May 6th, 2017
Greetings from Kenya! I realize I’m a bit late with my “weekly” newsletter. What I didn’t realize until Monday of this past week, is that I have very little free time. I am working in the field or in the HIV clinics from 8-5 and in the evenings I have calls every night with my faculty mentors at UCSF, the co-principal investigators for this study, as well as with my co-author for the paper we are writing, and with the collective UCSF-Kenya team. So when I am not working, I am writing or on the phone, and I can thankfully say, I am having the time of my life. I now find myself with my first moment to reflect on the past 10 days.
My first full week in Kenya has been a combination of learning experiences among the three sectors involved in our study: finance, agriculture, and HIV health. I was able to meet all 34 Kenyan research associates for our study, Shamba Maisha. Shamba Maisha means “farm life” in Swahili. I’m in awe of the work my new colleagues conduct each day. Because the participants in our study must meet the study criteria for 12 months, these research associates do whatever it takes, within the study protocols, to keep the participants enrolled. This is not easy because the participant requirements are as follows:
1. Attend clinic appointments for HIV care so that adherence to antiretroviral therapy (drugs that when taken properly can reduce a person’s HIV viral load to non-detectable and non-transmissible) can be assessed.
2. Show up to clinic appointments with MEMS cup, the pill bottle used to remotely track by computer, the participant’s opening and closing of the bottle to take their medications.
3. Comply with getting blood drawn to measure HIV viral load and other markers we use to determine health.
4. Produce down payment for loan to purchase irrigation pump and other farm implements.
5. Make monthly loan payments.
6. Attend financial training sessions.
7. Attend agricultural training sessions, both theory and practical trainings.
8. Plant seeds, cultivate crops, harvest, and bring to market excess crops not used for home consumption.
9. Attend agricultural group meetings to discuss successful methods, help members who are struggling, and determine voluntary group savings and investments.
10. Track income from crop sales as a result of Shamba Maisha.
11. Participate in interviews with research staff to assess progress in each component of the study.
12. If the participant has a child enrolled in the pediatric arm of the study, they must also attend additional clinic visits with the child to measure their health, nutritional and cognitive status.
13. Participate in home visits by research staff.
I’ve also had the privilege of meeting 10 of our 700 participants and their beautiful children. These are the people from which inspirational literary masterpieces can be written. Against all odds, they have found themselves in partnership with our study, finding a way forward that was previously beyond their reach. To be eligible for enrollment, each person must be HIV positive and meet the definition of suffering from food insecurity, as well as have access to water, the ability to farm on a certain size plot of land, and make the down payment for the irrigation pump required. And to stay in the study they must meet all the requirements above. Each participant is unique, obviously, with their own set of legitimate, competing demands for survival that sometimes get in the way of the study requirements. In these cases, I’ve witnessed the most elegant execution of scientific research combined with humanity and social work by our team.
Learning to Trust
There are no guarantees in this part of Kenya. Things seem to be in a constant state of flux due to lack of infrastructure. When the roads are flooded and people can’t get in or out of their villages, it is not news. Nobody is declaring a state of emergency; no government agencies provide relief. When I notice myself panic while our meticulous weekly plan dissolves due to the floods, I notice my Kenyan counterparts trust they will find a way forward. They shift our schedule of home visits with our study participants and then a domino effect occurs where the schedule for the next week is rewritten all keeping within the timelines of the protocols. None of this phases anyone here. They work together taking on each other’s tasks if needed and being oh-so-creative. Except some of our participants don’t have cell phones and so the process of getting in touch with them to confirm schedule changes could involve tracking them down before dawn at the beach where they also launch their small fishing boat each morning. But also making sure we are discreet because we can’t let the beach chairman know that the participant is involved in an HIV study. And anyway, why would two women be waiting for a fisherman at 4am? The research assistants just roll their eyes and laugh at what this task can do to their reputation. They care more about keeping the participants enrolled. This is true, this happened last week. But mostly, my days have started like this:
Honking horns blaring against the dusty, crowded streets of Kisumu, where riding in a tuktuk feels something like being in a live video game where the tuktuk has to avoid hundreds of pedestrians, cows, goats, bicycles, vans and other tuktuks while the goal is for everyone to move at once in the same direction without yielding. There are no traffic signals and I imagine if there were, they would be ignored. When we arrive at Lumumba Hospital unscathed and without hitting anyone, I feel a sense of relief wash over me. This is how most of my workdays begin. I’m in awe of the navigation skills my driver and the collective maneuvering of space, so that nobody or no animal is harmed. It makes me think that air traffic controllers’ work is pedestrian compared to this, pun intended. I have repeated this route enough that I now recognize the one person who is suffering from alcohol addiction, he is in the same place every morning; the hundreds of others are simply trying to survive. The streets are lined with every type of seller of goods and services you can imagine, each with a tiny hut enclosed on three sides, their wares and services spilling out to the street that is filled with garbage.
In some ways my experience in Kenya is exactly as I imagined it would be. In other ways, I feel my brain saturated and heavy from all that is new and I never imagined.
Until next week,