Just when you think it’s all going well…

2 years after setting up Luo Care, we thought the teething problems were over. 240 widows and hundreds of children were registered with NHIF (The Kenyan National Health Insurance Fund) and getting health care when they needed it. Donors had taken out standing orders to support them for years to come. Our scheme was welcomed and working well.

Then in March 2015, the Kenyan government dropped a bombshell. They tripled the insurance premiums, which means instead of paying £15 per family annually, we now have to pay £45.

After months of questions, misinformation and faffing around, it was confirmed that we had to pay up.

When we went to Simbiri in September 2015, we had some harsh decisions to take. We didn’t have enough money to continue supporting all the widows, so we were forced to cut the number from 240 to 100.

How did we pick the 100 beneficiaries? All our widows are recruited according to need, so the first widow was the worst off. After consulting our lead Community Health Worker and administrator, we decided to retain the 1st 75. The other 25 are widows with 5 or 6 or 7 children.

We have also decided to be ultra cautious when we register more widows, so that we can be absolutely certain that we can provide longterm assistance. This means keeping financial reserves. We never want to have to cross widows off the list again.

Now some good news. Our previous administrator Nicholas has joined the police force in Nairobi. He has been replaced by Shem Oducka, who was born and brought up in Simbiri and knows everyone. He has a backup team we can call on when necessary.

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Alice at home with her daughter

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Ann Egan and Alice in Simbiri 

One of the team is Alice, a Community Health Worker. She’s absolutely lovely, lives in a mud hut with her two daughters and seems to have boundless energy and cheerfulness.

Day 7 – Clarice – Saved by Luo Care

In which Clarice’s life is saved thanks to Luo Care

Click here to see our short film  (This film was made ages ago and the cost of the insurance premiums has gone up from £15 a year to £45. We still have to correct the film.)

Before we committed to setting up Luo Care, we ran a pilot scheme to test out how it would work. By signing up five widows, we discovered problems in the procedure that we would have to overcome. Eg. Every applicant needs an identity card and birth certificates for all her children before we can register them for health insurance. Most of the women cannot read or write, so we realised that Nicholas has to fill in the forms, get the photographs, submit the applications – extra work and cost we hadn’t anticipated before doing the pilot scheme. Now I can meet the five widows as Nicholas hands over their registration cards. When it’s cooler at around 4pm or 5pm, we walk to their huts dotted round the countryside and Nicholas tells me all about life in this area.

A typical hut where a widow lives with, on average, 4 children.

A typical hut where a widow lives with, on average, 4 children.

The five widows – Jacinta, Clarice, Caroline, Eunice and Emilia live in mud huts with corrugated iron roofs and earth floors. They have almost no furniture and cook outside over open fires. They carry water from holes dug in the beds of dried up streams and their tiny plots of land are too dry to cultivate. They live from day to day and health insurance is an impossible luxury. When we turn up with insurance registration for them and their children, they can hardly believe it.

Clarice, in particular, was in desperate need. She remained sitting on the ground, sifting dirt from dried beans, her solemn children watching as she was handed the card. She looked really depressed and lethargic. We didn’t realise that she was already seriously ill. Less than 24 hours later she was carried unconscious to Simbiri Health Centre suffering from HIV related illness and unlikely to survive. No one knew where the children were or whether anyone was caring for them.

Clarice in the health centre with her insurance card beside her.

Clarice in the health centre with her insurance card beside her.

Dr Ann Egan monitoring Clarice's recovery.

Dr Ann Egan monitoring Clarice’s recovery.

Having health insurance meant she was admitted and treated. Within two days, she was sitting up in bed, and eventually she went home. But her survival was touch and go – in fact without Luo Care’s insurance it would definitely have been go. It’s easy to be disheartened by the consequences of overwhelming poverty in this part of Kenya. But whenever I think “Oh, what’s the point? We’re flogging a dead horse here,” I try to think of Clarice and her kids and remind myself that Luo Care saved her life, stopped her children becoming orphans and in the wider scheme of things is making a tiny, tiny difference. Sermon over.

Day 6 – From top end banking to bottom end toilet cleaning

 Welcome to our world.

Our bathroom. Fancy a long soak in the bath? Forget it.

Our bathroom. Fancy soaking in the bath? Forget it.

All mod cons. Shame the cistern is missing.

All mod cons. Shame the cistern is missing.

