I am in the northern Rift Valley of Kenya. This is where much of the violence broke out last December and January following disputed national elections that unleashed long-simmering ethnic tensions across the country.
Based on what I’ve seen here the past few days, this region has clearly begun the slide into a second and potentially deadlier emergency.
During the conflict, about 1,000 people were killed and hundreds of thousands of others – many in the Rift Valley - were forced to flee their homes into displacement camps. In the months since, the rival political factions have worked toward creating a coalition for sharing power, which has brought some stability to the country. Now, those living in camps are being told to clear out, go back to their homes and begin their harvests in this fertile valley that is so dependent on farming.
The problem is, some 150,000 people either have no homes to return to – whole areas were scorched to the ground, including homes, churches, schools – or are afraid to return to areas where tribal animosities and resentments have not gone away.
So they are packing up and moving to what the Kenyan Red Cross calls “minor centers” and “resettlement” areas. New sites are sprouting like mushrooms – many with zero basic services. That means no water, no shelter, no sanitation or latrines, little available food, and no health care services. It is utter squalor. Diarrheal diseases are becoming commonplace. At night, the temperature can drop to the low 40s. Without blankets or enough clothing, children are suffering from upper respiratory infections. I watched children run around without shoes, playing amid burned-out buildings littered with broken glass. Their arms are covered in chiggers. They haven’t bathed in weeks. The potential for outbreaks is enormous.
The “emergency phase” of this crisis was supposed to be over. Many of the aid groups, including International Medical Corps, are about to run out of their funding and will be forced to pull up stakes. But anyone who looks at these sites and talks to those living in them knows this emergency is far from over. If these people stay where they are, their health is at great risk. If they return home (if they even have homes), violence could re-ignite.
I spoke to a woman named Rosanne, in Eldoret’s largest displacement camp, dubbed Showground, where International Medical Corps is providing primary and mental health care services to about 13,000 people. Rosanne’s arm was in a cast, she had a huge scar along the left side of her head, and a gaping black hole where her left eye used to be. She was attacked during the violence and her husband was killed. She has three children with her in the camp, but she has not been able to locate her fourth, a 16-year-old boy.
Rosanne and her children are being told they have to leave Showground soon. She angrily exclaims: “We cannot go home. We have nothing and it is not secure. How can we leave?” I ask her where she is going to go next, she just looks away and sighs.
We visited a small settlement near Burnt Forest, which became infamous during the conflict after a church was burned to the ground and 30 of those inside were killed.
At this settlement, just a couple of days ago, a few hundred people arrived and began erecting tents. Their only available water for drinking, cooking and cleaning was what they could hoist up from a deep well – the water inside was the color of milk chocolate. A little boy we saw wandering around had large, fresh gashes on his knee and stomach that had yet to be treated.
Seeing how desperate the conditions were, our program coordinator got on his cell and had one of our medical teams diverted from another camp to this site for at least a couple of hours to provide treatment. But this was just one of about 100 such remote sites where the population had left a camp with some services and relocated to an area with none. International Medical Corps and other relief groups are doing their best to reach these people – or create some sort of central point where they can go and get the help they need. But it’s frustrating and disheartening.
I have been asked many times how I avoid getting overwhelmed by the scope of the need. This is one of those times that tests me. We’re always trying to make the biggest impact, multiply our efforts, reach as many people as possible. In just one month in Eldoret and Kitale we saw more than 11,000 patients. And yet, we can’t always solve all the problems or help everyone we want. I remind myself that this is significant and certainly better than no help at all.
Showing posts with label IMC Field Dispatch-Kenya. Show all posts
Showing posts with label IMC Field Dispatch-Kenya. Show all posts
Monday, May 26, 2008
Monday, March 19, 2007
Water on the Brain
Hi, all.
For the past three days I’ve been mulling over and over in my mind the question of how much water I use in a day.
As many of you know, I'm not much of a water drinker - maybe two glasses a day.
But figure the average amount people use for drinking, cooking, bathing, washing clothes and dishes, flushing the toilet. In the U.S. it's around 20 liters, or about 75 gallons a day per person.
