It is a warm afternoon at two o’clock, and the benches of the Kokwanyo Dispensary are still full of patients. Some sit; others lie down on the hard wooden benches. All are waiting to see Richard, the one licensed health worker in Kokwanyo village.

The crowded scene is the norm. The dispensary serves a population of about 10,000 people in the Kaspul Kabondo subcounty in Homa Bay County.

“I usually see about 100 patients a day,” says Richard Kiplagat Rutto, the enrolled community health nurse who has worked at the facility for three years. “There are many with common ailments, pregnant women, and some collecting their antiretroviral drugs.”

Richard mans the dispensary nonstop five days a week. And when he’s not working, he is on call. On some nights, he attends to as many as four women in labor. In fact, he helped deliver 64 babies in a five month period. In the same period, 319 mothers came to the facility for antenatal care.

And they all see Richard.

“I usually see about 100 patients a day,” says Richard Kiplagat Rutto, the enrolled community health nurse who has worked at the facility for three years.

Due to the shortage of health workers in Kenya, Richard has mastered multitasking. He handles all the departments at the health center. His duties include patient support care, antenatal care, laboratory work, clerking, dispensing prescriptions including antiretroviral drugs (ARVs), HIV testing, family planning counseling, and so on.

“Sometimes I receive patients at the examination room, then walk with them through the entire process from diagnosis to the pharmacy where they get their prescriptions,” he says.Homa Bay County has the highest HIV prevalence in Kenya (25.7% compared to the 6% national average), and from his vast experience working in the area, Richard has learned a lot about the dynamics contributing to the epidemic.

For example, he speaks of a little-known high-risk population: the local boda boda riders (or motorcycle taxi drivers).

“Most of these riders are under the age of 30, and many are engaging in reckless sexual behaviors like competing with each other to have the most sexual partners,” says Richard.

But it’s not just young people at risk. He has also noticed older men getting infected, especially those who are polygamous. And stigma remains a strong barrier to people getting tested and treated.

The 2014 Ministry of Health’s HIV Estimates Report put the number of new HIV infections in Homa Bay County at 12,940. That means the county had more new infections in 2014 than ever before.

Most clients prefer to go to facilities or health centers where no one knows them.

At the Kokwanyo Dispensary, Richard often does the counseling and testing, and even connects clients newly diagnosed with HIV to support groups. Between March and July 2015, the facility tested 1,376 clients; 54 tested positive and went into treatment. Richard provides a total of 495 HIV-positive clients with ARVs, but he believes that number should be higher. Due to stigma, most clients prefer to go to facilities or health centers where no one knows them.

Despite his heavy workload, Richard still finds time to meet with community health workers, peer counselors, and support groups to discuss how to manage HIV stigma and help show the importance of taking ARVs to HIV-positive community members.

But Richard himself could also use more support.

“The county as well as partners are planning to post more clinical health staff to the facility, Richard says. “It will be a great relief to both the patients and myself.” Partners such as APHIAplus, Nyanza Reproductive, and Anglican Development Service provide support to the health center.

Through the USAID-funded HRH Capacity Bridge Project, IntraHealth International contracted and deployed Richard to Kokwanyo Dispensary to support HIV care and treatment. IntraHealth worked with Homa Bay county to transition contract health workers, including Richard, into permanent placement to sustain health service delivery beyond the life of the project. Across the country, 517 contract health workers have been successfully transitioned to county management on a permanent and pensionable basis.

Photo of Richard Kiplagat Rutto courtesy of Wycliffe Omanya.