Relocation Brings Opportunities to Participate in a Historical Event in Kenya

The Great Rift Valley, a predicted hotspot

By Jaclyn Carlsen

On Monday, the Masters in Development Practice interns at the Millennium Village Project in Sauri, Kenya were relocated to Nairobi as a precaution for the constitutional referendum taking place August 4. Although this put a damper on our projects, it did enable Steph, Denise and I to participate in a historical event and join 55+ volunteers in reporting incidences around the referendum. Our group concentrated on monitoring social media feeds, but also mapped incoming text messages and field reports and pulled data to draft a mid-day press release.

We did this through Uchaguzi.co.ke, a website which uses the Ushahidi platform to visualize violence, tension, voter issues, and peace efforts surrounding the referendum. The mapping took place at the iHub, home to Ushahidi and a innovative tech space in Nairobi. The majority of the events mapped were of a peaceful nature. All was fairly quiet.

The story was picked up by both CNN and Christian Science Monitor, which is pretty cool, especially considering that this tool was developed in Kenya and is now being used worldwide.

Check out the articles below for more info on how Kenyans are promoting fair and open political processes using Ushahidi:

CNN: http://ireport.cnn.com/docs/DOC-478629?ref=feeds/latest
Christian Science Monitor:  http://www.csmonitor.com/World/Africa/2010/0804/Kenya-referendum-monitored-by-SMS-and-Twitter

Here is a blog post I wrote that shares some background information on the event: http://blogs.ei.columbia.edu/2010/08/03/mapping-peace-protests-and-violence-around-the-kenyan-referendum/

Hope all is well in your corners of the world

Mapping Peace, Protests, and Violence in Kenya

By Jaclyn Carlsen

You may have heard that on Wednesday, August 4, a historic event will be taking place: a referendum deciding the acceptance or rejection of a new constitution for Kenya.

The Green side (aka ‘Yes camp’) is headed by President Mwai Kibaki and supported by Kenya prime minister Raila Odinga and much of the parliament. The Red side (aka ‘No camp’) is led by higher education minister William Ruto and has significant support from the church. The proposed constitution limits the sweeping powers of Kenya’s presidency, creating a second chamber of government and giving greater power to local leaders. Contentious issues include the creation of a land commission, retention of Kadhi (Islamic) courts, and a clause which allows abortions if a pregnancy endangers the life or health of the mother. Opinion polls indicate that most people support the proposed constitution.

The number one fear surrounding the vote is a renewal of ethnic tensions and violence in Kenya. In fact, there has been limited violence surrounding the upcoming referendum. The flashpoints are in areas where neighboring ethnic groups have different voting preferences. Among identified hotspots, the northern Rift Valley is considered most likely for violence as the area has many Kikuyu supporting the Yes camp and Kalenjin supporting the No camp. Like many other conflicts that have come before, the real issue at stake is land. Some feel that the Kikuyu, Kenya’s most populous ethnic group, were unfairly allocated land in the Rift Valley at independence. Kalenjin and Kikuyu members who clashed fiercely in the last election could be set off again by the land measures incorporated into this year’s referendum.

The upcoming referendum differs from the 2008 violence in a number of ways. The 2007 vote was highly controversial with widespread suspicion of election fraud. This time around, the government is much more prepared and has deployed a good deal of military and police. Most of the people we’ve talked to are expecting a peaceful vote with limited and isolated outbreaks of violence. Our team from SIPA’s MPA in Development Practice program is based in Nyanza Province, which is not considered a hotspot, but as a precaution we will relocate to Nairobi for the week of the referendum.

Potential chaos and evacuations aside, it’s a fascinating time to be here. An incredible amount of innovation is coming out of East Africa, and particularly from Kenya. Some may recall that SIPA was involved in mapping and monitoring incidences stemming from the earthquake in Chile last year, reporting collapsed bridges, closed schools, water and medical needs. I co-directed the team which did this remotely from New York using a tool called Ushahidi, an incredible platform which serves to aggregate media, twitter, and eye-witness reports around an issue – often disaster relief – in an online map. The key to the take-off of Ushahidi is that location basedincidences are brought together in one forum, in almost real-time, which then enables NGOs, media, and government to take action on real needs. The birthplace of this popular tool that’s being used in Haiti, Iraq, Chile, Washington DC, Ethiopia, South Africa, New York, and elsewhere? Kenya. Ushahidi was developed in Nairobi to report violence stemming from the 2007 election. As explained on the Ushahidi website:

The website was used to map incidents of violence and peace efforts throughout the country based on reports submitted via the web and mobile phone. This initial deployment of Ushahidi had 45,000 users in Kenya, and was the catalyst for us realizing there was a need for a platform based on it, which could be use by others around the world.

