Menopause blood or Cervical Cancer?

At Ahono Primary School in Siaya County a long queue of clients waited to access integrated reproductive health services that had been brought closer home. It was a Huduma Poa community based event day set aside for contraceptive services, cervical cancer screening and HIV testing and counseling.

In the queue was Teresa Adhiambo, waiting patiently just like the other women for her turn to get into the room and see a reproductive health personnel. For the last two years Teresa has not been having her monthly periods until they reappeared in September 2014 with intense waist pains and continuous profuse bleeding.

Teresa Adhiambo aged 43 years is a widow with a perfect story of the ruggedness of life one wouldn’t tell by just looking at her composed self, especially on a day like this.

The mother of seven, the oldest being 16 years and the youngest 10 years, was widowed in the year 2000 after her husband succumbed to a fatal road accident.

The following year she was inherited by her brother-in-law according to the Luo customs. After only two years in union, her new husband and the co-wife passed on after a series of prolonged illnesses.

Out of a mixture of fear, suspicion and caution she went for a HIV test, this being the second time. She turned out HIV positive.

Teresa somberly recalls how she insisted that the brother in law and her get tested first before their union which he accepted due to her persistence. They both turned out to be negative then.

Her predicament distressed her each day as she questioned how she came to get the virus. She says she suffered a period of regrets, self-blame and desperation.

‘I had a feeling my brother in law knew his HIV status earlier and had struck a deal with the nurse in charge not to disclose to me when we went to be tested. I would never have allowed him to infect me because I have children to take care of’, she discloses.

While still on her path to emotional healing, another complication arose. Her monthly periods reappeared after two years of no signs of bleeding only that this time she experienced intense waist pains and continuous heavy bleeding.

When she could not ignore the condition anymore she went to seek medication and without being tested, she was prescribed drugs to reduce the pain. Her condition did not improve despite being on medication and she continued to bleed for three months.

She says a nurse once told her that those were signs of approaching menopause.

Her face fills with melancholy as she recalls how she had to sell a goat to buy medicine costing 1300 shillings yet she still lived with the worst agony a single mum without a source of income

On this particular day she had come to seek a second medical opinion after her sister who lives in Sagam informed her of KMET’s Huduma Poa event day at Ahono Primary School.

After a cervical cancer screening she was found to have an advanced cervical cancer and she has been bleeding because her cervix tissues had already become cancerous.

The news shook her. She went quiet for some minutes and the first thing she uttered during counseling was where she would get money for her medication since she was referred to the nearby Yala Sub-County Hospital for examination under anesthesia and possible biopsy for histology. To her, this was a great reprieve “I hope all will be well and thank you KMET, you should come out here more frequently to help people like me”

By Pamela Nyagol,

 

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TB screening in prison saves warden’s family from infection

jela ya saya

She was on her official day-off, she planned to relax at home and catch up with her children but then she heard that a medical team was coming to test in-mates and staff of tuberculosis. She abandoned her initial idea and reported to Siaya Prison.

32 year old Maria is one of the few female wardens at the correctional facility based in Siaya County. She had been coughing and experiencing chest pains. She had gone to a nearby pharmacy and bought some septrin tablets which she took for a week or so.

Her condition did not get any better and she had trouble sleeping citing discomfort and experiencing night sweats. “I used to cough so much and sweat a lot at night just like a work mate of mine who was once diagnosed with TB,” she says.
A month before this day she had visited a clinic within town and later on was referred to a government facility where she was diagnosed with pneumonia and started on antibiotics. The mother of two notes that though she had a slight improvement after taking the antibiotics, she was still worried at the slow progress of her recovery.

The team of medics from KMET TB Reach program in collaboration with the Ministry of health officials in Siaya camped at the facility for three days talking to staff and inmates about tuberculosis infection, management and prevention as well as screening them for the infection.

mariah siaya

Maria willingly accepted to be screened for TB on the first day since she wanted to ensure whatever was ailing her was not TB. She did not wish to infect her family, especially her six months old baby having learnt that it is an airborne disease.
She was scheduled for tuberculosis tests. The results came the following day and unfortunately her fears were confirmed; the tests were positive.

