I would like to propose a strategy to my colleagues who will be leading a new venture for East Africa, a Health Clinic to educate, test and distribute contraception. The country I have chosen is Kenya that is located in East Africa. Kenya, which is about 580,367 km2 (224,081 sq mi), is surrounded by many important countries that are of our interest with respect to the purpose we are moving this health clinic to East Africa. As we all know and are aware of the fact is that majority of the countries in East Africa are affected by poverty, illiteracy and lack of basic human needs. Contraception can play an important role in helping the people of Kenya understand the reason of small household and how they can maintain it.
In order to be successful in our mission, it is necessary to not only setting up a Health Clinic in Kenya but also to run and make it useful for the people there, we need to understand some basic facts about the country and how those specifics can benefit us.
First of all, Kenya is a democratic country with a President being the head of the State and the government. Executive power is exercised by the government while the legislative one by the government and the national assembly. It is important to know that with Kenya being democratic, we can maneuver easily if not efficiently in the country and deal with the government. Had Kenya being an autocratic state or led by a dictator, we may not be able to understand how the daily state of affairs work. Our people on the ground would face difficulties in knowing who the decision maker with respect the area is.
One of the great and most positive things about Kenya is that it is an economically progressive country. The currency name is Shilling. Kenya is considered a financial hub of East Africa. It is very progressive with respect to local and foreign investment. This means that we can know for the fact that people of Kenya are broad minded people. They like and want to see their country make progress and move ahead and with their Television, Movie and Theater being very well established industry. It means that they do not mind seeing foreigners come to their country and do work as there has been some Hollywood movies made in Kenya. We can also use important and influential figures from TV, Film and Theater who are available and willing to help us promote and publicize our message.
Majority of the Kenyans are Protestant or Roman Catholic, as the message and idea of contraception can be offensive to them, we can understand that as we also come from the country that has similar religion as its majority use the necessary precautions and persuasive arguments to spread the point of contraception in a way that will not cause controversy or hurt anyone’s feelings and sentiments.
The culture of Kenya could work in or against our favor depending how we perceive it. Firstly, Swahili is the national language while English is also spoken widely amongst the educated. We may have to know the basics of their national language or find a local worker who can help us in this regard. The culture of Kenya is very mixed so much so that we cannot locate or pin point one thing that makes them stand out or help us identify them. Kenyans are renowned for their elaborate upper body adornment and jewelry. Kenya has diverse culture due to several pastoralist communities of north and different communities in central and western regions. It has about 42 different ethnic groupings, each of them with its own unique culture. However, majority of the culture have close resemblance in the language and cultural practices.
Firstly, we have to know and understand the basic of majority if not all of the ethnic groupings so that we can understand their customs and norms. Secondly, we have arranged public meetings or gatherings where we can extend our message, education and information about the service. Since Kenya is different and overall a diverse experience with respect to climate, culture and lifestyle, it is important that we do not rely on the people of our staff that we take with us. We need to hire and gather people from locality, educate and employ them so much so that they can take the message and significance of contraception to their locality and extend it further.
The crude birth rate is approximately 50 in Kenya. The country faces similar issues with respect to its neighboring countries as it is still underdeveloped. However, the good and most unique thing about Kenya is that it understands and accepts its problem of rapid population. Kenya knows for the fact that if its population continues to grow in similar fashion, not only it will not be able to correct and fix its problems but also may halt the economic progress that it is already making in the world market.
“The study shows that although a solid majority of adolescents appear to have received information on reproductive health, the quality of the information is generally low. Fewer than 8 percent could correctly identify the fertile period in a woman's menstrual cycle. A substantial proportion of the population surveyed, more than 50 percent, is sexually active, having initiated intercourse sometime between 13 and 14 years of age, on average.
In spite of a general disapproval of premarital sex (but approval of the use of contraceptives among the sexually active), most of the sexually active population--89 percent--have never used contraceptives. The many contradictions between attitudes and practices pose serious questions and demonstrate the need to reexamine the programs (and policies) that provide access to reproductive health services to adolescents in Kenya.” (Ajayi, Marangu, Miller & Paxman, 1991).
Kenya has made several efforts in the past with respect to contraception and family planning. The Ministry of Health began to provide free services with respect to family planning since 1968. They have made several in roads and received several funds from the government to help its cause. We can also benefit with this and get the help of the government as it is willing to use contraception and family planning to fix its problem of population growth. Our Health Clinic can also get the necessary help if not the funds from the local authorities to help understand the environment, understand how to communicate with the people when telling them on the issue and set up the clinic.
