As soon as she opens the door to her collapsing mud-house, the visitor immediately realizes Mrs. Dusila Okoko has been crying silently during her late afternoon nap from which she has been awoken.
And even before all the visitors can troop into her small two-room house in Kochia Village of Rangwe Sub-County, the 82-year old widow has already broken into a long prayer which betrays her pain that God may have forgotten her in her unforgiving world.
But when she starts narrating her pain, you realize that the bowels of several graves the old widow talks about as you entered her compound hide another sad story- her three children and their wives all died before their time.
When the second wife to Mrs. Okoko’s last son died in 2004, she left the elderly widow with three orphans to take care of.
Among the three orphans is 19-year old Linda Achieng who is currently completing her KSCE examinations after well wishers gave her a second chance to return to school after giving birth while still in form one three years ago.
She fell into the sexual trap of a local boda boda rider who cheated her with sweets, sanitary pads and a bottle of cheap lotion.
The boda boda rider abandoned her to take care of the pregnancy and eventually her baby girl, Sheryl, 3, who is now an additional burden to the widowed Mrs. Akoko.
Linda, who dreams to become a nurse, has been allowed to sit for her examinations despite huge fees arrears she owes her school.
There are now genuine fears that Cynthia Akoth, who has just completed her Standard Eight and sat her KCPE examinations, may not join Form one next year unless well-wishers come to her aid.
The sad circumstances facing the destitute family forced the last born son, Erick Ochieng out of school prematurely to become the caretaker of the family at a very young age.
About a kilometre away in the same village, 82-year-old Rusalina Okelo, who is partially blind, is also taking care of another two orphans, Quinter Achieng in Class 7 and Maureen Atieno in Class 6 whose parents also succumbed to the Aids scourge.
In Rangwe and Homabay town sub-counties, grandmothers and elderly widows aged over 60 years are the heads of over 50 homesteads where they take care of 170 orphaned children under very difficult circumstances.
Over in Suba Sub-County, which is one of the hardest hit regions by the HIV/Aids scourge, Jane Anyango Kisego is lost for words when she remembers losing 10 of her 12 children prematurely to what is feared to be HIV-related complications.
Their graves at her Kitheraka village are a sad reminder that she was once a proud mother of enough children from whom she expected support in her old age.
Now she is being forced to take care of four grandchildren and their mentally challenged mother. Two of these children are being sponsored by the World Vision to complete school.
In total, Suba Sub-County has 240 homesteads headed by either widowed or elderly grandmothers whose children have long succumbed to Aids leaving over 700 dependant orphans in their care.
This is the bane of Homabay County whose 8 sub-counties are all reeling under the weight of the HIV burden forcing Governor Cyprian Awiti to declare Aids a disaster in the County.
Although the eight sub-counties of Kasipul, Kabondo, Karachuonyo, Homabay Township, Ndhiwa, Suba, Mbita and Rangwe, are all affected by HIV/Aids, the last three are the worst hit.
“Mbita and Suba are the worst hit sub-counties. This is where we have the largest concentration of orphaned children”, says Suba sub-county Public Health Nurse Margaret Ogunda during an outreach mission by the Beyond Zero Mobile clinic at the Kitheraka Primary school grounds.
The Sub-County has a population of 124,000 people and an HIV prevalence of 23.5 per cent down from a high of 40 per cent three years ago. The Sub-County is home to one girl child aged 9 years, married, pregnant and HIV positive!
Indeed the said girl is not an isolated case because everywhere you go in the sub-county, you are confronted by many young adolescent girls carrying their own babies. It is a Sub-County of babies carrying babies.
From a population of 1.1 million in the entire Homabay County, 48.8 per cent of the people are largely dependents aged under 14 years, most of them orphans.
With an HIV prevalence of 26 per cent, Homabay County bears the largest burden of HIV in the country. This is 4.6 times higher than the national incidence of 6 per cent.
A total of 158,000 people live with Aids in the County, which records a total of 15,000 new infections per year. About 49 per cent of the residents live below the poverty line.
