Tuesday, May 29, 2012

A trip out West...

Travelling in style

I awoke at silly o'clock last Monday morning for my latest field trip to Kisumu in Western Kenya. Why so early? Because I was FLYING to Kisumu! Kisumu is about an 8 hour drive from Nairobi (give or take a few hours) but UNICEF being UNICEF my colleagues Roselyn, Nande and I were flying there. Taking a plane felt a little indulgent since many of my VSO colleagues regularly make that trip by road but the second the nice Kenya Airways stewardness handed me my complimentary nuts and juice I thought 'feck it' - let's enjoy this while I can.

The downside of flying is that you don't get to see the countryside between Nairobi and the West. But luckily my work for the few days was mostly outside of the city of Kisumu in places like Siaya, Rongo and Homa Bay. A few days squished into the back of a landcruiser meant I got to see some of what Western Kenya has to offer.

Lovely lush green countryside.

Unlike Garissa -the site of my last trip away with UNICEF - Western Kenya, and Nyanza province in particular, has had plenty this rainy season. In fact parts of Nyanza have experienced severe flooding in the past couple of weeks with hundreds of people left homeless from floods and landslides. Kenya overall has been pretty badly hit by extreme weather during the long rains. More information can be found here, and here.

Flooding as seen on the way to visit one of the health facilities


The purpose of the trip was to do some field research and monitoring of eMTCT activities. eMTCT, to recap for new readers, stands for the Elimination of Mother to Child Transmission of HIV. I have absolutely know idea why the 'e' is small but it appears that way on lots of official documents so I'm going to stick by the apparent convention. UNICEF, along with UN agencies partners such as UNAIDS and UNFPA, government partners, and NGO partners are about to launch a new national eMTCT framework, and a Communication Strategy to match. The aim is to reduce transmission rates in Kenya to below 5% by 2015. It's an ambitious target, but it's in line with global commitments set by UNAIDS and is in line with Millenium Development Goal targets for Maternal Mortality and HIV/AIDS. According to figures from 2009 the rate of transmission from mother to baby stood at 27% when the babies were tested for HIV at 18 months. So Kenya has a long way to go, and fast.

As I may have mentioned before eMTCT is probably the only HIV/AIDS intervention in which the funding is actually growing rather than shrinking. It has been identified as an area that is, for want of a better phrase, 'an easy win'. Thousands and thousands of infections can be prevented every year if simple steps are taken by pregnant mothers and their partners. These include getting HIV tested with your partner, attending at least 4 Ante-Natal Clinics (ANC), delivering the baby in a health facility and breast-feeding exclusively for 6 months.

Also, who doesn't want to fund babies?

A Kata Shauri poster on the door of
Rongo District Hospital -
not quite hanging 'pride of place' but still

Back in 2010 UNICEF Kenya and goverment partners launched a communication campaign called 'Kata Shauri' to promote key PMTCT messages (prevention of...). Kata Shauri means 'to make a decision' and the campaign asked people to make a decision to protect their children (the subtitle to the campaign was actually 'Tulinde Kizazi' which means to protect generations so the full message was 'Make a decision to protect the generations'). In light of the new eMTCT agenda we are in the process of updating the campaign but to do that we wanted to speak to the nurses, health promotion officers and community health workers who are engaged in these activities and who spread these messages everyday.

We went to visit district hospitals and health faciltiies in key places which have been identified as areas with high prevalences of HIV/AIDS and consequently high transmission rates. In the areas we visited we heard some of the same challenges to eMTCT repeated over and over again. These included the difficulty in getting men tested and involved with ANC visits, the reluctance/inability of women to exclusively breastfeed for 6 months, the high drop-out rates from ANC clinics etc... But individual health centres also told us interesting stories. The one that stuck with us most was that of the 'mentor mother' challenges.

The Mentor Mother Dilemma

Mentor mothers are HIV positive women who provide support, counselling, and a friendly face to HIV positive pregnant women who are going through Ante Natal Care while getting diagnosed and beginning treatment for HIV. Organisations like Mothers 2 Mothers have shown that the scheme can be very effective in reducing rates of transmission to babies, but more broadly in helping HIVpositive women to live healthier lives. The idea is that nurses and health workers have very little time to dedicate to individual patients so these women take some of the burden from healthcare workers too. The Kenyan government have been so impressed with the results that have come from the scheme that they have just launched a nationwide version called the Kenya Mentor Mother Programme.

Mentor mothers are meant to be based within health centres to provide their services but some places have been using them for defaulter tracing. This is where they go out in the community to track down women who have missed their scheduled ANC or other appointments (a job usually done by Community Health Workers). However, while most mentor mothers have disclosed their HIV positive status to the community many of the women they work with have not. So by seeking out women to check why they have missed a check-up they are unintentionally disclosing their status and therefore possibly stigmatising these women within their community. We have taken this feedback to our government partners and so we hope that there will be more guidance put in place as to how mentor mothers can help to support HIV positive pregnant women without potentially opening them up to discrimination in their community.

Mentor mothers wearing their Kata Shauri aprons

I found the visit overall to be extremely beneficial. There will be a direct benefit to my work as I understand more deeply what is actually involved in eMTCT. It has gone from being words on the high-level policy documents that I read to being something more tangible. Something that affects real women and children every day. Statistics about defaulters and drop-out rates make far more sense when I have seen the over-burdened health facilities, the dedicated but over-stretched health workers and the distances many women need to travel to seek help. On a more personal level every new part of Kenya helps me to understand the country more. I learn more about different tribes (this time it was the Luos) different cultural practices etc.

So long and thanks for all the fish
It wouldn't be a proper blogpost if I didn't mention food at some point. So let me talk briefly about the fish. As Kisumu is on Lake Victoria there is an abundance of yummy fish to be found there. And as the Luo people are well used to eating it they know how to cook it well. For lunch on the second and third day we headed to what Roselyn referred to as 'Car Wash'. Car wash is indeed where cars are washed and I wish I had taken a photo of the men driving cars into the lake in order to wash them. Not far in mind you. But it's also home to a string of about 12 restaurants, all serving roughly the same food, in similar surroundings. We settled on eating at 'Lakeside Hotel' and we were not disappointed.

A feast of fish and ugali

Samuel - my VSO colleague in Kisumu -
thrilled at the prospect of our lunch

Fish before

Fish after
As our office, in conjunction with partners, continue to push eMTCT I hope to make similar visits to areas where we are focusing on elimination and keeping mothers alive so I will be sure keep you all posted.

Happy out by the lake

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