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Alan Fox
Coordinator, International Programs
Eganville Rotary Charitable Trust
Date: June 2024
TABLE OF CONTENTS
Page
Our Sponsors ……………………………………………………………………………………….... 3
Introductions ………………………………………………………………………..……………....... 4
Imara Community Healthcare Centre Expansion & Refurbishment …………............................. 5
Menstrual Hygiene Management (MHM) at Siloam Learning Centre ………............................... 9
Launch a Peanut Butter Cooperative ……………………………………………………. .............. 14
Covid -19 Pandemic Protection Response ………………………………..……………................ 15
Say No, Be Counted (SNBC)-Prevention of Bullying and Sexual Interference .............................. 16
Appendix 6.1 Team Evaluation of MHM Workshops………………………………...................... 19
Appendix 6.2: Recommendations of Rotary Research Team……………………........................ 21
Appendix 6.3: Evaluation by Team Leader, Scholastika Mwakali ……………........ ................... 21
Appendix 6.4 Discussion about Menstrual Cup Usage………………………………..................... 22
Appendix 6.5 Reflections Nurse Kate and Scolar on the MHM Workshops…............................. 23
Concluding Remarks ………………………………………………………………………………........ 25
Ingredients of Success ……………………………………………………………………………........ 27
PROJECT SPONSORS
This project was made possible because of the generous support of many individuals and group sponsors. These include the following Rotary Clubs and other non-governmental organizations:
Rotary Clubs of Arnprior, Chesterville, Cataraqui-Kingston, Eganville, Gananoque, Kingston, Montreal Lakeshore, North Renfrew, Pembroke, West Ottawa,in Canada and Sowerby Bridge Rotary in the UK
and Syokimau Rotary in Kenya.
-The Women’s Inter-Church Council of Canada (WICC)
-The Canadian Union of Public Employees (CUPE)
-The Fellowship of the Least Coin (World Council of Churches)
-La Fondation Coup de Coeur
…and the donations of many loyal and generous individual supporters
INTRODUCTION
This Report provides a summary of projects supported by The Rotary Club of Eganville Charitable Trust, in the Mukuru kwa Njenga slum of Nairobi, between 2011 and 2024:
All these projects were conducted in partnership with local people and organizations in Nairobi, namely, the owners of the Imara Healthcare Centre and the Trustees of Siloam Learning Centre, as well as teachers and administrators at the school. Workshops were planned, organized and conducted by a team of community health workers (CHWs), led by Scolarstika (Scolar) Mwakali.
Scolarstika Mwakali also acted as our vetted project intermediary (foot on the ground) as required by the Canada Revenue Agency with responsibility for the accounting of and disbursement of project funds as approved and directed by Eganville Rotary Charitable Trust.
The project was under the direction of Eganville Rotary’s Coordinator of International Programs, Alan Fox.
1.0 IMARA COMMUNITY HEALTHCARE CENTRE EXPANSION & REFURBISHMENT
The Imara Healthcare Centre was established by the late Peter Inoti and his wife Francisca Muthoni, in 2002. Their objective was to provide health services for the residents of Nairobi’s Mukuru slum, which has a population of about 100.000 but very limited medical infrastructure.
Mukuru is near the industrial belt of Nairobi and many residents have left rural homes because of poverty and have the hope of finding work in the city. Living conditions in the city slums are shocking. Housing is dilapidated and made mostly from sheets of corrugated metal. There is no sanitation or running water. These conditions lead to a high rate of deaths from malaria, tuberculosis, HIV/AIDS and water-borne diseases. There is a high incidence of teenage pregnancies and with limited access to pre- and post-natal care, giving birth is a high-risk business. The infant death rate in Kenya is 31.8 per 1,000 live births in 2022. By comparison, in Canada, the infant death was 4.2 per 1000 live births according to statistics from the same year.
Francisca and Peter felt a moral responsibility to provide medical services for the residents of Mukuru qua Ngenja. Peter gave up a good job to establish the Clinic. However, despite their lofty aims, after ten years of business, they were barely making ends meet. They were losing staff as they couldn’t afford to pay them a competitive wage and the premises were in urgent need of repair. Of particular concern was drainage as the premises regularly flooded during the rainy seasons. Francisca worked part-time as an anesthesiologist at a government hospital and Peter was a health administrator with a large multinational organization.
Peter Inoti believed the key to becoming financially secure was to gain accreditation for in-patient care from the National Health Insurance Fund (NHIF). However, that required a significant investment to expand the facility to accommodate 30 beds, the minimum required to be designated as a hospital by NHIF. It also required a solution to the flooding problem, as well as the purchase of additional expensive equipment.
In 2013 Peter engaged Engineer Kenneth Kimathi to draw up plans for a major renovation of the premises. Several engineers/contractors had already surveyed the property and concluded that to prevent flooding it was necessary to raise the foundation
and replace the roof, among other work. The estimated cost was $26,150 (USD). In an agreement with a partner from Clovis California, Alyssa Singh of Imani Care International, the Rotary Club of Eganville Charitable Trust committed $8,000 (CAD) towards this work.
1.1 2014 Construction Begins
As the lead donor, Imani Care International prepared a Memorandum of Cooperation for the project management. The renovation involved the following work:
”We have good news! We are very pleased to officially inform you that God has been gracious to us and that we are at last officially on board with NHIF Inpatient. It has been a long journey of prayers, hard work, and patience for all of us. We sincerely THANK YOU for encouraging and supporting us financially as we made improvements at the Imara Healthcare facility, which has eventually contributed to this accreditation. “
1.2 Community Health Worker Training
In an effort to grow the membership of the Imara Centre and extend its reach, Peter proposed a 10-day training session for 18 healthcare workers, followed by a nine month apprenticeship at the Imara Healthcare Centre. The objectives of this training were to provide early diagnosis and treatment of disease and Improve community sanitation and personal hygiene
With a Rotary District Matching Grant the management consulting company of Progeny International was hired to manage the training. Community health workers agreed that the workshop was informative and well run and they learned a lot.
During their apprenticeship the CHWs made some 1,200 house visits. They also participated in two national inoculation campaigns : one on polio prevention and the other on the prevention of measles, mumps and rubella. They inoculated over 1,300 children in each campaign. During their apprenticeship there was an outbreak of cholera in Mukuru and the CHWs spent two weeks going door to door to impress the residents about the importance of hand washing and personal hygiene.
The CHWWs also played an important role as workshop assistants for the Menstrual Hygiene and the Say No projects outlined later in this report.
1.3 Equipping an Operating Theatre
The Imara Healthcare Centre had midwives on staff to conduct conventional maternal deliveries but if there were any complications in the pregnancy, the mother had to go to a government hospital. This could require travel to another part of the city where the mother could not have the support of family and friends. Peter and Francisca wanted to have the capability of doing caesarian sections and other minor surgical interventions. So a fundraising campaign was launched to equip an operating and post op rooms .
In the first phase of the campaign a Rotary District Matching Grant was awarded to purchase an operating table, an aesthesia machine, a suction machine and a patient monitor. Phase two fundraising enabled the purchase of a second patient monitor for
the Post Op room and a Baby Resuscitator and a Baby Incubator. The total budget for equipment purchases amounted to $28,753 CAD, of which $11,430 CAD came from District Matching Funds.
One of Eganville Rotary’s partners, the Rotary Club of Syokimau contributed funds to buy a surgical trolly and an array of surgical instruments.They also helped plan the reception when the Operating Room equipment was delivered and handed over to the Imara Centre.
