Wednesday, September 30, 2009

High Technology and Appropriate Technology

Nakuru is not far from the equator and today we travelled to Mogotio, even closer to the equator. We were there to irrigate onions, peppers and other vegetables. The irrigation process for a small shamba (smallholding) is fiddly and time consuming. The field is beside a river. The pump is petrol operated. But the process of attaching bits of pipe so that the water reaches the farthest parts of the shamba takes several people and a lot of time.

In fact, it's a process of attaching, detaching and re-attaching bits of pipe until the whole job is done. While two people add and remove pipes, two others use hoes to make furrows for the water to flow through and block furrows where adequate water has entered. Why do people not use good lengths of flexible pipe or drip irrigation?

This is a one acre shamba, the kind and size that many Kenyans own. It's for growing small amounts of produce. It's labour intensive but labour is cheap, flexible pipe and other pieces of equipment are expensive. If the shamba was bigger and more productive, we could afford drip irrigation or some other form of irrigation, but this sort of technology is beyond the means of most people here.

So I was pretty annoyed to come across an article about some 'clever' people who have developed a device which allows a farmer to SMS or call a number to turn on their irrigation system. Great, but people who can afford an irrigation system that can be switched on and off don't have to do much work on the shamba themselves. They employ people to do it. It's not the first time I have seen articles about how brilliant mobile phones are. They have their uses but most of the problems poor people suffer don't go away just because they have a mobile phone.

I also came across an article about how Uganda is using mobile phones to spread the 'message' about HIV. Do they really think their unsuccessful and very expensive programmes over the last 20 years failed because of the medium that was used? How much evidence do they need that the problem was not just with the medium?. Many people there and in other countries know all sorts of things about HIV, not all of them true. But they still engage in the sort of behaviour that is thought to spread HIV. So why should spreading the 'message' by mobile phone change anything?

Anyhow, as well as hoeing and irrigating the shamba, we were in Mogotio to demonstrate the process of solar cooking to some people there. We cooked rice, ugali (boiled maize meal) and sukuma wiki (a popular collard green). Sounds a bit starchy but Kenyans like a fair bit of starch. The result was excellent. The area is so hot that things cooked quickly. So the workers in the field were impressed at the large amount of food they were provided with and even more impressed that no charcoal or wood had been used in the cooking process.

I had my worries about the ugali. It is almost worshiped here and getting it wrong could be fatal. But it turned out pretty solid and sticky. I have tried a few other things, stew, various vegetables, even soda bread. They are very good, as long as the sun lasts. So it's time to be more adventurous and do a bit of experimenting. I have no doubt that some 'genius' will be able to invent a device that pulls a screen across the solar cooker when the food is cooked. Until then, I'll just use the time honoured process of looking at the food.


Monday, September 28, 2009

Selling Sunlight on the Equator

We have been trying out the solar cookers. Having faced the problem of too much wind, too much dust, too little sun and too much rain, yesterday started off well and sunny. But half way through the cooking, the sky clouded over and stayed that way. We hadn't even taken the precaution of having some charcoal handy. After a lengthy walk, we got the charcoal and finished cooking the partially cooked food. It was good but not good enough to sell solar cooking to a sceptical audience.

Today was very sunny and, starting earlier, the food was cooked to perfection in less than two hours. The only thermostat available here is experience and I must admit, I left it all on for a bit too long. The food tastes good but is a bit drier than it should be. As it was so sunny, I slipped in a soda bread loaf, which is browning nicely right now. But the sun has again slipped behind the clouds.

So, as a precaution, we could take some cooking baskets with us when we go out in the field. We were hoping to find people to make these baskets for us as they are very expensive in the supermarkets. But we'll get to all that eventually. And we need to make sure that we start early in the morning and that there is charcoal available if things go wrong.

While I cooked today, some people in the house next to me were cooking with charcoal. They were cooking the whole time I was cooking, so it's not just solar cooking that takes a long time. While I cooked, I also washed the clothes, read some articles and wrote a blog entry. I'm just trying to anticipate the comments I'll get!

Well, it could be worse. We are now pretty much prepared to face the hungry mob and demonstrate the process of cooking on a solar cooker. Now that we've tried it out a few times, I feel far more confident. Let's see if I still feel the same way after a few demonstrations. But I love the idea of selling sunlight on the equator.


Sunday, September 27, 2009

Some Things Change, Some Stay the Same

The Preliminary Report of the Kenya Aids Indicator Survey (KAIS) was released last July and was based on data collected in 2007. Prevalence was estimated to be 7.8% among 15-49 year olds (7.4% among 15-64 year olds). Many parties expressed surprise that HIV prevalence had increased since 2003, when the Demographic and Health Survey estimated prevalence to be 6.7% among 15-49 year olds.

HIV prevalence in Kenya peaked in the late 1990s and fell rapidly thereafter into the early 2000s. Prevalence fell because death rates were very high. But death rates peaked in the early to mid 2000s. If there had been few new HIV infections in the early to mid 2000s, HIV should have stabilized at a fairly low level. This didn't happen. Instead, prevalence increased.

One possible reason that HIV prevalence has been increasing throughout this decade is that antiretroviral therapy (ART) has been keeping many HIV positive people alive. However, the number of Kenyans on ART by 2005 was very small. Numbers have increased since then, although it's not yet clear what effect this will have on national prevalence figures.

Another possible reason why HIV prevalence has been increasing is that there are many people becoming newly infected every year. While huge sums of money have been poured into treatment and care for HIV positive people and their dependents, very little has been spent on prevention. What has been spent on prevention has been wasted on pointless finger-wagging about how people should and shouldn't lead their sex lives.

