Malaria, HIV and COVID. What’s changing with health in Kenya?

Posted on October 1, 2022 by johnageddes

Kenyans are used to dealing with illnesses that threaten their well-being.

Malaria is ever-present. I figure that malaria poses a much greater threat to me as a visitor than COVID as I visit Kenya and I take daily prophylaxis to protect me. Malaria can cause fever, malaise, muscle aches, headache and sometime death. Better medical management choices, rapid tests for malaria, and recent introduction of immunization for infants will soon reduce the prevalence and morbidity in Kenya (and other tropical countries) from malaria.

Africans have also been living with HIV for over 20 years now. Although HIV/AIDS was devastating a few years back it has become manageable with education and effective management. New cases of HIV are now much less common.

Preexposure Prophylaxis (PREP) and Postexposure Prophlaxis (PEP) are now available and medical management of AIDS has come down to one pill a day and an every six month checkup at a local health facility instead of 10 pills daily on a regimented schedule and monthly visits to a special clinic that is not close to home. A test and treat model whereby newly diagnosed cases are immediately put on antiretrovirals rather than waiting until their health indicators are deteriorating has reduced morbidity has made a huge difference.

When I traveled here in 2004 the prevalence of HIV was over 40% in one of the communities I frequently visited. Today I am told that new cases are much, much less common and most of the patients with HIV are long-standing and receiving effective ongoing care. In 2004, Kenyan life expectancy was 48 compared to Canada’s 81. Today it averages 68.

What about COVID? The recent COVID pandemic has disrupted the Kenyan economy and health as it has around the world.

During tHe height of the pandemic last year Kenyan Public Health authorities instituted a strict lockdown. Schools and most businesses were closed for over a year. There was a curfew imposed from 7pm to 6 am for over three months with the penalty for breaking the curfew being arrest. Hand washing and masks were required, along with frequent temperature checks before entering indoor establishments or stores. Gatherings for funerals or weddings were restricted. Masks were required in all public transportation including matatus (the ever present taxi vans often stuffed to the brim with 14 passengers) Vaccination was delayed but gradually became available (AstraZeneca) in mid to late 2021. Pfizer boosters have recently become available but, as in Canada, calling it a booster rather than a third scheduled shot to complete protection is making it seem optional to many and uptake is less.

**Dan rolls up his sleeve to get his Pfizer “booster”.**

There has been no easy way to determine how many were infected. My friends tell me that older folks were dying of short catastrophic illnesses but there was no way to know if it was COVID because testing was not readily available.

Businesses and individuals who worked in the hospitality/tourism sector suffered financially. Small street vendors were limited in how they could sell their wares or foods. There was no financial social assistance. It was a struggle.

Now, in September 2022, things look like they are returning to normal. Some people tell me that they think they probably had COVID as they had the common symptoms but no one really knows for sure. I have seen no one wearing a mask in the week that I have been living in this rural community. When I arrived there were a few masks in the airport and on the plane. This was requested but not required. No one talks about COVID unless I question them.

**Higher income countries have an older demographic. Look at the map of Old Age Dependency ratio, the darker areas having an older demographic**.

Western countries, Have an older demographic and have more diseases associated with aging like heart disease and diabetes and cancer. More people in these countries will require intensive management of COVID or even die from it because of the increased vulnerability caused by advanced age or co-morbidities. These cases do exist in Kenya, too, but they are difficult to diagnose because of lack of testing and little management that patients could access (ventilation or even oxygen therapy) unless they are well-off and live in a larger urban centre.

World death statistics from COVID show much lower death rates per 100,000 population for Kenya (in blue along the bottom) than the western world. Is this because the deaths are just not being identified or because the lower average age means less severe illness, or both?

So Kenyans have a couple of things going for them in terms of COVID. The much younger population are not as likely to become severely ill and if they acquire COVID at school or in the community they will develop natural immunity that might be boosted with recurring mild infections. They also have a warm climate here and folks spend most of their time outdoors. Weddings and funerals and other gatherings are mainly outdoors and homes have open doors and windows much of the time to improve ventilation. Vaccination is now available to them as well. The challenge now is how to encourage them to get it . The poorer uptake of the “booster” is mainly due to thinking it is optional rather than the resistance seen in North America by folks who think it is impacting their “freedom”.