1.4 The Imara Healthcare Centre Today
In contrast with the time when Rotary and Imani Care International first provided support to the Imara Healthcare Centre in 2011, it has become financially stable. It is the only health facility in Mukuru with an Operating Theatre and has benefitted from referrals from other health centres. They are a busy 30 bed Inpatient facility with a staff of 20 people. They hold regular clinics for ante-and post-natal care as well as a child welfare clinic. Last year they delivered 214 new-born infants and had 1,842 patients for in-patient care.They were also active providing Family Planning services to 880 customers
The Centre has also been busy with its out-patient services to Mukuru residents, treating 1,973 children under the age of 5 and 7218 children and adults over the age of 5. In addition they have given admission rights to doctors working in other facilities to do surgery in the Imara theatre.
Credit must be given to Francisca Muthoni for the way she has managed change at the Centre. Credit must also be given to her loyal and dedicated staff. The last couple of years have been very difficult due to the pandemic and then Peter Inoti’s passing on September 3rd 2021. May he rest in Peace.
2.0 INTRODUCTION OF MENSTRUAL HYGIENE MANAGEMENT (MHM) AT SILOAM KWARE PRIMARY SCHOOL
This project aims to improve the lives of girls at the Siloam School in Mukuru, Nairobi. This was done by teaching Menstrual Hygiene Management (MHM), so that girls no longer need feel embarrassed about their monthly period or have to miss school because they do not have access to sanitary wear.
When girls are able to attend school full time because they have access to sanitary wear and a place at school where they can change in private, they do well in their education and are able to get rewarding jobs. They become empowered. As a result, their families are better off and so is their community.
During a visit to the Imara Healthcare Centre, Alan and Mona Fox had an opportunity to meet Joel Nzuki, the Headmaster of Siloam Kware Education Centre, a private, registered school in the Mukuru slum. The school is managed by a Board of Trustees chaired by Paster Lukas Oyoo . The school has an enrolment of about 800 children at the primary level. The expressed purpose of the ‘child-friendly’ school is to reach the vulnerable and less fortunate children in the slum. Those children who spend their time loitering on the streets.
2.1 Menstruation & School Attendance
Joel Nzuki expressed interest in the challenge of educating girls and in particular, the influence of public attitudes about menstruation on educational attainment. Because of the stigma about menstruation, many girls skip school when they have their period. Among the reasons for staying home are to avoid being teased by the boys, or because they have no sanitary wear, or, because they have sanitary wear but there is nowhere private to change at school. The result is the same. Her school grades fall, she loses confidence in her abilities and she eventually drops out of school. This is often followed by early marriage to an older man and a life looking after her husband and children. This is a loss to the national economy. It is also a loss of the girl’s potential to become an empowered member of her community.
2.2 Sanitation
There is little point encouraging girls to go to school while they have their period, if there is nowhere private for them to change. With support from the Rotary clubs of Arnprior, West Ottawa and Eganville, as well as Siloam School, a new toilet block was built while the school was closed for the Easter 2019 holidays. The toilet block contains five female toilets, four boy’s toilets and a boy’s urinal in addition to a girl’s changing room. There is no need to incur the cost to have the toilets pumped as they are now connected to the municipal sewer. This is a major improvement in the school’s sanitation.
In May 2018 a planning workshop was held to test different designs and fabrics used for sewing sanitary pads. It was attended by 35 volunteers.
Two other planning workshops were held in 2018 and 2019. Both were led by Kate Waswa, a registered public nurse in Mukuru. One workshop focused on menstruation and was attended by the female teachers from the school as well as the female CHWs. An Evaluation Report on the workshop is in the Appendix. The other workshop was entitled Boys to Men and addressed issues related to boys’ transition through puberty. It was attended by the male teachers as well as representatives from the school’s Board of Trustees.
The purpose of these two workshops was to ensure that all the adults at the school were familiar with the training that was taking place at the school. It was also an opportunity for the CHWs to observe Nurse Kate lead the workshop before they took on that shared role.
Both workshops were well received by the participants. It was suggested that the MHM workshop could run over two days as there was so much interesting and valuable information to absorb. It was also suggested that the workshop should be repeated at other schools.
2.4 MHM Workshop Topics
The MHM workshop is valuable training in the education of adolescent girls as it covers the arrival of menstruation and mood changes as well as how to manage the monthly menstrual cycle. Emphasis is placed on hygiene in the home and the importance of hand-washing.
Topics addressed at the workshop included:
2.4.1 Workshop Results
Over 300 girls attended the four-hour workshops between October 2019 and mid-March 2020, just before all schools in Kenya were shut down due to the global pandemic.
Despite the school year being cut-back there have been significant accomplishments
It was suggested that boys should learn more about menstruation. They should be more understanding of the discomfort felt by girls when they have their period. Girls need empathy. Not teasing.
In their reflections on the value of the MHM workshops Scolar and Nurse Kate concluded:
“In general,this program has changed the attitude of many girls, boys and teachers towards menstruation and hygiene management. With continuous engagements and refresher training Mukuru Siloam will be a better place thus greater empowerment to the whole community.”
This program has helped in reducing teenage pregnancies in Mukuru. We didn’t report any in Siloam and we thank the Rotary Club for your support.
The girls also learned about the importance of their own well-being and how to handle life challenges during their growth and development
They concluded with the slogan: My HEALTH, my RESPONSIBILITY
2.4.2 Next Steps:
Menstrual hygiene should be taught to both girls and boys and the training should start at a relatively young age in primary school.
The questionnaire that students completed before attending the workshops revealed a widespread lack of knowledge about the function of menstruation and its role in the reduction of the human species. It is suggested that a sample of students complete a questionnaire again to determine whether there has been learning as a result of the workshop
2.4.3 Accessing Sanitary Wear
According to the Gates Foundation Report (Menstrual Health in Kenya: A Country Landscape Analysis, 2017 ) the primary obstacle facing the advancement of Kenyan girls is the lack of access to sanitary wear at an affordable price.
Access to sanitary wear should be a National health issue . The National government recognized this in 2017 when it legislated the distribution of free sanitary towels to Kenyan school girls. But they are not getting to children and youth from poor families who need them. An inquiry into expenditures revealed that a large part of the allocation had gone missing. The lack of access to sanitary wear sometimes has dire consequences.
One tragic case of the impact of this shortage was reported in Nairobi 's Daily Nation in 2019. A 14 year old girl hanged herself after she had been humiliated in front of her class by her teacher for soiling her dress.
2.4.4 Sewing by Canadian Volunteers
The availability of free sanitary wear for girls attending the Siloam school workshop has been possible because of the work of Mona Fox and a team of dedicated Canadian volunteers.
The last graduating class in November 2019 was given the choice of using a reusable pad or alternatively using a menstrual cup. The cup is made of high grade medical plastic and will usually last about 10 years compared to two or three years for the reusable pad, however, it costs a lot more (about $17 compared to two or three dollars for a homemade reusable pad). Out of 60 students graduating 45 chose the menstrual cup.
2.4.5 Boy’s Menstruation Education
Rotary financed the purchase of an electric /manual Singer sewing machine for interested students. The school might consider adopting sewing as an extracurricular activity so that those girls in need of sanitary wear can make their own and at the same time learn how to use a sewing machine.
There is no reason why boys cannot make sanitary ware too. Teaching boys about the role of menstruation in human reproduction will lead to a better understanding of the challenges of both boys and girls as they pass through puberty. Hopefully it would also contribute to more respectful relationships between boys and girls.
It is clear from the results of the survey questionnaires that were completed by the students before attending the MHM workshops that young Kenyan girls have only a limited knowledge about menstruation and its role in human reproduction. It is suggested that the education authorities consider placing a greater emphasis on MHM in their health curriculum. Also, funds should be made available for community-based groups, such as the Imara Community Health Workers, to conduct workshops on the subject in area schools.
3.0 SUPPORT FOR A COOPERATIVE PEANUT BUTTER BUSINESS
3.1 The Shakinah Women
Peter Inoti held periodic support group sessions for HIV positive mothers who attended the Imara Healthcare Centre. These women had difficulty getting employment or earning any income because of their HIV status. One idea they discussed was to try and sell kerosene. They subsequently decided to focus on making peanut butter for sale in the slum and appealed to Rotary for support.
