It took little more than a century for Nairobi’s sprawling mass to erupt from the highland savannahs of central Kenya. Commercial towers thrust upwards from the central core, flanked to the east and west by suburbs that flow for miles before eventually giving way to farms and grasslands – yellow or green depending on the season. Kenya’s economy is booming, boosted by a lively and innovative tech industry; but while evidence of new money can be seen almost everywhere you look, only a small minority of the city’s three million inhabitants ever get to touch it.
The rich tend to live to the north and west of the city centre, where meandering roads trail through green suburbs dotted with gleaming villas and bright blue pools. Or at least, that’s what we might have seen were it not for the gated roads, security guards and imposing walls topped with barbed wire. Driving through one day our Kiberan fixer, Jobe, asked me if this was what Europe looked like. “We don’t have as many walls,” I replied, prompting an ironic chuckle.
To the south, luxury homes give way abruptly to the informal settlements and slums of Kibera, the focus of yesterday’s piece whose NGO-infested slums I’ll return to later in the series. Mud and steel shacks cluster behind trees at the end of a putting green, marking a border between rich and poor so sharply-defined that from the air it looks as if some great socio-economic force-field has been erected to keep the two apart.
An aerial view of the distinct border between the rich suburbs of Nairobi and the northern edge of the dense Kibera slums (via Google Earth).
The eastern half of the city houses a much poorer population, but appearances can be deceptive. Immigrants from neighbouring Somalia have formed a thriving economy in Little Mogadishu, a former Arab neighbourhood profiled by Katrina Mason in the FT recently that turns over an estimated US$100 million annually. It was to the east, in a rather less wealthy neighbourhood that we found ourselves at the battered entrance to Pumwani Maternity Hospital.
We were assured that Pumwani was an ‘amazing’ place, where we would get to have an ’emotional experience’ staring at all the cute little African babies and their hopeful young mothers. This was the experience captured recently by the photojournalist Marco Di Lauro, who exhibited award-winning photos of the facility in France last September – images of happy young mothers in spacious, friendly and brightly-painted wards. Other journalists have written in glowing terms about the facility: “New mothers appreciated at Pumwani Maternity Hospital!” gushes one reporter.
Unfortunately there had been a miscommunication about the nature of our visit, and Doctor Omondi Kumba, the man in charge, was visibly surprised to see us; though not as surprised as he would be once the realisation dawned that he had just invited a dozen reporters into his office. With admirable speed and grace he composed himself, and began filling the SD card in my Zoom recorder with a stream of facts and figures that, like jigsaw pieces from some twisted sadist, made less sense the more of them we tried to fit together.
The entrance to Pumwani Maternity Hospital (photographed by Charlott Schönwetter)
The basics were clear enough. With 350 beds and sixty babies delivered each day – around a quarter of them by caesarean section – Pumwani is the largest maternity hospital in East Africa. It is staffed by just twenty doctors, supported by 180 nurses. “We are supposed to have about 250 or 300 [nurses],” Dr Kumba told us, but this was apparently impossible due to ‘budget issues.’
The hospital serves some of Nairobi’s poorest, and its fees are supposed to reflect that. “Our delivery fee is very minimal,” Kumba explained: 3,000 Kenyan Shillings (around £30) for a normal delivery, 6,000KSh for a C-section, and 400KSh per night for the bed – patients stay for two or three nights in most cases. That figure is heavily subsidised – at a private hospital the costs would be many times higher – but still there are those who can’t pay. “Every month we have a list of patients who are unable to pay and we waive the fee,” Kumba claimed, “we waive about a million shillings per month.”
A nurse brought tea into the room, joining a small gaggle of awkward-looking nurses and matrons – all women – forming a mini-entourage in Kumba’s shabby, colonial-era office. When she placed his drink on the conference table he ordered her to move it to his desk, flaunting petty power in the self-conscious and unconvincing manner of a man grasping for authority but never quite able to reach it; king of his own, meaningless domain.
The government were supposed to pay back the waived money, but Kumba claimed that in fact the hospital did “not get even one shilling” from them or the city council. “They [the City Council] only pay our salaries, that’s all.” Everything else from drugs to electricity had to be paid for by revenue from patients. Donors were strangely absent, save for a few boxes of mosquito nets in the corner of his office that had been donated by a passing Nigerian pop star. No wonder that in the first six months of 2011 alone, three hundred and forty-two infants died at birth – two deaths each and every day. This was a hospital desperately in need of more funding… or was it?
That wasn’t the only missing money: “We were told that every other hospital gets 2 million shillings per month to cover maintenance, gardening, and other expenses,” Mark Thoma, the lone economist on our trip, recorded on his blog that day, “but this one does not. We asked why, and the answer was: he wished he could tell us, but he didn’t know.” I was sitting immediately to Kumba’s left during the group interview, far closer than Mark, and as the economics professor asked his question a matron behind me leaned in and whispered to her boss: “We are not supposed to talk about this.”
A memo to staff reminds them of the importance of the “political neutrality and integrity of state and public officials.”
We wanted to know more about the fate of the women who couldn’t pay. “We are forced to waive because you cannot retain a mother who has delivered and cannot pay, the government policy is that you cannot detain a mother because she is not able to pay,” Kumba explained, helpfully reminding us that kidnapping post-natal women is legally-dubious.
“We have a social worker who will look at the family background and the income of the mother, the social status of the mother, the relatives and the husband and reach a conclusion that this mother will not pay, even if you retain her for two months, there’s nowhere she’s going to get this money,” he continued, “so let her go. And we sit down as a committee and we approve that she goes.”
