Floods in Budalangi

Since mid-August there has been flooding in the Budalangi region of Busia District. Part of a dyke near Mukabola health center gave way. The picture above shows people standing at the broken end of the dyke on day it collapsed. Apparently this happens almost every year at the end of the long rains. Year after year, the people in the area are displaced by flooding until the water evaporates and the dyke is repaired. Then they go back to their regular houses, or build a new hut if the old house was destroyed. According to members of our team who work at the health center, the water levels are higher this year and more people are displaced into makeshift camps. I'm hoping they build a stronger dyke this time around. They said the last one was weak becuase it was built by a "lady engineer."

Because MSF is a NGO dedicated to medical care in vulnerable populations, we are focusing mostly on health-related consequences of the floods. Gabriella, the doctor I work with from Argentina (pic in canoe below), goes out by bike, boat, and on foot to make sure the rural clinics have enough medicine and supplies. The logistics department also helped with building latrines and distribution of water tanks, mosquito nets, and water purification tablets. The pictures below show people displaced by the floods in their camps.

Chauma

I usually eat at home. We have a cook who makes a lot of delicious food. But every once in a while the New Yorker in me feels like eating out. There are only a few restaurants in Busia. Chauma is one of the best.

The only problem with Chauma is that it takes about two hours (minimum) from the time we order to the time the food makes it to the table. We've started going there at noon to order for an 8:00 pm dinner. When I saw the kitchen (pic at left), I understood why it takes so long. There are live chickens (not pictured) that run around until somebody orders chicken. Some of the mini-stoves burn firewood. The staff probably goes foraging for firewood after we order. The food is always delicious though!

HIV, Circumcision, and the Luo People of Western Kenya

The Washington Post ran a story on Friday about the high prevalence of HIV in the Luo tribe of Western Kenya. The article argues that it is due to the Luo tradition of shunning circumcision.

Over the last ten years, large clinical studies have shown an approximate 50% relative risk reduction of HIV with circumscion. I find this counterintuitive. It seems like the foreskin would act like a protective barrier. But this is not the case. A recent review of the subject in the British Medical Journal suggests that the penile foreskin puts men at risk for HIV when it is pulled back during sexual intercourse. HIV can freely enter the non-keratinized mucosa of the inner forskin layer. The outer layer of penile mucosa in circumcised men is keratinized, and therefore more difficult for the HIV virus to enter.

Traditionally the Luo do not circumcise young men, whereas most other tribes in Kenya circumcise boys on the brink of adulthood. The Luo Elders believe that circmcision robs manhood. Instead of circumcision, the Luo traditionally welcomed their young men and women into adulthood by whacking out six front teeth. The Luos I work with in Busia confirm this practice, but say that it stopped back in the 1950s. Many of their parents and grandparents are front toothless.

The Wasington Post's article exaggerates the benefit of circumcision, however. I do not agree with the article's assertion:

AIDS emanated from the jungles of Cameroon or Gabon but hit massive epidemic levels after reaching the uncircumcised tribes around Lake Victoria and, later, southern African tribes that had abandoned their own traditional circumcision rites. These differences help explain why West Africa, where circumcision is routine, has HIV rates much lower than in Southern or East Africa.

Who dreamed that up? How did it get past the editorial staff? It's true that the association between higher HIV risk and lack of circumcision has been shown in many studies, but the effect does not account for the magnitude of AIDS infection in sub-saharan Africa. Lack of circumcision is only one of many known HIV risk factors. Poverty, sexual practices, geographic mobility, prevalence of sexually transmitted diseases, and other complex socioeconomic factors likely all contribute to HIV risk. In the Luo communities, for example, both the fish-mongering economy and the tradition of wife inheritance also contribute to the high HIV prevalence. The practice of trading fish for sex is still a big problem in the fishing communities of Southern Busia district. I do not know much about wife inheritance. I will ask around.

Paper-Pusher

I've spent the last few days collecting data and churning out the reports. I did my weekly report for Aug 27th-31st on Friday. On Monday, I started my monthly report for the month of August. Now I'm working on the May-Aug Quarterly report. Every once in a while I break the monotony with a meeting about one of the reports, or writing a report about a meeting. Luckily I will not be here the last week of the year, when some poor sucker will bring in the New Year with a simultaneous weekly report, monthly report, quarterly report, and yearly report.