5 Things That Happened

5 Things That Happened

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Marlene got malaria (and we got a bug zapper racket)

Based on my own observations, expats in Africa are divided into two camps: first the “I’ve never had malaria and I can’t believe you have – surely you aren’t very careful!” group and the “I get malaria every two weeks and can’t figure out what to do about it” group. I’m not actually sure it’s possible to do anything about it (or anything more than we’re doing), but I’m hoping we end up somewhere in the middle, since now that we’ve both had malaria I would really like to avoid the experience again! There are no pictures of this particular adventure, since waking up in the middle of the night drenched in sweat as though someone had poured a bucket of water on you is not the kind of thing you want photographic evidence of. We always do our best to keep the mosquitos away, but this past week we finally managed to get our hands on a bug zapper, and hunting down all the mosquitos in our apartment has become a nightly ritual. I would also like to know why our treated mosquito net seems to kill every bug that lands on it except mosquitos. Thank goodness I was able to kill the mosquito that found its way into our net the other night… by nearly swallowing it.

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Way too excited.

photo 4The imprint on our wall of the mosquito that I am convinced gave me malaria. About two weeks before I got sick, I fell asleep outside the mosquito net. I woke up to Tim smashing this mosquito, full of my blood, against the wall. It had been biting my eyelid, which was really itchy and annoying. Then I got malaria. Is this blood splatter a little TMI? Oh well.

4WD up Mt Elgon

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Easily some of the most fun we’ve had in Kenya, our fun maximized by sharing it with Anne and Cameron when they came all the way out to Western Kenya to visit! Rocketing our way through the jungle, pausing to climb through caves and around waterfalls… the far out there corners of Kenya at their best. I was only slightly nervous about getting Marburg from this cave, but so far so good! (More coming soon from the epic adventures we took with Anne, Cameron, Madison, and Nate!)

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We started to actually enjoy ugali

At lunch the other day I ordered a large portion of ugali and couldn’t stop eating. I’m sure that my enjoyment had something to do with the amazing pile of nyama choma we also had, but it looks like we are finally integrating into the local culture if we are learning to love this stuff. Also, I can highly recommend a little place in Ekero for the best nyama choma in Western Kenya.

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My fear of snakes was confirmed

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My number one irrational and over the top fear here is SNAKES. I am way more afraid of them than things I should be more scared of. However for some reason seeing this on safari – when you’re supposed to see wild and crazy animals – was just awesome. But let’s keep the snakes out there.

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Yes, Tim actually took these pictures.

We played with animal poop

Our awesome friend Angela is here visiting! She is working on a study that involves testing animal feces. Since we’re really familiar with all things poop in our lab, we were happy to help out. So we’re in for some exciting field work collecting animal feces while everyone gives us funny looks. Crazy white people collecting animal poop!

photo 5So that’s a quick update about what’s been happening here! But that’s not everything, so more posts and pictures to come soon!

Why do you do what you do?

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This past week Tim and I both finally succumbed to all the disease floating around Western Kenya and got as sick as we’ve ever been – he with malaria, myself with a tick-borne rickettsial infection. I would highly suggest that you avoid both! Laying in bed completely miserable, far from the comforts of “home,” we kept thinking to ourselves – why are we here? Why are we doing what we’re doing? Why did we leave lucrative job opportunities and a comfortable life surrounded by friends and family to come to Western Kenya?

This is a constant question in development work, and the answers are as diverse as the people who work in this field. Sometimes it’s a love of adventure that drives people to seek out lifestyles and challenges different from their own, and sometimes it’s an academic interest in the way that the “other” lives and works. Sometimes it’s a compassionate bleeding heart, and sometimes it’s a longing for a simpler quieter life off the grid. I’ve heard all these reasons and more, and in each one of those reasons I see a piece of myself – I do love adventure and sought to cut down on the influence of material possessions in my life, and I deeply care about and am interested in the ways that although we are all different we are all the same and worthy of compassion. But none of those things are quite at center, none of those things are exactly what’s really driving us.

