Hard to Say Goodbye to Kenya

By Nina Woolley

Rising Senior; Candidate for B.S. in Biology and Certificate in Global Health

The thoughts and opinions expressed in this blog post are my own, and they do not necessarily reflect the views of SOTENI Kenya or SOTENI International.

My last ten days in Kenya went by so quickly that I didn’t have the time to compose a new blog entry, but I wanted to wrap up my experience somehow. Now I am writing this blog entry from my home in the U.S., where I arrived four days ago. I spent the end of my SOTENI internship in Mbakalo, the rural community in Western Province that I described previously. There, I spent about half of every day visiting homes to conduct needs assessments in the SOTENI Dispensary catchment area, and I spent the other half of every day in the dispensary working with staff to gather information for the process and procedures manual.

We conducted the needs assessment with the help of two types of SOTENI community health workers, AIDS Barefoot Doctors (ABDs) and Traditional Birth Attendants (TBAs). The ABDs and TBAs served as excellent guides and translators, and we liked getting to know them better while doing this survey, too. Going from home to home during the needs assessment was both enlightening and unsatisfying. I loved the opportunity to catch a glimpse into the lives of the people I was interviewing, and I hope that the information collected will help prioritize the next stages of development of the dispensary, but the 20-30 minutes spent with each person felt much too brief! I would have loved to be able to spend more time with each person and learn more about their personal narratives. Still, I suppose that in data collection it is neither possible nor advisable to develop a connection with each community member interviewed. By the time I left we had visited 99 homes, and what I’m left with is a blur of faces, homes and stories, punctuated by a few particular faces and stories I’ll remember.

During the afternoons I spent working at the dispensary, I worked with the staff members and a fellow intern Katy, an MPH student at Tulane, to gather as much information about their current process and procedures as possible. As an NGO facility, the dispensary does not have all of the Government of Kenya record-keeping systems put in place or the materials provided like in the Mituntu Health Centre where I had previously spent time. Since I was only in Mbakalo for about 10 days and since Katy was planning to work on the dispensary manual throughout the rest of her month there, I spent most of my time interviewing the dispensary staff about their current operations, shadowing them during their daily activities, recording as much information as possible, briefing Katy on all the government procedures I had learned, and making note of the highest-priority items needed in the dispensary in the eyes of the staff. I felt glad to be able to contribute to this ongoing project, but I definitely would have been happy to stay for a few more weeks to see it through!

Since I intended to comment a little bit about the differences between the health care in Kenya and the U.S., I will add a little bit about that now. There are, of course, monumental differences in facilities, technology and access based on the countries’ different stages of development. However, some of the subtle differences were most interesting to me. For example, one difference I noticed was that medical personnel in Kenya seemed to see their role as teachers more prominently than medical personnel in the U.S. It’s silly for me to generalize two entire countries based on personal experience, so I’ll state this as opinion: Following my shadowing in the U.S. and Kenya, I think that medical personnel in Kenya spend more time teaching their patients about their health than the medical personnel in the U.S. This difference, if it is real, could be based on many factors, such as the importance placed on disease prevention since treatment can be more expensive and harder to access, or the fact that many patients I saw had only a primary school education and didn’t know much about human physiology or medicine, or the lack of access to resources like libraries or the internet to search for health information. As someone interested in both medicine and education, I was interested in this dual role of doctor as healer and teacher.

When we were not working, the other interns and I enjoyed playing with local children. Some of our interactions with them were spontaneous, such as when hoards of children would follow us on our daily walks to and from the dispensary. I liked to call this “The Muzungu Parade,” as the little children would leave their homes in threes or fours to come follow the “muzungus,” imitate our accents, and laugh at our way of walking until we were leading a full-blown parade. Some of interactions with the children were also planned, such as our early evening soccer matches using a new soccer ball we brought from the U.S. Sadly, my middle-school soccer career did not prepare me sufficiently for soccer with Kenyan children, as they were too good! However, we had a lot of fun.

After saying goodbye to everyone in Mbakalo, I returned to Nairobi for a brief two days and then got on a plane to return to the U.S. After working so hard, learning so much, and being busy every day, I struggled to make sense of my entire internship experience – from my first few days in Kuria to my last few days in Mbakalo – and I was grateful for the set-aside debriefing period at the SOTENI International office in Cincinnati as I arrived back in the U.S.  Overall, I think that I’m even more excited and energetic now than when I left for Kenya because this internship confirmed my desire for a career in global health and a career as a physician. I hope I’ll return to Kenya one day, and I’ll certainly strive to keep in touch with the friends I made for years to come. Finally, I hope that this is the beginning of much more global health fieldwork for me!

