At 5:30pm, an AMREF Cessna Caravan piloted by Captain Daniel Baton was cleared for take-off. On board were Dr Kizito Osundwa and nurse Kilda Begisen. Both had taken part in countless evacuations, but neither had been involved in a case involving Siamese twins.

After 45 minutes, the light aircraft landed at an airstrip in Tabor Hills, 20km from Nyandarua. An ambulance was waiting nearby, as well as a large crowd of adults and children. On touch down, the AMREF team rushed to the ambulance, where they were briefed on the action taken by the medical team at the hospital and the condition of patients. The babies were then put into an incubator in the airplane where there condition could be monitored electronically. Their mother, Monica Wairimu, still suffering the after-effects of a caesarian operation, was assisted from the ambulance to the plane and immediately put on a drip. Her husband Elijah Maina accompanied his fragile family.

When everyone had settled in, Captain Baton prepared to take off again. It was 6:45pm. The plane’s rotating propellers pushed the swelling crowd back. Once airborne, an easy calm descended in the cabin. As Kilda did some paperwork, Kizito made sure the twins and their mother were comfortable.

Most rural hospitals are ill-equipped to anticipate or handle emergencies such as this. An obstetric ultra sound scan could easily have detected the nature of the pregnancy, protecting the mother and her children to unnecessary danger. As it is, doctors only got to discover that Monica was having twins after the incision for the Caesarean section was made. They had noticed that the baby’s presentation was peculiar as it was lying across the abdomen rather than head down, prompting them to perform the C-section.

The quick evacuation would ensure that Monica’s babies received the specialised care they needed. As the plane touched down at the Wilson Airport at 7:30pm, a waiting Flying Doctors ambulance moved in, ready to whisk them off to the Kenyatta National Hospital.

The 1st International Canoeing Marathon in Kenya will be from 5-8 November, 2008 starting from Malindi to Mombasa by sea. The event which was launched in Mombasa at the Tudor Water Resort in June has already drawn a lot of international attention and will see several renowned canoeists including Italy’s World Canoeing Champion Francesco Gambella and Kenyan champion Seif Patwa go round Mombasa Island on kayaks.

The themes for this year’s race will be: “Challenge your Horizon” and “Give the Gift of Water".

The Marathon is not all adventure and ocean waves but has also a social responsibility component whereby part of the proceedings raised from the event will go towards the AMREF’s water and sanitation activities at the Coast; specifically the Malindi school health project. Speaking at the launch of the event in June this year, the team Leader of the Italian Canoeing team Mr Francesco Gambella was optimistic that the event would be successful. “I am really looking forward to a fruitful event with very good participation”, he said.

International teams from Kenya, South Africa and France are expected to participate. Corporate teams of 4 are also encouraged to register for this exciting event.

The Kenyan government has given notable support to this event with the Ministries of Sports and Tourism throwing their full weight behind it. This is a Fundraising initiative of AMREF in Italy supported by AMREF in Kenya.

Since 1957 AMREF Flying Doctor Service has been involved in air rescue, evacuating patients from remote areas to appropriate medical facilities. The main operation is in Kenya, but more and more flights, and requests for flights are carried out from neighbouring countries. AMREF has always ensured that their airborne services are available to people in need, who cannot afford to pay. Until today, emergency evacuations are provided free of charge to the poor

The current poor economic conditions in the region are such that governments fund mainly preventive health care and little funds are left for curative services, the funds for curative services are further consumed by an ever-increasing HIV/AIDS epidemic (40-60% hospital bed occupancy in East African region is due to HIV/AIDS related illnesses).

Rural district hospitals in these uniquely difficult environments, suffer not only from harsh living conditions, isolation, often lack qualified health personnel, but also have difficulties in obtaining supplies and supervision due to problems with communications and long distances from referral centers. Health workers also have little opportunities to up date their knowledge and skills through continuing education. Most rural district hospitals in East Africa lack the capacity both in terms of human and financial resources, essential supplies and equipment needed to provide specialist health care.

Most requests received by AMREF Flying Doctor’s 24hour control center in Nairobi are from northern Kenya where living conditions are harsh, medical facilities few and far between, the road network insufficient and the majority of people living at an existential minimum. AMREF Flying Doctor Service evacuates these patients free of charge to medical facilities to receive appropriate medical care as a life saving measure. Without the assistance from the Flying Doctors, their lives would have been lost.

Such requests impose a burden which is both financial and moral on our service. AMREF Flying Doctor Service has given itself the mandate to avail their prime Air Ambulance Service to the most disadvantaged people of Kenya free of charge. The finance for such charity evacuations comes from a ”Charity Evacuations” budget.

Current Policy Guidelines

AMREF must make the best use of limited donated funds, and cannot fill the gaps in medical provision to everybody and all over the country. Consequently, a number of guidelines have been developed to help decide if free medical care is both appropriate and possible. These are:

Medical Considerations

• Is the patient in a life threatening condition?
• Is the prognosis for the patient likely to be significantly improved by air ambulance intervention?
• Does the patient have a good chance of surviving the evacuation flight and benefiting form any subsequent treatment?
• Are there any other effective ways of helping the patient?
  

Social Considerations

• Is the patient a supporter of dependants, especially children?
• Will the patient have the means to return home after the treatment?
• Will being far from home, relatives or people who speak the same language create major problems for the patient or compromise the treatment?
• Will the event of death at a location far from home create an irrevocable burden to the family/ relatives?
  

Other considerations

• Does AMREF have a suitable aircraft available? (AMREF will not normally charter aircraft for a free evacuation)
• Does the weather allow an immediate response?
• What will be the financial implications of the need to repatriate a patient home again after treatment?
  

Funding

• Is the patient covered by insurance, employers’ medical policy, government medical scheme, or any other means by which the flight can be paid for by a third party?
• Does the patient or family appear to have adequate funds to pay for the flight in part or full?
• Will the patient be able to contribute to the cost of treatment at the hospital to which he/she will be carried?
• Does AMREF currently have funds available in the “charity evacuations” budget?
  

Every year between 10 and 15% of AMREF Flying Doctors’ evacuation flights are on a humanitarian basis. To ensure that Flying Doctors can continue this vital activity, a fund needs to be established that can guarantee enough money at any given time to be able to respond to emergencies of deserving people who otherwise would have nowhere to turn to and whose lives would be lost.

