Filed under: Culture, Iguhu Health Center, Project: Emergency Responsiveness | Tags: Africa, Arjun Khanna, Development, Emergency Responsiveness, Foundation for Sustainable Development, Grant, Healthcare, Iguhu Health Center, International Development, Kakamega, Kenya, Sustainability
RECAP OF THE DAY: Woke up leisurely, went into town, re-stocked on peanut butter and jelly, went to the pool at Golf Hotel, hung out with everyone else, did a lot of work, realized how much I have left to do, showed everyone the database I designed using Access, everyone is duly impressed (trust me – it’s awesome), go find more bootlegged DVDs (they actually work here, so there’s limited risk involved, although once Josh bought a DVD supposedly with a bunch of Tom Cruise and Keano Reaves movies on it and it turned out to be a single season of a Spanish soap opera – not translated), matatued back, go home, work out, throat feeling a little weird so had some hot tea, worked, watched some 24, coerced the cat to come into my room to hunt down any cockroaches and eat them, more work, sleep.
REFLECTION
Only one week left! And as exciting as that is, it’s also pretty terrifying, because I have a LOT left to do. Sleep is now a low priority. I have to finish the patient wait time survey write-up, finish the training materials for the emergency responsiveness project to leave behind at the hospital, finish up the database, get the network connection working, set that up, and write a final report for FSD. Most of this must be done before Wednesday. Now you can understand why I haven’t blogged for the past week.
I’m really excited about the patient database, because it’s something that I think has great potential not only to help the hospital immediately but also for future interns to come and tweak to make even better. Aside from making reports easier to create and keep track of patient histories in a more effective way, the network will also help because it will prevent the hospital from having to purchase huge amounts of official record books from the ministry.
This project, like all of the things I’ve been doing in the last couple of weeks, is primarily designed and implemented with a “ball’s in your court” attitude. I began these projects obsessing about the community buy-in and how receptive the staff would be to using the network or retraining others in the community in emergency responsiveness. Lately, though, I’ve come to realize that my conscience is clear if I give the community all the tools and resources it needs to be able to sustain the project. I can’t control whether they choose to or not. Why should I beg them to use a computerized network? After all, it is designed to help them, not me. I feel like my moral obligation ends at setting up the network, designing an easy-to-use database, and instructing them on its use and how it can make their life easier. After that, I can rest easy knowing that I did everything I could to make their record-keeping more efficient, accurate, and useful. It’s up to them whether or not they want to use it.
As much as I’ve loved my time here, I am looking forward to going back home. This final week will hopefully provide some closure over the many ideas, projects, and realities I’ve had and faced over the past two months.
I’ll try to keep up blogging, but as you must understand my list of to-dos is extensive, so I make no promises. What I DO promise, however, is that all my generous donors will soon have a full description of exactly what their money provided to the community and how thankful the community is for these donations.
Filed under: Culture, Iguhu Health Center | Tags: Africa, African Culture, Aid, Arjun Khanna, Development, Foundation for Sustainable Development, Healthcare, HIV, Iguhu Health Center, International Development, Kakamega, Kenya, Sustainability
RECAP OF THE DAY: Woke up, went to Iguhu, day eight of training, finished up vital signs, began talking about medical patient assessment, everyone’s pretty excited about knowing how to take blood pressures and all, people thought that pupil constriction in the light was pretty cool, went home, worked out, took bath, lunch, back to work, started writing up the patient waiting time survey report, went home, cleaned room thoroughly, started packing for tomorrow’s mid-trip retreat, we leave at noon, Mama Joyce is also leaving to attend her son’s “passing out,” that doesn’t mean fainting, it means passing out of army training, I got a little concerned when she told me she was going to watch her son pass out, excited about tomorrow’s trip, sleep.
REFLECTION
With online fundraising going well (donate here!), I’m looking forward to how the project shapes up! We started medical patient assessment today, and I think it’s going pretty well. It’s exciting to see how all of the skills we have gone over so far are going to come together. Another bonus is the fact that we got all of our regulars to show up today – yesterday, for some reason, not many people came, which was kind of worrisome. I’m hoping it was because I advertised that we were doing blood pressure, and so people who already knew how to do blood pressure chose not to attend.
Tomorrow is the mid-trip retreat at Hell’s Gate national park. We leave at noon, so I’ll have to go to training in the morning before leaving for Kakamega to meet up with the others.
I learned today that the hospital was recently delivered four new computers. I’m really excited about this, because it means that I can try to make a patient database using Microsoft Access and connect all of the computers to make a network over the hospital. Trouble is, I’ve never used Microsoft Access, and for it to be successful here, the program has to be basically flawless. I’m giving it a shot, though, and if ANYONE out there has any experience with making databases using Access, please help me out!
Liz and Emily both had interesting blog posts yesterday that I want to talk about a little bit. Emily in particular found a girl working at ACCES who has a medical issue that she is worried about. What Emily discusses was whether the idea that “we can’t help everyone” was realistic or whether we were just assuming that. It’s an interesting question – I think most agree that long-term development, capacity building, and emphasis on sustainability is a good thing, but why is helping individual people when we can a bad thing? In other words, if Emily were to pay for the girl’s medical tests and treatment out of her own pocket, while that may not be a sustainable solution, how could it hurt?
