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Kenya Culture, Health, and Demographics
- 1. Katherine Brooke Longo, MSN, RN Church at Rock Creek Fall 2011
Editor's Notes
- Generalizations are only beginnings…….they are to help us not be the typical “Ugly Americans”
- Slightly smaller than Texas. Located on the equator on the East Coast of Africa. Bordered by part of Somalia & the Indian Ocean to the east, Uganda and Lake Victoria to the west, Ethiopia to the north, and Tanzania to the south. Cities: Capital --Nairobi (pop. 2.9 million; 2007 est.). Other cities --Mombasa (828,500; 2006 est.), Kisumu (650,846; 2005-6), Nakuru (1.3 million; 2005-6), Eldoret (193,830; 1999). Kenya rises from a low coastal plain on the Indian Ocean in a series of mountain ridges and plateaus which stand above 3,000 meters (9,000 ft.) in the center of the country. The Rift Valley bisects the country above Nairobi, opening up to a broad arid plain in the north. Highlands cover the south before descending to the shores of Lake Victoria in the west. Great Rift Valley & eastern Highlands are farming regions. Climate: Tropical in south, west, and central regions; arid and semi-arid in the north and the northeast. Kenya has no single culture that identifies it. With such diverse regional peoples such as the Swahili along the coast, several pastoralist communities mainly in the North and the different communities in Central and Western regions, having a mutually acceptable cultural identification is difficult. Kenyans tend to identify primarily with their tribe or ethnic group, and only secondarily with the nation as a whole. The Kikuyu, who were better represented in the independence movement than other groups, and who continue to dominate the government, are more likely to identify themselves as Kenyans (everyculture, 2011). There are about 37 different ethnic groupings in Kenya - each of these with its own unique culture, but majority of them with intertwining cultural practices brought about by the close resemblance in the languages, the similar environment and physical proximity of the ethnic groups. Population distribution of all Kenyans (CIA, 2011), as recently as this year, were: Kikuyu 22%, Luhya 14%, Luo 13%, Kalenjin 12%, Kamba 11%, Kisii 6%, Meru 6%, other African 15%, non-African (Asian, European, and Arab) 1% The ethnic groups are grouped into larger sub-groups - based on their cultural and linguistic similarities. The national motto of Kenya is Harambee , meaning "pull together." In that spirit, volunteers in hundreds of communities build schools, clinics, and other facilities each year and collect funds to send students abroad. Historically, Kenyan people have been in this region for a very long time. Fossils found in East Africa suggest that early humans roamed the area more than 20 million years ago. Recent finds near Kenya's Lake Turkana indicate that hominids lived in the area 2.6 million years ago. Cushitic-speaking people from what became Sudan, South Sudan, and Ethiopia moved into the area that is now Kenya beginning around 2000 BC. Arab traders began frequenting the Kenya coast around the first century AD. Kenya's proximity to the Arabian Peninsula invited colonization, and Arab and Persian settlements sprouted along the coast by the eighth century. During the first millennium AD, Nilotic and Bantu peoples moved into the region, and the latter now comprise two thirds of Kenya's population. Swahili, a Bantu language with significant Arabic vocabulary, developed as a trade language for the region. Arab dominance on the coast was interrupted for about 150 years following the arrival of the Portuguese in 1498. British exploration of East Africa in the mid-1800s eventually led to the establishment of Britain's East African Protectorate in 1895. The Protectorate promoted settlement of the fertile central highlands by Europeans, dispossessing the Kikuyu and others of their land. Some fertile and well watered parts of the Rift Valley inhabited by the Maasai and the western highlands inhabited by the Kalenjin were also handed over to European settlers. For other Kenyan communities, the British presence was slight, especially in the arid northern half of the country. The settlers were allowed a voice in government even before Kenya was officially made a British colony in 1920, but Africans were prohibited from direct political participation until 1944 when a few appointed (but not elected) African representatives were permitted to sit in the legislature. From 1952 to 1959, Kenya was under a state of emergency arising from the "Mau Mau" insurgency against British colonial rule in general and its land policies in particular. This rebellion took place almost exclusively in the highlands of central Kenya among the Kikuyu people. Tens of thousands of Kikuyu died in the fighting or in the detention camps and restricted villages. British losses were about 650. During this period, African participation in the political process increased rapidly. The first direct elections for Africans to the Legislative Council took place in 1957. Kenya became independent on December 12, 1963, and the next year joined the Commonwealth. Jomo Kenyatta, an ethnic Kikuyu and head of the Kenya African National Union (KANU), became Kenya's first President. The minority party, Kenya African Democratic Union (KADU), representing a coalition of small ethnic groups that had feared dominance by larger ones, dissolved itself in 1964 and joined KANU. A small but significant leftist opposition party, the Kenya People's Union (KPU), was formed in 1966, led by Jaramogi Oginga Odinga, a former Vice President and Luo elder. The KPU was banned shortly thereafter, however, and its leader detained. KANU became Kenya's sole political party. At Kenyatta's death in August 1978, Vice President Daniel arap Moi, a Kalenjin from Rift Valley province, became interim President. By October of that year, Moi became President formally after he was elected head of KANU and designated its sole nominee for the presidential election.