The Flying Doctor Society is a non profit organisation. The money not used in evacuating our members is used to undertake charity evacuations and outreach services within AMREF.

Read the stories about some of the charity evacuations that have been funded by our members:-

Charity Evacuation – Wamba Mission Hospital

Charity Evacuation of Siamese Twins - August 13, 2008

AMREF will be flagging off a 15 km peace race under the theme: “Running Side by side for Peace” The race will be flagged off at the Jamhuri show ground arena on Sunday, April 27, 2008 at 8am by Paul Tergat, 5 times world marathon champion, John Ngugi – 5 times world cross country and an Olympic gold medallist, Patrick Sang, Olympic Steeplechase silver medallist, Austrian Ambassador to Kenya H.E Roland Hauser and the AMREF Deputy Director General, Dr Florence Musiime.

The theme for this race is: “Running Side by Side for Peace” in pursuance of peace and healing in for the nation following the post-election crisis. The race will be run by Kenyan athletes from mixed ethnic communities signifying one nation & one people. In the team will also be the Kenyan athletes who have been slotted to compete in the AMREF Salzburg International marathon on May 4, 2008.

The peace race is one of the activities we are undertaking as part of our emergency and development activities in the informal settlement of Kibera, Kawangware and Dagoretti. The race targets communities from Kibera and Dagoretti who are partners in AMREF’s work and who were most affected by the post election violence. However the race will be open and free for entry to all.

Registration centres are at the AMREF offices -Wilson Airport, and the AMREF Training Centre/HQ on Lang’ata Road next to Sunshine School as well as the Athletics Kenya offices in Riadha House. Other centres are at Kibera AMREF clinic and AMREF Dagoretti Child in Need Project office at Dagoretti - DO’s office.

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AMREF Launches $1.5 m Global Appeal for 'Kenya in Crisis'

Activities Resume at the AMREF Dagoretti Children in Need Project...

AMREF Takes Africa's Voice to World Economic Forum 

'Kenya In Crisis' Update of AMREF activities at Jamhuri Park

War/Dance Nominated for Academy Award

Government tells displaced families to leave Jamhuri Park

AMREF initiated Documentary Film, War/Dance, Nominated for Oscar

HIV AIDS and TB Patients Unable to Access Treatment in Kenya 

Jamhuri Camp Reopened 

Baby Ryan Can Now Smile 

AMREF Mobile Clinics bring hope to Kibera

Measles Outbreak Feared in Kibera

AMREF Warns: 'Silent Emergency' Remains Even as Peace Beckons

'Camping' at Waithaka hill

AMREF to lead Continental Network 

Let Communities Guide Decisions on Development of Health Workers

Kenya Airways Launches Charity Kitty to Change Lives

Peace in Kenya: The Sick Can Now Access The AMREF Kibera Clinic

Kenyas Political Unrest - Thoughts and memories from Kibera

AMREF Board Member Receives The Hideyo Noguchi Africa Prize 2008

Thinking Outside the Box to Meet Health Workforce Needs

Running Side by Side for Peace

Village Health Teams: Setting the record straight!

Katine Community Gets into Drivers Seat

AMREF to host talks on community participation in health at global forum

Community Partnering - The Missing Link

NGOs Launch Code of Conduct to Support Public Health Systems

Responding to Crisis: Lessons from Kenya’s Silent Emergency

Katine Website Wins An Award

AMREF Seeks Effective Approaches to Save Africa’s Mothers and Children

Hammers Keeper Spreads Goodwill and Soccer Skills in Kenyan Slums

Shortage of Personnel Hurting Delivery of Anaesthesia in Africa

 Two weeks into a peace deal signed by feuding politicians in Kenya after weeks of politically and ethnic-instigated violence, AMREF talked to staff and clients at its Kibera Community Health Centre in the heart of the sprawling Kibera slum in Nairobi. They shared their thoughts, relieved memories of their experiences at the height of the bloodletting and told of hope in a new Kenya.
 

George Olali, Counsellor/ Patient Attendant and Kibera Resident

The chaos that swept through Kibera soon after the announcement of the disputed Presidential Election caught me unawares in my Soweto village home here in the slum. Supporters of the rival candidates were fighting - people were hacking others with machetes, others shooting arrows while shops were being looted and houses razed down. I quickly moved my family and valuables to safety in the neighbouring Highrise Estate while I remained behind to guard the house and other property.

In the most chaotic week, I could not access this clinic. Worse still, my appointment- I am living with HIV- to pick up Anti-Retroviral (ARV) drugs fell in the period and as fate would have it, I missed out on taking the daily dosage. Even then, the clinic had closed down owing to the crisis. I was in a dilemma as I remained hostage in my house. I could not venture out, for doing so would mean risking attack or death. Like many in the slum, I went hungry as the nearby food kiosks had no supplies or had been looted dry or burned down altogether. By not taking drugs and not eating well, I was exposing myself to infection for there was the danger of my immunity going down.
Things only brightened up when mediation talks started between President Kibaki and Orange Democratic Party leader Raila Odinga. The clinic eventually opened its doors and I made it to work as well as to replenish my ARV dosage. We, the Kibera community have received the news of the peace deal well.

Normalcy is slowly returning here, though there is still tension and fear whether the deal will hold. We are still apprehensive, fearing our neighbours may again turn against us. The clinic is experiencing renewed activity as people displaced by the raging conflict return. I am seeing more clients return to the ART clinic as those who defaulted in taking their ARVs or TB therapy are showing up.

Winfred Nzioka, Project Officer-Nursing Department

While I do work in the various areas - like the Ante-Natal Care, Maternity and the Family Planning Clinic, I also coordinate all the nursing activities in the centre. The chaos interrupted all our services and the numbers of patients just went down. The otherwise 24-hour service at the maternity had to be changed to a day only service. We referred mothers seeking services to either Pumwani or Lang’ata maternity. Some of the staff (nurses) could not return to work on time after the festive (December) season.

While the clinic operated, we had a difficult time tracing our clients within the slums. Some areas had become no-go zones, and the clients could not reach the health centre. Even our community health workers would not venture out of or into some of the villages in Kibera. However, AMREF was innovative enough and we launched outreach medical clinics to follow-up on the Kibera slum population. We organized clinics at Highrise Estate, at the Kibera DO Grounds and at Mashimoni village.

