Soap & water diplomacy

The wife of Israel’s ambassador to Kenya has pioneered health promotion in Nairobi’s slum schools.

By JUDY SIEGEL-ITZKOVICH
osnat keidar 311 (photo credit: courtesy)
osnat keidar 311
(photo credit: courtesy)
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.
Before 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.
Both 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 day.”
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 schools.
“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.
“Thus, the 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.
Obviously, the 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 children.
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.
The 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 potable.”
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.
“We started 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.”
The Nairobi 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.”
Keidar’s 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.