Thankful.

"Each friend represents a world in us, a world possibly not born until they arrive, and it is only by this meeting that a new world is born". -Anais Nin 

My time in Kenya has almost come to an end and it is bittersweet. Bitter because, even after a lifetime of practice, good-byes don't get any easier. Sweet because I know that this is just the beginning of what will be a lifelong relationship with East Africa and the people I have come to love. 

The office is always full of laughter

I look back on the past two and a half months and I am humbled. 

I am humbled because of how intimately God knows me. Each of my experiences was so perfectly tailored for me, down to the smallest detail, that it gives me goosebumps when I think about it. I felt as though God had put me in a time machine to show me a glimpse of what my future could look like. 

Thumbs up! With Chris' children Asher, Abijah, and Hadassah

I am humbled because the reluctant, half-hearted trust I had put in God pales against His incredible faithfulness. My mind drifts to early May when I was still in the process of sending out my first support letters and trying to figure out practical necessities for this trip. I was almost convinced that I would never be able to make it to Kenya. In fact, I had a whole list of reasons why this trip was not going to happen - finances being on the top of the list. Two and a half months down the line, I have not only completed my internship, but have experienced things beyond my imagination. 

With Lily, Anita, Catherine, and Chris

I arrived in Kenya with an uncertainty about my future after college. Each time I talked to someone about future plans and grad school, there was a suffocating heaviness in my heart that weighed me down. Although the situation hasn't changed and I still cannot see what the future holds, my understanding of God's abilities and power has. I have also learnt that working with communities and doing Public Health programs and medical work within those communities gives me so much joy and life. I have felt more alive than ever over the past few months because I believe God was showing me that this is the kind of work He is calling me to do. I leave Kenya excited to see what He can do in my future. 

A weekend with these three cuties; Rebecca, Charity and Grace. 

Baking M&M cookies with Nema's girls

As a missionary kid who has constantly moved around, the phrase "home is where the heart is" holds a lot of truth for me. It's hard to explain just how much care and love my supervisors, colleagues, and their families poured out on me. I am infinitely grateful that I now have another "home" and family in Kenya.

After eating chicken curry with Chris' family

A Sunday morning with my lovely sisters and Auntie Beth

I leave Kenya more whole that I arrived, and yet I leave behind a significant portion of my heart with the people I have grown to love dearly. 

Two fishing communities

"The people in a number of the stories are of the kind that many writers have recently got in the habit of referring to as "the little people." I regard this phrase as patronizing and repulsive. There are no little people in this book. They are as big as you are, whoever you are." -Joseph Mitchell, 'McSorley's Wonderful Saloon'

The entrance of the little church in the Akampala landing site

After a night's rest in Kampala, Allen, David, Nema and I packed our bags and headed east to a town called Soroti, by the Uganda-Kenya border. Every morning, for the next four days, we drove an hour out to a nearby town called Kaberomaido to meet with the programming staff of PAG-Kaberomaido, a partner organization, and walk with them through the training of "Designing a Behavior Change Framework" as they started a new program.

PAG-Kaberomaido

The program being started is an HIV program for men in two nearby fishing communities (i.e. landing sites). In these landing sites, there is a prevelance of HIV due to the fishermen having numerous sexual partners. Often times, a woman will sleep with a fisherman in exchange for fish or money. The program will be designed to encourage fishermen to be faithful to one sexual partner in order to protect themselves and their partners from HIV infection. 

A focused group discussion with some fishermen

After talking with the men and hearing their stories, I realized just how strong of a hold our culture and surroundings have on us. In these landing sites, there is a culture of drinking and sleeping with numerous women without concern of safe sex. It was saddening to hear the misconceptions that they had about women and HIV. I am no better than these fishermen - we are all broken. When it comes to changing behavior, it is equally difficult for me and often requires sacrifices that I don't want to make. Just like it was emphasized in the training, these fishermen need to be empowered and transformed in order to truly let go of their old habits and change their behavior - not for the organization's benefit, not for the government's benefit, but for their own. 

The kids came to see what was going on

Data analysis after interviewing community members

Over the past two weeks, I have grown more familiar with and confident in the process of designing a behavior change framework. I've learnt more about HIV programs and the fears and misconceptions people have around this disease. I've loved the interaction with community members, the long car rides, the hours of data analysis, and the fact that there has been something new to learn everyday. It's been an absolute blessing to have the oppurtunity to work with such great people and be inspired by them. 

