Over the last few days I have been in constant touch with Mike Meegan, International Director and founder of ICROSS as the situation in Kenya has deteriorated. Early this morning Mike was full of ideas as usual, thinking about new projects, and coping with the malaria programmes, water programmes etc . We had been talking on the internet about possible new grants and ideas for funding when Mike went offline. About an hour later he called my mobile to say that he and his staff were evacuating their base in Ngong because it was no longer safe. They intend to head into Maasai land away from the slum and urban areas where the trouble is at it's worst. To do that they must travel along roads that are currentl very dangerous. I am waiting to hear from Mike that he and his friends and staff are safe.
Monday, December 31, 2007
Sunday, December 23, 2007
Family Laundry
just back from Sri Lanka- 2 weeks here checking out my roots and meeting my cousins- so many photos......
Monday, November 12, 2007
Monday, November 5, 2007
Saturday, October 27, 2007
Sarune
http://www.icross.ie/news/newsarticle.aspx?cid=83
When I was in Kenya earlier this year Sarune was one of the people who took care of me- he is a gorgeous gentle man with a wicked sense of humour. This is the link to a new posting on the ICROSS website about him
When I was in Kenya earlier this year Sarune was one of the people who took care of me- he is a gorgeous gentle man with a wicked sense of humour. This is the link to a new posting on the ICROSS website about him
Sunday, October 7, 2007
women of crete 2
i have been sorting out the pictures from Crete . Ten days there was not enough. We spent much of the time just wandering though the Cretan countryside and checking out the Minoan and Roman ruins.The pictures I took reflect just that - and so i will not be posting all of the 800+ pictures of fascinating stones with the remains of writiing and frescoes, (I have a tendency to look at the details) A lot of the time i simply walked and climbed and did not take pictures. Of course my significant other - who can read maps- got us to all the these places in the little chevrolet we hired . The best advice we got was from the taxi r[drivier who brought us from the ariport to the hotel when we arrived- He said- get a small car - the roads in the towns are very narrow! - and they are!
Saturday, September 29, 2007
shadow of christianity
back from Crete- an interesting island with a varied history. We saw as many of the minoan sites as possible. But the visit also brought home to me the immediate realty of climate change- up to the mid 1980s there were runnning rivers and streams in the areas we visited- they are all dry now-
Friday, August 31, 2007
Friday Feeling
it's Friday- long day!! Busy week. So i did a quiz.. the issue now is how do I get the other 20% of life experience?
You've Experienced 80% of Life |
 You have all of the life experience that most adults will ever get. And unless you're already in your 40s, you're probably wise beyond your years. |
Monday, August 20, 2007
foxonpatio2.jpg- taken by David
OK- This is the closest this fox has come to our house in Dublin- and David, my son was there to take this picture.
Wednesday, August 15, 2007
China
I wonder sometimes about how and why we try to limit how we express ourselves.
Freedom of expression is one of the tenets of democracy and yet even in democracies we limit how people can do this. It seems that in so many countries this freedom is overtly curtailed. Today I got an email from a person whose pictures I have admired on Flickr: She said _ I have closed my account partly because Flickr is blocked in China.-
One of the most important things I have learned is that although I may not agree with opinions expressed by others, their right to express those opinions must be defended.Ok not such a huge insight- but in living that principle I think that it follows that I value the ideas and interpretations of others- and also feel that I can let them know how I agree or disagree with them.
So in my own life I agree with those who want to ensure that developing and developed countries improve their health outcomes but also realise that how I might want to do that may need to be informed by the opinions of others.....
AND FOR ALL THOSE IN CHINA WHO HAVE STOPPED POSTING PICTURES- WE NEED YOUR INSIGHTS
Freedom of expression is one of the tenets of democracy and yet even in democracies we limit how people can do this. It seems that in so many countries this freedom is overtly curtailed. Today I got an email from a person whose pictures I have admired on Flickr: She said _ I have closed my account partly because Flickr is blocked in China.-
One of the most important things I have learned is that although I may not agree with opinions expressed by others, their right to express those opinions must be defended.Ok not such a huge insight- but in living that principle I think that it follows that I value the ideas and interpretations of others- and also feel that I can let them know how I agree or disagree with them.
So in my own life I agree with those who want to ensure that developing and developed countries improve their health outcomes but also realise that how I might want to do that may need to be informed by the opinions of others.....
AND FOR ALL THOSE IN CHINA WHO HAVE STOPPED POSTING PICTURES- WE NEED YOUR INSIGHTS
Monday, July 9, 2007
Samburu- it still goes on
Just a quick note from the papers to give a flavour of the day to day problems in Samburu at the moment:
Kenya tribal attack claims 17 lives
Sun, 08 Jul 2007 20:19:46
Samburu is a remote Kenyan district located about 250 km northeast of Nairobi.
At least 17 people have been killed and dozens injured after gunmen attacked Kenyan district of Samburu, about 250 km northeast of Nairobi.
Police Commander Everest Wasige confirmed the attacks but could not disclose the number of casualties.
Local media reported at least 17 were killed in the tribal conflict at dawn and at least 1, 000 head of cattle and 300 goats stolen.
He added that the raiders, believed to have been armed with AK-47 rifles and M16 guns, fired as they drove away the livestock.
Less than two weeks ago in a neighboring district, Baringo, raiders killed scores of people and stole animals.
As a result of the attacks thousands of people have been displaced in both districts while struggling to find food, shelter and medical care. A number of schools have been shut down over a perennial conflict that has claimed several lives recently.
Hundreds of Kenyans have been killed in recent inter-clan clashes between different ethnic communities over lack of natural resources.
ZHD/RE
Kenya tribal attack claims 17 lives
Sun, 08 Jul 2007 20:19:46
Samburu is a remote Kenyan district located about 250 km northeast of Nairobi.
At least 17 people have been killed and dozens injured after gunmen attacked Kenyan district of Samburu, about 250 km northeast of Nairobi.
Police Commander Everest Wasige confirmed the attacks but could not disclose the number of casualties.
