Trading the stool for a stall: Migrant female sex workers in Majengo, Kenya

Today, I ventured out to Majengo, a heavily populated settlement zone on the outskirts of Nairobi, Kenya's capital city. I met with two migrant female sex workers who have been part of a peer education programme for the past two years. They talk about the impact the programme has had on their lives.

*Rosemary Maliwa sells fruits for a living. One year ago, she worked as a female sex worker, earning less than one dollar a day. She shares her story with us…

At the break of dawn, *Rosemary Maliwa walks out of her house. She pushes the door gently, to keep from waking her three grandchildren who are coiled up on the floor of her one-bedroom tin house. With fruits tightly packed into a small bucket, she wades through burst sewage pipes, to a makeshift wooden structure by the side of a road.

25 years as a sex worker

This is Majengo. A densely populated neighborhood on the outskirts of Nairobi, Kenya's capital city. Tanzanians, Rwandese, Ugandans and Congolese weave through the crowd of Kenyans, dodging speeding cars that fill the air with clouds of dust.

“If you came door-to-door for one week, you would not have met all the female sex workers in Majengo,” Rosemary, a migrant from Tanzania, explains.

She came to Majengo 26 years ago.

“A friend who cared for me brought me here; she worked here too.”

Rosemary was a housewife, and she relied on her husband for upkeep. When he became abusive and started spending more nights away from home, she decided to leave with their three children.

How much money I made depended on how much risk I was willing to take

On a good day, Rosemary was able to see ten clients. But there were days when no clients came to her house.

“The calculation was simple: ‘Should I let my children go hungry, or should I take the risk of having unprotected sex?’ It was not a difficult decision – I had unprotected sex many times.”

Along the way, Rosemary contracted the HIV virus.

Trading the stool for the stall

In Majengo, a female sex worker sits on a small, wooden stool outside her house to symobolize that she is at work. When a client approaches her, she follows him into her house with the stool in hand.

“One day, I learned about a peer education programme that NOPE and IOM were running. I was told that they could help me start up a business. I had always wanted to quit sex work, but I was unable to get start-up income for a business from any bank - it is hard when your papers are not okay. I grabbed the opportunity when it came my way.”

One year ago, Rosemary traded the stool for a stall. She now trades in fruits. She supplements her income with money she makes off fabrics she sells.

"When our clients see us on these stools, they know we are at work." Photo/Mary-Sanyu Osire


*Victoria Kalume is a female sex worker. One year ago, she did not know that undocumented migrants also have rights. Today, she insists that everyone deserves to be respected. Find out why…

Illegally connected electricity lines hang dangerously low over *Victoria Kalume’s house.

“Come in, have a seat,” she motions with her hand.

She grabs a wrinkled handkerchief to wipe sweat off her forehead. A small radio in the corner is blaring. She breathes heavily.

Victoria just saw a client.

She is a migrant female sex worker, one of hundreds of Congolese who make a living in Majengo, a heavy populated settlement zone in Nairobi.

Treated like dogs

“Kenya has had three presidents since independence; and we were here before the first president, yet law enforcement officers used to treat us like dogs.”

Sex work is illegal in Kenya. Victoria’s situation is exacerbated by the fact that she is an undocumented migrant.

Change

IOM and NOPE have been running human rights sensitization classes for sex workers and law enforcement officers, in an effort to raise public awareness about the rights of vulnerable migrants, and to empower migrants to speak up for their rights.

“Things have slowly started to change. These days, if one of our clients refuses to pay, we are confident enough to report the case to police. This was unthinkable a few years ago,” Victoria says.

She digs into her handbag and retrieves scrap paper with a number scribbled on it.

“If I got arrested today, I would call these people. They would help me. One year ago, I did not know what services were available. Today, I know who to go to for what kind of assistance.”


* not real name



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Region: Kenya, Horn of Africa
Theme(s): Migration, Health, Female sex work

The author is a health communications consultant. Follow her on Twitter [@msanyuosire] & keep tabs on tips she shares with health communications officers by "liking" my facebook page [Mary-Sanyu Osire].

Assessing the impact of the US Congress' proposal to cut global health funding

This morning, I read an article published by MSF about the US Congress' proposal to cut global health funding.

Chew on this:

"According to American Foundation for AIDS Research (AMFAR), for every 5% reduction in U.S. funding of global health programs, 182,000 people with HIV/AIDS and 2.1 million malaria patients will be left untreated; and millions of children will go without immunization against resurgent diseases like measles that can leave children with pneumonia, blindness, or death. Put another way: A 5% cut in US funding for global health is akin to shutting the doors of every MSF hospital and clinic in over 70 countries for an entire year."

