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traveling with the women who are increasing Kenya’s vaccination rate

For a long time, Kenya had hardly any vaccine doses against Covid-19. Now they are there, but parts of the population are suspicious. How do you convince them?

She’s actually a surgeon, but she’s currently mobilizing people to be vaccinated in rural Kenya: Neema Kaseje on the vaccination bus.

“It’s not ideal,” says Rose Ooro. She points to a coffee table, there are cigarettes and a mask. Ooro is sitting in the living room of the person who should wear the mask and stop smoking: Margaret Onyango, 68, a small farmer and a widow, her expression is grim. She should be vaccinated against Covid. But Margaret Onyango hesitates.

Onyango taps his chest, it hurts. She says: “I’m afraid that the vaccination will make the pain worse.”

Onyango would like more information. She wants to talk to experts. But the expert is sitting next to her, it’s Rose Ooro, the health worker in the village. Up until two years ago, Ooro gave advice to young mothers and people with HIV, changed bandages and distributed malaria medication. Then Corona came. Now she also reminds you to wash your hands and wear a mask. And above all: the vaccination.

In situations like this, Ooro always says the same thing: she too has ailments, diabetes, high blood pressure. But she was vaccinated – and survived. The vaccine is safe.

It is a Tuesday morning in January in the village of Mahaya in western Kenya. Lake Victoria is nearby, as is the border with Uganda, and Barack Obama’s father is buried a few kilometers away. The peak of the omicron wave has broken, but who knows when the next variant and wave will come. The next day there will be a free vaccination bus. He will take villagers to the small infirmary in the village. It cannot be reached on foot for many, because Mahaya is extensive.

It is a pilot test: by the end of the day, 120 people should have been newly vaccinated, 20 of them should be recruited by Rose Ooro. At the team meeting the day before, she had said: “Failure is out of the question.”

“A health worker has to be a good listener,” says Rose Ooro, here during a visit.

10 percent have now been vaccinated twice

According to the World Health Organization, 40 percent of Africans should be vaccinated against Covid-19 by the end of 2021. That was never realistic, because at first hardly any vaccine came, and when it came, there were problems with distribution, education and the fact that many vaccine doses were about to expire.

At the end of the year, 6 out of 54 countries had reached the target. Kenya was not one of them. 12 percent of the Kenyan population are now double vaccinated. In the capital, Nairobi, where distribution is easiest, it is 44 percent of adults. In rural Siaya County, where Mahaya Village is located: 26 percent of adults. In one-fifth of all counties, only one-tenth of adults are still double-vaccinated.

How do you change that? Perhaps by sending out those who are closer to the people than the state: the 135,000 volunteer health workers in Kenya’s villages and towns. They form the hinge between the communities and the health system, whose hospitals and doctors are often far away – especially for the more than 40 percent Kenyans who work in agriculture.

Nowhere in Kenya are the state health authorities relying more on volunteers than in Siaya County. It’s up to women like Rose Ooro if the government meets its goal of having 70 percent of the adult population vaccinated twice by mid-year. That’s 19 million people.

Margaret Onyango squirms for a few minutes, repeating that her chest hurts and that people said the vaccination made previous illnesses worse. But then she agrees: “If there’s a bus, I’ll come.” She is the first person Rose Ooro recruits that day. 19 missing.

“Saa adek”, says Ooro in the local language Luo – “9 o’clock”. Then the bus will stop at the crossing in front.

Ooro says goodbye and hikes on, over red paths between green fields, past corn and mango trees, past small houses with corrugated iron roofs. Ooro is 48, has been a health worker in the village for almost 25 years, is responsible for 256 people in 98 households, and earns the equivalent of 16 francs a month. She wears lipstick under the mask, a decent demeanor helps in this profession. And otherwise? “A health worker has to be a good listener,” says Ooro. “You have to be honest, be able to communicate well. To be an example.”

These are qualities that the Kenyan state can use. Because he himself showed little empathy during the pandemic. In the first ten days of a night-time curfew in spring 2020 alone, police officers shot dead six people. Health Department officials appeared in the villages of Siaya County looking like extraterrestrials in their hazmat suits. Sometimes they transported suspected infected people as if they were criminals. “In the beginning we used too much force,” says Ken Oruenjo, the director of health in Siaya County. People in the test centers are still giving false phone numbers for fear of being taken away after a positive test.

The Kenyan state has learned something new, at least a little. In Siaya County, the Department of Health promotes the vaccine at markets, churches and funerals. Those who test positive are no longer sent to quarantine centers, they are allowed to isolate themselves at home.

At the same time, the government in Nairobi imposed a de facto compulsory vaccination in December. A court had stopped them, but the Ministry of Health fouted the verdict. You actually needed a certificate for going to the authorities, for the supermarket, for public transport. Theoretically. Because the obligation to have certificates was stopped by reality: hardly any bank and no bar in a country with 10 percent double vaccination checks certificates. Not even the authorities do it.

“Does vaccination make you infertile?”

As Rose Ooro trudges through Mahaya and into living rooms filled with couches and family photos, she comes across as an itinerant preacher. And in fact, she always says: “We have come to deliver the message about vaccination.”

