A Kenyan Journalist Writing About Health

Archive for the category “Disability”

Sex and People with Disabilities

By Maryanne Waweru-Wanyama

Many are the times that Susan has come across people who have, with some astonishment, blatantly asked her, “You mean even people like you have sex?”  Such questions have come from her friends, relatives and strangers alike, and her reaction is almost always the same – one of consternation and bemusement at her sexuality.

You see, Susan, 25, has a physical disability. “Even though hurtful, I have learnt to live with society’s ignorance towards people like me,” she says.

One of the common societal attitudes towards people with disability is that they are asexual; that they do not have sexual relationships. Ignorance fuels these attitudes, where engaging in sexual intercourse does not seem acceptable – at least according to society.

Phitalis Were Masakhwe, a disability rights activist says the idea that people with disabilities do not engage in intimate relationships is the norm in society.

“People with disability are constantly portrayed as incapable of having sexual feelings. Yet, they are normal human beings who also seek meaningful relationships with members of the opposite sex. Just because one has a disability does not mean a diminished need to experience love and affection,” he says.

Often, sex is associated with physical fitness and the virility of youth. And with the media awash with the perfect body image, sex is also associated with the perfect physical body – one with a balanced symmetry devoid of physical limitations. Many people with disability, and especially women endure constant internal battles with the ideal body type, knowing only too well that they may never achieve it. For many, this affects their self-esteem and their relationships with other people, especially those of the opposite sex.

Susan says that society is fed on unrealistic images through the media – where boy meets a perfectly flawless beautiful girl, and they instantly fall in love.

“The sex which then follows is always mind-blowing. Physical attraction is always the dominant theme, and I am yet to see a soap opera that has the lead character as a person with disability. When cast in a programme, they are often portrayed negatively,” she says.

Besides the perfect body image, people with disability have a myriad of other issues to deal with, all of which can affect their sexual functioning. These include feelings of anxiety, fear and depression. Other times, certain prescribed medications may affect sex drive and sexual function.

For those with physical disabilities and whose mobility is aided by wheelchairs or crutches, their ability to move in what can be considered standard sexual ways is limited. Some have to contend with among others; pain and loss of sensation in areas where their partners expect them to be sensitive, as well as impaired bowel and bladder control. In men, it can have an effect on their erection and ejaculation.

For many people with disability, sex is not as spontaneous or as frequent as that of their able-bodied counterparts. Many times, it has to be a planned activity where issues of physical location and fatigue have to be considered. In some cases, the use of assistive devices to achieve pleasure is required.

“It takes a lot of effort and courage to explain some of these things to a sexual partner, especially one without disability,” says Susan. “That is why we prefer to date our kind most of the time – someone with a disability because they understand these things.”

Susan says that even though she gets attracted to people without disability, it is the fear of rejection that makes her stay away.

Even worse is the fact that some members of society consider it ‘embarrassing’ to date someone with a disability.

“Many men have sex with women with disability under the cover of darkness. They have intercourse with them at night but during the day, shun them. This accounts for the high number of women with disability who are single mothers. Often, their children have been sired by different men,” says Masakhwe.

Such a man, Masakhwe says, fears the likely ridicule he will receive from his family and friends, who will question his selection of a wife and tease him for his ‘unsuitable’ choice. “Such is the shame of our society”, he says.

In some communities, people with disabilities are often sterilized against their knowledge or will. Some women have even been forced to undergo abortions in the anticipated disgrace the pregnancy will bring to the family.

“It is this kind of prejudice that makes people with disability fear seeking health information,” Masakhwe says. “Even though sexually active, most lack confidence enough to seek information and services on ‘private matters’ such as reproductive health, even when this information is life-saving for them.

Caroline Agwanda, the proprietor of Hyacinth Ornament Production Enterprise (HOPE) in Kisumu, and who has a physical disability concurs with Masakhwe and further decries the reaction pregnant women with disability receive from society.

“Many express their sympathy at your pregnancy. They tell you ‘pole’ and question the morals of the man who ‘dared’ impregnate you. ‘What was he thinking? Why didn’t he look for another woman if he really wanted to have sex?’ they ask, while shaking their heads in disgust.

But it does not end there, Agwanda adds. “Woe unto you when society discovers that such a woman did indeed plan for the pregnancy,” says the mother of one.

“When I was expectant, many people asked me why I wanted to bring yet another disabled person into society. For them, it was automatic that I would give birth to a child with a bad leg like mine, and wondered what kind of a person I was to want to do so.”

Agwanda says that society’s ignorance on disability issues further manifested itself after she delivered. “After I got my baby girl, I was excited by the huge number of people who came to see me and my baby. However, I was to later discover that most were merely coming to ‘confirm’ that my child had been born with a bad leg too. This greatly saddened me.”

Too often, women with disabilities are teased, humiliated or otherwise harassed by peers and healthcare workers should they decide to become pregnant, decreasing the likelihood they will receive appropriate reproductive healthcare.

“Many are the times a clinician will ask a pregnant woman with disability; ‘Who got you pregnant? Why were you having sex in the first place?’ Even worse is that they ask this out loud along the hospital corridors, something that is really embarrassing,” says visually impaired Jacqueline Osoro, 31.

