The staff members at Tumaini Clinic are cut from a different cloth than most mortals. They willingly operate on the front lines of true change, despite the hardships they must confront both outside and inside the clinic.

Just last week, I was in the outpatient area when I heard a scream echo down the clinic hallway from the maternity ward.  This is not so uncommon given the number of births that take place on a daily basis, but this sound was different. It was a shriek of distress, not physical pain, so I went to investigate the source.

I passed her on my way to maternity…an anguished woman being ushered to the waiting area by a man I assumed was her husband. I walked past them into the birthing room, where a rolling cart now served as an emergency exam table.

The birthing room was filled with medical personnel, all huddled around the little girl’s convulsing body.

Lying on the table was a little four-year-old girl with tightly braided hair. She was clearly unconscious, but her body still moved. Her arms shook with subtle tremors, her mouth clenched shut, her eyes rolled back and her legs contorted in an unnatural pose.

A handful of medical personnel surrounded her, their mood tense. But their voices were composed and their movements controlled. Each played a part, like a sports team or an orchestra, and together, they acted as one.

The girl was in the midst of a fever-induced seizure, and the clinic staff was in crisis mode.

Maternity Nurse Jackie wraps a newborn in warm cloth.

A few hours before, the family had brought the child into the clinic and explained how she had been battling illness for days, which included terrible diarrhea along with fever.

By the time she arrived at the clinic, she was completely dehydrated and barely conscious. As soon as the nurse injected her with the appropriate medicine, her depleted body reacted violently, throwing her into the convulsions the staff now battled.

Two nurses pried her jaw open and forced a tube down her throat to allow airflow; others stretched and massaged her limbs; another injected more medicine to counteract the initial reaction.

Finally, the tension in her body eased, and her muscles slowly relaxed…she was going to pull through.

Puzzling Problems

The girl’s blood work indicated that she had stage III malaria (the most severe), coupled with typhoid fever.

Both ailments can be deadly but are completely curable if caught early and treated. Many families in the slums, however, wait days too long, hoping the sickness will abate. Lives are often lost as a result, and staffers are left helplessly shaking their heads.

After stabilizing the girl’s condition, the nurses asked the family to bring her back the next day for follow-up treatment.

The family never returned, and the staff wasn’t surprised. They’ve seen it plenty of times before, and they’ll certainly encounter it again.

In the meantime, staff members have other issues to worry about and more uphill battles to fight.

Medical Officer Eric finishes bandaging the ear he just reattached.

On average, they see 3,000 patients a month, and nearly every imaginable infirmity comes through the front doors of the clinic, from leprosy to AIDS and everything in between.

In my first week at the clinic, a lifeless man was dragged into the clinic by two friends, blood streaming down his swollen face. A victim of “mob justice,” he had been beaten nearly to death.

Nearly a month ago, an unconscious middle-aged woman was carried into the clinic by her grown daughter. She died soon after…the regrettable result of poisoning from ingesting too much homemade liquor, often laced with questionable chemicals (take a look at this article on the subject from The Economist).

And a few weeks back, a man came in with his ear almost completely detached after he was struck by a rock. He initially went to a nearby hospital, but left after waiting for hours without assistance.

These are the realities the staff must deal with on any given day. Malaria, typhoid and yellow fever are like common colds to them. Yet they still find the ability to treat every patient like a VIP, offering compassion and genuine concern.

The contrast to other medical facilities in Nairobi is palpable (read Barry’s article “A Breathtaking View” to see the other side).

Voluntary Sacrifices

Staff members at the clinic “preach without words” like no one I’ve ever met, and they do it willingly and without fanfare. They’re at the clinic 24 hours a day, 365 days a year,

During the day shift, about 15 to 20 employees meet at 8am and start the day with devotions and singing, which includes a cappella harmonies I likely won’t hear again this side of heaven.

Of the day shift, a half dozen or so are “frontline staff”…the do-it-alls who rotate through pharmacy, reception, cashier’s station, kitchen and maternity on any given day. Two or three nurses and medical officers work the outpatient area, treating upwards of 100 patients a day. A couple of technicians work in the lab doing blood tests and diagnostic work.

Lab Technician Everlyne prepares to draw blood from a patient.

Two or three midwifes and nurses work the maternity ward, which averages nearly three deliveries every 24 hours. A couple of managers try to minimize the general chaos, and a security guard keeps watch at the front gates.

At night, two people operate the clinic, and a different security guard keeps vigil. Of the staffers, one is a maternity nurse ready to usher in any new babies. The other is a “frontliner,” who’s there to clean the entire clinic and to assist the nurse with any maternity duties.

The night shift is a skeleton crew, and if any complications arise with a pregnancy, it gets far worse. The nurse must accompany the mother by taxi to a referral hospital when those occasions occur, and the frontliner is left to care for any other moms-to-be by herself. It’s far from ideal, but the clinic’s limited finances don’t allow more personnel.

The fact of the matter is that the clinic is in a constant battle to keep its head above the financial waterline, and its birthing services are the sole reason. While maternity expenses for a birth average about 5,000Ksh (Kenyan shillings, or about $60USD), new moms only pay between $10 and $20, depending on their financial ability. So with 70-80 births a month, the fiscal hemorrhaging is constant.

