Thursday, August 22, 2013

Gardening for Health

Over the past couple of weeks, we traversed many miles of roads and dirt tracks on the backs of boda bodas (motorcycle taxis) and on foot as we visited families and support groups who have started kitchen gardens in the past year. The purpose of our visits was to meet the beneficiaries of the kitchen garden program and hear about their successes and challenges. After listening to their stories, and then writing a report on the kitchen garden initiative, I wanted to reflect on the big picture, rather than all the small details and logistics I’ve been learning about bit by bit.
            It might not immediately be clear why an organization such as WOPLAH, which is dedicated to supporting people infected and affected by HIV, is focusing on a project such as kitchen gardens. The jump between growing kale and managing HIV might seem like a stretch. However, with a little thought, the connection becomes very clear. It’s so basic and simple that it can be easily overlooked. Without consistent access to nutritious food, any other health interventions are just band-aids. The administration of antiretroviral drugs to control HIV/AIDS is a case-in-point example. When taken without food, the drugs often have debilitating side-effects, such as nausea and dizziness. Dealing with these type of side effects on a daily basis can discourage people from taking their drugs, rendering the entire treatment process futile. In this case, the solution is not more expensive drugs or complicated initiatives. The solution can be as simple as turning over a small plot of land in a backyard and planting some seeds. A drug targets and treats a very specific problem. A kitchen garden addresses a wide variety of problems at their very roots.
            When a community, family, or individual gains the tools to grow a kitchen garden, they gain the ability to provide one of the most basic human necessities for themselves and those around them. The act of planting a seed, tending a plant, and finally preparing and sharing a meal that is the product solely of one’s own hard work can instill a vital sense of self-worth, self-confidence, and self-respect. In a place where people living positively with HIV are often ostracized and viewed as a burden, the independence that comes from being able to provide for one’s self and one’s family can play a powerful role in reducing stigma. When people see a HIV+ community member growing a verdant garden full of kale, cowpeas, pumpkins, maize, spinach, and tomatoes, they are forced to reconsider all their preconceptions about HIV/AIDS.
            Food is the greatest equalizer: it is a need we all have in common. When we sit down to share a meal with other people, we recognize our shared humanity. The barriers of race, age, socioeconomic status, and HIV status disappear as we fulfill the same basic needs at the same table. Eating is a simple act, one that many of us don’t give much thought to, but its power cannot be underestimated. A few weeks ago, we visited a health center where a children’s club for kids who are living positively or who have been impacted in some way by HIV meet once a month. It is a place where the children come to play, eat, learn, and be carefree. When we met up with Edwin that morning, he informed us of our plan for the day. We would spend the morning at the children’s club before moving on to another house for lunch. He said that even though we were going straight from the children’s club to a big lunch that was being prepared for us, we must be sure to eat some food with the children. He stressed that if we didn’t, the children would think we didn’t want to share food with them because of their HIV status. Eating with them, on the other hand, would send a message of equality and solidarity.
            The connection between global health work and kitchen gardens might be difficult to discern at first, but our human need for food cannot be separated from any aspect of life, especially basic health. Good nutrition is the keystone of good health, so it is important to consider the consistent provision of healthy food as a pillar of health care.  Kitchen gardens can be a great source of healthy food, as well as help generate income, and give people hope and self-respect.
            Of course, there are challenges associated with kitchen gardens, as we have learned from talking to many of the beneficiaries of WOPLAH’s garden project over the past few weeks. They struggle with pests that eat crops, unhealthy soil, water sources that are difficult to access, and changes in the climate that are making it increasingly difficult to get good yields. However, the beauty in planting a garden is that there is always hope. Each seed is placed in the ground with the promise that the future will bring a green sprout, a growing plant, a good harvest, and increased health.

Members of a support group in front of their kitchen garden.

Rory and Alexis helping plant tomatoes in a kitchen garden near the beginning of our internship. 

Sarah planting tomatoes in the same garden. 

The same garden and same tomato plants four weeks later! 

