July 3, 2010

We have arrived in Nairobi, Kenya!

Last night, Stephanie and I arrived safely in Nairobi, Kenya. Although we had about 22 hours of travel time, it seemed to go by very quickly, perhaps because I was excited and quite nervous. Once we arrived in Nairobi, we went through customs and to baggage claim. Unfortunately my luggage did not arrive; I do hope however that it will today! When we went out to where people wait for those arriving, Dr. Mull (our advisor) was there waiting. It was such a great feeling to arrive somewhere unknown and see a familiar face.

Just a little bit of what I have noticed thus far: the people here are incredibly kind and welcoming. Almost everyone you pass by smiles or says some sort of hello; even when you are about to get into a taxi you are told to come in with an expressive “Welcome!” (“Karibu” in Swahili). I have also noticed that at least in Nairobi, there is an incredibly diverse population. I am interested to see what it will be like in Shirati. Additionally, I have noticed that I personally would not be able to drive here  for quite a few reasons. For one thing there are paved roads, but no lines demarcating any lanes. Also, the driver is on the opposite side of the road than in America-I kept telling Stephanie how strange this was for me to see!

I feel truly blessed and honored to have this opportunity and to be here right now. I truly want to thank the Institute for Global Health as well as my friends and family for their support and encouragement and for helping make this a reality.

July 5, 2010

Today we drove from Nairobi, Kenya to Shirati, Tanzania which is about a 500km drive. As we began to leave the Mennonite Guest House where we were staying, the city of Nairobi began to drastically change. Where we were staying was a suburb that I could tell had a lot more wealth concentrated in it. However, as we began to drive into the heart of the city, I noticed the immense amount of poverty that existed. I saw children walking with no shoes on, women walking what seemed like incredibly far distances while balancing basins of water on their heads, houses made from recycled materials, buildings that appeared to be falling apart, and mud huts with branched rooftops. Despite the poverty however, children waved at us “foreigners” with huge smiles on their faces. Some children were playing soccer (seems to be a sport that transcends all borders), some pointed at us while calling out “mzungu” which apparently means “white person.” A whole bus of children waved at the van filled with us Americans and they all just kept saying “jambo” or “mambo,”which are different ways of saying hello.

As we were driving on a paved road, we looked onto the surreal-rolling green hills that appeared to go on infinitely. Guess what we saw? GIRAFFES! We saw some yesterday, but this time they were unbelievably close and it was truly a magical experience to just see giraffes in the middle of our drive. I also learned that speed bumps in Africa are known as “sleeping policemen” because you have no choice but to slow down. Isn’t that such a funny name?! 

Once we reached the Kenyan-Tanzanian border, we had to get off the vans and walk across. It was so interesting to see people with chickens and cows just walking across the border on what seemed like an incredibly natural walk. We walked up to an immigration office and showed them our passports and had to get a Tanzanian visa. Our vans met us eventually, after being inspected and then we continued on our way to Shirati. Shortly after, the towns we were passing began to once again change. The roads transitioned into being dirt rather than paved, the homes transitioned into being huts rather than brick.

All of a sudden as we were driving we saw a huge crowd of people on the side of the road and heard very loud cries. Our driver stopped and found out that a woman in her 20s had been run over and died, but the one who ran her over had run away. It was very sad to see everyone in the village mourning. Our driver said that this was very common and that when someone dies even those who do not know the person will mourn.

We then reached Shirati-my home for the next 5 weeks.

July 6-7, 2010

Tuesday morning was our first morning waking up in Shirati- a village riddled with beautiful rolling hills, green pastures, and a view of Lake Victoria. Stephanie and I met our translators who were very kind. They led us to a subvillage called Yakina. We went to what is known as the subvillage office and met the chairperson and secretary of Yakina. Apparently villages are split up into subvillages and each one appoints their own chairperson and secretary who oversee the area and are the one’s you come to for advice or for help. Our translators had to ask for the chairperson and secretary’s permission for Steph and I to survey there. After being given permission, we went to on our first home visit to do a practice run-through of our survey. It was amazing and so surreal that this was actually all happening. A study that Steph and I designed was actually becoming a reality-we were in Africa-we were actually doing what we had spent months planning.