According to the Association for the Physically Disabled in Kenya (APDK), 1.6 million Kenyans have a form of disability.

Of these, about 640,000 are physically challenged. One such woman is Godliver Omondi from Mumias, who shares that pregnant women with physical disability have an especially hard time accessing antenatal care.

“I remember when I was pregnant, a nurse asked me to climb onto the examination table for an examination procedure during an antenatal visit. I use a wheelchair for mobility, and it is hard for me to get atop an examining table without assistance. The nurse did not bother to assist me,” says the mother of three children aged between five and twelve years.

“All health facilities must be made accessible to women with disabilities, and these include accessible examining tables, ramps and sign language interpreters. Clinicians should also be trained on how to be more sensitive to our needs,” she says.

One time when she was in labor and on her wheelchair, Godliver says many nurses passed her, assuming that she was there to visit a patient.

“I kept asking for assistance, and when I finally managed to catch the attention of one nurse, she asked me which patient I had come to see. The nurse was shocked when I told her I was in labor. She had not imagined that I could possibly be pregnant”.

Dr Julius Rogena of Machakos District Hospital admits to the lackluster attitude of health providers.

“Just like any other person, people with disability engage in behaviors which place them at various health risks, such as HIV infection. It is unfortunate that the attitudes of some healthcare workers do not reflect this reality.

As it is, people with disability have limited access to HIV education, information and prevention services. They may be turned away from community HIV education forums because of assumptions that they are not sexually active, and therefore at little or no risk of infection,” Dr Rogena says.

This is despite a growing body of research that indicates that those with disabilities are at increased risk of HIV due to their vulnerability.

Thoraya Obaid, Executive Director of the United Nations Population Fund (UNFPA) alludes to studies that show that persons with disabilities are up to three times more likely to be victims of physical and sexual abuse, and are at increased risk of HIV/Aids.

Yet for people with disability to be responsible about their reproductive health, they must be provided with sexual health information and given the safe space to openly express their sexuality. Rarely do adolescents with disabilities receive, either at home, or in school, reproductive health education that enables them to prepare for or appropriately respond to their specific needs and situations.

Jacqueline, who attended an integrated school for her secondary education says the only credible information she ever received on reproductive health was what she learnt during her form three biology class.

“Those who attend special schools hardly receive any sex education, and depend on those who listen to radio or television programmes to ‘educate’ them. Most of the information people with disability have on sex is what they learn from their peers,” she says.

Daniel Aghan, Advocacy Officer at Handicap International says there is an urgent need for the development of policies on access to disability-friendly information, education and communication materials, which take into consideration the different facets of disability.

For the visually impaired, Masakhwe advocates for their special needs.

“To protect themselves from HIV, blind persons use condoms, but their privacy is infringed when for example, they need to check the expiry date on the condom pack.

“They have to rely on a seeing person to read it for them. It is time brailed condoms were designed and made available to this population,” he argues.

Masakhwe says reproductive health programmes should be more accessible through disability-friendly adaptations such as cassette tapes, sign language interpretation, Brailled information, or in formats that are easily readable (such as pictures) for those with intellectual disabilities.

Article courtesy: The Star

Fistula: When Childbirth is a Cause for Misery

By Maryanne Waweru-Wanyama

Lovina Okwara is a bubbly 17-year-old whose broad smile, infectious laughter and carefree attitude is evident of a young woman enjoying her life. However, this has not always been Lovina’s attitude. For the last four years, her life has been one of misery.

Lovina traces it all back to four years ago when she gave birth to her daughter. An occasion that was supposed to bring her untold joy and happiness turned out to be the beginning of her nightmare. She recalls the day.

“My mother helped me birth my baby in our small house. Maternity services were not free back then so going to hospital was not an option as I had no money,” Lovina says, adding that the baby’s father, also a young man, had no financial means either.

Lovina comes from Teso district, Western Kenya. She comes from a poor background and so do many of her neighbours. Many of the women deliver their babies at home with no skilled care — among the reasons being personal preference, ignorance and poverty. While some women and children die during childbirth, Lovina and her daughter are among the lucky who survived.

But it was not an easy survival.

“I laboured for about 48 hours and when my baby finally came, I was exhausted, physically damaged and in pain. My private parts had been ripped apart during the delivery,” she remembers.

A few hours later, Lovina noticed she was unable to control her flow of urine and faeces.

“When I sat, I felt wetness overcome me and when I looked down, I noticed I was urinating on myself. I also noticed that my underwear had stool. Worried, I asked my mother about it.”

Lovina’s mother reassured her that the leaking urine and faeces were nothing to worry about, that many other mothers experienced it too.

This situation would see Lovina, who dropped out of school in class seven, eat very little food and take few sips of liquids to avoid quickly filling up her bladder and bowels.

“I would starve myself yet I was breastfeeding. I also stopped laughing as this would make my urine gush out. Even though I am grateful for my daughter, it has been a harrowing experience for me ever since she was born,” she says.

When Lovina, a causal labourer in Nairobi, tried to seek treatment for her condition, she learnt it would cost her about Sh30,000, money she could not raise. So it therefore came as a pleasant surprise when in July this year, she came across information about a free fistula medical camp at Kenyatta National Hospital.

