What is most remarkable about MED25 is not just that the Seattle-based nonprofit is providing quality healthcare services largely without charge in a region of Kenya that has the highest HIV-infection rate in the country.
And it’s not just that within 18 months of opening, the clinic was fully subsidized, primarily by a mortuary created in collaboration with the local community of Mbita.
This is indeed an extraordinary feat given that MED25 is just a bit player among the state’s very large cast of big global health organizations – 168 to be exact, said Kristen Tetteh, director of communications for Washington Global Health Alliance. “Seeing a program become sustainable in such a short period of time is something I don’t see very often.”
But what impresses Tetteh as much if not more so is that MED25 went into Mbita with its ears open. “The community, in fact, wanted a mortuary. MED25 not only listened to what the community wanted, it created a valuable service that could sustain their health clinic in the process.”
“Listening to the community is by far the biggest reason for our success I would say,” said MED25 Founder and Executive Director Rebecca Okelo, who is also a nurse and the organization’s sole U.S. staff member. The name refers to Article 25 of the Universal Declaration of Human Rights, which address the right of everyone in the world to have access to healthcare.
Mbita has some of the poorest health statistics in East Africa, with an HIV-infection rate of 27 percent, compared to the national average in Kenya of about 6.1 percent, Okelo noted. On average, men live to age 37, and women to 41.
A former clinic had closed in Mbita, leaving its 118,000 residents without health care, but the community was adamant about needing a mortuary. The nearest one was two hours away, a cost-prohibitive journey in a community where individuals earn roughly 60 cents a day. It would take an entire year’s wages to transport a body that distance.
As a result, families were forced to bury bodies right after death, a cultural taboo as they believe the spirit will return to haunt them. Or they would leave deceased relatives at home long enough for families to gather and pay their respects, fueling the spread of disease and poor sanitation.
Often, nonprofit organizations go into communities like Mbita with the best of intentions to provide healthcare as a business, Okelo said. “The problem is a lot of people in these communities don’t prioritize health. If you’re in the hospital and need $5 to save your life, it’s hard to raise because everyone knows you could be sick again in a month. In African cultures, everyone you know will contribute $5 toward your funeral; it’s a one-time fund-off, and it’s because of their belief in caring for the spirit after they’ve passed on.”
Mortuary gathers support
So, after many conversations with community leaders, focus groups, and surveys, MED25 took the mortuary concept to its donors. It definitely raised some eyebrows, Okelo said, but enough of them came through with the funding to get the project off the ground. The $320,000 budget covered the site purchase, construction of the new mortuary and much larger outpatient facility than the one they had been renting. That sum also provided a guard house, providing electricity to the buildings, digging a well, and installing equipment to support the special requirements of the mortuary.
Okelo said Brian Curnow of Curnow Funeral Home in Sumner, Wash., was instrumental in helping with the building design and staff training in Kenya.
The mortuary opened in February 2014, and the clinic in July of that year. The entire project became sustainable by October 2015. “Since that time, we have not provided any financial support to the program in Kenya,” Okelo said.
The clinic costs about $100,000 a year to operate, $65,000 of which is paid for by the mortuary and smaller, related businesses, including the sale of coffins, suits and dresses, snacks and clean water, and the rental of a corpse transportation bus for ambulance use. The rest of the funding comes from clinic fees ranging from 50 cents to $4 for the treatment of chronic illnesses and more elaborate blood work that may be needed. Free services include HIV testing, counseling and treatment; prenatal care and well-baby checks; and immunizations.
The Kenya project is MED25’s second success at creating a sustainable health care facility in Africa. In partnership with local government entities, it created an HIV/AIDS care center, which includes a nursery school, vocational school, and orphanage, in Ghana. Three years after it had been up and running successfully, MED25 turned over the center to the Ghanaian government a local community organization to fund and manage in 2009.
These days, Okelo is looking ahead and considering a pivot to “a partnership approach” that would involve helping other organizations “who are doing good work but haven’t found the right model for sustainability.”
Already, Okelo and leaders of Village Reach are putting their heads together to see how the MED25 model can be scaled up for a broader impact. “We’re both looking at opportunities in the Democratic Republic of the Congo – ground zero for last-mile challenges,” said Village Reach President Evan Simpson.
The much larger global health care organization and MED25 are sharing ideas and experiences, he said. “I’m interested in incubating some of these innovative approaches like MED25. What Rebecca had tapped into is the can-do spirit of the community. At the last mile, those kinds of innovations are going to be the future.”