End of a long day for Justin

Wed, 31 May 2006 07:35:40 -0700 (PDT)

Subject: Habari!

From:  Justin List

Greetings friends, from the Buru Buru phase III district of Nairobi.
The experience we have had since we arrived at the Nairobi airport last Tuesday has been nothing short of overwhelming, powerful, and educational. Had I written before today, this email would have certainly had a more upsetting tenor than it will. But I don't want to paint a completely bleak picture of Nairobi in the attempt to inspire you to action. Yet at the same time, I hope you are moved to some action after reading my emails, reading the stories, and viewing images I share. I also want to thank so many of you for your interest, support, well wishes, and prayers. For without it, I would not be able to learn and act here in Kenya. And through your support, I bring you each with me.
I want to start off with some descriptive things before sharing stories, experiences, and social analysis. What a wonderful land Kenya is. We have only briefly journeyed outside Nairobi but we have seen green grandeur, baboons cross highways, and the stoic flat topped acacia tree that marks the lands of East Africa. The mix of Africans in Kenya represents much human beauty from the chocolate skinned to the Nubians (southern Sudanes) with skin dark as night and shiny as polished onyx or obsidian. Bright white smiles flash with a laugh and their eyes scrutinize us with curiosity as they should in these post-colonial days. The city, although polluted by air and in land in horrible ways, is bustling with life and what hope remains for a better life in an urban center.
We met our homestays on Tuesday night. I live with a wonderful family with 3 children, 2 of whom live at home right now, Collins (21) and Sheila (19). They have kindly adopted me as their big brother. My host mother, Betty, makes me more food than I can eat, and their host father travels as a coach so I've only met him a total of 30 seconds in my time here. They are "middle class" by Kenyan standards. But let me illustrate the relativity of that term. They have plumbing but the toilet only flushes sometimes because of how water is allotted. They have electricity but it goes out everyday. They live in a modest home, larger by Kenyan standards, but easily and drastically below Federal Poverty Line in American terms. They can't save and they can't afford to put the middle daughter through University. Collins doesn't know if he'll have continued sponsorship at University and the youngest is at a boarding secondary (high) school. (All secondary school in Kenya is private and expensive.) My host mom is the main breadearner and works 7 days a week in a fabric co-op financed by the one of the few and badly needed microfinance loans programs looking to empower small business owners trying to start employment. I have grown close to them. Our group has long days and they wait until I get home to make dinner, which is very kind, and we talk culture and politics non-stop. They have a TV, and I've been surprised to see that shows such as Alias, Everwood, OC, Kevin Hill, etc. are here. 
Unfortunately, my family's opinions confirms the problems of Kenya, many of which our group sees daily. Corruption, unemployment, and disease plagues these people. The first week has mainly been educational for us, but nothing prepared us for what would follow and continues to follow. But let me start with visits. We've on average had 10-11 hour days visiting local groups, hospitals, and NGOs. Our first visit was to Nyumbani, a well-funded (the "Mercedes-Benz") orphanage for HIV+ children run by a Jesuit priest doctor. The grounds were amazing, very green and rich environmentally, the facilities excellent, and the playground filled with very happy children. 94 children are there now. Yes, very happy. It was a shockingly positive introduction to the HIV world of Kenya, although the cemetary for children that died when the orphanage was more of a hospice program was beyond sobering. All the cemetaries we come across are. 
I'm going to honest here, too. I've met and know persons living with HIV/AIDS (PLWHA) but shortly after playing with kids, the hyper-hygiene germ-afraid person in me disappointed me as I acutely, almost instinctively, checked my hands for cuts that could serve as a means of transmission as they grabbed my hands, arms, and heart. I felt ashamed as I can knowledgeably recite all the statistics about transmission and risk that should prevent me from even looking at my hands and even knowing how many Kenyans get so much closer to those affected on a daily basis. Even more ashamed that these humans desire and badly need the warmth and love touch provides. I can tell you by a week's time here, though, my letting go of the irrational parts of my fear has been a quick and hasty process overall. Because of our itinerary it's rare we have gone to a place where the majority of people are not affected by HIV or TB.
