Kenya – Climate Change Water Crisis Impacts Hospital Maternity Care
Author: Womens UN Report Network
Date: July 5, 2010
WUNRN
Women News Network – July 13,
2010
Article Includes Video.
Kenya – Climate Change Water Crisis Impacts Hospital Maternal Care
Kakamega, Kenya: At the Kakamega Provincial
District General Hospital, located in Western Kenya, access to adequate and
clean water still remains a pipe dream. Even though the need is critical the hospital, which works with maternity
medicine and birthing procedures for women, still lacks an adequate plumbing
system for water. These conditions and others are only made worse by frequent
and severe water shortages in
“One-third of the people in
impacts of droughts,” predicted the World Water Forum in 2000.
The Kakamega’s hospital staff admits that
problems of water shortages are common. Because of this, women and children are
especially vulnerable as they face the destructive effects of unsafe water. “As
women constitute the largest percentage of the world’s poorest people, they are
most affected by these changes. Children and youth – especially girls – and
elderly women, are often the most vulnerable,” says BRIDGE, a research and
information program that is part of (IDS) the
Studies
Knowledge Services.
With the negative effects of climate change
rising, experts predict that the biggest challenge in the coming years for a
majority of the world’s people will be the ability to access clean, healthy and
safe water. Should access to clean water be considered a human right?
Rights defenders worldwide answer with a
strong, “Yes!” Even though the consensus agrees, water figures currently show
that resources and water supplies are declining quickly as global temperatures
continue to rise and water sources are literally beginning to “evaporate.”
Twenty year old, Hellen Wasiliwa, from the
western part of
went to the hospital so her birthing process would be monitored by medical
staff for safety and assurance. But things didn’t work out that way. After
giving birth she quickly developed typhoid fever, an often fatal waterborne
disease, as a result of her exposure, while she was in the hospital, to
untreated and unsafe water.
many of its hospitals, a condition that is unimaginable in most hospitals today
in the developed world. But conditions are shifting. Three fourths of all
Kenyan hospitals have inadequate and/or below standard facilities for both
drinking water and water used for sanitation and medical needs. Out of 160
medical centers across the country, a staggering 120, currently do not have
consistently working plumbing systems. Why? The reasons are varied.
Those who face the greatest impact in
who’s health conditions are usually compromised during pregnancy and severely
compromised during childbirth. According to statistics from the United Nations
Development Program (UNDP), adequate water is becoming scarce. More than 2.5
billion people and almost one billion children worldwide live today without any
basic sanitation.
Experts in
serious threat to the health of expectant mothers. Ranked 50th in the world in
maternal and child mortality, UNDP statistics show that
facts are clear. Climate change, water supply and sanitation play a responsible
role in many of these deaths.
Animal Waste / Human Waste
Human contact with polluted water often
includes wide exposures to bacteria, viruses and parasites as well as chemical
contaminants. The list of dangerous waterborne pathogens is long and extensive.
Human and animal waste in water is the most common contaminate. In industrial
regions, chemical contaminants are also an ongoing contributor to pollutants.
Hospitals, like
often forced to collect rain water in buckets to meet the needs of their
patients. Due to severe shortages, the limited water supply is usually shared
among patients and is also most often not purified or disinfected. Lack of
hospital supplies, proper procedures in sanitation, proper equipment, poor
plumbing and facilities, along with less than adequate sanitation training for
medical workers and assistants, as well as patient knowledge, contributes to an
abysmal mismanagement of water in the region.
Conditions are in a crisis. The dangers of
pathogenic contaminants are impacting the operations of hospitals region-wide
in
Kakamega township is only one of the areas recovering from a harsh 2009
cholera outbreak that claimed hundreds of lives in just one week. Surprisingly,
a number regional outbreaks of fatal cases of cholera, “originated in the
hospital itself,” explained Dr. Shanaz Sharif,
“Typhoid and paratyphoid fever are most
often acquired through consumption of water or food that has been contaminated
by feces by an acutely infected or convalescent individual or a chronic
asymptomatic carrier,” says Eric Mintz of the U.S. CDC – Centers for Disease
Control and Prevention.
“After giving birth we had to share (the
same) bathing water between seven women,” admits Hellen Wasiliwa describing the
days she spent in Kakamega’s hospital. “As a result, I developed a skin rash
and got typhoid. I was then re-hospitalized and my bills became very high,
despite the poor services. E-coli parasites then began to eat up my internal
organs. I almost died,” she said.
Like all other hospitals and health care
centers in
Rampant Mismanagement
Overcrowded conditions create more risks.
