When in Kenya...

This post has been written over the course of the last couple of weeks. It is meant to summarize the first week’s work (and has for the most part), but thoughts from throughout have crept in where appropriate. There is still plenty swirling around in my head (The second and third weeks will be coming as well as my account of the piki piki and matatu rides, our trip to Naiteri [when I didn’t have time to post or even write this], and other aspects of life here), but I apologize for the somewhat non-linear (chronologically speaking) style this has afforded me. I continue…

[With a quick interjection. If you are interested in Mo’s account of the experiences, go here. If you would be interested in a completely contrasting viewpoint of Kenya (i.e. the city life) and education, go to my girlfriend’s postings here and here.]

At Mama Anne’s, our diet has consisted of ugali (the staple food of Kenya [it’s what makes them strong we’re told]), chapo (chapatti), rice, meat (small amounts), sukume weke (like beet greens), grim grams (small beans), and Kenyan chai (tea) (boil water, add milk to boil, tea leaves and sugar). It seems that each night Mama brings out more and more food. Soon, she will be preparing a feast. For mornings, we have had fresh made scones (more biscuits, really) and also fresh made pancakes (called so because they are small cakes made in a pan [from flour, baking powder, sugar, egg, and milk mixed and dropped from a spoon]). She has also prepared homemade chips. The diet consists of the sukume, ugali, grim grams, meat every night and a rotation of the rice, chapo, and chips. I have found that the diet lacks much substance, since usually the ugali and other carbs and starches are most filling. (Several times, I have found myself digging into my supply of Clif bars and trail mix to keep myself going through the day.)

Also at Mama’s are four of her grandchildren, Nick, Lionel, Ian, and Eugene. Nick is quiet but not afraid to roughhouse and be the center of attention. Lionel is also quiet, but more reserved. When a Frisbee and ball were pulled out, he was the one who kept interest and was content simply tossing back and forth. When I went in for tea, he watched form the porch through the open window and gave a happy, thankful, knowing, friendship-type of smile (that I returned naturally) when I looked back form the table. (He might be my favorite. Though…). Ian is a ball of curiosity and energy. He’s always spouting off a stream of Kiswahili even though we will not understand. He’s always asking for a picha (thankfully, close enough sounding to and actually meaning picture. Though, he’s usually making for the mfuko [pocket] it’s in as to leave no doubt.) or to climb up our backs, and he’s constantly checking our pockets to see if there is anything else (Mama Anne relates that he’s the same with her, except asking “Wapi uko wazungu?” [Where are the white boys? Essentially]). He’s a handful at times but funny, nonetheless. I was unable to communicate well enough to get Eugene’s name until today (Saturday), but he’s the youngest and tends to try and join in the fun the older ones are having. His endearing story comes when we were playing with the ball and Frisbee. He lost interest quickly and began playing with the leaves instead. Soon, he comes up with some round bark with two strands of leaves each. Thinking they are gifts for me and Mo, I graciously accept my offering and turn to catch the Frisbee. I turn back and find that I was meant to receive it as a fine platter of African foliage! He’s vigorously munching on his strands of leaves! Despite the language barrier at times (we have resorted to simple Kiswahili and English [though, this is usually Ian and Nick saying in the deepest voice possible, “I am Pata! I am good!” to which I reply, “I am Nick! I am Ian!” in similar fashion.] or even just making faces at each other.), we have managed to communicate and have fun.

So far, Mo has worked primarily on the ABD program survey while I have jumped between that (Tuesday and Thursday) and visiting the sponsored OVC’s (Wednesday). Monday, after our arrival, Simon came to get the 60 pound bag of donations with his boda boda and showed us the way to the dispensary. This day was used to meet everyone at the SOTENI dispensary, Flo (one of the nurses), Japheth (a doctor), Issac (the lab tech), Victor (accounts), Dennis (in the computer room), Jane (cleaning staff), and Mttaki (the Local Management Committee (LMC) Chairman), and plan for the next weeks activities. During the course of the day, we also met a number of the ABD’s (in total there are six with an additional supervisor), Henry, Carol, Paul, Josephine, Catherine, Elicah, and Esther (the supervisor). Catherine, who we met the day before, walked us to Mama Anne’s for lunch via one of the number of shortcuts (I’ve come to be wary when I hear this word being used. It doesn’t always entail the smoothest ride on a piki piki).

