Life as a Volunteer at Ruben Centre

Last year, I had the privilege of volunteering at the Ruben Centre in Nairobi’s Mukuru slums, with the support of Ubuntu Through Health. My experience at the Ruben Centre was marked with both heartbreak and hope as I witnessed the challenges faced by the vulnerable community and the unwavering dedication of the Ruben Centre staff to make a difference. Through clinical work, public health initiatives and cultural immersion, I gained invaluable insights into the resilience and power of the Mukuru community.

As I began my volunteering journey, the first challenge that I faced nearly every day was getting into the community itself. A typical day as a volunteer would commence with a stroll to the local fruit and vegetable stand across the road. With breakfast in hand, I would set out to organise a ride-share to the Ruben Centre. Unfortunately, this could sometimes prove a challenge due to the reluctance of many drivers to venture into the Mukuru Slums, but with some patience, I would eventually find a driver willing to drop me off to the centre where the true adventure then began.

Nutrition Clinic

When I arrived at the Ruben Centre, I was greeted with many smiles and friendly greetings from everyone around. At the nutrition clinic there would be many mothers with their babies patiently waiting to be seen. There was a continual chorus of crying within the clinic as children received their vaccinations. The sight of many malnourished infants continually underscored the need for urgent intervention and the importance of the clinic. Yet, the unwavering dedication of the staff who worked with such purpose and compassion in the clinic was heartwarming to see. Even when there were no more Nutrition Packs available and only vitamins left to be given to the mothers, they would still do their best to support each patient and provide them with the care that they deserve.  

Maternity

The Maternity Clinic which was the only in-patient ward at Ruben. Here an extraordinary team of midwives worked tirelessly, delivering miracles with only the most basic resources. The absence of even the most fundamental medical equipment, such as an ultrasound, was a stark reminder of the disparities between our healthcare systems. Having the opportunity to support in the delivery of babies and hearing their first cry was a beautiful experience. There is nothing like holding a newborn baby and putting a cute little beanie on their head.

However, amidst the miracles, there were times when you had to face the stark reality of a maternity ward. The prevalence of high-risk births was concerning due to the lack of prenatal checks for expectant mothers. In such situations, I couldn’t help but worry about our capacity to handle any complication during labour with the limited resources we had available.

The heart-wrenching experience of delivering a stillborn following the loss of its heartbeat during labor, the perilous situation when a mother arrived in active labour with a breeched baby, or the alarming moment a mother began seizing due to a severe postpartum haemorrhage, are all instances that had me wondering about the potential divergent paths these mothers and their babies might have taken had they been in a well-resourced clinic. 

Furthermore, navigating through the cultural nuances and societal stigmas added another layer of complexity to the medical care provided. The pervasive stigma surrounding HIV and other sexually transmitted diseases, coupled with a lack of education on contraception in the community, underscored the pressing need for holistic intervention. Even the simplest acts, such as the absence of fathers in the labour ward, highlighted the significant cultural differences between our medical systems.

Additionally, during my time at the centre, I was told about a significant surge in underage pregnancies within the community. Witnessing the plight of a 13-year-old girl giving birth on my first day on the ward served as a reminder of the harsh realities faced by girls at Mukuru. Not only was it heart-wrenching to see, but it also highlighted the vulnerability of young girls and underscored the pressing need for concerted efforts to protect and support them. It was incredibly uplifting to learn about the proactive initiatives undertaken by the Ruben Centre in this regard. Their commitment to advocating for and implementing child safeguarding programs within the community, alongside their dedication to educating young girls on these critical matters, speaks volumes about their unwavering commitment to fostering a safer and more empowered environment for all.

Outpatient Clinic

The outpatient Clinic at the Ruben Centre is similar to a general practice clinic here in Australia. Each day, a steady stream of people would come to the clinic seeking medical attention. Despite the overwhelming demands, there was only one doctor available to attend to everyone’s needs.

One of the clinic's invaluable assets was its laboratory, which enabled diagnostic testing to be conducted on-site. However, the range of tests available was markedly limited compared to what one might find in an Australian hospital. Despite this limitation, having access to basic diagnostic tools was crucial for providing timely care to patients in need. However, in comparison to a typical family practice in Australia, the Ruben Centre's clinic was undeniably under-resourced.

