End of Internships and Closing Seminar

This is what happens when you commit to writing a travel blog because your friend made you, then you neglect it for several weeks: you find you have a lot to say. Following are two very long posts. If you find them interesting, read away.

The last week in Ukwala was hard- I didn’t feel at all ready to leave. Lucy and John had become a real family for me and I was far happier than I ever expected to be working at the clinic. Luckily for me, my last week was a busy one so I didn’t have too much time to dwell on my departure anxiety.
I’d spent a good deal of my time at Matibabu working with a few different maternal- child health initiatives, mostly infant vaccination campaigns but also the well- child and antenatal clinics. Apparently, in Kenya, this qualified me to help with the process of childbirth, so during my last week in Ukwala, I was called upon to assist with four deliveries. Of actual human infants, mind you. I should come clean here though- I’m exaggerating when I claim I helped with four deliveries. One was a set of twins, so it was in fact three deliveries that yielded four babies.


One special initiative that’s been getting a lot of attention in Nyanza Province is that of male circumcision. The CDC in partnership with the Kenya Ministry of Health recently released official recommendation for male circumcision to reduce the spread of HIV and improve general reproductive health and hygiene. This recommendation was met with a good deal of skepticism in Nyanzya Province, which is largely considered “Luo land” because the Luo tribe does not recognize circumcision in its cultural values. However, a number of free clinics have been set up throughout western Kenya, and I was offered the opportunity to observe the educational talks that preceded the circumcision (I didn’t get much out of that, as it was all in Luo) then help with the procedure itself. Let’s just say that I wasn’t exactly struck by a clear “Wow, circumcision must be what I’m meant to do with my life!” feeling, but all the same it was very interesting to learn about the cultural and medical significance of the procedure and talk to patients about their conceptions and motives for going ahead with it.

Another temporary program that was cool to get involved with was the distribution of “essential care packages” to HIV/AIDS patients. These were packages put together by donations from USAID and a number of other organizations. They included an insecticide- treated bednet, a water purification system (to prevent diarrheal diseases, which are a leading cause of death for AIDS patients in this region), a small basket of food grown in the community garden set up by Matibabu, and a few other things. Though the work I did for this project was largely clerical- ticking a patient’s name off the list and handing over their package, it was still pretty rewarding and involved a lot of contact with community members, so I enjoyed it a lot.

ALSO during my last week at the clinic was World AIDS Day, which involved dozens of celebrations all over Kenya. The Matibabu staff sent a group to the Ugunja gathering, and I opted to tag along. It was a hot day out in the sun, with tons of organizations setting up VCT booths, blood drives, informational booths, and running skits and talks. The skits tended to be humorous, and for the most part I really respected the quest speakers. They talked selflessly of their personal struggles against AIDS and of everything they were doing to help their peers learn the importance of getting tested. One man really upset me though; he spent at least half an hour talking about how he was certain his wife infected him through witchcraft. I guess everybody’s entitled to their own opinion.