I thought about this as our Landcruiser came upon a woman and her two young children on the side of a desolate road in Samburu District in central Kenya . In this area, populated almost entirely by the Masai tribe, women (they’re the ones who take on this task) walk an average of six miles every day to find water. They walk in sandals along dirt roads covered in canyons of scalding hot rocks and boulders. Some climb miles into the hillsides, searching for a fresh spring. Then, they walk all those miles back, carrying up to 20-liter containers of water for their families.
On this particular day, I was traveling with IMC’s country director for Kenya , Peter McOdida, as well as a Samburu District water official. The woman and her children whom we met were nowhere near a water source and had to resort to begging by the side of the road for whatever we or any other passersby might be able to provide. As we poured water into their containers, the two young girls playfully fought over them.
In this remote region of Kenya , water and the pursuit of it is everything.
Many Samburus go days without a drop. In the dry season, which constitutes a total of eight months of the year, they consume an average of about half a liter a day. Sometimes, they go with none. And whatever amount they are able to find goes immediately to drinking, sharing with farm animals, and cooking. Washing and general hygiene are a luxury. In the end, unsafe and insufficient water means sick children, unhealthy food, and malnutrition because animals don’t have enough to drink and fruits and vegetables are unable to thrive.
But there is another troubling result to the hours women and girls spend every day searching for water: these are hours that could’ve been spent getting an education or generating income. And for women with infants, this is time not spent breastfeeding. The lack of access to water compromises the health of the entire family.
So, what to do.
As in many of the crisis zones where IMC operates, a big part of the solution already exists within the community and it’s a matter of engaging the local population in fixing problems in a sustainable way. Samburu has numerous water points throughout the region but they are often far apart and/or are in disrepair, and they’re not being managed properly.
This month, Starbucks announced it was awarding $1 million to IMC over the next two years to train villagers and water officials in building and maintaining water supply systems in Samburu, as well as building latrines and providing hygiene and sanitation education programs.
We visited one of those water points slated for construction - in a village called Waso Rongai. There, we met a woman and her young daughter who had traveled about two miles to collect water from what amounted to a small bore hole in the middle of the sand. I peered into the hole at the dirty brown water as she scooped out cupfuls and poured them into a jerry can. For her, dirty water was better than no water at all. I dreaded to think what sorts of water-borne diseases she and her family might contract by drinking this.
She said what many other Samburus told me during this trip: “There is no water where we live and we have to travel great distances to find any. We need help.”
To get a sense of how IMC has already started helping, we went south to a village called Seren, where IMC helped residents construct a system of pipelines that extend to a freshwater spring about three miles up the mountainside. Before those water pipelines were there, women were forced to climb the mountain every day to reach the water source.
As I slowly – very slowly - made my way up this mountainside laden with boulders and dry sand, I imagined what it must be like for a woman to undertake this same trek day in and day out. I had a one liter bottle of water with me, which was empty by the time I reached the top, drenched in sweat and thoroughly out of breath. But she would have gone on that journey without water, then carried her heavy container back down the mountain.
Imagine what her life would be if the daily search for water were no longer a concern? As Peter said to me, “You fix the water problem and everything else falls into place.” A simple statement and I suspect a right one.
==============================
p.s. this coming Saturday at 10am, Starbucks is holding a "Walk for Water" from Santa Monica Pier to Venice Beach. The walk, which includes music and dance performances, is inspired by the three- to- six-miles journey women and children make every day in "water stressed" countries. The event marks World Water Day (which is officially this Thursday) and Starbucks will announce at that time the grant it's awarding to IMC.
Next week, I'm in Democratic Republic of Congo. I just hope my muscles can hold out.
For the past three days I’ve been mulling over and over in my mind the question of how much water I use in a day.
As many of you know, I'm not much of a water drinker - maybe two glasses a day.
But figure the average amount people use for drinking, cooking, bathing, washing clothes and dishes, flushing the toilet. In the U.S. it's around 20 liters, or about 75 gallons a day per person.
