Monday, October 30, 2006

Another Young Silent Death in Rural Kenya

Our friend Benson led us through the entrance of his family's traditional thatch and mud two-room hut where his brother lay dead on the floor. His cachectic body was simply dressed in plain clothes with a bandana tied around his mouth. There was no fancy coffin, no funeral home, no bouquets of flowers, no music, just a silence broken only by the heart-wrenching traditional wailing of his sister knelt at his side.

He was the third of Benson's brothers to die before their mid-30s. As with the other brothers, his body was consumed by tuberculosis, likely spread through cramped one-room living conditions and complicated by HIV. He was receiving anti-TB treatment, but was unable to reach the nearest medical center when complications arose, due to financial reasons. Instead of receiving available and effective treatment, he died silently in his home one night.

His case is not unique. Upon leaving the funeral we crossed paths with a local nurse who was on her way to the same funeral. When we asked where she was coming from, she told us she was coming from another funeral of a young man who died of HIV in the neighboring village. Throughout these islands, one could march from funeral to funeral of young people silently passing from the epidemic of HIV and TB destroying this area.

--Kevin Messacar

Chasing Tigers: Adventures in Finding a Tigers' Game in Rural Kenya

Over the past 5 months in Kenya, we've met some of the biggest Detroit sport's fans in the world... they just don't know it yet. We've encountered a fisherman on a remote island in Lake Victoria decked out in a Stevie Yzerman Red Wings jersey, a baby admitted to the hospital with malaria still proudly donning her Tigers jersey, and even an elderly man in the slums of Nairobi showing off a vintage 1984 World Series jacket complete with the name "Dorothy" embroidered on the front. Being fellow Detroit sports fanatics, we get extremely excited when we encounter any display of Detroit sports-gear. We'll run up to these folks and enthusiastically explain that Detroit is our hometown, and that we're so thrilled to meet fellow fans. However, the reply is always the same: a blank confused look and "No sorry, this is just a shirt (jacket, etc)." Although they may be merely wearing second-hand clothes to serve a purpose without understanding their significance, we know in our Detroit-heart-of-hearts that deep-down they really are Detroit sports fans... they just don't know it yet.

Despite this immense Detroit following in Kenya, we've had more than a heck of a time trying to catch a Detroit Tigers playoff game in an area where there is no running water, let alone electricity and you can count the number of TVs in town on one hand, let alone those with satellite connection for the MLB playoffs. That's not to say that we haven't been trying...

After asking all around town if anyone carried the baseball games and hearing the reply, "What is baseball? Is it like football (soccer, the only "real" sport according to the people here)?", we had our first stroke of luck at, of all places, a campsite on Lake Naivasha. We were astonished to find a television connected to satellite TV with the MLB playoffs on the schedule for 4 am. We begged and pleaded with the Masai guard to open the bar and turn on the TV in the middle of the night, which was successful after we explained, "watching the Tigers in the playoffs is like watching Kenya in the finals of the World Cup". We awoke at 4 am from our tent, walked past a pod of hippos, and popped on the TV expecting our first glimpse of the Tigers in the playoffs since our childhood. Instead what we found was a group of announcers at the sportsdesk announcing that this evening's game between the Tigers and Yankees was cancelled due to rain. What luck!... but we were not yet defeated.

Over the next 2 series, we struggled on the islands of Lake Victoria without access to any TV, but kept up with the action via text messages over the cellular phone. We would excitedly jump from bed in the middle of the night to find that the Tigers had taken a lead in the first, or had gone to extra innings, or that Mags had hit a game-winning home run. Though this kept us up-to-date on the scores, it couldn't replace actually seeing our Tig's take the field.

Our big break came as we were hiking beach to beach living in fishing villages. Between villages we came upon the sole exclusive tourist resort on the island, run by a British character, whom we have come to know over our stay here. He generously offered for us to crash at the resort for the night for a break. We seized the opportunity and quickly went to work feeding him drink after drink, until he agreed to stay up until 3 in the morning with us to watch the Tigers on his private satellite TV in his house. Needless to say the British chap passed out before the game started mumbling something about "this game is nothing but rounders", and we were left to finally watch our Detroit Tigers in Game 1 of the World Series.

