As I’ve noted in previous posts, we’re doing some research on snakebites in two areas of Kenya. I came out to Mbita in Western Kenya to do some routine management things for the demographic surveillance system that I run. This gave me an opportunity to go out and visit some houses of people who had indicated that someone in the family had been bitten by a snake in the past.
Today brought us to the Gembe East area of Mbita District in Homa Bay County, an area most associated with malaria transmission (of which I’ve written papers on). The Usao area we visited today is probably the poorest area of Gembe East. Roads are almost non-existent and the cell network is even harder to find. Among kids, skin infections are common, as are untreated wounds and eye infections. One kid has an eyeball so swollen that he couldn’t blink.
Discarded Coartem and Artefan packs litter the area. When I’m in the villages I always check the trash. It’s a great indicator of the public health situation. I often think that people should give up on surveys and just start mapping drug waste out here. At least we wouldn’t need to go through any (or at least few) bureaucratic hurdles.
We hired a single staff member at the last minute, assisted by a graduate student from Japan, hired a car and took off this morning to get here.
To find the snakebites, we compiled a list of houses where people had reported snakebites and then coordinated with our DSS staff to find them. Our registration system allows us to easily find houses in our survey areas, a real asset when one is doing these kinds of follow up surveys.
The first house we went to was vacant, everyone had taken off to do their daily chores. I became worried at this point since this area is so challenging to get to. Our list indicated that the neighboring house had a snakebite victim so we went over there and found the lady more than willing to talk.
Her son had been bitten ten years earlier by a puff adder in the space between her house and the water. Fortunately he didn’t suffer any permanent damage, but given that two houses right next to one another both experience snakebites, the area has to be considered somewhat dangerous.
She didn’t take the child to a clinic, instead enlisting the help of the local witchdoctor. Local practitioners treat snake bites by making small cuts around the wound, ostensibly to cut off routes that the venom can use to spread, then they apply a salve containing local herbs. The nature of the herbs is unknown. I plan to try and find one of these guys and see what it could possibly be.
Giving up, we returned to the market area, and suddenly several people came out of the woodwork claiming to have been bitten in the past. Some of them were in our list. Lucky day.
One gentleman had been bitten on the leg several years previous. He didn’t suffer any major damage, but the skin surrounding the wound is now scaly and tend to come off. Again, the culprit was a puff adder. The locals claim that the snake causes a persons skin to become snake-like, even shedding occasionally, just as a dog bite (rabies) causes a person to bite like a dog (it’s disconcerting how familiar people are with the symptoms of rabies here).
Our regular DSS survey worker pointed out that many people don’t want to report snakebites, presumably because of the associations with witchcraft. He also noted that when people hear about other people reporting bites, they tend to want to report them too. We had one lady who claimed that she hadn’t been bitten, but today was eager to talk about it. Just about everyone has some story about a snake, it appears.
After doing about six surveys, almost all of which were puff adder bites, we moved on. Most of the wounds we saw were minor. Some wasting of the legs, some skin problems, but no paralysis or debilitating long term issues.
A 12 year old boy, however, had been bitten on the hand by a puff adder about three years ago. Fortunately, his mother took him to the clinic immediately. He spent a month in the hospital, likely on intravenous antibiotics because the venom had destroyed most of the tissues in his left arm. Amputation was avoided, but he no long has full use of the arm and the hand is permanently deformed.
The survey worker tried to get the child to identify the snake by showing him a picture of other many kinds of snakes, but it had all the hallmarks of a serious puff adder bite. Clearly there was rotting of the tissue all the way up to shoulder and the joints were permanently bent. The elbow no longer moves due to the lack of muscle tissue and cartilage. The kid otherwise is a normal 12 year old boy. He is lucky to be alive.
Only two of the ten surveys today indicated that people went to a clinic for treatment. Someone noted that getting to the clinic is nearly impossible unless you have a motorcycle, and most of the people here just don’t have the means to call one. They opt for the witchdoctors, who make snakebites a principal part of their practice. Whether it is effective or not is unknown. Likely many minor bites might have resolved themselves on their own. Serious bites likely result in death so we’ll never know.
An incredibly boring and rambling post about yesterday’s journey to Mbita, Kenya that no one should read.
I have no money. I haven’t had more than a few dollars at a time for the past few weeks, and this pattern has been repeating itself for at least the last few months. Nairobi is a terrible place to live if you have no money. Now I can see why most people are so pissed off and mean a lot of the time.
It is incredibly stressful, but you learn ways of getting by. Eggs are cheap. If you are willing to walk a bit and aren’t picky about the taste, beans and a chapatti will only set you back about $.50. If you stock up on rice in the rich times, you can eat a reasonable dinner and stay full for a while.
Not leaving the house, ever, really helps. Every venture outside will cost you money you don’t have. Aside from the problems of having to run the gauntlet of people constantly demanding money… cause you’re white. And white people have money. And why don’t you have any money? You greedy bastard.
Whatever you do, don’t get pulled over. You might be able to plead your case and convince them of the truth, that you really have no money, but, if not, you’re going to jail, because you are a white guy and all white people have money somewhere.