The biggest drivers of the high HIV/Aids prevalence rates and equally high number of new infections include poverty, retrogressive cultural practices the fishing folk popularly known as the Jaboya with their unorthodox “fish for sex” behaviour alongside the over 50 beaches in Suba and Mbita alone.
Along these fish landing beaches, uncontrolled and unprotected sex with female fishmongers, fishermen, schoolgirls and commercial sex workers has become the biggest mode of transmission of the HIV virus.
This fish trade and its sad consequences attracts even fishermen from Uganda and Tanzania.
The other Challenge standing on the way to fight Aids is the large number of Traditional Birth Attendants (TBAs) who pause the greatest obstacle to skilled deliveries.
In Suba Sub-County alone, there are over 90 TBAs whose “popularity” frustrates the work of professional health care givers.
“In one recent case in Homabay Town, one TBA performed 72 deliveries in one month while a nearby health center only recorded 10 deliveries” says Mrs. Ogunda. “This is a case of major concern to us “, she adds.
For the last two years since the launch of the Beyond Zero Mobile Clinic in August 2014, the initiative has been collaborating with over 25 other partners working across Homabay County not only to address the Aids challenge by a myriad other health intervention including vaccination of thousands of children, nutrition, male circumcision, Cancer screening, the endemic Malaria, Diabetes and Family planning.
Besides the Beyond Zero, the National and County Government, the main partners include Women Fighting HIV Aids in Kenya (WOFAK), Elizabeth Glacia Paediatric Aids Foundation (EGPAF), World Vision, Unicef, Impact and the Enabling Sustainable Health Equity (ESHE).
While Beyond Zero addresses issues of health across the board especially matters concerning maternal and child health, each of the other partners prioritise on specific programmes like HIV/Aids, Nutrition and Family planning.
However, they all focus on empowerment, education, advocacy, testing and counseling on Aids in a joint attempt to bring down new infections and further spread of the disease.
Further interventions of health in Homabay come from the 12 hospitals and 224 dispensaries and Health Centers across the county.
The popularity and effectiveness of the Beyond Zero Clinic cannot be gainsaid in the vast County where it has provided services to the hardest to reach populations in Suba, Rangwe and Mbita and where residents are crying for additional mobile clinics or dispensaries.
Tobias Okusa Panyako, a beneficiary of the Mobile Clinic services talks proudly of the health benefits his wife continuously receives from the facility.
“My wife has received ante-natal services, my five children immunized while I was treated for Malaria. We also received Family planning service because I think my five children are enough”, says Panyako from Kitheraka village.
County Immunization Co-coordinator Ms. Christine Ong’ete says the Beyond Zero Programme has made great achievements in the provision of integrated services including the immunization of children who had previously defaulted on the critical vaccines.
“We are currently at 73.5 per cent immunization coverage. Our target is 90 per cent. Beyond Zero has done well in the integrated services especially during the outreaches’, says Ms. Ong’ete
So far, the mobile clinic makes 16-20 outreaches per month across the 8 sub-counties.
As a result of the Beyond Zero initiative, its advocacy and education programmes, skilled deliveries have shot from 41 per cent in 2013 to 62 percent in 2016. But this is still very low coverage as many women still prefer the unskilled deliveries by TBAs.
According to the County Executive Committee member (CEC) for Health Dr. Lawrence Koteng, the county leadership has taken the HIV /Aids challenge head on.
The County plans to launch the Homabay HIV Strategy on Thursday, November 24, 2016 to provide new guidelines on how to tackle the monster.
The new strategy includes a door-to-door testing of people aimed at developing a database of those infected and affected by the disease.
“This will enable us to assist those infected through medical interventions rather than waiting for them to come to hospital ailing”, said the CEC.
This strategy also combines with community health education programs to create awareness among the people.
Dr. Koteng says the strategy has full support of the County leadership and is housed in the office of the Governor.
“The Governor wants to see results”, says WOFAK Program Coordinator Ms Zahra Hassan. WOFAK was started by a group of women in 1993 by a group of women tired of the Stigma over HIV status.