"health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right"
Tuesday, October 03, 2006
"Are you coming back...?" ---Our efforts in the beaches with IMC
We knew we needed to head back to the islands of Lake Victoria after being very frustrated with the limited accessibility to health care for patients who were obviously stricken with HIV/AIDS during the mobile clinics with Operation Crossroads Africa. We wanted to work more on the public health level of the beaches to increase the HIV prevention and education efforts being done in the islands.
With the International Medical Corps, (IMC) we have been given the chance to get back the beaches where we ran mobile clinics in June and July. IMC has started a Condom and Other Preventions Effort, to reach beaches that have not been previously reached by any kind of HIV education or treatment outreach effort. It is our hope to pair these beaches with other organizations that are doing Voluntary Counseling and Testing (VCT), so that they can receive Antiretroviral treatment, (by groups such as FACES) in the future. Branches of IMC currently do mobile VCT in the lake region as well as mobile efforts to curb Pregnant Mother To Child Transmission (PMTCT). IMC Home Based Care services are beginning in Suba District as well, so that families can be counseled and tested in the comfort of their own home.
As part of the IMC Beaches Program, we initially meet with the Beach Management Unit (BMU), the local system of government for each beach. This is the point of access to each of the 12 beaches in the pilot program we are running. With their approval, we can enter the beach and ask different groups such as fishermen, fishmongers, teachers, youths, shopkeepers, and bar owners what they feel are the main contributing factors to HIV on their beach specifically, and how we can best work to solve those problems.
It is the individual interviews with different segments of the population that best help to elucidate the problems of HIV on the beach level. We take individuals aside to question them on the main issues facing their particular segment of the beach community, and we are continually struck by the responses that we get.
I spoke with a man named Michael on Remba, who was 35 years old and had completed his highschooling in Kisii. He had worked for Glaxo Smith Kline in Nairobi for a short time as a salesman. After his contract expired, he returned to the beach communities to fish, an opportunity that had its own droughts, but rarely led to unemployment. Michael noted that, "when a fisherman gets his money after a catch, before he thinks of his stomach, he thinks of a woman." There is the desire of immediate gratification on these islands with little hope for the future.
Okayofred, a 25 year old male from Milundu beach on Mfangano told me about growing up with 17 friends his same age. Now he is the only one left. "People want to give it (HIV/AIDS) to others" he said, "so that they don't have die by themselves."
When I asked Johnson, a teacher on Mfangano Island, what he thought were the main factors in the community contributing to HIV/AIDS, he thought for awhile and then responded with, “Well...the biggest factor is poverty.” His hesitation at an immediate response, and thoughtfulness showed how poverty was truly the major contributing factor to HIV was in the beach community. Lack of education, lack of access to health care, the fish for sex trade; it all comes down to poverty in the area.
On Remba Island, a woman stuck her head out of her small shop, as we passed by with luggage and medical supplies on the way to the boat, heading to the next island. "Are you coming back...? We'll be here dying...", she said. All we could answer was "yes." Then the sinking feeling began to set in.
We have since come back to the islands after that initial stage of preparation for further HIV training and condom distribution. Over October 7th, 8th and 9th, groups of nearly 40 beach leaders got together in at Ringiti, Sena beach on Mfangano and Luanda Rombo beach on Rusinga, respectively. The purpose of these meetings was to set up an HIV/AIDS Subcommittee so that locally, the beach could coordinate efforts between the Ministry of Health and other NGOs as well as oversee the condom distribution, HIV education, and health services offered by IMC on their beach. The most fruitful portion of the meetings turned out to be having the groups of women, fishermen, youths, and Beach Management Units (BMUs) work together to come up with the specific successes of their beach community, the problems they still face, and how to go about specifically reaching their group with HIV education. We realized that this kind of joint meeting between beaches for the sole purpose of exchanging ideas on how to best combat HIV had probably not been done before. We found that as groups were able to discuss the problems of the beach community leading to HIV such as Jaboya, the “fish for sex” trade, they could formulate reasonable solutions locally.
Still, we will be leaving the islands of Lake Victoria, Mbita, Suba District and the rest of Kenya in early December, and we don’t always know how to answer the question, “are you coming back…?”