Nema couldn't help taking this photo: exhausted after a good day's work

A happy bunch after finishing the week of training

Kabale: Uganda

Last week Sunday, Nema and I arrived at our hotel in Entebbe, central Uganda, a little past midnight- just in time to watch the winning goal of the World Cup Finals.

After travelling 8 hours west, we spent the week in Kabale, a hill-station near the Uganda-Rwanda border. Together with Allen, Carole, and Joseph, (three staff from the Uganda World Renew) we facilitated a four-day training for staff and volunteers of P.A.G Kabale, a partner organization, on ‘Designing a Behavioral Change Framework’. The training was based on the workshop that we attended (my first week in Kenya) and was modified to suit the community-based training.  P.A.G. Kabale is starting an HIV program for men between the ages of 18-49 years in three communities in the area. We helped them with coming up with a more specific program statement and a framework for them to design an effective HIV program. 

 

Singing and dancing couldn't be missed

It was a really eye-opening experience to see what the training I received at the workshop in June looked like when actively implemented in the community to develop a real program.

Data analysis after going into the community

It was another week of rich learning! With community-based training, flexibility and improvisation were key. We had to look at things from the level of the community members and walk with them through the steps of the training. It was amazing to see how the material changed from being book-knowledge to a practical community dialogue.

A training session

We were fed delicious food every day

Rather than programming from the offices, the training pushed us to go into the community and hear from the people about what motivated them, what struggles they faced and what their common practices were. All of our preconceived notions were pushed to the side and the project was programmed from what the community told us.

A focused group discussion with some men from the community

The people I have worked with and learnt from during this week were a special blessing. The Uganda World Renew team: Allen, Carole, and Joseph as well as Nema, my supervisor, have been a delight to be around. Our long car rides to and from Kabale were filled with laughter and chattering.

A happy bunch after a week of training

*After getting one day of rest in Kampala, Nema, Allen and I will be heading east to Soroti, a town close to the Uganda-Kenya border for another week of training partner staff on behavior change. I'm excited to share more stories next week! 

The Satisfied And The Suffering

“But tell me, this physician of whom you were just speaking, is he a money-maker, an earner of fees, or a healer of the sick?” –Plato, the Republic

"If I define my neighbor as the one I must go out to look for, on the highways and byways, in the factories and slums, on the farms and in the mines – then my world changes. This is what is happening with the “option of the poor,” for in the gospel it is the poor person who is the neighbor par excellence…But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."  -Gustavo Gutierrez

I recently finished reading a book, called “Pathologies of Power”, that has made me take a long hard look at myself, and the unjust, oppressive social structures that make up our world today. The author, Paul Farmer, is a man who’s work actually got me interested in the field of global public health. In the book, Farmer discusses health care, human rights and “the war against the poor”. As a physician-anthropologist who has served the poor in many different countries, Farmer has experienced the stark contrast in health care in elite hospitals in Boston and that in rural village clinics in Haiti. He brings to light the statement “health care is a human right” and asks the question “when will ‘everybody’ really mean ‘everybody’?” 

                                                                                                                            

This past week I travelled to the southern coast to visit St. Luke’s Mission Hospital in Kaloleni. During my short visit, I got to experience patient-care and hospital management. (Unfortunately, I ended up leaving my camera in Nairobi for this trip so I borrowed two photos from google.) Interacting with the patients and nurses reignited my love for medicine that had been muffled over the past few months by my excitement for learning about public health. 

With a change in management, the hospital has reached new milestones like a new OR and a well-stocked pharmacy. The number of deaths has also significantly reduced from 10 per month to 3 in seven months. 

Despite these achievements, there are still many areas that need attention. The maternity ward has so few beds that unless a woman has had severe problems during delivery, she must go home with her newborn as soon as she delivers – usually this means walking. There is only one doctor. The patients who come to the mission hospital are usually the vulnerable and poor to whom the word ‘insurance’ is foreign. They often wait till the last minute to come to the hospital for fear of the hospital bill. And although they are not charged much, many patients have to stay at the hospital after they are discharged until they are able to pay off the hospital bill. This is a common theme throughout Kenya.