Find the article at this link: http://www.huffingtonpost.com/matthew-spitzer/the-human-cost-of-cutting_b_1099870.html

THE HORN OF AFRICA: Drought & water-related diseases

I just came back from a mission to Turkana (northern Kenya). Here's the story I filed:

Worst drought in 60 years

It is hard living in Turkana. In addition to biting poverty, recurrent droughts and floods, a poor state of infrastructure and limited access to basic health care, the region is being ravaged by the worst drought in 60 years.

Turkana, nestled in north-west Kenya, has been hit hard by the drought. Two years of scarce rains have resulted in the driest season since 1950. The effects of the drought look set to continue into 2012. Loss of pasture and water has led to the death of thousands of cattle, a main source of livelihood for pastoralist communities, who are most affected by the drought.

“I lost half my herd of goats this season; I have been here 55 years and lived through many droughts, but I have never seen things this bad,” says Ereng Nangiro, one of the 12 million people affected.

Weak health systems

Sprawling empty arid land stretches for miles. The nearest health centre is kilometres away, leaving pastoralist communities in remote areas of Turkana vulnerable. With limited access to safe drinking water and basic health care, water-related diseases like diarrhoea and cholera are ongoing challenges.

Worldwide, around 1.1 billion people lack access to improved water sources and 2.4 billion have no basic sanitation. Water-related diseases are a leading cause of preventable deaths around the world, and are among five major causes of death in children under the age of five. Such diseases can be successfully treated with oral rehydration solution and antibiotics, but in regions like Turkana, health centers are rare, and those in existence lack basic supplies.

“My nine children are consistently suffering from akirem (diarrhoea),” says Ereng.

Health promotion

Erengs’ is one of many families that have received not only health and hygiene promotion education, but also diarrhoeal treatment from one of the International Organization for Migration’s (IOM) mobile rapid response health teams.

In partnership with Kenya’s Ministry of Public Health and Sanitation, equipped with basic commodities including re-hydration sachets, chlorine water treatment tablets, de-worming tablets, and medication for eye infections, IOM’s mobile rapid response health teams go to the hard-to-reach migrant and mobile communities in Turkana to distribute much-needed medication and conduct mass de-worming campaigns.

IOM is also running health and hygiene promotion talks, believing that small changes can have a big impact. Keeping in mind sustainability and cultural sensitivities, the health promotion campaign complements local knowledge with indigenous solutions. For example, communities are encouraged to wash their hands with ash, a local disinfectant that is free and easily accessible. 55,000 vulnerable members of the community are being targeted for IOM’s outreach.

Mobile health teams have proven to be more effective than static health facilities owing to the nomadic culture of communities in Turkana.

In 2010 and 2009, IOM dispatched four mobile rapid response health teams on similar missions to crisis-affected communities in Kenya’s Rift Valley, Western, and Nyanza provinces that were struggling to prevent and fight against water-related diseases. Over 492,000 people benefited.

According to Grace Khaguli, Field Coordinator for IOM’s Emergency project in Turkana: “Due to the scale of the drought, water is much harder to come by. This makes people more inclined to drink dirty, unsafe water. The situation is now more critical than ever. The worry is residents use contaminated water, and the area has very few toilets, which contributes to improper waste disposal. Lack of water is the main driver of epidemic water-related diseases.”

Senior Elder Echepan Ngelecha, a community leader in Nadapal Village, northern Turkana, says: “In our culture, we divide illnesses into those caused by God and those caused by Ngidekesiney ka ekapilan (witchcraft). Thanks to IOM, we are now aware that we can do certain things to prevent illnesses. This partnership needs to be continuous because it takes time to change behaviour, like remembering to use ash when we wash our hands in order to prevent spread of diseases.”


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Region: Kenya, Horn of Africa
Theme(s): Migration, Health, Drought

The author is a health communications consultant. Follow her on Twitter [@msanyuosire] & keep tabs on tips she shares with health communications officers by "liking" my facebook page [Mary-Sanyu Osire].

Food for thought ...

This morning, I was reading through a certain INGOs 2011-2015 national health strategy document, and stumbled upon this:

"Most countries in Africa continue to experience the loss of a sizeable number of highly skilled health professionals by their migration to developed countries.

The total cost of educating a single medical doctor from primary school to university is approximately US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment.

The total cost of educating one nurse from primary school to college of health sciences is $US 43, 180; and for every nurse that emigrates, a country loses about US$338,868 worth of returns from investment (Kirigia, 2006)."

An Aid Worker's Diary

I recently visited the largest refugee camp in the world on a Migration Health reporting assignment. Bottom line: I am persuaded that when it comes to health systems in displacement settings, "almost" does not count. We need comprehensive, equitable, convenient, migrant-friendly strategies that address the needs of EVERYONE - not a few, or the majority. To view my picture story, feed this URL into your browser:
http://www.flickr.com/photos/marysanyuosire/6041608118/in/set-72157627430341760

IOM Iraq facilitates cross-regional meeting between health officials in Iraq, Jordan and Kenya

by Mary-Sanyu Osire

Almost eight years after the U.S. military occupation, Iraq struggles to cope with large-scale displacement and pressing humanitarian needs.

