This past Saturday goes down as one of the weirdest days I’ve ever experienced. We wanted to explore the area around Kisumu and Lake Victoria, and we ended up seeing the wide spectrum that is the developing world.
I’ll keep things short this time – no history lesson.
Our day began with a cruise of Lake Victoria. Although it was no Royal Caribbean, we had a great time on the water. We saw some hippos. We saw some birds. We saw some boats. We saw some Lake Victoria. I’ve realized that our “vacations” will not be the usual safaris that most people travel to Kenya to experience. That is mainly because those are crazy expensive, but it is also because we are here long enough to enjoy the small things. No guidebook will highlight watching the fishermen sail home every afternoon on Lake Victoria, but we have the time and famished budget to stumble upon that sight. Well worth it. We also got to walk around a local fishing outpost, where all the fish is brought back and sold. Very simple life – worlds away from what I am used to in NYC, and even in downtown Kisumu. Along the way, we saw tons of people having their afternoon bath in the lake. Didn’t take any pictures, but it was refreshing to see people doing their thing.
After the cruise, we went to what is called Mega City. This is the perfect example of eerie globalization. Mega City is a warehouse/shopping mall. There is a huge Wal-Mart-esque store as well as other shops. Half of the spaces were vacant, and the ones that were full reminded me of Carolina East Mall in G-vegas (right before it was bulldozed). It was just a very strange strange place. You saw locals in traditional attire buying cases of Fanta, or flat-screened TVs. The weirdest part was upstairs where the ‘food court’ was. It was a large space full of rows and rows of empty tables with chairs. A few people were eating, but generally it was just creepy. [Ok, so there is also a theater here, which will be showing Harry Potter, so I can get my fix of western pop culture once that comes out, although I know it will be an experience laden with guilt and general discomfort. Luckily for HP, I am a die-hard fan, so I will endure it.] Overall, this place was bizarre. It’s also worth noting that there is a smoldering landfill directly behind Mega City, which adds to the creepiness of it all.
Photos of Hippos and Mega City
Tuesday, June 23, 2009
Friday, June 19, 2009
Frustrations and Encouragements
So I was trying to think of all of the things that we take for granted in the states. Obviously, the list is quite long. The one thing that stood out more than anything else seemed like one of the most simple: things work in the states. By ‘things’ I don't mean cars or roofs or power lines (all of which are certainly not a guarantee here), but I mean the systems that people use. You need to drop a class. Yea, the process may seem complicated and needlessly burdensome, but at the end of the day your class gets dropped. There is a fire in your building. You call 911. Yea, it might take the firemen a few minutes to get to your place, but they get there, and they tend to put out the fire. Things are by no means perfect in the states, but at least something is done that you can consider imperfect. It is hard to call nothingness imperfect, or inaction imperfect. That is what the people of Kisumu face ever day. Many of their systems, especially health systems, simply do not function. They have no 911. Their local health department does not have staff meetings or work plans. Those in power don’t check their email. If you need to send someone an attachment, you have to send it as well as print out two copies, one to drop off at their office that day and the other for a week later when they lose the original copy. When medical supplies are donated to the area, there is no system to distribute them. A couple of days ago, in fact, the local officials tried to steal a truckload of donated medical supplies from the district. My coordinator, Beldina, had to race to the storage place, demand that the gates be locked so they couldn't get away with the supplies, and force them to put everything back. Then when Beldina tried to figure out which clinics needed what, many asked for things that they didn't need. One clinic that had no fridge wanted a case of cold packs. And that is just the government. Trying to make sense of the mess of NGOs working here is even worse. NGOs come and go, as does their funding. One week you can rely on them, the next week you can’t. Most are not accountable to the people that they serve, and many policies come from abroad or God without considering local needs/concerns or science. Many do the same thing, so people don't know which to turn to. Many issue conflicting information, and there is no way of checking up on that.