Thursday, August 15, 2013

Biosocial Phenomena

Today, after a round of our usual kitchen garden monitoring and evaluation, we asked the Tujitolee support group if they had any questions for us. As we sat in the cool breeze of our shaded area, the group briefly discussed in Kiswahili. Then a woman named Genevieve slowly turned to us and softly asked us if there are people in the United States living positively with HIV/AIDS. She said, “In your country are there people living like us? Are they open; are they talking about it like us? We thought this was only an African disease. It will encourage us living positively in Kenya to share our stories and know we have counterparts across continents living like us.” I am always a little surprised when I hear that people think HIV is a burden unique to Africa. If only they could realize that this is a global epidemic and have a sense of solidarity with those living positively in developing and developed countries alike. Genevieve’s powerful and inspiring words immediately brought to mind another quote that I had just recently read. As if to address questions like Genevieve’s, in her book The Coming Plague, Laurie Garrett puts it this way:

Rapid globalization of human niches requires that human beings everywhere on the planet go beyond viewing their neighborhoods, provinces, countries, or hemispheres as the sum total of their personal ecospheres. Microbes, and their vectors, recognize none of the artificial boundaries erected by human beings. Theirs is a world of natural limitations: temperature, pH, ultraviolet light, the presence of vulnerable hosts, and mobile vectors.

Like most things in the natural world, bacteria and viruses pay no heed to lines drawn on a map. They do not care if you’re white or black, wealthy or poor, Catholic or agnostic. These disparities are but social fabrications with biological manifestations. What I mean by this is that Mycobacterium tuberculosis, for example, does not choose its victim based on skin color or religion. Instead, factors like race, socioeconomics, and drug or alcohol abuse create inequalities that drastically increase the likelihood of infection. In short, these social disparities provide environments in which diseases like tuberculosis are able to flourish. HIV/AIDS can be found anywhere and no matter where you are, it is certainly devastating. But depending on where you are, certain inequalities—like access to treatment and nutrition—make HIV a very different experience. When assessing basic healthcare inequalities around the world, we are not only looking at the availability of efficient care and treatment, but we must also take into account the opportunities available for education and economic empowerment.

WOPLAH has provided an amazing opportunity for us to learn these lessons firsthand. We did not have to fly twenty hours to study and work with people suffering from HIV/AIDS; we would have barely needed to drive twenty minutes from our cozy Colorado campus. We came to Kenya to study the complex interplay between certain social factors unique to Africa and HIV/AIDS. For example, at one of the very first support groups we visited as a GROW team we posed a difficult question: “When you were first diagnosed HIV-positive, did you face any backlash within your own family?” One woman, who was involved in a polygamist marriage, said that she is the only wife living positively and is therefore ostracized within her own family. This example of stigmatization within a tribal marriage is not something we would find back home.

Thinking about health and social justice in a Kenyan setting has challenged us to keep in mind that infectious diseases are what Paul Farmer calls a “biosocial phenomenon.” We are systematically learning that there are many more factors at play than biological factors like CD4 count. WOPLAH’s three main objectives, youth empowerment, health and reproductive education, and income generation, provide a wonderful template for addressing both the biological and social aspects of HIV/AIDS. One WOPLAH project that immediately comes to mind when thinking about this complex relationship is the jiggers campaign. When we visit infected children and adults, the biological ramifications of these parasites are awfully apparent in the form of very swollen and malformed feet. When we begin to talk to these unlucky individuals, we find out that because of jiggers, kids are staying home from school and falling behind with their education, and parents are not as able to support their families. This example demonstrates both the social and biological aspects of infectious disease.    

The GROW team is currently struggling with ideas on how the jiggers campaign can expand and become more sustainable in the future. In 2014, WOPLAH will cease purchasing shoes for beneficiaries, believing that families will begin to buy their own after having witnessed firsthand the positive effects of wearing shoes. I wonder though, since every person we have talked to thus far has listed school fees and food as their primary financial difficulties, whether they would actually allocate the money for shoes when there appears to be other priorities. The dilemma here is figuring out how to prioritize certain repercussions of poverty. Jiggers are a visibly heart-wrenching and serious issue these families face, but if they are still struggling to feed themselves, can we expect them to prioritize shoes over food?

