Relief that isn't

The already dramatic reduction in Kenya's fertility rate has not eased the daily tragedies in Nairobi's many slums. More than 100,000 people are concentrated into an area less than a mile square called Mukuru, a slum of nearly seamless metal roofs south of the city's industrial area.

In Mukuru, the problem with generalizations about population control and sweeping global programs is evident. Families here live without a safety net, but they are not without resources. Employment is high and a work ethic is strong. Many adults have jobs in nearby factories. Many families stress education, and Mukuru Primary School students consistently score among the top 10 of Nairobi schools on standardized tests.

Nevertheless, families here live in houses the size of a walk-in closet in America's suburbs. Women cook by small charcoal stoves and do without electricity. The local video joint, with juice from a car battery, shows Chuck Norris movies. "Roads" through the village are barely two shoulders wide. Families pay rent for their corrugated iron dwellings; they also pay for drums of water, and even pay to use latrines by the river bank. Privacy? Bathe outdoors at night. Tight quarters, together with poor sanitation and hygiene, swirl infectious diseases-and AIDS creeps in also.

International relief efforts, however, haven't given much relief. Jacinta Nyokabi has been a community-based health worker in Mukuru for almost 10 years. She has a clean-swept, two-room home with her husband and four children; their fifth is on the way. Mrs. Nyokabi has trained many women in taking care of their babies and preventing the spread of common diseases like diarrhea. "Now we know how to prevent many diseases that used to mean trips to the hospital," she said.

But it has been four years since she has received a refresher course from any of the NGOs that advertise health work among these poor. The Africa Medical and Research Foundation, which once organized care in Mukuru, prepared an extensive report on medical care and family planning in Mukuru, but did not release the report to community workers. It also promised to build a kerosene tank and a few other community projects, but they have not yet materialized.