Let Them Drink Sewage, As Long As They Buy Our Drugs

There's a suburb, a slum area, not far South of the town of Nakuru and it always smells bad. Well, perhaps all slums smell bad, but some smell worse than others. As you walk through the main street of Kaptembwa, there are deep trenches at the side of the road, apparently having something to do with the 'sewage system!. But all around, there is stagnant water and raw sewage. When there is a lot of rain, this effluent flows through the streets and even into people's houses. It also mixes with the water supply, such as it is.

I don't know how long Kaptembwa has been like this. People who have been there a long time say there has never been any proper sewage disposal. Now, children play in foul smelling puddles, with terrible consequences for their health. Adults also have to walk through the mess and put up with the smell, the dirt and even the diseases.

Places like Kaptembwa are ideal breeding grounds for water borne diseases. You could vaccinate every child against something like rotavirus and you would still have lots of them sickening and dying of water borne diseases. Both the children and the adults living in such areas need adequate sanitation and reliable supplies of clean water. No amount of vaccine will get rid of the health hazards caused by such conditions.

But also, people are entitled to some level of dignity. They should not have to live in dreadful and threatening conditions. Those who claim to be concerned about their health should consider these conditions first, not the headline grabbing but ultimately weak solution of vaccines or drugs. People shouldn't have to drink water that smells of sewage.

But for some reason, rotavirus vaccine has been much reported recently. Perhaps it's because the Gates Foundation has mentioned the development of the vaccine as one of their primary goals, perhaps it's because the pharmaceutical companies who are behind this lucrative prospect are good at issuing press releases. Journalists are certainly good at citing press releases, regardless of the levels of sales puff they may contain.

Among the three articles I came across today about Gates, Glaxo Smith Kline (and others) and their rotavirus vaccines, all say very little about water and sanitation. They ooze on about how brilliant all this medical technology is but they don't mention, or are not quoted as mentioning, that vaccines will be useless without high levels of spending on water and sanitation infrastructure. It could be wondered if all these groupies care, one way or the other, about how people are forced to live.

One of these articles cites an academic as saying that vaccines "represent the best hope for preventing the severe consequences of rotavirus infection". There is probably a sense in which this 'expert' is right but failing to mention water and sanitation renders the statement hot air. Vague mention is made of water and sanitation in the other articles but the focus is on the vaccine, as if children who are suffering from poor nutrition, multiple vitamin deficiencies and various parasites are going to be magically made healthy by a vaccination for one of the many water borne conditions that are endemic in developing countries.

One of the articles even mentions some the problems of rolling out large scale vaccinations, and the rotavirus vaccine in particular, in countries that have poor health systems and inadequate infrastructure. This article even mentions the high cost of vaccination programmes. Why is it that the Gates Foundation and other institutions don't seem to mind high costs when the main beneficiaries are pharmaceutical companies and other rich establishments?

All the articles list figures for how many lives could be saved by a rotavirus vaccine and the usual sort of stuff. But they don't list the figures for how many lives could be saved by spending money on a cheaper but far more urgent way of reducing deaths from water and sanitation related causes. I can't think why.

Religion and Health: Interference or Complementarity

Following my speculations about why some people seem to imagine that they can be made very rich by a miracle, a friend sent me an article entitled Religion, Spirituality, and Medicine. This article is a "comprehensive, though not systematic, review of the empirical evidence and ethical issues" and concludes that "the evidence of an association between religion, spirituality, and health is weak and inconsistent".

Perhaps more importantly, the authors question the ethics of mixing religion and medicine, a question that would still arise even if there was stronger evidence of an association between religion and health. One could ask, which religion would a doctor recommend or agree to discuss? What would they do with someone who didn't believe in any religion? Would each medical professional require special training and what kind of special training? (The authors of the paper did not raise all these questions, but they arise from considering the problems of combining medicine with religion).

Even if people go to a doctor without any expectation that the doctor is, to a large extent, a scientist, that doctor is obliged to do things that are supported by scientific evidence and avoid things that are not so supported. The fields of science and religion are completely different and the practitioners of each field work in different ways. Is it even feasible for doctors to also become experts in religion (as if religion were just one thing!)?

