The heat in Kacheliba is at 32 degrees celsius, and it is licking people’s dry faces. It is coiled around their limbs like a great hot-blooded serpent, but in this heat, the heart of clinical officer Solomon Turkei is cool, calm and at peace.
While all healthcare workers approach their work with an attitude of ‘it is a matter of life and death’, Turkei’s is a lot more serious, and borders on humanitarian work, and for that, he realized his medical knowledge was not the only set of skills needed to take care of his patients.
Turkei— known to his colleagues as Turkey— is the medical superintendent at Kacheliba Hospital, the only of Kenya’s two hospitals that treats Kalaazar, a little known disease transmitted by sandflies, which attacks organs and kills if not treated on time. Apart from Kacheliba, there’s only a clinic in Baringo and another hospital across the border in Uganda.
The disease is one of the 18 diseases that the World Health Organisation (WHO) classified as “neglected tropical diseases” (NTDs). In Kenya, the Head of Neglected Tropical Diseases at the Ministry Dr Sultani Matendechero reports, that it threatens more than 600,000 people in Turkana, West Pokot, Baringo, Isiolo, Baringo, Marsabit and Wajir.
First, Turkei has had to budget for food for extra people that often accompany the patient. The treatment for Kalaazar requires daily injection for more than two weeks, and to avoid defaulting, they are often kept in the hospital. It is not advisable, and in this case, patients cannot be asked to come for the daily injections. Mothers accompanying their sick child carry with them the other children because they have no one to leave them to.
The clinician told Nation that patients travel as far as 400 kilometres seeking care when symptoms—severe fever for more than two weeks, weight loss and fatigue, swelling of liver and spleen— set in. It does not help that West Pokot records the highest malnutrition rates in Kenya, next to Kitui according to the 2014 Kenya Demographic Survey. With poor nutrition, he says patients’ immune systems runs so low that they fall victim to severe anaemia. In that undernourished state, they become defenceless to infections such as pneumonia and Malaria which as are endemic in West Pokot. If not organ failure, they would die of other diseases.
HEAVY BURDEN OF DISEASE
Eunice Chemanang’ for instance, travelled with her two children from Akulo at the periphery of Baringo-West Pokot County borders. She travelled with the youngest of her child, because she had no one to leave him with. She left the oldest with a family, and at the hospital, she told Nation: “I hope they have given him something to eat”. A mother of three who can only afford a meal a day, this journey to save her son’s life impoverished her even more because she had to part with Sh1,700.
“I walked for about four hours to Akorekwang’ then paid Ksh200 from Akorekwang’ to Sigor, and then Ksh1, 500 from Sigor to Kacheliba on a motorbike,” she explained.
At the hospital, even though it breaks the hospital’s budget, Turkei allows that they are all fed.
The management of Kalaazar sometimes requires blood transfusion due to anaemia, and it is not unusual that Kacheliba runs out of blood. When that happens, Turkei has to refer to the nearest hospital, 70 kilometres in Amudat, in the Kenya-Uganda border.
His colleague on the Ugandan side, Dr Patrick Sagaki, treats Kenyans from as far as Sigor. Dr Sagaki, from the Baganda community, has had to learn the key words in Pokot, West Pokot and Karamoja language so that he communicates with his patients. The facility he heads is the only one in Uganda that treats Kalaazar.
As he reviews the medical files in his computer, Dr Sagaki is interrupted by two bubbly boys running and playing around the hospital.
“Stop it,” he orders them, and when they calm down, he apologizes profusely for his “sons”.
The boys are children of one of Sagaki’s patients who travelled for more than 400 kilometres to seek care when her husband abandoned her after she fell sick. The woman, a Kenyan from Baringo County, was suffering from Kalaazar.
MAKING TOUGH CALLS
When the woman— whose identity the healthcare workers asked to be kept anonymous for her safety— came to the hospital, she was too sick and her ears were already oozing pus. When taking her medical history, Dr Sagaki learnt that she was abandoned, and she had three children who had been left in Baringo. While it was not ideal, Dr Sagaki asked the hospital staff to bring the children to stay in the hospital with their mother.
Dr Sagaki told Nation “Food has become really expensive because while the budget was for one person, I have to include the rest”
Working in this region, the doctor has had to assume the role of brother and father to his patients. It is a double burden; Amudat is in Uganda’s poorest region of Karamoja, and also takes care of patients in Kenya’s Baringo, Turkana and West Pokot counties.
The United Nations categorized Karamoja as one of the world’s poorest areas, with high rates of malnutrition and a whopping 61 percent of its 1.2 million people living in absolute poverty. Majority had not even been vaccinated against common illnesses. The Kenyans that seek care in this facility do not come from better communities either. Some of them come as far as 400 kilometres from Kenya’s Baringo County, seeking care by travelling to Amudat, in a region with no established means of transport.
Health, Dr Sagaki says, is therefore complicated by the poverty and illiteracy of the Karamoja area— in which Amudat falls—and further worsened by the historical neglect of the area, which does not help the situation.
In an interview with the East African, a sister publication to this site, Dr Sagaki said: “Most of the patients who come here have low immunities because of the malnutrition, that when they get here, we are not treating Kalaazar alone but also other diseases that they may have fallen ill to such as Tuberculosis, Malaria, bronchitis and others”
When she got well, he did not discharge her immediately. He said: “She has to stay here, eat and regain her strength so that she can fend for her children when she leaves the hospital”
In the wards, Dr Sagaki explained the boarding arrangements.
He said: “When they are in the wards, the Pokot do not want to stay together because of the cattle rustling history”
It is not West Pokot alone where historical neglect has affected even the number of healthcare workers willing to stay and provide care. In Marmarai, Samburu, there are clinics that would offer the much needed primary healthcare services such as immunization. The nurses resigned and left.
HARSH LIVING CONDITIONS
Unforgiving does not begin to describe the terrain in Marmarai, East Samburu. The heat brakes the ground, literally. People share the little water available with elephants and other wild animals. It hardly rains here, but when it does, the downpour is so vicious, people have to wait on the other side of the river until the raging waters calm down. The few healthcare facilities there are could be on the other side of that river.
At Marmarai, there is no cellular coverage. Nurse Teobalda Michael of the county government relies on a non-governmental organisation to take occasional vaccination exercises to the people in Marmarai from Wamba Health Centre where she works, a four-hour laborious drive away.
“It is very difficult to refer patients, because you cannot call,” nurse Teobalda commented.
Stories were told of how nurses boarded motorbikes, riding until they stumble on network coverage to call and talk to their families. These challenges, worsened by the shaky human resources for health in the counties, have made it easy for healthcare workers to leave, a few, guided by some moral code, endure the hardship.
West Pokot, Samburu and other arid semi-arid areas have very few healthcare workers, as little as only 1 doctor per 100,000 patients, as places like Nairobi have as much as 90 doctors per 100,000 patients according to the Kenya Health Workforce Survey.