Health Rights in Kenya

Sarah and I have been back from Kenya for a few weeks now and have had time to reflect on our trip—our many site visits, the HERAF conference, meetings we had with colleagues and a special breakfast with medical/nursing students.

The lessons learned were many and the importance of our partnership with HERAF clear. PHR’s commitment to building an international movement of health professionals dedicated to the right to health for all remains strong and energized as a result of these experiences.

In one of the closing sessions of the conference, I had the privilege of reading a letter written by Paul Farmer (PDF), an HAA advisor. He applauded HERAF, and all those health professionals in attendance, for their commitment to health as a human right. He stated:

A lack of health infrastructure is no reason for inaction; rather, it is a clarion call to action! Let’s talk about food, about sutures, medications, electricity, water and other basic goods…we must link all of our projects to re-building health systems, poverty alleviation and food security to governments and global health policy.

His final statement was: “So, let’s get going!”

In keeping with this message HERAF acknowledged that it has significant work to do in 2008—and the momentum and energy to make it happen. At the end of the conference, HERAF National Coordinator Miano Munene outlined several education and advocacy campaigns which HERAF will move forward over the next year. These include:

• Continuing to build a movement of health workers from across Kenya who are mobilized to advocate for health rights
• Raising awareness of health rights through education, outreach and media engagement
• Advocating for increased and effective health sector financing and improved civil society participation in the budget making process
• Addressing stigma in health settings through education and training as well as through policy promotion, especially around the HIV/AIDS Act of 2006
• Advocating for a strong national health workforce policy in Kenya to ensure quality, equitable health care delivery for all
• Supporting polices and programs that address women and girls unique vulnerability to HIV/AIDAS, and the human rights violations that fuel this vulnerability

These plans may seem ambitious, and they are. But we think HERAF and PHR can do it. We invite you all to join us on this continuing journey—keep checking the PHR Health Action AIDS page for updates, ideas and opportunities for collaboration, and please contact us if you have ideas or thoughts moving forward.

Together, we can change the health rights outcomes for millions and make the world a more equitable, healthy, prosperous place.

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Inspirational, motivational, phenomenal…..are a few of the words shouted out by participants on Thursday afternoon when asked by the facilitator to describe their experience at the 1st annual HERAF conference. She paused, looked at the group and said: “and so are all of you!”

For 2 days our HAA delegation has had the privilege of sitting alongside 70 health care workers who traveled from across Kenya to address a shared vision: a country where “health is recognized as a fundamental human right with access to equitable, affordable health services for all.” The passion and commitment we witnessed to reaching this goal was remarkable.

We listened and learned as they challenged one another, confronted their government leaders and questioned policies that fail to promote human rights…. including the US policy that prohibits a person with HIV to freely travel to the US!

We discussed human resource shortages: inadequate government funding needed to build strong health care systems, stigma and discrimination within the healthcare work place and gender inequity. These barriers to the fulfillment of HERAF’s vision and the challenges ahead were candidly acknowledged, but I could not help note that the resolve for change was unwavering.

Of the many excellent presentations made there was one that resonated deeply for me…. “The Right to Health: Influencing the Gender Agenda in the Kenyan Health Care Setting,” given by Dr Peninah Ogada. Dr Ogada is an older woman who described herself as “recycled material.” Widowed at a young age in rural Kenya, she dedicated herself to her children’s well-being and education. She farmed, sold portions of her crops for money and worked hard to make ends meet. She recalled the many times she had to travel miles, often on foot, to the closest health clinic with a sick child, wait in long lines, pay fees she could not afford and then was frequently treated disrespectfully by those who called themselves “caregivers.”

Dr. Peninah Ogada speaks at a session of the HERAF conference.

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We thought you might enjoy this group photo of people from the conference.

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(Part 1)

During responses to Maina Kiai’s keynote presentation, Winifred Lichuma used the Treatment Action Campaign’s successful lawsuit against the South African government as an example of the power of the collective voice and spirit of the people. The lawsuit demanded that the government provide intervention to prevent mother to child HIV transmission among pregnant women. Having worked with the Treatment Action Campaign in 2001 and 2002, I remembered how TAC provided education and outreach through their Treatment Literacy mobile workshops—which engaged people in both urban and rural townships in changing the government response to HIV/AIDS. They based their campaign on the very progressive South African Constitution. Winifred acknowledged the Kenyan Constitution does not have the same progressive language as South Africa’s Constitution, but advocated for similar action and involvement in Kenya. Getting such language incorporated into the Constitution and getting similar levels of involvement in campaigns would greatly benefit Kenyans.

I remembered how TAC leadership was so involved and invested in their people. I thought about the words of one of my friends and personal heroes Mandla Majola, the TAC provincial organizer from the township of Gugulethu, who once told me that people are in need of leadership but in order to be a true leader the people must know and trust their leader, and the leader must know his or her community and people and to earn their trust. Mandla told me that sheep instinctively know not only the smell of their shepherd but also can sense the care of their shepherd. He gained people’s trust by getting to know them and profoundly caring about their welfare. The Treatment Action Campaign were some of the first activists I had ever met, and they moved me to want to be part of their work in South Africa.

