The Theme for Me Today Is Choice
Nov 14th, 2007 by Sarah Kalloch
Political theorist John Rawls poses an intriguing question about human rights: If none of us knew where we would be born, if we would be rich or poor, healthy or ill, male or female, short or tall, American or Kenyan or Indian or Chilean, what human rights would we want to be guaranteed? What choices would we want to have about how to live our one wild and precious life?
Today for me was all about the choices we have in America—and the choices Kenyans have, and what that means for health and human rights and the way we live and work and grow and play and celebrate. So what do I mean by choice?
The Choice to Live: In 1997, Mbagathi District Hospital, near Kibera slum, opened its first AIDS centre. Options were limited: there was no treatment, no ART, but there was counseling and psychosocial support—and a special kind of community dealing with sickness, and despair and death mixed with glimmers of hope. Ten years later, people living with AIDS who come to Mbagathi have a choice. The hospital’s Comprehensive Care Clinic has 3500 people on ART. We met one patient—a man in his 20’s or early 30’s named Boniface. Boniface is HIV Positive. But Boniface has choices. His CD4 count when he began ART at Mbagathi in 2004 was about 200. It is now over 800. Boniface has chosen to celebrate by becoming a peer counselor at the hospital: a few minutes after he left our delegation, we saw him giving a talk to patients in the AIDS clinic waiting room, coaching them, supporting them, connecting them, and making them feel like they can fight this disease. People with AIDS in Kenya have a choice now: they can get treatment. They can live for years and years. They can take care of their families and be part of their communities. We know prevention is critical, and many argue it is more cost effective than treatment, especially in Africa. But I wouldn’t want to tell Boniface that—would you?
The Choice to Give Birth with Joy: My friends are starting to have children: they have carefully planned when and where, had baby showers, decorated nurseries, chosen greens and blues and purples and polka dots. They have lots of choice (just check out Babies R Us online—do babies really need all that stuff? Come on now). According to an ob/gyn we met today at Kenyatta National Hospital, only 30% of women in Kenya have access to contraception; most cannot plan when they will have their first child … or their sixth. My friends had birth plans and midwives and dulas and knew if they wanted an epidural or not. They had choice. Only 40% of Kenyan women deliver in clinics; most give birth at home, with family or traditional birth attendents. Women deserve to give birth safely. Women deserve to give birth with joy. This can be the best day of their lives—or the last—depending on the choices governments and donors make to support women’s right and comprehensive health care.
The Choice to Make a Different Choice: ART is free in Kenya … but there are other costs associated with care that patients must bear. At Kenyatta National Hospital’s HIV/AIDS comprehensive care clinic, patients pay 300 Kenya shillings—about $4—per month for consultations and access to clinic staff and facilities. This might seem small is the face of America’s high co-pays and often outrageous medical fees, but for a poor woman in Kenya, this amount can be insurmountable. How many Americans spent that much on a latte at Starbucks today? (I think the holiday flavors are out now—gotta love the eggnog….) We are so very very lucky to have that choice. So many Kenyans do not have that luxury.
That is why the work of PHR and our partners here is so critical: it is about voice, it is about empowerment, it is about building a society that says health rights belong to us, and we will fight for them. It is about making choice a reality for millions—the choice to live, and live well, and live with the rights to which we are all entitled, by virtue of birth, no matter where, and who, we are.
Hey Sarah, thanks to you and Lissy for all the amazing work you guys are doing. It’s been great to follow the goings-on via the blog.
Thanks especially for this great post. Your insights are refreshing and bring back some hard memories from my recent trip there. As you know, I was in Kenya in the beginning of 2006 to evaluate a Home Based Care program for a local reproductive health-focused NGO based in Kisumu. When I read your post about “choices”… it reminded me of the disparities I witnessed between rural and urban inhabitants of the district I was in. In rural areas such as Rongo and Sagam, patients we interviewed had different choices to make than those of urban areas within Kisumu. In rural areas, patients were further apart and in harder to reach areas than the urban villages of West Kolwa. The tough terrain and distance make transportation a major challenge for both the volunteer Community Health Workers and their patients living with AIDS. Many patients did not have the means to pay for travel to the local clinic hospital for their monthly ARV pick up and check up. When presented with a choice between paying for transportation or food…the choice, not surprisingly was always food. During our client interviews, I spoke to many patients who had stopped their drug regimen because they had no means to pay for transportation to the local hospital.
A key component in the fight against stigma, and in support of the empowerment of women and people with HIV in a rights based approach is the respect and status afforded by a career and living wage. Community Health Workers need to be empowered to work in the resource-poor setting they live in and adequate compensation is needed to attract and retain quality personnel. Giving salaries to Community Health Workers benefits the community they live in by providing a source of income for people who are often times poor themselves or are at risk of disease.
Thanks again for all that you are doing. Travel back safe and see you soon.