Following the peace mediation talks, there is a gradual return to peace in the vast slum. AMREF has played its part and has had its Community Health Workers preach peace and a group of youths engage in puppetry to promote peace across Kibera slums. Now, the sick are trickling back to the clinic. But there is fear still and some people are apprehensive. It will take some time before real peace returns. These include those who were displaced, were attacked by rivals or had their property looted. Others had houses burned or lost relatives to the violence. Personally, I have a soft spot for women and tales of gang rape at the height of the clashes still haunt me. This coupled with the fact that I had to accommodate some of the displaced from the Rift Valle Province has affected me psychologically. I need some counselling.

Lavenda Owino, Mother seeking service at the AMREF clinic

I live in Siranga village in Kibera slums, about 30 minutes-walk away. I brought my daughter Gloria for medication. She has had a bad cold, is coughing and has sores on parts of her body. She was born four months ago and before the “war”, I always brought her for clinical examinations here at AMREF. It is the same with her other 10-year old sister. You see, I have always liked this clinic for its good service. It is cheap seeking treatment here. I only pay Sh50 (US$0.8) for the child while we adults are charged only Sh100 (US$1.5). Drugs are available here for free. Personally, I have sought services at the Family Planning Clinic as well as the general outpatient section.

Sadly during the crisis that hit Kibera in January (2008), none of us from Siranga would dare venture to Laini Saba where the AMREF clinic is situated. Residents in the two villages viewed each other with suspicion and as political and ethnic rivals. For her (Gloria) clinics, I had to walk all the way to Kenyatta Market and skip the AMREF clinic appointments. That was very far compared to this place. Many people in my village were attacked and injured and we would not bring them here for fear of being attacked on the way. Some even died before we could get them emergency treatment.

But now, there is change as peace beckons. People are slowly rebuilding their shattered lives. Food is now available while prices are coming down. I am now ready to resume my vegetable business in the slum. Those who had fled Siranga and other areas are coming back. As regards our health needs, there is hope. We can now access the AMREF clinic and people are generally happy.

Caroline Manyasi, Mother to Reagan Alwanga
 

I am happy that since (President Mwai) Kibaki and (ODM leader) Raila signed the peace deal, we are witnessing signs of peace in Kibera. It is now possible to crisscross much of Kibera. When the fighting was on, the people from my village could only venture up to Shimo La Tewa area of the slum. Now we can come all the way to the AMREF clinic in Laini Saba. That is how I have made it to bring Reagan. He is suffering from a lack of appetite and running nose. I have only paid Sh50 (US$0.8) and been given (displaying) all these drugs. I hope he will get better soon.

At the height of the conflict, my mother fell sick and we had no otherwise but to take her to a health centre in Karanja. There I paid Sh100 (US$1.5) and spent another Sh350 (US$5.4) on drugs from their pharmacy. Yet they still advised me to go and buy another Sh300 (US$4.6) drug! This is too much money for me. If AMREF (clinic) was accessible, I would only have paid Sh100 (US$1.5) and got all the drugs free.

Besides, when you walk around Kibera, there is no machete-wielding youth to inquire of your name and tribe. There is no chance one will not be beaten up by mobs of youths or police. People are free to go about their business as well as go to work outside the slum. Peace is also good for this (AMREF) clinic. It offers us cheap medical services. We, the mothers and our children are big beneficiaries. My sister gave birth here sometimes back and it would be great if the maternity operated fulltime again.

Maria Tororey, Clinical Officer
The chaos found me upcountry in the Rift Valley. I could not come back to work as travelling to Nairobi was next to impossible. What with the rampaging youths blocking highways and attacking and killings travellers? Even when I made it to Nairobi, I could not get to work immediately. Kibera was engulfed in skirmishes and it was not safe to move around.

Our (AMREF) clinic shut its doors to the public for some days and even when we returned, anxiety was still there. Everyone was monitoring the news of the conflict with bated breath. Few people dared to venture here to seek treatment. Some of our ARV clients could not access Laini Saba and missed out on their vital dosage. But with peace unfolding, they are coming back while the patients coming daily are on the increase.

Anxiety is now gone, replaced with bright faces. People can discuss development and other issues other than the bloodletting and politics. It is a welcome situation. I can now freely attend to patients, diagnose them - without much fear of attack. A number of people seeking medical help are showing signs of trauma and I have had to counsel them. Others, I refer to the social workers. A number of patients I have seen in the recent past had malaria, diarrhoeal diseases, respiratory tract infections and skin diseases. I have also attended to HIV and TB clients. It is nice to see this (AMREF) clinic vibrant again and coming to the aid of the sick and suffering. I am optimistic all will be well and the community will be free to enjoy our services in a peaceful environment.

Queen Wambua, Laundry Section, also Kibera resident

The chaos that broke out soon after the announcement of the Presidential Election results affected us a great deal- here at the clinic and the slums. We, the residents of Kibera’s Laini Saba could not get to the market, we could neither get to the railway line (cutting through the slum) nor get to the football field (both are on the exit routes from the Laini Saba side).

It was impossible to come to work at times when violence reared its ugly head in Kibera. I had to keep some staff residing out of Kibera updated on the security situation in and around Kibera. Some of the sick would call on me wondering when the (AMREF) clinic would open so they could access medical services. ART and TB therapy patients suffered most as they could not get their daily dosage when the clinic was shut or when they could not just make it to the facility. I advised some of them to check with Kenyatta National Hospital or Lang’ata Health Centre for the requisite drugs.

The conflict inflicted deep wounds that are hard to heal soon. The tribal fights had people displaced, property lost or destroyed, houses burnt and people maimed or killed. Now that the leaders are agreed on the way out of the crisis, they should get the ordinary people to reconcile. There is need to make amends- those who lost property or businesses must be compensated. The government should extend loans to people while all must be assured the peace deal is a serious undertaking.

Kenya Airways (KQ), the African Medical and Research Foundation (AMREF) and the Rotary Club of Nairobi have launched a US$900,000 (Ksh 63 million) charity programme to improve the lives of Africans.
The three-year programme, called 'Changing Lives', will fund projects that facilitate access to water, education, environmental sustainability and health care.

AMREF and the Nairobi Rotary Club are implementing partners of the programme, while KQ will raise the money by encouraging passengers on both international and local flights to donate loose change. The airline flies three million passengers every year, from whom it hopes to collect US$300,000 annually for the next three years.

“AMREF and the Rotary Club, in consultation with Kenya Airways, will invest the funds in activities that ensure disadvantaged people meet their basic needs and are able to live with dignity,” said Mr Titus Naikuni, the airline's Managing Director.