If I was renting a damp room that affected my health badly, should my doctor write a letter to my landlord and ask for my conditions to be improved? Medical advice could be brought to bear on an employer who was exposing me to health risks, but this is a matter for employment laws. The doctor doesn't intervene directly. Yet we know that environmental conditions are closely connected with people's health. We know that economic circumstances are closely connected with people's health but we don't expect our doctor to recommend a pay rise. Even government health advice about healthy eating is considered to be taking things too far by some.

I accept that certain beliefs can be comforting and I certainly wouldn't suggest that people should be told what to believe and what not to believe or how to express their beliefs. If they see praying as part of their recovery from illness or as helpful in bearing an illness from which they will not recover, no one has the right to interfere. But when it comes to prescribing medication, the doctor is the expert, not the religious leader. And when it comes to praying and giving religious advice, the religious leader is the expert.

In fact, I find it exasperating that there are many churches in developing countries who don't seem to be able to make that distinction. They feel they are experts in marriage, reproduction, sexual behaviour and protecting against sexually transmitted infections (STI). They are not experts, generally they know even less than lay people and should certainly have less experience. If you can't persuade someone to give up having sex or sex outside marriage, the least you can do is tell them how to avoid becoming infected with an STI, infecting someone else with one or giving rise to an unplanned pregnancy. Otherwise, these leaders are failing to do what they can to prevent serious consequences.

If religious leaders wish to give medical advice, they had better know what they are talking about. As for advice about sexual behaviour, contraception and reducing the spread of STIs and unwanted pregnancies, many don't seem to have had a lot of success and should leave the job to someone who has the appropriate knowledge and training. In the same token, doctors should discuss religious matters with patients if they feel able to do so and if they are requested to do so but it should never be seen as a type of medical care or treatment.

If someone has a particular set of religious beliefs, presumably they hold those beliefs regardless of their health or lack of health. It seems unlikely that they just 'adopt' those beliefs in the hope that they will get well. Whether someone is religious or not, some will suffer illnesses and injuries and all will die eventually. If the 'belief' is purely conditional on their health, the person's piety would be quite questionable. So I don't see why a religious person would be interested in whether religion is in any way connected with health outcomes in the first place.

Poverty Breeds Religion? Religion Breeds Poverty? Both?

Firstly, I must make it clear that I don't mean to appear biased, that I am just writing from my point of view. But this is hard for me. I have no problem questioning the motives of very powerful people like Bill Gates or the ethics of multinational industries, such as pharmaceuticals or biotechnology or even those of international institutions, such as the World Bank, the International Monetary Fund (IMF) or UNAIDS. But when it comes to talking about the ordinary people that I meet and interact with every day, I realise I could sound like I'm making some pretty unwarranted assumptions.

I am trying to understand certain things here (in the world, but also in Kenya), that's partly why I'm here. I think that we in the Western world, people and institutions and practices and other entities, do a lot to impoverish people in developing countries. I have argued the point on many occasions and will do so in the future. My whole concept of 'Development by Omission' is based on many instances of this very phenomenon. But I also wonder why some people seem to choose certain kinds of impoverishment or choose not to do things that are well within their capability that may raise their living standards and those of their dependents.

Rather than giving lots of examples, though there are many, I'd like to concentrate on one. I wonder if people who see their situation as desperate turn to what can be a very extreme adherence to some religion. I'm thinking especially of Christianity, in particular the more evangelical ones, though they all seem to be evangelical here. Some people give money they can ill afford to a church, some give it to a pastor. Some even give everything they have got in the hope that a miracle will change their lives. Many pastors and churches encourage these beliefs, it's how they make their money. However, all churches depend on donations for most of their income (or wealth).

Belief in miracles seems to be very widespread, not that miracles can occur, but that anyone and everyone may well have their lives transformed if they just pray a lot and, of course, send lots of money to churches and pastors who claim to be able to make this a reality. Even if I believed that miracles can occur, I don't accept that you can simply wish them to occur, pray for them to occur and least of all pay for them to occur.

I don't see people's wish to have their lives transformed, even their wish to be very rich, as greed. I think if I had nothing I might be more likely to want a lot than I would be to want just enough. Perhaps it's because I've had enough for so long and generally find that fine, a lot would be great, but it's unlikely to feel that much better than enough. I don't wish to preach (God forbid!), I'd love to have an income or, at least, the guarantee that I will one day have an income. But for now, I'm getting by. But I'm not just talking about what people wish for, which can be indefinitely great; I'm talking about what some people seem to sincerely believe they may one day attain.

