Thursday, October 11, 2012

A new challenge

I didn’t go to Ilkiloret this week. I’ve had pretty serious back pain that became more acute the previous week in Ilkiloret and then after a doctor’s visit last Friday actually got worse… so decided to stay home and rest this week…however rest is not exactly an easy skill for me to master.
So this Wednesday instead of climbing on a motorcycle, I climbed on a matatu and went to me ‘Nancy’ (not her real name), in Karen. Nancy is the former house girl of Grace’s daughter-in-law. Nancy is HIV+, she went off her medication in August because she lost her job and could not afford to buy enough food. The ARVs make her sick if she does not eat properly when taking them.
She was not able to pay rent this month and called Grace for assistance. Grace found out that she had stopped taking her medication and called me in a panic. I took Nancy to a HIV program in Karen Wednesday morning, but they said she would need a transfer letter from her current program. Nancy said she would stay with her current program but didn’t know if they would take her back because she had gone off her medication. So I went with her to a Medicines Sans Fronteras clinic in Kibera, the largest slum in Kenya and supposedly in all of Africa.
We took a matatu only a short distance into Kibera from the Ngong Road side, but then walked through the slum for a good 12-15 minutes. Nancy was carrying her 2-year-old son, which slowed up down a bit. That and it was quite hot…and every few meters you have to negotiate garbage or sewer in the road.
I would love to have one of those pens with a camera in it for walking through the slums. It’s not a particularly bright idea to pull out a camera in Kibera, especially to photograph people you don’t know… but a spy camera would be ideal!
When we reached the clinic that is tucked neatly into the side of a hill, I was a bit overwhelmed by the sea of people we encountered. Nancy said she was usually there by 7 am so that by 10am she could be on her way. The fact that we were arriving around 9:30 am was not lost on me. We squeezed our way onto an overcrowded bench and began what I thought might be an all day wait. Surprisingly enough, within 30 minutes we had been called to see the nurse, who took Nancy’s vitals. The nurse referred us to the counselor before the doctor, because Nancy had not complied with treatment regulations by not attending her last appointment in August.
We spent a half hour with the counselor who talked to Nancy about taking responsibility for her health and her family. (She also has a 14-year-old daughter named Cecelia). She also called in the social worker. He explained about a lack of feeding programs because they are so easily abused and because most nutrition programs only cover the very ill and bed ridden. My Westerness jumped to the surface quickly… “Well, if people like Nancy lose their employment and can’t buy food they will end up very ill. Why not try to prevent that from happening.” Okay, so I know I was preaching to the choir. But I need to express what in my mind was obvious.
The social worker explained to me that MSF originally had a feeding program, but it was more expensive than the drugs and it had to make a decision between doing it’s mandate which is to provide medical services and doing general assistance.
While I don’t fault them for their choice, I am still looking at a huge hole in the HIV wellness system. It people living with HIV don’t have access to nutritious food they will acquire full blown AIDS. I know feeding programs are expensive, but when MSF stopped providing food, no one stepped into fill the gap. The people living with HIV were effectively on his or her own.
So that brings me back to Nancy, whom I said I would call once a week to make sure she was taking her drugs. That got us out of the counselor’s office and into the queue to see the doctor. I can’t say for sure, but I don’t think it hurt, for Nancy to have a white advocate (me) with her. We seemed to zoom to the head of the queue. Because by now we’ve been at MSF for an hour and all the same people seem to still be there.
The doctor was helpful and seemed unhurried even though the waiting area was still teeming with patients. And although Kimani, Nancy’s son has already been dismissed from the program because he is not HIV positive, the doctor agreed to see him too. Kimani had a bad cough and an ear infection (the puss was literally running out of his little ears). After the lab for Nancy and then another round with the doctor for Kimani it was finally time for us to go.
The counselor came back in and said Nancy needed to sign up for the treatment experience (fatigue) support group before she left. The man who signed her up also wrote down the phone number for the place where the group meets and for the counselor for this MSF clinic.
Anyone who knows anything about published phone numbers in Kenya, knows that they are rarely correct. (As were the ones on the appointment card we had tried to call that morning from Karen).
We then headed to the clinic pharmacy, where we only waited a few minutes to be given drugs. In a little three hours we had waded through a sea of humanity and gotten Nancy back in the MSF HIV program. I am extremely impressed with the professionalism and efficiency of this MSF clinic! May have to volunteer for them sometime!
It wasn’t particularly evident because she was so tired, but I could see relief creep into the posture of Nancy's body. Even as we made our way slowly out of the slum, Kimani nestled on her back, wading through the garbage and sewage, she just seemed lighter.
We got back to the matatu stage and boarded a mat back to Ngong Road. There is a large fancy shopping center at the junction. We went to the food court and had lunch. Kimani at chips (French fries) and drank fresh squeezed orange juice like he had a bottomless pit for a stomach. However it was getting late and we needed to keep moving so we asked the waiter to wrap the rest of the chips, to which Kimani exploded into tears.
Kimani and his chips!

Nancy and Kimani having lunch with Auntie Jessica at Prestige Shopping Plaza.

Then I took Nancy grocery shopping. We bought all the staples, rice, ugali flour, sugar, oil and beans. I gave her more money to buy vegetables from the stalls by her house where they will be cheaper.
We had bought too many heavy things so I told her I would go with her to her house and help her carry the groceries. Nancy lives in a small slum on the opposite side of Ngong Road in an area called Lenana. She said her home wasn’t far from the road; it may have been that I was just tired, but I think we have different definitions of the word “far.”
When we finally arrived we had to pass over a river of sewage on stones and then duck under a clothesline to get to her small house. Which consisted of one room with a couch, a couple of chairs, a coffee table, a bed and cooking supplies. Nancy is a good housekeeper and her home has a comfortable feel despite the surroundings outside her door. She invites the neighbor children into say hi and introduces me as Kimani’s auntie.
We chat about what kind of income generating business she would like to start and she agrees to find out how much start up money she will need to sell sukuma (kale - a staple vegetable) and then she will call me.
As she walks me back to the matatu stage, her 10-year-old neighbor Mary walks hand-in-hand with me, stealing a sideways glance and then breaking into a huge smile when she sees me looking down at her. Nancy tells me that Mary’s mother leaves for work at 9 in the morning and comes home at around 11 at night. Her mother sometimes drinks all the money she makes so Mary and her 8 and 3 year-old siblings sometimes go hungry.
“I give them food when I have it,” Nancy says. "But mostly I just give them love. Sometimes I think they need love more than food.”
Nancy is 32 years old. She is back on ARVs. I’ve paid her rent for this month so she won’t be evicted while she tries to get a small business started. She has enough food for a couple of weeks.
What I would like is to receive an email in the next week or so from someone who would like to help me help Nancy. I want to be able to tell her we have the money to help her start a small business. I want to fix the gaping hole in the front of her mouth where she is missing a tooth. I want her to be able to enroll her daughter in a good high school next year. I want her to not feel so alone in the world. I want Nancy to be here in to see Cecelia and Kimani grow up.
Its a lot to want. I know that. But Nancy and I are daughters of the most amazing heavenly father who will not hear our cries and ignore us. Through one or many of you, he will provide exactly what Nancy needs!