On the Subject of Babies...

Aside from the fact that everywhere we go small children come sprinting from every direction yelling "Mzungu! Mzungu!" meaning white people or foreigners in Swahili, it seems that everything we do here is in some way directly or indirectly related to babies. For example, this morning we woke up to some strange sounds that we hadn't heard yet...and there are A LOT of strange sounds here. When we were leaving for the day I noticed some small furry figures huddled under one of the goats that lives in our compound. I thought at first they were cats which seemed odd, and as I got closer I realized they were baby goats - newborn baby goats!! They must have been born last night as they have adorable rolls of excess skin and stumble everywhere because they are just learning to walk. That was a great morning surprise after another day waking up to a power outage lasting from the night before.

Once we could finally pull ourselves away from the newborn members of our compound, we rode "boda bodas" (motorbike taxis) to a school. This school only has about 30 students, all of which come from families with at least one HIV-positive member; 8 of them are living positively themselves. This school was started by WOPLAH (and is one of Edwin's "babies") because this community was identified as having many vulnerable children who could not afford school. They were able to secure a small, one-room, mud school house and opened the school in 2008 with Edwin teaching full-time. They now have two volunteer teachers, but Edwin still goes to the school about once a week to teach and play with the kids. 

When we walked into the little room, the children greeted us with a song and spent the next 20 minutes of their morning lesson half-heartedly reciting various english words, letters and sounds but mostly focusing their attention on us. The students' ages ranged from 4-11, with the smallest children sitting in the front and the oldest in back. Soon it was breaktime and we went outside to play games and hand out stickers and lollipops! Although it was hard not to think about the level of education each child should have theoretically attained at their respective ages, I could also clearly see the importance of giving these children an opportunity for early-child development when they would otherwise be sitting at home or getting into trouble; it is amazing WOPLAH has been able to provide these children with valuable skills, socialization and a safe harbour that is no doubt better than any alternative.

After inviting Edwin to our house for a lunch of eggs and rice (scrambled eggs was the only semi-American food we could conjure up to share), we hopped on the "boda bodas" again to attend a self-help group where Edwin would be lecturing. He began by asking one of the members to do a recap of last week's lecture: a demonstration of proper female condom usage. Although we were all admitedly a bit uncomfortable watching a man literally use hand-motions to show how the condom should be inserted, it was a valuable and interesting experience to learn that people are taking these measures seriously and are willing to learn. Edwin proceeded to give a lecture about disclosure of one's HIV status. It is fascinating listening to him lecture about this, as he takes great care in elaborating on the delicate nature of disclosing one's status. He explained that it is a process; one should carefully choose who they tell first as well as the timing of the conversation and how to go about unfolding the story. He also highlighted the benefits to disclosing one's status: family members can help by picking up meds and being generally supportive, longer lifespan, eradication of self-stigma, more easily able to succesfully integrate into society etc. My favorite part about listening to Edwin's educational lectures is that he always has his audiences laughing and smiling; and the amount of passion in his voice cannot go unnoticed. 

So, each of our activities today was, in some way, related to babies: there were the newly born goats that greeted us as we left for our daily activities, the children in WOPLAH's school who were babies of HIV-positive parents, and Edwin's talk which concerned birth control methods and the effects of disclosure on family members (including one's children). 

- Nicole Jorgenson '14 

First Jiggers Day

Note: Photo credit for this post goes to Nicole Jorgenson. This post was originally published on Claire's personal blog (www.realitiesandtrivialities.wordpress.com) on July 18th, but internet and electricity have been spotty since then! Look out for a more recent post by Nicole coming very soon.

My lack of mental preparation for the day we had in store for us yesterday became obvious the moment we arrived at a local primary school. When our motorcycles pulled up, we were swarmed by around 500 kids shouting “mzungu” and “How are YOU.” Claustrophobia kicked in, but their smiles were something else. We were at the school to observe treatment for jiggers, a horrible flea that burrows into the skin and feeds off the flesh, creating incredibly painful sores that easily become infected and begin to look like small growths all over the feet and hands. When someone has untreated jiggers, walking becomes impossible. At the school we were at, 30 of its 600 students dropped out last year due to jiggers. It is debilitating, painful, stigmatized, and misunderstood. Treatment requires removal of all affected wounds, followed by a thorough cleaning, and this procedure must be repeated several times in cases where the jiggers has been allowed to develop. The organization that we are interning for, WOPLAH (Western Organization for People Living with HIV/AIDs), teaches Community Health Workers to treat jiggers and provides funds for the treatment procedures. We were there to watch this process, gain a better insight into the problem, and witness the role that WOPLAH plays in ending the jiggers epidemic in the Mumias area.

