Unprepared at the Time of Need
A displaced Kenyan mother and child in a refugee camp, MSF
Today we’ve published Bharat Kumar’s interview with Doctor Frank Bai, Medical Director of AmeriCares, America’s largest humanitarian aid organisation. Read the interview here. Meanwhile, today’s blog is from Vinit Shah, a 4th year medical student at Manchester University. He writes about the breakdown of the health services in Kenya after last year’s post-election violence.
Although the conflict is largely resolved at present, the death toll rose to 1,000 in the first month, while half a million people were displaced before international mediation arrived
It seems it was a moment long past and neatly tucked away into the world history books when a country overnight turned from a haven in the east of Africa to the centre of a bloodbath. Kenya, for many years, had maintained a united state and even though surrounded by countries facing internal violence and turmoil, kept its peace. However things took a turn for the worst on December 27, 2007, the day of election results, when opposition supporters were unsatisfied with results. This was a modern example of how quickly and substantially civil conflict can show its colours. Although the conflict is largely resolved at present, the death toll rose to 1,000 in the first month, while half a million people were displaced before international mediation arrived in February 2008. However this was the least of the suffering of the peoples of this geographically amazing country.
What happened?
The health care system was worst hit at the centre of the violence, and broke downwhere it was most needed. Many health care workers were among the displaced, and those who remained were unable to act because of the life-threatening insecurity and breakdown of the local infrastructure. Those who stayed to act were faced with the dilemma of providing services to ‘selected’ patient groups. This would raise the ethical brow in many, but what would anyone do when faced with the choice of either facing the knife yourself or helping only those who hold the knife? Those who probably are causing more harm and indiscriminately attacking the opposing communities in large numbers? No doubt; we are all bound by the Hippocratic Oath and would serve without prejudice. The Kenyan practitioners were no different.
In addition to the shortage of health care workers, services were over-stretched. As more and more trauma cases came in through the doors, spaces dwindled and supplies ran dangerously low. Drugs, equipment and even clean water and energy supplies were being compromised, and many who suffered traumatic injuries that would, in normal circumstances be easily treated, died from shamefully simple medical problems.
Not Just Acute Services
Obonyo and his colleagues (1) have quite extensively described the failing of the health care systems as the result of the violence. He has also described the poor state of the refugee camps for the displaced populations where supplies ran short, several disease outbreaks occurred and even reports of sexual abuse and violence directed against women. These were trying and desperate times but attention was often focussed away to the centres of violence.
The violence has also had huge implications on the treatment and control of diseases such as HIV/AIDS and tuberculosis. National control strategies have been set back by decades. The global health charity Médecins Sans Frontières (MSF), which supplies 2,000 patients in the capital with essential antiretrovirals (ARVs), reported a reduction in appointments for and access by patients to the ARV programs during the peak of violence (2). The MSF teams that were focusing on providing treatment for such chronic disease had to ‘change gears’ so as to support the ongoing efforts to help the wounded and injured in the regions wracked by the violence. This is a huge blow for the global fight against these diseases, and considering that the majority of affected populations are in developing countries such as Kenya, similar eruptions of violence can suddenly draw attention and effort from the fight against these difficult and complicated problems.
The Role of International Aid Organizations
The Kenya Red Cross was another international aid charity that worked tirelessly throughout the chaos to provide relief support to those affected by the violence. They supplied ambulances, first-aid kits, drugs and medical personnel to the desperate regions. They have also provided relief support to the populations displaced in the neighboring country, Uganda. Importantly, they had a team of 500 trained staff over the country with emergency contingency plans in place before the elections and so were prepared and organized to deliver emergency services (3). Support was also extended to help the displaced to return to their homes and rebuild their farmlands and livestock.
Lessons
The important lessons to be learned from Kenya are about the need for countries to prepare an emergency action plan for their health services to reach out to the most vulnerable. Emergency plans should also cover the development and maintenance of refugee camps and provision of essential amenities. Violence can be unpredictable but being prepared is everything. Governments should invest in these initiatives as many of them will have implications on welfare even after resolution of disputes, so cost-effectiveness should not be the factor preventing investment in such projects.
The roles played by international health organizations such as Red Cross and MSF are also vital, especially when national health framework fails and where they remain the only glimmer of hope for many of those affected. They are trained, experienced and have the skills to deal with crisis situations and are able to quickly mobilize. Support should be extended to these organizations internationally and encouraging the coordinated efforts of these charities in affected areas to avoid duplication or gaps in services.
However at present, although the country has mostly healed, they still face the after effects of violence; the bruises remain. One would pray that something similar would not repeat itself, but if it does, will they be prepared? And will they take action on the lessons they have learnt in 2007-2008?
References
1. Obonyo C,Omondi D and Mwinzi P, Public-health crisis after the election violence in Kenya, The Lancet 2008. 371; 1319–1321
2. Operational outlook: Kenya. Post-election violence wracks Kenya. Alert: Doctors without borders/Medecins sans frontiers. 2008. Vol. 11(7): 6-9. Available here.
3. The British Red Cross, Kenya Crisis 2008 (Feb). Available here.