To ascertain that the family was safe, Maria’s husband and two children were requested to come for Tb screening and tests to ensure they had not contracted TB too. The tests were negative

Maria was started on anti TBs and her six months baby was put on drugs too in a bid to reduce chances of the baby contracting TB from the mother.

Maria had been misdiagnosed and was on the wrong drugs for a month. Denis Nyaoko, the KMET TB-reach program coordinator confirms that there are other diseases with similar symptoms as TB such as pneumonia, bronchitis, or influenza.
In Kenya Approximately 3 million cases go undetected each year and the country is ranked 15th among the 22 high burden countries that collectively contribute about 80% of the world’s TB cases.

Denis says they are taking services to people in prisons and even slums ‘key population’ since their environment make them to be at high risk of TB infection and due to lack of information as well as misconceptions about TB, rarely take the initiative to walk into a facility for screening until it is late.

He adds that a well aerated environment is key in preventing TB infection, yet it is one thing that the people within the key population group find a luxury too expensive to afford.

By Dennis Nyaoko.

Taming costs in accessing quality health services

Community Health workers assist in regestering ckients at Ahero Medical Centre

Community Health workers assist in registering clients at Ahero Medical Centre

Prohibitive costs often affect access to quality healthcare services. In public health facilities where the costs of accessing care is relatively lower as compared to the private sector, congestion and higher patient to doctor ratio causes general apathy for clients accessing services thus leading to more time being spent on long queues and exhausted medical staff. This may compromise quality of services in these facilities.
In private health facilities, accessing quality healthcare is a function of one’s ability to afford the same. Huduma Poa health facilities being in this category of private facilities are also faced with the same challenge. Apart from corporate clients who can access healthcare with the support of health insurance covers, the rest of the clients who visit these facilities pay for services directly from the pocket.
When KMET established the Huduma Poa social franchise, the goals towards which this vehicle was driving, were; access to healthcare; Quality in service provision; Equity, and Cost-effectiveness. The costs of accessing healthcare is increased by different factors, key among them being cost of labor (staff), procurement of commodities and rent for facilities that do not have permanent structures.
KMET has sought to link its network of providers to the Ministry of Health to procure commodities for the supported services or directly to KEMSA.
Ahero Medical Centre has embraced a strategy that ensures its clients get intra-natal and family planning services at subsidized rates. Unlike in most private facilities countrywide where the cost for utilization of long acting and permanent contraceptive methods (LAPMs) range from Ksh200 to Ksh 5000, the Output Based Activity (OBA) cards used at Ahero Medical has made access for easy. Clients only pay registration fee of Ksh 100 to utilize the integrated reproductive health services.
Huduma Poa community health workers from two community units (Kakmie and Kobong’o) help in the mobilization of clients and recruitment of clients to acquire the OBA cards. The use of these cards have greatly improved the access to long acting methods of family planning at the facility among other reproductive health services. Prohibitive costs are no longer a challenge in the provision of quality family planning services at Ahero Medical Centre. The use of the OBA cards is a revolutionary strategy
Joshua Adhola
Program Officer, KMET