This discrepancy became painfully evident in instances where critical public health education failed to reach those in need, as illustrated by a tragic incident. I can still vividly recall the day when a little girl who was brought to the clinic in the end stages of respiratory failure due to untreated pneumonia. Her parents, unaware of the severity of her condition and lacking proper health education, had delayed seeking medical attention until it was too late. By the time they arrived at the clinic, the child's condition had deteriorated rapidly. Despite the doctor's best efforts, the child tragically passed away in his arms as he rushed to summon an ambulance for her transfer to a tertiary hospital. Such a devastating outcome would be virtually unheard of in Australia, where timely access to medical care and sufficient resources would likely prevent a child from presenting in such dire circumstances. This heartbreaking incident served as a poignant reminder of the critical importance of public health education and the stark disparities in healthcare resources between different regions. 
Public Health Work – Battling a Cholera Outbreak

While much of my time at the Ruben Centre revolved around clinical work, I was equally eager to collaborate with the public health team in devising initiatives to benefit the broader community. During my time as a volunteer, we faced a daunting challenge: there was a significant cholera outbreak in the neighbouring slum. The Mukuru community and the Ruben Centre staff were very concerned about Cholera as a previous outbreak had stretched the centres resources to its limits and necessitated the setup of makeshift patient beds outdoors to accommodate the influx of cases.

Preventing an outbreak in Mukuru was critical, and educating the community regarding how to prevent infection and spread of cholera was crucial. However, translating global health guidelines into actionable advice for the unique context of Mukuru proved to be a difficult task. The World Health Organization's (WHO) guidelines, while comprehensive, made assumptions that didn't align with the realities of life in Mukuru. For instance, the WHO made a basic assumption that there would be at least some access to safe water in the community which was not the case in Mukuru due compromised sewage infrastructure. With the majority of households lacking toilet facilities and few opting to use paid public toilets, a distressing phenomenon known as the 'flying toilet' emerged, whereby people wrapped-up and threw waste into the streets.

Two public health officers and I formulated a strategy to prevent the spread of cholera through the community that was specifically tailored to Mukuru’s unique infrastructure, resources and cultural dynamics. Fortunately, we had the opportunity to use ‘Ruben Radio’, a trusted education platform in the community, to disseminate public health information regarding cholera, while the Ruben Centre implemented complementary measures, such as supporting the cholera vaccination drive. Thankfully, a cholera outbreak was prevented with the concerted efforts of everyone in the community which was a significant relief.
Schooling and Vocational Training

Not all my time at the Ruben Centre was taken-up in the medical facilities. The Ruben Centre also offered a comprehensive array of services to the Mukuru community extending far beyond medical care. Within its grounds stood a thriving school where students not only received education but also nutritious meals. However, it was disheartening to learn that the school also faced challenges in terms of resourcing, just like the medical facilities. For instance, the Grade 2 class had a staggering 130 students with only one teacher. Nonetheless, amidst these hurdles, spending time with the students during school days provided a welcomed escape from the demands of the medical clinics. 

Moreover, the Ruben Centre didn’t just have a school, but they also offered vocational training in areas such as cosmetology, sewing, crafts, and IT to the residents of Mukuru. These initiatives equipped individuals with valuable skills to establish businesses, enter the job market, and generate income. Of particular note was the tailored-made training programs for young women, aimed at fostering independence and empowerment by providing them with valuable tools.
Exploring Nairobi

While my volunteering journey was primarily centred at the Ruben Centre, I was also eager to immerse myself in the bustling energy of Nairobi. Luckily I had many friends from the Ruben Centre who were more than willing to show me around the lively city.

Even getting into the city for the first time from Mukuru was an adventure. We had to navigate the city’s public transport system jumping into colourful matatus which were covered in vibrant artwork and playing very loud, lively music. Whether it was indulging in local foods, exploring the markets, attending a traditional music Zumba class or going to a live music concert, each experience was truly memorable. As I look back on these fond memories, I am grateful for the chance to explore the rich diversity of Nairobi's culture and community. 

Reflection

Many of the experiences that I had at Ruben will stay with me forever, such as the sight of malnourished infants, the heartbreaking loss of children to preventable diseases and the stark living conditions in the slums to name a few. This has reinforced my commitment to working both clinically and in the public health arena to promote meaningful change to vulnerable communities like Mukuru.

Amidst the challenges faced by many at the Ruben Centre, there is a profound sense of resilience and determination that everyone holds. It was a place where amidst the challenges, hope persisted, compassion prevailed, and humanity endured. As each day drew to a close, I always had a sense of fulfilment, carrying with me the memories of those we had assisted and a strengthened commitment to advocating for incremental change, one step at a time.

Thank you to Ubuntu Through Health for providing me with the opportunity to volunteer at the Ruben Centre!

