Developing Project SHE for girls’ health and education in western Kenya

Hi all!

Firstly, I apologize on the lack of updates. Internet has been spotty lately, and the program/leisure time has been extremely fun, yet time-consuming. Whether it’s rainforest hiking in the Kakamega Rainforest, mentoring amazing high school students at the first InnovateKenya conference, or enjoying the beautiful sunset on Lake Victoria, I’ve lost track of time in its most purest sense. It’s that feeling when you’re enjoying something so much, that time becomes insignificant as I indulge in every experience, encounter, and interaction, and tuk-tuk drive I have around the city. I’m thankful for the easygoing, relaxed “African time” culture. Quite a welcomed change in the pace of life.

As for any further exciting updates regarding global health, I’d like to share some updates about a project I’m implementing here with my friend Emilia!

Recently, I wrote for Ishani and Inesha’s awesome blog called seeingitoi.wordpress.com. It is about my “Lean In” Moment here in Kisumu, Kenya. Emilia and I are working for an NGO (i.e. non-profit) called SANA International, an organization that provides clean water, sanitation facilities, and hygiene education to schools and communities in the Nyanza province of western Kenya. After interacting with government officials from the Kenyan Ministry of Public Health, several school teachers, and many primary school students, we discovered that a significant issue was the lack of a comprehensive approach to addressing girls’ menstruation and health and girls’ educational outcomes. With this in mind, we initiated Project SHE, a program that partners SANA International with other NGOs in Kenya to provide Sanitation facilities, Hygiene supplies, and health Education in ~50 primary schools in western Kenya to increase school attendance and educational performance outcomes for primary school girls. Here’s a copy of the latest blog:

“Lean In Moments: Bernadette Lim” (featured on seeingitoi.wordpress.com)

Project SHE: Innovating girls’ health and education in western Kenya

Martha has high hopes to become a doctor. Trisha proudly exclaimed that she wanted to be a pilot, and Mary knew that she wanted to be a teacher like her mother. As the four of us began to share our future aspirations in one of my recent visits to Kibono Primary School, Trisha said something that deeply struck me: She didn’t know if she could become a doctor because she missed so much school.

One of the greatest highlights of my trip to Kisumu, Kenya has been working, with SANA International (Sustainable Aid in Africa), an organization that provides clean water, sanitation facilities, and hygiene education to local communities and primary schools in the Nyanza province of western Kenya. As one of its current projects, SANA partnered with UNICEF to build more latrines (toilets) and washrooms for girls in primary schools. According to a 2013 UNICEF study, if girls had these sanitation facilities available to them, they would be more likely to attend school, especially during their menstruation period. Coinciding nicely with my passion for girls’ empowerment through health and education, my partner and I were asked to evaluate this initiative. As a result, we have spent a lot of our time visiting primary schools and conversing with girls and teachers about their thoughts and reactions to these projects.

Our research led us to discover something intriguing. Getting girls to attend school during their menstrual period isn’t as simple as just building the facilities they need. A more effective solution should be multi-dimensional, one that includes to the reliable provision of sanitary pads and an accompanying health education curriculum centered on menstrual health. SANA addressed one facet of the problem by building the latrine facilities for girls and several NGOs operating in Kenya addressed the lack of sanitary napkins (with accompanying health education varying per organization,) Yet, despite their efforts, they had failed to coordinate to provide all of the girls with a comprehensive health solution to increase their attendance in schools.

Our solution? We initiated Project SHE: Kenya. By recognizing the need for a comprehensive solution to girls’ health in schools, we sought to lean in by talking to officials of the Kenya Ministry of Public Health, experts from SANA, teachers, and students about our idea. The mission of our project is to increase girls’ outcomes in schools by improving access to Sanitation facilities, Hygiene supplies, and health Education for primary school girls. By combining these efforts into one solution, we believe that we can deliver a more powerful intervention to increase girls’ education in Kenya’s primary schools.

Currently, we are planning to implement our plans in 50 primary schools throughout the Nyanza province in western Kenya to accompany the construction of girls’ latrines by SANA with various NGO partnerships that will provide free or affordable sanitary pads to these schools. Additionally, after reading Kenya’s National School Health Policy and discovering that menstrual health was not mentioned in its standard curriculum, we have spent time developing a curriculum to be run through established school health clubs; this curriculum will provide the information girls need to know about appropriate menstrual health management. We hope that our multi-faceted “package”— privacy and cleanliness of new latrines for girls, a reliable supply of sanitary pads, and comprehensive menstrual health education— will not only result in an increased attendance for girls but also elevate girls’ academic performance.