In an effort to build Iraq’s capacity to deal with the complexities of addressing the health concerns of so many internally displaced people, the International Organization for Migration (IOM) helped to facilitate a high-level cross-regional meeting between National Tuberculosis (TB) Control Program senior management staff from Iraq, Jordan, and Kenya.

The meeting, held in Jordan on May 2011, provided an opportunity for the health officers to share knowledge on managing mobile populations, effective border-control methods, and ways to prevent the spread of TB and other infectious diseases.

Iraq struggles to cope with large-scale displacement. PHOTO/IRIN

In 2011 alone, IOM Iraq has successfully provided health screening, care, and treatment for 12,000 displaced migrants who have been selected for resettlement to the US. This marks a significant increase from the 5,000 migrants who were screened by IOM in 2008.

IOM in Iraq has 35 health staff who work in a clinic within Albitar hospital, one of the leading health centres in Baghdad, Iraq’s capital city. In addition to migrants who have been accepted for resettlement to the US, IOM staff carries out health assessments for migrants traveling to Canada, Australia, New Zealand, Ireland, Finland, Austria, and France.

IOM’s health assessment program in Iraq is being run in close partnership with the Government and partners in the private sector.

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Region: Iraq, Middle East
Theme(s): Migration, Internally Displaced Persons (IDPs), Health

The author is soon to be one of East Africa's most revered Migration and Health communications officers. Email her on: msanyu@yahoo.com

SOUTHERN SUDAN – Addressing health concerns of scattered populations of Jau

by Mary-Sanyu Osire

Jau / SOUTHERN SUDAN, 02 July 2011 – The International Organization for Migration estimates that in the past month, 3,700 people have fled Jau, a small border town sandwiched between northern and southern Sudan.

Brief history of the region

The conflict in Sudan has been a long, convoluted civil war that recently culminated in a referendum that saw the southern region of the country overwhelmingly vote to secede from the North.

On the eve of preparations to mark the South’s Independence Day, pockets of resistance have sprung up across southern Sudan. Seven former army officers in the ruling southern Sudan’s People’s Liberation Movement have now turned the gun’s barrel against the movement, citing irreconcilable differences pegged to corruption and nepotism.

Displaced populations and health

According to a recent study that was commissioned by the British Broadcasting Corporation (BBC), “chronic and sustained human flight” is a major factor that contributes towards Sudan being one of the most unstable nations in the world.

Amnesty International paints a grim picture of the situation: “Sudan has the largest population of internally displaced persons in the world.”

The UN Office for the Coordination of Humanitarian Affairs places the figure of displaced persons in Sudan at four million.

Internally displaced southern Sudanese sleep on the floor of a church in the village of Mayen Abun, southern Sudan on Thursday May 26, 2011. Photo: Peter Muller / AP

Migration is a social determinant of health because mobile populations are often unable to enjoy the quality of health care that is at the disposal of static communities. For the Jau, the problem is compounded by the fact that displacement camps like the ones they have fled to are more susceptible to outbreaks of infections like cholera, tuberculosis and meningitis, which are highly contagious and thrive in crowded settlements with collapsed social amenities.

However, as the International Organization for Migration points out, it is important to note that not all migrants and mobile populations are equally at risk to adverse health: “It is not the movement per se that makes these migrants vulnerable, but rather the way in which they move and the context in which movement takes place. For example, separation from family, alcohol use and a lack of effective prevention programming may drive risky sexual behavior thus fuel HIV transmission in displacement camps.”

Such disparities between the needs of static and mobile populations are the primary reason why some countries have implemented specialized health care systems for highly mobile segments of their population. For example, the Ministry of Public Health and Sanitation in Kenya has mobile health teams and roaming health centres that attend to health concerns of nomads in northern Kenya.

The Way Forward

A concerted effort is required to ensure that the new government of southern Sudan incorporates the unique health concerns of mobile and migrant populations in its national health strategy. This would involve measures like drawing up policies and strategies that address these needs, carrying out research to establish gaps that need to be bridged, implementing health promotion activities and bolstering service delivery.

“Migrant friendly” health systems are essential because mobile groups like traders, truck drivers, pastoralists, and in this case the displaced populations of Jau do not live in isolation. They are part of the community and as such their health status has an impact on the community at-large.


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Region: Africa, Eastern Africa, South Sudan
Theme(s): Migration, Internally Displaced Persons (IDPs), Health

The author is a humanitarian analyst and she writes on migration health. Email her on: msanyu@yahoo.com