Of the total amount targeted, US$50,000 will be collected on local flights, and US$250,000 on international flights. Donations will be put into specially designed envelopes that will be collected by in-flight attendants. The attendants, who are the official ambassadors of the Changing Lives programme, have undergone a three-month preparatory course to ensure that the initiative is a success.

The Rotary and AMREF brands are globally recognised and respected with a presence in countries where Kenya Airways flies. “This is an excellent opportunity for Kenya Airways passengers to get involved in projects that directly touch the lives of people, improving their health and livelihood,” said Dr Michael Smalley, AMREF’s Director General.

 AMREF has called for the inclusion of communities as core decision-makers in the health care they receive, and resultantly the numbers and skills of workers deployed in the health system.
The First Global Forum on Human Resources for Health being held in Kampala, Uganda, asked governments to "determine the appropriate health workforce skill mix" required to deliver adequate quality health care in their countries. While the focus has been on the 'push' to train additional health workers with appropriate skills to deliver health care, AMREF believes that it ought to be more about the 'pull' of communities.

"We continue to argue for the central role of communities within the health system itself and in determining the services they need, the quality of those services, and therefore numbers and skills of health professionals that are needed," said Dr Michael Smalley, AMREF Director General.

Migration and retention of health workers were key concerns at the conference, convened by the Global Health workforce alliance to discuss a plan of action to tackle the accelerating health human resource crisis around the world. It is estimated that four million additional health workers are needed to deliver essential health care worldwide, one million of these in Africa alone.

In what was dubbed the 'Kampala Declaration and Agenda for Action', developed countries were asked to give priority to training and recruitment of their own health workers to stem the bleeding of vital health personnel from poorer nations. Similarly, both rich and poor countries were asked to establish appropriate mechanisms to encourage retention of their health workforce, including adequate pay and other incentives, safe and enabling working environments with opportunities for career growth, and tailoring of training of health workers to the needs of local communities.

The conference mandated the World Health Organisation to speed up negotiations for a code of practice on the recruitment of personnel worldwide. Suggestions were made for compensation arrangements between source countries and receiving countries, legal agreements and limits to recruitment of foreign health workers, and even arrangements for one country to train health workers to meet the health needs of another.

Dr Michael Smalley noted that failure to comprehensively address the health worker crisis in the last three decades had contributed in many ways to the weak health systems in Africa, hence the importance of the conference.

"AMREF is excited that a global gathering such as this is at last discussing an issue that has been central to our work for 50 years. We have long recognised the critical importance of providing appropriate skills to all health workers, including doctors, nurses and community health workers to ensure a workable and sustainable health system."

He added: "A number of initiatives that AMREF has been involved with have been shown to be relevant this week. These include the training of comprehensive nurses in Uganda to give them skills that are appropriate to community needs and do not pre-equip them to emigrate. There was also great interest in innovative approaches, and in particular in the e-learning project that AMREF has been managing in Kenya with Accenture, the Nursing Council of Kenya and the Ministry of Health. We are delighted to be able to share our experiences with others at this forum."

He reiterated AMREF's commitment to engaging with the GHWA as part of the AMREF’s strategy to strengthen health systems that are appropriately structured and adequately staffed. Outgoing AMREF Board Chair Prof Miriam Were is on the board of the GHWA, while AMREF Director of Capacity Building, Dr Peter Ngatia, is a member of the African Forum.

 

For further information please contact:   Betty Muriuki – AMREF Writing Manager, on +254 20 6993327, Cell: +254 726 261495, email: betty.muriuki@amref.org Bob Kioko – AMREF Communications Manager, on +254 20 6993111 or Cell: +254 735 546440, email: bob.kioko@amref.org

These IDPs had resisted the 25 February closure of the Jamhuri Park camp, refused to follow the government’s request to report back to the Chief in Kibera and return to their homes.

"We have had been hiding out “in the bushes” near Jamhuri. When the private guards from the showground found us, they threw their meagre belongings over the fence, where they were promptly looted and they organised our eviction”, says Naomi Njeri, one of the new arrivals.
Basically, this group of families, mainly from one ethnic group, claim they cannot return to Kibera as they are too frightened and do no trust their neighbours. Others claim that only a part of them are actually escaping from fear while many are taking advantage of the situation, of the confusion, to obtain some sorts of benefits. The fact remains that they are now “camping” on the Waithaka hill.

This new camp is now set up on the bare ground of the local administrator’s office compound. It has no running water, 2 old latrines and no security. The local Chief expects it to be closed within two or three weeks, but as most of these
people have been on the run since December 29th, the night the election results were announced, it is anybody’s guess when they might leave and – most importantly – where they might go.

Already on the morning of Friday 29th, AMREF installed water tanks and is currently still providing the required supplies. Today the AMREF staff organised for some barbed wire fencing to be installed around the camp, so as to protect these new residents. Other AMREF partners are providing food and portable latrines. Volunteers from a group of local churches were at the camp to provide the much needed help.

Waithaka’s 258 new residents are living under plastic sheeting hung from ropes tied to trees. They often sleep on blankets on the bare ground and if, as expected, in the next days or weeks the long rains arrive, they will soon be living in muddy mire.

AMREF will up its support for peace building efforts in the sprawling Nairobi’s Kibera slums.
The “silent crisis” still permeates the country in general, especially in the areas ravaged by the tribal violence that saw more than 1,000 people killed and over 300,000 displaced, the AMREF Kibera Project Manager, Mr Sakwa Mwangala said yesterday. Even as a deal was sealed between President Kibaki and opposition leader Raila Odinga on Thursday, Mr Mwangala noted that the effects of the bloodletting remain to haunt the victims. Trauma does not end quickly, but gradually.

“The silent emergency is still there. People are (still) traumatized (by the violence) - they lost their loved ones, had their houses burnt or are displaced,” he said. Mr Mwangala was however positive that the new deal witnessed by among others chief mediator Koffi Anan and Tanzanian President Jakaya Kikwete would usher in calm.  

Though the AMREF clinic in the heart of Kibera slums has not been specifically affected by the conflict that has raged on since the New Year, patients from various communities who were (previously) attended to at the clinic were unable to access it due to the ethnic tensions. The health centre experienced up to a 30 per cent decrease in outpatients and lost track of 60 per cent and 30 per cent of AIDS and TB patients respectively. Yesterday, Mr Mwangala noted that the community health workers and social workers have in the period reported an increase in gender based violence in the slums. He remarked, “People are jubilant following the peace deal, but emotionally, there are still challenges. The effects of gender based and other forms of violence, is a major crisis.”

