By 2030, carbon dioxide emissions caused by humans need to fall by about 45% from 2010 levels, reaching ‘net zero’ around 2050, says the report. Remaining emissions would need to be balanced by removing CO2 from the atmosphere, for example through reforestation and improved land management.
Big data — whether historical or real-time — can also help us tackle the problem, for example by locating harmful emissions or identifying pressure points along the supply chain. This transformative change in data capabilities is an example of what the World Economic Forum refers to as the Fourth Industrial Revolution (4IR).
When California Governor Jerry Brown announced in September that the US state would be launching “its own damn satellite” to monitor the effects of climate change, his promise was bold: an initiative to help governments, businesses and landowners to pinpoint — and stop — destructive emissions “with unprecedented precision, on a scale that’s never been done before”.
Launched against a backdrop of the Trump administration’s withdrawal from the Paris Agreement, California is taking local action to a global problem in the absence of federal leadership. Working with San Francisco-based Earth imaging company, Planet Labs, the state will develop and eventually launch a satellite capable of detecting the “point source” of climate pollutants, monitoring leaks and other anomalies at specific locations.
The satellite, an initiative of the California Air Resources Board, will complement project partner Environmental Defense Fund’s MethaneSAT, scheduled for launch in 2021. The latter will provide broader, more frequent coverage, quantifying emissions from oil and gas fields producing at least 80% of global output roughly every four days.
Individually, the projects will generate important data on harmful emissions. Combined, the data sets pack a bigger punch. For instance, if MethaneSAT waves a red flag about an emissions spike in a given field, the California instrument would then zero in on specific facilities and pinpoint the larger sources. EDF says it is “like having two camera lenses — wide angle and telephoto” that together produce a more complete picture of the methane problem.
The California Air Resources Board and Planet Labs will work in partnership with the Environmental Defense Fund amongst others to set up a new Climate Data Partnership, a common platform for reporting data to enable governments, businesses, landowners and others to pursue more targeted mitigation measures worldwide.
Tom Ingersoll, who is leading EDF’s MethaneSAT project, suggests thinking of these separate but complementary data projects “as a set of overlapping circles, like the Olympic rings”.
He says: “Multiple methods of assessing methane emissions lead to a more complete and actionable set of insights than any single method can by itself.”
Bringing solutions into focus
Combining data captured via satellite imagery and artificial intelligence to monitor forests and land use to provide the ‘where, why, when and who’ was among the solutions discussed at a 4IR event held at the recent Global Climate Action Summit in San Francisco.
Kavita Prakash-Mani, practice leader – markets & food at WWF, says data from projects such as Eyes on the Forest, which investigates deforestation and land grabs in Indonesia, needs to be combined with other information to create the full picture. “We need technology to monitor why we are losing forests, looking at traceability through citizen sites and data on where food is coming from,” she says.
One example of this is the Trase platform, which connects independent data sources to reveal the trade flows for commodities such as beef, soy and palm oil which are responsible for an estimated two thirds of tropical deforestation. The aim is bring transparency to global supply chains, using publicly available data to map in detail the links between consumer countries via trading companies to the places of production.
The Trase platform reveals trade flows for commodities such as beef, soy and palm oil. (Image: Trase)
Using existing data such as customs records and trade contracts, tax registration data, production data and shipping data, Trase pieces together a bigger picture of how exports are linked to agricultural conditions (including specific environmental and social risks) in the places where they are produced. This enables companies, governments and others to better understand the risks and identify opportunities for more sustainable production.
By 2021, Trase aims to map the trade of over 70% of commodities that pose a major risk to forests. Clément Suavat, lead developer at Trase, says combining different data sets “allows you to connect landscapes, to quickly identify sustainability risks”. So, a mash-up of supply chain information and shipping data for example can help a business to pinpoint exactly where to make changes that will have an impact on climate change goals.
Sharpening the picture
Like Orbital Insight, which is using geospatial analytics to support the Global Forest Watch monitoring initiative, the Trase and Planet Labs projects are just some examples of this fast-growing field of using technology for climate change transparency.
Most recently, US climate change think tank Woods Hole Research Center is using a satellite-based tool to create a new global carbon monitoring map. The dataset behind the launch of The Carbon Source comes from the Woods Hole Carbon Monitoring System, which employs an innovative time-series approach to measuring changes (losses and gains) in aboveground carbon density across tropical America, Africa and Asia.
