Doctors Without Borders: some key issues

http://www.doctorswithoutborders.org/news/kenya.cfm

In the East African nation of Kenya, an estimated 1.24 million of the country's 32 million people are HIV-positive. More than 200,000 people are in urgent need of treatment....

Thirty-three percent of children with HIV- positive mothers are born themselves with the disease and 50 percent of suspected HIV- positive children are dead by the time they reach two years of age..."Avoiding transmission is possible, but it requires a basic health-care system which many parts of Kenya lack"....(November 1, 2005)

Being afraid of HIV/AIDS testing is commonplace amongst women in Kenya and especially with those who are married for fear of being abandoned by their husbands who are the sole breadwinners....(November 1, 2005)

MSF runs HIV/AIDS-prevention and treatment programs in three parts of the country: Western province, Nyanza province and Nairobi, the capital....(2001)

What has become a chronic disease in Europe and America, where advanced treatments have reduced mortality by 80%, remains a death sentence in Africa. The antiretrovirals (ARVs) and other essential medicines now used to treat AIDS in the West have been too expensive in countries like Kenya, and legal barriers have prevented the import and production of affordable medicines....(2001)

MSF has also embarked on an extensive grassroots effort, eliciting the support of parents, village elders, religious leaders and others to encourage prevention of HIV/AIDS through the formation of school-based anti- AIDS clubs....(2002)

Because AIDS often strikes the young and economically active, key economic sectors – including agriculture and education – suffer directly from the consequences of the epidemic. ARVs can do much to reverse this loss of productivity: not only do patients feel better, but they can often resume employment and provide for themselves and their families....(2003)

the Kenyan government signed a patent law permitting importation and local manufacturing of more affordable generic ARVs....the government announced that it would strive to provide ARV treatment to 20% of AIDS patients by 2005, hoping to reach 50-60% of those in need by 2008....(2003)

analysis of Maasai AIDS/HIV situation (abstract with link to full pdf)

Around 1997,Tanzanian Maasai began seeking city jobs in noticeable numbers, due to intensifying poverty. Having limited knowledge of cities, elders were ill-equipped to advise their brothers, wives, and sons about migration, which has ostensibly diminished "traditional" elder authority. Ethnographic research between 1999 and 2001 revealed confusion and lack of accurate knowledge about the mechanisms of HIV/AIDS. Perceptions of Maasai "backwardness" perpetuate negative reactions, and there is little assistance or support in cities. Increasing impoverishment and migration from some areas, and misunderstandings about HIV/AIDS, are combined with customary Maasai polygyny and inability to rely on elders' guidance. This suite of circumstances puts Maasai labor migrants at particular risk for contracting HIV/AIDS. Health-education programs are critically needed to avert a catastrophe in Maasai communities.

A Holistic System of Healthcare....(short paragraph)

From the Journal of Alternative and Complementary Medicine

Oct 2001, Vol. 7, No. 5 : 547 -551

The orpul healing retreat practiced by the Maasai of East Africa, in which decoctions of medicinal plants are taken with large quantities of meat, provides an example of a holistic indigenous system of primary health care. Most of the plants utilized in orpul medicines by the Maasai of Eluwaii, northern Tanzania, have already been empirically demonstrated to possess pharmacologic activities in vitro and/or in vivo. In addition, the songs, meditation, and prayers that form part of the orpul experience are likely to contribute significantly to recovery, particularly in the case of psychosomatic and stress-related illness. This community-based health practice should be preserved and evaluated.

perceptions of primary health care: Maasai

This article is a cross sectional study regarding the perceptions, knowledge, and attitudes towards healthcare by the Maasai.

