Sunday 8 July 2007

Throwing Back the Starfish

A fisherman was walking down the beach just as high tide was rolling out. The tide had washed up thousands of starfish onto the sand, and now, as the waters repealed, the starfish were left to wither away in the hot afternoon sun. As he walked along he noticed an old man picking them up one by one and tossing them back into the ocean. The fisherman laughed to himself, wondering what this man thought he was going to achieve by saving maybe a handful of starfish out of the thousands left stranded on the beach. He approached the man, and asked him that very question. “What are you doing old man, don’t you realize your efforts are futile, you can’t possibly throw back all these starfish, you can’t possibly save them all.” Your right said the man, but I can save this one. And with that, he picked up another starfish and threw it back into the ocean.

The “parable of the starfish” illustrates the incredibly important concept of the “power of one” to do good in the world. For me, it has been a driving force in my studies and work. To wake up each morning confident in the fact that a single human being can achieve great things and create change in the world, in the vein of Ghandi, Paul Farmer, or Joe Mamlin, is an incredible inspiration. And at the same time, knowing that helping one person really does make a difference--a la throwing back one starfish out of a thousand, providing one family in the slums with a mattress and blanket, one child with school fees and a uniform, or one patient with life-saving medicine and treatment--gives me confidence that my efforts, although miniscule in the grand scheme of African poverty or the HIV/AIDS pandemic, are not without effect. The principle holds true not just in Africa, but in all acts of citizenship or social service in which efforts may seem like a drop in the bucket--i.e., donating one pint of blood to the Red Cross, publishing one scientific paper in the vast body of knowledge, making one small donation to a charity, or casting one vote in the upcoming elections. For me at least, there is nothing more peaceful, nothing more affirming, than consciously NOT allowing my ideas and my efforts to be consumed by the sea of vastness which seems to be our world's problems and issues. Last year, I heard George Bush Sr. give a speech at Butler University, and the championing of the individual to make the world a better place was his central premise. We live in a collective society, and if it wasn't for individual efforts, if we didn't help one person or solve one issue at a time, well...where would we be? I've heard too many people use the logic that 'if you can’t help them all, then you can’t help one' and frankly, to use that logic is just plain stupid, if not unconscionable.


(I'm indebted to my new friend Chaz for the starfish parable. I've kept this 'power of one' concept at the forefront of my mind for many years now, but it wasn't until a discussion one evening with Chaz that it was put so eloquently into story form. A future colleague in medicine, he's been in Eldoret a few months now doing some anthropological fieldwork which he'll continue in the fall at Oxford on a Rhodes Scholarship).

Saturday 7 July 2007

Children of the Street

“It flies with whatever it finds.”
-Kikuyu saying

Mwangi, one of my good Kenyan friends, told me this expression one evening, which comes from his tribe, Kikuyu. In most contexts, it refers to the fact that in the rural areas, whenever visiting someone in their home, usually family, one must always be served food and eat. Kenyans are extremely hospitable and always try to serve visitors something. The saying basically echoes the sentiment that you never pass up a meal if it is offered to you, stemming from a country and a culture that has grown all to used to uncertainty. Mwangi laughed, as he told me stories of visiting all his aunts and having to eat nearly six meals in a day. But for me, in my time I’ve spent here in Eldoret with street children, the saying took on a whole different meaning.

“I saw you out in town today, talking with many of the street boys,” Daniel said to me, one of the dishwashers at the IU house. He asked me how I did that, how I related to them, what made me go out there and hang out with those street boys. He was genuinely and warmly curious, but also a bit incredulous. “I fear them,” he said to me. His sentiment echoed that of most Kenyans, in fact of most working or middle or upper class people in developing countries, and certainly nearly all tourists and visitors. They see street children, and they turn the other way. One can hardly blame them, I did too my first time here. As a social class—more aptly described as a tragic phenomenon of the developing world—they are at the very bottom; the lowest of the low, poorest of the poor. They are kids who beg, steal, live among trash, eat rotten thrown away food, wear rags for clothes, sniff glue, and wander the streets, some with their belongings in burlap bags slung over their backs, some with no belongings to sling. In a meeting I had with the District Children's Officer of Eldoret the other morning, he told me that "street kids are a forgotten lot." The developing world, Africa, Kenya has many problems, and for too many, street children are not a priority.