Local media reported at least 17 were killed in the tribal conflict at dawn and at least 1, 000 head of cattle and 300 goats stolen.
He added that the raiders, believed to have been armed with AK-47 rifles and M16 guns, fired as they drove away the livestock.
Less than two weeks ago in a neighboring district, Baringo, raiders killed scores of people and stole animals.
As a result of the attacks thousands of people have been displaced in both districts while struggling to find food, shelter and medical care. A number of schools have been shut down over a perennial conflict that has claimed several lives recently.
Hundreds of Kenyans have been killed in recent inter-clan clashes between different ethnic communities over lack of natural resources.
ZHD/RE
Friday, July 6, 2007
roscommon castle
It is summer here I am told- but the weather has been wet, windy and chilly. Still, the scenery remains interesitng.....
Tuesday, July 3, 2007
Pakistan connection?
A while since I have posted anything - I have been busy at work, and have been away for a few days too. But I have also been in touch as usual with Mike Meegan and the work he and his friends are doing continues-A really exciting development is a visit by one of the guys who has been working in Africa as a volunteer to Pakistan- Ali himself is from Pakistan and he has been there for the last few weeks. So now I am wondering how the work that has been done by Mike Meegan and ICROSS in Kenya and elsewhere can now inform work that may be started in Pakistan- I spoke briefly to ALI at the weekend and he is still reflecting on what he saw-
There is a link to his blog in the links list
There is a link to his blog in the links list
Saturday, June 9, 2007
summer in ireland- but trouble in Kenya
The last week has been beautiful here- with sun and a short work week because of last weekend's bank holiday- but the news from Kenya is not good. a sect - the Mungiki -are out of control at the moment and have murdered many people- very close to where I was just last month- and I worry about the friends I have made there. While I was there I did hear of problems with the matutu drivers but it has escalated. reuters has jus published this:
alarm in Kenya
08 Jun 2007 10:49:35 GMT
Source: Reuters
By Barry Moody
NAIROBI, June 8 (Reuters) - Severed heads displayed on poles, savagely mutilated bodies and dozens of deaths have sparked alarm in Kenya as a secret criminal society goes on the rampage and police launch bloody retaliation.
With presidential elections little more than six months away, the crisis has sparked a fierce row between government and the judiciary, set politicians at each others' throats and brought calls for emergency rule in affected areas.
"The homeland is under siege", the Standard newspaper said.
At least 33 people died during paramilitary raids this week on a Nairobi slum that is a stronghold of the Mungiki, a gang that developed from an anti-Christian sect into Kenya's biggest criminal society.
In a conflict rapidly turning into a war of attrition with deep political overtones, the Mungiki have killed at least eight police and a dozen other people, striking terror into villages in central Kenya, heartland of the majority Kikuyu tribe from which they are drawn.
Some of the dead were elderly, dragged from their beds and beheaded despite having no known connection to the gang.
But the crackdown and fierce vows to wipe out the Mungiki from President Mwai Kibaki and Interior Minister John Michuki seem so far to have done little to dent their activities.
Four more people were decapitated this week in central Kenya and a skinned head turned up in Nairobi's Mathare slum.
Experts say the police violence, encouraged by Michuki's shoot-to-kill orders, will only make things worse.
"It is totally counterproductive. In fact he is just heightening the tensions," said Ken Ouko, a Nairobi university sociologist.
BETRAYAL
While the Mungiki, meaning "multitude" in Kikuyu, have been around since splitting from the Tent of the Living God sect in the early 1990s, their attacks have become more savage and frequent in the last few months.
There are several theories about why this has happened now but most revolve round the build-up to elections, a period notorious for violence over the last 15 years.
Several analysts said the Mungiki felt betrayed by Kikuyu politicians who they helped in the 2002 election that replaced the authoritarian Daniel arap Moi with Kibaki, a Kikuyu.
"A lot of Kikuyu politicians have had linkages with the Mungiki and they are now the ones in power," said Maina Kiai, head of the government's own human rights organisation.
"There is a feeling that this is their government in terms of ethnicity but their government has disowned them. ... I think they are doing this to try to get attention," Ouko said.
Opposition politicians may be trying to fan crime to discredit Kibaki and undermine his bid for a second term, analysts and security experts say.
This may explain the ferocity of the government response but could also be a dangerous Faustian bargain for the politicians.
"These are not stupid, illiterate people. ... They are used by the politicians but they also cleverly use the politicians themselves," said Mutuma Ruteere of the Kenya Human Rights Commission, an expert on the gang.
Politicians have long forged alliances with the Mungiki to exploit both their muscle for intimidating opponents and their ability to mobilise poor voters, especially destitute young men attracted into the gang's ranks by gruesome violence and money.
"This is a group that is brilliant when it comes to recruiting and organising people. They have the reach, especially in slum areas and among poor sectors of the community that the politicians would love to have," said Ruteere.
Five former or sitting members of parliament have recently been questioned by police over alleged Mungiki connections.
Mungiki infiltration of the police and civil service as well as powerful political circles, combined with the gang's intense secrecy, have undermined efforts to destroy it. Analysts say it could not survive without high level complicity.
MAFIA
The Mungiki have followed a trajectory similar to that of other criminal societies, including the Sicilian Mafia, beginning as a group to protect the oppressed and mutating into a violent gang over the last decade.
They claim succession to the Mau Mau movement of Kikuyu opposition to British colonial rule in the 1950s, using similar elaborate oathing, "baptism" ceremonies and secret handshakes.
Mungiki ranks were boosted in the 1990s when Moi's government instigated militia attacks, including the burning of villages, against Kikuyu areas, as pressure for multi-party democracy increased against him.
They are believed to have thousands of members and some estimates say they number up to 100,000.
The Mungiki began by offering protection to the operators of the minibus transport system used by most Kenyans then moved into wholesale extortion, including levying "door fees" on houses in the huge and squalid slums.
They also sell electricity, tapped from overhead wires in the shanty towns, and clean water. They are recently believed to have moved into kidnapping.
