Returning to Kenya

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Greetings from Kisumu, Kenya!  If you received this newsletter last year, you may recall it was a weekly edition.  Since I’ve been here for almost three weeks, I feel like I’m either behind in writing or giving you a break from extra reading.  When I wrote last year, it was a natural process to fill my evenings.  I was exposed to so much that I had never-before experienced and writing about it to share with loved ones, helped me process how I felt about the things I was experiencing.  Plus, I was in the middle of graduate school where I was engrossed in coursework on global politics, global health systems, etc., being asked to write essays on my observations.

I am here now under different circumstances with less time to write and less newness to my daily life.  More importantly, I feel a deep sadness to what I am seeing each day from the devastation of the most severe flooding in recent times.  The farms of those I’m trying to work with have been washed away, their livestock all dead, their tools nowhere to be found.  I can’t write about the crazy driving conditions, the livestock on the streets, or fears of getting trapped in a tin-roof building in a remote village during a tornado-like storm again.  I’m still experiencing those things but there is nothing new to say about them and they do not seem unusual or frightening now.  This time, I’m trying to get closer to the storms, so to speak.  I’m trying to measure their impact, through the experiences of the HIV positive farmers enrolled in our study.

My purpose for being here is to conduct a new arm of the larger study I worked on last year, to understand how climate change is impacting agriculture, food security, nutrition, and health and how gender influences coping and adaptation.  And while our study’s main outcome measures have to do with HIV health, we are measuring many other health targets related to reproductive health, child health and development, and mental health.

If you’re interested in daily life in the field, you can read blog entries from my field work last year which are housed on my blog, sixmonthsofair.com.

As I was sharing the news of my grant being funded and preparations for my trip, I was often asked the same questions.  So, I’ll start by answering them.

What does your research involve? 

The work I am doing is a continuation of the work I did for my master’s thesis.  In as short as I can possibly describe this: I conducted research with a long-standing project in Kenya called Shamba Maisha (SM), which means Farming for Life in Swahili.  SM is aimed at improving HIV health outcomes among infected smallholder farmers.  Our model improves HIV health through the pathways of improved agricultural productivity, food security, nutrition and income.  The improvements in these four areas happen through an agricultural livelihood and microfinance intervention that is designed with the specific health, nutrition, and lifestyle requirements of smallholder farmers living with HIV.  The intervention includes farming inputs like irrigation pumps, seeds, fertilizers, and training on sustainable, climate-adaptive techniques.  We also teach about market utilization and financial literacy.

We know health is connected to income, food, and nutrition, and we want to map out and measure exactly how these non-medical factors impact HIV viral loads, mental and reproductive health, and early childhood development in households with an HIV infected adult, and in some cases infected children.  Since 75% of people in the developing world make their living and provide the majority of their household food from smallholder farming, we think this model is an important one to have maximum impact, if we can scale it beyond the 4,000 people (700 participants plus family members living in the same household) involved in our study.

The study I conducted last year identified the specific pathways between the agricultural livelihood intervention and the statistically significant improvements in HIV viral load suppression, improved CD4 cell counts, food security and nutrition, that we measured in our intervention group as compared to our control group.  The control group’s health, food security, and nutrition became worse over time.  The control group does not receive the intervention components but they do receive the same HIV care and medicines as the intervention group.  Illustrating that the molecular components and efficacy of the anti-retroviral drugs are affected by non-molecular components (agriculture, empowerment, mental health) as well as molecular components separate from the drugs (nutritional components).

Through my thesis research, we identified 6 interconnected and reinforcing pathways.  If you’re interested in what those are, email me and I’ll be delighted to tell you all about them!  I think they are fascinating.  This work earned me a fellowship with the University of California President’s Global Food Initiative, enabling me to continue studying these pathways and identifying areas for future studies.  At the same time, I wanted to evaluate if and how the SM model might be adapted for US communities, particularly focused on single mothers living below the poverty level.  I was fortunate enough to be offered a research position in UCSF’s National Center of Excellence in Women’s Health to evaluate this model in the Bay Area.  So both of those positions, have given me the time and the mentorship required for this next phase of my career.

Which brings me to why I am here now.  I wrote a grant for a climate change, gender, agriculture, health study with the mentorship and guidance of two amazing women faculty members, Dr. Nancy Milliken and Dr. Sheri Weiser.  At this point in my new career, nobody is interested in funding me without the mentorship of leaders in the fields in which I’m working.  Much to my delight, my grant was funded, giving me my first primary investigator role in my new field of global health.  Yay!

For the next year, I’ll be evaluating three specific aims through my newly launched study:

  1. How participants in the SM study perceive changes in weather and its impact on their food security, nutrition and health. (Since they are all farmers, climate change is felt fast and hard.)
  2. How participants cope and adapt to changes in weather and the degree to which these strategies mitigate the effects of climate change. For participants in the SM intervention are, we are also evaluating if and how the SM intervention mitigates effects of climate change.
  3. How gender impacts ability to cope with climate change. Mini side-note, women farmers in the developing world are considered among the two most vulnerable groups impacted by climate change.  Women and girls who are refugees are the other group most affected.

We can’t find another paper published that has evaluated how climate change is impacting a specific health outcome, so this is considered very novel research.  We hope this work will pull back the veil on the interconnectedness of climate change on health, and perhaps interest other scientists in doing similar studies to build a body of information on this topic.  Ultimately, with enough data, global policies can be changed.  And I’d say, we definitely need some serious policy changes around how we deal with climate change and help those most affected to adapt.  This picture below depicts how I feel when I hear people deny that climate change exists or that it’s having an impact on people’s lives.

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Who are you working with, what organization?

I work with a team of researchers at UCSF and in Kenya.  Two UCSF faculty, Drs. Sheri Weiser and Craig Cohen began this work in 2008 by partnering with the Kenya Medical Research Institute (KEMRI) and the UCSF-established Family AIDS Care and Educational Services (FACES) clinics across many counties in Kenya.  These partnerships enable us to conduct such a large study (700 participants, 4000 family members, across 16 sites in western Kenya).  UCSF also has a research administration office in Kenya that helps UCSF faculty and researchers with things like procurement of supplies, human resources, payroll distribution, etc.  We have roughly 32 full-time research staff who are Kenyan citizen working on SM.  They keep the study going every day with visits from the UCSF team usually every month, often with more than one of us here at a time.  And as of this week, I’ve just hired my first research assistants who will continue the work after I leave and for the next year.

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One of our 16 study sites where our participants receive their healthcare.

Who is funding this research?

The funding for the larger SM study comes from the US National Institutes of Health (NIH) and the FACES clinics’ funding comes from US President’s Emergency Plan for AIDS Response (PEPFAR), started by George W. Bush.  All of this funding was secured many years ago for this long-term study.  We’re really proud of the funding we receive from the NIH because we are the only study they fund that evaluates how an agricultural intervention impacts health.  The program at UCSF that scored my smaller sub-study high enough to be put forward for funding is UCSF Gladstone Center for AIDS Research Mentored Scientist program.  Once my grant was scored high enough to be funded, I was matched to the Mount Zion Health Fund which is a private foundation focused on addressing social determinants or upstream factors of health for the most vulnerable populations.  I will forever be grateful to the Mount Zion Health Fund as they are the first private philanthropic organization giving me the opportunity to lead a study.

So, now that I’ve gotten all of the nuts and bolts out of the way, I will try to write about life here and my early observations of the data we are collecting, before I leave in a few days.