Miles into Lake Victoria sits a level three health facility on the island named Mageta after the island. The population on this island is roughly 8,000, with different health and social needs. It is easy for such a place to be forgotten since it sits far inside the lake, away from the urban town of Siaya. The Centre for Health Solution has been implementing several health interventions here as a means to help the community achieve the highest levels of good health and well-being.
Since March 2022, CHS has been supporting biomedical interventions (HIV testing, initiation of PrEP and ART, VMMC, cervical screening, STI and TB screening, and treatment). Also, behavioural intervention (promotion, demonstration, and distribution of condoms and lubricants) and structural intervention (community sensitization on key and vulnerable populations, GBV, and advocacy on stigma and discrimination)
Casper Anyango Otieno is a clinical officer by profession, working at Mageta Health Centre, Mageta Island. He says that the facility offers outpatient clinic services, care services for people living with HIV, and a maternal child clinic where, in a day, an average of 40 patients can be seen, that is, about 15–20 patients in the MCH Clinic and about 15-20 patients in the HIV Care clinics.
We sit down to have a chat with Casper, who is identified as a hero in this community through his life-saving work.
What is the state of HIV on this island?
The numbers are a bit high, but we have been implementing preventive measures like offering PrEP to clients as part of the mitigation measures for reducing HIV cases. Some of the factors that contribute to HIV cases stem from early marriages, the exchange of sex for fish, and poor levels of education, which contribute to poor judgment in sexual matters.
Describe your work with CHS.
My work with CHS has been very impactful for this region. Through CHS, we offer prevention services to fishermen and key populations. It has been of great impact because, through the integration of services, we have a one-stop shop at the facility for all their healthcare needs.
Why are the outreach efforts important?
Integrated outreach ideally means bringing health services to the community instead of going all the way to the facility. When we come to them, we offer comprehensive HIV prevention services to the clients including condom and lubricant promotion, risk assessment and risk reduction screening, STI screening, and treatment, TB screening and use of a portable x-ray machine for eligible clients, reproductive health services, family planning and cervical cancer screening and treatment, VMMC services to males over 15 years old, PrEP services, HIV treatment services. The key populations, MSMs, and FSWs are also handled with specific care package.
The community appreciates the outreaches since the services are brought to their doorstep and they come out in large numbers.
What should be done for the people of Mageta to ensure they live healthy lives?
We need to increase their levels of education and offer entrepreneurship skills to enable them to survive and stop fully depending on fish. Sometimes fish are not available during low seasons, and they suffer during such seasons.
Is there a relationship between TB and HIV?
Yes. TB is an opportunistic infection, especially among people living with HIV and AIDS. When someone has HIV, he or she can easily develop TB. We try as much as possible to ensure that people living with HIV don’t get TB infections. Anyone started on treatment; we cover them with TPT to prevent the development of the HIV infection. We also screen now and then both those with the infection and the general population because once we have the infection in the community, it is so easy to spread, even to children.
What has been your greatest joy so far?
I have worked on this island for five years. My greatest joy and appreciation is that the community is now embracing healthcare. When I first came to the island, it was rare to see clients coming to the facility. They would go to the churches seeking cures, and most ended up dead. Currently, we have many clients coming to seek help, as well as women who are coming to deliver from the hospital. In a month, we can help about 20 women deliver, which is no mean feat.
What do you hope for Mageta in the next 5 to 10 years?
I pray that the level of education will increase. That way, they will be equipped to make sound decisions, and issues like child marriages will cease. I hope that they will be more empowered and equipped with skills to help them diversify into other jobs and survival tactics.
What challenges do you experience?
Mageta Island is inhabited by people who are migrants by nature. Whenever we have a lot of fish on the island, many clients come to the health facility even from the neighbouring country, but when fish decline, they migrate. It becomes very difficult to follow up on clients. To address this as healthcare workers, we have had to be flexible. If a client says they will not be around for a certain time, we offer medication that would cover the period he or she will not be around.
In Siaya County CHS covers the main beaches through different health interventions. This financial year, from October 2023 to May 2024, 36,059 fisherfolk have been reached, and 18,579 have been tested for HIV.
Those currently on PrEP stand at 879, and the fisherfolk on ART are at 3,210. Fisherfolk who are eligible for viral load represent 99%, while those who have a valid viral load are at 82%.
It is crucial to ensure that those living with HIV are virally suppressed to below 200 copies of viral load. Currently, fisherfolk who are virally suppressed (<200) stand at 90%.
The number of those screened for TB, diagnosed, and on treatment is 56. We continue to implement different intervention programs on the island and the Siaya region as a whole to end the HIV epidemic.
