As I sit on the back porch of the chumba with new friends ("room" in Kiswahili, which doesn't really have walls and serves as our dining hall, classroom, and library), bundled in my new scarf to keep me warm on this relatively chilly Kenyan night, I cannot believe how fast this time has gone. It feels like only a few days ago that we were all excitedly taking our seats on the flight from London to Nairobi, nervously and tiredly commenting to each other about landing in Africa in the morning.
Thinking too much about leaving makes me a bit sad sometimes, so at the moment, our excitement is having trapped a flying beetle the size of a golf ball. We are hoping some unsuspecting sucker picks up the random upside-down bowl. We have reverted to third grade type fun.
In the next few days, we will have to at least pretend to act like the "public health officials" that our translators have introduced us as. We will practice and rework our presentation until Saturday, when we finally present it to the community and the district level health officials. What we've found is that there isn't a whole lot of difference between the communities with and without the Community Health Strategy, which has cost the government a pretty penny. That... is going to be an interesting message to deliver to the Kenyan Ministry of Health.
It's nervewracking, especially since we are all students (read: amateurs) and know that our study wasn't perfect by any stretch. We could have used a little more time, a lot more paved roads, and a few less cultural barriers which prevented us from getting accurate answers all of the time. Even with all of these flaws, we learned a lot, and had some great conversations with people that will hopefully get to the ears of the district health officials who can implement changes that they want.
So for now, we try to put that out of our minds, sit and wait for the beetle to fly in someone's face. It's gonna be awesome.
Wednesday, June 27, 2012
Friday, June 22, 2012
Kenya: Wildlife Lessons
1. The bugs are bigger.
There were two instances that hammered home this lesson. Last night, a grasshopper hopped its way onto the couch outside the chumba and it was actually the length of my index finger. In a moment of squeamishness, I moved to the other end of the couch and did not bother it. In one jump, it then landed on my leg before quickly launching itself to the next destination.
After that encounter, a smaller termite landed on me. This was more frightening, despite the smaller size, because these bugs are more aggressive and just plain wreckless. It was about the size of my thumb and looked like a worm with wings. Having seen them divebomb some unsuspecting classmates a few nights ago, I quickly swatted it off of me and stomped on it, which was aggressive on my part. As it crunched under me, I felt as though I had stomped on a baby bird. Good thing the askaris did not see this - they eat the termites, which are considered a post-wet season delicacy.
2. Monkeys are smart ...and domesticate-able.
The baboons are learning more every day, as they hang out and pace around our group meetings. I don't know if they're learning anything, really, but they look really pensive. I'm convinced that pretty soon, they are going to have their MPH's too! Thankfully, they have not stolen any computers. Yet.
The vervet monkeys, which sometimes fall prey to baboons, were fed treats by students from Spring Semester and now they invade our kitchen and occasionally steal snacks. They may look cute, but we have aptly named the invaders all "Dennis" (the Menace). Dennis likes sugar and peanut butter, which makes me think that we would get along, if only he'd get his own and stop stealing ours.
3. Simba means lion.
Simba very quickly made it into my Swahili vocabulary, under the mental category dedicated to "Survival" - thought that would make you happy, Mom and Dad.
4. At any moment, you can come across a whole family of ...anything.
And you and your camera had better be ready! My experiences outside of our safari have thankfully involved only giraffe and zebra, and it was entirely worth it both times to have carried around my giant camera all day for some up close and unexpected shots.
I think that's all so far. While there are many things about home that I'll welcome whole-heartedly, I'm certainly going to miss waking up to baboon fights in the middle of the night.
There were two instances that hammered home this lesson. Last night, a grasshopper hopped its way onto the couch outside the chumba and it was actually the length of my index finger. In a moment of squeamishness, I moved to the other end of the couch and did not bother it. In one jump, it then landed on my leg before quickly launching itself to the next destination.
After that encounter, a smaller termite landed on me. This was more frightening, despite the smaller size, because these bugs are more aggressive and just plain wreckless. It was about the size of my thumb and looked like a worm with wings. Having seen them divebomb some unsuspecting classmates a few nights ago, I quickly swatted it off of me and stomped on it, which was aggressive on my part. As it crunched under me, I felt as though I had stomped on a baby bird. Good thing the askaris did not see this - they eat the termites, which are considered a post-wet season delicacy.
