Fieldtrip to Kenya, final edition


Dear Friends,

Last time I wrote it was day 10 of my time in Kenya.  Today it is day 30 and my time here has come to an end.  Since I last wrote, my circumstances changed considerably and without warning.  While I knew I would be moving to a more remote location, I thought I would be able to use my phone as a modem for my computer such that I would still be connected to the Internet. However, when I arrived in Rongo, I learned that the cell signals were so weak that not only did I not have internet, but I often didn’t have the ability to make a phone call.  Electricity was also a bit of a luxury.  My colleague who lives there had not had electricity for one month.  When I arrived back in Kisumu with electricity and Internet for my last 5 days, I unfortunately had a health incident which landed me in the hospital.  I’m ok now, but it was not an ideal situation to write.  So please forgive the length of this newsletter and consider it installments for weeks 3 and 4.

Rongo is only a 3-hour drive from Kisumu, but a world apart.  This is a part of Kenya with an almost universal dependence upon farming.  75% of Kenyans make their living and provide the majority of their household food from smallholder farming, according to the World Bank and Kenya’s Ministry of Agriculture, however, when you are in Rongo that number shoots up to 100%.  It feels like one giant farm, which I loved.  But the Kenyan government seems to have forgotten this part of its country existed.  The extreme lack of infrastructure is shameful.  If you were in need of emergency medical care, you would die while trying to access it.  The leaders of this country have left the people of Rongo to fend for themselves.  If Kisumu’s farmers had problems with their roads flooding, the farmers of Rongo could be jealous of roads for which to become flooded.

Baptism by Rain

As we made our way to our final health clinic on my first day in Rongo, our driver Julius said, “This is more of a passage way than a road.  Don’t be alarmed, I know this vehicle can make it because we do it all the time.”  “It’s fine, I’m not afraid.”, attempting to sound aloof as I surveyed what looked something like a deep, dry riverbed with deeper crevasses and giant rock formations.  Thoughts of Joshua Tree came to mind.  Some of the rock formations were more like boulders.  Julius explained that each day when it rains, more and more of the soil is washed away and the Ministry of Transportation doesn’t provide any support to this area.  

As the sky turned black in the distance and the wind started to pick up, Julius and my colleague Bernard began calculating how much time it will take us to reach the clinic, do our quality control check on 9 random charts, talk with the research assistant and get back to the main road.  “Tammy, have you ever been stuck in a truck before?”  “Actually, I’ve been stuck in many worse places than a truck in the Kenyan countryside.  Do not worry about me.”  That was not entirely true, but I didn’t want to let on that I was getting a little uneasy.

When we arrived at the clinic and set up our quality control assembly line, Bernard with my computer and me with the charts, reading to him as he cross-checked, the wind started to howl underneath the tin corrugated roof that wasn’t quite flush with the cinder block walls.  Soon the glass and iron doors and windows were rattling like a Midwestern tornado was afoot.  Bernard sensed my fear and said, “Don’t worry, we will not have to pitch a tent here tonight.  This is going to pass.”  Next the rain started, first in heavy drops and then in sheets.  I looked at Julius’ face and realized I wasn’t the only one with the scent of fear, he asked, “How many charts do you have to complete?”  “We’re going as fast as we can.”  I replied.  And then the sheets of rain turned to something I’ve never seen before except maybe in the film, The Perfect Storm.  It was as if the air outside the clinic was being exchanged for water.  The air felt thick and heavy while a hi-fidelity symphony played of wind, lightning, and thunder.  Trees were bowing such that their tops were parallel to the ground.  I may have seen a few cows sail by.  And then almost as quickly as it started, it stopped.  What I learned over the course of my two weeks in Rongo, is that this storm visits every day like clockwork at roughly the same time.  What was most interesting was talking to the oldest farmers, whose families lived on their land for hundreds of years, talk about how this extreme weather did not exist in their childhoods or their ancestors.  It was like all the lectures I attended on climate change and global health in my non-communicable diseases class were coming to life.  These farmers were experiencing horrific weather conditions due to climate changed mostly caused by wealthy countries on the other side of the planet.  Us, we, Americans’ choices to ignore our impact on the environment is essentially making these already poor people, poorer.  Their yields have been falling without their changing their practices.  Try arguing with an 80-year old Kenyan farmer that climate change isn’t real.