In response to Emily’s question, I think that we absolutely can help everyone, but doling out money is not the way to do it. As I’m sure many agree, it should be the responsibility of those involved with the girl and her concerns – her family, her hospital, her community, her school, her government, and most importantly, herself – to address the problem. When people like Emily step in to provide direct aid to the girl by paying for her medical tests and treatment, what they actually do is free the involved people and organizations of their responsibility over the girl’s medical issues. When too many people like Emily start to provide such aid to girls like the one Emily discusses, the dangerous consequence is that communities are very quick to transfer the responsibility of care over girls in such situations to people like Emily. In effect, when a lot of aid is given, it quickly becomes Emily’s responsibility to provide assistance to the girl. When Emily stops, she will be blamed for the girl’s poor health. When communities see people like Emily giving what they do, there is a sense of entitlement that is created – a sense that Emily as an institution, not their community or government, should be giving this aid, and so there is no pressure, no motivation to attack the correct institutions at play.
A good example is HIV anti-retroviral treatment, which is currently provided free for all Kenyan citizens who are HIV positive. As Liz points out in her blog post, most of the ARV treatment is provided through direct aid by the American and British governments. The ARVs that are supplied support tens of thousands of patients in Kenya and many more throughout Africa. But now, imagine if that aid were stopped. Thousands would suffer and die, and who would be blamed? You can bet that fingers would be pointed at the American and British governments for stopping their life-saving donations. The Kenyan government – and governments all over Africa – has escaped in a major way from the responsibility of managing the epidemics that sweep the country and the continent. The same goes for malaria – the free mosquito nets given out at hospitals are donated by an NGO – and even water – the same NGO is the major source of water purification solutions.
So while you might want to help girls like Emily’s, consider carefully how you do it. Direct, one-time aid is not only meaningless in the long run; it is actually detrimental. Teach the girl how to advocate for herself and those around her. Talk to government officials about people like the girl. That is what “making change” means.
Filed under: Culture, Iguhu Health Center, Project: Emergency Responsiveness | Tags: Africa, African Culture, AIDS, Arjun Khanna, Development, Dr. Bomji, Emergency Responsiveness, Foundation for Sustainable Development, Grant, Grantwriting, Healthcare, HIV, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Sustainability
Note: While this post was uploaded on June 22, 2009, it was written on June 21, 2009.
RECAP OF THE DAY: Woke up, went to town, worked out, went to the market, went to Yakos, bought a bunch of DVDs to watch, came home, relaxed, talked to everyone at home, watched a chicken get slaughtered, feathered, cut up, and cooked, I was still hungry, ate it, work, sleep.
REFLECTION
First of all, I’d like to thank profusely the donors to my project that have already showed overwhelming support for the emergency responsiveness program. I assure you, your donation will make a difference, and I’ll be sure to keep you updated about what is happening at Iguhu District Hospital. For those who would like to donate, a project description and online donation link can be found here.
Second order of business – my grant decision came back on Saturday, and unfortunately it was not funded. As promised, a detailed evaluation has been filled out by the grant review committee, and I am scheduled to meet with Angie tomorrow to look over this evaluation. I’ll be sure to post it here. Moving forward, though, this makes my online fundraising even more critical. The original $500 fundraising goal has been raised to $1000. Every bit counts – again, a dollar goes a long way here – so anything you can contribute would be extremely helpful.
Because the grant decision came out negatively, I’m also in the process of deeply re-thinking the project and re-assessing the needs of the hospital. Perhaps you can help me; I’ll talk about my dilemma here. The original project was designed to train Iguhu staff on all the major practices they need to be trained on in order to respond to emergency situations, so the ultimate goal was to leave Iguhu with at least one set of trained staff ready to respond to either trauma cases (like a car accident) or medical cases (like chest pain). As it turns out, most of the equipment required for trauma cases is much cheaper than the equipment that medical cases require. My dilemma is whether to go ahead and purchase these things for the hospital and train them on their use or to just focus primarily on trauma cases. The reason why this is a debate, in my mind, is because your normal 911 system whereby people can call for ambulatory assistance from their home is at least 10 years away, given the massive shortage of monetary and human resources. That means that what the hospital is really going to be seeing will be trauma cases (and specifically, car accidents). So is it worth it to buy supplies for medical cases?
This question is complicated when you consider some of the other needs that could be fulfilled in the hospital. I’ve talked about the admirable CCC staff before; they need a laptop to log patients electronically, especially if I succeed in my mission of getting them permission to use hospital vehicles for village visits. So, nebulizer to treat severe asthma in an ambulance, or laptop for CCC use?
I think what this goes to show is that it’s difficult to focus on the long term (10+ years) when you see so many short term needs that could be filled. What I’m leaning towards is biting the bullet and doing everything for the emergency training, because I feel like it’s unfair to me to judge whether the capacity to handle medical cases is needed by the community before the capacity itself is there. It’s one of those things where you’re never really sure how many people would call an emergency vehicle from their home in response to a medical condition until people have the option of calling such an emergency vehicle. While there might be other needs – just as pressing, maybe – that could be filled, focusing on one task and making sure the hospital is equipped for the long term is in the best interests of everyone involved.
