When women are pregnant or breastfeeding, their bodies use more energy since they are essentially keeping someone else alive in addition to themselves. As such, they require more nutrients in order to keep both them and their babies healthy.
That fact might sound normal or routine, if you have the privilege of education and access to a reputable medical facility. In Kibera, proper health information is hard to come by, as is quality medical care. For Kiberans, proper nutrition during pregnancy or lactation is a serious and delicate matter.
Through its Community Wellness Program, Carolina for Kibera strives to provide families throughout Kibera with correct health information about a variety of topics, including nutrition, sexual health, and family planning.
Recently, the program held a training session on proper nutrition during pregnancy and breastfeeding. The audience engaged with several issues, including how to make sure children are getting proper nutrients, do’s and don’ts of lactation, and other facets of maternal health. Sanitation and hygiene were also discussed, since the lack of sanitation in Kibera presents a constant threat to the well-being of mothers and young children.
Esther, CFK Nutritionist, provided insight into the work she does bringing malnourished children back to full health at the Lishe Bora Mtaani Nutrition Center. She provided first-hand examples of the day-to-day realities the staff at the Nutrition Center face as well as pragmatic solutions that help kids stay on track. Keeping kids healthy and well-nourished from the moment they’re born is a top priority for CFK staff and volunteers. By disseminating proper information to the community at large, CFK is working to ensure that pregnant mothers are prepared to help them and their children stay in good health.
Recently I had the opportunity to tag along on a couple of “home visits” with Esther, one of the nutritionists at Carolina for Kibera’s Lishe Bora Mtaani Nutrition Center. Our destination was Gatwekera, a village in Kibera located south of the CFK office.
CFK staff members and Community Health Workers (CHWs) conduct regular home visits for several health-related reasons. CHWs go door-to-door to administer health surveys, acquiring basic health information from families all over Kibera. They also screen children for malnutrition; if the child is malnourished, they send them to CFK’s Nutrition Center. The purpose of our visits was a little different. We were checking up on some of the children who had completed the Nutrition Center’s 8-week program and been successfully brought back to full health earlier this year.
Esther is a resident of Gatwekera and led me through the maze of houses and narrow, winding streets— it’s been raining recently in Kibera, and although the dirt alleyways have been turned to thick, slippery corridors of mud, Esther made her way quickly and nimbly in her flats while I struggled to keep my balance in a pair of oversized gum boots.
Our first stop was at the home of Millicent and her 2-year-old daughter Mary, who was released from the nutrition center in January. As we stepped inside their home, Mary instantly hid herself behind the curtain separating the family’s bed from the main living area— she was happy to see Esther (her second mom/auntie), but wasn’t too sure about me. We sat down with Millicent and Esther asked her about Mary’s progress and status since leaving the center. She’s maintained a healthy weight, has good energy, and is meeting important developmental milestones such as walking and talking. Her mom told us that Mary is also a great eater: her favorite foods are rice and beans, spaghetti, and cabbage. Millicent also recently referred a neighbor to the nutrition center.
The home visits with Mary and other former patients of the nutrition center are a critical element of its holistic approach to treating malnutrition. Parents are equipped with the knowledge and skills to keep their children strong and healthy, and follow-ups serve to identify any challenges and provide support and assistance where needed. It was exciting and encouraging to meet the plump, happy, and healthy babies and their equally happy parents—it takes a village to raise a child, and nowhere does that ring truer than here in Kibera.
Health organizations worldwide treat even a single case of polio very seriously. According to the Global Polio Eradication Initiative, “Most people infected with the polio virus have no signs of illness and are never aware they have been infected. For this reason, the WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic – particularly in countries where very few cases occur.”
In 2013, 14 cases of polio were reported from the refugee camp in Dadaab (located in Northeastern Kenya). This was Kenya’s first occurrence of the disease since 2011. In response to the reported cases, the government of Kenya, supported by UNICEF and the WHO, began a polio immunization campaign in areas where the risk of polio is highest, such as in the refugee camps, on the borders, etc. Nairobi was also identified as a risk area, due to its population and transient nature. Social mobilization campaigns were organized within communities to draw awareness to the risk of polio, the importance of immunizations, and places/times where immunizations are available.
Carolina for Kibera’s volunteer Community Health Workers (CHWs) were rallied into the campaign. The government set the target of reaching 95% of children under the age of five (the most vulnerable population) in the three villages where CFK’s health programs operate. CHWs got to work, going door-to-door talking to their neighbors about getting their children immunized against polio.
Recently a report of the polio immunization campaign was released that indicated the targeted number of children under the age of five to be reached (11,123) in the villages where CFK works was met and surpassed by 32%. This means that a total of 14,651 children were immunized against polio and that CHWs managed to reach beyond the target to new families who had moved into the area or those who were passing through the three villages. None of the other villages in Kibera surpassed their targets. The second highest reach was 92%.
