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Kiberia: 20 years of MSF in one of Africa's largest slums.
Since July 2016 I've been working in Kibera [in Nairobi, Kenya], Africa's second biggest slum, where Médecins Sans Frontières/Doctors Without Borders (MSF) has been running several health centres and small clinics for almost 20 years.
Initially started as an HIV/tuberculosis (TB) programme, the project has grown to incorporate child & maternal health, non-communicable diseases, sexual and gender-based violence, and mental health.
It also caters for all day-to-day emergency cases, of which in an urban slum setting there are many.
Controlling the HIV pandemic
The two health centres currently employ close to 200 national staff, many of whom have been here from day one. This was during a dark period when HIV was stupidly out of control, causing misery to many people unable to access live-saving antiretroviral medications.
Nowadays, thanks to some incredible work from MSF and many other NGOs, the HIV pandemic in places like Kibera is much better controlled.
That said, there is still much progress to be made. On a daily basis I encounter many patients coming to see a doctor for the first time at a really late stage of their illness, or failing their treatment, usually because of poor adherence to their medication.
HIV is still highly stigmatised out here, and along with the many other social and cultural barriers, is a major contributor to unacceptable HIV-associated mortality.
Kiberia: A place of poverty and community spirit
My first ever time in an urban slum, Kibera is a fascinating place. Built on the edge of Nairobi, it truly feels like a city within a city.
Poverty at its most extreme is ubiquitous here, crime and violence is a daily occurrence. But that aside, Kibera is unbelievably vibrant and the community spirit is palpable. Small businesses operate, people frequent the bars, children attend schools... Life does go on here!
"In a country where patients frequently suffer crippling, extortionate bills even in the public hospitals, the service that we offer can really impact positively upon the lives of people living in poverty."
MSF has been a part of this community for many years, offering free primary healthcare to anyone who attends the clinics.
In a country where patients frequently suffer crippling, extortionate bills even in the public hospitals, the service that we offer can really impact positively upon the lives of people living in poverty.
Patients and staff
Throughout my short time here I regularly come across patients that have travelled to Kibera from the far side of Kenya to seek medical care from us.
Often we may not be able to provide the specific treatment they require. However, just providing patients with at least a diagnosis can be an overwhelming relief for them.
For me, as a medical doctor for the project, my greatest satisfaction comes from the patients.
The patients we see could not be more respectful and appreciative of the care we offer them (something that sadly I find is becoming a rarity in certainly the UK health system).
Patients will often spend close to a whole day within the health centre, passing through triage, seeing nurses or clinicians, then perhaps counsellors, nutritionists, and social workers. There can be a substantial waiting time but very rarely do you hear a complaint.
I think patients recognise that they will eventually be given the attention they deserve. This mutual respect makes my job feel incredibly worthwhile and enjoyable.
But the success of this project would not exist without the staff. The Kenyan staff, many of whom come from Kibera themselves, are overwhelmingly warm, humble, and caring.
Never in my career have I ever felt so welcomed into a new position. These people are the heart of the Kibera project.
It is obvious that many of the staff have really grown professionally within MSF, and are now armed with a bank of transferable skills.
Passing on the torch
After 20 years in Kibera, MSF is now in the process of handing over all responsibilities to the Ministry of Health. By June 2017, we will no longer have a physical presence in Kibera. It's a complex hand-over process, not without its multiple challenges and anxieties.
We recently transferred over the running of the TB department. Mine and other's roles are now adjusting to coaching and mentoring the new Ministry of Health staff and ensuring that the high standards of care can be maintained when we are not there.
But a sad and uncertain atmosphere now exists within the project.
Many staff will have to find new employers; patients are now asking what will happen when we leave: will my anti-convulsive and diabetic medications still be freely available? We don't have all the answers.
But we do know that MSF's mark has truly been left on Kibera. Many people have been empowered about their health, quality of life has been improved, and lives have been saved.
Now it's time to empower other health providers to continue to meet the needs of Kibera's people.
Without a doubt our presence will be felt for many years to come...