But I’m still not sure. I need to write up a new budget for my online fundraising by tonight, so hopefully I’ll have it figured out by then…
Now I’d like to turn to a highly controversial, ongoing discussion in international development work. I’ll take this time to present the topic here, because I think it’s something that everyone involved or interested in international development should think about. Most of all, I’m greatly interested in what your opinion is on the matter.
The origins of the issue stretch as far back as the first (and sometimes the most offensive) question: Why is it that we citizens of “developed” countries should care about or be motivated to act upon the conditions in the “developing” world? When we read about hunger, poverty, AIDS, or malaria, why should we do anything about it? What makes these things our problems, and why should we feel the need to send some of our own resources to the developing world to alleviate them?
Answer this question for yourself – it’s more difficult to articulate an answer than you might think! Most of us take this question for granted and consider it too horrifying to even consider. “Of course we should help,” people say. But why?
There are two answers that I’ve heard to this question. The first is based upon human emotion. When we hear about millions of people dying of starvation of malaria, we are outraged. Given that there is something we can do about it, we are motivated to act upon these problems by the idea that every human deserves some basic level of freedoms, and among those are freedom from hunger and freedom from disease. It’s a valid point. The roots of our desire to alleviate these problems stem from a belief in charity – we say that since these people are unable to help themselves, we should help them because doing so preserves the sanctity of life and maintains the human rights that we believe should be afforded to everyone on the earth.
The second answer is virtually the same as the first but adds that we have the obligation to perform development work because all we are really doing is undoing the detrimental effects of colonialism; in other words, given that many countries in the Western world played a large role in slowing or stopping the infrastructural growth of developing countries during the colonial period, it is only fair that we now help build the infrastructure that we prevented from sprouting.
Both of these responses fall under the umbrella of the concept of a “moral obligation” to help. We have a moral obligation to assist and sponsor development work, so we do. And up until now, everyone is basically on the same page, including myself.
But the question I would like to leave you with is this: when does our moral obligation end?
A big example is the HIV epidemic. Even after setting up free testing centers and offering free ARV treatment to those individuals found positive, we find that people still choose not to get tested for a variety of reasons, all of which center around a cultural stigma associated with the disease. Jonny Steinberg, in his work Sizwe’s Test (2008), says, “When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people.” Steinberg searches for this “miscalibration,” and makes for key realizations: The first is a reaffirmation of Edwin Cameron’s conclusion – that people are scared of getting tested for HIV because of the stigma associated with having the disease (see Witness to AIDS, 2005). Second, he finds that this stigma is greatly exacerbated by the fact that this stigma is applied onto you by people you know very well. Third, he realizes that hesitancy to be treated sometimes springs from a feeling of cultural humiliation associated with adopting “white medicine.” Finally, he discovers that procreation plays a critical role in the religion and culture of many societies, and that HIV is feared and ignored because it undermines a man’s virility and thus his spiritual success.
Sure, these findings are significant and elucidate many interesting aspects of the epidemic in Africa, but here’s the million-dollar question: What should we do about it?
So here’s the question to ponder – after setting up free testing centers galore, offering free ARV treatment, having testing caravans go to individual villages, and urging the incorporation of HIV education in schooling, if we still find people refuse to get tested and deal with the disease, is there more to be done, or have we fulfilled our “moral obligation?” Steinberg, Cameron, and many others have uncovered the real roots of the problem, which are largely cultural. Addressing this problem at its roots will require a complete overhaul of the culture itself. Is it our place to do such a thing? Is it our responsibility? Is it our obligation to do something about the “miscalibration between institutions and people?” What if those institutions are Western constructs, and the people are locals whose culture and beliefs are unlike anything we know?
The more I think about it, the more circular the discussion becomes. Yes, we have a moral obligation, and yes, we have set up institutions all over Africa (testing centers, counseling, ARV distribution networks) that we believe would work. If they don’t, we have done everything we know to try and address the issue, so maybe our obligation ends there. But what if we got the institutions wrong? What if the institutions we established are badly “miscalibrated?” Is it our obligation to rethink them? If so, how can we redesign them to fit a culture different from anything we know or truly understand? And how can we rely on people of a culture in denial about HIV to invent these institutions, if we must have them do it for themselves?
Essentially, the question is this – if an aspect of a culture needs to be changed, who should change it? Is that a change that needs to come from within, or are our efforts required?
I’m terribly interested to hear what others think on this issue. It’s important to answer these questions because the answers have massive implications in foreign policy around the world and might serve to point developing countries in the right directions in terms of long-term development. Be sure to comment on this post to dish out your opinions!
Filed under: Culture, Iguhu Health Center, Project: Emergency Responsiveness | Tags: Africa, African Culture, Arjun Khanna, Development, Dr. Bomji, Emergency Responsiveness, Foundation for Sustainable Development, Grant, Grantwriting, Healthcare, HIV, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Patient Surveys, Sustainability
RECAP OF THE DAY: Woke up really early, worked out, packed a bag for trip to Kisumu, went to Iguhu, gave training, left immediately for Kisumu right after, went to Kisumu, drove around the city for an hour looking for Emily’s store, we finally parked at the New Victoria Hotel and demanded that someone come get us, the store turns out to be embarrassingly close to the hotel, we buy a ton of stuff, I ask where my store is, he finds it in a second, we drive straight there, I write down all the prices that they can offer me, I then go to the other medical supply store, I “let slip” the prices that the other store quoted, they reduce all of their prices, I then go back to the first store and “let slip” the prices I got from the other store, and they drop all of their prices, I buy, I celebrate, we go to the Green Garden for lunch, it is so good, we head back, we drop off Emily’s stuff at her school, we meet up with Guillaume and Liz in town, we meet a Massai while we are waiting, we talk to him, the girls go off to buy skirts, Guillaume and I get haircuts, it costs less than a dollar, on the other hand we both probably have lice now, we walk to the supermarket, I get some stuff from the office supply store, it starts raining, we disperse, I head back on the matatu, arrive home, take everyone’s blood pressure at home, work, work, sleep.
