Stanford University
Questions Rob Breiman brainstormed off the top of his head in an email
21 February 2011
1) 80% of women in Kibera apparently deliver their babies in the home despite a fair number of varying levels of maternity capacity in the area. Would be good if a system could remind women to deliver and partner with various hospitals to find the right hospital to deliver based on the mother’s health needs (will they likely need a C-section; are there hiv-related issues), ability to pay, geographic location and virtually escort that mother to the health center, perhaps even sending someone to the home to help her get there. All done with SMS.
2) Follow-up for TB medication—ensure that newly diagnosed TB patients take their meds and that ill patients in the home are seen.
3) Use camera function to send suspicious skin lesions to a central location where a dermatologist can look at and recommend appropriate follow-up
4) Encourage and follow-up on various types of vaccinations
5) A reporting system and information system if there are animal die-offs in the area
6) Like with Sunny’s water project, how about a system that will let a patient know where certain medicines could be found and at what price. If the system had a little AI embedded within it, a mother could send a message saying a child let’s say as diarrhea—the system could determine that the first thing that the mother should do is get oral rehydration solutions (ORS) for the child and direct the mother to the nearest options (kiosks/dispensaries/clinics) which have ORS and provide information on price and availability.
7) Push smoke free cook-stoves
8) Push hand hygiene.
9) Encourage good nutrition
10) Find the latrines/price (also sort of similar to Sunny’s project)
Notes from phone conversation with John Neatherlin, Belinda, Audrie via Skype
11 March 2011, 12:00PM
SCHEDULE
• Thursday
o Airport - pick up from person with our sign
• Friday
o Morning
▪ Pick us from house up to bring us into office by 10am
▪ Intros, cell phone
▪ Intro to CDC office - within Kenyan medical institut
o Afternoon
▪ Go into Kibera
▪ Introduce to CDC field staff and CFK NGO staff (health, youth/sports, girls programs)
▪ Meet with project coordinators for us
▪ Meet community interviewers - we can team up or go separately.
• They're very powerful people and have a lot of information.
• Most come out of Kibera, speak English, are computer-savvy.
• They have their finger on the pulse of that community.
• Very intimate with these households they see every week.
• One of the best resources. Can put us in touch with a particular direction. Can put you firmly on that path.
• Weekend
o Tabitha clinic not open on weekends.
o Kibera is thriving on the weekends.
▪ Every weekday morning: exodus of men leaving, but on weekends they're there. Population is pretty much there.
▪ Humming place. Real live market environment. Never felt threatened there.
o Community interviewers don't work on weekends.
o Idea for weekends: get to know your UoN counterparts better.
WHAT
• Burns are a huge problem in Kibera.
o Family of 10 living in 10x10 living next to 40.
o Electricity.
o 3 Rock Stoves - charcoal cook stoves.
o Fires two days ago. Fires every month.
▪ Razes a good 10-20 homes, 100 displaced.
▪ Many injuries, no deaths.
▪ Our data may cay catch at household level, but definitely at clinic level.
• Road traffic accidents.
o Lack of EMS system - of a stabilization and transport system. Forget it!
o We're actually putting something out with a proposal. Want to look at morbidity, mortality, response capabilities.
• Researchers from UK come over last month
o Studied relationship between alcohol use and domestic violence.
o Toured some of local home brew / moonshine.
o They cook in little huts, sell it wholesale in huge drums for 40 shillings - 50 cents/shot. Expensive for Kibera.
o Kenyan gvt just legalized homebrew. Before you couldn't even access to study it: no white guy could walk in and ask about why - interesting and untouched topic.
• Infant mortality is exceptionally high.
• Making known network of NGO+Missionaries’ activity
o Hook them up to each other, better integrate/link existing services.
HOW
• Community interviewers: go to 30 households/day.
o The houses are stacked up on top of each other. Could be one structure.
o Busy. They're cool, chilled out.
o Hanging out with them is always educational experience.
• Three options
o Team Leaders of the Community Interviewers
▪ Also have interviews with households but also supervisory so not as busy.
▪ They also know the community.
▪ Hook up with one or two team leads.
o Community Interviewers
▪ Rotating you around with the 40 CI's so won’t overburden any one CI.
▪ Get different taste of different parts of Kibera, different opinions.
o Other NGO’s
▪ Connect via the CI's with other organization activities that are ongoing / NGO's.
▪ Everyone's throwing their money at Kibera.
▪ Dynamics of what all other agencies doing in this population
• Women's issues, domestic violence, water, food, health, education, latrines.
• Questions
o Role of UoN students?
▪ We’ll send an intro email and go from there.
o Can we speak with medical professionals?
▪ Tabitha Clinic: doctors, nurses
▪ Patients - possible, just need to set it up - there's a lot of queuing.
o Will we be a burden?
▪ It is disruptive when the CDC has to accommodate VIP’s (e.g. their donors). We're going to be no sweat.
BACKGROUND: JOHN
• Was supposed to travel to US on Friday the 18th. That’s been postponed.
• Will be in western Kenyan starting Monday.
• Has only been here since January 14th.
• Deputy Chief for the International Emerging Infections Program (which overseas Kibera among other things)
BACKGROUND: CDC
• Population-based surveillance
o ~25k residents enrolled
o 40 community interviewers who carry PDAs and visit households 1x/week
▪ Conduct interviews with head of household
▪ Look for diarrhea, fever, births, deaths, jaundice.
▪ Those sick are referred to clinic.
▪ Been doing for a few years and have really stable baseline of burden of disease in the community.
• Etyology of what's causing these diseases.
• Creates a platform that people want to access to do vaccine effectiveness studies.
• Example: Is there decreasing disease burden?
o TCB10 - pneumoncocal…
▪ Preservative-free vaccine distributed in two vials (2 shots/dose but no preservative in it).
▪ Trying to catch adverse events for the vaccine.
▪ Someone going to get a jab, follow-up if infection at injection site.
▪ Rolled out nationally. Part of government’s normal ministry immunization schedule.
• Look at typhoid vaccine effectiveness study.
o Reduction after infection of vaccine? So we have this platform that we've used to collect baseline data and now looking at it to do intervention studies. We hope can show intervention effectiveness.
• Influenza.
o Donated seasonal influenza vaccine. We did vaccination campaign last year. How popular was the influenza vaccine? 10k or 50k doses.
BACKGROUND: KIBERA
• one referral hospital (Pigate)
BACKGROUND: MAPPING PROJECT
• Longhouses
o One corrugated tin roof with cement wall structure: divided up. Can have literally 35 10x10 rooms in this one structure.
• We have mapped out and ID'ed each for our population surveillance: but only subset of Kibera.
• So densely populated that to get GPS reading on any single household: can't triangulate that closely.
• Plus there's migration in and out.
TO DO
• Introduce 2 other UoN students to John via email, welcome them for Friday morning 10am meeting.
• Email John to refer us to CFK people and ask about weekend activities/events that we can join
Meeting with CDC’s Leadership Team
Monday, 21 March 2011, 10:00AM
CDC’s Field Office in Kibera
In attendance
• CDC: Alice, Beatrice, George, Kennedy [? – last names, phone numbers, job position]
• Stanford University: Audrie, Belinda
• University of Nairobi: Ernest, Nancy
• International School of Kenya (high school): Laura
Beatrice
• CFK does youth programs; CDC gathers data
o CDC does morbidity surveillance, deaths, migrations, immunizations of children, HIV incidence in Soweto & HBCT [?]
• Vaccinations: idea for our research
o Many children don’t have the meniccocal [?] vaccine
o Mothers forget
o Children at different ages require different vaccinations
▪ At birth, 6 weeks, 10 weeks, 14 weeks, 9 months (measles, polio)
o Somehow prompt mothers to have better health-seeking behavior
▪ Example: take child to see physician when child is sick
George
• Big need: to take children to seek healthcare
• Challenges include
o Housing
▪ Structure, size
o Water
▪ Diarrhea, unclean water supply
o Sanitation
▪ Not many households have access to toilets because of distance & cost
o Low uptake of vaccinations
▪ national rate
• Diarrheal diseases
Beatrice
• Pregnancy – inform mothers of the danger signs to warn them so that they can go to the hospital instead of delivering at home
Alice
• Effect behavior change
• One cause of diarrheal diseases is poor sanitation due to poor drainage
George
• Mothers prefer to deliver at home due to a number of reasons: cost, distance, and preference for a traditional birth
Alice
• Provide trainings to recognize the danger signs of pregnancy
Beatrice
• Nutrition
• Daycare centers in Kibera – where a mother can drop off a child with food (daycare doesn’t provide), and can pick up later in the day for 20 shillings
• Provision of food is dependent on the mother’s discretion
Beatrice
• How to deal with emergencies
• There’ve been 3 fires in the slums
• Happens when it’s hot and dry
• Most fires occur in January and February
• No one really knows the cause – believed to be electric faults and cooking stoves
• Needed: alerting alarm, way to transport water
Beatrice
• Reproductive health
Kennedy
• Every day he sees diarrhea on the side of the road outside of daycare centers
George
• 1 formal toilet/structure per 200-300 people
• People use buckets
• People don’t go out to use formal toilet at night due to security issues
• Violent crime and rape
Jeffrey
• There’s no lighting in toilets so people don’t go at night because it’s scary
Jeffrey
• People consult religious/traditional leaders/healers instead of doctors
Kennedy
• Culture affects old age [?]
• Performance in sexual affairs [?]
Beatrice
• ICT solutions?
Beatrice
• 999 is supposed to be the number to call to reach police/emergency services
• But it doesn’t work – either the line doesn’t go through, no one picks up, or no one responds
• Proposed idea: hardwire the important hotlines (e.g. for the clinic) into the phone so that people don’t have to manually save it and it’s easy to access
Kennedy
• Diagnostic facilities, e.g. ultrasound and diagnosis for injuries/infections
• People don’t seek proper help because it’s not affordable for them
Beatrice
• Idea to inform people of the warning sign of illness
• Proposed idea: take temperature or blood pressure with a phone (e.g. maybe with the earbuds) and tell them to go to a doctor above a certain temperature
• 80-90% of people have a phone but what percentage have a thermometer?
Phone numbers
• Beatrice – 0733 747 818
• Jeffrey – 0721 815 359
• George – 0723 228 468
• Kennedy – 0720 331 985
• Alice –
• Hillary –
• Earnest –
• Nancy – 0712 505 346
Meeting with CDC/FK’s William Mwiti
Monday, 21 March 2011, 12:00PM
Tabitha Clinic
We spoke with William, the doctor at Tabitha Clinic. Eric gave us a tour of Tabitha Clinic.
Spoke with Mainamuzoh who works in the microbiology lab. The lab performs gram staining, blood cultures, and screens using 12 drugs. They look for pathogenic bacteria like salmonella, campylobacter, cholera, etc. Samples are sent to Kisumu for rotavirus assays (ELISA). The microscopy lab is separate from the culture-based lab. They screen for helminths in the microscopy lab.
All services are free for people in the surveillance population.
The fees at Tabitha if you are not in the surveillance population:
400 shillings for an X-ray
100 shillings for a consultation
50 shillings for lab tests
People can be referred to the district hospital in Kibera like Mission Hospital for more serious ailments.
While waiting to see the doctor, nurses check weight, temperature, and vitals of people waiting in the waiting room. Then people go to the registration room. Tabitha uses an electronic medical record system. After registration, the patient is sent to triage, where the nurse checks symptoms, fills out forms, and then the patient is sent upstairs to the doctor. In the waiting room, the clinician calls out the names of patients who they are going to see. There are 5 clinicians who are the equivalent of physician assistants with the ability to prescribe medicine. Room #6 is the HIV positive follow up room. “Living in positivity”. Patients given support. Room #7 is the treatment room where patients can relax and wait. Room #8 is the VCT room, where people are given counseling by volunteers. HIV testing is also done.
There is a pharmacy in Tabitha. On the front of the door is a posting with the lab tests offered and the turn around times for results.
There is an X-ray room at Tabitha. Eric, our tour guide, works in the x-ray room. They do x-rays for patients with TB or pneumonia. If there is no printed hard copy of the X-ray, then the patient doesn’t need to pay for it.
In the consultation room, blood is drawn. Microscopy is on the lowest floor. Board room is on the highest floor, William’s office is also on the same floor.
William says that patients are referred to Mbagathi, a district hospital at the far end of Kibera (40 min to 1 hour walk from Tabitha). Kenyatta National hospital is far (1 hour walking from Tabitha) William says driving time could vary from “10 minutes to 2 hours” due to traffic.
Tabitha clinic has
1 doctor (William) see patients with more serious conditions
6 clinical officers = physician assistants who can take medical histories and prescribe medicine
7 nurses
7 lab technicians
1 videographer
2 pharmacists
4 cleaners
2 guards
150-200 patients are seen at the clinic per day.
Tabitha doesn’t deliver babies. The pregnant women are sent to St Mary’s Clinic, Kenyatta, Mbgathi for deliveries.
60% of CDC study participants come to Tabitha, others go to other places like private practices or district/national hospitals.