My last full day at the clinic, Thursday, had to be one of my favorites of all. I was invited to go on a field visit with a few of Matibabu’s outreach workers. The four of us borrowed a fleet of bicycles that would probably qualify as antiques and set of for the remote villages surrounding Ukwala. We must have looked like a gang from The Sandlot, peddling around town. I certainly felt I was the essence of cool. We had a goal to visit ten homes that day, a goal one of the nurses told me was unlikely to come to fruition. Our fist stop was about a 45 minute bike ride from the main clinic, though it’s hard to estimate what distance this would translate to because Kenyans take a nice leisurely pace. No hurry to get anywhere, just enjoy the ride I guess.
Our first clients for the day were a middle aged couple and their son. All three were “positive”. That’s how people refer to HIV status, just “positive”. The stigma still runs so deep that a lot of people are too anxious to seek testing or treatment. All three had defaulted from ARV treatment and were firmly opposed to returning to Matibabu for further evaluation. This was extremely frustrating for me to see as an outsider. I’ve been very impressed with the effort put forth by Matibabu’s field workers. They scour the most remote areas of the district, seek out patients, and bring the care and drugs to them. Patients that would in the US be placed in a nursing home, but who obviously have no access to such facilities in the impoverished parts of rural Kenya still get care, because outreach workers come to bathe them, cook and clean, whatever needs to be done. And yet sitting before me were three stubborn defaulters. The issue at hand was not the cost of drugs- they’re free to all patients in Kenya needing assistance. Nor was it the logistics of travel- Matibabu had offered to help arrange transportation to the main clinic to re- commence ARV therapy. No, it was “What will the neighbors think if they find out we’re going to the clinic?” We sat in their hut for well over an hour, progressing from politely requesting they make an appointment to demanding to begging. No luck. Then, again frustrating to me, the ultimate conclusion was “Well, I guess if this mzungu came all the way out here and wants me to come to Ukwala, I’ll do it.” As much as I was glad that something finally worked, I was disappointed and ashamed that it was just my race that did the trick. Shouldn’t Kenyans be listening to other Kenyans, not just outsiders like me? I hadn’t done anything but listen and observe, the field workers are the ones who trek out every week, working so hard to deliver care to unwilling patients.
The rest of our visits that day followed roughly the same pattern: nobody wants to admit they have AIDS, that they’ve defaulted from treatment, that they should return to the clinic and get help. The field workers spend an hour coercing, we leave feeling we’ve accomplished something, but only a small something. We made it to three homes of the ten we’d hoped to visit that day.
Just as we were heading back to Ukwala around 5, it started to rain. Hard. We took shelter in the hut of the last patient of the day, and the storm passed in about a half hour. The roads were a complete mess. Mud a foot deep. It was impossible to ride our bikes, so we pushed them, stopping every few yards to scrape out the mud that clogged the tires. We came to a huge hill, and starting shoving our bikes up, making progress just inches at a time. The village kids that ran up ahead of me barefoot found my efforts to be hilarious. I was sweating hard and probably looked like a complete idiot. The nurse told me the kids were so thrilled because “now they see you’re a person just like them”. By the time we got home, dusk was settling and I was exhausted. I walked through the door dripping mud everywhere. “Oh, so you went to the field today” Lucy said by way of greeting. Yep, I sure did. I learned a lot in the field, but I couldn’t get over the frustrations I felt, that no matter what the community health workers do, there will be patients that don’t get the care they need or just suffer in silence rather than face the scrutiny of their family and friends.

Friday it was time for me to get to Kisumu, since I had an early morning bus back to Nairobi on Saturday. I stopped by the clinic in the morning to say my final goodbyes to the staff. There were hugs and jokes all around. The head clinician, Dr. Fred, requested that I leave a recording of me saying “Good morning, Dr. Fred!“ so he wouldn’t have to forget the sound of my voice. I’ve made a lot of wonderful friends and gained a lot of insight from the staff of Matibabu, I could never thank them enough.
Saying goodbye to Lucy and John was one of the most difficult obstacles I’ve faced over the course of this semester, way worse than saying goodbye to everybody at home because this time it felt a lot more permanent. The company car gave me a free lift to Kisumu, where I dumped my luggage at my friend Amanda’s house then we left together for another student’s house where a farewell dinner was being hosted in honor of all ten of us stationed in the Kisumu area. The food was amazing and it was fantastic to see the other students again, to discuss with them how hard it was to leave our internships and host families. A lot of us were really lucky to have wonderful experiences during the internship phase, but leaving was not easy. Furthermore, most of the students were flying back home on December 12; I just chose to extend my stay so I could do some more traveling, first with my friends from the program, then with my mom when she arrives. That’s a lot of goodbyes to have to deal with.
Saturday afternoon we got back to Nairobi and went to our respective host families there to rest up until the following morning when we had to check into the Methodist Guest House, the hotel where our final exams and closing seminars were to be held.

The closing seminar was a three day ordeal at the guest house, a chance for us to catch up with all the students who had been working in different parts of the country, take exams and finish term papers, and relax a little bit before heading home. Our final exams weren’t too terribly difficult but were a good way to reflect on what I’d learned over the course of the last three and a half months and to put my internship experience into the context of development. Our closing seminar activities included a lot of everybody talking about their respective internships and the challenges they’d faced as well as discussing what to expect when we go back home and how to deal with “re-entry shock”. The very night our program- related activities concluded, a group of us set of for the island of Zanzibar, but that’s another post.