Throughout the week, we visited many places such as WOFAK (Women Fighting AIDS in Kenya), and NGO that empowers HIV+ women; AfricaAlive!--an initiative at the Kenyan office of the United Nations High Commissioner for Refugees that goes into the slums (from here out Resource Poor Community (RPC)) to put on drama and puppet plays to educate on HIV and domestic violence. We went to the Mathare RPC and watched our first puppet drama. The sheer poverty that I saw in Mathare was overwhelming. But it would only pale compared to the next places we would visit as I'll write in the next email. We went to University of Nairobi medical school and Kenyatta Hospital (the country's national hospital) on another day. We met kind medical students after an informative visit with the dean. We received a detailed, informative tour of the Kenya AIDS Vaccine Initiative---a potentially exciting project for an HIV-1 vaccine funded by the NIH. We were told the Phase I trials there meet stringent international standards and an extensive IRB process is in place. We also received an exciting tour of Africa's soon-to-be first Infectious Disease Institute, complete with Level 3 laboratories (for working with more virulent pathogens). Walking around the wards at this hospital was sobering. Two persons to a bed. Dying or concerned eyes. Busy nurses. Concerned families. TB and general causes for hospitaliziation constituted the health problems we saw in our short walk through.
It wouldn't prepare us for our next experience---Mbagathi District Hospital. This hospital is a regional hospital. We first met some workers at the MSF (Doctors Without Borders) facility, one of the most respected NGOs in the world. They talked about the HIV/AIDS program and clinic there. We spoke mainly with a French woman who was a doctor for MSF. Most of the ARVs (anti-retroviral) drugs started coming here in September 2005 through PEPFAR. This is a program started by President Bush. We probed the doctor about any negative features of PEPFAR as it impacted her program, but she said there were none. Now a positive remark about a Pres. Bush initiative from a French woman might say quite a bit. But in 2 other settings we had complete approval of PEPFAR after extensive probing. So, in our experience, IF and when the PEPFAR gets to where it is needed, it does a world of good.
But some people aren't so lucky, especially if they get diagnosed with HIV at a later stage and teh efficacy of drugs is dubious at best. We left the MSF clinic and walked the wards of Mbagathi. The overcrowding and dying were overwhelming and the only reason I did not start crying was because how dare I cry when these people and their families are living through this and they aren't crying. There were 3 people to a bed, wasting away, afflicted with Karposi's disease (a cancer that affects progressive AIDS cases), and TB. The pediatric wards... The horror and injustice of children afflicted with HIV needs no description. The TB wards were just as disturbing, but TB and HIV are a deadly combination and many have both. I walked away aged and sobered, not only because I couldn't process everything I saw, but also because of the viciousness of these diseases. I still cannot comprehend what many of these places looked like before ARVs were here. And that was a time not too long ago.
During all these visits, we asked incessant questions about employment problems, disease, gender relations, hopes, and hopelessness. We wanted to learn and compare different groups' ideas of why problems exist, what they look like, and in what ways can we we assist to empower. Our final partnership of sorts was powerful and it came during a visit to Catholic University of East Africa. Our Physicians for Human Rights chapter at Loyola will be working with an equivalent group there in exciting ways. More on that in an action email to follow that of this trip. We have formed so many potential alliances we will bring back to Loyola to discuss with faculty and administrators there.
By Friday many of us needed to add action to our Kenyan context learning. It started Saturday in the completely ignored RPC of Bul Bul. And I will pick up here in the next email. Not only we were exposed to a people that in the eyes of the government and world fail to exist, we started partnerships that will hopefully make a difference.
It is through bearing witness to the human rights atrocities and negligences that I have to tell you stories and describe experiences to you, and I hope you will feel moved to be involved as I unpack ways to do so, ways that may be as simple as working from your own computer. The needs are beyond medical and we are no longer medical students here. We are American-educated and privileged, growingly socially aware, and well-connected students that have a burgeoning medical background. We aren't special. We're like everyone else we know. And the difference we can to empower those here holds promise. 
I'll fast forward a bit. As we are told, even in health centers by the disease-afflicted, the roots problems around HIV/AIDS and ALL social ills here are employment and the determinants that impact it---corruption and the current economic paradigm in Kenya. Our health needs assessment and education modules have begun to uncover a lot, much of it not new perhaps, but as we have been told by community members at Bul Bul in particular, we were the first to ask them and to be there. We have already discussed ideas and avenues of assistance with the Kenyans with whom we have worked.
I am having a hard time here--I'll be honest. This has been the most challenging trip for me on many levels. I have not been able to distance myself in a protective way and coupled with the Lariam (anti-malarial drug) sleep has been an issue at times. But I couldn't have it any different. The situation here is that dramatic and has touched me in a way that I have not felt in my experiences in Asia, Latin America, and Ghana. This is not to say my experiences there do not demand the same concern because they do, but I have never experienced such a neglected community that experiences structural violence from the powers that be. I've never felt more obligated. (More on this evolving wrestle of mine in subsequent emails.) I used to think poverty=poverty=poverty. And on one hand it does. And yet on another, they can be worlds apart. Possibility and hope are huge components of that analysis.