Eganville Rotary was able to secure a grant from the Women's Inter-Church Council of Canada (WICC) to buy a roaster and grinder as well as the supply of wholesale peanuts. Then they went into business trading as the Shakinah Women. Unfortunately they had problems with the equipment they bought, then they could not find a suitable location to operate from and went out of business.
3.2 Imara Community Health Workers Application
The peanut butter equipment was temporarily stored with Francisca Muthoni at the Imara Healthcare Centre. A proposal was subsequently submitted by Scholastica (Scolar),the leader of Rotary's research and training team in Mukuru. As much of the work by the health workers was part time or voluntary, it is hoped that the production and sale of peanut butter will help supplement their minimal incomes.
In a Memorandum of Understanding it was agreed that the health workers will have the use of the equipment and Eganville Rotary Charitable Trust will provide $1,000 in seed funding to get the equipment up and running again and buy necessary supplies. It is expected that the business will be self-sustaining in six months. It was agreed that all labour will be voluntary until the business becomes profitable. It was recognized that bridge funding may be required to buy peanuts and if that should be necessary, it too must be repaid before the business is self-sustaining.
A trip to Kenya by Alan and Mona Fox was planned for the end of March 2019, however, with the announcement of the global pandemic, all educational institutions in Kenya were closed and air traffic was grounded. The school lost all its income from school fees, so could not pay the teachers. A concern of the school management was that they might lose the best teachers if they decided to find other work. This would prejudice completion of the menstruation project.
By May 2020 the situation was serious. Food was scarce and expensive. At the request of her team, Scholastica appealed to Rotary for rations. Given the importance of keeping the team together, it was decided to award them a grant of $1,000 to buy provisions. This helped support 18 adults and 45 children.
With the expected resumption of schooling in January 2021, (and earlier for students taking the National exams), there was need for protection personal equipment (PPE) for the security of students. Rotary provided $3,050 to buy reusable masks, 20 handwashing stations, buckets and soap.
5.1 The Visionary Women’s Centre (VWC)
The VWC is a grassroots community based organization in rural Kenya, representing the interests of women and girls who work on subsistence farms. Lizette Gilday, founder of the VWC and a Canadian with a background in social work, psychotherapy and curriculum development, informed the Rotary team that the VWC had a program titled “Say No, Be Counted“. The goal of this workshop program was to educate adolescent girls on how to protect themselves from bullying and unwanted sexual attention and to save other victims from harassment or assault.
Eganville’s intermediary, Scholar Mwikali and a member of her team made the four hour bus ride from Nairobi to Turbo where they attended a SNBC workshop. They were able to liaise with the presenters and were given a copy of the SNBC curriculum for girls (My Girl Power) and boys (The Hero in Me). With the agreement of the VWC it was decided to adopt their curriculum rather than develop one on their own. In return the VWC was interested in using Rotary's menstruation workshop. A pilot orientation project was launched with the following objectives: determine if student bullying was a problem at Siloam Kware school. If, in the opinion of teachers and a sample of students, bullying is an issue, propose ways to prevent it
and provide community support for the students who have been victimized.
Then some 160 students from Siloam school attended six one-hour workshops on the following topics:
“The children of my mother hates me because I don't have any father I can call dad. I look at myself and say, I am nothing to them. I usually think about killing myself but something tells me no”.
Workshop participants felt there was need for a forum where children can talk, or write about being bullied and get help, if necessary . They also felt programs such as SNBC should be offered in area schools as early as the primary level
Scholastica Mwaka and her team prepared the reports in the Appendix on their experience working on this research and training project. They report that the project has improved their knowledge of menstruation and the importance of menstrual hygiene.
It is clear from the results of the survey questionnaires that were completed by the students before attending the MHM workshops that young Kenyan girls have only a limited knowledge about menstruation and its role in human reproduction. It is suggested that the Education authorities consider placing a greater emphasis on MHM in their Health curriculum. Also, funding should be made available for community based groups, such as the Imara Community Health Workers, to conduct workshops on the subject in area schools.
Workshop participants felt it was important that students, teachers and the Mukuru community recognize that the Mukuru Kware Learning Centre is a Non Violent Zone. Bullying and aggressive behavior will not be tolerated. Eganville Rotary provided the school with support to prepare a poster and pamphlets to publicize this policy..
APPENDIX
6.1 TEAM EVALUATION OF MENSTRUAL HYGIENE MANAGEMENT WORKSHOPS
Rotary Team Member Evaluation
Participants answered the following questions anonymously:
6.1.1 What will you remember most from this training?
Use of menstrual cups since it is a new idea
Pain management in MHM
Men’s role in MHM
How to assist physically and mentally challenged girls during menstruation
Psychological and emotional management during puberty
6.1.2 What did you learn from this training ?
-The need to educate the community on MHM
- Challenges faced by girls and women during menstruation and how to handle them
-Proper care and disposal of used pads
-Space for changing and cleaning MHM products safely
6.1.3 What are your positive impressions about this training?
Detailed information and right answers to questions i.e. clear explanations
Relevant topic to the scope of my work
Audibility and eloquence, open and ready to teach from known to unknown, no shying off from the facts
- Good language understood by everyone
- Good explanation of the menstrual cycle
- Good time management
6.1.4 What are your negative impressions or what would you like to change?
-Very little time for such an elaborate and interesting topic - need more time for training, at least 2 days
- Very few men present in the class. Involve more men
- No projector for the video
6.1.5 What are you going to do differently after this experience?
-Be a MHM advocate-Teach women and girls more on MHM, clarify facts and demystify myths on MHM
-Support the already affected girls and walk them through the MHM journey
-Help boys and girls understand themselves and each other during puberty through to adolescence
6.1.6 Any other comments?
- If possible lets have more of these sessions in different areas of the community
- Congrats for the good work
- Visit schools
- Sincere appreciation to the initiators and organizers of this training for it has taught us a lot.
6.1.7 Please rate training on a scale 1 - 10 Ten is the highest
- The workshop was rated at 93% by the participants
6.2 RECOMMENDATIONS OF THE ROTARY RESEARCH TEAM
6.2.1 The team made the following recommendations on Menstrual Health and Management:
6.3 EVALUATION BY TEAM LEADER SCHOLASTIKA MWAKALI
6.3.1 Knowledge of Menstruation
Girls have gotten some knowledge on menstruation periods. Before the girls didn’t have a clear picture on it and they had different beliefs. Some of these beliefs associated with the cultural view on menstruation that only thought it’s a taboo to discuss about it since their parents hardly speaks about it while others thought it’s for grown up women. This programme has made the girls understand better menstruation and the hygiene required to keep infections at bay. Others even thought its sickness . Sickness would come when proper hygiene was not observed. This was clearly taught. No doubt the girls have the right information now.
6.3.2 Menstrual Management
- The girls have knowledge on other products to manage their periods but the use of ruby cups is new to them. Our concentration was based on the ruby cups and the re usable pads. We made sure every girl attending the workshop had something of their choice to manage their periods. I decided to make a phone call follow up on the girls we gave the cups so that we are sure extra precaution are taken during this pandemic. Washing hands always on insertion of the cup is very important and would be a precautionary measure. Again, menstruation will never be stopped by a pandemic and that’s why everyone who participated in this initiative should smile that 300 girls in Siloam, Mukuru have something to manage menstruation. 6.3.3 Social Life - Before most of the girls could not afford products to manage their periods. They could not carry out the normal duties, neither at home nor at school. Some ended up missing school or missing extra curriculum activities at school. They are happy that this is solved for the longest time.
Students and graduates from the initial workshops attended an evaluation workshop on November 28th 2020. A discussion was held to share experiences with the cup. The following comments will be helpful in future MHM workshops and evaluations:
The facilitators recommend that more time be given to get used to the cup as the cup is something new in Mukuru . Practice and time will be needed.