We’ve been here nearly a week and a morning routine has evolved. Ann gets up first and tappity taps through my room to the kitchen. She sloshes water around, pouring it down the open toilet (no plumbing so no flush). Easy on the perkiness Ann. I’m dragging myself out of my sweaty hellhole while she makes the tea.

Ann, Nicholas, Miss Lizzie the deputy headmistress and Jonathan Head Nurse and boss, and I are going on a trip to the bank at Oyugis. We dress up for our trip to the big city, but we’re soon crumpled and covered in dust with three in the front of the vehicle and four in the back.

It takes two hours to open a bank account. The bank manager in Oyugis is helpful and puts herself out to open it while we are in Kenya. The service is a million times better than our dealings with Lloyds Bank which was dreadful.

We meet the National Hospital Insurance Fund officials, ply them with Fanta, then head for the supermarket for supplies. Oyugis High Street is wide, dusty, deeply rutted and busy. It’s lined with tin sheds that are shops with a hotchpotch of goods strewn on the road outside.

We go to the local hospital to film what the widows can access once Luo Care has paid their health insurance premiums. (To see this, click here) Filming in Britain entails getting written permission from everyone, health and safety forms, explanations of how the material will be used, etc. Here, I walk in, film anyone and everyone, and stroll out. No one bats an eyelid. Privacy and protection issues haven’t reached Oyugis.

Back home, I celebrate having a bank account by mopping the floor i.e. rearranging the grime. Is dirt better when it’s red dust or traditional grey?

Rubber gloves on to clean the toilet, washing it down with brown dishwater so it still looks like shit.

Supper – me- a tin of tuna, tinned sweetcorn, a green pepper. Ann – fried onions and spuds.

Day 5 – Noises in the Night

 In which we learn about the night life and try to win round volunteers.

Dogs here are night animals. By day, they keep a low profile, skulking around or sleeping in the shade. Come darkness, it’s party time. Barks, yelps, yowls and howls meld into an orchestral cacophony which sounds like distant music as I quietly melt on the bed.

Dry leaves and twigs clatter on the corrugated iron roof above me, and birds’ claws make such a racket they must be the size of eagles.

Security men in flip-flops shuffle round the outside of the house.

Then, in almost total darkness, a sudden silence falls like a blanket. Why do the dogs, humans, birds and leaves all do a synchronised stop?

She hunts antelopes, chases hyenas, and turns her nose up at lumpy porridge.

She hunts antelopes, chases hyenas, and turns her nose up at lumpy porridge.

I’m very tired this morning and keep dithering but no wonder. I’m sleep deprived.

Later on, I stroll up to the security guards, a grandiose title for blokes who sit around chatting and open or close the gate of the health centre compound now and again. “Why are the dogs so noisy at night?” I ask. They think the question is hilarious – don’t you have hyenas in Northumberland? – and explain that yowling hyenas prowling around trying to catch livestock as snarling dogs try to protect calves and hens. Silence falls when the hyenas retreat.

Dogs go hunting with gangs of barefoot men wielding spears and clubs who stalk antelope in the scrub. The idea of keeping a dog for a pet is ludicrous, so when I befriend Woofie Dawg I feed her very surreptitiously indeed.

We have a meeting with the Community Health Workers (CHWs) who will be key to Luo Care, because we want them to identify the most needy widows who need health insurance.

A cool hut where we meet the Community Health Workers

A cool hut where we meet the Community Health Workers

The CHWs are unpaid volunteers from 15 districts, who live in small villages and know everything about everyone. We explain the purpose of Luo Care and outline our plan in which they identify the recipients and then Nicholas and the local Chief endorse the widows they suggest, and we pay for their hospital insurance. They have an essential role but many CHWs are widows themselves, desperately needing support.

They look glum and ask what small thing we can give them for doing this very important job, meaning will we pay them? The last thing they need is more unpaid work. Ann stresses that every penny is for the poorest widows but offers a Fanta and a chapatti each. One CHW rolls her eyes and the others laugh – yes, they’ve been here before, haven’t we all, and I didn’t much like it when it happened to me.

“You’re terribly important and creative and now you have to use that creativity to find new ways of working for less money,” blah blah blah. I got a bunch of flowers and a bottle of wine instead of a pay rise and the health workers get a chapatti and Fanta.

Somehow we win them round, but no one looks delighted.

