[Written by Kelly Thoma. Kelly is a from Seattle, Washington and in currently in Kenya for the summer as a fellow with Access Afya.]
Condoms are one of the first things you will see for sale when you walk up to the pharmacy window at the Access Afya clinic is Kisii village in Nairobi, Kenya.
And condoms are a great choice as a family planning method, especially because they play a very important role in preventing the spread of STIs. And I thought that condoms would be the most frequently used form of birth control for patients coming in and out of the clinic. I thought that the accessibility, low cost and user friendly attributes of condoms would make them more popular within a slum. I was surprised when I came to talk to Access Afya’s clinical officer about birth control methods that condoms hardly entered our conversation. When I asked about them, I learned that most young women coming to Access Afya for family planning visits were not actually using condoms.In fact, and again to my surprise, when I was talking with Joan it seemed that a traditional local birth control method consisting of a weekly dose of an herbal liquid drug was more commonly used than condoms.
(To learn more about this dangerous herbal contraceptive, which comes in liquid and pill form, check out the Kenyan government’s Pharmacy and Poisons Board notice advising people against this method of birth control: http://www.pharmacyboardkenya.org/index.php?id=25 )
Joan, the clinical officer at Access Afya, grew up in central Kenya in Kianyaga. Her grandmother was a nurse at a Provincial General Hospital. She described for me that she thinks her desire to be in the medical field was something sparked out of the family she grew up in. Joan, like myself, had never heard about this herbal liquid birth control until she had a woman in her late twenties come into the clinic just about a month after having joined Access Afya.
The woman in her late twenties, as Joan described her, came in with incredible pain especially in her abdomen, unusual heavy menstrual bleeding, vomiting, and swelling in her calves; she wasn’t coming in with the intention to talk about family planning. However this woman, (let us call her Sara for the sake of this story), thought that perhaps the reason she had been in so much pain over the last week was because of the herbal liquid drugs she had been taking. She had been using this method of family planning, as did her other close female friends, for the last two years. But this was the first time the pain was this bad and the bleeding was so intense. Evidently a few days before Sara came to Access Afya, she was visiting her hometown in a nearby city when the pain started. Sara went to a larger clinic in that city and they discharged her after giving her some simple painkillers, so Sara then came to the Access Afya clinic days later because the problem wasn’t resolved.
She came to ask Joan how to stop the pain, but also possibly with the intention of finding a way of not having to take this herbal birth control anymore. Joan asked her about this herbal liquid more, as Joan wasn’t familiar with it. Joan talked more with her and they decided that she would stop taking this traditional form of birth control for good. So Joan asked Sara if she would like to hear about modern birth control options. Sara was extremely open to the topic. They discussed four: injections, implants, IUDs and the daily pill. Joan described to me how an important part of her job is to discuss with each patient about the side effects and advantages of each method so that they can fully understand all the presented methods before trying to make a choice. Sara had never heard of IUDs or implants and Joan said she seemed interested, but ultimately decided to go with the daily pill. She did say she wanted to go home and talk with her husband about IUDs though, in case that was something they wanted in the future since her husband wasn’t aware of that option either. However, Joan’s main goal for that day was to make sure Sara didn’t continue to suffer from all the pains she came into the clinic with that day.
Joan treated Sara and they finished with Joan instructing her to come back in a week for a check-up. Sara also purchased her month’s birth control pills at the pharmacy at Access Afya as she was leaving. Birth Control pills for a month supply are sold at the Access Afya clinic for the affordable price of just 30 shillings, or roughly 50 cents.
A week later, Sara came to the clinic to meet with Joan for her check-up as instructed. Sara said the pain was gone and that the bleeding had stopped completely. Joan and her finished the appointment with Joan asking her to come back in a month for a check-up to see how she was doing with the birth control pill that Sara now took daily. When Sara came back a month later, everything was going well and Sara proceeded to bring a couple friends over the next week to have them meet with Joan to discuss the problems associated with the traditional herbal birth control that Sara previously used. Sara would bring friends and wait in the waiting area at the clinic for them until they had finished their appointment with Joan. Many of Sara’s friends switched from the traditional herbal method to a modern birth control method.
I liked this story because it is so simple and yet so important. It would be difficult to measure exactly how many lives Joan changed by meeting with Sara, because of the ripple effect it has had through Sara’s friends and now Sara’s friends who have passed on this information to their friends and so on. In my mind, I see a picture of this knowledge Joan passed onto Sara about the dangers of this herbal contraceptive and how many other safe methods that are available now as knowledge undulating across the slum, reaching more and more ears person by person, increasing its potential reach each day with each new person’s awareness.