Woods Hole claims the approach is “poised to transform how the world measures and tracks changes in forest carbon” and its vision is to use the data “to tell a near real-time story” about the state and vulnerability of land-based carbon from the Arctic to the Tropics.
Dominic Waughray, head of the World Economic Forum’s Centre for Global Public Goods, predicts a “huge transformation” of the environmental community: “Think about how difficult it’s been to tackle climate change, to track emissions. And then think about the possibilities of large-scale transparency of data, and what that would mean to be a company or a civil society organization, finding that information and doing something with it.”
America’s governors, mayors and CEOs are forging ahead with climate change initiatives despite the Trump administration’s withdrawal from the Paris Agreement and commitment to reviving the coal industry. But a report published today sets out a roadmap that could quicken that pace and cut carbon emissions to 24% below 2005 levels by 2025 in the absence of federal leadership.
Many US states, cities and businesses have rallied around the Paris commitments since Donald Trump pulled out from the agreement in June 2017. The America’s Pledge on Climate initiative was set up the same year by former New York City mayor Michael Bloomberg and California governor Jerry Brown to map “bottom up” US climate action.
The US is already almost halfway to meeting its 2025 Paris Agreement emissions goal of 26-28% below 2005 levels by 2025. The report claims existing commitments and policies will drive US emissions to 17% below 2005 levels by 2025 – around two-thirds of the original Paris goal.
It also sets out 10 climate action strategies – across most major economic sectors including electricity, transportation and buildings – that, if implemented broadly, could lower emissions to 21% . Broader engagement and collaboration could bring this figure to 24%, the report suggests.
Strategies include setting and implementing more stringent renewable energy procurement policies, accelerating the phase out of super-polluting refrigerant gases, and mapping and repairing methane leaks from natural gas pipelines.
Researchers at the University of Maryland and the Rocky Mountain Institute, an independent thinktank, surveyed all 50 states, the largest 285 cities (100,000 plus population) and a cross section of businesses to map climate actions nationwide. Those committed to the Paris Agreement represent over half the US population (173 million people), over half the US economy ($11.4tn) and over 35% of nationwide greenhouse gas emissions.
Report co-author Paul Bodnar, managing director at the Rocky Mountain Institute, told The Guardian: “There have been growing coalitions in the US – cities working together, states working together, businesses working together. What’s changed in the last year and what’s new is this cross-cutting perspective. When states pass laws that help cities’ [emissions] strategies, or when states’ renewable portfolio standards are designed to help businesses – that’s really where we’re seeing really interesting, high impact results.”
The report, launched on the eve of Governor Brown’s Global Climate Action Summit in San Francisco this week, showcases examples of states, cities and businesses pioneering climate change initiatives.
Arkansas is the only state in the south-east with energy efficiency resource standards (EERS), which require electric and natural gas utilities to propose and administer energy efficiency programs. Since 2009, strategies ranging from customer outreach to new technology have supported these programs, resulting in megawatt-hour savings enough to power 28,000 homes for a year.
Los Angeles mayor Eric Garcetti was the driving force behind BlueLA, the city’s first all-electric car share program designed to sere low-income residents. Stations are located in LA’s most disadvantaged neighborhoods and is expected to take 1,000 vehicles off the road by 2020. BlueLA also employs community members to lead on education and outreach.
New Jersey’s largest utility, Public Service Electric & Gas used methane leak data collected by EDF and Google Street View vehicles equipped with leak detection sensors, leading to a 83% reduction in leakages.
Brown signed a bill this week pledging that the state will obtain 100% of its power from clean sources by 2045. California is the second US state to do so, following Hawaii’s pledge in 2015.
The report comes in the same week that the US Environmental Protection Agency (EPA) released proposals to ease monitoring of methane gas leaks. These would unpick the raft of rules introduced under the Obama administration in 2016 to monitor methane leaks because of their negative contribution to climate change.
Mary Nichols, chair of the California Air Resources Board and vice-chair of America’s Pledge, acknowledged that the bottom up approach “has no sanctions or penalties” but that it represented “a coalition of entities that have the capacity to make a difference”.
When she was diagnosed with breast cancer, Fauzia Aboud (middle) moved closer to home for the support of her family (Credit: David Macharia)
Cancer is the third highest cause of morbidity in Kenya.