 

The first girl to be treated was an incredibly skinny little girl with horrifying jiggers. Her mother and little brother were also seeking jiggers treatment, and we were told that the family is too poor to have a home, not to mention pay for the necessary items to treat jiggers. The girl soaked her feet and hands in hydrogen peroxide for fifteen minutes before Mark, the Kenyan WOPLAH intern, and a local Community Health Worker began using razor blades to cut out the infection. Within moments, she was wailing in pain. It was a scream of pain like I’ve never heard before, made worse by the fact that I could neither understand her words nor do anything to comfort her due to the language barrier. The procedure lasted for what seemed like a small eternity (some eternities are bigger than others, right?) and before long I wanted to be sick. I’ve never felt so helpless. When the razor blade portion was over, they soaked her hands and feet in Omo (a soap) and sodium bicarbonate, and then spread Vaseline all over the open wounds. There were over 40 students and community members who had come to be treated, but in the slightly longer eternity that we were at the school the workers were able to treat only a small fraction.

 

Throughout this process, I continued to tell myself that the pain these people were feeling was a means to an end, and would ultimately save them from a much harder and more enduring pain. However, this condolence became much less convincing when we witnessed the workers put the girl’s bleeding hands and feet back into the same tub with others who were getting the procedure done. We are, after all, working with a group that’s mission statement is about HIV/AIDs. How could they not see this as a potentially tragic problem? We would later read online that transmission of HIV/AIDs from jiggers treatments is an enormous problem. We discussed this with Edwin today, who explained that yesterday's errors were due to the school's lack of funding for buckets, but promised that WOPLAH would practice safer techniques in the future.

One excellent way of reducing jiggers infection is by wearing shoes, a problem that companies like Tom’s has tried to assist with. Tom’s, we learned, did actually donate shoes to this area. However, the shoes were so coveted that they didn’t end up in the hands of those who were most at risk of jiggers. Sometimes, even Community Health Workers kept them for themselves. WOPLAH raised money for shoes and asked Tom's for more, managing to donate some pairs but never enough.

Jiggers is not the only health problem these children face. Many had bald patches that we were told were from ringworm. And yet, they had more energy and optimism than I did that day. All they wanted was to talk to us, play soccer with Desi, and wave for photographs.

Last night, I returned home to learn on Facebook that a friend of mine passed away. I went to bed feeling angry with the disorder of the world, confused about my purpose in it, and sad that I wasn’t at home and celebrating my sister’s birthday. For the moment, my sense of balance has been rocked and I am seeking a new center of gravity.

Promising a happier post next time.

--Claire McNellan 

More Than Just AIDS

As we’ve settled into our new home and adjusted to the early morning wake-up call of goats and cows grazing just outside our windows, I’ve learned just how much can be accomplished in a day despite the “pole pole” pace of African Time. Our crash course on WOPLAH’s wide-ranging work has only just begun, and yet we’ve already gained numerous insights into the scope of and processes behind WOPLAH’s impact. In the past two days alone, it has become clear that WOPLAH’s reach extends far beyond those who have been directly affected by HIV/AIDS.

Yesterday we joined Edwin at the Maternal Child Health Center to generate an outline for monitoring and evaluation (M&E) questionnaires. In addition to the kitchen gardens, goat, poultry and jiggers projects – of which I already had an understanding – we discussed in depth WOPLAH’s village banking and community dialogue programs. Even more interesting however, were Edwin’s instructions on how such questions would be delivered. Prompts must be broad and inclusive of many questions so that respondents may answer in a story-like manner. While Americans are accustomed to numerous specific questions, Edwin warned that respondents would become bored and uninterested if we were to list out our many inquiries. Furthermore, when determining weaknesses within the program, it is better to ask generally if there is anything else they would like to share. This ensures that beneficiaries do not think they are listing problems they have experienced – which they would shy away from out of respect – but rather allowing them to illuminate details that convey such issues tacitly. We were all grateful for his attention to these small details that were to us unexpected potential cultural barriers.

