 Stalls inside Kisumu's Kiyube Market Luo word of the week: Nyongo. Nyongo means early morning, the time a little bit after the sun rises. It’s a nickname I’ve been called by people on the street when I’m walking to the market a couple of times. I still haven’t figured out why, but assume it has to do with me being new to Kisumu, my skin color, or the often confused or lost look on my face. I’m going to ask my coworkers- it’ll make a good laugh. This week I had the opportunity to spend time in the field and explore more of Kisumu. The last three weeks I’ve been working in the office on a concept note to bring PMTCT (Prevention of Mother to Child Transmission) of HIV to a grassroots level in the Kisumu District. HIV is a big problem in theregion, women are 3 times more likely to contract HIV here than any other place in Kenya. This YouTube video gives some insight on why HIV is more prevalent, or in the words of Professor Phil Murphy and his dark network, a “wicked problem.” Warning: This is a brutally-honest, scientifically-based video- there are some tough scenes. Please click "read more" for more pictures and the rest of the blog. Babies born to HIV+ women often die within 18 months of birth. Many people don’t visit clinic where they can receive free testing and care for HIV. It’s difficult for women to leave home for a day. Their trip includes leaving their children unattended, leaving field work that provides sustenance and income, not preparing meals for their family, and going on a 5 mile+ walk in 100F. Furthermore, they will be going to be tested and given drugs for something they don’t want to know about: a disease that will likely lead them to being ostracized from their community, maybe even kicked out of their home, and eventually kill them, leaving their children orphaned. OGRA’s concept note proposes an innovate way of getting women and their children the support they need, at their home (Level 1), while reducing the stigma of HIV. As a reward for completing the concept note on Monday, I was able to spend Tuesday with George- a Driver, Peter- the HIV Field Officer, and Steve - the HIV and AIDS Director. We visited 4 government clinics, and I received a tour of two of the clinics. Clinics are considered Level 2 care in Kenya’s public health system. Clinics are the first place people go when they are sick, they are where babies and children receive immunizations, women go to give birth and people can go to be tested and receive free ARVs for HIV. Unfortunately, for a number of reasons, Kenya is not able to properly provide its health facilities with the resources it needs to care for its people. Kenya signed an agreement with all of the other African nations, stating that 15% of their national budget would go to public health each year. Like all other African nations, Kenya has never met this goal. This year Kenya invested 7% of its budget into healthcare, the highest percentage ever. There are many vicious cycles in Kenya’s health care system, one of them is staffing. In Kenya, doctors, nurses, and health care workers are notoriously underpaid (most do not even receive a living-wage), which leads to a lack of doctors, nurses, and healthcare workers, which leads to overworked doctors, nurses, and healthcare workers, which leads to burnout, which leads to understaffed clinics and hospitals, which leads to overworked doctors, nurses, and health care workers. There are also issues related to insufficient electricity (no refrigeration, no electronic record keeping), toilet facilities (a giant hole behind the clinic), equipment (syringes, saline packs, all plastic tubing, stained and ratty towels – everything is sterilized and reused) and access to testing and drugs. Because of this, Kenya relies on NGOs (Non-Governmental Organizations a.k.a. Non-Profits) like OGRA, to fill the gaps that Kenya is unable to cover at this time. Where there is a lack in resources, there is an abundance of passion. The people I met that work in these facilities are energized, smart, strategic, thoughtful, generous, and gentle. The most interesting case they spoke of at the staff meeting I attended was about a 3 year old boy with HIV. The young man’s parents had been diligent in assuring he was taking his ARVs, and were regularly taking him to the clinic for check-ups. A few weeks ago a tumor was discovered on his palette. The clinic does not have the ability to test the tumor for cancer, and the parents do not have $300, plus travel expenses to take their son to the hospital to get the test. The staff worked together to share their knowledge of the patient, HIV, cancer, and basic health to find a solution. A staff-member had seen a case similar to this in the past, and they were able to clear-up the tumor by changing the patient’s ARVs. After some discussion and consensus, this is what the staff decided to do. If changing the drugs did not help clear the tumor within the next 2-3 weeks, they would discuss other alternatives, get advice, and work with the family to find the money they needed to get the test for the young man. Kenya has a high infant mortality rate as well as a high number of women that die during childbirth. This is a huge development issue, if your children and women are dying or spending their entire lives sick, you don’t have the workforce you need to pull your country out of poverty. Kenya recognizes this problem, and as a result, government-sponsored clinics offer a variety of free services. All children under 5 and all school-going children receive basic health services for free, all services for pregnant