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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On our last full day in Kenya we visited a grassroots AIDS service organization in downtown Nairobi named WOFAK, Women Fight AIDS in Kenya. Founded in 1993 by a group of women living with HIV, WOFAK presently provides care and support services to over 6,000 women and their families. As I walked into the simple, yet welcoming building that houses this amazing CBO, I saw a picture of Stephen Lewis. WOFAK”s executive director, Dorothy Onyango, proudly told me that WOFAK was the very first of the over 100 grassroots organizations in Africa presently supported by the Stephen Lewis Foundation—which to my mind is a sure sign of quality. Our partner organization here in Kenya, HERAF, is working closely with WOFAK on a national campaign, “Stop AIDS Now.” Dorothy explained how this project focuses on gender and HIV. She and her staff spoke of initiatives to change long held beliefs about women’s role in society and how they are challenging gender based attitudes and behavior. Empowerment support groups, community education that includes men, and advocating with policy makers to address the human rights violations against women, such as gender based violence and inheritance laws, are some of their frontline interventions. “It is an up-hill battle daily,” explained Helen, the co-coordinator of the campaign, “but we will continue.”
These courageous women seemed to be doing it all—providing a safe and caring place for women and their children while also recognizing the need to address the driving forces behind the feminization of the AIDS pandemic. When asked how they keep motivated to continue they responded by smiling and saying, “with the support of people like you.” With that they gave each of us a WOFAK t-shirt and asked us to put them on. “Now you are all soldiers for WOFAK,” said Dorothy.
PHR delegation with Dorthy Onyango, Helen Otieno and Charles Kaduwa from WOFAK.
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After a week in Kenya, on Thursday I attended a number of different institutions and discussions. Perhaps most moving and concerning was that involving a group of lawyers who researched and discussed violations against women in the Kenyan Healthcare system in a report entitled Failure to Deliver (PDF). Over a hundred women were interviewed about their experiences in the healthcare system, and the stories were frightening. They reported being hit, yelled at, bitten and ridiculed by healthcare workers for being pregnant. Those at highest risk were those also infected with HIV. Such discrimination and abuse was sobering, and although it is likely linked to the poor working conditions of the healthcare staff (underpaid, twenty hour workdays, hundreds of patients, poor facilities, lack of supplies), such behavior is intolerable and demands attention and support.
We also visited a group called WOFAK (Women fighting AIDS). They are doing front-line work by providing care, support, job training and referrals for thousands of women and girls who are living with HIV/AIDS. Again they struggle with lack of resources, staff and discrimination against women, but are committed to their work and are excited about a facility that will be built by the Italians in the year to come.
I am so impressed by the work being done by these organizations, but feel overwhelmed by the task facing them. I am excited to return to the states to advocate for continued support and increased funds for the work being done in East Africa. This epidemic is far from over, and the socioeconomic issues continue to fuel this fire. The staff of PHR and HERAF have been inspirational in their work. I look forward to working with them in the future. There’s much work to be done!
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The HERAF Conference is over, but it was another full day for the Health Action AIDS delegation. Here is an overview of what we did today.
8:30 a.m. – 9:30 a.m. Meeting with the USAID Capacity Project
The Capacity Project is funded by USAID, and works with the Ministry of Health in Kenya to build and sustain the health workforce. Capacity Project works to improve workforce policies and planning, develop better education and training programs for the workforce, and strengthen systems to support workforce performance. Currently, the Capacity Project has implemented low-cost work climate improvement interventions in 5 sites throughout Kenya (it is expanding), which will provide a foundation for understanding what determines performance of the health workforce. Capacity Project staff members are very interested in workplace culture among health professionals in Kenya, as well as a pervasive negative attitude among health workers, an area that HERAF members have also identified as an advocacy priority.
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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?
[Sarah Kalloch, HERAF Chairman Andrew Suleh, MD and Suzy Jed, MSN, APRN-BC at Mbagathi District Hospital]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?
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I woke up this morning thinking that I knew what to expect. But you can never know what to expect, and I’m grateful that I was wrong.
I thought I’d visited Mbagathi before. I’d seen the grounds and spoken with physicians and clinicians, but I hadn’t understood the true strength of the facility and the Comprehensive Care Center. We were lucky enough to share experiences with health workers at the Mbagathi CCC, including nutritionists, peer educators, counselors, HIV/AIDS trainers, and physicians. The facilities were minimal—simple tents set up for group counseling; one room with three wooden benches for discussions on second-line treatment and training health workers on HIV/AIDS-related stigma.