As more women patients are admitted than the number of beds allow, stress to
many hospitals increases exponentially. In hospitals the price of medical
treatment can be prohibitive. A majority of hospital pregnancy wards are still
charging more than most poor women can pay, approx $17- $40 USD, just for
admitting a woman as a new patient. This keeps many women who may wish to have
standard medical services out of hospitals all together.
On top of the fee to admit a patient, a
daily bed fee – plus a much higher and separate fee for medical procedures
during delivery – keeps women who make less than $2 USD per day far away from
any opportunity for medical treatment — unless they are in a critical need. In
certain hospitals, those who cannot pay have been known to lay on the floor
during their hospital stay while beds go to paying patients.
Finding it difficult to share her
experience, Wasiliwa led me from Kakamega’s hospital to her homestead while we
talked about her situation. Along the way, she revealed that her newborn son
had also developed typhoid as a result of eating food cooked with contaminated
water that contained bacteria and parasites.
According to medical evidence, water borne
parasites and bacteria can destroy the intestines, resulting in extreme pain
and possible death if medical attention is not given immediately. I felt that
Wasiliwa, and her newborn, were very lucky to have survived an ordeal that many
expectant mothers continuously face.
Some Kenyan rural hospitals have blamed
government mismanagement and misappropriation of funds that have been channeled
to hospitals in urban, instead of rural, areas as some of the causes for their
problems with water.
“The health workers did not seem to care,”
continued Hellen as she described the hospital in Kakamega. “At one point, I
noticed a nurse laughing at another woman who had just given birth. It was not
a nice experience. I and my baby had to be airlifted to
good Samaritan paid my hospital bill.”
“In
patient who had just given birth since the water shortage and drought has been
so very severe. She was very weak and sickly. I felt bad, but I had no power to
help her. She was then taken to a hospital in nearby Kisumu by air to receive
specialized treatment,” said Hellen Wasiliwa.
In 2007, the
production. It had zero people receiving safe drinking water. In addition to
this, massive problems in hospital management were wrapped in water needs of up
to 180,000 litres per day. The hospital had obvious challenges, opened since
1916, it suffered from frequent equipment break downs, along with long periods
of time when only enough water to use was saved for “essential services.”
“Non-piped water supplies, such as roof
catchments (rainwater harvesting), surface waters and water collected from
wells or springs, may often be contaminated with pathogens,” says WHO – the
World Health Organization in a May 2009, Guidelines for Drinking Water – Water
and Sanitation report. “Such sources often require treatment and protected
storage to achieve safe water,” continues the report.
Can Improvements Be Made?
For women, the sub-standard conditions at
the medical experience of a hospital setting and were in need of prenatal and
neonatal care. Outdoor latrines were used, sheets were not provided for beds,
polluted river water was purchased from vendors to use for cleaning and doctors
and nurses had little water to use to clean their hands after treating
patients.
Today improvements are being made. The
picture is drastically changing. Medical health care has improved in the region
as concentrated international efforts brought water to
people were receiving drinkable water. In 2008, over 3,000 people were
receiving drinkable water daily, although there has been much need for expanded
improvement of the original hospital building and plumbing as ongoing needs and
drought conditions continue to impact the region.
One of Hellen Wasiliwa’s nurses back in
remains a serious problem at the hospital where she works. To the nurse the
problems have appeared because of “mismanaged” funds. “This hospital for some
reason has not paid its water bill for the last 6 months,” she said. “As a
result, the water connection has been cut off since then. Money that is
supposed to be used for (hospital) necessities also has gone to some people’s
personal pockets. It is very unfortunate and a grave matter.”
Connection pipes for water at
renovations in order to meet proper health standards. Acknowledging Hellen
Wasiliwa’s medical woes, the nurse emphasized the severity of the situation
since Hellen developed several serious bacterial infections as a direct result
of drinking and using unclean water while she was a patient in the hospital.
“Her (Hellen Wasiliwa’s) case was
unfortunate. Because of this, we (
Dentists Board.” The Medical Practitioners and Dentists Board functions
partially as a watchdog group to offer Kenyans the most “effective and
efficient medical services available” by ensuring medical practitioners (and
dentists) are highly qualified in their profession.
“Most of my (hospital) colleagues are under
investigation now, including myself,” added the nurse. “The board is wondering
why such a situation in a major hospital has gone unreported; even after a
cholera outbreak originated from this facility. I do not take responsibility
for that, but only time will show the outcome.”
