Evaluation for Winter Quarter

Shockingly, another quarter of my senior year has passed - which means another evaluation must be composed. Like the last one, it sums up my last 2 and a half months here quite well, so I have pasted it below. Enjoy!

I find this evaluation particularly more difficult to compose than the last one. The last two and a half months have been an emotional whirlwind, catching and blowing me in every direction possible – although I am still immensely thankful that I have been given the opportunity for such intense learning to occur.

I have had the burning desire and pain that comes with wanting to be a part of any community you are not originally from. A very wise Professor has recently written me an email, questioning why the need to belong here is so great, and who this desire is serving. Is it my own personal desire to belong, or is this feeling shared by all people? It seems we are a community driven species – but what makes transplanting into another community so difficult? Is it fear that keeps us to what we know? Should we be content with the community we are born into, even if it doesn’t seem to fit? Is it unfair to force yourself into a community, if you are the only one benefiting – able to leave the situation behind you as you journey back to your home community?

I have had the wonderful opportunity to meet and hear 30 peoples’ stories that live in a village about 30 minutes away from where I am staying. I have sat and cracked groundnuts with a group of old people while they tell me old folklore about their community. I have cooked with a lady who makes her own charcoal. I have been shown how to make sisal rope by a woman living with HIV whose life is so painful, all I can do is listen and empathize, while her hands work steadily away. 

Originally, community based health was what drew me to this village in Kenya, but if you had to look at how I’ve spent my time in the past two months – you may not see a direct link to this. I have realized though, that everything I have been participating in and witnessing is health care. The single most important thing that I have learned here is that you have to meet people where they are at. You cannot do this without seeing, feeling, and understanding where they are from. The stories that I thought would be a separate and different part of my grant from healthcare are so intricately twisted and wrapped together that you could never – should never – untangle them.

I have sat and observed different health care practitioners while they are working. I have seen them struggle with the medicine here – the lack of prevention that exists and trying to throw band aids over fully gaping wounds. I wonder daily what the best way to improve the health care system here is. The society and community is different than ours back home – so why are we forcing ideas like primary health care in a package that has been wrapped and tailored for us? Is there another way to come up with the same outcome by taking a different path?

I feel immensely frustrated with what exists in documents about health – like the Alma Ata Declaration and the Human Rights Charter – to find that none of it is being put into practice. When has medicine been reduced to providing drugs alone – or has it always been this, and the documents are too dream-like, not based in reality? How can we start to change this? As a future doctor – will my knowledge be most useful to create change on an individual level, or on a larger scale?

Usually while travelling, I have moments that cover my arms with goose bumps, about where I am and the opportunity I have been given. Many times I feel that I am not doing enough for this grant, that the openness and ambiguity is sometimes so huge, it’s crushing. In moments of panic, I brainstorm multiple research questions that I am determined to find answers to. Then I write someone, or write an evaluation, and am reminded at how much I have learned, just how far I have come.  And somehow, I feel like the greatest gift of a truly shifted perspective and outlook is waiting patiently for me at home. I could not be more excited for that.

The Chief picked us up in his green station wagon, driving quickly towards the hill. I had no idea what to expect, where we were going, or how many people would be there when we arrived. The car was quiet, and as we drove higher and higher my stomach crisscrossed and knotted with nerves.

Finally the car crawled through a tiny space, toilet on one side and bushes on the other, into an opening. I got a glimpse of many people, instantly wishing I could disappear as I looked at Seth. ‘I hope you’re ready,’ he whispered to me. I nodded. Sam stopped the car, and I opened the door.

 ‘Amosiuru,’ I said to the group of people seated in a half circle. They laughed, surprised I was greeting them in Luo and responded. I walked around and shook each person’s hand, Luo greetings fumbling out of my mouth. There were small children there and women making baskets and rope. They motioned to a group of four plastic chairs in front of the group, and I sat. The Chief spoke quietly to me, saying that they were all here and it was up to me now.

I started speaking, nerves so tight they gripped my throat. I said a silent thank you that words were somehow slipping out one after the other. I introduced myself, explaining why I was there and telling them how thankful I was that they had agreed to come. The Chief translated to them in Luo, then looked at me saying they all knew and accepted. He then asked me what was next. I looked around, explaining that I would like to interview each person separately, and they suggested moving our chairs to the other side of the house. We stood and moved, someone carrying my chair for me. I walked on shaky legs behind them, overwhelmed and afraid at what would happen next.

I sat with my back facing trees, a slight breeze blowing against the nape of my neck. George’s house was in front of me, with a thatched roof and a dilapidated toilet in front. Cows mooed and donkeys brayed behind me. I took a deep breath as the first person walked over and sat in the chair across from me.

I had the privilege of listening to 14 peoples’ stories, although they informed me that there were many more should I want to hear them. I was and still am stunned at the depth of struggles these people are facing – unable to fully experience what their day to day lives are like, only to empathize while listening.

They told me the difficulties they have to feed their families and themselves, which they desperately need to do to have the ARVs be effective. During the dry season, clean water to swallow their pills comes from taps that flow at random. They are too far from rivers or the lake to fetch water from there. They walk to Homa Bay – easily an entire day – every 2 months to collect their ARVs, because the other hospitals in the area run out and they cannot count on them. If they have the money to take the one matatu that leaves Kokoth every morning for Homa Bay – it costs them 700 shillings round trip. I asked them what brought them joy, with most people answering me food, and the ability to wake up and feed their families.

I am still struggling with what I have heard, where here it’s not just about battling a chronic illness, but also crippling poverty. I remember meeting with someone from Doctor’s Without Boarders so long ago, to his answer of not providing food to people because they are strictly a medical program, not a social one. I wonder about all those articles I read about human rights and health, the Alma Ata Declaration and how what we preach is so far from what is being carried out. When is providing life saving drugs to someone considered enough, when they are struggling severely to find the food and water they must have to accompany these drugs? What can be done?