I know I that I am making it sound like everything is hopeless and no one does anything good. Not everyone is inept or corrupt. Not all systems are defunct. There are plenty of highly qualified individuals working and doing desperately needed tasks. But when the health and lives of half a million people depend on your work, like the city of Kisumu depends on the local health department, NGOs and private clinics, and you don't do your job, people die. A lot of people die. Yes, they need more money, and more training, and more support from the national and international governments, and less competition between NGOs, and less ethnic violence would help things too; but, at some point, a staff meeting would be a good idea, or maybe checking your email, or asking the community what they need or looking in a science journal rather than the Bible to decide what to do. It is quite a frustrating environment.
So things are frustrating, but there are encouragements along the way. Case and point: Migosi Health Center.
Photos of Migosi Health Center
It is the closest clinic to Manyatta. A year ago, it served about 5 people per day; today it serves around 50-60 people per day. There is no doctor. It only provides outpatient services. The local government provides them with medications twice a year, and it lasts about a week each time. There is a notebook to record names of patients and that is about it. There is one microscope for lab tests. Despite all that they do not have, Cecilia, the clinical officer (equivalent to a physician assistant) who runs the place, has made some great progress. She uses the small amount they charge for meds and buys more meds from the district hospital, which no government clinic should be responsible for. She got the clinic’s first autoclave donated, so now she can do minor surgeries and things like stitches. She fired half of the staff upon arrival (the old staff used to shout at the 5 patients and make them leave if they were too dirty) and still managed to increase the number of patients ten fold. Within two months, she plans on having a delivery ward opened. She and her 4 nurses are all trained to do deliveries, but they never could because they didn't have an autoclave, or authorization from the government. She even offers waivers for her poorer patients who cannot afford a round of antibiotics (which costs around 50 cents). All of her consultations are free. All services (including meds) to children under 5 are free. HIV/AIDS services are free. Some of these policies come from the national government (see, some things do work), but when a clinic only serves 5 people a day, they go wasted. I like Cecilia. And her head nurse Nancy.
Lessons learned: Many people don't do their jobs, which results in many systems faltering, which results in many people dying. Despite this, there are people who do their jobs, which results in salvaging some systems (or making a new one), which results in saving lives. I just need to do my best to be one the latter kind of person.
Sorry for the rant/ramble.
I know I that I am making it sound like everything is hopeless and no one does anything good. Not everyone is inept or corrupt. Not all systems are defunct. There are plenty of highly qualified individuals working and doing desperately needed tasks. But when the health and lives of half a million people depend on your work, like the city of Kisumu depends on the local health department, NGOs and private clinics, and you don't do your job, people die. A lot of people die. Yes, they need more money, and more training, and more support from the national and international governments, and less competition between NGOs, and less ethnic violence would help things too; but, at some point, a staff meeting would be a good idea, or maybe checking your email, or asking the community what they need or looking in a science journal rather than the Bible to decide what to do. It is quite a frustrating environment.
So things are frustrating, but there are encouragements along the way. Case and point: Migosi Health Center.
Photos of Migosi Health Center
It is the closest clinic to Manyatta. A year ago, it served about 5 people per day; today it serves around 50-60 people per day. There is no doctor. It only provides outpatient services. The local government provides them with medications twice a year, and it lasts about a week each time. There is a notebook to record names of patients and that is about it. There is one microscope for lab tests. Despite all that they do not have, Cecilia, the clinical officer (equivalent to a physician assistant) who runs the place, has made some great progress. She uses the small amount they charge for meds and buys more meds from the district hospital, which no government clinic should be responsible for. She got the clinic’s first autoclave donated, so now she can do minor surgeries and things like stitches. She fired half of the staff upon arrival (the old staff used to shout at the 5 patients and make them leave if they were too dirty) and still managed to increase the number of patients ten fold. Within two months, she plans on having a delivery ward opened. She and her 4 nurses are all trained to do deliveries, but they never could because they didn't have an autoclave, or authorization from the government. She even offers waivers for her poorer patients who cannot afford a round of antibiotics (which costs around 50 cents). All of her consultations are free. All services (including meds) to children under 5 are free. HIV/AIDS services are free. Some of these policies come from the national government (see, some things do work), but when a clinic only serves 5 people a day, they go wasted. I like Cecilia. And her head nurse Nancy.
