Saturday, July 15, 2006

Rural Life

Much of western Kenya resembles the dry, barren landscape of the southwestern US. Lake Victoria often becomes the one source of water if the few wells or riverbeds in the area dry up. Therefore, it is common to see women walking as far as ten miles to fill a 5 gallon jug with water which is gingerly placed atop their head for the walk back home. The day gets stretched into the night as one usually awakes early to begin the walk either to avoid the mid-day sun, or to make it back home in time in the morning for school, which is usually several miles away as well.

We recently stayed on the outskirts of Mbita at a home where the family is beginning to farm peanuts ("groundnuts") . The father in the family--a retired educator for many years--realized the value in grouping farmers in the area together to sell their yield, so has started a cooperative program where different types of peanuts (we tried varieties from Virginia and Cameroon) are grown to see what will thrive best on the land. It was encouraging to see the interest to improve the traditional methods of farming to grow a product that was both healthy for the people in the area and more profitable for the farmers in a communal sense. Too often, subsisting day to day doesn't allow for the ingenuity or open-mindedness to improve on the lifestyle.

Only recently have men begun to move away from the polygamous culture that was the norm for so long. It is traditional for males to come back to their parents homestead and build a home when they have the means. A separate house is built for each wife, and the wife is informed when the husband would visit that house. When a brother dies you inherit his wives and children. The spread of HIV and financial obligations to family are decreasing the desire for polygamy, but it is clearly evident how the culture system lead to such a quick spread of the disease through entire families.

(We also got to milk a cow, see below)

Left to Die

Each day we show up on an island with our mobile clinic, we are presented with a wide variety of medical problems from malaria, typhoid, and measles to tuberculosis, HIV, and end-stage syphilis. Many present with very advanced disease that has been present for years and have never been seen in a clinic or hospital. For example, our first day of clinic, we encountered a 1 year old child with severe failure to thrive. Her frail body, consisting only of bones with loose skin hanging off, looked as if it could barely support her out-of-proportion head due to malnutrition. It was clear that death was imminent within the next few months without intervention. In this case as in many others we are left questioning: Why would these people wait so long to seek medical care? How could this mother wake up each day and look at her child who is obviously wasting away towards certain death and carry on with her daily activities.

We also frequently encounter patients with problems beyond the scope of what we can handle with our basic medications and equipment. Logically, we had been directing those with advanced HIV, suspected TB, tumors and the like to the local hospital to receive more advanced medical care. However we couldn't help but wonder: How many of these patients would actually find their way to further medical care?

All of our questions were brutally answered when a young child was brought unconscious in a woman's arms to our immunization and deworming project on Rusinga Island. The child had been healthy one day prior and now was febrile with eyes rolled back and stiff neck, unable to respond to any stimuli. After performing a physical exam, we immediately suspected bacterial meningitis, a disease that can be rapidly progressive and fatal, where every hour can mean the difference between life, death, and permanent disability.

Sensing this urgency, we attempted to arrange for emergency transport to the nearest hospital. We soon found that not only are there no ambulances in the region, but there were not even any motorized vehicles available. Upon asking the local people how people reach the hospital, the answer became quite clear--- the majority don't and are left to die. Unwilling to accept this, we split up to run through the village and found a single car doing a promotion for herbal medicine in the town. We explained the urgent situation and were astonished to hear "your offer has not been accepted". It took a considerable amount of money and persuasion before we were able to comandeer the car and take the child and his guardian aboard. The ride from Rusinga to Mbita Hospital was nothing short of surreal. Maneuvering around donkey-carts and herds of cattle, we bounced along the rutted and pitted out roads praying every second that the child would reach the hospital alive.

When we reached the "hospital", we were shocked to find it was little more than two cement warehouse-type wards run by a nun and a single doctor. The line of the ill wrapped out the door as we barged in and layed the child down. The doctor agreed with our assessment of meningitis and plan for IV ceftriaxone. Unfortunately, "this is a very expensive medication and the family will not be able to pay" he stated matter-of-factly. Without money for medication, those lucky enough to find transportation to the hospital will be again left to die if they cannot pay for the medication up front. In this case, the guardian of the child was actually his grandmother, as he was orphaned by HIV/AIDS. The family had little to no money to live on a day to day basis, let alone provide an expensive medication. Unable to watch the child die in from of us, our group agreed to collectively provide the funds necessary.

To obtain the medication, we were told to purchase it at the hospital pharmacy and then bring it to the ward to be administered. It was little surprise at this point that the pharmacy was out of ceftriaxone. We were forced to run into town and find a local pharmacy who had stock of the medication, then return to see the medication delivered.