Written by Jasmin Somers

Returning to the Ruben Centre

On the 7th of December 2023, Ubuntu Through Health alumni member Mia Crous had the enormous privilege of visiting the Ruben Centre in Nairobi, Kenya. Ubuntu Through Health has been supporting the Ruben Centre’s malnutrition intervention program for over a decade, enabling babies and children of the Mukuru slum to have access to free, holistic treatment for acute malnutrition. Mothers, babies and infants are recruited to the Maternal and Child Health Clinic through a combination of referral from the on-site birthing service, community engagement, word of mouth, and active case-finding in the community. This clinic is free of charge, enabling even the poorest families to access this vital service.

On the morning of Mia’s visit, there was a very busy clinic underway which she got to see in action. Babies and infants were immunised, had their weight and height measured and plotted against growth charts, MUACs measured, feeding difficulties discussed, deworming and/or vitamin A supplementation given in line with age and weight guidelines, and follow-up arranged. Any child with faltering growth or measurements indicative of severe acute malnutrition were immediately provided with nutritional supplementation in the form of ‘plumpy nut’ on a dose per kilogram basis and admitted to the malnutrition intervention program for investigation of underlying causes, referral to other services, and ongoing treatment and follow up.

During her visit, Mia was also introduced to the multiple health services at the Ruben Centre by the dedicated health professionals of each service, including the occupational therapy team, the medical clinic, TB/HIV services, birthing unit, dental service, and laboratory. All these services work in tandem with one another to provide integrated care, making the Ruben Centre a true ‘one-stop-shop’ for its patients. This proves invaluable for children in the malnutrition intervention program, as it improves their diagnosis, management and follow up.

Whilst the malnutrition intervention program has been highly successful, recent increases in the cost of living have resulted in more mothers being unable to feed their children. This has resulted in an increase in admissions to the malnutrition intervention program, with a spike in cases over the months of October and November as noted in the meticulously kept records that were shown to Mia. It is therefore clear that Ubuntu Through Health’s ongoing support will be vital to ensure that child nutrition and health is maintained in the face of these pressures.

In addition to its malnutrition intervention program and health services, the Ruben Centre has an on-site school providing education for 3500 students, a radio station, and various social and economic empowerment programs. Mia had the privilege of meeting with The Ruben Centre’s founder, Brother Frank O’Shea, who spoke passionately about each of the programs that are running and is constantly looking for ways to improve the centre and provide the best possible service to the people of Mukuru. It was agreed that the Ruben Centre is truly an oasis within Mukuru.

A final point to illustrate just how unique the Ruben Centre is – Mia recalls the conversation she had with her local taxi driver on her way back from the Ruben Centre. He had never been to the Mukuru slum before, and he noted that not many taxi drivers would even agree to drive there due to the perception that it is a dangerous and hopeless place. However, after seeing the Ruben Centre and hearing about the work that is being done there he was dumbfounded, stating “Wow. I would have never dreamed that such a beautiful place could exist in Mukuru. The school and health centre buildings are better than many others in Nairobi. It feels like a safe haven. This is important work, and it is very good that you in Australia are supporting this. You should be proud”.

Mia did leave the Ruben Centre feeling proud to be part of an organisation that is supporting such an amazing project. It is clear that the funds raised by Ubuntu Through Health have been instrumental in allowing the malnutrition intervention program to continue, and that our ongoing efforts are needed now more than ever to ensure that the children of Mukuru have the best chance to have a healthy start to their lives. Let’s take every opportunity to keep making a difference in 2024!

Written by: Mia Crous

How do you plan a health camp?

So what does a COSAN women’s health camp actually look like? How exactly do a team of doctors and nurses deliver free healthcare to hundreds of women in remote parts of Nepal? How do they manage to make such a big impact in the space of just a few days?

These were the questions I sought to answer firsthand when I travelled to Nepal in November 2023, observing and participating in one of COSAN’s women’s health camps. Needless to say, I learnt that organising and facilitating these camps is a huge logistical process, and I walked away deeply impressed by the effectiveness, efficiency and expertise which permeated every layer of COSAN’s operation. So, what goes into making a health camp happen? Let’s start with step one – the set-up.

1.       The Set Up

The burden of pelvic organ prolapse and cervical cancer is significant and widespread across Nepal. Yet with the challenge of finite resources, the COSAN team need to shrewdly decide where to run their health camps. Recently, COSAN have been focusing on the southern region of Nepal, the Plains, where health literacy is limited and women’s health issues are extensive. With a view to cost-efficiency, the team will then liaise with local governments to enlist their support for the camps. On the camp I attended, the local government covered the costs of accommodation and food, meaning COSAN’s funds go directly to running the health camp and providing medical interventions to women in need. This is just one example of how COSAN seek to provide the greatest impact with the resources they have.