On Wednesday, I woke up to the sound of roosters cooing, wolves howling, and leaves bristling. Not to mention Africa totally has the most beautiful sunsets and sunrises. Stephanie and I got ready for our first day of formal surveying. We prepped the surveys, stuffed a few mosquito nets and hammers in our bags to help set up the nets, and picked up our translated informed consent. Then we were off for our first day. I wish I could tell you everything I saw and experienced today. I heard stories and saw things that I am sure will stay with me for a lifetime.

It was very interesting to see the politics of the village and to see how everything works. The chairperson and secretary actually continually tried to follow us to people’s homes as we surveyed. Our translator told us that most likely they wanted to tell the people of the subvillage that they cared about them and that is why Steph and I were bringing mosquito nets to Yakina. Something very interesting happened while we were sitting in the subvillage office- a woman came in and was raising her voice at the chairperson. Our translator told us that she was explaining to the chairperson that her brother-in-law had beat her, and that she needed a letter from him in order to go to the police. The chairperson said he wanted to speak to her husband and he also had put a stamp of approval on the letter but the stamp was not working, so the woman was telling the chairperson that he did not care about her. This made me see how the village actually works-how the people do in fact need to go through the subvillage leaders first before taking any action.

As I went from house to house to survey, go through our educational protocol and help families set up the net(s) we gave them-I was truly taken aback. I could not believe how many families said they had lost someone to malaria and how all of them felt this was a very serious and prevalent issue. I was amazed at how many families did not have enough nets for all the children in the household. I was also amazed by how willing everyone was to answering the survey questions and then letting me and my translator into their home to see their nets (if they had any) and to help set up new nets (if they needed any). I felt so honored and humbled to be allowed in and to be received with such a welcome.

July 8-9, 2010

Steph and I continued our home visits and continued to be amazed by the warmth and welcoming nature of the people in Shirati. Families were so thankful for a simple mosquito net. Through our surveys and home visits we realized that the government programs that are meant to address the extensive malaria problem, have actually done quite a good job. Many families are very much aware of what malaria is and how it is contracted. Many families at least in Yakina do in fact have nets, but many do not have enough for everyone in the household.

On our walk back from surveying, my translator Enock took me to the primary school here in Shirati so I could see it. I was truly amazed. There were about 60 desks crammed into one classroom and the only other thing in the room was a chalkboard. I could not believe that one teacher would teach so many students. Enock said that students have to fight for desks and those who don’t get one have to just sit on the floor. I started asking Enock questions about the education system here and about his experiences. He told me that there are public and private secondary schools. The public schools cost about 70,000 shillings per year and the private schools are about a million shillings per year. Enock actually went to a public secondary school, but he said that the students were revolting saying that they needed more supplies and that the teachers were not coming to teach everyday. The students therefore decided to burn down the school, so Enock had to transfer to another school. I asked him if this was common and he said it kind of was. This made me very sad and pensive about what could be done to remedy the inequities in the education system. As Steph and I were surveying, most people told us that they had only gone through primary school, which goes up to about when you are 12 years old-which makes sense since whether you go to a public or private secondary school you have to pay a fee. Part of our survey also asks about daily income and many are making less than a dollar per day which means less than 1400 shillings-so of course paying for a son or daughter’s education may not even be an option for many families. Despite the dire situation many families find themselves in however, Enock said there is a shift towards educating children longer and making ends meet so they can indeed pursue higher education. I am so proud of Enock-he is headed to college in November and I am really excited for him-I am certain that he is going to go very far and accomplish amazing things!