2. Monkeys are smart ...and domesticate-able.
The baboons are learning more every day, as they hang out and pace around our group meetings. I don't know if they're learning anything, really, but they look really pensive. I'm convinced that pretty soon, they are going to have their MPH's too! Thankfully, they have not stolen any computers. Yet.
The vervet monkeys, which sometimes fall prey to baboons, were fed treats by students from Spring Semester and now they invade our kitchen and occasionally steal snacks. They may look cute, but we have aptly named the invaders all "Dennis" (the Menace). Dennis likes sugar and peanut butter, which makes me think that we would get along, if only he'd get his own and stop stealing ours.
3. Simba means lion.
Simba very quickly made it into my Swahili vocabulary, under the mental category dedicated to "Survival" - thought that would make you happy, Mom and Dad.
4. At any moment, you can come across a whole family of ...anything.
And you and your camera had better be ready! My experiences outside of our safari have thankfully involved only giraffe and zebra, and it was entirely worth it both times to have carried around my giant camera all day for some up close and unexpected shots.
I think that's all so far. While there are many things about home that I'll welcome whole-heartedly, I'm certainly going to miss waking up to baboon fights in the middle of the night.
Sunday, June 17, 2012
Kenya: It's (Not) All about Data
I feel as though I have blinked and a week has gone by.
This was the week when being perpetually dirty, sleeping under a bug net, and responding to the dinner bell like Pavlov's dog all became as normal as life at home. I have had a few dreams about shopping malls and grocery stores that wake me up in a panic. Being in rural Kenya and so far away from all of that over-availability and (relative to here) incredible wealth definitely makes it seem eons away. But, that will probably be the topic of an entirely separate blog post.
For now, it's all about data.
This past week we spent a lot of time "in the field." This means, as I alluded to previously, that we split into randomly assigned partners and traveled around all day with our translators and any guides who picked us up along the way to find mamas with children less than five to answer the questions in our survey. They were our target audience because here, women are the primary users of the health care system and caretakers of children, who fall sick quite often. We have an eleven page survey that takes about forty minutes to complete, including translating and back translating questions and answers. There are lots of check boxes and "why's" and some rather intrusive questions about, ahem, waste facilities (or lack thereof).
Nonetheless, we were welcomed to their finest seats and benches, ogled by the children who shamelessly crawled all over us, offered cups of chai we had to find creative ways to graciously turn down, and some of us were even given homemade jewelry by women particularly happy with our efforts. And at some point, the check boxes became secondary.
By that I don't mean that we have been working less hard. Quite the opposite. I mean, similar to the shift I've felt in this life becoming more normal than when I first arrived, we have all felt a shift from importance of checking off the right box to improving conditions for people here. Throughout this week, it became less about decreasing the country's rate of mortality among children and more about making sure that little girl we saw, delirious with malaria, gets what she needs to feel better and go to school. It became more about and making sure that the pregnant mother goes to her antenatal visits to keep herself healthy and less about decreasing the maternal mortality rate.
So, I guess really, it's not all about data. It's about people.
This was the week when being perpetually dirty, sleeping under a bug net, and responding to the dinner bell like Pavlov's dog all became as normal as life at home. I have had a few dreams about shopping malls and grocery stores that wake me up in a panic. Being in rural Kenya and so far away from all of that over-availability and (relative to here) incredible wealth definitely makes it seem eons away. But, that will probably be the topic of an entirely separate blog post.
For now, it's all about data.
This past week we spent a lot of time "in the field." This means, as I alluded to previously, that we split into randomly assigned partners and traveled around all day with our translators and any guides who picked us up along the way to find mamas with children less than five to answer the questions in our survey. They were our target audience because here, women are the primary users of the health care system and caretakers of children, who fall sick quite often. We have an eleven page survey that takes about forty minutes to complete, including translating and back translating questions and answers. There are lots of check boxes and "why's" and some rather intrusive questions about, ahem, waste facilities (or lack thereof).
Nonetheless, we were welcomed to their finest seats and benches, ogled by the children who shamelessly crawled all over us, offered cups of chai we had to find creative ways to graciously turn down, and some of us were even given homemade jewelry by women particularly happy with our efforts. And at some point, the check boxes became secondary.
By that I don't mean that we have been working less hard. Quite the opposite. I mean, similar to the shift I've felt in this life becoming more normal than when I first arrived, we have all felt a shift from importance of checking off the right box to improving conditions for people here. Throughout this week, it became less about decreasing the country's rate of mortality among children and more about making sure that little girl we saw, delirious with malaria, gets what she needs to feel better and go to school. It became more about and making sure that the pregnant mother goes to her antenatal visits to keep herself healthy and less about decreasing the maternal mortality rate.
