TwoHelp Kenya

Finishing in Nairobi

February 4, 2006 on 1:37 pm | No Comments

Amidst the confusion surrounding the collapse of a building, Susan and I returned to Nairobi for the last few days of our trip. Nairobi, like the rest of Kenya, grew on me during my stay. Warnings of danger are worth heeding but common sense is king. I would never wander alone in the streets of an unknown neighborhood in Boston let alone even consider it in a city with which I am unfamiliar. My fear of the city, based on unsolicited warnings from many different people, collapsed into the reality of the way I live my life and I enjoyed the final days I spent there.

The hospitality of the Kenya Red Cross was amazing. In every location we visited we were met with thankful and happy staff and volunteers. All of them were excited to meet us, more than willing to help however they could, and eager to boast of the successes of their programs. Running a volunteer-driven organization is a challenge, the tackling of which requires the motivation and drive of a saint. While the intentions of the Kenya Red Cross are admirable, volunteers need more than admiration to work. In an environment where there is nothing other than peer support and the occasional free T-shirt as incentive, the program managers and project coordinators of the Kenya Red Cross have built volunteer-driven programs more impressive than any other I have seen. Considering the economic status of most of the volunteers (remember: more than 50% of Kenyans survive on less than $1 per day), the Kenya Red Cross has done remarkably.

Of course, there is room for improvement. The output of our project is meant to build capacity internally to help the Kenya Red Cross move itself towards an even better position. As a team, we continue to work with the data we collected and look forward to the chance to apply the impact measurement instrument that we develop to the programs we visited.

As a parting gift to us, Winnie, our contact through the Fritz Institute, arranged for Susan and me to meet the director of the Kenya Wildlife Service and have a special tour of the Kenyan national animal orphanage inside of Nairobi National Park. While the rangers claimed that they were fully domesticated, since they had been orphaned at 3 weeks of age, walking into an enclosure with 3 fully grown cheetahs was nevertheless somewhat intimidating. Their hair is coarse, not soft, and the black spots protrude slightly further than the yellow hair surrounding them. It turns out that when you pet a cheetah behind the ear, it purrs like a regular housecat. They also lick like housecats, raspy tongues and all.

Anybody interested in a film that portrays some of the challenges of working in public health in Kenya should watch The Constant Gardener. Many of the locations in the film are places we visited during our trip and the issues raised, while fictional, are realistic and germane to the work that we did.

Kenya is a fascinating country. The demographics, climate, scenery, and styles of life vary so greatly from Kisumu to Mombasa that it is sometimes difficult to believe they are in the same country. As the dry northeastern portion of the country suffers from a terrible famine, I think frequently of the infrastructure and services that we have in the United States that prevent us from ever being hungry. Had Kenya our roads, food distribution would improve. Had Kenya our economy, purchasing power would improve and famished sustenance farmers would not need to walk away from the food that is available due to inability to purchase it. Had Kenya our sense of environmental protection, many of the drought stricken areas may still be lush forests and pastures.

Hope survives, in spite of the disappointing political situation in the country. As Kenyans come to terms with their young democracy and begin to understanding the power they have in their vote, the international community must also learn that they systems of funding that we have for developing countries need to improve. It is ironic that ‘Band-Aid’ was the name of the 1980’s effort to raise money for famine relief in Africa. Band-aid style relief and development support is exactly what Kenyans do not need. Donor organizations and countries must learn to locate and support Kenyan projects that build capacity and sustainability within the country, instead of bringing it with them from other places. What comes easily goes easily; the aid truly needed in Kenya is neither easy to understand nor apply. More than anything, it must all be undertaken with a slant towards encouraging transparency and the development of internal capacity within existing systems of government.

It is my hope that the project that we helped with contributes to the Kenya Red Cross in this manner - that they may have less need, in the future, for help from outside. I hope you enjoyed reading my updates from Kenya. TwoHelp.org will continue to pursue work in international public health and will maintain websites meant to help inform you of the work that we do. Please check back from time to time for more information. Thank you.

Nakuru, Molo, and Sustainability

February 1, 2006 on 1:37 pm | No Comments

Probably the wealthiest city that I visited, Nakuru is at the other end of a very bumpy 3-hour drive northwest from Nairobi. Known for Lake Nakuru National Park, the town and park host more visitors each year than any other park in Kenya. Until several years ago, Lake Nakuru hosted the largest flock of flamingoes in Kenya. Environmental degradation drove them away, and they have only begun to return now that the local authorities are working to preserve the area.

Lake Nakuru National Park feels more like Jurassic Park than the Masai Mara does. The entire area (it is in a crater) is fenced in and the signs pointing drivers towards various roads and paths denote a well-cared-for if not over visited park. The park is the home to the largest herd of white rhinos in Kenya, some of which are currently being relocated to Meru National Park. Incidentally, Susan and I were told that they were hiding, since the rangers were after them for relocation.  Our trip to the park was short, so instead of playing hide-and-seek with the rhinos, we snuck up on some cranky old Cape Buffalo.

Just north of the town of Nakuru is Menengai Crater, an enormous caldera from a long-extinct volcano. Both areas are typical of the geology of the famous Rift Valley, which stretches thousands of miles down east Africa.