For the August 4th vote, Ushahidi is being used once again in its country of origin. This time, to monitor incidences around the referendum. The website is up at Uchaguzi (meaning ‘election’ in Swahili) and is likely to be one of the best — and first — sources of eye-witness reports surrounding security issues, voter issues, and defamation. It’s odd to wish for a project to not receive any reports, but here’s hoping that these incident categories are sparingly used.

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Note: If you are in Kenya, you can report incidences by sending a message to 3018, an email to reports@uchaguzi.co.ke, a tweet with the hashtag #uchaguzi, or by filling out a web based form. Remember, there’s also a category for “positive events”

My Day with a Community Health Worker

By Jaclyn Carlsen

The other week I walked the footpaths of Nyaminia to visit households with Richard*, a Community Health Worker (CHW). Going around with a CHW was eye-opening. It’s one thing to read about nutrition screenings and the use of mobile phones for health monitoring, but quite another to see it in action. Richard and I visited seven households where he took the nutrition measurements of children under-five with a simple tool called a “MUAC” – mid-upper arm circumference tool. This flexible ruler that goes around the arm of a child is an uncomplicated, effective field tool for identifying malnourished children under five.

CHW performs a nutrition screening using a MUAC

After measuring the children, Richard then let me use his mobile phone to text in the results of the screening to a central database which records all the personalized health data the 108 CHWs send in.

A major benefit of this system, known as ChildCount+, is that it provides immediate feedback to the CHW, guiding their action. For instance, if any of the children we monitored had had a MUAC below 115 mm, Richard would have received a message to refer them to the clinic for treatment of Severe Acute Malnutrition. Similar feedback is provided for malaria cases. In one home, after texting in the positive results of the rapid malaria diagnostic test and the estimated weight of the child displaying symptoms, the system sent back a text message stating the appropriate treatment dosage. Although an experienced CHW may know these prescriptions by heart, each of these texts acts as a check for diagnosis and prescription.

The ChildCount+ system confirms receipt of nutrition screening information through a reply message

I see great value in mobile systems such as the one used by the CHWs in Sauri. Beyond providing immediate feedback, this type of system can reinforce the training of newer CHWs, increase accountability by quantitatively measuring the actions of CHWs, improve tracking of health and disease patterns in a community, inform resource allocations, and with proper monitoring and evaluation tools, assist in measuring the effectiveness of interventions.

Although I’ve been impressed with the use of ChildCount+ in the field, my time with Richard reminded me once again that an information system is only as good as its people and its tools. Although none of the children monitored were severely malnourished, there were some children clearly not receiving all the necessary micronutrients. The MUAC measurement did not capture signs of this malnutrition, which could only be recognized and acted upon by a trained health worker like Richard. CHWs may refer malnourished families to a clinic for supplementary or emergency feeding. For longer-term solutions families may be referred to the agriculture team to attend a gardening training, or talk to a facilitator about the family’s eligibility for subsidized fertilizer and improved seeds.

Richard himself had some critiques of the ChildCount+ and CHW systems. The texting of medical information takes time and errors do occur.  As the CHW system has become more professionalized, responsibilities have expanded and many feel that the pay, a stipend provided by MVP, is far from adequate. Even though there are challenges, all the CHWs I’ve spoken with have seen an improvement in the nutrition status of the children in the region, and attribute these changes to MVP interventions such as door-to-door health screenings, nutrition training, and immediate clinic referrals for emergency and supplementary feeding.

CHW using the ChildCount+ system, this time to register a new person

For a short video of Community Health Workers using the mobile system in Sauri, Kenya, please click here.

*names changed

I met Hilary Clinton this week!

By Denise Lee

Also posted at www.summerinsauri.wordpress.com

No, not that Hilary Clinton, the one I met was a little boy (yes a boy) living in Nyamninia sub-location in the Sauri Millennium Village Cluster.  I met him during a house visit with a community health worker (CHW) who was conducting a mass nutrition screening of all children under five in her catchment area.  In the past, CHWs in the area were volunteers providing basic health advice and services, when MVP began operations a core part of their health strategy was to establish a network of professional CHWs providing them with training, a small stipend and greater responsibility and accountability.  In addition to mass nutrition screenings four times per year, CHWs in the MVP cluster also test and treat malaria in children under 5, treat children with diarrhea with oral rehydration salts and zinc, monitor pregnancies, sensitize households on water and sanitation, provide advice on family planning and give referrals for pneumonia and other more serious health issues.  For the past 7 months, the CHWs have been utilizing a new mHelath platfrom, ChildCount+ which uses SMS messages to monitor and track malnutrition as well as malaria and other childhood illnesses in children under 5.