But street children are just kids, and as “just kids” they also just like to play and laugh; they have warm hearts and know the values of friendship and caring; they want to eat a good meal; they want to go to school or get jobs; in the 25 or so boys I met today, I didn’t hear one say he loved his life on the street. No one made the choice between food-clothing-shelter, a good home life, and living on the streets. It was a choice that was in all reality already made for them, by poverty, by AIDS, by orphanhood, by abuse, by family struggles. These social conditions, and others like them, poured their glass half empty, not half full. They were born into a family or situation with a predilection for this life…and now, here they are.

Virginia and Margaret, two of the Community Health Workers (CHWs) who work in Langas stopped by the OVC office at the AMPATH centre in late morning and we set off for town. First we had to find Kumau a total orphan who is now 27 but still living on the street. He arrived in Eldoret in 1992, displaced from his rural home by the ethnic clashes of the early 90’s that took both his parents’ lives and, for all intents and purposes, erased the hope of regaining his father’s land to which he was culturally entitled. He had training to work as a carpenter, but because he was displaced and had no documentation, he was unable to get a Kenyan ID card. Without a Kenyan ID card, you could be a Kenyan citizen, but you could also be a refugee, and therefore getting a job is next to impossible. Kumau was a leader of sorts among the street kids, and by walking with him we were free from being harassed by other boys, and also privy to their hangouts, to their world. We entered through a building on one of the streets in town, went down a set of stairs, through a hallway, and then were spit out in an alley behind the building. It was a bit remniscent of Harry Potter entering Diagon Alley, except instead of a street of magical wonder, it was a garbage filled, muddy back alley, lined by shops housed in wooden shacks…and street children. We encountered the first group among a huge heap of garbage, covering the hill extending from the street above. Some areas of the garbage were being consumed by flames. As we approached, boys came and gathered around us. Virginia, an amazingly strong woman, began talking to them, and I reached out and extended greetings to as many as I could. I just wanted to begin building trust, building relationships, making my face known to them. I chatted in my extremely limited and broken Swahili, and in English with some of the older ones, which was similarly limited and broken on their end. We walked from the garbage hill along a foot path which led to another alley. Several of the boys followed us and we met many more along the way. Halfway along the path we stopped at one of those wooden shacks; we had arrived at Steve’s place, a small paper recycling business where many of the street children hang out and sleep. One of the boys, Charlie, probably 6 or 7 years old, hung on Virginia like she was his mother. He had the best smile. At Steve’s place, we sat on large bales of recycled paper, talking with more boys, finding out some of their stories. There was nearly one universal: all of the younger ones, who made up the majority, wanted to go to school. Milton, who had dropped out of Class 8, wanted to return so he could take the Kenyan national exam in November, that all kids take before entering high school. I scarcely let myself think what he would then do after taking that exam; free education stops after primary school in Africa. Dennis, clearly a bit of a loner among the street boys, was much cleaner, wore clothes that really resembled clothes, and was quite shy. When asked, he admitted to never trying glue. He had been on the street nearly a year, and he wanted desparately to leave and go back to school. Anywhere he said, even the Rescue Center. Jackson and Chunu were older, rented a one room place together in Kumukunji, another slum, and both desired training as a mechanic; both their parents had died, and like so many, were forced on the street for lack of a better option.

At least half had the familiar small glue bottles hanging from their lips, a few hiding them in their shirts. The glue staved off hunger and erased their memories of pain; it did NOT feed a delinquent addiction. They were dirty, not dirty from a day of playing in the mud, but from months or years of sleeping in the dirt. They all wore familiar tattered gray and beige and black rag-clothes. Their eyes were curious and almost all would smile when greeted or smiled at. None were threatening; none were harassing; none were violent; very few openly begged to us, except for a few whispers from the unbearably cute one, Charlie, who asked for 20 shillings. Many of them sat around with us, others played and wrestled just like little boys do.

