Reality Check

I started to write this post called “Identity: Africa” in which I was talking about recent discussions I’ve been having about how we refer to this continent. Then I went to work yesterday and I have now shelved that post. Instead I just want to tell you what I learned yesterday at work.

What is a household? At the Community Health Department (CHD) when doing statistical analyses we rarely refer to individuals and instead refer to households. But then I asked – what is the definition of a household? It turns out that the deciding factor of what household you are in is what pot you eat out of – literally - and this is not just a Kenyan concept I’ve been told, its an African concept. In rural villages, it does not matter if 10 people live in 10 different huts. If they congregate to eat the same food cooked by the same person, they constitute a household. At first, it seemed kind of odd when you are considering health outcomes to combine people simply on the basis of where they eat. I argued that the living standard, or the income of those 10 people, as well as the housing quality of those 10 people may be completely different. Not so I was rebutted. There is such a strong sense of group behaviour (which upon reflection I can say that is very true) here and a sense of what is mine is yours. Rarely in a village will you see one house standing strong while another is crumbling. Rarely will you see one person fail while another succeeds. But what happens when personal differences arise? Conflict must arise? Sure conflict arises, but even if you can’t stand the other person, even if you won’t talk to the other person, you will still eat with that person. If a situation gets to a point where 2 people can not eat together, one person will most likely end up leaving the community. How there came to be such an emphasis on the concept of food, I don’t know, and I’m told that it’s a cultural concept that maybe I just can’t understand. I guess to compare, we consider a household by where we sleep? That’s the closest I can think of.

Anyways, seems like a moot point, but I found it incredibly interesting. Over lunch with some colleagues (eating some questionable chicken that I’m hoping doesn’t come back to haunt me) we started discussing my ever-favourite topic of the benefits (or lack of depending on your view) of NGO’s in Africa and the work we do as CHD. For those of you who read my post called “Talking Sh*t” you’ll have read about how inspired I was after seeing a community so enthusiastic and empowered to make a change in their own community. How encouraging it was that they all came and wanted to make things better. Turns out, we have to pay them each 100 shillings (~$1.50) to come to our little sessions. Its an incentive. How, or why people require incentives to improve their health is beyond me. But that’s the reality.

Finally, near the end of the day, I sat in a meeting to discuss our community based health information system. We have collected an incredibly large quantity of data from households in villages across this province so that we can analyze it and develop evidence-based interventions. However, large discrepancies had been turning up in the data between what is being recorded at the community and what is being recorded at the facility. Why? Because our enumerators (data collectors) tend to make up the numbers. What?? Sure…sometimes they’re not keen, sometimes they’re complacent, sometimes the system just doesn’t work. There’s overlap, under-recording, over-recording, gaps, and pretty much every other inaccuracy you can imagine. The Ministry of Health has their own way of measuring, each district has their own way of measuring and the idea of a standardized way to measure just hasn’t come up yet I guess? But that’s the reality. Either we work with the system we have, or we sit on the sidelines.

I hope you are not interpreting this as a rant. Also, I am not trying to put down my organization. CHD is the one trying to make the change, but is being stifled in the process and I am actually developing quite a loyalty to the organization and my co-workers. So this isn’t a rant. Far from it. Rather it’s a realization, an epiphany about the system that I have to work within. But, my hope is that my awareness will enable my ability to overcome it (or at least deal with it). My only question now is…where do I begin?

A New Normal

I just wanna start off by clarifying something. I’ve received a few notes (which I appreciate) from people just making sure that I’m happy and well. After reading some of my previous blog entries, I realized that they sound a little dark and may make it sound as if my experience here has been…well..less than enjoyable. I hope that’s not the case. What I write here is my raw thoughts. I don’t edit this before I post it. Sometimes I just speak (or in this case write) my thoughts regardless of whether it makes sense or not. To be honest, I read back on some of these posts and I wonder what the heck I was thinking at the time. But that’s the beauty of a blog I figure…I’m not keeping a journal – I started to, but then quickly realized that what I was writing in my journal was exactly the same stuff I write here, and so was the frequency. So this is my journal, when I get home, I’ll print off every page (on recycled paper, double-sided and make sure to reuse the ink cartridge) and bind it into a book. But thanks to all for checkin in...