Lessons learned: Many people don't do their jobs, which results in many systems faltering, which results in many people dying. Despite this, there are people who do their jobs, which results in salvaging some systems (or making a new one), which results in saving lives. I just need to do my best to be one the latter kind of person.
Sorry for the rant/ramble.
Monday, June 15, 2009
Kakamega Forest
Photos of Kakamega Forest
Salina, Ayaka and I went to the Kakamega Forest, which is a national forest about 2 hours north of Kisumu. It was a bumpy matatu ride, but well worth it. Matatus are quintessentially African. They are old vans that are gutted and seats are added to take around 9 passengers. You will never see a matatu with only 9 passengers. The ones we rode had around 14-18 people in it, which makes sense because it is a very cheap travel option. They work like taxis around town, as well as long distance trips (there are matatus from Kisumu to Nairobi – a 6ish hour trip). When they drive by you just wave and hop on and hope to find a seat.
The forest itself was amazing. East Africa does not have many hardcore rainforests anymore. Millions of years ago most of Sub-Saharan Africa was a rainforest, but slowly the savanna took over and limited the rainforest to mainly central Africa. Kakamega Forest is a rare plot of rainforest that refused to change into savanna. Plenty of great trees, monkeys, and friendly forest rangers who showed us around. We trekked to a small waterfall, then heard some thunder, and ended up sprinting out of the forest. Despite our efforts, we got soaked along with come locals before we waited under the cover of a small shack for the next matatu speeding along the highway back to Kisumu.
Salina, Ayaka and I went to the Kakamega Forest, which is a national forest about 2 hours north of Kisumu. It was a bumpy matatu ride, but well worth it. Matatus are quintessentially African. They are old vans that are gutted and seats are added to take around 9 passengers. You will never see a matatu with only 9 passengers. The ones we rode had around 14-18 people in it, which makes sense because it is a very cheap travel option. They work like taxis around town, as well as long distance trips (there are matatus from Kisumu to Nairobi – a 6ish hour trip). When they drive by you just wave and hop on and hope to find a seat.
The forest itself was amazing. East Africa does not have many hardcore rainforests anymore. Millions of years ago most of Sub-Saharan Africa was a rainforest, but slowly the savanna took over and limited the rainforest to mainly central Africa. Kakamega Forest is a rare plot of rainforest that refused to change into savanna. Plenty of great trees, monkeys, and friendly forest rangers who showed us around. We trekked to a small waterfall, then heard some thunder, and ended up sprinting out of the forest. Despite our efforts, we got soaked along with come locals before we waited under the cover of a small shack for the next matatu speeding along the highway back to Kisumu.
A Little More on Kisumu
Photos of my travels to Kisumu
Photos of Kisumu and Manyatta
So I thought I would give a little more information about Kisumu, which is quite an interesting place. As I mentioned, it is the 3rd largest city in Kenya, but it feels much smaller. I have a slightly skewed perception of a city, living in NYC and all, but the pace here resembles a town. Many of the pictures you see of downtown I took from the roof of the guesthouse I am staying at. The pictures from the car come from my first trip into Manyatta slum. There will be more pictures of Manyatta as I spend more time there. These pictures were the ones I could get while riding in a car. Obviously the most beautiful part of Kisumu is the views of Lake Victoria. We actually sit in a small gulf off of the main lake, which makes for great sunsets.
