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Home » Get Involved » Field Journal » Change Starts with Small Steps in Kenya

Change Starts with Small Steps in Kenya

Kibera StreetThe sun pounded down on us as we walked to the middle of Kibera, the slum area of Nairobi that up to a million people call home. My colleagues and I entered through Kibera’s market area, where long aisles of vendors in corrugated metal structures sell anything from fresh produce to clothes to electronics. My Kenyan colleague, planning some apartment renovations, stopped at a hardware stall to inquire about the price of paint. I stood by, letting their Swahili run into a stream of words my English-speaking brain couldn’t make sense of, and examined an overstuffed ring of paintbrushes hanging on the wall. A man lay down seemingly unconscious in the middle of the path a few stores away, mostly ignored by others. It seemed like a typical day in the second largest slum in all of Africa.

We continued on, reaching the area of Kibera known as Mashimoni, which means “holes” or “pits” in English. I hopped over a few muddy areas covered in shoe soles and cardboard. The sun’s heat intensified the smell of unidentifiable waste emanating from the ground. When we entered the courtyard surrounding Frepals Nursing Home, I gratefully stepped onto the concrete floor that was swept free of any debris and in the shadow of the roof’s overhang. The clinic itself was cool and clean and Freda, the clinic’s owner, greeted us warmly. After the requisite introductions we followed her single file down a short hallway to see the birthing rooms. Freda paused to congratulate a new father, a teenager, and then ushered us into a room where her daughter, a trained nurse, and a technician were attending to the father’s newborn.

When Freda started Frepals in 1995, the clinic got off to a rocky start, suffering setbacks including a robbery that stripped it of all equipment and furniture. Today, re-stocked, the clinic serves as a refuge for Kibera women seeking health services. A relationship with an international grant-making organization keeps the clinic stocked with medicines and supplies and subsidizes the referral of complicated cases to a nearby hospital. An on-site generator ensures that electricity is available to power infant warmers and refrigerators storing medicines that must be kept cold.

Kibera Landscape - KenyaFreda showed us to a recently expanded second-floor with an area where new mothers recuperate after delivery. The beds are basic and lack much privacy or space to maneuver – amenities that a mother in the United States would likely blanch at doing without – but the brightly painted concrete walls and well-lit room seemed like a haven from its surroundings. When I stepped back outside the room and onto the surrounding balcony, I saw endless rows of metal roofs extending past us. The tall buildings of Nairobi proper were barely visible beyond the expanse of the slum.

I asked Freda how mothers living in Kibera even made it to the clinic to give birth. I couldn’t imagine how a woman in labor could navigate the narrow and unpaved paths, especially in the middle of the night. Freda explained that taxis could pick up a mother and bring her to Frepals, but the process of phoning the taxi to picking up the mother to dropping her off could take hours. A taxi broke down during the middle of a recent delivery and a new car wasn’t able to arrive for several hours. The mother eventually made it to the clinic but during those hours of waiting, the baby died.

Many taxi companies won’t even drive into Kibera; Freda had to develop relationships with those willing to enter the slum. If a taxi isn’t available, a mother might be hand-carried to Frepals in a make-shift stretcher. If she tries to walk alone, she risks robbery or other assault in addition to the uneven and unpaved paths.

Kitui Climb - KenyaWitnessing the obstacles that mothers living in urban areas must overcome to reach a health facility during delivery was stunning. I had expected such barriers in rural areas like Kitui district, where just a few days before I saw steep dirt roads leading to a single health clinic at the top of a hill. I met a mother there who gave birth at home, by herself; she couldn’t even hope to navigate the treacherous terrain to the clinic in the middle of the night. It was the only health facility that might be reasonable for her to reach (the next nearest clinic is hours away); and unlike Frepals, it didn’t have a maternity ward or remain open 24 hours a day. I realized that no matter what the setting, urban or rural, delivering at a well-equipped health facility is not a viable option for many Kenyan women.

Ensuring that an effective, affordable health technology like misoprostol is available to women will not fix the larger, systemic problems in Kibera or Kitui. However until large-scale improvements occur, misoprostol is a simple solution to help prevent mothers from dying of postpartum hemorrhage that works in both contexts. Change must begin somewhere. I believe it can start with an individual like Freda or with a few small tablets.

Debbie Koh, a program support specialist at VSI, traveled to Kenya in March 2011 to support the organization’s safe motherhood programs.


To read a Kenyan news story covering Freda and her clinic, click here.
To read about VSI’s Kenya Program, click here.