Reduce Suffering in Kenya Via Health Care Services

*Not their real names*

We met *Kanana on a Sunday morning when we briefly stopped at the shopping centre in Miomboni in the Tana River Ecosystem to see whether fp clients needed services. CHAT’s CORP partner, Mercy Kiura, spoke to *Kanana about the services that the CHAT motor mobile clinic offers. Kanana welcomed us to her home, rounded up a couple of women who wanted fp services and continues to let us use her home to provide services.

*Kanana is a thirty-year-old widowed mother of two. She has a small food kiosk, and the income from it is what she relies on to provide for her family, but it can sometimes get difficult to distribute her small income because she needs to make sure there is food on the table, a roof over their heads, clothes on their backs and for her children go to school. Her children are both in primary school. Her eldest is ten years old, and her youngest is seven.

She shared that her husband was in the army and was away for long periods. During one of these periods, Kanana suspects he got HIV. It was only after he passed away that she suspected he might have infected her with it, which she confirmed to be true from the local health dispensary. Her husband was the ‘breadwinner’ of their family, but now she had to fill in and support her children independently.

Kanana has a clear drive to provide for her children, and for her, family planning is a necessary measure. Kanana told us that she has been using a short-term fp method because she did not know about long-term fp contraceptive methods. She was happy to learn about the benefits of the long-term methods, especially as it will save her from having to go out every three months to get the 3-month pregnancy protection injectable method - Depo. The 3-month pregnancy protection method meant that she would have to close her kiosk during working hours to go to a clinic, but now she needs no more time off for that!

The major benefit of fp for Kanana is that she can stop having children completely and focus on raising her two children. She tells us that what drives her is the hopes and dreams of her children; her son wants to become a doctor, and her daughter, a teacher.

Thanks to GG support, in the past three months, CHAT was able to reach a total of 11,943 individuals with behaviour change information (bcc). 3,097 fp clients received different contraception methods of their choice, of which 2,073 chose the long-term pregnancy protection methods of either 3 or 5 years - against unwanted pregnancies.

“Birth control is the first important step woman must take toward the goal of her freedom. It is the first step she must take to be a man’s equal. It is the first step they must both take toward human emancipation.” - Margaret Sanger.

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*Not their real name

“When I started visiting the Obaria Beach at Lake Victoria in Western Kenya, I had the hope of not only reaching the fishermen who are busy out on the lake all day but also targeting the women who dry the caught fish around the shores," explained Emily, CHAT's CORP partner based at Kendu Bay in Homa Bay County. She went on to narrate that she understood the dynamics of her community well. She knew how vulnerable the women at the beach were, especially young women who relied on the fishermen and fishing activities for a living.

She remembers this young girl she interacted with on her very first day. "When I saw the yellow T-shirt and carrying a yellow bag on her back with a book in her hands, I was anxious to know what this lady was up to,” *Akinyi narrated. “She looked very composed and resourceful even at a distance,” she continued. She explains that though she had been busy spreading the fish to dry since morning, she wouldn’t mind enquiring what help the lady in the yellow T-shirt would be to her (CHAT CORP partners usually wear a bright yellow t-shirt to help community members identify them)

Emily met up with Akinyi on the shore and walked towards the fish-selling kiosks as they interacted. "Daktari, you should have come earlier than this! Many of us are suffering here, not knowing what to do nor where to go," Akinyi said after CORP Emily explained herself. Akinyi not only felt for herself but also for her friends, whom she knew would benefit enormously from Emily’s services. She would then tell Emily that she had had several men in her life, and she had a child from each of them, but only for them to leave her to bring them up alone. "I am a mother of three, two daughters and one son. It is not easy bringing them up, and I would not wish to have any more," Akinyi said emotionally. She explained how she had been mistreated by several of her boyfriends, recalling a scenario where she and three children spent a night in the rain outside after being chased out of the house at midnight.

