By Seth Munson
We met Agatha Ganira our first day volunteering at the Friends Hospital Kaimosi in Western Province, Kenya. Agatha’s friendly eyes and warm greeting put Emily and me at ease after we had spent two very long days in planes and airports on our way to East Africa from Colorado.
As we stood with Agatha in front of the hospital’s Comprehensive Care Centre (CCC), I was struck by both her unassuming reception of two complete strangers and the humility with which she described her work. “I am the coordinator of the CCC, which aims to provide services for people living with HIV/AIDS in the area,” she softly explained.
With 1.5 million people in Kenya infected with HIV (166,000 new cases reported each year), it is a giant task to teach people about prevention, conduct HIV testing and provide sufficient health care and support for the community. Add to this challenge helping those in the community overcome the fear, denial and discrimination associated with a positive status — many are isolated from their family and loved ones because a severe stigma surrounds the infection. Finally, multiply the work to be done and misguided views about HIV with the fact that many cannot afford adequate treatment and have nowhere to turn for help.
Agatha is not deterred by this mountain in front of her. “I’ve always wanted to help people … as a first born I helped my mother raise our family. Then I became a Girl Scout in school and learned how to provide first aid assistance to others. Outside of school, I wanted to help people carry heavy things, give up my seat for the elderly and direct people who needed help.”
Beginning in 2008, when Agatha became CCC coordinator at Friends Hospital Kaimosi, a typical day has consisted of greeting a large crowd of 30-40 patients who come to the CCC, taking their vitals, consulting with them about their health care needs, counseling them on positive living practices, providing antiretroviral and other medicines to fight the virus and referring them to the hospital for other services. In addition to treating current clients, Agatha also goes out into the community to find those needing assistance — people who may be too intimidated to come to the clinic for testing or treatment.
“I have to be a multi-tasker,” she says with an energetic smile. “My strict mother taught me responsibility from an early age. To get the job done now, I try to assist as many people as I can. I also provide training to new employees at the clinic so that we can expand our services.”
She estimates that services provided by the CCC reach community members within 20 kilometers of the clinic. When I asked Agatha about some of the challenges faced by the CCC, she replied, “Some people walk very far. People can be very sick and in need of more medical attention than they are receiving. Because they are sick, they are often out of work and don’t have money to take care of their medical needs.”
In a never-tiring effort to extend the reach of the clinic, a vital part of Agatha’s work is to train volunteers to become advocates for people living with HIV/AIDS. Many of the people Agatha trains as advocates are those who have a positive HIV status themselves. Agatha proclaims, “They are really the best people to help. Members of the community who have HIV best understand how to extend help and reach out to others who may be too afraid to come forward.”
Agatha explained that many of the people she trains as counselors, she also advises on how to educate the community on forms of HIV transmission. “There are a lot of religious and cultural taboos associated with sexual behavior, but we need to inform the community that they can be at risk if they are not careful.”
A key way in which Agatha breaks the horrible practice of discrimination against those with a positive status is to work with leaders in the community. “It’s not easy to break the stigma, but one of our best methods to change behavior is by working with a group of people who community members listen to.” Agatha and the CCC staff frequently train religious leaders and teachers on how to be supportive of people living with HIV/AIDS. “It is a good sign that we are seeing an increase in the number of referrals to the clinic from churches and schools,” Agatha mentions. The number of HIV infections in Kenya peaked in 2000, but since then has been dramatically reduced, partially due to increased education and awareness in the community, stemming from the hard work Agatha and many others are doing.
Agatha is an eternal optimist. “We have a long way to go, but it inspires me to talk to people who haven’t given up, to see clients accept their status and be hopeful about their lives.” Until recently, HIV was a death warrant for many due to the high costs of treatment and shortage of medicine in the country. Although the complete suite of drugs available in developed countries is lacking in Kenya, a few antiretroviral medicines that attack the virus are being used at the clinic with effectiveness.
“The Kenyan government provides a minimum. We still lack the money to pay for many of the drugs,” Agatha explains. For example, many lack the funds to treat tuberculosis and other illnesses associated with a suppressed immune system as HIV develops into AIDS. Aware of these setbacks, Agatha relentlessly scrambles around the clinic grounds making sure her patients are receiving the best possible care the CCC and hospital can provide.
Despite the strong impact Agatha’s work is having on the health of the community surrounding Kaimosi, I was shocked to learn that the CCC is entirely funded by the hospital and does not have a permanent source of funding to keep it running in the future. Like all HIV/AIDS programs in Kenya, the drugs and services are provided free of charge to the patients. However, most programs in Kenya are generously funded by donor organizations. Kaimosi Hospital’s clinic has grown through the sheer determination and commitment of the hospital staff.
Some of the biggest challenges facing the CCC result from the absence of donor support. Staff salaries are embarrassingly low; drugs and supplies are sometimes out of reach; the hospital lacks a critical piece of laboratory equipment — a CD4 count machine to measure viral load and determine the appropriate antiretroviral dosing.
Even with the noble efforts of Agatha and the CCC, many Kenyans are not being reached with HIV prevention and treatment services. The World Health Organization estimates that just under half of adults who need treatment and only one in five children needing treatment are receiving it. This leaves a lot of work to be done to meet the goal of providing universal access to HIV treatment, prevention and care.
The afternoon before Emily and I returned to the U.S., we sat around a table with Agatha and the hospital administration. Already having put in a full morning at the clinic, Agatha is leading an effort to make sure the hospital is up to date on its equipment and medicines by going through a checklist with everyone. Although Agatha is an astute listener and slow to speak, she is a natural leader and is well respected among the hospital staff. Going above the call of duty of her responsibilities at the clinic, Agatha frequently volunteers herself for extra work at the hospital, organizing workshops to keep members of the hospital team up to date on topics such as patient care and stress management.
As we prepared to leave Agatha and our new friends at the hospital, Agatha generously invited Emily and me to her house for dinner. Although I was already more than impressed with the work Agatha was doing at the CCC, I learned that she is also doing a fine job as a single mother, raising three of the most polite and beautiful children I’ve ever met. As we shared a meal together, I asked Agatha about her future goals in life.
“I’d really like to get more training and education to treat and counsel patients living with HIV,” she answers. Agatha is providing outstanding care to patients despite the fact she has received no formal medical education and has learned much of her work by attending trainings after she received her bachelor’s degree in Public Administration and Psychology. “Eventually, I’d like to go and help out other institutions that are just starting out and struggling to make a difference in the community.”
I think that Agatha is the perfect person to brighten the lives of people living with HIV/AIDS by teaching them that they can live with pride and dignity and enjoy a full life with the proper care.
You can help Friends Hospital Kaimosi and the Comprehensive Care Centre by sending donations to FUM, earmarked “Kaimosi Hospital.” Please consider these needs:
- Donate to provide inpatient health insurance for a person living with HIV and their family: $25 per family per year
- Support the salaries of the CCC staff: $750 per month for the whole clinic staff
- Support the community outreach and training activities of the CCC: $300 per month
Seth Munson is a graduate of Earlham College (2001) and returned to Kaimosi in December 2011 after a study abroad program to Kenya in 1999. For the most recent visit, Seth was accompanied by his girlfriend, Dr. Emily Lieder, who volunteered at Friends Hospital Kaimosi as part of an elective rotation in her family practice medicine residency program. Seth and Emily live in Colorado, attend Fort Collins Friends Meeting when they can and are grateful to Agatha, Eden Grace and the awesome staff at Friends Hospital Kaimosi for their hospitable reception.