She doesn’t take anyone by surprise. “Covid kills,” says the radio and television, where the government is calling for vaccination. But the government is better at warning than explaining.

A 78-year-old says: “People claim that I will die from the vaccination.”

A young man asks: “Why are there different vaccines?”

Another: “Does the vaccination make you infertile?”

Vaccination skepticism in Mahaya is not ideologically charged as it is in Europe or the USA. There is studies, who find that vaccination skepticism is lower in poorer countries than in rich ones anyway. There are also studies, which state that Kenyans are less skeptical about vaccinations in comparison to Africa. The Ministry of Health he lifted last summer that allegedly only 10 percent of the population reject the Covid vaccination.

The skepticism in Mahaya is often pragmatic: the infirmary where the vaccination is administered is too far away. The journey is too expensive – especially for subsistence farmers who hardly have any cash on hand. Some have made the journey, but there was no vaccine at the time. Why try again now that the number of cases is going down?

In other words, skepticism in Mahaya often has to do with logistics, not ideology.

This is also due to the fact that here in the country only a few have access to Facebook or YouTube. In the big city of Nairobi, many may believe that the upper arm is magnetic after the vaccination – as charlatans claim in videos. In Mahaya they don’t believe that. You rarely feel like you know better. But to know too little. For example: Why are people dying in Europe when so many of them are vaccinated?

If necessary, mobilizes on the phone: Rose Ooro.

If necessary, mobilizes on the phone: Rose Ooro.

Rose Ooro doesn’t say much to allay concerns. She listens, then tells her own story, and she makes an offer. The story is always the same: she too has previous illnesses, diabetes and high blood pressure. But she got vaccinated and she’s fine.

Their offer is: There’s a bus leaving tomorrow at 9, it’s free.

At 2:40 p.m., she counts on her fingers: she has recruited 17 people. That’s three fewer than targeted, but Ooro seems content. She’s closing time. At least that’s what she says.

Vaccination by moonlight

Kenya’s 47 counties have different tactics to push up vaccination coverage. In the north, on the border with Ethiopia, shepherds can have their camels vaccinated against infectious diseases – and at the same time vaccinate themselves against Covid. Elsewhere, helpers carry the vaccine to remote locations in solar-powered coolers. And in one county in the center of the country, the authorities offer “moonlight vaccinations” – that is, vaccinations even after sunset.

Siaya County relies on the volunteer health workers. One million people live here, they are cared for by 2000 volunteers. 1,350 of them have been trained as part of the project funded by the Wellcome Trust in the UK. The assistants are now using pulse oximeters to check the oxygen saturation in Covid patients, and during their visits they ask how the disease is progressing. And they remind you of the vaccination.

The woman who trained the helpers is called Neema Kaseje, she is in her early 40s, actually a surgeon, but she is currently learning a lot of psychology. She speaks of the “human factor” and means: “This is more difficult than surgery. People are complicated.”

People are complicated because they’re thinking when they’re not lying unconscious on an operating table. For example, whether it is worth making the trip to the vaccination center if it is not clear whether a second dose will be available in a few weeks.

Neema Kaseje sees the vaccination campaign as a race against time, she says: “If we let the skepticism ferment, we will have a problem.” It’s also a race against new variants and against expiration dates.

So Kaseje rushes through Siaya County, visiting nurses in the infirmaries, heads of villages and the volunteers. She also drives on the dustiest streets with the window open for ventilation, because her fight is also one against negligence. She believes that the pandemic will not be over until everyone here in rural Kenya has been vaccinated.

It will take Rose Ooro and the other health workers to win this fight. “They have the trust of the parishioners because they’ve always been there and don’t show up just to be gone.” Kaseje calls this «social capital».

In the last few weeks, the calculation has worked: between the beginning of December and the end of January, the rate of double vaccinated adults in Siaya has quadrupled from 5 to 20 percent. But is it enough to reach the target of 70 percent by mid-year?

The “Victoria Shuttle” rolls

The next day at half past nine a red bus stops at the intersection that had been agreed as the meeting point. Rose Ooro gets on and with her 7 people who want to be vaccinated. A little less than half of the recruits, not a debacle, but not the goal either. Did Ooro fail in the end? She says: “Some went with the motorcycle taxi.”

The bus rocks again on the unpaved road. Five minutes later he stops again, 5 people get on. It’s 12 now.

“Victoria Shuttle” is written on the back of the bus. He drives off again.

Another five minutes later he stops again. It’s 14 now.

Reggae sounds from the radio, the masked vaccinators sit in silence, the bus rumbles on.

He stops again. Then once again. Rose Ooro continued to mobilize on the phone yesterday afternoon. She meant it when she said, “Failure is out of the question.”

In the end, 33 people who wanted to be vaccinated got on, most of them over 65, some had to stand. Neema Kaseje is there too, she writes down names and numbers of ID cards while the bus shakes on.

Rose Ooro, on the other hand, has done her job. She is sitting at the front, by the open window. She has put on her sunglasses, her head in the wind, her elbows out. It’s a victory pose.

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