Kenya’s spending on rural health care leaves gaps

Joyce Agis Ekai waits for Merlin aid workers to set up a malnutrition clinic with her daughter, Lokwawi Turkei, Koono, Turkana, Kenya, Jan. 18, 2013. (Lindsey Campbell)

Joyce Agis Ekai waits for Merlin aid workers to set up a malnutrition clinic with her daughter, Lokwawi Tukei. (Lindsey Campbell)

By Lindsey Campbell

TURKANA, Kenya – Agis Ekai walked past the bags of corn-soy blend and a cooler of medication to place her 10-month-old daughter, Lokwawi Tukei, in a scale that hung from the branch of an acacia tree.

“Ten-point-five kilograms,” or about 14 pounds, said Geoffry Murrthi, a nutrition officer for Merlin. The British aid organization had set up this makeshift medical clinic on the sands of the village, Koono. The clinic consisted of a single metal card table, a plastic chair and three community health workers.

Murrthi continued examining Lokwawi, wrapping a paper ruler around the baby’s thin left arm. “Twelve-point-five centimeters,” he said. “She’s malnourished ‘till she’s 12.5, two weeks in a row.  She’s almost there.”

Lokwawi is one of many undernourished children and adults in Turkana, where malnutrition rates are three times higher than in the United States. Health workers say malnutrition is one of the most prevalent conditions in the arid region, along with diseases including malaria, gastroenteritis, bacterial infections and HIV— all deadly if not treated. In this rural region of northern Kenya, food and water are scarce – and so is access to modern medicine.

The Kenyan government spends an average of $26 to $29 per person on health care, compared to the $8,400 spent by the United States In Turkana, dilapidated dispensaries with undertrained staff give the people a small dose of Western medicine — if they are able to travel the long distances across harsh terrain that characterize Turkana life. Nongovernmental organizations, or NGOs, such as Merlin, the U.S. Agency for International Development and the Elizabeth Glaser Pediatric AIDS Foundation, have set up clinics to treat the sick and to educate the community on better health care practices.

Those who live far from a medical clinic must walk hours, sometimes days, to receive Western medicine. With little government-funded healthcare infrastructure in this region, the only other choice is often traditional, herbal treatments that do little to combat diseases such as malaria and AIDS.

NGO workers said the lack of government funding is a serious problem.

“It’s a weakness in all government ministries in rural areas,” said Adan Abdullahi, project coordinator for Merlin. “There are many challenges in sustaining programs we run. The ministry needs funds to procure supplies, and they are not able to do that.”

Some healthcare challenges in Turkana are related to the culture. Traditionally nomadic, the Turkana move from pasture to pasture, sometimes wandering even farther away from the few available clinics. This makes follow-up care a challenge.

In addition, many Turkana live off their own livestock and rely on water from nearby rivers. This leaves them vulnerable to food- and water-borne bacteria and illnesses. With no inspection or testing, gastroenteritis and diarrheal diseases are widespread. Left untreated, these can kill a child in a little over a day.

But even if communities overcome distance and the shortage of clinics, the stark conditions in Turkana raise another obstacle: finding and keeping medical staff.

On a recent morning, Eloto Lokai Esikiria and her two sons spent the night outside the Loreng’elup dispensary. They had walked three hours to get there. One of her sons was sick, but when they arrived, the clinic was empty. The head nurse was nowhere to be found.

“My son has malaria,” said Esikiria, whose neighbors had slaughtered a goat and poured water on her son’s body to treat his illness. “We found that he had a high fever by touching. His body was too hot.” After her traditional treatment didn’t work, she came to the dispensary. With no indication of when the nurse would return, the family sat waiting on its steps.

“One of the major challenges within Kenya, and Turkana specifically, is that there is a large health care worker shortage,” said Susanne Duberstein, senior country officer for the Glaser Foundation. “There are very few health care workers that want to go work in that area.”

The dry desert landscape, hot sun and scarce rainfall create a harsh environment. Access to clean water is limited. Most dispensaries must either go without electricity or invest in alternative energy sources such as solar panels. The government and aid organizations are often forced to find people from outside the Turkana communities to work at the clinics, creating a cultural barrier between the clinic and community.  These factors often leave clinics without staff for days, and people who need treatment may wait long periods for them to return.

And the Turkana themselves are not always eager to see Western medicine, aid workers say, because it clashes with their traditional beliefs. To battle this, NGOs try to educate the people on health issues, substituting science for superstition and training Turkana to be community health workers.

“The Turkana are people of tradition and sometimes are skeptical to change,” Abdullahi, the Merlin project coordinator, said. “Once the people are educated” by the trained Turkana community health workers, “they are receptive.”

Lokwawi’s mother, Ekai, has learned about the dangers of malnutrition. She returns faithfully to the makeshift Merlin clinic for the baby’s check-ups every two weeks. Still, she faces another challenge in keeping Lokwawi healthy.  Once her baby girl reaches the correct weight, the food aid and vaccines will stop.

Then Ekai will have to find enough food in the desert landscape to sustain her child.

“Without the aid,” Ekai said, “the children will suffer.”