Archive for July 11th, 2008

Healthcare Hurdles in Nairobi’s Slums

Posted on 11 July 2008. Filed under: Governance, MDGs, Public Health |


Photo: Manoocher Deghati/IRIN
Slums are underserved in terms of access to basic amenities

NAIROBI, 11 July 2008 (IRIN) – Quality healthcare is a luxury often beyond the reach of those who live in Nairobi’s slums, such as mother-of-seven Grace Awour Opondo.

“When you are sick you buy medicine from the local shops,” Opondo told IRIN. “If you are lucky you recover because the medicine is not usually the right one.

“Sometimes there is no medicine even in the hospitals, so they send you out with a prescription,” she said. “Then the chemists are expensive so often one has to make do without the medicine.”

According to Sakwa Mwangala, a programme manager with the African Medical and Research Foundation (AMREF), the fact that people are squatting on government land often prevents them from accessing essential services. Slums are regarded as informal illegal settlements, which means they are underserved in terms of infrastructure development and access to basic amenities.

“Government health facilities are also not easily accessible for most slum residents,” said Mwangala, who heads AMREF’s Kibera integrated healthcare programme. Kibera, on the southwestern edge of central Nairobi, is one of the largest and most densely populated slums in sub-Saharan Africa.

Most people operating health “facilities” in the slums are quacks, he said. “There is a lack of quality control, with the people in most of these clinics lacking skills.”

The urban poor fare worse than their rural counterparts on most health indicators, according to a report, Profiling the burden of disease on the residents of Nairobi slums prepared by the African Population and Health Research Center (APHRC).

Pneumonia, diarrhoeal diseases and stillbirths account for more than half the deaths of children under-five, while HIV/AIDS, tuberculosis, interpersonal violence injuries and road traffic accidents account for more than two-thirds of deaths among people aged five years and older, stated the report.

The poor health status of slum children is in part due to continuous exposure to environmental hazards coupled with a lack of basic amenities.

“The chances of one becoming sick are high because of the poor sanitation; most of the houses are also poorly ventilated,” according to Leonard Wawire, a teacher in the Mathare slum.

“Here, there are no trees to clean the air; any plant growing is usually growing out of waste,” Wawire said.

Prevention measures

Eliya Zulu, APHRC’s deputy director of research, told IRIN it was important to adopt a holistic approach to healthcare for the urban poor, one that focused as much on prevention – through improved nutrition and immunisation against major childhood diseases – as on treatment.


Photo: Julius Mwelu/IRIN
Grace Opondo, a resident of Mathare slums

“Increasingly, most people in the urban areas are living in deplorable conditions yet it is generally assumed that the better hospitals and schools are in the urban areas,” Zulu said.

When conducting general health surveys, urban areas tend to rank better than rural areas in terms of the health indicators. This, however, failed to bring into focus the health situation of the urban poor, he said.

The problems of the urban poor have often been overlooked while rural areas are seen as more vulnerable to shocks.

“In the rural set-up there is a sense of normalcy; you can have your toilet, the community also has a stream from which they draw their water – this is not the case in the slums,” Mwangala of AMREF said.

Many deaths in the slums are caused by preventable and treatable conditions, according to the APHRC report; inadequate sanitation encourages the spread of skin and waterborne diseases.

In a bid to improve sanitation in Kibera, a Kenyan NGO, the Umande Trust, is running a project that not only provides quality toilets for residents but also transforms human waste into biogas and liquid fertiliser.

Residents in areas such as Katwekera and Laini Saba in Kibera, pay two shillings (three US cents) to use the toilets and showers, according to Josiah Omotto of the Trust. For a subscription of 80 shillings ($1.19) a month, households get unlimited access to the facility.

The buildings’ basements house bio-digester domes, which turn human waste into methane and liquid fertiliser.

''When you are sick you buy medicine from the local shops; if you are lucky you recover because the medicine is not usually the right one''

According to Omotto, these help reduce the local use of firewood. Already, he said, the methane from the facility in Laini Saba was being used for fuel by a local nursery school. There are plans to construct similar facilities in other slums to supply the gas to residents living near the facilities.

So far, at least 500 residents are benefiting from each facility.

The division of environmental health in Kenya’s Ministry of Health is finalising policy documents aimed at ensuring that 90 percent of households have access to, and make use of, hygienic, affordable, functional and sustainable toilet and hand-washing facilities.

The policies also aim at reducing the national rate of preventable sanitation-related diseases by half.

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Post-Violence Sex Work Boom in Kenya

Posted on 11 July 2008. Filed under: Insecurity, Lifestyle, Refugees/ IDPs |


Photo: Eva-Lotta Jansson/IRIN
Desperation limits your options

MOMBASA, 9 July 2008 (PlusNews) – Like thousands of other Kenyans, Susan Wairimu, 17, was displaced from her home in the Rift Valley Province’s Molo district during the violence that followed a disputed presidential election in December 2007 and sought shelter in the nearby town of Nakuru.