My partner and I are still in the developing stages of coordinating Project SHE and ensuring its success and continuity beyond the four weeks I have left here in Kisumu. In the hopes of creating a more accessible and achievable future for girls in Kenya, we hope that Project SHE will be a simple and sustainable solution that will testify to the powerful and inextricable link among health, education, and empowerment for girls everywhere.

At Kibono Primary School!

Mentoring these amazing girls at the InnovateKenya!

Finally here!

After seventeen hours on airplanes and in airports, I finally arrived to Nairobi on Friday! Surprisingly, it actually wasn’t too bad of a travel journey. I finally got to catch up on some movies I’ve been meaning to watch (Argo! SO GOOD!)

When we arrived in Nairobi, something I immediately noticed was the prevalence of Western advertisements on my way out of the airport. Huge billboards lined the dirt roads as I was departing from the airport, most of them from Coca-Cola. Of course, this may be expected from its tourism industry. Yet, it was intriguing to see that there were White people on their billboards in addition to those of Kenyan ethnicity. Not sure what the significance of this is, though it may simply be a demonstration of the perpetual Western influence here, even if Kenya just marked its 50th anniversary of its nation’s independence and freedom from its former status as a British colony.

In the capital city, there were plazas and hotels/resorts that demonstrated industrial and infrastructure development, yet there were also homes and markets (oftentimes adjacent or nearby the swanky plazas) that were significantly less developed. These  homes and shops are close together, crowded, extremely small, and made of scrap material. Out of respect, I have decided not to take pictures of these areas.

The students who are on the trip with me are pretty cool. Most are either rising sophomores or juniors at Harvard, though we do have a few rising seniors and a graduate student. In addition, a few people are from Brown, Emory, and Canadian universities. Our RAs and TAs are awesome and have diverse experiences in global health, public health, and medicine. They are too cool!

We flew to Kisumu two days ago and finally arrived at the apartment complex we’d be staying at. Kisumu reminds me a lot of Boston, in that it has a busy downtown with several new, industrialized areas. Similarly, Kisumu still retains a significant part of its culture in spite of its infrastructural development. (It’s important to keep in mind that “industrialized” in Kisumu cannot be compared to that of the United States!) There were also significantly less developed areas in town, similar to those in Nairobi. The city is lakeshore, adjacent to Lake Victoria, the second largest freshwater lake in the world.

We’re living in the NGO (non-governmental organization aka non-profit) community here and are accommodated by  relatively nice infrastructure – a complete contrast to the less developed areas of town. Very interesting to see how the NGOs working in Kisumu have built their own community separated from the rest of the city. I wonder how the locals feel about this. Anyway, perhaps what impressed me the most about our rooms was how decorative the mosquito bed nets were! It’s like my 5-year-old princess Rapunzel dream has finally come true… 13 years later!

Bed nets = feeling like royalty!

For the past few days, we’ve been traveling in “tuk-tuks” all around town to buy additional amenities, groceries, and necessities. Most roads are simply dirt roads, so the trips to and from the market are really rocky. My tuk-tuk driver, Maurice, calls it the “dancing road”. Tuk-tuks are small vehicles that can take 3-4 people and will be my transportation to and from home, class, and our project sites!

Since there are ~17 of us and each tuk-tuk can only hold 3-4 people, we usually travel in a 4-5 tuk-tuk caravan around the city #touristproblems

As for food, I’ve had some really delicious meals including “Ugali”, their local corn starch staple food, with tilapia and some really good Indian curry (there’s a relatively large Indian population here). It’s only been a few days, so I can’t say much — but I’m looking forward to their fish and seafood since we’re right by the shore!

As for any further updates, today was our first day of class. We got to meet our professors, all of whom are really awesome, knowledgeable, and passionate about what they do. Our classes are held at KMET, one of the NGOs founded by one of the professors on our trip.  Their NGO focuses on reproductive health outreach, advocacy, and innovation. What’s great about the NGO is that most of the organization’s leadership are actually locals of Kisumu. The programs are multi-dimensional, in that they acknowledge the various factors that can contribute to a healthy lifestyle, including microenterprise opportunities, education, and technology.