Tim and I recently listened to a sermon as part of the Soulology series at MPPC called “Meaning,” in which Kevin Kim tackles the small problem of the meaning of life (Check it out here or on itunes). He discourses on some of the different philosophies that guide us as we make decisions about how to live our lives and how to find meaning in the confusion that they often bring, and the conclusion that he and we came to after a lengthy discussion was that the prospect of ongoing life after death and God’s ultimate promise to renew the earth gives a weight and purpose to everything we do that simply doesn’t exist if life ends with our death. Sure this is a controversial point, but after playing devil’s advocate for a while Tim and I remained pretty convinced that while it is a worthy goal to improve any individual’s life in the present, the hope that God will participate in that work with us into eternity gives all our efforts an extra meaning regardless of our failure or success in the moment.

You may be thinking to yourself, “That’s wonderful, Marlene, but how in the world does what you’re doing fit into that philosophy? You are trying to prevent people from getting sick and kids from dying NOW, in this life! What kind of eternal significance does that have? How many souls are you “winning for heaven” by examining contaminated water in Kenya under the umbrella of a secular organization?”

My answer is that eternity starts now. We live our lives doing the work of bringing God’s kingdom here now – not because we think that we alone can change the world, but because we believe that participating in the good that God is doing now and will make perfect into eternity is a worthy goal that brings us closer to God and to his people all over the world. We participate in the work of lifting up the poor and the sick in the present with the knowledge and encouragement that the work does not end with us or depend on us, and the trust that God is fulfilling his promises now and into the future.

So despite the occasional moments of discouragement when we are oh so sick in bed, we know why we do what we do! We are having incredible adventures, meeting new people and enjoying new places, developing our compassion for those different from us and those with less than us, and relying less on our material possessions. But ultimately we are here because God has asked us to be, and all of those other motivations take on a whole new color when viewed as part of the ongoing journey towards a restored world.

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Morbidity and Mortality

As I experience more of life in Kenya, I begin to understand the realities that lie behind the words “morbidity” and “mortality” that we so often use to describe the effects of disease.

Mortality – death – is the most definitive and the most sobering way to measure the effects of a disease. Simply put, how many people die because of it? 1.8 million children die from diarrhea worldwide each year. In 2010, malaria killed about 655,000 people – mostly children in Africa. These numbers are large and sobering, but in reality the simple number on a page doesn’t elicit much of a reaction, especially if you happen to spend a lot of time reading about such horrible things for your job (as I do).

But living in the midst of it is quite different. The town mortuary is right across the street from our lab and next to our apartment, and is regularly surrounded by crowds and buses and parades of mourners. Families bring a coffin to bury their loved one, usually strapped to the top of a car or sometimes the back of a motorbike. Sometimes I can’t walk to work without tearing up as I witness the ebb and flow of loud singing, at first seeming celebratory, and softer mournful hymns. But the thing that gives me goosebumps is the regularity with which the family is bringing in a small, child sized coffin.

Over the next few days Tim is going to be in Kisumu doing some training on verbal autopsy – an interview with the family of the deceased so that if a child who is part of our study dies, we can try to understand the causes. It is so devastating to consider that we have to prepare for these children who are not yet even born to die. I am glad that we will be able to look at the causes of mortality in this study to help prevent other children from dying in the future, but I hope that Tim has no use for this training.

As awful as it is to dig into mortality, morbidity is a more silent but still insidious force. Mortality is very clear cut and easy to measure, and we tend to assume that as long as someone recovers from their illness everything will be fine. But in reality even a complete recovery from illness can leave detrimental effects, and all too often there is lasting damage that has been done to a person’s body or mind by the trial they have suffered. Over the past few days I have been so struck by what an impact illness makes on work and productivity. Today it seems like half our staff is sick at the doctor or are taking a child to the doctor. Malaria and GI illness are the biggest culprits. Last week one of our staff was out with “a little malaria and a little typhoid.” He returned to work the next day because he said he was bored at home, and it is a regular occurance for staff to come into work with malaria. Despite this generally strong work ethic, 7 out of about 70 employees are out sick today. The cost to organizations and families of this lost work and productivity is enormous, and the loss of income due to illness can be devastating here as it is anywhere.

I don’t mean to be depressing, but I think it’s important to recognize the stark realities and upsetting facts behind the numbers. Understanding the sobering reality gives a purpose to what we do, and make me grateful to be a part of a group of people that are trying to change that reality. The numbers are impressive and maybe that should be enough to galvanize a response, but the reality is that there is nothing like living next to the mortuary in Kakamega to show you the true impact of preventable disease.

