A Story About a Shoe
The high cost of corruption
I’ve felt pride watching Kenya these past few months. Young people took to the streets, protesting proposed tax hikes amidst a cost of living crisis and a longstanding tradition of government workers lining their pockets with public funds. The controversial finance bill, with its taxes on bread and sanitary pads, was withdrawn. The protesters demanded government transparency and accountability. We are in the midst of an exciting moment tempting positive change, and while we have a long way to go, I feel an itch of optimism whenever I read the news coming out of Nairobi.
For years, I felt uncomfortable talking about corruption. Like my words might come back to bite Access Afya, harming our mission or our people. But it feels like the right time to share one of the most absurd stories from my time in Kenya. I think of this story whenever I read about disease outbreaks. Healthcare isn’t just about medicine, equipment and skilled people. It requires systems that work and aren’t beholden to corruption.
I changed names and details, but this post is based on a true story.
It would be a shame if polio resurfaced in Kenya on account of an expensive shoe.
As the sun rose over the wet roads in the industrial area, the air smelled like sugar. Factories churned out bread, animal feed, and plastic pipes. Hammers clanged and the air was thick with exhaust from cars navigating the wet roads. The rains had come the previous night, but the sun shone brightly by morning.
John, our nurse, was immersed in his duties. He sat behind a tower of government-issued books. Each day he meticulously tallied the number of children seen at the clinic and squeezed the sum into the cramped box designated for the corresponding day on the monthly reporting log. He also counted the pregnant women and noted any serious infectious diseases. Despite the clinic’s investment in electronic medical records, the manual books had to match each month. John rubbed his eyes and pushed his chair back from the desk to stretch his legs.
He oversaw a network of community clinics in Nairobi’s informal settlements. Millions of people, crammed into these slums, navigated limited options for their healthcare, education, and hygiene. This job required him to visit the clinics, train clinical teams, register each facility for government supplies and insurance schemes, and review the monthly reports. The days were often long, and the work could become monotonous, but every time he stepped into one of the clinics, he was surrounded by people who previously had not had access to healthcare.
Over the past year, he had diligently followed the process of registering these clinics for vaccines. Whenever he called to inquire about the status of these applications, he had to remind himself of the thousands of children depending on him. He scooted his chair back toward the desk and reached for his phone. Finally, a familiar crackle told him he was coming off hold.
“We are still working on processing your application,” said a government worker, “but you will hear from us once it has been entered into our system.”
If you had the money to grease the wheels, the vaccine registration process wasn’t hard. However, if you took a principled approach, this two-month process could drag on for years.
Our nurse had upheld the company line over the past year, deflecting requests for under-the-table cash payments to cover extravagant lunches or fabricated transportation funds. He stood strong.
No. Informal. Payments.
The process on the books might be slower, but it must bear fruit eventually.
Then, on a drizzly Tuesday morning, he sensed his big opportunity approaching. A win he could present to his company, and more importantly, to his community. For the first time in over a year, the health department called him. In an office in a weathered government building in Nairobi, his clinics’ names had been entered at the bottom of a list of hundreds of facilities across the country. He was in the system.
“We will visit you this Friday,” the government worker told him. “And we will contact you soon to discuss arrangements.”
We had a date. The inspection was the final step before a river of vaccines could flow to the community.
His assigned inspector, Shawna, called the day before the visit. "Can you send me $100 for a taxi?"
We knew a taxi would cost her five dollars, and she’d more likely take a bus back to the office for a nickel. John negotiated her request politely and with skill. He offered to pick her up on the company’s dime. On Friday morning, John and his taxi pulled up to the government building. Shawna walked out, smoothed her white pantsuit, and climbed in.
The car ride was short and long. Traffic crawls the day after it rains in Nairobi. John and Shawna made small talk. This visit was just a formality. The clinic had passed its licensing inspection and had received top scores for its quality. Shawna needed to see that they existed and check their fridge, and then 18 months of red tape would be behind them.
The driver pulled up to our small community clinic. John got out first and opened the door for the government inspector. An immaculate white shoe poked out.
“Ah, it rained last night!” exclaimed the civil servant.
The white shoe hovered momentarily, suspended in mid-air, before it retreated back into the car.
Our nurse ran into the clinic and grabbed empty boxes and bags. Anything to build a makeshift bridge for the shoe and its owner to traverse the two-foot chasm from car to clinic.
Shawna examined the bridge. She delivered her verdict. The risk of a splash of mud was too high. They were white shoes, after all.
“Perhaps a campaign contribution,” she smiles, “could resolve this issue of hygiene.”
John sighed.
Shawna shut the car door.
She never got out of the car. She never signed off on the procurement of the vaccines. The clinic carried on seeing thousands of patients each month, unable to vaccinate them. The nurse kept filling out form after form, hoping to reschedule a visit on a day with better weather.
The civil servant is still walking the halls of the county health department, despite carrying the weight of some of the costliest shoes in the country.
If you want a little more context for the protests in Kenya,
wrote this very fun overview here. Let me know if you like these stories. Unfortunately, I have more like this!
Wow Melissa. Both a heartbreaking and inspiring story about human potential. Either to keep serving in the face of impossible odds, or to lose our humanity when we're only willing to serve ourselves.
What a heartbreaking and infuriating story! I could murder that woman. Or at least pour a bucket of red paint over that white pantsuit.
Very well written, Melissa.