ATM Iko Wapi

Friday July 13th, 2018

Makutano, West Pokot County, Rift Valley Province, Kenya


The handshake is an important cultural greeting in Kenya. Every time you see someone in the street you know, you walk over and say “ujambo,” or another greeting and shake hands while maintaining eye contact. This ceremony is maintained when being introduced to strangers as well, and often occurs when two people happen to be in the same place for a short amount of time (e.g. walking through the hallway in the hotel). Sometimes, among close friends, the greeting starts with slapping hands, which then turns into an extended handshake and expressions of joy. It’s impossible not to feel like people are happy to meet you; each new person I meet here greets me like a long lost friend. I’ve shaken more hands in the past few days than in the previous 2 years.


 After another short night of sleep, I got up at 5 am to get to the airport. This time I was going to Wilson, which handles regional flights. Interestingly, there are about 20 different terminals all spread out over a few miles, which turned out to pose a challenge. The 3rd party I had booked my ticket through didn’t mention what Kenyan airline it contracted with. I went to the wrong terminal initially, but with help I found my way to SarfariLink with plenty of time to spare.

The flight was about an hour long. As we descended below the clouds Kitale came into view. I first noticed the grid-like fields; later I learned that the area around Kitale and much of West Pokot is known for its agriculture and food production.

A view of Kitale from the rooftop restaurant at my hotel

The lush green vegetation and impending thunder clouds seemed to indicate the climate was suitable for it. Kitale was bustling, with clouds of motorbikes darting every which way and brightly colored shops lining the sunset-red streets. In Kenya, motorbikes are taxis and a very common means of transportation. I think they’re especially useful because they get good gas mileage, are easy to maintain, and can transverse difficult roads.

I wasn’t in a good place to appreciate Kitale. The jet lag and busy day in Nairobi had taken its toll. I checked into my very nice hotel room – $40 USD a night gets you a bathrobe and slippers, a flatscreen tv, and a tiled bathroom – and took a 3 hour nap, which I desperately needed. In the evening, I went up to the rooftop restaurant to watch the semifinal World Cup game between England and Croatia. Ajay and his wife, both from Kitale, sat next to me. They were both Croatia fans, or at least anti-England fans.

Another view of Kitale with Mount Elgon in the background

As the night wore on and their bourbon glasses kept getting refilled, their exclamations of excitement when Croatia did well became more boisterous. Lets just say that there was a lot of hugging when Croatia scored that I happened to be involved with. Overall, the atmosphere was electric, everyone in the room exclaimed loudly when something happened. I seriously enjoyed myself. Also, Ajay put me in contact with a tour director who could get me a birding trip to Saiwa Swamp National Park – look for more on that in a later post.

The next day Wycleff, who’s name made me think of the Fuggees, drove me north to the Kalya hotel in Makutano, right next to Kapenguria. I saw a lot of livestock on the way, including cows followed by herders with long switches and goats grazing on the side of the road. Interestingly, there was usually a dog with the cattle, I assume to help with the herding. In general, the dogs looked like they were in good shape. After I got sorted at the hotel, I headed to the county offices with Peker, pronounced “Pee-kair.” He works for the county land commission, managing public lands, and has been roped in to helping me by his friend Sebastian, my Pokot contact at FAO.

Kilimo House: Ministry of Agriculture Irrigation and Pastoral Economy

We spent a lot of the day waiting for people (e.g. the director of public health), but I really enjoyed talking with Peker. He was curious about many aspects of the U.S., especially how agriculture works. We talked about the economics of scale and how in the U.S. large companies produce most of the food. I described Iowa to him, with it’s ubiquitous corn and soy – shoutout to Grinnell. In Kenya, most food production still happens on a small scale, with single plots of land being owned by a farmer. Peker also asked if most people lived in public or private housing. I got the impression he maybe thought that everyone was provided housing by the government. I explained the system is predominantly private, although based on what he said, it’s much easier to get a loan in the U.S.

Overall, it was a successful day. I used my rudimentary swahili to find an ATM, “iko wapi” translates to “where is it.” The public health CE indicated that with UoN clearance she would be happy to facilitate my research in Pokot. I also scheduled a meeting with the county director of veterinary services for Monday and identified who could help me with Alale and Konyau contacts. I’m well on my way!

The view from the Kalya hotel deck, where I wrote this post

 

 

 

 

 

“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

Call me Evans

This may be the shortest research blog ever, considering that I’ll be spending 6 weeks in one of the most remote regions of Kenya. Internet will be limited, but I’m hoping to post updates every once in awhile.

I can’t believe the departure date is almost here! I came up with the idea for this project in January (look for a project summary in a future blog post) after I saw a talk by Dr. Stacie Dunkle V’07 about work she did with the CDC in Ethiopia on integrated vaccination. Hours of emailing, skype meetings, and project planning later, I’ll be arriving in Kapenguria, Kenya in West Pokot County on July 11th.

One thing I’ve learned in my communications is that “Evan” is not a popular name in Kenya, but “Evans” is. I expect to hear “Jambo, Evans” a lot in the next few months! I’m excited to travel to Africa again. Studying abroad in South Africa during my junior year of college was one of the most influential experiences of my life. I not only learned about savannah ecology and African conservation – shoutout OTS – but also began to understand how most people live in the world. OTS started me on my current path to One Health and the understanding that everything is connected. I changed (grew I hope) as a person, which can best be summarized by the phrase, “empathy through experience.”

How will this summer change me? How will I grow? There are a few things that have been on my mind recently, and I’m wondering how my thoughts on them will change after my trip.

Animal welfare vs. animal rights: Veterinary medicine is firmly in the animal welfare camp, defined as ensuring that animals are healthy, comfortable, well nourished, safe, and are able to express innate behavior. Lately I feel like I’m looking over a fence at the animal rights camp (rights believed to belong to animals to live free from use in medical research, hunting, and other services to humans) and realizing that I might belong on the other side. However, many people in the world rely on livestock for their livelihoods. For example, Turkana pastoralists, some of whom I’ll be interviewing this summer, depend on livestock for nutrition and economic stability. How does animal welfare and animal rights exist in this setting? Importantly, I’m passionate about biodiversity conservation and I believe that conservation and agriculture can complement each other. Not only that, but livestock play an integral role in helping people across the world escape the poverty trap and live healthier lives; economic stability is a social determinant of health. Thus, while I acknowledge the sentience of non-human animals and sympathize with the concept of animal rights, I strongly believe that engaging stakeholders, in this case farmers and herders, is vital to achieving the conservation and development goals I believe in. Is this an insincere discrepancy? How about the fact that I frequently eat meat that comes from factory farms, which I disagree with on principle?

The social determinants of health: The more classes I take in public heath, the more I realize just how important the social determinants are. The most insightful (for me) thought I’ve had recently in this area is that fixing disparities in heath, education, and economics requires identifying socially-determined groups, i.e. identity politics. Without identifying these groups, it’s impossible to fix the disparities that exist between them. Thanks to Nate for starting the conversation on that one. Also, I really like the idea of health in all policies, defined as a collaborative approach to improving the health of all people by incorporating health, equity, and sustainability considerations into decision-making across sectors and policy areas. How can it be applied in the U.S. to a fuller extent? What about where I’m going in Kenya?

I’ll try to talk about my project more in my next post. Signing out for now!

Kwaheri,

Evan