Being Thankful

Today is Thanksgiving in the U.S. and I’m finding myself far away from home. I’ve been in this position before – sometimes by choice and sometimes by circumstance – and its always an odd feeling to be away from your family and many of your friends on a holiday.

For those of you who pay any attention to this blog, you’ll remember (and see below) that I said I would be back at it in late September/early October… It is now late November, funny how life goes. I’m afraid I don’t have anything witty or insightful or even interesting to say today, but I needed a nudge to get back to writing and Thanksgiving was it.

There are certainly things to talk about, however! New country, new job (prevention, NCDs, the built environment, HiAPs…), continued work with OHR, World AIDS Day coming-up next week, and new thoughts on community prevention and well-being. Looks like maybe its time to get writing..!

I am thankful for many, many things this year, not in the least my brilliant, interesting and supportive family and friends. I am also thankful for the opportunities I have to travel, and try new things, and read interesting stories. I am thankful I have the means to enjoy a large Thanksgiving meal this weekend. And I am thankful for the chance, in my small ways, to help those in our communities who can not.

Not Your Average Donation

Sunday is Mother’s Day (in the U.S.) and if you haven’t gotten at least a card for your mom already, you should get on that.

If you’re looking for a gift idea, might I suggest making a donation to the Organic Health Response. OHR, my “other” job, is a young and rapidly growing CBO on Mfangano Island, Lake Victoria, Kenya (the EK Center) and a U.S.-based non-profit. Rooted in HIV/AIDS, OHR’s ethos centers on harnessing new technology, supporting social and community solidarity, and promoting sustainability. Many of our programs revolve around the women and mothers of the community: a craft co-operative for HIV+ women; CHW training and support; full involvement of women in EK and organizational leadership; and a safe and accessible space for HIV testing and treatment.

OHR has accomplished an extraordinary amount in just 4 years, but all types of support are needed to keep these efforts moving forward. This is not your average donation – my own mother got a donation in her honor for Christmas (and if you ask me, she loved it) – it will directly support a community charting their own course towards well-being!

Global is Local

Happy New Year!

Earlier this week I came across a report about a new initiative in and around Seattle, Washington. A local health care system (think hospitals, physicians, medical homes, etc.) is launching a new program aimed at improving local communities’ health. This new initiative is not based on the newest, evidenced-based pilot from the CDC, but rather on practices and programs that have proven effective not in the U.S. but in parts of Africa and elsewhere.

Global to Local (love the name!) is based around a “new” paradigm for community health workers (CHWs). As stated on their website: “The Global to Local initiative is a new approach in applying global solutions to local healthcare challenges in underserved populations.”   CHWs have become a staple in the “global” health community – an invaluable tool in communities around the World – but are relative newcomers in our enigma of a health system (there are roughly 120,000 CHWs currently in the U.S.).  However, with the ongoing implementation of the Affordable Care Act* this year, further programs for CHWs will be established.

The basic element behind CHWs (which can span a spectrum of training and services) are individuals from the community working in the same community to educate, treat, and navigate their neighbors. In many communities CHWs have been instrumental in the promotion and adoption of bed-nets and enabling individuals to maintain their ARV treatments (e.g. OHR in Kenya has worked closely with CHWs to promote HIV VCT).   An equally important role that CHWs play is that which anthropologists call “gate-keepers” – a window into a specific community and culture.

Global to Local is aiming to do just this by employing local nurses and CHWs (and working with community colleges to train them!) who understand the local culture – structurally and linguistically. By looking at people’s whole environments (financial, housing, and educational services are going to be provided as well), Global to Local has the goal of promoting nutrition, changing health behaviors (and the structures which guide them), and providing people with greater access to health services.

Somewhere in the history of health care and public health (I don’t claim to be an expert, but I do understand how & why this occurred) there seems that an unspoken rule was established: What happens in the West/developed countries and what happens everywhere else in the World must function in two different spheres – us and them. Global to Local is breaking this rule – to some surprise – and why shouldn’t they?! Just as the anthropological technique of ethnography can be applied both on the other side of the globe and in our backyards, so too can methods for improving health. CHWs are culturally humble and perfectly positioned to apply “global solutions to local healthcare challenges” – improving the health of our global communities.

*As during its passage, this blog will not follow or address explicitly the Affordable Care Act, repeal attempts, or blanket implementation.