98% of patients who come to Tabitha are from the CDC surveillance population
There are 27,000-28,000 people in the CDC surveillance population and it is a fairly stable population even with migrations. They are continuously enrolling new people.
Flu vaccines start next week. They want to hire a nutritionist because there is CDC funding for a nutrition program. They will roll this out soon.
William thinks that ICT solutions could help with the following:
Vaccine availabilities – e.g. TB vaccines
Clinic hours of operation
Health facilities
Vaccine or medicine dose reminders
Appointment scheduling
Meeting with CDC’s Community Interviewers
Monday, 21 March 2011, 12:00PM
Tabitha B [used to be CFK’s second clinic before the merge; now is CDC office for CI’s]
In attendance
• CDC
o Bernard Odhiambo – 0725 151 313
o Robert Mutinda – 0722 777 514
o Celestine Opijo – 0722 497 391
o Otiende Jacob – 0729 363 687
o Erick Omae – 0724 853 019
o Wilson Ngene – 0722 531 348
o Gordon Paul – 0750 596 959 / 0728 872 972
o Pero Patrick – 072 590 3937
o Damiana Kimuyu – 0721 829 978
• Stanford University: Audrie, Belinda
• University of Nairobi: Ernest, Nancy
• International School of Kenya (high school): Laura
Wilson
• One health priority is the provision of dental care
• There are no dentists – they’re all a distance away
• They charge high fees – 350 shillings
• It’d be great if the CDC can bring in a dentist and charge a standardized fee
Damiana
• Idea: a maternity unit at Tabitha clinic
• So many women get pregnant
• Most opt for a traditional delivery, primarily due to cost
• Futhermore, if they experience labor pains at night, they won’t go to a clinic because it’s not safe
Someone [?]
• Idea: latrines
Gordon
• Idea: hygiene promotion campaign
• Promote handwashing
Wilson
• Hygiene is difficult without proper infrastructure & drainage
• Perhaps the government needs to provide that first before the handwashing can happen
Gordon
• No, I think that it starts with behavior change for handwashing
One more round between Wilson and Gordon before moving forward
Pero
• Idea: inform people to take medication
• People rely on hearsay from other people
• If others exhibit the same symptoms, they will borrow their drugs
• There is no proper prescription
• People take the wrong medication
Damiana
• How behave towards treatment & drugs [? – didn’t record her point]
Wilson
• Idea: people send in their symptoms and there’s a generated list of drugs & options (e.g. get a blood culture done, etc.)
Damiana
• Idea: people give their number to the clinic, clinic will send an SMS message to the head of the household and inform that the pneumonia vaccine is available
Robert
• Kibera has a 60% literacy rate
• Would have to send message in Kiswahili & English
Eric
• Idea: to get people to get home-based care, e.g. for those HIV positive or on hygiene
• People are not informed about how to take care of themselves
• How to provide instant & viable care
Celestine
• Idea: creating awareness of HIV
• How to reach household level
Jacob
• Seeing is more powerful than hearing
• Idea: circulate CD’s and DVD’s of infected people
• So people are instilled a fear of HIV by seeing someone suffering
Wilson
• People are more careless when they know there’re antiretrovirals available (a “cure”)
Robert
• To eat [?]
Pero
• People don’t know
• Ignorance [?]
Jacob
• Need to shock people into behavioral change
Pero
• Idea: provision of counseling to general public
• You can only get counseling if you’ve already got HIV and are infected
Damiana
• Need heightened awareness around
o HIV/AIDS
o STI’s (sexually transmitted infections) in general
o Tuberculosis
Damiana
• Idea: provide a network for all the NGO’s/agencies working in Kibera to know about each other and refer the same patients
• There are so many institutions/organizations
Damiana
• Idea: computer/info center not for internet, but for all healthcare information – the same healthcare information that a doctor would consult/have access to themselves at a clinic
• Say, have 4-5 centers – in CFK, church, etc. (churches are very safe)
Wilson
• Currently, lab results are hand-taken by CI’s to the individual homes/patients
• Idea: ICT database such that once your results are in, it’ll send a text to the patient. Example: “Your pneumonia test is positive, come see a doctor.”
Celestine
• Lab results take 2-3 weeks to get to a patient because they have to be taken in-person by the CI. And because people may not be in any given week and not be able to be found.
Jacob
• Idea: bring ambulances
• Clinics
o Free services by the CDC and MSF (Doctors Without Borders).
o Bhaghathi, Kwanga, St. Mary’s, Lakeside, Wema Clinics, Senye all provide fair prices
• But even so
o They don’t work after 3pm, or 4pm, or 5pm [basically, after business hours]
o None of these clinics send out ambulances; you still have to transport yourself to the clinic
• Methods of transportation: wheelbarrows, stretchers, on someone’s back
Jacob
• Idea: provision of fire extinguishers
• In the case of a fire, there are no routes
• Idea: connect to the police or emergency service
Who [?]
• Police arrest teens watching videos [teens not committing crimes]
• Police hurt us, not help us [they’re not on our side]
Damiana
• Idea: have a hotlines database of the resources in the community
• During the post-election violence, there were many rapes but people didn’t know how to handle rape, where to go, that they shouldn’t bathe themselves, etc.
Who [?]
• Allies who are important: opinion leaders, churches, mosques
Meeting with Hillary Omala
Monday, 21 March 2011, 2:30PM
Carolina for Kibera
In attendance
• CFK: Hillary Omala
• Stanford University: Audrie, Belinda
• University of Nairobi: Ernest, Nancy
• International School of Kenya (high school): Laura
Hillary used to manage Tabitha Clinic
He is currently the head of Health Services at CFK but still engaged w/ activities at Tabitha. Hillary graduated in 2004. Hillary used to work for World Vision. He worked for Kemri/CDC for 4 years and 1 year at CFK.
2 different missions for CFK & CDC.
CFK focuses on preventative services and CDC focuses on curative/research.
CFK started in 2000 with Rye Barcott. Rye originally meant to go to Rwanda but his trip failed so he went to Kenya instead. He lived in the slums of Kibera and rented a 10 X 10 shack. He studied the problems of the youth and tried to figure out what could be done to solve them. He had many discussions with the youth. He met a woman named Tabitha. She asked Rye to listen to her since he only listened to the youth before. She asked him to give her money to start a business. Rye gave her 2000 shillings = $26 US dollars. Tabitha sold veggies and raised capital with that money. She started a clinic in her house. Rye came back to Kenya and was impressed with Tabitha’s work. He raised funds to move the clinic into a 3-room facility. In 2004, Tabitha passed away and they named the clinic “Tabitha Clinic” in her honor. Rye convinced the University of North Carolina (where he was a student) to partner with Tabitha Clinic to become Carolina for Kibera (CFK).
CFK added more programs. They stared a sports program to broker peace among Nubians who claimed Kibera was theirs and other ethnic groups. During the sports programs, CFK would instill messages of peace, teach life skills and reproductive issues. In 2005, CDC was looking for a place to conduct research. Their criteria was:
1) Paucity of healthcare
2) Security
3) Cultural diversity
4) Possibility of demolition was low
5) Already existing facility
Tabitha clinic met all of their criteria and they started a partnership in 2005. The clinic expanded from 3-5 rooms to 8 rooms. CDC and Tabitha provided free services for households enrolled in the CDC household surveillance study. They started out with 15 patients and this number soon rose to 180 patients per day. With the expanding number of patients, Hillary had to look for a second clinic. He found Tabitha B, which looked like the houses in the slums. Tabitha consisted of 2 clinics until 2009.
In 2009, the two Tabitha clinics combined and were moved to a new giant clinic (where we visited).
Ben runs the CFK Sexual and Reproductive health program (SRHP). SRHP provides curative and preventative services at Tabitha. They provide health education regarding communicable diseases to the community members. They go to schools to teach health education as well. They are starting a new program that involves 12 village health committees. These village health committees are composed of community members from the 12 villages in Kibera. Each committee has 14 representatives. They will focus on academic and health programs. These committees provide jobs. Each committee must be aware of the health of their assigned village, and they will be in charge of the community surveillance system. They will also partner with African Medical Research Foundation (AMRF). If someone has diarrhea, the community health committees for each village can give recommendations about where to access help/treatment. CFK plans to roll out these health committees in May.
Another CFK program is Binti Pamoja which means “Daughters United”. It is a program for girls ages 12-18. It provides safe spaces for girls, financial literacy, scholarships, and other educational programming.
In the 2009 census, the government reported that there were 170,000 people living in Kibera. Hillary says that there are more than 170,000 people living in Kibera. The Soweto village alone has 30,000 people. Hillary’s estimate is 350,000-500,000 people living in Kibera. NGOs sometimes inflate the population estimates.
There are thousands of quack clinics that are run by nurses, doctors, pharmacists, chemists, traditional healers, religious healers, etc. In Hillary’s opinion, only 6 provide quality care: Tabitha, MSF, AMRF, etc.
Reasons that people visit quack clinics:
1) The turnaround time for malaria tests at Tabitha is slow. Patients just want to have drugs so they have “no need for a doctor”.
2) The clinic has a long queue
3) Distance
4) The belief that results that take long are “not real”
5) Free service is not legitimate
6) CFK used to be known as “Devil Worshippers”. Most hospitals have snakes in their logos and CFK has two arms that open to the sun, so it looks like the devil. Some people believed that CDC would draw blood from them and feed the blood to the snakes. Religious leaders would spread this lie and “protect the people”. Misinformation spreads quickly by word of mouth.
7) People who run the clinics are in competition and they want to make money. They spread misinformation to help their own businesses. They damage the reputations of other clinics and accept bribes.
Kibera is a direct transfer of people from rural to urban. When people visit the clinic they immediately self-diagnose and say “I have malaria” instead of saying “I have a fever”. Doctor must treat them for malaria or they will look for alternative care elsewhere. People think that they, themselves are a better source for medical knowledge than doctors.
There is a popular belief that there is no malaria in Nairobi, but there is. People who test positive for malaria are from Western Kenya and the coast.
Hillary’s opinions about health priorities in Kibera & technological solutions:
1) Basic data collection for HIV/communicable diseases. He thinks a better way than PDAs is a cell phone system that allows you to update the database in real time. Health committees could check their households in the village and send the info directly to the CDC main office using cell phones.
2) SMS health education tips. Reaches many people. Mobile usage is 85% so you can reach a huge population. Andrew is the CFK video coordinator (he is not staying beyond May 2011). He creates the health education videos that play in the waiting room at Tabitha clinic. Every morning there are short 15 minute health lectures. They play these on repeat. E.g. HIV info.
3) Phone based inquiries. Several people don’t have information so their questions could be answered with this system. Some people seek care but don’t know where to go. E.g. if you have an ob gyn problem, where can you go? It’s like a health hotline. You can also follow up with patients who have chronic conditions. E.g. “Defaulters” are people who appear once for their drugs and then disappear. You could remind these people to come back for follow up visits and drugs.
4) Google Uganda has a health tip service. You send questions to the system and it sends back information about what you need to do. E.g. Send in symptom like headache, stomach ache, and it returns a message about what you need to do.
5) Tabitha has been operating for 4 years. You could have a willingness to pay survey. Most people can’t afford to pay for services still. Hillary wants to see a community health financing program. It’s like community health insurance and microfinancing. You save money using phones like M-Pesa. 100 shillings or 5 shillings deducted and sent somewhere every time you buy airtime/phone credit. Often times people say, “Why save for health when I have no food/water?” But if you have a system that automatically deducts a percentage and saves it for health, then people won’t see that cost as much. People lack trust in each other. Furthermore, the prevailing mentality in Kibera is the idea that “When you get a better life, you’ll leave Kibera”. Some women’s groups gather 500 shillings to give to one person in the group. Men don’t like these types of groups.
Any system you use should be in Swahili because they’re the ones you want to target. Other languages could incite ethnic tension. Political parties are defined by tribe in Kenya.
CFK doesn’t have computer programmers, CDC does have programmers.
