Helene Gayle, president and CEO of CARE, reflects on her trip to Kenya.

During the past few days we've learned a lot, visited various sites, dividing into three groups going to communities and through urban areas.

When reflecting on visits to countries like Kenya, I'm always impressed and encouraged by the enthusiasm of the people I've met along the way. In the case of the recent Kenya Learning Tours trip, it gave me great hope to witness health workers, mothers, people with HIV and youth express their commitment to solve health problems and work to overcome extreme poverty. Their names, faces and powerful stories will always be with me to drive my work.

As co-chair of the CSIS Commission on Smart Global Health Policy with Admiral Bill Fallon, we hosted this trip to Kenya to learn and bring back messages to U.S. policy makers on global health solutions. Much can be drawn from Kenya to be applied more broadly as we look to enhance awareness and commitment to health issues around the world. We are seeing improvements but we aren't where we should be. Clearly, there's no quick nor easy fix to get there.

The good news is we know the kinds of things that make health systems work from procurement of medicines to training health workers to good policies that make efforts sustainable. And, as more evidence-based data is collected and analyzed, it will help drive priorities. Moving forward, as we look to solve health problems and increase access to health services, it's important to not solely think about the technical interventions. Donor integration and coordination is also extremely critical. Increased flexibility of investments will be a major driver of success. Ultimately, our goal is to allow governments and communities to use this platform to take on more of an ownership role and make it sustainable. The bottom line is that we need to get this strategy right and efforts should not be about political advantage but rather on the health and well-being of the people, like the one's I've met in Kenya and in so many other developing countries I've visited over the years.

A woman in Siaya District (Nyanza Province), Kenya. (2009 Allen Clinton/CARE)

Helene Gayle, president and CEO of CARE, blogs from her trip to Kenya.

August 11, 2008

It was a long, action packed day today, hopping between communities, dispensaries (clinics), hospitals, and donor and partner meetings. We left our Nairobi hotel at dawn to catch a half hour flight to the northern Kenyan town of Kisumu. After landing, we loaded up in vans and drove straight out to Siaya District. Accompanying me today were Rep. Keith Ellison of Minnesota; Rep. Rosa DeLauro's Chief of Staff Kevin Brennan of Connecticut; Rep. Adam Smith's Chief of Staff Shana Chandler of Washington; CSIS Global Health Policy Senior Adviser Lisa Carty; and my CARE colleagues JoDee Winterhof, Kevin Layton and Stephen Gwynne-Vaughan.

There were a couple visits that really left a strong impression on me and others in the delegation. One was to a CARE program once visited by President Obama when he was a senator. The program is called Tego Od Dayo or Strengthening the House of Nanny. It supports more than 1,000 women to help care for some 3,191 AIDS orphans and children orphaned by other circumstances. One woman, Anastasia Akinyi Otieno, said her son was killed during post-election violence in Nairobi last year and she took in his twin daughters as a result. The project helps support this grandmother's small cereal and vegetable business through access to credit. Using modest earnings from her hard work, she provides for her family. Anastasia named her two dogs Obama and Michelle, evidence of how much she appreciates the support.

Further down the road at another village, we spoke to members of an HIV and AIDS support group. One woman, Consolata Anyango, said she can't stand silently. This district has a 24 percent HIV prevalence rate. Consolata and her group are living proof that life can continue after a HIV positive test. After finding out she was HIV positive in 2004, she joined some 50 others in this community, working to stop the stigma, sensitize the community and advise others about prevention. At the neighboring clinic,Bar Olemgo Dispensary, Moses Busolo, a nurse who supports and distributes antiretroviral medications to Consolata's group, reaffirmed the message. He explained, "There's no difference between an HIV-positive person and someone who hasn't been tested." Moses delivers, on average, 10 babies a month at this facility and sees about 80 patients a day. This small dispensary also provides services like family planning and antenatal care.

Tomorrow, the Learning Tours group comes together in Nairobi to debrief and hold a public event to share our thoughts from the trip. I look forward to the discussion.

Helene Gayle, president and CEO of CARE, blogs from her trip to Kenya.

August 10, 2008

Well, we arrived last night to Nairobi around 9 p.m. and settled in. Most of the Learning Tours group ended up on the same flight to Nairobi from Amsterdam, which was great as it gave us a bit of time to connect with each other and get focused on the Learning Tour trip.

This morning after a breakfast briefing we loaded up in a van and headed to a drop off point to get to Kibera Tabitha Clinic. Kibera is a densely populated "informal settlement" or slum area of Nairobi. Population estimates for Kibera are as high as 1 million people. It's probably the largest and most studied slum in Africa – nearly the size of Manhattan's Central Park. From our drop off point at the top of a hill, it looks like a corrugated sea of rusted tin roofs and open sewers.

Reaching the clinic involves walking through a maze of muddy walking paths as there are no streets. While there we were briefed by Dr. Rob Breiman of the Centers for Disease Control and Prevention (CDC), who is a former colleague from my days at CDC, and the clinic's director, Salim Mohammed. The clinic took two years to build and was completed this year. The bricks to build it were all carried by hand down the same narrow, windy path to the site and was built by the community.

The clinic partners with the CDC to identify trends in infectious diseases and develop programs to meet the highest priorities for improving health. They also integrate HIV training, reproductive health and antenatal care. About 150-200 people visit this clinic every day.