Seeing the men in the Old English 'D' take the field sent shivers down the spine, and watching Comerica Park come alive in a way that Detroit has not seen since 1984 was something truly special. For that brief moment, we were able to forget where we were in the middle of Lake Victoria in Kenya, suspend the intense emotions that we've had to deal with over the past months in working in this impoverished, HIV-prevalent area, and experience a surge of pride and excitement in seeing our hometeam represent our hometown in the center of the world stage. We intently watched the first 3 innings, savoring every pitch as we had worked for weeks to have this opportunity, when the generator power cut out and we were left in darkness. While we didn't have the chance to see a whole game, the chance to catch a glimpse of Detroit Tigers baseball in the middle of rural Kenya was something we'll never forget.

Although we were unable to catch any more games and have received the sad news that the Tigers were defeated, we want to thank the Tigers for the amazing 2006 season. Their efforts were seen and felt literally around the world. From unifying a city ridden with auto-industry lay-offs and tough economic times, to providing those of us away from our Michigan home a chance to escape our situation and join our friends and family rooting on our Tigers, this team has made us all proud! BLESS YOU BOYS!

As we set off to hike Mount Kilimanjaro this week, we will proudly wear our Detroit Tigers' gear and hoist the Detroit foam finger (which, of course, we packed in our luggage 5 months ago) from high atop Africa.

As promised...

Tuesday, October 03, 2006

"Deadly Catch: Lake Victoria AIDS Crisis": A Film Documentary

If you have 15 minutes, please take a look at this film documentary on the situation in fishing villages along Lake Victoria. It was filmed in the Bondo district, next to the Suba district where we are working. The situation in the islands is very similar, if not more disturbing, due to their isolation. The website for the film is , scroll halfway down the page to the film titled "DEADLY CATCH". Let us know what you think...

Jaboya: The Fish for Sex Trade

Before living on the islands we had known that commercial sex was a problem on the islands leading to the spread of HIV. However, commercial sex to us meant a few prostitutes in the local bar selling sex for extra cash to the fisherman who could afford it. What we have come to understand through living in these areas and hearing the stories of those who live there, is that the exchange of sex is not an isolated practice, but a system which the fishing society revolves around.

The system, locally called "jaboya," involves the trade of a sexual relationship for the ability to obtain fish for sale. The men catch the fish, and women sell the fish locally, where others are sent for export. In order for a woman to obtain fish to sell locally, she must have a relationship with a fisherman. Without a boyfriend, a woman has little chance of having access to fish when the boats come in. The more relationships she has, the more likely she is to be able to obtain fish. If the woman wants to transport her fish to local markets aboard matatus, she often is forced to once again exchange sex with the "tauts" (or men who load the roofs of the trucks) in order to get their fish transported.

It is difficult to describe, but this is a system that goes much deeper than standard prostitution. Indeed, there are still "bar-girls" or commercial sex workers in the bars in these areas. However, the jaboya system is a social and economic system that pervades every aspect of these societies. The jaboya women are forced into having multiple sexual relationships with migrant fisherman and tauts in order to provide what is necessary for them and their children to survive. Often they are women widowed by HIV positive fisherman who have no other way of providing for their families.

In order for change to be made in this area, the structural violence of the jaboya system must be broken. An effective intervention must address the fishing industry, poverty, as well as the medical aspects of HIV.

Living in the "Hotbed" of HIV/AIDS Activity

When the sun goes down on fishing islands like Remba and Ringiti, fisherman back form a hard day of work resort to the nightly activities of drinking and sex. If the catch is big, the local bar is roaring with drunks and the hotel rooms are all full. Reading and being told about the practices that lead to the spread of HIV in these areas is one thing, hearing it bang against the tin wall alongside your bed is another.

For the past few weeks, we have been living the lives of migrant fisherman, traveling island to island. We have been eating what the fisherfolk eat, bathing where the fisherfolk bathe, and sleeping where fisherfolk sleep. Our lodging has been in the tin "hotels" that are the center of the prostitution practices on the islands. (The last we stayed in was called the "Usisime Guest House", translated "Don't-talk-about-it Guest House".) The rooms are little more than a tin box with a bed, and come with one candle, the source of light that lasts as long as most of the activities undertaken in these rooms. Rates are ~75-100KSh/ night (a little over 1 dollar), or they can be rented out for the "short-term" in hourly intervals. Each night, nearly all of the rooms surrounding ours are filled with fisherman and the women that are exchanging sex for fish with them, or prostitutes from the bar. Walking out of our room after one of our first nights in one of these hotels, we were torn between being disgusted by the used condom left in the hallway, and being pleased that at least one was used.

