Back in America, my friends with small children told me how incredibly difficult it can be to do, well, anything. What with all that strapping of car seats and planning around nap times and making sure you bring enough apple juice to keep the screaming to a low-to-medium decibel threshold. And I most certainly believe them. When I lived in upstate New York and drove to class/work constantly, it was a toss-up every day as to whether I’d put my coffee in the interior cup holder or simply drive off with it perched on the edge of my car’s roof. It’s probably a good thing I’m not a mother.

So it’s easy to understand how difficult it can be on rural families in Kenya to seek health care. Imagine: you’re a woman in your 20s, and have been told by a rural health worker or community elder how important it is to get the proper immunizations while pregnant. Perhaps you want to take advantage of your country’s “Sisi Ndani, Mbu Nje” (We Are Inside, Mosquitos Are Outside) program that gives free nets to all pregnant women, so as to prevent life-threatening cases of antenatal malaria. But it could be ten miles or more to the nearest clinic, which is a difficult walk in your third trimester. You could take a pikipiki (or motorcycle taxi), but that costs money, and you’re trying feed your family on 200 shillings (about $2USD) a day. By “family,” I mean you, your husband, your unborn child, and the two or three other children you already have. (The average family size in my area is six children per mother; such a brood is considered a blessing.) And if you DO decide to go, who’s going to take care of those kids while you’re waiting to see the doctor? Bringing them with you costs more money you don’t have. Not to mention: who’s going to cook that day? Who’s going to clean? Who’s going to take care of the livestock?

It has absolutely nothing to do with how much a mother loves her children, and everything to do with financial and time-related factors that can make seeking treatment for even the most serious ailments a major challenge.

So, one of the major projects I’ve been pushing for since I arrived at my clinic over a year ago is “outreach.” All government-run clinics are theoretically supposed to do them, but our clinic is fairly new, so our capacity-building efforts have been … shall we say … gradual. On paper, it’s simple: take the drugs and the doctors to a place where people can access them more easily. But as most things are, it’s logistically much more complex: what form of transport do we use? Who pays for that? What about per diems for the doctors? Where can we find a place to set up that will have enough space for a waiting crowd and enough chairs for the medical staff? How do you keep vaccines cool when it’s a-hundred-and-Dante degrees in the shade?

With the help of the USAID offshoot APHIA-PLUS, we’ve finally set up a schedule that should cover several different “zones” within our region every month. A rental sedan serves as the clowncar chariot for two registered nurses, two community health workers, one HIV testing counselor, one tireless, endlessly-inspiring unpaid tuberculosis specialist named Cony, and one overly enthused Peace Corps Volunteer (yours truly, of course). Pikipikis are hired for bring any supplies that won’t fit in the trunk (or are inevitably forgotten at the clinic during the rush to pack up) like boxes of gauze or the specially-made cooler to keep the heat-sensitive vaccine serums at a safe temperature.

Usually, these events are held at a place designed to handle crowds, like a church or a primary school, but really any place with a clearing and a tree to sit under will do. We can’t offer all the services of a clinic out in the bush – things like surgery or most lab tests are off-limits, for obvious reasons – but we do offer a varied and necessary assortment of options: HIV testing, collection of sputum (spit/snot) samples for later TB testing, general wellness check-ups for pregnant women and children under age five, assessment of thriving/failure to thrive, referrals for nutritional counseling, basic family planning, treatment for/removal of jiggers from feet, etc etc etc. One of the community health workers keeps basic data for everything we do, while the other delivers health talks to the waiting crowd about topics like water sanitation and breast health. (Several of which I brainstormed/researched/wrote. Victory is mine.)

After two events, we’ve already seen scores of children and pregnant women. Even a few men have come for HIV counseling or basic medical care. It’s not that the communities don’t care about health, it’s (again) generally just about time and access.

It’s a neat project that has the potential to do a great deal of good. I hope we can keep it up.


One of the nurses hands out drugs to treat minor ailments like respiratory infections and fevers.


The Baptist church that lent us benches and space for the outreach clinic. (Did you know I was Baptist once upon a time? Crazy old world.)


Attentive village women listening to a health talk from our TB specialist, Cony (lady at the front, in the tan skirt)


Long-Lasting Insecticide-Treated Nets (LLITNs, in development-speak) from the Kenyan government, ready to be given free to pregnant women. Malaria is dangerous. Malaria during pregnancy is double-plus extra dangerous.


A simple butcher’s scale hung from a tree branch can help assess young children for nutritional deficiencies and failure to thrive. (Not the infant pictured, though. Fat, happy, and adorable.)


An ounce of prevention: the chigoe flea, or “jigger,” can cause pain, secondary infection, loss of limb, or even death. Young children are especially susceptible, but proper hygiene – especially of the feet and lower legs – can dramatically reduce the risk of the flea getting burrowed in and laying eggs. At outreaches, community health workers provide both treatment (foot soaking, digging it out with a scalpel, etc) and preventative education.

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