My Last Two Weeks in Kenya

By Nina Woolley
Rising Senior; Candidate for B.S. in Biology and Certificate in Global Health

The thoughts and opinions expressed in this blog post are my own, and they do not necessarily reflect the views of SOTENI Kenya or SOTENI International.

After I arrived safely back in Nairobi last Wednesday, three new SOTENI interns arrived. They are three American students (an undergraduate at Ohio State, a medical student at Univ. of Cincinnati, and an MPH student at Tulane), and it has been great getting to know them over the past few days! After they had a quick orientation in Nairobi and I had a day to write many of my reports on the sponsored orphans and vulnerable children I had visited, we actually took a short break from work to be tourists.

We went on a completely remarkable three-day safari to Maasai Mara. Although I felt slightly uncomfortable with the contrast between the poverty I’d witnessed and the luxury safari lodge, I had a really amazing time once I allowed myself to enjoy it. I wish I could post the photos now, but each one takes about an hour to load when using this internet modem, so I think I’ll have to wait to upload photos at the very end of my internship. We saw every animal that we had wanted to see: elephants, zebras, gazelles (all types), buffalo, lions, hippos, cheetahs, ostriches, jackals, a rhino, a leopard, and many interesting small birds. At one point a large male elephant even chased our vehicle, and our guide told us that it was mating time and we had gotten too close to the female elephants. What a great experience! I’m so glad I took the time to enjoy this other aspect of Kenya.

I am now writing this from Mbakalo, in Western Province. It is a fertile, very rural sub-location near Webuye. We arrived here two days ago, and we hit the ground running. We spent the first day meeting with many health workers in the community, including the Public Health Officer at the nearest hospital, the SOTENI dispensary staff, the local management committee, the “AIDS Barefoot Doctors,” and the traditional birthing attendants. We are each working on different projects here. I will focus on working at the dispensary and helping to develop their process and procedures manual. After spending several days with my host mom Regina at a Government of Kenya Health Centre in Mituntu, I now have a lot of information about government health operations and I am looking forward to learning about NGO health operations. I hope to compare the daily operating procedures I learned at the Mituntu Health Centre with those at the SOTENI dispensary, and maybe introduce the Mituntu Health Centre methods of keeping records, controlling inventory, etc. to the SOTENI clinical officer, since he already seemed interested in that.

I have become somewhat acquainted with the dispensary in these past two days, but I certainly have a lot more to learn. The dispensary is a “level two” centre in Kenya, which is less comprehensive than Regina’s “level three” centre. They offer treatments for malaria, typhoid, other infections, allergies, and wounds; they offer some antenatal care and have a delivery room; they offer HIV testing and several other lab tests; and they offer immunizations and child growth-monitoring. The facility itself is very small and lacks indoor plumbing, but it has dedicated staff members and good solar-panel electricity. They are also hoping to improve the facility and maybe construct a new building over time. Today, I spoke with the accounts manager to learn about finance management and the procedures for procurement of drugs (in general, most drugs are purchased in bulk from the nearest large town, but vaccines are provided for free from the government). I am still looking forward to speaking in-depth with the clinical officer and the laboratory technician to learn more about the medical side of things at the dispensary.

Apart from my work with the dispensary, I will also visit another five or six sponsored students to update their reports. By the time I leave Kenya, I should have met with about 40 students! That is something I’ve enjoyed doing very much, as I get to learn about the lives of children who have been orphaned by AIDS and also get to learn about the Kenyan education system, since all of the students are sponsored to stay in school.

Finally, I will be helping a fellow intern conduct a needs assessment in the catchment area of the dispensary. We will be asking several questions, such as: Have you or your children ever visited the SOTENI dispensary? What care did you receive there? How many children have you given birth to? Where did you deliver? Do you have a bed net? Who slept under the net last night? There are many other questions as well, all designed to provide more information about the health conditions of the community and the best way for SOTENI to meet their needs at the dispensary. I will spend the whole day tomorrow visiting homes to conduct the assessment, and I’ll go with one translator while two other interns pair up with another. From then on, I’ll probably spend half of each day at the dispensary working on gathering information, shadowing the clinicians, and writing the procedures manual, and I’ll spend the other half of each day helping to conduct the needs assessment.
I have so much to do in so little time, but I am really energized and excited by my projects here in Mbakalo. I think this will be a wonderful way to finish up my internship!

