We’ve Moved!

For all of you who are following our Tumblr blog— thanks for your interest and support so far! We have launched a new website: www.accessafya.com. The blog has also relocated there as well.

Please start following our progress here!

      

We’ve also moved offices! Access Afya at the Afya Maisonettes- how perfect.

We’re GROWING!

We are taking big, exciting steps towards opening our pilot clinic-we’re HIRING our first full time employees! We put out job postings for 2-3 nurse practitioners and a pilot manager and we’ve got overwhelming amounts of applications for both! It has been really exciting to read about the applicants and see how interested people are in working for Access Afya because of our unique mission of serving low-income communities directly in the slums.

As we speak the first pilot manager interviews are underway and we hope to have this talented group narrowed down quite quickly.  We are still sorting through the nurse practitioners and will hopefully be conducting preliminary interviews early next week!

An open conversation

             Saturday September 1st, we are holding a community session quite unlike any of our prior health talks. We are holding a debate/conversation of sorts on the topic of unfaithfulness and why young people cheat. This conversation is important to us because it is directly correlated with the high proportion of STIs and HIV within Mukuru. We are inviting young women and men ages 16 to 28 to participate in our first coed conversation. We are expecting somewhere from 30-45 youth to participate in this exciting and unique event.

            This idea was created out of an informal conversation during the boys’ health session on STI’s and family planning. At some point during the conversation the boys began complaining that the girls in Mukuru were the unfaithful ones. They continued that the girls are gold diggers who go to the older men to have sex with because they have more money than the younger men. Clearly there are twoor more sides to this argument and we want to put it out there to discuss!  

            In preparation for this debate we created an anonymous survey, which has been distributed to around 50 youth in Mukuru. We will analyze and quantify the results to present in the beginning of the session.  Our hope is that the results of the anonymous survey will create an open discussion, where some of the facts are already laid out. 

Check back early next week for an exciting summary of the debate!

Same advice, different speaker

           Time and time again I ask myself, why is it that Access Afya can make such a difference within Mukuru when some individuals in the community already know a great deal about health. Esther, the community health worker who has worked with us throughout the process, though unaware of some conditions, has a very strong overall sense of what is healthy and what is not. Though the first time I got a hint of why she and smart people like herself have not been overly effective in promoting good health in Mukuru was when we were preparing for a talk on child nutrition.  I was instructing her to tell the mothers that young children should not have sweets or juice.  Esther interjected and said, “yes, I know that and I’ve told the mothers this lots but wont you just say this part? They listen to you differently, you are the new one they will believe you, you the mzungu.” This caught me totally off guard and didn’t make any sense, in fact I believed the complete opposite. Isn’t the first rule of community development to use community members to deliver the new information in a culturally sensitive way, from the bottom up?  

            Though the mentality behind this still does not make complete sense to me, I’m beginning to see this rule really does stand true in many circumstances.  While reading a blog post from Literacy Bridge, a non profit organization in Ghana who created The Talking Book, a simple device that serves rural areas with knowledge in health and agriculture, I came across an excerpt that described this same phenomena.

Growing up in Ving Ving, I was one of the few children who was able to attend school.  When I reached secondary school I focused on agricultural studies.  I came home with knowledge about new farming techniques that could be used to increase yield and told my family members about the techniques.  I tried to teach them that burning the bush to clear the land for farming would deplete the land of nutrients.  They told me that what I told them was not true, because they believed that the land was just going bad naturally and their parents had burned the land before them – it was just the way things were done.  They refused to try the new techniques because they thought I was merely a child.

 

However, when people hear the same advice that I was taught in school, but they hear this advice from the TalkBook, they believe it.  They have respect for the people they hear on the device and actually put the theories into practice.  Now they are seeing how these simple changes to how they farm can actually increase their yield.  By bringing agricultural information directly from the talkbook to the people, the theories are having a much stronger effect.  The land is being used more efficiently and families are enjoying more food to eat and crops to sell.  In the same way, a traditional birth attendant (TBA) in the village said that the talkbook is making the women of the village believers in her medicine.  The women in the village were reluctant to believe her advice, but she says that now that they have listened to this device they are finally following her teachings.  The women are having more healthy pregnancies, resulting in more healthy babies.

http://www.literacybridge.org/blog/

           I don’t believe that the device is the difference, but rather it’s that advice coming from on outside source is believed to be more valid and a NEW idea even if it’s just rephrasing ideas that have been circulating for years. 