Field Work

Right now I am sitting in mud hut in a small village supervising the field work that is happening today.  We are collecting urine and stool, which is quite a strange procedure. The baby that I’m with today is only 7 months old.  How can you collect urine from a child that small, you ask?  Well, we have a bag with adhesive on it that sticks around the child’s genitals. The bag hangs and collects any urine the child excretes for 5 hours, while a field officer periodically uses a tube from the bag to siphon off the urine into a jar.  Stool is scooped from a diaper and then taken to the lab, where it is processed for Kato-Katz. One problem has been that most of the mothers have never seen a disposable diaper, and need to be taught to attach it properly. Part of my never ending battle as lab manager is to ensure that everything is very sterile and that we don’t have stool or urine contaminating all of our surfaces when the samples are processed in the lab.  There is a very real risk of contracting worms from these samples, and I do not want any inside of me! While the young babies that we are looking at now usually do not have so many worms, the school aged children sometimes have awful infections.  Don’t worry, every child that we take a stool sample from receives a deworming pill.

The problem of parasites is so persistent here! I was having a conversation with Wekesa, a lab technician who is very knowledgeable about parasites, and he was asking me which parasitic diseases we have in the United States.  He was actually very surprised by how few we have – the main diseases that exist in both places are giardia and pinworm (probably the most benign of the wide range of parasitic infections available here). For many diseases, such as malaria and hookworm, I explained that we used to have it, but do not anymore. Wekesa was encouraged by this, and vowed that Kenya would also eliminate these diseases.  I hope so!  Because we experience so few of these infections in the United States it is very easy to underestimate the damage that they do.  Sometimes it seems like a waste to pour money into these “neglected tropical diseases” that only exist in secluded corners of the world that most of us rarely consider.  But when you visit a community and see the distended bellies on malnourished children everywhere and you realize the enormous impact that intestinal parasites have had on so many people in that place, you cannot deny that this is truly neglect.  Malaria is not a neglected disease – it is one of the “big three” tropical diseases that receive large numbers of donor dollars along with AIDS and TB. However I feel more and more surrounded by the hopelessness that people feel facing malaria, and wonder what the solution is. What I do know is that we cannot think that what we are doing is enough for malaria or the wide range of neglected tropical diseases that exist here.  Not only does malaria have a high mortality rate (especially in young children), Tim and I have met mothers who have miscarried at 8 months and children and adults who have suffered brain damage from acute malaria.  Just last week one of my lab techs was less talkative than usual, and I asked him what was wrong.  He pulled some pills out of his pocket to show me, and simply said “malaria.”  When Tim and I worked in Tanzania one of our workers also had malaria, so this was unfortunately familiar to me.  The costs of malaria are so high – the mortality, the morbidity, the productive time lost for families that are already scraping to get by. And despite everyone’s efforts, just today I saw – not for the first time – a mosquito net being used as a chicken coop.

As I sit in this boma monitoring the child’s urine bag, I feel face to face with these problems in a very real way.  I’m reading a report from the WHO that says 46% of deaths in the African region are children under 15 years old.  In high-income countries, that number is just 1%. The child in this house has a fever and horrendous cough, and when we suggested to the mother that she should take the child to the doctor she shrugged, saying that she doesn’t have the resources. She seems like a caring mother, but she kisses her baby and sits holding her, waiting to see what happens. At another home I was in recently, a pregnant mother holding her firstborn told us that she had given birth in the hospital.  After some further questioning we realized that she had clearly given birth at home, and the baby had never seen a doctor or received any vaccinations because the mother couldn’t afford the 100 shillings ($1.20) that it cost to see a doctor.  At a year old, she looked clearly underweight and we couldn’t even coax a smile.

Sometimes it feels discouraging to “just” do research when there are so many challenges facing the people around you.  However I am also confident that this is a good place to be and good work to be doing.  Water, Sanitation, and Hygiene have long been shown to have an impact on diarrheal disease and health of children, but there is currently a lack of studies evaluating interventions in these areas.  This study is an enormous undertaking that will hopefully provide information to help governments and organizations evaluate which interventions are most beneficial and cost effective, so that the projects that are implemented can have a real impact.  I am excited to be a part of this and I think that this work is very important – but still sometimes I want to throw in the towel and give all the money, all the interventions to the one sweet family that I meet with the adorable child with diarrhea.