6.5 REFLECTIONS ON THE ROTARY MENSTRUATION (MHM) PROJECT
With all the Covid -19 measures and protocols being observed, an evaluation was done to the various girls who had carried home the reusable pads and menstrual cups and feedback was given according to each one’s unique experience after using either the menstrual cup or reusable pad.
We had a one on one individual discussion (IDs) with the girls who used menstrual cups and also engaged all who used the reusable pads in a Focused Group Discussion (FDGs) which was very interactive
Topics discussed included:
These were the same topics that were addressed in the beginning before rolling out the project to gauge the girls understanding of menstruation management and their take on male involvement.
Feedback:
The Menstrual (RUBY) cup: The girls were very curious to try out the cups and have a feel of it with some doubts. On discussing with their parents, they got motivated when parents encouraged them to try them out and so it gave them confidence to use them again. Others got encourage by their friends whom they shared with the knowledge about menstrual cups and went ahead to use them. Most girls reported feeling funny the first day they used the cups but became better and comfortable the consequent days and months thus resulting in an increased demand for the menstrual cups.
Re–usable menstrual pads: These were found to be very easy and comfortable to use by the girls, also easy to clean and maintain them. Same as cups, most girls got motivated by their parents and siblings who welcomed the idea positively. They were happy it has helped to reduce the allergies most of them got, leakages since they could change as often as possible and not worry about expenses of buying pads.
Most girls can confidently explain the menstrual cycle and its importance to the girl child, how to manage pain and keeping themselves and the environment clean and safe during menstruation. They now understand the changes in their bodies and relate with the different stages of growth (puberty). Hygiene has greatly improved in the school with presence of the new toilets (THANKS TO THE ROTARY CLUB), because they are now enough and well separated i.e. boys and girls, hand washing points also increased and so cleanliness is now on a higher level and the same practice has been extended home.
Myths and misconceptions have no place now since the girls got empowered and in turn empowered their friends, siblings and even some parents.
Most girls have started building confidence and talk freely to their brothers back at home about menstruation, we had some who were confidently discussing with boys of their class what we have been teaching them and how to assist them in case they needed their help.
In general, this programme has changed the attitude of many girls, boys and teachers towards menstruation and hygiene management and with continuous engagements and refresher on the same, Mukuru Siloam will be a better place thus greater empowerment to the whole community.
The programme has helped in reducing teenage pregnancies in Mukuru and in the county as per the health statistics in the county. We didn’t report any teenage pregnancy in Siloam and we thank the Thanks to Rotary Club for your support.
The girls also learned about the importance of their own well-being and how to handle life challenges during their growth and development.
“ My HEALTH my RESPONSIBILITY! “
Prepared by
Kate and Scholar
CONCLUDING REMARKS
Through the workshop process there has been consultation with students from
a variety of age groups, as well as with teachers and administrators at Siloam
primary school. The main emphasis has been on the education of girls and how
they may be affected by the stigma of public attitudes toward menstruation.
We found that young girls had a relatively weak understanding of the role of the
monthly period in human development . It might be beneficial to students if the
subject was taught as an introduction to human science that could be used as
building blocks for further study.
Of particular concern is the incidence of bullying and it is hoped that new
measures to make the school a non-violent zone will improve the learning
environment for the children. The report suggests that activities such as
sporting events that bring boys and girls together can provide benefits to
children beyond their physical development. They provide opportunities for
skills development and a forum to put those skills into practice. They
encourage collaboration and teamwork.
These values are reflected in the goals and objectives of the Giants of Africa
(GOA), co-founded by Masai Ujiri, President of the Toronto Raptors of the
National Basketball Association. The goal of GOA is to inspire youth from the
African diasporas with programs focused on empowerment of African youth
and their leadership, both on and off the court. They subscribe to the values of
hard work,, self -discipline and community engagement to empower African
youth to bring about lasting change in their communities.
Given evidence of disrespectful relationships between boys and girls over
menstruation and the existence of bullying at Siloam Kware school,
management at the school would be well advised to review the curriculum
proposed at https://www.wada-ama.org/en/sport-values-every-classroom
This program provides a tool kit for teachers to teach the core values of respect,
equity and inclusion to boys and girls aged 8 to 12
THE INGREDIENTS OF SUCCESS
The successful expansion and refurbishment of the Imara Healthcare centre is
due in large part to the hands on management of the project by the late Peter
Inoti. Peter had the vision of the Centre as a hub meeting the needs of Mukuru
residents for the delivery of health services. He also saw the important role of
Community Health Workers and the training they needed to meet the needs for
qualified personnel to hold Clinics at the Centre as well as delivering health
services in peoples homes.
Considerable funding was required to complete the project and here we
acknowledge the support of Alyssa Singh and Imani Care International of Clovis,
California. We also recognize the central role of Rotary International and it’s
Matching Grant Program as well as the considerable support provided by
Rotary clubs in Canada , the UK and Kenya and the many individual donors.
Finally, we need to recognize the important role played by Scholastica (Scolar)
Mwakali as Team Leader of the Community Health Workers. She also acted as
our Canada Revenue Agency (CRA) Intermediary with responsibility for the
disbursement of funds in Kenya, having been approved by The Rotary Club of Eganville Charitable Trust. She fulfilled these roles with diligence and efficiency.
Alan Fox
Coordinator of International Programs
Rotary Club of Eganville Charitable Trust
FINANCIAL SUPPORT IS STILL NEEDED!
Donations towards the continuing projects in Mukuru will be gratefully accepted. The Rotary Club of Eganville Charitable Trust is a registered charity with Canada Revenue Agency. Income tax receipts will be issued.
Canada Revenue Agency BN 119124709RR0001 www.cra.gc.ca/charities
Cheques can be made out to The Rotary Club of Eganville Charitable Trust and mailed to
The Rotary Club of Eganville at PO Box 788 Eganville, Ontario
Or
Donations can be made through PayPal or Canada Helps by following the links at
www.eganvillerotary.com/donate
Or
eTransfers can be arranged by contacting the club treasurer through
eganville.rotary@gmail com
Coordinator, International Programs
Eganville Rotary Charitable Trust
Date: June 2024
TABLE OF CONTENTS
Page
Our Sponsors ……………………………………………………………………………………….... 3
Introductions ………………………………………………………………………..……………....... 4
Imara Community Healthcare Centre Expansion & Refurbishment …………............................. 5
Menstrual Hygiene Management (MHM) at Siloam Learning Centre ………............................... 9
Launch a Peanut Butter Cooperative ……………………………………………………. .............. 14
Covid -19 Pandemic Protection Response ………………………………..……………................ 15
Say No, Be Counted (SNBC)-Prevention of Bullying and Sexual Interference .............................. 16
Appendix 6.1 Team Evaluation of MHM Workshops………………………………...................... 19
Appendix 6.2: Recommendations of Rotary Research Team……………………........................ 21
Appendix 6.3: Evaluation by Team Leader, Scholastika Mwakali ……………........ ................... 21
Appendix 6.4 Discussion about Menstrual Cup Usage………………………………..................... 22
Appendix 6.5 Reflections Nurse Kate and Scolar on the MHM Workshops…............................. 23
Concluding Remarks ………………………………………………………………………………........ 25
Ingredients of Success ……………………………………………………………………………........ 27
PROJECT SPONSORS
This project was made possible because of the generous support of many individuals and group sponsors. These include the following Rotary Clubs and other non-governmental organizations:
Rotary Clubs of Arnprior, Chesterville, Cataraqui-Kingston, Eganville, Gananoque, Kingston, Montreal Lakeshore, North Renfrew, Pembroke, West Ottawa,in Canada and Sowerby Bridge Rotary in the UK
and Syokimau Rotary in Kenya.
