Day Seven

We started the morning by heading to Choma Zone Ruiru, a 4.5 star restaurant, for breakfast. It was a nice area. We were surprised when we saw an operating car wash right next to the restaurant. This is a common occurrence here. People often get their cars washed while enjoying the social atmosphere of a nearby restaurant, combining everyday tasks with time spent around others. A manual car wash and detailing only costs about $2 USD! For breakfast, we ate samosas, bacon, watermelon, and pineapple. We talked about today’s schedule while laughing and cracking jokes. 

After breakfast we went to a local clinic named Kahawa West Health Centre funded by the government and located on the outskirts of Nairobi. This is a level three clinic that provides services free of charge. The different levels indicate the type of care that the hospital can handle. Lower level clinics are for smaller cases while higher numbers can care for more complicated cases.

The purpose of the trip was to learn more about reproductive care in Kenya. Our discussions were led by Jane Kimani, a healthcare worker at the clinic. Around ten women (patients at the clinic) joined us to discuss the nuances of the healthcare systems in both Kenya and the United States. We started off the conversation by talking about why some women visit hospitals before giving birth but ultimately deliver their babies at home. Several factors were mentioned, including the distance between homes and hospitals. There are often larger distances to cover to get to hospitals, even within Nairobi. When the distance is not great, there is often heavy traffic that makes it harder to reach the hospitals at a comfortable time. 

Another reason for home births was who is believed to be the most reliable birth attendant and more capable than physicians. Midwives in Kenya are not necessarily medically trained (in the US today, you must be licensed), but they are usually women with deep cultural knowledge, knowing what ceremonies must occur, allowing family members easy access, and using traditional medicine to treat pain and discomfort. It is possible that families also have day-to-day access to midwives versus doctors. The women we sat with mentioned the large mother to doctor ratio. They explained that there are often eighty patients to one doctor, and Kahawa West is often inundated with people seeking free reproductive care. This lack of one-on-one care might lead a mother to choose to work with a midwife who could dedicate more time to them. So, although the midwife is not a physician, and the birth is not in a hospital, the mother might feel more comfortable this way. Many of them explained that they know that this is not ideal since they would not be near the needed equipment should anything go wrong, but it was the only option for most. Jane noted an ambulance could take 20 minutes to arrive, though emergency services might be on the phone with you to give directions, and one of the mothers mentioned the maternal mortality rates are high for those who give birth at home.

Staff members at the facility also shared insights about reproductive health in Kenya, which deepened our understanding of the broader social context. After childbirth, mothers are encouraged to use some form of birth control to prevent having another child so soon after their recent birth. They mentioned that, in Euro-American society, this is often called “family planning,” but they refer to it as “child spacing” in Kenya. The mothers are also given the needed prenatal and postnatal vitamins (for free at Kahawa West) and are coached on what to eat and do to maintain milk production. One difference that was noted when comparing Kenyan and American lactation consultation, was that in Kenya you provide a back massage to stimulate the brain for milk production as needed; whereas in the United States, we often encourage breast massages to keep the flow.

We also asked about the different support methods that mothers might experience during and after giving birth. There are many mechanisms in place for additional support that the United States does not have. There is something called a “community unit,” where everyone registers through an app called eCHIS (electronic Community Health Information System). This is a system created by the government, and community leaders are trained in some prenatal and postnatal care. They will use this app to see the different members of the community on one dashboard, will remind them to check up on mothers. 

During our conversation, some of the women invited us to hold and play with their children, an experience that added a meaningful and human dimension to the discussion. We also offered our own experiences in the hospital. Although none of us had given birth before, we told them about how the United States medical system works, water births, and our varying trust in doctors due to historical biases and a perceived lack of care or connection. In comparison to the United States, Kenyan medical care is much more oriented toward community and multilevel support, rather than the purchase of services and a transactional relationship.

We ended our lovely conversation by taking a group photo!

After the discussion, we toured the clinic. There is a tent set in the outside space of the clinic right when you enter through the gate. At this station, staff record the reason for the mother’s visit and take basic vital signs before directing her to the appropriate area of the clinic.

We then entered the clinic. We viewed HIV testing areas, the labor rooms, and postnatal wards. In the postnatal ward, Yuzuki and Melanie were able to see mosquito nets for the first time which were attached to the beds. They were really pretty and we thought they would be nice to have in our rooms during our time in Kenya. So you usually see these types of netting in princess rooms!