Our internal debate over the future of the jiggers campaign is no new quandary to nonprofits and health providers working in developing countries. As we explore social disparities and their biological manifestations, we are constantly challenging ourselves to think from both a medical and social standpoint. Every GROW team has indubitably faced this same problem masked in a different interaction between infection and sociology. The approach we take when considering health inequity around the globe must be a constantly evolving one based on the dynamics of local variation. GlobeMed has created a unique opportunity for this to occur by placing young, open-minded, and passionate health advocates all over the world. It is our job as the burgeoning generation to utilize an analytical and systemic mind to approach the widening gap between those who have access to efficient healthcare and those who must make do with the meager resources they are given.                


Wednesday, August 14, 2013

A Promising Future

            Yesterday morning, we had to say goodbye to our dear friend Rory and send her towards the airport and her long journey home. After weeks of struggling with a stomach bug, Rory decided it would be best to return home early in order to fully recover. During her time at WOPLAH, Rory passionately formed friendships and touched many people with her creativity and drive for problem-solving. 
            At our weekly meeting with the Ambassadors of Hope on Monday, I watched as Rory said her final goodbyes and thank yous, and made promises to visit again. A knot formed in my stomach as I realized that in just a week, it would be me trying to gather all my thoughts and feelings into comprehensible sentences as I said goodbye to these special people. Seeing Rory go through this process illuminated for the rest of the GROW team the fact that this experience is soon going to come to an end for us as well. Before Rory's departure, we reflected on what we have learned during our time with WOPLAH, and what we will take back with us.
            First, we spoke of some of the practical skills and knowledge that we’ve gained thus far. We all acknowledged that without this internship, we might not have been able to grasp the operation and structure of WOPLAH. Whereas before we might have described WOPLAH in vague terms, we now understand how the organization operates and why it chooses to initiate projects. We have learned how growing a personal garden increases one’s likelihood to adhere to his or her ARV drug course, and why a mother’s access to goats’ milk can play an important role in determining her child’s health. Now we can return to CC and while we are raising money for, say, the input of 500 seeds at two kitchen gardens, we can also explain what that means for the health of five families, 35 people.
            During the reflection, we also spoke about more “big-picture” take-aways. We thought about the term “grassroots,” and the new meaning that the word has taken on. After time spent with the Ambassadors of Hope, we would now describe it as a movement from within a community, for the health of the community, by people invested in that improved health.
            We spoke about the realization that during every interaction we have here, whether it be visiting a support group or dropping in at a local clinic, we are making promises of one sort or another. We realize that when we ask people how they would suggest improving a project, or what they need for their garden or goat initiative to flourish, we make a promise that we are going to work towards seeing that improvement come to fruition. And this is good, because we do want to help make these improvements. But it also raises the stakes—only by keeping these promises do we obtain the lasting trust of the beneficiaries and WOPLAH.
            Finally, Molly pointed out that no matter how much we work to support WOPLAH during the internship, we are learning “one-hundred times more than WOPLAH has gained since our being here.” Now this is not a bad thing for either party, if anything it is an indication that WOPLAH is headed towards a state of sustainability—a point where partnership with GlobeMed (as much as we love it) will not be necessary.
            Edwin Wetoyi and the Ambassadors of Hope have given us the unique opportunity to ask them a million questions, follow them into intimate interactions with beneficiaries, and join them in their homes to share meals and discussions about what has been accomplished thus far, and everything that still must be done.
            Perhaps we had to see one of our GROW team members leave before we were able to grasp how meaningful the relationships are that we have formed. Finally, we can begin to understand how much the people who began this grassroots movement for health equity in this one community in Western Kenya have done.
            -Maggie Dillon

Monday, August 12, 2013

Goodbye, For Now.