women, including childbirth is free, all HIV testing and ARV drugs are free, all immunizations are free. Unfortunately, Kenya still needs to figure out a more effective delivery system. There are many people who have never visited a clinic for these free services. The highlight of the day in the field involved a 10 year-old skinny Luo boy skipping-school and screwing-around on the side of the road. George, a 6’2”, 250lb, muscular, dark, mean-looking man spotted the boy, pulled the car over, and spent the next 3 minutes telling the boy off, that he needed to stop screwing-around, and get to school. (This was all in Luo, and was translated to me a few minutes later.) Then, the little boy, shaking in his shoes, took off in the direction of the school. I’m sure George told him he was going to check and make sure he was in class on his way back. George has a heart of gold. There are rumors that he has a secret army of street boys that fear him, adore him, and will do anything for him. I’m glad George likes me, and hasn’t caught me skipping work. Friday night I decided to be bold, and head to a 9:00pm, Indian, 750ksh ($8.00) all-you-can-eat buffet, at the Simba Club in Kisumu. It was worth it. I called a motorcycle taxi I have made friends with, Benson, to pick me up at 8:30. Simba Club is a Sikh-owned grass-hockey club in Kisumu. The Simba Club has a history of being the best grass-hockey team in Kenya, and has won many international titles. I’m not sure how they started the evening buffet, open to the public, but I am glad they have. Going alone was a little intimidating, so the moment I saw some mzungu girls that looked my age, I introduced myself and asked if I could join them for dinner. We became fast friends. Maggie and Megan are graduate students from George Washington University, working on degrees in Public Health, and are attached at the hip. They are spending the semester at Great Lakes University. Vanessa is a doctorate student from Australia, spending her final semester in Kisumu, working at the local hospital. We had a great time learning about each other and exploring the buffet- which included ice cream! (I haven’t had ice cream since arriving in Africa.) Saturday, I had the opportunity to explore parts of town I was too timid to visit on my own when I first arrived. (Thank you Dr. Mike, for thoroughly freaking me out when I arrived to Kisumu.) I began at the Kisumu Kiyube Market, a large green building filled with row after colorful row of wheat colored sacks filled with earthy-brown, golden-yellow, and grass-green beans, giant striped watermelon and morning-sun colored gourds, piles of fresh cilantro, and giant kale leaves, being shredded into tiny green ribbons with machete’s by women dressed in colorful fabrics, sitting on upside-down buckets. I may never go to the Nakumatt, the local grocery store, ever again. Next to the market, there are stands that carry tilapia, a delicious local fish. I have wanted to buy and learn to make tilapia. Walking through the fish stalls was an experience. Laid out onto sheets on the ground were sardines drying in the sun, above them on makeshift tables were stacks and stacks of descaled and smoked tilapia, and behind those tables were another row of tables stacked with fresh slimy tilapia – everything was covered in flies and smelled like dead fish. I couldn’t do it. I am an American, not use the sights and smells associated with what is required to eat meat. Maybe I’ll try again, in a couple of weeks, after I’ve decided to try eating intestine with ugali again. After visiting the market and fish stalls, I learned that fabric in Kenya is just as inexpensive as tailors in Kenya. I have probably begun what is likely to become a dangerous habit. Outside of the market there is a row of stalls rich in colorful fabrics. I wanted everything, but controlled myself and purchased 3 yards of fabric printed in brown, blue and green for 300ksh (about $3.50.) From there, I headed to a tailor recommended to me by Maggie and Megan the night before. The tailors are located next to one of my favorite restaurants in Kisumu, The Green Garden. The tailors and I hit it off immediately, they were honest, straightforward, and I felt comfortable with them. They recommended 2 other fabric shops close to their store, and gave good advice on how to select good fabric. For a total of 1000ksh ($12.00-including all fabric), I am getting a custom-made A-line skirt, with lining. I know this is going to be the beginning of a beautiful friendship. I want some tops, dresses, and have been eyeing the beautiful suits women wear around town that include a pencil skirt with a little flair. Thanks for reading my blog! I look forward to sharing my adventures with you next week! One of which will include the presenting and developing a Powercube to OGRA, at tool used to analyze, strategize and understand organizational power-dynamics. |  A village women talking to a clinician at a clinic  A clinician  Steve, the OGRA Foundation HIV Field Officer  Serena at a clinic (sweaty and dirty, again)  List of prices at a rural government clinic (1ksh=$1.20)  One of the government clinics, the clinic is on the left, the maternity ward is in the center (under construction), the brand new, soon to be opened HIV clinic is on the right, and a random water tank in the middle.  Sugar-can fields, the Kisumu District cash-crop  a herd of cattle, roaming the fields  Kiyube Market  Stalls at Kiyube Market  Kiyube tomato stall  Stalls outside of Kiyube Market  Sacks of grain in Kisumu |
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