26.07 Mindless ramblings to procrastinate doing real work

In the focus group discussions that I have been diligently typing until my eyes start to cross, one of the questions we asked was about the perceptions and connotations of HIV in the community.

One little tidbit: almost every group said there is no stigma any more, or it is much much less than it used to be, and then came back later and said nobody wants to be seen at AMPATH, nobody wants to be known as HIV+. Isn't that kind of what stigma is?

The more interesting bit, or at least what's been nagging at me is the one word answer of: "witchcraft." People say HIV is witchcraft. This probably seems like a whole and complete answer to the Kenyans actually moderating the FGDs, but if it were up to me, I would want to probe a little deeper. Now, I'm not quite  culturally illiterate enough to picture black hats and pointy noses with warts, but I do know next-to-nothing about witchcraft in Kenya. Everything I know pertains to the Azande (Thank you Anthropology of Religion class) who, if I recall correctly, are focused in Southern Sudan and parts of the Congo. Those aren't terriblyf ar from here, maybe there are some similarities?  And maybe some vague recollections from Things Fall Apart back in high school.

My impression is that essentially every unfortunate thing that occurs can be attributed to witchcraft, and, say, prevention through abstinence just doesn't quite fit into this model. It's not so much a religion, but a way of viewing the world; a perception of reality. Christianization/islamization/what-have-you does little to remove this mindset (it just gets painted over the top.) So if witchcraft causes everything, then witchcraft is probably the answer to everything. And this is where I start to ask more questions.  I know 'traditional healers' and 'herbalists' are still very prevalent here (the focus groups confirmed this), but I don't know if those are two different things or one and the same. In my mind, an herbalist treats with herbs, which may or may not have a tangible physical effect but undoubtedly have a psychological one. "Traditional healer," on the other hand, can mean very different things in different places, depending on what the "traditions" are. I suppose it could be an herbalist. But it could also be a witchdoctor or shaman dedicated to unearthing and reversing witchcraft and bad spirits by poisoning chickens, leading ritual healing dances, or traveling to other worlds (again, thank you Anthropology of Religion). I get the impression that the non-herbal aspects of these traditions garner their efficacy by treating the psychological basis of maladies, and idea that "modern" medicine (side-note: this is called "conventional" here, as opposed to "traditional", though Microsoft Word insists that these are synonyms)  is just recently starting to pick up on.

I have no desire to malign traditional healing or witchdoctors in general. At least among the Azande, it goes something like this: anyone can perform witchcraft simply by thinking unkind thoughts about someone else, and it is often unknowingly. Man 1 goes to witchdoctor convinced someone is cursing him, his crops just aren't doing well. Witchdoctor (this is a small community, most people probably have a good idea of where the rifts and arguments are) performs some ritual to determine that Man 2 is the culprit. Man 2 is approached; he really can't argue with the accusation because one often curses without ever trying to. In an effort to stop himself from doing witchcraft and requiring retribution, Man 2 tries very hard to only think the best of Man 1. Both men try to think warm thoughts about each other. Minor disagreement becomes unimportant; group/tribe/community remains cohesive.  Advice is also sought before making major decisions. Witchdoctor is able to see how this may affect the whole community and his ritual simply helps the supplicant make the decision most conducive to the health of the group. Pretty baller system actually.

And health-related traditional healing methods with absolutely no basis in physiological science have been shown to have an effect.  Maybe it's like the placebo effect (personally my favorite drug) with some added flare. Maybe it really does release the evil spirits.

But I sincerely doubt it has much efficacy in HIV, aside from relieving some stress. But with a disease so insidious that actually, scientifically, has some association with promiscuity and illicit drug use and which rampaged across this continent with a vengeance, I can kind of see where the witchcraft label would come from.  Add a tradition of witchcraft beliefs, and, geez, I'd be running to the witchdoctor instead of AMPATH too. Basically, to end this ramble, this whole improving linkage and retention campaign is a lot more complicated than it seems at first glance.

Posted at 18:51

23.07

One of my co-workers skips breakfast every morning, and is therefore desperate for snacks with her tea at 10:00ish. Every day. I suggested once that she should try to eat a little breakfast. Her answer was that she is not hungry in the morning. She starts to get hungry after arriving at work, so she buys samosas or mandazi to have with tea. My explanation of my tactic of eating breakfast to prevent hunger led to one of those "you crazy American" looks that I'm learning to kind of love. Granted, skipping breakfast is not an exclusively African trait, but it serves as an analogy for a general mindset.

This is the culture that we're trying to convince to care about hypertension, an often asymptomatic disease until it's too late. Except heart attacks and strokes are a little more significant than mid-morning hunger pains.

Posted at 18:48

please reserve judgment

Here's a little story I heard today. I was going to say "nice little story," but facetiousness does not come across well in writing and I should really stop mis-using words:

Woman in her twenties gets pregnant, should start ante-natal care. She is a regular visitor at Cardiology Clinic, probably rheumatic heart disease that will not be helped by pregnancy. She's unmarried, still living at home because that's what women do. It is nearly impossible to get a good enough job to support yourself without an education. Father gets rather angry, refuses to support her. Talks to her boyfriend: he doesn't have enough money to help her.  She comes into Cardiology clinic, doctor asks, "So, how is the pregnancy progressing?"  Her only reply, "there is no pregnancy."