I thought about this as our Landcruiser came upon a woman and her two young children on the side of a desolate road in Samburu District in central Kenya . In this area, populated almost entirely by the Masai tribe, women (they’re the ones who take on this task) walk an average of six miles every day to find water. They walk in sandals along dirt roads covered in canyons of scalding hot rocks and boulders. Some climb miles into the hillsides, searching for a fresh spring. Then, they walk all those miles back, carrying up to 20-liter containers of water for their families.
On this particular day, I was traveling with IMC’s country director for Kenya , Peter McOdida, as well as a Samburu District water official. The woman and her children whom we met were nowhere near a water source and had to resort to begging by the side of the road for whatever we or any other passersby might be able to provide. As we poured water into their containers, the two young girls playfully fought over them.
In this remote region of Kenya , water and the pursuit of it is everything.
Many Samburus go days without a drop. In the dry season, which constitutes a total of eight months of the year, they consume an average of about half a liter a day. Sometimes, they go with none. And whatever amount they are able to find goes immediately to drinking, sharing with farm animals, and cooking. Washing and general hygiene are a luxury. In the end, unsafe and insufficient water means sick children, unhealthy food, and malnutrition because animals don’t have enough to drink and fruits and vegetables are unable to thrive.
But there is another troubling result to the hours women and girls spend every day searching for water: these are hours that could’ve been spent getting an education or generating income. And for women with infants, this is time not spent breastfeeding. The lack of access to water compromises the health of the entire family.
So, what to do.
As in many of the crisis zones where IMC operates, a big part of the solution already exists within the community and it’s a matter of engaging the local population in fixing problems in a sustainable way. Samburu has numerous water points throughout the region but they are often far apart and/or are in disrepair, and they’re not being managed properly.
This month, Starbucks announced it was awarding $1 million to IMC over the next two years to train villagers and water officials in building and maintaining water supply systems in Samburu, as well as building latrines and providing hygiene and sanitation education programs.
We visited one of those water points slated for construction - in a village called Waso Rongai. There, we met a woman and her young daughter who had traveled about two miles to collect water from what amounted to a small bore hole in the middle of the sand. I peered into the hole at the dirty brown water as she scooped out cupfuls and poured them into a jerry can. For her, dirty water was better than no water at all. I dreaded to think what sorts of water-borne diseases she and her family might contract by drinking this.
She said what many other Samburus told me during this trip: “There is no water where we live and we have to travel great distances to find any. We need help.”
To get a sense of how IMC has already started helping, we went south to a village called Seren, where IMC helped residents construct a system of pipelines that extend to a freshwater spring about three miles up the mountainside. Before those water pipelines were there, women were forced to climb the mountain every day to reach the water source.
As I slowly – very slowly - made my way up this mountainside laden with boulders and dry sand, I imagined what it must be like for a woman to undertake this same trek day in and day out. I had a one liter bottle of water with me, which was empty by the time I reached the top, drenched in sweat and thoroughly out of breath. But she would have gone on that journey without water, then carried her heavy container back down the mountain.
Imagine what her life would be if the daily search for water were no longer a concern? As Peter said to me, “You fix the water problem and everything else falls into place.” A simple statement and I suspect a right one.
==============================
p.s. this coming Saturday at 10am, Starbucks is holding a "Walk for Water" from Santa Monica Pier to Venice Beach. The walk, which includes music and dance performances, is inspired by the three- to- six-miles journey women and children make every day in "water stressed" countries. The event marks World Water Day (which is officially this Thursday) and Starbucks will announce at that time the grant it's awarding to IMC.
Next week, I'm in Democratic Republic of Congo. I just hope my muscles can hold out.
Sunday, March 11, 2007
"Jambo" from Kenya
Hi everyone.
I’m sitting on the back porch of my room, looking through the palm trees and brilliant yellow African rose bushes down to the banks of Lake Victoria - the largest in Africa .
I rolled a lucky seven here, given other places I’ve stayed. We are in a town in Suba District called Mbita, in far southwestern Kenya , near the border with Uganda . Our housing is at an educational facility that includes primary and secondary schools for local kids. It is truly idyllic – and we’ve got running water, which is a real luxury in Suba. But I’ll get to that in a bit.
