Most of the children live in homes where daily earnings are less than $1 US per day. They may have only one change of clothing. One girl had no jacket but wore a bathrobe that she had found over her clothes. Shoes are a highly effective health measure to prevent cuts and subsequent infections as well as to decrease the incidence of burrowing worms and parasites.

    The shacks, which inevitable leak during storms, have no heat or light sources other than candles or paraffin. They are small, perhaps 8 X 10. There may be a chair and a small table. There may be a plate and spoon or cup for each family member but there may only be a pot and a few cups. Children may eat out of a single pot with their hands when food is served. There may be a bed, but some or all of the children may sleep on cardboard or mats on the dirt floor under the bed.. Even in winter, when the temp can drop to 40 degrees at night in Nairobi, the children may have only rags or a thin sheet for cover. Since most families sleep on the floor, incest is very common, especially in the rural areas. Family members would be very hesitant to report this behavior, since their very survival may depend on the financial contributions of the abuser.

    Water is in short supply and must be carried by hand from the nearest faucet, which is often miles from the home, even in the city. The children bathe from a bucket of cold water and may not have soap. The addition of a bar of antibacterial soap can clear up a myriad of superficial skin infections. Hands and food that are well washed can decrease the incidence of intestinal pinworms. Although there are traditional “tooth picks” which can clean teeth, toothbrushes and paste are very much appreciated. Very few children wear glasses in the slums even though they may need correction. A pair of magnifiers from the dollar store can improve the quality of life and vision for many kids and adults. Even a tube of antibiotic cream can make an improvement in overall health. A small cut that could have easily healed with a band aid and cream can become severely infected in a very short period of time, resulting in a costly hospitalization which the family can ill afford.

    The streets are filled with plastic bags containing human excrement. These are the famous “flying toilets.” Since latrines are not placed throughout the slum at regular intervals, some folks have no other options. It may cost a few shillings to use a public toilet. Toilets both inside homes and outside may consist of a hole in the floor which is flushed by water; or a latrine-type that drops excrement into a hole for decomposition. There may be no toilet paper; many use newspaper, or in its absence, nothing at all. It is not uncommon to see children with dried feces caking the backs of their shorts. The rotting feces gives rise to e-coli, dysentery,other diseases and clouds of black flies. The walkways become slippery, runny sewers after a rain with mud that sucks your shoes off. The smell does not come out of shoes or clothing. It permeates everything.

    Although there are many NGO’s which serve the slums, many folks remain underserved or are provided no services at all. The government will take no responsibility for the slums since the administration states that the land is not properly annexed to the city and the people who live there are squatters, rather than Nairobi residents. Somehow this justifies the lack of electricity, paved roads, running water, sewage and sanitation.

    Some NGO’s will assist HIV or tuberculosis (TB) patients in getting their medicines but medicines are sometimes irregularly provided. For example, Helen is a widow who has AIDS and antibiotic resistant TB but was not been admitted to the Kenyatta National charity ward because she could not come up with $50 for a bed. How could a hospital designate her indigent and then insist on charging her $50 to be admitted? Although it flies in the face of logic, the hospital triages charity cases on a first come, first serve basis, not on the severity or infectiousness of the condition; unless, of course, one has $50. Her sister, who lives in the rural “upcountry,” is the only family member who can help her. There is no such entity as a “vising nurse” in Kiambiu. Helen also has four children, is completely bed ridden and her home is so tiny that her sister and children sleep under her bed. The only other piece of furniture is a small settee. We visit her, gloved and masked, bringing her rice, porridge, cabbage, kale, tomatoes, onions and a few eggs. She’s too weak to speak but she looks into the bag and groceries and tears stream down her face.
Because of the hospital’s refusal to admit her, she has likely exposed her family and everyone with whom she comes in contact to TB. She is physically wasted, not just because the diseases are ravaging her but because she has so little to eat. Without decent baseline nutrition, it is doubtful that she will be able to keep down the antiviral meds if she is receiving them. Even if she does, her body may not be able to utilize them effectively in her state of malnutrition. Or if availability is irregular, she may develop immunity to the antiviral drugs. When she dies, she leaves four children and a sister who may well become as sick as she is. In the meantime, she is a “typhoid Mary” and there is nothing she can do about it, no doubt increasing her feelings of guilt and mental anguish.