So, I guess really, it's not all about data. It's about people.
Monday, June 11, 2012
Kenya: Our Mission
I have been getting lots of questions about what I'm doing when not roasting goats and writing letters to my bednet, so I thought I'd give a bit of an overview of the project we're doing. Get ready folks, you might be just as tired at the end of reading it as I am living it.
So, I didn't actually know what this project would entail until we got here and started to work on it. As it turns out, we are not working strictly on increasing access to safe water. Kenya's Ministry of Health (MOH) has implemented sort of a grassroots healthcare system called Community Health Strategy (CHS) in order to meet the Millenium Development Goals - which they are quite far from achieving at the moment. Many of them relate back to having clean water, which was the vague description we all received before arriving, so I imagine that's why it was framed that way. For instance, malaria is really prevalent here and so are anti-malarial drugs BUT you can't expect someone to recover from malaria, even with medication, if they don't have clean water to cook with and drink.
Anyway, we are collaborating with the Kenyan MOH to analyze the CHS by interviewing people at almost every level of the structure they've set up - district leaders, health clinic nurses, both paid and volunteer health workers and the people in the communities. The idea is to see where the disconnects are in the system to see why health outcomes are still so poor in Kenya, which has a life expectancy of 51. So far, we've interviewed all of the managers, nurses and paid health workers, which was relatively easy since they all spoke English.
Today, we trained our translators and we head out into the field with them on tomorrow to begin surveying the community, who do not speak English and may not even speak Kiswahili. Just to give you an idea of what this entails, there will be a lot of walking through places that even the Land Rovers have trouble going, sitting in the sun, making quite the fashion statement in long skirts and hikers, sweating, helping them with their chores so they do not give up on the survey halfway through to feed the chickens or something, and hopefully at least a little bonding and NO lion sightings.
In addition to interviewing the community members, we also must interview people as they leave the health clinic about their level of satisfaction with the care they receive. This will be especially challenging since no one ever says anything is bad - everyone always answers "Mzuri" which means good. (Sort of like answering "Fine" when you mean that it's exactly not fine.) We also have to interview the volunteer health workers, which is going to pose its own challenge since our translators are all their bosses, so honesty will probably be scarce at best.
The whole point of this is to get the Kenya MOH and their CHS program more in line with the culture of these communities because ultimately, the solution needs to be built around them. Otherwise, it is going to work about as well as it does now, which, I hope you've gathered by now, is not good. Hopefully we can manage to at least start to do this - get the people of Kenya a more sustainable and culturally reasonable approach to their healthcare - through our final report, written after the data collection this week and analysis next week.
We present this final report to the community on June 30 and fly out on July 2... which seems both extremely close and extremely far away. Wish us luck!
Friday, June 8, 2012
Kenya: Photo Opp
I've taken many photos since arriving, but this is one of my favorites.
Here, we're out in the field looking at a "furrow" or canal built for water to travel more efficiently from one town to another, losing less of it into the dirt along the way and allowing more to be used for watering crops, or cooking/drinking consumption. I keep forgetting that furrows are the only way that water travels from one community to another, and there aren't also underground pipes.
One of the craziest parts is that this furrow was built in the last ten years with a large grant that one of our professors, in the white coat, received. Before this was built, there was just a dirt canal that the water had carved out itself.
Here, we're out in the field looking at a "furrow" or canal built for water to travel more efficiently from one town to another, losing less of it into the dirt along the way and allowing more to be used for watering crops, or cooking/drinking consumption. I keep forgetting that furrows are the only way that water travels from one community to another, and there aren't also underground pipes.
One of the craziest parts is that this furrow was built in the last ten years with a large grant that one of our professors, in the white coat, received. Before this was built, there was just a dirt canal that the water had carved out itself.
And yes, that's Kili in the background.
Wednesday, June 6, 2012
Kenya: Goat Roast
Yesterday, we roasted a goat. Apparently it's a bit of a tradition here. This entry probably shouldn't be read by vegetarians, or anyone who does not like to know where their food comes from... or anyone trying to eat and read an interesting blog. That's your warning.
Historically, the Maasai, which is the ethnic group surrounding our Kilimanjaro Bush Camp home, were pastoralists, making their living by herding animals and either killing the animal for food when they needed to, or selling or trading it for goods they did not have. The government and other outside influences have been trying to privatize the land, parcel it up, and force these people into agriculture. It seems to be working - their houses are more permanent structures and they now grow many vegetables in the region. This is causing a whole bunch of new health issues in the population associated with an increasingly sedentary lifestyle, but that's a whole different blog entry.