After tucking in the white mosquito nets that hang above our neighboring twin beds and listening for a few moments to the final drips of the afternoons’ torrential downpour, Sarah read me a quote from her journal that I’ve continued to think about this morning. It was, “Travel guides us towards a better balance of wisdom and compassion and of seeing the world clearly, and yet feeling it truly.... And if travel is like love, it is, in the end, mostly because it’s a heightened state of awareness in which we are mindful, receptive, undimmed by familiarity, and ready to be transformed” -Iyar.  
In all of the books that I read about journeys, (Travels With Charlie by Steinbeck being one of my favorites) I’ve never heard it put so eloquently. After being in Kenya for several weeks now and preparing to go home tomorrow*, I wanted to spend this blog post reflecting on why we have traveled here, what wisdom we sought, what compassion we may have gained, and finally, to consider the memories that have impacted me the most. Whether good or bad, it is true that these instances are heightened in their clarity because their context is unfamiliar and their characters have become so dear- and will be greatly missed. 
To start, I traveled here because GlobeMed and WOPLAH offered an opportunity to be involved in more than a volunteer project, but a partnership oversees. I am continuously drawn to such adventures-perhaps for that sense of “love” referred to in Sarah’s quote. The Ambassadors of Hope seemed to have a mission that only their position as community members could enable them to understand, and only our arrival here could bring us to fully comprehend. Further, we came to aid in this mission, not through the imposition of funds and a Western perspective, but as partners in making a difference wherever possible. Thus, in the past few weeks, AOH has demonstrated an intricate network of community health workers, village support groups, income generating projects, and a unanimous endeavor to secure enough recourses to accomplish what they know needs to be done. Therefore our role here has mostly been to observe, to assist in technical dialogues such as media and grant writing, and to learn-not simply about the organization’s objectives, but about them as people. Essentially, I now see that the most fundamental elements in the indefatigable work of our partners are the power of love and the determination to help those who share in common struggles. To live healthy lives, to support loving families, and to empower your neighbor-this has been my lesson through WOPLAH’s mission and a lesson on how to live compassionately. 

Of our time in the field, I felt such compassion the most while working on a jiggers campaign at Edwin’s old elementary school in Musanda village. We spent the morning in an airy cement floored classroom filled with 59 children who had been infected with jiggers. From our arrival until each foot had been soaked in washing powder and scrubbed to help their infested feet, these students waited patiently for their turn in the stinging buckets. Halfway through this process, one of the head teachers introduced Edwin and myself to a 16 year old boy whose parents had both died in 2008, leaving him and his five younger siblings on their own. She told us that aid from the community had slowly diminished and the orphans were now left to fend for themselves. I was struck particularly hard when seeing this because I couldn’t help associating the face of the16 year old with that of my best friend’s younger brother back home. I thought about how differently they live their lives-one waking up each morning to haul for lobsters on the coast of Maine, making a decent amount of money to save for a car or new basketball shoes...while the other wakes to feed his younger siblings, wash their tattered school uniforms (noticeably the cleanest in the class), and take each day at a time. Of course such comparisons only serve so much of a purpose, but I am grateful for this memory because it is a reminder to appreciate what we have and bare in mind that there is always room to help. Furthermore, though generating change on a large scale is a daunting task, that boy’s individual face is the essence of who I want to make a difference for and that if no one else, the single effort of helping him and his family is progress.
In comparison, my fondest memories from the field have come from individual interactions with community members. We’ve begun many meetings sitting under the shade of luscious Kenyan avocado trees, meeting each arriving group member with an excited handshake, a kiss on either cheek, and often a hug accompanied by the repeated welcome of, “karibu!”. Such community power-houses are often dressed in deafening colors and bold African prints, their hair woven beautifully, and their smiles the most striking part of it all. These are individuals that we later find to be in their 30s and 40s, windowed or living on their own, HIV positive as well as suffering from TB or various other health problems, the parent of several children, and the adoptive parent of even more. Yet, despite all of these challenges, they are taking the time to dedicate themselves to helping even more people, to being a selfless steward in their community. Such vitality has been most impressive during my time here, and if nothing else, is what I hope to bring home, practice, and pass on to others. 
I wanted to close in saying that I can’t imagine a better group of people to have experienced this internship with. Gathered in our living room during the black-out last night, telling ghost stories around our blue kerosene lantern,  I thought of  how lucky we all are to share an eagerness to be present and enjoy our precious time here. It is my hope that we can take back what we have learned not only to GlobeMed and our family and friends, but let our experiences “guide us towards a better balance of wisdom and compassion”. So as I prepare myself to leave Edwin and the other Ambassadors, Mumias, and my friends here in Kenya, I must remember to preserve the relationships and lessons that I have gained. Finally, to have compassion, patience with progress, and faith in community. 