July 10, 2010

Today Steph and I met with the malaria director in this region. He was a very nice man and gave us some very good insight. Steph and I were curious as to whether there are any villages or subvillages nearby where most families do not have any nets at all. The director did tell us about one that is about 10km away. Steph and I are planning to maybe go there next week and perhaps give one net to every family that has a child under 1 year of age. We are still trying to figure everything out so I will keep you updated 

July 11, 2010

Today we woke up at 6am and headed off to an island that we were told was “uninhabited.” We all hopped on the boat and began our journey. It was truly beautiful. The lake was glistening as the sun was rising and in the distance we could see isolated formations of land. Once we got closer to the island we began to tease Dr. Esther Kawira (the only doctor who lives in Shirati and who has been hosting us 🙂 about how this island was definitely not uninhabited. As we came to shore, there were many people just staring at us and pointing-saying something in Luo I believe. I couldn’t help but wonder what they were saying. I could only imagine how strange it must have felt for them for a boat of about 20 Americans to land on their island. We got off the boat and hiked a bit-It was truly breathtaking. The mountains were literally covered in white because of all the birds that the island was home to. There were cows, goats, chickens, the biggest ants I have ever seen, and these funky little pesky things they called “lake flies.” After our beautiful hike to a vista point we walked back to the boat and had lunch as we headed back. Ok, so maybe I cannot say I have been to an “uninhabited” island, BUT I can say that I have been to a “slightly inhabited” island in Africa 

July 12, 2010

Today was incredibly difficult. In the morning Steph and I went with Evelyn (a PA for USC) and Margot (a nurse for USC) to Zappe Kindergarten. It was just a few minutes from our hostel. We passed out pencils, stickers, and other things to the kiddos who were absolutely adorable. They then sang a song for us and said “Asante!” (thank you) to us. We then spent a few hours just playing with them- teaching them how to play with the frisbees we past out and throwing the beach balls around  It was a lot of fun, but also heartbreaking to see how little the school had. Two students had to share a desk and all there was in the classroom was a chalkboard and the teacher said they needed chalk. We met a cute little boy named Babu-he was very lively and kept saying “how are you?” I suppose he heard us saying that and was emulating us. So cute!

Steph and I then headed off to continue our home visits and surveys. The first home that Steph went to belonged to a woman who was about 90 years old (she wasn’t quite sure of her age). She said that she took care of her grandson because the little boy’s dad had died and the mother had run away. Steph said the house was falling apart and the grandmother and grandson slept on scraps of different recycled materials. The grandmother mentioned that she had just come back from the market, so Pili (our translator) asked what she had bought and the grandmother responded saying she had gone there to beg. All she had for her grandson to eat was cabbage and oranges. As Steph was surveying this grandmother and hearing her story, the little boy Babu who we had met at the kindergarten ran in. He changed out of his uniform and into clothing that was riddled with holes and tears. You hear stories like these but it becomes so much more real when you actually hear, see, and experience them firsthand. Steph and I knew that he wanted to do something about this. We talked to Josiah (he is Doctor Esther Kawira’s husband) and he gave us a lot of insight on what our different options are. He said that Steph and I could help pay for this child to attend primary and secondary school. In addition, we could help sponsor a family member of this little boy’s who would be willing to take care of him since we don’t know how much longer his grandmother will live. Steph and I are still trying to figure this all out, but he were just very touched by this little boy and his grandmother.

We also met a little boy who cannot speak and did not seem to understand us or our translator when spoken to. It was incredibly heartbreaking because we saw him locked up, alone, without clothing in a dark room. The door was locked from the outside so the little boy could not get out, and there seemed to be no food or toys anywhere. He uttered sounds but we couldn’t make out what he was saying. We later talked to Dr. Kawira about this experience and she said that most likely his mother has no other option but to keep him locked up for his own safety. She said that Africa does not really have facilities for children like this, at least not in this region. This completely broke our hearts and was so disconcerting because we knew that the United States is filled with facilities to help children like Juney.

In the late afternoon, Steph and I went to the market with our translator Enock to buy some food for Babu and his grandmother as well as for Juney . The market was such a wild experience-it happens every Monday. There are crowds and crowds of people, a plethora of different smells, colored fabric, fresh fruit and vegetables, bustling sounds of people bargaining and trying to make sales. We brought the food back to Babu and Juney.

