Wednesday, July 17, 2013

From Under the Mosquito Net..

The last few days have been fascinating. While the intensive classroom time hasn’t been quite as exciting as the safari at Amboseli, we are learning so much and I am thoroughly enjoying it. On Monday and Tuesday we had classes from 8 to 16:00. It has been a bit tough getting myself up and going so early- cook crew starts at 6:30. However, the mornings are so peaceful and beautiful that it’s worth it. Despite the cold, it’s not too bad. Speaking of the cold, the weather has been WAY colder than expected; I’m so glad I brought my down vest. This week we have had six classes. First, we had a course on Child Malnutrition: Consequences and Mitigation Strategies. It is truly astonishing how impoverished people can live; many Maasai consider ‘dinner’ a glass of milk. And that’s on a good day. Here are some astonishing facts that I have learned so far: 
  • ·      1 in 4 of the world’s children are stunted
  • ·      This statistic increases to 1 in 3 in developing countries
  • ·      80% of stunted children live in just 20 countries
  • ·      The current projections are that 480 million children will be affected by stunting in the next 15 years
  • ·      7 countries are expected to see increases in the numbers of stunted children by 2015


It is very difficult to quantify the number of deaths attributed to malnutrition, because it weakens the immune system, leading to other diseases that are considered the cause of death. Therefore, as it is an indirect cause, it is under-represented, under-addressed and under prioritized.  This prompts the questions of where and how to break the cycle of poverty and disease, as they perpetuate each other.

The next lecture was on HIV & AIDS treatment, management strategies and indicator assessments. This was extremely helpful and fascinating because my directed research is focusing on HIV & AIDS. We basically applied the context of HIV/AIDS to different research methods, explaining studies such as experimental studies (randomized, quasi-experimental and observational) and cross sectional studies. We also discussed how to establish indicators, which is a necessary step in preparing for directed research.

This research is going to be incredibly fascinating. We are exploring the affects of the closing of the Imbirikani clinic on the health of the Imbirikani region. The Imbirikani clinic was a mobile health clinic run by a philanthropist from Chicago. She employed 120 staff and was incredibly proactive with ARV therapy, referrals, nutritional programs, etc. The region depended deeply on the Imbirikani clinic from 2003 until last November, when it closed overnight. This directly resulted in the deaths of many patients relying on the Imbirikani clinic (we don’t know the exact number yet, but we are going to find out- however it’s definitely going to be difficult to quantify). The closure of this clinic had detrimental effects on the region and now our job is to quantify these effects. We will be going out into many rural Bomas (Maasai villages) and conducting surveys to determine the influence of the closure of Imbirikani. Because my group is focusing on HIV/AIDS, we are going to the VCT Boma in Loitokitok on Thursday to sit in on a group support session of HIV positive women. I am so excited about this, however I am a bit nervous because we have to introduce ourselves and conduct discussions (not to mention listen) in Swahili, so I better get going on my practicing! As a group, we can determine what we want to do with this research: attempt to publish it, continue it, etc. I am so excited.

The next lesson we had was on Maasai Culture, Gender Roles and their Implications on Public Health. A wonderful Maasai Mama named Joyce who is staying with us for the month lead this lecture. It was fascinating to hear about this culture from someone who lives it every day. Joyce provides a very interesting perspective because she is somewhat of a hybrid between Western and Maasai culture. We first discussed female circumcision, sometimes called female genital cutting (FGC) or female genital mutilation (FGM), which is commonly practiced in Maasai culture, despite being federally illegal in Kenya. This was very interesting to me because we had an Intersections of Law and Culture conference at Franklin in fall 2010. This conference discussed the thin line between respecting a culture’s traditions and upholding human rights. Given this, it was very interesting that Joyce began the conversation calling the circumcisions “female genital mutilation”; this wording explicitly shows her opinion on the matter. As a female member of Maasai culture, this was very interesting and shows her setting herself apart from the controversial, yet embedded traditions of Maasai culture.

