Wednesday, October 26, 2011

Medical-Legal Partnership in Kenya

I spent part of my summer in Kenya looking into the possibility of establishing a medial-legal partnership (MLP) in Kibera, a sprawling slum on the outskirts of Nairobi.  The project, if it goes forward, will be in collaboration with an NGO called Carolina for Kibera (CFK), which I have mentioned in previous posts.  It would involve placing a Kenyan lawyer on staff at CFK's highly successful Tabitha Medical Clinic and asking that lawyer to address the "upstream social determinants" of the patients' health problems.  More on that below.

The MLP movement has been building in the U.S. since the early 1990s.  By many accounts, it started when Barry Zuckerman, a medical doctor at a pediatric health clinic in Boston, realized that he repeatedly treated children with asthma and other respiratory ailments, but that they repeatedly returned to his clinic in crisis because their poor housing conditions, including infestation by mold, roaches, and rodents, were exacerbating their medical conditions.  He hit on the idea of putting a lawyer on staff in the medical clinic to deal with the upstream social determinants.  In the case of the asthmatic child, the staff lawyer compelled the landlord to improve the child's housing conditions, and the medical problem improved.  This early success has now been duplicated across the U.S., and there is a budding literature describing the concept and a national organization dedicated to spreading the idea.

In Kibera, the legal issues affecting patients' health are different.  The paramount legal/health issue is gender based sexual violence, which is perpetrated with virtual impunity.  Another legal issue is the absence of wills.   Men who provide resources for their families die without wills, and collateral male relatives often claim the resources of the deceased, sometimes citing customary law.  This leaves the widow and children economically vulnerable, leading in turn to a panoply of negative health consequences including exposure to HIV/AIDS. 

The question is whether the MLP model developed in the U.S. will be efficacious in Africa and other parts of the developing world. One group in Kenya, Legal Aid of Eldoret (LACE), has launched what appears to be a successful MLP in a regional city.  That project was founded with the assistance of our law colleague, Fran Quigley, from the University of Indiana. 

The project I have in mind would attempt to implement such an MLP in Kibera and would from the start include a research component that would carefully measure the outcomes.  If the MLP  works, and if its success can be measured, more programs and more funding will follow.

We'll see.

TAK

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