One important point to note here is that when going about in communities with respect to contraception, its message and test we need to focus on tribes that are large in number. Majority of the government and/or non-government services or movements did the same when talking about family planning. They have faced or have cautioned people of our interest and business to stay away from nomadic tribes that move from one place to another. According to them, we may not be welcomed and face difficulties.
Moreover, it costs too much to move from one place to another with the tribes and with the change in climate and unfamiliarity with respect to the location, our staff may face uneasy and could get sick with the different environment altogether. That is why, it is necessary and best to start off at a place that has large number of people or is of a large tribe so that we can not only settle at the place but attract and connect with large number of people and spread the knowledge and information of contraception.
“The findings show that attitudes are changing toward age at marriage of 22 for women and 25.5 for men (women's responses); men's recommendations were lowers, and the lower educated nonstudents reported a lower age versus higher educated nonstudents. Age at birth of first child paralleled age at 1st marriage. Desired number of children was 4-5. In contract to the attitudes expressed, prior surveys of women 15-19 years old showed 75% married in these years.
Current fertility is 8.1 children with most 1st births before age 20. This study also revealed a lack of knowledge of reproductive health, with less than 1 in 10 recognizing the fertility cycle, and only 50% knowing the pregnancy could occur at 1st intercourse. Knowledge appears to increase with level of education. Knowledge of at least 1 modern contraceptive was 75% and the majority approved of use, but actual ever use among the sexually active was 11%. The reasons given for nonuse were lack of information and difficulty in contraceptive access. 60-65% disapproved of premarital sexual relations, yet 51% reported sexual activity.
The mean age of 1st experience was 13. Currently distribution of contraceptives among adolescents is disapproved of at the policy level. Abortion was not approved of, and it appears abortion is used in order to remain in school. A variety of educational approaches is suggested and 6 challenging questions are posed for those who implement policy. As the shadow of AIDs lengthens perhaps the issue of adolescent contraception will received proper attention.” (Mulupi, 2010)
As mentioned earlier about the economic progress of Kenya, it is important to know that mobile phones are very common over there. There is an active campaign in Kenya about spreading the message of contraception. This could be our major weapon in getting the message across. This tool not only with spread the message in large number in a snap of time but will not be costly with respect to going to one place to another. We can have a text message crusade where we go on to give messages to the population of our area about the need and basic information of contraception, tell them about our clinic and our services.
“The m4RH service provides users with automated information on family planning and other reproductive issues via SMS text messaging. With an estimated 20 million mobile phone subscribers in Kenya, the FHI project has the potential to reach a considerable number of people, if successful. FHI is implementing the project with a number of partners, including FHI’s PROGRESS project, USAID, Family Health Options Kenya (FHOK), Marie Stopes Kenya (MSK), Text To Change (TTC) and the Ministry of Public Health and Sanitation.”
To maximize participation in the service, FHI has been distributing promotional material in Nairobi through the health facilities operated by FHOK and MSK. Plans are underway to distribute the promotional material through universities, salons and areas where women and youth frequent. Ochieng explains that because male involvement in family planning is limited in Kenya, the service is more likely to be productive by targeting women.
“We have distributed 5,000 promotional write ups including flyers, palm cards and posters to promote the services. From May to August we received over 2,000 SMS hits .We are now analyzing the data to ascertain how many SMS’s came from unique numbers to find out how many people have used the service,” said Ochieng. (Mulupi, 2010)
It is common sense that we cannot be fully prepared of the situation in Kenya, but we can be knowledgeable as much as possible with respect to the basic needs and requirements of the area. The information and facts mentioned above can give us the jump start to set up the Clinic in Kenya and with the necessary information, our staff can know the fundamentals of how they will be living, behaving and conducting themselves in the best manner that is most productive in our cause and off course with more time spent in the country, our staff will be more experienced and will learn from their practice.
People cope with life’s uncertainties, especially mortality and disease, using medicine. Medical science uses not a sacred but a profane approach dealing with the ordinary, commonplace and secular. The poor suffer more health problems than the rest of the society as a result of low quality health care, more life stresses, and fewer coping resources.
Functionalists claim that the health care institution helps maintain a strong workforce, but conflict theorists argue that it has historically shifted the blame for ill health from the environment to the oppressed poor and through medicalization has extended its control over ever more parts of society. Even today, medical science focuses on the individual’s responsibilities for sickness rather than social causes. The capitalist system causes the health problems, but uses the medical institutions to escape blame and even profit from them. Suggested alternatives include more government intervention and greater consumer education.
Clinical care of patients are become more and more challenging with the passage of time. At the same time hospitals face difficulties in providing quality health care service in present economic condition. Thus, in such scenario,it is not only an important and successful attempt, but noble, important and necessary as well. With the current state of affairs and stats regarding the population and situation in Kenya, it is very important that we set up this business as soon as possible.