AMREF’s approach, he added, would be to integrate health support throughout Kibera. AMREF is getting the private (health) practitioners to refer cases to the AMREF clinic in Kibera. Also through faith-based organisations, local community based organisations, the village elders, youth and women; AMREF is supporting various peace efforts in the largest slum in the country.

“We will give support to peace building in Kibera. We will facilitate peace activities such as sponsorship of games and other conflict resolution events bringing together different communities,” Mwangala said in an interview.

Following the post-election crisis, AMREF has kicked off a series of mobile clinics aimed at reaching the Kibera communities affected by the violence. Services offered have include; child welfare, VCT; laboratory and Family Planning.

AMREF has also been providing measles vaccines and other immunization services, vitamin A tablets and deworming; facilitating preventive, promotive and curative services for malarial and other diseases, providing basic laboratory tests and psychosocial support in cooperation with other partners.

18 Feb 2008   

A measles outbreak is feared in Kibera in the heart of the Kenyan capital city, Nairobi.

At least 12 suspected cases of measles – a contagious disease that can also become a leading cause of death especially in children already suffering other infections – were reported over the weekend by AMREF’s mobile clinic team in Kibera. A week earlier, three other cases had been diagnosed by another AMREF medical team at the Highrise Estate camp for displaced persons from Kibera in the post-election violence in Kenya.

AMREF is working with the Kenya Medical Research Institute following the clinical diagnosis of measles.

A measles outbreak is expected to touch off an immunization drive in the extensive slum through combined efforts by the Ministry of Health and other health-related organizations and UN agencies.

The post-election strife has certainly set the stage for outbreak of diseases such as measles. In areas experiencing or recovering from war, civil strife or natural disasters, infection rates have been known to soar because of the poor state of infrastructure and health services, which interrupt routine immunization. Also, overcrowding in camps for internally displaced people greatly increases the risk of infection.

During a recent clinic session in Kibera, AMREF found that the majority of nearly 800 patients suffered respiratory infections, followed by rheumatism and joint pains, intestinal worms, diarrhoeal diseases and skin infections.

AMREF’s Dr. Khisa Wakasiaka said AMREF treated 306 children and 438 adults in one day. Dr. Khisa said that women are bearing the brunt of the violence and are suffering far greater trauma compared with their male counterparts. They were victims of sexual violence and witnessed family members being killed or brutalized. Many had lost property to looters and arsonists.

20-year old Evelyn Amati and her newly born daughter are still nursing a vicious cough. Like many other children in Kibera recently, Baby Sylvia has a blistering skin and rash covering her tiny mass.

The cough and the other complications have lingered on for six weeks-the entire time that Baby Sylvia has spent in the world.

“We have suffered like this since she was born. We haven’t had any (medical) help,” Amati says.
Amati explains that moments after baby Sylvia was born, she and her mother woke up to find Kibera slums burning. The announcement of the Presidential Election results touched off a wave of rioting in the vast slums. Mobs baying for blood were razing down houses and businesses, and police had reacted fast, clobbering people and throwing teargas canisters into the rioting crowds.

Alarmed, the nurses attending to her and the baby took off and bolted the door from outside. The two were “prisoners” throughout the terrifying dark night, with no food and no company. Fumes of teargas and smoke from burning tyres and property filled the tiny maternity choking her and her bundle of joy. But there was no escape.

Last weekend, Amati was all smiles as she lazily walked to the AMREF mobile clinic in Kibera slums. She radiantly hoped that all would be well for her and the child.

Single and unemployed, she says that despite the disturbing cough, she did not a have even a single cent to pay for treatment at the nearest private clinic. Besides, she has been too scared to venture far away from her shack in Makina slum in Kibera for fear of tribal gangs that roam the area brutalizing people and destroying property.
Proudly showing an assortment of drugs she received from the pharmacy at the AMREF mobile clinic, she said in an interview, “I am very happy with AMREF. The doctor has reviewed my case and I am sure we will get better now.”

AMREF is offering treatment for diseases but also teaching local community members on ways to avoid common diseases through simple hygiene; the clinics also offer child health; VCT; laboratory and family planning services.
Apart from the physical trauma, many are seeking counselling services.

George Olali, a counselor with AMREF says, “Since the wave of violence started, there has been a lot of burning of houses which has affected communities. People have been displaced, others relocated on their own will. Many have witnessed people being killed or beaten and are extremely traumatised.”

Majority of those seeking services at the AMREF mobile clinics are women and children. 12 cases of measles have already been reported. Other notable diseases diagnosed at the AMREF mobile clinics in Kibera include rheumatism, intestinal worms, diarrhoeal diseases, tuberculosis, eye infections and urinary tract infections.

In Kibera, most of the residents are employed in the informal sector or in low-paying jobs. In the present chaos many have lost employment and are relying on well wishers for food and basic services.

On an open ground in the heart of the sprawling Kibera slums, nine-month old baby Ryan lets out a feeble cry as he reaches for a bag his mother is holding in her hand. The clicking bottles arouse his curiosity, but the mother, Irene Musinzi holds him back.

Ryan has blisters on his neck and hands. His mother attributes this to teargas effects, “The teargas (canister) was thrown by the police at a rioting mob near my house in Mashimoni (a village in Kibera). The canister exploded emptying its contents in my house.”

She says that her single roomed shack was filled with the white smoke and shortly after that, Ryan’s blisters started appearing.

From the paper bag, Irene fishes out a skin ointment, a small bottle of a multi-vitamin and another containing a cough syrup. “I have been looking for this (pointing at the skin ointment) to apply on his neck in vain. Now I have it and I guess Ryan will smile too,” she happily says.

More such scenarios - smiles of hope punctuated with baby cries and music from the background and occasional announcement urging people to attend the free treatment - characterise the AMREF mobile clinics in Kibera. In response to the post-electoral violence, AMREF is heeding people’s cries for health solutions. The clinics are an emergency response to assist the displaced as well those who though staying in their neighbourhoods will not risk an encounter with bloodletting gangs on the prowl in the vast Kibera slums.

