Making movies and cuddling babies

                    

Megan and Sydney here- the nutrition interns from UPEI.  We have recently returned from Kenya, and wanted to bring you up to date on some of the work we did in July and August (now that it is easier to upload blogs and pictures!).

Over the summer, we worked on three projects: 1) the assessment of food security and diet among women in the Muchui and Ruuju women’s self help-groups 2) using a ‘train the trainer’ model with women ‘champs’ to teach women and men in the broader community about nutrition and healthy family meals and 3) the development of an infant feeding resource to improve the nutritional quality of infant foods and to extend the period of exclusive breastfeeding. This blog is about the final one-where we developed a video which can be used by the local St. Theresa’s hospital to educate women from the community.  It is our first ever experience as directors and videographers!

 Before we developed a video, we had to decide what information was needed, and what approach to take. That took a fair bit of interviewing and research. Our professor Jennifer (Prof Jen) provided us with information and concerns identified from previous nutrition interns [Amy, Harrison (2011); Kaylynne and Christina (2010)]; we also had the guidelines for infant feeding from the World Health Organization which would form the basis for our recommendations. 

Our first step was to meet with women in their homes and in the hospitals to get an understanding of what their infant feeding practices were. We also met with healthcare professionals such as dietitians, HIV advisors and nurses to get an idea of what the teachings around infant feeding were. Most of the women understood that breastfeeding was good for their baby but were unsure of how long to breastfeed for; many women breastfed for only one month before giving their baby solid foods.

We spoke with one of the new mothers (she had a healthy baby boy on July 10^th) who had not yet received any nutrition education from Caroline the dietitian (who was hired in 2012 after one of the UPEI nutrition students (Harrison) recommended they do so!). We were concerned about some of this mother's responses. She would be returning to work in three months and would no longer be able to breastfeed her child. She thought that because she was going back to work, there was no other alternative but to resort to a formula made with cow’s milk, bananas and Irish potatoes for her child.  She also told us that her mother said that the baby needed to be fed water immediately as well, or it would become dehydrated.  After interviewing the women and Caroline, we were reassured that one reason behind women weaning their infant too soon, or introducing less nutritious foods was a lack of knowledge and that our video could, in fact, help. We also believe that hiring a Dietitian was one of the best choices that St Theresa's Hospital could have made! Caroline is working with all the new mothers and educating them on the importance of exclusive breastfeeding, and complementary feeding once the child becomes six months old.  Our video can be one tool that she can use to help women from the surrounding community who come to the hospital.

 The information that we got from talking to the women and healthcare professionals helped us to decide what we needed  to include in the video. We developed an outline for the video and had it reviewed by Prof Jen.  After an introduction, we would cover benefits of breast feeding exclusively for 6 months, concerns and myths about breast feeding and infant feeding, and the how/when/what of introducing solid or complementary foods. We wanted to have the entire video in Kimeru with some English subtitles so that it would be understood by local pregnant women and new mothers, and the staff at the hospital.

Megan and a little baby girl

Now it was time for the fun stuff: we got out our high tech video gear (IPHONE) and went into women’s homes, the hospital and Machaka Children's home to get all this information on tape. At Machaka, Grace, the social worker, and Susan, a childcare provider, helped us out as we taped the babies being fed. They were all ready to begin when we arrived; the videotaping went very well and the women were excited to watch themselves on video.  They even called some of their coworkers to come watch it with us!   

Sydney and little Jonah at the children's home in Machaka

We interviewed several woman from the Kiirua area, some of whom were part of our home assessments in June of food security. One women, Harriet, is currently seven months pregnant with her first child. She is a working single mother and we were happy to hear that when she does have to go back to work, she will continue to breastfeed as her baby will be at work with her.  We videotaped her talking about two of the benefits of breastfeeding. Of course, she gave us a cup of Kenyan tea before we left!   