REFLECTION
Emily and I still anxiously await our grant decisions! We understand how difficult the decisions must be, given the large number of summer interns that must be reviewed. What we don’t understand is why it’s taking so long for online fundraising requests to be processed. I didn’t think it would take two weeks for my request to appear on the website, but it’s still not up yet.
Emily and I headed off to Kisumu today to purchase necessities for our projects after an hour of training this morning on artificial ventilation with the hospital staff (the training’s going well). We drive over and reflect on how nice it is to be sitting at a comfortable distance apart from each other and not have to be cramped in a tiny matatu with thousands of people crammed in. Once we arrive at Kisumu, the ride gets less nice. Neither of us have any idea where our shops are, and Kisumu is a huge place. We drive around aimlessly for about an hour, kind of hoping that a giant textile depot will suddenly appear in front of us. The odd thing, though, is that we repeatedly called the owner and handed the phone to our driver (Ken) to talk to him and find out where we are going. Each of these conversations lasted about five whole minutes, and after each of them Ken hands the phone back and says “we need to ask someone” whereupon we ask a random person on the street where the store is. They all stared back blankly at us, and spoke to Ken for another five minutes in Swahili. The result? “We need to ask someone else.”
Emily finally demands that we drive to a major landmark (the New Victoria Hotel) and asks someone to come get us from the store. As it turns out, it is basically right across the street. Embarrassed, we enter and then proceed to purchase items necessary for pad-making. Yeah, they thought we were pretty strange after that.
I go to my medical supply stores, and through some clever manipulation involving forced direct competition between the two stores, I walk away with medical supplies at half price and a huge smile on my face. Emily and I then drive over to the Green Gardens restaurant and have pizza, boneless chicken, and this mint lemon drink. A phenomenal break after daily ugali, let me tell you. We drive back and have a deep conversation about development in Kenya. When we arrive in Kakamega, we call Guillaume and Liz and ask them to meet us in the middle of town to hang out. While we wait for them, we meet a Massai and Emily freaks out. She’s asking him all these questions, and he’s demonstrating how he can pull on the giant hole in his ears and it doesn’t hurt. We meet up with Liz and Guillaume, and the girls want to shop for skirts or something, so Guillaume and I decide to get haircuts. We find a barber and go for it. Are we nervous? Absolutely. Thirty minutes later and we’re both sporting cool new haircuts that cost 30 shillings. Yes – 30 shillings. Two haircuts cost less than a US dollar; we were thrilled.
We walk around some more when it begins to rain. This is the third time I have been in Kakamega and it has started to pour; aside from the discomfort, it is inconvenient because matatu prices seem to escalate dramatically when it is raining because they know you just want to escape from the downpour. Fortunately, I asked a group of guys how much it would be, and one of them (obviously a newcomer) actually told me that it was 50 shillings. The others started yelling at him as I happily hopped into the matatu and had an extended conversation with a man who had the worst breath I have ever had the misfortune of smelling. Apparently, he is Obama’s cousin. I’m pretty sure everyone here thinks they’re Obama’s cousin.
I head home, then, and start working on tomorrow’s training session. I’m also excited because Charles has invited me to attend some HIV counseling sessions. I’m starting to organize the CCC data for them, and beyond that, I’m looking forward to being able to see firsthand what goes on behind these closed doors.
Filed under: Culture, Iguhu Health Center, Project: Emergency Responsiveness, Project: Landscaping, Project: Surveys | Tags: Africa, African Culture, AIDS, Arjun Khanna, ARVs, Comprehensive Care Clinic, Counselors, Development, Emergency Responsiveness, Foundation for Sustainable Development, Healthcare, HIV, Iguhu Health Center, International Development, Kakamega, Kenya, Kenyan Ministry of Health, Landscaping, Sustainability, Volunteers
RECAP OF THE DAY: Woke up really early, had to rush off to work to make the training session at 8:00 am, got there, no one was there yet, I was really upset, then everyone randomly showed up at 8:15 am, we started, everyone came to the training, it was really good, I felt a little sick after so I went home, rested until after lunch, Peter and company came to visit to make sure I was okay (aaaw), we talked about my projects, went back to work, started typing up description of the training, worked on patient waiting time survey, the data collection is finished, now all we have to do is analyze everything and write the report, I posted a memo to the hospital about the waiting time survey, people seemed really interested in it, had an interesting discussion with Charles Aluvisia about the Comprehensive Care Clinic, came home, started working, going to sleep early because of training tomorrow morning, going to Kisumu tomorrow to get some equipment, hopefully the grant results and online fundraising starts soon, sleep.