Back to the pastoral lifestyle - many of them are trying to maintain this, including some of our eskaris (Swahili for "insanely good security guard"). Some of them are Maasai and still herd animals as well as protect us from the various wildlife making quite the ruckus outside right now. Today, one of them graciously gave one of his goats to the camp for this festivity.
Before I sound too celebratory about this, I will fully admit that watching the goat happily chomp on some grass on the march in was sad, and I was queasy watching the eskaris actually kill it. BUT as a former vegetarian and informed meat-eater, I strongly believe that we all should know where our meat comes from. The majority of the world eats it, but is so far removed from the actual process of taking the life of an animal that we often forget how our beautifully packaged, perfect cuts of meat get to the supermarket.
It is deeply humbling to directly witness the loss of life for your benefit. As upsetting as watching the slaughter was, I find it more upsetting to know that the goats on most farms in the United States would not have been allowed to eat that grass, or whatever it wanted to eat, and run free in the way this goat did during its life. A goat raised in the US also would not have been used as completely as this animal was - everything not consumed was saved for the family of the eskari, who already had plans for all of the fur, organs, hooves, and so forth.
It was a total blast from the past, to be part of the slaughter and then eat it two hours later. While I was a little grossed out, I'm here for new experiences (as well as helping people get more drinking water).
...So, for the record: goat is quite chewy.
Historically, the Maasai, which is the ethnic group surrounding our Kilimanjaro Bush Camp home, were pastoralists, making their living by herding animals and either killing the animal for food when they needed to, or selling or trading it for goods they did not have. The government and other outside influences have been trying to privatize the land, parcel it up, and force these people into agriculture. It seems to be working - their houses are more permanent structures and they now grow many vegetables in the region. This is causing a whole bunch of new health issues in the population associated with an increasingly sedentary lifestyle, but that's a whole different blog entry.
Back to the pastoral lifestyle - many of them are trying to maintain this, including some of our eskaris (Swahili for "insanely good security guard"). Some of them are Maasai and still herd animals as well as protect us from the various wildlife making quite the ruckus outside right now. Today, one of them graciously gave one of his goats to the camp for this festivity.
Before I sound too celebratory about this, I will fully admit that watching the goat happily chomp on some grass on the march in was sad, and I was queasy watching the eskaris actually kill it. BUT as a former vegetarian and informed meat-eater, I strongly believe that we all should know where our meat comes from. The majority of the world eats it, but is so far removed from the actual process of taking the life of an animal that we often forget how our beautifully packaged, perfect cuts of meat get to the supermarket.
It is deeply humbling to directly witness the loss of life for your benefit. As upsetting as watching the slaughter was, I find it more upsetting to know that the goats on most farms in the United States would not have been allowed to eat that grass, or whatever it wanted to eat, and run free in the way this goat did during its life. A goat raised in the US also would not have been used as completely as this animal was - everything not consumed was saved for the family of the eskari, who already had plans for all of the fur, organs, hooves, and so forth.
It was a total blast from the past, to be part of the slaughter and then eat it two hours later. While I was a little grossed out, I'm here for new experiences (as well as helping people get more drinking water).
...So, for the record: goat is quite chewy.
Monday, June 4, 2012
Kenya: Dear Bednet...
Dear Bednet,
Holy cow. We have already been together for a week! We have become so close so fast. I must admit the first night I thought you were coming on a bit too strong, draping yourself all over my bed and me. However, since that first overbearing, albeit magical, night, I think we have established some more sustainable boundaries. You have tucked so nicely in around my mattress to prevent any unwanted visitors from crawling up the bedposts and invading my slumber. This also gives me a bit more room to move around without you - I really appreciate the space. It has made us a much better pair.
Now, I appreciate how you billow in the wind instead of being aware of your every movement.
Today, I caught you protecting my bed from a giant moth, and at least two mosquitoes (though there were probably more malaria machines lurking all around). But, because of you, I know I am safe from them. Aside from draping over the bed, which makes me feel "princess-like", you also chivalrously protect my space. I look forward to many more bugs being rejected from Slumber Palace under your vigilant watch.