-The Women’s Inter-Church Council of Canada (WICC)
-The Canadian Union of Public Employees (CUPE)
-The Fellowship of the Least Coin (World Council of Churches)
-La Fondation Coup de Coeur
…and the donations of many loyal and generous individual supporters
INTRODUCTION
This Report provides a summary of projects supported by The Rotary Club of Eganville Charitable Trust, in the Mukuru kwa Njenga slum of Nairobi, between 2011 and 2024:
- Imara Community Healthcare Centre Expansion & Refurbishment
- Introduction of Menstrual Hygiene Management (MHM) at Siloam Learning Centre
- The Challenge of Accessing Sanitary Wear for Girls at Siloam Learning Centre
- Support for Cooperative Peanut Butter Production and Sales
- Covid 19 Pandemic Protection Response,
- Say No, Be Counted (SNBC)-Prevention of Bullying and Sexual Interference
- Evaluation & Recommendations
All these projects were conducted in partnership with local people and organizations in Nairobi, namely, the owners of the Imara Healthcare Centre and the Trustees of Siloam Learning Centre, as well as teachers and administrators at the school. Workshops were planned, organized and conducted by a team of community health workers (CHWs), led by Scolarstika (Scolar) Mwakali.
Scolarstika Mwakali also acted as our vetted project intermediary (foot on the ground) as required by the Canada Revenue Agency with responsibility for the accounting of and disbursement of project funds as approved and directed by Eganville Rotary Charitable Trust.
The project was under the direction of Eganville Rotary’s Coordinator of International Programs, Alan Fox.
1.0 IMARA COMMUNITY HEALTHCARE CENTRE EXPANSION & REFURBISHMENT
The Imara Healthcare Centre was established by the late Peter Inoti and his wife Francisca Muthoni, in 2002. Their objective was to provide health services for the residents of Nairobi’s Mukuru slum, which has a population of about 100.000 but very limited medical infrastructure.
Mukuru is near the industrial belt of Nairobi and many residents have left rural homes because of poverty and have the hope of finding work in the city. Living conditions in the city slums are shocking. Housing is dilapidated and made mostly from sheets of corrugated metal. There is no sanitation or running water. These conditions lead to a high rate of deaths from malaria, tuberculosis, HIV/AIDS and water-borne diseases. There is a high incidence of teenage pregnancies and with limited access to pre- and post-natal care, giving birth is a high-risk business. The infant death rate in Kenya is 31.8 per 1,000 live births in 2022. By comparison, in Canada, the infant death was 4.2 per 1000 live births according to statistics from the same year.
Francisca and Peter felt a moral responsibility to provide medical services for the residents of Mukuru qua Ngenja. Peter gave up a good job to establish the Clinic. However, despite their lofty aims, after ten years of business, they were barely making ends meet. They were losing staff as they couldn’t afford to pay them a competitive wage and the premises were in urgent need of repair. Of particular concern was drainage as the premises regularly flooded during the rainy seasons. Francisca worked part-time as an anesthesiologist at a government hospital and Peter was a health administrator with a large multinational organization.
Peter Inoti believed the key to becoming financially secure was to gain accreditation for in-patient care from the National Health Insurance Fund (NHIF). However, that required a significant investment to expand the facility to accommodate 30 beds, the minimum required to be designated as a hospital by NHIF. It also required a solution to the flooding problem, as well as the purchase of additional expensive equipment.
In 2013 Peter engaged Engineer Kenneth Kimathi to draw up plans for a major renovation of the premises. Several engineers/contractors had already surveyed the property and concluded that to prevent flooding it was necessary to raise the foundation
and replace the roof, among other work. The estimated cost was $26,150 (USD). In an agreement with a partner from Clovis California, Alyssa Singh of Imani Care International, the Rotary Club of Eganville Charitable Trust committed $8,000 (CAD) towards this work.
1.1 2014 Construction Begins
As the lead donor, Imani Care International prepared a Memorandum of Cooperation for the project management. The renovation involved the following work:
- Raise the rear part of the premises to mitigate flooding
- Expand the premises to the second floor
- Instal wash basins, toilets and plumbing and connect to the municipal sewer
- Upgrade the electrical wiring
- Instal tiles and paint the premises
”We have good news! We are very pleased to officially inform you that God has been gracious to us and that we are at last officially on board with NHIF Inpatient. It has been a long journey of prayers, hard work, and patience for all of us. We sincerely THANK YOU for encouraging and supporting us financially as we made improvements at the Imara Healthcare facility, which has eventually contributed to this accreditation. “
1.2 Community Health Worker Training
In an effort to grow the membership of the Imara Centre and extend its reach, Peter proposed a 10-day training session for 18 healthcare workers, followed by a nine month apprenticeship at the Imara Healthcare Centre. The objectives of this training were to provide early diagnosis and treatment of disease and Improve community sanitation and personal hygiene
With a Rotary District Matching Grant the management consulting company of Progeny International was hired to manage the training. Community health workers agreed that the workshop was informative and well run and they learned a lot.
During their apprenticeship the CHWs made some 1,200 house visits. They also participated in two national inoculation campaigns : one on polio prevention and the other on the prevention of measles, mumps and rubella. They inoculated over 1,300 children in each campaign. During their apprenticeship there was an outbreak of cholera in Mukuru and the CHWs spent two weeks going door to door to impress the residents about the importance of hand washing and personal hygiene.
The CHWWs also played an important role as workshop assistants for the Menstrual Hygiene and the Say No projects outlined later in this report.
1.3 Equipping an Operating Theatre
The Imara Healthcare Centre had midwives on staff to conduct conventional maternal deliveries but if there were any complications in the pregnancy, the mother had to go to a government hospital. This could require travel to another part of the city where the mother could not have the support of family and friends. Peter and Francisca wanted to have the capability of doing caesarian sections and other minor surgical interventions. So a fundraising campaign was launched to equip an operating and post op rooms .
In the first phase of the campaign a Rotary District Matching Grant was awarded to purchase an operating table, an aesthesia machine, a suction machine and a patient monitor. Phase two fundraising enabled the purchase of a second patient monitor for
the Post Op room and a Baby Resuscitator and a Baby Incubator. The total budget for equipment purchases amounted to $28,753 CAD, of which $11,430 CAD came from District Matching Funds.
One of Eganville Rotary’s partners, the Rotary Club of Syokimau contributed funds to buy a surgical trolly and an array of surgical instruments.They also helped plan the reception when the Operating Room equipment was delivered and handed over to the Imara Centre.
1.4 The Imara Healthcare Centre Today
In contrast with the time when Rotary and Imani Care International first provided support to the Imara Healthcare Centre in 2011, it has become financially stable. It is the only health facility in Mukuru with an Operating Theatre and has benefitted from referrals from other health centres. They are a busy 30 bed Inpatient facility with a staff of 20 people. They hold regular clinics for ante-and post-natal care as well as a child welfare clinic. Last year they delivered 214 new-born infants and had 1,842 patients for in-patient care.They were also active providing Family Planning services to 880 customers
The Centre has also been busy with its out-patient services to Mukuru residents, treating 1,973 children under the age of 5 and 7218 children and adults over the age of 5. In addition they have given admission rights to doctors working in other facilities to do surgery in the Imara theatre.
Credit must be given to Francisca Muthoni for the way she has managed change at the Centre. Credit must also be given to her loyal and dedicated staff. The last couple of years have been very difficult due to the pandemic and then Peter Inoti’s passing on September 3rd 2021. May he rest in Peace.
2.0 INTRODUCTION OF MENSTRUAL HYGIENE MANAGEMENT (MHM) AT SILOAM KWARE PRIMARY SCHOOL
This project aims to improve the lives of girls at the Siloam School in Mukuru, Nairobi. This was done by teaching Menstrual Hygiene Management (MHM), so that girls no longer need feel embarrassed about their monthly period or have to miss school because they do not have access to sanitary wear.
