Yesterday’s terrible news that at least 75 people died when a pipeline caught fire in a Nairobi slum, has had me thinking about Kenya again and the poverty that the majority of the people there live in.
When I was in Kenya earlier this year, after much perseverance at the primary school, I was allowed to spend some time at the nearest rural health dispensary, which was nearly a 2 hour walk away in a village called Olosho-Oibor (you could get a piki piki (motorbike taxi) but you had to wait hours for one and pay double because no-one wanted to ride out so far from Ngong (the nearest main town). Here’s a map (click through for an interactive version):
Running the dispensary while I was there was a nurse called Rhoda. She normally shares the running of the dispensary with another nurse, but he had taken a few days off to plant maize (as had nearly everyone else, as the rainy season had just started). When the rains start, it’s quite common just to call up work the same morning and say you’re not coming in. Everyone relies on crops here and you can’t predict the weather, or annual leave to accommodate. Somehow they seem to manage!
Rhoda is from just outside Nairobi, and studied there too, but the state requires qualified professionals – nurses, teachers and so on, to work for them for three years post qualification before you can get a job of your choice with them, as healthcare & education are funded by the state. Staff are posted where there is the greatest need in the (usually rural) community for 3 years, but generally they don’t get even a first or second choice as to location, regardless of whether they have family or children to support (which is common – it costs a lot to train professionally in Kenya and people are often older when they qualify as they’ve had to save to pay for their training).
Kids and spouses can of course go with them but in rural communities there may not be schooling facilities for the kids, and it’s unlikely there will be jobs for a partner. This leads to a lot of professional families living apart while they follow their careers, like Samson from Kimuka Primary school. Parents often only see their young families only once or twice a month, or less if the distance is greater or you simply don’t have the money to travel. I do wonder if this discourages Kenyans from either training as professionals, or from staying in the country once trained – I certainly came across reports that professionals preferred to take their skills abroad where things were “better organised” – a great shame as there’s a lot of talent in Kenya, it just needs nurturing properly.
Despite being stuck in the middle of nowhere, Rhoda was great company and very happy to answer my questions and show me round. I felt bad I couldn’t speak Maasai, or even Swahili well enough to help her out with her patients more. But I was able to help by organising the donated medication in the dispensary (most of which wasn’t really relevant for the setting, and didn’t come with useful identification) and giving out (plentiful, state-provided) medicines to patients, most of whom could understand enough English to know how many to take how many times a day. Lucy, the healthcare assistant who worked with Rhoda, helped me out with language if I got funny looks from patients!
This particular dispensary was funded and built by a large NGO (possibly the UN, although I wasn’t 100% clear). As a result the facilities were pretty impressive compared to where I’d been living in Kimuka. It was built from brick, was clean and freshly painted, had sinks in all the treatment rooms, and flushing toilets. There was a flat provided too, of similar specifications, so that staff like Rhoda who were sent there by the government, could live in satisfactory conditions. There was a small windfarm (well, one windmill) which powered the majority of the dispensary’s requirements, including TV in Rhoda’s flat for a few hours a day, quite a luxury which I’d forgotten I’d not seen for so long!
Rhoda took me on a tour of the facility, which wasn’t quite finished. There was a dispensary room where were were based, a consultation room and a vaccination/treatment room, where we gave babies’ vaccinations and inject women with the depot contraceptive. There is a soon-to-be completed maternity ward with flushing loo, and a healthcare library with internet access and public health education materials that the community health workers use with villagers. Patients can access these facilities too. The waiting area is outside, and it’s a friendly, informal place, although it wasn’t as busy as it can be in the dry season as people don’t like to be rained on on their way to the clinic.
Most people are able to be treated at the clinic, and given medication to take away, or Rhoda will administer injections, dress wounds, and so on, on site. The clinic works on a walk-in basis for general conditions, but there are special mother & baby sessions on Thursdays where antenatal, postnatal & family planning healthcare is given one on one, and education groups are run. It’s a safe place where women can come for advice, and the uptake of these advice, information and check up services seems to be good. The dispensaries are designed to be a one-stop shop for all the healthcare needs of rural communities, and the system does seem to be well thought out and comprehensive. If someone can’t be treated adequately at a dispensary, then they can be referred to one of the provincial, regional or the national hospitals for further investigations or in-patient treatment (which carries different costs). Given the poverty of the region I was concerned that there are charges at all, but exemptions seem to be applied where there is greatest need which is better than nothing.
Pregnant women, children under 5 and people being treated for HIV or malaria are exempt, otherwise there’s a blanket 50ksh (about 30p) charge per visit. It doesn’t sound a lot but it’s not uncommon for people not to have the money – fortunately Rhoda knows most of them and in a real emergency she will let someone pay later – either way it’s much cheaper (and quicker) than travelling to Ngong and going to one of the private pharmacies. More on what sorts of patients the dispensary looks after in the next post…