Kenya: Face to face with the people you help


Anna MacSwan
Monday, 5 November, 2012
16th November

Vehicles for Turkana ladies

Merlin's pickup trucks are becoming famous in Turkana - according to local nurses, having been nicknamed as "vehicles for Turkana ladies." Since there are only two hospitals in an area of 77,000 km2 which would be able to offer a caesarean or blood transfusion if a delivery were to be complicated, Merlin has given vehicles to smaller clinics. This means that women can be referred if there are any emergencies and deliver safely - often the difference in surviving childbirth.

15th November

Goodbye scars and chest pain, James is getting a wheelchair!

For the first 17 years of his life, James lived being unable to walk, and without a wheelchair. He grew up with his mother, but when he was 15, she died. The only way for him to make a living was to beg on the streets.

James got around with elbow crutches and still has scars on his arms from using them. These would only allow him to move for about 100 metres before having to stop for a rest. His life changed when he was given a 'tricycle'- which works like a bicycle powered by arms. “I finally felt like any other person,” he says, able to go to the market or to visit a friend.

Merlin has helped James as part of a new project for disabled communities in Turkana. He has just been measured for a new wheelchair. The one he has at the moment is causing chest problems because he has to use his arms to pedal the bicycle on rough terrain. He is, however, lucky compared to some of his disabled peers. Many have no assistive devices whatsoever, and have to resort to using wheelbarrows or are entirely dependent on their families. And those in rural areas are even worse off. While everyone else can easily move around to get to their livestock or relocate if there is tribal conflict, those that cannot walk, are left behind. 

Photo by Ben Langdon

14th November

Dorkas sees midwife for first time, after five children

Today, I saw Dorkas have her first appointment with a midwife, ever - despite already having had five children. Pregnant again and suffering from stomach cramps, today she left her village at 6 am and walked for three hours to Kakimat, a neighbouring town where she had heard Merlin was conducting a mobile clinic. Like many Turkana women, Dorkas has had her children at home, with no medical help on hand. Thankfully, health education by Merlin in partnership with local NGOs is helping increase the number of women seeking skilled help during pregnancy.

Photos by Ben Langdon

13th November

Taking health care where it's needed

Nancy is a midwife and has worked with Merlin for a year. To make sure that new mothers and mothers to be are healthy, she visits every two weeks and sets up this mobile clinic in Locheredome, Turkana. Nancy is based at a clinic an hour's drive away - the closest to this village. She does everything from immunisations to checking blood pressure. Here she is giving ante and post natal care. 

Making the most of what's available, Nancy checks the baby's heartbeat in a separate hut area for some privacy!

12th November

Off to Turkana

The second leg of our trip is to the Turkana region in the northwest of Kenya. If the tiny plane which is clearly mostly filled with colleagues from other NGOs isn't enough to give you a sense of how remote the region is, it's confirmed when we touch down at the airstrip in Lodwar, after flying over what seems like endless miles of unpopulated bush and arid land. At the airstrip the waiting and check-in area is just a few benches and the majority of the town's central functions, including the hospital, are within a 10 minute walk.

This remoteness is at the core of why Turkana's health indicators are so far behind the rest of Kenya's. With only one tarmac road for an area of 77,000 km2, a visit to a clinic for most involves walking for hours in stifling heat - which last year reached proportions so high that 12 million across East Africa were left at risk of starvation. At an interview at Lodwar District Hospital, the region's biggest, a nurse tells me that today she had to wait for blood to be brought in from Eldoret (an hour's flight away) for a patient who needed a blood transfusion.

The sheer physical difficulty of getting to a clinic from Turkana's rural villages, combined with strong cultural beliefs like giving birth in hospital being seen as a sign of weakness, mean that the vast majority of births here take place at home. Yet, hours away from medical assistance, complications like ante and post partum haemarraghing and pre-eclampsia are all too common and go untreated - the result being a maternal mortality ratio of 360 (per 100,000 live births). This is thought to be much higher for Turkana. 

For the past three years Merlin has been working with local charities and funding from the European Union to encourage Turkana women to give birth with the skilled assistance which can mean the difference between life and death. This includes education for women and giving extra training to the traditional birth attendants who are the gatekeepers to many communities. Over the next week, we'll send back reports on the mothers, newborn children and midwives who we meet.

9th November

How Merlin helps HIV+ people

"There's a lot of stigma in Kisii here, and it's still possible for someone to be HIV+ and lose all their social networks and friends. Merlin tried to help individuals cope pscychologically with difficult emotional challenges," says Fred Barasa, Merlin Programme Officer for HIV care and treatment in Kisii.  