NEhoo…last wknd we decided to take a trip out to Haller park which is an animal sanctuary just outside Nyali. It was a great day and I got to see giraffes, hippos, crocs, gators, and probably the coolest – giant tortoises. It got me very excited about the prospect of that magical Kenyan experience – safari’ing! No – no set date yet, but it will happen…stay tuned. Traveling large distances in Africa is not the easiest thing to do (or cheapest). After that we hit the beach till dark and once again I saw probably my favourite sight of all - the sight of the full moon illuminating the Indian ocean as it crashes onto the shores…I never get tired of it.

The work week has been slow, but maybe its just that my blood pressure has finally returned to normal as I continue to settle down. The sights, the sounds, even the smells are becoming familiar. I know when to hold my breath, I know when/where to just look straight, and I know when to wear ear plugs (not that I carry them around). Yesterday, we had the odd cloudy day (its rarely cloudy here) which meant that it would be cooler (the heat is coming)…so I decided to take an hour over lunch and just wander the streets a bit with no particular destination. Its really amazing when you just randomly hit the pavement to see the microcosm that is not only Mombasa, but maybe Kenya, and maybe Africa (ok that’s a big generalization). First there are just tons of people who are walking around with somewhat empty looks on their faces and you wonder if they’re actually walking somewhere, or just walking. Then, there’s tons of people just sitting on the side of the street, not really doing anything, just chilling, as if they plan to sit there all day. There’s street vendors everywhere selling everything you can imagine. There’s food stalls that tempt you, but I continue walking lest I want to spend an afternoon on the toilet. Tiny narrow alleyways entice you to walk through and see what they have to offer. Music is blasting at almost every corner, and if you can’t hear the music, its probably because its being drowned out by the (sometimes musical) horns of matatus and their conductors yelling where they’re going and haggling you to get on (even you’re walking in the opposite direction they’re going)

There’s the modern mixed with the rural. The western-style business people going out to lunch mixed with the traditionally dressed women with an incredibly large quantity of goods on their head and tiny infants wrapped around their backs. Finally, there is probably the saddest sight - the sight of multiple street kids sniffing glue. They also walk around with lifeless looks on their face, except that they are unjustly young, barefooted with ripped/minimal clothing and have plastic water bottles with industrial strength glue in them stuck to their noses which they sniff all day. Its truly a heart breaking sight to see youth that are so lost…seems so unfair.

But this is Mombasa, this is my adopted home, in all its beauty and all its grime. It tingles at your senses and emotions and invites you to interact. You can see both where Africa has come from, and maybe a little bit of where its going (however that’s a whole other debate). So I think I’ll continue to wander, to walk, and explore the streets of this old industrial port town and see what else I find. Its not Toronto, its not normal, but it’s a new normal.

A Mombasa Month

Yesterday marked the one month anniversary of the day I left the comfiness of home for my Kenyan adventure. Today marks the one month anniversary of my arrival. So I’ve made it through a month here! Therefore, I thought i would take this chance to just think about what’s gone on the past month. So i’ll start off with a bit of a confession – Mombasa is not what I expected.

When I was first told I would be placed in Mombasa, and started mentioning Mombasa to others who knew of the city back in Canada, I got the impression of sleepy, airy, relaxed sea-side town where the ocean is just footsteps away, you don’t need to take out life insurance to cross the street, the air is (somewhat) clean and its peace and quiet is around every corner.

Now those of you who I actually talked to about Mombasa may either be wondering a) how the hell did he get that from what I said? Or b) you mean it isn’t? (probably more A). But I have to say, living and visiting a city are 2 completely different experiences. When I first arrived in Mombasa it was easy to see why people instantly fall in love with the place. We stayed in a gorgeous hotel on the coast of the Indian ocean, and everything seems so scenic. That first night I saw the full moon brilliantly shine over the Indian ocean I can honestly say I was hooked. However, it was a little short lived. The hotels are actually quite a distance from the island (the actual city is an island the hotels are off the island). The island is more of a congested, smelly, loud mess. Having said that though, I’m also settling in pretty well and Mombasa is not that bad – just not what I expected. We have found a nice little place that is on the island but removed from the chaos and smelliness of the city centre and is actually right on the waterfront. Every night I am able to come home and sit out on our porch swing and watch the sunset over the water (I can’t go watch the moon on account of our guard dogs who still don’t recognize me at night and come charging at full speed).

