Sitting in a lounge in the Brussels airport drinking a cappuccino and eating cheese and bread I am having a hard time connecting this reality from that which I just came. It is truly remarkable how quickly one re-adjusts to a new setting, where past realities can feel more like a dream than anything else. Even the running water and lightning fast Internet already feels standard before my arrival in DC later this afternoon. But I have a suspicion there will be some facets of my experience that will carry with me.
It has been sometime since I posted a blog. Perhaps it was the slow internet connection, lack of time, or just my common challenge of being in communication. In any case, here I recount the past months leading to my departure from Kenya.
I suppose I should start by filling in some details about my research project. Without giving you all the boring details, I was conducting research on the adoption of latrines. The basic study was to implement a behavioral intervention known as community led total sanitation (CLTS) and see if, when, and where people decide to build latrines (a basic pit toilet). CLTS is becoming increasingly popular as it basically relies on the fact that people don’t like shit (you have to excuse the language, those working in sanitation usually aim straight for the ugly word). Through basic demonstrations (involving actual shit), CLTS connects the simple truth that if you shit outside it goes into the drinking water and then those collecting this water consume it. The take home message…if your community does not shit in a hole they are eating and drinking their own shit. Simple, straightforward, and a downright disgusting thought. CLTS is now used all over the world (mainly in rural areas in Africa and Asia) and has been extremely effective as once the message is clear people don’t wait around for someone else to build a latrine, they just start digging. That is basis of my research and as far as studies go this one is pretty straightforward …that is after you deal with the bureaucracy.
Enter the Kenya Medical Research Institute (KEMRI) and the ethical review process (IRB in the US). For those not familiar with the ethical review process, you are lucky, it’s a bit of a headache. But the simple explanation is that all studies dealing with human subjects have to get approval from an institution or a university who looks over the study details to ensure no study participants are being taken advantage of. This approval must be granted before any data collection. In my case I needed two of these reviews, one from the University of California San Francisco (UCSF) and one from KEMRI. I submitted my documents to KEMRI when I arrived and they somehow managed to delay my approval for nine months. This might be understandable for those studies dealing with HIV treatments or other studies with significant health risks, but I am just asking about toilets.
For contrast, UCSF took less than six weeks for the ethics approval.
So there I found myself with eight weeks left until heading back to the US, no KEMRI approval, and seriously doubting whether my research project would even start. With no other option, I decided to go forward with the CLTS intervention and hope I would have approval when it came time for data collection. Luckily two weeks prior to my departure I received approval. So now my study goes on…without me, though managed by a dedicated team of Kenyans.
I have to say it was entertaining watching people’s reaction to CLTS and in fact it is working already, with people building latrines in several communities throughout Mfangano Island. There are still significant challenges ahead, however, as the eventual goal is to get all 20,000+ inhabitants of Mfangano to stop shitting in the bush and use a latrine. This is far beyond the research project and may take years to achieve, but the challenge allures me.
Reflecting on the past year, I think it may have been one of my most challenging to date. I will leave with no overwhelming sense of pride or accomplishment, but a subtle satisfaction that I made progress, however small. This progress extends far beyond work, as living in remote regions can teach you a lot about your relationships, your ability rely on others, and communicate across cultures. It can teach you to relearn your relationship with your food, your environment, and all the basic necessities of life. It can surprise you by demonstrating how our obsession with new technologies does not translate into quality of life, how easy access to whatever we want may not actually make us happier or healthier.
Living on Mfangano was by no means a life of paradise, but there is plenty I will miss. I will miss the fireflies dancing at night to a chorus of frogs with a backdrop of stars and thunderstorms on the horizon. I will miss heading to the garden and leaving with a satchel of fresh vegetables, of cars being a rare sight, of a friendly interaction with a local neighbor, or the excitement of seeing a deadly snake at a safe distance.
Despite the things I will miss, I am welcoming this homecoming and the next chapter which will see my return to my hometown of San Diego where I have accepted a position as program director for a non-profit known as the ECOLIFE Foundation. It is an exciting opportunity that will send me back to Africa as well as Mexico, but will also allow me to engage with communities at home, a personal interest that has been growing for some time.
With less than an hour until my plane flight, I think I am ready to head home. It has been a year mixed with a multitude of emotions and experiences, a year I will never forget and one that will likely impact me for years to come.