More teens seek for long acting and reversible contraceptives to avoid dropping out of school

migori

In a village, 30 kilometers away from Migori town, a mother and her daughter of 15 years walks into a dispensary for family planning services.
Benta Aoko, a housewife and mother of eleven children visits Kopanga Dispensary after getting word from Huduma Poa Community Health Worker that there is a health event offering reproductive health services.
Benta’s worry is not only her expanding family but her 15 year old daughter who she believes is sexually active and may end up with a pregnancy.
“My daughter is in class seven and I would not like her to drop out of school, please talk to her,” she appeals.
The Daughter-Immaculate Achieng is the second born of eleven children while the first born, a boy aged 17, had dropped out of primary school.
The nurse counsels Benta who settles on a non-hormonal IUCD for birth control saying that she likes the fact that it can help her avoid pregnancy for over 10 years.
The daughter while having a separate session with the nurse confesses that she has a boyfriend having a sexual relationship.
Immaculate and her boyfriend who is also a student haven’t been using any contraceptive.
She says, she knows of friends who use injectable contraceptives but she has never tried it herself. “Some girls around here go for Depo but I haven’t tried it,” she acknowledges.
After undergoing a pregnancy test and counseling on sexual reproductive health, Immaculate also chose an IUCD as her preferred method of contraception.

gau and client

“I am happy because I know I will give birth only when I want and I thank the nurse for talking to the girl,” Benta beams.
She however, expresses fears that her husband would not be pleased to find out that their daughter is on birth control.
Elsewhere in Siaya County, 16 year old Consolata Adhiambo walks into Ngiya Dispensary purposely to get a contraceptive. Like her counterpart in Migori County, she has ever had that talk with her mother regarding early pregnancies.
Consolata Adhiambo is a form two student and says she has seen a number of her peers drop out of school never to resume again due to pregnancies. She does not want to go down that path. She wants to complete her studies uninterrupted and one day become a teacher though she has a boyfriend.
She tells me that her mother has always insisted that prevention is better than cure and advised her to come to the dispensary and seek for a birth control method. 38
Consolata is lucky because on the particular date, a team of health providers from an indigenous NGO, Kisumu Medical and Education Trust had come to the Dispensary to support provision of family health services and reproductive health education.
She was attended and chose on an implanon to prevent her from conceiving for 3 years.
According to the 2008-2009 KDHS data, 42% of women aged 15-19 years in Migori County have begun childbearing while at least one in ten (10 per cent) women aged 15-49 years have had a live birth before age of 15 in Siaya County.
Each year worldwide, an estimated 13 million births take place among young women between the ages of 15 to 19. In Kenya every year up to 13,000 girls leave school due to pregnancy. In fact, teenage pregnancy is one of the reasons why girls leave school in many parts of this country.

By Emmanuel Oyier,

KMET Empowers a Forgotten Group in HIV/AIDS Campaign: Nyanya Oloo narrates the plight of grandmothers affected by HIV/AIDS and how KMET came to their rescue.

Maria Oloo narrating how KMET came to her aid and the others in their group.

Maria Oloo narrating how KMET came to her aid and the others in their group.

The impact of HIV/AIDS in the society has been told again and again but little is usually highlighted on its effect on the elderly, especially grandmothers who always have to resume the role of child upkeep.

Maria Oloo an elderly lady in Obwolo, Kisumu, is one of the many grandmothers who have to spend their old age trying to make ends meet for her early orphaned grandchildren due to HIV/AIDS.

The 69 year old lady, mostly referred to as Nyanya Oloo, says her son and daughter in law succumbed to HIV/AIDS leaving her in custody of five grandchildren.

Nyanya Oloo becomes melancholic as she recalls a new responsibility she had of ensuring her grandchildren got at least basic education yet she was living in abject poverty.

She says her life had to change completely and she decided to seek help by walking with her grandchildren from one organization to another to get well wishers who could help her grandchildren go to school.

In the process of walking from place to place with her grandchildren, other orphans within the village who also faced the same predicament joined her until she found herself voicing the plight of 30 other orphans to attain at least basic education.

As a result of her involvement with children who are either infected or affected with HIV/AIDS, Nyanya Oloo was one of the old ladies selected to attend KMET training on Nyanyas (grandmothers) and access to ECDE education, income generating activity and entrepreneurial skills, care giving as well as community Conversation.

