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MSF in Kenya, 2011
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For more than two decades, Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing medical care in Kenya. In 2011, MSF assisted both local people and the large Somali refugee population. Drought in the Horn of Africa aggravated the already dire situation for refugees in the overcrowded camps around Dadaab, in eastern Kenya.
A surge of people fleeing Somalia in search of safety, food, healthcare and shelter in the three camps of Ifo, Dagahaley and Hagadera resulted in a humanitarian emergency. The camps, which had been built for 90,000, swelled to a total population of nearly half a million, making the Dadaab area the third-largest city in Kenya. At the height of the crisis in July, malnutrition levels were well above the emergency threshold. Aid agencies struggled to cope.
Two new camps were opened – Ifo 2 and Kambioos. However, at the end of the year, some 5,000 refugees were living outside Dagahaley, unable to find a place to stay in any of the camps. Inside Dagahaley, MSF was the main provider of healthcare for nearly 125,000 registered refugees, and also catered for the needs of refugees referred to its hospital from other camps. The team tripled capacity, setting up an emergency nutrition center with more than 200 beds, while maintaining a 100-bed hospital for maternal care, pediatrics, emergencies and general medical assistance.
MSF conducted more than 170,000 consultations in its hospital and health posts in Dagahaley camp, over 4,000 more per month than planned. Admissions for nutritional support averaged at 350 per month. Over 11,500 patients were admitted to the outpatient nutrition program during the year. As most of the refugees from Somalia had had little or no access to healthcare for two decades, outbreak of disease was a major concern, and MSF launched a measles vaccination campaign.
After protracted negotiations with the government of Kenya and local communities, MSF began working in Ifo 2 camp in July. However, just three months later, in October, two staff members were abducted by a group of armed men, forcing MSF to reduce health activities in the camp.
As insecurity grew, refugee registration was closed. Refugees were no longer being transported to Dadaab or relocated elsewhere. There was a general reduction in non-lifesaving activities, which threatened to reverse the gains achieved during the year.
Liboi, 80 kilometres from Dadaab, is one of the primary crossing points between Somalia and Kenya. When the flow of new arrivals was at its peak, MSF worked in a health center there, providing care for both Kenyans and Somalis. Further south, in Ijaara district, MSF assisted Ministry of Health staff in the provision of maternal and child healthcare. In March, fighting in the Somali town of Bula Hawa drove approximately 15,000 refugees and 5,000 displaced people to the Kenyan border town of Mandera. MSF supported the district hospital and conducted over 1,500 outpatient consultations.
The drought in the Horn of Africa also affected other parts of Kenya. In April, MSF organized mobile clinics and ensured access to water for nomadic pastoralists in Ijaara district. In addition, the team offered reproductive healthcare and saw an increase in the number of women seeking medical assistance during childbirth. In June, MSF launched an emergency nutrition program in the Lapur and Kibish subdistricts of Turkana, in northwestern Kenya.
Breaking ground in addressing neglected diseases
In 2011, the Kenyan government, with the help of MSF, launched the first ever national strategic plan to control neglected tropical diseases, including kala azar (visceral leishmaniasis). Kala azar, which is transmitted by the bite of a sandfly, is almost always fatal if not treated.
MSF has worked with kala azar patients in Kacheliba, western Kenya since 2006, and in 2011 concluded a validation study of rapid diagnostic tests (RDTs) for the disease. The results of this study contributed to the government’s decision to approve the tests as a first-line diagnostic tool. An RDT is ideal for use in resource-poor settings, and allows a greater number of people to be screened for the disease, thereby improving access to treatment.
A new combination treatment for kala azar, which takes just 17 instead of 30 days, was introduced, and MSF also gave training to local medical staff working in districts where kala azar is endemic.
HIV and tuberculosis (TB) care
Around 1.3 million people are living with HIV in Kenya, but only an estimated 550,000 are receiving antiretroviral (ARV) treatment. MSF has been providing HIV and tuberculosis (TB) treatment for over a decade, and is currently treating more than 17,000 people living with HIV/AIDS and TB in urban areas and rural communities in Nairobi and Nyanza provinces.
In September, MSF detected quality problems with one ARV medicine, Zidolam-N. The drugs were confirmed to be falsified versions of World Health Organization quality-assured medicines that were purchased via a distributor certified by the Kenya Pharmacy and Poisons Board. MSF took immediate measures to trace and inform patients, replace the affected drugs and provide medical follow-up.
In 2011, MSF completed the switch from d4T-based first-line treatment to a TDF/AZTregime, which has fewer side effects. All new patients are put on TDF/AZT.
New TB diagnostic machines have been introduced in Nairobi, which are faster and more sensitive . MSF also expanded its TB program in Mathare, Nairobi, to the predominantly Somali neighbourhood of Eastleigh, where only limited TB treatment services were available. Some 900 patients with chronic diseases other than HIV also received treatment at MSF health centers in Nairobi.
Due to be completed in 2012, MSF is building a new health center on the outskirts of Kibera slum. It will at first be run jointly by MSF and the Ministry of Health, then gradually handed over to the ministry.
Addressing sexual violence
In the slums of Kibera and Mathare, MSF continues to focus on treating victims of sexual violence. In both areas, the number of child victims is very high – 65 percent of patients in Mathare are under 18. MSF provided medical assistance to over 1,000 new patients, offering post-exposure prophylaxis – treatment to reduce the risk of infection with HIV and other sexually transmitted diseases – as well as counseling and social support.
At the end of 2011, MSF had 798 staff in Kenya. MSF has been working in the country since 1987.