I don’t question or blame the hospital for the challenges it has. I am aware that serving in such an impoverished area means a struggle in finances and have seen the hard work of the staff. But I do question the larger systems and structures that allow, as Farmer puts it, a “cynical calculus by which some lives are considered more valuable and others expendable.” 

“When will ‘everybody’ really mean ‘everybody’? I don’t think equity means efficiency. Jesus didn’t call us to be efficient. And yet, here we are living in a world where medicine has become a business and efficiency is the desired goal. We live in world where the very people who are most vulnerable to sickness and disease are barred from treatment that could cure them because it is not considered “cost-effective”.  We live in a world where, despite plugging into the full promise of science and technology, there are thousands of people dying of malnutrition and TB.

I pray we don’t forget that we, both the satisfied and the suffering, all live in the same world.

“Is not this the kind of fasting I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke? Is it not to share your food with the hungry and to provide the poor wanderer with shelter – when you see the naked, to clothe him, and not to turn away from your own flesh and blood?” –Isaiah 58:6-7

*Tomorrow, I am headed off to Uganda! I will be accompanying Nema for 2 weeks to help with community-based training on designing a behavioral change framework. I’m excited to share the new adventures and experiences that I will face in Uganda!

Opportunity Gaps

"Rats and roaches live by competition under the law of supply and demand. It is the privilege of human beings to live under the law of justice and mercy." -Wendall Berry 

Another wonderful, busy week has gone by. 

On the way to Taita Taveta we spotted a giant baobab!

This past week, I returned to the Taita Taveta district - the target area for the Mwanzo Mwema project (which I wrote about earlier). My time back in the little town of Voi was quite a different experience from my earlier trip. It was a week consisting mostly of  meetings and discussions on the progress of the project. The three organization involved in Mwanzo Mwema - the University of Manitoba,  ADS Pwani, and World Renew - came together to discuss the data, challenges, successes and goals. 

Discussing and evaluating

I was blessed with a chance to experience the long (often very long) project review meetings and have some insightful conversations with doctors, public health experts and community development workers. There are some valuable things that I learnt through my experience. Here are a few of the biggest lessons learnt:

-Partnership and teamwork are essential for a public health project. Different experiences, expertise, and skills help strengthen the team. In our meetings, we would have time to split into different speciality groups such as the management team, the health team, the programming team, the finances team, etc. It showed me just how valuable teamwork is. 

-In public health, you should always be aware of your denominator. That way you can know who you have not been able to reach yet and why. You need to be constantly thinking about how you can reach the unreached.  

-Something one of the public health experts said during the meeting still resonates with me, "gaps in the project aren't something we should feel bad about. They are 'opportunity gaps' to improve the project further and help more people."

The health team

Travelling in style: riding in the trunk to go on a home visit 

In the midst of our review meetings, we decided to split up into groups and spend an afternoon going on field visits to meet with the beneficiaries of the program. My group visited the home of a lactating mother, Doris, and spent some precious time interacting with her. 

Walking to a beneficiary's home with the community health workers

The family of seven had just recently moved to their new home and were all sleeping in one tiny mud hut. The hope I saw was starkly different from the poverty that surrounded the family. Doris was determined follow Mwanzo Mwema's lessons and was practicing exclusive breastfeeding. As a result, her 2 month old Paul, was a fat and healthy baby. The family was building another hut to expand their home and the mother said that the next time we visit them they will have a big house ready. 

Adorable Paul

Davis lovingly held  Paul thoughout the home visit

On the last day in Taita Taveta, my supervisers felt that we all deserved a break from our long week before driving 6 hours back to Nairobi. We stayed the night at Saltlick Lodge, a hotel located in the middle of a game park. It was one of the most amazing experiences of my life. The lodge had salt water ponds that attracted herds of wild animals. Our rooms were suspended 15 feet off the ground to protect us from the wildlife. In my excitement, I found myself waking up early in the morning to watch the herds of elephants come to drink water. As I sat on the balcony, the savanna grasslands stretching as far as my eyes could see and the birds singing morning tunes, I was yet again reminded of my Father's vast and intimate love. He didn't have to let me stay at the lodge that day, but I felt like it was his small gift of love for his daughter.

I was grinning from ear to ear the rest of that day.

The monkeys had to take a break and let the zebras have their share

A herd of elephants coming for a morning drink

A handsome bull

Gentle Whispers.