In Suba, HIV and AIDS are having a catastrophic impact on every single person in the region; someone either has the disease, is helping care for someone with it, or a child whose parents died of it.
Here’s a staggering set of statistics for you: while the rate of HIV among the adult population of Kenya is around six percent, it is 38 percent in Suba. What’s worse, many of those with HIV also contract tuberculosis because of their compromised immune systems. Throw in the heightened incidence of malaria and you’ve got a population that’s literally being decimated.
In gathering places and markets everywhere, you see posters, signs, people wearing t-shirts with messages advocating AIDS and TB awareness, prevention, testing, and counseling. The word is slowly getting out. Four years ago, when IMC began working here with funding from PEPFAR (President’s Emergency Plan for AIDS Relief) and the CDC, rates of HIV were even higher – 44 percent.
But there are deep pockets where generations of behavior are damn difficult to reverse and where people are living in such remote areas that information doesn’t easily get to them. These are the areas most often ignored by the rest of the world, so they are where IMC is focusing its activities.
That means hours by boat across the lake, or in a Landcruiser, traveling along dusty, rocky, unpaved roads to reach people who have close to nothing except the mud huts where they live, their family members, and a disease that is destroying all of them.
DAY ONE - POSITIVE OR NEGATIVE
Our first day here, we set out with a handful of IMC community mobilizers from Suba to a remote “cul de sac” of mud huts where a large extended family lived. Our guide was a phenomenal woman with IMC named Grace Muthumbi, a nurse who is our HIV/AIDS Program Coordinator based in Nairobi . Grace’s face was badly burned in a fire in 1991; she has had to confront issue of stigma ever since. She came to work for IMC in 2000, hoping to help others stigmatized by society because of diseases like AIDS.
When Grace and the rest of our small group walked into the mud hut we found waiting for us the patriarch of the family, his brother (both in their 60’s), his daughter and his two wives. Polygamy is practiced by about a quarter of the population of 165,000 in Suba, making the spread of HIV and people’s (especially women’s) ability to protect themselves from it that much more difficult.
This family was receptive to our visit and gave their consent for me to videotape. They knew the basics about the disease and that it can be spread through sex. The community mobilizers had a relaxed conversation with them, dispelled some of their misconceptions, stressed the need for taking personal responsibility and using condoms, and talked about the importance of taking medications properly in the event any of them tested positive.
The family then agreed to give blood and receive their test results immediately, right there, right in front of us and my camera.
I wasn’t fully prepared for this.
After taking their blood, the counselor examined all five test stick-results. I watched him and again pondered the statistics for Suba: 38 percent. There are five people in this room. I was suddenly very troubled by the odds.
One by one, the counselor showed the two older men and the wives their results, holding the test stick before them, and the chart displaying two columns of results: positive and negative. Each of their results was negative.
Then he took the 26-year-old daughter to the other side of the room, away from the others. He showed her the stick and how it compared it to the chart. He looked at her and whispered, “positive.” She stared at the stick, without expression. Her whole life was changing.
I shut off my camera and walked outside.
A different counselor took the young woman to another hut to talk with her about the results and the drug regimen she now should follow. She agreed to take medications.
I know that without IMC this woman (who has no children) likely wouldn’t have found out she had HIV ‘til much later - perhaps when HIV turned into full-blown AIDS; wouldn’t have started taking drugs that could save her life; wouldn’t have informed her husband, from whom she was already separated, that he was at risk. I know it is good that we’re here. This is what it’s all about. People get AIDS and we have to do our best to strangle its impact.
But it was crushing to watch this unfold for her.
DAY TWO – MEETING A COUPLE OF HEROES
The next day Grace and I traveled two hours in the opposite direction to some remote villages and to a clinic that IMC built primarily for the treatment and prevention of HIV/AIDS, TB and malaria.
With us was IMC’s Country Director, Peter McOdida, who is a native of Suba. Peter is fantastic – big, toothy smile and a great laugh. He’s loved by his staff and has a warm, fatherly way with the beneficiaries as he offers guidance and encouragement.