At the women's homes and at the hospital, we were a little rusty at first with the information having to first go through Rose (our translator) first and then one of the women to be videotaped. The women were happy to help and excited to be famous throughout Kiirua!   After two weeks of taping in the community, the hospital and Machaka children’s home, it was time to make our edits, add in English subtitles and get it flowing together nicely. We completed the video and went to the Muchui Business Centre to have the first showing of the video. We wanted to evaluate how effective the video was so we had the women do a short multiple choice quiz before the video and the same one after.  We were pleased that most women chose the correct answer after watching the video. 

Sydney(L) and Megan's (R) CME presentation

The last showing of the video was for the healthcare professionals at the hospital because this is where the video will be used the most.These CME, or continuing medical education, presentations are a bit nerve racking because they are around an hour and 15 minutes and the people that come are all health professionals…doctors, surgeons, nurses, clinical officers, etc. (We waited 45 minutes for people to show up...we are finally learning to live on Kenyan time!)  The presentation went fantastic which was great, because the Minister of Health happened to show up…. Talk about intimidating!! After the presentation, she said she loved the presentation and said it was one of the most creative things she’s seen. She asked for a copy to take back with her. How cool!   Caroline also asked for a copy of the video for herself and we hope that she will use it as a resource within the hospital and community.   By the way, a small TV and DVD player was bought with the money from last year's UPEI Students for Development fundraising dinner which will be used in the Maternity ward to show the video. 

Overall, the video recording went really well, considering it was both our first ever experience producing a movie.We showed it to Prof Jen a few days ago, and she was pretty pumped about it.  We had raised money for a small TV and DVD player in the hopes that the video will be shown at the MCH (Maternal & Child Health) clinic at the hospital, and will help educate pregnant women, new mothers and their families to give babies the best possible start in life.  We plan to have a screening of the video in the Department of Applied Human Sciences this fall- we will keep you posted on that!

      

Farewell Kiirua!

I am sad to say that we are entering our last week here in Kiirua.  It has been an exciting 12 weeks in Kenya; we have learned so much about ourselves through our work in the hospital and in the communities.

We have met so many amazing and inspirational people here in Kenya.   A few weeks back, we were invited to sit in on an HIV support group, held by staff at the hospital once per month.  This was a positive and emotional experience for me as I witnessed so much strength and courage during that meeting.  Members were so supportive of one another and their happiness and determination was noteworthy.  During the meeting, individuals asked questions ranging from diabetes  management to making healthy lifestyle choices.  They were very grateful of our presence and asked us many questions.  We have had limited exposure to HIV/AIDS in Canada so we told them that we wanted to learn from them.  This was one of many experiences that has opened my eyes to how truly privileged I am to live in Canada and to have my health.

My time in Kenya has given me newfound respect for individuals that live in substandard conditions.  The people of Kenya have a contagious spirit that makes you look at life in a whole new light.  Kenyans are hard working and innovative-they make the most of what they have.  I have witnessed numerous occasions in the hospital where staff members have had to use alternative methods because they have limited resources.  I have seen surgeons use bladder catheters as surgical drains because drains are limited and reserved for emergencies.  Although they don’t have the resources that we have in Canada, the things they do and the choices they make are safe and logical.  They take things to a new level, something that Canadian healthcare professionals never have the need to do.  They are creative and they are successful.

Although I have had limited opportunity to work within the rural Kenyan communities, I have witnessed the incredible strength and willpower of the Kenyan women.  These women are unlike any I have ever encountered.  They work long days; managing their farms, collecting firewood, and feeding and dressing their families while maintaining an air of grace and pride.  The women will go to bed hungry if it means that their children have had sufficient food during the day.  The women were very grateful of our presence and welcomed us into their homes (Karibu).  The work of Farmers Helping Farmers and the support of CIDA have improved many of these women’s lives drastically.  Many have screenhouses for their crops to grow, water tanks for clean drinking water and kitchen gardens, where they can grow green vegetables and vitamin A rich vegetables for their families.  By making these changes in the community, these organizations have started a health promotion initiative that will hopefully minimize hospital visits for these families and improve their overall health.

