The past two days I have been visiting the rural part of Kenya where my TB surveillance project will occur. I had the opportunity to follow a CI (community interviewer) to the compounds and households where the health interviews occur.
The gentleman who I accompanied is nicknamed Rat--which is short for the world elephant in Dho-Luo because he is a giant--not only in stature but also in warmth, personality and intelligence. He is now a TL (team leader) but was once a CI years ago in the village in which we were visiting. Everyone we passed greeted him and asked where he had been for such a long time. He passed on some sage words, "To succeed in this job you must have a huge heart and a small brain."
We visited 10 households and he patiently explained the system of interviews, and I am going to save you from the details but suffice it say, it's thorough and 25,000 people a week are run through this. Amazingly everyone I saw greeted the interviewers kindly, stopped their work and answered questions for 20-30 minutes.
Despite my living in Tanzania for two years, I entered as many mud huts yesterday as I had in all my time there. I did not take pictures of the inside (and I will get a picture up of the outside so you can appreciate where I am) but I will explain to you the best I can.
There is only one hut design in this area--you duck low to avoid the roof to enter the doorway set in the middle of the house. You enter immediately into a greeting area with chairs or couches with foam cushions aligned along the right side and the back with a table in the middle. There are a few pictures, a calendar or small decorations attached to the walls. The room is divided from the sleeping quarters by either a mud interior wall or a sheet. On the other side of the sheet is where the family sleeps--everyone. In the framing for the roof there are woven grass mats, farming tools and other possessions in storage. Small livestock are as present in the home as the family.
Upon entering the room you are immediately struck by how hot or how cool the structure feels and this is completely dependent upon the roofing. Grass roofs are very cool but need to be replaced twice yearly. Metal roofs make the hut a sauna but you can collect rain water from them and they need to be replaced every 5-10 years.
During the interviews which were conducted in Dho-Luo, a language which I am sure I will pick up some--got "ahonda" for cough and "deip" for diarrhea and a few greetings so far, I sat and watched the interactions. Interviewees would very rarely give a "yes" or "no" but would respond almost nonverbally with cues that were mutually understood by everyone but me. I also watched the kids who were in the house--more than a few times it was mentioned that I was the first white person ever to visit their house, or the first their children had seen outside of a car. One little girl asked her mother if I was a woman--I hope she was associating the color of my skin with gender and there wasn't anything else I was giving off, especially considering I have a pretty solid beard right now and I consider myself masculine. At the end of the interview I would squat next to the kids and give them a high-five or let them touch my skin--a lot of them like running their hands through the hair on my forearm.
The next day I visited the hospital where our study will be centered and met with some more people. I also had a chance to have a little clinical experience as I learned about the work-flow of the office. The head clinical officer and head of the hospital asked me what a normal patient load was for a physician in the US. I said a busy family doctor might run a few rooms at a time and see 30-40 patients on a long day. He saw at least that many in the morning session, including five members of the same family.
Almost amazing I haven't mentioned much about the food I ate, but lunch for the past two days has been at a little guest house a few hundred meters from Lake Victoria where everyone comes to eat. It has been recommended to me by two of my co-workers out in Lwak Hospital doing field work for the IEIP. And guess what, when Senator Obama came to visit before launching his first campaign, he ate at this little guesti as well. The food's quite good and the company is even better.
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