road network.” 

Access here is not simply about whether care exists. It is about whether it can be reached in time.

And for Emmanuel, that burden is heavier still. When he was a baby, after a severe infection, his leg was amputated to save his life. He grew up carrying that loss, then outliving it. He walked to school with a stick. He endured poverty. He kept going. He trained as a Community Health Assistant, graduated with distinction, and returned to serve communities that many would consider too hard to reach. 

So when Emmanuel crosses the swamp, this is not a spectacle. It is a duty. 

Sometimes that day starts before sunrise. Sometimes, he says, “you wake up around 04:00, you start walking in the waters, lifting up the bicycles in the waters… reaching maybe a 20-kilometre area,” only later finding dry ground where cycling can begin again. The journey is rarely one thing. It is the bicycle, then water, then canoe, then a bicycle again. It is effort layered upon effort, just to reach supplies, a health facility, a meeting, a patient. 

And yet this is not a story about hardship for hardship’s sake. It is a story about what that hardship is in the service of.

Because Emmanuel is not walking through the swamp merely to endure it. He is walking so that families in the remotest parts of Chilubi are not abandoned to distance, misinformation, or delay. “The thing that motivates me is when I see people changing their (social) behaviour.” He sees mothers coming earlier for antenatal care. He sees pregnant women taking anti-malaria medicines. He sees children being brought to the facility quickly. He sees families using mosquito nets for their intended purpose. He sees people protecting themselves, and seeking help sooner. And in that change, he says, he knows he is “doing the right thing.” 

That is the quiet genius of primary health care. It does not begin with hospitals. It begins in the small but life-saving act of showing up early enough to stop a disease from becoming an emergency.

Emmanuel has seen what happens when care arrives too late.

He remembers a woman who brought in a child with severe malaria from a fishing camp. The child needed urgent referral for a blood transfusion. The family worried about the journey ahead. They tried to go, but “they couldn’t make it until that child died along the way.” Emmanuel says it broke his heart, especially because the child was the only child in that family. Tragic.

But grief is not the whole story.

There is change, too. More people are seeking treatment quickly because of the information shared, especially on Malaria, which is endemic in the district. Cases that once felt constant have begun to fall. Where they might once see around 20 malaria cases in a week, he says, now it may be 10, or even 4 or 5. 

That matters, and perhaps that is what stays with you most after walking with Emmanuel in the swamps. It matters because workers like Emmanuel are not standing at the margins of the health system; in places like Chilubi, they are the system’s living edge.

They are the ones who carry health information where roads do not reach. They are the ones who make sure a fever is noticed before it becomes severe malaria. They are the ones who persuade a mother to seek care in the first trimester, monitor illness, treat what can be treated, and refer what must be referred. They are the bridge between household and health post, between the community and the formal system, between danger and survival. 

And Emmanuel understands something even larger: dignity in health care means that people in remote places should not receive less simply because they are hard to reach. As he puts it, people in places like his “are not left behind.” They, too, deserve knowledge. They, too, deserve protection. They, too, deserve the same chance at health as anyone in an urban centre. It almost feels like a pledge when he says it.

That is why community health workers like Emmanuel remain crucial to primary health care. Because primary health care is not an idea. It is someone who will cross the swamp with a walking stick and a bicycle on his shoulder. Someone who understands that for many families, the first line of care is also the thinnest line between life and death.

I mean, you can talk about resilience in broad, easy language. You can admire it from afar. But in Chilubi, Zambia, resilience has a body. It has a name. It moves through water.

It is Emmanuel.

Story by Wesley Kipng’enoh Koskei, Fundraising Content Manager