"Let us be silent, so that we may hear the whisper of God." -Ralph Waldo Emerson

Where have I seen the face of my Creator this week? Where have I heard his gentle whisper? These are the questions that I asked myself last night. The list started to flow...an effortless, steady stream:


The quiet morning walks to the office.

Feeling the unfamiliarity of living with a new family peel-away and be replaced with comfort.

Laughing effortlessly with Naomi at her sarcastic remarks.

Walking around the neighborhood and talking about life with my sister Helen.

The smiling security guard, Kevin, who greets me good-morning each day.

Being able to sit down and eat a whole papaya for breakfast.

The people who have drop by my office cubicle to talk to me.

Cooking up a storm with the sisters. (and then doing the massive pile of dishes together shortly after).

How Helen walked all the way to Sarit to get me Indian take-out because I missed home food.

Lily's warm hugs when I finally reach the office in the morning, sweaty and panting.

Singing, dancing and praising God at church - worship has no language barriers.

Messages of encouragement from loved ones around the world.

Watching late night world cup matches with the whole family and waking up the neighborhood with our cheers.

"She's not our guest. She's out sister."




...The list grows and will continue to grow...

morning walks 

My sister, Helen

“I believe that the community - in the fullest sense: a place and all its creatures - is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.” ― Wendell Berry

A Precious Bag of Arrowroot

"If I define my neighbor as the one I must go out to look for, on the highways and byways, in the factories and slums, on the farms and in the mines – then my world changes. This is what is happening with the “option of the poor,” for in the gospel it is the poor person who is the neighbor par excellence…

But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."

-Gustavo Gutierrez

This week I accompanied Nema and Naomi to do a mid-term evaluation on the "HIV Control and Reproductive Health Enhancement Project" in Ng'enda. Depending on the temperamental Kenyan traffic, Ng'enda is about an hours drive from Nairobi. The drive back and forth with one of my superviser, Nema, allowed for valuable, insightful conversation. Nema is a passionate and purposeful woman. Her stories and advice were steeped with years of experience as a Public Health worker and her passion for HIV/AIDS.

Just a little traffic = more talking time

Let me give you some background to the Ng'enda project. In Ng'enda, AIDS has caused pervasive premature mortality of the most productive groups, leaving behind orphaned children and overwhelmed widows. AIDS has destroyed human capital and reduced labor force. Sadly, increased stigma around HIV has resulted in denial of basic human rights for people living with HIV. In addition, the soil in the area is infertile resulting in high crop failure and low food security. The goal of this project is to improve the overall health status of the community by reducing HIV transmissions and mitigating HIV impact in the area. The project also focuses on improving the economic status and food security, especially for women and girls, in the area.

The final discussion to analyze all the FGDs 

Similar to Taita Taveta, although not as extensive, we held various focused group discussions (FGD) with the community health workers, the village men and women, and the elders. The FGDs would help us see how the project is progressing and what changes need to be made. Like most World Renew projects, the Ng'enda project is closely partnering with a local church, government officials, and local organizations.

The partner church

The small nursery school run by the church

I've realized that community development is more about the process and less about the results. If you look past the process, you won't get the results. The process involves transformation of heart - starting with the development worker and working around every member of the community. That transformation of heart does not take place overnight. Like gardening, it requires patience and nurture. Often, donors and big organizations want results fast. They are interested in cookie-cutter projects and quantitative, not qualitative, data. But without transformation of heart, there's no ownership. An orphan may very easily become "that organization's problem" rather than the community's child. I think it's human nature to want to focus on the harvest rather than the process of seed-planting and growth.
It's been nearly two years since the Ng'enda project began and they are only just beginning to see a change of heart and ownership in some community members - that's how much patience is required.

This makes me think of how God feels when He sees me making countless mistakes. He could choose to get fast results by getting me from point A to point B without letting me ask questions. Instead, the Maker of the Universe chooses to let me make my own mistakes. He is patient with me when, time and time again, I turn away from Him and seek my own will. He is faithful and doesn't give up on me even when I've lost hope in myself. He's more interested in the transformation of my heart than in seeing "results". Goodness, where would I be - where would we all be - if God was simply focused on "results".

On the last day in Ng'enda with Naomi, Patrick, Nema, and Belinda 

Just before we left, a group of women from the community called us over to talk to us. They handed us each a black plastic bag. I peered inside to find some fresh arrowroot - a "thank-you" from the community.