I leave Kenya feeling grateful that I have been given this opportunity.  It has helped me grow as an individual, made me excited about my career, kindled a love for travel, and compelled me to do further trips that work towards making communities sustainable.  I hope to be able to share my experiences with others so that they feel compelled to witness what I am witnessing.  As well, I hope to inspire others to become involved with Farmers Helping Farmers or other organizations, to do their part in helping underdeveloped communities grow stronger. 

-Danielle Perry; Nursing Intern

Vet team working in Mukurwe-ini , Kenya

Vet team working in Mukurwe-ini doing research on feedning cows and calves owned by farmers who ship milk to the Mukurwe-ini Wakulima Dairy Ltd.
Left to right

Dr. Shauna Richards (AVC'10), Dr. Gertrude Shepelo (UoNairobi'12), Genevieve Luca (FVM'16), Jessie Wilkins (UoCalgary'15) and Dr. John van Leeuwen (AVC Professor)

The People You Meet

By Jessie July 23, 2013 5:47 pm

We came at night – it felt strange because we typically don’t go out after dark falls.  As we walked to the door, I could see a beautiful set of smiling teeth and a pink dress suit.  Our host greeted us warmly, and took us up the front stoop.  As we were about to go in, she whispered that she was just finishing hosting a big celebration for a recent graduate of IT school.  She apologized that they hadn’t quite left yet, but were about to leave shortly.  We took off our shoes and she opened the door.  There were about 30 people inside, all with their heads bowed – they were praying a blessing over the new graduate.  We paused at the door to let the prayer finish.

As we entered, we shook the hands that came from every direction and were quickly shown a seat.  All of a sudden cake appeared before us, and food started to multiply on the kitchen table.  We chatted with some of the guests, then filled our plates to overflowing with mokimo (potatoes), githeri (bean stew), lamb, chapattis, fresh fruit, and rice.  It was delicious.
Then our host was freed up enough to sit and have a chat with us.  I was already in awe of this formidable women and her hospitality.  There had been a little mix up.  We were supposed to stay with her over the weekend, but somehow the dates got miscommunicated and she already had a houseful of guests from the graduation celebration.  She insisted that we still show up for a meal – all without ever having met us before.
Jennifer Murgocho works in association with an organization that were are working with in Kenya called Farmers Helping Farmers.  She is based in Meru – and we were visiting for the weekend.  She told us about her involvement with Farmers Helping Farmers.  She detailed the schools, women’s groups and communities that she has worked with, and the changes she has been a part of in the years past.  As we sat and listened, I reminded myself what a privilege it is to listen to someone talk about their true passion.  It’s even more of a privilege to see that passion turn into reality through the course of their life work.  There are some people that I have sat with in my life that leave me deeply inspired and hopeful.  Jennifer was one of those people, with one of those incredible stories.
I was reminded that a life well-lived goes far beyond a job.  A life well-lived is passionate enough to host a graduation celebration with a large guest list.  To invite complete strangers into your home for a meal.  To make people feel welcome, cared for and understood.  To be compassionate enough to see areas that need improvement, brave enough to act and committed enough to follow through.  These are great life lessons for a veterinary student to learn and remember.
I can’t say I’ve ever had milk directly from a cow.  It was boiled of course – to kill all the nasty pathogens that raw milk can harbour.  I’ve never been able to directly attribute my milk products to a specific cow.  It’s kind of an odd feeling to look at a cow while you are drinking the milk it made a few hours earlier.  But when I think about it, and it’s really not all that odd at all.  And it’s far more rewarding to see a product go (as we say in food safety courses) from ‘farm to fork.’
It was freezing on Monday, and the warm milk was a welcome gift.  There were four of us on the farm that day and we each had a glass.  I’d estimate that we drank roughly a litre of the farmer’s milk.  In Kenya, farmers are paid 27 Kenyan Shillings per kilogram of milk produced.  That’s just over 30 cents Canadian.  For many farmers, the milk proceeds are a large proportion of income for the household.  Most cows in Kenya are producing roughly 9 kg per day, compared to a typical Canadian cow which produces roughly 32 kg per day.  It’s also important to keep in mind that most farms in Kenya have less than 3 actively milking cows at any given time.
So this hot milk on a cold Monday morning was not just a simple gift.  The farmer’s name is Waruguru.  She told us how two of her daughters passed away, so she is responsible for feeding and caring for the cow.  She has one daughter left, who was there to help answer some of our questions and help with the farm.  Her grandson was there as well.  The teachers strike ended on Monday, with most students heading back to classes.  His presence on the farm likely means that school fees are too expensive, and he is not able to attend classes.  He was incredibly helpful – holding the calf, getting me soap, moving the cow into the milking pen, and holding supplies for me.
While Jennifer inspired me with her courage and commitment, Waruguru inspired me with her kindness and generosity.  Her gift to us was of high personal cost and I’m deeply appreciative for it.  Two stories from two strong Kenyan women who have big enough hearts to give – at times beyond their means.
And this is why I love veterinary medicine, and why it’s so much more than just a job to me.  Students that want to become vets because they love animals and dislike people are misled.  People are our job.  A veterinarian gets unique insight into the lives of the people owning animals and the ability to make a real difference in both the lives of the animal and it’s human.
And once in a while, their humans make a real difference to us, too.