Horrific mutilation and beheading is meted out to those who betray the gang or even try to leave it, enforcing a code of silence like the Mafia's omerta.
And while East Africa's biggest economy continues to suffer stark disparities between rich and desperately poor it seems there will be no shortage of recruits.
"When you have a dysfunctional society, then this is the price to pay," Ouko said.
alarm in Kenya
08 Jun 2007 10:49:35 GMT
Source: Reuters
By Barry Moody
NAIROBI, June 8 (Reuters) - Severed heads displayed on poles, savagely mutilated bodies and dozens of deaths have sparked alarm in Kenya as a secret criminal society goes on the rampage and police launch bloody retaliation.
With presidential elections little more than six months away, the crisis has sparked a fierce row between government and the judiciary, set politicians at each others' throats and brought calls for emergency rule in affected areas.
"The homeland is under siege", the Standard newspaper said.
At least 33 people died during paramilitary raids this week on a Nairobi slum that is a stronghold of the Mungiki, a gang that developed from an anti-Christian sect into Kenya's biggest criminal society.
In a conflict rapidly turning into a war of attrition with deep political overtones, the Mungiki have killed at least eight police and a dozen other people, striking terror into villages in central Kenya, heartland of the majority Kikuyu tribe from which they are drawn.
Some of the dead were elderly, dragged from their beds and beheaded despite having no known connection to the gang.
But the crackdown and fierce vows to wipe out the Mungiki from President Mwai Kibaki and Interior Minister John Michuki seem so far to have done little to dent their activities.
Four more people were decapitated this week in central Kenya and a skinned head turned up in Nairobi's Mathare slum.
Experts say the police violence, encouraged by Michuki's shoot-to-kill orders, will only make things worse.
"It is totally counterproductive. In fact he is just heightening the tensions," said Ken Ouko, a Nairobi university sociologist.
BETRAYAL
While the Mungiki, meaning "multitude" in Kikuyu, have been around since splitting from the Tent of the Living God sect in the early 1990s, their attacks have become more savage and frequent in the last few months.
There are several theories about why this has happened now but most revolve round the build-up to elections, a period notorious for violence over the last 15 years.
Several analysts said the Mungiki felt betrayed by Kikuyu politicians who they helped in the 2002 election that replaced the authoritarian Daniel arap Moi with Kibaki, a Kikuyu.
"A lot of Kikuyu politicians have had linkages with the Mungiki and they are now the ones in power," said Maina Kiai, head of the government's own human rights organisation.
"There is a feeling that this is their government in terms of ethnicity but their government has disowned them. ... I think they are doing this to try to get attention," Ouko said.
Opposition politicians may be trying to fan crime to discredit Kibaki and undermine his bid for a second term, analysts and security experts say.
This may explain the ferocity of the government response but could also be a dangerous Faustian bargain for the politicians.
"These are not stupid, illiterate people. ... They are used by the politicians but they also cleverly use the politicians themselves," said Mutuma Ruteere of the Kenya Human Rights Commission, an expert on the gang.
Politicians have long forged alliances with the Mungiki to exploit both their muscle for intimidating opponents and their ability to mobilise poor voters, especially destitute young men attracted into the gang's ranks by gruesome violence and money.
"This is a group that is brilliant when it comes to recruiting and organising people. They have the reach, especially in slum areas and among poor sectors of the community that the politicians would love to have," said Ruteere.
Five former or sitting members of parliament have recently been questioned by police over alleged Mungiki connections.
Mungiki infiltration of the police and civil service as well as powerful political circles, combined with the gang's intense secrecy, have undermined efforts to destroy it. Analysts say it could not survive without high level complicity.
MAFIA
The Mungiki have followed a trajectory similar to that of other criminal societies, including the Sicilian Mafia, beginning as a group to protect the oppressed and mutating into a violent gang over the last decade.
They claim succession to the Mau Mau movement of Kikuyu opposition to British colonial rule in the 1950s, using similar elaborate oathing, "baptism" ceremonies and secret handshakes.
Mungiki ranks were boosted in the 1990s when Moi's government instigated militia attacks, including the burning of villages, against Kikuyu areas, as pressure for multi-party democracy increased against him.
They are believed to have thousands of members and some estimates say they number up to 100,000.
The Mungiki began by offering protection to the operators of the minibus transport system used by most Kenyans then moved into wholesale extortion, including levying "door fees" on houses in the huge and squalid slums.
They also sell electricity, tapped from overhead wires in the shanty towns, and clean water. They are recently believed to have moved into kidnapping.
Horrific mutilation and beheading is meted out to those who betray the gang or even try to leave it, enforcing a code of silence like the Mafia's omerta.
And while East Africa's biggest economy continues to suffer stark disparities between rich and desperately poor it seems there will be no shortage of recruits.
"When you have a dysfunctional society, then this is the price to pay," Ouko said.
Friday, May 25, 2007
Reunion
Ok - we all admit it- 20 years ago we all were together doing a post-graduate Masters degree in Public Health. We met for dinner the other night-unfortunately it was at short notice so some of the others who were also in the class could not get there. Morten was visiting from Norway to attend a conference and the 5 of us got together after the Graves lecture in the College of Physicians. We don't think we have changed a bit.......
Sunday, May 20, 2007
Lemoite
MIke Meegan, International director and founder of ICROSS says this about Lemoite:
The people with the best social skills do not even need to speak. One of my adopted sons in Africa is called Lemoite, ‘he who is everlasting’. Lemoite is a serene and gentle Samburu from the northern deserts of Kenya. He has always been a magnet for creation. Wild wart hogs played with him as a child, near his home he ran between the baby elephants and their mothers in Seketet, and angry guard dogs came to him like puppies, stilled by him. Birds and butterflies sat on his shoulder and Dikdiks and gazelles would come at his call. People are drawn to him in an unspoken relationship, effortless and innate. Perhaps it is a serenity that speaks to something inside us or a harmony as yet unstudied but I have few examples of such social power. Social intelligence is rooted in respect, self possession, delight in others and an insatiable appetite to embrace the stranger. There are in fact no strangers, only people waiting to be friends.