Notes on Mfangano – Community Health

Before I set-off on my travels at the beginning of July, I posted about community prevention – I mused about how community prevention has to come from within communities, and more importantly how communities’ embodiment of wellness is just as important as the tools they may or may not have at their disposal for achieving this. After participating in an intense conversation about the structural and behavioral changes that communities (in this case, in the broadest sense of the word – populations bound together by geography, demography, or something else) need to help them live in environments in which “healthy” choices are the given choices, I set-off for Mfangano.

Not knowing entirely what I’d find on the island, I arrived unsure of how “community health” would present itself in this corner of the world. As I gained my barrings on the island, and met and became friends with the people, I witnessed health – and community engagement with health – in an organic state. Starting from the end of my time on Mfangano…

On my last day on the island, having acquired a low fever over night, I made my way (via motorbike!) to the Ministry of Health (MoH) run health center in the village of Sena. It was a busy Friday morning, with islanders there to collect ARVs, participate in a free eye-care service being provided by a collection of missionaries, and consultations for a variety of other ailments and conditions. Unfortunately, I was scooted to the front of the line and rushed into a consult room. After describing my symptoms (many of which are common to traveling and being in a new environment) and saying “aahhhhh”, I was given a list of five medications, including malaria treatment. After several questions from me, I convinced the nurse that maybe I should have a malaria test…just in case.

Waiting for the test result (negative) and to collect my medications from the pharmacy gave me the opportunity to soak in the atmosphere of the center. There was a mix of Kenyan and foreign health care providers; mother’s with small children; and elderly couples leading one another up and down steps. The lab was a small, dusty room with a windowsill and it cost me all of 30 KES (the equivalent of $.37) for the consultation and the medications. Providing the only government sponsored care on the island (besides weekly mobile ARV clinics), this health center serves as the first point of care (sometimes 2nd after a CHW) for nearly all islanders in non-emergency situations. The health center at Sena is the health service epicenter for Mfangano.

About a week earlier, myself and the group of US researchers were offered the opportunity to travel to the island of Remba, further out in the lake. A meer speck on the horizon as you sail west from the south-east coast of Mfangano, Remba appears to be more like a large rock than an island. As we approached, the sun glinting off the tin roofs, we began to see that while Remba may be a geological speck in Lake Victoria, it is definitely not a human one! Fishing boats crammed every available piece of shore-line (our own had to squeeze in) and besides the plot of land designated for the football pitch (and small play area/farming area/”open space”) and maybe three trees, the island is packed with tin buildings and people.

Fueled by the profitable, deeper waters of this part of the lake – only about 500 meters from the Ugandan border (this based on a companion pointing out into the lake at the border) - Remba is overflowing with fish, foreigners (representing at least three other countries in East Africa), young men, alcohol, and HIV. My immediate sensory reaction was how still the air was, stale, with smells and heat hanging. Walking around the island, which does have distinct “neighborhoods”, we seemed to be in a slum - overcrowded, no latrines, trash everywhere, the lake as the only source of water – yet, it is not. Remba is a wealthy place and is seen by many, both on and off the island, as a desirable place to be, despite being relatively lawless (which gets it in the news for skirmishes and violent outbreaks). This desire has made Remba a cross-roads of HIV in the Lake Victoria region, and at times has had an adult infection rate hovering near 60%.

The first permanent health care facility was just recently opened, but even this will not have permanent staff – a mobile ARV clinic has been coming to the island once a week for several years. Nearly the entire group expressed, either at the time or later on, feeling extremely uncomfortable on Remba. Yes, it was something new, something foreign for many of us, but there was something else going on too. Even our guides (friends from Mfangano) expressed distaste and levels of uncomfortable-ness being on the island. One saying, “it is a scary place. If there was a disease here, there would be no way of escaping it, no one to help.” The community health of Remba is not removed from that of Mfangano, it has a huge impact on it and the surrounding region – the islands like overlapping circles. Remba’s health is about money and all the things lots of money can bring you, including, in this corner of the world, HIV. As one of my colleagues so eloquently stated, on Remba we were seeing HIV – how it lives, how it spreads, how it thrives, how it is part of life. Maybe this was that added something none of us could quite put our finger on.

