Wives of Israeli ambassadors often spend their years abroad as hostesses at
receptions and dinners, discovering the new country and perhaps teaching Hebrew
in the local Jewish school.
Osnat Keidar, whose husband Jacob has been
Israel’s ambassador to Kenya for over three years, was so shocked by the poverty
and disease in that African country, and their effects on children, that she
devoted most of her energy to making a difference in their lives.
their departure, the ambassador’s wife worked as a physical education teacher,
and earned a master’s degree in public health; she advanced in the Education
Ministry to become a health instructor in schools. Before leaving for Africa,
she applied for doctoral studies at the Hebrew University-Hadassah Braun School
of Public Health and Community Medicine.
LIFE EXPECTANCY in Kenya is
around 50, but plummets in the slums. After seeing the challenges of Kenya’s
slum schools, Keidar decided to devote her time there to promoting health and
preventing disease among children in the Korogocho and Viwandani slum
communities of Nairobi, and to write her thesis on what she had learned and
done. Her supervisors were Prof, Elliot Berry, director of the Braun School’s
department of human nutrition and metabolism and head of the World Health
Organization (WHO) Collaborating Center for Capacity Building in Public Health,
and Dr. Milka Donchin, head of the health promotion track at Braun.
of them even came to visit her in Africa.
“I knew that personal hygiene
is the key to promoting health in primary schools in the slums,” she said in an
interview with The Jerusalem Post during a recent visit home. “A majority of
Nairobi’s population lives in slums, which are among the worst in the world. And
there is a great gap between the rich and poor, who live on less than $1 a
The Kenyan authorities welcomed her project, and she joined
Nairobi’s African Population and Health Research Center (APHRC), as a visiting
researcher and worked as a volunteer. “Israel has a very good name there,” she
says, even though a tenth of Kenya’s people are Muslim, and there have been
terror attacks. Like all family members of Israeli diplomats, Keidar was
constantly accompanied by security guards.
Keidar decided to focus her
intervention on 11 elementary schools, only two of them public educational
institutions and the rest much-lower-standard private and community
“In 2003, the Kenyan government launched free education for this
age group, but the infrastructure remains poor. The demand for schooling
resources rose dramatically, leading to overcrowding in formal government
schools, especially in the slums. Due to unmet demand for schooling in public
schools in the slums, many parents who could not get their children admitted or
who felt concerned by the overcrowding in public schools withdrew their children
or registered them in informal schools,” according to Keidar.
majority of children in the slums currently attend informal schools, which are
often not supervised by the Ministry of Education and are in poor physical
condition, lacking basic water and sanitation conditions.
slum children’s educational performance is way below that of other Kenyan
children. “They are in terrible physical condition, with no toilets or piped-in
water. The teachers – including the 40% men alongside the women – have no
teaching certificates,” she said.
The living conditions and health status
of slum residents in Nairobi, she noted, highlight the need for intervention.
The informal settlements occupy less than 6% of the city’s residential land, but
host at least 60% of the city’s population. The children in the slums have
higher mortality and morbidity rates than children in other parts of Kenya, she
explained. “They are less likely to be vaccinated, and suffer more from common
infections such as pneumonia and diarrhea, resulting mainly from environmental
sanitation hazards like the shortage of toilets, poor waste disposal and
drainage systems and the lack of safe water.”
AIDS has devastated Kenya.
“Some 30% to 40% of the children have only one parent, while others are full
orphans and have only a guardian.” Keidar decided not to get involved in that
disease problem, but in interventions that could quickly benefit the
Going to the schools three or four times a week, she and her
local colleagues found the most urgent targets. Each school appointed an
educator to serve as coordinator of a health committee including teachers,
parents and even children. Coordinators received basic education about health
promotion and disease prevention in English, which is an official language in
Kenya, while funding was provided by the UN HABITAT organization.
most urgent need was for toilets, water tanks and faucets, as children were
constantly threatened by bacterial, viral and parasitic diseases such as severe
diarrhea, upper respiratory infections and worms. Once these were in place, the
children had to be taught how to wash their hands. With paper towels at a
premium, they were taught to dry their hands in the air. They even learned how
to prepare liquid soap and harvest rainwater.
“We set up health clubs
comprised of peer educators and promoted drama, songs and debates about hygiene
to boost awareness of the need to wash hands with soap,” Keidar recalls. “Some
schools were near a large dump site, so we tested the water to see if it was
drinkable, which it was. We also received a donation of water filters, and
teachers learned to test the water on an ongoing basis to make sure it was
KEIDAR AND colleagues were certain that their intervention
would make a difference, but they had to prove it scientifically. A control
group of slum children without intervention in 11 schools was used to assess
progress in the 11 schools where Keidar’s program, involving 7,000 children with
an average age of 12 and over 300 teachers, was carried out.
with no one washing their hands and reached as much as 82% doing so. We knew
this by organized observations before they ate and after they visited the
toilets,” she said. “Symptoms of fever, stomach aches and cough were
significantly reduced, leading to a fall in the prevalence of disease. We
checked weight, height and body mass index. An average of 12% were underweight
before the project, but only 9% after the intervention, even though the children
did not get more food. The difference was made simply by improved hygiene and
better awareness of health. The kids ran after me and shouted my name,
‘Osnaaaat!’” Her effort was based on the WHO’s Health Promoting Schools (HPS)
initiative, which was launched in 1997 as African projects for healthy
nutrition, infection control, smoking prevention and mental, dental and
environmental health of schoolchildren. “It is unbelievable but true – our type
of program in the slums was unique. I didn’t find mention of any such program
anywhere in the world,” Keidar notes with amazement.
“Just setting up
water tanks and installing faucets is nice, but children have to be educated. It
not, they just won’t use the faucets to wash their hands.”
research foundation published material on the team’s accomplishments, and Keidar
has already written articles and her thesis. She and her colleagues recommended
implementation of personal hygiene with a focus on washing hands with soap while
children are in schools. This was “identified as a primary entry point for the
HPS initiative. This intervention should include upgrading of schools’ water
facilities and teachers’ health-promotion training.”
But will the progress
vanish when the Keidars return to Israel in the summer? “We believe it will be
sustained in at least nine schools, because we got the community involved. We
worked in coordination with Kenya’s education and public health ministries. The
ministers in charge came to the schools to see our work. They were enthusiastic,
and promised to increase funding per child for hygiene, totaling an investment
of some $3.7 million in the coming year throughout Kenya.”
program, which could easily become a pilot for slum children throughout the
Third World, is not the only Israeli project to benefit the people of Kenya. The
Foreign Ministry’s Department for International Cooperation (MASHAV) recently
constructed the first full-service emergency room in the country’s third-largest
city of Kisumu, which has six million residents in the city and its environs.
Until the team of 10 Israeli engineers built the state-of-the-art facility and
provided all the equipment at no cost, residents had nowhere to go for emergency
medical care. Now local Kenyan doctors and nurses will be trained there as well.