At the clinic I was introduced to Risper and her husband, Sebastian, a vibrant, gregarious couple in their 30’s. In 2004, Risper met with an IMC mobilizer who urged her to get an HIV test. She tested positive. At the time, she was pregnant with her third child. She tells me that when she first learned of her status, she was afraid for her life and that of her unborn child – and afraid to confront her husband with the news. But an IMC counselor convinced her how important it was to have Sebastian tested as well. He did, and he was positive.
IMC worked with Risper and Sebastian to counsel them, get them treatment, and try to prevent transmission of the virus to their child with the help of prophylactic anti-retroviral drugs and more effective feeding practices once the child was born.
Today, that child is a gorgeous three-year-old named Salome, who regularly tests negative for HIV. She very likely would not have been so lucky had her parents given in to the widespread fear and denial of the disease.
Risper and Sebastian are currently healthy and are now employed by IMC as community mobilizers, raising awareness about HIV. Risper says she feels strong and loves knowing that despite the adversity she faces, she is helping to save the lives of the people in her community.
DAY 3 – A FLOATING SLUM
The next morning, I was up at 5:30 to meet the boat that would take us across Lake Victoria to a series of islands where the primary engines of economy are fishing and prostitution. HIV is rampant here; it’s difficult to mobilize and educate villagers because of the transient nature of the population, the intractable stigma surrounding the disease, and the fact that the commerce of sex is essentially sanctioned by beach community leaders.
There is a massive need for robust HIV/AIDS programs – not to mention water and sanitation systems.
As we approach our first destination, Mfangano Island , I see a shoreline crowded with hundreds of long, colorful fishing boats. But once we dock, the conditions we find are appalling. Garbage is strewn everywhere - mounds of it. And packed in tightly across the island are tiny corrugated tin dwellings. This is for all intents and purposes a slum.
There are about 6,000 people on each island, and only one or maybe two latrines for all of them. When it rains, the refuse washes down to shore, where people bathe, clean their clothes and dishes, and collect water for drinking. It’s completely unacceptable but it’s all they have.
On these islands, nearly all the men fish for a living, then travel from beach to beach, selling their catch. You find that many of the women have children but no husband or partner (many have died of AIDS and other diseases), so they must find ways to buy food for themselves and their kids. But the only financial opportunity available to them is selling fish. To do that, a woman is required to first go to the chairman of the beach community. He then assigns her to a man, who will give her fish to sell. The understanding of course is that the man will demand sex from her in exchange for the fish.
The women tell Grace and me they desperately want other options, perhaps building more latrines for pay, or opening a cafe. IMC is working to persuade the various beach committee chairmen to work with the women in devising different income-generating opportunities, but ritual is difficult to undo. And let’s be honest, the men like getting sex.
IMC has enlisted hundreds of women and men with HIV living on these islands to form groups and become community mobilizers. On this day, we’ve brought a big box of t-shirts branded with IMC and Kenyan Ministry of Health logos, promoting HIV awareness and the prevention of mother-to-child transmission – what we call PMTCT. After discussing strategies with these groups for fighting HIV and creating new economic livelihood opportunities, we hand out the t-shirts. They proudly slip these on and then beam for my camera.
I think about the small steps you have to take. I think about the man on Remba Island who walked away dismissively when we tried to talk to him about HIV, but who later was engaged in that very discussion with one of the community mobilizers wearing his new IMC t-shirt. It’s tough to chip away at taboos, and getting buy-in from men is generally so much harder than from women.
But in just this three-day period I witnessed dozens and dozens of people being reached for the first time. Maybe in another four years the HIV rate will be down another six percent. How many lives is that? By my calculation, just over 10,000.
Next week I'm headed to the north, where Starbucks just gave IMC a $1 million grant to build a water and sanitation system serving about 180,000 people.
I love you all...
m
I’m sitting on the back porch of my room, looking through the palm trees and brilliant yellow African rose bushes down to the banks of Lake Victoria - the largest in Africa .