Some musings I’ve had regarding today’s discussion and readings on the Millennium Development Goals and Human Rights and my experience so far:

• The MDGs are fairly noteworthy for their high achieving goals, yet their success is largely centered on outcomes rather than the process of achieving these goals. For example, one of the MDGs is to eradicate extreme poverty and hunger in the world by half. This success, however, is largely based on numbers and outcome statistics, including a country’s proportion of people living under $1 and its poverty gap ratio. A country can claim that they reduced poverty by half, but this assertion can easily be flawed. For example, a country might simply want to be motivated to achieve these goals for international recognition and may merely concentrate its efforts in urban areas (where most people in developing countries are increasingly living), but neglect the poor in rural, hard to reach/access areas. On the same note, it is these areas where individuals are less likely to assert for their own health and human rights. MDG goals and the claim to achievement of these goals can significantly be contorted and flawed, so it is important that more detailed statistics are seen during the analysis of a country’s achievement of MDGs. This analysis can also be linked to how the MDGs may simply promote solution achievement in numbers rather than quality achievement.
• My views of what define poverty are somewhat changing. After reading Muhammad Yunus and his adamant belief in the use of microcredit and small business to help the poor rise from poverty, I am now hesitant to label people who live in the less developed areas of Kisumu as among those under extreme poverty. In fact, this now comes to me as a question that asks: what is poverty? The word seems to be ambiguous and dependent on the opinions of the beholder. While many in Kisumu live in rickety housing (or so as I perceive it), many of these people have their own businesses – ranging from cooking, selling various amounts of goods/clothing, performing auto repairs/construction, etc – outside of their homes. I wonder how people who live in these areas view their economic situation. I think the indicators that still allow me to believe that these people can live in poverty is the fact that their homes and markets are situated in unsanitary environments. However, poverty is officially associated by the UN to those who live under $1.25 USD per day, and it seems that many of these people live above this demarcation point due to the presence of small businesses. But even thinking about it… $1.25 is definitely not enough to sustain a proper livelihood either. I anticipate that this thinking will further develop as the course goes along.
• Health is used as a “litmus test” for human rights. It has been researched that a decline in health is oftentimes linked to a decline in the standard of living and a decline in other freedoms/rights. Might be an obvious thing, but I thought that the centrality of health as an indicator for human rights was interesting.
• 70% of Kenyans regularly use mobile technology! I know mobile technology has been used as an adherence mechanism for ARV treatment for HIV/AIDS. I don’t think it was as effective as predicted, though I do wonder if mobile technology can be used another way…
• Things I’m really excited for: learning more about reproductive health, interacting with more locals, and meeting Obama’s grandma next weekend (yep, you read that right!)

The weather is amazing, just like SoCal’s warm and breezy weather. Locals are also really friendly. Also, I am LOVING the Reggaeton & Gospel music that is heard in our neighborhood nearly 24/7 (though this music ain’t poppin when the locals are partying from 11 pm to 5 am and I’m sleeping…)

First Swahili lessons tomorrow! Exciting.

Talent is universal. Opportunity is not.

Two more days until Kenya! It’s been a great week back home, and I’ve gotten the opportunity to see many of the people I love. Yes, I’ve even admittedly missed the infamous Katy Pham and her ability to scream sing along to Demi Lovato’s “Heart Attack” at midnight… 

Amidst the unhealthy amounts of boba I’ve consumed and the silly shenanigans I’ve ventured with best friends, I’ve taken a lot of time to reflect and react to the readings and research I’ve performed on healthcare and international development (ID) work in Kenya. Some things I’ve been musing:

Good intentions are not enough.

I’ve mentioned in my first blog about the precarious nature of international development work. Many organizations and multilateral institutions like the UN and WHO have great goals and resources, yet oftentimes their work is far from effective. In fact, sometimes what these forces do is not only ineffective, but can actually does more harm than good.

In the field of international development, good intentions are not enough. Yes, many are gung-ho about making a difference and there is no doubt that they want to use their talents and knowledge to help others. But there has to be more. I’ve realized that my talents, my knowledge, and motivations are essential, but not sufficient. Instead, the key to international development will be found in the willingness to understand, learn, and observe. Any effective success is found not in the ability to implement one’s skills and knowledge onto others, but rather in the empowerment of creating a change that actively involves and empowers with the voices and opinions of the people you serve. Notice the italicized conjunctions. Working with the local community rather than onto/for the local community is where the greatest potential for change in international development lies.

