she complained of chest pain because a cow kicked her the day before.  Not something we see much at home!  Anyway, we gave her some ibuprofen and perhaps she’ll feel better for a couple of days.  We can’t exactly tell people to put ice on an injury given that they don’t have running water or refrigeration.

On Tuesday we went to a site near our old driver’s home.  There were some issues with the adults showing up so we got a bit mixed up from our routine and it really agitated me in the morning.  However, we managed to pull it together and finish well.  People at this site were pretty well off, which hasn’t been the case in the past.  I am not sure if this means that life is improving in the area or if we are pulling from a different group. 

On Wednesday, we went to a site that is on top of a large hill.  It has a beautiful view of the sugar plantations below.  I always enjoy this site, not only for the view but because cows pass by occasionally.  At this site people were generally healthy, which means we start to see higher blood pressures.  It seems that the sugar plantations increase people’s wealth enough to increase their likelihood of getting chronic diseases.   Andrew enjoyed watching the cows at this site and started saying moo.  He’s picked up several Luo words, gweno for chicken, n’ago for “what’s up”, toto for baby.   Elizabeth has really learned a lot of Luo; she asks all the children how old they are and can understand their answer.  The children and elders seem to really respond to her.  There was a little boy at this site that kept giving her and some of the rest of us googy eyes.  It was cute.  At the end of they day, since we finished so early, we walked down the dirt road to meet the vehicles at the main road.  It was nice. 

Thursday started out pretty well, had elders and children on time and we were very close to Ahero so we started early.  Unfortunately, Andrew had a fever and I had to leave the site early.  I heard that it was hectic after I left but otherwise went well.  The team, American and Luo, all seemed to pull together and work hard to get the job down.  Amy did a good job at running the show in my absence.  So Andrew got tonsillitis and starting with Denise on Monday, one by one we all got a cold/flu.  It is their “winter” here so it is cold and flu season.  It has been tough, people working when they haven’t been feeling great.  I took Friday off also so I could take Andrew to see Dr. Allibhoy.  It is really nice being able to call him any time, day or night and he saw Andrew first thing Friday morning.  I gather that things went well on Friday. 

On Saturday, most of the girls went to the Kakamega forest.  I hear that they had a great time, saw lots of monkeys.  Chelsea went to Ahero where she met with members of the group, Lagnet.  It is a group that has a center for teens to go to and they have been working hard to raise awareness about HIV/AIDS.  Chelsea got to see one of their plays.  Prior to coming to Kenya she managed to get 2000 condoms – all donated to bring here.  She was able to distribute them to various places with the help of the Lagnet team.  Given her interest in reproductive healthcare, Saturday was a great experience for her.  Amy and I rested and also went to the tailor to get our African outfits made.  Supposedly the tailor is going to have all of our clothes made by this Sunday and she is determined to have no alterations.  My prediction is that we will be getting stuff as we leave Kisumu but…..

Sunday was a restful day for all of us.  Brenda (one of the fieldworkers) had all of us over for an early dinner.  Chelsea and Katie went early to learn how to cook the food.  It was a great feast – the best fried chicken I’ve eaten, green grams, kale, pilau, chapatti, fish, ugali, pudding (which is really fruit salad), mandazi (fried dough) and chai.  It was wonderful.  Her family is always so generous to us. Andrew was fascinated with the neighbor’s son who was probably about two.  He kept following him around and then the boy got scared and ran in his house crying.  Andrew tried to go into the house after him.  He also had fun chasing chickens around. 

Monday, we were back to work.  We got a late start as we waited to get into a building to work and most of the elders didn’t show up.  We worked with mostly men that day.  They generally seemed in good health, well or over nourished.  The work went well but at the end of the day, Jaja informed a couple of the girls that some of the things they have been saying have been offensive to him and some of the Kenyans.  One of the things that is so challenging for students (and me as well) when they come here is learning to deal with the slow pace and general confusion.  It often seems that we spend a lot of time waiting for no good reason.  Very often when you think you know what is happening, you really don’t and things happen in the opposite way than what is expected.  You have a long conversation with someone, thinking everything is clear; only to find out later that what you understand about the conversation is completely different than what the fieldworkers understand.  So to deal with this frustration, the girls started a running joke that the number one rule is we are in Kenya, where things don’t seem to be what you would expect.  When such a situation happens or someone asks, why we are sitting in the van for no reason, someone says K1 for Kenya rule #1 or TIA – which I gather is from the movie Blood Diamond.  Jaja confronted a couple of the girls about this and it really upset them.  It upset them because they didn’t think they were being derogatory – just that it was a way to deal with life here when it seemed to be out of your control.  I think students generally have trouble with the total lack of control and the seemingly constant chaos.  I often do as well.  Anyway, they were also very upset to find that they might have offended people.  We had long discussions about it and I had planned on having a group discussion about the issue on Tuesday. 

