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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