On the way back, we took another shortcut that conveniently went past several of Catherine’s relatives (I felt a little like I was being shown off), but when we returned, Simon took us to the field where the new dispensary is planned to be built (we didn’t know this until we arrived). Each room began to take shape, the courtyard formed in place, each section took on a look of its own as Simon slowly turned, describing each new features that would accompany the building (and his grander scheme for when things really took off [cybers and places to eat]) The look that settled on his face, as we imagined the building’s completion, was a proud look, a look of what it would mean to him and (more importantly for him) a look of what it would mean to the community when they all could be better served.

How should I begin to describe Simon? First, his many titles. From Monday to Saturday (we’ve noticed the Kenyan calendars start on Monday), he is the SVH-Mbakalo Coordinator, the treasurer for World Vision (chaired by Mttaki, works to sponsor and monitor the 1000+ OVC’s in the area), helps with the water project, runs the dispensary, and is the facilitator for the seven sponsored SOTENI OVC’s (all of which he is very proud of I could see him glow as he listed the ones he knew would make a public university [the system is set up so that the best students can attend the better and less expensive public universities after a two year period on the waiting list or pay more to go to a private university]). On Sunday, he is the pastor of a local Christian church. He is also a husband and a father (to three girls). Simon is a man of character. At lunch, during our visit to some of the farther OVC’s on Wednesday, he made the comment that, despite only knowing me for a short time (about a day and a half), he could tell that I am a man of integrity. Of him, I could easily say the same. He is a man that cares. When we were returning from the dispensary building site (just a well and the start of a latrine pit so far, btw), children from one of the homes told of how they had not eaten for two days. Simon gave the few coins he had in his pocket. On one of the legs of the journey to visit the OVC’s (which I will detail later), the driver of the matatu hesitated at one of the stops to allow a crowd and it’s ringleader to have a little fun at my expense, speaking in the mother toungue (as they put it), touching the hair on my head and chin, one man telling me that he was a college graduate and that my closest friends can be my worst enemies while raising his fists to his forehead as though the horns of the devil (I can only presume). I could sense Simon’s disappointment as he sat stonily next to me while the crowd and the passengers of the matatu cackled and laughed, and again as we pulled away, whispering in my ear, “Those are disturbed people.” An apology that it should happen, an apology that where he calls home could be in such a state.

Thankfully, this has been an isolated incident. Everyone we have met has either tried to invite us into their homes or welcomed us back as we were leaving. We have been told that Kenyans value visitors first and food second, so our presence is viewed as a blessing to the homes. On Friday, Esther has us over for lunch, and she brought plate after plate of food (this one did turn into a feast). First, was chicken and soup with chapo and ugali. Then she brought avocados. This was followed by chai and hard-boiled eggs (which were a very bright yellow, almost gold). Finally, she topped us off with a glass of fermented milk. It was chunky with a sour taste of yogurt (Not something I’d want again necessarily, but I could tell it was saved for special occasions and was not one to turn it down). It was an interesting experience because while we were being continually fed, Douglas, her husband, and the others (two ABD’s) had stopped eating. (It was also interesting because hens were running in and out of the house and jumping on the table with food.) We were their guests (and have been everyone’s it seems), so they were concerned about giving us the best (and in other cases, this entitles us to the best seats [or a chair if there aren’t enough], offers for bags to be carried, and reluctance to let us help. It has been difficult to turn down any form of hospitality even though we’d rather stand [or sit on the ground], or are perfectly capable of carrying a heavy load. [This also has meant that I have had more caffeine from tea and soda in the past week than I have had in the past few years.]) Even on the ABD home visits, some of the clients have provided us with dishes of food (or have expressed disappointment at not knowing we would be coming, so they could prepare). Every time we receive something, it makes me wonder how much they are sacrificing because we are guests (already well provided for guests at that).

