I, Anneliese, have been spending my hours in the nutrition and counseling rooms. Patients enter at the request of the doctor and some, surprisingly, for their own personal curiosity and problems. The concept of ‘nutrition,’ especially the study as a science that practically applies to life, is a pioneer wagon, roaming lawless and without a road, towards a destination spelled out by nothing other than faith. The ‘study’ of nutrition was just introduced to Kenya a bit over a year ago. To me, this signals a huge upward leap, as nutrition, quite frankly, is really more something of privilege. A delicacy. No longer do you eat to survive, you now have choices and can regulate how you survive. –This how has been quite antithetical to my previous modus operands, where people are viewing nutrition as diets that are supposed to drop weight and control the overindulging and hyper-consumption of foods. Here—fortunately or unfortunately—they are looking at nutrition as a method to keep on the pounds, eat foods that cooperate with their ARVs and come up with an affordable way to somehow eat meals that are 15-20% protein, 50-60% carbs, and 25% fat everyday.
Kenya has adopted their curriculum from the World Health Organization and USAID, and then made a few adjustments to bring it closer to home: a country with a declared national disaster of food shortages at least every decade, arid lands that produce some of the weakest and smallest vegetables I’ve ever laid eyes upon, an extreme lack of water, and a population resting either on or below the gate of poverty.
The most pressing issue with nutrition in Kenya, especially for the HIV infected who require nearly 20% more food and nutrients than a healthy person, is the brutal fact that they simply do not have access to food. Many of the people I see are surviving on uji—Kenyan porridge made from ultra-cheap maize or millet flour, with water, sugar, and sometimes milk. And that’s it. And that’s it always, that is on days they actually eat. Others are more fortunate and eat the standard Kenyan dishes. (There are really only about five options….at home, in a restaurant, or in a cookbook!) They survive on white rice, njahi (beans), sukima wiki (over-stewed, bitter, and salty micro-chopped African kale), maize (in a few forms), potatoes, and horrendous cuts of fatty, dried out meat (goat, pork, beef, chicken, mutton).
I spent the first few days quickly learning Kenyan (and all) nutrition and observing the nutritionists in action—how they interacted with the patients, what the patients were being seen for, their stories, what they were eating, how the nutritionists recommended specific dietary choices, and prescribed food supplements. (Donated by USAID; giant bricks of maize flour for uji that are fortified with nutrients and vitamins to supplement those who are literally ‘wasting away’ and dropping too many pounds each week, never reaching anywhere near the recommended body-mass index, BMI, of height/weight ratio.)
I was quite discouraged, to say the least, that the staff had adequate information, necessary materials, plenty of time to visit with patients, and minimal paperwork, yet they spent a good 70% of their day doing crossword puzzles, texting friends, staring into space, and chatting. Frequently, when a patient would enter the room, the staff would continue their puzzle or raucous laughter. Needless to say, I quickly found a place to work and make a difference.
Thankfully we’re learning Swahili, as we should be fluent working at Thika District Hospital. A good 10% of the patients speak English, and the staff knows the basics.
I anxiously await the patients and greet them at the door, “hujambo!” (how are you/hello) or “karibuni.” (Come in/welcome). A white person, me, throws them off guard and some seem either pacified….perhaps they think I’ll be more help…and others become instantly frightened…maybe making the scenario seem more grave. I do what I can in asking them why they are here (with a translator) and read their card which they carry around for the entirety of treatment at the CCC (there is no database or computer system at the CCC that is efficient or can handle records), therefore the red, 5x7 inch card-stock papers are airbrushed with layers of dirt and grease and god knows what else, with folds so antique you’d be convinced you’re reading an old map of the silk trade.
I weigh the patient on a temperamental scale and take their height. Next, I chart their body-mass index and record all three readings, by hand, on their red card. If their BMI is in the ‘underweight zone,’ which nearly 80% of my patients have been, I give them a prescription for Foundation Plus, the adult food supplement. (Others for children and infants.) I find myself losing the war at this point in the battle, as my intentions travel a different road than those of the resident nutritionists. It seems absolutely important to discuss with the patient, why they’re losing weight, for how long, what their daily diet has been like, where are they getting food, if they can’t afford food—I should give them strategies. My pre-school Swahili can’t communicate this and when I ask for translation, my judgment smells foul and over-the-top. So we let the patient go.
This is the recurring problem in all areas of the CCC. The staff is here to get paid and follow rules and guidelines like robots. Input in. Interpret. Output out. No one listens, internalizes, comes up with solutions, or takes concern in why these patients are here and how they are in a great position to help and make a huge difference. They simply don’t care. It’s more than frustrating; it’s embarrassing.
After a week playing nutritionist, I had to take a step back and see how we could utilize or strengths best and create a better system under such circumstances. Austin has expressed similar frustration and shocking news reports (the blood samples wait for their turn to go into the diagnostic machine open, without a top, and placed in a window-less windowsill opposite the dirt parking lot. No one uses latex gloves although there are boxes of them crowding the hallway. The chemist cleans his tubes with his own dirty lab coat while the cleaning solution is out and available).
Let me pose a bit more insight here and elaborate on why this is happening. It’s not due to carelessness or neglect, or greed of a paycheck robbing humans of morality. It seems to be connected to a deeper, older problem. Although the staff at Thika Hospital holds proper credentials for trained, Kenyan doctors, pharmacists, and nutritionists, this is simply not enough. Healthcare, especially the systematics of AIDS, is very new and intellectually foreign, despite the localism of the actual problem. They truly don’t know much about it, as their only training is word for word from the material handed to the schools and hospitals from WHO and USAID. The lackadaisical nature of Kenya exacerbates the problem and creates a society and hospital that functions merely on information and care that is vomited back into the world. Very rarely is anything digested, producing a new form.
Rather than contributing to the over-populated and inefficient staffing problem, we’ve decided that we could be more powerful in other ways, here at the CCC. While still working in our respective rooms for a bit of each day, we’re spending the other half (and our evenings at home…thank god we’re both workhorses) creating brochures and information sheets for all Kenyan hospitals, and hopefully AIDS-related organizations. The hospital rooms have no handouts or information to give the patients so they may reflect back upon the issues once they’ve returned home. Because of this, many forget to take their medication correctly, eat or avoid specific foods, or even remember that HIV is infectious.
We’re almost finished with a Nutrition & HIV pamphlet, one on ARVs, and one on Reducing the Stigma of HIV. Next, we will translate the English into Swahili—hopefully with the help of Mount Kenya University—and print those as well. We will also build racks in each room (to hold the brochures) and send them to different hospitals.
Our volunteership at Thika District Hospital’s CCC ends the 22nd of February and we are brainstorming our next placement. Most likely in Nairobi’s trenches or in the starving villages by the coast.