Supper – Fried potatoes and onions with dried oregano and rosemary. Semolina and marmalade.

Click here to see our short film   (This film was made ages ago and the cost of the insurance premiums has gone up from £15 a year to £45. We still have to correct the film.)

Day 4 – Bribes and Big Decisions

In which we’re confronted with corruption and make a simple decision complicated.

Decisions, decisions.

In Britain, we think bribes are bad. But many Kenyans admit that corruption keeps their country going. Nothing happens without cash handouts to officials. We don’t want to participate in it. It’s a no brainer until a dilemma arises.

Government offices in background

Government offices in background

A government apparatchik says he’s doing us an enormous favour fitting us into his busy schedule, waving his hand over a pile of dusty papers on his desk. We must register Luo Care, but there is such a backlog of paperwork that it will take months, he warns. He doesn’t even have the right documents but he will make a special concession and sort it out the next day for £75 cash.

Cue alarms bells.

We are up against the clock and need to organise everything while we are there so that Luo Care can be run from a distance when we return to England. If the only way of doing that is by coughing up wonga then perhaps we have to be pragmatic.  Should we, shouldn’t we? Round and round in circles we go.

Back home, I lie on the bed flapping a grubby, wet flannel over my head as I mull it over. Ann has a sweaty hands and feet problem at the best of times so she is caked in red dust and it stops her thinking straight.

However, we make an important decision. We cannot pay bribes, even if we fail to achieve what we set out to do. Everyone would expect handouts for evermore. It would give a terrible message to our administrator Nicholas and how could we tell him not to pay backhanders when we’ve done it ourselves?

We trudge back along the dirt track, and the cool water in our bottles becomes hot (and I do mean hot, not lukewarm) by the time we arrive at the government office. We diplomatically say we’ve changed our minds and we won’t pay anyone anything. We’re braced for an angry showdown but instead the apparatchik admits we don’t really need the documents straight away anyway, and he wishes us good luck.

We walk back to our house wondering what all our angst was about. Once a decision is made, it seems so obvious. Bribes?Handouts? No. No. No.

Click here to see our short film   (This film was made ages ago and the cost of the insurance premiums has gone up from £15 a year to £45. We still have to correct the film.)

Day 3 – Hot, Bothered and Sunday Best.

In which the heat gets to me, we meet some widows and wonder what the hell we’re doing…

I’m the kind of person who crosses the road to walk on the sunny side of the street.  But the heat here is formidable and slows the pace of life.

We should have known we’d have a hard day as we set off for church, godless heathens putting in an appearance, just this once, in a land where everyone professes to worship God, sometimes in very strange ways.

We scrub up and wear Sunday best with scarves draped respectfully around our shoulders. The half mile walk is far enough for us to become dishevelled, scarves screwed up in sweaty hands.

The church we attended. There are many small churches like this dotted around the countryside.

The church we attended, typical of small churches dotted around the countryside.

All eyes swivel on to us, men and boys on one side, women and girls on the other. To our dismay, Pastor Jim (head nightwatchman at the health centre), asks George the Carpenter/Coffin Builder to translate the entire service for us. That’s two solid hours of readings from Jeremiah and warnings that we’ll die, no question, if we don’t come to The Lord.

People drift in and out, children sleep on the floor.

Top billing was Dr Ann singing “The Lord Is My Shepherd”, followed by thanks from the congregation that God led us here. Wrong. It was KLM and Kenyan Airways.

David, the Health Centre manager, makes a late entrance.  “Women from England aren’t made for the heat,” he says. “They’re struggling, and that’s why they’re dressed that way.”

Our sartorial effort was wasted. So am I. Totally wasted.

Later, Nicholas leads us through the bush to give the first three beneficiaries their NHIF health insurance cards. We’ve forgotten to bring any water and within minutes, we’re parched.

Inside Caroline’s square, mud hut, she and her 7 children sit quietly. They have nothing except chairs with antimacassars on the backs, a small table and a dusty old Arsenal poster. (Well, we all make mistakes.) No toilet, no running water, no beds, an earth floor and corrugated iron roof.

Her shamba, a little plot of land around the hut, is dry to cultivate anything.

I’ve seen absolute poverty before but somehow this is overwhelming. Where do we begin and what difference will our efforts make? I’m incredibly thirsty, hot and grimy, but Caroline endures it every single day.