Greed is what we see in the pastors and churches themselves who extort money out of poor people with promises of great wealth. Greed is what we see in the people who spread misleading information about pyramid schemes and the like and thereby prey on poor people. Greed is the biotechnology multinationals, who want people to think they are getting a good deal when they are in fact entering a form of indentured slavery. Greed is the pharmaceutical companies who keep their prices artificially high and lobby governments of rich countries, who obligingly use public money to subsidise these products and call it aid.

Desperation could be one reason for turning to a religion, even believing quite irrational things or accepting irrational interpretations of the bible. But maybe there are many reasons. Many terrible things are being done every day in the name of religion but maybe only some of them are meant to be terrible. The people running a 'children's home' we came across recently may well believe they are following the word of the bible. They certainly say they are. True, they have stolen most of the donations to the home and put the lives of many children at risk, but it is vaguely possible they started out trying to do something good, while at the same time making enough money to keep their own households and send their children to (relatively expensive) schools.

Perhaps there is just a lot of religious fervour in Kenya, for various interpretations of the bible, for various different churches and for various different religious personalities, perhaps it's not desperation at all. But similarly irrational beliefs seem to be held about foreign people and how rich they all are and how they just come here to give out money. Ok, some foreigners do that, but several times every week, sometimes several times in the day, I am asked for money, often by people who have asked me many times before. And I know others who have had the same experience.

Some people seem to believe that if only they could get a scholarship or if only someone would sponsor them to go to Europe or the US (or somewhere else) or if someone would set them up in business, or if they would marry them, they would be ok, they would be very happy. Maybe people everywhere believe these things, I don't know, maybe people here are just more honest about it. But I think there is a difference between wishing for something and actually expecting it to happen.

Is it desperation that fuels this apparent devotion (or whatever it is)? Or does devotion to the belief that material wealth will be thrust upon all those who pray enough or give enough to pastors and churches or ask enough foreigners keep people from doing things to change their own circumstances? They could question preachers who keep promising them what is just material wealth. They could question where all the money they give goes to when they are poor and the preachers are wealthy, often staggeringly wealthy. I'm not saying there is work aplenty for everyone, sadly, there is not. And though there is wealth enough for everyone those who have most of it, and they are few, are not likely to part with it quickly.

I don't feel I'm much closer to understanding people's seemingly pathological attachment to religion, miracles, pastors and churches. Biased I may be, but I blame churches, not for poverty, but for influencing people in such a way that many people here behave quite irrationally. I blame religion for people's apparent belief that, although they can do nothing to change their own situation, someone, God, rich people, pastors or someone else, can make their lives better. I think the evidence is fairly clear that there is no one who will help most people except those people themselves. But then, when has evidence or experience ever had much impact on religion?

Gates the Autocrat: Malignant or Benign?

It's nice to get a long letter, except perhaps when it comes from Bill Gates and it's 14 pages long. But I feel obliged to try and keep up to date with what he and his foundation are up to. Their various concerns are very interesting but I'm always curious about the ways the foundation chooses to approach these concerns.

For example, the foundation is particularly interested in vaccines for pneumonia and rotavirus and concentrates much of its attention and funding on a relatively small group of diseases. This vertical approach to health, which could better be called a vertical approach to disease, is not one that everyone would be comfortable with. Huge amounts of money and resources for a few diseases could easily result in people suffering from or dying from some of the many other diseases commonly found in developing countries.

Indeed, people's health (as opposed to their diseases) have a lot to do with their environment, their living and working conditions, water and sanitation and, of course, nutrition and food security. The determinants of health are arguably more important than a few of the individual diseases that are seen as particularly worth funding. Even susceptibility to the diseases the foundation is funding is to a large extent governed by, for example, nutritional levels and food security. These, as I shall claim below, are being seriously compromised by the same foundation.

When it comes to TB and HIV, especially, this vertical approach runs a high risk of widespread resistance developing to whatever drugs are made available in large enough quantities. The Gates Foundation puts a lot of faith in technology, in vaccines and the like. These are all very expensive approaches, both to prevention and treatment. It is absolutely necessary to treat people who are ill, but it could be questioned how sustainable, as a whole, the foundation's approach is. Or maybe sustainability is not an issue and resistance can be dealt with by newer round of (even more expensive) drugs.

After all, rotavirus, polio, pneumonia and to a different extent malaria and HIV, are very closely related to the conditions in which poor people live, not just to a group of disease agents or pathogens. Can a high dependence on drugs for prevention and treatment of diseases work to save lives and reduce suffering when, at the same time, health services, education systems, infrastructures, food and food security and social services are almost non existent?