The people with the best social skills do not even need to speak. One of my adopted sons in Africa is called Lemoite, ‘he who is everlasting’. Lemoite is a serene and gentle Samburu from the northern deserts of Kenya. He has always been a magnet for creation. Wild wart hogs played with him as a child, near his home he ran between the baby elephants and their mothers in Seketet, and angry guard dogs came to him like puppies, stilled by him. Birds and butterflies sat on his shoulder and Dikdiks and gazelles would come at his call. People are drawn to him in an unspoken relationship, effortless and innate. Perhaps it is a serenity that speaks to something inside us or a harmony as yet unstudied but I have few examples of such social power. Social intelligence is rooted in respect, self possession, delight in others and an insatiable appetite to embrace the stranger. There are in fact no strangers, only people waiting to be friends.
Sunday, May 13, 2007
traditional birth attendant (TBA)
There is lack of consensus on the role of the TBA in
Kenya and other countries . There is evidence in the medical literature both from Kenya and other countries that training traditional birth attendants in hygeine and modern birth techniques may not always result in improved outcomes for mothers, while other literature shows that such training can in fact improve outcomes . It has been noted in reviews of maternal care in Kenya also that women continue to die in childbirth because they are not referred in time for obstetric care. However, in looking at some of the literature it is clear that such evaluations do not always in tur evaluate the quality of training offered to TBAs. It is also clear to me that in the rural areas of Kenya, where people live in a traditional manner and where lack of roads and infrastructure meant that travel is extremely difficult it may not be simply a failure of the TBAS to refer for care in time
There is also shortage of skilled midwives and doctors to provide care in the rural areas . No more than in developed countries qualified professional staff in Kenya in general choose to live and work in the larger urban centers- Sylvia- the nurse mentioned in a previous post is a exceptional person.
Kenya continues to provide training for TBAs, and this as part of the wider suite of interventions to address many of the other social and health issues is a positive approach.. As a recent report form kenya says : Evidence has shown
that where there is strong leadership, motivated or
supported health care providers, and strong
partnerships with TBAs, more women seek the
quality care services during pregnancy, childbirth
and postpartum period. The challenge is now to
utilise the TBA more effectively during a transition
strategy from TBAs to increased skilled attendance for all women at birth.http://www.popcouncil.org/pdfs/SafeMom_TBA.pdf.
Kenya and other countries . There is evidence in the medical literature both from Kenya and other countries that training traditional birth attendants in hygeine and modern birth techniques may not always result in improved outcomes for mothers, while other literature shows that such training can in fact improve outcomes . It has been noted in reviews of maternal care in Kenya also that women continue to die in childbirth because they are not referred in time for obstetric care. However, in looking at some of the literature it is clear that such evaluations do not always in tur evaluate the quality of training offered to TBAs. It is also clear to me that in the rural areas of Kenya, where people live in a traditional manner and where lack of roads and infrastructure meant that travel is extremely difficult it may not be simply a failure of the TBAS to refer for care in time
There is also shortage of skilled midwives and doctors to provide care in the rural areas . No more than in developed countries qualified professional staff in Kenya in general choose to live and work in the larger urban centers- Sylvia- the nurse mentioned in a previous post is a exceptional person.
Kenya continues to provide training for TBAs, and this as part of the wider suite of interventions to address many of the other social and health issues is a positive approach.. As a recent report form kenya says : Evidence has shown
that where there is strong leadership, motivated or
supported health care providers, and strong
partnerships with TBAs, more women seek the
quality care services during pregnancy, childbirth
and postpartum period. The challenge is now to
utilise the TBA more effectively during a transition
strategy from TBAs to increased skilled attendance for all women at birth.http://www.popcouncil.org/pdfs/SafeMom_TBA.pdf.
Friday, May 11, 2007
samburu mother and child
Kenyan Unicef statistics for 2005 :Under-five mortality rate - Probability of dying between birth and exactly five years of age expressed per 1,000 live births =120
Kenyan Infant mortality rate in 2005 - Probability of dying between birth and exactly one year of age expressed per 1,000 live births.= 79
In Ireland in 2005 the under 5 mortality rate was 6 and the infant mortality rate was 5.
Kenyan Infant mortality rate in 2005 - Probability of dying between birth and exactly one year of age expressed per 1,000 live births.= 79
In Ireland in 2005 the under 5 mortality rate was 6 and the infant mortality rate was 5.
Daily Nation article
NEWS
Teachers’ wage bill up by Sh2.5bn
Story by NATION Correspondents
Publication Date: 5/11/2007
The Government will spend an additional Sh2.5 billion on salaries for its workers this month.
This follows the new salary perks for teachers announced recently. The Teachers Service Commission (TSC) secretary, Mr Gabriel Lengoiboni, disclosed this in Samburu yesterday.
Speaking at the launch of the Samburu Teachers Sacco front office, Mr Lengoiboni also noted that the commission needed 50,000 teachers to stem the current shortage.
Noting that some 36,000 children of school going age were still out of school, he urged pastoralists to take advantage of the free primary education programme to educate their children.
The TSC secretary made the announcement as the Bungoma Kenya National Union of Teachers (Knut) branch demanded 3,000 more teachers for local schools.
Branch executive secretary, Mr Fred Sichangi, said the teachers were needed to cater for about 5,000 pupils who had relocated from schools in the clash-torn Mt Elgon District.
Urgently need
“We urgently need 2,500 additional teachers for primary schools and another 500 for secondary schools,” Mr Sichangi said.
Seven teachers and five pupils have been killed in the violence in Mt Elgon, prompting desertion of 26 out of the district’s 107 schools. More than 170 teachers also fled the area.
Mr Sichangi warned that teachers in Bungoma would down tools in support of their colleagues in Mt Elgon unless the authorities moved fast to restore peace to facilitate learning activities.
