David Nawrocki at Maseno, Kenya - Chapter 5

Chapter 5   Community Health Outreach Work in Maseno and Luanda: HIV, ARVs and AIDS   There continues to be a tremendous stigma associated with HIV in Kenya therefore many people in Maseno and neighboring Luanda do not pursue the healthcare they need to treat the disease.  Family members in some cases abandon children with HIV.  Life is very hard in Kenya with very limited money and a very high unemployment rate.  People make tough choices every day about the little money they have and how to spend it.  Healthcare still costs money in Kenya although it is pennies compared to what we spend in the U.S.  Community Health Outreach Workers from Maseno Mission Hospital travel by foot to the neighboring villages in Maseno and Luanda encouraging people in the community to seek the healthcare they need rather than face the inevitable death sentence that HIV places on them without immediate healthcare.  Many of the Community Health Outreach Workers have HIV themselves; therefore, they can relate to their clients the importance of getting treatment for the virus before it turns into AIDS.  HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Autoimmune Immunodeficiency Disease).  Antiretrovirals (ARVs) are medicines that help lower the amount of virus carried in your body when you are first diagnosed with HIV.   The Walk Through Luanda   Paroxetes Agara is one of Community Outreach Workers who was recently diagnosed with HIV as well as tuberculosis.  Most of the patients we see at the hospital have complications associated with HIV, malaria and tuberculosis.  She had taken a break from her daily community visits where she walks several kilometers while she was being treated for her tuberculosis with regular injections of streptomycin and working from the outpatient clinic.  She agreed to make an exception and take Helen and me out for a day of home visits since she knew the outlying villages so well.    Helen, Paroxetes and I left Maseno Mission Hospital early in the morning. and walked for several kilometers through the jungle back trails of first Maseno and then Luanda.  We left the backroad trails at one point and came back up on the highway just in time to pass through Luanda center.  Luanda center is filled with outdoor merchants, bicycles, trucks, small fires with pots of oil cooking fish and samosas (fried dough with lentils).  All along the shops there are small children barely clothed playing amongst the abandoned skeletons of cars that once traveled the roads.  The children make up games from anything they find along the roadside.  Shingles, tin cans, plastic cups, automobile tires all become the objects of a game to be played in the hot late morning sun.  There is no trash pick-up or recycling in Maseno or Luanda.  Everyone burns their trash including plastics.  On many days there are several fires producing their acrid smoke that fills the air as you walk the dirt roads.  Most of the cars and trucks operate with diesel fuel.  The exhaust they produce is dark, black and suffocating especially after the third or fourth truck passes by in tandem.  Walking through the township with dozens of Trans African tractor trailor trucks idling in the town square made the walk almost impossible if you wanted to breathe. There was a sigh of relief as we made it to the outer limits of Luanda township. I stopped for a minute, took a deep breath and renewed myself for the journey into the local villages  As we walked through town, Paroxetes continually met clients she knew who were HIV positive and were continually monitored for consistently taking their ARVs so that the medication would keep the HIV virus in check.  We would stop so she could shake hands with her clients, reaffirm their commitment to their medication regimen and more importantly their commitment to life itself.  "Asante-san" as we continued walking.   The Kisumu to Mombassa Highway & the Kenyan Railway   As we left the town center on the main highway that passes from Kisumu to Mombassa, we passed another one of Paroxetes' clients, a middle aged woman who was HIV positive with her eight year old son in one hand and a live chicken with its legs tied in the other hand.  She said that she was on her way to Luanda township to sell her chicken for 380 Kenyan Schillings.  She would use the money to pay for her son's circumcision at the Maseno Hospital circumcision clinic that morning.  (Maseno Mission Hospital sponsors a circumcision clinic once a week and performs the surgery on eighteen to twenty-two boys per week).  She said that the rest of her money after the surgery would be used to buy food for her son and a ride home in a "mutata" (Kenyan minibus that functions like a local cab/bus service).  We said "Asante-san" after talking for a few minutes and continued on our journey down the long steep hill and back up the crest of the next hill.  All along the highway, people walked with jugs of water balanced on their heads.  Farmers tended their cattle with ropes tied to one of their legs.  Little children played in the fields along the roadside smiling as they hid behind the corn crops atop the many hillsides on the other side of the highway wondering why there were "mzungu" walking along the road.  As we reached the crest of the second hill, we turned left off the main highway and walked behind a closed store front until we came to railway tracks that had been laid down during the occupation of Kenya by the British.  The railroad bed was poorly maintained but still functional.  I am told there is a train that passes on the track three times a week from Nairobi to Mombassa and is extremely unreliable and dangerous to travel on.  The tour guide books tell you it is a safe and romantic ride through the Kenyan country side.  