What is the "real" Kenya?

Our time here is drawing to a close--tomorrow we head to Nairobi. On Thursday, Lusaka. Hopefully, on Friday,Victoria Falls! Last night we checked out prices for helicopter rides and ziplines!

After a packed week in Eldoret, on Friday, we went to Webuye, a smaller town about 1 hr away, to learn more about AMPATH's home-based counseling and testing program. For the past two years, AMPATH has been sweeping through the villages hidden on back roads, surrounded by fields and fields of maize, doing rapid diagnosistic tests in people's houses. Some of the technology they use is also pretty cool--the counselor uses a GPS to mark the exact location of the house and conducts a household survey using a PDA. The house that I visited was occupied by a young couple--the wife and her daughter were at home, the husband away as he works in a village nearby. We ask about HIV and she says that they go to the clinic together to get tested every 3 months. I honestly can't fathom that as a routine part of a relationship, but if everyone did there here, it could prevent a lot of HIV. Meanwhile, my colleague accompanied a counselor to a house next door, where a man, his wife, and their 10+ kids had heard of HIV but did not know how one contracted it. They were extremely nervous as the counselor ran the tests for them in their sitting room. Luckily, everyone was negative. The counselors were amazing adept as combining compassion with education with professionalism; they worked in messages about mosquito nets, prevention of mother to child transmission of HIV, and de-worming into their conversation. It was a real eye opener for me--the first time I've been in such a rural place in Africa. We saw guys bringing home-brewed liquor by on a bicycle, ate guava straight off the tree, and came face to face with seriously malnourished children--guava and boiled maize are not enough to live (and thrive) on. Made me wonder how long we can continue to treat HIV with the exceptionalism it receives when hunger, lack of access to family planning, and a host of other issues that stem from poverty continue to ravage the same populations that we fight so hard to protect from HIV.

We headed out to Kisumu for the weekend. Kisumu is Kenya's third largest city--it sits on Lake Victoria and has a much larger city feel (i.e. it has sidewalks and similar luxuries). After throwing our stuff in a bare-bones motel, we walked down to the waterfront to a number of shacks on the beach. They escort you to the back, where you choose the fish you want for lunch--all tlapia, varying sizes (and most likely freshness, but I'm not that much of a fish connesseiur). They steamed it, covered it with stewed tomatoes and onions, and brought it out with sides of collard greens, chapati, and ugali. We washed it down with a Tusker beer and watched the boats out on the lake. Just a day after I decided that global health was too focused on HIV, here I was in a restaurant, observing the vast sea of street children that wander Kisumu, sniffing glue and begging. While Kenya's HIV rate is around 8%, Kisumu's is closer to 15%. The children are often high when they tug at your arm, and hang out around these fish shacks with plastic bags to collect the uneaten food left by customers. While it's heartbreaking to watch now, trying to predict the consequences of what will happen to Kenya (and the world) as these children turn into adults is difficult, but speaks for the need to take the long-term consequences of present (in)actions. But what to do? These problems require the complex, long-term solutions that are difficult to implement and sustain, and its an area no doubt riddled by good intentions and disappointing outcomes.

Not to paint a negative picture of Kisumu! We walked around the city, spending a good portion of the afternoon sitting on the second floor of a bar in the middle of the park, watching a local soccer game and enjoying the breeze off the lake. Saturday night we went to a place playing local music, where we mingled with the locals. The band played Ohangla music--which has a nice, laidback rhythym and fun guitar melodies.

The drive back may have been my favorite part. For the most part, the road is good, though the 90km trip takes about 3 hours in total. We unfortunately were hit by a violent rain storm, and found ourselves crawling along to avoid the numerous potholes (almost more potholes than remaining road), as the dirt side road that has been formed by the numerous cars that prefer dirt to the uneven asphalt had become sticky, treacherous mud (not that it stopped the matatus, the van-like buses, from flying along through them). The silver lining was that the many stops meant that there were many photo opportunities for me, squished in the back of the van on the left side. The landscape was amazing. The hills were so green--many covered with tea plantations. The flatter ground that directly surrounded us was drier--the rain was sorely needed by the maize and sugar cane. The mist and rain only made the greens seem deeper and added a semi-mystical-like quality to the whole countryside. It was not what I would say was typically "African" by western standards, but beautiful and indicative of how not "resource-limited" Kenya is in many ways. My favorite part, of course, was how, out here, when we saw so few people and so few signs of any human habitation other than the huts and small tin-roofed houses that peppered the hills, suddenly we'd come across a pack of lean and fast runners, dressed like they'd just stepped out of a nike commerical, taking the rocky road in stride and climbing the hills as if they weren't there! Best image of the essence of a runner that I can imagine.

As always, I'm honored by how willing the people here have been to let us step into their world, despite our superificial understandings of so many things and as always, regrettably ephemeral presence (at least from my perspective). We've heard first-hand accounts from those who lived through the post-election violence last year, heard former street kids talk about their childhoods, and met many who are HIV positive (including the 4th patient AMPATH started on ART) or who have lost friends and family to the disease. I can only hope that the experience helps open my eyes to the full scope of the world's problems, gives me the courage, humility, and hope to help take over at least some small portion of it. I'm inspired greatly by what I see here, though at times it feels like it's a drop in one very big bucket.

So on that note, I will end. I'm off to Mosoriot today to see the transition of one AMPATH site from just HIV care to primary care (for all). Good stuff.