Teachers’ wage bill up by Sh2.5bn
Story by NATION Correspondents
Publication Date: 5/11/2007
The Government will spend an additional Sh2.5 billion on salaries for its workers this month.
This follows the new salary perks for teachers announced recently. The Teachers Service Commission (TSC) secretary, Mr Gabriel Lengoiboni, disclosed this in Samburu yesterday.
Speaking at the launch of the Samburu Teachers Sacco front office, Mr Lengoiboni also noted that the commission needed 50,000 teachers to stem the current shortage.
Noting that some 36,000 children of school going age were still out of school, he urged pastoralists to take advantage of the free primary education programme to educate their children.
The TSC secretary made the announcement as the Bungoma Kenya National Union of Teachers (Knut) branch demanded 3,000 more teachers for local schools.
Branch executive secretary, Mr Fred Sichangi, said the teachers were needed to cater for about 5,000 pupils who had relocated from schools in the clash-torn Mt Elgon District.
Urgently need
“We urgently need 2,500 additional teachers for primary schools and another 500 for secondary schools,” Mr Sichangi said.
Seven teachers and five pupils have been killed in the violence in Mt Elgon, prompting desertion of 26 out of the district’s 107 schools. More than 170 teachers also fled the area.
Mr Sichangi warned that teachers in Bungoma would down tools in support of their colleagues in Mt Elgon unless the authorities moved fast to restore peace to facilitate learning activities.
Thursday, May 10, 2007
A lesson from Kenya
I have not really commented on the current nurses' industrial dispute in the HSE - but there are interesting lessons to be learned from Kenya- yes it is a third world country in many ways , but I have seen real and increasingly successful attempts to provide primary health care, in a way that embraces sustainable community development. I met skilled health professionals who are living and working within their own communities, many with a commitment to developing quality services that is truly inspiring. One of the news soundbites tonight was that Ireland is like a third world country in terms of it's health services- I think that in fact we are not doing half as well as many third world countries who have realised that actually developing preventive and primary care services is the way to ensure that they get best value for their investment in health. We talk about reorienting the services to primary care but it seems that it is the hospitals that always get most attention. For many - both public and professional, plans for reorientation simply mean taking the interventions done in hospitals into the community instead of actually refocussing what we are delivering to address all of the determinants of health in a coherent and effective way.
www.healthintelligence.ie
www.healthintelligence.ie
studying for a scholarship
in 2003 the Kenyan government made primary education free for all children. Since then the rate of enrolment of children in primary school has increaed exponentially. However there remain regional disparities, and the large number of children who have enrolled has overwhelmed the system in many places. However ICROSS recognises that education is fundamental to improving health and reducing social inequalities, including gender inequalities. Therefore it has partnered with the government to help build schools in some of the most remote areas. T
However free primary schooling and a high enrolment rate is only the first part of the story- as well as the creaking system other issues mean that attendng school is difficult- As I have described simply finding water and food is a priority for many families-so actually getting to school is not the first thing they think of. As pastoralists the areas over which the familes may range is large and so children often must walk many kilometers to school- and as also one person told me - small children, while they might be able to walk long distances, are also in danger of being attacked by wild animals. Allied to this has been -in the Samburu area at least- a drought last year and intertribal raids which meant families moved out of the areas as refugees- and so again for many school was not a priority. Thankfully they are now moving back .
Teachers are paid by the government and are allocated to areas with little or no choice in that allocation - so they may be allocated to areas where they are not familiar with the local tribal language- I was told teaching is done through Swahili and English.
Girls are less likely to attend school than boys- Many of the practices that impact negatively on women can really only be addressed by education- Female genital mutilation, early marriages and general social deprivation all are best addressed by educating women to a level that allows then to become both questioning of the social norms and also independant and able to earn a living for themselves.
No more thanprovsion of free ARVS for HIV/AIDS but then charging for tests etc, free education does not extend to providing basic basic requirements such as copy books and pens- again ICROSS steps in to help by giving these discreetly to deprived families though the local community workers.
Providing very basic school buildings and pencils and paper may not have the immediacy of, for instance, caring directly for people with AIDS but as a way to improve the health of the population in a sustainable way and address gender inequalities this is the way to go. ~A challenge for ICROSS KENYA is to use it's assets well to address the many areas it needs to deal with-and to balance the application of it's help between good evidence base and sustainablity and immediate and high profile media- ( and donor) attractive interventions.
However free primary schooling and a high enrolment rate is only the first part of the story- as well as the creaking system other issues mean that attendng school is difficult- As I have described simply finding water and food is a priority for many families-so actually getting to school is not the first thing they think of. As pastoralists the areas over which the familes may range is large and so children often must walk many kilometers to school- and as also one person told me - small children, while they might be able to walk long distances, are also in danger of being attacked by wild animals. Allied to this has been -in the Samburu area at least- a drought last year and intertribal raids which meant families moved out of the areas as refugees- and so again for many school was not a priority. Thankfully they are now moving back .
Teachers are paid by the government and are allocated to areas with little or no choice in that allocation - so they may be allocated to areas where they are not familiar with the local tribal language- I was told teaching is done through Swahili and English.
Girls are less likely to attend school than boys- Many of the practices that impact negatively on women can really only be addressed by education- Female genital mutilation, early marriages and general social deprivation all are best addressed by educating women to a level that allows then to become both questioning of the social norms and also independant and able to earn a living for themselves.
No more thanprovsion of free ARVS for HIV/AIDS but then charging for tests etc, free education does not extend to providing basic basic requirements such as copy books and pens- again ICROSS steps in to help by giving these discreetly to deprived families though the local community workers.
Providing very basic school buildings and pencils and paper may not have the immediacy of, for instance, caring directly for people with AIDS but as a way to improve the health of the population in a sustainable way and address gender inequalities this is the way to go. ~A challenge for ICROSS KENYA is to use it's assets well to address the many areas it needs to deal with-and to balance the application of it's help between good evidence base and sustainablity and immediate and high profile media- ( and donor) attractive interventions.