Analyzing my role as a foreign student traveler 

Perhaps one of the greatest overarching themes of the field of international development is the act of defining to what extent and to what purpose my trip abroad holds to myself and to the people I encounter. How much can I realistically do in 6 weeks? Am I simply there to perform volunteer service work, or am I working towards a sustainable change? Would the change that I hope to make by going to my trip to Africa be more beneficial in the form of monetary donations? Is my work replaceable? If so, how can I contribute my talents to best understand the area I am helping and ignite an innovative change?

I’ve struggled to define what exactly what I’ll be doing in Kenya, and after much reflection, I’ve decided that I want to refrain from simply labeling myself a volunteer. The premise of the trip is to contrive an “innovation (i.e. solution) to an existing problem in the Kenyan healthcare system” after 6 weeks of in-class seminars and field experience with an NGO. To call myself a volunteer is to imply that what I will be doing is replaceable and can be done by simply anyone who travels to Kenya through the program I am in. On the contrary, I hope to shape my role to be much more substantial and sustainable.

After much contemplation, I think my roles on this trip cross between being a learner and an innovator. This trip will undoubtedly be a great personal learning opportunity. However, even more important than my own personal gain, this experience gives me the chance to create a product or service with the knowledge I gain from my professors, NGO, and local leaders about the Kenyan healthcare system. I want to learn of the talents, skills, abilities, and resources available to the community I will be helping. Moreover, I want to learn of the opportunities they lack and see where I can effectively and respectfully intervene.

I know this sounds like a lot of fluff, labeling myself as a learner and an innovator. I even might incite some “Western-complex” critique by labeling myself with such self-promoting labels. Yet, as we look at the history of changemakers that have created expansive, effective, and respectable solutions to the world’s most pressing problems, they all have the common quality of learning through observing and listening. By doing this, innovation and change is oftentimes a matter of working with and listening to the concerns of local community members. Empowerment is the product of creating opportunity for local communities to take ownership and responsibility towards finding solutions.

“Talent is universal. Opportunity is not.”

I think being effective in international development world can (ironically) be summed up by realizing one simple phrase: Talent is universal. Opportunity is not.

It’s interesting to see how the public is exposed to two different sides of the developing world. On one hand, we have glossy pictures and films of life in the developing world, such as those that depict girls of varying ethnicities holding hands under a beaming sun and frollicking through green grass (yes, I am making a subtle reference and critique of Girl Rising). On the other hand, we have something called “poverty porn” that depict and generalize the poor as horribly emaciated, incapacitated, and helpess, just as we so often generalize the “starving children in Africa” as encompassing, well, every child in Africa.

vs.

For a good example of poverty porn, watch this video by World Vision called “Hidden Faces of AIDS” (the image is clickable). It’s lauded on YouTube… but do we really need the  dramatic eerie music to accompany the depiction of poverty? Are the fire and flames and B&W pics really necessary? How many times do they need to emphasize the word “DIE”? And what about the creepy voice starting around 0:45? Ugh, I can’t. I feel like I’m watching a cheap horror movie.

The stories of Rye Barcott’s It Happened On the Way to War and Muhammad Yunus’s Creating a World Without Poverty both center on how we so often underestimate the determination, work ethic, and talents of the poor. We have the habit of seeing the poor as individuals to be helped rather than individuals who, if given the resources, can help themselves. The poor are so often stigmatized as burdens of society, yet our institutions fail to provide adequate opportunity for the poor to prove themselves otherwise.

Rye Barcott’s NGO called Carolina for Kibera is an organization that clearly exemplifies the benefits of “participatory development”. Its mission statement is to “develop local leaders, catalyze positive change and alleviate poverty in the Kibera slum of Nairobi.” In his book, Barcott invests money into the entrepreneurial and altruistic aspirations of the people he meets in Kibera. He gets to know the local community on a personal level and invests the leadership of the organization into the hands of the local leaders themselves.

Muhammad Yunus is known as the “banker to the poor” and created the renowned Bangladesh microfinance institution, Grameen Bank. He has lended millions of small loans of money to the poor with small, flexible interest rates in order for the poor to create their own small businesses. To his surprise (and my surprise as well), the rate of money returned to the bank by the poor was 98.6%! He noticed that many of the most trustworthy and effective businesses were those run by women, as personal profit gained by their businesses were often given to their families rather than themselves. His book also revealed a new concept I thought was very intriguing called “social business”, in which the profits of a social business would be devoted to paying back investors the exact money they contributed, yet using the remaining profit as a means of expanding social services or improving product qualities in lieu of giving back the profit to investors. Quite a twist from the customary non-profit model, for-profit model, and even social entrepreneurship hype. I’m hoping to read more into it — the model sounds feasible and promising for the future of using capitalism for social good.