Once these logistics are arranged, members of the COSAN team will drive from their base in Kathmandu to the chosen district for the health camp. This is usually a long day of travel: up and down mountains, across beaten up roads, up and down some more mountains.

Now, if you plan on driving eight or so hours south of Kathmandu, through the curving, mountainous roads of Nepal, you’re going to want to make sure there are some patients waiting for you on the other side. This is why COSAN employ local individuals to go door to door advertising their camps ahead of time, spreading the details far and wide amongst the local community, making sure all the women are aware of the forthcoming clinic. 

2.       The Camp

Once all these moving parts are aligned, the COSAN team is ready to go with the camp. Women from the local area begin to arrive and receive medical attention. After checking in at the arrival desk, the women proceed through a variety of rooms to receive a thorough medical assessment, as follows:

1.       Blood pressure and blood sugar screening outside the health clinic.

2.       Proceed to nurses’ room, for cervical cancer screening/treatment and women’s health counselling.

3.       Proceed to gynaecologist’s clinic room for assessment and treatment planning.

4.       Proceed to pharmacist’s room, to receive any required medications.

In terms of personnel, the team is made up of a gynaecologist, a camp coordinator, three nurses, a pharmacist, a driver and a few helpers to assist with sanitation and other minor tasks. Importantly, COSAN involve local health workers in their camps, facilitating the provision of culturally appropriate care and overcoming any reservations local populations may have regarding the health advice they receive.

Over the course of two days, hundreds of women are typically seen in a COSAN health camp. At the camp I attended, 450 women were seen. From this cohort, 72 women were found to be experiencing pelvic organ prolapse. 12 women with severe pelvic organ prolapse were referred for surgical repair, funded by COSAN, and 36 women were provided with ring pessaries to help manage their condition.

In regard to the cervical cancer screening, 12 women were found to have precancerous changes of the cervix. These patients were provided with on-the-spot treatment, preventing further development of the cancer.

3.       The Follow Up

Once the camp is wrapped up, the women with severe pelvic organ prolapse undergo surgical treatment at one of a few hospitals with whom COSAN have a partnership. Planning then begins for another camp, in another region of Nepal!

As you can see, it is no mean feat to put on a camp as impactful and sustainable as those done by COSAN. It takes ingenuity, resourcefulness, local knowledge, and, perhaps most importantly, passion. The COSAN team are fiercely passionate about their mission to overcome the problems of pelvic organ prolapse and cervical cancer amongst the women of Nepal. Seeing the camps first hand, I can testify to the significant impact Ubuntu Through Health’s fundraising for COSAN has on the women of Nepal. It is truly a pleasure to be partnered with an organisation as life changing as COSAN!

Written by: Oscar McCabe

A day in the life of a COSAN health camp

You would be hard pressed to find a team that works more tirelessly than the COSAN field workers during one of their rural health camps. I was lucky enough to see the team in action and spent a week with them during their camp to the southern Tarai region of Nepal in September last year. Over the six days that we were stationed there, we attended to 1920 women, identifying 396 cases of pelvic organ prolapse, inserted 72 ring pessaries, and referred 40 women for life-changing surgery to correct their prolapses. 

So how did all this get achieved over the course of 6 days? Well, it requires a tight schedule that looks like this:

0600: The day starts relatively early to ensure we have enough time to service the women of this area. The team loads up on breakfast and gets ready for the busy day ahead!

0700: We leave our hotels and pack up the Jeep to make our way to the rural health outpost. 

0730: Once we arrive at the outpost, we unload the car that was filled to the brim with equipment- gloves, medication, speculums, and a mobile sterilisation container. We try to make use of the resources that the health outpost is equipped with, but sometimes we have to improvise if certain things aren’t available. Tables become makeshift examination beds, and a storage room becomes a temporary dispensary. 

0800: The women begin arriving to be checked in with COSAN. For some of these women, it’s their first time being seen by a doctor, and there’s a sense of excited anticipation. Some local health volunteers take vitals while the women wait to be seen. The women first see a gynaecologist who ascertains if they have any reproductive or gynaecological issues. Next, they move into the examination room for a speculum inspection of the cervix. If any abnormalities are found, they’re treated immediately with a thermocoagulator. We take this time to also assess the women for any pelvic organ prolapse. 

1300: The team breaks for a well-deserved lunch! Usually, the health outpost serves us a delicious meal of dhal bat to power us through the afternoon.

1400: We go back to our stations and resume our work. The camps generally run until 5pm, but we don’t turn away any women if they come to us after we’ve closed for the day.