Saturday, May 5, 2007
and when the boreholes work
So here is an example of a working borehole- These gorgeous women standing on each side of me were about to go to the market when we arrived to see the borehole- they are members of the key-holding family. The borehole itself is a center of activity- when we walked down to it there were some morans ( young warriors) there. Sorry no photographs as they actually had been washing , did not have all their jewellery ( or clothes) on and anyway were rather surprised to see a middle aged mzungu at their water hole. Many people in Kenya do not like to have their pictures taken and I made a point of not photographing anyone unless they were happy for me to do so.
So back to the water issue- if you look at the other pictures I have posted on Flickr you will see that around the well is green and fertile, and there is water available. As both humans and animals use this as a water source, one of the things that would improve the situiaton further is to build some facilities that separate the human and animal usage, as at present there is a possibility that the source itself can become contaminated by animal excrement. Also as I noted, it is being used for washing and so if a separate washing area was built with the run-off diverted away from the source it would also be an improvement. There are keyholders for the borehole and i was told that the water is locked to conserve it- however the cement lid over the source had been broken - clearly people were accessing the water through this when the pump was locked. But it was clear that the support given by ICROSS to provide the pump was very much appreciated, and has made a considerable difference to the people living nearby who now not only were following the traditional herder lifestyle but also were growing crops such as beans and maize
So back to the water issue- if you look at the other pictures I have posted on Flickr you will see that around the well is green and fertile, and there is water available. As both humans and animals use this as a water source, one of the things that would improve the situiaton further is to build some facilities that separate the human and animal usage, as at present there is a possibility that the source itself can become contaminated by animal excrement. Also as I noted, it is being used for washing and so if a separate washing area was built with the run-off diverted away from the source it would also be an improvement. There are keyholders for the borehole and i was told that the water is locked to conserve it- however the cement lid over the source had been broken - clearly people were accessing the water through this when the pump was locked. But it was clear that the support given by ICROSS to provide the pump was very much appreciated, and has made a considerable difference to the people living nearby who now not only were following the traditional herder lifestyle but also were growing crops such as beans and maize
Thursday, May 3, 2007
the patriarch- Nataka Maji
Nataka maji- I need water.
Water is a basic necessity of life. However in the Samburu area the water sources are often unreliable. The area recently suffered a major drought from which it is slowly recovering. Added to that is the distance and infrastrucutural issues I have mentioned before.
We visited a number of water projects that had been funded by ICROSS. These pictures are about a borehole that had been dug about 2 years ago. But for the last 3 months the pump has been broken. There had been some difficulty finding a new pump part and in consequence the community in the area have to travel up to 10 kilometres to another water source. I can understand how mistakes cam be made in accessing suitable spare parts, but relying on Ministry of Health - try as it does - or the local community to maintain the water supplies and schools and other community supports that have been seed funded by NGOs may be premature. I absolutely understand the need to ensure that communities become self sustaining , but I question how quickly this can be expected to happen. The other question is in terms of immediate public health, and if a more medium term commitment to maintenance while lobbying for and developing other area of infrastructure would be a more effective longterm strategy? I don't know the answer at present- but I do know that the people I saw here were struggling to cope and were clear that a priority for them was restoring the water pump as soon as possible. AS for the other issues- NGOs such as ICROSS are just part of the picture- but perhaps we need to support them more explicitly to sustain the projects they help to start
Water is a basic necessity of life. However in the Samburu area the water sources are often unreliable. The area recently suffered a major drought from which it is slowly recovering. Added to that is the distance and infrastrucutural issues I have mentioned before.
We visited a number of water projects that had been funded by ICROSS. These pictures are about a borehole that had been dug about 2 years ago. But for the last 3 months the pump has been broken. There had been some difficulty finding a new pump part and in consequence the community in the area have to travel up to 10 kilometres to another water source. I can understand how mistakes cam be made in accessing suitable spare parts, but relying on Ministry of Health - try as it does - or the local community to maintain the water supplies and schools and other community supports that have been seed funded by NGOs may be premature. I absolutely understand the need to ensure that communities become self sustaining , but I question how quickly this can be expected to happen. The other question is in terms of immediate public health, and if a more medium term commitment to maintenance while lobbying for and developing other area of infrastructure would be a more effective longterm strategy? I don't know the answer at present- but I do know that the people I saw here were struggling to cope and were clear that a priority for them was restoring the water pump as soon as possible. AS for the other issues- NGOs such as ICROSS are just part of the picture- but perhaps we need to support them more explicitly to sustain the projects they help to start
Sunday, April 29, 2007
grandmothers rule-ok- Another story
All over Africa there are grandmothers left with the care of their grandchildren and mourning the loss of their own children. These are women who deserve our support and care - they are carrying twice the responsibilities they expected.
Saturday, April 28, 2007
AIDS and community supports
AIDS is an area where much support and help for people is required in Kenya. In the areas I visited there were varying rates of AIDS and HIV reported-most rates are simply estimates. In some of the urban slum area the rate is alt least 40 to 50% though the estimated rate in the country is reported by UNAIDS to have fallen to 7% in 2003 from a peak of 10% in adults in the mid-1990s. UNAIDS reports that more recent sentinel surveillance data indicates that adult prevalence has fallen even further to 6.1% as at end 2004 (Kenya HIV and AIDS Data Booklet, 2005). They say the decline is not uniform however, and in some areas prevalence remains as high as 13%. Gender disparities are of particular concern: HIV prevalence in women aged 15–49 is 8.3%, while for men aged 15–49 it is 4.3%. Young women are especially vulnerable to HIV infection compared with young men; 4.9% of women aged 15–24 are HIV-infected, compared with 0.9% of men of the same age group. However ministry of health officials and community workers estimated prevalence as far higher than this when I spoke to them. They cited difficulties in ascertainment, inaccurate baseline population data from the census and population projections and the issue of stigmatisation that means that people do not admit to the disease or attend for treatment. In some areas the local workers to whom I spoke estimated a prevalence rate of 18% - and in some pockets of the slum areas up to 40 0r 50%
So what can I report from my short visit? - definitely in Nakuru as I walked though the slum areas where there is often no electricity or running water it was clear that many of the people living there were living with AIDS. On www.flickr.com/photos/davida3 I am posting a number of stories of people I met. There was the mother in what seemed the terminal stages of AIDs whose 9 month old daughter was also HIV positive. Perhaps she will have a few more years now that the ICROSS team have moved in and are giving her and her family some practical help in the form of nutritional supplements and dietary advice as well as trying to ensure that her medical care is organised. _ More of that later-
Poor nutritional status precipitates a downward spiral. People live in deprived conditions- so poor nutrition, water problems, and HIV predispose to opportunistic infections- Tuberculosis is a particular problem.