When girls are able to attend school full time because they have access to sanitary wear and a place at school where they can change in private, they do well in their education and are able to get rewarding jobs. They become empowered. As a result, their families are better off and so is their community.
During a visit to the Imara Healthcare Centre, Alan and Mona Fox had an opportunity to meet Joel Nzuki, the Headmaster of Siloam Kware Education Centre, a private, registered school in the Mukuru slum. The school is managed by a Board of Trustees chaired by Paster Lukas Oyoo . The school has an enrolment of about 800 children at the primary level. The expressed purpose of the ‘child-friendly’ school is to reach the vulnerable and less fortunate children in the slum. Those children who spend their time loitering on the streets.
2.1 Menstruation & School Attendance
Joel Nzuki expressed interest in the challenge of educating girls and in particular, the influence of public attitudes about menstruation on educational attainment. Because of the stigma about menstruation, many girls skip school when they have their period. Among the reasons for staying home are to avoid being teased by the boys, or because they have no sanitary wear, or, because they have sanitary wear but there is nowhere private to change at school. The result is the same. Her school grades fall, she loses confidence in her abilities and she eventually drops out of school. This is often followed by early marriage to an older man and a life looking after her husband and children. This is a loss to the national economy. It is also a loss of the girl’s potential to become an empowered member of her community.
2.2 Sanitation
There is little point encouraging girls to go to school while they have their period, if there is nowhere private for them to change. With support from the Rotary clubs of Arnprior, West Ottawa and Eganville, as well as Siloam School, a new toilet block was built while the school was closed for the Easter 2019 holidays. The toilet block contains five female toilets, four boy’s toilets and a boy’s urinal in addition to a girl’s changing room. There is no need to incur the cost to have the toilets pumped as they are now connected to the municipal sewer. This is a major improvement in the school’s sanitation.
- 2.3 Workshop Planning
In May 2018 a planning workshop was held to test different designs and fabrics used for sewing sanitary pads. It was attended by 35 volunteers.
Two other planning workshops were held in 2018 and 2019. Both were led by Kate Waswa, a registered public nurse in Mukuru. One workshop focused on menstruation and was attended by the female teachers from the school as well as the female CHWs. An Evaluation Report on the workshop is in the Appendix. The other workshop was entitled Boys to Men and addressed issues related to boys’ transition through puberty. It was attended by the male teachers as well as representatives from the school’s Board of Trustees.
The purpose of these two workshops was to ensure that all the adults at the school were familiar with the training that was taking place at the school. It was also an opportunity for the CHWs to observe Nurse Kate lead the workshop before they took on that shared role.
Both workshops were well received by the participants. It was suggested that the MHM workshop could run over two days as there was so much interesting and valuable information to absorb. It was also suggested that the workshop should be repeated at other schools.
2.4 MHM Workshop Topics
The MHM workshop is valuable training in the education of adolescent girls as it covers the arrival of menstruation and mood changes as well as how to manage the monthly menstrual cycle. Emphasis is placed on hygiene in the home and the importance of hand-washing.
Topics addressed at the workshop included:
- Myths about menstruation
- The menstrual cycle – the facts
- Puberty, mood changes and hormones
- Monthly management using recyclable pads or menstrual cups The role of boys and men
2.4.1 Workshop Results
Over 300 girls attended the four-hour workshops between October 2019 and mid-March 2020, just before all schools in Kenya were shut down due to the global pandemic.
Despite the school year being cut-back there have been significant accomplishments
- The workshop was taken by over 300 girls who are now well informed about the function of menstruation and its role in human reproduction
- Siloam school teachers took the training and they agreed that it enhanced their knowledge of the sensitive subject and increased their confidence in teaching the subject to their students
- Learning does not stop at the school gates. Children talk about what they have learned at school and so knowledge about the importance of handwashing and other hygienic practices is passed on to family and friends. It also helps dispel the stigma of menstruation in the community.
It was suggested that boys should learn more about menstruation. They should be more understanding of the discomfort felt by girls when they have their period. Girls need empathy. Not teasing.
In their reflections on the value of the MHM workshops Scolar and Nurse Kate concluded:
“In general,this program has changed the attitude of many girls, boys and teachers towards menstruation and hygiene management. With continuous engagements and refresher training Mukuru Siloam will be a better place thus greater empowerment to the whole community.”
This program has helped in reducing teenage pregnancies in Mukuru. We didn’t report any in Siloam and we thank the Rotary Club for your support.
The girls also learned about the importance of their own well-being and how to handle life challenges during their growth and development
They concluded with the slogan: My HEALTH, my RESPONSIBILITY
2.4.2 Next Steps:
Menstrual hygiene should be taught to both girls and boys and the training should start at a relatively young age in primary school.
The questionnaire that students completed before attending the workshops revealed a widespread lack of knowledge about the function of menstruation and its role in the reduction of the human species. It is suggested that a sample of students complete a questionnaire again to determine whether there has been learning as a result of the workshop
2.4.3 Accessing Sanitary Wear
According to the Gates Foundation Report (Menstrual Health in Kenya: A Country Landscape Analysis, 2017 ) the primary obstacle facing the advancement of Kenyan girls is the lack of access to sanitary wear at an affordable price.
Access to sanitary wear should be a National health issue . The National government recognized this in 2017 when it legislated the distribution of free sanitary towels to Kenyan school girls. But they are not getting to children and youth from poor families who need them. An inquiry into expenditures revealed that a large part of the allocation had gone missing. The lack of access to sanitary wear sometimes has dire consequences.
One tragic case of the impact of this shortage was reported in Nairobi 's Daily Nation in 2019. A 14 year old girl hanged herself after she had been humiliated in front of her class by her teacher for soiling her dress.
2.4.4 Sewing by Canadian Volunteers
The availability of free sanitary wear for girls attending the Siloam school workshop has been possible because of the work of Mona Fox and a team of dedicated Canadian volunteers.
The last graduating class in November 2019 was given the choice of using a reusable pad or alternatively using a menstrual cup. The cup is made of high grade medical plastic and will usually last about 10 years compared to two or three years for the reusable pad, however, it costs a lot more (about $17 compared to two or three dollars for a homemade reusable pad). Out of 60 students graduating 45 chose the menstrual cup.
2.4.5 Boy’s Menstruation Education
Rotary financed the purchase of an electric /manual Singer sewing machine for interested students. The school might consider adopting sewing as an extracurricular activity so that those girls in need of sanitary wear can make their own and at the same time learn how to use a sewing machine.
There is no reason why boys cannot make sanitary ware too. Teaching boys about the role of menstruation in human reproduction will lead to a better understanding of the challenges of both boys and girls as they pass through puberty. Hopefully it would also contribute to more respectful relationships between boys and girls.
It is clear from the results of the survey questionnaires that were completed by the students before attending the MHM workshops that young Kenyan girls have only a limited knowledge about menstruation and its role in human reproduction. It is suggested that the education authorities consider placing a greater emphasis on MHM in their health curriculum. Also, funds should be made available for community-based groups, such as the Imara Community Health Workers, to conduct workshops on the subject in area schools.
3.0 SUPPORT FOR A COOPERATIVE PEANUT BUTTER BUSINESS
3.1 The Shakinah Women
Peter Inoti held periodic support group sessions for HIV positive mothers who attended the Imara Healthcare Centre. These women had difficulty getting employment or earning any income because of their HIV status. One idea they discussed was to try and sell kerosene. They subsequently decided to focus on making peanut butter for sale in the slum and appealed to Rotary for support.
Eganville Rotary was able to secure a grant from the Women's Inter-Church Council of Canada (WICC) to buy a roaster and grinder as well as the supply of wholesale peanuts. Then they went into business trading as the Shakinah Women. Unfortunately they had problems with the equipment they bought, then they could not find a suitable location to operate from and went out of business.