(Video) Socializing after church outdoors. Some get a COVID booster under a tree while others remain inside to sing some more.

What’s next? There has recently been a small outbreak of Ebola in Uganda and another suspected case in Kenya. The border between Kenya and Uganda has been closed. Hopefully, this will be contained as in the past. We have seen how HIV and COVID can insidiously invade a community.the fear is always that Ebola will become more difficult to manage as well.

**To end on a cheery note, here is the hibiscus I have been looking at this afternoon beside the porch at Dan’s house as I write this post.**

NOTE: This post has a video image. If you are reading the post on an email you must click on the title of the post to be taken to the WordPress site where the video can be streamed.

“Dedo*, what are savages?”

Posted on August 11, 2018 by johnageddes

I spent a day this week with my 7 year old granddaughter and out of the blue she asked me what a savage was. I was a bit taken aback. I had not heard that word used for some time.

It turns out that she had seen the word “Salvage” written on a truck but obviously had been exposed to the word “savage” somewhere else and though it was the same thing.

I realized that this was a word that I would have heard quite a bit when I was younger but it is not used any more (as a noun**) or if it is, it has to be used cautiously and with some tact.

I tried to explain that it used to refer to people who were uneducated or uncultured or had some wild tendencies, who lived in societies where there was not the same education or sophistication as one that we are used to. (Try putting that into words for a 7 year old). I also added that I don’t think anyone these days is seen as being that way because even if people live remotely or away from what we call civilization they are not necessarily “savage” in that they have their own cultures and habits which might be different from ours but not inferior.

“So are they called homeless people now?” she asked.

This was getting complicated. And over the week I have been thinking about this word.

This morning I walked past the statue in City Park of Sir John A MacDonald, Canada’s first Prime Minister and wondered if there would be a move to have it taken out of the park, given his involvement with the establishment of Residential Schools in Canada. I reflected on how times and attitudes have changed (for most) and how back in those days, our Canadian Aboriginal population would have been though of as “savages”. Uneducated. Not British. No sophistication. Our settler ancestors actually saw this as an opportunity to educate them and make them less “savage”. Totally wrong but coming from a place that we can not fathom today.

A portion of Kent Monkman’s painting “The Scream”. Canadian indigenous children being wrenched from their families to be taken to a residential school. A horrendous page of Canadian history that we must acknowledge.

“When the school is on the reserve the child lives with its parents, who are savages, and though he may learn to read and write, his habits and training mode of thought are Indian. He is simply a savage who can read and write.” Canada’s Prime Minister, John A MacDonald May 1883

I remember having a midnight conversation a few years back with my close Maasai friend, Stephen. He had just described to me several Maasai customs that were quite different from ours but that all had definite significance and meaning and reason behind them to preserve longstanding customs that gave order to their society and even preserved it. I recall him saying that white people may have thought of African cultures as being “savage” – the Dark Continent – but these cultures do have laws and rules and customs that have developed over the years to keep them functioning. Those customs may be different from ours. Not worse or primitive. Just different. The same comment might apply to our Canadian indigenous people.

Maasai men drawing blood from a cow to drink (mixed with milk) at a celebration. Not something we would do. It didn’t hurt the cow at all (like you getting your blood taken) and makes perfect sense since they have no refrigeration, and so only slaughter their cattle occasionally when the meat can all be cooked and eaten in one day. This gives them some iron and protein without sacrificing the cow and if they rotate through the herd, the cow does not miss the blood at all. Probably over time, the warriors who drank the blood were healthier so the custom persists in some rural Maasai communities.

Western literature sometimes portrayed the image of the “Noble Savage” –uncorrupted by civilization and pure but unsophisticated and uneducated. Both North American aboriginal people and native Africans were seen as a bit of a novelty by some. Charles Dickens, however, was in disagreement with this image and wrote this in his journal in 1853.