"Had I known this long before, I wouldn't have made these mistakes. I don't regret my choices. I regret my ignorance and lack of knowledge," she said bitterly. "Now I have known the way and seen the light, I will return. Not alone, but with my friends who gave me company in this tough journey of ignorance," Akinyi said satirically. She would later introduce CORP Emily to a talk to the other girls and women at the beach. Emily recalls how Akinyi reacted when she saw her coming accompanied by a nurse the following day. Akinyi shouted joyfully, "Freedom is here!" Later, she would continue to be the one to link CORP Emily on when to bring the nurse to serve her other busy friends.

Thanks to GG support, in the past three months CHAT was able to reach: a total of 12,943individuals with behaviour change information (bcc), with 3,195 family planning clients receiving different contraception methods of their choice, of which 2,211 chose the long-term pregnancy protection methods of 3 & 5 years’ against unwanted pregnancies.

“If we don’t halt population growth with justice and compassion, it will be done for us by nature, brutally and without pity- and will leave a ravaged world.” Nobel Laureate Henry W. Kendall

*Not their real names

Akinyi* is 35 years old from Simbi Nyaima in Homabay County on the shores of Lake Victoria in western Kenya. She has been married for over 10 years and has 9 children. After giving birth to her 5^th child, her husband slowly began to lack interest in providing for such a large family. He eventually left her - leaving her to deal with the children alone. Akinyi found it very difficult to survive alone with so many children, so she found a partner with whom she has 4 children. Her latest husband does what he can to support her and the children.

Akinyi explained that she had heard of family planning before but didn’t know where to get it from, and on visiting a private health clinic nearby, it was simply unaffordable. CHAT’s CORP partner, Emily, was going door to door for service provision with a government nurse and explained all the various types of contraception protection methods. Akinyi eventually chose the three-year implant. “I have this little amount I would like to give you for the good service you have provided me. You have enlightened me and brought these precious services right to my doorstep!” Akinyi said as she handed over a hundred-shilling note to the nurse.

“Thank you for that, but keep it to buy at least something for the children,” The nurse said. “CHAT offers these family planning services to the communities we serve, for free. The kind donations from our donors enable this.” CORP Emily explained. “All I will ask of you is to ensure you tell your friends about this.” She continued. Akinyi was overjoyed to hear this. She then decided to extend kindness to her sisters and friends who were also suffering without any form of support with their little children.

The following day, CORP Emily was surprised to receive a phone call from the facility in charge that five women were asking for her. She went to the health facility and found Akinyi with four other girls. She had also brought them to get implants, as they had heard what happened at her home. What a joy it was to see this. She ensured that she sensitised them, and they all chose FP contraception methods they were comfortable with.

“I am always happy when I educate my clients, and they choose a family planning method, but it's even greater joy when they go an extra mile to bring their friends in for the services. It shows that what I am doing is needed and the right solution to our problems.” CORP Emily shared. Akinyi left with her friend promising to continue sharing the news with more people.

Thanks to GG support, in the past three months, CHAT was able to reach: a total of 13,862 individuals with behaviour change information (bcc), with 4,004 family planning clients receiving different contraception methods, of which 3,008 chose the long-term methods 3 & 5 years’ protection against unwanted pregnancies.

“The evidence is pretty strong: if you have access to family planning and birth control, the abortion rate is going to go down.” Bob Casey, Jr.

* Not their real names

When the motor mobile team got to Lailai, they were surprised to see how many people were waiting for the services. It had been ages since the community members had seen the team in their village and this was a relief for them. As soon as they started offering services, an argument ensued at the furthest end of the camp. It was between Nankeri* and her husband *Laisuman. Laisuman wanted Nankeri to immediately go to the tent and receive a five-year Implant so that they would stop having children.

 He was furious that his wife could not understand that they were poor and more children meant that they were not going to survive at all especially due to the lack of food and other basic needs. All his children could barely attend school and the toddler that Nankeri was carrying did not even have any clothes on his back since all hand me downs from his elder sibling had now turned into rags.

