Wednesday, September 4, 2013

Tuonane (See You Soon)

            I thought after nearly two months in Africa, I would be ready for home. I love my family and friends, I love my home, I love school. Never did I expect to have a pit in my stomach for days ahead of our departure and strong, bittersweet emotions about the return home. Instead of excitement, I was only feeling overwhelmed by all the things I still wished to do, everything there still was to learn, and all the people with whom I still wanted to talk. The Ambassadors of Hope welcomed us into their lives with a love and warmth that I have never experienced in my life. This is not an exaggeration. Every interaction I had was full of sweetness and kindness, support and positivity.
            The Ambassadors were unique in many ways, and the love they exuded was a dominant trait that ran through them all. An equally endearing yet far less obvious trait was a strong humility. We asked the Ambassadors to explain why they decided to join WOPLAH and work towards health equity in Mumias. Again and again the Ambassadors answered in the simplest way. They did not tell stories of inspiration, or personal hardship. They did not paint a picture of themselves as martyrs or saints. Rather, they framed it like this: a problem existed in their community, and they had the ability to fix it. They saw a solution, or at least a beginning of one, so they’re doing what they can to reach that solution. Simple, logical, incredibly humble.
            The love that the Ambassadors of Hope have for their community is perfectly expressed in the words of Joseph Shitseswe, an Ambassador, to members of the Khaunga support group:

“I love your life, so you have to make sure that you love your life… On behalf of the Ambassadors of Hope, we have hope. We will live. We want to make you to feel like you have life. We hope when these visitors leave, and return again later, they will find you healthier than today… The Ambassadors of Hope—we are together with you, and we care for you, and we love you.”

            There is so much more to say about this experience, what we learned and what we’ll bring back to GlobeMed at CC. For now, I will say that I feel more blessed after this summer than I ever have before. I am blessed, first, for the time spent surrounded by these amazing people. And also, for everything I did return back to that was wonderful and comfortable and safe.

            So, the day to leave the Ambassadors of Hope did come. I left Mumias with promises to see the Ambassadors again—first over Skype, and later in person. We learned more from the Ambassadors than we would have ever been able to give. This summer we entered a partnership that will last for years into the future, and now we are confident that this exchange of knowledge, and a strong friendship to go along with it, will make the partnership strong.

