Esther Kimani est une sage-femme qui vit à Nairobi (Kenya). Polyvalente et engagée, elle exerce également comme doula et fournit son expertise en tant que spécialiste de l’allaitement et des soins infantiles. La vie et les méthodes de travail d’Esther ont connu de profonds bouleversements. Confrontée à de nombreuses difficultés dans l’accompagnement et le suivi de ses patientes (manque d’informations, manque de moyens des hôpitaux, peurs et angoisses des futures mères etc.), Esther a su s’adapter et innover pour continuer à pratiquer son métier de sage-femme dans un contexte de crise sanitaire.

Esther Kimani is a birth worker who lives in Nairobi, the capital of Kenya in East Africa. In her daily work, she has practices different functions:  she works as a doula, a childbirth educator, a lactation specialist and she also provides her expertise as an infant care specialist. In her conversation with Afriques Decryptages, she shared her point of view on the pandemic as a health and childcare expert, but also from a personal view, as a mother.

Esther, thanks for being with us. From your point of view, how did the pandemic of COVID-19 develop in Kenya since the discovery of the first case on March 13th

In the initial stages, a Kenyan woman who had come from the US was confirmed to have tested positive to COVID 19, there was contact tracing and some of her contacts tested positive including two people who had sat next to her in the plane. Initially the numbers grew from imported transmissions and then the positive cases started to be seen in the two major cities in Kenya, which are the capital Nairobi and the coastal city Mombasa. However, local transmissions picked up by the month of April and the numbers as of 12 June stand at 3,305 infected, 96 deaths and 1,164 recoveries. However, experts say that the majority of the positive cases have been asymptomatic or with mild symptoms.

Which measures are currently undertaken by the government and municipalities in Kenya ?

Some of the measures include the closure of the borders including restrictions to passenger flights and people crossing neighbouring countries except for movement of cargo. Of course, the government imposed the quarantine of any suspected or positive cases of COVID 19, a national curfew from 9pm to 4pm except for essential services and the closure of all education facilities. Mass meeting such as weddings, funerals, religious congregations etc. are still forbidden and the restriction of movement from the two major cities in Kenya (Nairobi and Mombasa) still remains.

On a daily basis, wearing a mask in public has been made mandatory, cashless transactions are encouraged and temperature checks and hand sanitizer points are set up before all business points

To what extent are you affected, personally, by the crisis from the sanitary, economic and professional point of views?  

On the sanitary level, I have to wear Personal Protective Equipments (PPEs) when interacting with my clients and during all other activities and to sanitize everything I purchase. I must carry sanitizers everywhere I go and wash my hands as I enter my client’s homes.

On the economic level, I have had a significant reduction in my revenues due to the economic slump brought on by the pandemic. I have also had to reduce my fees to enable my clients to afford the services.

I have also had to continue paying my domestic worker even though she does not come to work as she lives in an informal sector.  She told me that the majority of her neighbours have been relieved of their duties without payment, leaving hundreds of families with no livelihood.

The situation also affects my professional activities: due to hospital restrictions, I am unable to accompany my clients during labour and delivery as most hospitals are either not allowing or allowing only one support person for a woman in labour.

I have had to innovate to be able to offer some virtual support services for women in labour, lactation support or infant care sessions. I have had to move my childbirth classes online as physical classes are restricted.

Only now, I can see my clients in urgent breastfeeding cases at their home and I ensure that I wear my PPEs during the sessions.

From your experience as a health expert, how does the health sector in Kenya absorb the crisis? What are the challenges?

There has been a significant drop in people seeking health services in hospitals and some private hospitals have even had to lay off some of their staff as people avoid the hospitals.  The quarantine centres provided by the government, however, are becoming overwhelmed by the numbers of patients, which has led to the government recently introducing guidelines for home-care for COVID-19 positive patients who do not need specialised care in a hospital to be able to decongest the quarantine centres. There is still a very limited number of PPEs for medical personnel and specialised equipment like intensive care units and ventilators, which would result in a big crisis if there was a spike of patients that need specialised care.

Are there specific challenges regarding women, mother-to-be and young mother’s health?

The greatest challenge I have noted is that because the new mothers are being discharged very quickly from hospital, there are going home with very limited information in infant care and breastfeeding leading to cases of infant dehydration or poor weight gain due to breastfeeding challenges, cord infection, etc. Likewise, some women have ended up giving birth at home without skilled support due to the curfew as they lacked the means to get to hospital or fear of venturing out at night. Moreover, some mothers develop a fear of going to hospitals and don’t attend to their pre-natal clinics or even take their newborns for vaccinations fearing getting infected with the virus.

Is there any other aspect about COVID-19 in Kenya you would like to draw the reader’s attention to, either from a personal point of view or as a health expert?

Delay in health seeking behaviour may eventually cause more deaths than the virus itself as people wait too long to go to hospitals leading to complications from infections that are treatable when caught early

How do you see the situation in next few months in Kenya? What will be the main challenges? And what are your hopes?  

People will be forced to go back to their usual economic activity to be able to make ends meet.  However, this may lead to large spikes of infection which in turn may overwhelm our already strained health systems. The hope is that people will continue to follow the guidelines provided to be able to keep safe and lessen the chances of infection as we await a vaccine.