With Love, Rory 
* While traveling at the start of the month, I picked up two kinds of food-borne bacteria that have made me continuously nauseous and struggle to hold down food. Because there isn’t the necessary medical care here in Mumias and I’m not improving. This has been a very difficult decision, but I plan to stay in communication with our team these last two weeks, bring my experiences back with me, and of course continue the relationships I have formed with WOPLAH and the Ambassadors of Hope. 

The Team

Our Mama and Me

The Ambassadors and GROW

Sunday, August 11, 2013

The Jiggers Campaign Initiative

One of the projects that GlobeMed at Colorado College funded last year was a jiggers campaign. The Ambassadors of Hope bought 90 pairs of shoes and 90 blankets to distribute to people who have been infested with jiggers. Jiggers, also known as chigoe fleas, are parasites that burrow into feet, and lay their eggs inside the foot. The result is loss of toenails, toe deformation, swelling, and intense pain. Before I came to Kenya I read a definition similar to this, but it wasn’t until I saw 90 children file into a classroom for jiggers treatment that the immensity of this problem hit me. Jiggers live in soil and sand, which makes them a prevalent issue in the dusty rural areas around Mumias. Most houses have mud walls and floors made with dirt and cow dung. Children very rarely wear shoes because they are either deemed unnecessary or their parents can’t afford to buy any. Jiggers make walking incredibly painful, so children with severe cases often can’t go to school.
            The treatment is rather simple. All you need is Omo washing detergent, jiggers powder (we are not yet exactly sure what this is), and water. Sometimes Edwin uses hydrogen peroxide as an alternative treatment. At Musanda Primary School, we treated 90 children in about 2 hours, fitting 4 or 5 kids’ feet in one bucket at a time. They soaked for 15 minutes, then the next kids would hop in the bucket. That afternoon we visited several homes of families who had received shoes from WOPLAH in January. We asked one young man to show us the shoes he got since he wasn’t wearing any, and he dug them out from under his bed. They looked like they were still new, so out of curiosity I asked him if he wears them. He said no, because he doesn’t know when he’ll get another pair so he doesn’t want to wear them out. We proceeded to visit a few more houses, all with children who had received shoes. We asked the parents if the children wear the shoes, and most answered that they wear the shoes every day, but they’re very worn out. Since the parents can’t afford to buy a new pair of shoes, the children wear them into the ground. Both ends of the spectrum were troubling to me. Why give someone a pair of shoes that will never be worn for fear of wearing them out? On the other end, what’s the point of giving people shoes if they’ll only last six months? What happens then, won’t they be right where they were six months before?
            Today we did another outreach in a nearby community and treated about 25 people of all ages. This time, we did the Omo treatment, but also scrubbed the feet with a pumice stone. The looks of searing pain and the tears running down the faces of the children broke our hearts. In the moment we were all thinking a large chunk of our fundraising next year should go to buying shoes. It’s such a simple fix. But that isn’t the GlobeMed way, where is the sustainability in that? So I came back to the questions that I had been pondering over all week and did the most sensible thing, I asked Edwin all of them. I challenged him by saying that it seems like nothing about the jiggers campaign is preventative. A few days ago Edwin said in order to succeed in this work you have to act, not react. All of this seemed like reacting. Edwin agreed with me, but then explained that the jiggers campaign is very new, and he has big plans. His hope is that giving people shoes is almost like a trial period. He believes that if children are given shoes and their jiggers go away, their parents will deem shoes a worthwhile investment. He said that many more families can afford shoes than we think, they just don’t want to spend the money. He also said, “we need to start somewhere, right?” The jiggers campaign may not be the perfect solution, but it is a start. With dedication, resources, and time, the campaign can continue to improve and spread hope in the surrounding communities. 

- Molly

Edwin teaching the children at Musanda Primary School the importance of hygiene

All the necessary ingredients for jiggers treatment

Gladys (community health worker) administering jiggers treatment

An example of a jiggers infection

Alexis and Sarah spreading vaseline on the treated feet