As we left, four of the boys followed who had been with us since we arrived at the garbage hill a few hours before—three of the little ones, and Milton. One of the little ones held my hand, practically skipping as we walked. These were the kids most people vowed as delinquents, kids most turned away from, kids most people were scared of. But they were just kids, kids who had fled from their home in search of a solution or a better life. They were hungry, but we refused to give them money. Rather, we took them to a small hotel (cafĂ©) and bought them lunch. Ugali, sukuma wiki, and pork for each. They all washed their hands before eating, sat down, and grinned from ear to ear. Soon their bellies would be full. It cost me 120 Ksh to feed the four of them. A dollar and a half.

Thursday 5 July 2007

Wako hapo tu

Wako hapo tu

In Kiswahili, wako hapo tu, translates to "they are there continuously", or more colloquially, wako tu, means “just there.” That is the expression for too many people living in the urban slums of African towns; places like Langas, Huruma, and Kumukunji, the slums surrounding Eldoret, where I have spent most of my time while in Kenya this year. “Just there” is the state of existence for too many people living here. They are just there. Just existing. Many are sick, all are poor, and too many have just given up. They are just there.

I rarely let my emotions take hold of me when visiting place like this. Partly, because I feel like they interfere with my ability to understand and to help; partly because I’ve been here before and have seen many, many people in dire straits; partly because I have dedicated my life to helping people in poverty so being overwhelmed by emotions every day would make for an utterly fruitless career; and partly because I feel my emotions are irrelevant compared to the suffering to which I’m bearing witness. But Wednesday evening, after a long day in Langas, I was on the verge of tears. For a moment, I felt myself start to break down. I needed an outlet, I needed to scream out loud that I had just visited 8 homes taking care of 56 orphans, hoping someone would hear, hoping beyond all hope that something would be done about it. Luckily I found Ken, my best Kenyan friend. We probably talk at least twice a day on ways to solve Africa’s problems, but tonight, we could barely muster a discussion. He looked at me and told me I should take it easy. “Don’t get overwhelmed, don’t overwork yourself, or you won’t be able to do anything,” he told me. “I’ve seen too much of what you saw today and I know it’s awful. These people, their lives, it is so sad. Wako tu.”

On Wednesday, the 4th day of July, as America celebrated its independence day, I trudged through the mud in Langas making home visits with two amazing community health workers, Virginia and Veronicah, to households caring for children orphaned by AIDS. We visited eight homes. Those eight homes housed a total of fifty-six orphans. I realized this staggering number as we walked, but I pushed it out of my mind, focusing instead on the faces in front of me. It wasn’t until I looked back at my pictures later that evening and did the math that my jaw, stomach, and heart all dropped. The day before, while in Huruma, Veronicah said to me jokingly that we could go door to door for two weeks in each of the slums, eight to five, and find orphans in nearly every home. We both knew that in reality that she wasn’t joking in the least. I had finally come to the very grave realization that the aftermath of the AIDS pandemic—i.e., the orphaned children it would leave—would be worse than the disease itself. How could a single disease leave one generation dead and leave the next uneducated and jobless?

All eight of the homes were one room mud houses. Every one of the homes we visited housed more children than it had space on a mattress. Every home was dark, damp, and dirty. Almost all the children were coughing a deep, wet cough. Too many were home from school because of a lack of school fees or money for uniforms. All of the caretakers—grandmothers, aunts, siblings—reported “casual labor” as their source of income. To say they were economically unstable would be a cruel understatement. Besides, most had too many children under their care to work anyways. I have lived in one of the most rural villages in western Kenya, where poverty is the norm, albeit an extreme norm, but at least in the village they have space, they have land, they have natural water springs, they have grass for animals to graze and children to play, and they have a constant supply of food. In the slums, there was none of that. Nothing was certain. There was no space, no land, and not always food. This was poverty like I’d never seen before. The whole situation was utterly dire.