Debrief amongst Audrie, Belinda, Ernest, Nancy, Laura left early
Monday, 21 March 2011, 3:30PM
CDC’s Field Office in Kibera
• Go around and everyone give the top themes of today
• Come up with the following big “buckets” that everyone shared
o Health education
▪ Followup for vaccinations & lab results
▪ Inquiry service for health information that will inform person what to do if there are symptoms, pains, illnesses, warning signs
▪ Water & sanitation, latrines, drainage, diarrheal diseases, handwashing, hygiene
▪ Usage of formal clinic instead of other clinics, local chemists, traditional leaders
▪ Taking proper medication and not being misinformed
o Nutrition
▪ Child malnutrition, provision of balanced & affordable meals
▪ Daycares?
o Maternal health
▪ People deliver at home instead of at the clinic – cost, distance, safety
▪ Inform people of the danger signs for pregnancy
o Emergency services & security
▪ Rape, fire, crime
▪ Alarm, hotline, response, nighttime escort service, lighting at toilets, network/connect all the existing services
• Brainstorm people to interview
o Residents – check
o Community interviewers – check
o Mothers – check
o Medical professionals (doctors, nurses) – check
o Local chemists / the quacks – check
o Traditional healers
o Religious leaders
o Daycare centers
o Police officers – check
o Security guards
o Other NGO’s (e.g. MSF) – check
• Homework assignment for tonight: everyone responsible for brainstorming the following buckets
o Health Education – Belinda & Ernest
o Nutrition – Audrie
o Maternal Health – Audrie
o Emergency Services & Security – Nancy
• Proposed action plan for the week
o Tuesday & Wednesday – interview CI’s and Kibera residents
o Thursday – go outside the CDC encatchment population & go to other NGO’s/agencies
o Friday – loose threads, give presentation to the CDC/CFK
Meeting at Nokia
Monday, 21 March 2011, 4:00PM (we arrived late at 5:00PM)
Nokia’s office in Africa, Nairobi city center
In attendance
• Stanford University: Audrie, Belinda; Aleema, Davis; Claire, Pablo
• University of Nairobi: Dan, all UoN students except Ernset & Nancy
• Nokia: Jusif, Moses
Intros & backgrounds by everyone
• Jusif
o Leads the research center of 17 interdisciplinary researchers
o Anthropology/ethnography background
o Studied social media & children in six slums
• Moses
o Economics & international development background
Caution to not attribute behaviors to cultural reasons
• Jusif gives the example of TV consumption in slums
• He observed that there would be up to 100 people in one room watching TV, each paying 5 shillings to get in
• He thought maybe this was a cultural thing [an African thing, a slum thing, etc.]
• One year later, he comes back and he didn’t see any more!
• In the meantime, cheap coloured TV’s had flooded Africa
• Now, everyone could buy a TV
• Overnight, “communal TV consumption” vanished
• Instead of any cultural reason, it was out of economic necessity
An example of a product/service that came out of community research
• Mobile application that will do bookkeeping & stock management for small businesses
• Also provides access to loans
• Will inform you of which products are fastest-selling
• Not yet on the market, but will soon
Advice
• The user validation stage is very important
• Ask a lot of questions on your assumptions
• You can identify a lot by identifying strengths in a community
• If you’re problem-centric, you’re helping and it won’t be sustainable
Debrief amongst Audrie, Belinda, Ernest, Nancy (Laura accidentally slept in & missed the day)
Tuesday, 22 March 2011, 9:00AM
CDC’s Field Office in Kibera
Summary of meeting
• Share questions we each brainstormed last night
o Add to other questions
o Devise list of “basic information” questions
• Devise the plan for the rest of the day
o Split up, accompany CI’s to interview residents
o Belinda – Wilson
o Audrie – Celestine
o Nancy – Damiana
o Ernest – Jacob
Basic Information
1. Name
2. Age
3. Number of kids
4. Length of time in Kibera
5. Profession
6. How much do you make?
7. How do you pay for healthcare?
8. Do you own a cell phone?
9. Do you use SMS?
10. What language are you most comfortable with?
11. If the service were in English, would you still use it?
12. Can you read and/or write?
Medication and Information
1. What kind of illnesses, pains, and symptoms do you experience on a day-to-day basis? How about your children?
2. When you do feel sick, what do you do?
3. Do you self-medicate?
4. What medications do you use most often?
5. Where do you buy your medication?
6. How do you get information about health?
7. What sources of health information do you trust?
8. How may ICT help you access health information and services?
9. Would you prefer to SMS or use a menu of options?
10. What kind of information would you want to receive?
11. How would you compare such a service to existing sources of health information?
Vaccinations & Lab Tests
1. What clinics do you go to?
2. What is your attitude towards vaccinations?
3. Why do you think vaccinations are important? Why or why not?
4. What, if any, diseases are you and your children vaccinated for?
5. If so, where do you go to get vaccinated?
6. Do you know that some vaccinations require multiple doses?
7. Do you send your kids for followup doses? Why or why not?
8. How do you find out about new vaccinations that have just arrived?
9. How long does it take for you to receive lab results?
10. After you get your lab result, do you go back to the clinic? Do you go somewhere else?
11. How may ICT help you or your children with vaccinations and lab tests?
Health Information/Education
1. To get from Ernest….
Fire
1. How prevalent is fire, and what are the consequences?
2. What are the major causes of fires?
3. How are fires handled & extinguished?
4. Are there existing hotlines?
5. Who provides assistance, e.g. police and firefighters?
6. By what medium (e.g. technology) are assisters informed?
7. Do they get there in time?
8. How can ICT help?
Rape
1. What are the attitudes surrounding rape?
2. How prevalent is rape?
3. Are you aware of what should be done in the case of rape?
4. What are facilities and resources available?
5. Do rape survivors report rapes? Why or why not? What is the response?
6. What demographic are rape survivors?
7. Are there support groups for rape survivors?
8. How can ICT help?
Security
1. How is the level of security in Kibera?
2. What are the major security issues?
3. Who are the perpetrators?
4. How do they affect healthcare in Kibera?
5. What is the role of the police?
6. What about nighttime security?
7. Are there hotlines?
8. How does one reach the police?
9. How long does it take before help responds?
10. How can ICT help?
Maternal Health
1. How old were you when you had your first child? Second child? Third child, etc?
2. When you had/have labor pains, who did/will you call first? What did/will you do? Where did/do you go? Why?
3. In the months leading up to the birth of your child (prenatal care), how do you take care of your body? What kind of preparations (if any) do you make? Who do you see? Do you change what you eat?
4. If the clinic had an SMS service that helped warn you of danger signs to look for during pregnancy, would you use such a service? How much would you be willing to pay for it?
5. If you use a traditional birth attendant: Why? Which one do you choose? Is she someone you know? What does she do during a pregnancy/delivery? What are the reasons for not going to a clinic?
6. Do you know where the nearest clinic is for delivery?
7. Who is usually present at the birth?
8. Do you know what the danger signs to watch for are during pregnancy? Please give examples.
9. Have you heard about mothers dying during childbirth? How frequently? Have you heard about miscarriages?
Diet & Nutrition
1. What is your household income?
2. How much money do you spend on food for your child per day?
3. How do you pay for the food (cash? M-Pesa?)
4. What does your child eat for breakfast, lunch, and dinner?
5. What foods do you think are most nutritious or best for your child? What do you think is a balanced diet? How frequently are you able to achieve that balanced diet?
6. What do you and your husband eat for breakfast, lunch, and dinner?
7. How do you prepare foods? What kind of cooking methods do you use?
8. Where do you buy food? When? How often?
9. If the clinic designed a balanced meal plan for your children using SMS, would you use the service? How much would you be willing to pay for the service?
10. What foods did you eat as a child?
11. How much food does your child eat in one sitting?
12. What do you consider a staple food?
13. What do you consider the cheapest food?
Resident: Paul Otieno, age 32, 0713-685-082
Interviewer: Belinda Chiang
Translator: Wilson Ngene
Tuesday, 22 March 2011
Belinda: Who are the members of your household?
Paul: My household has six members: my wife, my two brothers, and my two children.
Belinda: What do you do when you are sick?
Paul: When I feel sick, I don’t go to the doctor; I go to the chemist. There are no other sources of health information. He’ll tell me to take these three drugs and I’ll take them, even though I may not know what I’m ingesting.
Belinda: Do you have a phone?
Paul: Yes, I do have a phone.
Belinda: How do you think SMS technology can help you?
Paul: I think it’d be a great idea if I got notified about general health information.
Belinda: Wow, that’s awesome [since that’s exactly what Wilson proposed yesterday]. Would you prefer a menu or typing it in yourself?
Paul: I prefer a menu instead of typing in my health symptoms because it’d be more straightforward and easy.
Paul: Would this service work for any phone under all networks?
Belinda: Well, this is just a hypothetical. We don’t actually know what we’ll be designing yet.
Paul: Can there be a mobile technology that would allow donors to subsidize my healthcare costs? For example, if I go to the hospital and the bill comes out to half a million shillings, can someone pay for that for me?
Belinda: That’s a great idea. Maybe we can look into that.
Paul: Will this service only be within Kibera? How about if I have an accident in the countryside? Can I still SMS in my injury?
Belinda: I don’t know – we still haven’t designed what we’re doing yet, but if we do something similar to this, we can consider making it available beyond Kibera.
Belinda: What are examples of medical conditions you would want advice on?
Paul: Amoeba/parasite infection, typhoid, accidents.
Belinda: Would you want medical advice on the more severe but less frequent medical conditions or more common but also more trivial medical conditions?
Paul: I’m more concerned about the big issues. Even if you vomit, etc. you’re still going to survive the day.
Belinda: What kind of information would you want to be informed about?
Paul: If I’m sick, I’d like to know what drugs to take, if I need to see a doctor, which clinics are nearby, any other relevant health information.
Paul: Another good information I’d like is nutrition for the women who are the ones responsible for taking care of the families.
Belinda: Would you be willing to receive unsolicited health information/advice?
Paul: Yes.
Wilson: Safaricom already sends unsolicited advertisements and news events via SMS.
Paul: There are already ads that I receive via mobile. Usually they’re advertisements. If I can afford the product they’re advertising, then great, I buy it. If not, then it’s no problem. I don’t mind receiving unsolicited health information.
Resident: Jacob Mudaki, age 46
Interviewers: Belinda Chiang
Translator: Wilson Ngene
Tuesday, 22 March 2011
Belinda: Where do you go when you’re sick?
Jacob: First point of help is the chemist, not the CDC.
Belinda: What do you think of vaccines?
Jacob: Vaccines are good so I don’t get attacked by diseases.
Belinda: What do you think of the chemists? Do you trust them?
Jacob: Sometimes they’re good. Some are doctors, some are nurses, some are school dropouts. At Lakeside Clinic, I can both get treated and receive drugs.
Belinda: Would you use an SMS service that would inform you about healthcare information and resources?
Jacob: Yes, because improving my health is good and I prefer being healthy.
Belinda: What types of illnesses have you experienced lately?
Jacob: Fungal infection, body pains, joint pain
Belinda: Where do you get your health information?
Jacob: There are no information centers. I talk with people.
Belinda: Do you think chemists are enough of a resource for your health information needs?
Jacob: I’m willing to get information anywhere. I prefer more information to less.
Belinda: Would you value the information from your local chemist more or information from an outside trusted source, e.g. via SMS?
Jacob: If the SMS information is from doctors, I would trust the SMS more.
Resident: Pauline Akinyi, age 30
Interviewer: Belinda Chiang
Translator: Wilson Ngene
Tuesday, 22 March 2011
Belinda: What kind of symptoms do you experience on a day-to-day basis?
Pauline: Rashes, cough, cold, malaria.
Belinda: What kind of medications do you use most often?
Pauline: Amoxicillin (antibiotic), Paracetamol (analgesic), Piritan (for the common cold)
Belinda: Where do you go when you’re sick?
Pauline: The CDC.
Belinda: Why not the local chemist?
Pauline: Because I prefer going to the clinic. The local chemist won’t be able to test samples in a lab.
Belinda: Would you use a service that you can SMS for health inquiries?
Pauline: Yes, I would.
One thing I would be concerned with is that some people don’t know how to write.
If something is major, I would be taken to the hospital. If minor, I’ll just buy from the chemist.
Belinda: Would you use a service that would SMS you to remind you of healthcare resources? For example, a service informing you of the second or third dose of a multi-course vaccination.
Pauline: Yes. But I always check vaccination dates.
Belinda: How do you find out about new vaccinations?
Pauline: Through CDC community health workers. Sometimes the doctors write the new vaccinations on the vaccination card.
Belinda: Would you use a SMS service if you typed in your symptoms?
Pauline: No, that would be too tiresome.
Belinda: What if you had a menu of choices?
Pauline: Yes, then I would use the service as that would be simpler.
Belinda: Are there chemists who you trust?
Pauline: Yes, there are two. One is a Nigerian-owned pharmacy. The other is Lakeside. I go to these two chemists because they are educated and will give drugs that work. I look at the level of education that they possess.
Belinda: What level of education do chemists possess?
Pauline: Some are high school leavers. Others hold some university diploma.
Wilson: I know of no doctor who lives in Kibera. I would trust those chemists who are employed by some national hospital. But I would not trust those chemists who only possess a high school certificate. They may not know about drug interactions and drug allergies [he himself has an allergy to penicillin that once nearly killed him]. Also, I believe that no qualified doctor would hire an equally qualified doctor to be a chemist because then he’d have to pay that person just as much as he’d pay himself. Thus, he’d much rather pay a high school leaver – who would then know very little about medicine.
Resident: Charles Omondi, born 1977, age 34
Interviewer: Belinda Chiang
Translator: Wilson Ngene
Tuesday, 22 March 2011
Belinda: Do you know if your kids are immunized?
Charles: It’s the mother’s decision to immunize the kids because even though I’m the head of the household, I’m out during the day, busy working.
Belinda: Do you know that some vaccinations have multiple doses?
Charles: It’s the mother who remembers all the vaccination dates. Sometimes, they vaccinate in the schools so it’s the mother who is better able to keep track.
Belinda: What do you do when you’re sick?
Charles: I walk to the CDC?