Our clinics providing sexually transmitted disease treatment and anti-retroviral therapy are often held in the same location that the disease was likely transmitted in the first place. We rent either the hotel rooms described above or partition the local bar into patient rooms and treatment areas. After seeing a steady flow of patients all day, we are often left no other option (as there is none available in town), but to sleep in the same room that we have been seeing patients all day. Picture your doctor treating ill patients all day on the same table, then deciding to curl up on that table and sleep for the night-- that will give you a good idea of how we've been living.

The islands have no source of clean water, leaving most to drink water straight from the lake (although we rely on bottled water). As there are no public latrines, you must walk to the end of the island away from homes to relieve yourself. When the rains come and wash the rocky island clean, cholera and waterbourne diseases run rampant as this waste trickles down to the source of drinking water. This also makes bathing tricky, as the water you are to bathe in is likely dirtier than you are in the first place. We have been forced to do our best to find a "clean" point of the island, scrub up, and swim out into Lake Victoria. Food is severd in one "restaurant" in town, which often has a long menu posted upon the wall. However, after ordering you quickly learn that the only available options are fried fish, boiled fish, or fish stew.

The experience of eating, sleeping, drinking, and bathing as migrant fisherfolk for the past few weeks has allowed us to enter into the lives of the population we have been working with. We have seen and heard firsthand the practices that contribute to HIV in these areas. Most of all, the undeniable link between poverty and the spread of disease has been cemented into our consciousness.

"Are you coming back...?" ---Our efforts in the beaches with IMC

We knew we needed to head back to the islands of Lake Victoria after being very frustrated with the limited accessibility to health care for patients who were obviously stricken with HIV/AIDS during the mobile clinics with Operation Crossroads Africa. We wanted to work more on the public health level of the beaches to increase the HIV prevention and education efforts being done in the islands.

With the International Medical Corps, (IMC) we have been given the chance to get back the beaches where we ran mobile clinics in June and July. IMC has started a Condom and Other Preventions Effort, to reach beaches that have not been previously reached by any kind of HIV education or treatment outreach effort. It is our hope to pair these beaches with other organizations that are doing Voluntary Counseling and Testing (VCT), so that they can receive Antiretroviral treatment, (by groups such as FACES) in the future. Branches of IMC currently do mobile VCT in the lake region as well as mobile efforts to curb Pregnant Mother To Child Transmission (PMTCT). IMC Home Based Care services are beginning in Suba District as well, so that families can be counseled and tested in the comfort of their own home.

As part of the IMC Beaches Program, we initially meet with the Beach Management Unit (BMU), the local system of government for each beach. This is the point of access to each of the 12 beaches in the pilot program we are running. With their approval, we can enter the beach and ask different groups such as fishermen, fishmongers, teachers, youths, shopkeepers, and bar owners what they feel are the main contributing factors to HIV on their beach specifically, and how we can best work to solve those problems.

It is the individual interviews with different segments of the population that best help to elucidate the problems of HIV on the beach level. We take individuals aside to question them on the main issues facing their particular segment of the beach community, and we are continually struck by the responses that we get.

I spoke with a man named Michael on Remba, who was 35 years old and had completed his highschooling in Kisii. He had worked for Glaxo Smith Kline in Nairobi for a short time as a salesman. After his contract expired, he returned to the beach communities to fish, an opportunity that had its own droughts, but rarely led to unemployment. Michael noted that, "when a fisherman gets his money after a catch, before he thinks of his stomach, he thinks of a woman." There is the desire of immediate gratification on these islands with little hope for the future.

Okayofred, a 25 year old male from Milundu beach on Mfangano told me about growing up with 17 friends his same age. Now he is the only one left. "People want to give it (HIV/AIDS) to others" he said, "so that they don't have die by themselves."

When I asked Johnson, a teacher on Mfangano Island, what he thought were the main factors in the community contributing to HIV/AIDS, he thought for awhile and then responded with, “Well...the biggest factor is poverty.” His hesitation at an immediate response, and thoughtfulness showed how poverty was truly the major contributing factor to HIV was in the beach community. Lack of education, lack of access to health care, the fish for sex trade; it all comes down to poverty in the area.