The local people tell us that the train ride is anything but romantic.  The train frequently breaks down in the middle of the country and can take hours or days to be repaired.    The First Home Visit and President Barack Obama   Once we walked over the ancient railway, we were on clay path that meandered into crop fields, lush tropical vegetation and dozens of homes that were dispersed deep amongst the tropical foliage.  After three turns in the path with multiple intersections, I became completely lost and totally dependent on our guide.  There were labyrinths of homes and trails that went deep into the countryside of Kenya.  I had no idea how Paroxetes knew which house to go to.  We would simply leave the path and begin walking down someone's dirt path to their home when we were directed by Paroxetes.   Our first client, Evelyn, was a woman who had just given birth.  Evelyn's mother graciously invited us into their home.  Kenyan rural village homes typically have a few chairs, a table and a couch.  If a house has more than one couch, it is a sign of wealth.  Roofs are made of tin.  Pictures of family members can be seen lining the walls along the inside of the home with a Kenyan calendar, and sometimes a poster that reflects the recent election violence in Kenya.  There is also usually some type of poster that describes the election of President Barack Obama in the U.S.  Everyone asks us during our visits about the work President Obama is doing in the U.S.  We have even heard children quote Obama as their president in Kenya out of frustration with their current political leaders.   Evelyn' son was two weeks old.  The mother was religiously taking her HIV medication and her son had already started his medication from the time of birth.  Both mother and son were doing well as long s they took their medication.  The HIV medications will keep the level of virus in their blood at a low level as long as they continue their ARV medications.   Sounds of Life in the Chair   Our second client was an elderly woman named Florence.  She lived in a dirt floor home that had minimal furniture, tin signs, and dusty pictures of family members along the wall who had long since left home or passed away.  The house was dark, cool and musty with dust many layers thick on the wall. Chickens walked in and out of the house at will as we spoke about the status of her daughter.  The house was not unlike the home of someone in America who had aged to the point that they had difficulty taking care of themselves as well as the house they lived in.  Florence's daughter had missed several appointments at the HIV clinic.  As we spoke with Florence, we noticed the quiet sounds of another two week child wrapped in a blanket sleeping in a chair near the end of the table where we all sat.  It was Florence's granddaughter, Marilyn.  Florence reassured Paroxetes that the child was fine and taking her HIV medication.  Concerns were raised for Evelyn's daughter regarding her possible current level of HIV infection since she had not been seen at the HIV clinic for several weeks. The grandmother promised she would speak to her daughter and reinforce the importance of returning to the HIV clinic for medication monitoring and follow-up.   Sounds of Chickens By Our Feet   As we left Florence's house we passed several men herding their cattle and goats down the dirt path we were walking on.  Most livestock interactions were without incident.  Cattle were usually more interested in the grass they grazed on then the "mzungu" walking by.  Kenyans are very proud of their cattle and goats both for their monetary value and visible sense of pride.  We often waited for them to pass before we continued on our journey.  We made several more turns in the red clay covered paths until we walked along a line of corn fields to the entrance of a home where Michael lived with his two sons.  He was HIV positive and had started his ARV medication until he was attacked one night by a gang of youths, brutally beaten, and had his right leg broken.  He showed us his leg cast and stated that he had become more focused on his pain medications and forgotten about his HIV medications.  Our counselor reviewed with him his HIV status and arranged a time that he could come back to the clinic to restart his HIV medication regimen.  The entire time we were sitting in his home, Helen constantly heard the sound of chickens under a basket by her feet in the chair she was sitting in.  After the HIV counseling was completed, I asked Michael why he had chickens under a basket in his house.  He explained that his bean crops were at a critical stage and that chickens eat the leaves of the immature plants stunting the growth of the mature plant.  I asked if we could see the chickens.  Once he lifted up the edge of the basket, chickens went running everywhere and the chase began for the birds through the front door and out into the fields.  I apologized for creating more work for Michael and his sons.  He graciously said no problem, have a safe journey as he reached and picked up one of his chickens by the tail feathers and feet.   Death of a Brother   As we left Michael's house, we met a local community aid worker who joined us for our continued walk.  Her name was Linda.  She was responsible for supporting HIV infected people in her immediate neighborhood.  She led us down paths that even Paroxetes was not able to find.  The paths we walked on were typically at an angle since the land we walked was always on the side of a hill.  Our walking paths were also the drainage paths for the water running down the hillside when the heavy rains came.  I often imagined being lost on one of the many paths and watching the running flood waters coming at me as I scrambled to find my way out of the fields and onto the highway.  