Ewuaso Kedong is a division to the north of Kajiado County, south west of Nairobi, Kenya where prevalence rates for maternal and neonatal child mortalities are at their peak. But these deaths are largely characterized by a culture of silence and acceptance.
The number of women and children dying during childbirth in Ewuaso Kedong has been growing unabated into a silent, reproductive health monster. Its scale and severity is precipitated by a combination of factors tacitly condoned by retrogressive social customs and attitudes.
Ewuaso Kedong trading center is a small, dusty town located in the Kedong Valley in a vastly semi-arid area that stretches from the lee ward side of the Ngong Hills in Kajiado to the county’s border with Kiambu, Narok and Nakuru.
The division is mainly inhabited by members of the indigenous Maasai community who subsist on semi-nomadic livestock farming in harsh, semi-arid climatic conditions. The division has no tarmac road and public transport is only available on market day.
Although the trading center hosts the divisional headquarters - a well furnished, ultra-modern administration office complex - standing in stark contrast is the adjacent Ewuaso Kedong dispensary, in which little medical activity takes place on normal days except on Mondays.
On market day, the town comes back to life with all manner of overloaded, mostly un-road worthy, pick up vans, lorries, motor bikes and donkey carts, cashing in on hundreds of desperate commuters, small scale traders, patients and livestock from places as remote as Mosiro.
On this day, Ewuaso Kedong dispensary serves an average of 75 antenatal care (ANC) clients, almost entirely comprising of unaccompanied pregnant women, some of whom will have had to walk long and treacherous distances in order to take advantage of the market day convenience.
In all, Ewuaso Kedong division has nine dispensaries in an area estimated to cover over 3000 square kilometers. The dispensaries are so far apart that the distance from one dispensary to the next averages 90 kilometers and span areas infested with marauding wildlife.
Due to its location at the administrative center and its proximity to the sub-district hospital in Ngong, which is nearly two hours drive away on an alternately rocky and dusty road, Ewuaso Kedong dispensary is considered the biggest referral facility in the division.
In spite of being without a reliable means of transport or a defined medical storage facility, the one block dispensary serves as the major life line for the other dispensaries in terms of delivering, storing and distributing medical and relief supplies from the Kenya Medical Supplies Agency (KEMSA).
The dispensary is served by the only public ambulance available in Kajiado North district, which is stationed at the sub-district hospital in Ngong, and is not adequately equipped to handle medical emergencies including those related to pregnancy, HIV and sexual, gender based violence.
When it rains in neighboring hill areas, most road networks and bridges are overrun by fierce flash floods. These can last for days and will cause debris of huge volcanic rocks to scatter onto the roads, cutting off villages and institutions that rely on Ewuaso Kedong for their survival.
Mr. Joshua Punyua, the nursing officer in charge of Ewuaso Kedong dispensary, says the facility has no laboratory, no theatre and no admission facility and a staff capacity of three nurses yet serves 11,085 people in 1168 households across six villages.
The estimated number of pregnant women in the Kedong Valley is 454 out of 2660 women of reproductive age between the ages of 15-49 years. But according to Mr. Punyua, the proportion of women receiving ANC services in Kedong Valley is vastly different to the number of women delivering at the facility. Since May, only one out of 454 expected deliveries occurred at the dispensary. According to area assistant chief ,Mr. John Sayo, 19 home deliveries were reported to his office in the month of June alone.
These two figures account for only 20 of 454 possible deliveries. This leaves 434 pregnant women in the Kedong Valley who cannot be accounted for in terms of delivery, survival or mortality. No official records of their whereabouts are available at Ngong police station, Ewuaso Kedong dispensary or at the sub-district hospital in Ngong.
In the last six months, only 50 out of 584 households were reached by community health workers with maternal and neonatal child (MNCH) health messages, representing a poultry nine percent of all households. No community health dialogues or community health action days have been held in the division so far.
As if to ask for the help the dispensary needs the most, this sad reality is publicly displayed on the dispensary’s community health blackboard. According to the district health partners mapping exercise conducted in March 2010 by the DHMT Kajiado North, there was no NGO operating in the division.
This prompted Kenya’s Social Welfare Development Programme (SOWED), with support from UK Aid, International HIV/AIDS Alliance, Kenya Aids NGOs Consortium (KANCO) and the National Partnership Platform (NPP), to hold two strategic dialogue forums involving 50 locally influential men to seek their support in reducing HIV related maternal and neonatal child mortalities in Kedong Valley.