The Rift Valley is dry. Dust devils spin across the arid terrain, whipping up dust storms that engulf people, cars, homes, and livestock. From miles away, I could see other roads by the trails of dust that were yellow plumes in the air. While this area is normally arid, the dust was a reminder of the severe drought conditions across all of Kenya.

The Nakuru Branch of the Kenya Red Cross serves 7 sub-branches. One of these, in a small town called Molo, has well-developed HIV/AIDS programs, supported through funding from the French Red Cross. By this point in our journey, Susan and I had heard the same stories told many times in focus group interviews with Peer Educators and Community Health Workers. Transportation is a problem for all of the volunteers, many of whom serve large areas. There are not enough written resources available for Peer Educators to learn more about HIV. The KRCS training does not cover anti-retroviral therapy in enough depth. Not enough teachers are educated about HIV.

Oddly, we found different problems in Molo. Of all of the locations that I visited, Molo is the only one that was in a hilly area. Yet, through the French Red Cross funding, Molo is the only site where all volunteers have a bicycle. While most branches of the KRCS pleaded with me to help them secure funding for bicycles, volunteers from Molo noted that they were difficult to use in the area because of all of the hills. Furthermore, none of them served clients that were more than 1 km from their own homes.

Other branches spoke of difficulties getting community leaders to accept the KRCS programs on HIV sensitization. Molo works with a village health council that works to integrate HIV learning into the communities and nominates community health workers to the KRCS programs. Where some branches had inadequate facilities, Molo, a sub-branch, has its own office with a meeting room and another large meeting hall that is available for use. Schools in Molo are well-integrated into the Red Cross Club program and students from the area had recently won the national competition on HIV awareness, known as the Chanuka Challenge. Other areas have problems with access to drugs to treat opportunistic infections, but Molo has its own community pharmacy, supported by the KRCS.

It is clear that money injected into programs can bring positive results. While volunteer retention is a problem due to lack of pay, the local population in Molo seems to be hearing and receiving the messages that the KRCS spreads about the dangers of HIV. From initial appearances, Nakuru is on the right track with their HIV program implementation.

Through our visit, the other sub-branches were never mentioned. Incorrectly assuming that they were also working under the French Red Cross funding, Susan and I were surprised when we heard, on the evening of our final day in Molo, that the other sub-branches are suffering greatly. Molo is in the hills, where the drought is not a problem. However, the sub-branch of Lower Subukia is not.

Lower Subukia is a remote sub-branch of Nakuru that covers a larger area than Molo, with fewer staff. The one nurse who serves many of the home-based care clients has to walk up to 15 kilometers to make visits. She has no bicycle. The area is one of the region’s hardest hit by the drought and nutritional complications with HIV are taking a heavy toll on the KRCS clients in the area. What in the world is going on?

The ultimate end-goal of our project is to help the Kenya Red Cross Society build the internal capacity to show donors how their money impacts the community so that they will know that their money is well-spent. Sure, the French Red Cross money is very well spent in Molo — but what about Lower Subukia and the other branches around Kenya that lack transportation? Why are there over 80 Red Cross bicycles in the one area where they are of little use?

The answer lies in the fact that donors are able to specify exactly where they want their funding to go. Molo and Lower Subukia are completely at the whim of the French Red Cross and other external donors. While injecting money into a single community seems like a good idea, it creates a disparity in treatment so stark that people from the other sub-branch areas have moved to Molo for better treatment and KRCS services. The rich are getting richer, so to speak, while the poor are left to fend for themselves.

If that seems like a difficult situation, consider that the French Red Cross funding is set to expire this February. Since the Nakuru Branch of the KRCS does not receive enough funding (or feedback) from headquarters to support the program on its own, the systems set up with French funding will quietly be cancelled and go away if they have not already become self-sustaining. Yet, none of the KRCS programs are designed to be self-sustaining. What Nakuru has is a small natural experiment in what happens when funding is withdrawn.

Their response is to seek further funding from external organizations. They are currently scrambling to secure some Swiss funding, in hopes that the programs in Molo won’t collapse. But what about Lower Subukia and the 5 other under-funded sub-branches? Unfortunately, with nothing to show for progress in those areas, it is difficult to attract funding, causing a aggravation of the vicious cycle that feeds the growth of service disparity in the region.

Nakuru has a chance, though, if only for the bright and devoted staff at the main branch and the sub-branches. They continue to take creative solutions to the difficult problem of program funding and are working on the establishment of a revolving fund to support income generating activities for the various branches and program clients. The village health council in Molo is committed to helping the communities overcome the blight of HIV/AIDS and the peer educators continue to perform exceptional community outreach programs, in the form of drama and puppet shows.

The systems of international aid are complicated and frustrating. While nobody can point a finger at the French Red Cross and say that they did a bad thing by funding the Molo projects, plenty of people understand the price that the other sub-branches of Nakuru paid for the funding influx in Molo. Money dumped indiscriminately on communities can do harm. It is important that organizations like the Kenya Red Cross develop the internal capacity to negotiate with donors to ensure the needs of all of their clients are met. Molo is both a great example of successful community-based HIV/AIDS programs and of the problems inherent in the world of international aid.