            So what does this mean for the future of the spread of knowledge and ideas in Mukuru? Obviously it is not feasible for me, or another member of Access Afya to give health talks and be the only voicesfor the rest of time, in fact we wont always be seen as the outsiders. Since we’ve seen that certain ideas are best absorbed and trusted from outside the community could the Internet be a part of the spread of knowledge? It’s interesting because Eric Topol, author of The Creative Destruction of Medicine argues that the majority of Americans have at some time, or consistently sought out health and medical information via, personal networks, online resources such as the Mayo Clinic and health blogs. Individuals trust these sources. So, will the rise of access to information via the Internet and applications that Access Afya uses in clinics become a way for simple ideas to finally stick in Mukuru? This change in the medium of knowledge disbursement has been occurring in the west for many, many years though is just beginning to really hit Africa. I anticipate that the Internet really will have a huge effect on the health of Africans who begin to have access to continuous outside knowledge.

            This means that our patients in Mukuru will be able to advance their own health by following the advice that has been around for many years.  Quite simply it means that the methods we are excited about using to get information out including: eHealth, mHealth, health talks, youth and maternal hours and equipping the community health workers with new technologies, will be effective in penetrating the thinking of individuals which has not yet been possible. 

A Song for Mukuru

Isaac is a musician, youth leader, and much more. As is typical for many growing up in the slums, he learned to wear many hats. He first became involved with Access Afya in January. Having done some work assisting development organizations in their survey work, he was recommended to me to assist with my field research. During the past month his involvement in community outreach and planning for Access Afya has grown: he has helped navigate local political structures, mobilize youth, and plan health events. He continues to work on his music and performances. The following is dedicated to Mukuru, our pilot community.

        

Greetings People of these wonderful and mystic world where the rainfalls sun a shine at the same time, warm breeze a blow, rivers streams a flow feeding mother earth making it easier for mama earth to provides for it’s beautiful inhabitant. Nature includes us and wildlife as a whole, it provides more than enough for the survival of it’s inhabitant, but it keeps me wondering asking myself questions but no answers. What why these double standard lifestyle and fashions in the name of modernity and civilization that favors a few and oppress the majority? Who made classes, first second and downtrodden citizens of the world? All I know is that we are journeying, either from realization to ignorance or vice-versa, because it seems no one cares whether the situation grows from good to worse, urban-rural migration people moving to cities and towns in search of jobs and good life which ends in frustrations.

Since independence, life in urban set up has been expensive as usual. Most of this people couldn’t afford bills especially rent –

they turned to build structures made of cartons and polythene papers, as a way to survive within the cities.

As the trend continued slums were born now made of mud, poles and iron sheets and they are rapidly emerging at the moment due to high cost of living.

The past leaderships didn’t put a plan or quarters for low income earners. And if it is there I don’t know how long or far it will go.

Slums is a world within the world you know.


 

In slums there are a few or no formal structure,

infrastructure

sufficient sanitation

good drainage

enough schools and medical facilities.

Slums are the most populated and congested areas, squeezed open sewages running water children playing barefooted, some half naked, flies, garbage in every corridor. Slums where poverty, desperation, disease, crimes, political violence, exploitation, drugs and ignorance find a host by force.

Like in my home slum, big in the middle of industrial parks and middle class suburbs.

When am crossing this bridge, where the river cries black tears cutting across this big slums of Mukuru.

Houses of rusted iron sheets measuring 10 by 10 feet hosting families,

Sometime they call them ‘’self-confused’’ housing because this house performs many functions:

Its’ the kitchen

living room

bedroom

study

and sometimes the bathroom.

Imagine you are a family of seven members in that small room! That’s not new come to these places when there’s disaster like slum fire or illicit brew killings.

Outreach Session #1

We are super ecstatic with the turnout of our community outreach sessions so far. Taking out the sitting fee was something we knew we had to do, but were definitely afraid of enacting. However, all fears have been dismissed because at our first event 13, wonderful, fully engaged young women (and not to mention their adorable babies) showed up knowing that they weren’t being paid.

Our first session had quite an ambitious itinerary including STI’s, female reproductive issues, contraceptives, family planning, and rape. How we thought we could cram this into a 2 hour session is beyond me but needless to say, the first take-away was that we need far less of a schedule and allow more room for discussion. The second take-away, following closely, was my desire to suddenly speak fluent Swahili.

The majority of the session was conducted in Swahili from our wonderful community health worker, Esther. However, if you’ve ever been to Nairobi, you know that Swahili is usually combined with “sheng,” which is slang and usually includes some English integration making it pretty obvious to understand what topic Esther and the girls were talking about. In addition to sheng, Esther’s hilarious mannerisms and dramatic displays also aided in this process of understanding for us English speakers.  