Western Kenya has been slow to develop, especially after the collapse of the East African economic coalition about 20 years ago. Kisumu suffered a lot with that collapse, as its ferry system shut down and trains in and out of town became irregular at best. From what I can gather, Kisumu has seen better days, and there are a lot of efforts to bring back investment in the area and increase employment. One of the biggest challenges to attract investment is the ethnic conflicts. I’m sure most of you heard of the post election violence that took place in Kenya in early 2008. That violence was centered here in Kisumu. I see remnants of the violence all over town. Any building that looks burnt or destroyed was done so during the post election violence. There are huge potholes in the road to Manyatta where huge tires were set on fire (as roadblocks) to demand money from the wealthy citizens fleeing town, or coming back to town. Only the wealthy could do something like leave via car, so they were targeted on their way in and out. I won’t pretend to understand the ‘why’ to the violence, but on the most basic level, it comes down to tribal loyalty. The local Luo people tried to run out of town many non-Luo members of the community once elections results came in supporting a Kikuyu candidate. The main tension is between Luo and Kikuyu (who generally are from more central Kenya, like Nairobi), but there are definitely tension between the Luo and those of Indian descent, who own about 90% of business in Kisumu. After weeks of violence, a coalition government was formed, the president is Kikuyu while the prime minister is Luo. Kofi Annan is still mediating the coalition government, and many people are watching to see how it turns out. This stuff is really interesting, especially for people working in development, because there are a lot of questions raised about how western Kenya has been treated by the Nairobi based government. Many locals accuse the capital of not sending enough funds, people, and concern in their direction. Some blame this on Nairobi discriminating against the western Luo, some think it is due to general poor governance, and some don’t really buy it and see all of Kenya struggling. Working with the community here has taught me that you cannot come into town and try to help out without trying to understand these sorts of politics, despite them being very very very hard to comprehend. I am doing my best.
Sorry for the history lesson. Check out the pictures of Kisumu – it’s my home til August.
Photos of Kisumu and Manyatta
So I thought I would give a little more information about Kisumu, which is quite an interesting place. As I mentioned, it is the 3rd largest city in Kenya, but it feels much smaller. I have a slightly skewed perception of a city, living in NYC and all, but the pace here resembles a town. Many of the pictures you see of downtown I took from the roof of the guesthouse I am staying at. The pictures from the car come from my first trip into Manyatta slum. There will be more pictures of Manyatta as I spend more time there. These pictures were the ones I could get while riding in a car. Obviously the most beautiful part of Kisumu is the views of Lake Victoria. We actually sit in a small gulf off of the main lake, which makes for great sunsets.
Western Kenya has been slow to develop, especially after the collapse of the East African economic coalition about 20 years ago. Kisumu suffered a lot with that collapse, as its ferry system shut down and trains in and out of town became irregular at best. From what I can gather, Kisumu has seen better days, and there are a lot of efforts to bring back investment in the area and increase employment. One of the biggest challenges to attract investment is the ethnic conflicts. I’m sure most of you heard of the post election violence that took place in Kenya in early 2008. That violence was centered here in Kisumu. I see remnants of the violence all over town. Any building that looks burnt or destroyed was done so during the post election violence. There are huge potholes in the road to Manyatta where huge tires were set on fire (as roadblocks) to demand money from the wealthy citizens fleeing town, or coming back to town. Only the wealthy could do something like leave via car, so they were targeted on their way in and out. I won’t pretend to understand the ‘why’ to the violence, but on the most basic level, it comes down to tribal loyalty. The local Luo people tried to run out of town many non-Luo members of the community once elections results came in supporting a Kikuyu candidate. The main tension is between Luo and Kikuyu (who generally are from more central Kenya, like Nairobi), but there are definitely tension between the Luo and those of Indian descent, who own about 90% of business in Kisumu. After weeks of violence, a coalition government was formed, the president is Kikuyu while the prime minister is Luo. Kofi Annan is still mediating the coalition government, and many people are watching to see how it turns out. This stuff is really interesting, especially for people working in development, because there are a lot of questions raised about how western Kenya has been treated by the Nairobi based government. Many locals accuse the capital of not sending enough funds, people, and concern in their direction. Some blame this on Nairobi discriminating against the western Luo, some think it is due to general poor governance, and some don’t really buy it and see all of Kenya struggling. Working with the community here has taught me that you cannot come into town and try to help out without trying to understand these sorts of politics, despite them being very very very hard to comprehend. I am doing my best.