I love and miss you all. Thankfully, I continue to be physically healthy even after new foods, foreign milk, and who knows what else.
Thanks again. I am acting and learning with your support.

Date: Wed, 7 Jun 2006 07:00:20 -0700 (PDT)
From: Justin List Subject: It takes a donkey vendor…
To: justin.list@aya.yale.edu

...to deliver water in Naivasha.

 I’m going to hop around in terms of timeline here, and I hope it’s not too confusing. Saturday morning brought some hopefully promising news for our impact here. We ran into a USAID (United States Agency for International Development) program leader in Kenya at Lea Toto clinics in Kawangware RPC last week. Friday night she called Keen to talk more about what we were doing. She expressed interest about our project and particular excitement about our needs assessment, data that they are not aware of having been collected in the manner in which we have done. We hope to meet with her again before we return home to discuss the mutual recommendations we’ve come up with working with the Kenyans on the ground. Stay tuned…
Monday morning. Upendo Village in the small yet bustling town of Naivasha just about 2 hours drive from Nairobi. Sunday after returning from Nakuru wildlife reserve we dropped off 2 laptops, vitamins, dental supplies, shoes, and clothes to here where we’d be working through Tuesday afternoon. We were joyfully greeted by orphan children at the adjoining St. Francis Xavier church and the Sisters who run Upendo Village project—a clinic and employment center for HIV+ or otherwise sick women, men, and children. The social workers and home-based caregivers based out of Upendo also go on many home visits to the ill (about 400 people right now). They also provide grief counseling for those who’ve lost loved ones to HIV/AIDS and other diseases. Their clinic runs on Monday and Friday and serves about 30 patients each of those days. The sisters act as health care practitioners and provide antibiotics, “de-worming” anti-helmith drugs, and vitamins among other things. On top of these services, the sisters are now running a will making and memory book making program, the latter which provide dying parents a way to leave memories for their children. Both these programs touched us, and we are recommending them as possible ways for future groups to participate and suggested donation items for groups going to Upendo. The governing body of Upendo Village happens to reside in Wheaton, IL, which makes supporting it quite easy. (www.upendovillage.org)
We exited the van, and a little boy called me Mr. Bean. I laughed and we sat down for a few minutes to finish off a good-bye party for Sister Catherine, who was being transferred to a different church. We left for our hotel, which proved to match my ideas of a typical African hotel. Pastels, faded and chipped paint, simplistic rooms, crumbling concrete and plaster that had a certain elegance to it. Views from wrought iron enclosed small and narrow balconies permitted gazes of the town and surrounding land. Rich sounds filled the air: calls to prayer from a local mosque, hypnotic and playful Afro rhythms from a local café, and a community in motion. We were getting a differently sensual immersion into East Africa. We would group process tonight before returning to our work on Monday. And Monday, more ever powerful narratives continued to shape our experiences, bringing a sense of hope and/or despair, a fear or a laugh, or even deepest felt encouragement—mostly to us from the surveyed, a truly humbling experience.
Let me recount from four Monday interviews whose “data outside the data” really moved me. Lisa’s first needs assessment affected us strongly. A single grandmother—I’ll call her Lucy— shared some powerful dialogue and story with her. Right now Lucy takes care of 13 grandchildren—11 of them from 2 of Lucy’s 5 deceased children. (She has four living children that remain.)  One son died of TB, another died in jail from untreated malaria after being arrested for a reason Lucy and the son did not know. He didn’t get a trial. Two daughters and another son died from AIDS related illness. One of her daughters died while we were in Kenya shortly before we came to Naivasha. One of Lucy’s living daughters is very violent to the grandchildren (suspected mental illness Lucy said) so Lucy, a single grandmother, works to earn money for 2 rented homes: hers and one to house 7 of the 13 grandchildren so they are protected from her violent daughter. (Lisa told me I could share all the details.) By the end of the interview Lucy was crying after recounting her children’s death and Lisa started tearing. And then Lucy said to her, “God is with you and will give you strength.” Then she scoured her purse for her telephone number not knowing where to find it in order to give it to Lisa. When she and the translator found it she gave it to Lisa and said, “If you ever need to talk, please call me.” Then she asked Lisa if she could do anything for her. We were dumbstruck when Lisa shared this after coming out of the room. It wasn’t the only story of its kind during this experience.