The final KAIS report was launched in the last few days. I can't find a copy of it online but there have been many articles about it and they all, like this one, talk about the report as if these figures are new and surprising. It is not surprising that there are more people living in rural areas infected with HIV. The vast majority of Kenyans live in rural areas. Prevalence is lower in rural areas than in urban areas but the absolute numbers are higher. This is not a new trend.

Various commentators in various articles have resolved to deal with trends noted by the KAIS report but many of these trends go back many years. Even the KAIS figures are already two years out of date. And there are likely to be quite different trends now because, in case these commentators haven't noticed, some profound changes have taken place in the lives of all Kenyans. There was a violent election campaign, a violent election and a particularly violent post election period, during which many people were killed, injured and displaced. There have been energy shortages, food shortages, water shortages, a global economic collapse, increasing unemployment and, no doubt, countless other pressures on people's lives.

Some things are not the same now as they were two years ago, when data was collected for KAIS. They are certainly not the same as they were in 2003. But the HIV prevention work that is being carried out by Kenya's health and HIV agencies is pretty much unaffected by anything that has happened in the last ten and perhaps even twenty years.

Consequently, HIV prevention continues to be given low priority and takes forms that continue to have little or no impact. That's why a recent survey of 13-19 year olds shows that, many years and tens of millions of dollars later, less than 50% understand what abstinence means. More importantly, only 20% understand what being faithful means and only 7% fully comprehend condom use. The question is, do the 48% who can say what abstinence means really understand sex and safe sex? I think the answer is clearly 'no'; all they have taken in is a definition. They will not be able to protect themselves adequately, despite being able to parrot definitions of abstinence and the like.

HIV prevention work in Kenya needs to do new things, not continue with the failed, dogmatic activities of the past. Children (and adults) need to know what sex and safe sex are, they need to know how to protect themselves and often, they need protection. There are young people pouring into Nairobi and other cities now, they are desperate for work and until they find work, countless thousands will become involved in some form of transactional sex. People's living conditions need to be changed so that they don't face such dangers.

HIV policy needs to be based on what is happening now, not what was happening, or what someone thought was happening, years ago. And policies that failed years ago need to be changed, not shored up with excuses. HIV trends can change very quickly and all Kenyans are at risk of becoming infected, though some are at higher risk than others. There is no point in just concentrating on high prevalence areas, as one Kenyan WHO representative suggests; low prevalence areas can quickly become high prevalence areas. Also, absolute numbers can be a far better indicator than percentages when it comes to describing how an epidemic is spreading.

But the Kenyan government needs also to concentrate on people's lives, livelihoods, environments and opportunities. People still need the things they have always needed, health, education, social services, infrastructure, good housing, employment and protection from harm. Relevant authorities such as the National Aids Control Council and, indeed UNAIDS, need to be able to distinguish between the things that change and the things that don't change.


Friday, September 25, 2009

Painting Pots Black

This is not to stir up the long running dispute between the pots and the kettles. We're painting pots black so we can use them with the solar cookers we purchased during the week from Solar Cookers International. We've talked to people who work with, make and research solar devices and we've talked to those who want to buy them and use them. Now it's time to go out and demonstrate them and, hopefully, persuade people to part with the $6 or so that they need to invest.

Of course, people need to invest a little time and, god forbid, they need to embrace change, just a tiny bit of change! We can make ourselves some food over the weekend and decide on the best ways to demonstrate these devices. I'm looking forward to it but I'm also a bit apprehensive. After all, much of what I believe about development could be severely tested over the next week or so.

We will be working in and around Nakuru. My colleagues have been working here for some time and they have introduced me to various community support groups. Most of these groups have grown around the need to support people who are HIV positive, people who are directly affected by HIV and, particularly, those who are on antiretroviral therapy (ART).

Some of the groups are very active, with volunteers making regular visits to those who need support of various kinds, who need to be taken to hospital, who are having problems affording school fees or rent and whatever. Many of the groups are already exploring ways of making some money, such as growing and selling fruit, vegetables, milk, eggs and the like. Others make things and sell them.

Solar cookers are a bit different from other activities these groups are involved in. If someone buys a solar cooker, they have the means of saving money they would spend on charcoal. They may save the time they spend collecting firewood. They can use the cookers to cook food, dry food and boil water, the last being particularly important for people who are HIV positive.

People who are HIV positive need to be very careful about how they live their lives, what they eat and drink, what dangers they may be exposing themselves to. Their immune system is damaged by HIV and, even though many are on treatment, they still have to be careful. It is hoped that one more way of pasteurising water will be of great help in reducing exposure to diarrhoea and other water borne diseases.

Today, my colleague and I went to a support group at the camp for internally displaced persons (IDP) just outside town. People there are just trying to get by, some doing well, some not so well. We were accompanied by a woman who works for an agency that gives microloans to help people set up small businesses. Hopefully, they will see the benefits of solar cooking and, if they can come up with the money, also buy some cookers. And maybe some of them will want to take things further and use the cookers to produce something they can cook and sell.

That's the hope, anyhow. I'll write up what happens here, even if it shatters my heartfelt beliefs!


Wednesday, September 23, 2009

International Policy Network Partly Right and Partly Wrong About HIV/Aids

Philip Stevens of the International Policy Network questions the wisdom of spending so much money on a single illness, HIV/Aids, and asks if this can do more harm than good. I have long been asking the same question. My feelings are that it has done very little good and has probably done a lot of harm, especially to HIV prevention efforts.

The health of a nation is unlikely to be made or broken by one, single health condition. Even when there is a serious epidemic, there are probably always more people suffering from and dying from ordinary, every day things than from that epidemic disease. Health depends on people's lifestyles, living conditions, levels of nutrition and food security, education and economic circumstances, for example.

Stevens rightly criticizes UNAIDS's prioritization of treatment over prevention. Since treatments for HIV have been developed, far more money has always been spent on that than on prevention. So while many have been treated, millions more have become infected. Greater emphasis on prevention could have made a lot of difference, although precious few effective prevention interventions have been developed and implemented in any high HIV prevalence countries.

