Health one of the biggest headaches for slum dwellers

• One woman’s tough life in Kibera typifies what thousands of poor people undergo

Bringing up six grandchildren in the mire of city life in her golden years on a Sh200 income has been a gruesome task for the 60-year-old grandmother.

Mrs Fanice Musimbi Ngatia points out malaria bouts are a common occurrence in the family of seven that lives in Kibera slums.

Inadequate shelter, unemployment, crime, unavailability of clean water, inadequate drainage and sanitation are some of the urban challenges facing the country as the world observes World Health Day on Wednesday.

And as the day is celebrated, Mrs Ngatia called for a keener approach to address health hazards in the environment, especially for slum residents.

Polythene bags

“We use polythene bags as toilets and later throw them behind the house,” Mrs Ngatia said in an interview at her Kibera home on Tuesday.

If only we had toilets and clean water, we would be healthier, Mrs Ngatia said adding the children defecated in the open trenches outside their doorsteps due to lack of toilets.

Of her ten children, two daughters passed away while a son has refused to return home due to the harsh economic times in the city, leaving her with five grandchildren to fend for, all aged between three and nine years old.

Her husband is in Western Kenya fending for another set of grandchildren.

Experts on Tuesday called for a multi-sectoral approach to deal with health challenges in the urban areas.

The day marks the founding of the global body, World Health Organisation. Key global health issues are selected and highlighted on this day. This year’s focus is on urbanisation and health.

Access to emergency health facilities remains a challenge to people living in informal settlements, a fact Mrs Ngatia affirms.

Recently, she and her neighbours rushed 22-year-old neighbour Olivia Khavea, who is three months pregnant, to a nearby clinic but they could not afford a full medical checkup.

“I am still experiencing pains and vomiting but I do not have money to go to the hospital,” Ms Khavea said.

A 2005 WHO report says children are especially vulnerable due to exposure to air pollution especially in the cities.

The thirst for urban settlement has increased tremendously in the last five years, a fact that WHO country representative David Okello describes as a crisis if solutions are not found soon.

“Disease outbreaks like cholera have been reported in urban areas, especially in the slum areas where hygiene levels have been compromised,” Dr Okello told participants at a conference organised by the African Population and Research Centre in Nairobi on Tuesday.

“Running stomachs and vomiting are a common occurrence in my house but we have learnt to boil water,” Mrs Ngatia said. However, a 20 litre jerrican of water costs Sh3 yet I need to wash, cook and bathe the children, Mrs Ngatia who does her laundry in a nearby estate said.

Dr Okello said more than half the global population has moved to the cities as per 2007 statistics. The trend is slowly catching up in the continent, challenging governments to improve urban health.

Recently, the Nakuru Municipal Council launched a Sh50 million project to decongest the provincial headquarters following an upsurge in population.

Reports say more people have been moving into Nakuru from the North Rift, Nyanza and Western thus the population of the town has shot up from about 600,000 people three years ago to close to a million.

High population growth rates, widespread poverty and escalating cost of housing have been blamed for the rapid deterioration of living conditions.

Mrs Ngatia pays Sh1,000 rent per month for a single room that is not inclusive of water and sanitation facilities.

“We live in town but out of town as well,” Mrs Ngatia said adding urban life had become expensive and more hazardous compared to when she first moved to Kibera two decades ago.

Dr Okello called for concerted efforts between the government, local authorities and the private sector to solve the urban crisis.

It is estimated that more than half of Kenya’s urban population, or more than five million people, now lives in slums and informal settlements.

Urban lifestyles have increased exposure to both communicable and non-communicable diseases for dwellers.

“With the drastic population growths, urban areas shelter the larger disease burden” Dr Okello said.

More resilient

He called for participatory approach to improve urban areas, especially slums to make them more resilient to emergencies and disasters.

“Make the informal settlements formal by prioritising on urban planning,” Dr Okello urged the government and other stakeholders.

A key urbanisation concern was the high maternal deaths recorded countrywide despite a reported increase in health indicators over the past one year.

APHRC executive director Alex Ezeh called for decentralisation of health facilities to bring services closer to the people.

Dr Ezeh Expressed concern over the burden of communicable and non-communicable diseases in urban areas.

“Eighty per cent of deaths are caused by preventable diseases like pneumonia and diarrhoea,” he said adding lifestyle diseases like diabetes and hypertension could be averted by avoiding sedentary live which is characteristic of urban populations.

“Unless we make a difference in improving health indicators in the slums, we will be chasing a shadow,” Dr Ezeh said.

According to estimates six out of ten people will be living in urban areas by 2030 whereas by 2050, seven will be living in the cities.

However, a grave concern haunts urbanisation in Kenya, there has been an upsurge of maternal deaths despite improvement of health indicators.

Dr Margaret Meme, head of Maternal and Child Health at the Ministry of Public Health, called for a more aggressive approach to avert the high number of deaths.

She called for a paradigm shift where pregnancy has been termed as a private issue between the expectant mother and her family, locking out the society.

“We lose 7,000 mothers annually in our country yet it seems a negligible figure,” Dr Meme said comparing the toll to that of road accidents, fires, air crashes amongst others.

Greatest culprit

Poverty seems to be the greatest culprit as slum dwellers suffer all manner of diseases.

Despite living in an urban setting, many are the days that Mrs Ngatia has sent her six grandchildren to bed hungry on unfruitful days when there are no clothes to wash.

“The children understand life is hard and unbearable, there is little I can do,” she adds. Mrs Ngatia only hopes that health conditions in the slums will be improved as Kenyan struggles to ensure it becomes a healthy nation.