Our hands are tied

Joseph Mutisya, aged 14 months, has been a frequent visitor at the centre, following recurrent diarrhoea episodes. “He started vomiting and passing out, loose stool. I gave him some medication but his condition did not improve, so I had to rush him here,” his mother, Blantina Kamene, says, seated by her son’s hospital bed on August 14, 2012. 

Young Mutisya looked weak and severely dehydrated. He could hardly smile even when his mother asked him to look into the camera.

They sat pensively in a ward waiting for a nurse who would put him on intravenous drip, at Soweto Kayole Primary Health Care (PHC) centre, in the outskirts of Nairobi.

Soweto Kayole PHC is a community owned health facility, situated in a slum settlement, and it is supported by the government. 

It constantly lacks essential medicines, including drugs for diarrhoea, a common illness which kills over 30,000 people in Kenya. The Ministry of Public Health and Sanitation says children account for 16 per cent of the deaths.

The frustration of working to prevent deaths of children against a backdrop of perennial drug shortages is better explained by Anastacia Egala, the Sister in-Charge at Soweto Kayole PHC. “It greatly demoralises us. It feels terrible when you, as a health care giver, know what you are supposed to do but your hands are tied. We have the personnel but no drugs,” she says. 

“The government does not supply us with enough medicines so we have to buy. When we do not have money to purchase the drugs, we refer patients to other health facilities,” Anastacia observes. She tells about last July, when her institution experienced a drug stock-out, and was unable to pay Ksh 70,000 [about US $833] to buy medication. They had to rely on partners to pay; meanwhile, they continued to refer the sick to other health centres. 

“We refer when the child is in critical condition. Sometimes when we refer to another centre and it has no drugs, we end up losing the child unnecessarily,” Anastacia adds.

Currently, her clinic is in urgent need of Oral Dehydrating Salts (ORS), Zinc tablets and Intravenous (IV) fluids, all of which are on the health ministry’s essential medicines list.

Health care at Soweto Kayole PHC is on cost sharing basis with an adult being charged a user fee of 400 Ksh [about US $5] and a child 250 Ksh [about US $2.50].

Many cannot afford to pay for medical expenses in a country where 46 per cent of the population lives below the poverty line. This has impacted on the prevention and treatment of diarrhoea-related ailments.

The disease tops the list of attendance at the facility, which recorded 221 diarrhoea cases in children under five in August 2012, compared to pneumonia and malaria at 203 and 88 cases respectively.

Lack of access to clean water, coupled with poor faecal and waste disposal worsens the situation. “We buy water from a vendor who fetches it from a borehole. Many times the water has impurities. Once in a while we get tap water. But the taps are connected to burst pipes where the water mixes with sewers. Definitely the water will be contaminated; what can we do?” Blantina asks.

Awareness campaigns conducted by community health workers (CHWs) on water treatment have not borne fruit in what is described as ignorance on the part of the community. “Most of the residents here have come from rural areas where the idea of treating water for drinking or cooking does not arise. So they continue consuming untreated water,” observes Fredrick Baraza, a CHW with Soweto Kayole PHC.

His attempts to press on with talks on water treatment and hygiene practices have been met with demands for compensation from community members. “Some ask you ‘What are you going to give us in exchange for us to treat water?’. Such attitudes continue to impact on the fight to end preventable deaths of children,” he asserts.

A total of 50 community health workers, including Baraza, are attached to Soweto Kayole PHC, which serves a population of 50,000. It is a daunting task for the World Vision’s trained workers to change negative community perceptions in order to address unnecessary deaths. 

“Even as we engage with CHWs and other health care staff, our goal is to reduce the prevalence of preventable diseases among women of child bearing age and children under five years,” notes Susan Wamuti, WV’s health project officer in Soweto.

The organisation’s objective is in line with United Nation’s Millennium Development Goals four and five, which seek to reduce child mortality, and improve maternal health respectively, by 2015.