Of course, this is not necessarily the foundation's concern. But Gates and Co. must want their expensive interventions to work. They hardly put huge amounts of money into something that doesn't work. But what results do they expect? They surely expect a lot more people to be cured of diseases and a lot more people to be vaccinated against diseases. But it could be argued that another 'result' of the foundation's work is to enrich the pharmaceutical and other companies that receive much of the money being handed out.

I am not claiming that the money is just being handed over to multinationals. But the foundation's money that is not being disbursed is being invested to maximize its profit. It is being invested in pharmaceutical companies and others, regardless of their impact on poverty levels, distortion of markets, the environment, etc. There is a danger that the foundation is funding some of the problems it purports to be remedying.

So much for health, I'm finding it hard to get my head around whether the foundation is doing good work or if it is, at best, diluting its possible benefits, at worst, sneakily throwing money at multinationals that are closely tied to the foundation's wealth. But when it comes to genetically modified (GM) organisms and the multinationals who produce GM products, I have less doubt about what to think.

GM crops have not succeeded in giving any of the benefits claimed by industry hype. All GM crops grown on a large scale have had massive drawbacks that farmers in poor countries cannot afford. Developing country farmers are mostly subsistence farmers. They get enough from their land to eat and to trade for the following year's costs and perhaps a few other household costs. Even small additional costs will eat into money that they need for school fees, health, food and whatever else.

Taking on GM crops means that the costs that have to be met every year by farmers is higher than the costs of traditional crops. But also, the costs go up every year. GM seeds have to be bought every year and they have increased in cost much faster than traditional seeds. Fertilizers need to be purchased in higher quantities every year and their cost is also much higher than organic methods of fertilizing. Pesticides are more expensive and not only do more and more have to be used every year but eventually, the farmer needs to find new ways or new pesticides to continue growing the GM crop.

The Gates Foundation doesn't seem to favour sustainable ways of approaching diseases. They certainly don't favour sustainable agricultural practices (something that is flatly denied by Gates in his letter). And they don't seem to favour increasing self reliance among people in developing countries. Perhaps I'm judging the foundation too harshly but I think these questions need to be raised because there are too many people who are making so much money out of this type of philanthropy that they will never raise them.

I think we'll have to wait a long time to find out who gains most from the Gates Foundation but I suspect some of the most powerful companies in the world will do very well indeed. After all, if they don't do well, the foundation's investments will not do well and it's funds will eventually be eroded away. I would question the aim to give what Gates calls 'recognition' to these multinationals when recognition usually seems to mean profits. At present, the foundation appears to be paying the inflated costs demanded by these multinationals and making it worth their while keeping their prices high.

Maybe people in poor countries will gain more than they will lose from some of the foundation's projects, but it will be hard to tell. And there will certainly be huge losses for any country that buys in to the hype of GM. Countries that are already suffering from these losses, such as the US and Canada, may be able to afford them but developing countries can not. It seems as if many people in the developing world are depending on the whim of an autocrat. All they can do is hope that he is a benign one.

Income Generation Activities Galore

Just over a year ago I appealed to people I know, especially on Facebook, to help me to identify possible income generation activities suitable for developing countries where little capital, skills or infrastructure are available. I was overwhelmed by the slightly fewer than two responses I received and the first one didn't fly. So I set about researching on the internet, contacting people and talking to anyone who was prepared to discuss the subject. Now that I have started making a list, I decided to post it here on my blog so that others trying to research the same thing won't have to start right at the beginning. And maybe some people will even contribute to the list!

The list is by no means exhaustive and the categories are just based on the way things look from here. They overlap to some extent and they are in no particular order, though I think the first two are particularly important because local acceptability can make or break an income generation activity, no matter how 'good' it may seem. And some of the activities that are already widely carried out have a lot to recommend them. The community based organisation I work with, Ribbon of Hope, already grow a number of crops and have financed several livestock programmes. But it's time to branch out, try new things, diversify and ensure that people get the maximum benefit possible.

The approach we are likely to take is to ask our clients what gaps they feel there are in their local market, what local materials are available or could be made available. Also, what skills are there, what do people already know how to do. There must be local products that we don't know about and sometimes it turns out that people can make or do things but just hadn't realised the value of that skill. I'm not sure in advance what we will gain from this or how we are going to elicit the sort of information we want, but I think it could be a valuable exercise. Rather than just teaching people a skill or a few skills, we would also like them to be able to assess all the opportunities that exist and consider acquiring as many skills as possible. So that's the first category.

