Callers to BK radio, a station broadcasting to the remote region around Mount Elgon in western Kenya, were worried on Wednesday evening.
“Will the government help us if we stay indoors and we need food?” one asked. “What if we have small houses, where we can’t stay too far apart?” asked another.
The station was hosting a show with staff from a charity that provides livestock and training to rural farmers, and answering questions about coronavirus from a nervous community. The first case of the global pandemic in Kenya was confirmed in Nairobi on Friday last week, and the number of confirmed cases had risen to seven by Wednesday 18 March.
So far there have been no cases in rural Kenya, according to Dr Suvajee Good, health promotion programme manager for the World Health Organization’s (WHO) Africa region.
But health experts worry about if and when the virus spreads to where limited access to sanitation and healthcare services mean infectious disease is already a huge problem.
“We’ve been fortunate so far, but we cannot be relaxed about it,” Good said.
With people travelling from cities to rural areas, often by public transport, “community infections could happen any time”, he stressed.
There are 645 million people living in rural areas in sub-Saharan Africa, according to World Bank data – and three-quarters of them don’t have the facilities at home to wash their hands with soap and water.
In fact, said Titus Sagala, country director of Send a Cow, the charity featured on the radio show, 95% of the Kenyan households with which his organisation works don’t have access to running water. And although the situation has improved since the NGO first began its work, in some households soap is an unaffordable luxury.
Now, given that thorough handwashing is one of the most effective ways to prevent the spread of Covid-19, the disease associated with coronavirus, health workers are emphasising the importance of personal hygiene, according to Samuel Airo, a community health worker in Busia county, on the Kenya-Uganda border.
This is especially important because the culture in western Kenya is very sociable, said Sagala. People greet each other with handshakes and hugs, and spend much of their time in groups for meals, ceremonies and worship.
Kenya’s government has announced restrictive measures in an attempt to stop the spread of the virus, including school closures, bans on entry for non-Kenyans, and instructions for anyone who has travelled internationally in the previous 14 days to self-quarantine.
A spokesperson for the government said on Tuesday that it has tested 110 people and aims to have testing facilities in each of Kenya’s 47 counties.
County governments are setting up isolation units, but Sagala worries they could quickly become overwhelmed during an outbreak. He added that measures such as self-isolation and staying away from work are difficult for the communities he serves, where many people live hand to mouth.
“It’s not possible for them to quarantine, because they cannot stock up,” he said. “A lockdown will make the lives of these communities very tough.”
The WHO recommends that rural communities create plans to deal with any outbreak, said Good, who emphasised the importance of isolation for anyone showing symptoms of the disease.
“We acknowledge that people cannot have their own separate rooms and toilets and equipment and utensils everywhere,” she said. “But the community should have a plan to support people who have these kind of symptoms, and have their own arrangement for isolation.”
That means being vigilant and acting fast if anyone shows symptoms, Good said. And given the conditions in rural areas, and how quickly the disease has spread elsewhere, it also means bracing for the possibility that if someone in the community tests positive, “the whole community may be infected”.