Back to the mass screening, it’s part of the MVP strategy of community-based management of acute malnutrition.  Four times a year the CHWs go from household to household measuring the mid-upper arm circumference (MUAC) of all children under 5.  They then send a short text that encodes the results of the visit to the ChildCount+ platform – a low MUAC would result in a response instructing the CHW to refer the patient to the clinic for therapeutic or supplementary feeding.  Although the CHW most likely already knew what to do, the ChildCount+ system processes the information in a database that makes monitoring faster and easier.

Hilary’s MUAC did not indicate undernutrition, but it had dropped from 210mm to 168mm prompting the CHW to inquire about Hilary’s health and eating habits.  Hilary’s mother mentioned he had been sick recently, the CHW then explained the importance of seeking medical attention in such cases and ensuring a nutritious diet.

Reflections from Health Week

By Denise Lee

Last week I was walked out of the MVP office convinced that agriculture was the foundation of all other sectors, and that surely food security must come before any other interventions. However, this week a member of the health team rightly pointed out that if a farmer is too ill to farm, then even the best agricultural intervention will fail.  It makes sense that two such fundamental human rights, food and health, are so closely interlinked and one can’t be considered more basic than the other.

The MVP approach to health includes interventions at the household, community, health center and hospital levels.  I started my week observing a nutrition intervention at the community level.  Every month a nutrition clinic is offered at each health center; this week’s was in Marenyo.  30 minutes after it began there was only 1 client. Patients in Marenyo prefer to get nutrition supplements directly from the health center because they can do it on their own time. Our client was a listless 1 ½ year old girl with malaria. She had been on supplementary flour to treat moderate malnutrition, but having malaria had pushed her into severe acute malnutrition so the nutritionist prescribed ready to use therapeutic food.  Toward the end of the consultation, the mother asked the community health worker if she could get a new bednet because hers had a rip in it.  Compared to stories I’ve heard about families not using bednets, a cheap and easy way to prevent malaria, even when they’ve lost children from malaria, it was inspiring to see a mother proactively seeking to use one.

Children are given the ready to use therapeutic food to establish appetite for it. In this case the little girl did not eat any of it, but her mother was given a week’s supply and the Community Health Worker was instructed to follow up on her progress.

When leaving the Minhinde clinic we gave a ride to a man with his two kids.  The driver recognized his accent and asked where he’d come from, the response was quite far, outside the cluster area.  Knowing that his local clinic wouldn’t have medication to treat his daughter, he’d brought her all the way to Minhinde.  Patients coming to the clinics from outside the area is a reason why numbers at the clinics remain high despite overall health improvements in the villages.  It’s difficult to imagine how these clinics will continue to provide the care that they do when MVP leaves (and with it support for staff and supplementary supplies) and how all rural clinics will be able to  reach a higher level of care without additional support.

A leisurely day on the Nile

By Denise Lee

I am a big fan of white water rafting!  After graduating from high school my big trip was to go rafting with a few friend in West Virginia, I’ve gone on several rafting trips in the Adirondacks and during 2 months spent learning Spanish in Costa Rica I went on no fewer than 5 rafting trips.  None of this previous experience prepared me for rafting the Nile!  I was a little confused when my friends informed me that I wouldn’t need waterproof sandals for the trip, usually they’re used to wedge your feet in to the boat when going through rapids.  I was also puzzled by the talk of flipping rafts – I couldn’t understand why any guide would flip a raft on purpose or even for fun.  Once in the water things started off normally enough going over some basics: forward paddle, back paddle, left turn, right turn.  But then there was “get down” – I had never been instructed to get down before.  Apparently this is the strategy for going through rapids instead of wedging your feet in.

