tulia, simba!: port victoria, part III

we are winding down here in the field. it's been an interesting 3 weeks. the other night kayla and my room was invested with little bugs. it kind of looked like the walls were moving. that passed, thank goodness. but now they're dead all over the floor. it's become a little cooler and i have gotten quite used to wearing ankle length kindergarten-teacher-esque skirts. the main takeaway message from our fieldwork has been that nothing in kenya really goes as planned. we were at the mercy of the ministry of health--they were to be our tour guides--and as many kenyans feel, (i'm sure) they don't always do what they say they will. or it's a cultural difference. or it gets lost in translation. or all of the above.

we spent a lot of time touring hospitals and dispensaries. a majority of women in this rural region deliver their babies at home. it's not entirely surprising when you see the health care facilities. in the mid 1980s the Ministry of Health initiated a campaign to incorporate and train TBAs--they were brought into big cities and given certificates and then sent back home to begin delivering their neighbor's children. then in 2002 the WHO published a meta-analysis stating that the use of TBAs increases maternal mortality, so the MOH retracted their previous training and banned all connection with TBAs. we met an elderly woman yesterday who was a TBA for 20 years. she was toothless and walked with a cane and gave us a real-life demonstration of a "typical birth" using a 4 year old bystander as her pregnant mother. we met with a handful of mothers in a clinic as well. it has been whispered that depo is the preferred method of birth control, because they can hide the injection from their husbands. some nurses even train women on how to fake having their period every month so their husband does not become suspicious.

and...now! the port victoria double-decker music video!!

earlier this week we had been going on (endless?) rounds with the CLTS (Community Led Total Sanitation) group and UNICEF who sent an important lady to check on the progress. they "trigger" communities by walking around and picking up their poop, without latrines people defecate in the open, which then gets into the water, their food and their bellies = definite health problems. CLTS was started in Bangladesh following the tsunami and the idea is that people will be so disgusted they will find ways to build latrines. in theory this should work, but when people are living on less than a dollar a day they find it challenging to find resources to build latrines. for three days, however, we walked around and checked out the latrines that had been built. was the footpath leading to it worn? were there flies around (suggesting use)? was there privacy? was it near a borehole? how many people shared it? was it built in the V-formation to ensure stability? we held a number of focus group discussions, always under large trees. the trees were the "conference room," they belong to the community, they are not trimmed and are just there to provide a meeting place and shade. miraculously, a dozen chairs always appear at said gatherings, as does a visitors book to sign. it was discovered in a focus discussion group that a father and a daughter-in-law can't share a latrine, this poses problems when building one for a homestead where 40+ people may live.

there was also a supposed cholera outbreak while we were here. a handful of us paired up with our kenyan doctor counterparts and went to take histories of 4 patients. they put the cholera patients in "isolation" (the side room next to the operating theater). i watched as mr. odukis took a history on a 40 year old HIV+ woman who looked like a skeleton. they were all lying on cots with holes cut out so they could just defecate into buckets below the cots--some had had diarrhea for 2+ days. then the rest of the team went down to the beach and distributed AquaTabs and Pur and instructed bystanders and fishermen on the importance of treating drinking water.

we've spent a lot of time talking with people about malaria as well--it's quite prevalent in this area. LLITNs (long lasting insecticide treated bed nets) have been distributed, but interestingly people have been using them for various other uses: fishing in the river, building latrines, as a blanket and to protect their crops in their kitchen gardens. many people have used them correctly though and much progress has been made in the area around malaria prevention.

i spent an afternoon with a few CHWs (community health workers) we visited homes, and walked for hours, talking about health topics. i was offered a kitten and learned that kenyans are taught america is rich because we keep 10% of our crops and export 90%, so we always have enough. we have spent every afternoon "taking a soda" which is usually a highlight. this past weekend we went back to our home city and it was so nice to dance and have cold drinks and sleep without bugs--it's the little things in life. there is also an affordable beer here--it's now called 'president'. but back in the day it was called 'senator.' the brewery switched the name once obama was elected. i liked that.

i could go on and on. but i suppose that means i'm learning. namely that a dozen kenyan children can appear out of seemingly no where yelling, "Mzungu! how are you! fine!" wearing 1980's track jackets and no pants. this next week is spring break. i plan to learn nothing but how to apply sunscreen on the white beaches of lamu.