The second category is to get people to help us make an inventory of what could be produced in the area and sold in a local market or business. I'm thinking of things like sunflower or sesame oil, peanut butter, jam from seasonal fruits, honey, butter, cheese or anything else, even things that are already produced but for which there is little or no market, yet. I'm thinking of a campsite I stayed at in Tanzania which sourced things like this in a relatively remote area. The result was spectacular because many of these products here are only available in highly processed, branded forms (which taste disgusting). They should be produced locally if at all possible.

Ribbon of Hope already supports several shambas (smallholdings), which I have mentioned several times on this blog. Those smallholdings should produce everyday foods that people in the area need but they could also produce high value crops, such as sesame and sunflower seed, where clients can also produce the sesame or sunflower oil. These have the advantage of yielding highly nutritious oil cake as a by-product, which makes excellent animal feed. We should produce animal fodder, especially fodder that can be stored for use during dry periods, which are all too regular and protracted here. And there are all sorts of interesting crops we could consider growing, just to keep things diverse.

Dairy cattle, goats and chickens are a well tried income generation scheme and they are usually successful. Because they are such a good bet, they can require a fair amount of capital, which some of the more risky and less well tried schemes don't. But not everyone can afford to take risks. I'd say, get the low risk schemes started first and then add the others in at leisure. We mustn't forget the hides and furs of stock such as cattle, goats and sheep, either. Certainly, there are many uses for sheep wool, regardless of the quality. But another type of livestock that you don't see so much around here is rabbits, especially the very big ones that are bred for meat. There must be many uses for their fur, too.

There are good opportunities for different types of food processing here, especially food drying. Fruit and vegetables can be solar dried at very low cost. Many crops, such as mango, pineapple, banana and tomato flood the market at certain times of the year and a lot is dumped. These are all good when dried. Ribbon of Hope produced a beautiful crop of coriander in the last few weeks and this would be as good dried as fresh, except that it would be a far more viable crop if we could dry large amounts of it. Mushrooms are grown locally and are a potentially lucrative and nutritious crop that is also good dried. Yoghurt is already widely produced, cheese isn't so popular and maybe there's a reason for that. But many things could be made with local ingredients, such as biscuits, cakes, bread, cassava chips and the like.

Some of the areas here are blighted with a monoculture, especially sisal. But I'm sure people could be persuaded to make things of higher value rather than rope, which is how most of the local sisal ends up. We'll see what people who have been surrounded with sisal all their lives come up with. Not too far from here, silk worms are farmed, so that's another possibility. I've mentioned before the possibility of producing reusable sanitary pads. There are probably going to be lots of objections but many people, especially young girls, can't afford disposable ones so it's worth some effort. Leather goods may be another possibility, especially if local people are successfully breeding relevant livestock. No doubt there are other artisanal products, such as pottery, candles and whatever else. Sorry for being vague but the gaps will be filled in eventually.

Ribbon of Hope has already funded a successful project selling water and this raised surprisingly large amounts of money. Another possibility would be to pasteurize water using solar cookers or solar heaters and selling it. Included in this category, not many people in this dry province of Rift Valley use irrigation, nor do many people harvest rainwater. This is short-sighted and even journalists are apt to bemoan the fact that there is an unwise dependency on rain fed agriculture throughout Kenya (if journalists notice, it’s probably been a problem for decades). It's time to change this, even if it's only to a small extent. Equally, many people don't irrigate their land, even when there is a source of water close by. Since Ribbon of Hope started irrigating its fields, neighbouring farmers have started borrowing their pump. So it is catching on!

One of my favourite types of income generation activity or cost saving activity relates to fuel or energy. I have mentioned solar cookers, such as simple reflective boxes or more complicated parabolic cookers. These are great for cooking food, drying food and for pasteurizing water or milk. Some of our projects involve milk production so free pasteurization would help reduce costs a lot. I've also mentioned fuel briquettes made from waste of various kinds. People could produce these for their own household but they could also produce them for sale in the local area. Wood and charcoal, the most common cooking fuels, are expensive and likely to go up in price. Solar is cheaper, cleaner and better for the environment and could be used to supplement other sources of fuel. Biogas is more difficult to produce but we are hoping to get some to train us in how to produce the stuff.