Breast cancer is the second most common type of cancer in the country, with women under 50 accounting for 50% of those presenting.
Of the estimated 5,000 people diagnosed with breast cancer each year, around 2,000 will die from this disease.
Many of these women are mothers or carers, employees or small business owners so the impact is felt on their families, the wider community and on Kenya’s economy.
Navigating the cancer journey
Fauzia Aboud had recently given birth to her fourth child and was breastfeeding when she noticed that something wasn’t quite right. At first the 42-year-old, who was living in Tanzania at the time, dismissed what she’d found as a cracked nipple. Nothing to worry about, her sister reassured her. But when the discomfort persisted, Fauzia’s sister knew it was time to seek advice. One doctor’s appointment led to another and finally to a specialist who recommended a scan and biopsy tests that confirmed her breast cancer.
Living away from the support network of her family in Kenya, and with three children and a young baby to care for, Fauzia admits that the diagnosis in May 2016 and subsequent mastectomy surgery was “overwhelming.” So when her doctor in Dar es Salaam recommended returning to Kenya for follow-up treatment, Fauzia knew that she needed to move home and let her family help her navigate the next stages of this confusing and difficult journey.
How would she pay for the cycles of chemotherapy and radiotherapy that she needed? Who could she turn to for support on managing the side effects? And how would she be able to make the eight hour bus trip from Mombasa to Nairobi every few weeks to receive her treatment?
Listening to Fauzia and her sisters talk about these concerns brings into sharp focus the myriad challenges that people with cancer in Kenya face every day—from recognising symptoms and getting an early diagnosis, to accessing appropriate treatment.
David Makumi, chairman of the Kenyan Network of Cancer Organisations (KENCO). (Credit: David Macharia)
David Makumi is chairman of the Kenyan Network of Cancer Organisations (KENCO), the national umbrella body for cancer support groups and patient groups. He reels off some of the many complexities along the patient journey. For instance, a woman may discover a lump but lack awareness of cancer symptoms and not feel pain so will do nothing. If she does follow up, her doctor might not suspect cancer because of a gap in professional knowledge. If referred for a biopsy, she might not have the money to pay for it because her children’s school fees are due. And, when she eventually has the biopsy, the results may get lost so she has to start the process again.
“Then, if the patient finds out it’s cancer, the feeling is that cancer equals death because they don’t have enough information,” explains Makumi. “If there’s a district or county surgeon, they may do a mastectomy. The patient is booked to go in four weeks—she has to go back home, figure out costs, break the news to the family.”
After surgery, the patient may be referred for chemo and show up for two cycles then stop because she can’t afford to continue and doesn’t know how to access funding. Makumi explains: “These are primarily social issues, not medical issues; that’s where we come in. Information is an important piece that impacts on the way patients complete their treatment.”
The escalating burden of cancer
It’s 9am on Wednesday morning and the cancer centre at Kenyatta National Hospital (KNH) in Nairobi is already crowded. There are no empty spaces on the benches outside the chemo treatment room and its rows of hoods and chairs. Women and children stand where the seats don’t exist. Some people will have traveled hundreds of kilometers for treatment but may not even get seen today.
Upstairs in the cancer clinic, lines of men and women snake along the corridors, around corners and up the staircase as patients check in for open-door appointments at the public hospital, the largest referral facility in east and central Africa.
Non-communicable diseases (NCDs) such as cancer are a growing burden in Kenya, accounting for 31% of deaths in in 2015 and more than half of in-patient admissions.
The prevalence in Kenya of communicable diseases such as HIV, malaria and TB has led to the government channeling health spending towards these areas, with successful public health campaigns and outcomes. However NCDs have not been similarly prioritised until fairly recently, resulting in a cancer treatment and care infrastructure that struggles to meet the needs of Kenyans who develop cancer.
According to Robert Makori, assistant chief nurse at KNH’s cancer treatment center, the scenes at the hospital are the new normal. Makori sees 15 new patients a day so around 60 per week. An average 60-70 people are seen on the centre’s chemo days (Monday, Wednesday and Friday) between clinic hours of 8am to 4:30pm. From Monday to Friday, around 120-130 patients come in every day for radiotherapy.
Staff and clinic hours struggle to cope with patient volume, admits Makori: “KNH is the only public hospital with both radiotherapy and chemotherapy, and many of our patients have to travel a long way for treatment,” he explains. “A person could be given an appointment but if they’re not feeling well, they can’t have their treatment and may not get seen that day.”