Lovina wasted no time in going to the hospital for screening and a few days later, underwent a successful fistula repair surgery. Today, she is a happy teenager who has since regained her cheer and laughter which had been taken away by the fistula she suffered for four years.

Lovina Okwara

Photo: Lovina Okwara

Lovina’s fistula is likely to have been caused by the prolonged labour she went through. According to Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon at Kenyatta National Hospital, obstetric fistula is a childbirth injury that develops due to prolonged and neglected labour which becomes obstructed.

“Obstructed labour causes destruction of vaginal tissue which leads to the development of a hole (fistula) between the bladder and birth canal. This causes urine to leak continuously through this hole. When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal,” he says.

Prolonged labour is that which goes on for more than 24 hours and according to the World Health Organization, obstructed labour accounts for up to six per cent of all maternal deaths. Dr Mutiso says that majority of the patients who present with fistula often have laboured for three to five days at home usually under the assistance of relatives or traditional birth attendants. In most of these cases, nine out of ten babies are born dead. Many of the women are from remote areas where the overall infrastructure is poor and they are unable to reach hospitals in good time.

In Mwingi district, Kitui County in Eastern province for example, women have to walk long distances in rough terrain to the nearest health centre. And when they get there, lack of personnel as well as lack of equipment and supplies is yet another challenge. A case example is Nyaani dispensary in Nuu location, where there is only one health worker, a community nurse who attends to all patients seeking services there. Nyaani dispensary serves a population of about 7,000 people.

Without a theatre or other basic equipment necessary for handling birth complications, the nurse has to call for an ambulance from Mwingi District Hospital which is 79km away. By the time the ambulance arrives and gets the pregnant woman to hospital, about four hours have elapsed. And this is when an ambulance is available. Many times it is not.

“A pregnant woman experiencing a birth complication and who is referred to the district hospital often has to use public transport. Public vehicles are hard to come by because of the poor state of the roads. Sourcing for transport and eventually getting to the hospital can even take a day,” says Damaris Wanjiru, the nurse in-charge at Nyaani dispensary.

Interestingly, while Damaris sees an average of 12 pregnant women a month attending antenatal clinics, she only delivers about three babies a month, with the rest delivering at home. Lack of transport is one of the major reasons the women cite for failing to make it to the dispensary when labour checks in.

Eastern province is one of the regions that bears the highest number of fistula cases. Other areas include Nyanza, Coast and Northern Kenya regions, as well as West Pokot. It is important to note that fistula can affect any woman regardless of her age, marital status, education level or income status. For as long as she experiences prolonged and obstructed labour and does not have access to emergency and quality obstetric intervention, then she can develop fistula.

In Kenya, there are an estimated 300,000 women living with fistula, with an occurrence of about 1,000 new fistulas each year, according to Dr Mutiso.

The consequences of fistula on the woman are dire. Stella Mburu, a nurse at Mbagathi District Hospital and who has been trained in fistula care, says that in most of the cases, the woman is emotionally pained following the loss of her baby. In addition, she has to deal with the continuous leaking of urine or faeces which make her smell foul. Most women from poor areas cannot afford fistula repair surgery and therefore use pieces of old cloth or mattresses to contain the leaking urine or faeces.

“They face rejection by their families and communities and because of the stigma, they soon stop going to public places such as the church or the market. They also stop attending social gatherings like weddings or chama. They also find it hard to find employment or engage in business. Some women experience domestic violence while some are disowned by their men who leave them to marry other women. Some women suffer depression as a result,” she says.

The good news is that fistula is treatable. Small fistulas can heal if a urinary bladder catheter is inserted for about four weeks immediately the fistula occurs. Surgery is the other option. However, the costs of surgery remain far beyond the reach of many women affected by fistula. In public hospitals, fistula repair surgery costs between Sh20,000 and Sh40,000 which is a subsidised fee. In private hospitals the price is much higher.

For women such as Lovina who cannot even afford the subsidised cost at government hospitals, they are lucky to benefit from organisations that sponsor their treatment through free fistula medical camps. Her surgery was made possible by the Freedom from Fistula Foundation, the Flying Doctors Society of Africa and Kenyatta National Hospital.

Fistula can be prevented by delaying the age of pregnancy and ensuring that all women have access to quality maternal care. The free maternity services in public health facilities are aimed at encouraging more women to deliver in hospitals under the supervision of skilled birth attendants to reduce negative maternal outcomes such as fistula.

Article courtesy: The Star

Senator Harold Kipchumba: “Polio Shattered my Dream to be a Soldier”

By Maryanne Waweru-Wanyama

Anti-polio campaign ambassador Harold Kipchumba, who was paralysed when he was four, appeals to parents to ensure their children get all required immunisation

Growing up as a young boy in the small village of Kaptiony in Baringo County, 52-year-old Harold Kipchumba vividly remembers some of his childhood escapades.

“I would run wildly with other boys picking wild fruits, playing hide and seek games and chasing after birds while herding cattle.”

This however changed one day when at four years old; Kipchumba began feeling unwell.

