Kenyans in Nairobi slum shun free clinic

MIT students set out to learn why, change attitudes

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NAIROBI, Kenya | The clinic’s paperwork carried a common medical symbol - a snake coiling around a wooden rod. But that simple insignia sparked a rumor in Nairobi’s largest slum: The U.S.-funded clinic was a center for snake worshipping.

For the poor residents of Kibera, who have little exposure to the medical community, the conclusion was logical. Africans sometimes turn to traditional healers or witch doctors.

But the false rumor was just a part of a puzzle for the clinic: If the clinic is high-quality, close by and nearly free, why weren’t more slum residents using it?

Students from one of America’s most exclusive universities were called in to find out, as part of their class aimed at increasing efficiencies of health facilities in Third World countries. They soon found themselves in a crowded and fetid slum, one of the poorest in the world.

The clinic is run by Carolina for Kibera (CFK), an aid group co-founded by a University of North Carolina graduate and two Kenyans. The group turned to Massachusetts Institute of Technology professor Anjali Sastry, who sends graduate students across Africa and India for her Global Health Delivery Project class.

The aim is for students to identify and study systemic problems at clinics or hospitals and offer lasting solutions.

The four students who traveled to Nairobi in March squeezed through Kibera’s muddy back alleys, past one-room tin shacks and jumped over slimy streams of sewage in search of ways to increase the clinic’s client base.

The answer could be found only by entering Nairobi’s most cast-down homes and listening to a poor but proud population.

Many residents, the students heard, didn’t even know about the CFK clinic. Others cited social stigmas, such as the idea that if something is free, it’s low-quality.

For many, the clinic was simply a mystery.

“Someone said, ‘They draw blood, and we don’t know what they do with it,’ ” said Nirav Patel, 29, one of the four researchers.

He was so committed to finding out why the clinic wasn’t attracting more patients that he intended to do interviews at night, when more men were at home. But the level of crime made walking around at night too risky.

Kibera, Kenya, is a maze of rusty shacks crammed between open sewers. Bags of human waste — dubbed “flying toilets” — are thrown from houses after dark because criminal attacks make public toilets too risky. Fly-covered fish heads discarded from upmarket establishments are a delicacy in a neighborhood where most people live on $1 a day.

The four MIT researchers visited 75 homes, learning how much people made (not much), what they valued in doctor visits (quality and respect) and why they didn’t go to the clinic (many didn’t know they could).

The project energized the students, who hoped they could offer fixes that would truly help.

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