Our farmer trainings over these two weeks took on a slightly different form than the trainings we did in Kisumu because this rain, this rain affects everything.  And the effort these HIV-positive farmers must make to reach the clinics to get their HIV medications is something to behold.  Much to my surprise, one day I learned that an additional challenge of one of our participants was the hippopotami who kept creeping over the river that separates this part of Kenya from Tanzania.  They were destroying her crops.  This too was a living example of human encroachment on the environment.  Hippos were not always a threat to farmers here.  However, due to human development encroaching on wildlife habitats, the wildlife seeks new areas to survive.  And now I had one more thing to be afraid of, a surprise attack by a hippopotamus while doing farm visits on the Tanzanian border.  With all the time I was spending worrying about getting malaria, I wasn’t sure where I would fit this new source of worry.


The Law of the Cow

While working on a multisectoral project like ours, that aims to address the upstream causes (malnutrition and poverty) of poor HIV outcomes, while creating a sustainable solution, it’s natural to want to understand as many cultural, social, political, economic, etc. systems and how those might affect poor health outcomes.  One day a group of my Kenyan colleagues, myself, and one of my UCSF colleagues were making the 3-hour drive from Rongo to Kisumu and we learned a male travel companion was going to spend his weekend helping his brother transport 5 cows, 10 goats, and a clutch of chickens to his brother’s fiancé’s parents’ home.  This opened a conversation where our Kenyan friends asked us two Americans what men had to give to a woman’s parents in the US in order to be able to marry.  We laughed and told them, “nothing”.  We explained that in the US, both males and females are supposed to be valued equally and are supposed to enter into marriage of their own free will, not as a transaction between the male suitor and the female’s parents.  Our Kenyan friends pressed us, “Not even cash?  What about the US dollars?  Those are as valuable as cows.  Doesn’t the man give the woman’s parents some cash then?”  We laughed some more.  Then we asked the others in the vehicle if they participated in this exchange of cows and livestock, they all answered in the affirmative.  Lillian who is from Uganda and married a Kenyan explained that her husband had to travel to Uganda to buy the cows and other livestock there because, “No respectable man would present those sickly, tiny Kenyan cows to Ugandan parents and expect the parents to give their daughter away.  It wouldn’t be fair.”  We also learned that in Uganda, after the cows and livestock are exchanged, all the sisters and cousins of the prospective bride’s family who are of similar age to her, must dress in identical clothes with their heads and faces covered.  The prospective bride does this along with her cousins and sisters.  Then they all kneel with their heads bowed and the future bridegroom enters the room and he has to identify his future bride, or else, he gets stuck with whomever he chooses.  We couldn’t believe this seemingly unfair ritual and expressed our shock.  Then Lilian told us that the couple makes a pact before this ritual; for the woman to use a certain nail polish or to make a hand signal so their union can be protected.  Then we got on the topic of domestic violence and what laws exist to protect a woman if she wants to get a divorce due to her husband beating her.  We learned that first the woman goes to her parents’ house and seeks refuge.  Then after a day or so of rest, she is told to go back to her husband because being beaten is just a fact of life.  If she returns to her husband’s house and the beating continues and she decides to leave her husband and seek a divorce using the laws that allow this process…she is out of luck if there was an exchange of cows.  Cows trump written laws.  It turns out, if a woman goes through the legal process to get a divorce and is granted one, her family and the family of her now ex-husband, will not recognize the legally binding papers, “Because her family has the cows.”  Instead, she will just live elsewhere but when she dies, she will be buried on her ex-husband’s property because of the cows.  “Otherwise her spirit would be unsettled if she were buried elsewhere and the living would run the risk of being terrorized by her spirit being in the wrong place.  Because her husband gave her parents the cows, she has to rest on his property.”  We asked Lilian, a seemingly modern woman who has a 10-year old daughter, “Are you going to make your daughter go through these rituals when she is old enough to marry?”  Lilian burst out laughing, “Hell no.  If my daughter marries and her husband beats her, she will come home.  And when that man comes to get her, I will beat him so badly that he’ll wish he never gave us a cow.  And I would never let her go back.”  So there is hope.  Maybe all of our efforts to level the playing field for women farmers is not in vain.