Stevens also mentions the poor and declining state of health infrastructure in high HIV prevalence countries. Indeed, some of the major funding bodies involved in pouring money into HIV treatment and care (and a little prevention) were, at the same time, urging developing countries to reduce spending on health, education and other social services.

If it is the case that some parties have claimed that everyone in the world is at equal risk of becoming infected with HIV, then this is truly shameful. I think the message was that every sexually active person is at risk, which is true. But it is not true that everyone faces equal risk. Perhaps this message has been confused by publicists, politicians, church leaders and various money grabbers who knew nothing about health, least of all HIV, but still wanted to get on the bandwaggon for their own ends.

And Stevens is wrong to claim that UNAIDS exaggerated the numbers of people infected and were 'embarrassingly forced to revise down the estimates for dozens of countries'. Methods of estimating numbers were improved, that's why the figures went down. Many figures are still very doubtful in that they could be higher or lower than presently estimated. Kenya was one of the countries for whom figures were revised down. A short time later they had to be revised up again.

Stephens' analysis, I think, is misleading. He makes it sound as if HIV/Aids is still a problem, but less of a problem that it was. I disagree. I believe that we neither have enough data to support his view nor directly to refute it. But there is plenty of evidence that people in high HIV prevalence countries still face serious and perhaps increasing risk of becoming infected.

I hope Stevens is right that donors have finally realized the folly of directing so much money towards one disease. However, I don't think he is right. I think he has allowed himself to be fooled by all the rhetoric about strengthening primary health care and health systems. If that is ever going to happen, I'll believe it when I see it.


Tuesday, September 22, 2009

There is Always More Than One Way to Prevent a Disease from Spreading

A church spokesperson in Botswana has said that the only way to win the battle against HIV is to change people's behaviour. It's true that people need to change their behaviour but that is by no means the only way to fight against HIV.

The church leaders could consider Botswana's main source of revenue. It's not very difficult, mining accounts for something like 70% of the country's total revenue. Areas around extractive industries in African countries have some of the highest rates of HIV anywhere.

Why is this? Well, most of the extractive industries are controlled by a few, extremely rich firms, who are usually foreign and absentee. They pay as little as possible in taxes and they are usually able to keep their costs low with the help of obligingly lax labour laws.

So millions of poor people migrate for long periods to the slums that grow around the mines. These slums are mostly inhabited by male workers, without their wives and families. Some mining firms even provide accommodation for their employees but it is almost always dormitory accommodation and of a very low standard.

Unsurprisingly, some women also move to these slums to find work, mainly as sex workers. There is little to do in dormitory accommodation during free time, aside from going to bars and sleeping with sex workers. People become infected, people infect other people.

Extractive industries come with many hazards, poor health and disease being just some of these hazards. TB, for example, is very common, as are other occupational conditions. So some healthy and some sick people all come together and the result is many sick people who then return to their home areas to infect their wives and families.

Rather than just praying for people to change their behaviour, they could approach the owners of extractive industries, many of whom, I'm sure, are Christians. They could also lobby politicians, another group that should contain some Christians. And here are a few things they could ask them to do:

- Improve labour laws so that workers, including migrants and seasonal migrants, are protected
- Improve health services and health screening and allow access to all employees
- Improve working conditions for those in and around the mines
- Improve living conditions, perhaps by providing proper housing and infrastructure
- Provide married/family accommodation for those who need it
- Provide sources of entertainment for people, things to do aside from drink
- Provide subsidized transport for husbands/fathers to visit families or for families to visit husbands/fathers
- Provide decent wages and benefits for miners and other workers
- Protect small landowners and artisanal miners who are affected by big mining operations moving in

Apparently substantial amounts of gold have just been found in Kenya. So there is plenty that church leaders here can do to avoid their future mining areas experiencing the sort of HIV transmission levels as those found in Botswana.

Diseases are not just spread by individual behaviour. The conditions in which people live, in which the behaviour takes place, are also important. These conditions can and must be influenced and changed.


Monday, September 21, 2009

Meaningless Figures and Empty Achievements

Because the Kenyan government is so busy concentrating on the Millennium Development Goal (MDG) to ensure that all children complete primary school education, goal 2, they seem to have forgotten that schools require teachers. It is is estimated that they are short of about 65,000 teachers, mostly in the primary sector.

This demonstrates the futility of aiming at some defined 'goal' at all costs. Since Kibaki announced that there would be free primary education in 2003, the enabling conditions for providing this education have been ignored. Millions more children have since been enrolled, often into hopelessly large classes.

But many of them will not complete primary education. There will be times they are not able to attend school, for various reasons, often related to poverty. Many will eventually drop out. And part of the aim of MDG 2, to ensure that girls as well as boys are enrolled, will also be frustrated. Girls are usually more affected than boys when families have to take their children out of school.

Then, yet another aim of MDG 2, to increase the literacy rate of 15-24 year olds, is also likely to be missed. But if you go to the MDG monitor site, you will be fed 'good' news, if there is any. There just doesn't happen to be any data at all for Kenya. But having good figures for enrollment is not really good news if many are not attending school or have dropped out, or if there are such serious shortages of teachers and resources.

Achieving MDG 2 is not just a matter of bumping up the enrollment figures, so let's not be deceived by these good news stories. Unless the country can fill the huge gap in teacher training and recruitment and also provide genuinely free primary education, the goal will never be achieved. At present, it will not be achieved by 2015, so if the country claims to achieve it we need to scrutinize the figures very carefully.


Sunday, September 20, 2009

Solar Cookers and Cooking Baskets

Photo: An IDP camp in Molo, Rift Valley.