3.2 Imara Community Health Workers Application
The peanut butter equipment was temporarily stored with Francisca Muthoni at the Imara Healthcare Centre. A proposal was subsequently submitted by Scholastica (Scolar),the leader of Rotary's research and training team in Mukuru. As much of the work by the health workers was part time or voluntary, it is hoped that the production and sale of peanut butter will help supplement their minimal incomes.
In a Memorandum of Understanding it was agreed that the health workers will have the use of the equipment and Eganville Rotary Charitable Trust will provide $1,000 in seed funding to get the equipment up and running again and buy necessary supplies. It is expected that the business will be self-sustaining in six months. It was agreed that all labour will be voluntary until the business becomes profitable. It was recognized that bridge funding may be required to buy peanuts and if that should be necessary, it too must be repaid before the business is self-sustaining.
- 4.0 THE COVID-19 PANDEMIC PROTECTION RESPONSE
A trip to Kenya by Alan and Mona Fox was planned for the end of March 2019, however, with the announcement of the global pandemic, all educational institutions in Kenya were closed and air traffic was grounded. The school lost all its income from school fees, so could not pay the teachers. A concern of the school management was that they might lose the best teachers if they decided to find other work. This would prejudice completion of the menstruation project.
By May 2020 the situation was serious. Food was scarce and expensive. At the request of her team, Scholastica appealed to Rotary for rations. Given the importance of keeping the team together, it was decided to award them a grant of $1,000 to buy provisions. This helped support 18 adults and 45 children.
With the expected resumption of schooling in January 2021, (and earlier for students taking the National exams), there was need for protection personal equipment (PPE) for the security of students. Rotary provided $3,050 to buy reusable masks, 20 handwashing stations, buckets and soap.
- 5.0 SAY NO, BE COUNTED (SNBC) – PREVENTION OF BULLYING AND SEXUAL INTERFERENCE
5.1 The Visionary Women’s Centre (VWC)
The VWC is a grassroots community based organization in rural Kenya, representing the interests of women and girls who work on subsistence farms. Lizette Gilday, founder of the VWC and a Canadian with a background in social work, psychotherapy and curriculum development, informed the Rotary team that the VWC had a program titled “Say No, Be Counted“. The goal of this workshop program was to educate adolescent girls on how to protect themselves from bullying and unwanted sexual attention and to save other victims from harassment or assault.
Eganville’s intermediary, Scholar Mwikali and a member of her team made the four hour bus ride from Nairobi to Turbo where they attended a SNBC workshop. They were able to liaise with the presenters and were given a copy of the SNBC curriculum for girls (My Girl Power) and boys (The Hero in Me). With the agreement of the VWC it was decided to adopt their curriculum rather than develop one on their own. In return the VWC was interested in using Rotary's menstruation workshop. A pilot orientation project was launched with the following objectives: determine if student bullying was a problem at Siloam Kware school. If, in the opinion of teachers and a sample of students, bullying is an issue, propose ways to prevent it
and provide community support for the students who have been victimized.
Then some 160 students from Siloam school attended six one-hour workshops on the following topics:
- Bullying and Harassment; Gender-Based Violence; Fundamental Human Rights; Skills ; Personalities; Sexual Harassment
- 5.2 Workshop Conclusions and Actions
“The children of my mother hates me because I don't have any father I can call dad. I look at myself and say, I am nothing to them. I usually think about killing myself but something tells me no”.
Workshop participants felt there was need for a forum where children can talk, or write about being bullied and get help, if necessary . They also felt programs such as SNBC should be offered in area schools as early as the primary level
Scholastica Mwaka and her team prepared the reports in the Appendix on their experience working on this research and training project. They report that the project has improved their knowledge of menstruation and the importance of menstrual hygiene.
It is clear from the results of the survey questionnaires that were completed by the students before attending the MHM workshops that young Kenyan girls have only a limited knowledge about menstruation and its role in human reproduction. It is suggested that the Education authorities consider placing a greater emphasis on MHM in their Health curriculum. Also, funding should be made available for community based groups, such as the Imara Community Health Workers, to conduct workshops on the subject in area schools.
Workshop participants felt it was important that students, teachers and the Mukuru community recognize that the Mukuru Kware Learning Centre is a Non Violent Zone. Bullying and aggressive behavior will not be tolerated. Eganville Rotary provided the school with support to prepare a poster and pamphlets to publicize this policy..
APPENDIX
6.1 TEAM EVALUATION OF MENSTRUAL HYGIENE MANAGEMENT WORKSHOPS
Rotary Team Member Evaluation
Participants answered the following questions anonymously:
6.1.1 What will you remember most from this training?
Use of menstrual cups since it is a new idea
Pain management in MHM
Men’s role in MHM
How to assist physically and mentally challenged girls during menstruation
Psychological and emotional management during puberty
6.1.2 What did you learn from this training ?
-The need to educate the community on MHM
- Challenges faced by girls and women during menstruation and how to handle them
-Proper care and disposal of used pads
-Space for changing and cleaning MHM products safely
6.1.3 What are your positive impressions about this training?
Detailed information and right answers to questions i.e. clear explanations
Relevant topic to the scope of my work
Audibility and eloquence, open and ready to teach from known to unknown, no shying off from the facts
- Good language understood by everyone
- Good explanation of the menstrual cycle
- Good time management
6.1.4 What are your negative impressions or what would you like to change?
-Very little time for such an elaborate and interesting topic - need more time for training, at least 2 days
- Very few men present in the class. Involve more men
- No projector for the video
6.1.5 What are you going to do differently after this experience?
-Be a MHM advocate-Teach women and girls more on MHM, clarify facts and demystify myths on MHM
-Support the already affected girls and walk them through the MHM journey
-Help boys and girls understand themselves and each other during puberty through to adolescence
6.1.6 Any other comments?
- If possible lets have more of these sessions in different areas of the community
- Congrats for the good work
- Visit schools
- Sincere appreciation to the initiators and organizers of this training for it has taught us a lot.
6.1.7 Please rate training on a scale 1 - 10 Ten is the highest
- The workshop was rated at 93% by the participants
6.2 RECOMMENDATIONS OF THE ROTARY RESEARCH TEAM
6.2.1 The team made the following recommendations on Menstrual Health and Management:
- The girls should be given the freedom to choose what product works best for them. However, preference should be given to reusable sanitary pads (or, menstrual cups) rather than disposable pads
- The boy child should be given the same opportunity as the girl child to learn about puberty and should be encouraged to support girls rather than stigmatizing them
- The school should organize activities that bring boys and girls together and encourage mutual respect
- The Imara CHWs should have the opportunity to take continued training on menstrual health
- The Education authorities should encourage and support community-based initiatives to increase awareness by primary school girls of the importance of the hygienic management of their monthly period.
6.3 EVALUATION BY TEAM LEADER SCHOLASTIKA MWAKALI
6.3.1 Knowledge of Menstruation
Girls have gotten some knowledge on menstruation periods. Before the girls didn’t have a clear picture on it and they had different beliefs. Some of these beliefs associated with the cultural view on menstruation that only thought it’s a taboo to discuss about it since their parents hardly speaks about it while others thought it’s for grown up women. This programme has made the girls understand better menstruation and the hygiene required to keep infections at bay. Others even thought its sickness . Sickness would come when proper hygiene was not observed. This was clearly taught. No doubt the girls have the right information now.
6.3.2 Menstrual Management
- The girls have knowledge on other products to manage their periods but the use of ruby cups is new to them. Our concentration was based on the ruby cups and the re usable pads. We made sure every girl attending the workshop had something of their choice to manage their periods. I decided to make a phone call follow up on the girls we gave the cups so that we are sure extra precaution are taken during this pandemic. Washing hands always on insertion of the cup is very important and would be a precautionary measure. Again, menstruation will never be stopped by a pandemic and that’s why everyone who participated in this initiative should smile that 300 girls in Siloam, Mukuru have something to manage menstruation. 6.3.3 Social Life - Before most of the girls could not afford products to manage their periods. They could not carry out the normal duties, neither at home nor at school. Some ended up missing school or missing extra curriculum activities at school. They are happy that this is solved for the longest time.