As a final note: We are staying with a wonderful woman called “Mama Anne” who has eight HIGHLY energetic young grandchildren. The children are entranced by us, and they love to run around, climb on us, scream, and jump. In addition, they think it is completely hilarious that white skin turns pink when you slap or pinch it… Ouch! Definitely not funny.

Healthcare and Agriculture in Mituntu, Kenya

By Nina Woolley

Rising senior; Candidate for B.S. in Biology and Certificate in Global Health

The thoughts and opinions expressed in this blog post are my own, and they do not necessarily reflect the views of SOTENI Kenya or SOTENI International.

As usual, the time has been flying by. I have been in Mituntu for a full two weeks now, but I am sadly leaving tomorrow to return to Nairobi and then move on to Mbakalo in Western Province. So much has happened in these past two weeks!

As I mentioned before, I enjoyed going with my host mom Regina to the health center (centre) where she is the in-charge nurse. I spent another day with her there, shadowing her in the consultation room with sick patients and assisting her in the antenatal care room by recording the patients’ information (weight, age, number of previous pregnancies, HIV status, etc.) while she did the check-up. Much of the work of the health center focuses on maternal and child health – from the antenatal care to delivery and postnatal care to immunizations for children – and all services for pregnant women and children under five are provided free of charge. An insecticide-treated net is also distributed to every pregnant woman seeking antenatal care, since malaria can lead to several pregnancy complications. I was interested to find out that all of the nets being distributed are donated by Family Health International. I told Regina that FHI has its headquarters right around the corner from Duke University, and she told me to let them know that their intervention has helped: she has personally seen the numbers of pregnant women suffering from malaria decrease since they started distributing nets.

Out of curiosity, I asked Regina what diseases bring the most number of patients to the health centre. Based on her records, the top ten under-5 morbidities are malaria, upper respiratory infection, diarrheal disease, intestinal worms, eye conditions, ear conditions, skin conditions, mumps, chicken pox, and burns, and the top ten over-5 morbidities are malaria, upper respiratory infection, intestinal worms, rheumatism, hypertension, eye conditions, ear conditions, STIs including HIV, typhoid fever, and skin conditions. Although I could have predicted several of those, I was surprised that hypertension is a common problem here, just like in the U.S., that children are vaccinated against measles but not mumps, and that rheumatism is within the top five reasons adults seek medical care at the centre.

Besides working at the health centre, I have done many other things in Mituntu. Most recently, I spent three days visiting 15 sponsored orphans and vulnerable children (OVC) to conduct needs assessments and update their sponsorship reports. The journey was not without complication – a SOTENI staff member’s cell phone was stolen, the car got two flat tires in one day, and we often visited students’ homes several times before finding them home – but eventually I managed to meet all 15 students and update their reports. What most struck me in visiting the children was seeing the effect of the drought on their families. Although the students fortunately have enough food when they are at boarding school, the persistent drought in the region has made lack of food a major concern for the students when they’re home on holiday and a big struggle for their families year-round. Many of the guardians of the OVC are small farmers who do not have irrigation. The drought has resulted in dried and withered crops in much of the area, reducing their food and income.

On a related topic, I spent part of two days visiting support groups for people living with HIV/AIDS (PLWHA), during which an agricultural officer gave training on agricultural “value addition and utilization” (essentially, increasing crop yield and sales profits and promoting healthy nutrition). SOTENI has community health workers called “AIDS Barefoot Doctors” that provide care and support to 18 groups of PLWHA in this area. The agricultural officer had several interesting practical suggestions for the group members, such as suggesting that they create “trench gardens” at their homes for growing vegetables. He explained how to construct such a garden, including covering the bottom of the trench with a plastic sheet or plastic bags before replacing the soil and planting the vegetables, ensuring that the garden retains rainwater well and can grow even with limited rainfall. He also provided a detailed lesson on best nutrition practices based on local food availability, since nutrition is particularly important for health maintenance for PLWHA.

Participating in these several different projects has allowed me to get a very good sense of the community and the many different operations of SOTENI. I have felt particularly immersed and integrated with the life of the community here since I have been the only foreigner working with SOTENI for the past three weeks. I have had to adjust my notions of efficiency a little bit to accommodate the leisurely pace of life, but I have certainly enjoyed this remarkable experience! My “solo” period will end shortly, however, as tomorrow I will meet three American interns with whom I will be working for the rest of my stay in Kenya. I am looking forward to the work I will do with them, too!