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?