Nairobi Perspective: Lessons from the East African bush

Abstract

The goals set at the Alma Ata Conference--community health care water and sanitation schemes mobile rural clinics for nomads and nutrition and immunization programs--are being implemented in the Kenyan bush by the African Medical and Research Foundation (AMREF). AMREF currently has over 100 projects underway in 5 states in East Africa a staff of 600 and an annual budget of 10 million pounds. Among AMREFs 24 projects in Kenya is the Turkana hydatid control effort. A community research program launched in 1976 in this nomadic group uncovered the epidemiology of hydatid found that it could be diagnosed by ultrasound and serology and demonstrated the effectiveness of treatment with albendazole. 10% of tribe members were affected by the disease which was spread through the practice of having dogs clean up infants bowel movements. AMREFs mobile clinics include not only nurses parasitologists and laboratory technicians but also an anthropologist charged with devising ways of getting the tribe to abandon this tradition. AMREF has been able to establish community-based primary health care among another nomadic tribe the Maasai because this group is large enough to have base to which the adults return and the young and elderly never leave. Here community health workers are attempting to reduce the prevalence--now at 60% of village children--of trachoma. This infection is spread by contaminated drinking water and flies that are drawn to the huts constructed of cow dung and branches. Most successful has been a primary health care project among the Kamba in Kibwezi which includes monthly training for birth attendants construction of pit latrines community-based contraceptive distribution clean water projects a scheme for the rehabilitation of the disabled a health center and an information office to collect data on unmet needs.