Frustrations and Encouragements

So I was trying to think of all of the things that we take for granted in the states. Obviously, the list is quite long. The one thing that stood out more than anything else seemed like one of the most simple: things work in the states. By ‘things’ I don't mean cars or roofs or power lines (all of which are certainly not a guarantee here), but I mean the systems that people use. You need to drop a class. Yea, the process may seem complicated and needlessly burdensome, but at the end of the day your class gets dropped. There is a fire in your building. You call 911. Yea, it might take the firemen a few minutes to get to your place, but they get there, and they tend to put out the fire. Things are by no means perfect in the states, but at least something is done that you can consider imperfect. It is hard to call nothingness imperfect, or inaction imperfect. That is what the people of Kisumu face ever day. Many of their systems, especially health systems, simply do not function. They have no 911. Their local health department does not have staff meetings or work plans. Those in power don’t check their email. If you need to send someone an attachment, you have to send it as well as print out two copies, one to drop off at their office that day and the other for a week later when they lose the original copy. When medical supplies are donated to the area, there is no system to distribute them. A couple of days ago, in fact, the local officials tried to steal a truckload of donated medical supplies from the district. My coordinator, Beldina, had to race to the storage place, demand that the gates be locked so they couldn't get away with the supplies, and force them to put everything back. Then when Beldina tried to figure out which clinics needed what, many asked for things that they didn't need. One clinic that had no fridge wanted a case of cold packs. And that is just the government. Trying to make sense of the mess of NGOs working here is even worse. NGOs come and go, as does their funding. One week you can rely on them, the next week you can’t. Most are not accountable to the people that they serve, and many policies come from abroad or God without considering local needs/concerns or science. Many do the same thing, so people don't know which to turn to. Many issue conflicting information, and there is no way of checking up on that.

I know I that I am making it sound like everything is hopeless and no one does anything good. Not everyone is inept or corrupt. Not all systems are defunct. There are plenty of highly qualified individuals working and doing desperately needed tasks. But when the health and lives of half a million people depend on your work, like the city of Kisumu depends on the local health department, NGOs and private clinics, and you don't do your job, people die. A lot of people die. Yes, they need more money, and more training, and more support from the national and international governments, and less competition between NGOs, and less ethnic violence would help things too; but, at some point, a staff meeting would be a good idea, or maybe checking your email, or asking the community what they need or looking in a science journal rather than the Bible to decide what to do. It is quite a frustrating environment.

So things are frustrating, but there are encouragements along the way. Case and point: Migosi Health Center.

Photos of Migosi Health Center

It is the closest clinic to Manyatta. A year ago, it served about 5 people per day; today it serves around 50-60 people per day. There is no doctor. It only provides outpatient services. The local government provides them with medications twice a year, and it lasts about a week each time. There is a notebook to record names of patients and that is about it. There is one microscope for lab tests. Despite all that they do not have, Cecilia, the clinical officer (equivalent to a physician assistant) who runs the place, has made some great progress. She uses the small amount they charge for meds and buys more meds from the district hospital, which no government clinic should be responsible for. She got the clinic’s first autoclave donated, so now she can do minor surgeries and things like stitches. She fired half of the staff upon arrival (the old staff used to shout at the 5 patients and make them leave if they were too dirty) and still managed to increase the number of patients ten fold. Within two months, she plans on having a delivery ward opened. She and her 4 nurses are all trained to do deliveries, but they never could because they didn't have an autoclave, or authorization from the government. She even offers waivers for her poorer patients who cannot afford a round of antibiotics (which costs around 50 cents). All of her consultations are free. All services (including meds) to children under 5 are free. HIV/AIDS services are free. Some of these policies come from the national government (see, some things do work), but when a clinic only serves 5 people a day, they go wasted. I like Cecilia. And her head nurse Nancy.

Lessons learned: Many people don't do their jobs, which results in many systems faltering, which results in many people dying. Despite this, there are people who do their jobs, which results in salvaging some systems (or making a new one), which results in saving lives. I just need to do my best to be one the latter kind of person.

Sorry for the rant/ramble.