There were certain topics, which the girls were definitely more engaged in than others. For example, most of the women had not ever heard of UTIs or Yeast Infections, though you would be wrong if you assumed that these women are immune, they just associate these symptoms with STIs.  Therefore they usually opt for getting their hands on some antibiotics or worse yet, taking a visit to an herbalist to drink down a “cure all cocktail.” This is honestly bewildering to me as I cannot imagine that all of the symptoms associated with UTIs and Yeast infections were ameliorated by these generic medications. More so, the effects of withholding treatment for these ailments are painful and unhealthy to say the least.

One of the most beneficial parts of the session was when we opened up the floor and asked the women if they would like future similar sessions and secondly what they wanted to see in these sessions. They instantly voiced that they enjoyed the information presented and wanted similar sessions every week! We immediately agreed and said “same place same time next week!” Some of the topics they came up with for future meetings were young child nutrition, care of infants, female sanitation and rape(especially targeting young girls and boys).

I cannot explain how satisfying it was to have not only a great showing but also a super engaged and awesome group of young women. We had prepared ourselves for the worst and it couldn’t have been a more opposite experience.  Since the first outreach session we have had 1 more girls session and 1 boys session, with astounding retention and turnout for both! Looks like we’re doing something right!

Access Afya Chosen to Join Inaugural Village Capital Nairobi Program!

After an intense application process this last month including written application, individual interviews, a pitch-fest, and peer interviews, Access Afya won a spot in the first ever Village Capital program in Nairobi

Village Capital has a reputation for supporting incubation programs around the world, building the skills and business plans of entrepreneurs while connecting them with mentors and investors. The Growth Hub is the latest of Nairobi’s “Hubs”, which offer a range of support and networking for start-ups.

I was so motivated and inspired by the other organizations at the initial pitch day, and hearing their ideas and feedback during group interviews. I am excited for Access Afya to join this community for the next 20 weeks. At the end, there is another pitch competition. The twist is that the entrepreneurs who went through the program vote on who receives an investment from Growth Africa!

The backwardness of development

A big aspect of Access Afya before it officially opens in September is to engage with the community and gain a sense of trust. To do this we plan on having multiple community outreach sessions, varying in content and style but which all target what we perceive to be big issues in Mukuru. Though planning our community mobilization sessions I’ve come across a question I had never expected: How much will you pay for the sitting allowance?

Sitting allowance, what does that mean? To explain this it’s absolutely necessary to tell you the history of Mukuru and it’s relationship with external organizations. It was only after getting an in depth history lesson on this relationship from Fredrick Wanga, that I learned why people thought it was acceptable to be paid a sitting allowance for attending an informative learning session.

When the first NGOs began engaging with Mukuru they were heavily funded by large aid programs. The idea was to get as many individuals from the community into seminars as possible because the funders wanted to be sure that their information was reaching a huge amount of community members. Most of these programs were horizontally funded, targeting one malady through an intensive program. At some point organizations reasoned that to get the greatest amount of people they should incentivize people for coming to listen by offering a “sitting allowance.” The cost of this varied but it was shown to be extremely effective at amassing large groups of people. However, what is not known and was definitely overlooked is how effective the sitting allowance was at instilling the information and values being brought forth by the NGOs.

This brings us to the dilemma today. People have become so accustomed to being paid for coming to the seminars that the wrong people are coming: those who could care less about the information and more or less use seminars as a source of steady income. When discussing this huge problem, I asked what would happen if we didn’t provide any sitting allowance and immediately I was told that this was attempted in the past and people walked out one by one.

It’s now come to a point where groups and individuals know it is ridiculous to pay this sitting fee, however if you want your idea to reach the people it effects, it seems you almost have to give in because of the precedent set by years and years of sitting allowances.

It’s also easy to get wrapped up into the real lives of the people we want most to come! Our first seminar is targeting girls ages 15-24, many of whom are single mothers with very small children. We realize that in order to attend our seminar they’ll have to leave their children with a trusted neighbor or family member and maybe even pay them to do this. We also realize that many of these young women have very small, informal shops and they either don’t want to leave their goods out to be stolen, or they’re afraid of missing out on the couple hours of income they could have made. The last thing we want is to be unsympathetic to these young women, however equally as dismal would be drawing in a group of women who couldn’t care less about what we are discussing.

Thus we had to make a difficult decision: the sitting allowance stops with Access Afya. We may provide beverages such as water and tea though we wont advertise this. We’ve instructed the community health worker who is recruiting the girls to promise them nothing besides knowledge. If we are only able to rouse 3 women, who don’t expect to gain anything but knowledge then we’ll be ecstatic. If this happens, maybe those three empowered women will talk to their friends in similar positions and speak of the gain of real knowledge as opposed to a small monetary gain.

