From 2005-2007, we addressed problems of access to epilepsy care in Kilifi, Kenya from an anthropological perspective. Researchers have identified a lack of attention to contextual constraints on treatment decision-making (Garro, 1998, p. 321; Good, 1986, p. 164). Few studies have examined the social and procedural factors that shape and constrain the treatment choices for epilepsy, such as the roles of providers in the community and the structural differences between biomedical and alternative treatments. To address this shortcoming, we employed a comparative ethnographic approach to explore the distinguishing characteristics of services for childhood epilepsy in Kilifi. We focused on how treatment-seeking is facilitated or deterred by the availability of treatment options and characteristics of service providers, rather than by characteristics of the persons in need of treatment (see Finkler 1994 for a notable example of this approach). To our knowledge, this was the first study to contrast features of service providers as potential determinants of treatment choice for children with epilepsy.In addition to gathering qualitative data on biomedical health providers, we conducted participant observations and interviews with a group of traditional healers in Kilifi. Each healer was seen in a series of meetings over a period of 10 months. Our research revealed complex explanations of epilepsy symptoms and treatments that had cultural and social meaning for treatment seekers. Our data also indicated important differences between traditional and biomedical treatment options. This essay briefly discusses the traditional healer component of the study, and presents aspects of their services that help explain the local popularity of this treatment option.The local term for epilepsy in Kilifi District is Kifafa. Traditional healers expressed consistent definitions of the symptoms and causes of Kifafa. One healer described Kifafa as, "…a problem that comes when a person falls on the ground and shakes like this [demonstrates a convulsion]. His arms move like this and his legs do this…When the person wakes up he does not remember what has happened…This is Kifafa if it comes again and again." Traditional healers attributed epilepsy and other illnesses to natural spirits or Nyagu, curses or Majini, and ancestral spirits. Healers employed a different treatment ideology for each of the three spirit-based causes of childhood epilepsy.

Introduction Metastatic breast cancer (MBC) patients have several unmet needs. The needs and quality of life of MBC women living in sub-Saharan Africa (SSA) are understudied. Facilitating the interaction of various caregivers is beneficial in addressing the needs. Internet-based resources play an important role in reaching out to these patients. We aimed to bring the various stakeholders into a joint network force, create a web-based portal, understand the needs of MBC patients, and assess the utilization of web-based resources for women from Kenya. Methods A network of various stakeholders considered crucial in the care of Kenyan women with MBC was created. We conducted educational camps and assessed their needs, quality of life (QoL), and knowledge. We assessed the impact of utilizing web-based resources by MBC patients from here. Results We formed a network involving partners and launched the first dedicated website for MBC from Kenya. The website has received 13,944 visits and 310,379 hits in 2 years. One hundred fourteen women living with MBC were interviewed, and our findings show that psychological needs (63%), physical support needs (60%), and health care system needs (55%) are leading areas of needs that increase with rural residence ( p = 0.001), less education ( p = 0.003), and aggressive treatments ( p = 0.008). Quality of life (QoL) confirmed better scores with urban residence ( p = 0.002), internet access ( p = 0.010), and stable disease ( p = 0.042). Conclusions Creating a network of caregivers provides opportunities for cohesive efforts in understanding the psychosocial and medical needs of patients with MBC. Internet-based resources are an effective way of reaching out to them. Kenyan patients show extremely good uptake of internet-based resources. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06539-5.

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