On the wall of Arthur and Marion’s house is a calendar. By the light of the paraffin lamp I can see that it’s three years out of date, but being illiterate, they can’t read the anti-corruption message that each month conveys anyway. The four walls are composed of wattle and daub with the crumbling remains of some plaster so the calendar was probably only ever intended to add some colour. But it’s a metaphor for their lives because to a large degree, Arthur and Marion have been left behind.
Arthur is sick with HIV. Marion struggles to find work washing and cannot earn enough to both pay the rent and buy food for her family. The solution to the latter has been to send her four daughters to their grandparents. She last saw the girls two years ago. The solution to their rent is harder to resolve and they have no idea what will happen to them when the landlord next comes to call. Life in Kibera, Kenya and Africa’s largest slum, is incredibly hard. Arthur gets his anti-retroviral therapy (ART) paid for but in a sprawling, tightly packed city with no sanitation, little access to water and no access to electricity for the majority he lives with the daily risk of disease and infections for which there is no free medicine. They proudly show their ‘Couples against transmission’ certificates which indicate that they have had formal counselling in how to ensure Marion remains uninfected, but that’s not enough for their neighbours. Both of them are ostracized by their community; HIV still carries stigma.
It is so easy to forget that although increasingly available ART in countries with a high prevalence of HIV infection is crucial to survival, when there is no other public health provision, the odds are still stacked against the weak and sick. Increasing access to ARTs is a noble and humane Millennium Development Goal (MDG), and a quarter of the Kenyan health budget goes on HIV and Aids supplemented by millions in western aid. In the west, public health is something that we do well, so well that most people have forgotten the transformational impact of clean water and sewerage. One visit to Kibera, walking on pathways that double as rubbish dumps and criss-crossing them to avoid the faeces is enough for you never to forget.
Whilst we try out a new configuration for public health in England, there remains a dearth of any public health progress in Africa’s largest slum. Two associated MDGs – halving the population with no access to clean drinking water and basic sanitation, and improving the lives of slum dwellers – don’t seem to have touched the lives of the people here. As the G20 countries wrangle together on overspending, profligate living and the euro time-bomb, would it be too much to ask them to remember their commitment to those who are being left behind?
I am hugely grateful to the International Reporting Project and the Gates Foundation for making this trip to Kenya possible. I will be tweeting and blogging over the coming week as we visit health projects across the country.