Archive for October 4th, 2007

Kenya Mothers: Agony of Giving Birth in Public Clinics

Posted on 4 October 2007. Filed under: Affirmative Action, Public Health |

The women complain of abuse and neglect before and during delivery

NAIROBI, (IRIN) – Margaret Wanjiru would rather forget the experience of having her first baby at one of the public hospitals in Nairobi, Kenya’s capital.

“I remember going to the hospital in 2001. I was in pain, like most of the other women, but we were made to sit on a wooden bench and were not allowed to go into the labour ward without paying,” Wanjiru recalled.

Once in the ward, there were a lot of insults: “You are asked to spread your legs ‘like you did for your husband’,” she said.

According to a report, Failure to deliver, prepared by the Federation of Women Lawyers in Kenya and the Center for Reproductive Rights (CRR), there are numerous challenges facing women in Kenya’s health facilities, including suffering abuse and neglect before and during delivery.

This includes being forbidden to enter hospitals without enough money for a deposit, and not being allowed to have family members on the premises or during delivery, according to the report.

According to Wanjiru, the female nurses are often very cruel, while the men are better.
“They [the nurses] are also old enough to be our mothers so we cannot answer back when they insult us,” she said, “Sometimes they beat you up and say that you are pretending yet you are in pain.”

According to the report, the women are also subjected to unreasonable delays waiting for suturing or to poor stitching. Due to insufficient beds, sharing is common, with those women who fail to pay ending up on the floor.

Free deliveries

The ministry of health has instituted a maternity health waiver allowing for free deliveries in health centres and dispensaries. This is intended to encourage more women to give birth in medical facilities while decongesting hospitals like Pumwani in Nairobi – the largest and busiest maternity hospital in East and Central Africa.

However, Wanjiru is not optimistic. “We were being mistreated even when we were paying, how about now that it is free?”

Elisa Slattery, legal adviser of the CRR’s Africa programme, says the violation of women’s rights in Kenya is widespread, systematic and has been going on for decades.

Women are abused before and after receiving reproductive health services, Slattery said.

Poor record-keeping means increased patient waiting time, with only 23 percent of the facilities conducting reviews of maternal or newborn deaths or near-misses, she said.

Women also often lack access to contraceptives of their choice in some health facilities.

“Women are often abused verbally and physically,” she said. “While motherhood is valued, there are many problems associated with it.”

Photo: Gregory Di Cresce/IRIN

The cost of delivery at a private hospital is prohibitive

Private clinics

The situation is, however, different in most private health facilities, according to Ruth Otieno*, a nurse working at a private hospital in Nairobi.

“We do not keep the women waiting and our labour ward is always ready as our clients are aware of their rights and the kind of service to expect,” Otieno said.

Moreover, at the end of their hospital stay, she said, the clients fill in a questionnaire assessing the quality of care provided.

The cost of a “normal” delivery, without including other charges, such as for the bed and consultation, at a private hospital is a prohibitive 30,000 shillings (US$448).

According to Otieno, the overwhelming burden of delivering many babies daily in public hospitals prevents the nurses from having a one-to-one relationship with the patients. Most public health facilities often lack trained personnel, medical equipment and bed space; in addition, staff are poorly paid.

Women in Kenya have a 1-in-25 lifetime risk of dying from a pregnancy-related cause, with at least 20 percent of all births being unwanted and another 25 mistimed, according to the Kenya Demographic and Health Survey for 2003.

Low morale

The chief clinical officer with the ministry of health, Alfred JBO Odhiambo, said: “The violation of patients’ rights occurs in isolated cases.” He argued that the number of staff should be increased, along with the improvement of salaries and the provision of adequate medical equipment, to improve morale.

More health centres have been opened all over the country to decongest the main hospitals, thus allowing for improved care of patients, he added.

Women are often abused verbally and physically…while motherhood is valued, there are many problems associated with it

The hospitals now have a customer relations desk to improve service delivery. “We have made mistakes in the past which we are now correcting.”