I see in this Kenyan conference similar rumblings of intelligence, commitment, activism and demand for care, and I hear the frustration and burnout of health care workers feeling heavily burdened and demoralized. Activists and people living with illness, abuse and disregard are fed up and angry at a system that is not serving their needs. I know this tremendous anger can translate into tremendous energy, and I am grateful to have this exposure to human rights issues in Kenya.

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The conference has been very motivational and stimulating! The presenters were of  incredible caliber and the attendees have a commendable willingness to advocate for healthcare rights. Their freedom and commitment to discuss difficult issues and to question the current status of healthcare rights and healthcare is inspiring.

Part of the excitement to be agents for change may stem, in part, from the current charge that can be felt throughout Nairobi. General elections are scheduled for December 27 and Kenyans are anticipating the opportunity to elicit tangible change.

All too often we think of care for HIV-infected individuals in terms of access to antiretrovirals and testing for HIV. It is easy to forget the intimate relationship between development and health. This was one of the topics discussed at length yesterday. Instead of defining healthcare as physical wellness or the lack of disease/physical signs and symptoms, the concept of healthcare should be examined as a whole. Addressing healthcare issues includes also influencing physical, emotional and spiritual health and setting goals to decrease poverty and improve access to education, sanitation, access to clean water, employment and food security.

Another essential aspect of comprehensive health care discussed at length during site visits and at the conference, is how to best care for the health care worker. We heard from many sources how health care workers often do not seek their own health care at their site of employment. Stigma, lack of confidentiality, lack of space, and all too little emphasis on employee health are all contributing factors. As a result, retention and employee health suffer.

While visiting one of the clinic sites, we saw the one room clinic space currently set aside for employee health care. In an effort to provide better care to the health care workers (HCWs), one of the physicians is hoping to gain access to a larger space on the hospital campus to provide more services and greater confidentiality. Along similar lines, the other clinic has begun to take their voluntary testing and counseling services to each of the units, providing stigma training and offering testing. So far they have had a significant number of HCWs testing for HIV. I am looking forward to our meeting with another agency today, that has been attempting to increase care to HCWs by mobilizing professional organizations and taking small steps to improve work place satisfaction.

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Dr. Nyunya is Chairman of the Eldoret Branch of the Kenya Medical Association and leads the department of reproductive health at Moi University in Kenya. A longtime health and human rights activist, Dr. Nyunya works closely with the Health Rights Advocacy Forum, raising awareness of reproductive health and rights and the key barriers preventing women from accessing health care in Kenya.

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Having now spent a couple of days in Kenya, I am learning a lot about the healthcare crisis they are facing. Yesterday we visited the Kenyatta hospital which is the tertiary care center for much of Kenya and the teaching hospital. We also talked with the Director of Programs for AMREF, a foundation which provides services to rural communities and those affected with HIV, TB and malaria by use of airplanes and education strategies.It is clear that severe shortages in healthcare workers (some estimates are as low as 1 provider per 100,000 patients) along with stigma and discrimination toward women and those infected with HIV are severely limiting this country’s ability to achieve its healthcare goals. Today’s conference focused on creating relationships with others in the healthcare industry who are committed to ensuring healthcare is a human right, that should not be reserved for the rich or urban citizens.

At first I felt overwhelmed by the work that lies ahead for this community. Like many complex systems, ensuring quality healthcare for all is not an easy task. But today examples were cited that make sense of how this group moves toward advocating for this right. I am struck by the diversity and commitment of the group, and the sense of community I immediately felt. I am incredibly appreciative of Physicians for Human Rights for inviting me to such a forum to learn and advocate; and for their vision in creating such a forum to bring allies together. I look forward to learning ways that I and my US colleagues can help the ongoing struggle.

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We spent yesterday at the Health Rights Advocacy Forum Conference. The agenda was phenomenal, including well-known Kenyan speakers and a range of topics including: basic health rights, advocacy for health care workers, the impact of development partners on health worker policies and health sector reforms. The sessions were informative, yet overwhelming. It was all I could do to try to soak it all in and attempt basic processing of the information.

One of the topics touched on throughout the day was the issue of brain drain, the loss of trained health care workers from developing nations to wealthier nations. Health care worker shortage in Kenya is a complex issue. Kenya actually has a surplus of trained nurses but a shortage of funding to provide positions for all of them.

[Suzy Jed, MSN, APRN-BC and the American and Kenyan teams in the Kenyatta National Hospital HIV Comprehensive Care Clinic Laboratory]
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The Health Action AIDS delegation will spend all day today and tomorrow participating in the 1st Annual Health Rights Advocacy Forum Conference. We’ll be blogging about some of the conference happenings in a little while. In the meantime you can read the conference overview and peruse the schedule of sessions.

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