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Published: September 5th 2006
Ah I have taken email access for granted these past few weeks. How frustrating and what a sense of isolation to be cut off from the world when the service is down as it has been for the past 36 hours. I’ve realized how dependent I have become on it both to keep me connected and to fill a key component of my daily routine. I’ve had to pursue other activities - writing business proposals, reading and exploring Kisumu - which may be is the point. I have also been relatively immune to the lack of consistent availability of water, power and telecommunications - which of course my Kenyan colleagues face everyday. So a good experience!
Thought you might be interested in my adventures last Wednesday. I arrived at the FACES clinic shortly after 10 am planning to spend the day. The first couple of hours were spent on the enrolment bench, the middle hours were spent touring the surrounding rural areas with Christine, a community health worker, and the last part of the day was spent at a farewell party for one of the visiting medical students from the US. Medical students are routinely rotated through this US presidential office funded program. And the month seems to have a profound impact on their field choices if my conversation with Aliya is any indication. She is planning to specialize in tropical medicine and paediatrics
But let me tell you about the Boda Boda adventure. I didn’t have my camera with me. And what a loss because you would have enjoyed the pictures of Christine and I being transported by Boda Boda (bicycle taxi) on the country roads - well really paths. We were searching for 5 clients who according to their files had missed appointments. So for a period of 4 hours out in the hot sun and on the dusty roads we conducted our search. Now there are no addresses for these rural homes. You are given stage places along the main road, and landmarks - such as a bridge, a stall, a school or a church. Once arriving at the general vicinity you then stop a friendly looking bystander and ask if they know where the person and family we are looking for lives. People are protective and curious all at once and we have to be careful not to betray any confidences - remember HIV/Aids is taboo here and most patients still do not disclose their status. So again the community health workers are masters at the art of conversation and investigation!
We arrived at our first stage and found the stall we were looking for. After engaging the local women in conversation and watching them make what seemed to be a tomato salsa, we learned that the young women we were seeking had passed away two months ago. Big gulp and a sigh. Christine said this never gets easier…this was the fifth client she had discovered had passed away this week and it was only Wednesday. We were off in search of the next home.
This time we grabbed a Matatu to take us up the road. We squeezed in with 15 others into this mini bus. I practically had someone sitting on my lap. For those of you who are claustrophobic - I don’t recommend this form of transport. And no seatbelts. Of course this would be illegal in Canada…but here it is a necessary and cheap form of transport - 10 shillings flat rate (about 14 cents) I said a prayer and off we went…getting off some 5 minutes down the road. We were looking for a bridge. Found two boda boda riders washing their bicycles in the muddy river. Christine pointed out this is the water used to cook with, wash with and drink. We were pointed up the road to another group of boda boda riders ( I was fast learning these fellas were the best source of information in the area - well most of the time) - who sent us back to the bridge we started at and directed us to a mud house about 200 meters away.
We made a way into the yard and Christine commented that she was grateful there were no guard dogs. We were greeted by 5 children between the ages of 2 and 8, an elderly woman and a young woman sitting under the shade of a tree - appearing to be quite lethargic and in pain. We were welcomed and offered little stools to sit on under the shade of the tree. Christine determined that indeed the young woman was who we were looking for. Her name is Pamela. And over the course of the next half hour we determined that in deed she was not doing well. She was suffering from headaches, stomach pain and chronic diarrhoea. Christine asked to see her meds (Antiretrovirals and multiple vitamins - taken hand in hand to help boost the immune system) and thought it looked like she hadn’t been taking them. We learned that Pamela had been to a local healer a week ago - and had been taking some herbs and told she was suffering from a child bearing related illness or curse - certainly not Aids.
And this is the dilemma the health care workers are facing in the rural areas -- mixed and downright wrong messages from traditional healers - who are the first source and often only source of medical help in the rural areas. I have since learned of some innovative programming in Uganda that is trying to tap into this natural network and educate the healers so that they can promote effective medical treatment and responses - in combination with their traditional knowledge.