- Swahili and English are official languages. Swahili is compulsory in primary education, and, along with English, serves as the main lingua franca between the various ethnic groups. SIL Ethnologue lists a total of 69 individual languages spoken in Kenya. There are three major unifying categories of languages: the Bantu speaking people of the Coastal region, the Central Highlands and the Western Kenya Region, The Nilotes who are mainly found in the Great Rift Valley and the Lake Victoria Region and the Cushites who are mainly composed of pastoralists and nomads in the drier North Eastern part of the country. Of note is that these sub-groups span a vast area of not just Kenya, but the East, Central and Southern African Region as a whole. Avoiding eye contact is considered a sign of respect among people of different ages & sexes. Touch is acceptable in certain instances. Males hold hands as a sign of friendship. Adults may touch children on the forehead as a greeting and to show respect to the child’s parents.
- Male dominance is displayed in all tribes. “Caning” one’s wife is not uncommon. Polygamy is traditional, and in the past it was not uncommon for men to have five or six wives. The practice is becoming less typical today as it has been opposed by Christian missionaries, and is increasingly impractical as few men can afford to support multiple partners. When a man chooses a potential wife, he negotiates a bride price of money or cattle with the woman's father. The price is generally higher for a first wife than for subsequent ones. The wedding ceremony and feast are celebrated in the husband's home. Women are generally taught to be submissive to their husbands and agreeable with his other wives. The influences of Christian doctrine has begun slowly changing these practices. During times of illness the mother takes on the major role as caregiver to the children. Mothers are responsible for keeping the home clean, obtaining water & wood for fuel, preparing food & feeding & caring for the children. Mothers are required to keep children quiet & obedient. Mothers usually tie their babies to their backs with a cloth sling. Girls begin caring for younger siblings at a very early age, and it is not uncommon to see a five- or six-year-old girl caring for a baby. Child rearing is generally strict, with instant spanking being the most common form of discipline. Young children generally sleep with parents until age 4. Child rearing is communal and responsibility for the children is shared among aunts, uncles, grandparents, and other members of the community. Boys and girls have fairly separate upbringings. Each is taught the duties and obligations specific to their sex: girls learn early how to carry water, cook, and care for children, while boys are schooled in the ways of herding or working in the fields. Children are also grouped into "age sets" with peers born in the same year. Members of a given age set form a special bond, and undergo initiation rituals as a group. Primary school, which children attend from the age of seven to the age of fourteen, is free. Secondary school for students ages fourteen to eighteen is prohibitively expensive for most of the population. Only half of all children complete the first seven years of schooling, and only one-seventh of these Aged are generally well respected in Kenya. The equivalent of nursing homes are a new phenomenon in Kenya. Traditionally aging people lived with their adult children, however, because of the high incidence of AIDS many men and women from this generation have died leaving no one to care for their aging parents. In the traditional living arrangement, a man builds a separate hut for each of his wives, where she will live with her children, and a hut for himself. In a amily with one wife, the parents often live together with girls and younger boys, while the older boys have smaller houses close by. It is common for several generations to live together under the same roof. According to tradition, it is the responsibility of the youngest son to care for his aging parents. Among the Maasai, houses are divided into four sections: one section for the women, one section for the children, one section for the husband, and one section for cooking and eating. According to the tradition, inheritance passes from father to son. This is still the case today, and there are legal as well as cultural obstacles to women inheriting property. Extended families are considered a single unit; children are often equally close to cousins and siblings, and aunts and uncles are thought of as fathers and mothers. These large family groups often live together in small settlements. Among the Maasai, for example, ten or twelve huts are built in a circle surrounded by a thornbush fence. This is known as a kraal.
- Although the regional hub for trade and finance in East Africa, Kenya has been hampered by corruption and by reliance upon several primary goods whose prices have remained low. In 1997, the IMF suspended Kenya's Enhanced Structural Adjustment Program due to the government's failure to maintain reforms and curb corruption. The IMF, which had resumed loans in 2000 to help Kenya through a drought, again halted lending in 2001 when the government failed to institute several anticorruption measures. In the key December 2002 elections, Daniel Arap MOI's 24-year-old reign ended, and a new opposition government took on the formidable economic problems facing the nation. After some early progress in rooting out corruption and encouraging donor support, the KIBAKI government was rocked by high-level graft scandals in 2005 and 2006. In 2006, the World Bank and IMF delayed loans pending action by the government on corruption. The international financial institutions and donors have since resumed lending, despite little action on the government's part to deal with corruption. Post-election violence in early 2008, coupled with the effects of the global financial crisis on remittance and exports, reduced GDP growth to 1.7 in 2008, but the economy rebounded in 2009-10.