Hang on, I thought, what happens to the women while this investigation is happening? The nimbler mind of Salon’s Irin Carmon beat me to the question: “But you do retain them for a while?” “For two weeks,” Kumba replied, “as we investigate.”
We wanted to push further, but it was time for the scheduled emotional experience. Eight of us at a time shuffled into a narrow corridor, kept at a stifling heat for the newborns. Awkwardly we picked our way past a long line of topless mothers, who either clutched their babies to their breasts, or watched them through windows as they lay in various incubation chambers. We were assured that the new mothers had consented to this, but they didn’t seem overjoyed by our presence. Kumba repeatedly warned us not to post pictures of the semi-naked women on the internet, aware on some level at least how intrusive this was. Fifty feet later I’d stopped looking at anything but the floor, and the cool, boob-free air outside couldn’t be reached too soon.
We continued deeper into the hospital, sparse but apparently clean and well-maintained aside from the peeling paint and the odd broken window. The Chinese government promised to invest KSh800 million in improving the hospital’s infrastructure last year, but I couldn’t find any evidence that it had reached these buildings. Free condom dispensers lay empty and spent, their contents long since ejaculated into the eager hands of patients apparently not too keen on a second visit.
A condom machine at Pumwani Maternity Hospital stands empty, its patients apparently not to eager to come back.
Perhaps I had been unsettled by all the boobs, but the further we walked the more uncomfortable I felt. Some of the patients were clearly in distress, and Mumsnet’s Lynn Schreiber recorded a particular moving encounter at her blog: “One woman sat with her back to us, crying softly. When one of the organizers of the trip spoke with her, she explained that she was waiting to leave after having lost a baby. She was sharing a ward with women who had just given birth and who were cuddling their babies.” Nobody seemed particularly concerned about her mental well-being.
Doors opened into examination rooms where women lay curled up on beds, their backs to us, facing the wall. Signs on the wall warned staff of the dangers of careless political remarks. Lynn rightly describes the hospital as “regimented and cold.” Throughout the tour, conflicting emotions played with my judgement: the urge to connect with vulnerable mothers not quite overcoming the fear that I was a tourist in their tragedy.
The scale of that tragedy would only become apparent after we left, and had a chance to investigate further. In May 2009 a local journalist with a hidden camera found 44 new mothers held in a locked room at the nearby Kenyatta National Hospital. Soon after, the Kenya Network of Grassroots Organizations (KENGO) found 34 mothers held in ‘inhuman’ conditions at Pumwani. Vulnerable new mothers, unable to pay their fees, were routinely imprisoned with their babies for weeks or months in an attempt to extort money from family and friends. Not only were these women imprisoned for giving birth, they were charged a nightly rate for their cell, the costs escalating with each passing day. The chief public relations officer at KNH, when challenged on this record, was unrepentant, saying simply that: “The culture of not planning for unforeseen circumstances in this country needs to change.”
Irin Carmon found and interviewed Margaret, a local women who had given birth at the hospital four times: “Margaret recalled that when she was last admitted, a woman was told her baby had died, but when her husband demanded to see the baby’s body, its skin was peeling, indicating a much older corpse. She said she knew of single mothers who have been offered by nurses 50,000 shillings (about $600) in exchange for their babies.” Some of these babies ended up in the West, trafficked by people like Pastor Gilbert Deya, a bogus bishop from Peckham, south London, who claimed to deliver ‘miracle babies’ to local women who had been told they could not have children.
Irin found others too. One described being forced to sleep on the floor, having to “wrangle some spirits from a security guard” in order to treat their own bleeding wounds. Another woman was forced to get out of bed the day after her caesarean as staff verbally abused her: “Why do you open your legs and give birth every time?” The UN’s 2007 assessment still rings true five years later:
PMH’s patients are among the poorest and the youngest women in Kenya, making them particularly vulnerable to discrimination and abuse. Women who delivered at PMH described decades of egregious rights violations—including unsafe conditions for delivery and behaviour by medical staff that abused and humiliated women and endangered their lives and the lives of their infants.
[Pumwani] vividly illustrates the Kenyan government’s failure to take responsibility for severe human rights violations in health facilities.
We had been taken to see a leading African maternity hospital, a place in desperate need of funding and support, where we would have an ’emotional experience’ witnessing the amazing work of a hundred or so hard-pressed medical workers bringing shiny new Kenyans into the world. There were glimmers of light here and there – the loving smiles of new mothers, brave little infants receiving their first vaccinations, the brightly-painted colours of walls that had been sponsored by Pampers – but they couldn’t mask the rotting heart of the institution.
Most maternity hospitals work on the principle that one person enters and two people leave. Many of the vulnerable young women who ran the dehumanising gauntlet of Pumwani Maternity Hospital were lucky if even one undamaged person made it through to the other side. The extent of these problems should be self-evident from even a cursory Google search, and yet shockingly there are journalists – even some from our trip – who pass through completely oblivious to them.
I’ll come back to the role of NGOs later in this series, but we will never get good information about Africa if the journalists who go there simply write whatever story is put in front of them; whether it’s repeating claims that Kibera holds a million people, or telling the story of a hospital that could be amazing if only it had a bit more money to work with. The problems of Pumwani are so widely-reported that few are likely to miss them, and yet incredibly some still do. How many similar places remain under the radar for the want of a few tough questions, and much advocacy propaganda has been written about them?
As for me, well I received my emotional experience; but the feelings I left with were not the ones I had been promised.