Maggie Dillon

One Day

Days later, as I sit in my New Orleans home, it is hard to imagine that I ever was in Mumias. What were chapatti, ugali, and boiled greens has now been replaced with fried oysters, poboys, and crawfish etouffee. What used to be mulish cows and goats roaming our front yard is now the domesticated cats and dogs I call my pets. In short, much has changed about my surroundings. Kenya, and probably all of Africa, is a vastly different setting than my hometown in the United States. Different environments, different socioeconomic factors at play, different cultural norms, and different health care struggles.  According to the CDC, the leading cause of death in Kenya is actually HIV/AIDS, attributing to 38% of deaths nationwide. In the United States, the leading cause of death is heart disease, often credited to the voracious appetite of Americans and the high stress of civilized life. Kenyans are plagued by infectious disease like malaria and tuberculosis that thrive in the climate and poverty of Africa. Americans, on the other hand, are plagued by diseases caused by lifestyle choices like obesity, diabetes, and lung cancer. There is a phrase that both GlobeMed and WOPLAH love to tout: ‘health is a human right.’ Are we, as Americans, taking this right for granted?
Tuberculosis for example, now the disease of developing nations, used to be an urban plague. Due to sanitation advancements, educational reforms, and the growth of medicine, infectious diseases like TB are no longer able to prey on urban dwellers. In essence, thanks to the affluence of an industrialized nation, we were able to beat theses diseases down to the shadows. And in their place we have cultivated a slew of lifestyle diseases. Many people are all too willing to point fingers at developing nations and blame cultural practices for the proliferation of disease. For instance, when HIV first hit Haiti, multiple medical publications in the United States blamed romanticized notions of voodoo for its rampant spread.  This exaggeration of personal agency leads the assignment of blame without any movement to address the phenomena that propagate powerlessness. It is easy to say that voodoo rituals play an important role in the spread of HIV/AIDS in Haiti. It is less easy to say that lack of education and proper medical care play an important role in the spread of HIV because these factors have connotations of global, not personal responsibility.   
Days before I left for the GROW internship, I had already gotten used to hearing how dangerous this trip would be and how brave I was for going to Africa. But I found one interaction to be particularly startling. A physician practicing in the U.S. told me to be extra careful not to contract HIV. I went home that night and did research on the transmission of HIV through nonsexual interactions. All the sources I had found said that, outside of sharing needles, HIV is not easily spread via nonsexual contact. So did he know this, or did he just have questions surrounding my moral turpitude? To me this represents an example of the “the geography of blame.” We have all heard about the HIV/AIDS crisis throughout Africa (Africa usually being used as a blanket term, referring to no particular country in general). But the HIV rate in Kenya is comparable to the rates found amongst poor urban Americans. This challenges the notion of HIV as a virus unique to ‘third-world’ nations. Would people have been as worried about my health if I had traveled to the projects of Boston or New York? The tendency to assign cultural blame, exaggerate personal agency, and propagate stereotypes is counter productive at least. The fact is that HIV is a global pandemic and there is a great need for global solutions.
Working with WOPLAH this summer has provided me with a unique opportunity to study the treatment and management of HIV both in Kenya, and now in my own backyard. One of my biggest goals this year is for GlobeMed at CC to become active within the HIV positive community of Colorado Springs. I also hope to find a local partner that will educate us on the ongoing programs that address the needs of those living with HIV/AIDS in Colorado. I wasn’t in Mumias when HIV first made its impact and so it would be impossible for me to identify any social factors that lent to proliferation of HIV in the community. However after six weeks, I do feel confident in pointing to distinct cultural elements that make the fight against HIV/AIDS in Mumias so influential for me. The one that stands out the most for me is the amazing sense of community. On one of our last days of the internship, we sat down with Edwin to discuss some of the strengths and weaknesses of the GROW team, of WOPLAH and of Edwin. As one of his strengths, Edwin listed the support of his families and friends. As Edwin had just demonstrated for us, the importance of family in Mumias cannot be stated enough. One of the support groups we visited in that last week, The Sky is the Limit, has a similar devotion to the idea of community. The support group was named after the potential a community can reach when HIV positive and HIV negative community members band together. Many of WOPLAH’s programs are aimed at supporting the ‘infected and affected.’ To me this shows a strong sense of solidarity. At first I was confused to see HIV negative people in a HIV support group, but now I see how important that incorporation is. HIV can have powerful emotional and economic impacts on a family, and those family members were also in need.
While we were there, I also noted on the burgeoning role of women in the Mumias society. When I was assigned the task of creating an informational pamphlet on clean water, Edwin instructed me to include a section of gender equity. At the time, I had no idea how the two were related. As I researched for the pamphlet, I learned that gender equity in the gathering and treatment of water was a global movement. Women in the developing world are often forced to travel miles for a source of water. This task alone can take up hours of he day. If men were to help with this acquisition of water, women would have more time for self-improvement. Edwin’s insistence that this information go into the pamphlet represented to me the ongoing movement of female empowerment in Mumias.  The clinic Edwin works out of, Maternal and Child Health (MCH), also offers birth control and viricidal methods to women, putting the responsibility and power in their hands. I was surprised at first to learn that MCH provided IUDs to women and found it to be very progressive. These types of measures help empower women in the community with visible effects. The vast majority of support group members and community health workers that we met were truly inspired and determined women.                  
This internship with WOPLAH served for me as a powerful lesson about the types of social movements that occur when a population bands together for the shared purpose of achieving health. Throughout support groups we heard again and again about the importance of shedding self-stigma and the empowering effects of education. We also saw a dynamic willingness to adapt in Mumias. For example, WOPLAH now advocates against traditional polygamous marriage as a way to impede the spread of HIV. While we were there we also saw a large movement away from traditional male circumcision, which involves the same knife being used on up to fifty boys. In fact, MCH hosted a voluntary medical male circumcision day and around 80 teenagers and men from the community came to be safely circumcised. Large strides like these against the spread of HIV/AIDS are what make WOPLAH so inspiringly farsighted. One day I will return to Mumias, maybe as a physician or as a doctorate of public health always carrying with me the lessons I learned from the Ambassadors, and I will find little to no HIV, less poverty, a liberated community, and the next generation of Ambassadors with even bigger dreams. I will find the achievements of WOPLAH in every successful support group, every empowered community health worker, and every child that grew up learning the importance of reproductive health. 

Tuesday, September 3, 2013

Goodbye For Now

Dear Ambassadors of Hope,

It is difficult to believe that our six weeks with you passed so quickly. In that time, you made us feel like we were home, and I want to thank you for that. You welcomed us into your meetings, your support groups, and your homes, and that is something we will never forget and for which we will always be grateful.

