Safari Village

Sept 29, 2012

Determined to create a social life outside of work (although I enjoy that social life as well), and interested in discovering the tiny ex-pat community in Mbita, I ventured out to Safari Village today and found beautiful little get-away and a few lovely wazungu’s (white people) who live in the area. Sigh.

I enjoy having Kenyan friends – that is why I came out here after all – but I also know from my time in Tanzania, that it can be quite nice to have a few wazungu friends. I understand why immigrants from a particular place tend to find each other, creating their own this social spider web, which may be more or less integrated into the surrounding community. There are just certain things that we have in common, that makes the conversation a little easier, that makes for a fun travelling buddy, that validates the thoughts you struggle with but have difficulty expressing in a cross-cultural situation.

Don’t get me wrong, I think that struggling through those conversations and developing those cross-cultural relationships is important, but sometimes you just need mapumziko (a break) and someone who gets you. So I’m glad I found a little place that I can go when I need that little break.

Friday Night in a Tin Hallway

Sept 28, 2012

My first Friday night in Mbita and I’m going out! I didn’t think I would find anywhere to go out dancing in this little one lane town, but I had my feelers out for the social scene – however small it might be. Somehow I managed to find a German girl and two Kenyan guys who work at the insect research center here who were also looking for a night out.

We walk down the one lane towards the sound of African music. I start things off on the right foot by stepping directly into a giant cow pie. Lovely. After a bit of shuffling to remove my pie, we enter the “club”: a dark little hall constructed of tin sheeting, lit up with colorful plastic chairs and coca-cola sponsored plastic tables, complete with a stage and small dance floor. Live music fills the tin hall. As usual, the drummer is the coolest band member, banging out a rockin’ rhythm on a big plastic box. Young fishermen sip their sodas and beers, a few brave souls venture onto the dance floor… soon limbs are flying this way and that, the floor filling up with men dancing with each other*.

My new friends and I join in the fray, spinning each other to help block the advances of a few more assertive dancers. The music soon takes over my body and I lose any sense except the sense of movement. I love to dance. It just makes me feel completely free. But I really love to dance in Africa. I should say it’s the music, the beats, the open air… but if I’m being completely honest, it’s the freedom that comes with already being labeled as different. I am totally free to move however the music moves me because I can chalk up my weird dance moves (I said I loved dancing, I never said I was any good at it!) to being a foreigner. No one has to know the truth that the weird moves are uniquely mine! So it’s just me and the music.

*Note: Unlike in the U.S., straight men in East Africa frequently hold hands and dance with each other. You’re “not allowed” to be gay here (it may even be illegal) and it would be extremely dangerous to come out as gay, so there is no question in people’s minds about why two men are dancing with each other. Also, it’s mostly the men who go out dancing, so if they didn’t dance with each other, they’d usually be dancing all alone!

"Resting"

Suba I absolutely lovely, but… what do people do here for fun? On the weekends? When you finish working? As the weekend approaches, I’ve been asking everyone this question. The unanimous response: we rest.

Rest by doing what? Do you go swimming? Hiking? Dancing? I already know the answer, but I don’t want to believe it yet. We finish our housework (the cleaning seems endless) and then we sit around and watch TV if we have one or watch the day slip away.

Sigh. I suppose I should learn how to “rest”. But honestly, I just can’t. I’m scoping out the ‘town’ trying to figure out how to entertain myself so that I don’t go through my entire stock of books in my first few weeks here. Could I join a fishing crew? Learn how to sail a dhow? Brave the hippos and go for a swim (people seem to think this is crazy)? Get someone to teach me how to ride a motorcycle? Figure out how to make yogurt?

I need a project, a hobby of some sort – something other than just work (because I’m not supposed to be a workaholic this year and because there is only so much work that can be done – I just need to wait on stuff!). I’m sure I’ll find things to busy myself with, but it’s going to take some action on my part – totally different than San Francisco where “stuff to do” simply falls into your lap. And perhaps I will practice “resting”.