Plotting the road map for cancer control
To address this escalating burden, the Kenyan government last year published the 2017-2022 National Cancer Control Strategy (NCCS) which builds on the work of the government’s first cancer strategy launched in 2011. It aligns with the Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases 2015-2020 and with the government’s Kenya Vision 2030 commitment to improve the quality of life of all Kenyans.
More broadly, the NCCS is a response to the Sustainable Development Goal (SDG) target for 2030 of reducing premature mortality from non-communicable diseases, such as cancer, by one third.
Designed as a road map to how Kenya addresses cancer control, the NCCS has five focus areas: prevention, early detection and screening; diagnosis, registration and surveillance; treatment, palliative care and survivorship; coordination, partnership and financing for cancer control; and monitoring, evaluation and research. The strategy recognises that public-private partnership and collaboration with the non-health sector is pivotal to this work.
Financial access to cancer treatment is one of the biggest barriers to successful outcomes. Kenya does not yet have universal health coverage (UHC) although affordable healthcare for all is one of the government’s ‘Big Four’ economic development priorities.
Most Kenyans live on just a few US dollars a day, based on figures from the government’s latest economic survey. With an estimated 75% of the population not covered by a public, private or community health insurance scheme, paying for basic healthcare is already a challenge and paying for treatment for a life-threatening disease is even more of a stretch. According to the World Bank, nearly one million Kenyans fall below the poverty line because of health care related expenditures.
The state-run National Hospital Insurance Fund (NHIF) offers insurance to anyone over 18, with monthly payments based on income and starting from 150 KS (USD 1.50). Coverage was recently extended to provide 25,000 KS (USD 250) per patient towards cancer care.
But with treatment more likely to run into millions of Kenyan shillings and private finance interest rates of 20%-30%, many people with cancer have to rely on the Kenyan concept of ‘harambee’–community-self-help—or crowd funding to cover their costs. Alternatively, they go without treatment.
Makori at KNH comments: “Most people we see don’t have coverage so they start treatment but then 40% don’t finish because of lack of finance. It’s a challenge for our patients.”
A partnership approach to improving access
Rose Wambui was just 32 years old when she was diagnosed with breast cancer. The mother of two underwent a full mastectomy followed by eight cycles of chemo then 25 of radiotherapy. “It was quite a shock to get cancer at my age,” explains Rose, who had two children aged under eight when she was receiving her treatment.
When Rose’s oncologist suggested she pursue hormone therapy for her HER2-positive cancer, there was more worry: “It was so expensive and I knew that I couldn’t afford it.” It was then that her oncologist referred her to a special programme that KNH had set up to offer women free HER2-positive treatment. “I was overjoyed. I had to wait just one week then I started the treatment,” says Rose. “To have access to that treatment for free means a lot to us cancer patients.”
In Mombasa, Fauzia had begun her HER2-positive treatment privately but had to stop when her NHIF funding ran out. Family and friends pitched in to help her continue treatment and she even had to take out loans, but all fell short of her treatment costs. Finally, Fauzia’s sister Warda heard about the KNH programme and encouraged Fauzia to participate.
“I had been doing research and I kept thinking, ‘How can I lose my sister because of the cost of a drug?’ We thought it was the end of the road but then we heard about the programme and our imaginations started running wild,” says Warda. Through the KNH programme, Fauzia was able to complete the remainder of her treatment.
Fauzia and Rose are among the 82 women to date who have been able to participate in this programme at KNH thanks to an innovative public-private partnership formed in 2016 between Kenya’s Ministry of Health and Roche Kenya. The partnership, launched by First Lady Margaret Kenyatta, is designed “to improve access to timely and precise diagnostic services and tailored cancer treatment to make cancer therapy much more effective”.
Most Kenyans live on just a few US dollars a day, and paying for treatment for a life-threatening disease is a huge stretch. Special programmes like the one from KNH offer a solution. (Credit: David Macharia)
As part of this partnership, Roche and the Kenyan government have a memorandum of understanding to jointly cover the costs of HER2-positive treatment at public institutions (designed to be a stop gap measure until further NHIF or other government funding is possible).