When we attended the GlobeMed East Africa forum (put on in Uganda by GlobeMed for all the East African partners), the first weekend after arriving in Kenya, the director of GlobeMed spoke about the meaning of partnership. She said that a strong partnership is built on kept promises. One year ago, when we agreed on the Memorandum of Understanding between WOPLAH and GlobeMed, we made a promise that bound GlobeMed at CC and WOPLAH together. Over the past year, many students worked hard on behalf of GlobeMed at CC to honor that promise. We held meetings and fundraisers and educational activities as we worked to share the mission and work of WOPLAH with our community.  However, we did this without truly understanding our partner. We knew about the kitchen gardens and the goats and the jiggers and the community dialogues, but we could not picture the people behind these projects.

The six weeks we spent in Mumias changed this. The GROW team came to know you, the Ambassadors of Hope, as friends and mentors. We learned from you and were inspired by you. We met the beneficiaries of your many projects, and heard about their successes and challenges. We learned how a kitchen garden can help someone with ARV adherence and how being able to raise a goat and passing it on to a neighbor can reduce stigma. We learned how the support groups give people hope to live when they have none. We learned that giving a pair of shoes to someone with jiggers is just the first step to creating a permanent solution. We saw the impact that a single Community Health Worker can have on his or her community.

Most importantly, we learned the true meaning of empowerment. Real empowerment has a ripple effect. It starts with one person, one kitchen garden, one goat, one pair of shoes, and then spreads to an entire community. This is expressed in the sentiments of a woman from the Khaunga support group. She told us her story of getting tested and being found positive for HIV, and how joining a support group impacted her. She said, “I used to fear but now I am free. Now, sometimes others come to me to disclose because they know I can help.” During our monitoring and evaluation, we always ended our interviews by asking the beneficiaries what dreams they have for the future. Invariably, they answered that they want to expand the projects so that more people can benefit. They want to enlarge their current income generating activities and pioneer new ones so that they can help fellow community members be healthy and prosper. This is true empowerment: once set in motion, it spreads through individuals, families, and communities.

We also saw the power of community. You invited us into your homes and support groups, and showed us grassroots work in action. You, better than anyone else, understand the challenges your family, friends, neighbors, and communities face, and you use this unique perspective to work towards addressing these challenges.  When each of you visits a home to administer jiggers treatments or convince someone to get HIV tested, you are not only there as a health professional, you are there as a friend. We accompanied you into the field many times during our internship, and listened as you shared your personal stories with the people we visited. We were inspired by your courage and by the solidarity you were not afraid to express, and we saw that it had results. People trusted you and took your advice, and as a result of that there are more people who know their HIV status, more people who practice jiggers prevention techniques, more people living with hope. We understand now why you call yourselves the Ambassadors of Hope.

Two months ago, as I boarded a plane to come to Kenya, I had some qualms about this internship. I struggled with the ethics of spending so much money to fly across an ocean under the pretext of helping people when there is so much that can be done right outside my back door. I wondered what made me, a 20-year-old college student from the United States, think I could show up in Mumias, Kenya and make a difference. There is a lot of value in thinking critically and carefully about my role as a foreigner and an inexperienced student in WOPLAH’s work. However, what I learned in the last six weeks is that overthinking it can also be crippling. When I became too caught up in this internal debate over the ethics and morals of our presence in Mumias, I stopped interacting fully and open-heartedly with the people I met, which is the exact opposite of what I traveled to Kenya to do. In the most simple and human terms, our visit was about caring. It was about recognizing shared humanity between all people, whether American or Kenyan, HIV positive or negative, student or professional health worker, caregiver or patient. 

One question that many HIV support group members asked us during our visits is whether or not there are people in the U.S. who are living positively like they are. The first time we were asked this, I was surprised and also saddened by the thought that these people, who were so resilient in the face of many challenges, thought they were the only ones in the world dealing with HIV. The movement for global health equity is about ensuring equal access to basic health care for all peoples. However, I think an equally important aspect is showing people who are struggling with health issues such as HIV that they are not alone. Viruses do not recognize borders or skin color or dollar signs. All people are equal in the face of illness. We all face the same health challenges, we are all fighting them in our own ways, and we can draw hope and strength from our shared experience. 

During our time in Kenya, the GROW team did not implement any major changes or try to shift the way WOPLAH operates. We merely listened and offered a new perspective when called upon. WOPLAH does not need direction, nor were we at all qualified to give it. The true value of our visit was creating relationships that span continents, and I think this is a valuable role that youth and students across the world can play in the movement for global health equity. We may not be qualified to administer immunizations or deliver ARVs or build hospitals, but we can create global partnerships and friendships. We can learn from each other and teach other, so that when we do set out to change things, we will work together as equals, with all our strength combined into a powerful movement aimed at making health a human right.