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Just realized this blog post was probably too long for its own good. But it’s helpful on a personal level because I talk about international development with others and find a hard time articulating all my thoughts concisely. These main three points encompass a lot of my reactions. Hopefully they’re helpful to anyone who’s following! And dang, I still can’t get over that poverty video above. I don’t know how anyone finds that video inspiring or an effective call-to-action.

Blog on my summer bucket list to come tomorrow!

‘Kwa sababu naweza’: Because I Can

While this may (dangerously) perpetuate my current blogging addiction, I’ve chosen to create a blog to document my experiences, thoughts, and ideas related to my interests in global health simply because I can and want to share this learning experience. Please excuse my present and future witty commentary, touristy excitement, and pathetic (yet genuine) attempts at conveying my linguistic Swahili abilities — it all stems from the bright-eyed excitement for the anticipated awesomeness of this summer!

So my summer in a nutshell: I will be traveling to Kenya from June to mid-July for 6 weeks and then returning home until late August to resume writing, relaxing, hanging out with old friends, and working on girls’ empowerment research.

A basic overview of the program in Kenya:

• There are 13 teaching staff members (10 professors, 3 TFs) and 15 students going on the trip! The head of the courses are Dr. Thomas Burke, founding Director of the MGH Center for Global Health Human Rights and Dr. Roy Ahn, Associate Director of the MGH Center for Global Health and Human Rights. Other prominent professors include Ann Prestipino MPH; Hanni Stoklosa; Nadi Kaonga MHS; Melody Eckardt MD, MPH; Bob Keith; Brett Nelson MD, MPH; Monica Oguttu, MPH; and Sean Flannery. Yes, they are all badasses. And yes, I can’t contain my excitement realizing how badass they all are.
• The program includes classroom work and fieldwork experience. After the first week, I will be spending Tuesdays and Thursdays in the classroom. On Mondays, Wednesdays, and Fridays, I will be doing fieldwork at a local NGO placement (we get to choose at the end of our first week).
• As the the program is called “Innovating for Health Transformations in Africa,” the main goal of the program is to analyze how to effectively create and implement an innovative solution to healthcare in the developing world. We’ll be learning and experiencing the history and transformation of current healthcare topics in Kenya/east Africa in order to contrive our own solutions to problems we learn and see while we are there. (A huge mistake in international development oftentimes influenced by the “Messiah-complex” is the assumption that many NGOs and non-profits take in forcing their ideas, theories, and practices into the developing world without the input or communication with the local area. It’s an ethical issue wrought with hubris and ignorance.) — Hooray for entrepreneurial experiential learning!
• Fun touristy things I cannot freaking wait to do: rainforest hikes (!!), boat rides along the river (!!!), and a weekend safari escapade (!!!!!!!)

As I await my flight to Nairobi at the end of this month, I’ve been doing quite a bit of preparation for the trip, including a lot of personal and required reading. My next blog will be a summation of the findings I’ve learned about the Kenyan healthcare system from my own personal research and from the required pre-departure readings I have to do. I’ve begun reading all of them and they are super interesting and thought-provoking, so I definitely recommend reading them if you’re interested in international development or global health.

• Yunus, Muhammad. Creating a World Without Poverty. New York: PublicAffairs, 2007. (There’s a free PDF of the whole book online somewhere)
• Bodnar, Benjamin. So you think you want to save the world. Yale Journal of Biology and Medicine, 2011 Sep;84(3):227-36. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178852/.
• It Happened on the Way to War by Rye Barcott
• A “Learning Swahili” book

Both books courtesy of my good friend Brandon Liu!

In addition to my 6 weeks in Kenya, I have a bucket list this summer that I’ll post sometime this week. The list includes my personal goals – including the list of books I’ll be reading (Yay for summer reading! Yay intelligence!), languages I’ll be learning (Swahili and Tagalog whoot whoot), and skills I’ll be developing (such as cooking aka learning how to not be afraid of the stove because there’s a high probability I will be in DeWolfe housing next year.)

I’ll finish up my research and reading by the end of the week and follow with a blog post summarizing what I’ve learned and my reactions.

As for what I’ve been doing in my free time aside from blogging and researching? Eating In-N-Out and consuming unhealthy amounts of Tastea boba (duh). I’m very thankful to be home. #noshame