I rolled a lucky seven here, given other places I’ve stayed. We are in a town in Suba District called Mbita, in far southwestern Kenya , near the border with Uganda . Our housing is at an educational facility that includes primary and secondary schools for local kids. It is truly idyllic – and we’ve got running water, which is a real luxury in Suba. But I’ll get to that in a bit.
In Suba, HIV and AIDS are having a catastrophic impact on every single person in the region; someone either has the disease, is helping care for someone with it, or a child whose parents died of it.
Here’s a staggering set of statistics for you: while the rate of HIV among the adult population of Kenya is around six percent, it is 38 percent in Suba. What’s worse, many of those with HIV also contract tuberculosis because of their compromised immune systems. Throw in the heightened incidence of malaria and you’ve got a population that’s literally being decimated.
In gathering places and markets everywhere, you see posters, signs, people wearing t-shirts with messages advocating AIDS and TB awareness, prevention, testing, and counseling. The word is slowly getting out. Four years ago, when IMC began working here with funding from PEPFAR (President’s Emergency Plan for AIDS Relief) and the CDC, rates of HIV were even higher – 44 percent.
But there are deep pockets where generations of behavior are damn difficult to reverse and where people are living in such remote areas that information doesn’t easily get to them. These are the areas most often ignored by the rest of the world, so they are where IMC is focusing its activities.
That means hours by boat across the lake, or in a Landcruiser, traveling along dusty, rocky, unpaved roads to reach people who have close to nothing except the mud huts where they live, their family members, and a disease that is destroying all of them.
DAY ONE - POSITIVE OR NEGATIVE
Our first day here, we set out with a handful of IMC community mobilizers from Suba to a remote “cul de sac” of mud huts where a large extended family lived. Our guide was a phenomenal woman with IMC named Grace Muthumbi, a nurse who is our HIV/AIDS Program Coordinator based in Nairobi . Grace’s face was badly burned in a fire in 1991; she has had to confront issue of stigma ever since. She came to work for IMC in 2000, hoping to help others stigmatized by society because of diseases like AIDS.
When Grace and the rest of our small group walked into the mud hut we found waiting for us the patriarch of the family, his brother (both in their 60’s), his daughter and his two wives. Polygamy is practiced by about a quarter of the population of 165,000 in Suba, making the spread of HIV and people’s (especially women’s) ability to protect themselves from it that much more difficult.
This family was receptive to our visit and gave their consent for me to videotape. They knew the basics about the disease and that it can be spread through sex. The community mobilizers had a relaxed conversation with them, dispelled some of their misconceptions, stressed the need for taking personal responsibility and using condoms, and talked about the importance of taking medications properly in the event any of them tested positive.
The family then agreed to give blood and receive their test results immediately, right there, right in front of us and my camera.
I wasn’t fully prepared for this.
After taking their blood, the counselor examined all five test stick-results. I watched him and again pondered the statistics for Suba: 38 percent. There are five people in this room. I was suddenly very troubled by the odds.
One by one, the counselor showed the two older men and the wives their results, holding the test stick before them, and the chart displaying two columns of results: positive and negative. Each of their results was negative.
Then he took the 26-year-old daughter to the other side of the room, away from the others. He showed her the stick and how it compared it to the chart. He looked at her and whispered, “positive.” She stared at the stick, without expression. Her whole life was changing.
I shut off my camera and walked outside.
A different counselor took the young woman to another hut to talk with her about the results and the drug regimen she now should follow. She agreed to take medications.
I know that without IMC this woman (who has no children) likely wouldn’t have found out she had HIV ‘til much later - perhaps when HIV turned into full-blown AIDS; wouldn’t have started taking drugs that could save her life; wouldn’t have informed her husband, from whom she was already separated, that he was at risk. I know it is good that we’re here. This is what it’s all about. People get AIDS and we have to do our best to strangle its impact.
But it was crushing to watch this unfold for her.
DAY TWO – MEETING A COUPLE OF HEROES
The next day Grace and I traveled two hours in the opposite direction to some remote villages and to a clinic that IMC built primarily for the treatment and prevention of HIV/AIDS, TB and malaria.
