Filed under: Orientation | Tags: Africa, Development, Foundation for Sustainable Development, International Development, Kakamega, Kenya
Note: While this post was uploaded on May 27, 2009, it was written on May 21, 2009.
RECAP OF THE DAY: Woke up to roosters at a merciful 5:30, wanted to get up to work out but couldn’t get up in time, still no water, went down after a failed shave, had the same breakfast, someone said the water was back so inhaled the rest of my toast to go try to get a shower, still no water, listened to Angie about designing a work plan, went into town for lunch on bodabodas, accidentally paid my bodaboda twice, had fried chicken and chips (which are French fries here), had a hurried Kiswahili lesson because Panina had to go back to Nairobi on a bus that left at 5:00, talked about Sam’s meth lab, glue, and the joint, asked how to say “to cross-dress” in Kiswahili, asked how to say “to swim in rocks” in Kiswahili, talked with Katy and Dan about their projects and buying a wireless modem, called dad to confirm plan of buying wireless modem, went to the bank with Liz to withdraw money, Liz jumps violently onto the bodaboda, the drivers look at each other with shocked faces, they say to each other “that just happened”, we ride to Barclays, I withdraw a ton of money, I brought my US Dollars with me just in case the machine ate my card, we go to the bag vendor right next to the bank to buy bags for Liz, I accidentally pull out my wad of cash, Liz gets really scared and says “that might have been the dumbest thing you’ve ever done” and starts getting really anxious to leave, assuring that the bag that she wanted was not there, the shopkeeper is visibly drooling at my cash, we walk back to Mama Watoto’s, we ask a bwana where Mama Watoto’s is, Liz gets hit by a car, she turns around and says to me “I just got hit by a car.” “I know Liz, I was right here.” “that just happened”, we meet a street kid who keeps asking where we’re going, Liz gets freaked out and says “not where you’re going”, Liz is still in shock about getting hit by a car, we go to the wireless store, I discover the exact prices of internet, I want to check whether Safaricom has service near Iguhu so I vow to come back on Saturday, we walk back to the hotel, I see a pile of plastic bags, it’s actually a woman, I freak out, I can’t deal with it, we stagger back to the hotel, Liz slips on the stairs, marking the fifth near-death experience we’ve had, I go back to town to visit the cyber café, I come back, I go to sleep on the couch, Erica wakes me up by screaming, I freak out, Liz is still in shock about getting hit by a car, everyone making fajitas, they are served, Guillaume and I make a lot of fun of Angie during dinner, she’s a good sport and laughs along, we all laugh hysterically for the rest of the night, sleep.
Filed under: Orientation | Tags: Africa, African Culture, AIDS, Development, Foundation for Sustainable Development, Healthcare, HIV, International Development, Jonny Steinberg, Kakamega, Kenya, Sizwe's Test, Sustainability
Note: While this post was uploaded on May 27, 2009, it was written on May 20, 2009.
RECAP OF THE DAY: Woke up to roosters, no water in the bathroom so couldn’t shave or shower, instructions to buy a variety of foods from the market using the Kiswahili we’ve learned, talked to the many excited locals in the market, bought a lot of food, met Mama Rosa, ate a mango the Indian way, drove to Iguhu Health Center for the first time, met my supervisor, toured the facilities, drove to Shibewe Health Center, toured the facilities, went to Peter’s house, had lunch, discussed past projects while a cat ate our fallen scraps of food, met Peter’s mother, saw kitchen in house, saw compound, learned the use of mud and cow dung in construction, drove back to hotel, advocacy workshop, dinner, relax, sleep.
REFLECTION
I wanted to pursue a health internship with FSD after reading Sizwe’s Test by Jonny Steinberg and discovering how health issues in many parts of Africa extend way beyond funding problems and actually are unique and difficult questions regarding public health policy. How do we make health policy compatible with the local culture and condition? It is important to realize, to that note, that this “compatibility” encompasses both political and pragmatic issues; that is to say, skillfully constructed public health policy needs to be complemented with methods to make healthcare more accessible to underprivileged members of the local society.