After a long midday walk, we took our reliable piki pikis to visit the Siowote (Not All) Self Help Group. Formed in March and comprised primarily of men, the members use WOPLAH’s village banking system to raise pigs for income generation. They were extremely friendly, and very eager to make their way into our photo albums. Only after returning to our compound did Edwin mention the group’s unique background: all members had been male sex workers since childhood (and some still are). Some of the men are HIV positive, and those who still engage in sex work are provided with condoms and continued education regarding prevention. Over time, as the pigs and other future microfinance projects return a stable profit, we hope they will no longer feel dependent upon the sex industry.

Over the next few weeks we will conduct interviews with the majority of WOPLAH’s beneficiaries in order to gain insight into the intricacies of implementation, define the impact these programs achieve, and determine opportunities for improvement. Witnessing a group of 18 men debate their individual debts and collective assets, when just months ago they were selling themselves on the streets, was incredibly inspiring. And while not every group that WOPLAH collaborates with is explicitly composed of those living with HIV/AIDS, the impact is just the same. By empowering all members of a community together, WOPLAH is creating a healthy integrated environment in which people living positively may flourish.

- Shannon (International Political Economy Major / Urban Studies Minor, Class of 2016)

We Have Arrived!

We arrived at our Kisumu home after dark, feeling lucky to have made it at all. After four of the five of us were delayed by an airline that strictly obeyed the policy, “in Africa, there is no hurry,” and a treacherous taxi ride that involved tying 6 suitcases to the roof and many moments when I thought I might never see the light of day again, we were greeted with warm food, hot sugar water, and welcoming smiles.

Singing from a local church was the soundtrack to our introduction to Mumias the next morning. The music followed us as we walked along a path through corn and cement homes until we reached the main road in Mumias. Sunday is market day, so Mumias was bumping with music, shouting, and colorful produce. We were the talk of the town wherever we went; it’s hard to be discreet when five mzungus (foreigners or white people) are seen carting bags full of groceries from one fruit or vegetable to stand to the next. It was a day of endless shopping, termites for lunch (politely refused), goats in the kitchen, rats in the bed, and cockroaches on the porch. It was after 1 a.m. when the World Cup game ended and we finally crawled under our mosquito nets and fell asleep, completely exhausted.

Today, we attended the WOPLAH monthly meeting. We were first introduced to Khamis, a nurse who works at the Maternal Child Health Center (MCH). Khamis explained to us the challenges involved with pre- and post-natal care and family planning. The clinic’s services are offered free of charge. He talked about the pervasive myths and stigmas that prevent women from feeling comfortable using contraceptives, getting tested for or talking with their husbands about STIs, or continuing treatments once they have been prescribed. Khamis then stated that WOPLAH has been an answer to a prayer. He explained that Edwin, the Program Coordinator for WOPLAH, an ARV distributor, and our Dad/supervisor for the next six weeks, has been instrumental in coordinating a successful movement to reduce the stigma around STIs and improve the health of the women and children of Mumias.

Next, we joined the circle of 14 Ambassadors of Hope and 1 intern, Mark, under a tree outside the clinic. The meeting started with a general check-in, in which each person was asked to report on the progress of his or her projects. Next, the AOHs introduced themselves and their role in WOPLAH to us, and we introduced ourselves to them. Together, we discussed our assigned reading from last night, Article 25 (http://join25.org/) and Story of a Girl (http://www.storyofagirlproject.org/). Over the next 6 weeks, we will be brainstorming ideas for how WOPLAH and GlobeMed can best contribute to these internationally-oriented health projects. After a soda pop refreshment, we outlined a plan for the coming weeks and listened as the AOHs discussed Village Banking balances—a project that entails lending money to to the WOPLAH support groups in order to fund microfinance projects. Tomorrow, we will get to see one of these microfinance projects in person, a mostly male support group that works on pig raising.

The GROW interns with the Ambassadors of Hope and WOPLAH intern, Mark (bottom right)

When the meeting ended, we took motorcycles (piki pikis) to the market so that we could pick up a few more things before heading home for the night. After our full day of shopping yesterday, one would think there would be nothing left to buy, but, alas, we had somehow managed to finish all 12 bananas in 24 hours. It was our second motorcycle ride of the day and the second of our lives, but already we felt like naturals as we rode through the streets of Mumias. We are transitioning, pole pole (slowly), and soon we will begin to feel at home (dskia nmbani).

-Claire McNellan, Neuroscience Major / Bioethics Minor, Class of 2014