Using his Rolex Award to fund a telemedicine centre, Kenyan Aggrey Otieno plans to save the lives of mothers and babies – and seed a sense of optimism – in a poverty-wracked Nairobi slum.
It is past midnight when Penina Awino Odhiambo hurries out of her shack in Korogocho, one of Nairobi’s many slums. Inside, Awino’s pregnant daughter, Esther, lies prone on the dirt floor, in desperate need of hospital care. The cold air is thick with the acrid smoke of charcoal stoves, the smell barely masking the stench emanating from the open drains. With crime an ever-present threat, nobody ventures out at night here; there are no street lights, in fact, there are no streets, no electricity. The 200,000 people that crowd into a mere 1.5 km2 suffer from overwhelming poverty and disease.
Awino’s luck holds. Some local thugs confront her, but on discovering that they know her son, they help her to find a taxi from a neighbouring community to transport her daughter to hospital. Without that assistance, Esther and her baby Kimberly, born that night by caesarian section, would have died.
That evening proved to be a watershed for the mothers of Korogocho. Odhiambo’s son, Aggrey Otieno, was so disturbed by the experience that he resolved to find a way to make pregnancy and childbirth safer in his home town. “I have long known that Korogocho has a reputation as one of the worst places in East Africa to give birth. Falling pregnant here in Korogocho is a curse which condemns many of these young women to death,” he says.
Too poor for transport
In this slum alone, about 300 women die from a range of conditions such as eclampsia – seizures during childbirth – as well as poorly performed abortions, haemorrhages, infection, and ruptured uteruses, every year.
“Women die because they live outside the reach of modern medicine,” Otieno explains. “Expectant mothers are usually too poor to afford the transport costs to a proper medical facility, let alone to pay for the actual services. Most medical facilities in Korogocho lack the necessary resources to handle even minor obstetric complications.” The absence of roads makes the situation worse, as ambulances cannot enter the area’s tiny alleyways.
Otieno saw a way for pregnant women to access sound medical advice when he noticed that – despite the poverty – most Korogocho residents owned a mobile phone. “Using open-source technology that I came across while in America, I developed a powerful mobile phone texting software programme called M-Birth. This application facilitates free text messaging between pregnant women and health practitioners.”
M-Birth links frontline community health workers with skilled medical attendants based outside Korogocho, allowing them to monitor pregnant women, and teach them about maternal and child health.
To coordinate these communications, Otieno will build a telemedicine centre. A 24-hour doctor will be available to respond to pregnancy-related medical matters, all via mobile phone. “I envisage the centre creating a new health eco-system within Korogocho,” says Otieno. “The Rolex Award gives me the finances to construct the centre, as well as to buy our own emergency transport vehicle which will be dispatched by the doctor when needed.” In the three-year pilot phase, Otieno hopes to help 3,000 pregnant women, potentially saving hundreds of lives.
The telemedicine centre represents the apex of a multi-faceted approach Otieno has adopted to care for Korogocho’s mothers. He has already set up support groups where pregnant women are given health advice and taught skills such as basketry. Ensuring that women earn an income while they are pregnant means they can afford hospital care should they need it, as Otieno explains: “Healthcare is not free, and we cannot pay for any hospital admissions. Instead, we encourage our mothers to join the National Hospital Insurance Fund. The money earned in the group should cover the monthly fees, as well as other essential items.”
Otieno is also providing training for the 30 traditional birth attendants who work in Korogocho – women like Anne Mbala, 43, who delivers up to 20 babies a month. “Many women, either because of cultural, religious or financial reasons, resist going to medical facilities, rather entrusting their pregnancy to traditional birth attendants,” explains Otieno. “Though well meaning, these women do not have the necessary skills and equipment to deal with high risk pregnancies. Many do not even have gloves, putting both themselves and their patients at risk of being infected with HIV.”
Otieno is realistic enough to know that he will not be able to shift this mindset in the short term. Instead, he has welcomed these women into his programme, training them to identify high-risk patients and encouraging them to send these patients to a medical facility for check-ups. The training will allow them to be recognized by the government as Safe Delivery Advocates (SDA).
An extensive outreach campaign, incorporating forums and video programmes, has been implemented by Otieno to increase awareness about health issues and the need for family planning. Radio is the cornerstone of his campaign, but while he has been able to support his existing work via various charities and NGOs, radio has proved too expensive. The Rolex Award allows Otieno to finally purchase radio equipment to realize his dream of reaching out to more than one million slum dwellers.
Otieno’s achievements bear testimony to his commitment to his community. He studied in the U.S. and became the first person from Korogocho to receive a master’s degree (in communications). “When I told my friends in Ohio that I was going back home, some told me that I needed to go for a mental check-up! But I knew I could use my skills, knowledge, strength and international exposure to improve the living conditions of my people, to give back to the community that fed, clothed and educated me.”
His mother’s belief in the power of education instilled a passion for learning in Otieno. “She always checked my homework, encouraging me to get as many ‘ticks’ as I could. When I later discovered that she was illiterate and could not understand what she was looking at, it drove me to excel even more. I realized that the only way I could help her help me was to get sponsorship, and I worked hard to receive financial support from Action Aid, and later from the Catholic Church and the Ford Foundation, for my education.”
Otieno has long given his time to assisting the poorer communities of Kenya: while still at school he set up Korogocho’s first community library; he has helped with initiatives to prevent child trafficking and raise awareness of tuberculosis screening and treatment; and, in 2011, he established the non-profit organization, Pambazuko Mashinani. Meaning “grass-roots awakening” in Swahili, the organization aims to empower the poor. “Because we live in a slum, because we are poor, because we are often uneducated, many people seem to forget that we are human beings,” Otieno says.
His achievements offer hope in a world that is bleak. His dreams extend outwards and he plans to implement his telemedicine centre programme in neighbouring slums, and throughout Africa. Reflects Otieno, “It is sad that by the time you finish reading this article, at least one woman somewhere in the world will have died due to pregnancy-related complications. With the telemedicine centre initiative, I hope that the women from Korogocho are not part of these statistics.”
Alexa Schoof Marketos
Published in 2012