Yesterday, myself and two members of a local community based organisation, that I'll be revealing more about in the near future, went to a camp for internally displaced people (IDP), just outside Nakuru. This tent city was set up by the United Nations High Commission for Refugees (UNHCR) following the post election violence more than one and a half years ago. The UNHCR has now left the camp and people there are getting by as best they can.

It's disgraceful that the Kenyan government has yet to resettle people properly after all this time. Many of those in the camp find it difficult to get to services and facilities as they are an expensive bus journey away from the town. Even health facilities are hard to get at and people on antiretroviral therapy (ART) are in a particularly precarious position. ART is nominally free in Kenya but there are logistical problems relating to getting to health centres, buying other medicines and the like.

Anyhow, many people in IDP camps see themselves being there for some time. They have planted fields of fruit and vegetables and done their best to be more self reliant. Unfortunately, a herd of buffalo came recently and destroyed much of what they had grown. And the current drought doesn't help either, many crops are stunted or withered because of the lack of rain. But there are also green and flourishing gardens that must have required a lot of care and attention.

Some aid agencies have been to the IDP camp and have given some assistance. But much of that assistance is in the form of handouts of goods and money, which is not sustainable and does not allow people to be self reliant. This community based organisation are advising people on ways of saving in order to be able to access microcredit facilities. They are also advising on potential income generation schemes so that people can get some money for their work or, at least, find out about ways of spending less.

One technique we are hoping to introduce to people is the use of solar cookers for cooking food. The area gets a lot of sun and solar cookers could be used for much of the year. There are numerous advantages to using solar cookers but the advantage we want to make clearest is the cost saving. Charcoal and wood, which people use now, are expensive. They are also in short supply and becoming scarcer. Cutting the amount of smoke people inhale on a daily basis also springs to mind, and the list goes on. Oh, and it's a great way of pasteurising water!

Complementary to solar cookers would be cooking baskets, which are best explained on the Cooking in a Basket blog. These are insulated baskets that cook food which has been partially cooked, thus saving a lot of time and fuel.

In principle, it should be possible to source the materials and makers of these two tools, the solar cooker and the cooking basket, locally. That may take time and we can use ready made ones in the meantime. It may also be possible to get some of the materials free or almost free. Currently, a local sisal unit dumps large amounts of material that would make great insulation padding. But we'll spend the next few weeks working out the logistics and I'll post up our progress as we go along.


Saturday, September 19, 2009

Does Everyone at the World Bank Share the Same Brain Cell?

The World Bank certainly knows how to give mixed messages. The overfed, overpaid over there now admit the dangers of climate change, especially for developing countries, and they are urging industrialised countries to reduce carbon emissions. This took many years of arguing against the climate change denialists, who dominated industry and finance, so this was no mean feat.

But the World Bank is also financing massive coal fired electricity plants in developing countries that will pump out greenhouse gases for decades. In a country like Kenya, where they don't produce coal in large quantities, this will also mean an unwanted increase in dependence on imported energy.

Dearest World Bank people, we never expected genius to emanate from among you, but nor did we expect such total idiocy. Right now, foreign governments are gagging to get their hands on Kenyan land so they can grow crops for biofuels, even though one quarter or more Kenyans face food shortages and the country is experiencing prolonged drought. This will also increase the countries carbon emissions. And there are plenty of other things happening here that are inimical to emission reduction.

Perhaps the people at the World Bank have heard of solar energy? To this piece of knowledge, perhaps they could add the fact that Kenya and other African countries get a lot of sun? Or maybe I'm overloading your thought faculties a bit? Well, there's also something here called geothermal energy, which also emits little or no carbon. There's also wind energy, which I'm sure even World Bank people would have some understanding of.

So why, with these abundant sources of renewable, not polluting energy, does the World Bank choose a non-renewable, polluting source of energy that will cripple poor countries with debt and swell their balance of payments deficit?

Would it be an exaggeration to suggest that the people at the World Bank have completely lost it and shouldn't be trusted with a piggy bank, let alone the billions they propose wasting on increasing the potential catastrophes brought about by climate change?


Friday, September 18, 2009

Good Leadership and Facing the Realities Around HIV/Aids

Still trying to familiarize myself with the area around Nakuru, the towns, villages and rural areas. More importantly, I'm trying to get a picture of the organisations and initiatives that I hope to work with, their members, leaders, qualities, interests and levels of activity.

Some are very active and productive, with keen participants and strong projects. I couldn't help agreeing with the home based care worker I met yesterday who said he thought leadership is the key. I don't believe for a moment he was talking about himself as he is a very modest man. But in Salgaa, he gives excellent leadership and gets excellent results. Leadership does appear to have a vital bearing on the success or failure of support groups and their activities.

Peter knows all of the people in his two community support groups very well because he lives near many and pays regular visits to others, travelling many kilometers every week on his bike, on a hired motorbike or on public transport. There is no substitute for covering as much of this large area as possible, as often as possible.

But the results of his work include regular meetings, high levels of support given to and given by participants; Peter and others working in the area can tell you all about each participant and they know when someone is sick or in trouble. Not everyone takes an equally active part, of course, but compared to some other support groups that don't even meet most of the time, Salgaa has a very healthy community.

Most importantly, people there who are on antiretroviral therapy (ART) are taking their medication as they should. This means they gradually become as healthy as they were before they were affected by the opportunistic infections that appear in people in advanced stages of HIV. This is one of the primary aims of the support groups and in that respect, they are doing very well.

As for HIV prevention, the area has not been so lucky. The Kenya National Aids Control Council has never really spent much time, effort or money on HIV prevention. They talk about it a lot but neither Kenya, nor any country in the world, have really implemented programmes that demonstrably reduce HIV transmission. Calling their programmes, such as they are, 'evidence based', does not mean they have had any effect.

