Location, Location, Location

With all of the other things that are going on, one underlying issue all along has been where the clinic will be located.  Our mission is to bring high quality preventative  and acute care to low resource segments of the population.  The idea being to have the clinic in a high population density area of low income people so that they can walk to the clinic and we can have easy contact with them.  That translates into a slum area, as opposed to a rural area, where the people are just as poor but we would not the numbers or the access we need.  We also need to have electricity, water, sewer, and access to fiber internet, as we want to use a cloud based Medical Record system, that will be accessible to us, our patients, and other healthcare providers seeing the patients.  One of the frustrations of the doctors at Jaromogi Oginga Odinga Teaching and Referral Hospital when I was working there was that they often had patients come in with no idea of their diagnoses or medications, or even a history of how long complaints had been present.  But everyone has a cell phone, so with a patient portal, their records can be available to any doctor they see.  It also means that our records are not susceptible to fire, flood, equipment thefts or other unfortunate events.  Of course we will also need backup systems for each, but a back up is a lot less expensive than a full system.

Our initial plan was to start out by renting a building, and progressing to owning our own facility some time in the future. As we looked at possible sights, several factors worked against us.   First, when people with buildings, such as schools that were not doing well, heard that we were thinking of placing a clinic there, they thought it was a great idea.  So great in fact, ithat they decided to cut out the middle man and just set up their own clinic!  Others said they were so glad that we were interested, because now they could put their children through college and retire on the huge amount of rent they would be collecting from us!  We also had considered seeing if some of the rent could be reduced by doing renovations, but that also proved to be unpopular.  Then there were warnings from local business people that contracts really don’t have the same meaning here that they have in America.  In other words, even if we got a decent rental rate, and did the renovations, there would be nothing stopping the landlord from arbitrarily raising the rent, or vacating us.  Of course you could take it to court, and in 2-3 years the case would be heard, but there would be no guarantee that the judge had not been bought off by the landlord.  So our attention turned to land ownership and building, rather than renovating.

You might think that land in a slum would be very low cost. You would be wrong.  Several dynamics are in play, but the largest one seem to be political.  Area chiefs are appointed by the government based on the tribe of the majority landowners of the area.  So even though the temporary mud houses on the land might not bring in much rent, the clout of owning the land and the people on it is very valuable politically. Another factor is the mzungu factor- pale skin still says “money for free” very loudly, so if I would go to see land, the price would immediately increase by 3-5 times, up to $35,000 for less than 1/6 acre!  Another factor is that the area is being set up to be growing economically with a new port being established to connect to the Chinese railway system that Is being built from Mombasa. This has brought Asian and Somali investors, who are willing to pay top dollar for investment purposes.  Which all goes to say, land is not cheap.

Obunga is the name of probably the poorest area in the Kisumu region.  We had a guy willing to sell, and it looked like a good location- directly across the street from a public school, and beside an orphan feeding center.  But on closer examination, there were issues. There was no sewer line. The area where the sewer would run, would be along a road that was seen on the map, but was covered in real life with makeshift housing.  The school across the street was using outhouses for toilets. The other issue was the internet.  I talked to the Safaricom people about the possibility of getting the fiber network in the neighborhood. It is already across the road in Tom Mboya estate, and across the road in Kondele, but they didn’t feel there would be enough customers to justify the expansion across the road.  I suggested to the manager  that there might be some PR value to supporting a clinic in the poorest neighborhood, but so far they have been unimpressed. So our search expanded to Nyamisaria,  Nyalenda, Manyatta, and Kondele, areas where the fiber at least runs through if not to!  We also have gone a little further out to Rabuor, to a little more rural area that still has some population density and is on the main road where the fiber runs.

The other problem with buying land is figuring out exactly what land is being sold, and who exactly owns it.  The plot maps often show access roads where temporary housing developments now sit, and houses straddle what is supposed to be a boundary.  The issues of land title are also legion. There are the transfer titles, where the land has been transferred to a group of siblings and one of them wants to sell, but has to get things changed over.  Even legal land titles can be an issue in a place where the proper amount of money can generate a perfectly legal title for someone else’s land! And it may change hands legally several times before the competing titles are brought to light.  So as of now, we are still looking for the right land, and praying that God will help us through the morass!