On Remba Island, a woman stuck her head out of her small shop, as we passed by with luggage and medical supplies on the way to the boat, heading to the next island. "Are you coming back...? We'll be here dying...", she said. All we could answer was "yes." Then the sinking feeling began to set in.

We have since come back to the islands after that initial stage of preparation for further HIV training and condom distribution. Over October 7th, 8th and 9th, groups of nearly 40 beach leaders got together in at Ringiti, Sena beach on Mfangano and Luanda Rombo beach on Rusinga, respectively. The purpose of these meetings was to set up an HIV/AIDS Subcommittee so that locally, the beach could coordinate efforts between the Ministry of Health and other NGOs as well as oversee the condom distribution, HIV education, and health services offered by IMC on their beach. The most fruitful portion of the meetings turned out to be having the groups of women, fishermen, youths, and Beach Management Units (BMUs) work together to come up with the specific successes of their beach community, the problems they still face, and how to go about specifically reaching their group with HIV education. We realized that this kind of joint meeting between beaches for the sole purpose of exchanging ideas on how to best combat HIV had probably not been done before. We found that as groups were able to discuss the problems of the beach community leading to HIV such as Jaboya, the “fish for sex” trade, they could formulate reasonable solutions locally.

Still, we will be leaving the islands of Lake Victoria, Mbita, Suba District and the rest of Kenya in early December, and we don’t always know how to answer the question, “are you coming back…?”

-----John Kurap

Anyone care for another round of Chang'aa?

Instructions: Take water, molasses, and cornmeal; add to 5-liter bucket with lid. Secure lid and wait 36-40 hours. Then take your pick; either drink the liquid straight as a porridge or distill it to the point where the fumes from your drink will make the tin shack walls around you rust and crumble.

This is chang’aa, the moonshine of Kenya. Typically a beverage taken by village elders when sitting around and telling stories of the old days, chang’aa is also a very cheap and very potent beverage of choice for many fishermen on the beach.

We have never tried the stuff for fear of immediately going blind, but there are many people around here who drink it daily. There is no sense of savings or planning for the future in the beach community, so after a bountiful catch, the bars and hotels are full with men spending their recent earnings on chang’aa, until the money is all gone. Two days in a row on Rusinga Island we attempted to have a meeting with the Beach Management Unit (BMU); the integral government channel for access to the beach. Two days in a row we evidently interrupted the early morning chang’aa session, and encountered most of the BMU to be drunk.

We met with the Secretary of the BMU, to discuss the future plans for setting up an HIV/AIDS Subcommittee as part of their local government, so that future prevention and treatment efforts could reach the beach. While able to speak English, Chang’aa English was what the Secretary of the BMU was fluent in that day. A series of unintelligible slurred phrases came out, with “America,” “mzungu” (white man), and a little saying about he and his wife’s nightly activities--that isn’t fit for anyone to read--being the majority of the intelligible phrases. We were later told by this man that by merely educating people about HIV/AIDS at the beach level, “the program is going to fail, because you aren’t putting money in anyone’s pocket.” This is someone in a position of leadership in the beach community, and one of the few that speaks English. He could be greatly influencing the health of his community, yet his mind cares more for the chang’aa in his cup.

There seems to be more patience here for public drunkenness than there is in the States, but there is no tolerance for men drunk on chang’aa who harass the mzungus on the beach. We are watched over in the communities with a great deal of respect, and are either led through the maze of tin shacks or are consistently pointed in the right direction. When staggering men approach us with bloodshot eyes, we know its only a matter of time before they are thoroughly disposed of by one of their peers on the beach. The man in the photograph, above, got himself into two fights in one day by persistently approaching us, claiming in a mix of broken English and Swahili to be a long-lost friend.

Yet tomorrow, after another catch, he’ll probably have his glass raised high, asking for another round of chang’aa.


Monday, October 02, 2006

Acting Out Against HIV

When people are constantly surrounded by atrocious living conditions it may be human nature--as some sort of survival instinct--to mentally wall oneself off, so that you are not continually exhausted by what you are experiencing. People are often able to resist the realities around them, and only when those realities are observed in a different form--be it films, photographs, or other media--are people able to truly comprehend a dreadful situation.