Notes:

Main Lifestyle of Maasai: herding cattle in semiarid resource constrained environment; how much cattle they have corresponds with their economic status/wealth

Live in semi-permanent hut-like structures made of wood and cowdung: poorly ventilated

AMREF Nomadic Health Unit endeavors to improve the health of pastoralist people through: mobile clinics, providing immunization, growth monitoring, and provision of health care
They also conduct education in schools, workshops, training of volunteers like traditional birth attendants (TBA's) and community health workers (CHW)
TBAs' have an important role in health care; acted as advisors to Mother to Child Health, and nutrition for moms during pregnancy; have been educated on cultural taboos associated w/ restriction of protein diet during pregnancy, and adverse pre/antenatal health problems have been reduced


Growth monitoring: showed little wasting was occurring, but considerable stunting was observed. Girls showed more stunting (favoring boys over girls)

Pregnancy: moms restrict diet in the last 2-3 months of pregnancy to produce small babies/easy delivery
Anemia is common because of primary milk and maize diet
Mother/child are kept indoors in first 2-3 months

Ailments in rank of most common: respiratory infections, malaria, conjunctive, scabies, myalgia, myositis, trachoma and diarrhea, trachoma (found in 65% of patients- could be prevented w/ adequate hand/face washing practices)

Community based health care focused on: raising awareness about prevention of diseases :malaria, diarrhea, vomiting, scabies, eye diseases, pneumonia, tb
CBHW trained in oral rehydration solution, growth monitoring, kitchen gardens, improvement of traditional houses, pit latrines, and water jars

removal of deciduous canine tooth buds in infants to treat febrile illnesses
prevalence of removal of DCB is: 80%; 70% of moms say they perform surgery on their own
Complication of DCB is bacteraemia/bleeding; long term malocclusion in deciduous/permanent dentition
TBA's are being made aware of hazards of DCB removal w/ decline in practice in some areas
Advocy is very important

Dental fluorosis is observed in children: community unsure why. Might be excess fluoride in water; alternative measures should be explored: use of unfluoridated rain water

Study found most common ailments in children are as follows: malaria 79%, diarrhea 70%, pmeumonia 52%, eye problems, worms, malnutrition worms, and dental problems 27%
respiratory disease in children could result from cultural clothing. Inadequate warm clothing:expose children to cold mornings/nights
poor personal hygiene contributed to trachoma/ringworms
other major health hazards: anemia, eye problems, intestinal worms, lack of balanced diet, STDs, accidents causing burns/fractures
dental problems: Oral infections dental carries, bleeding gums, malocclusion/dental flourosis,
Practice of cleaning teeth w/ mswaki should be promoted


Most common mode of treatment reported by mothers: traditional medicines 79%, used conventional meds: 71%, felt health care service was available/affordable/accessible: 69%
Med workers specify: diarrhea diseases specifically as: amoebiasis, giardiasis, cholera, and typhoid

Diet provided to young children reported by mothers: milk and curd 89.5%, fruits 56.3%, beans 41.6%, green veggies 31.5%, meat 37.5%, maize 22.9%, less than 20%: potatoes, millet porridge, bananas, ugali, rice animal oil, soup
need for dietary guidance on changing from traditional diet: community should be encouraged to use more milk and curd, green vegetables, other essential nutrients from herbs, roots, and fruits

Main causes of diseases: unclean water, ingestion of contaminated foods, unventilated indoor living conditions

Water: distance to water could vary from 3-20 km; great seasonal variation of availability of water (resulted in lack of water for bathing/cooking) 54% moms reported boiling drinking water
Bore holes water is available in some areas w/ support from AMREF/community participation

Health Care seeking behavior: dictated by accessibility to health care deliver services/ availability of traditional medicines and cures.
During rainy seasons, Maasai migrate and transport to nearest healthcare becomes a problem because of poor infrastructure
wild animals in the area pose problem for sick to undertake long trips

Aggressive health care education, coupled with accessible health facilities is being done by AMREF and MOH w/ community help by involving TBA and community health workers in harmony w/ traditional practices and culture.

Primary health care intervention intended to address misleading perceptions, beliefs and practices relating to health may have a major impact on the above mentioned diseases amongst the Maasai