One Kenyan's Story: Care Amidst Chaos

Violent backlash from the perceived fraudulent election of President Mwai Kibaki in December 2007 erupted in Kenya's largest slum, Kibera. Dorah Nyanja, who runs a franchised clinic there, recounts for NOW how she treated the overwhelming flow of patients and fought to keep her business open amidst the danger and chaos that surrounded her.

The political unrest began at night when people realized the election was a fraud. My city is a stronghold for the opposition and they were outraged and began to fight back. It was crazy because everybody turned wild, especially the youth. They were looting and burning down houses: the situation was just terrible.

"We had a lot of injuries because people were fighting back—it was just chaotic."

My clinic is situated in front of the railway line which was being uprooted by rebels. I had to stay because I was treating injuries and also to protect the clinic as there were fears that my business was going to be raided. I stayed in the clinic throughout the unrest. I spent four nights there when things were very bad. We had a lot of injuries because people were fighting back—it was just chaotic. The opposition would loot as a way of expressing anger and to fight back against the administration, who was throwing tear gas canisters at them.

I stayed at the clinic because the people in the community trust me and know they can always come to me in times of need. I had to be with them. This is an area where the poverty levels are really high and it was worse during that period because some of them were casual workers and had not been paid. Some of them, due to their fear of being looted, had to close down their small businesses. I charged [patients] a small amount for services that I rendered, but most people couldn't even pay 40 percent of the fee.

"I treated gunshots, machete wounds, slit throats, you name it."

During that period I initially felt very uneasy, especially because I had pressure from my family—my spouse, my children, and my parents—to leave. But I had made up my mind. I have to serve the people of Kibera because they deserve professional health care. My heart was there but I was very afraid. I received text messages on my phone with information about attempted attacks by other military groups, but I had to support the people who were fighting back.

On a normal working day I treat an average of 65 patients. During the unrest, I saw over 100 patients a day. The injuries that were being sustained were great. People say this was a war zone area. Tear gas canisters were being thrown into the houses. The children were suffering from upper respiratory infections as a result of inhaling the gas. Women were going into early labor. I cannot accommodate two or three births at the same time in my clinic and I had a rough time transferring them [to the hospital] as well. The people with bullet wounds also had to be transferred. At times it was very frustrating because the national hospital was overcrowded. The wounds we treated at the time were some I had never seen in my 18 years of practice. I treated gunshots, machete wounds, slit throats, you name it.

"The thing that saved my clinic from destruction in the unrest is the trust and confidence that people had in me."

One experience that I had, which I had no idea how I was going handle, was a trauma case that came in. One of the men from the town ran into a vigilante group as he was crossing the railroad line and they attacked him. His genitals were completely cut off. He was brought in unconscious. It was crazy; I had to treat him for shock because he came in bleeding so heavily. His blood pressure was low and his pulse rate was very high. I started first aid measures and organized to transfer him to the national hospital as fast as I could.

We were able to save everyone that came into my clinic during the unrest. It only became difficult when I ran out of supplies, but everybody that passed through my clinic got service and medicine. The [patients] that I could not handle were safely transferred to bigger hospitals.

"I have the zeal to continue working here because I love my work."

The thing that saved my clinic from destruction in the unrest is the trust and confidence that people had in me—the general personal relationship that I have with the community and the fact that they know they can always count on me in times of need. They protected the premises from being looted and also protected me from harm.

The conditions at the clinic now are terrible. My clients cannot afford basic medicine even at the affordable prices I am giving them. The economy was destroyed. I used my savings during [the unrest] because patients were coming and they were unable to pay for the medicine so I gave it to them. But I still had to replenish my stock.

I have rent in arrears because I have not paid my landlord. I have electricity bills which are also pending and I also have other bills to pay. So generally, my business is suffering now because I don't have money. But I have the zeal to continue working here because I love my work and I love the community that I am serving. I'm here to stay.