Nankeri, on the other hand, did not want to get the implant as she thought that it was a majorly painful operation and she could not put herself through it. This argument attracted the attention of CHAT’s Community Own Resource Person (CORP) partner, Asha, who went to try and solve the issue. Upon mediation, she was able to understand that Nankeri is scared so Ashe promised to be with her every step of the way. She even told her that she would not feel any pain apart from the injection that is for the local anesthetic if she chose an implant. Nankeri agreed and it was okay, she could have the method of her choice, the implant, but only on condition that she would not feel any pain when the nurse was inserting it.

The idea that having the implant was such a huge operation was from her friend *Laninu who was scared so she decided to inflict fear on Nankeri also. Once Nankeri who closed her eyes tightly and buried her head in her clothes was injected with the local anesthetic the area became numb and she even turned to look at what the nurse was doing! She could not believe that within five minutes they were done with the pain-free procedure and she could go home. She went straight to her Laninu’s house and told her of her experience, then brought Laninu to receive the service too!

'A lot of misconception and misinformation is from the women themselves who do have adequate knowledge of what contraception is. They mostly share fantasies and imaginations from the top of their heads but if they all could just seek a little more information then things would change.'  nurse Ann went on to explain that 'It is very unusual to see the man advocating for family planning and the woman refusing! This is a wise man.'

Thanks to GG support, in the past three months, CHAT was able to reach a total of 12,911 individuals with behavior change information (bcc) with 3,004 family planning clients receiving different contraception methods, of which 2,738 chose the long-term methods – 3 & 5 years protection against unwanted pregnancies.

“Our women need help and a lot of education since the lack of information is what is the cause of so much of their suffering. I know if they had access to this kind of knowledge before, they would be planning their families better and not having these sort of problems.” Susan Lenantare CHAT CORP partner.

*Not their real names

“Five years ago a friend of mine- Muthoni*, died.” CORP Rosie narrated. “She had a daughter called Makena* who was always tagging along with the mother every time she went to the market to restock for her small vegetable stand in Mungetho slum where they lived in Nanyuki. What Muthoni was not truthful about is that she used to sell ‘illicit brew’ (lethal homemade alcohol) as a side hustle to her veggie business. Often from time to time, she would get arrested and Makena had to bail her out. Being a 15-year-old and going through such things hardened her at an early age.

When Muthoni passed on, Makena took up her job but could not keep up. She later disappeared and it was speculated that she moved back to their rural home. A month ago, I decided to go to the market in the evening. I saw roasted maize being sold and decide to snack on it as I shopped. The seller had a familiar face but I could not place it but no sooner had she spoken than I realized it was Makena! She had a baby tagging on her dress as another one was on the back sound asleep. I wondered if they were hers. I asked her to visit my house for supper as we caught up.

She indeed showed up and was grateful for a good meal. Although she has a business, the little she was earning was really hard to sustain her family. She has 3 children. Soni* who is about to turn five, Nderu*, who is 3, and Kesha* who is just 6 months old. They were all born so close. They all had different fathers who had promised to marry her but left her as soon as she had conceived. It was a streak of bad luck with the men. It was just sad. She kept saying she now understood why her mother only had one child. It is easier and cheaper to bring one up I introduced her to the different family planning contraception methods. She was wowed by the idea that she could take a break and work toward making her life stable. She decided to go all out and take the five-year pregnancy protection implant that would go a long time – compared to other choices.”

Thanks to GG support, in the past three months, CHAT was able to reach a total of 12,134 individuals with behaviour change information (bcc). Out of which, 3,912 became family planning clients receiving different contraception methods, of these 3,001 chose the long-term methods - 3/5-years protection against unwanted pregnancies.

 “We view it (family planning) as an aspect of human freedom! In the same way, as we give people education so as to open wider horizons for them in the world, the same way as you provide a farmer with greater knowledge about the seed - this so the person cannot be restricted in his living by ignorance and know the means of spacing children,” Mwai Kibaki – ex-President of Kenya