Ikutha is a town from the Sub-Sahara Africa punished by whips
of the AIDS, the lack of water and educative and sanitary resources.
During years there is no development worked against zones more
disadvantaged and the international aids have still not arrived
at this zone. This rural locality has only around 500 inhabitants
and is located in the heart of Kenya already worn away by a government
who has corrupted it for more than 20 years. It belongs to the
region of Kitui that, in spite of its proximity to the capital,
Nairobi, is one of the developed areas less of the country. Nothing
else to arrive, after lengths and tedious kilometres of dust and
pockets, great posters give the welcome you: Let’s talk,
we speak. They are the mirror of a society that moved away of
the new technologies, the telephone, and the running water and
of the electricity, it has not been able to escape of which it
has been the epidemic of century XX: the AIDS.
Over the last two decades, Kenya has been experiencing serious
sequences of rain failure in arid and semi-arid lands (ASAL) that
make up 70 percent of Kenya’s land mass. Floods have not
been as frequent. A complete or partial failure of long or short
rains is likely to occur an average of every three or four years.
During the last 20 years, rain failure in the ASAL has occurred
five times: 1976-78, 1982-84, 1992-94, 1996-97 and 2000. Even
though floods have become less frequent, the 1997 short rain season
in Kenya saw some of the most intense rainfall in 40 years. The
ASAL districts experienced floods in 1970, 1974, 1984, 1991 and
1992, plus more severe floods in 1997 and 1998.
Though Kenya is predominantly an agricultural country, fertile,
arable land is scarce and competition for resources often leads
to conflict and environmental damage as land is overused. More
than half of Kenya's 30 million people still live below the poverty
line. Northern Kenya is facing food shortages because of recent
drought. Kenya’s new government has promised economic reform
and an end to corruption, giving many people hope for the future.
Other challenges include: HIV/AIDS: Official statistics show that
around 2 million Kenyans are living with HIV/AIDS. Poor livelihoods:
Large numbers of people living in towns and cities have little
or no employment; women are hardest hit, especially in rural areas.
Environmental damage: climate change is causing insufficient and
irregular rain and deforestation. Pollution in urban and industrial
areas is also recognised as a major health problem. The Kitui
Catholic Diocese’s Strengthening Water Supplies and Community
Empowerment project, whichhas constructed a variety of water supply
facilities, including rock catchments, sand dams, earth dams,
storage tanks and shallow wells. The diocese’s other activities
include training communities on HIV/AIDS, hygiene and sanitation
and environmental conservation, as well as on management of community-owned
Four or five times in a decade drought and/or heavy rainfall
are likely to cause increased morbidity and mortality rates among
people and livestock in the ASAL. Pastoralists, the largest land
users in the ASAL, are often forced during droughts to migrate
with camels and cattle to traditional grazing areas in other districts
or neighbouring countries, leaving sheep and goats behind. This
causes acute shortages of traditional food – milk, blood
and meat – for family members left behind (mainly children
and women), leading to widespread undernutrition and high rates
of malnutrition. Additionally, there are increasing cases of health-related
problems associated with lowered resistance to disease arising
from the population’s declining nutrition status, as well
as problems related to the use of contaminated water from drying
water pans. The failure of the short rains in 1995 and long rains
in 1996 not only inhibited regeneration of vegetation, it failed
to replenish water pans and dams, diminishing levels of natural
water sources and boreholes for humans and livestock. The latest
drought severely affected about 4.1 million people. The 1997-98
floods affected populations that had just begun the long process
of recovery from the severe drought of 1995-96. ASAL inhabitants
lost 80 percent of goats, sheep, cattle, and camels, and the area
suffered significant damage to roads, bridges, human settlements,
and other infrastructure.
Kenya: Ministry issues TB, malaria warning
The Ministry of Health in Kenya has sounded an alarm on the increase
of malaria and tuberculosis (TB) cases in Kajiado District.
Area public health officer, Paul Tikolo, said malaria prevalence
had shot up to 27 per cent from 23 per cent in 2004. Infection
rate of TB, he said, stood at 3 per cent from 2 per cent last
"We have been forced to come up with special TB manyattas
at the district hospital so that the patients can complete their
dosage," he said.
He said many people in the area failed to complete medication.
Tikolo was speaking at the weekend in Loitokitok during the launch
of a global campaign on HIV/Aids, TB and malaria.