The Kenyan government made antiretrovirals available free of charge about 3 years ago- Similarly TB medications are free. However there remains a stigma in regard to AIDS which means that people are slow to present for treatment or to accept the diagnosis. Allied to that is the problem that although the medications are free, hospital attendance, blood tests and x-rays are not. There is a special waiver system for people who cannot afford to pay, but this is limited. However applying for such waivers for individuals is part of the work that ICROSS KENYA does, as well as where possible funding blood tests and x=rays. They also work with communities to reduce stigma and educate people about the epidemiology and modes of transmission of HIV.
As for the accuracy of disease prevalence data and population census data- I think that sentinel surveillence of people who present for care is an under estimate for the reasons outlined above. Also the baseline census data is inevitably inaccurate. We know that even in western countries such as here in Ireland there are problems in ensuring that everyone is enumerated. In a country such as Kenya, where there is movement of communities as I saw among the Maasai and Samburu,- who are essentially nomadic - and where roads and infrastructure simply do not exist, actually ensuring that people are included is a very difficult task. Allied to that is a reluctance to count family, particularly children, lest counting and acknowledging them openly should bring misfortune. I confirmed that for myself when I asked people how many children they had and the inevitable answer was a few, or not many .
So what can I report from my short visit? - definitely in Nakuru as I walked though the slum areas where there is often no electricity or running water it was clear that many of the people living there were living with AIDS. On www.flickr.com/photos/davida3 I am posting a number of stories of people I met. There was the mother in what seemed the terminal stages of AIDs whose 9 month old daughter was also HIV positive. Perhaps she will have a few more years now that the ICROSS team have moved in and are giving her and her family some practical help in the form of nutritional supplements and dietary advice as well as trying to ensure that her medical care is organised. _ More of that later-
Poor nutritional status precipitates a downward spiral. People live in deprived conditions- so poor nutrition, water problems, and HIV predispose to opportunistic infections- Tuberculosis is a particular problem.
The Kenyan government made antiretrovirals available free of charge about 3 years ago- Similarly TB medications are free. However there remains a stigma in regard to AIDS which means that people are slow to present for treatment or to accept the diagnosis. Allied to that is the problem that although the medications are free, hospital attendance, blood tests and x-rays are not. There is a special waiver system for people who cannot afford to pay, but this is limited. However applying for such waivers for individuals is part of the work that ICROSS KENYA does, as well as where possible funding blood tests and x=rays. They also work with communities to reduce stigma and educate people about the epidemiology and modes of transmission of HIV.
As for the accuracy of disease prevalence data and population census data- I think that sentinel surveillence of people who present for care is an under estimate for the reasons outlined above. Also the baseline census data is inevitably inaccurate. We know that even in western countries such as here in Ireland there are problems in ensuring that everyone is enumerated. In a country such as Kenya, where there is movement of communities as I saw among the Maasai and Samburu,- who are essentially nomadic - and where roads and infrastructure simply do not exist, actually ensuring that people are included is a very difficult task. Allied to that is a reluctance to count family, particularly children, lest counting and acknowledging them openly should bring misfortune. I confirmed that for myself when I asked people how many children they had and the inevitable answer was a few, or not many .
Friday, April 27, 2007
Tuesday, April 24, 2007
the story
this is a really special story of childbirth, challenging of assumptions and ensuring that one little girl has a future.
click on the picture...
click on the picture...
Monday, April 23, 2007
Men come first !
So as I was there watching how the people were being cared for, the committee representatives arrivesd and looked extremely business -like - greeted me and were friendly- but it was clear that at least one had additional business.
herding goats- life goes on...
One of the most striking things about the people I met as I visited some of the work that ICROSS KENYA does was the kindness and friendliness of everyone. The country itself was probably at it's best as the rainy season was just beginning and the animals had water and forage. However just 8 months ago many parts of the country were in the grip of drought and animals and indeed people were dying. ICROSS KENYA had assisted in food distribution in the very areas I have now visited. It is clear to me that in that environment there is a short distance between "enough" and "crisis"- and so the work that is being done to develop communities and to develop sustainable food sources is a priority.
Saturday, April 21, 2007
Back from Kenya
I arrived back yesterday from a very short visit to Kenya to see some of the work that ICROSS Kenya is doing in some of the most deprived areas of the country. I will post some of the pictures i took over the next few weeks. My son Peter came with me- he is studying osteo-archaeology as a follow-on to his basic degree in human genetics, and so had an interest in seeing how the people in the tribes in the Rift Valley live.
Things happen fairly slowly and at a relaxed pace in Kenya- so that was the first adjustment I had to make. I am used to a very organised and fast paced day, and that is not really the way life is in Kenya. However from the very beginning my first overall impression was of the friendliness and kindness of the Kenyan people that I met.
I had arrived in Kenya with very little cash as it was not possible to get Kenyan Shillings here in Ireland and I assumed that I would simply be able to get to an ATM to get cash once I arrived. However this proved to be not so simple- most of the ATMs there did not have Cirrus or Maestro and then when I finally found a Barclays Bank in Karen, a small towm just outside Nairobi where we stayed for the first 2 nights, the ATM was out of order.A few panicked calls home and attempts to organise western union or bank transfer ensued, but then the ATM was repaired and All Was Well.
