Friday Fluff: In the Car

Commiserating with my young friend about driving here today.

Commiserating with my young friend about driving here today.

This week involved trips to pediatric HIV clinics across the western portion of Kenya, requiring 6-8 hours in the car a day and leaving me pretty exhausted. At the moment, I’m too tired to write about the good work our teams are doing or the sick kids we are taking care of, and so here’s a Friday list reflecting on life in the car in Kenya.

1. I swear more while driving in Kenya than during any other activity. When I have my team in the car, I try to do this silently.

2. My greatest asset for Kenya fieldwork may well be the fact that I don’t get motion sickness. Working on my computer in the car can still be a challenge when the laptop is bouncing off my lap every 20 feet.

3. My greatest weakness for Kenya fieldwork is likely my walnut-sized bladder. I have learned to identify roadside locations with just enough shrubbery.

4. The aggressiveness of my driving appears to increase with every 30 minute interval on the road. As the time goes by, I become a more fearless passer on narrow roads and uphill climbs. Some would say this is fueled by rage; I like to think I am adapting to my surroundings.

5. Often, while driving in this country, I imagine myself in a driving videogame with myriad obstacles. I am now very good at such games.

6. The traffic and parting police in town have absolutely no concern for the fact that you have parked illegally on the sidewalk in something that could never be construed as a legitimate parking spot. On the other hand, they are keenly concerned about whether you paid your dollar for the daily parking permit.

7. Driving in Kenya is done best with a zen-like balance between thinking one might die at any moment and thinking that death is impossible.

The position in which I spent much of the week.

The position in which I spent much of the week.

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Wordless Wednesday: Carry the Weight


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Sixteen and scrawny, Jonathan sticks out on the bench of mothers and aunties and grandmothers waiting with their children to see the pediatrician in the HIV clinic. An older boy among the line of women.

I often see adolescents who come to the clinic by themselves, often walking for over an hour to the clinic to collect their medicines and see the doctor each month. Jonathan is not here at the clinic for himself though. He is here because he has become a mother of sorts for his young cousin.

George’s mother and father died from HIV in the course of the past two years, leaving six-year-old George in the care of his aunt, Jonathan’s mother. Then, the virus took her life too, leaving both Jonathan and George orphaned, leaving Jonathan to take over the responsibilities of the household. Jonathan also watches over his younger brother, an 8-year-old.

Jonathan tries to take good care of George. He gives him his HIV medicines every day, although it becomes clear in our discussion that he has a hard time getting George some of his doses on time. He tries to get enough food for George every day, but “food is a problem” the 16-year-old tells me. I see the worry in his eyes.

I am worried too. George is not growing. He is losing weight, and the cells that mark how well his immune system is holding out against HIV are getting lower and lower and lower. I am worried that this sweetly smiling six-year-old needs more food and new HIV medicines. I am also worried that both George and Jonathan could really still use a mother.

One million children in this country have been orphaned by HIV. George and Jonathan are just two of one million.

I tried my best with my usual set of doctor tools – a physical exam and blood tests and prescriptions and lots of counseling about how to take these medicines so that they work. I was at a far-away clinic that did not have a nutritionist or a social worker today, but we attempted some arrangements for Jonathan’s little family to get some extra help and extra food.

I am thankful for Jonathan, who has stepped forward to take care of his brother and his cousin amidst the devastation of his childhood and his family. I am thankful for a clinic with teachable, kind clinicians and my faithful study team who will follow families of any kind very closely. I am thankful for our Orphans and Vulnerable Children program, who will use what few resources they have to help children like these. How I depend on them… I want these teams at every clinic.

We’ll do our best to offer Jonathan a few less days of worry, even though I find myself worrying about those two still.

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On the Streets

I have a hard time thinking of a group that is more marginalized than children who live on the street. Forgotten. Neglected. Feared.

When you see a dirty boy clutching a bottle of glue and lying in the gutter in a city in the world’s poorest places, it is hard to know what to do. Often, you just want to walk quickly past. Knowing that 100 million children are living on the streets right now is impossible and sad beyond belief.

100 million boys and girls like Philip and his friends.



Sometimes, the best thing that can happen in the face of great, big problems is to shine as bright a light as you can on them. The world’s orphaned and neglected children, the forgotten, the poorest of the poor – they really need that light.

One of the teams of researchers in our Kenya partnership studies issues involving street children, especially the risks they face from things like substance abuse. Our team just published an analysis in the journal Addictions looking at substance use among street children around the world. The review makes it clear that substance use is incredibly common among these children, and they face all the risks that go along with using drugs while their bodies and brains are still developing. If you look at that photo that Philip took, the boy has one hand on the precious soccer ball they found in the trash and a bottle of glue in the other hand.

I’m thrilled this publication on street children has been featured in some other places like the Toronto Star and the Voice of America, with interviews with my colleague Paula Braitstein. It also highlights the work my friends have done at the Tumaini Children’s Drop-In Centre to empower and serve street children here in western Kenya. If you want to do something for children on the streets, support the Tumaini Centre.

In poor places, children often turn to things like glue to numb their hunger, cold, and the pain in their hearts. Substance use among street children is a complicated problem to try to solve, but shining a bright light on their needs is a good start.

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Friday Gratitude


I am very grateful for my big, blue beast of a car that carries me and my study team across terrible roads to the clinics in Kenya’s remote corners where mamas and babies wait.



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