Thursday, March 13, 2008

Sorry for not posting!

I'm very sorry I haven't posted for so long. I'm so busy and exhausted that if I'm not working or studying I'm sleeping. Fanette left last week for vacation before going on to her next posting in Central African Republic, and her replacement arrived 2 weeks ago, and I am having to do her job as well as mine so I'm going completely crazy. And I have two major assignments worth 30% of my grade due at the end of March: a group assignment for Epidemiology of Infectious Diseases which is a cholera outbreak investigation, then a paper on a statistical analysis of a data set from Malawi to determine whether or not tuberculosis vaccination provides protection against leprosy for Statistics. I know these sound like absolutely riveting subject material! Actually both are very interesting but very time consuming.

Things are fine here security wise. No incidents have happened here since January and work has been going on pretty much as usual. To be honest I haven't even had time to read a newspaper or check websites for news about Kenya for the past 3 weeks so totally missed the big deal on the power sharing agreement, all I know is that something has been worked out and Kofi Annan went home. I hear the odd thing about disagreements on the actual deal and stories about secret negotiations and rumors about secret pacts being signed but I haven't the time or energy to follow it, as long as I'm able to work and go to Busia when I need money it doesn't really matter as far as I'm concerned.

In the past three weeks I also had to write a proposal for an extension of this programme for another two months, as well as contribute to a proposal for working to provide emergency malaria control services in the Rift Valley in areas where people have been displaced or are returning to their ancestral homes to get away from the ethnic violence. It's a huge proposal, over 2 million dollars, for a 9-month programme. The concern is that a huge number of people who fled the violence left non malaria-endemic areas and the Rift is a very high transmission area so these returnees will have no immunity and a huge malaria epidemic will happen. Also the health care system in these areas has collapsed because of health care workers fleeing the area. Anyways, we'll see what happens. It takes forever for grant proposals to get reviewed and funding to be put in place.

Work here is going on but we have shifted our base to a new location and it has been a logistical nightmare. We finished spraying south of the river (over 10,000 houses sprayed in 3 months, good for us!) where our office is and we used it for a base. Now we are working in a whole new area and we have had to shift operations to a new area, find a new base, move the teams and equipment, find water sources, etc etc and it has been very challenging. However, the acceptance rate has been very high so far which is good.

I found out some interesting things about the communities on the south side. We met a lot of resistance in some villages, people refusing to have their houses sprayed even after we explain the benefits to them thoroughly. These communities are used to flooding, every year, sometimes twice a year. They WANT the floods to happen because then the Aid Brigade comes in with donations of food, blankets, pots and pans, mosquito nets, etc etc. In fact there is an entire culture of aid in this area (and in many parts of Africa that experience natural disasters I suspect). People refused spraying because this jeopardizes their chances of getting another mosquito net in the next flood, which they promptly sell for a few dollars. They line up for food distributions even if their gardens are full and their houses did not flood. It makes sense when you think about it. The West has created this culture, unfortunately. I don't know what the answer is.

The people on the North side of the river, which does not flood, never get any of this aid so have been much more receptive to the spraying.

Most interestingly, I found out that the people in the South may have actually sabotaged the dyke that broke and caused this year's flooding. Apparently they dug out the base of it so that it would collapse and their aid would come. They are absolutely not interesting in rebuilding it so that it doesn't flood next year.

It's very frustrating to know that we have created a culture that expects a handout. We experience the same thing every time we try to run an educational programme for people. Everyone expects a handout for turning up at a workshop. If you don't give them their "per diem" they won't come. I don't know who started this idea but it makes getting anything done very difficult and expensive. We invite the elders of villages to an educational session on how to prevent malaria, and they refuse to participate unless we give them sodas and a couple of dollars. The same thing has been happening with the staff in the hospitals. We provide drugs, training and support, and in some places they have absolutely refused to follow the procedures that we (on behalf of the Ministry of Health, their boss) have trained them in because we are not giving them "motivation". They ask us for MENTOR t-shirts EVERY TIME we show up at the Health Center. They are charging people for doing the diagnostic tests that we have provided to them for free, and pocket the money. Rumor has it that they are selling the drugs that we have provided as well.

It's all extremely frustrating, and I must say my tolerance level has gone down significantly in the last few weeks.

At least I have a Logistician now! we hired a guy to help me with cars and administrivia that have occupied 95% of my time for the past few months. I've handed everything over to him and all I ask now is what car am I using today. He's a very bright Kenyan guy who worked for 4 years in South Sudan with GOAL, an Irish medical NGO. I'm so happy!!!!

OK, that's all for now, sorry if I sound negative, I'm just VERY tired. Things will get better once I get my assignments finished!

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