So, finally, the ABD project. The seven members are remarkable. Esther and Henry double as night staff (nurses and also guard in Henry’s case) at the dispensary. Henry and Carol are HIV positive, which (they have said) helps them relate to the clients, having been in similar circumstances of desperation, and has made the project even more important for them (to be models, that living with HIV is possible). Each time the ABD’s meet with someone and discuss HIV/AIDS and the person then tests positive, that person is added as a client. The number of people they visit is now at 85 (granted, some are found in the same homes). This is for seven people and the roads can cover long distances over bad roads. Originally, each of the six ABD’s were supposed to cover 4-5 people, but, as Esther has stated multiple time, “How can we visit this person and recommend testing, then when they are positive, tell them no, tell them they are on their own, we can’t help? We can’t. It’s not right.”

To give a brief intro/background for the program, there are six ABD’s both in Mbakalo and Mituntu. Individually in a month, they are required to do twenty home visits, conduct two educational forums, and sell mosquito nets and various medicines (painkillers and deworming tablets) at half-price. They also work in pairs, so basically, double those numbers. The home visits consist of giving emotional/psycho-social support, answering questions, checking on health, assisting with the cleaning and treating of sores and other ailments (equivalent to first aid), giving referrals to local dispensaries, educating a caretaker in the family, and others. The educational forums are given at schools, barazas (town meetings), and other such affairs and cover what HIV/AIDS is, how it is spread, how to prevent spread, and the signs and symptoms. The program is relatively new (only a year, with phase II set to cover an additional seven months), but it has taken many strides in promoting awareness and encouraging the community to remove the stigma and openly discuss a once taboo issue.

To give a simple overview of the clientele, they are poor. They have little money for food (eating porridge or maybe ugali once or twice a day [or maybe something else if they can grow it themselves, but currently, it is the dry season, and they don’t have equipment to keep food from spoiling.]), transportation to Naiteri (location of the dispensary which provides ARV’s [anti-retrovirals] for free), clothes, school fees for children, etc. They have rare access to soap or even simply clean water (even boiling is difficult because they can’t afford fuel). Almost all of them wish the ABD’s visited more. Some of the clients are children (some more aware of their situation than others). Most of the clients are weak (sometimes too weak to consistently work). The ARV’s can be toxic and must be taken with food. Naiteri is supposed to provide nutritional support to people with a CD4+ t-cell (immune cells that HIV attacks. I can get more detailed if you would really like.) count that is below a certain level (and continue to do so until the count is above the level), but the person is either too far to walk (clients are weak and have no money) or the dispensary is out of stock (it’s a pack of nutritionally supplemented porridge that can last up to two weeks [depending on use]). The situation is desperate, and (as you can see) a bit cyclic.

Visiting the clients has been… an emotional… ride of sorts (reference anyone?). So far (this is as of writing last week. Next week will be in another post), I have been to eight homes. A farmer and his positive wife unable to comprehend why some people on ARVs look healthy and fit but she can’t eat some foods and has been weakened by the toxic effects. A mother in a dress of gold, set against her dark skin and pale red eyes, with two young children, alert, happy, oblivious, interested only in the strange visitors, set against the somber mood (her husband is also positive). Steven, 4 (maybe), excited to see Henry, running to greet the wazungu, but sensing the seriousness of the visit once inside, knowing only that he takes pills twice a day. A quiet man (positive) and his exuberant wife struggling with the condition but working to spread what knowledge they have learned to the community. Paris, a young child (8), locked out of her grandfather’s small, small hut, taken in by her aunt and uncle next door, with a baby sister to also look after and no fees for school (there is free tuition from the government, but additional fees get tacked on). A woman, eight months pregnant, too weak and too pregnant to work or travel well. A widow (positive and husband was also positive) needing to care for her paralyzed son (also positive, unknown cause of paralysis), whose only means of communication is through moans and tears, struggling to turn him or change the sheets, afraid to ask her other children for help because the son contracted the disease when nursing the father. Brian, another child, with 10+ brothers and sisters and a positive mother, a CD4+ count of 7 (extremely low [normal range is 800-1000]. He should be bedridden.), and no nutritional support from Naiteri and limited from home. Also, Mo has related his visit to a woman so affected by psychological problems, she brings her cows into her small two room hut to prevent theft and exposes herself and her children (possibly sleeping in the same room) to disease and filth. It’s difficult to enter these homes, to hear a paralyzed man begin crying, to see a child unaware, and have only questions.

But there is hope.