Even with numerous cases of newborn
diarrhea that have been charted and still remain high in many regions in East
and
trend. In Sub-Saharan Africa, medical treatment for diarrhea is usually given
only approx 12% of a hospital’s working budget, as hospitals battle with more
than half of their patients who suffer from fecal-contaminate related disease.
After pneumonia, UNICEF statistics show
that waterborne diseases such as cholera, amoeba, e-coli and typhoid are the
second leading cause of death for children over 5yrs of age. Waterborne disease
has been documented as the, “leading cause of death,” among African infants and
children who are younger than five years of age.
Due to a growing water shortage and the
widespread occurrence of water related disease, pregnancy in
blessing for many Kenyan mothers. Increasing scarcity of water and lack of
water hygiene continues to present grave challenges for women who give birth,
some who do end up dying during or after child birth because of an avoidable
break in hygienic safety. The numbers of deaths and the numbers of women and
children who have contracted waterborne disease is often not adequately charted
or reported.
Forty-three Percent Without Access to Safe
Drinking Water
Pumwani Maternity Hospital, in Kenya’s
capital of Nairobi, is the largest maternity hospital in East Africa. As a much
more modern facility, it has all the right equipment with an adequate supply of
water most of the time. But regular disconnections in the hospital’s water are
still common; especially when bills, running in the region of $50,000 USD per
month, aren’t paid on time. It’s obvious that water shortage has lead to
increases in the price of water, a fate that can cripple the operations of many
hospitals.
The situation of water safety is critical.
“Forty-three percent of the population of Kenya is without any sustainable
access to safe drinking water,” says a 2006 UNICEF Africa report. Because of
this the odds against women for safe procedures in hospitals run against them.
Maternal mortality is a real and looming possibility even when medical care is
supervising. Shortages extend to more than just water. A need for more trained
doctors and medical personnel for non-urban Kenyan hospitals is ongoing.
“We need a better understanding of why so
many mothers die during child birth,” said former Kenya World Health
Organisation Country Director, David Okello.
27 yr old, Jane Kisia, delivered her child
at Nairobi’s, urban centered, Pumwani Maternity Hospital only eight days ago.
Despite the fact that Pumwani Hospital has adequate facilities , the hospital
ward remained without water for more than a week while Kisia was a patient
there. Due to these extreme hardships Jane’s newborn daughter developed a
life-threatening case of diarrhea.
“My daughter developed serious medical
complications,” said Jane. “We called public health officers to the hospital.
It was only then when my sanity was restored,” she admitted.
“Last year alone, more than 7,000 Kenyan
children (under five years old) died from diarrheal diseases,” said Dr. Francis
Kimani, Kenya’s Director of Medical Services. “Most through eating contaminated
food and lack of access to basic hygiene and sanitation.”
Water safety implementations are playing a
direct and key role in controlling unwanted disease and deaths in
Facing Responsibility
“While there is no magic bullet that solves
all maternal health problems, the great majority of maternal deaths can be
prevented through simple cost-effective measures, which can be implemented even
where resources are scarce,” says Women Deliver, an international advocacy
organization working to raise reproductive dignity and health for women.
“Yes, there is a history of water shortages
in most of the 160 (officially registered) hospitals in
are (now in the process of) renovating more than 100 hospitals in the country
as the government invests more than 800 million USD for renovating facilities.
Aimed at improving medical services, the renovations are extensive and should
be complete by mid 2011,” added the Director.
Additional 2011 funds from the World Bank,
up to 200 million USD, are planned to help
health institutions across the country. At the same time,
help implement the project. Other NGOs like The Rotary Club (Colorado, U.S.)
are helping individual hospitals, like the Kisii District Hospital near Kisumu,
where sagging plumbing systems are coming up to standards as they help get
water “on the agenda.”
“Sewage contaminated water used for
drinking, washing or preparing foods, is a significant form of indirect
transmission, especially for gastrointestinal diseases such as cholera,
rotavirus infection, cryptosporidiosis and giardiasis,” says a recent 2010
report by the U.S. based leader in the field of science education, the BSCS –
Biological Sciences Curriculum Study, that currently works under the U.S.
National Institutes of Health and the National Institute of Allergy and
Infectious Diseases.
Like countless other women in
face the challenge of living in an environment where low water hygiene and
“climate change provoked” water scarcity surrounds her. She is not the only one
impacted by this. In her own household she lives together with her extended
family — including her parents and other relatives.
Even though Hellen has given birth recently
she has little time to rest and regularly makes a two hour trip, each way, to
fetch water for her household. When she reaches her destination the water she
gathers is in decline and often unsafe for drinking.
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