I know a handful of artists in Mukuru. There are a lot of youth in the slums, and most of them are un-and underemployed. To pass time, they join youth groups, listen to music, sometimes act or sing, some clean up their community, others exercise together. The clinic is interested in bonding with the youth- Kenya has a young population with 43% aged 15 and under.

Some of the youth in Mukuru were trained by French and German NGO programs that used to hold artist workshops in the slums. Others picked arts and handicrafts up in search of livelihoods. Others create with their youth groups.

The first postcard: women washing clothes, children playing “tire” and double-decker corrugated iron houses.

Mongololoh is one of our community artists who stops by the clinic occasionally and knows our workers. Access Afya commissioned him to draw postcards of the Mukuru slums in the streets and path surrounding the clinic for donors to our crowdfunding campaign. We want our supporters to see the world we work in. $1.25 of each donation of at least $25 goes to supporting this artist. Each postcard we mail to supporters is signed by him.

Mukuru after dark; the Masaai painted here patrol the streets in the evenings.

I asked him if he had ever drawn his neighborhood before, and he said no. Usually, he draws Masaai warriors and lions and things that he can sell to tourists passing through Nairobi on their way to safaris. He told me he liked having a job where he was able to sit and draw his life.

He named the series “Mist in the Ghetto”, by Mongololoh.

Title of the series scrawled on the side of the book.

Help Access Afya expand our reach and receive your own original watercolor postcard of the vibrant Mukuru slums.

Domianah is not even five feet tall but she has a certain presence when she enters a room that commands attention. She is fashionable- her clothes match her shoes and she always has a funky accessory to complete the look.

Domianah, or Dommy as she is often called, grew up in the Mukuru slums.

Domianah Smiling

I first met her at an outreach event Access Afya organized for young mothers. After the event I was talking with her about this slum and the community there- something about her made me sure I wanted to work with her. While we were talking I complemented her bracelets- simple amber rings that ran up her wrist.

“They are the female condoms. The expired ones.” She replied.

Domianah volunteers with the Sex Worker Outreach Program, or SWOP, so she is an expert on the subject. She teaches commercial sex workers and other high-risk groups about their options for protection and refers them to clinics for routine sexual health checks. One of the challenges, she tells me, of working with sex workers is shipments come in bulk for female condoms, and workers stock up because they do not know when they will get them again. The women store them in their crowded homes; there is not sophisticated inventory management. Expiration dates come and go and women do not always notice.

When Domianah sees packages of female condoms where the expiration date had passed, she takes them from the workers, opens them, removes the inner plastic ring, washes it, dyes it, and hands them out to health workers as bracelets to raise awareness in the community.

I laughed out loud. I was impressed by her creativity and inspired by her commitment to work with some of the toughest challenges faced by this community and have a little fun while doing it. I asked her to get me some bracelets.

Domianah now has her first full time job, paid with benefits, as a Community Outreach Coordinator with Access Afya.

Global Health Bracelets

We are raising money to open a second mini-clinic in a different neighborhood within the Mukuru slums. Our top-level supporters will receive their own set of three Global Health Bracelets. We encourage these supporters to take photographs of themselves wearing their bracelets around the world, send them to us, and we will add them to our blog, showcasing our global network of individuals supporting Access Afya and raising awareness about safe sex! Please consider supporting our Start Some Good campaign and sharing the information with your networks.

Some of our drop-in customers went for a consultation elsewhere, where they were given a prescription that could not be filled on site. This is a frequent story with the public facilities in our area.

The fourth and final customer profile is of a mother who came from a surrounding public outpatient clinic, where the model is a low-cost 20 shilling all-in fee for consultation and medication, although they had run out of most medications including all three things they had prescribed for the child. While illuminating one of the frequent challenges in “accessing” care through existing facilities, this story also raises another ethical issue in social enterprise.

We had everything on her prescription in stock. The child had diarrhea and was fussing. The treatment was zinc tablets, antibiotics, and a cough syrup. The mother looked at the list, the prices, and asked if we could lower the cost for her.

We certainly don’t do free medication or discounts, but we do know that antibiotics are consistently over-prescribed in Kenya – and probably in most of the world. The World Health Organization and the Kenya National Standards for the treatment and prevention of diarrhea both recommend oral rehydration salts and zinc are given immediately, but that antibiotics add no practical value unless the case is severe and dysentery suspected.

We recommended she use ORS salts, buy the zinc, and forgo the rest. People are used to buying antibiotics in response to almost every visit, but we make sure we recommend it only when necessary.

This lowered the cost of the treatment for her. This lowered our revenue. This action was in line with global and national best practices. We believe in the long-run, what is good for the customer is good for business, and the lifetime value of this family will be greater for us if they trust us and know we are looking out for their health and their wallets.

Resilient children of Mukuru

Our third profile was a classic case of someone thinking they had malaria. Malaria is endemic in parts of Kenya, and people are scared of it for good reason. Despite global attention to the disease, increased availability and affordability of testing and treatment, and millions spent on prevention, malaria is still the leading cause of mortality in Kenya (See the most recent Demographic and Health Survey of Kenya).

This man did not lead with talk of malaria; rather he started asking to buy some over the counter painkillers. Then, be began to inquire which brands of malaria treatments we stocked. Why was he concerned with our brands? He had bought some malaria medication from a nearby chemist, but they were not making him feel better. So he was thinking of trying a new brand.

Rather than recommending our brand, we recommended he think about letting us do a consultation with him and running a rapid test to see if he did in fact have malaria. A more likely reason for his medication not working was that he was treating the wrong thing, not taking the wrong brand.

Many people living in the slums still travel frequently to rural areas, so it is not impossible that some would pick up the disease. However, actual instances of malaria in Nairobi are uncommon, although most people with fever still assume that it is the cause.

He was excited that we had on-site testing capability. He told us he would be back, and spread the word that there was a place to get a malaria test nearby. This is one advantage we have with our location- from the outside, looking like a chemist. People stop in for a familiar interaction, and we are able to give them new information.

This is the second post in a series of profiles of the challenges and opportunities we face every day working on selling holistic health in the slums, where status quo is to ignore symptoms, self-diagnose with no information and buy medication from local informal chemists, or in some extreme cases to go to government facilities, wait in long lines, and likely be sent back to those same unreliable chemists to fill prescriptions that the government dispensaries can’t handle.

Our second profile is of a woman who was feeling dizzy. She walked up to the counter, told this to Carolyne, and asked what medication she should buy. Carolyne is a registered nurse (although she runs clinical operations for Access Afya) and at this point she asked the woman to come back and have a consultation for 100 Kenyan shillings (around $1.25) to find out what was causing that dizziness.

“You can’t just sell me something here?” The woman asked.

“No,” said Carolyn, who went on to explain why we wanted to collect a full background, that dizziness could be caused by a number of issues, and some of the issues with over the counter medication that our previous post raised.

The woman listened and said she would go to find some money and come back later. We hear this a lot. Sometimes people do come back, and sometimes it is just a polite excuse to go and buy drugs from another chemist.

But this woman actually came back. She spent 100 shillings on that consultation, and also purchased a lab test to confirm diagnosis. We ran the rapid diagnostic test on site and collected an additional 100 for that, plus for medication prescribed.

While the previous post tells a story of us “losing” a sale, but sticking to our principals and giving out valuable information, just hours later the opposite happened. Here, we made a medication sale but also consultation and lab. We are certainly optimistic that in the long run, “what is good for the customer is good for business” can work for us.

Inside the Access Afya consultation room.