Sorry for the history lesson. Check out the pictures of Kisumu – it’s my home til August.
Thursday, June 11, 2009
First 72 hours
So I have rewritten this first post about 5 times before putting it up here, which is indicative of how uncomfortable I feel maintaining a blog. (By the way, my spell check is telling me that blog is misspelled, which only reinforces my resistance to them) I have always felt it is a bit egotistical to have a blog, especially one that just updates people on what you are doing. So pardon my ego, and I will try to keep this short. If you really want to hear more, just email me (grantgraziani@gmail.com) and I’ll give you more of a scoop that way.
With that said, here goes.
For those of you who don’t know what I am doing in Kenya this summer, I will try to give a brief explanation. I have an internship in Kisumu, Kenya until late August. The main organization that I am working for is the Millennium Cities Initiative (http://www.earth.columbia.edu/mci/), which is operated by Columbia’s Earth Institute. MCI is the urban sibling of the more popular Millennium Village Project. Kisumu was named a Millennium City in 2006, and the coordinators here have been working to help the city reach the Millennium Development Goals (MGDs, http://www.un.org/millenniumgoals/). The current project that I am working on with Salina, my fellow intern who just graduated from Columbia and is headed to medical school next fall, is to implement a community health worker (CHW) program in one of the slums around Kisumu. The slum is named Manyatta, and I hope to have some pictures up soon. Along with the CHW program comes CommCare (http://www.dimagi.com/content/commcare.html), a software package used on cell phones by CHWs. I am trying to develop this software to be used here in Kisumu once the CHW program is up and running. I am no computer scientist, so most of what I do is simple coding, while spending a lot of time on figuring out the best way for the software to be implemented, from operations to training to points of entry. I hope that made sense. If not, and you really care, just email me.
As for my travels so far: The flight to Kenya was simple enough. I left Raleigh on Sunday and changed planes in Zurich (nice Alps in the distance) and landed in Nairobi Monday night. Salina and I stayed with a distant friend of her family, a wealthy man of Indian descent, who was the most hospitable person ever. His place was kind of ridiculous: on the same road as the US Embassy, a few cooks, a driver, beautiful grounds, etc. Almost felt like royalty. A very ironic introduction to Kenya. The next morning we took a bus to Kisumu, which is on the shore of Lake Victoria. The bus ride went through the Great Rift Valley, which was beautiful. My favorite part of the ride was the 3-point turn we made in the middle of a town once we saw some road construction coming up. The bus was a large coach bus and the roads were no more than 1.5 lanes wide (hard to tell because there are no lines). We arrived in Kisumu in the early afternoon and settled into the guesthouse in which we are staying. We are staying in the middle of downtown Kisumu, which is convenient because our office is directly across the street. A little about Kisumu: 3rd largest city in Kenya (about half a million people), mainly populated by the Luo ethnic group (Obama’s) and is generally laid back. Pictures should come soon.
On our first day on the job, we saw a lot. We did the rounds with Beldina (our coordinator) in the morning. We met the major of Kisumu, the head doctors at the hospital, and various government administrators and health coordinators. We quickly drove through Manyatta slum on its one paved road to get a sense of it, and came back after lunch for a community member meeting (like a town hall meeting) which we were organizing and facilitating. The meeting lasted 3 hours (it started 2 hours late, which seems like the norm here) and was very impressive. About 200 people who live in Manyatta crammed into a room that wasn’t quite big enough. To spare you the details, let me just say that the level of community involvement Manyatta would put the US to shame. There had been previous meetings of the subunits of Manyatta, and representatives presented the major issues facing the community and proposed solutions and general concerns. It was a great way to see what issues were of top priority for those living in Manyatta, and how the CHW program can help address them. It definitely showed Salina and me that we have out work cut out for us, which is exciting. A lot needs to be done, and the first step if figuring out what the first step should be, which should come from the community, not me.