REFLECTION
I’m glad to report that the emergency responsiveness training is off to a good start. People seem interested, especially the non-medical staff, so it’s looking good.
I had an interesting discussion with Charles Aluvisia today, a man I have come to respect greatly at the hospital. He’s an elderly guy who works as a volunteer in the Comprehensive Care Clinic. He is HIV-positive and has dedicated himself to counseling other people living with the disease, connecting people with the disease to form support groups, and ensuring that people with the disease adhere to their ARV treatment.
To overcome the cultural stigma associated with HIV is one thing, but to then dedicate one’s life to supporting others with the disease – all for no pay – is something else altogether. Charles and other volunteers at the CCC are the most spirited group at the hospital. In fact, during the patient waiting time survey, the CCC turned out flawless timecards and had almost 90% of their patients return them. Compare this to the 70% of patients who returned cards from the outpatient ward and the fact that half the cards we got were not filled out correctly. The only difference, really, is the mindset and the work ethic of the people involved. Charles is always excited to be at the hospital and is putting in a ton of effort into co-training with me.
Seeing someone I respect then talk to me about the discrimination he faces on a daily basis even within the hospital makes me really upset. He and the other volunteer counselors that work in the CCC are not allowed in the hospital kitchen; they related to me a story about how they were yelled at for getting a cup of tea from the hospital canteen, and they showed me a posted sign that prohibits CCC volunteers and patients from entering the kitchen. If this kind of ignorant discrimination can persist in a hospital, where people are fully aware of how HIV is transmitted, can you imagine what kind of treatment these people receive in the community?
I wanted to do something for Charles and his team of volunteers. My desire is to get them on the hospital payroll, something they deserve, especially since they serve more patients than most of the rest of the hospital staff on a daily basis and have positively affected more lives. What did they say when I asked them what they would like? A motorbike. Why? So they can travel to remote areas where HIV-affected individuals live to counsel them, make sure they adhere to the ARV treatment, and deliver medication.
We’ll ignore for the time being that these people – who probably need money the most of anyone I’ve met so far, given that they earn literally no money – asked not for money but instead for a tool to expand the scope of their public service. We’ll focus instead on the specific thing that they asked for: a motorbike.
As it turns out, there is a shiny new motorbike locked away in the hospital garage that has been there since I arrived at Iguhu and has not moved in the three weeks I have been here. Apparently, the Ministry of Health Services gave four of these things to the hospital a while back to use during public health trips. One of them is in use, and given that the hospital owns two large vehicles which are more often used for public health trips, this particular motorbike is never used.
I tell this to Charles, who knows about the motorbike. The thing is that the motorbike was given to the hospital for use by “the hospital staff.” When “they” got the motorbike, Charles tells me, the use of the motorbike by the CCC was out of the question, because he is not considered one of “them.”
I am outraged at this on many levels. Charles and his team of volunteers are single-handedly attacking a continental epidemic on no pay. They see dozens of patients a day, host counseling sessions, distribute ARV treatments, test CD4 counts, keep diligent records, connect patients with others, and more. It is outrageous to me that they are not considered hospital staff. I can identify ten individuals who work at Iguhu who do less work than anyone in the CCC but are paid. So it is ridiculous that CCC volunteers have to donate their time in the first place, but it is even more preposterous that they are denied the tools they need to serve the community better. It’s as if the hospital doesn’t even appreciate the time and effort that they put in. Let me tell you something – these people are pillars of public health in the community, absolute pillars. And at Iguhu, they are taken for granted and abused for no reason.
I get along with the Iguhu staff pretty well. I like everyone, and everyone is okay with me. There are a lot of things that I disagree with about the hospital, but I hold my tongue, keep my head down, and do what I can. But this is the battle I have chosen! I’ve decided to organize all of their data, analyze it, and demonstrate empirically how valuable the CCC volunteers are. I’m then going to present it to hospital administration and as many members of the Ministry of Health Services that I can. I’m also going to MAKE SURE that the volunteers are allowed to use the random motorbike that the hospital has. This cannot stand.
Even if you look at it from a “sustainable development” point of view, this is terrible. We’ve talked a lot about avoiding aid and moving toward development. Iguhu is relying on aid – donated, free time – to handle the AIDS epidemic that continues to rage across the country. That’s not sustainable. It’s time that everyone in the hospital affirms their dedication to fight the epidemic, not just those who have already been affected.
In other news, the border that I helped build in front of the hospital has begun getting painted. It looks good! Check out the pictures below.
Green and white border
...and more
...and more. Feel free to tell me how great this looks.