Belinda: Do you go to the local chemist or pharmacy?
Charles: No.
Belinda: Why not?
Charles: Because the healthcare at the CDC is free.
Belinda: Would you use a service that you can SMS for health inquiries?
Charles: Yes.
Belinda: Would you prefer a pre-programmed menu or manually typing it?
Charles: I’d prefer to type it in because it’d be easier. Also, I would be worried if something’s not in the drop-down menu.
Notes from Informal Conversation with Wilson throughout the Day
Belinda & Wilson
Tuesday, 22 March 2011
• Wilson’s background
o Currently doing a bachelors in networking at a public university
o Next December (?) will be taking the exam to go into year 2 of a 3-year degree
o Immediately afterwards, wants a masters in statistics because that’s who the CDC hires
o Has worked with the CDC since 2005 (the past 6 years)
o Wants to continue working for them: really enjoys the work and wants to be a network analyst for them – the internet goes out daily
o Grew up and still lives in Kibera
o Went to a private boarding school because the schools in Kibera are not good
o Mother could afford the tuition fees because she owns a couple of shops selling African clothes outside of Kibera [never mentions his father]
o Has three brothers – 2 in Afghanistan with the Marines with the US Marines, 1 artist who’s unemployed but talented [note of embarrassment], he’s the youngest
o Does both work and school from 5-8:30pm
• Mortgages (i.e., house prices) are high
o No middle class – only the rich and the poor
o No housing regulation by the government
o So people can set whatever prices they want ( thus very high
• When you get married, you have to move out of your parents’ house
• Interested in the States
o Lots of questions
o Wants to visit NY, CA, TX
o Asked about Pasadena because he watches the TV show, The Big Bang Theory
Maternal Health Interview Conducted by Audrie
Tuesday, 22 March 2011
Name: Lilian Achieng
Enrolled in CDC surveillance study.
Date of Birth: 12/12/1983
Job: Housewife
# of kids: 4
# of years lived in Kibera: 7
She does not own a cellphone, her husband owns one.
Their family makes 150 shillings/day
1. She had her first child when she was 18 years old. Her 2nd child when she was 20 years old. Her 3rd child when she was 23 years old. And her 4th child when she was 27 years old.
2. She had her first child upcountry in her home village where she was born. Since she was not married at the time, she contacted her mother first when she started going into labor. Her mother was the only one present during her first birth. Her mother had had experience giving birth in the past, so she was able to help her daughter during labor. Lilian's other 2nd and 4th child were also born upcountry. She gave birth at home because in the village, the clinic is very far away. Her 3rd child was born in Kibera. Her husband was present as well as her neighbor. Her neighbor had had experience helping other women give birth, but was not a traditional birth attendant.
3. For prenatal care, she visited the Langatta Hospital clinic every month. Langatta Hospital costs 20 shillings per prenatal visit. Her diet remained unchanged during pregnancy.
4. Her 3rd child came late, at midnight. She was already in labor pains and there was no time to transport her to the hospital.
5. She knows about Langatta Hospital and Kwanga Hospital. Langatta is a government hospital owned by the city council of Nairobi. Kwanga hospital is a private hospital.
In Celestine's (the CI's) opinion: Although private hospitals are more expensive, they provide better care compared to public hospitals. Kwanga and St Mary's are examples of private hospitals. Sometimes when you go to Langatta, the nurses are ignorant and you could be in labor but they'll ignore you.
7, She knows some danger signs. For example, if the placenta doesn't come out, the the pregnancy is risky. But the only signs she knows of, she thinks it will be too late to go to the hospital by the time she recognizes them.
9. She doesn't know of any mothers who have died during childbirth. She also knows no one who has had a miscarriage.
10. If there was an SMS service, she would use it. She is not willing to pay for it and wants it to be free. If she needs to use a cellphone for this service then she will borrow her neighbors' cell phones, she would not rely on her husband's cell phone.
Diet Interview Conducted by Audrie
Tuesday, 22 March 2011
Name: Anne Adhambo
Not in enrolled in CDC surveillance study, but Celestine (the CI) enrolled her before this interview was conducted.
Date of birth: 20-12-1993
# of kids: 1 son who is 3 months old
# of years lived in Kibera: 0.5 years (6 months)
Lives in a house that is the length and width of 2 twin beds.
Does not own a cell phone. She does have access to her husband's cell phone.
She uses cash to buy her food.
1. 120 shillings per month for a kilo of flour. 4 shillings/day
2. Breakfast, lunch, and dinner: Porridge. Porridge is prepared with unga (millet flour), water, and milk.
3. Anne thinks the best foods for her child would be ugali in soup, bananas, and pumpkin. She says she doesn't know or doesn't understand what a balanced diet means.
4. Breakfast: chai, chapati. Lunch: ugali + boga (vegetable) Dinner: meat + ugali + vegetable. She and her husband eat fish 3 times a week. They have beef 2 times per week. They have vegetables 3 times per week.
5. She buys food from vendors in the marketplace twice a week. She buys greens and vegetables on a daily basis in the evenings.
6. Her child eats 4 times per day. He eats cup-sized portions. (1 US cup size). She also breastfeeds her child.
7. Yes, it would be a useful service to her. She is willing to pay for the service. She doesn't know how much she would be willing to pay and has to ask her husband. If there was an SMS service, she could rely on her neighbors to pass along the message to her.
Diet Interview Conducted by Audrie
Tuesday, 22 March 2011
Name: Margaret Omondi
Enrolled in CDC surveillance study
Age: 41 years old
The house is twice the size of Anne’s house (you could fit 4 twin beds in the space)
# of kids: 5 (Ages 5, 12,16, 18, 22)
# of years lived in Kibera: 10 years
She owns a cell phone. She can receive texts but can’t send texts.
Job: unskilled laborer. She earns 200+ shillings per day. She is not sure how much her husband makes per day. Her husband does contribute to the food bill.
She uses cash to buy her food.
1. 100 shillings per child per day’
2. Breakfast: chai (milk in tea), chapati. Lunch: rice, beans. Dinner: ugali + boga (vegetables). Snack: mangoes everyday. They eat meat once per week. They eat fish once per week.
3. She thinks that eating a balance diet means eating food from 3 food groups at any one particular meal. (Carbohydrates, proteins, vegetables) The best foods for the child are ugali, cooked meat, vegetables, fruit. She learned about a balanced diet from the clinic.
4. Her and her husband’s breakfast, lunch, and dinner are the same as the kids’ food.
5. Veggies are cooked (not raw). Meat is cooked.
6. She goes to the market any time that she has money when she is coming home from work everyday.
9. If a nutrition related SMS service were available, she says she is “so much willing to use it”. She prefers that the service is free and is not willing to pay for it.
10. Big difference between when she was growing up and what she feeds her children today. Back then, she lived on a farm in a village. She was brought up on plenty of food, balanced diet. She ate maize, sweet potatoes, fruits, potatoes, milk. Now in Kibera, it is hard to give her kids a balanced diet. Little money for food. Sweet potatoes are 80 shillings in Kibera, which is very expensive. Milk is hard to access. Food is expensive.
11. Medium sized bowl (the size of 2 rice bowls).
Summary of Maternal Health Interviews by Nancy
Tuesday, 22 March 2011
(See next page.)
|Basic Info | |
| |Responds |
Name
|Jentricks Athiambo |Angela |Topista |Mercy Atieno |Did not disclose |Caroline |Mary |Marilene Anyango | |Age
|22yrs |26yrs |25yrs |29yrs |32yrs |26yrs |45yrs |24yrs | |Number of kids
|2 |2 |3 |5 |6 |3 |4 |1 | |Length of stay in Kibera
|2yrs |10yrs |3yrs | |20yrs |6yrs |31yrs |1yr 6months | |Profession
|Saloonist |Was doing business but stop because of her child illness that needed more attention |Owns a shop for selling the food and grains |Sell vegetables by the road side |Sell vegetables and fruits by the road side |Sell blankets in the market and roast maize at the road side |Cook and sell mandazi |No working | |How do you pay for the health care?
|Goes to the CDC clinic which is free Or to Langatta District Hospital which is Ksh20. for giving birth and clinic is free |Goes to the CDC clinic which is free Or to Langatta District Hospital |Goes to the CDC clinic which is free. Or to Langatta District Hospital |Goes to the CDC clinic which is free Or to Langatta District Hospital for giving birth |Goes to the CDC clinic which is free. |Goes to the CDC clinic which is free Or to Langatta District Hospital for giving birth |Goes to the CDC clinic which is free Or to Langatta District Hospital which is free for children but adults pay ksh20 |Goes to the CDC clinic which is free Or to Langatta District Hospital | |Source of income
|From the saloon |From the husband |From the business |From the business |From the business |From the business |From the business |From the husband | |How much do you make?
|400-200ksh per day |The husband earns 18,000Ksh per month |Was not willing to disclose. |Was not sure coz the business is not stable |150-250khs per day |Approximately ksh3000 per month |100-150ksh per day |Not ware how much the husband earns | |Do you own a cell phone?
|Used to(stolen) |Yes, Nokia |Yes, Nokia |No, it got spoilt |Yes, Nokia |Yes, Smadoll |Yes, Nokia |Yes, Nokia | |Do you use Sms?
|No |Yes |Yes |rarely |Yes |No, because she does not know how to use an sms. |Not that much |No, because does not know how to. | |What language are you comfortable with?
|Kiswahili |Both Kiswahili and English |Kiswahili |Kiswahili |Kiswahili |Kiswahili |Both Kiswahili and English |Kiswahili and luo | |If the service were in English would you still use it?
|No |Yes |No |Not sure |No |No |Yes |Yes | |Maternal health | | | | | | | | | |How old were you when you had your children?
|1st -19yrs
2nd -22yrs |1st -22yrs
2nd -23yrs |Was not comfortable with all the other questions. |1st -16yrs |1st 17yrs |1st-16yrs | |1st -13yrs | |When you had labor whom assisted you?
|The woman next door |Was already at hospital | |Is always home alone so had no assistance | |The neighbors’ who took her to the hospital | |Was at the rural area where the neighbours helped her and took her to the neared hospital | |What did you do?
|Was already in hospital for the 1st child | | |She gave birth alone in the house for all the 5 kids because it happens so fast she couldn’t make it to the hospital | |Call the neighbors’ for help. | | | |Where did you go?
|Langatta District Hospital |Langatta District Hospital | | |Langatta District Hospital |Langatta District Hospital | | | |Before birth what preparations did you make?
|Yes, going for training, buying leso’s and baby clothes |Yes, going for training, buying leso’s and baby clothes | |Yes, going for training, buying leso’s and baby clothes |Yes, going for training, buying leso’s and baby clothes |Yes, going for training, buying leso’s and baby clothes |Yes ,going for training, buying leso’s and baby clothes |Yes, going for training, buying leso’s and baby clothes | |Would you use an Sms service that would help you know the danger signs during pregnancy |Yes, although not comfortable using Sms’s |Yes |Yes |Yes, if there is help on how to use it. |Yes, if it’s going to be free. A friend nearby said No because the process of sending a sms is too long and she is going to use her airtime. She claims it is better to just go to the hospital straight because the money spent on airtime can be used for other purposes. |Yes ,if there is help either from a neighbors’ or if trained on how to used a Sms. |Yes |Yes, if she is taught how to use Sms. | |If u use a traditional birth attendant why?
|It was too late to go to the hospital and needed someone who would help her instantly. | | | | | | | | |Which one do you chose? Is she someone you know
|The woman next door who is experienced in deliveries | | | | | | | | |
Summary of Health Education Interviews by Ernest
Tuesday, 22 March 2011
(See next page.)
HEALTH INFORMATICS SUMMARY OF FINDINGS
According to the interviews conducted concerning health information dissemination, the following were
Most respondents who were available were women with kids mostly doing house work while husbands go to work to raise the family income.
All my respondents have stayed in Kibera for 1-5 years. None has stayed more than the 5 years.
Basically all families have mobile phones and use both sms and calling services. However to my surprise, most families have one phone which is left with the house wife to keep. Husbands tend not to carry phones around.
All respondents prefer Kiswahili as the language of choice for giving health information since it is locally spoken and easy. However ,written Kiswahili at times presents difficulties to comprehend due to its long and complex grammar. English is also preferred by some though they don’t use it regularly but since health information is normally written in English, they feel its okay. In cases where the information passed is not clearly understood, it is clear that they seek help from people who can easily understand the information to tell them the meaning.
Much of the health information is conveyed to them by use of leaflets and fliers distributed by the CI’s . Some people take time to read them during their free time (if any) while others just pile them up due to ignorance and fear of reading .Those who read them claim that they are okay but something needs to be done to make it easy to read/ get the infor.
Clinics and health centers also take a central role when it comes to making the community aware of health issues. Most clinics e.g Kawanga(MSF) have regular morning teachings/ lessons taught to patients as they await treatment. This is normally done by selected health workers who choose a particular topic to teach on a daily basis. Respondents felt that this has helped a lot.
