For the outgoing World Health Organisation representative to Kenya, Dr Custodia das Dores Isaac Mandlhate, retirement from work does not mean retreating from life.
“It is the beginning, not an end,” she says as she settles for this interview after introducing some of the staff of the WHO Kenya office at the fourth floor office at the ACK Garden House in Nairobi.
Dr Mandlhate’s was posted to Kenya four years ago. This was her third country assignment with the global health body, after Namibia and Mozambique, her country of origin.
“I am a real senior citizen! I am now retiring and closing the cycle by going back home though I still have some energy to give back to my country,” she says.
Tuesday will be her last day at work and she hopes to go into teaching and consultancy.
She laughs when I call her by her Kenyan name, Dr Mathenge, which she was given by a presenter at a meeting. He failed to pronounce Mandlhate.
“It’s humorous, but most people are safer with Dr Custodia which I do not mind,” she says.
One of her most challenging initial assignments was working with two health ministries: Ministry of Medical Services under Professor Anyang’ Nyong’o and the Ministry of Public Health and Sanitation under Beth Mugo.
“My team and I provided briefs to both ministries which presented a unique task but we weathered it all and it became simpler when the two ministries were merged and health functions devolved.”
During her term, she led teams in responding to public health emergencies like Ebola preparedness, the reported cases of polio and the most recent cases of Yellow Fever from Angola.
“Even one case of polio is considered an outbreak and our goal was to conduct an effective campaign by reaching every last child with polio vaccine,” she says.
She is also proud to have led the team that coordinated the team of Kenyan volunteer health workers who travelled to mitigate the spread of Ebola in Liberia and Sierra Leone in 2015.
“Ebola is a global public health concern and Kenya being a signatory to international health pacts had to step in and help the affected countries,” she says, adding that health workers in Kenya also learnt how to manage an Ebola outbreak.
In retirement, her ultimate dream is to see the eradication of diseases like polio, tetanus and measles as was done with small pox in 1980 when the World Health Organisation lead a global immunisation campaign.
How did she weather the storm created by a section of the Church which called on the public to boycott tetanus and polio vaccination drive?
She terms the clash as ideological, and says that “vaccines are safe, well researched and cost effective disease control interventions” and “the Ministry of Health and partners have the best interests of the population at heart.”
Even though she was raised a Catholic, she is firm on the significance of public health interventions like immunisations that help fight diseases better.
She embraced a holistic approach when handling the WHO Kenya office. “My priorities were to assist the country to identify diseases for eradication like polio; eliminate diseases like tetanus and measles and control others like Tuberculosis and malaria,” she says.
According to Dr Mandlhate, one of the priorities during her term has been looking at better diagnosis, treatment and management of non-communicable diseases such as cancer, diabetes, high blood pressure, injuries and mental health conditions which she notes are on the rise.
“Many African countries including Kenya are going through a double burden of communicable diseases such as malaria, Tuberculosis, HIV and the non-communicable ones such as cancer and diabetes by increasing funding to both fronts,” she says.
She appreciates that Kenya launched the National Strategy for Non Communicable Diseases during her reign and calls for the effective implementation up to the counties level.
“Kenya now has a strategy for NCDs where elements of prevention and control are well articulated. The risk factors like physical inactivity, tobacco consumption, alcohol abuse, unhealthy diets are linked to behaviour and they can be addressed at zero cost,” she says.
Dr Mandlhate is optimistic that the strategy would promote early screening and management of these lifestyle diseases.
“Early detection is fundamental for the outcome. Treating advanced cancer is expensive and not accessible to many people therefore prevention and early detection are the best strategies,” she adds.
Pursue Education
As a mental health specialist, the launch of a mental health policy a fortnight ago is a dream-come-true after two decades of pushing for the recognition of mental health as an integral and essential component of health.
“It’s the beginning of a journey for Kenya to have a mental health policy,” she says, adding that there is no health without mental health.
How did her early years influence her?
Growing up in Mozambique under the colonial rule, she appreciates her parents for providing her with opportunities similar to her two brothers to pursue education within a mixed-race system at a mission Catholic School in Nampula Province in Northern Mozambique.
“They believed in my potential and guided me to fulfill my aspirations by teaching me values like mutual respect, hard work and perseverance. This home-made guidance was the pillar for my managerial and leadership skills,” she says.
Initially she aspired to be lawyer but later opted to study medicine, living up to the meaning of her first name, Custodia which loosely means “caring.”
At medical school, the influences of a Cuban teacher saw her develop an interest in psychiatry and on her return from Switzerland as the first indigenous mental health specialist in Mozambique, she took up a teaching position at Eduardo University and later became the director of the Mozambique’s national mental health referral hospital
It was during her term as the first director of Mental Health Programme in Mozambique that she pushed for the recognition of mental health as a critical component of the health system so that this previously ignored area of health could be addressed.
She joined the World Health Organisation in 1997 as a Regional Advisor for Mental Health for the African region. She was in charge of 46 countries.
She later took up the challenge as the WHO country representative in Namibia in 2003, and moved to Zimbabwe in the same position four years later.
What is her vision for Kenya in attaining equitable health? Dr Mandlhate would like to see the actualisation of county health profiles where public health interventions benefit the people and the bigger health facilities are left for referral issues.
She acknowledges the Abuja Declaration where countries committed to dedicate 15 per cent of their national budgets to health and hopes that Kenya will lead the way by increasing the allocation from the current six to seven percent.
Donor Funding
“The Abuja Declaration was a high level commitment by Heads of State to dedicate at least 15 per cent to health. Unfortunately this is not happening and countries are diverting the national budgets to other areas and leaving health totally dependent on donor funding,” she says.
The transition from the Millennium Development Goals, she says, presents unique challenges for countries that were yet to meet the health related goals, especially Number 4 and Number 5, which are about reducing child mortality and improving maternal health. A World Health Organisation report notes that only a few countries have made progress in increasing their domestic funding towards the promise with Rwanda at 18.8 per cent, Botswana (17.8 per cent), Niger (17.8 per cent), Malawi (17.1 per cent), Zambia (16.4 per cent) and Burkina Faso (15.8 per cent).
She emphasises that domestic funding should be the source of health funds, and adds that the reliance on donors holds countries at ransom, more so, when the benefactor fails to meet a country’s health needs.
“When donors cut funding, either partially or withdraw completely, Kenya will suffer,” she warns.
Dr Mandlhate is a mother to a daughter and a son, Eduardo and Anna, who is a doctor in Mozambique.
She appreciates Kenya’s cultural heritage and the delightful weather that made her work trips, and stay bearable.
But one thing, besides the hospitality of Kenyans, that will forever be etched on her memory is “oh, the Nairobi traffic.”
