Newly opened MSF clinic services patients in Africa's largest slum. Photo © MSF

On June 29, Doctors Without Borders/Médecins Sans Frontières (MSF) inaugurated a new medical clinic in Silanga, in the heart of the Kibera slum on the outskirts of the Kenyan capital, Nairobi. It is the third HIV/AIDS treatment clinic opened by MSF in Kibera, the largest slum in Africa with an estimated 1.2 million inhabitants.

The crescent-shaped slum covers several square miles and the houses–ranging from solid brick buildings to mud and stick shacks–are packed together amid a labyrinth of mud paths.

To reach the new clinic requires considerable local knowledge, as it would be simple to take a wrong turn on the winding streets. The sign for the MSF clinic hangs onto a bustling main path and directs you down a rutted track with roughly constructed houses to each side. The clinic appears seemingly out of nowhere. Standing behind it, the view contains a sea of ramshackle single-story homes, most with rusted metal roofs, spreading out in every direction.

In Kibera, no square inch of land goes to waste and the clinic is literally hemmed in by houses. Laundry is draped on a line just several feet from the front entrance. The conditions might seem far from the sanitary surroundings that people expect of a health facility, but the location of this clinic is deliberate–the closer to the people you work, the greater the chance of success.

"This is the aim of the new clinic," says MSF head of mission Christine Jamet. "We wanted to have it right in the middle of the slum to make it as easy as possible for people to get to. The three clinics are located in the east, west, and now in the middle of the slum."

The clinic will provide a comprehensive package of care for HIV/AIDS including the provision of antiretroviral (ARV) treatment, in addition to a range of other basic health services. The services, in cooperation with the Kenyan Ministry of Health, will be free of charge.

"Having free care is vital as the vast majority of the people living in this slum are desperately poor," says Jamet. "Even the smallest fee can prevent them from getting or adhering to treatment."

Catherine Atieno. Photo © MSF

Catherine Atieno is one of the nearly 500 people receiving ARV treatment from MSF in Kibera through the two other MSF clinics. Her home is a room of no more than 10 square feet, divided into two by a sheet hung from the ceiling. She lives with her four children and two left by her brother who died of AIDS in 1999.

When her sister succumbed to the disease in 2000, she too left behind children. Today they still live in Nyanza, some 200 miles from Nairobi, and also rely on what little money Catherine can earn.

"I used to fetch water for people and do bits of work here and there to earn enough money," she says. "When I first got ill I couldn't do this any more, so I couldn't pay the rent. We couldn't even afford food." It was as this point that Catherine heard about the possibility of getting free ARV treatment at the MSF clinic. She began taking the life-extending medicines in July 2003 and was soon able to resume working.

Today she looks healthy and smiles radiantly as she looks out of the window of her home. "Since I am well," she says, "I can look after my children." Life is still hard for Catherine, but the medicines she receives mean an enormous amount, not just for her but also for the children she supports. "I can provide for my children to go to school and I even hope that my eldest daughter will make it to university," she adds.

Catherine is one of the 5,000 people that are receiving ARV treatment from MSF in four locations across Kenya. But there are still 1.24 million Kenyans living with HIV/AIDS and it is estimated that 200,000 of them are in clinical need of treatment today. However, only 44,000 are receiving it.

Catherine is one of the lucky few and as Christine Jamet concludes, "the new clinic is another important step, but the capacity of MSF is limited and it is clear that there is so much more to do."

She adds, "There need to be dramatic improvements in the health infrastructure in Kenya, as there is a crying shortage of trained medical staff and adequate facilities. The high prices and limited availability of quality ARV medicines and treatment are also major obstacles in the treatment of HIV/AIDS that need to be addressed."

"Having free care is vital as the vast majority of the people living in this slum are desperately poor," says Jamet. "Even the smallest fee can prevent them from getting or adhering to treatment."