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  • Endemic/epidemic disease
  • Healthcare exclusion

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This is an extract from our latest Activity Report, looking back on our work in the previous year.

2012

Healthcare needs are great in Kenya’s urban slums and refugee settlements, where poor living conditions put people at increased risk of contracting communicable diseases.

Refugee camps and urban slums are overcrowded and characterised by a lack of basic services such as water and sanitation. Accessing healthcare is a challenge, particularly for people with chronic or neglected diseases such as HIV and tuberculosis (TB).

Healthcare in Dadaab

Located on a desert plain in northeastern Kenya, Dadaab is the largest refugee complex in the world. The population, mainly Somalis fleeing conflict and drought in their country, is approaching half a million.

In addition to the original camps of Dagahaley, Hagadera and Ifo, there are two new camps – Ifo extension and Kambios – which were set up to accommodate the growing numbers of refugees who started to arrive in 2011. In December 2012, the Kenyan government announced the cessation of refugee reception, registration and documentation in urban centres in an effort to relocate refugees and asylum seekers to the camps. Yet the camps are ill-equipped to meet people’s basic needs.

Médecins Sans Frontières/Doctors Without Borders (MSF) has been the sole provider of healthcare in Dagahaley camp since 2009, working out of a 200-bed hospital and at four health centres, where medical services include vaccinations, antenatal consultations and mental healthcare.

Staff carried out an average of 14,000 consultations and admitted 1,000 patients from the refugee and host communities to the hospital each month.

Malnutrition

High rates of acute malnutrition were recorded in children over five-years-old in the camps in 2012. MSF included children up to 10-years-of-age in its feeding programme and lobbied for other healthcare providers to include this age group in their annual nutritional surveys.

More than 2,200 severely malnourished children were admitted for inpatient treatment over the year. There is also concern about the quality of shelter and sanitation. Poor sanitation has led to outbreaks of disease that otherwise could have been controlled: in September, MSF responded to hepatitis E and cholera outbreaks in the camps. Both diseases are transmitted mainly through contaminated water.

Since July 2012, following several security incidents in which aid workers were targeted, it has not been possible for MSF international staff to work on a permanent basis in Dadaab.

Response to violence in the Tana River area

Clashes between the two major communities in the Tana River district, the Orma and the Pokomo, caused dozens of casualties and significant displacement in August and September. MSF provided psychosocial support to more than 900 people affected by the violence, as well as medical and logistical assistance to health facilities and in the camps for displaced people.

HIV and TB

In Homa Bay, Nyanza province, MSF is providing care to over 10,500 people living with HIV/AIDS. Roughly one in four of the 4,500 people tested in 2012 were found to be HIV positive and around a quarter of these joined the HIV programme. An additional 345 patients were registered in the TB programme.

In Nairobi, MSF continues to run the Blue House clinic in the slum area of Mathare and three clinics in Kibera. A new TB diagnostic test introduced in 2011 has led to an increase in the number of people identified with both drug-sensitive and drug-resistant TB.

MSF provides a range of services in Kibera, including HIV diagnosis and treatment, maternal and paediatric care, and treatment for chronic diseases such as diabetes and hypertension. In 2012, cervical cancer screening was introduced for women with HIV. In total, the teams in Nairobi saw more than 10,000 patients per month.

A large health centre incorporating a 24-hour maternity unit was completed on the edge of Kibera in 2012. It will be run jointly by MSF and the Ministry of Health from the beginning of 2013.

Sexual violence

Sexual violence is a major social and medical issue in Mathare, and MSF has provided medical care and psychological support there since 2008. Each month, dozens of people, more than half of them children, come to the centre for help.

A new 24-hour sexual violence clinic was opened on the outskirts of Kibera in 2012. Each week it provides 20 to 30 victims of rape with treatment to reduce the risk of contracting sexually transmitted infections, psychological support and medical treatment.

Kala azar

Kala azar, a parasitic disease transmitted by sandflies, is almost always fatal without treatment. In 2012, 500 patients were treated for kala azar in Kacheliba hospital in West Pokot district, where MSF has run a programme since 2006, with a 98 per cent cure rate.

In December, the programme was handed over to the Ministry of Health, which is implementing a national kala azar control programme, supported by the not-for-profit research and development organisation the Drugs for Neglected Diseases initiative. Before the handover, MSF trained health workers and raised awareness of kala azar among the population through a photo exhibition in Pokot, Turkana, Merti, Wajir and Habaswein.

Handover of Ijara programme

In October, a basic healthcare programme with a focus on women and children in the Ijara district of North Eastern province was handed over to the Ministry of Health and Atlantic Global Aid, a local organisation. MSF provided reproductive healthcare and treatment for 4,800 people in 2012, and offered vaccinations and supported TB care.

At the end of 2012, MSF had 851 staff in Kenya. MSF has worked in the country since 1987.

Patient story

Dickens, 34-years-old, is undergoing treatment for HIV and multidrug-resistant TB (MDR-TB).

"I discovered that I had TB in 2008, when I was working in Tanzania. I wasn’t getting better and in February 2010 I came back home. I was put on first-line medication – three tablets. I started losing weight very rapidly. It was scary. I weighed 58 kg, and then within two weeks I dropped to 51. They realised that I was probably resistant. So they sent my sputum to Nairobi and the result came back that I had MDR-TB. I was referred to Homa Bay, and luckily I got into the programme and started treatment in October 2010.

I also have HIV. I take 19 tablets for MDR-TB and four tablets for HIV every day. I’ve not undergone many other treatments, but I don’t think that there is any treatment worse than this one. We [the patients] support each other. It’s important, because sometimes people feel like running away. When I got here I was very weak, I could walk only short distances. Now I weigh 60 kg, I am walking, and I am already halfway through treatment."

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