After a while we navigated toward the first rapids, I was a little surprised that our guide didn’t take any time in advance to explain to us the route we would be taking or any special features of the rapids, but all turned out well and there was a feeling of accomplishment and excitement on the boat afterward.  It was the next rapids where our “luck” changed.  Once again we weren’t given any instruction going into “Easy Rider,” as we got into it I turned around to see us approaching a big hole sideways and the thought that immediately came into my mind, was “Oh my God, we’re going to flip” – events after that are a little fuzzy, but as you can see below mayhem ensued and eventually I had to give up my grip on the boat, the last one to do so.  The one good thing about this terrifying experience is that the kayaks hired by the company to pick up people who have fallen out were excellent and everyone was quickly taken back to the boat safely if a bit shaken.

All hell breaks loose!

Sorry... but you're going down! Diana and Denise are the last ones "standing."

Shockingly, even after this we still didn’t receive any instruction going into the next rapid, a level 5 rapid called “Big Brother.”  I don’t think it will surprise anyone that once again we ran into some trouble.  This time the boat didn’t flip completely, but everyone except the guide and Sahil got knocked off the boat.  Our theory is that not knowing how to swim strengthened Sahil’s instincts for staying on the boat, at that point most of us wrongly assumed that when the boat got into trouble we should get out of there – when we directly questioned our guide after this experience he said that in fact you should always hang on as long as you can.  I should mention that we were all knocked out at the beginning of a long series of serious rapids – yes that means that we went through the rest with nothing but our life vests protecting us.

Thankfully, this was our last experience swallowing half the Nile, the other boats’ luck however, was about to change.  Perhaps most shocking event of the day was the near tipping of the safety boat on the next rapids called the waterfall.   Although you can’t see Diana and Jiangli seated in the back, you can see below that the boat was nearly vertical and it was all the guides could do to hang on – it’s unsurprising then that Jiangli was knocked into the water.  She described the terrifying experience of being stuck in a hole going around and around until she finally spun out of it and a kayaker picked her up – did I mention this happened to the SAFETY boat!

Hang on!

From there out it was smooth sailing until the last rapid when the other boat flipped on the rapid named  “The Bad Place.”  A few people from our boat opted out of going down this last rapid, but four of us went through as our guide promised to take us on the “Chicken Route” – he held up his end of the deal but also decided to jump out of the boat without telling us.  No really don’t worry about us we got it, that’s him below doing a back flip out of the boat.

Our guide flips out!

We had a GREAT time hanging out with MDP Team Uganda, but I think we’ll be holding off on any adrenaline rushes for a while!

We're so happy... happy to be alive!

I got myself a case of “AnalPar”

By Stephanie P. Ruiz

Jaclyn turns to me and says “you’re looking particularly analpar today.” “Excuse me”, I say. “I mean you look like you got a bad case of Analysis Paralysis.”

“Yes, Jax, I guess you’re right. I’m a little overwhelmed reading all the quarterly, annual, midterm reports and trying to get my head around the 1000 interventions. What’s really going on in these villages?!?”

“Don’t worry” Jax says, “It’ll come to you holistically.”

There’s that word again! Holistically! Millennium Village Project loves that word. That’s the nature of our Masters in Development Practice (MDP) degree.

Well, the life of a development practitioner isn’t easy. One day you marvel at the benefits of school meals. The next day, you realize kids are drinking contaminated water at the very same schools.

It is frustrating. At times you think you should just focus on one thing and be super smart at it because MDP has made you realize how dumb you are and you actually came to Columbia feeling pretty confident that you knew a thing or two about development. Of course, I love hearing the criticism that we are trained to become dilettantes. But why would I feel so dumb if that were the case…. shouldn’t I feel super smart at dinner parties? Instead, it’s a race against time to learn about rice cultivation, growth models, and the life cycle of the malaria parasite. I have to admit, I don’t know if I can retain everything, but I have been pounded by Sachs & Co. that I need to be literate in all these fields and it’s my responsibility to constantly keep learning once I graduate. A couple of weeks ago, I heard the head of a major organization who focused on water (an extremely smart and competent man) refer to CD6 count instead of CD4 count and I giggled a little inside and thought I can’t be forgiven for making that mistake.

Well back to my weekly reflections. This week: Education. The main question on the minds of the education team: How can we ensure that school meals will continue after MVP? I heard the education coordinator talk emphatically yesterday to a school committee on the importance of encouraging parents to diversify to high value crops (bananas, beans, onions) in order to generate more income so that the 24 kg of maize contribution to the school meal program can be more manageable. There’s a big parents meeting next week to discuss what can be done to ensure that parents will continue to contribute to school meals after MVP leaves………stay tuned.

