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 water projects.

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 year.
"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 highly contaminated.

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 people.
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 crop production.
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 doing this.
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 harvest.
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 eat
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 of weeks.”
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 children.
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 salaries overseas.
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 agriculture.
The drought hit hardest the poor and most vulnerable, especially those already weakened by HIV and AIDS and too sick to work for food.
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 do.
"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 be effective.