I’m making a film about Luo Care on my iPad and capture Nicholas handing over the insurance card and Caroline smiles and thanks us, but the children are undemonstrative. Outside, I produce bubble mixture and they spring into life, trying to catch bubbles and giggling – all except the eldest boy Humphrey who is seriously fed up.

I boss Ann around – stand here, stop talking, hold this, do that, trying to film but it’s too shady, too windy, too hot, all too much for me.

Eventually Humphrey asks if Ann will pay for his education and she says no. We can’t help everyone. We have limited funds and we’re concentrating on the widows. But it’s as plausible to the depressed teenager as Bill Gates saying, “Sorry, I’m not really all that much of a millionaire.”

Humphrey leads us across red soil and eroded gullies to the next widow.

Widow No 2 is Emily, a polio victim who walks on knees padded with rubber patches and earns a pittance stripping flesh from leaves to expose strands that are twisted into rope. She has a rudimentary invalid carriage that won’t work on the rugged ground. She owns even less than Caroline – no seats, just some plastic containers for water.

I feel like a poverty voyeur filming her. But we press on to meet widow No 3, Eunice and her two children. She smiles happily when she’s given her NHIF card.

I’m relieved to arrive home, seriously wondering what we’re doing because the widows’ existence is impossibly hard.

Ann questions how valuable education is, if the result is better educated people who are aware of their plight but cannot to lift themselves up. English is supposed to be the unifying language in Kenya but lots cannot speak it or write it. I wonder how many never go to school at all.

We both feel useless and discuss whether we’re wasting our time. But if just one person’s life improves… etc etc.

To top it all, when Ann phones Mark he helpfully warns us that 4-7 days after a cockroach dies, thousands of her eggs hatch, and they’ll all be in my bed. I’m not bothered. They’ll drown in a sea of sweat.

Click here to see Caroline and Emily on our short film  (This film was made ages ago and the cost of the insurance premiums has gone up from £15 a year to £45. We still have to correct the film.)

Day 2 – Bernard the Banker and Cockroach Carnage

In which we’re addled by administration and cockroach carnage under the mozzie net…

For the full story, click here to watch a short film  (This film was made ages ago and the cost of the insurance premiums has gone up from £15 a year to £45. We still have to correct the film.)

It’s hard to crack on with work in searing temperatures and humidity and we’re crumpled, grimy and sweaty, unlike our main contact here, 25 year old Nicholas Odwar.

Nicholas was born and raised in Simbiri. He knows everyone and a British sponsor paid for his education so he has a degree and speaks good English. He  works for the Health Centre, but he’s done a pilot project with 5 desperate widows nearby, discovering the hidden jobs and costs involved in registering with the National Hospital Insurance Fund of Kenya.

Each widow needs her identity card, children’s birth certificates, a passport photo and £45 (about 6,000 Kenyan Shillings KSh). Many women have none of these, and they’re illiterate, so Nicholas has done the legwork – picked up and filled in forms, arranged photos, collected certificates.

We’d planned to send funds whenever he needed to pay for hospital insurance, transferring it from our bank in England via Western Union. However, it’s finally dawned on us that big cash transactions aren’t such a great idea. We need a bank account in Kenya. But what kind? Business? Charitable? Ordinary current account? Each has its own tedious, bureaucratic paperwork. Needing 5 possible signatories (Ann and me when we’re in Kenya,  + 3 others when we’re not) apparently can’t be done because the form isn’t big enough.

We’re grumbling about feeling out of our depth when Nicholas appears with his mate Bernard the Banker from Postmaster who seems clued up and sets up a meeting for next week. sunset

Bedtime 9pm. It’s pitch black, and noisy with dog fights, drumming, and what sounds like a pterodactyl nesting on the tin roof. I’m dozing off when I feel something drop on my tummy and I vaguely decide I imagined it. Suddenly it flutters in my face, then again, and bad back or no bad back, with a shriek I’m out from under that mozzie net and Ann appears waving her torch around. A cockroach the size of a mouse is circling the inside of the netting. It’s a job for heavy duty rubber gloves. I pulverise it, crunching it three times, stomach churning.

I’d wondered where all the insects were and now I know – in my bed. Spent the rest of the night twitching in a pool of sweat.

Breakfast – toast. Lunch – 2 chapattis. Supper – pasta, cheese, onions and tomatoes.