Frontline Staffer Emily prepares a bed for a new mom in the maternity ward.

Change for the Changemakers

In all other areas, the clinic is self-sufficient, but the maternity ward costs them dearly.

Every single member of the staff is grossly underpaid as a result, from security and frontline staff to medical officers and managers. Honestly, it’s one of the greatest injustices I’ve witnessed since arriving in Kenya, particularly given the monumental work that they do.

While the general deprivation in the slums is clearly severe, it’s a large-scale problem that will take generations to remedy. The staff salaries, on the other hand, can (and should) be improved with relative ease. It’s a solvable problem with a realistic solution.

To gauge their monthly pay, I asked around to get a handle on salaries in other non-profit organizations in Kenya. For the lowest entry-level employee, the average was 16,000Ksh, or about $190 a month.

When I inquired at the clinic, my jaw dropped. For frontline staff, the average entry-level is 3,000Ksh, or $36 a month. Same for security. The highest paid employees (those just short of doctor status) receive $320 a month.

If Tumaini’s ‘Mother Theresa’, who reached out and touched the Tragic Trio, worked at any other medical facility in Kenya, she would be making two to three times as much.

If Cecilia, who helped Winnie find hope in a hopeless situation, worked at a different non-profit, she would be making five times as much.

An Appeal

The staff members at Tumaini Clinic get paid little but deserve far more.

So I write today to make an appeal to each one of you. I write today to raise money solely devoted to staff salaries. This is a chance to have a direct impact on the lives of those most deserving…an opportunity to enhance many lives with a few dollars.

The clinic’s mantra of VIP treatment should begin with its staff, particularly since many of them live in Koch, the very slum in which they work. They should be given the necessary boost to improve their own lives and the lives of their families.

These are folks who choose to labor in the trenches day in and day out, doing the dirty work and making the sacrifices that few in the world are willing to do. They are welcoming strangers. They are healing the sick. They are nourishing the poor…mind, body and spirit.

The least we can do is help our brothers and sisters afford the opportunity to break the cycle of poverty that many of them have also inherited, and continue to endure.

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Next Steps
    • Donate to staff salaries!! A $60 donation will provide a 1,000Ksh bonus ($12) to five employees, which is considerable, and there are 24 employees total. One-time donations are perfectly acceptable and fully appreciated, but I also want at least two of you to make a year-long commitment (or more) to donate a monthly amount to the clinic for long-term salary improvement. All donations will be equally divided among the staff, whether as a one-time bonus or long-term improvement.
    • Contact the clinic’s executive officer, Ceri Njuguna, for more information and payment options… You can also befriend the clinic on Facebook at “Tumaini Clinics Nairobi,” where you’ll soon find additional information!
    • The “Adopt-a-Mama” fundraising campaign is also getting off the ground, which is a great way to help plug the financial hole caused by the maternity ward. By ‘adopting’ a mama-to-be, you can fund all of her birthing expenses, from prenatal care to post-birth immunizations. The cost is $60, and you’ll be sent a biography and photos of the mom you adopted. Again, contact Ceri Njuguna for more information.
    • Pray for the clinic and its staff. Pray for continued strength of mind and heart for them, as they battle the stresses and hardships that accompany their line of work. Pray for God’s guiding hand in the clinic’s ongoing efforts in the slum community.
    Next Steps

About the Author: Stephen Crane is a year-long fellow with World Next Door. He has a bachelor's degree in theology from Calvin College and a master's degree in journalism from Indiana University. He has a passion for overlooked places and people and would snowboard at all times if it were possible!

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  1. Gary Paultre said... 


    August 12th, 2011 at 7:53 am  

    It was really good seeing the video of the staff at morning devotions. These are truly wonderful people doing great things! Thanks for the story Stephen.

  2. Cathy Storms said... 


    August 12th, 2011 at 11:55 am  

    Wonderful article Stephen. I have enjoyed reading your stories. They are dear to my heart. I cannot wait to “adopt-a-mama”! These clinic workers truly amaze me. May God bless their hands and healing ways and continue to keep them safe as they love working to help those in need. God wrap your arms around these fantastic people!

  3. Ceri said... 


    August 13th, 2011 at 7:43 am  

    We are ministry trying to imitate Christ in how we roll out care for the underprivileged; we actively address Goals 4 & 5 of the Millennium Development Goals (MDGs), reducing child mortality and improve maternal health, respectively; we do this at a cost to the Clinics so the poorest of the poor is not turned away by high prices. That’s about the long & short of it. The work we do is amazing and the staff team is simply magnificent… then how come it’s so hard to be doing such good work? I think on one hand, it keeps us dependent on God & on the other, it allows for friends to partner with us. Thanks again Steve! Salaries are an admin cost that’s not so glamorous to support but where would we be without the dedicated staff?

    I’m digging “…harmonies I likely won’t hear again this side of heaven”, too right! :)

  4. Veronica said... 


    October 16th, 2011 at 9:05 am  

    To think, I was just complaining yesterday about how a patient of mine coughed stuff out of his trachea in my office. This certainly checks my heart.

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