The New Kimanjo Health Centre!

After a year of hard work, last month nurses and patients  moved into the out-patients department of the new Health Centre. Whilst work continues to finish the conversion of the old buildings into staff accommodation, landscaping, and finishing touches to the Community Health Workers Building and Youth Friendly Centre, we are proud to have finished work on a very high quality 24 bed hospital.  We are currently beginning the equipping of the In-Patient building. The facility comprises three wards, a  maternity unit,  a large operating theatre, X-ray room,  doctor’s accommodation, laboratory, out-patients wing  and reception building. This ‘cottage’ hospital would not look out of place in a small European town (well - perhaps rather more open ventilation!), and the building team have surpassed themselves in the quality of the finishes.  The roof has been designed for maximum water catchment with large holding tanks, whilst the pipeline from the newly sunk borehole should ensure the water supply during drought. 

Reception building with Out Patients to the left and services to the right

This has been a long and challenging process made possible through the belief and dedication of the donor and of an enthusiastic community. This is a government facility built on government land, made possible entirely through private funding. As such we spent almost a year working with the GOK health department, and the community, before we could begin construction.

In-Patient building

We are aware that this is only Phase One of the process: the year ahead will be  equally challenging as the government works with us to meet its  partnership commitments to post new staff  and we work on more private partnerships to train and support the new team so that we can grow into this  facility.

 

Cleaning Day in March!

A prime focus will be to drastically reduce maternal and infant mortality by having mothers access pre and post natal care, as well as increasing access to hospital deliveries.  The multiple factors of female circumcision, poor nutrition, diseases of poverty and teenage pregnancies mean that childbirth is the leading cause of death for pastoralist women – as many as 1 in 40 women will die in childbirth -  something that should not be seen by any of us as acceptable in the Twenty-First century.

 

The Pharmacy

Enormous thanks to all who have made this journey possible so far - (with the risk of sounding like an awards ceremony speech) our thanks go to: our wonderful donor, the Management and Liaison committees,  the DPHN and her team,  the DPWO, the Community Health Workers,  all the local Chiefs and community leaders, the Builders and their Sterling Crew of workers... and the Wider Community who have lent their voices of support. … and EVERYONE who has had added enthusiasm along the way.

We  now continue to work together to improve the health of the whole community. The NHP  team of CHWs  starts today their final training to make them a fully fledged  Community Health Unit. 

The future of  community healthcare begins today.

.....And a wonderful nurse!

International Women’s Day- March 8th

Women are making great progress in so many areas throughout the world but progress can sometimes be painfully slow in the rural areas of Africa.

We have just finished our survey of the schools we support- the most positive gender ratio we have currently achieved in Primary Schools is 42% girls to 58% boys in Maasai areas, falling to 35% girls in the Samburu areas, with some classes as low as 13% girls. In order not to ‘lose’ this whole generation of girls we are currently conducting a house to house survey, with the help of very active Chiefs and Community Health Workers, to see how many children are still at home (both boys and girls) and to work with families on ways to help the parents to register their children. Sometimes something as simple as a uniform can be the difference between parents giving their child an education or not.

Imagine having your whole future hinging on a dress or a pair of shorts.

It goes without saying that education is a basic human right. We often have to remind ourselves here that this is the 21st century: just because kids here were born on the wrong side of the equatorial divide they still have equal rights. Girls have as much right to education as boys- but in educating girls the benefits for the future can be far, far larger. In the rural areas where FGM rates are still very high- 98% in the most remote communities, early marriage is inevitable. Since in the developing world 70,000 adolescents are killed by pregnancy the health risks involved in FGM are far reaching: keeping girls in school delays FGM and therefore delays marriage and saves lives: that simple. Babies born to adolescent Mum’s are 50% more likely to die in their first year. This is the 21st century. That figure is just not acceptable. Education saves lives.

In addition the effects on the economy and the environment are clear. Whilst there is enormous debate on the actual statistics, there is nevertheless an agreement that there is a clear correlation between the number of years a girl spends in school and her family size. Many studies agree that a 10% increase in female literacy leads to a decline of 0.5% total fertility; seven or more years in school leads to half the number of children; giving a girl no education she will bear 6.8 children, if she completes secondary this will fall to 3.2 children. Whatever figures you are reading the correlation remains. Moreover a mere one year in Primary school boosts the earning power of women with girls putting up to 90% of their earnings back into the family income compared to boys who will put back only 35%. Statistics are statistics and open to abuse, but the trend is clear.

An educated girl accesses health care not only for herself but also for her family. She is more likely to access pre and post natal care, to give birth in a health facility, to access family planning, to have a reduced risk of HIV AIDS both for herself and her family. She is less likely to be spending the 3 - 7 hours a day by an open fire exposing herself and her infant to smoke that is 100 times above accepted safety levels- the equivalent of smoking 2 packs of cigarettes a day...... and so the list goes on.. and on...

Study after study has shown that educating girls is one of the most effective ways to fight poverty and social prejudice. An educated girl has more say in her home, family decisions are more democratic and domestic violence is reduced.

Despite all these benefits, 30 million more girls than boys are out of school in the world. Empowering women and achieving gender equality is a difficult and slow process that entails shifting attitudes, traditions and practices.

How can we afford NOT to educate women? If only as the most effective way of improving health care and reducing healthcare costs. If only to reduce population growth. If only to improve family incomes. If only to give the girls in the developing world some of the chances that our girls in the West have had for three generations.

Above: meet Rose and her daughter Selina...Rose, who was unable to finish her own Primary education, was the first woman in the locality to open a bank account saving for Selina's 'university' education, Rose was also the first woman to wear trousers - I have often thought that the best gender equality motivator in schools would be to offer the girls a chance to wear trousers. (Rose is also an excellent pancake tosser......)