Andre Mendoza, country manager of Roche Kenya and East Africa says that the partners had to take a step back and develop a holistic approach to improving breast cancer treatment and care in Kenya. “Public-private partnership was part of the government of Kenya’s strategy but the infrastructure was not ready,” he says. “The puzzle in front of us was how can we solve affordability issues—and everything else—through partnership so in the end patients can have access.”
Improving treatment through early diagnosis
An estimated 80% of cancer cases in Kenya are diagnosed at late stages due to low awareness of symptoms, inadequate screening and poorly structured referral facilities.
Dr Andrew Gachii, head of laboratory medicine at KNH, says: “As institutions, we’ve been grappling with infectious diseases and now all of a sudden we have this huge cancer burden. The unfortunate thing is that many patients come in late—stage 3 or 4—so some are just coming in for palliative care.”
To help improve early diagnosis of cancer, and as part of the overall partnership programme, Roche funded the installation of an immunohistochemistry analyzer at KNH. The machine is capable of advanced testing for seven types of cancer. Roche is also funding reagents for breast cancer testing at the 2,200-person facility.
The diagnostic equipment enables KNH to test whether a patient’s tumour is hormone responsive or non hormone responsive, indicating suitability for standard of care treatment for HER2-positive breast cancer. This is standard of care testing, now available for the first time in a public facility in Kenya. It is enabling patients to have a faster and much more accurate diagnosis.
With national screening guidelines still some way off, Dr Gachii says the partnership is helping KNH to improve diagnostics by providing more precise results but without the 10,000 KS (USD 100) fee charged by private facilities offering screening. He adds the cost of testing has been reduced to around 6,000 KS (USD 60): “Before we had the machine, less than 20%—perhaps two or three out of 10 patients—could afford tests. So 80% couldn’t get proper diagnosis to continue treatment.” Building capacity for cancer treatment
The Beth Mugo Cancer Foundation (BMCF) was set up in 2016 to promote access to information, detection and treatment of breast, cervical and prostate cancer. The organisation was founded by politician Beth Mugo, who in 1997 became the first woman to be elected to the Kenyan Parliament. In 2011, Mugo was diagnosed with breast cancer. Her initial response was to keep her disease a secret because of the stigma associated with it; eventually she began to discuss her cancer openly, attracting media attention and encouraging women across Kenya to get check-ups.
As part of Roche’s commitment to improving access to healthcare in Kenya, the company signed a memorandum of understanding with the BMCF in October 2016. Aimed at supporting people with breast, cervical and prostate cancer in Kenya, the agreement involves Roche providing training for BMCF employees on the subject of cancer and helping the foundation establish international links with similar organisations.
Building healthcare professional (HCPs) capacity is another priority. Kenya has a population of 45 million people, yet it only has nine medical oncologists across its four cancer treatment facilities. Makori at KNH comments: “We still have inadequate personnel… it’s not enough to manage the entire population.”
If the right structures, equipment and doctors could be deployed to every county, we could address the [cancer care] problems squarely.
Under the partnership with the Kenyan government, Roche is funding training scholarships for five medical oncologists and six oncology nurses, almost doubling the capacity of HCPs for cancer in the country. The training also includes support for two two-week surgical preceptorship programmes in biopsy techniques. The Ministry of Health has agreed to support and retain HCPs from scholarships and expand oncology treatment by increasing number of treatment centers and units.
Dr Angela Waweru, clinical oncologist at The Nairobi Hospital. (Credit: David Macharia)
Dr Angela Waweru is a clinical oncologist at The Nairobi Hospital (TNH), a private hospital, but is also on a six-month specialist attachment at KNH’s cancer clinic. Before joining TNH, Dr Waweru was employed by the United Kingdom’s publicly-funded National Health Service. She believes there is scope for further partnership between public and private cancer care facilities in Kenya to strengthen capacity. “I think that there’s opportunity for more. We do NHIF applications for patients at KNH and we’ve been treating the brachytherapy patients because the machine at KNH is out of action. Patients are waiting months for what we could do tomorrow.
TNH houses the Cancer Treatment Center, which offers a comprehensive service from diagnosis and surgery to treatment and rehabilitation. The center’s radiation treatment unit opened in 2012 and includes radiation therapy machines and a high dose brachytherapy unit. In addition to offering pro bono support to KNH with radiation treatments, lead radiotherapist Fredrick Asige says the center also offers free chemotherapy treatment to KNH patients with leukemia on alternate Saturdays as part of the hospital’s CSR programme.