It was also clear that most families tend to self medicate first before going to the hospital especially over the weekend. This is mostly to reduce pain , fever and other mild symptoms. Hence most families keep painkillers in the house. They depend on the information around them to administer these drugs.
Generally the community would like to get information on all aspects related to health i.e
o Causes of certain diseases
o How to prevent them
o What to do in case of an emergency.
Concerning use of sms to transfer information,
o Respondents felt that it was a good idea to bring such a service.
o Most were in agreement that it would be easily adopted as long it is made affordable( < 5 ksh per sms) and that they would use it.
In summary, leaflets + sms can work best for them.
Interviews with 2 Community Health Workers by Ernest
Tuesday, 23 March 2011
Forthcoming.
Debrief amongst Audrie, Belinda, Ernest, Nancy, Laura, and Amee
Wednesday, 23 March 2011, 9:00AM
CDC’s Field Office in Kibera
Summary of meeting
• Ernest & Nancy left early on Tuesday before Belinda & Audrie were done so instead met all together on Wednesday morning
• Welcome Amee, who’s here in Nairobi studying abroad via SIT.
o History major and junior at Barnard College. Was at Mount Holyoke freshman year before transferring.
o Very interested in women’s health, public health, plans to get her NP nursing degree.
o Studies Swahili.
o Conducted independent research on marital rape in Mombasa, Kenya the past summer.
• Share findings from yesterday
• Action plan for today
o Ernest – accompany CI Jacob to ask about nutrition
o Nancy – accompany CI ____ to ask about ______
o Belinda – accompany CHW James
o Audrie – accompany CHW Ann
Resident: Jared Ogato
Interviewer: Belinda Chiang
Translator: James _____ [?]
Wednesday, 23 March 2011, 11:00AM
Jared Ogato is a 44-year-old man with a wife of 30 years old, two boys aged 11 and 13, and two girls aged 6 and 8.
On March 8th around 2:00PM or 3:00PM, a fire burned down Jared’s house as well as four structures (each structure as defined as sharing one roof), destroying at least 25 houses. While some of the wall structures remain intact, the insides of each were entirely destroyed. The cause of the fire is uncertain, but it is believed to be an electric fault: started when electronic gadgets are left unattended. Fires are common but unpredictable in Kibera, occurring mainly during their dry spell from December to February.
For Charles, this fire had destroyed all his possessions: from his government identification papers to his bed to his television. He had possessions that were so valuable and precious to him he didn’t know how or when he’d ever be able to replace them. His only wardrobe was the very clothes he had on his back.
Thankfully, no one from his family was hurt. However, Jared has a daughter with a disability who was in the house when the fire started. Jared was in another part of Kibera at the time. Witnessing the smoke coming from his part of town, he ran back to try to save his daughter [implication that daughter can’t move herself out of harm’s way]. Fortunately, her mother had already helped carry her out of the house.
People broke the nearby waterpipes to extinguish the fire, taking about an hour before it completely died down. No formal authorities or firefighters came to the rescue: only those immediately affected or those who had houses threatened by the fire laboured to smother the fire and prevent it from spreading. The only official authorities who responded came after the fire had died down, and were representatives and the chief from the office of Sarangombe, the part of Kibera that they were in. The chief had made everyone stand in front of his or her structure. Then, he said that he would bring them some blankets. No one ever came back.
In the meantime, Jared and his family have been staying in a small room granted by a friend of his. However, the friend has other plans for the room so he won’t be able to stay as long as he wanted initially. Jared has taken to sleeping in the open air, under the roof of a church that has otherwise also been gutted by the fire.
There is still a lot of construction that must be done. Jared has been collecting money from friends to accumulate enough for a new roof, which has missing iron sheets. The walls, too, are still under construction.
Jared had lived in the house that had been burned down for the past fifteen years, and it was his third home in Kibera. He had lived in two others (also in Kibera) over the past twenty years, and prior to that he had lived in Kisii, countryside on the western side of Kenya. He had come to Kibera looking for work. When he arrived, his first job was as a security guard for Securico Kenya. His last job was also as a security guard for a small, private security firm.
However, Jared has been unemployed for the last four years. He survives by cultivating sukumawiki (a vegetable) on the other end of Kibera in what he estimates to be a garden about half an acre. He works on the garden every day, but is only able to gain an income when it’s “in season,” as defined as during and after rains, which are very unpredictable. Even when the sukuma are in season, he must wait two weeks between harvests in order for the sukuma to grow. He doesn’t sell the vegetables himself, but instead sells to vendors who then sell it in the markets. They go for 10 shillings a bunch (however much he can hold in his two hands), and on a good day can get as much as 500 shillings but it varies.
When he sells well, he is able to afford meat for the family, but that’s not very often. Even when he does buy meat, he is only able to buy about a quarter of a kilogram at a time. In the morning, he has “strong tea,” as defined as “tea without milk” for breakfast. During the day and for supper, he is out but when the mother is there, she usually prepares ugali as well as sukuma for the children. Together, they spend about 300 shillings per day for the entire family per day. When asked about what basic food groups should be consumed, he replies: fruits, vegetables, and eggs.
It is hard for him to estimate how much he spends on healthcare because it spikes when there’s someone falls ill. Lakeside clinic charges 700 shillings for treatment. The kids occasionally get the flu, and he gets malaria. He got malaria for the first time a long time ago, and he says he’s had malaria “as long as I’ve been staying around.” Each bout lasts one to two months, and it’ll come back after three months.
Sometimes Jared buys drugs, and sometimes he goes to the clinic. If he goes to the hospital, the doctors give him pain medications that don’t treat malaria, and this is why he goes to alternative treatment, e.g. at Lakeside or Kenyatta. Some medical conditions can’t be treated at the CDC, e.g. if a treatment requires stitches, so he’d then go to Lakeside. On one occasion, his son had a fractured hand. He went first to the CDC, but they couldn’t handle it. He got referred to the Infectious Diseases Hospital, now called Bhagathi Dstrict Hospital. But they couldn’t treat his son there either, so he finally brought his son to Kenyatta Hospital where his son was able to be treated.
Jared gets his health information from the people around him. Other people have had similar problems or symptoms. When asked if he goes to the local chemist, he says, “no, not much.” He doesn’t like them, and he’d rather go to the clinic. However, he’ll wait until his disease becomes serious.
He and his children have been vaccinated. He heard about it because it was announced around town by people using a loudspeaker. He also gets information from the CDC people and the African Medical Research Foundation, which is a big clinic on the other side of Kibera.
James has a phone, but he doesn’t use SMS. He uses his phone mostly to call. He can read and write “a little” [from the sound of it, “a little” isn’t very much]. He wouldn’t mind receiving health tips or vaccination reminders via SMS as long as he knows where the texts are coming from because he has received fraudulent texts before. When asked how SMS would compare to other sources of health information (say, a doctor), he replies that the SMS would not be able to run lab tests for him. Information that he would want to know would be where to go get treatment. Citing the time his son had a fractured hand and they had to go to three separate clinics before receiving treatment. He wouldn’t mind paying for such a service, but would be willing to pay whatever it costs to receive an SMS. Someone sitting with us listening in on the interview says it’d be one shilling.
Notes from Informal Conversation with CHW James & Belinda
Wednesday, 23 March 2011
• During the course of the interview someone asked for an example of how technology can help. I gave the example that Damiana proposed: having computers in five different locations around Kibera that would provide comprehensive healthcare information.
• James gave his feedback, warning me not to have just one computer in one location. He advised me to keep resources decentralized because if there were simply one or even a few computers, there would be long lines and people would find it discouraging and leave. He says, “it kills my morale to go there again.”
• Another piece of advice that James gave was to target youth if we decide to use ICT. Adults, such as Jared, only use the phone for calling, not SMS. The youth, however, are very comfortable with SMS.
Interview with Ann Arum by Audrie
Wednesday, 23 March 2011
Ann Arum, CDC Community Health Worker
The interview was conducted in between visits to households. We had a bit of a language barrier during this interview…(this is not an exact transcript)
Community health workers raise health awareness in the community. They go door-to-door reminding people to take their kids in for vaccinations. They issue vaccination cards and schedule appointments. They are also responsible for follow up visits.
Today Ann was registering kids for the April 5th vaccination appointments.
What is the most important health issue in the community?
Flu
How many kids live in each house?
4 or 5 kids per house
What do you do when you go door-to-door?
Teach the mothers about how flu virus causes disease and the importance of vaccine.
If you bring your child in on April 4th for the 1st dose, you must bring them back in May for the 2nd dose. Ann come back in May to follow up and remind mothers to bring their kids into the clinic for the 2nd dose. Moms say they will bring their kids back for vaccination. The nurses give them instructions about when to return, and they will return.
Some reasons that mothers can’t take their kids for the vaccination are that her child is sick, so she can’t leave them at home alone.
Ann estimates that ¾ of mothers remember to get vaccinated.
If the mothers are not in the study, they don’t get to be in the vaccination program. Sometimes, the houses that Ann visits aren’t in the CDC study area because the people have moved away. The CDC paints a blue number on each house that is part of the CDC surveillance population.
Ann started working as a community health worker in 1992 for different organizations: the Catholic Church, Pathfinder, MSF (in 1999), AMRF, and CDC (started last year).
She says some community health workers also teach mothers about nutrition.
If one of the household members has diarrhea, the community health worker will tell them to get treatment at a hospital.
Last year, the flu vaccine schedule looked like this:
April – start enrollment
May – mobilize reminders
June – Flu vaccine
Last year they had paper registration only. (the logbook that Ann keeps for each household)
This year, they issue vaccination cards to each household. These appointment cards have appointment dates written on them, and a space where you can write the actual date of immunization.
Ann thinks that there are a couple main reasons why mothers do not bring their children in for a second vaccine does:
1) Moms are busy. They need to tend to their businesses selling vegetables and fruits
2) Ann says, “carelessness, too”
On average, Ann visits 20 households per day.
If the parents aren’t home, she’ll keep returning on subsequent days until she finds the parents.
Sometimes the parents aren’t home because they have migrated out of the study area or the parents are at work.
It’s approximately 1:00 pm today. Ann has visited 10 households to inform them about the new CDC vaccines.
Ann says that her job would be easier with a phone.
She says texting would cost money.
She says that it is important to see the person and talk with them and teach them how to prevent diseases, “Wash Hands”, “Be Clean” “After toilet, wash hands”, “cook food, keep clean”. If you use cell phones only, you cannot see the person you want to talk to about these health issues.
(If you want to include any rough floor plan sketches in your future presentations, I can track down a scanner and scan them)
Interview with George Aked by Audrie
Wednesday, 23 March 2011
George Aked, resident of Kibera and volunteer with the Kibera Youth Consortium
800+ people in the Kibera Youth Consortium. They are Kibera youth who volunteer to participate in environmental (picking up garbage) and peacebuilding efforts. They use football and other sports to do peacebuilding between the Luo and Kikuyu. They also host cultural activities such as dances and cultural shows for cultural exchange. They started this organization last June. George is from Kisumu and he has lived in Kibera for the past 5 years.
Why do you volunteer with the Kibera Youth Consortium?
“I like to help, it’s my nature. I don’t know where you come from but I help you because it’s human being.” ~ George
“I’m from the US” ~ Me
“If I am in the US, you would help me.” ~ George
In George’s opinion, the youth are jobless, so they participate in activities that aren’t so good. If people take photos of them, they demand money. The youth consortium provides them with a temporary volunteer job.
George used to work in tourism. He worked with AWIS travel institute in Westlands (“where people are murdered,” says George)
The people in the youth consortium have begun a small campaign to eradicate crime. There are “chairmanship” and “youth leader” positions.
Why isn’t it safe in Kibera?
Many pickpockets. The muggers block the roads and night and steal from people.
Do you feel scared at night?
“Yes, and it starts around 10 (at night) ” ~ George “until 6 in the morning”
How many people should you travel with at night?
“10!” ~ George
“Really?! 10 people minimum?” ~ Me
“Yes, 10 is safest! If mugged, 1 can go, 1 can remain” ~ George
City Council of Nairobi installed safety lights. Kibera residents’ elected officials installed them after demands from the residents. There are 3 lights in George’s neighborhood. The city council paid for the installation of the light.
If there is crime committed, do the police arrive?
“The police used to come, but now sometimes they don’t even come” ~ George
When a thief is caught, the mob (composed of neighbors) will beat up and sometimes kill the thief. George says that sometimes in the morning you will see a dead man on the side of the road who has been badly beaten. But you can’t tell how they died so the police take the body and since there are no leads, “there’s no answer”.
When you are mugged, you scream and the neighbors will come. You scream, “thief, thief, thief!” The mob will burn him, stone him, etc.
“You have the right in your hand” ~ George
If the police do show up, it’s to rescue the thief before the mob kills the thief. If the thief is alive, he should have to pay a fine and spend time in jail.
When people take the thief to the police, oftentimes the police just records the statements and nothing happens.
If a crime is committed, how often does the mob take care of the matter?
50% of the time, there is mob justice. 50% of the time, the thief gets away.
“The police never really help” ~ George
The residents of Kibera rarely see the police. Some thieves are friends with the police and the police accept bribes. George believes most Kenyan police are corrupt. Only a few are not.