AMREF is offering treatment for diseases but also teaching local community members on ways to avoid common diseases through simple hygiene; the clinics also offer child health; VCT; laboratory and family planning services.

Majority of those seeking services at the AMREF mobile clinics are women and children. 12 cases of measles have already been reported while a majority of the sick- about four out of every 10 - had diseases of the respiratory system. In Kibera, most of the residents are employed in the informal sector or in low-paying jobs and in the present chaos many have lost employment and are relying on food donations.

Thousands of people living with HIV/AIDS and TB are still unable to access treatment in Kibera slum in Nairobi,
Kenya, following post-election violence in the country. Patients are staying away from AMREF’s health centre in the Laina Saba area of the slum for fear of being attacked. And health workers who go out into the community to visit patients in their homes have been unable to do so because of the tension in the slum.

AMREF’s country director for Kenya, Mette Kjaer, explained: “We’ve lost 60 per cent of patients who were on anti-retroviral (ARV) treatment and another 30 per cent of those on TB therapy.” Patients had to leave treatment behind as they fled for their lives, and are now unable to reach the health centre to replace it. AMREF’s Deputy Director General Florence Muli-Musiime explained that the situation “is similar to people being under house arrest. We don’t know where our patients are. We had a very good tracking system using our contacts in the community, but this has now broken down”.

Abigail Lukhwaro, a research assistant at AMREF’s health centre in Kibera, said that out of the 30 patients she usually works with, only five are coming to the centre. “Most of them live more than 30 minutes away and are just too afraid to attempt the journey here.”

She added that the situation is also causing problems for those who are able to get the drugs. “Patients don’t have access to the nutritious food that they need for the drugs to be effective. They are anxious and not sleeping well and are having stomach problems. All of these factors are reducing the effectiveness of the medication. One patient who visited the clinic told us she had only eaten porridge for the last three weeks. She lost a lot of weight and was unable to take the drugs as they were making her ill. AMREF has now given her nutritional supplements and she has started taking her medicine again, but there are so many people who we are unable to reach.”

AMREF’s volunteer health workers are desperate to get out into the community to continue their work but many have been threatened by vigilante groups. “Nobody trusts anyone,” says Sakwa Mwangala, AMREF’s Project Manager in Kibera. “The tensions are so high. In the clinic we have to operate on a strict number system so that we are not seen to be favouring any particular ethnic group.”

In order to address this grave situation, AMREF is ensuring that the current sensitivities are taken into account when deploying community workers, and is sending people to their own communities, where they can be trusted and are secure. AMREF’s mobile clinics are also being managed in a way that ensures that all communities are served.

 24  Jan 2008                                                                                                         

The Academy of Motion Picture Arts and Sciences announced this week that War Dance, a feature-length documentary filmed in Uganda, has received an Oscar nomination for Best Documentary Feature.

The film tells the story of three children from Patongo Displacement Camp in northern Uganda. Dominic, Rose and Nancy are members of a school music group who get a chance to compete in Uganda’s national music festival. Although each of them has a heart-breaking story to tell about the effects of the 20-year conflict in northern Uganda, the documentary captures their magical and courageous journey to one of the most exciting events in their lives.

The documentary also features interviews with the country director for AMREF in Uganda, Joshua Kyallo. AMREF has been working to promote health in the northern Uganda districts of Gulu, Kitgum and Pader, which have experienced insurgency for the last 20 years, forcing over two million people to flee their homes and settle in crowded camps for Internally Displaced Persons. AMREF activities in the region include provision of water, promotion of hygiene and sanitation, immunization services, prevention and control of HIV and AIDS, and development of health infrastructure.

War Dance was funded by Shine Global, a non-profit organization that is dedicated to ending abuse and exploitation of children through the production of documentaries and media products that raise awareness and inspire social and political change. Since 2005, AMREF has been working with Shine Global to draw the attention of the international community to the suffering of Ugandan children and families whose lives and opportunities for development have been destroyed by a senseless civil war that has gone on for too long. War Dance is a product of this initiative.

The awards ceremony for the 80th Annual Academy awards will be held on February 24, 2008, in Hollywood, USA. Over the past year, War Dance has won critical acclaim and many international awards, including the Directing Award at the Sundance Film Festival. Proceeds from the film will fund programmes in northern Uganda run by AMREF and other organizations.

The Government of Kenya has decided to close the camp for internally displaced people at Jamhuri Park in Nairobi where hundreds of families displaced in the post-election violence have been living. Consequently, the refugees have been asked to return to their homes by tomorrow, January 23rd.

The closure was announced despite strong lobbying by AMREF and other non-governmental organisations, including UNHCR, UNICEF, RED CROSS, IRC and MAP, who felt that the move was hurried. They asked that the government allow at least two weeks for orderly and humane repatriations.

But Nairobi West District Commissioner, Mr Evans Owankwa, who held a meeting with the NGOs yesterday, reiterated the government’s decision to shut the camp, arguing that calm had returned to most parts of the city, and the country, and security had been restored. He said that many of the people flocking into the camp now, particularly at mealtimes, were not genuine refugees but, paused a new security risk. Those leaving the camp would be given food and other essential supplies he said, while any one who will not have left by Wednesday will have their cases reviewed on individual basis and relocated to chiefs’ camps and churches in Kibera and parts of the city.

Although a few of the displaced people began moving out yesterday, many others were unhappy with the decision, saying that they had nowhere to go, as their homes and businesses had been burnt. Others said their houses had been occupied by other people and they did not know how they would get them out.

Following this decision, it was agreed that all relief work should continue as usual until Wednesday this week. By yesterday, AMREF had completed construction of 8 out of 12 toilets, and three bathroom blocks with four washing areas each. Four out of five water tanks had been installed, and five volunteers had already done a lot of education on sanitation and hygiene among the refugees.

“We are waiting to see what happens tomorrow before we decide what to do next,” said Gerald Rukunga, AMREF’s Head of Water and Sanitation. “In the meantime, we are considering installing the fifth water tank at Olympic Primary School in Kibera, where most children from the slum learn, and to relocate the remaining four toilets for use in the community.”

Tomorrow, Wednesday 23rd, AMREF holds a meeting for donor agencies, corporate leaders, and the diplomatic corp to highlight AMREF’s views on the humanitarian crisis in Kenya, and particularly the ‘silent emergency’ beyond the IDP camps, with focus on communities that are isolated within informal settlements and who cannot access basic services because of fear and insecurity. Those most adversely affected are women and children, whom AMREF intends to target in its outreach services to the community through services such as maternal care, family planning services and immunisation. Also targeted are TB and HIV/AIDS care.

