Caught in Between

By Joy Liu

My time in Muhuru Bay has come to an end. The last weeks were divided between work on the project, painting a mural, and visiting students and friends I treasure spending time with. The most pressing task in the last two weeks was writing a report of our program evaluation on childhood vaccination. The end result was a 35-page document that detailed our purpose, methodology, data, analysis, case studies, recommendations, and further areas of research, among others. To summarize, we discovered that the problem with low immunization rates in Muhuru centered around defaulting. Most mothers began immunizations for their children, but failed to follow up for subsequent immunizations. Only 9% of the mothers we surveyed reported having their children fully immunized. Barriers identified included distance, fee, stock-outs, and prevalence of traditional beliefs. We made both short-term and long-term recommendations to the clinic outlining steps we believe would increase immunization rates based on the data collected. In our final days at Muhuru Bay, we did a series of three presentations to the community (mostly composed of community health workers), the clinic, and the district public health office. In each, we outlined our findings and recommendations. Following this, we answered questions and listened to comments and suggestions from the attendees. It was important not only for communicating our findings, but also in establishing a solid relationship with the community.

As I begin processing and reflecting upon the entirety of my experience this summer, I think what stands out most to me is the community. When I walk into the local town during its busiest hour, I’m aware of just how many contrasts exist. It’s like a society caught between two worlds-the traditions and customs that have been present for decades and the effects of globalization. It’s marked in the small clustered storefronts that sell Cola-Cola and Sprite and Fanta. It’s the women walking to the lake in the morning to fetch water like their mothers and grandmothers before them, only with plastic buckets and metal cups decorated with generic flowers and patterns. It’s the darkness of the small huts made from earth, but filled with bright calendars and posters, sofas and chairs, and merchandise that range from Dora the Explorer to purses inscribed ornately with the word Paris. The people seem to move in between the two worlds seamlessly, but the clash (or blend, depending on which way you think about it) of the two worlds is present in views and opinions. One of the conversations that left the deepest impression on me occurred during my last night at Muhuru when I talked with an employee of WISER. He received a degree of education, followed the news almost religiously, was aware and opinionated on many issues, and stressed to me multiple times the importance of educating women. But he also believed that a woman had specific roles in the household and that the man possessed the decision-making power in the household. He defended the prevalence of polygamy and believed that the way a woman showed love to her husband was predominantly through cooking and housework. The fact that all these views can coexist in someone I considered rather liberal and idealistic really made me think. His physical surroundings and mindset both harbor elements from the old and the new. He moves in between the two.

And as for me? I’m caught somewhere in the middle as well. The community has welcomed the Duke students more quickly and openly than I ever anticipated. What stands out to me most about my experience this summer are the connections I made-the stories and memories I now think back to. I think of the time I met a young boy running an errand for his father and somehow we ended up huddled together reading a book in an empty classroom of his primary school. I think of the first time I met the student I was most reluctant to say goodbye to-an encounter entirely by chance. I wasn’t supposed to be there that day, but a spontaneous decision on my part led me to him. Before I left, he told me that I reminded him of his mother-the person he speaks about with the most love, the person whose long absence from his life has left the largest unfilled hole. I think of the time a WISER employee told me how he met his wife with a distant, soft gaze in his eyes. He’s a rather quiet man, but he confessed to me that he often thinks how amazing it was that he was there at the right place at the right time. Otherwise, his life might have turned out entirely different. His words now echo in my mind, because that’s my perception of my time in Muhuru. So many chance encounters, so many conversations and interactions that I can’t imagine not having now. I’m torn between that world and my life at Duke.

But maybe being caught in between a good thing. It’s a position I never expected to be in, perhaps because I’ve never become so attached to a place so quickly. I wish I could tell you why, how, everything I learned, and how I’ve changed from the experience. But I can’t. I can’t articulate much of it right now, except to say that it has impacted me in a way I would have dismissed as impossible two months ago. It has made me the person in the middle, moving between two worlds, comparing and contrasting, processing and reflecting. I’m caught in between.

