NAIROBI, KENYA — Before entering one of the world's largest slums, a dozen American journalists are directed toward a row of knee-high rubber boots. The instruction is to swap your shoes for boots and keep your pants tucked inside the boot tops.
The message: Whatever we'd step through inside the narrow, muddy alleys of the shantytown would be bad to take back to a hotel or suitcase.
If we looked out of place clomping around in boots on a warm June day, the barefoot and sandal-wearing locals didn't seem to notice. Visitors now are fairly common in Kibera, much to the dismay of some Kenyan political leaders who would prefer that the area that "pricks our conscience" not be on so many must-see lists.
One million people — one-third of Nairobi's population — live in Kibera, a tin-roof maze of living spaces that lack clean running water and basic sanitation. The "better" dwellings can count on only erratic electricity. Water must be purchased and hauled, and "container" gardens (a bag of dirt for growing vegetables) is a step forward. An outhouse is a limited luxury. Come nightfall, many resort to tossing out "flying toilets," plastic bags filled with human waste. Rain turns dirt walkways into streams of sewage, both human and animal.
Kibera, approaching 60 years old, remains a humanitarian disgrace.
"Why do people move from beautiful rural areas to Dante-like urban areas?" asked Robert Breiman, Kenyan coordinator for the Global Disease Detection Network.
It's important to understand. Urbanization is increasing rapidly throughout Africa.
Breiman has some hypotheses. People come to cities for cash, educational opportunities and as a way to break from tribal bounds. But unskilled urban immigrants find few jobs and overcrowded schools. Sanitation, water supplies and health systems are all lacking.
Now sections of Kibera are study pools for emerging pathogens. Thousands of residents are under intense surveillance, visited every two weeks by health workers for major research efforts led by the U.S. Centers for Disease Control and Prevention and the Kenyan Medical Research Institute.
Armed with hand-held PDAs, health workers zip through questions about recent illnesses. Families, familiar with the routine, have ready answers.
Those who participate get free clinic care. Childhood mortality among study families is down.
Yet preventable illness is everywhere.
Just soap and clean water (if families can afford them) could reduce pneumonia and diarrhea, both common and deadly, by 50 percent.
Malaria in rural Kenya is far worse than in the higher elevations of Nairobi. But that safety is slipping. Malaria is appearing more frequently, particularly among the young.
Alice Ouma, one of dozens of community health interviewers, strides through twisting pathways, greeting neighbors, certain she is making a difference. She has helped parents seek clinic care for ailing children and themselves, and encourages good follow-through with medicines.
In one recent home-health visit, the mother of the family had been sick for three days, the father had active malaria and their 10-year-old daughter was out of school with a fever. The nearby clinic provided anti-malaria medicine, analgesics and antibiotics for the ill family members. Ouma checked temperatures and breathing rates. Two other children weren’t home, but the parents reported no problems for them.
Ouma stops by 60 such households each day, hoping to find enough families at home to complete 35 interviews. For this slice of Kibera, health care is improving. But the sprawling settlement has far more needs than health projects.
The tragedy is how little government help is available. It was Kenya's vice president, Kalonzo Musyoka, who recently said Kibera pricks the conscience. Ten years from now, he suggests, the nation should be able to say, "The Kibera that was."
Indeed it should. But Kibera has heard promises before, and few hold out such hope.
ABOUT THE WRITER
Miriam Pepper, editorial page editor, visited Kenya in June on a fellowship program organized by the International Reporting Project. To reach her, send e-mail to email@example.com.