Posted by: kasiawilk | December 8, 2010

Sliding into local life

 “Do you eat snails and lizards?” I look down at the white slug in a plastic bag that is being presented to me by a 4year old boy on the outskirts of Embu, as we continue along our walk with Bancy and her friends. The child smiles at me and has beautiful curious eyes. I reply a few broken fragmented sentences in Swahili and ask if I can take a photo of him and his siblings as they giggle and smile. I’m not sure if they understand me but they eagerly pose as I bring out my camera. I ask their names and after introducing myself and shaking their hands, they run off eagerly, happy to have had contact with a “muzungu”, and perhaps will have stories to tell now. These are just some of the many children we run into regularly whenever Ludan and I walk among the rural roads of small communities. Some children run and follow us quite some distance, just to have a look at these peculiar strangers. One boy ran quite some distance in front of us, only to then stand ahead and watch us as we approached him. I hope we don’t seem too strange to them, however I always smile whenever we get asked peculiar questions.

Today we are visiting rural Embu, with local friends who have been warmly sharing with us their neighbourhood homes and knowledge. We visit coffee plantations, and a coffee processing plant, as well as a forest full of banana trees, and a small waterfall. We attract the attention of locals who smile and wave, often saying “how are you?” to which we reply “mzuri sana!”

 The previous weekend we visited another part of Embu with Ros, and met lots of local children and had a chance to see the Embu slums. Based right beside the town centre, they create quite a visual contrast to the busy traffic and varied shops tucked behind the slums’ backyards. Most people here get their water from a nearby small waterfall and have no refuse for garbage or sewage. Ros tells me these people have no land and no possessions and are displaced in the slums if they have nowhere to go. Chickens and pigs run around the area with no boundaries in place as I see some dogs rummaging through a garbage pile. I hear the animals are trained well enough that they return to their respective owners in the evenings most of the time. Despite the desolate landscape, children and families peek out of the slums and run out to have a look, to wave, to smile. It seems in many places the contrast of wealth and poverty are allocated back to back within close proximity, as if to showcase the duality of life, and Vancouver’s East and West Hastings Street in my Canadian neighbourhood is no different I remember. I continually feel humbled when meeting locals, and am aiming to become semi-fluent in Swahili by the time I leave Kenya!

 We have also been fortunate to learn how to make ugali and chapati at our local hostel kitchen. It feels great to expand my culinary expertise to include Kenyan dishes and I have a few more to learn including Mandazi, Samosa, and hopefully Nimechoma (a popular meat roast in Kenya).

 Dec. 1st was World Aids Day and I reflected on how fortunate I am to be able to work with a partner organization who contributes substantially towards reducing the spread of HIV, improving the quality of life of those infected and affected, and mitigate the socioeconomic impact of the epidemic in Kenya. The following HIV/AIDS statistics are still prevalent:

 33 million people are living with HIV, of which 40% are young people between 15-25 years old.

 AIDS is the leading global killer of women of reproductive age (20-59).

 Human toll is still catastrophic – 25 million dead

There is some good news: Since 1999, the year in which it is thought that the epidemic peaked, globally, the number of new infections has fallen by 19%. Of the estimated 15 million people living with HIV in low- and middle-income countries who need treatment today, 5.2 million have access—translating into fewer AIDS-related deaths. The gains are real but still fragile. Future progress will depend heavily on the joint efforts of everyone involved in the HIV response.

Since 1988, World AIDS Day has served to raise awareness about the epidemic, honour those who have died, draw global attention to the rights of people living with HIV&AIDS, and inspire positive action.  The theme for 2010 is “Universal Access and Human Rights”, and the aim is to highlight that in many countries reduced access to essential HIV information, prevention tools, treatment, and services is occurring as a result of laws and policies that are inconsistent with their commitments to human rights.  The day aims to mobilize support for the protection of these rights in order to achieve universal access to HIV prevention, treatment, care and support and combat stigma and discrimination.

 In addition, the Aphia II Eastern project works to improve and expand services at health facilities including reproductive health and family planning (RH/FP), TB, PMTCT, Malaria, and Voluntary Counselling and Testing (VCT) for HIV. We had a chance firsthand to visit the Embu District Hospital on Nov. 16th and have a look at the recent renovations done in the maternity ward by Jhpiego. The new rooms are clean, have dividing curtains, and improved showers with ceramic tiles that provide more comfortable and private space during a mothers post partum stay with her newborn. The old rooms are overcrowded, have no privacy, and contain lower cleanliness standards in the washrooms and wards. As a result, it is reported that less than 50% of mothers deliver inside local hospitals, with the # 1 reason being a lack of privacy during childbirth.

The new mothers we saw that day were not placed in the renovated rooms unfortunately due to pending final approval from Jhpiego’s main office in Baltimore, U.S, and were still spending time in the overcrowded, dirty rooms. That’s the downside of having such a large organization overseeing so many international projects – it takes time to implement and gain final approval of certain actions, something I hope will improve in the future. We also spoke with the head nursing officer and learnt about the recent post partum family planning program which aims to educate and serve mothers following birth on further family planning methods. There is a 20% FP follow up rate in rural communities, but all staff are working to improve this number. Another innovative approach being used with APHIA II is integrating many healthcare services for individuals all at one location. This includes services such as couples testing, VCT, and PMTCT. In the past, this was not the case. More spouses are also being encouraged to participate in PMTCT services for women, and it is encouraging to know that children born to HIV + mothers can be born HIV – with the right treatment and services. After learning about the various health worker trainings in FP/RH methods, we spoke with the medical director of Embu hospital and learned that 10 million Ksh is being put forth to renovate it further and improve the current infrastructure.  Seeing as Embu is one of the largest hospitals in the district (300-500 individuals pass through each day) and that there are a shortage of health workers, this is rewarding news.