1700: We pack up the rooms and move equipment back into the Jeep, ready to move on to the next town the following day!

Written by: Sonya Yegorova-Lee

Ubuntu Through Health In The Times of COVID-19

COVID-19 Update

Like people and projects around the world, Ubuntu Through Health has had to change the way things are done in response to the COVID-19 pandemic. With reluctance yet understanding we’ve had to cancel our fundraising events this year – both the Jungle Party and the Annual Dinner. However we’re determined to rebound bigger and better than ever once restrictions are lifted. It’s these great events that allow us to support our overseas projects. They too have been adapting to the unique challenges that the pandemic has brought on. Read on to hear about their situation and the strategies they’re adopting to continue providing aid work and community support in these difficult times.

A New Video

Ubuntu Through Health has a new video!! This was made by the team in February 2020 on the Griffith University Gold Coast campus and gives a run down on what we do! Throw us a like, subscribe, and a share! :)

2020 Update From The Projects

The Ruben Centre April 2020  

The Ruben Centre located at the heart of the Mukuru Slums in Nairobi, Kenya is Ubuntu Through Health’s longest supported project. It acts as a sanctuary and is critical to the continued success of the entire community. It was also the project most recently visited by our current third year members Megan, Che and Grace late last year.

This year unfortunately the Ruben Centre (and Kenya more generally) has faced numerous challenges – a locust plague, flooding from the current rainy season, and of course the global challenge that is COVID-19. This has had significant implications on their operations especially with the impracticality of social distancing and the lack of adequate clean drinking water and sanitation. With groups such as Ubuntu Through Health having to cancel fundraising events, they have also felt a financial sting from the pandemic.

(taken prior to social distancing)

However, faced with this adversity the Ruben Centre has risen to the challenge. They’ve made numerous changes in order to help slow the spread of COVID-19 and continue to serve the community. One example is that they’ve been producing their own PPE in order to cope with increasing demands and increasing costs. This has so far included hand washing soap and masks. They’ve also taken the precaution of closing the school – just keeping the health centre and radio station open. 

Outside of the recent challenges associated with COVID-19, the Maternity Unit has continued to thrive. This unit has been serving the community since June 2018 and continues to provide the antenatal, labour care and postnatal care for safe births. March was a month of milestones with the birth of the 1600th baby since the centre opened, with March 2020 also representing the 1st month that more than 100 babies were born at the centre.

 We will keep the Ruben Centre at the forefront of our minds during this difficult time, and hope to continue our support of their efforts once restrictions are lifted.

COSAN April 2020  

COSAN turns 25 this year! 

 COSAN (Community Service Academy Nepal) is a community organisation that runs women’s health camps around Nepal. Ubuntu Through Health has been partnered with them since our visit there in December 2018. In their 25 years they have provided surgical assistance to over 12,500 ladies all over Nepal at various stages of pelvic organ prolapse. Aside from surgical and conservative management, COSAN also provide training on prevention of uterine prolapse, cervical cancer screening, and community awareness on the impact of child marriage and women’s reproductive rights. 

Women waiting in line at health care camps in Western Nepal (prior to social distancing)

This year COSAN has been mostly working in Western Nepal where many villages are remote, difficult to reach and have certain traditional practices that risk the reproductive health of women. COSAN screens between 600 and 1200 ladies for cervical cancer in regular 2-day clinics conducted in local villages. For this they use VIA – a very simple screening test that produces instant reports and can lead to prevention of long-term morbidity and mortality. In 2019/2020, COSAN screened 7000 ladies for cervical cancer, and 150 ladies received surgery for pelvic organ prolapse.

In the current COVID-19 pandemic, restrictions have been put on travel around Nepal and the women’s health camps have been put on hold. Yet COSAN are endeavouring to continue their efforts using new, socially distant methods. They are undertaking awareness programs on radio, and women are referred to local health care workers (auxiliary midwives) for diagnosis if necessary. The midwives contact COSAN who organise for transport to hospitals for ongoing treatment for their condition if required. 

Ubuntu Through Health looks forward to continuing our support for COSAN’s important community work once restrictions are ceased. The necessity of which is nicely summarised by the director of COSAN, Rama. 

““We are glad to be involved with this project of reaching to the ladies in a country where gender discrimination lingers in the society and vulnerable ladies suffer silently, by providing them with a screening of a condition that could dramatically change their lives and improve their quality of life.””

That’s all from us. Stay safe! Look after yourselves! And keep an eye out for more updates from us in the future.

- The Ubuntu Through Health team

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