And some organisations never learn. After many years of bleating about sexual abstinence and how it reduces transmission, even though it clearly does not, many of those involved in HIV prevention are still coming out with the same tripe.

Yes, young people need to know they can refuse those who try to persuade them to have sex. And those who are in a position to refuse either don't have sex or they only have sex under circumstances they choose. That's great for people who have freedom of choice but fails to address those who, for many reasons, don't have the choice or don't have much choice.

Children (and adults) need to know the reality of sex and choice and many other things. Abstinence campaigns, even ones that include partner reduction and condom use, do not have a history of teaching realities. There are still many adults who believe all sorts of rubbish about condoms, circumcision, reproduction and other vital matters. And there are still people who use the word 'abstain' all the time and have very little useful knowledge about what they are supposed to be abstaining from. It's sex, it's a big subject and it goes far beyond a few over used slogans.

These bogus HIV prevention campaigns demonstrate something else, besides leadership, that is missing from initiatives that fail: reality. There is plenty of money and therefore plenty of 'leadership' behind abstinence and the related sanctimonious parphenalia. But because they are not rooted in the realities of people's lives, they have little or no impact on their lives.

In Salgaa, the support groups don't just have good leadership. The groups arose from the realities of living with HIV/Aids. People need to get on with their lives, facing the same realities that may well have resulted in their becoming infected. They don't survive by refusing to accept the realities, rather, those who refuse to accept the realities become sick and die.


Thursday, September 17, 2009

How Many Mobile Phones Does it Take to Change a Bandage?

Photo: This donkey is more likely to save lives than a mobile phone.

The media never tire of writing self-satisfied articles about how brilliant technology is and how so many things can be done now because of technological advances. No doubt, there have been remarkable advances and we can now do things that were never dreamed of a few decades or even a few years ago.

Despite this, there is an increasing number of poor and undernourished people. Most, if not all the Millennium Development Goals are going to be missed by most developing countries. People are dying of preventable and curable diseases. Yes, preventable and curable. They can be prevented and they can be cured but, for some reason, they are neither prevented nor cured.

There is a whole rash of articles on the use of mobile phones for HIV care and prevention, articles written with all the confidence you would expect of suit-wearing, job-holding academics and consultants. But all these articles appear to be based on anecdote rather than on comprehensive data. You can support adherence, send prevention and health messages, even diagnose diseases and perhaps issue prescriptions.

But that's only if there is some kind of infrastructure available. There's little point in issuing a prescription to people who can't afford the medicine or the trip to the pharmacy or where the pharmacy has run out of supplies or if there's no public transport or if there is no clean water to take pills or...etc, etc. Even where the infrastructure is in place, Kenya is not blessed with adequate numbers of trained health personnel.

I'm not running down technology, I agree mobile phones are great, as are handheld computers, laptops, mobile internet and anything else that can be dreamed up. But ultimately, people also need the basic things that the survival of the human race up till now has depended on.

That's what's missing, food, water, sanitation, basic health, basic education. Missing are the education, health and social service facilities and, more importantly, the trained, skilled and well equipped people who provide services.

All of the health care workers I've met recently have mobile phones. Notably, they are also all volunteers, with very little training. There are not too many people they can call, least of all skilled medical personnel, as they are in very short supply. And if someone calls them late at night, most of them don't even have a bicycle to get to the client. If the client needs to be moved, they might have a wheelbarrow or a cart to get the client to the nearest public transport vehicle. This is not a joke.

There is also a shortage of electricity here and a shortage of money for credit. Many handsets don't work or don't work very well because of the heat and dust or because they are cheap handsets that don't function for very long. True, people can use solar energy to charge their phones but most don't because this particular technology is too expensive.

Mobile services could even be paid for by the state. But the state doesn't provide the few pennies necessary to treat and prevent intestinal parasites that stunt the physical growth and mental development of vast numbers of children every year.

I'm sure people are very happy that we 'can' do all these marvelous things with technology but they'll be a whole lot happier if their immediate needs are attended to, whether they require technology or not.


Wednesday, September 16, 2009

The Extended Family and Other Myths

Sometimes people write about developing countries as if they are all very similar and they may throw in terms like 'extended family' and 'coping strategies', as if this makes poverty, illness and unemployment less of a burden. They write about 'incongruities', such as drought and famine, but lots of smiling children, playing happily in the dust.

Some people do 'cope', because they have no other option. Many live in large families and they do co-operate, with the sick, young and old being looked after by the able bodied. And of course, children play happily in the dust or mud or whatever.

However, such commentators may not see or may choose to ignore the children and adults lying in bed or the ones who never come out because their disabilities are too great or because they are too stigmatised, for example.

The fact is, people in developing countries have family disagreements, neighbourly jealousies, local spats and far more serious eruptions of discontent and outright violence, just as they do in other countries.

Here in Nakuru, there are differences and perceived differences that make it unlikely that some people will agree to work with some others and that community based organisations with members who see themselves as essentially different from other members can be prone to failure, sometimes quickly, sometimes slowly. Merely setting up a group that consists of members from different groups does not mean people will work happily together.

I don't believe this situation is all that different from wealthier countries. But crucially, many people in developing countries need support, perhaps many different kinds of support, right away and often for a very long period.

There is a severe shortage of most basic resources in developing countries, food, clean water, education, employment, etc. These are some of the things that allow them to be characterised as underdeveloped. When there is a shortage of resources, knowing that your neighbour has plenty when you have none is bound to cause discontent, no matter how friendly you have been in the past.

When people are under extreme pressure, they can do extreme things. Some don't, perhaps most people don't. But community based organisations and various initiatives are often set up when people are already under extreme pressure and they are therefore already precarious.

