Looking for life, destroying life: Kibera

Destitution, in the most extreme sense, may seem abstract — perhaps even intangible. But the implications of social inequity are concrete, and they translate into serious, often overlooked, health repercussions for a select few, namely poor people.

The air in Kibera is dusty and vaguely smells of gasoline. Streets teem with the hurried comings and goings of Kenyans. Along the path are women hauling heavy jerrycans, spilling water as they trudge homeward along sewage lines brimming with human waste. Feral dogs follow the scent of beans and ugali being cooked in alleyways of tin houses with curtains as doors. As a "mzungu" (foreigner), I am troubled that I see children eating soil, which I know contains helminth eggs. I worry because none of them are in school, instead running barefoot along the dirt roads, avoiding the bodas coming at 45 kilometers per hour.

But this is just what I see. I know that beyond this rough exterior, there lie realities that I cannot see. Ones that are even rougher. Kibera is the largest slum in Africa. These tightly woven pathways, home to a quarter million people, present a serious risk for the spread of infectious disease. Slums are distinct entities, representing an entire neighborhood with residents existing in close proximity. Because of this, slums tend to be an ideal place to facilitate public health interventions, as potential benefits reverberate through the entire community.

Regardless of potential positive outcomes, slums rarely catch the eye of academics. The immense literature gaps that exist regarding urban poverty makes it virtually impossible to implement evidence-based initiatives. In fact, a 2016 podcast from The Lancet reveals that less than 3% of research conducted in low and middle-income countries is based in slums. Additionally, most research conducted in these locations does not actually pertain to slum health, but rather tests the efficacy of vaccines or medications on its populations.

After studying global health, this information is deeply disconcerting because relatively cheap interventions make enormous impacts on low-resource communities. Installing a communal latrine, school-based deworming (costing $0.60/child), proper footwear to prevent hookworm and distributing condoms to mitigate the spread of HIV are just a few examples. No child should suffer from preventable and treatable illnesses as a result of circumstances.

It is not idealistic to think that slum dwellers are entitled to clean air, potable water and proper sanitation. Some drew the short end of the birth lottery; does that really have to mean they spend the rest of their existence making up for it? It shouldn’t, but the vicious cycle of poverty isn’t exactly compassionate. In Tracy Kidder’s book “Mountains beyond Mountains”(2003), Kidder describes the quest of Paul Farmer, an American doctor treating tuberculosis among the urban poor in Cange, Haiti. Farmer goes on to say, “The idea that some lives matter less is the root of all that is wrong with the world.” The etching of the words “welcom to mi happe home” on the tin surface of one household really says it all. People are people, and they all deserve to be healthy.