The Government, he said, had embarked on an anti-malaria campaign
in the district aimed at disinfecting all open draining systems
in public places.
"The disposal of drainage in the open because of poor sewerage
system has provided breeding zones for mosquitoes," he said.
He directed health officials to oversee the formation of TB and
malaria community control systems. Tikolo banned direct discharge
of raw sewage into River Kiserian whose waters he described as
Food and grace help people survive during drought
By Evans McGowan, ACT International
Machakos region, Kenya, June 15, 2006 - Agnes Katile had never
seen so much maize in her life. After months without rain and
not knowing how to feed her four children, she received 74 kilograms
of maize through a relief program coordinated by Church World
Service (CWS), a member of the global alliance Action by Churches
Together (ACT) International, and its local partner, the Africa
Brotherhood Church (ABC).
The Katile family is one of more than 500 drought-affected families
who received maize in late March to sustain them through the planting
season. Communities hit by the drought selected the families to
receive assistance, considering especially the most vulnerable
- single-headed households, the elderly, orphans and handicapped
With assistance from CWS-ACT and ABC, farmers can now sustain
themselves and keep their children in school until the crops are
ready to be harvested. The farmers also received cassava, a root
vegetable that is very hardy in a dry climate, cowpeas and sweet
potato seeds. The rains have finally come to the Machakos region,
an hour's drive east of Nairobi. However, the farmers don't expect
to harvest until July.
Although Machakos is known for having fertile land, heavy deforestation
and climate changes have led to soil erosion that severely decreases
When the rains start falling in March until the ground dries in
August, Agnes is able to fetch water from the river about half
a kilometer from her home. During the dry season, however, she
must walk 10 kilometers to the local town to obtain water. More
than 20 years ago, an earthen dam was built to retain water. Now,
soil run-off has completely filled the dam, and some farmers have
even begun planting where the dam once lay. A well has been dug
to access what little water can be found below the surface. CWS
emergency relief consultant Sam Mutua has suggested de-silting
the dam and building a subsurface dam farther upstream to catch
the silt and create a long-term solution to the ongoing challenge
of having a water supply.
Agnes received some assistance from the government in February
- seven kilos of maize and enough seed to plant two rows of maize
- but it was not enough. By assisting the most impoverished, CWS-ACT
hopes to lift up the entire community and not let the most vulnerable
people suffer unnecessarily.
Agnes has four children. Her oldest son, Videlis Mambo, is in
Form 2 (the second year of secondary school). She has three other
children who are all attending school: Kilonzo (13), Mercy (9)
and Kamanthe (7). With only 1.5 acres to farm, a good harvest
will bring a maximum of four bags of maize, too little to sell,
and which will provide the family with only six months of sustenance.
To support themselves when the maize is gone, the family cuts
sisal to weave strands and sell as rope. They also cut trees to
make charcoal, but there are too few trees remaining to continue
In Agnes' community, individuals survive by the grace of others.
Despite her vulnerable position, Agnes has shared what little
she has with her neighbors. She feels compelled to continue sharing
the grace she first received in the assistance from CWS while
hoping and praying the rains will last and bring a substantial
Evans McGowan is working at the Church World Service East Africa
Regional Office as a volunteer through the Presbyterian Church
(USA) Young Adult Volunteer Program. Both Church World Service
and the Presbyterian Church (USA) (Presbyterian Disaster Assistance)
are members of ACT International
Aids: when the drugs don’t work
The campaign to deliver cheap anti-retroviral drugs to HIV patients
in Africa is at last making progress. But the therapy can actually
make matters worse if those being treated do not have enough to
In the drought-stricken regions of northern Kenya, some people
face a stark choice: they either eat or risk being struck down
by an Aids-related illness.
“People know that HIV will kill them in months, but hunger
might kill them by the end of the week,” said Dr John Mundi
Amolo as he makes his tour of the HIV and Aids patients admitted
to Mutomo Hospital. “If someone has only 50 bob [35p], then
they would rather buy food than get drugs for their HIV. They
have no choice.”
Mutomo Hospital is in the Kitui district, which has been hit hard
by five years of drought. Rivers have dried up, crops destroyed,
and the people worn down by hunger. Among the most affected have
been those with HIV and Aids. Although life-saving drugs are cheap
and available, the small food and medical costs necessary to be
able to take them are often too much.