Sustainable Interventions Require Community-Led Organizations

 

Trained Bee Keepers Enter Kakamega Silk and Honey Marketplace

 

By Jaclyn Carlsen

Also published at www.jaclyncarlsen.com

This week I was attached to the agricultural team and attended a site exploration for irrigation training, honey processing field trip, cooperative community sensitization meeting, irrigation pre-training meeting and an internal cross-sector MVP field staff meeting.

My main take-away from agriculture week is that interventions require community-led organizations to be sustainable. MVP Sauri approaches this by tapping into existing groups and by initiating new ones to support and direct interventions. In education, a basic organizational management structure already existed, but to promote bee-keeping, for instance, interested individuals had to be identified, brought together, trained, coached and supported. Building these self-sustaining structures is extremely time-consuming. It requires meeting after meeting of what’s referred to as “community sensitization” where MVP staff or government officials introduce concepts such as coops to interested community members and answer questions. Building sustainable community organizations also requires identifying good leadership, building trust, allocating start-up resources, and a great deal of problem solving.

Because MVP focuses on promoting these community-led interventions, as in education, we see a trade-off between impact and sustainability in agriculture. Since MVP began phasing out subsidies, average crop yields in Sauri have fallen from 27 bags of maize/acre in 2006 to 24 bags/acre in 2008 (although both figures are preferable to 8 bags/acre with no subsidies in 2004). Also, out of the 11 cereal banks led by elected community members, two have been blatantly stolen from, while six are judged to be sustainable. Given these challenges, it’s less of a surprise to me that the project has been extended beyond five years in Sauri.

Busia: A Weekend in a Border Town

MVP in Busia (Steph, Jaclyn, Jiangli, Denise)

By Jaclyn Carlsen

We spent the weekend in Busia, where Stephanie used to live, and met up with some folks from Innovations for Poverty Action/Poverty Action Lab (IPA/JPAL), where she used to work. Busia is the essence of a border town: aggressive, trade-driven, dirty, and bustling. Busia also has the distinction of being the location where Jung almost got arrested. Apparently guards frown upon taking pictures at the Kenyan/Ugandan border. But our trip wasn’t all harassment and almost-arrests. On Saturday night we had one of the best dinners we’ve had while in Kenya at Chauma, where we actually ate something beside ugali, chapati and chicken! We also watched the World Cup games (go USA! go Republic of Korea!), went to a nightclub (a real nightclub!), and bought a good amount of dry-goods for the upcoming weeks (read: ramen, cookies, and chocolate), which made the crammed, hot, 2+ hour matatu (minibus) ride back completely worthwhile.

Oil tankers lined up to cross into Uganda

Jung’s 1st week in the field-Infrastructure

This week, my field orientation sector was infrastructure including road, electricity, water, sanitation, and facility construction. However, I could only join the sector partly because facilitators for road and electricity were out of town. Therefore, I tried to focus on the following four areas: what has been going on overall in infrastructure, what have been done in the field, what is the role of MVP, government, and community members, how people in community think about MVP.

My main activity was joining community meetings for making decisions on facility construction, and looking around facilities to see what has been done and what projects are in what have done or being on the process.  Role of community members in infrastructure is very interesting. They mainly make a decision about the place of intervention and select construction contractor. During the meeting, community representatives and the facilitator of MVP talked about challenges of construction, contribution of community members, and schedule of construction.

The Followings are my observation during the first week:

Two classrooms and two ventilated improved pits (VIP) in Rembe Primary school are under construction. The cost of the construction is funded by Kenya government (one classroom), MVP (one classroom and two VIP), and community (10% of contribution). However, due to rocky ground, VIP construction has lagged behind the schedule. Currently, MV facilitator is encouraging community members to contribute to the cost gap and labor force.

Borehole construction project needs to be reconsidered in terms of cost. For one borehole construction, the estimated cost is from 700,000ksh to 900,000ksh. That is, in dollar, it costs from $8,750 to $11,250. ($3,750 for installing pump, $1,250 for geographical survey, $ 3,750-6,250 for drilling)

VIP is somewhat different from what I learned in the classroom. One of the VIP I looked at has no door, therefore, is not a closed latrine. Instead, they modified the VIP according to the environment and materials that were available at a low cost.

For the sustainable water supply, alternative water supply method is urgent. Among water supply facilities using natural water spring which most Sauri people still rely on, most facilities have problem with supplying water during dry season while a few facilities supply water regardless of season.

Involvement of community members is somewhat of a challenge. I had a plan to join 6 meetings, but only 4 meetings were held because community representatives did not attend.