“I felt pain in my body, I felt tired and I felt weak. Unable to get out and play with my friends, I remained indoors with my mother,” he remembers.

But his mother thought he was just being lazy.

“She scolded me, saying I was being sluggish because I wanted to avoid doing house chores such as fetching water and firewood. She thought I only wanted to eat and sleep.”

Harold Kipchumba

Photo: Harold Kipchumba during the interview 

Within a week, Kipchumba found himself completely unable to move his body from the waist down, especially his legs. It was only then that his parents took the matter seriously.

“They thought someone had poisoned me and pestered me about whose home I had visited and what I had eaten there. They asked who I had met along the way, and if the person had looked at me with bad eyes — thinking that a jealous neighbour had bewitched me. They also asked if I had eaten any wild fruits that may have been poisonous, or if I had touched any wild leaves that could have caused an allergic reaction on my legs,” he recalls.

His parents then sought the expertise of local herbalists to help cure their son.

“The medicine men made me swallow bitter concoctions. They would painfully massage my legs with traditional herbs and oils as they tried to straighten them. But none of their cures worked.”

Finally, after two months and with his legs still immobile, Kipchumba’s parents decided to take him to hospital.

And therein lay another challenge.

The nearest health centre was 40 km away from Kaptiony village. With no public transport in the area, the family had to wait for days for a Good Samaritan to offer them transport.

Eventually, Kipchumba and his parents reached the hospital. But there was no good news for them.

“The doctor said I had polio, which was irreversible. They told my parents that the condition could have been prevented if they had been keen on ensuring I had received all the polio vaccines in my early childhood.”

Kipchumba’s mother did not take the news of her son’s paralysis well, and spent years seeking a cure for him.

“She took me to countless traditional medicine men across the country — from Ukambani, to Kisii, to Kisumu. But none of them ever healed me. It was an exhausting experience for her, as she would get weary carrying me on her back as I was unable to walk or stand. I was big and heavy, but her determination is what kept her going,” he recalls.

Back in the village, Kipchumba would admire his age mates who had already started school.

“I was not in school because the interview for class one required one to touch their left ear with the right hand. I was short and plump with a big head and a very heavy upper body, so I repeatedly failed this test because I could not get my hand over my head. I watched all my age mates go to school while I stayed at home simply because I could not pass this interview,” he recalls.

Frustrated, Kipchumba’s mother decided to return him to hospital. And then she did the unexpected.

“My mother dropped me at the hospital and left, never to return for me. After a while, some Catholic nuns noticed me and took me with them to Nyabondo Home for the Crippled in Kisumu. There, I underwent rehabilitation for my legs, and I was also able to get an education.”

However, the young boy always remained hopeful that his mother would return for him someday.

“As I watched my friends get visited by their family on visiting days and be picked by their parents on closing day, I always stared at the gate, looking out for my mother. But she never came.”

That notwithstanding, Kipchumba was a bright pupil, and scored well enough to earn him a spot in Lenana School, a national school in Nairobi. While there, the school helped trace his family. It had been more than 13 years since he had seen his mother. He remembers the reunion.

“I cannot forget that moment. I was overjoyed. On seeing me, my mother shed tears, apologising profusely — saying she had never meant to leave me at the hospital, but had done so out of helplessness and frustration. Begging for my forgiveness, mother told me she had spent years regretting her decision to abandon me. I was too happy to see her and easily forgave her. I was also reunited with my siblings, including those who had been born after I had left,” he says.

After competing secondary school, Kipchumba was admitted to Kenyatta College (now university) for a degree course, but turned it down for an offer at Kimmage Development Centre in Ireland where he pursued development studies. He however says that one of his greatest dreams while growing up was to be a military man.

“When I showed up for the recruitment exercise in 1986 at the age of 24 years, the officers were shocked at my presence. They asked me why I was there, yet they had made it very clear that they wanted youths who were physically fit.

“I argued with them, saying I was physically fit, only that I was in crutches. Besides, I told them that I was capable enough to serve in the military in the administration, logistics or planning departments. But they turned me away.”

Dejected, the young Kipchumba returned home.

“If my mother had ensured I had received those two polio drops, then my dream to serve in Kenya’s Defence Forces would have been valid, just like Lupita’s.”

Principal Secretary for Health Prof Fred Sigor, Baringo County Governor Benjamin Cheboi and anti-polio campaign ambassador Harold Kipchumba during the world Health Day celebration in Marigat in April

Kipchumba during the World Health Day celebrations

Kipchumba, who holds a Masters degree in Local Governance and Leadership, is today a development consultant. Married with three children, he finds time off his busy schedule to participate in polio campaigns. He works together with the Ministry of Health to champion the cause of polio across the country.

Polio is an infectious disease that attacks the nervous system and can lead to paralysis, disability or even death. The polio virus enters the body through the mouth in water or food that has been contaminated with faecal material from an infected person.

The disease mainly affects children under five years old who are not fully vaccinated. Children in Kenya are vaccinated against polio in routine immunisations through the Kenya Expanded Programme of Vaccination (Kepi). They are required to receive at least four doses of the oral polio vaccine in the first year of life. Polio symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. For every 200 people infected with polio, one of them ends up with irreversible paralysis (usually in the legs). Among those paralysed, 5 – 10 per cent die when their breathing muscles become immobilised by the virus.