Kenya’s Smallholder Farmers for the Environmental Win

In what seemed like a never ending state of realizations that Kenya’s government is doing everything wrong while the US has historically done things better, I found a deviation from this constant, even if the deviation involves utter neglect on the part of the Kenyan government.  Attention Kenyan Ministry of Agriculture: your smallholder farmers need your help!  Most Americans have no idea where their food comes from, nor do they care.  If animals are kept in crates their entire lives while fattened on grain and chemicals, Americans in large part could care less, as long as their grocery bills stay cheap.  If the land is over-tilled, showered with pesticides, and chemical fertilizers so they can buy cheap vegetables and sugar-sweetened everything, Americans in general, vote against the notion of changing this.  There is a battle going on in agriculture in the developing world, smallholder verses factory farming.  (I’m sad to say there is less of a battle happening in the US because Americans may be too far gone into their coma of cheap, processed food, happy to pretend their food supply isn’t affecting global warming, happy pay the price with their diabetes, cancers, obesity, heart attacks, and the like.)  In Kenya, nearly everyone knows exactly how and where their food is grown.  With 75% of Kenyans making their living and supplying the majority of their food from smallholder farming, this means their food supply, for the most part, respects the environment.  But their farming practices need improvement in order to diversify their diets and improve nutrition to meet the needs of a developing child’s brain, a breastfeeding mother, an HIV infected individual, or an elderly adult.  When the English colonized Kenya they used the land to farm corn and sugarcane because these crops can become commodities, while blueberries, spinach, beets, and broccoli cannot.  Now China is investing massive amounts of capital in sub-Saharan African agriculture that is profit and market-opportunity driven, not environmentally or health driven.  While there is no doubt, agriculture needs improvement in Kenya and all of sub-Saharan Africa, if the smallholder farmers can hang on to their respect for the environment while increasing their yields and diversifying their crops, the whole world will win.  Working side-by-side with smallholder farmers in Kenya gave me hope because projects like ours that are environmental and health centric are what the farmers want.  They appreciate the diversity of birds that populate their farms and understand that when the birds disappear, something is out of balance in their environment.  Essentially, I saw a greater respect for the environment in the poorest people I’ve ever worked with, than I see in my own fellow Americans, the richest in the world.


As I finish writing this newsletter, I am enjoying France, reuniting with Brent, who has also been traveling while I was in Kenya.  We will also be visiting my friend Stephanie, whom I met in graduate school in the late 90’s when we were studying Animal Science with Dr. Matt Wheeler at the University of Illinois.  I’m encouraged by Dr. Wheeler’s work because he is still advancing the field of food production while decreasing the carbon footprint of animal agriculture and applying it to the developing world.  This is one of the ways I realize my past and present fit so naturally together; recycling my former graduate education with my current.

Being away from Kenya and not yet back to San Francisco, is providing a reflecting pool to digest and process the many lessons learned, problems left unsolved and how it all fits into the world at large.  In Friday’s New York Times, there is a great opinion piece by former Secretary of State Colin Powell titled “Leadership isn’t free”.  If you get a chance, please read it online,  He outlines why the 1% of our GDP that we have historically spent on foreign aid, for programs like the one in which I’m working, is a necessary component of world peace and economic prosperity for Americans. 

At our best, being a great nation has always meant a commitment to building a better, safer world — not just for ourselves, but for our children and grandchildren. This has meant leading the world in advancing the cause of peace, responding when disease and disaster strike, lifting millions out of poverty and inspiring those yearning for freedom.”  General Powell goes on to say that decreasing the US budget for foreign aid “…would be internationally irresponsible, distressing our friends, encouraging our enemies and undermining our own economic and national security interests.”

Listening to my Kenyan friends tell me that it gave them hope, to have an American graduate student teaching them how to be better farmers and healthier people, and seeing it in their eyes, reminded me of the book, The Power of One by Bryce Courtenay, a true story set in South Africa about the power in each of us, published the year I graduated from high school and given as a gift by my mom.  Each of these Kenyans has the power to change the world and I can only give thanks that I had the opportunity to be a tiny part of


In peace and hope, Tammy


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