Through conversation Christine gained Pamela’s agreement to come to the clinic the following Monday. She re-iterated to Pamela that she was sick and suffering from HIV/Aids symptoms and that it was very important that she take her medication, eat well and make her follow-up appointments. The mother-in-law engaged Christine in an intense conversation as we were leaving the yard. She thanked us for coming and explained that she had just returned from being away for a month. With the death of her husband and Pamela’s husband, she the mother-in-law was the sole bread winner and toured villages selling fish. She counted on Pamela to look after the children while she was away. When she had left - Pamela was healthy - when she returned she had noticed a serious change in her condition and was fearful for the family’s survival. What would they do if she couldn’t work and had to take care of the children? And this is the story being played out family by family in this part of the world. Heartbreaking -- We need to help! I again was reminded how it is the women, particularly the grandmothers who are carrying the burden of this pandemic.
On Boda Boda we headed out looking for our next client. We came upon a series of mud huts teeming with children in various states of dress, goats and young girls. We were welcomed in to one of the homes and asked to sit. An older women came from another room and greeted us. Again after some 10 minutes of conversation and with children filing in curious to see what the white girl and city girl wanted - we learned that the woman we were seeking was this woman’s daughter and she had passed away in May. We also learned that she, the woman we were talking with, had just lost her husband a month ago. So much tragedy…yet life continues for the sake of the children. We hugged the women and shed a tear with her. She thanked us so much for coming to visit -- And invited us to visit again.
There is something inside you that just dies when you are in these situations. But you dig deep and find the inner strength to carry on - just like these women - two more clients to try to locate. Back on the boda boda and after some 15 minutes we located our client. And she was great! Feeling great and looking great. In fact she had been to the clinic the previous week - showed us her card to prove it. Turns out her file was not up to date. It was so good to see someone doing well. And with this shot of hope - we are off again by boda boda. But this time we couldn’t locate who we were looking for - seemed we had the wrong location information - the landmarks made no sense. So patient number 5 was untraceable.
It was time to head back to Kisumu. Again we flagged down a Matatu and arrived back in town - tired, thirsty and hungry - it was 3:30 pm and we were long over due for lunch - which I offered to buy. Christine took me to a local favourite café - she had chips, I had chapattis and chicken. We both had water and a coke - all for 250 ksh ( about $3.50) - I teased Christine that she was a cheap date. Feeling rejuvenated we headed back to the clinic and reported on our afternoon’s activities.
At about 5:30 pm after returning to the FACES clinic from our field work - the clinic staff piled into a van - and we were delivered to the clinic’s coordinator’s flat - the site of Aliya’s farewell party. This was the US medical student who had spent the last month working at the clinic. I felt privileged to be asked to join this party and apologized to Aliya for crashing her farewell party - we had met 5 minutes ago! Aliya told me that the first party she attended when arriving was also a farewell party - so not to worry and to enjoy! And I did. This party was organized by the staff - some 20 in attendance. They had taken up a collection, bought tea, pop and snacks and arranged for music and a small gift for Aliya. The favourite party snack is French toast…quite wonderful with marsala tea! And dancing was not an option - it was mandatory. I was quickly taught the local dance - the hungula. The group dances in a circle and each takes a turn deciding the moves the other dancers will replicate...all the while shaking your booty. And let me tell you these Kenyans can shake! Very fun and again no observers allowed. There was a formal presentation to Aliya thanking her for her contributions. Several of the team members spoke and I as special guest was invited to say a few words. Can’t even tell you what I said - but my comments were referenced by others who followed me..so I guess I hit the mark. The evening ended early at 8 pm - it was an afterwork function after all. And one of the team graciously drove me back to the hotel. I was full from party snacks - so need for dinner that night.
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Ben Smith
non-member comment
Thanks for Sharing
Jan, your descriptions are so vivid. Thanks for sharing them. It is a good reminder of how small or trivial some of our challenges are here back home relative to the difficult path the people you are meeting face every day. Ben