Every day scientists work on innovations and breakthroughs, sometimes for years, to save lives based on evidence and numbers, but sometimes when they get to the ground where the beneficiaries of the discoveries are, things don’t go as planned. Instead of embracing scientific ideas with open arms, the targets reject them without a second glance.
The surprising rejections often lead the researchers back to the drawing board, but this time wiser enough to know that sometimes cultural practices override science and modern medicine. It could be the rejection of super-foods like millet and cassava for their association with poverty, despite their known health benefits, or the rejection of boiled camel milk to curb brucellosis just because raw milk tastes so much better.
Here, a sample of health campaigns where millions of shillings were spent, only to be rejected.
1. LESSONS FROM THE PAST
Birth control and hospital deliveries? No, thanks!
For a long time, the government tried to encourage women in rural Narok to take up contraceptives and give birth in hospitals to no avail.
Although Narok County did not record high deaths of mothers as compared to other regions (191 in every 100, 000 births according to 2013 data from the Ministry of Health), there was the worry that the 1, 256 HIV-pregnant mothers, 85 per cent of whom did not deliver in health facilities, according to 2012 National AIDS Control Council numbers, would pass on the virus to their babies.
The women stuck to traditional birth attendants (TBAs) who had no means to prevent mother-to-child HIV transmission or deal with childbirth emergencies. Then a bulb lit up in the county reproductive health director Esterine Nenee’s mind and she came up with an unexpected proposal.
The government interventions hadn’t worked because they left out TBAs that women had come to trust and rely on, and men, whose word is final, in this patriarchal community. She asked the county government to pay every TBA who brought a woman to hospital Sh500.
They also roped in the men, who have always distanced themselves from “feminine” matters. Nenee crafted a curriculum and got a man to talk to his peers about the need for birth control. He likened it to using the meregich, a skin put on goats to keep them from mating and getting pregnant during drought when food is scarce and persuaded them to extend the same care to their wives.
This led to a turnaround that saw women take up contraception and men get more involved to the point of even starting a tuk tuk ambulance to ferry women in labour to health centres for childbirth.
2. MULTI-TASKING NETS
Net of prevention or shroud of death?
Although malaria is a known killer at the coast and in Nyanza, and can be prevented by sleeping under mosquito nets, in 2006, scientists were forced to go back to the drawing board when the people they were trying to save from the disease with free mosquito nets, no less, rejected them.
Instead of sleeping under them, the locals used the nets for fishing and on crop nursery beds, leaving them exposed to mosquitoes.
At the coast, residents rejected the white bed nets saying that they were white like the shrouds used to cover the dead, so they thought that they were being prepared for death.
Dr Bernhards Ogutu was among the malaria scientists who learnt the hard way that the science cannot be proved without taking into account social and cultural factors that may turn a breakthrough into a breakdown. “So we did not use white mosquito nets there again,” he said.
3. TOILET TABOO
Of sharing pit latrines and incest
Dr Sultani Matendechero who heads the unit for neglected tropical diseases at the Ministry of Health, planned to use the WASH tactic – water, sanitation and hygiene – to tackle some of the 17 neglected tropical diseases in Kenya. He had it all figured out, and the first step was to construct a whole lot of toilets in Migori County, to solve the problem.
To his surprise, the toilets were not embraced as quickly as he had imagined and a talk with village elders unraveled the puzzle – Men would never share toilets with their daughters because the fact that their sexual organs were involved in relieving themselves made them feel like sharing toilets with their daughters was akin to committing incest.
4. REAL MEN
Wrong cut, wrong words against HIV
When the World Health Organisation reported that medical circumcision could reduce the risk of HIV infection by 60 per cent, scientists in Kenya welcomed the news, seeing it as a solution to the infection rate in Migori, Siaya, Kisumu and Homa Bay counties that account for nearly half of all HIV infections in Kenya.
However, there was one little thing – communities in those counties did not practise male circumcision. That, however, did not stop the roll out of circumcision for men in hospitals.
Things went well for a while, and then politics threw a spanner in the works. In 2007, just after the disputed presidential elections, the male sexual organ became the subject of derision for those who had not been circumcised.
They were taunted for not being real men. In turn, the people who had been targeted for medical circumcision, feared it was a ploy to sterilise them and bring down their political numbers.
Though lead researcher Dr Agot Kawango managed to persuade the target group to divorce medicine from politics, there was another problem with communication.
Some men thought that 60 per cent reduced risk meant that as long as they did not exceed a limit of 60 female sex partners, they would not get infected.
It took aggressive health campaigns for more than a year and endorsement by political leaders for men to accept the procedure.
5. TRUE LOVE WAITS
Preaching abstinence to curb sexual activity in teens
When the Tumechill abstinence campaign was launched in September 2004, targeting teenagers, the numbers of teens infected with HIV went up instead of going down. HIV incidence rose from 29 per cent in 2014 to 46 per cent in 2016. Currently, there are 435,224 adolescents living with HIV in Kenya.
Nevertheless, the debate on whether teens should have access to contraception and condoms to prevent unplanned pregnancies and protect them from HIV rages on. Backed by religious intonation with vocal proponents, the idea that teens could benefit from age-appropriate sex and contraceptive education was flatly rejected.
Those who advance the theory of abstinence because Kenya is a religious country do not consider the socio-economic conditions under which children have sex. The Kenya Aids Indicator Survey (KAIS) reported that the age of sex debut is as low as 11 years and the reasons for early sex range from “fun” or “I was in love” to “I was influenced by the media.”
Dr Vernon Mochache, the head of research at the National Aids Control Council (NACC), reported on impediments like the ‘sponsor menace’ being a thorn in the flesh of strategies against new infections in young women. Sponsors are older men in relationships with younger women who look up to them for financial provision. Dr Mochache, explained further that there is never a single strategy to deal with the issue of teenage sexuality.
This is one of the campaigns where scientists haven’t found a breakthrough yet.
Dr Mochache thinks that a collaboration between the church in their mandate to preach morality and researchers with their hard numbers would be ideal, but the wide gap between the two approaches is yet to be closed.