Nothing prepared me for the personal and professional experiences I encountered during the month I spent in Kenya. I went to work on two research activities led by Dr. Constance Gewa, Associate Professor at George Mason University’s Department of Nutrition and Food Studies. Constance was my nutrition professor when I returned to university for my Master’s in Public Health. She was/is my inspiration and has become a valued colleague and close friend. But my experiences were so much more than expected — including 1½ hours with President Obama’s grandmother, Mama Sarah.
The two studies exemplify the transition that Kenya, like many developing countries, now faces: the rise in overweight and obesity while still facing the problem of malnutrition. The first activity investigated this transition by assessing prevalence and cause of obesity among school children ages 10-12. The second activity was a follow-on to a 2017 study Constance and her colleagues conducted, evaluating food insecurity and undernutrition among mothers with children under two years of age. This time, we went to hold meetings to provide the study results, get feedback, and incorporate them into proposals for programs to address their most critical needs.
The obesity study concentrated on six primary schools and their surrounding areas: three in Nairobi and three in Kisumu, a city of 225,000 on the shores of Lake Victoria. Research assistants (RAs) went to each of the schools and took physical assessments — height, weight, skinfolds, waist and hip circumference, and blood pressure — on approximately 75 students in each of the schools. The RAs were our link to the students and their parents. They explained all of the components to each student: logging their meals for a week, parent questionnaires, and parent focus group discussions. Students received incentives — wristbands to remind them to log their meals at the start and a pedometer and jump rope when they returned all of their forms. They loved them — there were jump rope contests and a lot of running around to see who could get the most steps.
Finally, there was an assessment of the “food environment” — what kinds of food are sold in each school, nearby, and around students’ residential areas. Most, but not all, schools have food available on site, and there are also a variety of vendors nearby, selling snacks to the students. They might be as simple as someone showing up and setting up a temporary stand selling popular snacks like mandazi — amazing fried dough, similar to beignets; or small “minimarts” selling soda and packaged foods; or large modern grocery stores with prepared foods.
When all the data collection, interviews, and focus groups are completed, the data will be analyzed and used to assess the correlation between diet, behaviors, environment, and socio-economic status and overweight and obesity. The ultimate goal is to utilize study findings to guide interventions aimed at preventing obesity among children in Kenya.
The second activity, on food insecurity and undernutrition, took place in two rural villages in the sub-County of Seme in Kisumu County. The principal activities were conducting interactive meetings with members of the communities and the local government to report on the findings of the 2017 study and get their feedback. Seme is also close to Lake Victoria, and many of the men are fishermen. As most cannot survive on income just from fishing, there is also subsistence farming. This area is relatively dry and poor and the findings of the 2017 research show high levels of food insecurity.
For example, 76 percent of mothers reported that at least one household member had to eat fewer meals in a day due to lack of resources. When you visit communities and three out of every four households tell you that someone living with them missed at least one meal every day, it is very sobering. Some were families of six living in two rooms with dirt floors and no land, while others who are more successful live in larger homes, with land and household gardens and perhaps even a small plot to cultivate for themselves or market. Most, however, were struggling.
During one of my home visits, a woman who made ropes to sell to the fishermen never stopped twisting the fibers while she talked. One of her daughters, who was home from school that day, worked alongside her. The cost of the materials was so high that she made little profit, and every spare moment of the day was spent making ropes.
The meetings offered interesting insights. Approximately 30 people came to each — mothers (some with infants), religious leaders, community chiefs, and women leaders. Participants spoke passionately about their concerns — limited access to quality seeds, not enough rain or water for irrigation, pests. Several stated that they are frequently asked questions for surveys, but we were the first team to come back with results — and ask for their input. All wanted to know what the next steps are.
The same concerns were echoed in the meeting with the sub-County Government officials. Although many were from ministries that should be helping — health and agriculture, for example — they felt that at the sub-County level, they were not getting adequate support from the County level. Our next step is to take all of their input, develop a proposal, and find funding so we can return and begin developing and implementing community-based programs that can ultimately be self-sustaining.
Constance divided her time between Kisumu and Nairobi. I spent most of my time working in Kisumu and Seme. We lived in a house she and her husband built a year ago on his family homestead in a nearby county called Siaya — not far from where President Obama’s grandmother lived.
The first night we drove there, it was pouring rain and we were tired after a long day in the schools and I asked Constance if we were really going to make this drive — nearly 90 minutes — every day. She cheerfully replied that it wasn’t really that far. As is the custom in Luo (Constance’s tribe) households, we had dinner at her mother-in-law’s house. I didn’t know then, but that would be our very welcome routine every day. After long, interesting, busy, varied days, we would come home to fantastic traditional Kenyan meals of fish stew, greens, ugali, rice, and chapatis, all prepared by Rose, caregiver for Constance’s 80-year-old mother-in-law, cook extraordinaire, the Pied Piper to all the chickens and sheep, and my guardian angel. Rose, Constance’s mother-in-law, and Constance were my family for the month. We ate, laughed, and even danced together. We became very close, despite language barriers.
The morning after that harrowing rainy drive I woke up to a spectacular sunrise, the loud singing of birds, followed by a quick (cold) shower, breakfast, and the drive back to Kisumu — something that I came to look forward to every day. So much life everywhere you look — children walking to school (sometimes four or more kilometers), women carrying goods balanced on their heads to market, people working in the fields, markets in every town, cows and goats walking in the road.
We worked most of every day — making for long days and short nights. We took “time off” for two things: visiting Constance’s family and visiting Mama Sarah. She lives in Siaya, near where we lived. Every day we drove near her house and every day we said we were going to go the next weekend or maybe at the end of the day. It became clear we had to have a plan. So one day, on the way into Kisumu, we stopped by and made an appointment. (Yes, you can make appointments.) I was beside myself.
We met in her living room, talking, listening to her talk about all she has done — which is quite considerable — and how proud she is of her grandson. She’s 97 and regal. She can be very quiet, but when you bring up her grandson’s name or ask about the work she does with orphans and vulnerable children, her face lights up and she responds. It was inspiring to spend time with her. She didn’t learn to read until she married and her husband taught her. She became a teacher, raised her family, and farmed. Now, at 97, she has a foundation supporting the most vulnerable in her community.
I consider myself very fortunate to live in Rappahannock — so much beauty, so many wonderful people. I seldom go anywhere that even comes close to moving me the way Rappahannock does. However, the month I spent in Kenya — the work, the kind and gracious people, the experiences — moved me in ways that will stay with me forever. I look forward to working with Constance to develop our next proposal, get funding, and return to Seme and start working to improve the nutrition and food security in their community. And to go back and see my Kenyan family.
— The writer has spent the latter part of her career working in global health and development, including living in sub-Saharan Africa and focusing on women’s economic hurdles, community health services, and HIV/AIDS. She serves on the board of Belle Meade Montessori School in Sperryville. If you are interested in learning more about the project on food insecurity and undernutrition in Seme sub-county, please contact Kit at email@example.com or Constance at firstname.lastname@example.org.