“The anti-Aids drugs don’t work well without good
nutrition,” said the doctor. “People have not been
eating day after day. Taking the drugs on an empty stomach makes
them feel sick so they stop. If you don’t keep the same
level of the drugs in your blood, HIV very quickly attacks the
immune system. We are seeing very ill people being carried in
all the time.”
When nurses from the hospital found Paul Kwaluma, he weighed just
34kg. “I thought I was going to die,” he said. “I
could not get out of bed. I was very weak.” He started taking
the anti-retroviral drugs last year, but went off them after his
small vegetable plot dried up and he was left without food. “I
stopped taking the medicine because when you have nothing in your
stomach it makes you feel very ill. But as soon as I stopped,
I rapidly became unwell. I had lost half my body weight in a couple
Mr Kwaluma is nearly back to health after being admitted to Mutomo
Hospital, where he was fed and returned to his anti-Aids drug
therapy again. The hospital is part of the Catholic diocese of
Kitui HIV and Aids programme. It’s a long-established programme
supported by Cafod that works out of four hospitals, helping 5,000
people with home-based care, testing, education, counselling,
income-generating projects and supporting orphans and vulnerable
Counselling stresses the importance of eating properly and always
sticking to taking the drugs. Missing doses allows the virus to
become resistant to the medicine. If less than 95 per cent of
the drugs are taken on time, resistance develops quickly, the
medicine becomes less effective and the patient becomes very ill.
Although a second generation of HIV drugs can then be used, they
are prohibitively expensive.
Paul Kwaluma’s case is all too common for Fr Paul Healy,
the administrator of Kitui diocese. “You are getting people
in Kitui who don’t have any food,” he said. “When
starvation comes, you don’t have many choices. If you don’t
have money for food, you can’t eat. And you can’t
take the drugs if you can’t eat. With HIV and drought, you
are constantly ill with infections. People are getting sicker
and doing more damage to their bodies.”
Last week, the Kenyan Government promised free drugs to those
who need them. Dr James Nical, director of medical services at
the Ministry of Health, is Kenya’s leading medic. He says
his country has been making tremendous progress on HIV. Kenya
has one of the highest numbers of people with HIV in Africa at
1.3 million, though the number of new infections is the lowest
in years. The Government is providing more drugs – doubling
the number on anti-retrovirals since 2003. Still, of the 220,000
Kenyans with HIV who are ill enough to be on the anti-Aids therapy,
only one in three actually takes them. In Mutomo, the people who
take the drugs and eat properly look healthy; they can work and
they can lead positive lives. It makes for a dramatic juxtaposition
with those who don’t.
“I have a high fever, I cough all the time, and I feel so
tired,” said Teresa, a 45-year-old mother of eight children.
Although her health is plainly deteriorating and her blood tests
show that she should be taking the drugs, she cannot afford the
other costs that go with that, such as transport. Mutomo Hospital
provides the only healthcare in a 70km radius, and she lives too
far away. “I don’t have enough money to pay to get
to the hospital or for the check-up tests,” she said. “My
husband has a new wife and will not give me any money. He pays
the hospital costs of our youngest child who also is HIV positive,
but for me he gives nothing.” She estimates it would cost
her just £3 a month to pay for the transport and the regular
tests. It is £3 that might save her life if she had it.
Cafod believes that providing drugs alone will not be enough to
tackle the pandemic. The aid agency believes that in the short
term there is a need to see supplementary feeding for people with
HIV and Aids, but beyond that the cycle of poverty, drought and
hunger must be broken. That will mean beefing up Kenya’s
healthcare, according to Fr Paul Healy, who adds: “We need
the capacity to deliver the drugs effectively. We need more medical
staff and we need more outreach clinics closer to the people.”
He says that for Kitui they need three times the medical staff
to be able to administer anti-retroviral drugs to people who should
but aren’t taking them. Nationally, the Kenyan Government
says it needs to increase the number of nurses from 18,000 to
24,000 to be able to meet the demand. It’s a target made
increasingly difficult as more nurses are attracted to better
The brain drain of trained medical staff from poor to rich countries
was just one of the topics at last week’s United Nations
General Assembly Special Session on HIV and Aids (UNGASS) in New
York. The summit looked back at progress made in the fight against
the pandemic. World leaders signed up to providing universal access
to prevention, treatment and care by 2010. But the target looks
utopian to many experts. On the issue of access to anti-Aids drugs,
only 1.3 million people receive Aids drugs out of the 6.5 million
people who need them. Cafod’s Chris Bain was part of the
Caritas delegation of Catholic Church aid agencies at the UN meeting.