Asante Sana,
Jackie
Holy cow. We have already been together for a week! We have become so close so fast. I must admit the first night I thought you were coming on a bit too strong, draping yourself all over my bed and me. However, since that first overbearing, albeit magical, night, I think we have established some more sustainable boundaries. You have tucked so nicely in around my mattress to prevent any unwanted visitors from crawling up the bedposts and invading my slumber. This also gives me a bit more room to move around without you - I really appreciate the space. It has made us a much better pair.
Now, I appreciate how you billow in the wind instead of being aware of your every movement.
Today, I caught you protecting my bed from a giant moth, and at least two mosquitoes (though there were probably more malaria machines lurking all around). But, because of you, I know I am safe from them. Aside from draping over the bed, which makes me feel "princess-like", you also chivalrously protect my space. I look forward to many more bugs being rejected from Slumber Palace under your vigilant watch.
Asante Sana,
Jackie
Friday, June 1, 2012
Kenya: Getting Real
Carrying water is a luxury. Just think about that for a moment.
At the market we stopped at before arriving here, I was offered anything in this man's shop in exchange for my water bottle. I told him I was here for many weeks and needed it, but he said to come back to his shop on my way home and we would barter. This was my first conversation with any Kenyan natives, and though I found it interesting that he'd noticed my water bottle given our purpose here, I didn't really think about it more than the excitement of choosing anything in his cool shop and putting my negotiation skills to work.
Since arriving, I have been asked for a drink from my water bottle by many small children. They yell at us through the fence protecting us from various wildlife and follow us around yelling "Mwanafunzi!" (Student) and "Mzungu!" (White person) or ask for, in perfect English, "Sweet! Sweet!" and our watches and pretty much anything else that we have and take for granted. But the only thing I have been asked for by these tiny, adorable wide-eyed children is a drink of water or my water bottle. And it's heartbreaking to say no.
The idea that carrying water is a luxury is entirely new. People everywhere in Boston and here have side pockets in their backpacks specifically for carrying a water bottle or insulated mug for coffee or tea or anything else they want. We are concerned with them fitting in such sidepockets or the cupholders in our cars or if the plastic contains BPA or even if they are the color that we wanted.
Here, they have backpacks but I haven't seen anyone with a water bottle. It's one of the many blatant signs that we're not from around here.
This could be for any number of reasons - none are for sale, none are available to the merchants, or there isn't really a clean source of water worth carrying with you... or something else entirely. I don't really know. What I do know is this: when I'm thirsty after walking around in this sun for a few hours, my water bottle is one of my favorite things.
Even after having my eyes opened to the fact that carrying water is a luxury, I don't think I will ever fully understand how fortunate I am to have this luxury, mostly since it's likely that I'll continue to be able to access and carry clean water. But I think I understand, maybe just a little bit, more how important this work is.
At the market we stopped at before arriving here, I was offered anything in this man's shop in exchange for my water bottle. I told him I was here for many weeks and needed it, but he said to come back to his shop on my way home and we would barter. This was my first conversation with any Kenyan natives, and though I found it interesting that he'd noticed my water bottle given our purpose here, I didn't really think about it more than the excitement of choosing anything in his cool shop and putting my negotiation skills to work.
Since arriving, I have been asked for a drink from my water bottle by many small children. They yell at us through the fence protecting us from various wildlife and follow us around yelling "Mwanafunzi!" (Student) and "Mzungu!" (White person) or ask for, in perfect English, "Sweet! Sweet!" and our watches and pretty much anything else that we have and take for granted. But the only thing I have been asked for by these tiny, adorable wide-eyed children is a drink of water or my water bottle. And it's heartbreaking to say no.
The idea that carrying water is a luxury is entirely new. People everywhere in Boston and here have side pockets in their backpacks specifically for carrying a water bottle or insulated mug for coffee or tea or anything else they want. We are concerned with them fitting in such sidepockets or the cupholders in our cars or if the plastic contains BPA or even if they are the color that we wanted.
Here, they have backpacks but I haven't seen anyone with a water bottle. It's one of the many blatant signs that we're not from around here.
This could be for any number of reasons - none are for sale, none are available to the merchants, or there isn't really a clean source of water worth carrying with you... or something else entirely. I don't really know. What I do know is this: when I'm thirsty after walking around in this sun for a few hours, my water bottle is one of my favorite things.
Even after having my eyes opened to the fact that carrying water is a luxury, I don't think I will ever fully understand how fortunate I am to have this luxury, mostly since it's likely that I'll continue to be able to access and carry clean water. But I think I understand, maybe just a little bit, more how important this work is.
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