I had a much more comparatively uplifting needs assessment interview with Felix. Felix was recently diagnosed at HIV+ and lives with his HIV+ “woman” (translation for girlfriend). When he was most sick, he weighed 55 kg but now he is up to 76 kg. He illuminated many troubling societal ills for me. Primary school is supposed to be free here, but it still costs money, as other community members in the different areas have told us. We didn’t know how. Felix, as a former secondary teacher (he was laid off—permanently—when he was sick), explained it well. Basically, school administrators lie or bully most families saying that the families will have to buy books (because the school “ran out”) or a desk so that the child can go to school. Now the law is that schooling is free but we’ve encountered maybe one or two survey participants (out of 80 so far) who’ve reported free primary education. His hospital stories were equally disturbing. Private hospitals, known for their expediency and care, often will not tell patients reasons for tests or results, even if the patients ask for them. That is, they refused to tell him his results, for as he said, “they want you to return to the hospital for business reasons.” They get your business, you get fast and “good” care, but you don’t have patient rights. Whereas at the public hospital, the care is slower, but they ask you if a certain test is OK and tell you results. But their drug access is more precarious than private hospitals. This all to say that he kept going to the private hospital for a few weeks and paying them, but finally too sick, tried a public place and found out his HIV status. The private hospital certainly knew his status the whole time.
The most exciting dimension of the interview for me was our discussion of Kenyan men’s health issues. On Sunday he would be attending a meeting at the only Kenyan men’s HIV+ NGO and look to start a support group in Naivasha. Already, he has been a male leader having convinced men to come to quietly come to Upendo Village with him for HIV testing. We talked about stigma, gender roles, and strategies to get men to take care of their health. ARVs change lives radically for so many. He’s a living testament to that.
Mark surveyed—I’ll call him George—George. George was probably fired because his employer heard or thought he might be HIV+ (fired without reason, which coincided shortly after he was tested when he was ill). George lives with his family locally in Naivasha now, but he lies to them about where he goes during the day. If they find out he goes to Upendo Village, he’s afraid the resulting stigma will equal disownment. But he is newly a friend with Felix, so there’s hope for a stronger support community for him.
One of Kathy’s interviews was with the oldest HIV+ patient of Upendo Village—I’ll call her Shirley. Shirley is 60 and all 4 of her children are dead. 4 sons died related to AIDS. She did not know that her sons explicitly had HIV at the time, but upon learning about the disease at a meeting one time, she realized that they probably had. Not aware of this, she probably didn’t know proper care giving because she was not firmly educated on HIV transmission as the survey suggested. (All almost all survey have known so far.) She feels that she contracted it while caring for them. Shirley has the most beautiful skin, and I did get a picture of her. A whole generation lost to HIV/AIDS. Shirley was a living testament to a whole generation wiped out. Thankfully, Upendo is here for her now.
We started our nutritional analysis surveys at Upendo. They were much easier emotionally for us to conduct and were a fun cross-cultural exchange for all involved. We will analyze the contents of their diets for nutritional content and get back to Upendo with the results. Most of the diets were OK since many of those surveyed eat at Upendo. Since they are on ARVs (Upendo provides a cadre of drugs but not ARVs) nutrition is a MUST complement to the drugs. (The ARVs are available across the street at a government clinic.)
On that note, a major news story since we’ve been here is the new provision of free ARVs. The 100 Kenya Shilling (Ksh) copay has been dropped. But “free ARVs” comes with attachments, because patients are still financially responsible for up to 6000 Ksh in tests (usually about 3000 Ksh), which is more than many make in months. It is a step, though, albeit a small one. Not surprisingly, water here costs money (prohibitive cost for obtaining needed daily amounts) and is untreated. However, instead of walking to wells or tanks, donkey-driven carts carry water around the town, and people can leave out their jugs or approach an approaching donkey vendor. I’ve shared my two cents on the detriments of water privatization here, but don’t let me leave you thinking that privatization is monolithic. For it takes a donkey vendor in Naivasha to get water to a child.