While many countries across the world have managed to completely eradicate polio, others still continue to grapple with this preventable disease. Kenya is one of them, and has an interesting history to it.

For 22 years from 1984 to 2006, Kenya was polio-free. However, this changed with the influx of foreign nationals into the country, mainly those from neighbouring countries. In 2006, two polio cases were reported in the country, which were importations from Somalia. In 2009, there were 19 detected cases of the virus in Turkana, which were importations from South Sudan. Another case was detected in Rongo, Nyanza province in 2011, and which was linked to the 2010 outbreak in Uganda — which was in turn linked to the 2009 outbreak in Kenya. As of December 2013, there were 14 confirmed cases in the country.

In light of this, the Ministry of Heath has been working with partners such as Unicef, World Health Organisation, and polio ambassadors such as Kipchumba in conducting mass immunisation campaigns to ensure all children are vaccinated against polio. Polio has no cure, and can only be prevented through immunisation.

According to Dr Ian Njeru, the head of the Division of Disease Surveillance and Response, these campaigns will continue taking place until all children are reached.

“All children in the country must be immunised, because for as long as there is a detected polio case, then all children across the country are at risk,” he says.

The polio virus knows no borders and carriers frequently move from place to place. Meaning the virus can appear anywhere in the country. Despite heightened awareness campaigns, the ministry is still not achieving its target of having more than 90 per cent of children immunised.

“Some of the barriers include religious sects that do not believe in vaccination or modern medicine. The poor infrastructure and dire security situation in some regions has also made it hard for us to reach all children,” he says.

According to Dr Njeru, children who have received previous polio vaccines should still be immunised in every campaign.

“It is safe to administer multiple doses of the polio vaccine to children. The extra doses give valuable additional immunity against polio,” he says.

Article courtesy: The Star

Kenya on Awareness Campaign to Increase Uptake of Iron and Folic Acid in Pregnant Women

When Scholastica Kasyoka conceived her first child six years ago, she was elated at the thought of becoming a new mother. To ensure that all would be well with her pregnancy, she immediately started her antenatal clinics at a health facility near her home in Kayole, Nairobi.

During her initial ANC visits, she was given iron and folic acid tablets and was told to take one tablet each day. These tablets, she was told, would help her have a healthy pregnancy and healthy baby. And indeed, Scholastica took one tablet daily -as instructed. But just for a while, for a few days later, she stopped.

“I would feel very sick every time I swallowed them. I would feel nauseated, weak, and would many times vomit. Hard as I tried to keep up with the tablets, I just could not. So I stashed them away and carried on with the pregnancy,” she remembers.

Nine months later, Scholastica gave birth to a baby girl. But something was wrong. The nurses told her that her newborn had a problem.

“They said my daughter’s spinal cord was not well formed,” she recalls of the disheartening news that cut short her celebrations as a new mum.

Scholastica Kasyoka. Her daughter was born with spina bifida --a neural tube defect.

Scholastica Kasyoka. Her daughter was born with spina bifida –a neural tube defect.

Scholastica was later to leant that her daughter had spina bifida. She had never heard of spina bifida; she had no idea what it was.

“The nurses told me that my baby was born with a deformed spine because I had stopped taking the iron and folic acid tablets I had been given,” she remembers.

Spina bifida is a neural tube defect characterized by the incomplete development of the brain, spinal cord, or the protective covering around the brain and spinal cord.

Anne Mulwa, a clinician at Bethany Kids Hospital –hosted by the AIC Kijabe Hospital in Central Kenya, says that in some cases of children with spina bifida, part of the contents of the spinal canal protrude through the spinal column. Spina bifida may lead to disability.

“Spina bifida may cause difficulties with bladder control, and can lead to paralysis at the point where the bifida is highest. Depending on the severity of the deformity, people with spina bifida may be paralyzed or may have challenged mobility,” she says.

Bethany Kids Hospital is one of the largest referral hospitals in Kenya for children with disabilities and who need surgical intervention. The highest numbers of referrals are those of neural tube defects. From its inception in 2004 to the year 2012, Bethany Kids conducted a total of 14,333 surgical procedures. Operations on children with neural tube defects accounted for more than half (51%) of the total surgeries. Scholastica’s daughter Grace, is among these statistics.

Bethany pie 2_img_0

Though the exact cause of spina bifida is not known, research suggests that lack of enough folic acid in the pregnant woman’s diet, more so during the first trimester when the spinal cord is being formed as a key factor in causing spina bifida and other neural tube defects. Folic acid is particularly essential before the woman gets pregnant –and within 28 days after conception.

Esther Kariuki, a nutritionist with the Micronutrient Initiative says that women, especially those in the childbearing age should make it a habit to eat foods rich in iron and folic acid, and where necessary, boost this with recommended supplements. Some of the foods that contain high amounts of these essential nutrients, Ms. Kariuki says, include; liver, meat, green leafy vegetables and fruits rich in citric acid.