House Hunting Turned Bathing Expedition

After a small detour to grab a bag of french fries for a late lunch, we made our way back home. I set off in search of a place to stay for the next several months. I’ve got lodging for a week, then I’m hoping to find a more permanent place of my own. So I went to check out the kind of place that one of my co-workers, Sabina, lives in. She’s in a complex of cement houses that share a faucet and a latrine. She has a one room place with a bed on one side and all her kitchen stuff on another side. It’s pretty clean and really isn’t so bad. I could totally do this – kindda like a studio in NYC. Just a few things are missing.

“Running water? Haha. This is Suba. I don’t think you’ll find that here. And it’s hard to find housing here. Hmmm…”

I can’t tell you how many times I’ve heard this in the last week. So I figured I better learn how it’s done without running water. In a nutshell, it’s both horrible and glorious.

I’m not going to lie and try to be tough and whatnot. I’m just going to call it like it is. The pit latrine is gross. Plain and simple. G-R-O-S-S. During the day, I think I could handle it, but there is no way I’d creep in there after dark (or so I say now). As Sabina put it, “You train your bowels to go during the day and mostly at work.” Yup, I’d agree with that.

And then there is the shower situation. Well, bathing, really. Most people go down to the lake and bathe in the lake. (The men and women have separate areas.) This was actually pretty nice. The weather is beautiful, the lake water is cool but not cold, and I’ve been assured that “the hippos and crocodiles are not dangerous”. Uh-huh. So what is an American woman to do after running around getting sweaty and dirty all day? I suppose I have to join. Naturally, my fluorescent white skin draws a fair bit of laughter and a few extra women and children to the lakeside, but I can’t complain because I’m laughing my head off and having a ball trying to teach one of the women how to swim. It’s also kindda difficult to give a swim lesson when you are afraid to touch the student to help hold them up because they are in nothing but their birthday suit. I eventually grab one of the buckets used for washing dishes and try to show her how to use that as a floatation device, which seems to work… until she loses a flip flop. Then while we are trying to find the flip flop in the murky brown water, the bucket sinks and then we have to find the bucket. Who knew that bathing could be such a big job!?!?

I like it here. The lake is beautiful. The people are friendly. The work is both challenging and worthwhile. What more could I ask for? Oh… just some sawdust and ash for that pit latrine.

Kitare Health Center

After an introduction to Sindo, we piled into the back of the FACES vehicle to head to Kitare, one of the CCSP peripheral sites. A few detours to drop off lab results at other facilities and 4.5 hours after we left this morning, we arrived at Kitare where our day’s activities began. Unfortunately all the people who were originally trained to do the cervical cancer screening have been transferred to other facilities. So instead of supervising and mentoring the staff, we pulled out a box of back up supplies and did the screenings ourselves. We saw eight patients in a few hours. Most were nervous about the exam, but also curious to know more about cervical cancer and grateful for the screening service. We just need to figure out how to make the screening available all day everyday, not just when the supervising staff can come out once a month! Screening at this site was going great initially and then just dropped off entirely because of lack of trained staff. Just one example of how difficult it is to build a sustainable program. We’ll get there though.

Sindo Hospital

I finally made it out to Suba where my project is based. I am working with the Cervical Cancer Screening and Prevention (CCSP) team in Suba and Mbita for the next seven months and today was Day #1. I got a grand tour of Sindo Hospital which is actually an impressively large facility. There is a section with HIV services, maternity ward, peds, men & women’s inpatient wards, etc. It reminded me of Huruma Hospital in Rombo, Tanzania. That was the hospital where I fell in love with medicine and with Africa about six years ago. The blue and white walls, the benches of people waiting to be seen, the beautiful surrounding landscape… the set-up is exactly the same and the feel of this place brings back happy memories.

By tuktuk, matatu, dhow, and motorcycle...

September 24, 2012

By tuktuk, matatu, dhow, and motorcycle, I made my way to Suba today.