So that was entirely too long (I am killing time right now before a meeting), and I promise this will not happen again. Just keep checking this blog, pictures will come soon, and more updates. I really don’t want to bore you with too may details, so I will do a better job keeping this simple. But seriously, if you have questions or whatever, please email me. I am still like a kid that gets excited when mail arrives for him.
With that said, here goes.
For those of you who don’t know what I am doing in Kenya this summer, I will try to give a brief explanation. I have an internship in Kisumu, Kenya until late August. The main organization that I am working for is the Millennium Cities Initiative (http://www.earth.columbia.edu/mci/), which is operated by Columbia’s Earth Institute. MCI is the urban sibling of the more popular Millennium Village Project. Kisumu was named a Millennium City in 2006, and the coordinators here have been working to help the city reach the Millennium Development Goals (MGDs, http://www.un.org/millenniumgoals/). The current project that I am working on with Salina, my fellow intern who just graduated from Columbia and is headed to medical school next fall, is to implement a community health worker (CHW) program in one of the slums around Kisumu. The slum is named Manyatta, and I hope to have some pictures up soon. Along with the CHW program comes CommCare (http://www.dimagi.com/content/commcare.html), a software package used on cell phones by CHWs. I am trying to develop this software to be used here in Kisumu once the CHW program is up and running. I am no computer scientist, so most of what I do is simple coding, while spending a lot of time on figuring out the best way for the software to be implemented, from operations to training to points of entry. I hope that made sense. If not, and you really care, just email me.
As for my travels so far: The flight to Kenya was simple enough. I left Raleigh on Sunday and changed planes in Zurich (nice Alps in the distance) and landed in Nairobi Monday night. Salina and I stayed with a distant friend of her family, a wealthy man of Indian descent, who was the most hospitable person ever. His place was kind of ridiculous: on the same road as the US Embassy, a few cooks, a driver, beautiful grounds, etc. Almost felt like royalty. A very ironic introduction to Kenya. The next morning we took a bus to Kisumu, which is on the shore of Lake Victoria. The bus ride went through the Great Rift Valley, which was beautiful. My favorite part of the ride was the 3-point turn we made in the middle of a town once we saw some road construction coming up. The bus was a large coach bus and the roads were no more than 1.5 lanes wide (hard to tell because there are no lines). We arrived in Kisumu in the early afternoon and settled into the guesthouse in which we are staying. We are staying in the middle of downtown Kisumu, which is convenient because our office is directly across the street. A little about Kisumu: 3rd largest city in Kenya (about half a million people), mainly populated by the Luo ethnic group (Obama’s) and is generally laid back. Pictures should come soon.
On our first day on the job, we saw a lot. We did the rounds with Beldina (our coordinator) in the morning. We met the major of Kisumu, the head doctors at the hospital, and various government administrators and health coordinators. We quickly drove through Manyatta slum on its one paved road to get a sense of it, and came back after lunch for a community member meeting (like a town hall meeting) which we were organizing and facilitating. The meeting lasted 3 hours (it started 2 hours late, which seems like the norm here) and was very impressive. About 200 people who live in Manyatta crammed into a room that wasn’t quite big enough. To spare you the details, let me just say that the level of community involvement Manyatta would put the US to shame. There had been previous meetings of the subunits of Manyatta, and representatives presented the major issues facing the community and proposed solutions and general concerns. It was a great way to see what issues were of top priority for those living in Manyatta, and how the CHW program can help address them. It definitely showed Salina and me that we have out work cut out for us, which is exciting. A lot needs to be done, and the first step if figuring out what the first step should be, which should come from the community, not me.
So that was entirely too long (I am killing time right now before a meeting), and I promise this will not happen again. Just keep checking this blog, pictures will come soon, and more updates. I really don’t want to bore you with too may details, so I will do a better job keeping this simple. But seriously, if you have questions or whatever, please email me. I am still like a kid that gets excited when mail arrives for him.
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