I awoke Tuesday morning to wonderful Afro beat music on the streets and harmonized to it in the shower. Today we accompanied social worker Bridget on home-based care visits. Each holds a moving story unto itself. A melancholic visit, we visited Veronica’s mother. Veronica was a friend of Keen’s from her visit last year. Keen found out that Veronica had died when we arrived at Upendo on Sunday. Keen had brought a number of things for Veronica with her on this trip, and she ended up giving them to her mother after we sat with her family for awhile in a mostly uplifting gathering. Another touching story came when visiting Jane. Jane is HIV+ and looked great. She lives on a shamba (farm). She is not on ARVs right now because her CD4 count is in the 700s (not low enough to necessitate ARVs). Jane’s husband died of AIDS related illness and both of the families have nothing to do with Jane now, and they haven’t told her why so she’s read between the lines. Now she’s in charge of a small farm and her 3 children. The drought in January and February hit this area the hardest in Kenya we were told. All her crops died and so she started selling rocks that she broke into smaller pieces for building. She was making less than a dollar a day and often they wouldn’t have any meals. Upendo came through for them in many ways. But even they were limited in helping Jane reach basic needs until a pilot child sponsorship program started supporting schooling and food for her children. Upendo and Jane have a transparent accountability rigmarole down for the use of those funds. Jane can “even consistently provide 2 meals a day” for her children. Another daughter can now go to secondary school. As far as we could tell, hope has blossomed at this place amidst sickness and the downtrodden economy. We left Tuesday for Nairobi on a nothing less than adventurous matatu ride back to Buru Buru.
NAKURU (Saturday through Sunday morning)
Now you see, the thing is, one can come to Kenya and see almost nothing that we have. One and a half million visitors came to Kenya last year. That number reflects about a 7% increase from the previous year. One could easily take a safari to a beautiful park, stay at the Hilton in downtown Nairobi Center (not far from where the US Embassy was bombed in 1998), and hear American music in a game park dining room. Maybe this is part of the larger sinister nature and perpetuation of poverty here. You can come here and be hidden from it all and not even experience the need in an impacting way. My Lonely Planet guide mentions the word “slum” one time in the entire book and does not include anywhere on the map outside the affluent and “safe” Nairobi city center. Of course, slums aren’t on a tourist agenda usually and maybe it’s not strategic to say that they exist and it is true that they can be dangerous. Yet such a cover-up and/or lack of attention to the reality situation feel like an extremely harmful “don’t ask, don’t tell” policy.
At the Nakuru wildfire park where we spent a rejuvenating 28 hour journey, it all came to us how once could come experience the amazing natural wonders of Kenya and leave Kenya thinking things aren’t all that bad here. The landscape is as powerful as its people. You will hopefully enjoy the pictures from this aspect of the experience. At the same time, we placed our finger on the country within a country: “the country of international affluence.” I’m not going to call it an intrinsically “bad” place, because it does not have to be of course, but severe deficiencies are structurally a part of it too often perhaps.
It’s a place where those of international affluence (that includes our group) come together to celebrate the wonders of a particular country. You’ll hear languages from 5 continents being spoken around you. You’ll hear Western songs, e.g., Simon and Garfunkel, Beatles, Whitney Houston, played by locals, often on local instruments, even in the local tongue, while you are eating. You’ll always here “Yesterday” from Peru to Mongolia to Kenya while eating often ubiquitously chosen international cuisine you’d find in another region of the “country of international.” One won’t see poverty if one’s trip stays within this “country” for the duration. Keen knew the owner of our lodge so we were cut a break. But we felt paradoxically both fitting right in and uncomfortable—not in a self-righteous way—but especially because the lodge presented such an economic disparity from our experiences in the past two weeks.
What was undeniable was our need for brief, but substantive, recharging in some way. We have the luxury of escaping to get it. The beauty of the land and the excitement of seeing gazelles, impala, giraffes, rhinoceros, hippopotamus, zebra, ostrich, lions, baboons frolicking, and perky, spunky warthogs made me feel like a child in a candy store. The famed pink flamingos, thousands of them, of Lake Nakuru were always in view. As the drive out to Nakuru demonstrated, (besides horrible and completely fun, broken roads) the Great Rift Valley, where “The Tree Where Man Was Born” resides, has majesty all unto itself. The awkward, tortured, beautiful geography and geology, the ochre-rust earth and green land, provided a vision of the more verdant, less polluted side of Kenya. Two weeks in Nairobi does not confer such a vision or experience unfortunately. But watching a thunderstorm sweep the savannah does. And the cold rain on my skin brought some life.
MUKURU RPC (Wednesday through Friday)
Mukuru falls in league with Kibera, Kawangware, and Mathare. Rubbish, shit, struggles of a community left behind by the Kenyan government and much of the international community. However, our experiences here from the outset inspired us and demonstrated what fruitful assistance and empowerment can do in the lives of impoverished persons, many living with HIV. My next email (and last from Kenya for this experience) will pick up here with Wednesday’s events. Thanks again for your support, your emails, questions, thoughts, and prayers.