Filed under: Culture, Host Family, Project: Emergency Responsiveness | Tags: Africa, African Culture, African Family, Arjun Khanna, Development, Emergency Responsiveness, Fajitas, Family, Foundation for Sustainable Development, Healthcare, Iguhu Health Center, International Development, Kakamega, Kenya, Mama Joyce, Quesadillas
RECAP OF THE DAY: Wake up really early, head into town to do some work and work out at a track that we located last week, I happen to meet Renson (a nurse from Iguhu) on the matatu, I also meet a man who educates people about modern farming techniques if there is chronic famine in order to increase their crop yields, he got a PhD from Colorado State University and is a Kenyan national and permanent resident, arrived in Kakamega, we couldn’t go to the track because they were having what seemed to be church there, we went to the shady track we used the day before, no school so no one was there to let us in, we go towards a hotel and see a bunch of people trailing a bull with sticks and machetes, it turns out the reason we couldn’t run at the track was because they were having a bullfight, not church, we end up at a “reformatory” school in Kakamega, we ask permission to work out on their field, we lock our bags to a goal post, we start working out, everyone’s looking at us, we invite the kids to come join us, at the end we play soccer with them, I buy a watermelon from the market on the way back and start eating it, I go back home, start making quesadillas for lunch, it’s a disaster, the cheese tastes awful here, the guacamole was really good though, I start prepping for fajitas for dinner, Mama Joyce’s sister is visiting from Khayega after church, she leaves, we have fajitas, they are amazing, I could put Chipotle out of business, everyone’s stuffed, work, sleep.
REFLECTION
Today was a really inspiring, great day. It helps that I say that while I am full of delicious fajitas, but really, today was great. I woke up really early – at 3:30 am – because my mosquito net fell down on me. I fixed that issue and went to sleep again, but fifteen minutes later my cell phone started dying and emitting intermittent beeps. At 4:00 am. I groggily wake up, grope around for my phone, and start looking through my stuff for the charger; I accidentally knock over my aluminum waterbottle and it clangs to the floor violently as I cringe. The roosters start crowing, the dogs start barking…the Muliro house has been woken up.
I head on over to Kakamega for an early-morning run and work at a print shop. On the way, I bump into a guy who starts asking me about my work at Iguhu and tells me about the work he does educating people about modern farming techniques to increase their crop yields in times of famine. It turns out this guy is a PhD from Colorado State University.
I know this type of person exists, but it’s difficult to explain how happy I was to learn that a Kenyan had made the decision to get a foreign education and return to Kenya to work and serve. There are many more like him, but as I have not seen any of them, it was an awesome feeling to meet and talk with him. The “brain drain” phenomenon might be one of the most crippling to a country’s development, and it was refreshing and great to learn that higher education in the US had made its way to Kakamega, Kenya through this man.
We ended up working out at a school where street children are taken in and reformed. While we were playing with the kids, one of the school’s staff walks up to us and advises us to put our belongings in her office next time because “she knows these kids” and she doesn’t trust them. Maybe it’s naïve, and perhaps one day our trust in the kids will be shattered, but Liz and I decided that the kids were trustworthy and that our things didn’t need to be moved. The kids didn’t take anything or even try to take anything; they were very respectful of us and our things, in fact. It was nice to have our faith in these young kids upheld by their actions.
After I return home, I spend a combined total of six hours making Mexican food for my family (see previous post). The quesadillas were a disaster – the cheese here is disgusting – but the fajitas were amazing. I’m currently about to go to sleep on an exceptionally full stomach utterly satisfied after a great day.
Finally, I have decided on a topic to write a culminating piece on for my duration here. The details are still being worked out in my mind, so I’m not going to post it here, but it will rock the foundations of US policy towards developing countries forever.
Tomorrow is the first day of EMT training at Iguhu. I hope everything goes well!
Filed under: Culture, Host Family | Tags: Africa, African Culture, African Family, Arjun Khanna, Development, Family, Foundation for Sustainable Development, Host Family, Kakamega, Kenya, Mama Joyce
RECAP OF THE DAY: Woke up early, went to town early for the third weekly meeting with the rest of the interns, took a while for a matatu to get there, finally caught one, rushed into town, met everyone, caught up, heard about everyone’s weeks, talked about religion and culture in Kenya, Angie made an executive decision to go to Hell’s Gate for our midterm retreat, she told us that she would not go, we all revolted, she gave in and said she would accompany us, the other interns are also going to come with us, it should be a lot of fun, we talk about the 13,000 shillings we all get, there’s some confusion about exchange rates, we all collect money, props to Angie for fighting for us and getting everyone transportation and lunch grants, my group starts making lunch, Emily and I escape to go for a run, we go to our usual field, there’s some track meet happening, we go over to a school next to Sheiwe Guest House, ask the security guard to let us in to exercise, he says okay, it’s kind of a shady area, we run a lot, make our way back, we stop by Yakos supermarket to buy stuff, I stop by the market to pick up a bunch of food for fajitas tomorrow with the host family, mouth is watering just thinking about it, I have to wash dishes since I didn’t help cook, it starts raining, I head back, get back to the house, nap for a bit, talk with Mama Joyce, I’m going to teach everyone how to play card games tonight, need to go to town early tomorrow morning so tuck in early.
REFLECTION
Today was relatively uneventful, except for the tons of vegetables I have sitting in my room right now. Yesterday night, as I was wrapping up work, Mama Joyce asks me if they eat ugali in the United States.
For those who don’t know, ugali is just corn flour mixed with water and then boiled (there may be salt involved somewhere – I’m not sure) to form a sort of caked, semi-cooked bagel. It doesn’t really have a taste, but interestingly enough the texture is really satisfying. It’s definitely grown on me, but naturally it’s completely foreign to people back home.