Through this experience our questions have been answered. We now have come to the brutal realization that there is no lack of initiative amongst people seeking medical care, and that likely none of the patients we had referred to the local hospital actually had received medical care. The barriers of lack of primary health resources, transportation, and cost of medication restrict nearly all of these people from the basic human right of health care. Though the child with meningitis did recover after IV antibiotics, it is very scary to think of what would have happened if not for outside help and financing. The harsh reality is that in this impoverished area, most people are left to die of preventable and treatable diseases.

Children Without a Childhood

As we pull ashore each beach on our fishing boat, a pack of smiling children runs to greet us. The happy faces and screams of Mzungu (white people) make for a joyous welcome. However, the dark reality sets in as one takes a closer look upon the heads infested with fungus, the tattered single pair of clothes, and the lack of any guardian within sight; that these are children fighting to survive on their own. These faces bring to life the cold number of 10 million children orphaned by HIV/AIDS.

Unlike in the US, there is no governmental safety net for these children. The extremely lucky are taken in by remaining family, usually grandparents. The very lucky are taken in by other families in the community who have the money to support additional children (it is not uncommon for a family to have up to 3 orphan children in addition to their own). The lucky find their way to an orphanage that usually provides schooling and sometimes 1 meal a day. However, many are left to fend for themselves at a very young age. These orphans band together in packs, and it is not uncommon to see a 6 year old caring for a 1 year old who is clinging to her back.

Primary school often brings the few joys of the younger years. We were approached by many children without clothes or food asking not for money or a meal, but instead for books. After primary school, the fees charged prohibit the majority of students, and nearly all orphans without family support from reaching a higher education. Even the best and the brightest students are funneled into the poverty-ridden industry of fishing.
When not in school, children are often found at the lake scrubbing pots and pans, carrying buckets of water, or chopping and collecting firewood from high atop the mountain. We encountered the children in the picture above upon a 2 hour hike to the top of Mfangano Island. These children were carrying ~100 lbs of wood they had chopped at the top of the mountain down a rocky hike in bare feet. The firewood would be sold for 50 Kenya shillings, the equivalent of less than a dollar. When you see how difficult their lives are and how hard they work, it is sometimes easy to forget they are children. However, bring out something as simple as a balloon, frisbee, or soccer ball, and you will see faces light up and flocks of giggling youths. You soon remember that these are indeed children; children who have been robbed of a childhood.

Friday, July 07, 2006

Structural Violence: Fishing, Women, and HIV on Lake Victoria

In the Suba District, where the HIV prevalence rate is over 40%, the women suffer the most devastating plight in life. The islands of Lake Victoria are dominated by the fishing industry of omena (minnows), tilapia, and Nile Perch. In this poverty-stricken area, fishing provides the men with a quick reward of hard cash at the end of the catch, which is often spent the following day. As some days the catch is large and other days the fishermen are left empty-handed, life here is lived on a day-by-day basis. For the women however, there is little to no ability to raise their own income, as the fishing is solely done by men. One of the only ways to raise money is to sell the fish caught by the men. In order to sell fish on an island, a woman must have a connection to a fisherman, usually a sexual relationship, to obtain daily catch for the market. With little other option to obtain money for food, the woman are stripped of their personal agency and forced by structural violence into a life of polygamy, poverty, and HIV.

In search of the best catch, the men travel each week from island to island. As they skip from place to place with little respect for establishing permanent living conditions besides a tin hut, the women, often pregnant with their children, are left to fend for themselves with no source of money. With the migration of fisherman follows the rapid spread of HIV throughout the islands, leaving women wasting away without even the money to travel to the mainland for medication.

The poverty cycle continues as young woman, raised by mothers in poverty, begin to attend school. Often without funds to buy proper clothes, most have no money to provide sanitary napkins once they hit a maturing age. Local teachers note that the young girls often will be absent each month for one week during their period. Others who attend school will need to go down to the beach when their clothes are soiled to wash in the water. These are the same beaches inhabited by fisherman coming back with their quick cash from the daily catch. The young girls are frequently offered money for hygiene products, food, and clothes they could otherwise not afford. Teen pregnancy, HIV, and the poverty cycle continue to propogate.

Tuesday, July 04, 2006

The Island

Someone once said that Mfangano is the farthest place you could travel to in the world and still be on Earth...After the four days of travel from NYC to get here, everyone began to understand the truth of that statement. Much remains the same here as hundreds of years ago. Constuction for the first road on the island was started a few months ago, but most people still get around by way of small single track paths that crisscross the island between villages. Fishing boats carry people between most of the villages and an hour and a half ride will get you to the nearest port city, Mbita for groceries. Fishing is the life blood of the area and with it comes the diseases of the nomadic lifestyle. The Suba District has the highest HIV rate in the nation at around 40%.
Other than the visitors to a very high end resort, few western tourists are ever seen on the island. Therefore, after the look of astonishment disappears we are always greeted very pleasantly in Luo or Kiswahili, and hear high pitched calls of "How are youuu!?" through the cornfields by young children wherever we pass.