A few other interesting aspects of Maasai culture are that wives and husbands don’t sleep in the same bed. While of course husbands can (and do) have multiple wives or ‘girlfriends’ these women are always married women. So, while women cannot have multiple husbands, it is common for another man to be sleeping with a man’s wife and is not a problem. Also, flies are considered a symbol of wealth. The number of cows determines the wealth of Maasai, and cows bring flies. Therefore, flies equal wealth. Interesting!  Finally, I had explained the interesting aspect of the removal of teeth for feeding and drinking with lockjaw; this is in fact true, however it is also an identifying factor for Maasai members (other identifiers are the facial scarring, which I think are beautiful).

We have also had lectures on epidemiology, further research collection methods and the research process of our project. I am so excited to begin the field research next week. It is really empowering to know that our research can have a resounding effect on people’s livelihoods and their public health. We have four days of research in even more rural areas than where we are now. If I haven’t mentioned it, we are in Kimana, which is an extremely impoverished town in a very rural area. There is one other town, Loitokitok (where the VCT Boma is) near us, but besides that we are relatively on our own out here, surrounded by Maasai tribes who have never had an outsider visit. We are about 45 minutes from any other “town” and four hours drive from Nairobi using a good Land-Rover. Using public transportation, the drive can take over 7 hours. Anyways, we are going even further out to do our research. We will be within the Imbirikani Group Ranch, but we will be leaving by 7 AM (that means cook crew is at 5:30!!!) and we won’t be returning until 7 PM, when we will need to begin the data recording and analysis. These four days will be stressing, and our professors keep saying “there will be life after next week”. I am very excited to begin, but slightly nervous. The Bomas are 1-2 KM apart and we are visiting about eight per day and interviewing them with a questionnaire that we are establishing tomorrow. We finalized the list of indicators today. We will be doing these visits in pairs with a translator/guide who speaks Maasai, Swahili and English; he will also be introducing us to the villagers and explaining our study. Apparently, the chiefs and other members of these communities have been spreading the word that a group of Americans and Kenyans will be visiting and asking some questions of a sensitive nature, which they should answer. I can’t wait to see the final product of this project!

Here are a few other interesting experiences that I’ve had:

·     -  The other day, during lecture, we heard a few chickens outside. Our classroom is the Chumba, which we eat, study and have classes in; it is open air and birds, bugs and such often come in. We were all looking around at each other, slightly perplexed because we haven’t had chickens on the property before, when without warning a deep and piercing chicken-scream rung out and continued ringing for a good 20 seconds. As our professor said mid-sentence, “the chicken will be squawking no more” and continued the lecture.
·      - We went to the Tuesday market in Kimana yesterday. This is the one-day of the week when everyone gets dressed and leaves to sell or buy items. The market was bustling with everything from livestock to jewellery, household items and food. I even saw a Red Sox shirt among a clothes pile! The market was great. As mzungo’s, the Maasai Mama’s surrounded us the entire time trying to sell us jewellery. A strong “hapana asante” would usually send them away, but one persistent Mama followed us through the market for a while. Finally, another group of Mzungos came by in a big tour group on their way to Amboseli and they received the attention. These mzungos were taking pictures of us, as it is such a spectacle to see them out here (weird!). It is common to hear “mzungo!” yelled as you’re walking by, people extending their hands to see if your white skin is soft or hard, or people asking to come stay with you in America.
·   -    It has been so fun to play soccer or volleyball after class everyday with other students and staff members. When we play in the evenings, right up until dinner, I can see Kilimanjaro and the baboons swinging in the trees behind us. It’s so wonderful here; I already don’t want to leave.
·      - Another wonderful view of Kili can be seen when brushing my teeth. Despite having to use my water bottle because the water quality is not up to par, and having consistently cold showers and communal bathrooms with twelve people, I am happier than I have been in such a long time. It’s truly great to be with such empowered people, in a place where people with so little give so much. The incredible friendliness of the staff never ceases to astound me.

We’re about to have a group movie night, so I’m off for now! I will update soon!


J

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