The Academy of Motion Picture Arts and Sciences announced today that War/Dance, which features an interview with AMREF Uganda’s Country Director, Joshua Kyallo, has been nominated for an Academy Award for Best Documentary Feature. War/Dance was made by Shine Global Inc. and directed by Andrea Nix Fine and Sean Fine of Fine Films.

Set against the backdrop of Northern Uganda’s 20 year war during which 30,000 children have been abducted by the notorious rebel group the Lord’s Resistance Army (LRA), War/Dance tells the story of three children, Dominic, Rose and Nancy – and their schoolmates in the Patongo Internally Displaced Camp as they take an historic journey to Kampala to compete in Uganda’s national school dance and music festival – of which AMREF Uganda is a major sponsor.

According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) 90% of Northern Uganda’s nearly 1.7 million people (1.3 million people) have been displaced from their homes and are living in camps. The Uganda AIDS Commission (UAC) recently reported that there are nearly 180 camps in the region with population ranging from 5,000 – 65,000 people. The camps lack adequate water and sanitary facilities, medical care and other basic necessities.

“We are so very proud to have AMREF’s work included in the miraculous documentary War/Dance. In wars children are often silent casualties – and this incredible film gives them a necessary voice,” said Lisa Meadowcroft, Executive Director of AMREF USA. The documentary War/Dance offers a ray of hope amid utter devastation – and illustrates poignantly the resilience of the human condition.

Next month, Mena Suvari, AMREF USA’s Goodwill Ambassador, will be traveling to Northern Uganda to visit AMREF projects.

18 Jan 2008

AMREF’s activities at Jamhuri Park are well underway. This is in spite of some minor delays from suppliers, especially in the delivery of construction materials and water tanks, due to the ongoing clashes in Nairobi. AMREF is appointed the lead agency for water and sanitation activities at the camp, and has established a strong working relationship with key players including the Red Cross and the International Rescue Committee.

Over the last couple of days there have been renewed protests with more people seeking refuge in the Jamhuri Internally Displaced Persons Camp (IDP) in Nairobi. Those spending the night at the Camp have increased from a previous 1,100 to 3,133 consisting of various nationalities. These are: 2,893 Kenyans; 226 Ethiopians; 12 Congolese; and 2 Somalis. Daytime numbers are now up to nearly 7,000 IDPs.

So far, AMREF has delivered water tanks with a capacity of 25,000 litres. These have now been connected to the main water system and are fully functional. In addition, AMREF will be delivering a further 200 (20litre) containers to families along with 50,000 aqua tabs to ensure that all water is treated.

To ensure access to proper sanitation facilities, AMREF has already dug 12 pit latrines with support from the Nairobi Water Company. The latrines will be ready for use by Sunday. Toilet disinfectants have also been ordered and plans for the cleaning and maintenance of these facilities have been made for the next three months. Also, 8 bath shelters/ showers will be complete by 20th January.

Due to the increased number of residents in the camp, and to avoid disease outbreaks, 100 more toilets are needed. Currently, to control diseases outbreaks, such as malaria, cholera and dysentery, among others, AMREF, in partnership with Ministry of Health, is regularly spraying the grounds and sleeping places with a multiple effect chemical that acts as a microbicide and insecticide . Coupled with personal hygiene and sanitation training going at the camp, the spraying helps to protect the health of the people living under the difficult and challenging conditions at Jamhuri Park Camp

For the third year running, the African Medical and Research Foundation takes the African voice on health to the annual meeting of the World Economic Forum being held in Davos, Switzerland, from 22nd to 27th January.

“World business and political leaders increasingly recognise that without good health for their customers and workforce, we are not going to have any sustainable and meaningful economic development,” says AMREF Director General Dr Michael Smalley.

AMREF is concerned that there are presently too many unnecessary barriers that prevent poor and marginalised families from getting the quality of health care they need and which is theirs by right. And that is the message that the organisation is taking to Davos. With 50 years of experience working with African communities and governments, and as the only health development organisation from Africa at the annual forum, AMREF will be in a unique position to voice the needs and concerns of the continent’s people and discuss opportunities for business and political leaders to get involved in achieving better health.

“The serious health challenges we face in Africa can only be fixed within functioning health systems,” Dr Smalley said, adding: “It must be realised that the poor and disadvantaged communities across Africa in need of improved health care are part and parcel of that health system, not just passive recipients of what someone else decides they need. We must deliberately listen to concerns, priorities and issues of these communities.”

Recent events in Kenya have shown how fragile health delivery is for so many people, especially those living in slums like Kibera, where AMREF works. Although the Ministry of Health in Kenya has done an outstanding job in coordinating the delivery of health following the post-election troubles, there are many displaced people and even more people who remain trapped within slums unable to access any form of health care. Says Dr Smalley: “Business leaders attending the World Economic Forum have a role to play in helping improve health and health delivery for poor and marginalised people across Africa – through funding but increasingly through the sharing of practical skills and proven experience.”

An important topic at the Davos meeting will be the role of the private sector in public-private partnerships (PPPs) in health. AMREF has already played a leading role in shaping a WEF initiative using PPPs to strengthen health systems in Africa. “AMREF’s representation at the forum will continue to emphasise the role of political and business leaders in health delivery, ensuring that “we are responsive to the real needs of real people on the ground”, says Dr Smalley.

Dr Smalley will represent AMREF at discussions on the long-term future of AIDS; on what it will take to stop malaria; on public-private partnerships in health; and on health and workforce productivity.

During the sessions, both the street children and children in school are encouraged to share their experiences of the past weeks, including the violence they have seen, to analyse the implications of the current instability and to propose ways in which reconciliation can be achieved amongst the different groups and what benefits this reconciliation could bring. Finally, the children are being invited to think about what each one of us can do to bring back harmony and stability in our communities.

At the centre there were about 60 small children having their breakfast; the older children from Kawangware market were expected to arrive later in the morning to get some food, bath and wash their clothes.

Meanwhile at the IDP camp at the Jamhuri Park, AMREF is already at work building water tanks and latrines. The camp is currently home to over 5,000, mainly women and children, and AMREF is working with other agencies and government departments to meet water and sanitation needs.