- During menstruation periods,85% of the girls confessed to feel unworthy and not happy about it. The stigma they experience from the boys is too much. Some teachers will also embarrass them. They feel that no one understands them.
Students and graduates from the initial workshops attended an evaluation workshop on November 28th 2020. A discussion was held to share experiences with the cup. The following comments will be helpful in future MHM workshops and evaluations:
- About 80% of the parents gave the girls approval to try the cup and see how it works.
- The cup exhibits discomfort when poorly inserted. Some girls had not initially managed the proper insertion technique.
- Almost all the girls were afraid the cup would interfere with the hymen and reassurance to the contrary had to be given.
- While in boarding school students are not using the cup because there is not enough accessible hot water to clean the device. Most of the girls who are using the cup are in day school and can go home and sanitize the device in the evening.
- The girls with re-usable pads are okay and feel comfortable using them.
- It was discovered there's leakage with the cup for girls with heavy flows.
- There was some complaint of pain when removing the cup because of the pressure of pushing it out. It was suggested that this might be because they didn't twist the cup to allow some air in and detach the cup from the vagina.
The facilitators recommend that more time be given to get used to the cup as the cup is something new in Mukuru . Practice and time will be needed.
6.5 REFLECTIONS ON THE ROTARY MENSTRUATION (MHM) PROJECT
With all the Covid -19 measures and protocols being observed, an evaluation was done to the various girls who had carried home the reusable pads and menstrual cups and feedback was given according to each one’s unique experience after using either the menstrual cup or reusable pad.
We had a one on one individual discussion (IDs) with the girls who used menstrual cups and also engaged all who used the reusable pads in a Focused Group Discussion (FDGs) which was very interactive
Topics discussed included:
- Puberty, mood changes and hormones
- The menstrual cycle – the facts
- Myths and misconceptions about menstruation
- Monthly management of menstruation using re-usable pads and Cups
- Proper hygiene during menstrual management, consequences of poor hygiene management
- Pain management
- The role of boys and men
- General well-being and confidence issues as girls in the society
These were the same topics that were addressed in the beginning before rolling out the project to gauge the girls understanding of menstruation management and their take on male involvement.
Feedback:
The Menstrual (RUBY) cup: The girls were very curious to try out the cups and have a feel of it with some doubts. On discussing with their parents, they got motivated when parents encouraged them to try them out and so it gave them confidence to use them again. Others got encourage by their friends whom they shared with the knowledge about menstrual cups and went ahead to use them. Most girls reported feeling funny the first day they used the cups but became better and comfortable the consequent days and months thus resulting in an increased demand for the menstrual cups.
Re–usable menstrual pads: These were found to be very easy and comfortable to use by the girls, also easy to clean and maintain them. Same as cups, most girls got motivated by their parents and siblings who welcomed the idea positively. They were happy it has helped to reduce the allergies most of them got, leakages since they could change as often as possible and not worry about expenses of buying pads.
Most girls can confidently explain the menstrual cycle and its importance to the girl child, how to manage pain and keeping themselves and the environment clean and safe during menstruation. They now understand the changes in their bodies and relate with the different stages of growth (puberty). Hygiene has greatly improved in the school with presence of the new toilets (THANKS TO THE ROTARY CLUB), because they are now enough and well separated i.e. boys and girls, hand washing points also increased and so cleanliness is now on a higher level and the same practice has been extended home.
Myths and misconceptions have no place now since the girls got empowered and in turn empowered their friends, siblings and even some parents.
Most girls have started building confidence and talk freely to their brothers back at home about menstruation, we had some who were confidently discussing with boys of their class what we have been teaching them and how to assist them in case they needed their help.
In general, this programme has changed the attitude of many girls, boys and teachers towards menstruation and hygiene management and with continuous engagements and refresher on the same, Mukuru Siloam will be a better place thus greater empowerment to the whole community.
The programme has helped in reducing teenage pregnancies in Mukuru and in the county as per the health statistics in the county. We didn’t report any teenage pregnancy in Siloam and we thank the Thanks to Rotary Club for your support.
The girls also learned about the importance of their own well-being and how to handle life challenges during their growth and development.
“ My HEALTH my RESPONSIBILITY! “
Prepared by
Kate and Scholar
CONCLUDING REMARKS
Through the workshop process there has been consultation with students from
a variety of age groups, as well as with teachers and administrators at Siloam
primary school. The main emphasis has been on the education of girls and how
they may be affected by the stigma of public attitudes toward menstruation.
We found that young girls had a relatively weak understanding of the role of the
monthly period in human development . It might be beneficial to students if the
subject was taught as an introduction to human science that could be used as
building blocks for further study.
Of particular concern is the incidence of bullying and it is hoped that new
measures to make the school a non-violent zone will improve the learning
environment for the children. The report suggests that activities such as
sporting events that bring boys and girls together can provide benefits to
children beyond their physical development. They provide opportunities for
skills development and a forum to put those skills into practice. They
encourage collaboration and teamwork.
These values are reflected in the goals and objectives of the Giants of Africa
(GOA), co-founded by Masai Ujiri, President of the Toronto Raptors of the
National Basketball Association. The goal of GOA is to inspire youth from the
African diasporas with programs focused on empowerment of African youth
and their leadership, both on and off the court. They subscribe to the values of
hard work,, self -discipline and community engagement to empower African
youth to bring about lasting change in their communities.
Given evidence of disrespectful relationships between boys and girls over
menstruation and the existence of bullying at Siloam Kware school,
management at the school would be well advised to review the curriculum
proposed at https://www.wada-ama.org/en/sport-values-every-classroom
This program provides a tool kit for teachers to teach the core values of respect,
equity and inclusion to boys and girls aged 8 to 12
THE INGREDIENTS OF SUCCESS
The successful expansion and refurbishment of the Imara Healthcare centre is
due in large part to the hands on management of the project by the late Peter
Inoti. Peter had the vision of the Centre as a hub meeting the needs of Mukuru
residents for the delivery of health services. He also saw the important role of
Community Health Workers and the training they needed to meet the needs for
qualified personnel to hold Clinics at the Centre as well as delivering health
services in peoples homes.
Considerable funding was required to complete the project and here we
acknowledge the support of Alyssa Singh and Imani Care International of Clovis,
California. We also recognize the central role of Rotary International and it’s
Matching Grant Program as well as the considerable support provided by
Rotary clubs in Canada , the UK and Kenya and the many individual donors.
Finally, we need to recognize the important role played by Scholastica (Scolar)
Mwakali as Team Leader of the Community Health Workers. She also acted as
our Canada Revenue Agency (CRA) Intermediary with responsibility for the
disbursement of funds in Kenya, having been approved by The Rotary Club of Eganville Charitable Trust. She fulfilled these roles with diligence and efficiency.
Alan Fox
Coordinator of International Programs
Rotary Club of Eganville Charitable Trust
FINANCIAL SUPPORT IS STILL NEEDED!
Donations towards the continuing projects in Mukuru will be gratefully accepted. The Rotary Club of Eganville Charitable Trust is a registered charity with Canada Revenue Agency. Income tax receipts will be issued.
Canada Revenue Agency BN 119124709RR0001 www.cra.gc.ca/charities
Cheques can be made out to The Rotary Club of Eganville Charitable Trust and mailed to
The Rotary Club of Eganville at PO Box 788 Eganville, Ontario
Or
Donations can be made through PayPal or Canada Helps by following the links at
www.eganvillerotary.com/donate
Or
eTransfers can be arranged by contacting the club treasurer through
eganville.rotary@gmail com