- Cholera is endemic around Lake Victoria region, which has perennial floods. Typhoid fever and tuberculosis have resurged in urban areas, as a result of poor & inadequate health infrastructure, resulting from a rapid increase in urban population & overcrowding, as Kenyans flock to the cities to seek work in the service industries. Malaria is the most predominant disease in Kenya and is common along the coasts or lake regions. Vector-borne (mosquito) and thrives in hot & humid climates. Acute respiratory diseases, Parasitic GI infections & diarrheal diseases are next most common and are nearly all related to areas of crowded populations, indoor cooking on charcoal fires & untreated drinking water supply. Drinking water sources throughout Kenya: improved: urban: 83% of population rural: 52% of population total: 59% of population unimproved: urban: 17% of population rural: 48% of population total: 41% of population (CIA, 2008). HIV/AIDS and their associated opportunistic infections currently account for nearly half of the occupied hospital beds in Kenya. Prevalence varies from one region of the country to another, but it is estimated that 19% of adults in urban areas are infected with the disease, with a country-wide prevalance rate of ~6.3%...the 14 th highest worldwide (CIA, 2009).
- http://www.who.int/mental_health/evidence/alcohol_final.pdf http://pdf.usaid.gov/pdf_docs/Pnada308.pdf https://www.cpc.unc.edu/measure/publications/ja-11-132
- Kenyans who live in agricultural areas rely heavily on plant proteins supplemented by meat proteins. Those who live around the lake region survive on fish and starches, especially cornmeal, or ugali. Kenyans who live in the highlands depend mostly on beans & corn as staple foods. Milk is consumed either fresh, fermented, or mixed with blood (Masia). Food in Daily Life. Corn (or maize) is the staple food of Kenyans. It is ground into flour and prepared as a porridge called posho, which is sometimes mixed with mashed beans, potatoes, and vegetables, to make a dish called irio. Another popular meal is a beef stew called ugali. This is eaten from a big pot, and each diner takes a piece of ugali, which he or she uses as a spoon to pick up beans and other vegetables. Boiled greens, called mboga, are a common side dish. Banana porridge, called matoke, is another common dish. Meat is expensive, and is rarely eaten. Herders depend on milk as their primary food, and fish is popular on the coast and around Lake Victoria. Mombasa is known for its Indian foods brought by the numerous immigrants from the subcontinent, including curries, samosas, and chapatti, a fried bread. Snacks include corn on the cob, mandazi (fried dough), potato chips, and peanuts. Tea mixed with milk and sugar is a common drink. Palm wine is another popular libation, especially in Mombasa. Beer is ubiquitous, most of it produced locally by the Kenyan Breweries. One special type of brew, made with honey, is called uki. Food Customs at Ceremonial Occasions. For special occasions, it is customary to kill and roast a goat. Other meats, including sheep and cow, are also served at celebrations. The special dish is called nyama choma, which translates as "burnt meat."
- 34 th largest birth rate world wide (CIA, 2011) 44 th largest infant mortality rate world wide : 55.03 male infant deaths/1,000 live births; 49.49 female infant deaths/1,000 live births (CIA, A survey of Kenyan women who had given birth in the 12 months prior to the survey (ORC, 2004) showed that approximately 88% of women who gave at least a live birth received prenatal care at least once from a skilled health care provider. C-section is one of the most frequently performed emergency obstetric procedures during childbirth in the U.S.. The latest data in 2003 indicated that 4% of births were delivered by C-section in Kenya. Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. One of the most critical interventions for safe motherhood is to ensure skilled care provided by skilled professionals during pregnancy and childbirth. In Kenya, the latest survey in 2003 showed that approximately 42% of births were assisted by trained healthcare providers. A large disparity in accessing to skilled care was reported between urban and rural areas (38%). In Kenya, 81% of the 59% of women who deliver outside the health facility do not receive postnatal care.
- At death, Kenyans believe that one enters the spirit world, which has great influence in the world of the living. Many Kenyans believe in reincarnation, and children are thought to be the embodiment of the souls of a family's ancestors.