Dairy feeding research

Hello Farmers Helping Farmers Blog readers, 

My name is Shauna Richards and I am a veterinarian who has returned to the Atlantic Veterinary College (AVC) to pursue a graduate degree in veterinary epidemiology (study of disease in populations).   My project at the AVC is supervised by Dr. John Vanleeuwen and funded/ partnered with Farmers Helping Farmers, The Canadian International Development Agency, Association of Universities and Colleges of Canada, AVC, Vets Without Borders (VWB) and the University of Nairobi. 

The project aim is to determine the cost benefit of feeding additional purchased feeds to dairy cows and calves owned by smallholder dairy farmers in Kenya. Specifically we are working with farmers who are members of the Wakulima Dairy Ltd. in Mukurweini, Nyeri County.  While it may seem obvious that more feed will allow a cow to produce more milk, and allow a calf to grow faster, the concern is if buying these additional feeds will make the farmer money in the short and long term.  

The study plans to purchase grain and mineral for milking cows and feed them in varying amounts to locally owned cows to determine their milk production and farmer’s subsequent income over the first 2 months of a cows lactation.  At the same time the calf of the cow will be fed varying amounts of purchased grain and milk to determine if they will grow faster.  In the long term calves which grow faster will become productive herd members earlier, and therefore make the farmer more money.  

In addition to the feeding part of the study we will be evaluating and sampling milk from the study cows to determine the rate of mastitis in smallholder dairy farms in Kenya. We will also evaluate the pathogens causing mastitis.  Finally we will be evaluating the rate of gastrointestinal pathogens in the study calves. 

This study is unique in that we have 111 farms enrolled and we will make repeated visits to the farms over a 2 month period.  This will provide us with better data in order to determine the cost-benefit of additional feed, the rate of mastitis in cows, and the rate of gastrointestinal disease in calves. 

Aside from providing better data, the repeated farm visits allow us to develop a relationship with the farmers and allows us to make helpful recommendations on how they can improve their dairy farm.  This is important because aside from the additional feed that the farmer is receiving, they are also gaining knowledge.  And while we aren’t allowing them to share feed with other farmers, they certainly can share what they are learning! Following completion of the study we plan to publish the results, and to also disseminate them to farmers who are members of the WDL so they can make sound financial decisions  on their dairy farms. 

I would also like to briefly describe the team members whom are working here in Kenya for future reference in additional blog entries:

Genevieve: second year veterinary student at University of Montreal whom is funded by VWB

Jessie: second year veterinary student at University of Calgary whom is also funded by VWB.

Shepelo: Veterinarian from the University of Nairobi, who is also pursuing a graduate degree in veterinary epidemiology and is running the study with me here in Kenya.

Priscilla: Our local and very talented, very friendly translator, whom I could not do any of this project without!

Ephraim: One of our drivers, who also commonly stands in as veterinary technician on all of our farm visits.

Godfrey: Our other driver, who often provides his milking skills to collect milk samples, as well as provides excellent comic relief.