Tuesday, we got tragic news.  I was home with Andrew who still wasn’t feeling well.  One of the Kenyan women got news that Agness, one of our fieldworkers, lost her 8 month old son late the night before.  He had been sick with diarrhea and vomiting and had been to the clinic but late at night he took a turn for the worse and they couldn’t get him to the hospital because we had a bad rain storm and the roads were impassable.  The news hit everyone so hard.  One of the girls called me to ask what to do about working.  My response was to do whatever is culturally appropriate to do – ask the fieldworkers and go on from there.  The problem was that clearly, there was no one culturally appropriate response and their seemed to be different opinions – largely across gender lines.  My understanding was that most of Luo women were too upset to work and felt that they needed to be with Agness.  The men felt that we should work.  They all went to Agness’ house to see her and the baby’s body was laid out on the floor in front of Agness and her husband.  The American girls were crushed by the experience.  When they came back, it was commented that the sound of a mother’s cry is the worst thing they have ever heard.  So, I got several more calls from the Americans asking what to do, telling me what was going on and they felt extremely frustrated because it seemed that the Luo women were not being heard (not that they were speaking out) and that the men were being harsh.  I called Jaja and told him that the day should be canceled as should today since that was the day of the burial.  He thought that we should work yesterday for a number of reasons as did the men and some of the women.  The American’s clearly couldn’t handle it and felt that they were being accused of being pushy rather than just really upset by a heartbreaking situation, with which they have no experience.  So, this conversation went on and on until finally, they did call it a day and came back to Kisumu.  Everyone remained frustrated and shaken by the day and the tragedy.            

Many of the girls felt like they couldn’t bear to be at the funeral after their experience on Tuesday, however, Edna informed us that it would be expected that we go.  Most of us went today.  When we arrived at the homestead, a tent was set up and music was blaring from a huge speaker hooked up to a generator.  Agness and her husband were in their home with the baby still laid out on the floor.  We all sat under the tent.  It took a long time for the ceremony to begin as people came and went in to view the body.  I was asked if I wanted to go in and I just couldn’t.  I hope that I did not break some kind of custom or offend anyone but I just didn’t feel like I could handle it – too close to home.  Then a man rode in on a bike with a small coffin which was wrapped in velvet.  They brought into the home and we could hear singing while the body was placed in the coffin.  Eventually Agness and her husband and family came out and the funeral began.  The service was conducted by a Seventh Day Adventist minister and was directed by a close friend of Agness and her husband.  Several relatives got up and spoke.  Agness’ mother came and spoke and thanked the elder of the homestead for allowing her to attend.  When the elder spoke, he thanked all of Agness’ family for coming to the homestead despite the Luo tradition and emphasized that they should be free to come whenever they like.  Many people spoke that this was God’s plan and that Agness will have more children.  I wondered how that could be comforting – new children couldn’t possibly replace one who has died.  Several people also mentioned the Americans coming and thanked us and Agness’ father-in-law actually brought up our project and told us he wanted to discuss a change in location.  I felt horrible that because of us, Agness had to sit through a longer ceremony that was largely irrelevant.  Everything was translated into English, further elongating the service.  I would have been happy to just sit through a Luo service.  Agness remained fairly stoic until one of our team members spoke.  After many speeches we all went up and shook hands with Agness and her husband and family.  It broke my heart.  After that the minister spoke and got very animated and seemingly right in Agness’ face, who at that point was truly struggling to get through the event.  He told Agness that she had to stop crying now because there was someone who lost more and he told a story about someone who lost all of his children and he spoke to God about it.  I don’t know it was a very confusing, loud and long sermon which was seemingly a mix of Christian and Luo lessons.  I just kept thinking, how is Agness getting through this?  After the sermon, they went on to the burial.  For some reason, we did not go to this.  I had told Jaja that I didn’t feel well and that I needed to make it as short as possible so I could get back to Andrew who was at the hotel with Katie and Denise.  He had to speak to the elder of the house who has to dismiss us before we can leave.  It was important to him that we eat before we leave, so we ate while everyone went to the actual burial of the child, which was on the homestead.  It felt wrong and was difficult.  Before we left, Amy, Brenda and I went to say goodbye to Agness and to give her some money we had collected to assist with the burial expenses.  She was concerned that we got something to eat before we left –wow.  As we walked away, Angess’ sister pulled me aside to ask me for the OMM tables that we use for the physical examinations.  I don’t even know how to describe my feelings with that one.