The ABD’s, simply by visiting the homes, caring for these people, removing the stigma of HIV/AIDS, have brought a new attitude for these victims. During the visits, the biggest things that everyone we have talked to has hoped for is a VCT (Voluntary Counseling and Testing) Center (supplies HIV tests and ARV’s) be located at the SOTENI dispensary. This is closer than Naiteri (I’m not sure by how much, but having riden through today [6/12], it seems to be considerable) and is also the only dispensary in the area operating twenty-four hours a day. Another factor is the treatment by the staff at the respective locations. SOTENI’s staff seems to be more sympathetic and understanding while Naiteri’s only concern is if you can pay (and even then, can still be detached and unfriendly [even harsh at times. Occasionally causing someone to default and stop taking their ARVs]). Obviously, everyone wishes that nutritional support be included in the visits, but it would be better if a sustainable means of income were produced. I think self-sufficiency is the last thing on some of the clients’ minds, however. I have attempted asking at various points when a client would feel comfortable reducing the number of visits by their ABD, but none have seemed to realize that this should be the real goal. There are a few other suggestions that may help maximize the care and reduce the stress for the ABD’s. Since some of the clients are close, it would be more effective, it would be more effective to have them join each other in one house to reduce the number of visits for multiple clients to just one (though, I saw today (6/9) a household with both husband and wife with each a separate ABD. I was told this was to bring new ideas [a fair assessment] and to allow the husband and wife to open up more [they are the caregivers for each other and were both there as I asked questions, so I’m slightly baffled]. So, for neighbors to be asked to have the same level of openness as a husband and wife may be a bit difficult to ask for these joint meeting. [Although, most of the clients are in similar support groups throughout the areas, so depending on what they cover there, this may not be an issue.]). The other thing that has been suggested is to create a support group for the children because they are left to themselves (being spread across the area) and (I would imagine) could find it difficult to relate to the adults in the current support groups (and also for the adults. I think they would baby them and thus diminish their voice and thoughts about a serious topic). Despite everything that still needs to be done, everyone has also said that the visits and care from the ABD’s has improved how they live, has improved how they even think about and approach life, has given them reassurance that they can make it.

As we were walking in the field (i.e. doing home visits) with Henry on our first day of work (6/2), Henry was describing to us how he viewed the program expanding. The previous night, after our day of planning with Simon, he walked us to back to Mama’s. Henry’s house was along the way, so naturally, he invited us in. (Yes, this felt a bit similar to the activities at lunch with Catherine, but the feeling was quickly removed as he very sincerely welcomed us. [“This is Henry’s home. Here, you are always welcome.”]) It is an interesting place. On one side of the door hangs an “Obama in, Bush out” poster (everyone here loves Obama. In fact, while in Ugenya, I may visit his grandmother). On the other side of the door hangs a “Rise and Fall of Saddam Hussein” poster. The reason for the latter was this, “I want my children to see that it is possible to come to great power and then to lose it very quickly.” As we departed his home and made the short trek to Mama’s, he was telling us about his experience discovering he was positive, his time of self-pitying, self-loathing, and desperation, and how the ABD program has helped him have a more optimistic, fulfilled outlook and to pass this view onto others. It was easy to tell how important this program was for him. So, as he was describing his grand scheme, it was apparent it was not just talk. “It starts as a Village of Hope,” he said. “Then, with time, it spreads and becomes a Nation of Hope. When people see you walking along the road, when you came into their homes, they have hope. They know that someone is out there that cares about them. You are Ambassadors of Hope.”

Wow.

Who am I to be given such a status? Who am I to have been taken (earlier in the day) to exchange words with the village elder (who oversees and makes decisions for his people)? Who am I to affect such change just by stepping off a bus? A 22-year old, recent college graduate is able to do that?

Wow. This one will take a little longer to settle in.