The Difference Between What Works and What Doesn’t

By Joy Liu

Somehow our weeks here in Muhuru Bay are always more filled than I expect. In the past week, our childhood vaccination study has progressed from surveying to data entry and analysis. In addition, we held a focus group for community health workers, visited nearby dispensaries and clinics, and participated in a mobile clinic outreach program. In the process, my understanding of the healthcare system here and the numerous factors that make it functional has deepened. The reoccurring theme that my thoughts constantly returned to this week was the difference between what works and what doesn’t.

Since starting the project, our group has been so focused on finding the gaps and shortcomings that I was surprised to find fully functional dispensaries in our visit to nearby health centers. Some mothers we surveyed mentioned three dispensaries nearby that they visited for vaccinations. In an attempt to get a better sense of what services the mothers received, I paid a visit to the dispensaries. The differences were drastic. The first, a newly opened clinic, lacked patients and personnel. The doctor arrived at the clinic two hours later than his scheduled time, presumably because he had been notified that the clinic had foreign visitors. The second was also a dispensary, but it was the polar opposite of the first. There were at least twenty or thirty patients when we arrived. The head nurse gave us a tour of the facility. Every door that he opened had a staff worker or patients inside. I felt like an intruder, which in retrospect reveals so much about the facility. I’ve never even had the opportunity of feeling like an intruder at any other clinic here because there are never enough patients and staff to fill up all the rooms. The dispensary said they rarely had a shortage of drugs, and the pharmacy did indeed look well-stocked. Although they lacked electricity, they bought a gas-powered refrigeration system to store vaccines. Despite taking everything that’s said with a grain of salt now, I left wondering how different the services can be when the two dispensaries (plus the one we are working with, Tagache) are a mere 15 or 20 minutes away from each other. What makes one successful and another a failure?

This theme came up again and again throughout the week. In our focus group for community health workers, it was apparent that some programs (like indoor residual spraying) I saw each day while others languished. Some outreach attempts reach their target audience (Katy Falleta and I had fun deworming children) while others never get off the ground at all (we only went on the mobile clinic on our third attempt). While I realize that there is a host of complex factors, my curiosity prompted me to seek some answers or ideas. I have been having informal conversations with some of the staff at WISER-people who are knowledgeable about the community but also know me well enough to tell me what’s on their mind. The responses have been jogging my mind, considering everything from income level and the ability to go to private clinics to the strictness of the community especially from local chiefs and elders.

Ultimately, the goal is to erase the difference in between, to turn what does not work into something that is fully functional. The differences are present, whether in policy or management or community attitude or economic status. They are differences I welcome. I love that there is a standard to measure against not 20 minutes away. I love that I personally witnessed the contrast. In looking for the shortcomings and what is lacking, it’s sometimes easy to forget what has already been achieved. This week provided me an opportunity both to appreciate what has worked and to question what hasn’t.

Oyawore!

By Reese Sim

The literal translation of this Dholuo greeting is, “The sky has opened.” I know, very poetic compared to our drab good mornings. It’s probably the most frequently used phrase by most of the DukeEngagers here. My name is Reese and I am a rising Sophomore on fire for all things global health. This is my first blog entry from my current location in Muhuru Bay, Kenya. Sorry it’s taken so long for me to say hello, but we’ve been up to a lot here with WISER and so without further ado, let me go into a little about what I’ve been up to with the Sanitary Pads research project.

