6.10.2006
Kicks in Kenya
My time in Kenya so far has been a week-by-week progression from big city to medium town to small town. I started in Nairobi, a city where crime is so pervasive (or the fear of it is, at least), that I found myself shuttled from guarded enclave to guarded enclave—CDC office, my friend's hotel, expat-frequented restaurants. It was hard to get my bearings and hard to feel like I was somewhere new. My first Sunday I got to tag along with a Kenyan family as they went to their family farm just outside the city. It was a special occasion because a grandchild had just been born and was coming home from the hospital. As the first daughter, she was named after the father's mother and had to pass through her grandmother's house before she went home. Evidently, for Kikuyu people, there are strict rules about what to name each child—the first daughter after the father's mother, the second after the mother's mother, then on to the parents' brothers and sisters. The family conversed in English, Swahili, and Kikuyu there were maybe twenty people there, and all the kids the same age had the same names, which added to the general confusion. Also there was the new baby's great-grandmother, a woman of nearly 100 with dangling stretched earlobes. Apparently, she is a bit senile, but if she could remember everything that's happened in the last 100 years, that would be amazing. I congratulated myself on working my way through a heaping plate of food at 3 in the afternoon, but just as I was taking my last bites a bowl full of roasted goat meat was placed before me and I had to incur the profound disappointment of the grandmother who asked me, wasn't the food alright?
And then I decamped to Kisumu, my home base for the next 8 or so weeks. I didn't know anything about the town except that it is on Lake Victoria. It's actually very lovely—the downtown is comprised of white two and three story buildings and is overrun with bicycle taxis. At the shore, there is a row of tin shacks serving huge fish that are deep-fried whole and served with tomato sauce, greens, and ugali (stiff corn porridge), one of the most delicious meals I have ever eaten. I found a place to live with a family in a Kenyan version of a gated community—paved streets in a neat grid, house numbers, and the "estate" has a school, a soccer field, and a small pub. The funny thing is that there isn't any visible extra security, just one gate that is unguarded and always ajar. Yet somehow the imposition of order keeps the usual African chaos at bay. Or maybe I'm missing something. My host mother, Florence, is a nurse from the TB ward at the provincial hospital and she invited me to live with her "African-style". She promised that I would only have to share a room with her 7 year old daughter, but the other day I looked over and the bed next to mine had 4 people in it. I suppose a better person than I would have offered to share, but, let's be real, I need my beauty sleep.
And then this last week I made a trip to the small town of Nyamira. I knew nothing about the place except that the district hospital was one of the sites that the people at the head office wanted me to look at. It is up in the hills and from the guesthouse there is a gorgeous view of the valley below, a green patchwork of small farms, mostly growing tea. The other afternoon, it rained and you could see it coming from the opposite hill, the shopkeepers packing up their wares as the first fat drops fell. The town itself consists of some general shops lining a single road, trafficked primarily by pedestrians, and there is no internet or restaurant anywhere. Still, at night, the bar across the street was blasting Congolese music and it sounded like plenty of people were there having a good time.
And there is the project I am doing. Basically, this province has a very high prevalence of HIV, and the prevalence is even higher among expectant mothers (20-30%). Most of these women attend some form of prenatal care, so that is a really important time to make sure they get tested for HIV to prevent transmission to the baby and to provide the mother with care. There are different ways that facilities are trying to follow up with HIV-positive pregnant women, so I am going to three of these to compare how their programs are working. The hospitals record all their data on paper (the one I was working at is the largest in the district and has a grand total of 2 computers for the whole facility) so I found myself entering data into my laptop in various wards while trying not to be distracted by the screams of babies being vaccinated, women giving birth, and one very disgruntled cow in the field beside the records office. The worst part about the project is seeing how under-resourced the health workers are, and then knowing that I have to bother them in order to make my project happen. Instead of feeling like I am doing something helpful, I can see that my project actually has a direct negative impact on patient care. To assuage my guilt, I attended a meeting of an AIDS patients club to offer moral support. As I should have expected, I was treated like the guest of honor, and ended up blathering about human rights in Swahili for a good chunk of time, as if those poor people hadn't suffered enough.