In the event of an emergency, residents go to MSF or CDC. Most Kibera residents are told to register with either MSF or CDC for their medical care. Emergencies are reported to the CDC. The neighbors assist in carrying the person to the hospital. “sometimes even on the shoulder” ~ George. There are people who are volunteers in the community who have been trained by local clinics in 1st aid. The neighbors rely on them. In a medical emergency, the neighbors call the 1st aid volunteers first. In George’s neighborhood, there are 3 people who are trained in first aid, including George.
But the problem is…
“What if I’m not around?” ~ George
This first aid help is voluntary and not paid. Problems arise if none of the volunteers are home and no one knows where they are.
Best solution according to George is to pay the 1st aid volunteers so it’s their job to help people. Also, you have to know the personal phone numbers of the people who have been trained in 1st aid.
George says that the CDC has a program where medical workers will provide home based care to people. If someone has the intention of committing suicide, the home based care worker can provide consultation and “calm them down”, says George. Home based care also means testing for HIV/AIDS, in fact, that is the main aim of the home based care program. They are mobile and move from house to house.
George thinks it would be best if the CDC clinic were open 24 hours a day.
When women are pregnant and need to deliver at night, they are carried to St. Mary’s (a private hospital) because it is closer to where George lives. Merciline (private hospital) is also close too. Langata Hospital is also close by for daytime medical needs.
Most fires are caused by “electricity faults”. The people put out the fire themselves. Accessibility to the fire is a problem (due to path conditions).
What do people do to alert other people that a fire is happening in their neighborhood?
George looks amused and says, “Send message through smoke…”
They call people to come help put it out. When a fire burns down someone’s house, the landlord and the tenant have to work together to build the house back up. The government gives food, some building materials, blankets, and 1st aid (I recall from an earlier conversation with Celestine, the CDC community interviewer, that the building materials that the government gives is sometimes stolen and the officials resell the building materials in the market and pocket the profits)
Kenya Red Cross sometimes shows up in a fire emergency.
611 is the number to call to report child abuse. It is a government sponsored hotline.
999 is what you call to reach the police. But they usually don’t come.
For 1st aid in medical emergencies, you must know the personal phone numbers of the people in your neighborhood who are trained in 1st aid.
Interview on Diet & Nutrition by Ernest with Community Interviewer
Wednesday, 23 March 2011
1. Truphosa
• Basic info
o Age: 40
o Number of children: 5 aged between 5 and 25 years
o Husband is a tailor and the typical family income per day is 700/=
o Both spouse use mobile phone but sms is considered as a time waster especially that calling is cheap and maybe some consider it difficult to type text.
• The family spends the following of food per day:
o Breakfast 100/=
o Lunch 100/=
o Supper + evening tea 200/=
• Breakfast is typically tea and mandazi (fried dough)
• Parents are aware of what is a balanced diet and basically buy food from the road side or market.
• Truphosa grew up in Nairobi and says that meals those days were cheap hence achieving a balanced diet was easy.
• Amount of food eaten by child depends on type of food. If rice and stew or rice and beans ,then the child tends to eat more. However child doesn’t like ugali at all hence consumes very little.
• Cheapest meal in the locality is ugali and sukumawiki (kales). For proteins, omena (dagga) is preferred since it is nutritious and cheap.
• Truphosa says that slum dwellers are ignorant and hence see information as a bother. Few are willing to change despite the information around.
• According to her, English is the preferred language for information transfer since Kiswahili words are challenging and involve complex grammar.
• She also says that some parents give their children a few coins to buy food (approximately 10-20/=) when they are away or when they go to school. However some children buy biscuits or French fries and hence lack the opportunity to eat good food. She says that parents should be discouraged from giving children money but instead cook for them food which they can carry along say to school.
• Some public schools have feeding programs (lunch) which parents pay approximately 100/= per month. However Truphosa says that the school food is not fit for consumption. Most children during the first days ,complain of stomache pain and some even diarrhoea. She says since the food is meant to serve over 700 pupils, its difficult to ensure quality. Much of this food is provided by NGO’s and other support groups. The food is normally a mixture of maize and beans called ‘Githeri’ in the local language. Pupils are made to consume this the whole week hence miss out on balanced diet.
• She says that much needs to be done to sensitize parents to give healthy foods to their children especially over the weekend when they are at home to compensate for the lack of balanced food during the week.
• According to our observation and findings, Truphosa seems to be doing well off as compared to most of her neighbours and is much more educated since she speaks fluent English and Kiswahili.
2. Millicent Achieng
• Basic info
o Age :26
o Kids : 3 ages 1,5 and 8 respectively
o Doesn’t work but depends on husband for family income.
o Husband does fitting of houses.
• Cost of food per day : 300/=. If more income then 400/= as food varies.
• Breakfast is typically Tea and bread.
o For the young one milk and uji (porridge is the option )
• Millicent know about balanced diet
• She says that information on such is gotten from clinic ,TV etc
• However she feels infor is not enough and more needs to be done
• She buys food from the villages but prices are high especially for beef and fish.
• Her other children (those in school) consume school food. However the children are complaining that school food is little. These children are in a private school (Green Pastures academy) and the food is normally balanced.
• She says that sms service to create awareness on diet can help but cost of sms n=must be considered.
• She says that such service can only work if suggested food is cheap and locally available.
3. Joyce Auma
• Basic Info
o Age : 28
o Kids : 4 ages 2,6,9 and 12
o Joyce sells Kales and vegetables in the village
o Husband is a jua kali worker. (casual labourer)
o Income per day is 100/= on Kales as profit.
o Husband income is unknown to her.
o There is only one mobile phone in the house( for husband)
• Meals roughly cost 200/= per day.
• She says that if money is not enough, they skip some meals such as breakfast and lunch but they have to take supper.
• Breakfast is uji. They also take tea but rarely.
• Her family is enrolled in the CDC programme and hence she knows well about balanced diet.
• She says that the clinic plays a central role as it teached about balanced diet and put up posters.
• However she says that money is a problem in trying to achieve a balanced diet.
• She mostly buys food stuff in bulk since buying little by little is expensive. Also by buying bulk, she sticks to one type of meal per week.
• She buys food mostly along the road side.
• Her children take school food but they ever complain of stomachaches and say food has weevisl at times .However they are forced to eat due to circumstances.
• School food is mostly Githeri(mixture of maize and beans) and sometimes green grams. Joyce says food is not clean due to minimal number of workers compared to the number of students they have to attend to.
• She says that sms can help since you can have money to buy food but knowing what to buy can be a problem hence missing out on diet.
• Kiswahili is most preferred for such a system
4. Lydia
• Basic info
o Age :21
o Kids: 2 ages 2.5 and 4.5 respectively.
o She sells groceries to earn some income.
o Her husband is a jua kali person.
o Income per day is 200/=
o She has mobile phone.
• Food per day is 100/=
• Breakfast is tea and mandazi.
• She know about balanced diet as the clinic normally teaches them on these diet issues.
• However she says that more ways need to be added to inform them of diet issues. She says that some women forget easily about such teachings hence constant reminder is necessary.
• Her child comes back home for lunch and they have lunch together.
• She feels sms can help but suggested food must be cheap since money is the major challenge to most families in Kibera.
• (Lydia was not so outspoken so I dint get much information from her. )
5. Mildred Achieng
• Basic info
o Age: 31
o Kids 5 aged between 4 to 11 years.
o She sells groceries while her husband is a jua kali person making cushions for sofasets.
o The family income varies (She did not disclose the income)
• Cost of food per day is 200/=
• Breakfast is Uji. At times tea and mandazi.
• She knows about balanced diet.
• Mildred says that she can barely afford a balanced diet due to money issues.
• She buys food from the market but says that all food are generally expensive.
• She grew up in upcountry and says that long time ago, meals were cheap and balanced.
• Since her children are in school, she also commented about school food. She says that school food a problem. Children are given githeri. Her children often complain of itching.
• Mildred says that they are taught about diet at the hospital.
• She is also of the opinion that the sms system can work only if suggested food is cheap and probably in Kiswahili language.
Interviews on Rape, Fires, and Emergencies by Nancy
Wednesday, 23 March 2011
Name: Mama Njeri
Basic information
1. Do you use SMS? Yes
2. What language are you comfortable with? Both Kiswahili and English
Fires
1. What is the first step to take if there is a fire?
Disconnecting electric appliances
Extinguish the fire
2. What are the major causes of fire in the area?
Electric fault, the wiring here is done locally by people with no experience.
Electric heater or when the heater is left on during a blackout and the electricity comes back abruptly.
3. How are you aware of a fire in the area?
We hear screams that alert us. You can also see an unusual smoke from a distance and know there is a fire.
4. How is fire extinguished?
Using water and soil
5. Are there any existing hotlines to call if there is a fire?
Yes, some people have this number but she does not have the number.
6. Is there any assistance when there is a fire outbreak e.g. forms the police, firefighter?
Yes, from the firefighters
They could be more helpful if there was access into the slums.
7. How are they informed that there is a fire?
They are called by one of the residents.
8. How Prevalent is fire?
There is a fire weekly
9. What are the consequences of fire?
Loss of property, people get hurt, burnt or even displaced mostly with Kibera.
It causes damage of property but the damage depends on when it was noticed, the number of people who are willing to help and the materials used to build the house.
She gave me a story about a school near her home that burnout during the day. The primary school was in a two sorry building and the students were still inside when the fire had started spreading. The community responded very quickly and when they realized that children were trapped they remove the roofing (iron sheet) so that they could rescuer the children trapped upstairs. Luckily they managed to rescuer everyone but unfortunately two children got burnt and two broke their legs trying to save themselves by jumping off the roof.
She says that if your house is burnt down it is very difficult to start over, some people find this so hard they have to go back to their villages in the rural areas.
10. How do you transport the injured?
They are carried to the main road then from there they can get a car.
Rape
1. Is the community aware of what should be done in case of rape?
Yes
2. Are there facilities within that deal with rape cases?
Yes, MSF at Olympic
3. Do most of the rape victims report the matter to the authorities?
Rarely
If not why?
If they report the matter to the police the police don’t treat them with respect, they ask embarrassing questions in an embarrassing way.
How do they respond?
The respond is not nice but if the rapist does this repeatedly the police will follow up the matter.
4. Who are the majority victims?
Children
She tells a story about a neighbor’s child who was repeatedly raped by her neighbor. The girl was 7, she was threatened by the rapist that if she told anyone he will kill her and showed her a knife. Her teacher noticed that they were something wrong with the girl because she was walked differently. The teacher tried to get information on what had happened to her but at first she was very terrified but afterwards spoke out. The parents were informed and the child was taken to MSF; a treatment and counseling center. The rapist noticed that people were looking for him and he toke off.
Adults are also raped but this happens mostly to those who get drunk and try to get home when it’s late.
Rape happens at any time of the day .Children are mostly raped during the day when their mother are away maybe doing business or when they are left home alone. It also happens when the child has been told to go home earlier than usual and finds the door locked. They tend to go to their neighbours who in most instances assault them.
5. Are there any support groups?
No
6. What is the community attitude towards rape?
The community sympathies with the rape victims especially if they are children. They also give moral and financial support if needed
The rapists are beaten up in a mob, if they are lucky the police will show up.
Security
1. How is security in the area?
Not bad but along the railway it’s risky to pass there at 10.00p.m or 11.00p.m
2. What are the major security issues in the area?
Mugging
3. How does security affect health?
It affect health because is someone is rape, the mental and physical health will be compromised.
4. How do you reach the police?
You have to personally go to the police station
5. Are there any hotlines that are available that reach the police?
The 999
6. How long do they take to respond?
They take a long time to respond unless someone is killed in a mob justice. They are also corrupt if you ask for help they ask money for fuel.
Name: Irene Akoth
Basic information:
1. Age: 21yrs
2. Number of Children: 2
3. Length of stay in Kibera: 10yrs
4. Profession: Housewife
5. Do you own a cell phone? No, it got spoilt
6. What language are you most comfortable with? Kiswahili
Fires
1. What is the first step to take if there is a fire?
I don’t know I get confused.
2. What are the major causes of fire in the area?
Electric fault, heaters and the wire is done locally by untrained people.
3. How are you aware of a fire in the area?
You see unusual smoke and hear screams.
4. How is fire extinguished?
By using tap water.
5. Are there any existing hotlines to call if there is a fire?
No
6. Is there any assistance when there is a fire outbreak e.g. forms the police, firefighter?
Yes form the neighbours most of the help is local.
7. What are the consequences of fire?
Loss of property. Some people find it difficult to start over again and go back to their home town back in the village
Rape
1. Is the community aware of what should be done in case of rape?
Yes, go to the hospital and get tested for HIV/AIDS.
Didn’t answer any of the other questions claiming that she has never been raped and she doesn’t know what happens if someone is.
2. Are there facilities within that deal with rape cases?
3. Do most of the rape victims report the matter to the authorities?
4. Who are the majority victims?
5. Are there any support groups?
6. What is the community attitude towards rape?
7. How prevalent is rape?
Security
1. How is security in the area?
The area is not secure.