As I stated before, for every moment of despair, there is an equal moment of joy. (Ok. Maybe it was reversed.) As we have traveled between clients’ homes, we are greeted with cries of “How are you?!” (emphasis on a high pitched “you”) or shouts of “Mzungu!” If the lunch hour is upon us, we are followed by mobs of school children (As Mo has commented, we may as well be Obama. I am beginning to realize what it is like to be a celebrity. This happens everywhere we go. If they had cameras, I wouldn’t be surprised to be constantly blinded by flashes. In our case, we have been parceling out smiles and handshakes, but it also becomes a bit tiresome after a long day and as it is repeated again and again despite being given responses.) We are able to laugh and joke with the ABD’s and Esther (who has been accompanying us on the trips). If a boy is born to the pregnant client in a month (not today. Had to be there, but essentially, still a communication barrier in English as Mo has a Connecticut accent and tends to speak a bit quickly. We have now been invited to witness and help deliver a baby should the opportunity arise at the dispensary. This is despite our complete lack of interest to partake, let alone any training or knowledge as to what we would even begin to do. [Lamaze?]), he will be called “Patmo.” (I’m not kidding.) We have been able to laugh about anything and everything from mistaking “due date” with “today”, to Esther’s emphatic way of saying “Yeeeessss!” (“I’m coming!/We’re going!”), to pregnant women spitting a lot, there fore Mo must be pregnant (he’s a former baseball player in college, therefore spitting is a habit.)

Each day of the last week has been busy from the time we wake up (around 7 or 8) to the time we go to sleep (9 or 10). This does not mean that we necessarily start the day at those times, however. Generally, the base plan from Monday has been thrown out because we leave late (hours sometimes), so something that was supposed to take the morning actually lasts all day. (This hasn’t been a big issue for me. Go with the flow. Things will get done. [and volleyball and soccer have helped fill the voids] When in Kenya…) The other projects of the first week have been getting along well. The water project will be bringing wells and springs to the area to provide clean, protected water (as well as latrines and rainwater collection tanks). SVH-Mbakalo as a CBO (community based organization) is working with a supporting organization to lead the effort. (They have recently put of a tender for advertising and have chosen the contractors to perform the construction.) World Vision, working with Afia 2 (which is under SOTENI and is chaired by Mttaki), has been helping to sponsor 1000+ children (all OVC’s) in the Mbakalo area and provide for their most pressing needs (food, school clothing, home clothing, etc.). The women’s group met with a financial advisor/educator (who spoke mainly in Kiswahili because the older mamas only know that) to go over their project/proposals for which they will be receiving loans from SOTENI. We learned from Mama Anne that night (6/6) that is was very helpful for those who didn’t understand loan interest and business plans. Talking to the sponsored students has been difficult at best. They are shy (though, understandably so) and don’t always understand my accent, but they are good students and are involved in a number of activities (drama club, choir [both boys, actually], athletics [i.e. track], journal club, community service, etc.) and dream of being pilots, professors, and the like. On Friday (6/5) after our feast, we attended one of Henry’s forums at the Polytechnic next door (trade school [sewing, mechanics, masonry, etc.]) and saw essentially what I will be doing when I go to the secondary schools in the other SVH’s.

So far, the experience, in a word, has been surreal. It’s hard to believe that I have been traveling on bumpy dirt roads by foot or on the back of a motorbike, that I have been visiting homes in such desperate state (out of a commercial it seems. Flies everywhere. Chickens running through the house [sometimes jumping on beds and tables]. Small lizards crawling up the walls.), that during the downtime, I have been kicking around a soccer ball or playing a game of volleyball (with an invisible net) with some Africans (some of which include the Chairman and Vice-Chairman of the LMC). Kenya is not nearly as hot or dusty as I pictured it to be. Shorts and t-shirt are comfortable attire, and the landscape is green and hilly. And it’s full of life. Now, it’s bikes and motorcycles and people mingling with cows and sheep and goats (though the same traffic rules apply. Go with what works). A variety of birds and butterflies flit and flutter across the paths, dancing from maize leaf to tree branch to barbed wire fencing, as we walk from place to place. People are sitting outside their shops, working in their fields, talking to their companions (and usually staring at us as we walk by. I’ve found that confronting them [in a sense] by waving, smiling, and saying “Jambo” [Hello] usually gets a smile [and what smiles they have] and wave in response [for the most part]. I have so much more to describe, but since this has been some time in coming, I will stop it here, and leave you waiting until next time. Essentially, I have found that when in Kenya, do as the Kenyans do (occasionally, do as the Romans do). Overall, it’s been good. It’s been thought-provoking. It’s been different.

-Pat