Fortunately the weather was in my favor, lots of sunshine and little rain for the day.   As we turned left onto another red clay path we saw a family sitting on a couch outside in front of their house about 25 yards down the path.  The couch was positioned between two homes on the path.  In front of the couch there was a campfire with the evening meal cooking and the freshly covered grave just past the fire in front of the couch.  As we approached children ran to meet us with their father directly behind them.  His name was Lawrence Mongata.  Lawrence invited us into his house and introduced his wife and six children to us.  He commented on how he had just buried his brother outside his house and was blessed that he had "mzungu" visiting in his home.  He said that this was a positive sign celebrating the memory of his brother.  He said a prayer for all of us and then wished safe passage for the white clinicians back to America when they finished their work in Kenya.  He had one daughter who was HIV positive.   He promised her continued compliance with her HIV medications and shared one last prayer with us before we left.  Before we left his property we walked out to his brother's grave site and said prayers and expressed condolences once again for his loss.   The Value of a Life   We continued our journey into the endless clay paths until we came upon a house set deep into the property with multiple cattle tied on the lawn.  There were several buildings on the property used as shelter for the animals as well as other members of the extended family.  There were children three and four years' old gathering firewood, then carrying it under their arms to the building where the family cooking was done.  We were once again welcomed into someone's home to discuss the health of one their children.  They explained that one of their daughters, Ann, who was HIV positive, had been sick for several weeks, had stopped eating, and could no longer swallow.  Helen and I were allowed to see Ann where she slept and evaluate her condition.  Ann was severely dehydrated, mal-nourished and required immediate medical attention in a hospital.  The family was reluctant to go forward with hospitalization due to their financial condition and concern that Ann was HIV positive and had little chance of surviving as it was.  Community Health Outreach Workers spent most of the day convincing the family to bring Ann to Maseno Mission Hospital.  Ann arrived at the hospital the following morning.               Jiggers and the Bishop's Message on St. Luke's Day   Many of the rural homes in western Kenya have dirt floors where children sleep at night.  There are no beds or mattresses in many cases.  The children often become infected with insects from the dirt and develop a disease called "jiggers".  The insects enter their skin while they sleep on the dirt floors during the night and infect them gradually from head to toe.  The disease is often fatal if not treated in time.  Children are washed in insecticidal soap and treated for chronic skin infection if caught soon enough. The home remedy also involves taking cow manure and covering the floor of the house with it.  The cow manure kills the infective insects and makes sleeping on the dirt floor safe again The Rotary Club International of Maseno is currently sponsoring a community awareness campaign to teach parents how to cover their dirt floors with cow manure to prevent their children from getting "jiggers".  Bishop Orchect's annual message which was given on St. Luke's Day (October 19th) also had references to the tragedy of children dying as a result of "jiggers" in Kenya.  He emphasized the importance of better educating parents regarding the disease as he spoke to a packed audience at Maseno Mission Hospital.   Our Final Visit   Our final home visit was with a young woman named Judith who recently found out she was HIV positive and was reluctant to seek medical care due to the stigma of the disease in her community.  She was a beautiful thin woman with a quiet demeanor and a resigned attitude that her life was over.  Paroxetes shared her life story and the importance of not giving up hope and that life was still possible with proper medication and treatment.   As we sat in Judith's living room children playing outside continually poked their heads just inside the doorway to see who the white strangers were.  They laughed and ran back in forth in the afternoon sun giggling in Swahili.  One two year old boy looked inside the doorway with a beautiful engaging smile over his dirt covered face that made you disregard the fact that he was dressed only in a shirt and no pants.  He did not seem to care nor did his friends.  He was proud and happy.  His smile conveyed his sense of confidence as he ran back out amongst the cattle, goats, chickens and cats roaming the yard.   Judith eventually agreed to come by Maseno Mission Hospital and be treated with ARVs to lower the level of virus in her body and hopefully have a second chance at living once again.  As we walked out the front door, the children were waiting for us.  "Hello mzungu, how are you?" The appropriate response was always the same. "I am fine, how are you?" Most children in Kenya only know the English words "Hello, how are you, I am fine."  You hear these words from children in the country side, along the roads, and along the red clay paths that crisscross the sides of the fields and hills.   The children playing in the yard posed for a few last pictures.  Paroxetes, Helen and I then began our two hour walk home back to Maseno Mission Hospital. Paroxetes said hello to a few more clients as we passed through Luanda center.  The late afternoon sun bore down on us as we passed through Luanda and then turned back into the countryside red clay paths to avoid the exhaust fumes of the passing trucks on the highway.