“Neural tube defects happen in the first few weeks of pregnancy; usually before a woman even knows she is pregnant. It doesn’t help matters that many pregnancies are unplanned, so by the time she realizes she’s pregnant, it could be too late to prevent these birth defects.” she says.

Women who have had prior pregnancies that resulted in babies with spina bifida or other neural tube defects are also at a high risk of having a subsequent similar pregnancy. Ms. Mulwa adds that such women are advised to take folic acid even when they are not pregnant.

It is for this reason that Scholastica was put on folic acid supplements after she delivered her daughter, even though she was not sure she wanted to have a baby again –not with the problems she was facing with her daughter -a child who would need lifelong care because of her disability.

Various fruits and vegetables are rich in iron and folic acid.

Various fruits and vegetables are rich in iron and folic acid.

The World Health Organization (WHO) recommends daily iron and folic acid supplementation for pregnant women. The recommended daily dose is 60mg of iron, and 0.4 mg of folic acid. Doing so reduces the risk of having a pregnancy affected with spina bifida or other neural tube defects, reduces the risk of having babies with low birth weight and iron defects. The supplements also reduce the risk of maternal anaemia.

Kenya’s Ministry of Health has been implementing the WHO recommendation of daily supplements for pregnant women through its antenatal care strategies. However, the current uptake and adherence rates of iron and  folic acid supplements among pregnant women has been low, according to Ms. Evelyn Kikechi, a nutritionist at the Department of Nutrition. This could be due to a combination of many factors.

One of them is pregnant women’s failure to follow the instructions given to them about taking the tablets.

“When the women are given the supplements during their ANC, many of them stop taking them once they start experiencing side effects. The side effects include nausea, vomiting, a general feeling of weakness as well as a taste of ‘metal’ in the mouth”.

Ms. Kikechi aptly describes some of the side effects that Scholastica experienced, which made her stop taking the supplements. Many women, Kikechi says, do not understand the importance of these supplements. It also doesn’t help that women delay their first ANC visit, thereby missing out on the opportunity to be given the supplements in their first trimester.

A mother and her child at Bethany Kids Hospital. The child has spina bifida.

A mother and her child at Bethany Kids Hospital.

Some religions don’t allow visits to hospitals or taking of ‘Western’ medicine, thus women don’t visit ANC clinics –missing out on opportunities for the needed supplements. Pregnant women are also reluctant to vist ANC because they fear they will get tested for HIV. Others are not able to attend ANC clinics because the health facilities are far off, and they may not have money for transport. Getting to the health facility is therefore not a priority –over tilling the land and preparing meals for their families.

According to the 2008-09 KDHS, less than half (47%) of pregnant women make four or more ANC visits and only 15% access antenatal care while in the first trimester of their pregnancy. The report adds that about half (52%) receive care before the 6th month of pregnancy. The median number of months of pregnancy at first visit is above the first trimester –at 5.6 months.

Some cultural practices also stand in the way of women accessing iron and folic acid supplements. Some communities prescribe certain herbs and specific soils and stones to the pregnant women, claiming these are sufficient enough to enable them have healthy babies. But this is not always the case, where infact, eating the soils and stones could lead to even bigger health problems for the woman.

Another reason for the low uptake of iron and folic acid supplements by pregnant women is some health provider’s limited understanding on the reason for giving their clients the supplements.

Kenyatta National Hospital. The government is sensitizing all health workers on iron and folic acid supplements for pregnant women.

Kenyatta National Hospital. The government is sensitizing all health workers on iron and folic acid supplements for pregnant women.

“Because some health providers in the ANC clinics do not have a clear understanding of the importance of these supplements, they fail to give the pregnant women sufficient information on the same. They do not stress on the need for these women to take these tablets, so the women do not take it seriously either,” Ms. Kikechi says.

According to her, all staff at public health hospitals are currently being sensitized on the need to inform women on the importance of iron and folic acid supplements, and give them to every pregnant woman who visits an antenatal clinic. The government, in collaboration with other partners and stakeholders is also engaged in various awareness campaigns, including the use of mass media to pass on messages of the importance of iron and folic acid supplements.

But the government too has its contributory role in the low uptake of these iron and folic acid supplements among pregnant women.  A Kenya Service Provision Assessment (KSPA) survey done in 2010 showed that not all government facilities were stocked with these supplements. Only 2 out of every 5 health facilities had iron tablets, while 74% had folic acid tablets.

In addition, for facilities that stocked the supplements, there were frequent stock-outs, caused by among others: communication breakdown between facilities and depots, low prioritization of IFA supplements by government, differences in forecasting by different MOH units, and inadequate budget allocation.

Even further, the current country policy on iron and folic acid supplementation requires that all pregnant women be given these supplements whether they have been screened for anaemia or not. However, current practice at the facility level is that health workers insist on screening pregnant women for anaemia before prescribing the tablets. This is despite statistics from the 2010 Kenya Service Provision Assessment (KSPA) showing that just about 36% of ANC facilities have the capacity to test for anaemia –thereby denying supplements to the ‘eligible’ target group.

A happy mother with her healthy child.

A happy mother with her healthy child.