Posted at 08:13

Umnumnumnum

So it took a few weeks (  :/  ) but I finally have lots of work to do.  And of course, the busier I get, the fewer things I have to write about. Hence, few posts. I doubt anybody wants to hear about the thrills of searching for information about diabetes and hypertension in Kiswahili, with frustratingly slow internet. Or, better yet, trying to find culturally-appropriate information; it seems kind of pointless to say "eat less pasta" to a culture that, by and large, doesn't eat much pasta. Though actually, maybe this gives me an excuse to talk about food, my favorite subject…

Actually, food ties in rather well to some of the work I'm doing with hypertension and diabetes (both under-recognized and growing problems here.) It's unfortunate, but I get the impression that food was both more nutritious and better tasting 50- 80 years ago.  As much as I love corn, I hate what it does to diet. Much like America, it has become far too much of a staple. Here, it's ugali: corn flour and boiling water. High calorie, low nutrient food that may easily be ¾ of the plate. But it's cheap (I actually don't understand why- it can only be harvested once a year while some other plants can go through at least three harvest cycles). There is an alternative. Brown ugali is made with, as far as I can tell, millet and sorghum and some other things (I pretty sure there were four grains mentioned). So it's less-processed and has more nutrients. But I have yet to eat it, whereas maize ugali is unavoidable.

 Typically, ugali is served with some beef stew and a small portion of green leafy vegetable-of-choice. This ranges from sukuma wiki (which they say is kale but it seems mis-translated as sukuma has little to no nutritional value) to managu (nightshade leaves) to cabbage (cabbage). There are at least a half-dozen other greens to be found in the market, but those three seem to be the ones I encounter most often. They are, of course, cooked in oil and smothered in salt. There is a group in FPI that is working with mboga kenyaji (native Kenyan green leafy vegetables), researching and training farmers on better techniques. I do love projects that work on multiple levels: economic empowerment AND diet improvement.

An alternative meal is githeri: beans + maize + whatever else the cook feels like adding, usually potatoes. It's usually pretty tasty, but today my portion had 2 pieces of carrot and that was the extent of the vegetables (no, maize is not a real veggie).

And combining pilau (a general term for any spiced rice dish that varies greatly depending on who makes it) with chappati (an unleavened Indian-style bread with approximately as much oil as flour) is the excepted norm. Carb + carb=yummy, but you may be starting to understand why diabetes is an emerging problem. 

Chappati, too, can be made in a 'brown' form. Simply add whole wheat; I've done it. It's not difficult, yet it's not common. My guess is it is more expensive or harder to find.

Mid-morning and mid-afternoon is tea-time.  Which is kind of nice; I won't complain about scheduled snack breaks. To clarify though, tea here is "chai": half-water/half-milk (whole milk of course) as the base and approximately two tablespoons of sugar per cup. A common accompaniment is mandazi (a deep-fried dough concoction not unlike a plain doughnut). Or, at one of the training sessions I observed, the tea served immediately after the lecture on proper diet came with 3 slices of very white bread with Blue Band (~margarine). Lunch that day was half ugali, with chicken and beef and some greens. There were complaints that the traditional soda had been replaced by bananas. Again, this is at a training session on hypertension and diabetes!

I have not personally experienced this, but I have heard stories of many lunches consisting of orange Fanta and white bread with Blue Band. I can't imagine that is even the slightest bit filling, but it will raise your blood glucose. Which, at times, is all you need. But in someone at risk for or in the early stages of diabetes, it's probably not a good call.

Needless to say, diet education here will be no less difficult than in the U.S. and changing the diet may be even more difficult. Try telling someone who has always grown maize that it is not only a poor crop choice economically in many circumstances, but it's also just not something you should be eating.

I could rant all day about food and diet and still not say everything I wanted to. So I'll leave you with just that taste (hehehe) of what I've seen here.

Posted at 00:00

Underappreciated talents

At the risk of generalizing to the point of stereotyping, I have noticed a few talents that seem to be quite prevalent here. Obviously, they don't apply to everyone, but they are noticeable.

  1. Maybe jembes are just better than shovels, but ditches get dug very efficiently here. In a day, a 3-foot deep, 10-inch wide, block-long crevasse can just appear.  These tend to be for laying telecommunications lines, but I imagine that a really concerted effort to expand and revamp water, gas, and sewage lines could be completed faster (even without the use of heavy machinery) here than anywhere I've been.
  2. We've started a sort of game, wherein we share stories of the craziest things we have seen carried on the back of a bicycle. It's a bit of a competition of who can find the best. Cargo ranges from the logical to the completely unexpected (which is usually still logical upon reflection). Some things that can be transported by bike: a passenger (or 2 maybe 3), two bushels of coal, a stack of firewood 6 feet high (contained between vertical poles), 7 crates of bread, ~ 100 chickens, 7 mattresses (7!), grasses to build a roof, and a lawnmower. All of these things need to be transported, and I guess a bike is faster and easier than walking with 7 mattresses. But from the perspective of someone who has trouble balancing with just herself on a bike: that takes talent.
  3. For a place where most of the roads are dirt (well, mud), people and things stay remarkably clean. Shoes can be deftly wiped on any spare patch of grass or exposed grate. Car washes spring up next to every area with flowing water. Shoe shining is a booming business. People wash their motorbikes in ditches. And I have yet to figure out the other tricks. The bottom two inches of every pair of pants I have is stained slightly red; I can't avoid it. Yet no Kenyan seems to have that problem.
  4. Kenya, and this region in particular, are known for producing a disproportionate number of phenomenal marathoners. But I'm pretty sure they could field an Olympic speed-walking team straight off the street. For a culture this relaxed about timeliness, a startling number of people burn by me without even looking like they are trying to walk fast. Disclaimer: this is only a small minority; most walk agonizingly slow.
  5. They can turn about anything green and leafy into delicious food. Even pumpkin leaves.

Call it resourceful, creative, practical. Basically people everywhere will find a way to do what needs to be done.

Posted at 09:17

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