Gerald: Coordinator at the Wakulima Dairy and for this project.

I hope this blog entry provides some context to the wonderful entries by the 2 veterinary students whom I am working with this summer.  

Manners and Manure

By Geneviève - July 21, 2013 - 5:59 pm

The inhabitants of Kenya are known for being a warm and welcoming people. After spending a few weeks in their company, I can but confirm this fact. Kenyans are not only thoughtful hosts, they also show a politeness and manners often incompatible with our North-American placid, planning and always-in-a-rush habits. Indeed, what Canadian city dweller wouldn’t be suspicious, sometimes scornful, of a handshake from a perfect stranger met on his way? And who would actually make – or even accept – an unexpected invitation to have a cup of tea in the middle of an already busy work day? Yet these things are common in this country that welcomes me so generously.

According to good manners here, you should greet anyone you meet with a good handshake and a cordial “Habari”, often followed by a series of other greetings. Whether it’s a collegue, a new acquaintance or someone that will remain a stranger doesn’t matter : it’s greeting before talking. And so, when our driver stops the vehicule to ask someone passing by directions to a certain farm, a hand enters by Ephraim’s opened window and must meet the hand of every single passenger, accompanied by many “habari”, before the person, bent over the window, will give us the desired answer. Even one with a wet or dirty hand cannot escape from this human contact : in those cases, he must present his arm, flexing the carpal joint, and the other person can then grap and shake his forearm, just up the wrist.
Kenyans also have the habit of saying “sorry” when some undesirable thing happens to you. Therefore, every time I fall on a slippery slope, every time I drop my pen in the mud and every time I hit my head – which happens every single day because of the acrobatics I perform to get inside the pens – the witnesses will immediately say “sorry”, even though these troubles are entirely my fault.
Generosity is yet another aspect of the Kenyan culture. When we are visiting farms, we frequently leave with a bunch of bananas, papayas, sugur canes, eggs, corn, or avocados as big as a head. We tell the farmers that they don’t have to give us anything, that their participation in our study is more than enough, but they are happy to share the result of their laboured soil, in addition to the time they already spend with us. Besides, I doubt Francis, our cook, will ever be able to make enough banana bread to empty our stocks.
Sharing is an essential value here. Even those who haven’t got much will give you all they can possibly offer if you are in need. This weekend for example, we had planned on going to visit the students from UPEI staying in Meru (they are also travelling for some projects with the Farmers Helping Farmers organization). A misunderstanding kept us from staying at Jennifer’s house (she is an active member of a wowen’s group for community development and used to be their chairperson), since she thought we were coming on the next week and had therefore no more rooms available for Saturday night. Dismayed by this misunderstanding, she wanted us to sleep in her own room rather than to have us staying in a hotel a bit further away. We simply couldn’t accept such an offer, so she almost forced us to at least come at her house for dinner, and she nicely received us even though she already had a very busy evening.
The Kenyans’ generosity is only equalled by the local hospitality. We often receive invitation to sit down and have a cup of tea. Our daily schedule is quite busy and we tend to decline those offers, but the farmers insist, some of them even adding that it is not very polite to refuse. Therefore, except if we really are in a hurry – which seldom happens, with the African beat we are starting to catch – we let ourselves be guided towards chairs, wooden benches or even inside the house, in a small living room, to sit down and to take the time to enjoy our hosts’ company, a much appreciated token of gratitude. They sometimes serve us food and, when it’s the case, it’s usually in enormous quantities. Of course, it is considered rude not to finish your plate…
Farmers wish so much to show good manners as hosts that they insist on having us sitting on a piece of decorated material instead of directly on a log and they tell us not to remove our boots when we come inside their house. Can’t they see that we already are covered in dirt and other filthy things? They don’t seem to care : they wouldn’t accept to see a bit of dust from a log or from the floor going on their guests’ precious scrubs. In front of those very – too? – thoughtful hosts, we smile, but we let them understand that we would actually be disrespectful to such good manners by covering the place with manure.

Geneviève C. L.