Steinberg’s work provides a thorough insight into cultural issues that might get in the way of HIV/AIDS testing and treatment. Specifically exploring the epidemic in South Africa, he concludes that many individuals are hesitant to get tested because of a variety of cultural barriers, including a social stigma associated with being positive for the disease, the closeness of communities and subsequent difficulty in achieving true confidentiality, a mistrust of antiretroviral medication, and the fact that the disease is seen to challenge a man’s virility, which is paramount in many African cultures. In the five short days I’ve been in the country, I can already see many of these themes present in Kakamega and surrounding areas. Advertisements that announce “AIDS is not a curse, it’s a disease” aim to diminish the social stigma in Kakamega, where everyone seems to know each other. We’ve been told by our Kiswahili teacher, Bibi Panina, how Kenyan men take reproductive success very seriously (and I learned firsthand that the concept of “outside wives” I had studied just months earlier was, in fact, a real thing).
We visited the Iguhu Health Centre today, which is the place I will be working for the next seven weeks. A cheerful doctor greeted us and handed us off to another to tour the facilities. Through my excitement of seeing the place for the first time, I noticed many things. The first and most staggering were the malaria posters and the hospital’s own records of malaria cases. How can so many people die of a disease we know how to cure and can do so quite inexpensively? Over a thousand patients walked into the clinic with malaria in a single month. I’m not sure how many of them survived, but many patients in Africa do not. Other services included minor outpatient services, like chest examinations, pre- and antenatal care, and wound-dressing. There was an inpatient house, but we did not tour it.
We then drove to Shibewe Health Center, where Deborah will be working, which is less developed and far more rural. The doctor who walked us around also showed us the placenta pit – a pit in which placentas are thrown after birth as per cultural norms. Bizarre, I thought, but probably only the first of many such cultural requirements that have implications in health services. This would also probably be one of the more minor ones.
Later that day, Peter told us about a past FSD initiative to pressure the government to fund and approve a V.C.T. – Voluntary Counseling and Testing – centre at Shibewe. We had indeed seen a VCT center at Shibewe, which was a separate building altogether from the rest of the compound. Voluntary testing is not as simple as previously thought, as Steinberg informs us – the size and character of the community makes confidentiality in HIV/AIDS testing limited, and given the aforementioned perceived challenge to a man’s virility that the disease poses, many choose not to get tested for HIV/AIDS.
This got me thinking about VCTs and AIDS policy. Does something as simple as having a separate VCT facility in some way signify a general reluctance for the disease to be integrated in everyday medical practice? Is the necessity for government approval of VCTs a reaffirmation that the disease is not a “normal” one?
On the topic of stigma associated with AIDS, it’s not fair or accurate to claim that the solution to Africa’s AIDS problem is to eliminate its stigma, as Hermann Reuter did in Steinberg’s Sizwe’s Test, because the same stigma still exists everywhere in the rest of the world. Though unfortunate, it is undeniable that there exists a social judgment that is placed upon people who are HIV-positive even in the Western world. Other terminal illnesses have escaped this phenomenon – cancer, for instance, is not something that people are ashamed of – and yet AIDS still suffers from this predicament. It is wrong to conclude that the African stigma on AIDS is the reason behind the continent’s epidemic. The same stigma exists everywhere. There are more rooted aspects that are often overlooked. If patient confidentiality could not be taken for granted, for instance, AIDS testing would be less popular in the Western world. But how do you enforce patient confidentiality in a community where people live in such close quarters and interact so frequently and intimately? How can anyone take ARV medication privately in a society where privacy is not emphasized as it is elsewhere?
The first steps that may need to be taken, therefore, are not solely comprised of financial matters or even of educational ones but instead of policy concerns. Addressing such issues is not so much an exercise in accumulating resources or distributing aid as it is an exercise in asking (and answering) the right questions. The questions we need to address are ones of health policies. These answers are far from absolute.