Some trees and shrubs could be a useful addition to any shamba. The Kenyan government is thinking of introducing a law about people growing a certain number of trees per acre. True to form, they are not giving any advice as to what trees should be grown and which should be avoided (there are some serious problems that result from choosing the wrong trees). And people with very small, possibly rented shambas, will not want to risk reducing their yield by sticking something unproductive in their fields. But there are productive trees and ones that are good for the soil. There are some that produce fruit without compromising the field crops and others that produce oils and even animal fodder. There are trees that can benefit in various ways, so these should be carefully selected.

Finally, some organisations end up with assets that they only sometimes use, such as equipment and tools. These could be rented out to neighbouring farmers or swapped for other benefits, such as labour or tools that are lacking. Tools and machinery are prohibitively expensive here, which is why so many farmers try to fly by the seat of their pants and sometimes fail. Even rainwater harvesting and irrigation involve costs that small farmers can't always meet. But they might be able to share, for a fee, of course. Ribbon of Hope's neighbours have increased their yields so much in the last few months by using their petrol pump that they could easily afford to pay a small fee.

Well, that's it for the moment, but that's quite a list. I'll continue researching and noting progress (and problems) and I'll add links to further information when I can get around to it. I hope people find this list useful and if anyone has other ideas for income generation activities, please let me know. Thank you in anticipation!

Relative Deprivation in Urban and Rural Settings

It's been a mixed week so far for Ribbon of Hope in Nakuru. We spent the first few days in the hot, dry Mogotio, a few hundred metres from the equator. Despite the heat and lack of rain, there is a river nearby. Ribbon of Hope purchased a petrol powered pump, and later a foot operated pump, to irrigate their fields there. The results on our fields was so good that owners of neighbouring fields have been borrowing the pump to irrigate their crops, again, with encouraging results.

We have started trying to harvest the sizable crop of beans but very heavy rains at the end of the growing season resulted in extensive new growth, which means that each bean plant contains a mixture of beans that are ready to harvest and beans that are still green. The ones that are ready to harvest are starting to pop out of their pods and the green ones need to stay in the ground for another few days or even weeks. It's a bit of a dilemma and we are looking for ways to work around this. But the field has produced and continues to produce other vegetables and, in the end, it will more than pay for this year's and perhaps next year's costs.

The recently rented field that has been planted with watermelons is doing well and the constant irrigation, weeding and other work required gives casual employment to several local people. Mogotio is very short of jobs, most people do casual work of some kind and that's scarce enough as well. The area has depended for a long time on the sisal industry, which dominates the area completely but product output is very low and, for some reason, the sisal factories don't seem to like paying their employees. For some employees, arrears go back years.

So there are people who are happy to work in fields and there is a ready market for the produce. The soil is very good and with proper tending, seems to be well suited to quite a range of vegetables. Some of Ribbon of Hope's modest aims of reducing poverty and dependency to a small extent in Mogotio have been realised and we hope that this progress continues well into the future. It is a credit to the people there who have been so willing to work hard to ensure that things have worked out well.

There are several other similar projects in other villages and they have not all worked out so well. One perfectly viable smallholding has been neglected to the extent that there is little there now but weeds. My colleague and I felt ashamed when we walked around it because it stands out from the surrounding fields, which are packed with greenery, maize, beans, fodder crops and others. This sort of wastage of money, labour, resources and opportunity needs to be avoided, but how? Lots of people say they want help but Ribbon of Hope has limited resources. The only way they can help is by starting sustainable projects, ones that require a small initial outlay that can eventually be returned to the organisation.

One of my colleagues pointed out to me when I arrived in Nakuru that the rural based projects tend to do well but urban based projects, or projects involving urban based people, tend to fail. This has been demonstrated to me over and over again. Big NGOs don't tend to go to villages, even ones quite close to big towns. Villages and rural areas seem to be overlooked by funds, schemes, initiatives and projects, yet many people there welcome any opportunities that present themselves.

But people who are based in urban areas seem to have NGOs knocking at their doors (beating them down, even). It is not an exaggeration to say that there are people who join each and every group in order to see what they can get from it. Some have several different group meetings every day of the working week. If they don't get something to take home, something immediate and tangible, they lose interest very quickly. Ribbon of Hope runs relatively short term projects but even three to four months is too long for some people who are used to receiving cash handouts, food, clothing, per diems, courses in making things (which they subsequently never make) and who knows what else.