[Lissy Desantis, HERAF Chairman Dr. Andrew Suleh and Pediatric AIDS Counselor Judy Ouko at Mbagathi Hospital, Nairobi]
In the women’s general ward, there are 30 beds. This morning, there were 50 patients, and nearly every bed had 2 women sleeping head to toe, wrapped in their own blankets. Yet Mbagathi is much more than overcrowded wards and the bare minimum facilities. Mbagathi is a model Comprehensive Care Center in Kenya, not because of the quality of its training room or the videos it has playing in the children’s waiting room. It is a model CCC because of the staff that comes to work every day. Including Judy, who counsels children receiving ART and conducts anti-stigma training among her fellow health workers, reminding them that “Before we point a finger, [health workers] must realize that we are all at risk.” Also Boniface, a peer educator at the CCC living positively with HIV. His CD 4 count has increased from 200 to 887 in eighteen months on treatment at Mbagathi. And Dr. A.J. Suleh, Chair of the Health Rights Advocacy Forum and Practitioner in Internal Medicine at Mbagathi, one of the only staff actually employed by the Kenyan Government.
And that’s the twist to the story: the majority of the dedicated and motivated staff at Mbagathi, all of whom work in tiring conditions with minimal facilities, are set to be moved from the facility in February of 2008. They are employed by Médcins Sans Frontières, whose three-year agreement with the Kenyan government has come to an end. It’s now the government’s responsibility to staff this clinic, to promote the comprehensive care of HIV positive patients, and to promote the well-being and psychosocial support of its health workers. And while there is pressure on the government to do this, the workers at Mbagathi who will remain after February are worried. The numbers of patients will only increase, training needs will only increase, and the need for psychosocial support—for patients and providers—will only increase. The Kenyan government’s promises aren’t enough for these health workers. And they won’t be enough for the patients seeking care either.
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As promised in my previous post, I’ll be sharing the plans of the Health Action AIDS delegation each day. Today our group will visit two hospitals and meet with two partner organizations.
9:00 a.m. – 11:00 a.m. Visit to Mbagathi District Hospital
This tour will be led by Dr. A.J. Suleh, Chairman of the Health Rights Advocacy Forum and Chairman of the Kenya Medical Association’s Nairobi branch. Mbagathi District Hospital is a key health facility in Nairobi, and has been at the heart of providing comprehensive HIV/AIDS care in the face of the unfolding epidemic in Kenya. Mbagathi handles 10,000 patients, 1,000 of whom are children. The hospital also has 5,000 adults and 500 children on antiretroviral therapy and performs 150 consultations daily. Mbagathi District Hospital offers VCT, DTC, PICT, and PMTCT services, as well as TB care and counseling, among other services.
Mbagathi is a public health facility funded by the Kenyan government, and it also receives support from the international donor community, including the Clinton Foundation. As a provider of comprehensive HIV/AIDS care and treatment, a recipient of public funding and a target for international funding, Mbagathi District Hospital is critical for identifying advocacy needs for health workers in Kenya.
The PHR delegation will first meet with senior MDH staff for an overview of services offered, as well as recent successes and challenges in providing HIV/AIDS prevention, treatment and care. The delegation will then tour the complete hospital facilities, including the wards, and have a chance to shadow MDH nurses and doctors and exchange with Kenyan colleagues.
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This week is a very exciting week for us here in Kenya. The Health Rights Advocacy Forum (HERAF) will be hosting the first conference of its kind in Kenya, assessing Kenya’s commitment to the right to health. Health workers from throughout the country will be attending the conference in Nairobi, and we have a group of doctors, nurses and PHR staff coming from the United States to support the conference and stand in solidarity with Kenyan colleagues.
The Kenyan health sector faces incredible challenges, but HERAF’s work over the past seven months has shown that Kenyan health workers are up to the task. The annual conference will address 4 key issues in Kenya: realization of the right to health, financing for health, support for the health workforce, and stigma and discrimination in the health setting.
The Health Action AIDS Campaign doctors and nurses will also visit Kenyatta National Hospital, the largest referral and teaching hospital in Kenya, and Mbagathi District Hospital, a flagship comprehensive care center for HIV/AIDS. However, these visits are just the beginning. They’ll also have a chance to meet with key partners in health workforce development and HIV-prevention among women and girls, to share PHR’s work across the globe and to learn from the experience of service providers on the ground here in Kenya.
Through Saturday, I’ll be posting an overview of what the Health Action AIDS Campaign has planned each day, and the doctors and nurses and others will blog with their perspectives on these experiences. This is an incredible opportunity to build connections across continents and forge the partnerships necessary to change the way health is imagined, demanded and delivered in both the United States and Africa.
Lissy Desantis is Kenya Program Associate for the Health Action AIDS Campaign, Physicians for Human Rights.
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