Videos, such as Deadly Catch (see link) or others that I have seen about certain areas of Kenya have always made the day to day experience around here powerfully tangible. When you can watch it on the screen, and then take a step outside and see the same fishing boats, the same women exchanging fish for sex, the same patients being carried from their car to the health center, and back to the car again, it really makes you take the situation to heart and realize where you are.

On Remba and Ringiti, a theatre group of trained community health workers uses drama as this conversion of reality to demonstrate topics related to HIV affecting the beach community. We watched two performances by residents of these islands that covered topics such as; the promiscuous nature of life in the islands, wife inheritance, going to a Voluntary Counseling and Testing Center (VCT), finding out about a positive HIV test result, becoming ill and haggard as a result of the disease, and confronting family members about one’s status.

The performances drew a large audience of interested community members. By using humor to address a disease most people at the beach level still fear because of a lack of understanding, the performance achieved its goal to make people think about HIV and its treatment methods.

One skit in particular was about seeking different methods of treatment for someone whose promiscuity had led to her to become very sick with HIV, but had not been tested yet. In the skit, the actors went from a church, to a witchdoctor, and finally to a VCT for the confirmatory test. There was a big roar of laughter from the crowd after the actors supporting the ill “patient” left the witchdoctor (played by an actual witchdoctor from the community). His line was, “I'm a witchdoctor, I can’t do anything for these people…that woman evidently has AIDS, she needs real medicine. But I still got their money…hahaha!” By focusing on such topics of the local culture, these theatre groups not only solve the issue of idleness on the beach for a few hours each week, but also reach people personally in a way that makes them stop and understand the problems affecting their own community.

-----John Kurap

Taxing the Poor: Corruption on the Local Level

For every kilogram of fish that is caught in the lake, the County Council takes one shilling as taxation. In bandas that routinely catch over 10,000 kilos of fish, after a week’s time, this can amount to a sizable sum of money. In the beach communities, that money is supposed to return to the people in the form of latrines built by the county council, or other sanitation efforts. However, this is rarely done, and the money just gets pocketed. On Remba, there is only one public latrine specifically built by the council for the population of about 8000 people. Think about that the next time you are waiting in line at The Big House or Comerica Park for a little relief….In addition, the public latrine is usually locked, forcing people to either track down the councilman with the key, or relieve themselves wherever they see fit.

In every discussion that I had with someone regarding this sort of “taxation without sanitation,” I found that the people in these isolated islands have an overwhelming feeling of helplessness in regards to dealing with anyone from the government. Pair that notion with the transient lifestyle of everyone in these beach communities and their response becomes “well, it’s not really that bad, the government could tax us much worse." The people realize that they are lining the pockets of the County Council and District Commissioners, yet without a unifying voice, they feel utterly helpless in the situation. They know that they’ll be moving on to another beach shortly, so the feeling is, what's the sense of taking care of the area they are in?

The corruption goes far beyond the taxation without sanitation at the beach level. Matatus are only supposed to carry a certain amount of passengers, but when an overcrowded matatu comes to an “official” police check point there are a couple options available. There is either a handshake exchanged with a bit of cash inside or several bills are wadded up and nonchalantly dropped to the ground as “garbage,” which the officer disposes of in a plastic bag as soon as the matatu drives off.

We often head to work out in the beach communities on the back of a motorcycle, known locally as piki-piki. We were delayed one morning during the attempt to leave by the county councilman who chained up the motorcycles until the drivers paid their taxes. I inquired what the taxes were for, and the councilman replied that they were some sort of fee for standing or parking in the certain location. I asked what the drivers get in return for paying the tax, to which the councilman replied, “they will have a shade up by next month.” Two weeks have passed and no efforts have yet been made. The worst case I’ve heard of recently, is that to play soccer in a local field, children have been taxed by this same councilman.

The funniest or saddest one I’ve heard, depending on how you look at it, happened on the streets outside of Nairobi. A buddy of mine in Nairobi was telling me about a time he was stopped by a policeman who accused him of speeding and was asked to pay a fine right then and there or he would be thrown in jail. Tim laughed at the officer knowing how they often act, and said “show me your speed gun.” The officer replied “no,” to which Tim replied, “why, because it’s actually a hairdryer?” Tim had seen that the officer had been holding up a hairdryer, and requiring that people pay for going over medium-warm kilometers per hour.

-----John Kurap