There is a lot of poverty in urban areas, I wouldn't wish to suggest otherwise. And I'm pretty sure there are plenty of people who know nothing about this system of 'support group hopping' and are unaware of benefits that they could really do with. But small community based organisations who can't provide people with something to take home cannot compete with organisations who can. So perhaps, given our size and means, we should concentrate on rural based groups. Perhaps we shouldn't try to box above our weight.

The last remaining urban based group that we worked with may now be drifting away and I won't be shedding any tears for them. As for the remaining rural based groups, most are doing well, not as well as Mogotio, but it's early days. We have some great ideas to try out over the next year or so. There have been more encouraging signs than discouraging ones and perhaps now is a good time to do some selective pruning and simply rip out the plants that will hold back the others in the long run. Sorry for the cheesy ending but it seems apt.

Kenyans Don't Need Rights, Especially if They Are Women

The Kenyan MPs reviewing the draft constitution have decided that women will not have equal rights to men in marriage. They don't at present, so no change there. And a big missed opportunity in the fight against domestic violence, family impoverishment and indeed, the spread of HIV and other sexually transmitted infections (STI), along with unplanned pregnancies, including those among women who are HIV positive.

These extremely well paid MPs have decided to exclude much in the constitution that relates to rights and the role of civil society. This includes religious groups (and the Kenyan National Commission on Human Rights), so I'm sure the MPs will be persuaded to change their minds about the former! But Kenyans certainly, these MPs feel, don't need rights to water, housing or food (or social security, health, founding a family, safe environment, access to quality goods or efficient administrative action). It could be wondered what rights Kenyans are deemed to be entitled to by these (Kenyan) MPs.

One of the reasons that the use of condoms for reducing the spread of HIV, STIs and unplanned pregnancies has not been too successful is that women say they don't have the option to refuse to have unprotected sex with their husbands or partners. Effectively, they don't have the option to avoid becoming pregnant, even when they don't want more children or when they know they or their partners are HIV positive.

The Christian churches, the ones whose part in running the country may or may not be threatened by this constitutional review, of course, object to the use of contraception. The fact that it could prevent all sorts of social problems, such as the ones mentioned above, is irrelevant. Harm reduction will probably never cut any ice with Christian dogma. But it is unlikely that women's rights will fare any better in the ultimate male dominated institution.

However, on the insistence of the same Christian churches, the controversial paragraph that mentions the right to life without stating when life begins has been altered to stipulate that life begins at conception. Are all Kenyans Christians? Clearly not, but some vocal sectors of the civil society that these MPs seem to want to silence appear to have a lot more say in the new constitution than others.

Abortion is already illegal in Kenya. With very few exceptions, the hundreds of thousands of abortions that take place in Kenya every year are, therefore, unsafe. These unsafe abortions contribute to the maternal death rate of 30% and an estimated 2000 women die every year from unsafe abortions.

So the Christian churches are interested in the right to life of the unborn, but they don't seem to be so interested in the right of women to choose whether to become pregnant or even to choose who can make them pregnant or when. Women who know their partner or husband is HIV positive do not have the right to refuse to have sex or to insist on the use of a condom. Why are these Christian churches not as concerned about the rights of the very women who are expected to carry, give birth to and raise children where they do not choose to, perhaps because they or their partner is HIV positive?

A canon who was interviewed about this matter said that 'pregnancy is God's design' and that men and women are 'responsible to control themselves and engage in sex as a husband and wife', which, if you are a Christian, may well be true. But is the canon not aware that a lot of sexual activity doesn't take place between husbands and wives, that a lot of people have sex with people other than their husbands and wives, that some people don't get to choose when, where and with whom they have sex? The Christian churches, of all churches, should be aware of things like this.

If the Christian churches wish to oppose the use of contraception and a woman's right to choose, they need to pay some attention to the rights that women are currently being denied. Because it is in part the denial of these rights that is giving rise to huge numbers of unplanned pregnancies in the first place. If they sincerely want to reduce unplanned pregnancies, transmission of HIV and other STIs, sexual and gender based violence and other social problems, they would need to reconsider their position on contraception, for a start. If they are unable or unwilling to do that, these churches will find their relevance to the majority of Kenyans, especially poor Kenyans, diminishing as quickly as it has done in Western countries over the past few decades.