Staff also do home visits to households every other week, asking questions to identify possible health issues. For example, if someone has a cough or potential complications with a pregnancy, it initiates a specific set of questions to help determine the whether there is a problem that needs attention. I had the chance to go on a home visit to meet with a woman named Cynthia, a mother of five. It was interesting to see how the local health worker, Jaciuta, gathered surveillance information on Cynthia's family that was logged on a handheld PDA – technology put to good use. This allowed the home health worker to go back to the office and upload household health information on a daily basis. Sure beats old fashion paper record keeping!

From there, we walked through another part of Kibera to meet with a group of women. They told us about the daily struggles they face as well as some of the support they receive from a woman named Judy, a retired nurse who started her own organization that CARE supports as a local partner through our Local Links program. Judy helps the women start small businesses, like selling vegetables, to earn their own income.

The story of one woman, Mwinza Mwema, especially impressed me. She has seven children and two orphans in her care. Her vegetable stand was burned to the ground during the post-election violence in Kenya last year but she didn't give up hope. She takes on jobs washing clothes and dishes, making a little over a dollar a day. It never ceases to amaze me the resilience of women like Mwinza, who continues to have a positive attitude despite the hardship she faces. This is a woman who survived home childbirth, cutting the umbilical cords herself because she couldn't afford to go to a hospital. She was lucky to have survived and that her children still have a mother. She mentioned other women she knew who didn't survive home childbirth, a common practice in poor areas. Hopefully as more clinics like Tabitha go up, more people will start accessing health and family planning services.

During lunch we spoke with Peter Anyang Nyong, minister for medical services, who noted health challenges in Kenya, and how improving infrastructure and human resources are critical to the country's development.

(L to R: Admiral Fallon, Minister for Medical Services Peter Anyang Nyongo and me at lunch)

From there we drove to Pumwani Maternity Hospital for our final visit of the day. According to the director, Dr. Charles Wanyoni, it's the busiest maternal health hospital on the continent. This year, he said they've experienced seven maternal deaths for some 11,000 deliveries. He noted that "when it's this busy you can expect complicated cases." The hospital has two operating rooms, one antenatal clinic, family planning services, services to prevent mother-child transmission of HIV and comprehensive care. Because it's located right next to Kibera, many women and girls who deliver there have to work out with a hospital committee how they will pay for services – approximately $40 for a normal delivery and double that if a caesarean-section is needed.

(Here I am visiting the Pumwani Maternal Health Hospital's neonatal unit.)

Because the hospital was built in 1926, it was obvious they've have to expand, which is a constant struggle when facing high demand and low funding. It was good to see that the CDC is supporting the hospital with a laboratory, and it also receives PEPFAR (the U.S. President's Emergency Plan for AIDS Relief) funding. The hospital staff has aspirations for developing their infrastructure during the next five years to include things like a new water system and more skills training workshops for staff.

I really hope for the day when poor women can focus on getting the care they need without putting themselves in precarious financial positions that deepens their poverty. This is what I will continue to push for: more investment in maternal health and family planning. These issues really need to become a priority, not just in Kenya, but  on a global scale.

Tonight, I have to brush off the dust from today's trip to wear another hat: meeting with health leaders and key donors at the residence of U.S. Ambassador Ranneberger. More tomorrow!

Blog by Allen Clinton, CARE staff, currently on a Learning Tours trip to Kenya.

Helene, Admiral Fallon, congressional staff and others on the Learning Tours trip are about to land in Nairobi. As final information packets have been placed in folders for the delegates, we just sent a team to the airport to get them. There's been so much work put into this trip over the past few weeks, it's almost strange how fast we all know it will fly by when it happens. We're looking forward to getting the group together and getting underway.

At the hotel we are staying at here in Nairobi, I had to do a double take at one of the restaurant employees who at first (and even second and third glance) looks like the actor Don Cheadle. We took a photo with him. What do you think? When we (Sarah Lynch, who is overseeing the Learning Tours, our videographer Indra Palmer and I) sat down for dinner he asked us if we wanted soup. We said no. He replied: "No soup for you?" We all laughed out loud…memories of the famous Seinfeld Soup Nazi episode.

L to R: Indra Palmer, Don Cheadle look-alike, Allen Clinton, Sarah Lynch

Blog by Allen Clinton, CARE staff, currently on a Learning Tours trip to Kenya.

There's a lot involved in putting together a Learning Tours trip. Right now I'm in Kenya as part of a team doing an advance run-through. I'll hold back on all the program details until the trip starts but I will say we've been on the road a lot visiting numerous communities, hospitals and clinics to make sure delegates have a safe, well managed and well informed trip.

On the way to one clinic in the slums of Kibera to review the schedule and time the walk, we were instructed to keep moving along a narrow one lane pathway so we don't hold up anyone coming from the other direction. As parts were muddy, black rubber boots were provided. Some who didn't have the right shoes on wore the boots. For the majority of us who didn't try out the black boots, we did survive walking through or stepping over drainage ditches. I took a few photos to show you what I mean.

Along the way children would walk with us for a few steps asking, "How are you?" When we respond we're fine and returned the same question, they would always smile and giggle. Some even asked the folks with the boots on when it was going to rain.