A cousin living in the coastal town of Mombasa offered to accommodate her until the violence ended, offering an escape from the single tent she shared with her parents at the displaced persons camp in Nakuru.

“I had no idea of the kind of work my cousin used to do in the beginning; I came to know some few days after my arrival, when she told me she operates as a call girl from the beaches.”

Kenya’s coast is one of its most popular tourist destinations: an estimated two million tourists visited Kenya in 2007, many of them heading for the Indian Ocean towns of Mombasa, Malindi and Lamu, where commercial sex work is one of the main ways many women earn money.

Before long Wairimu was introduced to the business of selling sex. “We now have the skills and have learnt that the amount of money a man parts with will determine the kind of pleasure we will offer him. For example, making love without a condom will cost a client more money than using one,” she said.

“The killing in my village taught me a lesson and prepared me for a tough life, and now I do not fear death any more,” she added. “I do not fear HIV and I believe that you will die when your day arrives, and the disease will not determine, but only God.”

Wairimu accepts as little as 300 Kenya shillings (US$4.50) for an entire night, sometimes with two men.

Locals at the coast say sex workers in the region traditionally used to target wealthy foreign tourists, usually from Europe. Today, a fall in tourist numbers after the post-election violence and an increased number of sex workers means every man, old or young, black or white, is seen as a potential customer.

Wairimu is one of an estimated two hundred girls between 15 and 18 years of age who are now engaged in full-time sex work along Kenya’s coast, according to Solidarity with Women in Distress (SOLWODI), a local non-governmental organisation that sensitises sex workers to the dangers of HIV/AIDS.

Increase in child sex trade

Child sex work is not uncommon along the coast; a 2006 study by the government and the United Nations Children’s Fund (UNICEF) found that up to 30 percent of teenagers in some coastal areas were involved in casual sex for cash.

Agnetta Mirikau, a child protection specialist with UNICEF Kenya, told IRIN/PlusNews that the organisation had received reports of an increase in the child sex trade since the election.

SOLWODI’s field coordinator in Mombasa, Grace Odembo, told IRIN/PlusNews that most of the girls who resorted to sex work were high school drop-outs, which would make it difficult for them to find formal employment.

“The girls have opted to sell their bodies in order to get money for survival,” Odembo said. “We try as much as we can … to convince them out of [sex work].”

The 2006 study also found that 35.5 percent of all sex acts involving children and tourists took place without condoms, putting the girls at risk of contracting HIV and other sexually transmitted infections. The HIV prevalence in Kenya’s Coast Province is 5.9 percent, higher than the national average of 5.1 percent.

SOLWODI runs counselling, return-to-school programmes and vocational skills training for girls who wish to get out of the trade. Since its formation in 1997, the organisation has managed to get 5,000 girls and women to leave the sex industry.

''The girls have opted to sell their bodies in order to get money for survival … We try as much as we can to convince them out of [sex work].''

Hoteliers often turn a blind eye to residents bringing underage girls into their rooms, but some have a more strict policy regarding commercial sex on their premises.

“We never accommodate any visitors who try to check into our hotels with young-looking girls until we get some required details about the girl,” Mohammed Hersi, general manager of the Mombasa’s Sarova White Sands Beach Hotel, told IRIN/PlusNews. “[We usually] establish who the girls are, what they are up to and, most important, their ages.”

SOLWODI also trains hotels to implement an existing code of conduct to prevent sexual exploitation in the travel and tourism sector, but by late 2007, only 20 hotels had signed the code of conduct.

The deputy mayor of Mombasa, John Mcharo, said keeping the girls off the streets was difficult. “Yes, we can arrest the girls but only charge them with loitering, just like we’ve done before, but this can’t stop the girls from finding their way back to the streets and beaches as soon as they come out of our custody.”

Girls at the beach generally wear bathing suits, so it is difficult to distinguish between sex workers trawling the beach for customers and girls who are simply enjoying a day at the beach.

Local law enforcement officers and religious leaders have called on the government to do more to stop underage girls selling sex in the area. “The government has to come up with a special programme that can get the girls not only off the beaches but off the streets,” said Sheikh Mohammed Khalifa, organising secretary of the council of Imams and preachers of Kenya.

He added that his organisation frequently held workshops to urge underage girls to quit the trade, and provided them with spiritual guidance.

The government has a children’s department in every district, which is responsible for the protection of children from exploitation and abuse. According to Patrick Wafula, of the Mombasa police department, much of the work of the department’s special tourism unit consists of arresting the perpetrators of child sex abuse and exploitation.

“We usually carry out raids in areas we suspect to be meeting points for the girls and their potential clients,” he said.

The government also recently expanded the child protection units at police stations, adding children’s officers and improving judicial services, so that they are now better prepared to handle children’s issues.

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    A blog created to cover environmental and political information in Kenya with a view to promoting POVERTY ALLEVIATION through creating awareness of the Millennium Development Goals

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