When we got back to the hotel, we all did what we had to do to deal with the experience of the day.  I spoke with Brenda and heard more about the feelings of the Kenyans and the different accusations that have been going around.  This could really divide our team and is totally unnecessary.  I feel like in all the mess that happened yesterday, it was lost that Agness suffered a great loss and we all had a hard time with that.  Tomorrow, I will have to start the day talking to the whole team about being tolerant and supportive of others.  Hopefully, we will have a brighter future as a group, although it will be hard to move forward given the loss of Agness. 

Gillian

July 10, 2007 

Sorry I haven’t been able to send any detailed updates.  The internet connection at the hotel has been pretty good, I gather but I can’t seem to get up to the lounge for the connection.  Once I do, the internet seems to always be down.  Anyway, we also had an incredibly busy and exhausting first week.  Everyone is healthy, although there is the usual GI distress and emotional adjustment. 

The first week is always chaotic but has been particularly so with the added component of Amy’s dissertation project on children.  Despite very detailed instructions and weekly calls to our field coordinators the three months leading up to the trip; they did not complete the tasks to properly recruit the elders and children for this year.  We went with what we had and selected from incomplete rosters, with only half of my previous year’s sample and hoped for the best. 

For those of you new to the project, let me tell how things are supposed to run.  We leave the hotel at 7 am; we arrive in Ahero, a small town 30 minutes from Kisumu, where we pick up the field workers.  Then we pack up the van with food supplies and people and head to a site somewhere in the interior.  We hope to arrive somewhere between 8 and 8:30, preferably with participants waiting for us.  We set up at a school or church but most if not all of us work outside, with sheets of plastic set up for the physical exams.  We set up stations and we pair up to work on various tasks.  Jaja (and now also a fieldworker) works on determining the sample based on who shows up and allow us to meet the various study criteria.  Once he does that he goes through the process of getting consent and assent from children.  They then go on to get a height and weight (this was an adjustment in process, which has helped us move along a bit faster), and then they have a finger stick for glucose and hemoglobin for the elders and just hemoglobin for the children.  We load the elders with a glucose bolus and reassess them in an hour.  After that they go to whatever station is open, including: clinical history, physical exam, interview, 24-hour food recall, anthropometrics and on the first two days function testing for elders and blood pressure for children but we just weren’t able to accomplish that with our current team.  They are fitted with an Actical, which is an activity monitor which estimates energy expenditure during the physical exam.  After we do all the research, we gather orphans from the local schools and hand out shoes and mathematics sets.  We have between 50-150 orphans per site.  We also give the schools a soccer ball and jump rope.  The next day, two people go back to the previous day’s site to go to elders homes to watch what they do and what they eat.  Edna Wangui, from Geography, also goes to a couple homes for additional interviews on livelihood.  In the afternoon, those fieldworkers collect acticals and saliva from the elders for cortisol analysis.  

Monday, the majority of my sample, for which we had no advance data on children, showed up but it was going very smoothly in the morning.  I could sense this was wrong and then at around 1 when the children were supposed to show up and they hadn’t, all hell broke loose.  Jaja was overwhelmed, Amy was understandably nervous and I was just trying to move things along.  We only ended up with 6 children (we were supposed to have 22).   So, we spent most of the evening trying to figure out how we were going to figure out how to remedy the situation.  We decided to unlink the projects so that we could both retain my sample and recruit enough children for Amy.  Where there is overlap, great but, we have to maintain integrity of each component. 

