This January I spent a month of my course in Migori, which is a small town in south west Kenya. It is a very rural environment, approximately 7 hours drive from Nairobi and one hour from the nearest city of Kisii, which is still relatively small. In terms of development, the town is mostly composed of kiosks and markets, with some apartment blocks but many more shacks of corrugated iron. Despite this, the town is hardly the worst in terms of poverty, there are many more villages which are simply collections of mud huts. There is no street lighting, one tarmacked road which passes through the town centre and is the only route in and out. There are several schools in the town, but the proportion of children sitting the Kenyan equivalent of GCSEs is unfortunately only around 50% and is lower still for girls.
My time was spent in a Catholic Mission Hospital, which despite being the biggest hospital for miles around was less than half the size of most UK district general hospitals. The facilities starkly contrast to those available in the UK, there is no national health system, although some essential drugs such as antiretrovirals for HIV are free. Other healthcare is paid for out of the pockets of the patients, some have insurance but a sizeable proportion do not. This fact means that people will only visit hospital when gravely ill or in a great deal of pain. In the UK there is much more preventative medicine and conditions are treated at an earlier stage which means a greater chance of survival.
It’s probably not surprising that the spectrum of illnesses encountered is also very different from those seen within the NHS. Infectious disease (malaria, HIV and typhoid mainly), injuries from road traffic accidents, peptic ulcers and maternity services are the main focus of the care that is provided. There is also no A&E, you turn up and wait for a doctor to come to clinic to be admitted. There are no scanners, just an X Ray machine, lab services are basic and there is no call system for nurses, you have to rely on your relatives or another patient to fetch them if they are off the ward. All of this makes the whole experience of being unwell a much bigger uncertainty than is in western society, which potentially breeds great anxiety. Having said this there is a much stronger sense of community and despite the high prevalence of abject poverty, people seem generally happy with their lives. The strong sense of community means that there is a lot less isolation and loneliness, though still considerable divisions can occur around elections, thankfully the elections year were peaceful and democratic.
The natural surroundings are incredible, as you can see from the pictures that show the view from the centre of town. You can see the bushy landscape for miles, unscathed by pylons or high rise buildings. I was living in the small white buildings barely visible in the photo. Another photo shows a more complete view of the town, with an impressive storm brewing that is typical of the intense rain that occurs between the heat. The other is taken on the road into town, to where the market is. Donkeys are sadly not as frequently used as motorbikes, but are a considerably safer way to travel!