The majority of people in developing countries have been waiting for much or all of their lives for the most basic of goods. I suspect that that is why now, some people seem to grasp at anything that comes their way, even if it is intended to be shared with others. I think if I were starving, or if my children were, I would do pretty much anything to get food.

This doesn't explain why some of the richest people in the country, politicians, business people, colonials who remained after independence and various other organisations, also grab what they can. Some of them have been stealing vast sums of money and resources intended for people who were in dire need.

It doesn't explain why large multinationals exploit developing countries and see them as vast markets, why international organisations pretend to help developing countries when they are really enriching themselves at the expense of those countries, why huge 'pro-poor' initiatives are really about making rich people richer, selling arms, 'national security' or some other agenda, completely unrelated to development.

It would be nice to think that poverty is really quite a happy, fortunate state, given that the majority of people in the world live in poverty, many in absolute poverty. But it's not true. It's not true that everyone in developing countries live in 'extended families' that make sure no one 'falls through the net'. We just don't see those who fall through the net. It's not true that people 'cope', they either survive or they die, often after a lot of suffering.

Those who see and write about 'extended families' and people 'coping' may just miss or choose to miss those who have fallen through the net, because those who have fallen are no longer visible.


Tuesday, September 15, 2009

Free Education, For Those Who Can Afford It

If you follow the official literature and commentaries on Kenyan education, you may think that all primary school age children get free schooling. If you go into it in a little more depth, you will find that there are many hidden costs such as 'extra' tuition, which the children have to attend, shoes and uniforms, which have to be worn, exams, materials and various other items.

Therefore, many poorer children fall through the loop. Having no school fees is irrelevant for the parents who are unable to meet the additional costs. Unknown numbers of children don't go to school or don't go to school very much because their families are too poor. The Kenyan government is not too keen to admit to the existence of these children, of course. They enjoy the praise they receive from the press and from foreign donors.

Added to these children of poor families, there are orphans and other children who have been abandoned or who don't have people to provide everything they need. There are well over one million, perhaps as many as two million. There are street children, children who start school so late that they will never catch up and will drop out early, there are children who are sent out to work for much or all of the time they are supposed to be at school.

All in all, the Kenyan government is quite shy about anything that could be called bad news. The recent census may not even account for all the children in this country. It may remain difficult to know how many children are not at school or who don't receive much schooling before they become too old to attend school.

Yesterday, we were in Rhonda again, this time to visit a children's home. There are 120 children being schooled there, 20 of whom live there all the time. Because this children's home is not a public school, they receive nothing towards the children's schooling. There are many such homes around the country. No one has any idea how many, exactly. And the government will not be so keen to talk about these either.

So, for all the money that is said to be spent on 'free' primary education, if would be interesting to know how many really benefit, how many don't get anything and if it's true, as it appears to be, that only the better off get to go to school. It appears that those with least and those who are under the most pressure are also least likely to be able to afford the costs of 'free' education.


Saturday, September 12, 2009

Differing Mindsets: a Goal or a Way of Life?

Western Non Governmental Organisations (NGO), funders and most Western volunteers tend to think in terms of projects, programmes, lengths of time, numbers of participants, amounts of money, outcomes, objectives, goals and targets. Of course, there needs to be accountability, there needs be a good level of monitoring and evaluation and all that. Things need to be managed.

But it's remarkable how differently local Community Based Organisations (CBO) and Kenyan volunteers work. Much of the work is never ending so things are not viewed as projects or programmes. Lengths of time are irrelevant, as are numbers and stated goals and targets. People are very pragmatic. Orphans are looked after until they grow up, sick people are looked after till they recover, if they recover, old people are looked after till they die.

There is no need to ask what a good or bad outcome is, either an intervention works, in which case it will be continued or it doesn't work, in which case it will not be continued. Of course, there are exceptions, foreign volunteers who become very pragmatic and Kenyans who become sticklers for measureable things, exclusively.

When it comes to money, attitudes vary also. Of course, people who have no money look for ways of making some. Everyone would prefer a job that is not too strenuous or stressful and one that is better paid. But some CBOs just get on with whatever it is they set out to do. Others get on with writing a proposal and waiting around for money. If they get money they may get on with the job, or they may see getting the money as an end in itself.

But some of the CBOs that just get on with the job and see funding as a longer term requirement often do amazing work before raising a single dollar. Even volunteers working for a small amount of money for a period often continue working just as hard when the money stops coming in.

Today, we interviewed four people to volunteer to work perhaps half a day, five or six days a week for six months. All of them said they would be willing to work for as long as required, a year, several years. After all, they have already worked as volunteers for three to five years. They were all asking for very little in allowances. And that's just as well because the allowance on offer is very small.

For some people, the work they volunteer to do is more of a way of life than just a job that has measurable, countable outcomes. Perhaps these differing mindsets explain some of the friction between those who always insist on targets and results and those whose aim seems to be to bring about some kind of change for the better.


Friday, September 11, 2009

Support Groups May Need Support Too

To Lanet, not far from Nakuru. We turned up for a support group meeting for people with HIV. It's not unusual for people to be very late for meetings but an hour after it was due to start it was clear that people were not going to come. I wouldn't blame them if the rumour I heard was true; that one of the local churches was distributing free maize! Well, after a while three people drifted in. They wanted some medicines that we were able to distribute. Two got their medicines and drifted out.

One man sat and talked for a while. Although many people who need antiretroviral drugs in Kenya are not getting them, perhaps as many as 65%, some of those who do get them are very happy to have arrested the disease. This man is healthy and fit to work. Unfortunately, there is no work for him to do. And it's difficult staying fit and healthy with no guaranteed income.

I also met an 11 year old girl who had had meningitis. She had known that she was HIV positive but she was not receiving enough medical attention to catch the meningitis in time and now she is blind. Her mother refuses to believe that her daughter's eyes could be permanently damaged and has yet to take her to be assessed. Perhaps her sight could be saved. If not, she needs to get back to her education as soon as possible and to get her specific needs attended to.