Support girls education today in whatever way you can!!

Charcoal, wood and cook-stoves- best fit for Maasai women?

Undoubtedly charcoal burning is a major problem across the semi arid and arid lands. The destruction of trees and vegetation leads to erosion, land degradation and a reduced water table, decreasing grazing land and increasing the cycle of poverty.   Without a licence of course it is illegal to burn charcoal but the only people with a vested interest in enforcing this are the landowners themselves. The local Group Ranches that are involved in conservation all have a good understanding that charcoal burning is not in their interests. The picture shows a charcoal operation carried out by local Chiefs and Ol Lentille rangers, with the backing of the police, to confiscate sacks of illegal charcoal. Such operations have to be ongoing to keep on top of the problem, and these operations need excellent organisation to be successful and are expensive to perform. The vast majority of illegal  charcoal is sent out on trucks to towns where the money obtained is ten times what is given to the local charcoal burner. 

Some charcoal is sold locally and used by ‘wealthier’ women on cook-stoves, where it is more efficient and less smoky than the traditional open wood fires.  These women will be those  in employment who  have less time to collect wood. In the last few months there has been something of a technology shift: the price of charcoal has rocketed and women are finding it harder to purchase. The wealthiest of these women are now buying 6kg gas cylinders and the trucks coming up to the two weekly market are bringing refills. So far the number of women buying is very small, but this seems to be something very much market driven and, with access to small ‘development’ loans from the local micro-finance project odds are on that 2012 -13 will see a larger shift. All forms of development are, for better or worse, aspirational: the more women who have these gas stoves the more will want one.

Still, this is going to be well outside the budget for poorer families- especially since it is likely to be these families with more children and greater fuel needs.

We have been working over the last year with selling subsidised low smoke stoves to households. But undoubtedly there are very real challenges with the current stove designs. Still too much wood is required for the busiest employed women and the stoves are too slow to get hot. For each mealtime or tea time the cook-stove has to be re lit- whereas the traditional open fire will stay hot all day, and adding another piece of wood and a pan is a quick process . In addition the stoves are too small to cook meals for the larger family sizes. Additionally the stoves give off a fair amount of smoke whilst lighting- leading many ladies to consider that the health benefits we are so keen on touting ‘less smoke- less smoke’... are not quite realistic.

So for those families who are unlikely to be moving to the gas generation any time soon we are looking for some ways forward.

Taking lessons from the pit latrine building programme – behaviour can be adapted only when the benefits can be clearly seen. And of course then there is the critical mass phenomenon - once enough latrines have been erected the ball takes on its own momentum. But the fit has to be the right one. Our health campaign work  badly needs to help enable  women to find less smoky cooking solutions. The younger educated women know this and are concerned but the design of the stove has to be the right fit for the community. Only when the younger women have a stove design they can work well with will the older women jump onto the bandwagon too.

Female Genital Mutilation -moving away from The Cut

This is a busy week for the NHP team at Lentille. Prior to the December circumcision season they are organising as many 'barazas' as they can cope with.

A Baraza is a big community meeting, under a tree, with Chiefs, Community Leaders, men, women and youth.. and much food to be consumed! The subject of discussion is alternatives to female circumcision.. last year over 2,000 people attended these meetings.. as we extend now into Isiolo District this number is expected to rise. This week 3 barazas will be organised in an attempt to keep girls in school in January- and prevent the medical horrors of The Cut which leads to so many child- birth problems. Traditionally, as soon as girls are circumcised they are taken out of school to be married -and childbirth quickly follows. Since the traditional age here for circumcision is puberty (13 years) the medical complications for these young girls giving birth when they are still growing rises further. Often the girls starve themselves during pregnancy in the hope of giving birth to a smaller baby... not a healthy state of affairs for mother or child.

However tradition is changing very fast and in the two years we have been running these barazas we have seen a huge sea-shift in the attitudes to girl-child education and a far greater understanding of the dangers of circumcision. Increasing numbers of girls are now being allowed to delay circumcision until completion of secondary school when they can themselves make an informed choice. Health care here is tied directly to education- with the buiding of the new classes at Kimanjo Secondary school parents and daughters can see a real economically viable alternative to marriage. By incorporating the new government secondary Principal, and the Primary head-teachers, into these barazas we try to join up the education/health-care work.

This year we are also trying to positively incorporate the female circumcisors into health care work by offering them incentives to become agents of referral in bringing pregnant Mums-to -be, to the clinic... so they no longer need the added revenue stream of conducting circumcisions. We look forward to following up this post on how lively these barazas are this week! Change will not come without contoversy for sure!

Polio Campaign

 This week is phase one of the Polio Campaign for Laikipia North and Isiolo District. Kenya has been Polio free since 1984, but occasional outbreaks spread from neighbouring countries. The most recent, this year, spread from Uganda. The current campaign is organised by the Ministry of Public Health in association with World Health, UNICEF and partners. It targets all children under five, regardless of whether they have been vaccinated already. Nurses are traveling door to door with Community Health Workers to persuade all families to allow infants to be vaccinated against this incurable disease.Onset of polimyelitis can cause paralysis leading to deformity, more often in the legs than the arms, it is spread through faecal contact from infected persons,generally in the under fives. Sudden onset of weakness in limbs in those under 15years should be reported immediately to health professionals. So long as take up for the vaccination remains very high we will not see this tragic disease on the resurgence. Ol lentille Trust conveys great thanks to our Nabakisho Health Care team and its 36 Community Health Workers - health care programmes across so much of Africa are made possible by such locally dedicated men and women. Thank you all!