Médecins Sans Frontières (MSF) continues to respond to the medical needs of some of Kenya’s most vulnerable people: inhabitants of slum settlements and refugee camps, patients with HIV/AIDS and tuberculosis (TB), and victims of sexual violence.
Over 350,000 people, mostly Somalis, live in precarious conditions in Dadaab, the world’s largest long-term refugee settlement. Following a tripartite agreement on voluntary return (signed by the UN Refugee Agency and the governments of Kenya and Somalia in 2014), the refugees can either go back to a war-torn country or stay in closed camps where they receive minimal assistance. The threat of kidnappings, robberies and sexual assault puts significant pressure on the people living in the camps and insecurity severely limits the capacity of humanitarian organisations to provide services.
MSF has not had a permanent international staff presence in Dagahaley camp, 80 kilometres from the border with Somalia, since 2011 due to increased insecurity, but continues to manage a 100-bed hospital and an inpatient feeding centre through the work of national staff and remote management. Outpatient and inpatient services for children and adults are provided, including maternity care, emergency surgery and treatment for HIV/AIDS and TB. Four health posts in Dagahaley offer basic healthcare consultations and outreach activities including mental health support. Each month, teams carried out around 15,000 outpatient consultations and 1,000 antenatal consultations, and admitted an average of 1,000 patients to hospital. MSF issued a briefing paper in March 2014, drawing attention to the inadequate and insecure conditions in Dagahaley and calling for more government and donor support for the Dadaab camps.
MSF’s programme in Homa Bay has provided antiretroviral (ARV) treatment to people living with HIV since 2001. Homa Bay was the first public hospital in Kenya to offer it free of charge. The programme is in the process of being handed over to the health ministry. More than 7,400 people were on ARVs in 2014. A new programme was started in Ndhiwa, where MSF has found adult HIV prevalence as high as 24 per cent and a worrying rate of new infections at two per cent per year. In order to reduce this, an integrated and simplified model of care will be introduced in health ministry facilities and in the communities in order to diagnose and care for most people living with HIV and decrease their viral load. Support will be given to health authorities to improve access to HIV testing, voluntary medical male circumcision, and prevention of mother-to-child transmission of the virus. MSF will also focus on follow-up and treatment adherence, and on improving the quality of care in Ndhiwa and Homa Bay hospitals’ inpatient wards where mortality rates among HIV patients remain high.
Healthcare in Nairobi slum settlements
In the Eastlands slums, poverty, drug use, crime and impunity contribute to high levels of violence, including sexual assaults. Victims, however, have very limited access to emergency medical care in this part of the city. MSF has been working to fill this gap with its programme at the Lavender House clinic in Mathare, which offers comprehensive care to victims of sexual and gender-based violence, including access to a 24-hour hotline and pick-up by ambulance. Patients receive medical consultations, treatment to prevent transmission of HIV and sexually transmitted infections, a pregnancy test when relevant, swabs for legal purposes, psychological counselling, and referrals for social and legal support. In 2014, more than 200 patients received aftercare each month; half of these were minors, and a quarter were under the age of 12. A trauma room at Lavender House was also established to manage ambulant medical emergencies, and stabilise and refer patients to other facilities when needed. Some 300 patients received care in the trauma room each month, the majority for physical assault.
After evaluating the health needs in the area, MSF decided to address the population’s lack of access to hospitals and specialist healthcare. A dispatch centre was set up and two ambulances were made available to the residents of Mathare and Eastleigh. During the first six weeks of the project, 141 calls were received. MSF also started supporting the accident and emergency department of Mama Lucy Kibaki hospital – the only hospital accessible for Eastlands’s two million residents – with additional staff, equipment, training and supervision. A programme focusing on detection and treatment of people with drug-resistant TB continued at Green House, Mathare, and MSF started the first patient diagnosed with extremely drug-resistant TB on a regimen that includes the new anti-TB drug bedaquiline.
The only free basic healthcare for people in the Kibera slum is provided through two MSF clinics. Treatment for HIV/AIDS, TB and chronic diseases is available, and the team runs a comprehensive aftercare programme for victims of sexual violence. MSF opened a new clinic in Kibera South, offering basic healthcare and maternity services. There is an inpatient maternity ward and an ambulance service for obstetric and other emergencies. Integrated management for diseases such as HIV, diabetes and asthma make it a one-stop service, improving patient access to medical care and facilitating early diagnosis, treatment and follow-up. Health education sessions, counselling and social support are also available. More than 60 per cent of all consultations at MSF’s Kibera clinics were for respiratory infections and diarrhoeal or skin diseases, a result of overcrowding, as well as poor hygiene and sanitation in the slum.
No. staff in 2014: 603 | Expenditure: €17.4 million | Year MSF first worked in the country: 1987 | msf.org/kenya