I have to say that traveling like this, with a task, can be a lot more interesting than pure tourism, even though I am only here for a relatively short time. In addition to that ridiculous speech, I got to play and sing with a group of HIV-positive toddlers at another hospital and to attend a soccer practice for a team of boys from Kisumu's largest slum. I have been invited for dinner at several houses and I just feel much more connected to the places I've been. It's not really about authenticity, because I know that I am still in Kenya's little public health world, but about actually being here, instead of feeling like I am just passing through. Kenya is great, and I'm having a really good time.
And then I decamped to Kisumu, my home base for the next 8 or so weeks. I didn't know anything about the town except that it is on Lake Victoria. It's actually very lovely—the downtown is comprised of white two and three story buildings and is overrun with bicycle taxis. At the shore, there is a row of tin shacks serving huge fish that are deep-fried whole and served with tomato sauce, greens, and ugali (stiff corn porridge), one of the most delicious meals I have ever eaten. I found a place to live with a family in a Kenyan version of a gated community—paved streets in a neat grid, house numbers, and the "estate" has a school, a soccer field, and a small pub. The funny thing is that there isn't any visible extra security, just one gate that is unguarded and always ajar. Yet somehow the imposition of order keeps the usual African chaos at bay. Or maybe I'm missing something. My host mother, Florence, is a nurse from the TB ward at the provincial hospital and she invited me to live with her "African-style". She promised that I would only have to share a room with her 7 year old daughter, but the other day I looked over and the bed next to mine had 4 people in it. I suppose a better person than I would have offered to share, but, let's be real, I need my beauty sleep.
And then this last week I made a trip to the small town of Nyamira. I knew nothing about the place except that the district hospital was one of the sites that the people at the head office wanted me to look at. It is up in the hills and from the guesthouse there is a gorgeous view of the valley below, a green patchwork of small farms, mostly growing tea. The other afternoon, it rained and you could see it coming from the opposite hill, the shopkeepers packing up their wares as the first fat drops fell. The town itself consists of some general shops lining a single road, trafficked primarily by pedestrians, and there is no internet or restaurant anywhere. Still, at night, the bar across the street was blasting Congolese music and it sounded like plenty of people were there having a good time.
And there is the project I am doing. Basically, this province has a very high prevalence of HIV, and the prevalence is even higher among expectant mothers (20-30%). Most of these women attend some form of prenatal care, so that is a really important time to make sure they get tested for HIV to prevent transmission to the baby and to provide the mother with care. There are different ways that facilities are trying to follow up with HIV-positive pregnant women, so I am going to three of these to compare how their programs are working. The hospitals record all their data on paper (the one I was working at is the largest in the district and has a grand total of 2 computers for the whole facility) so I found myself entering data into my laptop in various wards while trying not to be distracted by the screams of babies being vaccinated, women giving birth, and one very disgruntled cow in the field beside the records office. The worst part about the project is seeing how under-resourced the health workers are, and then knowing that I have to bother them in order to make my project happen. Instead of feeling like I am doing something helpful, I can see that my project actually has a direct negative impact on patient care. To assuage my guilt, I attended a meeting of an AIDS patients club to offer moral support. As I should have expected, I was treated like the guest of honor, and ended up blathering about human rights in Swahili for a good chunk of time, as if those poor people hadn't suffered enough.
I have to say that traveling like this, with a task, can be a lot more interesting than pure tourism, even though I am only here for a relatively short time. In addition to that ridiculous speech, I got to play and sing with a group of HIV-positive toddlers at another hospital and to attend a soccer practice for a team of boys from Kisumu's largest slum. I have been invited for dinner at several houses and I just feel much more connected to the places I've been. It's not really about authenticity, because I know that I am still in Kenya's little public health world, but about actually being here, instead of feeling like I am just passing through. Kenya is great, and I'm having a really good time.
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