Some kind of support group may well be able to help the two people I met today, I don't know. But several people I have spoken to have alluded to the fact that there are so many groups and meetings that they can sometimes interfere with each other. Perhaps there's a case for a bit of networking, so support groups can support each other as sell as supporting their members.


Thursday, September 10, 2009

Some Signs of Prosperity in Kaptembwa?

Kaptembwa is not that far from Nakuru but, for some reason, there was a more prosperous feel about some of the homesteads and fields. We were there to visit people who are HIV positive and taking antiretrovirals (ARV). But people taking ARVs can, in most cases, go back to the work they were doing before they became ill. One woman we visited kept hens, goats and sheep. She also grew maize and various vegetables and had a small shop, a hole in the side of the house, to sell food and other day to day items to neighbours. It is a long way from the nearest big shops, but that is handy for people who can be enterprising, as this woman is.

The picture is not as rosy for many people because once they have Aids, they can suffer a lot of illness. ARVs don't work as well for some people as they do for others. One family we visited had to move from a bigger house when the father and mother found they were both HIV positive and in need of treatment. The father of the family is unemployed, as is his wife. His young boy is also HIV positive and suffering from various illnesses as a result. The youngest in the family, a three month old girl, may turn out to be HIV negative, it's not always certain at that age.

It's no secret that catching HIV early, before it results in people losing their livelihoods, is something worth concentrating on. But for people who are very poor and perhaps unemployed before they become infected, an early diagnosis may not help much. The family with no income get free drugs but can't always afford trips to health centres to collect drugs and for other visits. They can't afford a good variety of food to keep themselves and the children healthy. Children need a good diet, especially. But also, people who are on ARV treatment suffer side effects if they don't have a good level of nutrition. Some suffer so badly that they just stop taking their drugs.

Much of the money spent on HIV/Aids goes to drugs but many people infected and affected by this disease need a lot more than drugs. They need good food, clean water, proper housing, health, education and social services. Some people are doing well despite being HIV positive. But some are doing no better than they were before becoming infected while most are a lot worse.


Wednesday, September 9, 2009

Athenai and the Plague of Monoculture

Like Rhonda, mentioned a couple of days ago, it's not an accident that Athenai sounds like Athens. This huge area is 'owned' by a Greek who lives somewhere in Nairobi. There is little to see but sisal. Sisal is one of the disastrous monocultures that dominates parts of Kenya. The crop was introduced by the colonials before petrochemical products made plastics much cheaper than sisal based ropes, string, matting, etc.

The sisal estate dates back to the 1950s, when labour was dirt cheap. Luckily for the owner, labour is still dirt cheap, but it's hard to make much money from the product now. But it's an enormous holding and there is little else for people to do there but work for a pittance in the fields or in the factory. It's as if the colonial days never ended, really.

The factory is quite a museum piece, all in working order. The sisal is crushed, dried, brushed and turned by machines from the fifties, still in working order. They are not working today because of power rationing. There is a shortage of the oil that generates so much of Kenya's electricity. Never mind the long hours of sunshine or even the ample winds that blow through this area.

HIV rates are high in this area, as they are in all the hubs of monocultures. Rates are high around the sugar factory in Mumias, the tea plantations in Kericho and the flower producing units in Naivasha. Many people in Athenai are too sick to work and are unable to afford medical care, let alone food, education or other social services.

I'm unsure what would be a long term option: do people continue to work with sisal, as they have done for decades, or do they diversify? If they diversify, what would be the best things for this relatively isolated area to get involved in?


Tuesday, September 8, 2009

Support Group Meeting, Bondeni

There has been rain on most days for the past couple of weeks so maybe the short rains have started in earnest. At least a bit of rain is better than none. There are many crops that are at the stage where they need rain badly. But some areas, apparently, are threatened with flooding. It's so disconcerting to be in a place where a long drought can turn into a devastating flood.

But we were in Bondeni for a meeting of members of a support group. They get together to discuss matters of common interest and share experiences and advice about things like microcredit, farming, income generating schemes and anything else that can be of help to the group. Well, it was a long haul for me, I admit. The meeting was due to start at ten but I was assured that if I turned up at 11 it would just be taking off. We got there before 11, started at 1130 and it was nearly 1400 by the time we finished. That's a long time to sit on a bench made for very small children.

As for the income generation schemes discussed, they included the usual things: hens, cows, bead jewellery, crochet and market gardening. Apparently hens are old hat and people are being advised to buy dairy cows. Of course, most income generation schemes only really get off the ground if the person or people involved work very hard and have a fair amount of luck. Some of these ingredients can be in short supply. But I'd like to come across people who are doing something different to generate income, something that people all across the country are not doing. But when I come across such schemes, I'll be sure to post them up here.


Monday, September 7, 2009

Fresh Perspectives on HIV from Rhonda, Nakuru

Photo: Sand quarries in Rhonda, Nakuru. Everything is done by hand.

Yes, I thought of Wales too. Apparently the whole area was once 'owned' by someone from the UK, perhaps that person was Welsh. It is a mining area. Sand, used for building, is mined here. It's very gritty sand, broken down volcanic rock. The whole area is covered in the softest, finest dust. It billows around your feet as you walk. But it gets into everything, your lungs, eyes, mouth...

But we were in Rhonda to meet some people who receive home based care. They are HIV positive people so they need help with food supplementation, drugs, hospital visits, household items and the like. Most of the people we visited were happy to be on antiretroviral treatment, happy to be surviving with HIV. Some complained about problems paying the rent, being able to buy enough food and things like that. But even some people who are well and employed are having these problems.