So Tuesday, we got to the site late, which is pretty typical pretty early in the season before the fieldworkers get second or third, be on time and don’t waste time in Ahero pep-talk and there were no children.   Jaja sent someone to get 50 kids so we would ensure that we had enough 7-11 year olds of the proper mix of orphan/non and girl/boy (we decided to work with 25 children per day to make up for Monday).  Well, they showed up with 80+ and more chaos.  On top of that, people weren’t being moved through the stations so a bunch of us spent a lot of time sitting around waiting in the morning and the palm pilots, on which we collect our data, were dying and everyone was just plain overwhelmed.  We finished up at 6, all completely exhausted.  We had to make further adjustments, which is when we decided to drop the function testing and blood pressure on children.

Wednesday we couldn’t go to our regular site because there were heavy rains the night before and the road was impassable.  Instead we went to a school next the road and asked the elders and children to walk to us.  As a result we had to wait for them to show up and started at 11.  No children were there in the morning due to additional confusion over what we were supposed to do from the fieldworkers – this is a theme here.  Anyway, we managed to get through 23 elders and 25 children by 6 with less chaos then the day before but it was thoroughly exhausting.  Luckily, the students felt good about the experience despite the fact that they were tired. 

Wednesday night it rained again and as a result we were not able to get to our site, Masara (Dr. Bonyo’s village) because the roads were impassable.  It would have taken too long for the elders to come to us and it would have taken us at least an hour to walk with a great deal of equipment.  So, we cancelled the day and will reschedule for the end of the trip.  I think everyone was relieved as they were so tired and Amy and I had a chance to catch up on some of the work that we just haven’t been able to finish at night.  We are already each staying up until 12 or 1 to get ready for the next day.  Two of the fieldworkers and Edna and her field assistant still went back to Wednesday’s site and had to wade through water, sometimes thigh high to get to the participants.  Florence, one of our new fieldworkers told me that it was a day that she’ll never forget.   

Friday, they day went more or less as it should.  We got to the site by 8:15, almost all of my elders were there and so were children.  We all worked hard and managed to finish the research by 4:30.  We had two extra fieldworkers who would have typically been at the previous day’s site but I think we will manage to get on that pace by the end of next week as people become more comfortable in their jobs and spend a little less time socializing in the morning.  (That is assuming the elders and children show up on time).  

So that is generally, the events of last week – already behind for the next week.  Because we are so busy in the field, much of it is a blur to me.  We have seen many adults and children who are severely malnourished, worse at some sites than others.  Most of the children have worms and fungal infections.  Chelsea has been cleaning out a lot of ears.  I hear that one child had about 12 ants in his ear.  The first year medical students have also gotten so see many of the examinations.  We have two new excellent clinical officers assisting us with the physical exams.  On Friday a woman brought her infant – maybe a year old, which had a severe burn on her arm.  Before I saw the child, I was beginning to give my standard line, we don’t provide treatment and then I saw the child.  I had to send her in to the clinical officer and Chelsea to see if they could do anything.  One of the clinical officers cleaned and debrided the burn and sent them home with lots of triple antibiotic cream and bandages.

I have amazed myself at how much Dholuo I remember.  I can’t remember any of it at home but as soon as I get my skinfold calipers out, it just comes back to me.  The elders find it amusing, except when they ask me something complicated and I am at a loss.  All of the students are slowly picking up terms and seem to be enjoying interacting with both the children and elders.  Talk about trial by fire thought!  Andrew (my 18 month old son), seems to have adjusted to the babysitter who is in the field with us.  He holds court everyday as the kids circle around him, as they are fascinated by the mazungu baby.   He’s frequently also entertained by the drivers and the rest of the field team.  While we were waiting to get started on

In the evenings, Chelsea has been cooking for us.  I feel like we’ve been eating healthier than I ever have.  Actually eating lots of vegetables and not eating too much fried food.  Amy gets “egg in a hole” every morning.  

Much more to say but at 3 pages, I should probably end this.  Everyone please keep in touch, I know that many of the students are feeling home sick.

Gillian