Disease of the urban’ knocks on the doors of sleepy Turkana

The Ministry of Health's Director of Medical Services Dr Nicholas Muraguri addressing the media on August 9, 2014. According to the Ministry, approximately 19,000 adults out of the 39,000 living with HIV here need antiretroviral therapy, but only 20 per cent of them are accessing it. PHOTO | JEFF ANGOTE |  NATION MEDIA GROUP

In Summary

• The 2012 Kenya Aids Indicator Survey places Turkana County among the top 10 regions with the highest adult HIV prevalence in Kenya.
• Turkana is now considered a high-risk county and, although other factors may have contributed to the rising prevalence rate, traditional practices like polygamy and widow inheritance, coupled with belief in traditional medicine, have greatly promoted the spread of HIV.
• The unrest in Africa’s youngest nation, South Sudan, has led to an influx of refugees into this camp. This has in turn led to a rise in the number of TB patients, and more cases of persons living with HIV have been reported.

By MERCY JUMA
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With an effortless click, Nakali Ekitoe shoots a jet of saliva through the gap between her two front teeth, then calls out to me before shifting the baby from her back to her bosom.

She is sitting on a stone and, with the baby safely made comfortable, she rests her tiny frame against the only tree stump in her homestead.

She then motions with her hand, asking me to sit next to her.

Ekitoe lives here with her three-month-old last born daughter. “The disease of the urban people caught up with me,” she begins. “I thought we were resistant.”

Pthooo! She releases yet another stream of sputum and rubs it into the dry, thirsty ground with her foot.

“I blame all this on my late husband. I started being sick when he went to that other woman,” she continues.

Ekitoe, in her 40s, lives in Kanamkemer, a dusty village tucked deep inside Kenya’s largest county, Turkana.

Her community is among the few in Kenya that have stuck to their traditional practices and way of life, having accepted little, if any, influence from Western cultures and modernisation.

TRADITIONAL PRACTICES
But, although this rich culture gives them an identity and brings out the unique personalities of the likes of Ekitoe, it has also been a stumbling block to their socio-economic development and growth, and has fuelled the spread of HIV.

The Turkana are distinguished as being great survivors who have conquered the inhospitable terrain they call home, but the battle against HIV is one they have almost lost.

The 2012 Kenya Aids Indicator Survey places Turkana County among the top 10 regions with the highest adult HIV prevalence in Kenya.

It is a new entrant into the top 10, with an adult prevalence of 7.6 per cent, which is higher than the national prevalence of 6.0 per cent.

Many people do not know it, but Turkana is now considered a high-risk county and, although other factors may have contributed to the rising prevalence rate, traditional practices like polygamy and widow inheritance, coupled with belief in traditional medicine, have greatly promoted the spread of HIV.

It is normal in Turkana for a man to leave his home for another woman when one of his wives gets pregnant, and to only come back when his wife gives birth.

UNPROTECTED SEX
Ekitoe’s husband, for instance, left home for another woman when she was pregnant with their fourth child. “When he came back, I had four consecutive miscarriages.

I was devastated, because every time I miscarried he beat me and blamed me for my unfortunate condition. Eventually, I went to the local hospital, where I was told I had ‘the disease of the urban people’,” she says.

“I decided to take medication after a great deal of convincing by the doctor, since I was pregnant at the time, but my husband refused to take any drugs, or to even take an HIV test. He is dead now.”

When the husbands leave, their likelihood of engaging in extramarital, often unprotected sex increases. This raises their vulnerability to HIV, as well as that of their wives when they return home.

In many regions of this vast county, it is taboo to say “condom” and “HIV”. Condoms are particularly vilified because they prohibit procreation, yet a man’s wealth here is seen through the number of wives he has, the size of his livestock herd, and the number of children.

Polygamy is encouraged so that a man can create a large working unit. As a result, a man must marry as often as possible. It is believed that one wife is a misfortune, sort of like a man with one leg.

“We need many children and wives, so that in case there is famine or drought or floods then at least there is a chance of some surviving,” explains Peter Ekiru, a resident of Lokichar in Turkana and husband to three women.

“What happens if you have one wife and three children? The possibility of all dying when disaster strikes is very high. But if I have three wives and 15 children, at least some will survive.”

HERBAL MEDICINE
Ekitoe is among the few Turkana women lucky to access antiretroviral treatment after knowing their status. She says many women live and die with the virus without knowing their status due to ignorance and taboos.

Dr Echakan Esimit, the Deputy County Director of Health, says the belief that herbal medicine can cure any disease has stifled the uptake of antiretroviral in the county.

“Even when they test positive, many do not embrace the idea of taking medication, and most of those who enrol into the programme default,” he says.

According to the Ministry of Health, approximately 19,000 adults out of the 39,000 living with HIV here need antiretroviral therapy, but only 20 per cent of them are accessing it.

In the next homestead, Margaret Adome, a 40-year-old woman living with HIV, walks me to the back of her house. Here we count seven graves, one still very fresh.

“This is my whole family,” she tells me. “They all died of Lokicharmale. It is just malaria.”

Lokicharmale means “malaria from Lokichar” in the local dialect. It is the name given to HIV and Aids here since it is an abomination to mention the term HIV. Approximately 2,000 people die annually in Turkana from the disease.

STIGMATISATION FEARS
Adome’s story is no different from that of her neighbour, Ekitoe. She says she got the virus after her husband left to be with another woman, then came back home.

“I only used to hear about this disease in songs in matatus. I thought it was a disease of the young people. You see, I was faithful to my husband, who was very faithful to my three co-wives and I,” she says.

“But now he is dead, and the other two wives are dead too. The third one has been inherited by my brother-in-law and lives in Lokitaung’.”

Unlike Ekitoe, Adome’s family does not know her status. She says she fears being stigmatised. Here, people living with HIV are considered liabilities, so they fear disclosing their status lest they lose social capital.

“They have a lot of self and community stigma,” says Dr Jonathan Imana, the Head of HIV and TB unit in Kakuma. “The community here can really discriminate if they know you have HIV.

That has made it difficult even to trace patients because when they come here they give false names.”

When asked whether she will be inherited too, Adome says it is tradition and she cannot go against the wishes of the elders, whose word is final.

They are the advisers on questions of grazing rights and the interactions between the various sections of the tribe, and their experience means their judgments are never questioned.

INCREASED TB PATIENTS
But culture and traditions are not the only factors that have put Turkana on the map as a burdened county.

Before 2012, Lokichar was a little-known town in Turkana South, but the announcement that this town held commercially viable oil deposits put it on the map and on investors’ Explore List.

Within no time, it has expanded. Residential and commercial buildings are coming up quickly, and transactional sex, predictably, has gone up too.

Again, Turkana is host to the region’s largest refugee camp, Kakuma, with a population of about 170,000.

The unrest in Africa’s youngest nation, South Sudan, has led to an influx of refugees into this camp. This has in turn led to a rise in the number of TB patients, and more cases of persons living with HIV have been reported.

People living with HIV are unable to adequately recover from emergencies, and are increasingly becoming weak.

When the general conditions are improving, and large parts of the healthy population are making modest steps towards recovery, HIV patients here are stuck in a continuing “micro-emergency”.

The steps marked by the rest of the country 30 years since HIV was discovered in Kenya might not mean a lot to this population. Turkana still need the basics. The county still needs ‘The 101 of Culture vs HIV and Aids’.