‘Kaka wanyanya, KMET nopuonjowa kadho aora komak lwetwa ber moingo ka oting’wa e tok, ‘she   says in Luo as she beams with happiness. (KMET taught us that it was better to cross the river with our hands held instead of being carried on the back)

Nyanya Oloo notes that the KMET training was an eye opener since the Nyanyas living with orphans opted not to wait for handouts but instead formed a group, started income generating activities to support the orphans and even mobilized the community and enrolled many children at Obwolo ECDE with the support of KMET.

She is very grateful to KMET for having chosen to empower a forgotten group, the elderly ladies, who most often are charged with the responsibility of taking care of HIV/AIDS infected or affected children after their parents pass away.

By Lynette Ouma.

Woman gets a new lease of life

Judith Aoko lives with her grandmother and two of her children In Kanyairo village about 20 km from Siaya town. Her grandmother is the breadwinner to both Aoko and the children.
The 27 year old Aoko wears a shy demeanour, looks naïve and doesn’t speak much. She is epileptic the grandmother tells us.
Aoko has had two births while in her twenties yet no man has claimed responsibility of the children says her grandmother.
“I think some men take advantage of her situation when she gets epileptic fits or because she appears to be little mentally challenged” adds Rose Sewe a community health Volunteer working for Huduma Poa.

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Judith’s grandmother (left) and Judith Aoko at their home in Kanyoire Village

Rose Sewe had heard about Aoko’s story and decided to consult Rose’s extended family for a solution. She talked to the Uncle and grandmother and they unanimously agreed that it will be prudent to have the lady put on a contraceptive method.
Aoko who was orphaned at a young age attended primary school and is able to write and read even though her comprehension of facts is questionable. She was taken in for counselling at Future Life Medical Clinic and through the guidance of the clinical staff she settled on an implant.
The grandmother says she is happy that her granddaughter is now on a birth control method because she is not ready for more grandchildren.

“Life has become hard, the farm does not produce enough like it used to, so we have to be wise. I love my granddaughter and I wish she gets a good man to live with her someday,” she concludes.

By Emmanuel Oyier

Ignorance on family planning messed me up says mother of seven

ilepicha 

 Rosemary  (In black t-shirt) with her children at her house in Siaya 

Far right is Caroline the Huduma Poa Community health volunteer who counselled her.

Rosemary Atieno had just gotten married as a second wife in Udida Village, Siaya County and like in many polygamous relationships she enjoyed a lot of attention and affection from her husband.

The first wife had given birth to one child and had been unable to conceive thereafter, so when Rosemary bore a baby girl within their first year of the marriage the husband’s family was delighted.

That was 23 years ago and a lot has changed since then. Rosemary now 38 years old, is a mother of seven children who she has to support by herself.

Her first born daughter born in 1991 completed primary school and got married off due to what Rosemary terms as hardship within her home.

Her husband who is a casual labourer has since given her house a wide berth and spends all his time in the first wife’s house claiming that Rosemary’s house is too crowded and chaotic because of the children.

Rosemary says that she feels like her spouse is blaming her for having given birth to too many children, yet it is the man who had been constantly asking for baby boys in their marriage.

“Sometimes I ask for money and he says the little he earned has been consumed and at a point even asked me why I could not do family planning like other mothers do.”

The state of affairs at Rosemary’s house caught the attention of one community health volunteer (CHV) attached to a Huduma Poa Health facility nearby.

The CHV known as Caroline counselled the mother and referred her to Future Life Health Clinic for a method of contraception. Unluckily, Rosemary tested positive for pregnancy and could not have a method then.

She had to wait until six months after delivery to get a 5 year implant.

“I wish I had this information earlier, my life would have been better “says Rosemary.  “I feel bad I knew too late” she sombrely adds.

She says she is contemplating having a permanent method of contraception meanwhile she is on a five year implant.

Like many other ladies, Rosemary says she had only heard about Deprovera as a method of contraception prior to talking to the Huduma Poa Community Volunteer but did not go for it because of the side effects ladies say it has on them.