He feels that the meeting came up short, saying: “The first
case of HIV was diagnosed 25 years ago this week. Since then the
pandemic has killed 25 million people, with two-thirds of the
victims being in Africa. Millions more already infected will die
unless we see a proper commitment to tackling the poverty that
underpins HIV. We can beat Aids if we make the right choices.”
Back in Kitui, the choices are limited. Paul Kwaluma is optimistic,
after short rains in May, that there will be enough food for his
immediate needs. But with the river beds already starting to dry
up, all he can offer is a shrug as to what he’ll do if the
main rains fail to deliver in the winter. “The world cannot
pretend to ignore the severity of the problem,” said Fr
Healy. “Unless we get long-term solutions, people will be
more impoverished. People with HIV and Aids will not stand a chance.”
Learning lessons about HIV and health
The Mutomo clinic tackles HIV in Kenya, but the struggle for food
and basic healthcare affects patients' ability to take life-saving
drugs, as Paul Kwaluma discovered
"I stopped taking the HIV medicine because when you have
nothing in your stomach it makes you feel very ill," said
Paul Kwaluma, a 40-year-old from Kitui district in rural Kenya.
Food has been scarce in the Kitui after a cycle of poor rains
over the last five years left the earth parched and devastated
The drought hit hardest the poor and most vulnerable, especially
those already weakened by HIV and AIDS and too sick to work for
Paul Kwaluma tested positive is 1999, and started taking the life-saving
anti-retroviral drugs (ARVs) that stops the HIV virus attacking
the immune system last year.
But, for the drugs to be effective, patients need to be on an
adequate diet. Paul was too ill to work in his job as a driver,
and the drought meant that his family’s small plot of land
did not produce enough food.
Dramatic weight loss
"When I stopped taking the drugs in October, I weighed about
62 kg, and I was healthy," said Paul, "But quickly I
became very sick. I thought I was going to die.
"I could not get out of bed. I lost weight dramatically.
The nurses from the Mutomo clinic came and took me straight into
hospital. I weighed just 34 kg at the time."
Mutomo Hospital is part of the Catholic Diocese of Kitui HIV and
AIDS programme. It is a long-established and well-run programme
that works out of four hospitals in Kitui helping 5,000 people
with home-based care, testing, counselling, education, income
generating projects, and supporting orphans and vulnerable children.
Mutomo clinic alone receives £55,000 a year from CAFOD to
help people with HIV and AIDS.
Paul Kwaluma is nearly back to being healthy after receiving food
and being put on his anti-AIDS drug therapy again by the staff
in Mutomo. He has received counselling on the importance of not
missing any of his drug treatment.
"I have learned an important lesson. I must ensure that I
have enough food. I must get healthy so I can get back to work
and provide for me and my family."
Progress on ARVs
More than 1.3 million people in Kenya are infected with the virus,
although the number of new cases declined last year. Kenya has
made progress in providing anti-AIDS drugs to people who need
them – doubling the number on ARVs since 2003.
The drugs have become cheaper and money from donors such as the
Global Fund for HIV/AIDS, Tuberculosis and Malaria has made them
more widely available.
Still, of the 220,000 of the people with HIV are ill enough to
be receiving the anti-AIDS drugs, only one in three of them actually
"Some people decline the anti-AIDS drugs because they know
they don’t have enough food," said Dr John Mundi Amolo
of Mutomo Hospital.
"People know that you have to eat to be able to take the
drugs. But if they don’t have the food, they have no choice.
They have to pay to come to the hospital and for the testing.
"If somebody has only 50 shillings (a few pence), they might
prefer to buy food because although HIV will kill you in a couple
of months, famine might kill you in a week.
"Some cannot afford the addition costs such as the regular
blood tests that are required. Even the price of transportation
to the nearest clinic can be too much for many people living below
the poverty line.
"Providing the actual drugs is only part of the problem,
we must also provide the necessary food and healthcare."
Dr John says it is not a shortage of the drugs, but a shortage
of trained medical personnel. He says that to treat all the people
with HIV who should be on the drugs in his hospital’s area
would require three times the number of staff.
CAFOD’s Chris Bain has been at the UN General Assembly Special
Session in New York this week. His message to donors is that providing
universal access is not just about delivering drugs, but also
about providing the health service and food for those drugs to