TNH has also partnered with the NGO, Partners in Health (PIH) to offer free treatment to cancer patients in Rwanda. Under the agreement made in 2016 and supported by the Rwanda High Commission in Nairobi, PIH is funding the discounted TNH treatment over two years. Around 100-150 people are expected to be received radiotherapy treatments at TNH.
According to Mendoza at Roche, this approach to strengthening infrastructure began by listening to stakeholders to identify and fully understand the access hurdles to cancer treatment. “When we first started, the patient journey to get any sort of treatment was around nine months. The patient might get to another stage of cancer over this time and it might be too late. But with all these interventions, it’s now four months and going down. It is an ecosystem approach; you have to address all of the elements, or the patient will never get to the point of treatment.”
Jackie Wambua, stakeholder relations and health policy manager, Roche Kenya. (Credit: David Macharia)
Having champions like the First Lady and Senator Beth Mugo were key to opening doors and keeping momentum going, says Jackie Wambua, stakeholder relations and health policy manager, Roche Kenya. Wambua reached out to a range of stakeholders over two and a half years from 2015 before the government agreed to partner with Roche on breast cancer treatment. From early morning meetings at the Ministry of Health to listening to patient group concerns via KENCO, she joined the dots to help make the programme a reality.
“We had committees with government, Roche and KNH on what protocols do we need, what guidelines do we follow,” she explains. “We had to look at processes that weren’t there and set up ways for the patient to navigate from casualty or from referrals outside city.”
Against a background of devolution of health services in Kenya, with counties being given a bigger responsibility in prioritising and allocating resources, Kenya’s cancer strategy provides a framework for planning and implementing cancer prevention and control interventions.
Makumi at KENCO advocates for screening to be done at county level via outreach clinics once or twice a month. Makori at KNH would like to see the government offer the private sector incentives to invest in healthcare and provide equipment so that people with cancer can have the same treatment without having to travel across the country.
Removing the stigma of cancer
Although breast cancer occurs in both men and women, more than 90% of cases present in women. Risk factors include gender (being female), family history, alcohol and tobacco use, being obese or overweight and exposure to estrogen hormones through contraceptives.
Makumi at KENCO also believes faith-based groups have a role to play as partners in spreading this message. “We looked at what worked with HIV and what changed the tide is when religious leaders got involved in talking about HIV in temples, in mosques, in churches, in the shrines, in the places of worship. When they started doing that then folks listened. So we want to craft specific cancer messages especially around prevention.”
Dr Tom Menge, chief pharmacist and deputy director, pharmaceutical services at KNH, agrees that cancer needs to be a public health priority. “Look at how the country dealt with HIV/AIDS—it was a concerted effort, declared a disaster and addressed issues of access,” he explains. “I believe that’s the direction that cancer is going.” He adds that the National Cancer Institute, currently in a formative stage, will contribute to this vision. “We worked on an amazing model for HIV; I keep wondering whether we can do same for cancer.”
Diya Melanoi Mohamed, another patient on the Roche/KNH treatment programme, wants to see more information about cancer treatment options. The 58-year-old and her husband, Farooq, had the support of their grown-up children to navigate her treatment. Farooq, who had recently retired when Diya was diagnosed with breast cancer, researched options and kept careful notes about his wife’s surgery, chemo and radiotherapy appointments.
But Diya knows not every patient will be as fortunate: “A lot needs to be done around education. Whether rural or in town, when you hear cancer, you think it’s a death sentence, it’s scary. But when you meet friends and talk freely about cancer, they’re surprised and realize you don’t have to be scared of it.”
The Kenya agreement is part of Roche’s Africa Strategy which began in 2015 and is working with local partners on a range of initiatives including strengthening healthcare systems, professional training and private health insurance with local companies. Markus Gemeund, head of Roche in sub-Saharan Africa, says the next step in Kenya is to find creative funding solutions. “The biggest challenge is funding and reimbursement. Cancer is cancer—it doesn’t wait for the economy to do well.” To this end, Roche is looking at what other creative funding mechanisms can be put in place until countries like Kenya have universal health care.
Back in Mombasa, Fauzia talks about reopening a hairdressing and beauty salon like the one she worked at before her cancer treatment. What would she wish for others who are newly diagnosed with cancer? “No-one should be afraid to reach out,” she says. “You will get help if you’re willing to look for help.”