To reduce the health burden of the country, stringent efforts to educate the public, especially women, on the essentials of good maternal and child health is of utmost importance. If Kenya is to achieve MDGs 4 and 5, then it needs to seriously pull up its socks. Creating awareness on the importance of iron and folic acid supplements to childbearing women and health workers, as well as policy makers will go a long way in reducing the number of children born with birth defects.

Living with Epilepsy in Kenya: A Young Woman Shares Her Story

The estimated number of people living with Epilepsy in Africa is close to 10 million. Of these, 75% are children and adolescents below the age of twenty years. In many African communities, Epilepsy is associated with withcraft, and because of the stigma attached to Epilepsy, many of them never get to see a medical professional about their condition, and therefore continue to suffer the negative consequences of this.

Sally Njenga is a young Kenyan woman who was fortunate enough to seek medical intervention for her Epilepsy, and is today an Epilepsy awareness advocate. She shares her story.

Shiatsu Therapy: The Story of Angeline Akai, A Visually Impaired Lady

On a Saturday morning, Angeline Akai walks to work from her Kibera house to the Salus Oculi offices in Hurlingham, Nairobi. Angela is a shiatsu therapist.

Shiatsu is a unique, non-invasive therapy designed to stimulate the body’s inherent ability to heal itself. Angeline’s work involves the application of pressure on a client’s body using her fingers, thumbs and palms in a continuous rhythmic sequence. This stimulates a natural flow of energy through the body, calming the nervous system, improving circulation and relieving stiff muscles and easing stress. In Shiatsu therapy, no massage oil is applied, and the person remains fully clothed throughout the therapy session.

Angeline has been doing this job on a part-time basis for the last eight years. She is totally blind, and hers is a story of determination.

At the age of three, Angeline got a measles attack but unfortunately, lack of timely medical intervention threw her into the world of darkness. Angeline attended Kilimani Primary School, an integrated school which accommodates children with special needs. She attended the school courtesy of Sightsavers International.

Each day, Angeline had to trek to and from her Kibera home to school, something that was very difficult, more so when crossing the busy roads. Often, she would go hungry all day long owing to her parent’s inability to pay for her lunch. Many times, her family would do with only one meal a day. It was also the norm for the family to spend nights in the cold owing to her father’s inability to pay house rent.

Owing to these challenging circumstances, Angeline was lucky to get a place at Thika School for the Blind in class six, where she was able to comfortably pursue her studies.

“Life was much easier there, though each time I thought of my family and their tribulations back home, I would get very stressed.”
But in spite of these woes, Angeline managed impressive grades in her Kenya Certificate of Primary Education (KCPE). Scoring 510 marks out of 700, she was admitted to Moi Girls’ School Nairobi, a school which also caters for those with special needs.

As her parents were once again unable to pay her fees, Angeline’s stay in school was erratic, as she relied on different well-wishers to settle her arrears. Despite this struggles, she sat for her Kenya Certificate of Secondary Education (KCSE) in 2002 and attained a C plain.

“My dream career was in counseling and I looked forward to joining university. But I knew that was just wishful thinking because my parents couldn’t afford it and from experience, I knew that finding a sponsor was going to be difficult,” she remembers.

To keep herself busy, Angeline, together with other visually impaired people were trained in shiatsu therapy by the Japan International Cooperative Agency (JICA).

Luck smiled on her when in 2004, she got sponsorship to Highridge Teachers College where she later graduated with a P1 teaching certificate. The challenge, however, lay in securing employment.

“When I talked to my fellow graduates who were sighted, they told me they were also facing difficulties in being absorbed into the teaching industry. As a blind teacher, my chances were close to nil.”

To avoid becoming rusty in her teaching skills, Angeline volunteered at her former school – Kilimani Primary. She also continued working as a shiatsu therapist and used her income to support her parents and siblings.  Among her three other siblings, Angeline is the only one who made it beyond class 7.  In those days, before the introduction of free primary education, her parents could not afford the required school fees.
As she continued searching for a job, Angeline secured sponsorship for a certificate counseling course at Kenya Association of Professional Counsellors (KAPC) in 2006.

“Counseling has always been my passion. After taking the course, I confirmed that counseling is where my passion lay. I resolved to take a degree in counseling. Sadly, the sponsorship was only for a certificate. I hope to attain a degree in counseling someday.

In January 2009, I got a job as a rehabilitation assistant at Nairobi Comprehensive Eye Services. My work involved identifying recently blind people in different communities, counseling them, and training them on independent living skills. Many newly blind people live in denial about their visual inability, and many of them still harbor lots of anger and bitterness towards life. My counseling skills came in handy as I spoke to them, and encouraged them to accept their status and move on with their life. Blindness is not the worst thing that can happen in life.”

Unfortunately, the project Angeline was affected by dwindling donor funds due to the economic crunch, forcing it to downsize. Angeline was retrenched just a few months into the job she had come to love.

Martin Kieti, Executive Officer of Kenya Union of the Blind (KUB) says that among the greatest challenges for people with the disability is securing employment.