 We spent several days in Isiolo and Kitui, helping to close down the APHIA II Eastern satellite offices that have been operating in the field to deliver effective and innovative outreach services to community members in hard to reach areas. We attended close out presentation meetings that highlighted the successful results in the projects’ 3 result areas. These consist of 1) Improved & expanded facility-based HIV/AIDS, TB, RH/FP, malaria and MCH services 2) Improved & expanded civil society activities to increase healthy behaviours and 3) Improved and expanded care for people and families affected by HIV/AIDS.  

Through partnership with local implementing partners, Jhpiego has been able to achieve many innovative outreach activities in very hard to reach areas. One of them involves moonlight VCT outreaches, where people can be tested at night, reducing the stigma that is often associated with public knowledge of carrying the HIV virus. Further outreaches have included creating sporting events and games where many hundreds and thousands of people have been able to be tested at the intermissions between games. This approach of bringing testing and counselling to the people, as opposed to making the people come to the testing centres, is one approach that has worked very well in A2E. Involving the community in collaborative civil society activities and support groups has resulted in improved behavioural changes to prevent HIV transmission and more importantly has served as a way to reduce the stigma of living with HIV/AIDS. A2E does this through involving people of all ages, for example in Magnet Theatre which allows individuals to engage in role playing scenarios that educate and address situations involving stigma and RH. A2E also cares for some 62,000 orphans and vulnerable children (OVC) providing psychosocial support, nutrition, shelter, healthcare, education, legal protection, and HIV prevention. We got a chance to meet many of the local implementing partners and listen in on the various lessons that have been learnt over the last 5 years regarding capacity building, systems strengthening, joint planning by all partners, empowering communities to take responsibility for their health, and how to better implement community health trainings.

Many of these lessons and feedback will be incorporated into the transition plans of starting up APHIA Plus which is another 5 year project also funded by USAID that Jhpiego has just recently received funding for! Everyone at A2E is very excited about this and my role will be to help provide technical expertise in project startup and implementation during the early phases of establishing baselines and protocols that build on the previous successes and improve on the lessons learnt. So I am very much looking forward to this part of my placement, and the possible relocation to a new satellite office which will be either in Nyeri or Machakos. It will be however sad to leave Embu, as I am growing more fond of the people here day by day.

After closing out the offices in Isiolo and Kitui, and clearing all staff, we got to know everyone better at the two social evenings and goodbye parties we attended with Isiolo and Kitui office staff. In Isiolo we listened to Patrick Mose (Isiolo office coordinator) say loving and welcoming words of parting and gratitude for working with such a great team. I felt very welcomed to be with such wonderful people and to learn about their work and culture. In fact, I learnt more about Kenya in speaking with my work colleagues than I have in all the pre-reading material I read before my placement! It was great to compare cultures and to learn from each other. After a nice meal, I even tried some dancing – Kenyan style! I think my valiant effort did not match my Kenyan counterparts however. In Kitui, it was a similar experience of meetings, staff clearance, and office closeout procedures followed by one of the best meals I’ve had here at a lovely restaurant called Bavaria. The food was amazing! We also sang Christmas songs, wished everyone a Merry Christmas and Happy New Year, and received presents. I wanted to stay for the dancing, but had an early morning back to Embu so had to depart before it all started.

 On our drive back to Embu I filmed a little of the diverse landscape that encompasses Kenya – we went from dry desert surroundings in Isiolo to green tropical lush forests upon reaching Embu. From deserts to rainforests, to sandy beaches, to snowy mountains, Kenya has it all! I can’t wait to see more of this beautiful landscape over the coming months, and bask in the warm and tropical weather all winter. I saw many young children walking by themselves barefoot from school close to the road as we were driving and I couldn’t help wondering how safe they were, so close to the road, so young (some as small as 3-4yrs old!). It seems however that children here are much more independent than back home in Canada. They learn to take care of themselves at a very young age and help their families at home and with farm animals as soon as possible. I couldn’t help wondering how different childhood is like here for these kids…without all the materialistic comforts that kids are used to back at home. And because of this, even small surprises are much appreciated, their enthusiasm and curiosity is contagious, always smiling and laughing, shouting to us and not being shy for the most part. We stopped to buy some mini sweet bananas from a road vendor for only 50Ksh and I continued to observe the many sights on our drive – the women and men working hard in the fields, people herding their goats and sheep, or some sitting by the road looking at passerby’s for a lack of employment is still a reality for many.

The slower pace of life here is something I have embraced quite well and something I fully appreciate. It was one of the things I eagerly looked forward to in the last few weeks before departing for Kenya, when I was running around from morning till night, barely having time to fit in all my commitments, projects, work assignments, and preparations. Here, I can finally breathe. I have time to think, to reflect, to write J I have time to talk to people, to not be in a rush, and generally to take it easy. We’ve had time to have dinner with the hostel manager, learn some Swahili from the hostel staff, cook ugali and chapati with them, and watch the popular Tusker Fame Project singing show with them on the weekends. I have also begun to get to know the people in my neighbourhood better such as the ladies who sell bananas and fruit outside our hostel, or the people we pass on our way to work and we see when we go to have lunch. I enjoy the greetings, smiles, handshakes, and general conversations we have although there are days when I’m frustrated with my lack of Swahili.

 I could write another few pages…but I think I will save the most recent experiences for my next blog…to be coming shortly!

So for now my new roommate Lizzie (I have a lizard living in my room with me) and I bid you farewell and happy holiday preparations. I wonder what it will be like to have my first Christmas in a tropical climate….

 Till next time…Kwaheri!

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