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MSF in Kenya, 2006
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Photo © Dieter Telemans
In the early months of 2006, the consequences of three consecutively failed rainy seasons tipped the mainly pastoral population of northern Kenya over the brink. With the onset of child malnutrition, MSF set up a therapeutic feeding program in the northeastern town of El Wak, treated over 500 children for severe acute malnutrition and immunised 19,000 against measles. Responding to the urgent need for water, MSF trucked hundreds of thousands of gallons to five districts in the region.
Across the north of Kenya, the drought had a devastating impact on livestock. In El Wak, the bleached white earth became littered with carcasses of goats, cows, donkeys and camels — a crippling blow to the people of this neglected region. In this part of Kenya, animals are the lifeblood, serving as wealth as well as the primary source of nutrition.
"When we opened the office in El Wak, people would turn up at the door literally begging for water."
MSF emergency co-ordinator Ibrahim Younis
An MSF nutritional survey in March showed 30 per cent of children to be severely malnourished and many more teetering on the edge. When torrential rains eventually began in April, children already weakened by malnutrition developd diarrhoea and respiratory infections. Their nutritional status also worsened. During the month of May, the admission rate in El Wak increased by 50 per cent over previous monthly averages, and MSF began to see children suffering from kwashiorkor, the form of severe malnutrition that creates swelling and is caused by insufficient protein and acute infections, all a result of insufficient food intake.
In May, a second intervention was started 400 km west, in three of the most arid regions in Marsabit District. MSF adopted a simplified strategy and ensured maximum mobility of the team to effectively reach the scattered, pastoral population displaced by ongoing inter-clan conflict and widespread loss of livestock. Two mobile teams provided biweekly medico-nutritional assistance in 35 sites in villages or peripheral settlements. By the end of June, 700 children at risk of death were enrolled in the treatment program and some severe cases were referred to health structures including the district hospital, where MSF set up a therapeutic facility.
Improving HIV/AIDS care
For the past decade, the primary focus of MSF's work in Kenya has been HIV/AIDS. MSF provides a comprehensive package of care, from testing through to treatment, in the slums of the capital, Nairobi, as well as Homa Bay and Busia in the west of the country. By March 2006, over 8500 people were receiving antiretroviral treatment (ART) from MSF sites and over 17,000 were enrolled in the projects.
In Homa Bay and the Kibera and Mathare slums of Nairobi, MSF has specialised in the treatment of HIV/AIDS and tuberculosis (TB) co-infection. Immune systems weakened by AIDS help to fuel tuberculosis and one of the objectives of the projects is to develop an optimum treatment strategy. MSF is piloting the field application of high-tech diagnostic methods to increase TB case detection amongst patients who are co-infected with TB and HIV. In the sprawling Kibera slum, MSF runs three clinics, two including HIV/AIDS as one part of a full primary healthcare package, with a particular focus on mother-to-child healthcare. Early diagnosis of children born to HIV-positive mothers is now accessible at all these sites and there has been a significant increase in treatment of infected infants below 18 months of age.
Handover to local authorities
After building an HIV/AIDS clinic on the grounds of Mbagathi District Hospital, Dagoretti district, Nairobi, MSF has been providing comprehensive HIV/AIDS care alongside health authorities. MSF is now supporting the Ministry of Health to take over this project.
The goal of increasing access to treatment is showing the need to decentralise, and make care available at a greater number of sites — not only through peripheral health structures but also directly through the community, which is increasingly committed to participating in the follow-up of newly tested patients and supporting people new to treatment.
In Kenya as a whole, only about 75,000 of the more than 200,000 HIV/AIDS patients who urgently need antiretroviral therapy now receive the drugs, according to the health ministry. In June 2006, the government made the positive step of providing free HIV/AIDS care in all public health facilities: a vital move given more than 60 per cent of Kenya's 33 million people live on less than one dollar a day and about 1.2 million Kenyans are HIV-positive.
MSF has worked in Kenya since 1987.