Definitions:

Tuktuk:  a 3-wheeled golfcart that lets in a nice breeze as you zip around town, trying to avoid bikes and pedestrians

Matatu: a van usually carrying about 20 cramped people

Dhow: a wood boat holding a dozen people, powered by wind or by motor

Motorcycle: you should know this one; also the main form of transportation in Suba

My journey started out alright. I boarded a tuktuk with all my luggage and headed to the bus stand where I said I wanted to go to Luanda. All seemed to be going well until an hour into the ride they say, “here’s Luanda!”. Um… no. Luanda is supposed to be a 3 hour ride away and is supposed to be on Lake Victoria. Yes, I’m sure because I’m now supposed to get on a ferry. That’s Lwanda? Seriously? Lwanda, not Luanda. Lovely. So how do I get to Lwanda? Go back to where I started, eh? Alright, I guess I won’t be catching the 3pm ferry anymore. The 6 o’clock ferry it is! Sigh.

I had about 7 minutes of being frustrated by wasted time and bus fare, the fact that I’d be getting in around dark, the idea of cramming myself and my bags into another matatu (my legs are just  starting to regain feeling in them), etc. But after about 7 minutes, I took a deep breath and remembered that this is just part of travelling, part of living in Africa, part of life.  I remind myself that a bit more patience could probably do me some good. And this really ain’t so bad.

And as I’m trying to remind myself to take a chill pill, I look around and see a young man walking next to me. He’s probably my age but looks like he can’t weigh more than 90 pounds. His bright pink pants have seen better days, his feet are encased in something that at one point probably resembled shoes, and his shirt has become a mottled brown of dirt and sweat. He’s got a suitcase in each hand and stoops forward, balancing a giant sack of grain on his back. My extra few hours sitting in a matatu (reading a good book no less!) seems leisurely. The two big bags crushing my legs seem like due punishment for having so much stuff.

An hour or so later, I’m escorted off my matatu and transferred to my fourth matatu of the day. I climb in next to a friendly older gentleman. When he eventually gets off, I notice he’s wearing rubber knee pads made out of car tires and it takes me a second to realize that he can’t walk – he skoots around on his hands and knees. Polio? Cerebral palsy? I’m not sure. I’m reminded though of how common it is to see people here with obvious disabilities somehow surviving with makeshift adaptations. Wheelchairs don’t maneuver very well in Africa so people find other ways – some create modified wheelchair-tricycles, some swing on crutches, and some skoot on hands and knees. As this friendly older gentleman skoots off the road, I take a moment to try to take it all in – the sadness of suffering, the injustice of unequal access to services, the awe of human resiliency. And I’m only halfway through my transport methods!

I eventually find my way to Lwanda and sure enough I’ve missed the 3pm ferry. However, I’m convinced to board a small wooden dhow for our one hour ride on Lake Victoria to Mbita. I attempt to tie my lifevest in such a way that it won’t just fall off the minute I’m thrown into the water and laugh as the captain tries to cover us all with giant plastic sheets to protect us from the splashing waves. This is glorious – the cool wind whipping my hair into a giant tangle, the water gently spraying my face, the expansive lake stretching out in front of us, feeling like I’m in Tanzania, Kenya, Uganda, Rwanda, and DRC all at the same time by sailing out into this lake. I’m just going to soak this in.

Because my transportation device is the dreaded pikipiki (motorcycle)… Somehow this guy manages to get me and my two large bags onto the back of his motorcycle – an impressive feat in my opinion. Fortunately, this leg of the journey only lasts a couple kilometers and then I arrive at ICIPE – the insect research center!

Phew. Made it. Just 7 hours and 4 modes of transportation later. I better not want to leave anytime soon.

"You are not a woman."

