Visits to the vulnerable

I was one of five Regional Coordinators, along with Ken Patterson, who had the privilege to travel to Kenya and witness the effects RESULTS advocacy has had on people living in extreme poverty. The rest of the RCs: Peter Fiekowsky from Northern California; Catherine Lyons-Spear from Ashville, NC; Heide Craig from Greenville, SC; and Carol Huston from NYC. Our home during our stay in Kenya was Multi Media University (MMU) on the outskirts of Nairobi. The purpose of our trip: to see and hear firsthand from the Kenyans themselves, the end result of our advocacy on global poverty reduction.

MMU

Friday, February 12th was site visit day. The six of us from RESULTS were joined with representatives from KANCO (Kenya AIDS NGOs Consortium.) A key partner in Kenya for us, KANCO provided us access to the beneficiaries of life saving medicines and support. KANCO’s other partners include Action Now Kenya, The Global Fund to Fight AIDS, TB and Malaria; United Nations Development Programme, The Center for Disease Control & Prevention, The International AIDS Alliance and many others.

We traveled in a nine passenger 4 wheel drive van, along with Jack Ndegwa from KANCO, leaving MMU at morning commute time.  The road infrastructure around Nairobi is overburdened with private cars, taxis, trucks, aggressive ”matatus,” which are heavy duty buses jamb-packed with people, and garishly painted with pop culture references. The two lane roads are impossibly crowded with commuters heading into the central business district of Nairobi. Fortunately, we were traveling into the countryside away from Nairobi and against the endless line of vehicles headed toward us.

This is a 2 lane road

After a couple of hours on the road, our first stop was the compound of Apostles of Jesus AIDS Ministry (AJAM). The Executive Director of AJAM, Fr. Firminus Shirima, is also the Chairman of the Board of KANCO.  We learned from him that AJAM has become the main force for delivering services to the poor in the Ngong Hills area. AJAM gets its funding through Catholic Relief Services, USAID, and KANCO-facilitated Global Fund monies. Father Firminus  told us about their mission of protecting vulnerable children and women in a holistic way.  They raise HIV awareness in schools and social organizations, provide vocational skills training targeted to youth who’ve dropped out of school or never attended school due to poverty. They provide counseling to sick and affected families and supply free medicines, nutritious food aid and some cash. AJAM also runs a small orphanage for HIV orphans and other vulnerable children to eventually re-integrate them into society.

USAID poster on bed nets

Cathy with AJAM orphans

Next we traveled to a community center where Action Now Kenya director, Irene Kamura, was leading advocacy training with local activists. She was following the RESULTS model and conducting an E&A with 24 Kenyans. The similarities with the Kenyan participants and US RESULTS counterparts were striking. The action to be taken in the meeting: letter writing to Members of Parliament to initiate a pledge of $2 million to The Global Fund replenishment. Kenya has been a recipient of The Global Fund, but now the Kenyan government is being asked to contribute to the fund to help other African countries. Additionally they are asking the National Assembly to increase domestic funding on HIV/AIDS. The lesson included tips such as pointing out to the MP that the current budget for all healthcare is only 4.8%, and needs to be adjusted upwards to 15% to meet current needs. Each of us RCs present got the opportunity to speak to the group about our experiences as lobbyists to our government over the same issues. We emphasized to our audience that persistence is key to getting breakthroughs with elected officials. Several of the Kenyan advocates talked to us afterward and during lunch, excited about the connection they were making with their elected officials, and that we had faced the same issues  they had.

Irene Kamura conducting an E&A

Lunch with the activists

 For the rest of the afternoon, we divided into small teams for home, clinic and hospital visits to meet some of the beneficiaries of our poverty advocacy. KANCO representatives and community health volunteers joined us. The three teams departed in different directions in three vehicles. My team, which had the 4 wheel drive van, consisted of Heidi Craig, Jack Ndegwa, me and Anne Sila of Action Now Kenya.

 

Evelyn, John, Anne and Heide

My team drove into the Ngong Hills southwest of Nairobi where Maasai culture is more prevalent. We met our community health volunteer, Evelyn, near our first stop. She is married to a Maasai man, which gave us access to the people she serves. Our first visit stop involved parking the van on the side of the road and walking a few hundred meters on a path through the pasturelands to a very small farm on a hillside. There we met Peninah, a six-year-old girl and her caregiver. The little girl has a deformed leg, which prevents her from going to school. It was our first encounter with the extremely paternalistic Maasai culture. Women and children must not directly address a man or look directly at them. Typically the child will bow her head in front of you and wait until you acknowledge her by placing a hand on her head. As the little girl presented the top of her head to us, I found it endearing to lay my hand on her braided hair. The small concrete farmhouse is surrounded by mud so we removed our shoes as we went inside. Peninah’s caregiver, her aunt, said that ordinarily the child is talkative and laughs easily, but we heard barely a peep out of her while we were there. The community health volunteer visits once a week and provides valuable counseling to try to provide a path for Peninah to get into school. Currently she is kept indoors and away from other children because of the paternal shame of her condition. The volunteers from KANCO and AJAM are giving her a chance to integrate into society by providing school materials and counseling to her parents.