As a schoolgirl in rural Tanzania, Memusi Saibulu was determined that becoming someone’s wife at the age of 14 would not be part of her life plan.
Growing up in the predominantly Maasai region of northern Tanzania, Memusi knew that her family would expect their daughter to follow tradition and give up her education in her early teens for married life. But the stellar student had other dreams: to continue with her schooling and eventually train to become a doctor.
Memusi, a quietly spoken teenager dressed in her school uniform of red sweater, red tie and black over-the-knee pleated skirt, says her mother had always encouraged her to study hard and do well at school. But her father, driven by cultural convention, had other plans — arranging a marriage and dowry for his daughter while she was still in primary school.
When Memusi told her favorite teacher that family expectations and prohibitive school fees meant she probably wouldn’t be continuing her education to secondary school, the instructor was concerned that such a bright student wouldn’t be given the opportunity to pursue her studies. Perhaps she could apply for a scholarship?
Then, just two days later, the man who was to be Memusi’s husband visited her family home. “The drunk son of my father’s friend,” is how she contemptuously describes the man who forced himself upon her that evening then urged her to leave her parents’ home for a life with him.
On her suitor’s next visit, Memusi felt angry and more confrontational. “You’re not going to get your crooked little legs in my bed,” she told her unwanted intended.
Memusi admits to feeling proud of herself about her defiance but also very scared: “What if he tells my father? What if he tells others in my community?” she thought to herself.
Meanwhile, thanks to the encouragement of her primary teacher, Memusi had secured a place at Orkeeswa School, a community-based secondary school in northern Tanzania that provides holistic education to high performing students whose families don’t have the financial means to pay school fees.
When Memusi received the acceptance letter for secondary school, her mother “jumped up and down” with excitement. Then Memusi took the letter to her father, which forced him to set aside the traditional path he’d envisaged for his daughter in favor of a different journey.
Memusi explained to him that marriage would be the death of her dreams. Secondary school would unlock myriad opportunities, she argued. She won her battle. Because of these strong opinions, says Memusi, she gained herself a bit of a reputation: “I am considered to be a role model for my community.”
Fewer than one per cent of girls in rural Tanzania continue their education to form five and A-levels. Memusi is currently studying physics, chemistry and biology as a form six student. She’s also served as student body vice president, a peer counselor and a leader in community service projects and extra-curriculum activities. Her dream, she says, is to become a general practice doctor who can treat people — particularly women and girls — in her community.
As Memusi shared her experience with others via The Moth storytelling project in Nairobi, Kenya, she was acutely aware of her choice to reject the role of child bride and rail against tradition. She concludes: “I don’t want to destroy culture but I want to change girls being married at a young age.”
Memusi Saibulu participated in ‘Stories of Women & Girls: The Moth in Nairobi’ in January 2018. https://www.themoth.org/
Sisters Selam (left) and Simret play cards to help pass the time while their family seeks refuge from the wildfires at a Red Cross shelter in Santa Rosa, California. Photo by Marko Kokic for The American Red Cross
Northern California’s wildfires have sparked headlines around the world for their devastating impact on popular Wine Country destinations like Napa and Sonoma. But as firefighters gradually contain the flames and evacuated residents return to their homes, the story emerging is one not just of lost lives and jobs but also of the ‘hidden’ victims: the undocumented and low-income workers so crucial to the local economy.
“One of the deadliest and costliest wildfire catastrophes in California’s history” is how the state’s insurance commissioner Dave Jones describes recent events. According to CalFire, at least 42 people have died and over 8,400 structures (homes, outbuildings and commercial properties) have been destroyed in the wildfires which began on October 8. Thousands have been displaced from homes that range from wineries and town houses to trailer parks.
CalFire has declared the Tubbs wildfire the state’s worst ever, claiming 22 lives and 5,300 structures. Four of the fires —Tubbs and Nuns in Sonoma, Atlas in Napa and Solano, and Mendocino’s Redwood Valley — now rate among the top 20 most destructive wildfires in California’s history.
The fires have dealt yet another harsh blow to Napa, which is still recovering from the magnitude 6 earthquake that hit the south of the county in 2014. The quake caused an estimated $400 million in public and private sector damages and at least $80 million in losses to the wine sector. Preliminary estimates of losses from the current wildfires exceed $1 billion, according to Jones.