Not only does the polio campaign illustrate the effective way a community can rally around a cause and support one another, but it shows the high level of organization and trust that is present in places where CFK’s health program operates.
During a monthly parents’ meeting at CFK’s Nutrition Center, a young mother gets up and walks towards a makeshift hand-washing station at the front of the room. A Community Health Worker (CHW) is standing next to it, encouraging volunteers to come up and try it out. The young mother giggles as she turns to the other parents, who are standing and leaning between each other to watch. She then turns and begins to wash her hands. When she is finished, the CHW applauds her and asks the other parents what they saw. “She didn’t wash under her fingernails,” one mother says. “She needed to wash farther up her wrists,” says another.
This forum is jovial and friendly, but behind the community laughter is the hard truth that anyone living in Kenya learns: clean hands save lives. Unlike in the US where bacteria and parasites are usually separated from our food, water, and way of life, in Kibera, there is no separation. The best protection against water born diseases, food poisoning and cross contamination illnesses is proper sanitation and hygiene, with hand-washing being a large part of this.
Thanks to the support of Ronald McDonald House of Charity (RMHC) CFK’s integrated health programs have been rallying the community to pay close attention to hand washing as part of their daily routines. The campaign “Your Health is in Your Hands” is being promoted across CFK programs.
The Tabitha Clinic, in partnership with CDC, recently noted that the incidences of typhoid have reduced. Typhoid is a serious disease that is connected with areas where water is contaminated and there is a lack of sanitation. While it’s not certain why cases have reduced in Kibera, clinicians have speculated that the increased education of hand washing and better sanitation practices have made an impact in stopping the spread of the disease.
CFK determined that its first priority for this behavior change program would be to focus on population groups whose practices have the greatest influence on children, as they are at a higher risk of serious, long-term health issues and developmental problems as a result of illnesses. So far, the campaign has reached 1,541 households with children under the age of five, 32 pregnant women and 16 traditional birth attendants who regularly help women give birth at home and interact with pregnant women and new mothers.
While the repetition of hand-washing information can seem superfluous to those looking in from the outside, the reminders and continuous dialogue about the issue build long-term habits for healthier living. For this reason, CHWs take their time visiting households and continue to hold forums to talk about the critical nature of hand-washing and proper sanitation and hygiene for the long-term health of families.
When CFK met Isaac in May of this year he weighed 6 kgs (~13 lbs), at 13 months old. The normal weight of a child his age in Kenya is usually around 8 kgs (~18 lbs). That may not seem like a lot, but it is for a young child.
During a community screening for malnutrition, CFK Community Health Workers (CHWs) met Isaac and his parents. Isaac’s mother is a housewife who, at the time, had just moved to Kibera from the rural areas with her son to be with her husband, Isaac’s father, who works as a casual laborer. Only making 150 shillings (~$1.75) a day, the minimal income wasn’t enough to provide for the family, and Isaac’s health showed it.
Not only was Isaac severely malnourished, but he suffered from anemia, pneumonia and developmental delays. Doctors at CFK’s Tabitha Medical Clinic recommended that Isaac be admitted to Mbagathi Hospital for eight weeks. Not able to cover their usual day-to-day expenses, Isaac’s family was worried about the hospital expenses. Thanks to the support from CFK’s Health Department emergency fund, the bill of 4,800 shillings (~$56) was covered, and Isaac was released from the hospital weighing 6.7 kgs (~15 lbs).
After being released from the hospital, Isaac was enrolled in CFK’s Lishe Bora nutrition center where he was fed every two hours, with feeding supplements and balanced meals and snacks. As part of the holistic program, Isaac’s mother took classes on preparing balanced meals for her child and on the importance of good hygiene and sanitation for families living in Kibera. After just two months in the centre, Isaac was able to stand and walk on his own and was beginning to speak, all developmental milestones he previously hadn’t reached. He was finally discharged from the nutrition center weighing 18 lbs.
Isaac’s journey still continues. He and his family receive weekly home visits from the nutrition center and CHW teams at CFK to make sure Isaac continues to progress. In November, I joined CFK Nutritionist, Esther and CHW Francis as they visited Isaac in his home. A shy but clearly loved and happy little boy, Isaac recognized Esther when she arrived at his home. Isaac’s mother held and hugged her little boy, talking to Esther about how she was able to change meal preparations to make them more nutritionally rich and healthy for her family, something she learned from Lishe Bora. She told Esther that if it weren’t for CFK, she may have lost her son. Esther replied, “This is what we do. We’re just doing our part for the health of the kids.”
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