Jack negotiating mud on the path

Peninah's sister, Heide, Peninah, Evelyn and John

Peninah

Walking back to the van we were struck by the beauty of the surroundings. Recent heavy rains provided rich fodder for the goats and cows, and a hatch of hundreds of butterflies, which emerged as we walked along the path. This area is the setting for the novel, “Out of Africa”. Later the movie of the same name was filmed near here in 1985.

Approaching the van on the side of the road

 Back in the van, we drove a short distance to meet another community health volunteer, Lillian. Both she and the other volunteer were dressed in traditional Maasai clothing and jewelry. Lillian directed us to another beneficiary who is on regular ARV therapy for HIV. We walked down a steep hillside to a compound of bunker-like buildings with dozens of children and adults living there. Lillian’s client is the oldest of 4 children whose parents have died from HIV/AIDS. They live in a windowless concrete enclave with a metal door.  The only illumination inside came from the open door. It was a pretty depressing place.  As we went inside, the client seemed a little uncomfortable with us being there. Typically a community health volunteer comes alone and finds out what she needs help with and provides one-on-one conversation. We didn’t stay long; the conversation was rather brief - I don’t think she felt well. Anne Sila and Jack Ndegwa acted as translators from Swahili to English. As we left, Jack remarked to me, “At least she has a concrete floor to keep her children dry.”

Our next stop was a short drive and walk from the road to another beneficiary, Laura and her six-year-old daughter Valentine. Though the house was a one room corrugated tin structure with a dirt floor, it had cracked windows that let in light.  Both she and her daughter are living with HIV, but it seems a happy place. There was a well-tended garden outside and colorful posters on the walls inside.  The client, Laura, seemed positively radiant. In 2010 she been admitted to a hospital with TB and had given birth to Valentine about the same time. It turned out that both of them were infected with HIV/AIDS. It must’ve been very difficult for her through months of recovery as she endured wasting of her lean body mass, and was unable to get out of bed. After months of treatment she recovered fully.  The CHV home visits ensured that she and her infant daughter received adequate nutrition. Today with all of her strength back, she is able to cut firewood and carry it for cooking and to tend to her corn and vegetable garden. She feels blessed and glad to be alive.

Laura at home with Lillian

Laura, Lillian, Valentine and Evelyn

Hiede, Valentine, John and Laura

ARVs and TB DOTS schedule

 Our last visit was to a displaced Maasai family two or three km off of the road. Normally the community health volunteer has to walk this extremely hilly distance on a track that is barely passable using a motorbike.  Riding in the van seemed like we were navigating a streambed rather than a road. We passed by a primary school whose children seem excited to see a van driving on their ‘road’. At the end of the track we got out and walked through cornfields to a small hut where a family of five live. This was our first chance to interact with the male head of a household. The family had been living in the distant Maasai lands, which because of their remoteness, was difficult for health workers to get to on a regular basis. Since they were not able to function in a normal Maasai culture due to HIV/AIDS, the KANCO network enabled them to move to a temporary location.  Essentially squatting in a corn field, they now have access to regular supplies of ARVs.

Anne, Heide, 12 yr old boy, 7 yr old girl, 45 yr old father, John and Mother & wife

School children at last visit with Anne, John and Heide

The lack of transportation infrastructure impressed on me how precarious their situation is. As we learned about their one year transition to health, Jack was asked by the mother if we could take the two girls and her into town. The youngest girl who had remained in the hut, had pneumonia and needed to be seen at a clinic. We agreed and packed the three extra passengers into the van. We could tell that the little sick girl was unwell, but other than coughing, she made no noise as she lay on her mother’s lap.  The ride into town took 20 minutes. Later I asked, “How would she have gotten the sick girl to the clinic if we hadn’t happen to come? “ The answer: she probably would’ve been carried by her mother to the road, then hired a motorbike to take them in.  It was doubtful that she would’ve been able to pay for it, however. As we dropped them off in the village of Kiserian, Jack slipped the mother some cash for the return trip.

Mother with sick child

Now minus two community health volunteers who lived in that town, and the mother and her two children; our van drove through the slums on the outskirts of Nairobi to meet up with the rest of our teams. Peter and Carol had visited a hospital to visit beneficiaries suffering from HIV/AIDS. Cathy and Ken had spent time at local clinics visiting other beneficiaries and in apartments in the slums of Ongata Rongai, south of Nairobi. They had a very intense experience of people living in extreme poverty.

Cathy with her KANCO friend at end of visit

 Now reunited with the rest of the RCs, we returned to MMU at dusk as we passed the miles of backed-up traffic heading home on their evening commute.