One person in particular shared his own, very interesting perspective on HIV. He is a pastor and was articulate in English and Kiswahili. He said that he accepted having HIV rather than some other illness because with HIV, you don't just sicken and die. Rather, you have time to help other people with HIV, to help other people to avoid HIV, to live a full and active life.

This man was only diagnosed as being HIV a few years ago, when he was already very sick. He was in a coma for two weeks, he then recovered and could get around in a wheelchair. Gradually he went from there to using crutches, then a walking stick and now he can walk a bit, unaided. After he spoke to us he was due to give a sermon.

His mother also had an interesting perspective. She reminded us that she stuck by her son and continues to stick by him, looking after his every need now that he is able bodied, just as she did when he was in a coma. And, despite the fact that her son is a pastor, this woman said she thought that some of the churches use the existence of HIV to make a lot of money. She was not criticizing all churches, just some that do more fundraising than distribution.


Saturday, September 5, 2009

How Much Can We Steal From Africa and Call it Aid?

HIV/Aids, TB and Malaria, sometimes called the 'big three' diseases, receive amounts of money way out of proportion to the number of people affected by them. Neglected tropical diseases (NTD) affect more than 500 million people in Sub-Saharan Africa; that's more than half the entire population of the African continent.

But the thing about the big three is that they require a lot of research, a lot of money and a lot of work just to reduce the massive burden they represent. Whereas, NTDs are mostly caused by parasites and can be prevented and treated easily and cheaply. It is estimated that $200-400 million a year over five years could reduce NTDs significantly.

You think a few billion dollars is a lot of money? Well the determinants of all these NTDs, along with TB, malaria and, to some extent, HIV/Aids are environmental. They relate to people's physical environments, especially water, sanitation, food and food security, housing, air quality, etc.

Compare this few billion dollars to the plans to invest around $80 billion in hydroelectric power in the Democratic Republic of Congo. Investors will only be interested in this project if some of the electricity generated will go to Europe. What a surprise. And some of the money going into this project will be aid money. Some will be public money from other sources but the 'private' money involved will only be available, you can be sure, if it is guaranteed to make a return.

Bear in mind also a $400 billion scheme to supply solar electricity to Europe, generated in African countries. And the hundreds of billions of dollars worth of oil, gas and other natural resources extracted from other African countries every year. The amount needed to reduce NTDs and even the 'big three' is puny in comparison.

Ironic as it may seem, many of the NTDs are caused by parasites that thrive in hydroelectric dams; these are ecological disasters and this has been recognised for decades. For how long can we pretend that these expensive projects are for the benefit of Africans when they clearly are not? And for how long can we refuse to attend to programmes that could benefit the whole continent of Africa?

Good water and sanitation, food security and other basic benefits are the way forward for development, not the continued extraction of the continent's wealth at the expense of its people.


Friday, September 4, 2009

SODIS in Wanyororo

Photo: SODIS users in Wanyororo. The woman in yellow is Elizabeth, a local volunteer.

Wanyororo is a lot greener and more prosperous looking than Salgaa, though appearances can deceive. The maize grows tall and green and there is quite a variety of different crops grown there, especially in the shambas (small holdings). However, many of the popular crops are badly affected by the current drought. Some crops are late, some die and others are small, stunted and possibly useless.

Wanyaroro also produces hand cut blocks of stone for building. The buildings around there are typically constructed from these stone blocks and cemented with mud. This results in sturdy, relatively cheap and potentially attractive buildings. The area is dotted with little quarries where people busy themselves hacking out the soft, black volcanic stone.

Again, we (ICROSS) were looking at people's use of the SODIS method to purify water. We visited homes where the water comes from various sources, rivers, boreholes and piped supply. Even from reliable supplies, the water is somewhat cloudy and can contain pathogens that cause intestinal problems, such as diarrhea. If you look carefully at people's houses, you can spot the plastic bottles on roofs, walls and on the ground.

Photo: Water pasteurizing in the sun using the SODIS method.


Thursday, September 3, 2009

SODIS in Salgaa, Nakuru

Photo: A selection of male condoms and one female condom.

I arrived in Nakuru on Tuesday and hope to be here for some time. Yesterday I went to Salgaa, in the district, to see some of the work ICROSS is doing there. Food was being distributed among HIV positive people, who are in especial need of good nutrition in order to ensure their antiretroviral drugs work properly.

Food is in short supply in many parts of Kenya right now but even when there is plenty of food, HIV positive people don't always have access to it because they have little money and can't always reach the market. Sometimes the government meets its obligations and supplies a little food. At other times the food must be supplied by NGOs and other parties. After the food was distributed by ICROSS volunteers and local care workers we went to visit some of the recipients.

The main work I hope to be involved in is a solar water purification method called SODIS. Water is exposed to sunlight for a number of hours and the combined effect of ultraviolet light and heat kills many of the pathogens. This means that people can avail of a cheap method of water purification which helps reduce incidence of water borne conditions, especially ones that result in diarrhea, which affects millions of people every year and is responsible for about 20% of deaths among children.

The main targets for promotion of SODIS, in addition to children, are people with HIV. They are particularly susceptible to any conditions and reducing water borne diseases should make a big difference in reducing the number of pathogens they are exposed to.

The efficacy of SODIS has long been demonstrated and ICROSS was one of the pioneers of the method and of the controlled trials. Despite this, a recent paper questioning the effectiveness of SODIS on the ground in Bolivia has been published. This has attracted a lot of attention because the authors suggest delaying promotion of the method until further research has been carried out.

Proponents of SODIS, including myself, would disagree, as the method has undergone many successful trials. Work with the method is at a very advanced stage. What needs to be questioned is a trial where the results are so poor. Of course, advocating the method is a long and difficult process and everyone involved has much to learn. But SODIS does work; how well supported the communities adopting it are is an entirely different question.

But more on SODIS presently.