I respond to her and tell her that no, nobody eats ugali. She then asks me, “really? Like less than two times a month?” To which I respond, “no. Nobody has ever heard of ugali in the US and no one eats anything like it.” She could not believe what she was hearing. Thus began the topic of foreign cuisines, and I discovered that Mama Joyce has actually never tasted food from any other country ever before in her life. When she goes to hotels and they have a buffet, she tells me, she goes straight for the ugali and kale because “it’s what [she] know[s].” Yikes! I figured that, since she is a pretty open-minded person and I’m up for any kind of experimentation, we could try something interesting and cook food from a different cuisine every Sunday to get a kind of “around-the-world” experience in the next five weeks.
Tomorrow is Mexican; I’m going with fajitas and quesadillas with guacamole and chips. I have everything prepared and I’m pretty excited about it. Not that I don’t like the food here, but it will be nice to have a bit of a change. I bought a ton of stuff in the market today and I’m ready to begin tomorrow.
Tonight, I tried to teach everyone card games. I figured that Spades was easy enough to begin with, right? Wrong. My host family has never really played with cards before, so it was basically starting from scratch. We digressed from Spades down to a weird form of Spoons finally down to Go Fish, which they absolutely loved; and I mean knee-slapping, doubled-over laughing, fun. I was mesmerized at the ease with which everyone was entertained; I’ve never really considered Go Fish to be a fun game, but I honestly will never look at it the same way.
I have to sleep early today, since I’m going to town really early tomorrow and I have to wash all of my clothes before that.
Filed under: Culture | Tags: Africa, African Culture, AIDS, Arjun Khanna, Development, Foundation for Sustainable Development, International Development, Kakamega, Kenya
RECAP OF THE DAY: Woke up, went to town for second group meeting, got there a little late, met the new PC (Kirsten) who will be taking over for Angie in six weeks, Angie gave me some Crystal Light so I will be able to have non-charcoal-tasting water (VICTORY!!!), talked about everyone’s weeks, had a very interesting discussion about race and racial awareness in Kenya, discussed at great length about Nakuru National Park versus Hell’s Gate, we deliberated for literally about an hour, we were in gridlock, when Angie suddenly tells us the perfect alternative, don’t know why she didn’t say that sooner, site team is going to check prices and get back to us, team 1 makes grilled cheese for lunch, I have five sandwiches, we go to Yakos, I buy a bunch of peanuts to snack on during the week, it starts raining, I get excited because the rain will water the plants that we planted at Iguhu on Tuesday (there’s been no rain since then), get back home, I find out that it didn’t rain in Iguhu, we lose power for about an hour, there’s one lantern in the house, we sit outside, talk about culture, have fish for dinner, it’s delicious, work, sleep.
REFLECTION
At the second weekly meeting, we had a chance to introduce our workplans to the group and talk further about our experiences at our host family and host organizations. As a thought-provoker, Angie shared with us a poem by Rudyard Kipling called “We and They”:
Father and Mother, and Me,
Sister and Auntie say
All the people like us are We,
And every one else is They.
And They live over the sea,
While We live over the way,
But-would you believe it? –They look upon We
As only a sort of They!
We eat pork and beef
With cow-horn-handled knives.
They who gobble Their rice off a leaf,
Are horrified out of Their lives;
While they who live up a tree,
And feast on grubs and clay,
(Isn’t it scandalous? ) look upon We
As a simply disgusting They!
We shoot birds with a gun.
They stick lions with spears.
Their full-dress is un-.
We dress up to Our ears.
They like Their friends for tea.
We like Our friends to stay;
And, after all that, They look upon We
As an utterly ignorant They!
We eat kitcheny food.
We have doors that latch.
They drink milk or blood,
Under an open thatch.
We have Doctors to fee.
They have Wizards to pay.
And (impudent heathen!) They look upon We
As a quite impossible They!
All good people agree,
And all good people say,
All nice people, like Us, are We
And every one else is They:
But if you cross over the sea,
Instead of over the way,
You may end by (think of it!) looking on We
As only a sort of They!
This got us talking. In particular, Deborah, an Asian girl in our group working at Shibwe Sub-District Hospital, told us that she was having quite a difficult time dealing with what she considered insufferable comments and jokes about her race. We all share the experience of having to hear “muzungu” screamed after us wherever we go, and it’s something that while at first is endearing gets frustrating very quickly. We were warned about this, however; we were told about how “muzungu” will be our name by default until people discovered our real names (and even then, sometimes, it persists as a kind of title, instead of “Mr.” or “Ms.”) and also about how common and blatant reference to race was less of a discriminatory practice and more of a method of identification that was commonly used because of its convenience and unambiguousness.
Deborah, however, has had somewhat of an extreme experience. It continues to offend her greatly when people yell greetings or jokes at her as she walks that she obviously cannot understand, and how she must listen to the crowd laugh and jeer at her unresponsiveness. Apparently, people have also been shouting what we consider to be highly offensive things associated with her Asian identity.
What was surprisingly difficult for me to decide during the course of this discussion was whether or not I feel upset at the locals who are upsetting Deborah. Upon reflection much later, I feel as though I have reached a conclusion.
On a superficial level, it is very easy to get angry at these locals, given that their comments are unnecessary and offensive. What they are doing is in violation of the basic cultural rules that we have known and grown up with. It’s easy to see, though, how this somewhat shallow interpretation of the situation is wrong. The cultural rules that we know are very different from the cultural rules that they know. As we have been told, racial sensitivity is not something that is valued very highly in their culture, so racial comments and jokes, despite having no place in respectful Western culture, may be acceptable here.