After dinner that night, I went to the Mamlin’s house to collect some clothes for two of the orphans who were sick and had completely inadequate bedding and clothing for the currently cold, wet, Kenyan rainy season. I had given Virginia some money to get them some blankets and a mattress earlier that day—it was no longer possible to wait for their needs to be processed through the OVC department; but they still needed shoes, sweaters, and pants, which we collected from the Mamlin's "store"-donations from their church back home. I told Joe about the eight homes, fifty-six orphans I visited today, and even he, who has nearly seen it all, was briefly overtaken by a look of despair. He told me that the orphan crisis was going to ruin this country unless we got these kids back into school. Then, completely unexpectedly, he thanked me for being out there, bearing witness to this situation. He told me I should write up some of their stories, so at least people would know. Inside, I was floored, and totally recharged. I told him I would be back out there until I left, and then would be back again next year to do the same.

I hesitate to write about situations so sad, so awful. I hate to paint such a picture of a country and people I have truly grown to love and respect. Yet, their story must be told. In his book Race Against Time, Stephen Lewis, at times, writes with reckless abandon, in a prose that depicts the reality of African poverty and the tragedy of the African HIV/AIDS epidemic like nothing I’ve ever read. It’s enough to move one to tears. He even writes about the same hesitations as I, hating to paint such an ugly picture. But we (and I use we in humbled reverence, as Stephen Lewis is an incredible human being who I can only hope to emulate in spirit and work), are bound by the realities of human suffering, bound to tell the truth, bound to tell these people’s stories as we see them, for we will never know what it is like to actually live them. Everyone, all of humanity, must know that this kind of poverty, this kind of suffering exists in our world today. What you do with that knowledge is then your own, but I am here, I am seeing this with my own eyes, and I therefore feel bound to tell you what I see. I asked Virginia as we left our last house if these people liked having a mzungu (white person) come into their homes like I was doing. She replied, “In Africa, we have a saying to never refuse a visitor because we want people to see how we live, at least so you know.”

Monday 2 July 2007

Groundwork Overview

Before I start telling stories, I should begin with what I'm doing over here. At the IU House in Eldoret, Kenya it's a totally appropriate question to ask, "what are you doing here?" or "what's your story?", so here it is...

In my time here last year, I learned very quickly that one must be on the ground over here to get anything done. Armed with that simple bit of knowledge, but without a totally clear picture of what it was exactly I wanted to and would do while here, I went to my supervisors and the "right" people here in Kenya, telling them I wanted to return, with the vague plan of just being on the ground so I could lay groundwork for more meaningful and intelligent work in the future. Thankfully, I was supported by wonderful people both here in Kenya and at IU, and even more thankfully, in my week and a half here, I have been proven right. One must be on the ground to do meaningful work and to really learn. And thus I have, right in the thick of things, meeting with people, working in the office, working out in the field, making contacts, generating ideas, and building relationships.

The Orphans and Vulnerable Children (OVC) department at AMPATH is where I report to work each morning around 7:30. I became very interested and passionate about working for OVC's last summer, in addition to street children and the urban poor living in the slums surrounding Eldoret (OVCs and street children are sort of related issues, but in reality something needing to be addressed all on their own; but the OVC department is a great place to figure that out and a great access point to CHWs, kids on the streets, and families in the slums). The OVC department is a new initiative of AMPATH, started just earlier this year, but already with over 3,000 OVC's registered and receiving services--medical care, school fees and/or uniforms, food or agricultural assistance, shelter, and other odds and ends of basic necessities. Community Health Workers (CHWs) are on the front lines, they live and work in their communities and are on the pulse of what their community members need. They identify the AIDS orphans or vulnerable children (i.e., parents who are HIV+ but still alive), determine what services they need, fill out the appropriate forms which they then bring into the office where they are "put into the system." From there, services are distributed. Now...a lot goes on in between, and lots of organizational and accountability "stuff" is still getting worked out, but that's the jist. The program is growing at an exponential rate, a reality all at once heartwarming and heartwrenching.

So that's a very quick overview "what I'm doing here." It is so wonderful to be back to Kenya, helping and learning, enjoying the way of life I quickly grew to love last year, and racking my brain for new ideas and new solutions to problems and issues I feel we (read: humanity or we the people or we in the West) must solve. More to come...