Sunday, September 1, 2013

Stickers, Bubbles and Coloring: Pure Forms of Happiness

On Saturday we visited a pediatric support group, which was the perfect way to end an incredible six weeks. Over the past 42 days we have tried to understand what it’s like to be living positively with HIV, and we have observed many training sessions about transmission prevention and reduction. We have met and interacted with over 100 people who are living positively with HIV. But something about Saturday was different from every other day. We were amongst 50 children, most of whom have been HIV positive since the day they were born. Some of them come to the support group to get the love and nurturing that isn’t available at home. Some come just for something fun to do on their Saturday. Some come to learn about HIV and the importance of taking their HIV drugs. But most importantly, they all come just to be kids.
The children are split into two groups: those who know that they’re positive, and those who don’t. We were immediately drawn to the small faces of the children in the group who don’t know they are positive, so we sat down and joined them. We got there during story time, and shortly after we arrived, it was coloring time. Each child was given a picture to color in and one crayon. As the coloring began we became aware of the crayon trading system, one that seems so simple but was so powerful for me to observe. When a child wanted a different color, he or she would find someone who wanted to switch colors. This system was in order until each child had a very colorful, beautiful drawing.  There was never any crayon stealing, arguing or pushing. After coloring time, we brought out the container of bubbles we brought, a guaranteed crowd-pleaser. The fun continued as the children took turns blowing bubbles, jostling over whose turn it was. At the same time, a game similar to dodge ball broke out with children whipping a ball back and forth at each other laughing and screaming. We also brought around 500 stickers that were gone within the hour. Children formed a line in front of me, requesting stickers all over their faces. Most popular were the star sticker earrings, which became the fashion statement of the day.
This day helped me realize something I have been reflecting on for the past six weeks. In the U.S. we’re always looking for a complex multifaceted solution to issues. The more layers we try to address, the better.  I’ve heard many times that the answer can’t be so simple and that there has to be an in-depth level of critical thinking to solve any problem. Last fall I remember learning that one of WOPLAH’s main goals is to improve the lives of people living with HIV. I then learned that their main area of focus is income generation. In my head I thought, that seemed like too simple a solution to address an issue as huge as the AIDS epidemic. From the 89 people that we interviewed over the past 6 weeks I have come to realize that it can indeed be that simple. Income generation not only provides a family with money, it also instills a sense of pride and self-worth. People living with HIV are no longer seen as worthless members of the community, they are gardeners, goat-rearers, and most importantly, normal human beings. They have a voice that needs to be heard, and through WOPLAH’s activities their voice is given validity.
Then comes the issue of how on earth do you give hope to children who have been HIV positive since birth? How do you show them that they too are valuable members of society, even when their parents tell them that they don’t want to pay school fees and provide food for their children who are just going to die of HIV? In the U.S. it would probably involve intense counseling, family interventions, and the result would be a child who might feel even more different than they did originally. In Kenya a few brilliant people have found a much better solution. You bring these children together, and you let them do what any other child wants to do. You tell stories, you blow bubbles, you play games, and you trade crayons. Maybe you stick in some lessons about drug adherence, but most importantly, you teach them how to become self- empowered. And you make sure that the day a child’s parents tell their child that he or she is HIV positive, that child has a group of peers to confide in and who know exactly what he/she is going through. You make sure that these children know they are not alone, and they never will be. It is reassuring that there are people like Carol, the director of this pediatric support group, who make sure no child is alone in this fight. Further, I’m leaving Kenya knowing that there are people like Edwin who dedicate their lives to making the lives of HIV positive people more full. Everyone in this world deserves to feel like their life is worth living, and WOPLAH is making incredible yet simple strides towards making this a reality in Western Kenya.
It’s very easy to get caught up in an experience and not realize the extent of what you’ve done until it’s over. As I sit on the plane looking through the 4,000 pictures we collectively took in 6 weeks, I’m realizing how incredible our experience really was. As I finally get around to posting this, I’m sitting in my room back at Colorado College, and Kenya seems further away than ever. A phrase I often heard was “karibu tena”, meaning welcome again. And to that I say, “tuonane”, see you soon, Kenya.

- Molly
Missing you already Edwin!

Look at the determination on that girls face

Stickers solve everything