The cultural appreciator, therefore, being at a higher level of cultural awareness and understanding, will dismiss these locals’ comments. With this line of thought, one is inspired not only to forgive these remarks but to create an explanation for them. It is this line of thought that we pursued as a group. Our discussion centered on the idea of ignorance about other cultures and other peoples; we talked about how a lack of knowledge and understanding of the world beyond Kenya led people to react with great surprise when encountering someone of a different race. To them, the fact that you look visibly different is the 800-pound gorilla in the room – something so obvious as to warrant immediate recognition – so it is natural that they comment, and even joke, about what they see. And what about comments that we consider racially offensive because they play on stereotypes? We concluded that, given that poorly-made television soap operas are the only window that many people have to outside cultures, it is only natural that, once they finally meet an Asian or an Indian or even a White, they freely assume that all of us will relate immediately to the characters they have seen on television.
This is where most similar discussions end. Deborah, however, did not buy it. “How much can you really account to ignorance? How ignorant do you have to be to understand that the person who doesn’t look like you is also a human being who has feelings?”
I agree with Deborah. Pleading ignorance on their behalf is talking down to them and belittling the understanding they do have. It does not take any level of education to understand that making jokes about someone in a language they don’t understand and then laughing loudly about it is inappropriate and offensive. There are certain universal courtesies, I argue, that we can and should expect all cultures to extend. Now, a statement like that is inherently loaded because the extent of these “universal courtesies” is not easily defined, nor is it static. Questions of women’s rights, animal rights, legal rights, etc. – these issues remain in the (quite expansive) gray area between what we consider right and what is truly universally right.
At this point, this discussion has extended far beyond the few racial comments in bad taste made to Deborah and arrived at the more general topic of how to deal with a clash of cultural rules. So to Deborah, future interns, current interns, or anyone, I would say, listen to Gandhi: “You must be the change you wish to see in the world.”
Deborah, the comments you receive are offensive to you. They violate your rules of courtesy and kindness of human interaction. If you believe strongly enough – which I think you do – that your rules represent universal courtesies, you should not hesitate to stop and correct your offenders. It is part of why you are here, I think – if you see areas that need to be developed, you develop them. There’s no reason why the lack of cultural awareness should be overlooked as a development area. You would like to see more cultural awareness, sensitivity, and courtesy; you must take it upon yourself to make this change happen.
I will give other small examples. Women in this culture, while very rarely outwardly demeaned, are expected to perform all of the household tasks in the compound, including serving dinner, collecting dirty dishes, and washing clothes. I know it is a small thing, but I feel – strongly enough, I guess – that men should in no way feel demeaned when they perform these tasks themselves. So I make it a point to help bring out the dinner, bring my own dishes to the kitchen, and help wash my own clothes. The way I see it, there’s no way us interns can both tout Women’s Empowerment in the workplace and return home to a household that consigns women to doing laundry and kitchen work. If we advocate equality for women, we must demonstrate it even in our own host homes.
I will give another far more important example. HIV/AIDS has been such a difficult disease to battle in Kenya and much of Africa because of the cultural stigma that surrounds the disease. Less bold activists might have hesitated to change this cultural institution. It took years of concerted effort, but the culture has changed; the fight against the disease is strong. It takes the bravest kind of people – the HIV counselors at Iguhu, all of whom are HIV positive, face cultural stigma every day, but have resolved to fight it. Culture is to be respected, yes. But when you believe strongly that change is in order, I believe it is not only your right but also your duty to be that change you wish to see.
It was a beautiful night.
Filed under: Culture, Iguhu Health Center, Project: Surveys | Tags: Africa, African Culture, Arjun Khanna, Development, Dr. Bomji, Emergency Responsiveness, Foundation for Sustainable Development, Healthcare, Iguhu Health Center, Kakamega, Kenya, Kenyan Ministry of Health, Mama Joyce, Sustainability
RECAP OF THE DAY: Woke up, went to work, began the card system to measure baselines for patient waiting times, it was really hard getting everyone to follow the system, I got really stressed out, I design a data analysis program, I end up distributing about 100 cards, only 19 come back, I’m kind of upset about this, I finish my Excel program, I work on my workplan (due tomorrow), work, work, work, sleep.
REFLECTION
I had exaggerated expectations about how compliant Iguhu would be on the first day of the implementation of my survey project. It is my fault; future interns: it is difficult, extremely difficult, to implement an organization-wide system in a single day. I knew this beforehand, though, but a small part of me, reflecting on how easy everything has been thus far, wished (and, I daresay, expected) Iguhu to fall nicely into place in the scheme of the patient survey project.
“It will take a little more time,” says Mama Joyce. I know. I have been unrealistic in expecting change to happen in a single day. Such is the name of the game in sustainable development, I guess – overly-enthusiastic, wide-eyed, optimistic interns like I come and expect everyone around him or her to feel exactly the same way. And perhaps they do, but there are certain realities – primary among which is the fact that all of this takes more time than anyone would like.
I’m currently tending to my runny nose which is the most irritating illness one can have, because it’s not real enough to provide an excuse from efficiency but it’s annoying and persistent enough to debilitate work because your right hand is constantly wiping away mucous.
Hopefully tomorrow goes a little better than today…