2. What are the major security issues in the area?
Mugging and stealing
She didn’t want to talk about the police since she was afraid that this information may be used against her.
3. How do you reach the police?
4. Are there any hotlines that are available that reach the police?
5. How long do they take to respond?
Name: Lillian
Basic information
1. Age: 25yrs
2. Number of Children: 3
3. Length of stay in Kibera: 10yrs
4. Profession: Saloonist
5. Do you own a cell phone? Yes, but my husband is using it
6. Do you use SMS? No
7. What language are you most comfortable with? Kiswahili
Fires
1. What is the first step to take if there is a fire?
If I’m inside the house I would run outside, look for water to extinguish the fire and scream for help.
2. What are the major causes of fire in the area?
Electric fault
3. How are you aware of a fire in the area?
You see unusual smoke and hear screams.
4. How is fire extinguished?
Using water
5. Are there any existing hotlines to call if there is a fire?
Yes, some of the people in the area have the firefighter’s number but personally I don’t have.
6. Is there any assistance when there is a fire outbreak e.g. forms the police, firefighter?
Yes, form the firefighter.
Observation: All the people living close to the main road said that they received help from the firefighters.
7. How long does it take to get there?
About 1/2 hour.
8. How are they informed that there is a fire?
They are called
9. How prevalent is fire?
This month there has been 5 fires.
Rape
1. Is the community aware of what should be done in case of rape?
Yes, don’t shower, take your clothes to the police, and go to the hospitals which are Nairobi Women’s Hospital, Langatta Hospital
2. Are there resources within that deal with rape cases?
Yes, At CFK
3. Do most of the rape victims report the matter to the authorities?
4. Who are the majority victims?
Children because they an easy target, the rapist can easily threaten them. The rape usually goes on for a couple of days before the mother notice
5. What is the community attitude towards rape?
The rape victims if known are beaten by a mob sometimes even to death.
Name: Teresia Motete
Basic information
1. Age: 37yrs
2. Number of Children: 3
3. Length of stay in Kibera: 13yrs
4. Profession: Housewife
5. Do you own a cell phone? Yes, Nokia
6. Do you Sms? Yes
7. What language are you most comfortable with? Kiswahili
Fires
1. What is the first step to take if there is a fire?
Try to save the some staff from the burning house by removing them outside. Some people take advantage of this situation and as you remove your staff outside they steal them.
2. What are the major causes of fire in the area?
Electric fault, mostly electric coils used for cooking and overloaded electricity polls.
3. How are you aware of a fire in the area?
4. How is fire extinguished?
Using water from our houses Or from the water venders.
5. Are there any existing hotlines to call if there is a fire?
Yes, some people in the community have this number but I don’t have it.
6. Is there any assistance when there is a fire outbreak e.g. forms the police, firefighter?
No, because there is no access into the slums. The roads and too small for the firefighting-tracks to pass through
7. How Prevalent is fire?
It is very often, in the last 2 months there has been 2 fires.
8. What are the consequences of fire?
Losses of property form the fire and also people who steal your staff when you try to save them from your burning house.
9. How do you transport the injured?
By carry them to the main road and use a taxi to the hospital.
Rape
1. Is the community aware of what should be done in case of rape?
Yes, don’t shower, seek help before 72 hrs, and go to the hospital.
2. Are there facilities within that deal with rape cases?
Yes, MSF and the Nairobi Women Hospital where the services are free.
3. Do most of the rape victims report the matter to the authorities?
Yes
How do they respond?
Police don’t offer any kind of help.
4. Who are the majority victims?
Children
Most mothers leave their children at home alone making them an easy target.
5. Are there any support groups?
No
6. What is the community attitude towards rape?
They sympathize with the rape victim.
7. How prevalent is rape?
Rare
Security
1. How is security in the area?
The area is very insecure. Along the railway is most dangerous especially at 5.00 in the morning and from 12.00 at night.
Women going to the market are mostly the target, they go to the market at 5.00 A.M where they are mugged.
2. What are the major security issues in the area?
Mugging
3. How do you reach the police?
Go to the station and report the matter personally
4. Are there any hotlines that are available that reach the police?
I don’t know of any.
5. How long do they take to respond?
It takes hours to a day or they don’t even show up.
Notes: Majority of the rapist are the next door neighbours
Name: Florence Anyango
Basic information
1. Age: 25yrs
2. Number of Children: 2
3. Length of stay in Kibera: 5yrs
4. Profession: Saloonist
5. Do you own a cell phone? Yes
6. What language are you most comfortable with? Both Kiswahili and English
Fires
1. What is the first step to take if there is a fire?
Switch off electricity appliances’
2. What are the major causes of fire in the area?
Electric fault and carelessness like leaving the heater on when there no electricity and they suddenly come back.
3. How is fire extinguished?
Using water
4. Are there any existing hotlines to call if there is a fire?
Yes, some of the people in the area have the firefighter’s number but personally I don’t have.
5. Is there any assistance when there is a fire outbreak e.g. forms the police, firefighter?
Yes, from the fire fighters
After the fire the government provides Iron sheet, blankets and mattresses to the affected people but some people don’t get this help because before their area is reached the iron sheet, blankets and mattresses are over.
6. How long do they take to respond?
30 – 45 minutes
7. What are the consequences of fire?
After the fire if you take too long to rebuild you house your space (land) will be taken by someone else.
8. How prevalent is fire?
There is a fire every week. In the past week there have been 4 fires
9. How do you transport the sick to the hospital?
At night it’s not safe
Rape
1. Is the community aware of what should be done in case of rape?
Yes, Report the matter to Olympic (MSF) before 24hrs, go to the hospital which is Nairobi Women’s Hospital and report the matter to the police.
2. Are there resources within that deal with rape cases?
Yes, MSF who deal with rape issues.
3. Who are the majority victims?
Children between the ages of 5 – 6yrs
4. Are there any support groups?
Yes, at Olympic (MSF)
5. What is the community attitude towards rape?
If the rapist is known a mob justice is done and the rapist is beaten sometimes to death if the police don’t get there in time.
6. Are there any hotlines?
Not that I know of.
Security
1. How is security in the area?
The area is very insecure. She owns a business along the road and explains how her salon has been robed severally. The thieves mostly take off the roofing (iron sheet) and get into her saloon stealing all the equipments.
She is never at peace afraid that someone is going to steal from her again
If someone falls sick at night it’s very risky to take them to the hospital. You can call a taxi but may be carjacked on the way to the hospital.
2. What are the major security issues in the area?
Mugging at night and stealing of mobile phones.
3. Are there any hotlines that are available that reach the police?
Yes, 999 which does not work.
4. How long do they take to respond?
They take a long time to respond and if they do they require you the pay for their fuel or give them some cash to receive their help.
Debrief Meeting
Wednesday, 23 March 2011, 2:00PM-4:00PM
Savannah Café, Kibera
• In attendance: Belinda, Audrie, Ernest, Nancy.
• Amee and Laura were supposed to be partnered with a CI during the day to interview residents, but unfortunately George was not able to connect them as he was out of the office for the day. After waiting for two hours for their CI and multiple phone calls, they left early.
• We shared our findings for the day.
• We discussed what to do tomorrow: going to interview those outside of the CDC encatchment population + other NGO’s/players in this space.
• Brainstorm:
o NGO’s
o African Medical Research Foundation
o MSF’s rape center in Olympia
o Girl’s support group in CFK
o Security officers, police officers, firefighters
o Food stand sellers
o Doctors, nurses, nutritionist at Tabitha
o Traditional birth attendance
o “Reformed muggers”
o Youth
• Itinerary for tomorrow
o TB Day events
o Caroline of CFK’s girls support group
o CFK & CDC CI’s
Breakfast
Thursday, 24 March 2011, 9:00AM
Arziki Restaurant, University of Nairobi
• In attendance: all Stanford students, all UoN students, Josh, Terry, Sunny, Dan
• Everyone go around and highlight some observations/reflections & work so far
• Davis
o Ethics of aid
o 538 organizations that don’t work together within Kibera. Needed is coordination of already-existing resources to make them more efficient. Sense of competition, probably rooted in funding. Each organization carves out own piece.
o Different people say different, contradictory, mutually exclusive statements
• Ernest
o Religion/tradition’s influence on views of home deliveries and vaccinations
o Hard to track down the traditional birth attendants because they’re illegal
• Belinda
o Struggle to achieve both breadth & depth during this one week
o So far, CDC as a partner has been both a blessing and a constraint: what else is out there?
• Audrie
o Contrast between cooperation amongst residents and corruption by officials
• Josh
o Leverage existing published research that’s out there, e.g. by anthropologists. Many of the questions we’re grappling with has been studied by others too.
• Claire
o How resourceful the people are, e.g. switching motherboard of TV’s and computers to produce a cheaper screen
o Highly polluted by politics: we just can’t tackle systematic change
• Doreen
o MYSA has been hailed as a success story, but it doesn’t take in a section of Mdare called 4B because of corruption
• Claire
o If the person doesn’t have a birth certificate, restricts their education, going abroad, etc.
• Belinda
o There’s this NGO called Mobile Metrix that tries to identify all these “missing people” via PDA’s
• Terry
o There’s a whole NGO in India just devoted to getting birth certificates
• Sunny
o At the beginning, when working in the US, Kibera sounded like a depressing slum
o Then, he got here and saw people with hope and children running around
o Now, he thinks it’s just a façade. At the end of the day, they still have to sleep there. And things are really bad. The human spirit has to do something about that [some implication of self-delusion in order to stay resilient…but it doesn’t refute how bad the conditions are in Kibera].
• Sunny (asked to give advice by Belinda)
o Build strong partnerships with the people/community. If you don’t have their trust [and anyone on your side], you can’t even set up shop in Kibera.
o Design is just the first step. Implementation is a big deal too [paraphrased]. Now, he’s signing contracts, getting legal help, etc.
• Josh
o PACS should have a nonprofit legal clinic
World Tuberculosis Day
Thursday, 24 March 2011, 11:00AM
Kibera
• Went and observed the event that multiple organizations collaborated to put on
• Conducted in Swahili, so we couldn’t understand.
Pause
Thursday, 24 March 2011, 11:00AM
CFK Office
• Informed that someone was robbed in clear daylight just now and to not go out by ourselves
• Waited for CDC/CFK to find us people to go with so that we wouldn’t be easy targets
• Decided it would be safer for us to go coupled up
• Timing inefficient, caught lunch in the meantime
• Dropped off all our stuff at the secure office in CFK so we only carried notepads
• Ernest & Nancy went with one person (Eric? Forgot.)
• Audrie & Belinda went with Yvonne & Judy, Sexual & Reproductive Health representatives at CFK
• Amee & Laura went with Celestine, a Community Interviewer
Interviews by Amee & Laura on Women’s Health
Thursday, 24 March 2011
The following interviews all took place in Kibera, Nairobi on March 24th, 2011. Amee Wurzburg conducted the interviews with Community Interviewer (CI) Celestine. The interviews were in a mix of Kiswahili and English. The three women that were interviewed are all part of the CDC’s program, and answered questions regarding fire, rape, and security issues in Kibera.
Josephine is a twenty-two year old woman who has lived in Kibera for four years. She has two children, ages 4 years and 8 months. She possesses a phone, and stated that she uses SMS. When asked what causes fires in Kibera, she stated “power breakages” and that the people of Kibera put out the fire with water. She said that there are existing hotlines to call, but “I do not know the names.” When there are fires she said firefighters do come in a timely manner. When asked how they know to get there, she said “They see the smoke” and seemed amused at the question.
Josephine said that rape occurs “mara kwa mara,” or time by time, but that it is not frequent. When asked what facilities rape survivors can go to, she responded there is a place in Olympic (a neighborhood right about Kibera, that hosts many organizations and NGO’s that work in Kibera—such as the CDC, Carolina for Kibera, and MSF). When prompted to say more, she said that it was run through MSF. She said that people do report rape—first they go to the clinic in Olympic, and then go to the chief to report. She believes that children are primarily victims. She knows of one hotline that people can call, which is the MSF hotline number.
When asked how the security is in the area, she said “Sijui” (I don’t know). When the question was rephrased to “Do you feel safe” she paused and said “Iko safe” (It’s safe). She said she does not know what are the major security issues in the area, and could not elaborate. When asked if the police help to improve safety in the area, she replied “through the chief.” She did not know of a direct way to reach the police, and said that one has to go through the chief. However, she said it “does not take a long time” for the police to arrive in the area.
Researcher’s notes and observations: Grace seemed reluctant to give answers, and especially to elaborate on questions. MSF appears to have done a good job reaching her about their services for sexual violence. In emergencies such as fire, theft, and violence, she has no formal protocol of what to do. While she knows about services such as firefighters and the police, she does not know how to contact them. The responsibility to get in contact with aid falls on the chief. During the interview I wondered how many times people have needed help, and been unable to get in contact with the chief, but did not want to ask since Grace already felt highly uncomfortable during the interview. I found it disconcerting that in order to get aid, one must go through a third party.