So what have I done in the past month and what have I learned? Well…for one thing, I have shaken more hands in the past month than I have in the past decade. Kenyans love to shake hands…so much so that they will go out of their way to do so, but it’s a nice gesture. I've also learned that there is no improper time to answer a cellphone. I've seen meeting chairs (in mid-sentence) and teachers (while teaching) stop to answer their phone...its a little ridiculous, oh and no one's heard of the vibrate feature..they all just ring. Kenya is also probably also one of the slowest country's I’ve ever been to - nothing moves fast here…except for the matatu’s. My work has been slow to say the least. I miss critical thinking and having my mind challenged and managing multiple tasks. I don’t mean to sound condescending, but I feel as if the pace at work is starting to make me dumber. But I’m learning to adapt – I mean, as long as I’m not wearing my bright red Toronto FC t-shirt, I can pass off as a local anyday. I swear I’m even starting to recognize some of the matatu drivers. Streets are starting to look familiar, I can navigate my way around and I’m starting to speak “a little” crude Swahili (really wanna take some lessons). OH! and the last few times I’ve taken a tuk tuk, they’ve quoted me the local price right away, no bargaining needed! So there is some good news.

Recently I took a field trip out to a district where we were going to do a health education session at a rural school (built by an NGO) which had the most interesting motto:

Struggle for Success.

Struggle for Success? Struggle? I found it very odd that a motto would indicate that you need to struggle in order to succeed. Why not “strive for success” or something? But as I thought about it, in a cynical manner I thought that it maybe that does somewhat describe whats going on in Kenya. Success is a struggle. I know I wrote a little while ago on the level of complacency that exists here, but there are those who have true passion and ambition and want to see change – I’ve met them! I am lucky to count my supervisor at work as one of these people. But it just seems like there are so many things holding them back - corruption, violence, injustice, poverty…the list goes on.

Its funny how much can change in a month. Recently I was talking to my fellow intern Sarah who mentioned that sights that would make us run for disinfectant back in Canada are just brushed aside here. At home the sight of a gecko on the wall inside my house, would probably have me a little concerned. Here, as long as he’s not trying to tell me how much i can save on car insurance its all good. I’m starting to learn to re-adjust my standards. What we would consider chaos in Canada is organized in Kenya. You just have to remember, as I’ve been told so many times “this is Africa”. So, you adapt, its what human beings do. Billions of people have been doing it for billions of years before me - at least that’s what I keep reminding myself otherwise I’m never gonna make it.

So one month down, 7 to go and i look to the next 7 months with optimisim. I am optimistic that my work will become more challenging and maybe even faster paced, I am optimistic that I will meet more Kenyans with true passion and ambition for change, I am optimistic that I will adapt.
Here’s hoping the next 7 months are full of life, laughter and learning.
The journey continues…

because it matters..

just a short note here.

as i approach my one month anniversary of being in kenya i just want to say how much i appreciate the thoughts/emails/msg's i've been getting from back home. I can't tell you how good it feels to know that people back home are reading and I hope you are enjoying reading this blog as much i am writing it. it gives you a great sense of connection and sometimes in a land where political correctness is primary about what you say, having an arena like this to express your thoughts is a saviour.

so keep em coming, i assure you i read them all and love to get them...especially on those days when home seems so far away...

Back to School...

I hate starting sentences with “In Canada…”

One initiative that my work is trying to implement is its Program for Continuous Education”. Basically, training courses for health care professionals right now come from mostly East Africa, but we hope, worldwide. So when I found out that we were offering a course this week on “Community Based Health Development” I jumped at the opportunity to grab my pen and paper and audit the course for a day to see what its like.

Well…to begin with, its just like every other training course I’ve been on. Introductions in the morning, coffee at 10, lunch at 1, and the token guy who will just keep talking and talking with no regard for time (yes I know…African time). Actually, and I mean no disrespect here at all, what surprised me was just how little we were covering! (Yes I realize that I’m talking about a course being offered by own workplace). It took us 2 hours to come to the conclusion that the household was the “structure” which influenced health the most….i mean...its an important fact..but really..2 hours!?!? We then spent some time discussing Community empowerment and how we could best empower grassroots action…finally the good stuff! It was a bit of a circular discussion, and basically the class felt that NGO’s and international donors should not provide support at the grassroots level as there are many levels of hierarchy to go through (sigh…). The talkative dude then went so far as to say “They should just give the money straight to the government and let the government decide how to spend it.” Bite my tongue.