Sept 21, 2012

Language reflects the ideas, attitudes, and priorities of a culture. From our very first words, our mindsets start to be shaped by the language around us. Yet we are often completely oblivious to this.  How can you recognize that an idea is unique to your culture or absent from your culture if you have no way words to identify the idea? Until you have to translate something…

Part of the complexity of global health research is of course the multitude of languages. It’s part fun, part frustrating, and occasionally enlightening. I spent the last several days going over consent forms, survey questions, and patient education materials with some Kenyan colleagues.  Everything needs to be in English, Kiswahili, and Dholuo. Here are a few highlights:

1.     “god” – I don’t understand. What are you saying? Good? Oh, you mean God with a capital G. No one would recognize what ‘god’ means.

2.     “woman” – Well, what do you mean by “woman”? You can only be a woman after you are married and have had a child. For example, we wouldn’t consider you a woman. No, you are definitely not a woman.

3.     “sex worker” –  This is a hard question to ask. There are so many different types of sex workers. Some women have exchanged sex for money, but they are not sex workers and they would be offended to be called a prostitute. Some women will tell you they are a sex worker – like a confession.

4.     “relationship status” – There is no way to say this. There is only a translation for “marital status”. You are single or married. That’s it.

5.     “cervix” – Again, there is no word of cervix. We can only describe it as the “neck of the womb” or the “door of the bag that holds birth”.

Settling In

So I just want to give a brief, general update. I’m great. Really, that’s all I need to say.

For those who want a slightly longer version… I have been meeting a ton of the Family AIDS Care and Education Services (FACES) staff over the last three days and they are all wonderful people. Everyday I’m figuring out about how the system currently operates and am making plans for how I’m going to become integrated into that system and hopefully help the team take some steps forward in the coming months. I’m enjoying eating ugali, beans, and spinach with my hands at lunch and bantering with mamas at the market. When my room key got stuck in the lock today, I got a kick out of trying to take the entire handle off the door with my guard and roommate, using a bottle of WD40 and a foot-long kitchen knife (as the screwdriver). I then enjoyed a delicious Indian dinner overlooking Lake Victoria, the sunset fading into the lillypads and being replaced by a bright moon.

I am sure that the coming months will bring its ups and its downs, but I’m settling in. It’s strange, but I feel oddly at home here. I’m in a different country, different city, different work environment than the last time I was in East Africa, but there is so much that feels the same. I guess in a way East Africa is where I grew into being an adult. I came here right after undergrad. It was the first place I ever rented a house and set up an electric bill. It was the first place I ever went to work every morning and hung out with friends in the evenings. It was where I learned how to cook, how to hail a taxi, how to network, how to scrub my socks until they were (off-)white. It’s where I learned how to be an adult. So I suppose it makes sense that I feel comfortable, happy really – even when I’m batting flies away from my plate of ugali or searching for a bathroom with toilet paper. I’m really glad to be here.

First Day Back on the Job

So I finally made it out to Kisumu and had my first day of work. The range of emotions is slightly overwhelming. Much of what I am experiencing is very familiar – cramming into a van for a long bumpy ride over dirt roads… reaching through the bus window to buy a cob of grilled maize that gives your jaw a workout… fending off aggressive taxi drivers… eavesdropping on people who think I don’t understand Swahili… haggling in the market for tomatoes and beans… climbing into bed underneath a mosquito net.

But that familiarity also includes confronting sorrow, hardship, even tragedy head-on, over and over again. My heart screamed out with every new patient. Beautiful young women, frail old men, some looking healthy, others looking beaten down and in pain. All waiting patiently for hours to get their HIV medications and the chance to see a nurse or doctor briefly. The services at this clinic are fantastic by Kenyan standards and people travel here from very far to access these services. But it is still so far from what they need to live happy healthy lives. Although the nurses are some of the kindest I’ve seen in East Africa, there is still little patient privacy, cleanliness is still wanting, and space is very tight.