What next for undocumented workers?
California’s wildfires are the latest disaster that the Federal Emergency Management Agency(FEMA) has had to deal with this year, quickly following major hurricanes that affected eight states and two U.S. territories. Applications are now open for FEMA disaster assistance grantsto help homeowners and renters pay for temporary housing, essential home repairs and uninsured/underinsured personal property losses.
Recovering from the wildfires will be particularly hard for undocumented workers employed by the region’s vineyards, hotels, and restaurants as they are not eligible for FEMA assistance unless they have a U.S. citizen in their household (e.g. a child with a Social Security number).
Napa County is home to between 11,000 and 15,000 undocumented immigrants and an estimated 28,000 live and work in Sonoma County. Many juggle two or more jobs to make ends meet. Unlike foreign national workers on the H-2A visa program that requires employers to provide free housing and transportation for seasonal agricultural employees, these workers have no safety net.
Ana Lugo, president of Sonoma-based campaign group North Bay Organizing Project (NBOP), says undocumented fire victims are dealing with losses of property and income but fear that seeking help, for instance via the local assistance centers which act as one-stop shops for disaster support, will lead to deportation.
“It’s overwhelming: they can’t pay their rent or buy food because they haven’t worked for two weeks,” says Lugo. “They were already so vulnerable before the fires; now they don’t know where to go for help.”
UndocuFund will help with costs such as temporary housing, home repairs, and medical care. “We’re in desperate need of more funds,” Lugo said. “People are going to need much more to get back on their feet.”
Supporting low-income families
California has the nation’s highest poverty rate — around 20 percent — if factors such as cost of living are factored in. The average vineyard worker salary is $30,528 or $15 an hour. But a 2013 study by the California Budget Project suggests a two-parent family with one employed parent needs an annual income of $50,383 (equivalent to an hourly wage of $24.22) while a family with two working parents needs to earn $72,343 a year (equivalent to each parent earning an hourly wage of $17.39).
The Redwood Empire Food Bank (REFB) in Santa Rosa has been distributing food to fire victims via its own drive-through facility and across 70 percent of its regular distribution sites in Sonoma County. REFB says most of those using the food bank have lost their jobs either temporarily or permanently due to the fires. Some have several evacuated families staying with them in their home. And many are low-income families who were already receiving food before the fires.
“Many people working in the service industry could have already been on the edge, receiving food at work, and now they are without jobs,” explains David Goodman, CEO at REFB.
The North Bay Fire Relief Fund, run by Redwood Credit Union, state Sen. Mike McGuire (D-Healdsburg), and the local newspaper The Press Democrat, has raised $11.3 million from more than 17,000 donors. The fund has allocated $6 million to support families who lost their homes in Sonoma, Napa, Lake, and Mendocino counties
Tipping Point Community, a San Francisco based anti-poverty group, has also set up a relief fund for “low income, vulnerable communities” impacted by the crisis, including vineyard workers, immigrants, displaced young people, and students. Phase one of funding will address urgent needs; phase two will support mid- and long-term rebuilding efforts.
In California, Latinos make up 71 percent of the workforce at vineyards and more than 40 percent of the tourism and hospitality workforce. In Sonoma’s Santa Rosa, a community decimated by the fires, Latinos account for a third of the population.
Sara Velten, vice president – philanthropy at LCF, says the fund — which hopes to start distributing funds this week — will be a lifeline for low income families: “In a regular year, the winter months are hard. With the harvest season cut short, people will need help to survive,” she says.
Even before the wildfires, housing in this region was scarce and costly due to limited stock and proximity to San Francisco and Silicon Valley. Santa Rosa lost over 2,900 homes, or 5 percent of its housing stock, with middle-class neighborhoods such as Coffey Park and two mobile home parks for seniors among the worst casualties. On Craigslist, the cheapest one-bedroom apartment rents for about $1,200 per month.
Joye Storey, an emergency disaster services director with the Salvation Army, says the housing prognosis is not good for low-income families. “People who already had a small window of choices and living paycheck to paycheck will have to be relocated out of town. If they have a job in town, that means a higher price for gasoline and another layer of stress.”
NVCF president Terence Mulligan says: “More and more families are living in overcrowded housing or commuting from other counties. The worry is that housing costs are so astronomical that soon we won’t have a workforce.”