My primary focus, along with two other Duke undergraduate students, is working with Amy Stopford, a graduate student at Duke University, on her research regarding the influence of sanitary pads on health, educational outcomes, and self-esteem of many female adolescents in Kenya, specifically here in Muhuru Bay. Amy has been here since May and has been able to do much of the preliminary research planning, but we’ve leaped lightyears in terms of the work that needs to be done and planned just this past week. It was clear from discussion groups and the background information that was gathered during our time here that the use (or lack thereof) of sanitary pads when young girls are menstruating has a negative impact on their health and education. Building on this foundation, Amy has worked alongside the local women who have been dubbed her research assistants, the three Duke musketeers assisting her, and the local schools and teachers in order to arrange a survey in Dholuo for a random sample of girls to take. The girls must meet a certain age criteria and be menstruating, so this week Tara, Nupur, and I collected rosters from the 14 primary schools in the area, worked some magic with Excel, and generated a list of 380 girls to survey starting this coming week. Simultaneously this past week, Amy and the three of us have been holding research training for the nine women that will be surveying the girls. It’s a review of their responsibilities, ethics pertaining to research, and actually practicing giving the survey with one another. Albeit a little tedious, it’s been rewarding to see the women step up and do something positive for their community, even if nothing much can be done immediately. While it is true that many of them flocked for the job because of the financial incentive, in the end, the research is being done thanks to their efforts, and hopefully it will be a catalyst for positive change in Muhuru Bay in the not to distant future. The surveys will start this coming week, so keep your fingers crossed for the best!

And as you probably know, I’ve been up to much more than just assisting the Sanitary Pads research. Rather than tell you what we’ve been up to every moment of our stay here, I’ll share some thoughts that have been frolicking through my mind recently.

One, the strong sense of community that I’ve come to love in the two short weeks I spent in Malawi a few summers ago, I rediscovered again here in Kenya. Maybe it has to do with the African sun and a fever for the love of neighbors and friends, but the people here are so darn friendly and I find myself reaching out and taking initiative to interact on my own more and more. Everyone is their own sun, exuding a sense of genuine and outright love for each other and it makes me jealous that I don’t get to experience this and share this experience with others every day of my own life back home.

Two, there is an incredible amount of staring going on, much more than any of us are used to. For a lot of the people here in Muhuru Bay, “mzungus” or persons of foreign descent are rare, and the children follow us around shouting “how are you?” (something that they have simply memorized), and the older men and women often just stare and sometimes send a smile and wave our direction. It’s inevitable as we must look so strange with our western clothes and long colorful hair, but it’s definitely taking some time to get used to. It’s like having been placed in the spotlight for simply being who we’ve been our entire lives.

Three, children grow up so much faster here than in the United States, or any industrialized country for that matter. I see children who can’t be any more than six carrying infants in slings on their backs. I see children who should be anxious without a caregiver herding animals on the side of the road. Little boys and girls who are forced into the reality of the situation that they are faced with, having been through and going through so much more hardship than any of us are used to. Some people never grow up back in the States. Here, everyone is forced to grow up.

Four, I absolutely love conversing with the WISER girls here, sharing a little about myself and the background that makes me who I am today, learning so much about the girls in return, and learning the mother-tongue (Dholuo) so that I can interact with the locals a little better to show them that I care. I’d have to say that learning the new language is my new favorite challenge. The accents are strange and new on my tongue but hearing the peals of laughter and shy grins of both the girls when I pronounce something well, and the delighted locals when I call out to them is beyond just satisfaction. It’s fostering and nurturing a new love for the people here.

Lastly, coming to Kenya, I didn’t board the plane with expectations or preconceived notions about what I would find here. I’ve been in Muhuru Bay for about three weeks now, and it feels as if I have been here forever at times, and at others I feel as if I’m just starting to understand just how different it is here compared to the place I call home. For me, it’s not as much of a culture shock as it is not wanting to get used to what I experience or see day to day here. I don’t want to have to get used to why some students rip a page out from their notebook to have something to eat for lunch. I don’t want to have to understand why so many of these students, especially girls, will never go on to secondary school, or even finish primary school. I don’t want to have to get used to the reality that so many girls are lured into providing sexual services for food or school fees or sanitary pads. I don’t want to ever feel like I’ve accepted that this is how it is, and that there is nothing that can be done about it.