- Protestant 45%, Roman Catholic 33%, Muslim 10%, indigenous beliefs 10%, other 2% note: a large majority of Kenyans are Christian, but estimates for the percentage of the population that adheres to Islam or indigenous beliefs vary widely African religions are typically based on natural phenomena and reverence to ancestors. The dead are presumed to merely transform into another state of being and capable of bringing good fortune or calamity to the living. Most religious rites are therefore centered on appeasing the dead through sacrifices and proper burial rites. The dead's wishes must also be followed to the letter. Followers of traditional Kikuyu religion believe Ngai resides on Mt. Kenya and say their prayers facing the mountain. Followers of traditional Mijikenda religion have their holy shrines in the forests where they offer sacrifices and pray. The spread of Christianity has largely eliminated many of the traditional and tribal beliefs held by the people of Kenya, prior to contact with Europeans. Tribes who most closely continue to live in their traditional ways, are the ones who also still hold their old beliefs. Christianity has not made much headway among the Samburu, Turkana or the Masai tribes, particularly. Overall, about 10% of the population still follow their African religion in Kenya. For the most part, each tribe has its own set of beliefs, usually tied somewhat to their territory. Tribes that lived near Mount Kenya, for example, often believed that God lived at its peak. Like Christians, Kenyans originally believed in a single creator God. "Ngai" or "Were" are common names for God, though not the only ones. Each tribe had its own creation story, which usually attributes their tribe as being directly created by God. Even Kenyans who identify themselves as Christian may continue to hold beliefs based on their traditional spirituality. Various superstitions, particularly about ancestral spirits or even witchcraft still exist. Even mainstream churches sometimes follow a blended form of religion in Kenya, in order to bring in more converts.
- The health care system in Kenya is understaffed and poorly supplied. The government runs clinics throughout the country that focus primarily on preventive medicine. These clinics have had some success in reducing the rate of sleeping sickness and malaria through the use of vaccines, but the country is still plagued with high rates of gastroenteritis, dysentery, diarrhea, sexually transmitted diseases, and trachoma. Access to modern health care is rare, particularly in rural areas, and many people still depend on traditional cures including herbal medicines and healing rituals. Kenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units. The structure thus consists of the following hierarchy: Dispensaries and private clinics Health centers Sub-district hospitals and nursing homes District hospital and private hospitals (each to serve a minimum of 80,000 Kenyans) Provincial hospital (8 in Kenya at this level, intensive care & life saving efforts are provided) National hospital (2 in Kenya) Kenya has one of the world's highest birth rates, and birth control programs have been largely ineffective. The life expectancy, while higher than in some other African nations, is still only fifty-four years. AIDS has been devastating to the country, and at least five hundred Kenyans die of the disease each day. President Moi has declared the AIDS epidemic a national disaster, but has nonetheless refused to encourage condom use. According to the CIA worldbook (2011), the infectious disease degree of risk is high for travelers as well as native Kenyans. Those include food or waterborne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever vectorborne disease: malaria and Rift Valley fever water contact disease: schistosomiasis animal contact disease: rabies (2009) The importance of traditional medicines for humans as well as animals in Africa both now and in the past is enormous. Traditional medicine takes on a diverse and complex definition and though it involves some aspects of mind-body interventions and use of animal-based products, it is largely plant-based. Conventional medicine focuses on experiment and disease causing pathogens. Traditional medicine however postulates that the human being is both a somatic and spiritual entity, and that disease can be due to supernatural causes arising from the anger of ancestral or evil spirits, the result of witchcraft or the entry of an object into the body. It is therefore not only the symptoms of the disease that are taken into account, but also psychological and sociological factors. Thus the holistic nature and culture-based approach to traditional healthcare is an important aspect of the practice, and sets it apart from conventional western approaches. For most communities studied in Kenya, as is the case with most of Africa, traditional medicine is the only affordable and accessible health care. African traditional medicine thus plays an almost inestimable role in the health care delivery, and the pharmacopoeia of indigenous prescriptions traditionally used in Africa including the communities studied is colossal. African traditional medicine practice includes diverse health practices, remedies, approaches, knowledge and beliefs incorporating plant, animal and mineral products, spiritual therapies and charms. Traditional healers utilize a variety of approaches to diagnose, treat or prevent illness. Physicians density: 0.14 physicians/1,000 population (2002) country comparison to the world: 159 Hospital bed density : 1.4 beds/1,000 population (2006) country comparison to the world: 125
- Access to health and medical care is unequally distributed across the country, as is the fertility rate and the level of education. Generally speaking, the Central Province and Nairobi are deemed to have the best facilities, whereas the North-Eastern Province is found to be the most underdeveloped. Poor people in rural areas who are ill and choose to seek care, usually only have the option of treatment at primary care facilities. These facilities are often under-staffed, under-equipped and have limited medicines. Among those Kenyans who are ill and do not choose to seek care, 44% were hindered by cost. Another 18% were hindered by the long distance to the nearest health facility.