If you’ve been reading anything about Kenya, you can’t read more than 2 sentences without seeing the word corruption…its everywhere! As much as I wanted to pipe and say “really??..like you want me to give you my tax dollars (via CIDA) to your government so they can buy themselves another Armani suit they saw?" Ok fine…unfair generalization, but I don’t think giving to only to government is the answer - at least not in the current system. But I also didn’t want to risk an international incident and possible lynching by insulting their government. Turns out though..i didn’t have to! The lady beside talkative dude…just blurted out “I’m a proud Kenyan, but our government is just too corrupt!”. Sweet! What ensued was a huge rant on government corruption and how if donors gave money directly to government, nothing would ever happen. Finally i see some passion! Props to talkative dude here, he somehow rearranged his argument to convince the class that “no..maybe donors should be giving only to government”. Ok…now I had to pipe in (either that or the teacher saw the huge smirk on my face and couldn’t resist). I tried to choose my words carefully and basically posed the question “How can we create confidence in the international community that corruption will not eat away at international aid?” (this is where I tried to refrain from the “In Canada…”). What I was hoping for was a spirited answer surrounding making governments more accountable and increasing transparency….power to the people!

Instead what I got was complacency. An answer of how to simply work with the system. “Well, if there’s so many layers of red tape and therefore many more chances for corruption, lets try to remove some of the layers…the people will still be corrupt, but there’s just less of them.” Nuts. Not what I was hoping for. I guess that was enough for one day.

Anyways, it’s a 2 week course and they’ve invited me back to attend next week so who knows…either I’ll dazzle them with my wit and intelligence, or I’ll be on the 6:00 news and home a lot sooner than I planned.

Oh, and I almost got run over by a matatu on the way home.

Health Action Day

On Saturday, the three of us decided to volunteer our time at a Health Action Day that was being put on jointly by the Madrassa Resource Centre and the Community Health Department (my workplace).

We arrived bright and early Saturday morning (and very blurry eyed due to a late Friday night) at 7am at the MRC office in downtown Mombasa ready to go. We were driving to Kalifi district which is just over an hour outside Mombasa. An incredibly bumpy ride as we got more and more rural the number of potholes and bumps totally outnumbered the amount of paved road (or what passes for roads out here).

Anyways, we arrived in a small village in Kalifi to find that there were probably about a hundred people already waiting for us. We were basically setting up a free clinic for rural villagers to come and see a doctor and get medication if need be (separate clinics fro men and women/children were setup). There was also a voluntary AIDS testing centre where people could get their HIV status…makes me wonder how many people received a death sentence…There was also a testing centre for young children to be weighed to ensure they were being nourished properly.

People from all over the area (some I was told would walk about 10km) to this clinic. They would begin by registering themselves where we took their name, age, sex and hometown (it was interesting to note that some did not even know their age). From there they were directed to the appropriate clinic. It should come as no surprise that before we knew it, the lineup stretched probably a good 4-500 metres.

I was placed in the pharmacy to help pack drugs to dispense to patients as they came with their prescriptions from the doctors (~15 doctors in total had volunteered their time). It was a bit of a rush in the beginning as the lineup outside the makeshift pharmacy continued to grow and we pack drugs as fast as we could. At one point we decided to count just how many Canadian laws we were breaking by doing what we were doing (lost count eventually) but then again – Canadian laws don’t exactly matter here.

The hours passed somewhat quickly as patients came in and out and medical advice/prescriptions were passed out. In the afternoon, I switched over to the registration desk to help register people as they came. We started seeing patients at ~9am and about 6 hours and over 1200 patients later, we decided that we had to at least stop registering patients as we realized that it was already 3pm and to see the patients that were already registered and waiting in line would take another 3 hours or so and then cleanup and debrief.

While I completely understood and agreed with closing down registration, it was incredibly disheartening to have to turn people away and times like these I’m glad I don’t understand the local language as I didn’t want to know what the people were saying when we told them we couldn’t help them. I will never forget the look on the face of the frist man we told we couldn’t register as we had to close. Some were resigned and started the long walk back home, others decided to just hang around the clinic – maybe if anything to justify their long walk there. But you could definitely see a look of anguish on some of their faces. While its comforting to know that over 1200 people were seen, I foolishly wish that we could have helped them all. But my hats off to the physicians who tirelessly and without breaks stayed all day to see and treat these people. Sometimes I wonder though, were the drugs we were prescribing really going to help? Would the illnesses these people were suffering from be cured by a few advils or some cough syrup? Part of me thinks that the real medicine was the one-to-one interaction with the doctor and that just having someone who listened was the best medicine. I’m glad I got the opportunity to see grassroots health like this in action and I hope I get the chance to do it again. As for those people who didn’t get to be seen, I hope they come back…