Anna is a twenty-one year woman who has lived in Kibera for three years. She has three children, ages 4, 2, and 1 ½. She owns a phone, and says that while she knows how to text, she only calls people.
She says that fire is a prevalent issue in Kibera, due to “wiring and power.” People put the fires out with water from the tanks. She said there are no hotlines, and that she has never seen firefighters or police helping with fires. Instead, “Tunajisaidia” (We help ourselves). She laughed at the question when we asked if there was ever assistance, and seemed humored and bitter at the idea. She wishes there was a number people could call where they could actually get help.
Anna says rape happens, but “not often.” She said that people do get help, and that “There is a new hospital in Olympic.” She said people do report to the police, and then stated “You shouldn’t bathe before going.” She said she feels that the police are helpful. When asked who are victims, she said “Wote” (all). When asked how the community responds to rape, she stated “We take him or her to the hospital,” though she said there is stigma and people fear the person. She does now know of any existing hotlines. When we followed up and asked her if she thought a hotline would be helpful, she said “Only if they respond.”
Anna does not feel safe at night, and cited the lack of gates in Kibera. She said that a problem was people taking property at night from people’s homes. Because of how unsafe she feels at night, she says she and others do not walk around at night. She said there is no police presence at night, and that while there is a number to call the police, “It takes at least one hour for them to respond.” She is not sure a hotline would help, because “It is too late once you know there is a problem.”
Researcher’s notes and observations: Anna appeared to be more well off than Josephine—her house had more rooms, and she possesses a television and radio. She also used more English than Josephine, and much of the interview was conducted in English. She was very aware of what people should do if they have been raped, and it was interesting to note her gender pronouns, as she used both male and female pronouns when we discussed rape. While she knew about the MSF clinic in Olympic, she is not aware of the hotline service they have.
Although Grace said she knows how to text, the more I asked if texting could be a way to help, she seemed very unsure of what texting was. I question if she is truly able to text.
Grace seemed very aware of the lack of resources for people in Kibera, and felt that the police and firefighters do not care. This was especially apparent when we discussed the possibility of a hotline and she said it would only be useful if people responded. This is clearly a problem in Kibera, where people try to reach out for help, but no one responds (such as it taking the police an hour to respond). If there was an ICT system, a problem would be getting people to trust that the system would respond and help them. Because people like Anna have so little trust in the systems that already exist, it may be a problem getting her to try something new. As well, if the system did fail, it would further shatter Anna’s trust in authority to aid her community.
The last interview was with Selphine, a twenty-six year old women. She just came to live in Kibera last August from her home up north, but her husband has lived her for a while. She has four children, ages 12, 11, 7, and 3. She says she possesses her own phone, and said she only calls people. When asked if she uses SMS, she seemed defensive and said “Yes, I know how to write.”
Selphine feels fire is a problem in Kibera, and that it is caused “from power.” When asked how people respond to fire, she stated that they call the counselor, who from there contacts firefighters. She said that “Wanachelewa kufika,” or that they are late to arrive.
She said mostly girls are raped, but that it does not happen frequently. She said the resources that are available are the police and the hospital. However, she said that not many go to the police. When pressed why, she seemed flustered and stated “Sijui kwa nini” (I do not know why). She said that the community does not change their perception of a person who has been raped. Selphine said there are no numbers anyone can call.
Selphine said that she does not feel security is that bad. At this point, Celestine asked her “Kweli?” (truthfully), but Selphine said that nothing bad happens at night. When asked what are security problems in Kibera, she said theft and violence, though Celestine prompted her with both those responses. Selphine said that people call the police and “wamefika haraka” (They arrive quickly).
Researcher’s notes and observations: Celestine seemed fairly doubtful and agitated during this interview. When we left, she said that some people are uneducated and not knowledgeable about the problems people face. She seemed frustrated, and during the interview it could be seen that she disagreed with Selphine, as she kept asking follow up questions and was very doubtful when Selphine said she felt safe in Kibera.
Selphine was very defensive when asked if she could use SMS. She stated that she could read when I asked if she ever uses SMS. However, Selphine does not understand any English, and as well struggled with Kiswahili. At some points, Celestine switched to Luo to ask questions. I question if Selphine is literate, considering her struggle with English and Kiswahili, since in schools students are taught English and take Kiswahili. Her defensiveness shows that it is shameful to be seen as illiterate, and that if people are illiterate, they make sure to hide the fact.
This will be a huge problem with an ICT system. It is likely there is a decent sized population in Kibera who are illiterate, making it impossible to use an SMS system. However, they would be reluctant to admit this, and would likely say that they could use such as system. In order for an ICT system to work that focuses on SMS, literacy programs would be necessary first.
Overall notes and observations from the whole interview period:
Illiteracy will greatly hinder an ICT system. Text messaging would be ineffective, since people would not be able to read them and would be too ashamed to ask others to read the texts for them. This is likely a bigger problem for women, since often families focus on educating boys if they do not have enough money to send all their children to school. Women are more likely to be illiterate, and they are often the target community for health messages since they are in charge of managing their children’s health.
During this time I questioned how effective educational posters and pamphlets about health have been. Several people who were interviewed stated that they do not have time to read them and either pass posters by without reading them or pile up pamphlets they are given. Since many people have lower levels of education, reading them takes time and effort, and pausing to read a poster may give away the fact that they are struggling to read it. There needs to be more efforts to address this, especially since women are the ones who must keep track of vaccinations. As well, by continuing to give illiterate people things to read, it increases their frustration with authority and makes them more distrustful of medical personnel, as they feel there is an even wider gap between them and that they do not understand the people of Kibera.
It would be impossible to consider this project without taking into account the gender disparities. Women are the ones who are more likely to benefit from an ICT program, but they are less likely to be able to text. Older women especially would be at a disadvantage, since more youth are tech savy. As well, in the poorer homes there is only one phone that is shared between all parties, and men can be reluctant to share messages or help their partner understand SMS. These factors would greatly hinder the success of an ICT program. For an ICT program to be truly successful, there would need to be greater gender equality.
Interviews by Ernest & Nancy in Kianda, outside the CDC Encatchment Area
Thursday, 24 March 2011, 11:00AM
Name: Evans
• Age: 30yrs
• Does not know what the CDC does.
• He was jobless because he could not go and look for work due to sickness.
• When he gets sick he preferred to go to the chemist and buy medicine instead of going to the hospital. He goes to the hospital only when the sickness is very serious. But when the child falls sick he takes them to the hospitals which are Langatta and Mbaghati district hospital.
• In case someone get sick at night and needs to be rushed to the hospital he said that he would rather wait until morning irrespective of the extend of sickness. This is because the area is very insecure.
• He said that the major causes of fire is Electric faults and the wiring is not the best done by the power brokers.
• He gets health information from reading from posters and the Internet using the phone or from the radio.
• He claims that the organizations in Kibera are not helping them because they take a portion of Kibera due to the population. The organizations are only there to get money in the name of helping.
• He suggested a way that they will benefit from the organization, is when they reach out to everyone on the ground through a one on one basis.
• He said that he is aware of vaccinations but he has never being vaccinated at old age.
• He mostly get information about vaccines eg, the polio vaccine through loud speaker announcement in the area.
• He was working as a social worker and he understand the imports of information he said,”Information is power”.
• He says that the Sms service would be great and will be willing to pay for it if it is beneficial.
Name: Charles & Ken
• Age: Charles is 25 yr, Ken is 27 yr
• They are not aware of what CDC does.
• They both don’t know much about health information and the only get such information from the hospital when they are sick.
• Q: How do you get your health information?
• Charles: said that he had never seen a poster around the neighborhood and he only sees them in the main road. He usually never read them because either he is a hurry or too busy.
o If he falls sick he often goes to Otiende or Benrode which is private hospital.
• Ken: said he goes to the hospital not knowing what he suffers from and when given drugs does not know anything about them but just take them.
• Q: What happens when someone is sick during the night and need to go to the hospital?
• Ken: It depends on the time and the degree of sickness if the person is not that sick they would rather wait until the morning because it was not safe to walk at night, but if it’s really bad they have to take a risk.
• Charles: Added that it’s very risky at night.
• Q: What are the security issues in the area?
• Ken: Most of the incidents are mugging. He added that the some muggers are known since they are from around.
• Q: Has anyone tried it stop them?
• Ken: Says and I Quote, “They are doing their job”. But the police have tried to stop them but haven’t arrested everyone, the police are mostly at the main road but when they try to get the criminal they run inside the side slum where the police can’t follow them.
• Personal Comments: the police was scared to get deep into the slums.
• Q: incase of fire what happens?
• Ken: They are mostly helped by the neighbours to extinguish the fire using water. Some of the people have the firefighters’ hotline who calls them.
• Both Ken and Charles rarely use sms.
Name: Magrate
• Age: 33yrs
• Number of children: 2
o Age of children: 1st -10 yrs, 2nd -14 yrs
• She does not know what CDC does.
• Q: What is balances Diet?
o I don’t know what it is. I cook for my kids anything as long as its food.
• Q: How much do you spend on food?
o I spend ksh300 per day this is for my kid and the neighbours children.
• Breakfast
o Tea with milk and Mandazi.
• Lunch
o The children eat ‘githeri’ a mixture of maize and beans at schol.
o Q: Are there any complains from the children about the food? No, I haven’t heard any.
• Dinner
o The children eat what she eats.
• Q: How much do you pay for their school fees? ksh500 and 1600
o She was not able to give us information about maternal health and vaccination because and I quote ‘I have forgotten it has been too long’.
• Q: Where do you get your health information?
o From the clinic when I’m sick.
o She adds that majority of the women in her area go to give birth in the hospital but their is still some who give birth in their homes, she says that the major reason is cost. Most of them go to the US AID clinic to give birth which is 24hrs.
Name: Winnie and Damaris
• Age: Winnie 27yrs
o Damaris 26yrs
• Number of children: Both have I kid.
• Q: Do you know what a balance diet is?
o Both of them were not aware of this.
• Q: What do you feed your children?
o Damaris: Break1st –milk and wheatabix (type of cereal)
▪ Lunch- Mashed Bananas
▪ Dinner – Ugali and whatever she is taking.
o Winnie: Break1st –Uji or tea
▪ Lunch- Ugali and eggs
▪ Dinner – whatever she eats.
• Q: How much do you spend in food?
o Both use ksh200 per day.
• Q: How do you get your health information?
o We get it only from the hospital when we fall sick and have to go to the hospital.
• Q: How do you get information about vaccination?
o Damaris: loudspeakers are used to spread the vaccinations in the area. They also get this information from the clinic where they take their children.
o The clinic name is Senye for a normal birth they pay ksh2500, if there are complications they pay ksh3000.They mostly prefer to go to this private hospital during the night as it is close. During the day they go to Otiende because it’s cheap (ksh20 for delivery).
o Information about vaccination of a child is written on a card containing the vaccination day, and other details. Every mother is required to have this card. They are mostly given when the child is born or when they are 1st vaccinated.
• Q: Do you own mobile phone?
o Damaris: No, I gave mine to my mother because I don’t need it.
o Winnie: No, I sold mine
• Q: If you wish to communicate how do you do that?
o We borrow phones from our neighbours
• Q: Do you use SMS?
o Damaris: Yes
o Winnie: No
Meeting with Sarah Waithera, Assistant to Caroline, 0721 431 310
Thursday, 24 March 2011, 12:00PM
CFK’s Binti Pamoja
• Structure of Binti
o Leaders
o 5 village coordinators for 12 villages.
▪ VC’s monitor 2 villages. In charge of 10 girls. 5 groups of 2 each. [? – confusing]
o 2 social workers
o 2 program officers, one for Core and one for Safe Spaces
• Two major programs
o Core
o Safe Spaces
o Alumni of the Core lead the Safe Spaces
o All programs are free: they require commitment on the part of the mothers.
• Core
o Recruitment 1x/year
o 10-18 year olds
o Meet every Sat & Sun
o Sat – poetry, drama, the arts
o Sun – prepared topic: sexuality, STD’s, etc. – very interactive, ask any questions they want
o Program for 2 ½ years
o Each year, full training for 3 days: on reproductive health, financial literacy, life skills
o Weekday afternoons – can come in for arts, activities
o When graduate, become alumni leaders who lead safe spaces
o TOT – trainers of trainees
o Meet at CFK hall
• Safe spaces
o Can be in church, mosque, school, etc.
o Leaders identify the safe space
o Kibera has a lot of bars [? – does this mean they do or don’t meet in bars?]
o Groundwork to discuss anything
o Pair into 2
o 35 safe spaces
o Each group can’t have 750 girls and adding more
• Leaders
o Every quarter (every 3 months) they submit a workplan, a schedule of topics that they want to lead, for the safe spaces. They’re guided by a manual that lists pre-brainstormed topics.
o Examples of topics by leaders
▪ Adolescence
▪ Growth and development
▪ Menstruation
▪ Self-esteem
▪ Values
▪ Teenage pregnancy
▪ Early marriage
▪ Abortion (only for those older age groups)
o Leaders ................
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