“TO come to the point at once, I beg to say that I have not the least belief in the Noble Savage. I consider him a prodigious nuisance, and an enormous superstition. His calling rum fire-water, and me a pale face, wholly fail to reconcile me to him. I don’t care what he calls me. I call him a savage, and I call a savage a something highly desirable to be civilised off the face of the earth. I think a mere gent (which I take to be the lowest form of civilisation) better than a howling, whistling, clucking, stamping, jumping, tearing savage. It is all one to me, whether he sticks a fish-bone through his visage, or bits of trees through the lobes of his ears, or bird’s feathers in his head; whether he flattens his hair between two boards, or spreads his nose over the breadth of his face, or drags his lower lip down by great weights, or blackens his teeth, or knocks them out, or paints one cheek red and the other blue, or tattoos himself, or oils himself, or rubs his body with fat, or crimps it with knives. Yielding to whichsoever of these agreeable eccentricities, he is a savage — cruel, false, thievish, murderous; addicted more or less to grease, entrails, and beastly customs; a wild animal with the questionable gift of boasting; a conceited, tiresome, bloodthirsty, monotonous humbug.” Charles Dickens – June 1853.

To write something like this today would be considered racist and inflammatory.

Times change. We don’t use the word “savage”** much any more (as a noun to describe people) and if we do, we have to be pretty careful about it. There are lots of other “ethnic” terms that seemed quite common when I was a kid that are deemed totally racist and inappropriate today. Most of us ( in my circle at any rate) are respectful of other cultures and aware that although we are different in our beliefs and customs and language and skin colour and history, we are neither inferior or superior to one another. And that is a very good thing.

*When my first granddaughter was born I was working in Bosnia and Herzegovina, didn’t relish being called grandpa so took the Bosnian name for grandfather, Dedo. Now I am Dedo to five grandkids and this is what the whole family call me – and other kids too.

** Savage can be a noun, an adjective or a verb. As an adjective it can be used to mean uncultured, boorish, or wild. ( a savage beast) As a verb it can mean to attack brutally. (The tornado savaged the neighbourhood). As a noun it generally refers to a primitive, uncivilized person.

Bosnia is struggling.

Posted on May 22, 2014 by johnageddes

Since I have returned from my visit to Bosnia and Herzegovina, my first in five years, I have been asked many times “What has changed since you were there last?” I have been surprised to have to say, “Not much.”

I worked in Bosnia on and off from 1998 to 2009. I came to be very familiar with much of the country but was usually based in Sarajevo, a second home for me for a few years. It was in the relatively immediate post-war period so there were a lot of international dollars being spent in recovery in one way or another. Every time I returned, there would be some obvious changes – new roofs on buildings that were damaged during the conflict, people moving back into neighborhoods that had been demolished by war. Many of the locals were being employed or supported in some way by the recovery efforts. Recovery was the industry but many of those programs had a ten year lifespan. Ours went for about 15 years, but like the others, the money to maintain it was doled out over a fixed term and once that was done, we withdrew and our local associates needed to find other sources of income.

Ready for the tourist dollar.

So now, five years later, it seems like the country is once again stalled. The one area where there has been more development is in the tourism sector. Of course, during the post war period, tourists, except for very curious and courageous ones, were not coming to Bosnia. Now it seems that industry is stuck or even declined and tourism is the only sector that is in some way flourishing. This is true of the Croatian coast as well.

Hotels have been fixed up and are quite presentable, comfortable and not expensive. When I first went to Bosnia in 1998, there was no internet or banks or computers. Now the coffee shops and hotels all have WiFi, there are ATM’s on all city streets and credit cards are accepted widely.

The people are a bit frustrated. In fact, there have been some demonstrations throughout the country protesting lack of economic security.

To add to the economic woes, in the last week the region has received record rainfall – three months worth of rain in three days – with resulting catastrophic flooding and landslides causing havoc, destruction and loss of life. It has been estimated that 40% of the country has been affected by flooding and damage exceeds 2 billion dollars, money that Bosnia doesn’t have. The flooding has uncovered or exposed buried land mines left over from the war, adding to the disaster and many are without safe drinking water. Thousands have again been made homeless.

An election scheduled for the fall but there is skepticism that anything significant will (or can) change. In the next few months there will be a lot of mopping up to do. Bosnians are, once again, facing the challenges of coping with recovery – financial, infrastructure and political. They will need some help.