I think today just really opened my eyes to some of the very dire realities in Africa. I have seen a lot of poverty and suffering, but what I saw today was even more drastic. One thing I do know though is that this nation is filled with strong, resilient, and amazing people.

July 17, 2010

This week was one to remember, but then again every day I have spent in Africa has been!

On Friday, July 16, Steph and I went out to a village called Roche. It is about a 45 minute drive from Shirati. We went with 3 architects/engineers from the United States. They are working with an organization called “Village Life” building a health clinic. Their project is truly amazing! They believe in sustainability and in training/involving locals- that way they personally invest into the making of the new health clinic. This health clinic is being built in a high-need area-it is 2 km from the Kenyan border and there is no clinic 20 km north or south of this area. Many people therefore either do not seek medical care when needed or walk outrageous distances to the “nearest” clinic. As we pulled up to the worksite I could not believe what I saw. I saw brick walls that were 3 times my height and I saw local “Roche-ans” working hard. As we got off the car everyone clapped for us and then I received the warmest welcome I have probably ever received. A line of people came up to us and shook our hands, asked for our names, asked how we were and welcomed us. Steph and I then got straight to work-we were eager to help out in any way we could. It was quite fun-neither one of us had much construction experience but we did what we could. We drew measurement marks on all the walls to help with Saturday’s work of adding in gravel. We then were given these massive hammers and told to crush the bricks that were broken so they could be used as gravel. Steph and I were surrounded by about 10 men who were just laughing and talking in Swahili or Luo-I wish I knew what they were saying  We had a lot of fun slamming down the hammers as hard as we could in the blistering sun. Steph and I then had the amazing opportunity of going to a “water sanitation meeting.” We followed our friend Bryant, who is a master’s student in environmental engineering, into a sunlit living room with chickens running around in it. Shortly after our arrival 7 men from Roche walked in and took a seat-these men were all part of what they called the “clean water committee.” It was an amazing, productive, and interesting meeting. Bryant was explaining to the committee the water system for the new clinic and addressed any questions that they had. The committee told us that out of the more than 1000 families that live in Roche, only 54 have slow sand filters to disinfect water, and that as a result many community members will want to fetch water from the well that will serve the new clinic. Bryant explained to them that this is definitely a possibility, but they would need to figure out a way to limit the amount of water community members get so the water suffices. I have always heard of communities where water is scarce, where people have to walk for various kilometers to find water, and where drinking the available water led to ailment-but this meeting made the stories I have heard come to life.

On Saturday, July 17, Steph and I went out for our first day of evaluation. It went so well. We returned to the first 7 houses Steph went to during baseline. It was so neat because our hypothesis was totally validated. Those who were part of the experimental group and had received education from us, could recall most if not all of what we had taught them. Those who were part of the control group did not know much of the vital information about mosquito net use and maintenance. We spent time giving them the educational component and making sure they understood the importance of using a net everyday and how to properly use it. It was amazing to go into a home that we had given the education to and seeing them using the net perfectly and seeing our pictorial instruction sheet hanging in their home. Everyone was incredibly sweet and welcoming, many offered food to Steph and I. At one of the houses we visited, it was hard to say “no thank you” because they took out a wooden table and 4 mugs for me, Steph, Enock, and the father of the family. They filled our mugs with chai tea and took out a plate of fresh pumpkin. It was delicious and fun to just stop and “break bread” with this family. They were so incredibly hospitable-the minute my mug was empty they insisted on serving me more 

Today, Sunday July 18, I had the opportunity to go to a church in Shirati. It was so celebratory and everyone was so welcoming. There was a lot of singing and dancing. Now I am writing from our common room in the hostel. It just rained for a few minutes-it was truly enchanting to just look outside and see the raindrops hitting the countless trees.

I apologize for how long this all is and also for posting all these entries at once. Internet here is not very accessible. I hope you are all doing extremely well!