With us was IMC’s Country Director, Peter McOdida, who is a native of Suba. Peter is fantastic – big, toothy smile and a great laugh. He’s loved by his staff and has a warm, fatherly way with the beneficiaries as he offers guidance and encouragement.
At the clinic I was introduced to Risper and her husband, Sebastian, a vibrant, gregarious couple in their 30’s. In 2004, Risper met with an IMC mobilizer who urged her to get an HIV test. She tested positive. At the time, she was pregnant with her third child. She tells me that when she first learned of her status, she was afraid for her life and that of her unborn child – and afraid to confront her husband with the news. But an IMC counselor convinced her how important it was to have Sebastian tested as well. He did, and he was positive.
IMC worked with Risper and Sebastian to counsel them, get them treatment, and try to prevent transmission of the virus to their child with the help of prophylactic anti-retroviral drugs and more effective feeding practices once the child was born.
Today, that child is a gorgeous three-year-old named Salome, who regularly tests negative for HIV. She very likely would not have been so lucky had her parents given in to the widespread fear and denial of the disease.
Risper and Sebastian are currently healthy and are now employed by IMC as community mobilizers, raising awareness about HIV. Risper says she feels strong and loves knowing that despite the adversity she faces, she is helping to save the lives of the people in her community.
DAY 3 – A FLOATING SLUM
The next morning, I was up at 5:30 to meet the boat that would take us across Lake Victoria to a series of islands where the primary engines of economy are fishing and prostitution. HIV is rampant here; it’s difficult to mobilize and educate villagers because of the transient nature of the population, the intractable stigma surrounding the disease, and the fact that the commerce of sex is essentially sanctioned by beach community leaders.
There is a massive need for robust HIV/AIDS programs – not to mention water and sanitation systems.
As we approach our first destination, Mfangano Island , I see a shoreline crowded with hundreds of long, colorful fishing boats. But once we dock, the conditions we find are appalling. Garbage is strewn everywhere - mounds of it. And packed in tightly across the island are tiny corrugated tin dwellings. This is for all intents and purposes a slum.
There are about 6,000 people on each island, and only one or maybe two latrines for all of them. When it rains, the refuse washes down to shore, where people bathe, clean their clothes and dishes, and collect water for drinking. It’s completely unacceptable but it’s all they have.
On these islands, nearly all the men fish for a living, then travel from beach to beach, selling their catch. You find that many of the women have children but no husband or partner (many have died of AIDS and other diseases), so they must find ways to buy food for themselves and their kids. But the only financial opportunity available to them is selling fish. To do that, a woman is required to first go to the chairman of the beach community. He then assigns her to a man, who will give her fish to sell. The understanding of course is that the man will demand sex from her in exchange for the fish.
The women tell Grace and me they desperately want other options, perhaps building more latrines for pay, or opening a cafe. IMC is working to persuade the various beach committee chairmen to work with the women in devising different income-generating opportunities, but ritual is difficult to undo. And let’s be honest, the men like getting sex.
IMC has enlisted hundreds of women and men with HIV living on these islands to form groups and become community mobilizers. On this day, we’ve brought a big box of t-shirts branded with IMC and Kenyan Ministry of Health logos, promoting HIV awareness and the prevention of mother-to-child transmission – what we call PMTCT. After discussing strategies with these groups for fighting HIV and creating new economic livelihood opportunities, we hand out the t-shirts. They proudly slip these on and then beam for my camera.
I think about the small steps you have to take. I think about the man on Remba Island who walked away dismissively when we tried to talk to him about HIV, but who later was engaged in that very discussion with one of the community mobilizers wearing his new IMC t-shirt. It’s tough to chip away at taboos, and getting buy-in from men is generally so much harder than from women.
But in just this three-day period I witnessed dozens and dozens of people being reached for the first time. Maybe in another four years the HIV rate will be down another six percent. How many lives is that? By my calculation, just over 10,000.
Next week I'm headed to the north, where Starbucks just gave IMC a $1 million grant to build a water and sanitation system serving about 180,000 people.
I love you all...
m
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