“What if we lived there and you lived here?”

Nairobi, Kenya

Nairobi is chaotic traffic: vans blasting music, buses with men hanging out of the sides, old cars belching black smoke, motorbikes speeding between vehicles, their drivers wearing bright green fluorescent vets, incessant honking, and pedestrians leaking onto the road. Once a large enough crowd (5-10) people builds up, everyone crosses the street in a mass, dodging the cars that slow down just enough not to run you over as they navigate the traffic circles. Men wearing business suits hurry past, women in brightly colored dresses – Maasai red, blues, and yellows – stand out in the crowd. School kids in uniforms joke and talk loudly on their way to class. Venders sell roasted corn on the sidewalk and some homeless people burn trash. Smells fill the air, mostly diesel and gasoline, cooking meat and trash – the heavy smell of the city seeps into your nostrils and sits there until you don’t notice it. In the city center, shops line the streets, buildings jostling for space like trees competing for sunlight. Clothing stores, convenience stores, cell phone services, internet cafes, banks and hotels – you can buy anything.


I woke up at 4:30 am sharp, the sounds of traffic coming through my window. A few  hours later and after a delicious breakfast buffet and 3 small cups of coffee (I think I needed more), I headed out from my hotel to explore the city center. I stumbled across John Michuki Memorial Park where there’s a market every Tuesday. Because I was there so early, the venders were just unpacking their wares. I talked with almost everyone and was told many times that “being the first customer is lucky, I will give you a good price.” They were selling ornamental masks, Maasai blankets, brightly colored, beaded earrings, carved can openers, wood statues of wildlife, bracelets, necklaces, paintings, and a lot of other things. Safe to say I got my gift purchases out of the way!

After the market, I headed off to the University of Nairobi (UoN) College of Agriculture and Veterinary Sciences to meet with Dr. Abuom, my project mentor and the head of the One Health Central and East Africa (OHCEA) Network – Kenya. Driving up to the campus, we were surrounded by lush fields: corn and coffee and other crops. As we got closer to the small animal clinic, I also saw livestock housing, kennels and everything you’d expect at a vet school. I really enjoyed being there because although the landscape was different, I still felt a sense of connection based on the continuity of veterinary medicine.

UofN College of Agriculture and Veterinary Sciences

The drive to the school

Vet students in their coveralls, a familiar sight

I didn’t know until very recently that I needed ethical clearance from UoN for my project. The Department of Veterinary Services (DVS) – Kenya lost my letter requesting approval for my study and took 6 weeks to get back to me. When they did, they said I also needed to seek approval from UoN. The purpose of my meeting with Dr. Abuom was to get the whole crazy mess figured out. Diana, the OHCEA administrator helped me make copies of my application and get everything in order before we went to the UoN medical school to turn in the form (online applications aren’t for things like this, apparently). I probably could have made this description a lot simpler, but conducting One Health research is messy, especially when you’re working in a different country, and I want to highlight how the process works. Luck and not giving up is definitely involved!

I really enjoyed meeting Diana and getting to talk with her, not only about OHCEA-Kenya and the projects they’re involved in, but also about what it’s like to live in Kenya. We were both interested in learning something about each other’s culture. One moment that stands out is when we were discussing infectious diseases and Diana said “what if we lived there and you lived here?” She was talking about how there are many more infectious diseases in Kenya (the tropics really), which is compounded by the fact the public health infrastructure (e.g. surveillance programs, emergency response, medical facilities and treatment, etc) is less developed in Kenya compared to the United States. I think inherent in the comment too, at least in the way I was thinking about it, was the thought that the U.S. might not be the economic juggernaut it is if the environment was tropical instead of temperate. In other words, the environment, including infectious diseases, have a large impact on the economy and development. Just another reason that One Health is so important; health is inherently tied to livelihoods and economic security. I also had another thought about her comment, that the situation she describes actually occurs if you look at evolutionary time. A few million years ago, every Homo sapiens individual was living in Africa, along with a lot of other species in the genus Homo. Now sapiens, originating from Africa, have spread across the word and while we might look somewhat different, we aren’t, really. For example, I had to get vaccines for all the tropical diseases found in Kenya, I can still catch them even though I’m not from here. Obviously, that’s not the time frame Diana was talking about, but an interesting thought none the less.

The mythical Kenyatta National Hospital (KNH)/UoN Ethics & Research Committee – we found it!

After gathering the necessary materials, we headed down to the UoN College of Health Sciences to submit the application, an adventure of epic proportions. Once we actually found the office after wandering around campus, I discovered that not only had I filled out the wrong form, but my study wasn’t appropriate for the type of ethics review they normally do. Luckily, the head of the committee was available to advise us. After I described the basic aspects of my project, she grilled me to the 10th degree. I felt like I was defending a PhD thesis, which after 17 hrs of travel and 7 hrs of sleep in 2 days was a challenge to say the least! She didn’t understand the purpose of my study, which Diana told me didn’t surprise her since One Health isn’t as large in the M.D. world in Kenya, similar to the U.S. She also kept asking questions about outcomes (e.g. why would the public heath department want to work with veterinarians?), which I found challenging to answer since finding those things out is the whole point of my study! Ultimately, I adequately got the facts across (*celebration*) and she said when the committee meets on Wednesday, she would bring up my study for approval. I’m cautiously optimistic, but nothing is for certain. As Dr. Abuom and Diana said, it will get done with perseverance!

After that, I went to a wildlife sanctuary near the city. I really enjoyed seeing all the different species of African snakes. They’re beautiful! Then I watched the world cup game at the hotel bar and enjoyed my first taste of Tusker, Kenya’s finest beer. Kitale tomorrow and then Kapenguria for the start of interviews. I can’t wait!

Kwaheri,

Evan

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