On the streets, healthcare is a foreign concept

Reuben Mwambingu @reubenmwambingu

It is a humid mid-morning in Mombasa. With the sweltering heat triggering profuse sweating, sauntering the streets and alleys of the coastal town, feels like a punishment. The situation is made worse by the honking and hooting of cars in traffic.

But Bob (not his real name) is resting. Not even the continuous honking and deafening music from passing traffic appears to trouble the 13-year-old.

His head rests on a gunny sack stuffed with dozens of plastic bottles, Bob lackadaisically sprawls on the cabro pavement on the Msanifu Kombo street.

A haggard face and swollen eyes, signify the teenager could be unwell.

 “I have a serious headache, I experienced shivers the whole night. Let me rest. I have a task to accomplish later today…No need of going to the hospital, I can’t afford it. I will get better I am sure,” Bob says, this is not the first time he has fallen sick while on the streets but is quick to add that he recovered naturally in all his previous experiences. 

Bob’s situation mirrors a typical life of street families not only in Mombasa, but across the country and the entire globe.

The World Health Organisation (WHO) says due to exposure to harsh environments and the nature of lifestyle, street families are vulnerable to substance use which threatens their mental, physical, social and spiritual wellbeing.

“In many regions most of these children use alcohol and other psychoactive substances. In addition, these children are confronted with discrimination and view health and social services with suspicion.

Street children live a transitory lifestyle and are vulnerable to inadequate nutrition, physical injuries, substance use, and health problems including sexual and reproductive health problems,” states WHO report titled Working with Street children.

The above factors, the report says reduce the effectiveness of interventions that target street families.

According to the street families rehabilitation fund the population of street families in the country stood at 46,639 as per the national census of street families conducted in 2018.

Nairobi was leading in highest concentration of street persons with 15,337 followed by Mombasa with 7,529, Kisumu 2,746, Uasin Gishu 2,147 and Nakuru 2,005, according to the Funds programmes officer Ronald Wanda.

Wanda says currently the government through the street families rehabilitation trust fund is in the process of developing a policy that seeks to restore the dignity of street families in the country.

Government plans

And even as the government plans to roll out the Universal Health Coverage (UHC) for national sustainable development, access to affordable healthcare among street families remains a challenge.

Having been on the streets for 22 years, Robert Kariuki 31, who is a member of street families at Maboxini base in Mombasa, says the experience isn’t for the faint hearted.

He started living on the streets  at the age eight, when he was living with his parents in Rongai, Nairobi, after his relationship with his “domineering father” went south.

He recalls  at one time, he almost died after he plunged into a cattle dip.

“We were playing with other street  children at cattle dip in Rongai when I skidded into the dip.

The only person in charge of rescue was  far away and had to be called as I waited two hours later.

I was then taken to hospital where I stayed for almost a year and my parents didn’t even know my whereabouts,” he recalls.

 At the age of nine, Kariuki who is now a family man with a wife and a daughter fully joined the streets. His world revolved around drug abuse, which triggered kidney complications.

He recalls experiencing a sharp pain from one side of his back and lower abdomen after jumping off a perimeter wall near Mbaraki adjacent.

It was Elizabeth Macharia, the founder of Mothers Touch Community Based Organization (CBO), which supports street families who took him to hospital where he was diagnosed with kidney malfunction.

“The organisation cleared my Sh20,000 bill which I couldn’t afford. I was discharged and given drugs,” he says.

Besides the Kidney problem, Kariuki says this year, he battled Tuberculosis (TB) from the same streets.

“At first when I went to a medical facility in Ganjoni after experiencing a persistent cough for two weeks, I would sweat at night.

Instead of first conducting a laboratory examination to be sure, they just prescribed drugs and asked me to use for 10 days.

The drugs could not respond and the problem persisted growing from bad to worse. I experienced a sudden weight loss,” he says.

He was advised by colleagues to visit Coast General Teaching and Referral Hospital (CGTRH) where he was diagnosed with TB and commenced treatment.

Now a talented spoken word artist, a hype man and Yoga trainer, Kariuki says streets hardships have imparted in him incredible survival skills.

Kariuki’s close friend Alex Esau 29, who left the streets following successful rehabilitation by Mewa Centre Organisation where he now works, says it is regrettable that Street families in Kenya have been neglected  for years.

 “The fact that in most cases we are considered lesser humans, whenever we go to hospital we are often mistreated and that is why we are mostly reluctant to visit health facilities especially if it is not an emergency.

On several occasions we have taken our colleagues to hospital and they ended up dead,” Esau says.

Accurate records

Macharia says unavailability of accurate records and credible documentation for street families is a challenge towards helping the families access healthcare.

“Some of them are not willing to give their details. Some don’t even have ID cards, birth certificates or even notifications and therefore it becomes difficult to trace their background to help them acquire proper documentation like NHIF.

For a few of them we have been able to go with them to their home villages to start the process of helping them get these documents,” she says.

Health Chief Administrative Secretary Dr Mercy Mwangangi says the government plans to enroll street families in the programme through County Governments.

“It is expected that due to the vulnerabilities of street families, enrollment will be conducted by each county.

The families will then get access to UHC scheme entitlements including outpatient care and inpatient care,” explained Dr Mwangangi in an interview with People Daily.