Distributing mosquito nets in Mwingi district, Kenya
We worked for three weeks at Gai clinic, Mwingi district, Kenya, for the UK-based charity Akamba Aid Fund (AAF) distributing insecticide-treated bednets and shadowing nurses at the local clinic.
The World Swim Against Malaria has to date donated 288,276 Long-Lasting Insecticide-treated Nets (LLINs) to 155 programmes in 26 countries. In order to spend 100% of their funds on nets, distribution is entrusted to experienced NGOs.
In October 2006, through AAF, we applied for a distribution contract for 3700 nets. In developing our strategy we collaborated with staff at Gai clinic, community leaders of Mwingi district, the London School of Hygiene and Tropical Medicine, the African Medical Research Foundation, the Kenya Malaria Advisory Service, the World Swim’s Malaria Advisory Group and the Mwingi District Medical Officer for Health.
Despite this careful planning, we encountered challenges at every step. A refusal of VAT exemption at the port in Mombasa forced us to source the nets from within Kenya instead of Thailand, at four times the logistical expense. A storage crisis in Nairobi was averted by a kind offer of free warehouse space from our manufacturing partner. The hire truck was over 24 hours late collecting the nets from Nairobi, and disappeared off the radar altogether for a nail-biting 12 hours overnight between Mwingi town and Gai village. Inaccurate census figures forced us to choose 14 villages to discount. Although we had been careful not to make any promises, word spread from neighbouring villages and the Assistant Chief was beleaguered by demands.
The distribution itself was labour-intensive, with the checking and re-checking of papers issued during an excellent preparatory visit by Imperial College medical students. Village elders were on hand to solve rare disputes of identity. The clinic chaplain spoke out against rumours from the Northern villages of the ‘white spirits’ in the nets suffocating children as they slept.
Meanwhile, in the clinic, a 6 day-old neonate lay comatose and fitting. Opisthotonus, clenched fists and feeding difficulties immediately rang alarm bells. Our neonatal tetanus diagnosis was not so simple to establish as the baby also had Plasmodium parasitaemia and the mother initially confirmed receiving ante-natal tetanus vaccinations. The nurses administered IM chloramphenicol and quinine when IV access failed. The scared young mother then admitted to having missed tetanus immunisation, and to cutting the cord with a razor blade after home delivery. The baby was referred; we had no anti-toxin. Nor did we have any for a 12 year-old’s snake bite: staff instead used an antiquated-looking electrocautery machine. This is a controversial procedure, but he recovered well.
After seven days of educational plays, songs, poems and speeches, and the hacking open of hundreds of metal bands securing bales of nets with large and unwieldy knives, we had provided nets to cover an estimated 100% of sleeping spaces in our 23 villages. Our experience in Gai was often frustrating and incredibly challenging, but witnessing people coming together to talk about health, and watching hundreds walk home with their new nets was immeasurably rewarding.
Rose J Crane and Stephanie MS Wilmore
Royal Free and University College London Medical School
Gower Street
London WC1E 6BT
r.crane@ucl.ac.uk and s.wilmore@ucl.ac.uk