Every new woman who came into the exam room ripped at my heart and it took everything in me not to cry for their lives. I know that we have problems in the U.S. , that there are people suffering in every city in America, and that lack of access to care results in much unnecessary suffering and death in my home country. But I’m sorry, it just doesn’t compare. I think of the most severe pain and despair that I’ve ever felt and just know that so many of these people are bearing more than I can ever imagine. I have no fancy words to describe it. It breaks my heart. It just breaks my heart.

Integration for Impact Conference (Sept 15, 2012)

There is so much going on in global health research! I won’t get into all the details of what I learned at the conference in Nairobi this week. In general, it was about the growing effort to integrate reproductive health and HIV services, providing multiple services to patients at one place, at one visit. The project that I’m working on is doing this – we are trying to integrate cervical cancer screening services and HIV care. The number of projects trying to evaluate and then expand this idea of integrated services is really impressive and inspiring. Coming together with people from all over Africa (and the world) who are doing a range of work on this topic was so cool! I felt like I could become (and I suppose I already am becoming) a part of this global health community. I’m sure I’m idealizing it to a certain extent, but the intelligence, energy, and true compassion that I saw in the people who I listened to got me totally jazzed for jumping into my work in western Kenya!  I can’t wait!

Luxury (Sept 15, 2012)

So my return to East Africa has started off with a bit of luxurious living. I’m starting off the trip at the New Safari Hotel in Nairobi, a fancy conference center with an exquisite network of swimming pools, beautiful landscaping, fancy rooms, yummy food, etc. (Please note I’m staying here for a conference, not just for kicks.) One night we had waiters dance around the tables with giant spits of meat that they shaved onto our sizzling cast iron plates – at least 20 different types of meat were sliced onto my plate with enormous kitchen knives right in front of me! Then a group of at least 20 dancers bounced on stage to give a wild performance that combined some impressive acrobatics/dancing with sexy leopard print outfits that invoked thoughts of Victoria Secret and a stereotypical ‘western’ image of wild African peoples.  (Hmmm… not sure how to feel about that performance.)

After the conference, we went to Sopa Lodge at Lake Naivasha and experienced even more luxury. At the lodge, antelope, impala, dik dik, hartbeast, even giraffes gently grazed in the ‘backyard’, literally 10-20 yards away from where we walked. A dozen hippos took over the lawn at night and we were instructed not to walk from our rooms to the dining room without an armed escort. The restaurant was filled with ridiculous amounts of amazing food and desserts. I suppose this is what many people experience when they visit East Africa. It’s just so different than what I think of when I think of East Africa. I have to admit I enjoyed it – how could you not enjoy a fancy hotel room in a beautiful place, with delicious food and exotic animals? But it’s difficult to fully enjoy this kind of luxury when you know that the people who live in this country will never have the opportunity to experience what I as a visitor can. It will be good to get to Suba and get down to work.

The Hope of Africa (Sept 11, 2012)

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Africa has so many problems – poverty, HIV, poor education, corruption, war – why would you want to go there? Because I have hope.  And I have hope because of people like Joseph, Kerubino, and Lino.

I met Joseph, Kerubino, and Lino in January 2007 in Pokot, a remote area in the Rift Valley. The story of how I met them is a long one that some of you may remember me writing about. It was during the last Kenyan elections – the election that erupted in violence and once again put Africa in the news for it’s display of political instability. But the short story is that they became my friends and they are a story of recovery.  I had the good fortune of seeing Joseph and Kerubino again this week, five years after our friendship began.

Joseph, Kerubino, and Lino were Sudanese refugees living in Pokot. They did not know how old they were, but guessed that they were in their mid-twenties.  They did not know what had happened to any of their family. They were a little trio living in an extremely remote part of Kenya. They shared a small house with each other and one January they shared ugali (maize meal) with a young American woman who also found her way to Pokot.

Joseph, Kerubino, and Lino are students. Joseph is currently working towards a diploma in Business, with aspirations of then completing a degree program in Business. Kerubino is double-majoring in Community Development and Peace & Conflict. Lino studied economics through secondary school and then returned to Sudan when he failed to find a sponsor for university.

