Treatment programmes recover patients lost in post-election violence

When post-election violence struck western Kenya's Rift Valley last year, hundreds of patients failed to collect their antiretroviral medication from their regular clinics, leading health workers to fear that their patients would develop resistance, or fall ill and even die.

More than 90 percent of patients at the Academic Model for the Prevention and Treatment of HIV (AMPATH) did not report to the facility for their treatment; but today, Cleophas Chesoli, AMPATH's social work manager, is a much happier man. Most patients have returned from the camps for internally displaced persons (IDPs) where they sought refuge, and so far there have been no signs of resistance.

Violence broke out across the country after a hotly contested presidential election at the end of 2007, displacing more than 600,000 Kenyans; according to the National AIDS Control Council, at least 15,000 IDPs were HIV-positive. The government has now closed all official IDP camps, and up to 250,000 people have returned to their homes.

"Our ART [antiretroviral therapy] programme has recovered for the most part," he told IRIN/PlusNews. "The few who haven't returned are likely to have enrolled in ARV programmes wherever the have settled."

Chesoli said adherence counselling meant most patients were aware of the importance of maintaining their drug regimens, so many fled with their ARVs and made finding new supplies a priority. AMPATH set up satellite services in several of the larger IDP camps in the province, where nurses and volunteers - many of them also IDPs - provided ARVs and psychosocial support.

At the time of the violence, AMPATH was providing ARVs to an estimated 30,000 people across the northern Rift Valley; today, many have returned home and that number has grown to more than 40,000.

During the violence, several health organisations, including AMPATH and the international medical charity, Médecins Sans Frontières (MSF), used the national media to alert patients to the location of health centres. MSF also set up a call centre with a toll-free hotline to give information on HIV and tuberculosis to those who could not return to their usual clinic.

MSF, which provides ARVs to almost 2,000 people in Kibera, the largest slum in the Kenyan capital, Nairobi, noticed in January 2008, when the violence was at its peak, that patients delayed keeping their appointments, but were largely being kept in February.

Many ART programmes were disrupted by the violence and the resulting chaos. "There is a need to have a plan for such emergencies in the future - that way we avoid being caught unprepared," Chesoli said. "We also need to ensure our staff are trained to handle things like sexual violence and reproductive health in emergencies."

Lessons learned

He said there was also a need to organise the camps so that health services were immediately available to people, and vital services such as water were placed in well-lit areas of the camps to lower the possibility of sexual assaults.

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According to MSF, organisations need to develop "a simple, emergency data management system that can continue to record clinical information during the crisis, and that contains the essential information for ongoing care."

There should also be better coordination among agencies during an emergency, Chesoli said, to avoid duplication of services or gaps in service provision.

"We have also noted a need for post-crisis livelihood support," he added. "Many people have returned to homes that were burnt down, [their] livestock was stolen, and they of course have not cultivated any land because they were in camps most of the year."

IRIN/PlusNews again spoke to Henry Mwiterere, who was displaced from his home in Burnt Forest, one of the worst-affected areas in Rift Valley, to an IDP camp in Nakuru, about 150km northwest of Nairobi.

Mwiterere is back in Burnt Forest and glad to be working again as a support group facilitator for AMPATH, but his life has changed. "My house was burnt during the election violence, so I am renting a room here in Burnt Forest but my family has to remain in Nakuru until I can afford to have them here and feel safe enough for them to return," he said.

He feels that the tension between rival ethnic communities is still high and doesn't want to risk having to flee again. "Now food is so expensive, and since we haven't farmed we have to buy everything," he added. "Relief food is sporadic, so times are really rough."

Fresh challenges

Chesoli agreed that for many recently returned IDPs, staying healthy was a challenge. "WFP [the United Nations World Food Programme] provides food for 30,000 HIV-positive AMPATH patients and their families, but the number who need support has grown tremendously with the current food crisis," he said.

An estimated 10 million Kenyans are battling a food crisis as a result of crop failure due to poor rains and drought, high food prices, and the disruption of farming activities in the Rift Valley, the country's breadbasket caused by the post-election violence.

Chesoli noted that AMPATH has had to become extremely stringent in its classification of people as 'vulnerable', and therefore deserving of relief food.

"People lost their livelihoods and need a helping hand to get back to the economic position they were in before the violence broke out," he said. "So although our people are back in the ARV programme, we have to work very hard that they remain able to keep taking the drugs despite the food shortages."

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