As all eyes focus on political negotiations in Kenya, MSF teams continue to provide medical care in Nairobi, Rift Valley, Western and Nyanza Provinces. Although the overall situation is much calmer than it has been in recent weeks, many areas remain tense. In Nairobi, MSF had adapted long-running HIV/AIDS projects to provide care for victims of violence. In western Kenya, MSF is responding to the ongoing needs by working in internally displaced person's (IDP) camps and supporting health centres and hospitals. Mobile teams travel to numerous different locations every week to provide medical care to the many hundreds of Kenyans who are trapped in rural areas with little or no aid. Nairobi
Treating victims of violence
The situation in Nairobi's slums remains tense. The MSF medical teams working in two of Nairobi's biggest slums - Mathare and Kibera - continue to see victims of violence on a daily basis and to provide follow up care to people who have been injured in the last days and weeks. In January, staff in Kibera performed more than 11,500 consultations, of which 86 were intentional physical traumas, related to the post-election violence. On February 21 and 22, MSF staff in Mathare received 25 wounded people, the majority had been beaten or cut with machetes.
Ongoing HIV/AIDS and TB care
MSF's projects providing primary health care, HIV/AIDS and TB care in Kibera and Mathare are running as normal. However, the violence and insecurity of the past few weeks has had an impact on the number of patients attending appointments. In Kibera, where MSF supports four health structures, nearly 20 percent of patients receiving HIV care missed appointments in January. In Mathare, the figure was around 10 percent. There has also been a drop in the number of new patients enrolling in MSF's treatment programmes. In Kibera South Health Centre, where MSF would normally enroll around 100 new HIV patients each month, only 60 new patients were enrolled in January. As one of the steps to recapture patients, MSF has set up a toll-free telephone hotline, marketed with advertisements, posters and flyers. Rift Valley Province
Responding to changing needs
The situation in the Rift Valley, where thousands of people have been displaced, is very fluid. Since early January, many people have been living in large sites like stadiums and showgrounds. Others have sought protection at police stations, prisons and churches or are living in small groups in remote areas. In some areas people are moving regularly, sites that were once filled with people can be empty just a few days later. So mobile clinics, where MSF medical teams visit different sites every week, are an essential way of responding to the changing needs. During these mobile clinics MSF staff provide medical consultations and ensure that clean water and sanitation facilities are available. For example in Molo district mobile teams visited 13 sites and provided 5,400 consultations between February 11 to 24. The majority of consultations are for upper respiratory tract infections and diarrheoa. When necessary MSF teams also vaccinate children under five against measles, polio and tuberculosis, provide them with vitamin A supplements and assess their nutritional status. In addition to running mobile clinics, a 'flying team' made up of one doctor, one nurse and a logistician are visiting different locations such as Kisumu, Kisii and Transmara in order to evaluate the needs. A long standing conflict in the Mount Elgon region has left many Ministry of Health facilities unable to operate as normal and as a result many people in this area cannot access health care. MSF mobile teams have been working in the region since April, 2007, and are also monitoring the health situation in the neighbouring Trans Nzoia district which has seen an increase in violence in recent weeks.
Supporting health centres and hospitals
At times a shortage of staff, combined with an increase of patients, has left the Kenyan Ministry of Health in need of extra assistance so MSF is also supporting some health centres and hospitals in Kenya. In late January surgical teams supported hospitals in Naivasha and Nakuru when violent clashes left many wounded. Between February 8 to 21, a surgeon, anaesthetist and nurse performed 22 operations at Kericho hospital. As only 50 percent of the hospital's regular staff have returned to work, an MSF medical team will continue to support the hospital in the coming weeks. In Timborao, south of Eldoret, MSF started working in a health centre near to a displaced person's camp where around 4,000 people are living on February 20. MSF will run clinics in the health centre every morning, supply the centre with drugs and supervise and train the existing staff.
Providing care in Internally Displaced Persons camps
MSF has been working in Kitale since January 7. Teams have helped set up two camps for internally displaced people in Cherangani and Endebess. In Endebess, MSF staff built tents for around 6,500 people. As this shelter was intended to be temporary and the rainy season is approaching, MSF is now focusing on upgrading these tents into more permanent structures. A health post was opened in the camp on February 9 and MSF teams are responsible for health promotion, hygiene and water sanitation - providing showers, latrines and clean water; mental health counseling and hospital referrals. MSF will continue to monitor the health activities in Cherangani camp and will provide some shelter in Kitale showground. In Nakuru a medical team continues to work in the stadium, where around 2,000 people are thought to be living, providing around 150 consultations every day.
In Kacheliba, Pokot District, MSF has been treating people infected with visceral Leishmaniasis, also known as Kala Azar, since the end of 2006. Our activity in this region have not been affected by the insecurity and violence in other parts of Kenya and teams continue to treat patients infected with this potentially fatal disease. Western and Nyanza Province
Ongoing HIV/AIDS care
Long running HIV/AIDS projects in both Busia and Homa Bay continue as normal.