And don’t worry, we’ll definitely update you with the results of our first seminar set for tomorrow, Saturday July 21st!

Observations From Mukuru

Hey there, my name is Kelly Church and I’m working with Access Afya as a summer fellow here in Nairobi, Kenya. Access Afya is the most exciting project I have been involved in to date and I love that each day is something entirely different! I choose Access Afya because of its mission to improve quality and access to healthcare and equally as importantly it’s smart, sustainable business plan.

 The Access Afya team was lucky enough to spend the day shadowing Community Health Workers in Mukuru. We wanted the day to seem as natural as possible so each of us split off with one of the three health workers. I followed Esther, an extremely vibrant, compassionate and well respected leader in Mukuru. Before heading off to see patients in their homes, Esther explained that her central role is to work on reproductive health and family planning within the community. I found this especially interesting because I’m currently in the midst of planning a community outreach event based on these same foundations!

We began the day quite simply by saying hello to familiar faces and occasionally and casually stopping by patients’ homes. That day I saw a huge variety of discussions but I found one to be especially intriguing.

I walked into the small room, which held three beds, a small, hanging TV, an area for washing dishes and a few out of date calendars turned posters on the wall. Though tiny and very cramped, this small home had a very warm and tidy feel to it. And more so, it seemed to have everything the three people who lived there needed.

There was a young man, age 32, his sister age 38 and an older woman who I would presume to be a mother or aunt of the two. Esther and the three people casually spoke for a few minutes in Swahili with smiling faces and inquisitive looks. If I didn’t know better I would have thought they were just old friends catching up. However, this was not the case. Esther translated to me and said she had asked the young man about his sexual practices. He is married, though his wife lives in Uganda for work and he simply explained that because of the distance, well he is a man and “goes outside of marriage.” While Esther was explaining this to me in English I asked “ does he do this on a regular basis?” And before Esther could answer, the man answered me in perfect English, “yes, I do it quite often, but I do want to protect my wife.” I was shocked that this man could understand everything Esther was translating to me and was not ashamed of himself for admitting to cheating on his wife. Throughout the day with Esther though I realized these people are not ashamed because of the kind, gentle and understanding soul of Esther. More importantly, I realized it does no good to be ashamed because through admittance comes preventative measures like the use of condoms.

A big part of Esther’s daily rounds is to find out the method of birth control that people are using, identify if they are using it correctly i.e., every time and to find out if they have enough to get through the next couple weeks safely. Though cheating is an imperfect part of life, the worst effects (STIs like HIV) are ameliorated by acceptance and constructive fixes.

I saw this same theme, over and over in each and every home. People were made to feel so comfortable about their health choices and statuses. It is something that I believe we should take note of in the United States. I think the stigma and isolation associated with a disease like HIV can actually outweigh the detrimental health risks and lead to the spread of more disease.

Mukuru, though certainly not disease free, is an extremely open community, which is definitely necessary for Access Afya to have a positive effect on the wellbeing of individuals. Initially I worried about the number of individuals with preexisting diseases that would come to our clinic for evaluations and medicine, but now I am quite confident that this is one barrier we wont have to fight.

 http://blogs.timeslive.co.za/hiv/tag/international-aids-society/

Access Afya Featured on Photography Site

Check out the link to a sampling of Rick Roxburgh’s wonderful work. I met Rick at the iHub, where he is spending three weeks doing photography projects for a range of start-ups. He spent two days with me in the field visiting the people, partners, and future Access Afya site in Mukuru Kayaba. 

His first day with me was at a community health worker training. The 25 men and women in the room with us do a phenomenal service to their community, volunteering to spread health information and link families to existing resources. This quarterly refresher training was focused on identifying and referring cases of malnutrition. World Vision reports that around half a million children in Kenya are malnourished, with numbers rising. 

         

The work featured on the site comes from our second day together, when we took an in-depth look at the flow of water through Mukuru. We saw youth and men wading through the water, collecting metals and plastics to sell to recycling centers. We saw the results of factories in the industrial zones dumping their waste in the river. We visited sandbanks where we could see the backs of homes and latrines dumping human waste into this same river. And we saw pipes, carrying drinking water, winding through the maze of roads, buildings, and rivers in Mukuru. 

As a new health organization in the community, it is essential for us to understand the environmental health conditions of people’s day-to-day lives in Mukuru. We are partnering with a water and sanitation groups for the first clinic site. We are talking with technology and research groups about the lowest cost methods to provide clean drinking water. Our team is committed to a holistic approach towards our patients health.