The health ministry has seconded some staff to work with the local government ministries responsible for some of the understaffed hospitals.

It is important that the medical personnel have a human touch, he said, adding that the cooperation of patients was also important. “Some of the clients already have negative attitudes towards nurses.

“We are changing how we handle clients and there is now a service charter spelling out what needs to be done across the board,” he said.

According to Slattery, government guidelines on patients’ rights should be disseminated widely so women are aware of their rights.

Recent government efforts to improve public health facilities seem to be paying off, albeit slowly, according to Wanjiru. The hospitals seem cleaner and the nurses help patients make their beds and there are also mosquito nets, she said.

“Since most women lack the funds to go to private health facilities there is a need for improvement of the public ones,” she said.

*Not their real names

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How British Supermarket Flowers Empty Kenya’s Rivers

Posted on 4 October 2007. Filed under: Environment |

About 160km from its source on the northern slopes of Mount Kenya, the great River Ngiro was just ankle deep on Friday as nomadic farmers walked through waters that have become the focus of conflict.

Kenya’s second-largest river is a life-sustaining resource for these farmers, but it also sustains big business for flower farms supplying United Kingdom supermarkets.

British and European-owned flower companies grow vast quantities of blooms and vegetables for export, and the official Kenyan Water Authority, regional bodies, human rights and development groups as well as small-scale farmers have accused flower companies near Mount Kenya of “stealing” water that would normally fill the river.

According to the head of the water authority, the 12 largest flower firms — which farm hundreds of hectares of flowers, fruit and vegetables in the region and supply British supermarkets such as Tesco, Sainsbury’s and M&S and the European market — may be taking as much as 25% of water normally available to more than 100 000 small farmers.

“The big flower farms should be taking water only [during] the floods, but they are taking it from high up the mountains whenever they need it. They are all stealing water. We follow the river at night and see them do it,” said Severino Maitima, head of the recently set up, government-appointed Ewaso [River] NgiroWater Authority, which manages all the water in the region.

“They steal it between 10pm and 2am. We do not know exactly how much they are taking, but it is a lot of water. They take it to replenish their stores when they think we sleep,” he said.

Locals and campaigners say the river now peters out 96km short of where it used to, and the overuse of water is contributing directly to conflict between small-scale farmers. The big companies are accused of directly risking the lives of nomadic pastoralists.

“The flower companies are exporting our water. A flower is 90% water. We are one of the driest countries in the world and we are exporting water to one of the wettest. The minute that the flower firms came they met resistance. It was very acrimonious,” said Maitima. “They are in direct competition with the peasant farmers for water and the biggest companies pay the same as the smallest peasant for water.”

No British supermarket would comment on the amount of water being used to grow its flowers from Kenya, but the largest horticulture company, British-owned Homegrown, which cultivates more than 300ha of flowers in the region and has built five major reservoirs and diverted a river on the slopes of Mount Kenya, accused other companies of taking water illegally.

“We only take what and when we are legally entitled to. There have been instances of some water users taking water at night to avoid detection,” said Robert Fox, MD of Homegrown Kenya.

Bans flouted
The water authority, set up last year to end the free-for-all for water, says it is still compiling data on how much individual companies are using but is now having to lock up water outlets to prevent theft by the flower companies.

Philip Gichuki, manager of the Ewaso Ngiro River Basin Development Authority in Isiolo, said: “The small farmers have started to break the large flower farmers’ [water] collecting points. It is not sustainable when the flower farmers survive and the small farmers do not. The large flower farms should plough back money. They should teach the more efficient use of water.

“It cannot get more serious than it is. In some areas there has been no rain for three years. There is a 100km stretch of river which is dry. The companies have blocked rivers and are tapping streams on the mountain side,” said Gichuki.

The greatest impact is being felt on the nomadic pastoralists in the semi arid areas to the north and east of Mount Kenya, says John Ole Tingoi of Hope, a Maasai human rights group supported by ActionAid in Kenya. “The flower farms have taken over land that the pastoralists used and there is now less water.”

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