Joseph, Kerubino, and Lino are the hope of South Sudan.  It doesn’t take long to figure these guys out. They want nothing more than to return to Sudan with the skills to help rebuild their country. Just this past January (2012), South Sudan gained its independence from the north, after over five decades of struggle and conflict. The country is young. The current president describes South Sudan as a baby that needs to be nurtured. And just as the infant mortality rate in Africa is dangerously high, so is the collapse of new governments. A little unrest… a coup… a power vacuum… a cycle of political instability. I’m no political scientist, but it’s not too hard to see that pattern playing out over and over in several African states. It makes you scared, makes you cynical, makes you lose hope…

But then you meet Joseph, Kerubino, and Lino, the future leaders of South Sudan… and you see the glimmer. You see three young men burning with an intensity, with a singular focus: to become educated to the highest possible degree and then return home to develop their country to the highest possible potential. You can hear it in their voices and see it in their deep dark faces. They speak of bridging gaps between ethnic groups, of developing the economy, of living peacefully with families. And you just have to believe in them. You just know that they will do it. You just see them and see hope.

Introducing Nairobi (Sept 10, 2012)

Introducing: Nakumatt Junction, your American-size grocery store carrying all the worldly goods you can think. Want cheese? Got that. Tupperware? A non-stick frying pan? Check, check. Electronics? Yup. Camera, smartphone, Lindt & Toblerone? Honey, we carry it all. And it’s all nested away inside a giant mall, complete with a food court, movie theater (with like 12 different movies playing!), casino, bakery, clothing shops, and more.

I’m slightly overwhelmed. Not because this is unfamiliar – I mean, I did just arrive from the U.S. today, but because this is unfamiliar to me in Africa. Nairobi – probably the biggest city in Eastern Africa – is like a miniature New York City. I swear, you could find almost anything here. For a price, certainly, but you can get it. It’s not entirely NYC though – it’s NY with an African flair. You pass a trendy shop displaying clothes and bags made from kikoi fabric… the food court offers chicken n’ chips with passion fruit juice. It has the familiar hints of Africa and the familiar hints of America, but somehow seems so foreign to me. It’s Afro-metropolitan.

Introducing: a traffic jam, brought to you by your friendly Nairobi bus driver! Traffic is something I am quite familiar with, having grown up in Los Angeles. However, the traffic in LA pales in comparison to the traffic here. I will just give you two numbers: 10 & 3. The first is the number of miles I had to go. The second is the number of hours it took. Yes, in retrospect, I should have walked.

But them I never would have made a new friend. I sat down next to an older British gentleman who had been living in Nairobi and working on project development for the last ten years. We meandered into a discussion on wind energy. I was of course very excited about the prospects of wind energy in East Africa. In fact, I was in the middle of a book about a young boy from Malawi who, after being forced to drop out of school because he couldn’t afford school fees, poured through books at the library and eventually figured out how to build a windmill out of scraps that he fished out of the junkyard and lit up his house and eventually his entire village!  (check it out: The Boy Who Harnessed the Wind) But alas, my new friend informed me that the renewable energy industry was not the shiny pot of gold that I dreamed it to be in Africa. The bottom line: no one wants to pay for it. Investors just aren’t willing to harness the wind – he has a friend who has been trying unsuccessfully for five years to get a wind farm going just North of Nairobi. Sigh. Sounds reminiscent of my research into recycling plastic bottles in Tanzania several years ago. I’m holding out hope for green development though! “So where is the money?”, I ask. Construction. And raw minerals. Hm. I liked the windmill.

Travelling

One lost Nalgene, a 12 hour delay in London, and 36 hours after leaving Los Angeles, I arrived in Nairobi where I proceeded to wait two hours for a visa, only to end up sitting in traffic for another two hours on my way to the hostel. I made it. 9AM. Now I must keep myself awake so that I can sleep tonight. Here goes....