8th November

Alice's fight for her life

Today I met Alice and her one year old son Emmanuel. When she became pregnant, which is one of life’s happiest times for many women, she ended up fighting for her life not once, but twice. First, she found out that she was HIV positive. It’s hard to believe that the same woman who is smiling and determined to finish our interview in time to make it to work at the local market, had considered giving up on life and hanging herself.
She says that it was because of psychosocial support and counselling from Merlin that she realised “her life could continue,” and that ART medication makes it possible for those who are living with HIV to lead healthy lives for years.
Yet after six months, she became ill again – this time with malaria, which is particularly dangerous for pregnant women and their unborn children. This time Merlin gave her medicine, as well as new mosquito nets and a water guard to help prevent infections in the future. This is vital in a village where a day’s labour would earn 150 Kenyan shillings (KSH) – barely enough to buy food for a family – but to buy a net at a supermarket would cost 750 KSH.
Photo by Ben Langdon

7th November

Meet Maureen...what an inspiration

At the age of 25, Maureen Mbogo might be one of the most inspirational people I have ever met. She was drafted in by Merlin to work as a nurse at Iyabe District Hospital, just outside Kisii town. Her job is to look after HIV and TB patients in a new patient support unit built as part of the Chagua Maisha (Choose Life) project by Merlin, CARE and CDC (Centers for Disease Control and Prevention). Previously HIV and TB patients were treated in the main wing of the hospital which meant long queues, little privacy and most crucially very little time for the counselling which is such a crucial part of successful treatment for HIV.

A typical day for Maureen involves anything from prescribing ART (antiretroviral) medication, providing DOTS (directly observed treatment) for TB to counselling before and after testing for HIV and TB. She sees on average about 15 patients a day. The training and mentorship which she has been given by Merlin has been vital - this includes training on how to provide ART treatment, counselling and preventing mother to child transmission, and regular meetings with a mentor to help her deal with difficult cases. She says that before coming to Kisii she knew nothing about HIV but now she would be able to talk about treatment and counselling in her sleep.

Despite witnessing heartbreaking stories all too often - parents having to tell their children they have been exposed to HIV, couples despondent on being diagnosed and immediately separating, expectant mothers finding out that they might pass HIV on to their children - she says that her patients keep her going. “There are many challenges, but seeing a patient who was depressed come back after a few months or an HIV positive mother with a healthy child is very encouraging.”

Photo by Ben Langdon

6th November 

Healthy and happy

We spent today with a lovely family in Kisii who have been receiving support in prevention of mother to child transmission of HIV from Merlin. Both Elizabeth and her husband Charles are HIV positive, but because they have been on ART medication, their three children were born healthy. Simple but life saving...

Photo by Ben Langdon

5th November

One year on...

I’m coming back to Kenya after a year. A year ago I shared my experience of working with the people of Turkana. It's a very remote area in western Kenya where people desperately need health care.

People often ask why Kenya needs aid – perhaps famous in the UK mostly as a holiday destination for beaches and safaris.  The green hills of Kisii where most make a modest living on subsistence agriculture feel a world away from Nairobi’s airport where I’m told new terminal is being built to accommodate increased demand to do business in east Africa’s largest economy. Further north in Turkana live communities who are entirely dependent on the rains and a dry season will almost certainly lead to spikes in children needing treatment for severe malnutrition. Clearly, the need for aid is still great. 

I am travelling today to Kisii, the base for Merlin’s HIV, TB and malaria projects in Nyanza province. Although the region is often referred to as Kenya’s breadbasket - where most of the tea, coffee and other crops exported by the nation are grown, disease burden is very high. HIV prevalence is 15% - double the national average of 7%. The rains which enable most to make a living also bring with them high burden of malaria – to the extent that only a few years ago, local nurses recall queues of people sleeping outside health facilities with each rainy season.

Merlin’s work in Kisii centres around education – linking communities to the services which are already provided by the Kenyan ministry of health, but are all too often never used. We have trained around 300 community health workers in Nyanza province, who take responsibility within their local villages to educate people about the signs and symptoms of malaria, how to correctly use insecticide treated nets, etc. As a result, use of insecticide treated nets is now widespread and with it malaria prevalence has fallen considerably. Similarly, with HIV we are counselling people to know their status and take up ART treatment. It’s a great example of how a bit of willpower helps maximise and build local skills/capacity.

Since 2010, thanks to European Union funding Merlin has run a safe motherhood program in Turkana, Kenya. Located in the arid region of northern Kenya, Turkana's health indicators are the lowest in the country, with only 16% of deliveries being supervised by a skilled birth attendant. Merlin is working with the Kenyan Ministry of Health and civil society partners to train midwives and improve access to reproductive health services. We are also running education programmes to encourage pregnant women to seek antenatal care and give birth in health facilities - vital to tackling Kenya's maternal mortality ratio of 360 per 100,000 live births.

“This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of Merlin and can in no way be taken to reflect the views of the European Union.”