Finally, early on my time on the island, I spent one morning on the Organic Health Response’s (OHR) farm. Sitting on land in Kitewi donated, and now run by Joel Oguta, the farm is nearly a complete opposite of Remba. It is green and lush, free of trash and people. The farm was started as the first phase of OHR – Joel’s dream to introduce organic and sustainable farming to the island. Now, in collaboration with OHR’s Ekialo Kiona center, Joel and the farm are embarking on a project to change the community’s nutritional health – one vegetable at a time. In addition to the current demonstration farm which is routinely trying out new produce to see what can thrive on the island (and then giving it away to those in need); research is being conducted on what produce and herbs are beneficial to those individuals on ARV regimens, to increase their nutritional capacities; and there are plans for running courses with community farmers on how they too can grow and provide pest control organically. While the OHR farm welcomes WWOOFers, it is the brain child of Joel and could only be described as locally run.

In addition to the Cyber-VCT at the EK center (which I wrote on in an earlier note), the farm is literally growing a healthy environment from the center of the community. Instead of just focusing on prevention, the people of Mfangano east are focusing on well-being. Yes, it has been shown that knowing your serostatus (whether or not you are HIV +) can positively affect  your choices and likelihood of passing the disease on to others, and this is a preventative tool. However, on Mfangano, knowing your status opens you up to a whole world of possibilities for living positively with or without HIV.

Community health on Mfangano is organic – it has evolved to have several arms embracing the island. There are the structured and institutionalized health services designed to preserve and serve as triage to the current state of community health, seen at the MoH health center in Sena. There are the outside influences, desires, and temptations which are all too human, yet perpetuate the disease which has come to define many lives here. And there are the growing, plentiful, and rich farm and community center which are breaking the surface for a new way to health. The embodiment of wellness was evident to me on Mfangano – the community is gaining tools “we” feel are useful for achieving better health and coming-up with some of their own – with community engagement becoming the easy choice.

I’m still pondering community health, and community prevention, and community well-being and I don’t think there is any one right answer. I do believe that defining, promoting, and achieving community health has to be done at the community level. Goals set for many, wherever in the World they may be, do not address the real and organic nature of living communities – cultural well-being as much of a goal as physiological and mental well-being. While I in no way feel I have done justice to my time on Mfangano, or produced an ethnographic description worthy of my education, I do hope that in these three notes I have told a part of the story. A story about an island, its people, and their health.

Images are author’s own – Mfangano and Remba Islands, Lake Victoria, Suba District, Kenya.

In the News: Here Comes Summer

Summer is just around the corner and here are some healthy news items to get you thinking, as the days heat up!

*Last week it was announced that scientists had witnessed the first cell produced entirely from synthetic DNA. I am not even going to pretend to understand the science behind it, but I’m happy to ponder the implications for human health (waaaaay down the road). Encouraging progress in technologies that have the potential to improve human health is important (really important!), yet at the same time it is also important to examine the systems and cultures in which these improvements are made and what implications they may have beyond healing.

*I grew-up spending my summers swimming…in pools, in Lake Michigan, in the ocean. If you ask me, in the water is the best place to spend the summer. NPR reported last week that a shocking number of American pools are not up to snuff when it comes to water cleanliness. Pools can be an easy place to catch an infection, the kind that can ruin any kids summer. Let’s hope that pools around the U.S. clean-up their act – swimming and days at the pool are an essential element of the American summer and it would be a shame if kids started to miss out because their pools weren’t being kept clean!

*Summer is the best season (unless you live somewhere super hot!) to get outside. We all know that exercise, even a little bit, can do wonders for our health, right now and down the road. We also know that you can’t simply make people exercise. However, if you look at where people go, what they like to do to begin with, and why they may or may not be exercising, there are simple (and dare I say, culturally appropriate) solutions to getting people moving. Last week in London, an “adult playground” opened in Hyde Park. Designed for low impact exercises, the machines at this playground include stationary bikes and ellipticals, are free, and easy to use. Hopefully this idea will catch-on in the UK and other western countries, and more and more adults will get moving outside.

*Fresh fruits and veggies are abundant in many areas all summer long and this provides us with the perfect opportunity to try-out new recipes. The NYTimes’ Recipes for Health page is a great resource for finding new, tasty, and healthy recipes (check-out Court’s Kitchen for other great ideas). We should remember, though, that many around us are struggling just to put enough food on their tables. Maybe this summer we can all do a small part to help those in need of a meal!

Happy Summer!

*Image is author’s own: Duck, North Carolina, USA.