“It is very difficult for blind persons to find employment in Kenya unless they have qualifications that are above average. Most blind persons train as teachers, with the profession accounting for more than 90% of blind persons who proceed to tertiary institutions

Unfortunately, since the Teachers Service Commission (TSC) stopped the direct employment of teachers from college and introduced the interview system at District Education Boards (DEBs) and Boards of Governors (BOGs), many blind teachers are today going unemployed,” says Kieti.

As she continues to search for a job, Angeline today survives on her earnings from shiatsu therapy. On average, she makes 7,000 shillings a month. Her income is spent on among other needs, rent for her one-room house in Kibera which she shares with her sister – a single mother. She also supports her father, now a widower.

Angeline and other visually impaired people who practice Shiatsu therapy are hosted by Salus Oculi Kenya, an organization which empowers the visually impaired.

Do Kenyans Pay Any Attention to Helmets?

Many Kenyan roads nowadays are awash with cyclists, and especially ‘boda boda’ cyclists whose motorcycles or bicycles are used as taxi’s.

While this new mode of public transportation has easened the life of many commuters, is has, in equal measure, brought devastation to many families. Many cyclists and their passengers account for a huge number of road accident statistics in Kenya today. Many lives have been lost with many others maimed and scarred for life –physically, mentally and emotionally.

An overloaded motorcycle in rural Kenya.








Cyclists are always advised to always wear bicycle helmets when riding, and especially when riding in public places. Bicycle helmets greatly reduce the risk of head injuries, which are the major cause of death and injury to cyclists and their passengers. The World Health Organization reports that wearing a good-quality helmet can reduce the risk of death from a road crash by almost 40%, and the risk of severe injury by over 70%.

A schoolgirl aboard a motorcycle in Nairobi’s Uhuru Highway/Haile Selassie roundabout. While the bike rider has a protective helmet, she does not have one, leaving her head exposed.










Despite many cyclists and their passengers being aware of the protection provided by the helmets incase of an accident, many of them continue to ignore wearing them. Some of the excuses that I’ve heard people give against wearing helmets include:
–    I’ll get a headache if I use it
–    The helmet will mess up my hairstyle
–    It’s just a short distance so I don’t need it
–    There are not traffic cops ahead so why bother?
–    A helmet will make me feel too hot and uncomfortable
–    I’m a very good bike rider and I know how to act fast incase of anything
–    The helmet has been used by other people so I could possibly ‘catch’ something like ringworms

A bike rider and his passenger in traffic in Nairobi’s Uhuru Highway. The bike rider has a protective helmet but his passenger does not.










What we forget is that most accidents happen in just a flash, caused or contributed by even the most of experienced drivers. It might be an unseen pothole, a miscalculated bend, a slippery road, erroneous judgment on the distance of the pavement or the speed of the car infront, next to or behind….and you soon find yourself hurtling down –with your head exposed.

A cyclist and his passenger.








A head injury can be fatal. That’s why it’s so important to wear a  helmet. It doesn’t hurt to wear one, so let’s help spread the message about it.

Girl with Hearing Impairment Defies Odds

Siphilisiwe is a thirteen year old girl with hearing impairment. She is a Form 1 student at Malisa Secondary School, Zimbabwe.

Even though she has difficulties in hearing, many people otherwise dismiss her as being deaf. No surprise there, because issues surrounding disability are barely well understood in many of our communities. Lots of misinformation, stigma and discrimination surround people living with disability. Young pupils with disabilities are more likely to be victims of bullying from their peers. Such children also face various forms of exclusion from some community members who fail to understand the nature of disabilities.

Siphilisiwe (left) studying with a frien


“People used to call me isacuthe (the deaf one) and my peers did not want to play with me. I felt unwanted. At school, my performance was bad as I did not get everything that the teacher taught,” Siphilisiwe says.

Life however changed for this young girl when she began using assistive hearing aids, courtesy of Plan International. Her performance in class has since improved notably.

Asked about her hopes and aspirations, she said: “I want to be a nurse. I want to help the less privileged.”

Although many African governments today provide free primary education to children with disabilities, more focus is still needed on the issues affecting such children. The 2010 progress report for the UN Millennium Development Goals notes that despite some countries’ progress towards achieving the goal of universal primary education, children with disabilities represent the majority of those excluded from such free education schemes.

Since 2003, the Kenyan government prioritized Education for All, including free primary education. This led to a significant increase of enrollment rates in public primary schools, including schools with special education facilities.

An Educational Assessment and Resource Center (EARC) in Western Kenya.










However, according to a report by the United Nations Development Program (UNDP), only 26 000, or 1.7% of the estimated 1.5 million children with disabilities in Kenya, have actual access to some form of education. Meaning that most of the Kenyan children with special needs are not receiving any educational support. There could be various reasons for this, including poverty, lack of appropriate information by parents about the need for their children with disability to attend schools, few special education schools, limited training of teachers and lack of assistive devices like hearing aids and Braille books. Out of 149 districts in Kenya, 72 of them have Education Assessment Resource Centers (EARC’s), which have been established to facilitate the identification, assessment, referrals and placement of children with disabilities.

The 22nd Day of the African Child takes place across Africa on June 16 2012, taking the theme: “The Rights of Children with Disabilities: The Duty to Protect, Respect, Promote and Fulfill”.


Images: Plan International,


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