(KISUMU) – Kenya faces a growing Ebola threat from neighbouring countries, yet the government has not told its citizens where they can find isolation facilities. The Ministry of Health says 22 centres are ready across the country. It has not published a list of their locations or any public guidance on how to reach them.
The outbreak in the region is serious. The Democratic Republic of Congo has recorded over 1,000 confirmed and suspected cases with 254 deaths. Uganda has confirmed 20 cases and two deaths. The World Health Organisation has declared the outbreak a Public Health Emergency of International Concern. The Africa Centres for Disease Control and Prevention has raised it to Grade 3, its highest risk level. The reasons include confirmed spread across borders, late detection of cases, high movement of people in the region and a total lack of approved vaccines or treatments for the Bundibugyo strain driving the current spread.
Kenya shares borders and busy travel routes with both affected countries. Lake Victoria, the world’s second largest freshwater lake, is an open crossing point. The Kenyan shoreline runs for roughly 200 kilometres through the counties of Kisumu, Siaya, Homa Bay and Migori. Fishermen from Kenya and Uganda meet on the water most nights. There is no border post, no checkpoint and no health officer where one country ends and the other begins.
At Dunga Beach in Kisumu, boats land before 4am with the night’s catch. James Omondi, 41, fishes from this beach. He has heard about Ebola on the radio. He knows it is in Uganda and knows it is dangerous. But he does not know if his nets, which sometimes tangle with those from Ugandan boats, can carry the virus. He does not know if the fuel line they share between boats is a risk. “We share everything on the water. Fuel, food, sometimes we eat together if the night is long,” he said. “If one of them is sick, then all of us could get infected.”
Despite this daily contact, a Kenyan in Kisumu, Mombasa, Eldoret or Garissa who looks for official advice will find nothing useful. The Ministry of Health website does not tell them where to go, what signs to watch for or what the health system will do if they arrive at a hospital with Ebola symptoms.
Health Cabinet Secretary Aden Duale has said Kenya has 22 designated isolation facilities. He has not said where they are. In a public statement, Mr Duale mentioned an eight bed unit at Kenyatta National Hospital and 49 beds ready for use at the National Police Service Hospital. But a number without a location is not a facility, it is a statement. There is no public list for a county health officer in Mandera, a nurse in Homa Bay or a bus driver who has just arrived from Kampala to consult.
The only contact made public is the general health line, *719#. This is a USSD code meant for general health questions, not for directing people during an outbreak.
When pressed on the locations, the Ministry changed its message. The talk of 22 designated facilities shifted towards a promise of isolation wards at all referral hospitals. In a court document, Mr Duale said the government was building isolation and quarantine wards at all referral hospitals and at police and armed forces hospitals.
While Kenyan citizens wait for answers, one Ebola facility has received both attention and resources. It is not for Kenyans. The United States government announced the facility as part of its Ebola plan for the DRC outbreak. It is meant for American nationals who have had high risk contact with Ebola but do not yet show signs of illness. Confirmed cases would be flown to Europe or the United States for treatment.
The facility was still being built at the time of reporting. The decision has landed Mr Duale in legal trouble. The facility was authorised without the openness and public involvement that Kenya’s constitution requires. The matter is now in court, and Mr Duale has not followed the court’s orders.
This raises a question the Ministry has not answered. Kenya is a sovereign country with its own population facing a real Ebola risk. The government found the political will and the diplomatic ties to build a facility for American staff. It has failed to publish a list of isolation centres for its own citizens.
The World Health Organisation’s guidance on Ebola facility design has three main points. The first is location. Facilities must be placed near existing health services so staff can be shared and sick people do not travel long distances. The land must be flat, secure, connected to water and telecommunications and large enough to grow if needed.
The second is infection prevention. Every facility needs a screening area at the entrance, an isolation area with one way patient flow, separate zones for putting on and removing protective equipment, hand washing points at every care station and safe waste handling. Beds must be at least one metre apart with clear separation between high and low risk areas.
The third is community acceptance. This is not optional. Governments must talk to local communities and get their agreement. In the DRC’s current outbreak, health centres have been attacked by communities that had no trust in the response and no say in the facilities placed near them. Kenya’s Ministry has not shown that it has held community talks for even one of its 22 designated centres.
At Kenyatta National Hospital, the picture is somewhat clearer. Dr Daniel Nyukuria, the infectious disease specialist running the isolation unit, confirmed the facility has eight beds and can expand. He said the Ministry is the body that finds extra space. The unit exists and has a specialist in charge. But the planning is internal. The public is not part of it.
The outbreak is at Kenya’s door. The Bundibugyo strain has no approved vaccine. Uganda, which has far more experience with Ebola than Kenya, has already recorded deaths. Movement between Uganda, DRC and Kenya is daily and heavy. A Kenyan who develops fever, headache and muscle pain after travelling from Kampala needs to know one thing above all else. Where to go. As of now, the Ministry of Health has not told them.