Over the last two days, activities in Kibera and other informal settlements have been disrupted, as these areas have formed the epicentre of the protests. After a week of relative calm across the country, Nairobi, Kisumu, Mombasa and Eldoret have provided the stage for upheaval following renewed calls for “mass action” by opposition leaders over the contested December 2007 elections.

A mediation initiative that was expected to take off this week led by former UN Secretary General Kofi Annan failed to materialise after Mr. Annan postponed his visit.

AMREF has launched a global appeal to raise $1.5m to provide health care to victims of the post-election violence in Kenya that has left nearly 500 dead and over 300,000 people living in camps for internally displaced persons (IDPs) across the country.

AMREF already works in the places affected by the recent events such as Kibera, Kisumu and Eldoret. In fact, as Africa’s leading health organisation and having worked in Kenya for 50 years, AMREF is uniquely placed to intervene in the humanitarian crisis and protect the health of those affected.

“In most of the affected communities, people had very little to start with but the violence destroyed many homes and livelihoods. Families have fled their homes in fear, and thousands of people are living in makeshift camps with rudimentary water supplies, sanitation and health care. Many more are trapped in their own homes, afraid to venture out to seek health services,” said Mette Kjaer AMREF’s Kenya Country Director.

AMREF in partnership with the Kenyan government is applying its specialist medical skills and health sector experience in the most affected areas, including Kibera, one of Africa’s largest informal settlements. AMREF is launching three new mobile clinics to provide essential health services. Though AMREF’s Community Health Centre in Kibera, which was serving 97,000 people before the crisis, has re-opened, few people are coming for services due to the prevailing tension. AMREF Director General Dr Michael Smalley said: “The mobile clinics will be deployed in different areas, providing essential health services. This is back to AMREF’s roots. If people can’t come to us, we will go to them.”

The outreach will be extended to Kawangware, Dagoretti and Baba Dogo in Nairobi which are home to over 1 million of the most affected communities. AMREF’s work will focus on the needs of women and children, providing maternal health services, immunisation, health education, counseling, and HIV/ AIDS and TB care and treatment.

At the Jamhuri IDP camp in Nairobi, which is home to 4,000 internally displaced people, many have to share public toilets and water supply is sporadic. AMREF is concerned about the possibility of disease outbreak and is providing clean water, sanitation facilities and laboratory services. The laboratory will test anyone who gets sick so they can be diagnosed and treated quickly.

According to AMREF Deputy Director General Florence Muli-Musiime, though the worst part of the violence seems to be over, there is still great need. “People continue to suffer. Many are traumatized and living in make-shift conditions. The money raised will support AMREF’s appeal in Kenya. If we raise more money than we need the extra will go towards supporting our existing programmes in Kenya and other parts of Africa,” she said.

 

For further information please contact:   Betty Muriuki – Writing Manager, on +254 20 6993327, Cell: +254 726 261495, email: betty.muriuki@amref.org Bob Kioko – Communications Manager, on +254 20 6993111 or Cell: +254 735 546440, email: bob.kioko@amref.org

There has been debate surrounding the AMREF Katine Community Partnership Development Project Village Health Teams (VHT). The questions range from their expertise to the terms used to refer to them.

“Why are they called village doctors?”

“Why VHT and not community health workers like we have previously known them?”

“How do they diagnose, before giving treatment?”

All these were questions raised at the AMREF Katine Project stake holders meeting, held on April 3, 2008.

The village health doctors’ title has been controversial to say the least. It has been said that it may mislead the VHTs into thinking that they may have more technical expertise than they actually do or, that they may start assuming more medical roles than they are trained for. However, the fact is, that the title is based on a story title published a couple of months ago.

“This is not a term coined by the community or the project,” said Dr. Charles Luwaga, AMREF Katine’s project officer for health. “It was a creative name given to a story; it was symbolic if anything. It was just taken out of context”

VHTs don’t walk around assuming their village doctors because of the story that run, matter of fact, most of them are unaware of it.

Thirty eight- year-old Ebalu Moses who has been a VHT since 2001 has never even heard of the name. “If you were to use the title, people would assume you’re referring to herbalists or traditional healers rather than VHTs” he says

Part two. The reason VHTs are not referred to as community health workers, is the fact that AMREF believes very much in capacity building through the already existing structures. VHT is a structure that was developed by the Ugandan government. It was established under the Ministry of Health National policy.

“VHTs are the way to go in the decentralized health delivery system,” says Dr.Okadi, deputy district health officer, Soroti District. “They are in the policy of promotion and prevention of health care, most diseases are preventable and it is our role to empower communities to promote ways to prevent them.”

AMREF has been giving training to the VHTs; the most recent was the training on home based care of children illnesses.

“We invest and reinforce existing structures,” says Dr. Charles, we are giving training to the community itself for a more efficient and people driven service delivery.”

Initially, VHTs were broken into two groups. There were the mobilizers referred to then as VHTs and drug administers referred to as Community Medicine Distributors (CMDs). Nowadays, they are all just known as VHTs. They all receive training on diagnosis and treatment. However, there roles in both cases are limited to Malaria and diarrhea, which are some of the main ailments in Katine Sub County.

“The VHTs are not trained to conduct laboratory tests but simple clinical diagnosis” says Dr. Charles. As a government guideline, any fever cases for children beyond 2 months of age are treated as malaria. This is what the VHTs go by, since Katine is a malaria prone area.

According to a community survey conducted by the AMREF project in December 2007, malaria in children is a burden through out the year. Almost 8,000 cases, 63% of the total outpatient visited the three health centers in Katine between October 2006 and October 2007.

VHTs are only allowed to give first aid, or treat malaria and diarrhea through anti malaria tablets or oral rehydration salts for diarrhoea.

“Malaria is a huge problem that is being tackled by VHT; they are reducing the enormous pressure on the health centres. Many people who can not get to health centres due to the distance are also ensured of support. A single VHT supports 25 homes within his area of residence,” says Ekulu Emmanuel, a VHT parish coordinator, Ojom parish.

Twenty-three-year old Samuel Esagu is one of such. “I have been a VHT for the last 3 years; I walk around homes just to make sure that they have the necessary information. I also check on the hygienic sanitation practices and net use. If any one in the homes is unwell, I offer basic treatment or refer them to hospital.”

Nora Among, a mother of 2, from Obocoi Village, agrees, “VHTs help you quickly because they are so close by. Before, one would have to walk very far to get to the health centre or access medicine.”