So after a day of sorting all that out I finally got to meet Elle Kihara again, Patrick the National Director for ICROSS KENYA and the 2 people who were to be our companions and guides for most of our time there-Little Joe and John/Sarune. I will post pictures and some commentary on Flickr as I work through sorting them all out. However the bottom line is that I have seen the work that this organisation- ICROSS KENYA is doing on the ground. It is making a real and positive difference to people who are living in very deprived and difficult conditions. ICROSS Kenya and the teams of people working there need and deserve to be supported.
Things happen fairly slowly and at a relaxed pace in Kenya- so that was the first adjustment I had to make. I am used to a very organised and fast paced day, and that is not really the way life is in Kenya. However from the very beginning my first overall impression was of the friendliness and kindness of the Kenyan people that I met.
I had arrived in Kenya with very little cash as it was not possible to get Kenyan Shillings here in Ireland and I assumed that I would simply be able to get to an ATM to get cash once I arrived. However this proved to be not so simple- most of the ATMs there did not have Cirrus or Maestro and then when I finally found a Barclays Bank in Karen, a small towm just outside Nairobi where we stayed for the first 2 nights, the ATM was out of order.A few panicked calls home and attempts to organise western union or bank transfer ensued, but then the ATM was repaired and All Was Well.
So after a day of sorting all that out I finally got to meet Elle Kihara again, Patrick the National Director for ICROSS KENYA and the 2 people who were to be our companions and guides for most of our time there-Little Joe and John/Sarune. I will post pictures and some commentary on Flickr as I work through sorting them all out. However the bottom line is that I have seen the work that this organisation- ICROSS KENYA is doing on the ground. It is making a real and positive difference to people who are living in very deprived and difficult conditions. ICROSS Kenya and the teams of people working there need and deserve to be supported.
Tuesday, April 3, 2007
what a day.... busy .... and not just because the health service is in further crisis with nurses now threatening rolling stoppages. In the meantime the economy is on the downturn- though I am not not sure how much that really means for people trying to manage day to day compared to some of the other less developed countries that are dealing with major health problems.
Interesting contrasts between our economy and that of other nations-Our spend on health per capita is so much more than others with greater problems. Though anxious about what I will see - and not sure how a health service doctor and manager from Ireland can help- I 'm looking forward to seeing a little more of the public health approach in Kenya.
IRELAND 2004
Total population: 4,148,000 (in 2004) and rising -2006 census: 4,239,848
GDP per capita (Intl $, 2004): 36,371
Life expectancy at birth m/f (years): 75.0/81.0
Healthy life expectancy at birth m/f (years, 2002): 68.1/71.5
Child mortality m/f (per 1000): 7/5
Adult mortality m/f (per 1000): 105/60
Total health expenditure per capita (Intl $, 2003): 2,496
Total health expenditure as % of GDP (2003): 7.3
KENYA 2004
Total population: 34,256,000
GDP per capita (Intl $, 2004): 1,586
Life expectancy at birth m/f (years): 51.0/50.0
Healthy life expectancy at birth m/f (years, 2002): 44.1/44.8
Child mortality m/f (per 1000): 129/110
Adult mortality m/f (per 1000): 477/502
Total health expenditure per capita (Intl $, 2003): 65
Total health expenditure as % of GDP (2003): 4.3
Interesting contrasts between our economy and that of other nations-Our spend on health per capita is so much more than others with greater problems. Though anxious about what I will see - and not sure how a health service doctor and manager from Ireland can help- I 'm looking forward to seeing a little more of the public health approach in Kenya.
IRELAND 2004
Total population: 4,148,000 (in 2004) and rising -2006 census: 4,239,848
GDP per capita (Intl $, 2004): 36,371
Life expectancy at birth m/f (years): 75.0/81.0
Healthy life expectancy at birth m/f (years, 2002): 68.1/71.5
Child mortality m/f (per 1000): 7/5
Adult mortality m/f (per 1000): 105/60
Total health expenditure per capita (Intl $, 2003): 2,496
Total health expenditure as % of GDP (2003): 7.3
KENYA 2004
Total population: 34,256,000
GDP per capita (Intl $, 2004): 1,586
Life expectancy at birth m/f (years): 51.0/50.0
Healthy life expectancy at birth m/f (years, 2002): 44.1/44.8
Child mortality m/f (per 1000): 129/110
Adult mortality m/f (per 1000): 477/502
Total health expenditure per capita (Intl $, 2003): 65
Total health expenditure as % of GDP (2003): 4.3
Monday, April 2, 2007
Back to work after fairly busy weekend -though I took some time out for myself to walk and enjoy the Wicklow area. Had a bit of a crisis when I realised that though I am off to Kenya in a week to see the work that ICROSS and Mike Meegan and his organisation are doing, it was not really sorted out about where we would be staying-and as I like to have things sorted out and know exactly what I am doing well in advance (or at least a week) I decided to look at that area where Gup Shup said is expensive and sort of European- Karen township - so if all alse fails I can stay there. Elle had said "no problem "when he invited me over -and Mike Meegan is in Cambodia and orchestrating things from afar so as usual have decided to have a back up plan.
As for the day to day work - the relatively new Health Service Executive is dealing with major industrial relations problems- exacerbated by the run up to an election - so managing is not easy in such an environment.
As for the day to day work - the relatively new Health Service Executive is dealing with major industrial relations problems- exacerbated by the run up to an election - so managing is not easy in such an environment.
Sunday, April 1, 2007
So the April 1st weekend is just over and I am beginning to learn to use this- having been a fairly active presence on on Flickr for a long time:
Flickr? - it's over there - on the links- my photos...
For anyone who is interested, the photos reflect me and my life- a bit more interested in the minutiae in the daily routine of my personal life- but quite the opposite in my working life, where longer term and bigger issues take precedence.
Flickr? - it's over there - on the links- my photos...
For anyone who is interested, the photos reflect me and my life- a bit more interested in the minutiae in the daily routine of my personal life- but quite the opposite in my working life, where longer term and bigger issues take precedence.
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