But that’s not what I was going to write about. Because I have no money, I scheduled a trip to Mbita. I can get the per diems out here and at least eat and not feel horribly fucking poor. So it was a grand plan. Go on the road and not feel poor and ashamed like I did when I was in high school.
Was going to take the bus because I feel guilty about using my employers money, but had to get here by noonish so I just took the damn flight. It was only $40 more than the bus. Maybe they could spend that $40 on something useful and not me, but fuck it, I’ll fly.
The problem with coming out here is that you fly into Kisumu, then have to travel about 90km to the ferry and take a one hour ferry ride to Mbita. Though you are constrained by the ferry schedule. So you have to wait a while. The whole trip can take as long as the bus if you do it wrong.
The cab from the airport to the ferry is $80. Yes, the cab is more expensive than the flight. I think these guy s are ripping us off. So I hate them. I don’t want to use them. So I decided not to, aside from the bigger issue of having to front the money for the cab (money I don’t have) and fight to get reimbursed. Too much trouble.
So, I elect to take a matatu (bus). I run the gauntlet of cab drivers, one recognizes me, I tell him I have no money and have to take the bus, which is true. Kenyans first look at you like you are lying, then they look at you as if you are greedy, then there is some glimmer of understanding when they think about who they are talking to…. At that point, they just think you are pathetic.. like the KCs (perjorative for white Kenyans), some of whom really are dirt poor.
Oh well. I walk past and go out to the road. A matatu comes by, I tell him I want to go to the Luanda Port, he says get in. I do. We roll along. At some point we pass by a familiar junction and pass it. “Why didn’t we turn?” I think. I ignore it and roll along with the ride. We are riding. They gave me the front seat. I’m not recognizing anything at all.
After an hour, we get to Luanda. Luanda Town. Not Luanda Port.
Fuck. “Nimesema Luanda Port, si Luanda Town! Nataka kuende ferry port, harafu naende Mbita Town. Sijui?”
When Kenyans realize they fucked up, they kind of shut down. It’s weird. Like even apologizing or offering to help you get out of your predicament are admissions of guilt and inherently dangerous. There’s really not a whole lot you can do at that point.
I saw a shop selling drums. Maybe there’s something good. If I’m going to be lost, I might as well check it out. I run the gauntlet of Luos screaming “Mzungu!” Don’t they teach these people manners?
The shop is just curio crap. Wood giraffes and other assorted junk. Giraffes aren’t even out here. Not sure why it matters to create cheap carvings of them. Maybe they should carve hyacinth which is starving the lake for oxygen and light or even tilapia. Or cholera. I don’t know. Giraffes don’t make a whole lot of sense out here. For all their talk of “culture” in Kenya, the face they present to tourists is remarkably incongruent to anything resembling local culture. Now, I’m complaining.
Maybe an NGO taught them what to carve at one point and they just did it because it seemed like a good idea. No clue. That’s usually how it works.
I’m wondering what the hell to do. Go back to that junction we passed? Seems reasonable. A bus is there. I tell the tout I want to go to the port. He says, OK, take this bus and get off at Ramulu, then change to a cockroach.
A cockroach is a Toyota ProBox which has been converted into a taxi. It normally seats ten. If you are lucky, you can sit in the hatchback, which is the cheapest seat, but the place where no one wants to sit because only the truly poor sit back there. The downside is that you’re locked in so if there’s an accident, you can’t get out. The upside is that you are the only dude back there for the whole ride.
The other seats are usually crammed four to a seat. As the Kenyan diet gets more and more calorie rich, people are getting bigger. You can imagine what it’s like to sit four across in the backseat of a ProBox. I’ll take the boot Er.. the hatchback. We’re British here.
OK, so I do all that. Just like the dude says. I look at Google Maps. We pass a road that goes right down to the port. Should I get out? I figure that the road might be bad. That’s why he’s passing it. Yes, that must be it. Yes. No need to fear. It’s only 25 km to the town where I have to get in the cockroach.
We get to the town, I get out, he shows me the cockroaches. I need food. I go and buy some chicken. Animal Planet is one the TV. Reptiles are eating one another. It is an apt analogy for Kenya, perhaps. At least at election time. Maybe it’s an apt analogy for the US. I don’t know.
The chicken isn’t bad. Better than that terrible Nairobi chicken from those farms where they use hormones, which cause chickens to grow into full adults within an hour and give people breasts. At least that’s what taxi drivers tell me.
I go toward the cockroach. A guy is approaching me hoping to rip me off. I speak Swahili. He repels and yells loudly to his friends that I speak Swahili. They leave me alone. I must be a lost cause.
The cockroaches are waiting. Here, cockroaches wait until the car is full before they embark. Unless you have stuff to carry, it’s stupid to wait because you’ll be sitting there all day long. If you walk down the road for a while a rogue cockroach will come by and pick you up. Those guys are hated by the guys at the stages waiting for customers. They look at them as bottom feeding trolls. No pride.
I start walking. The cockroach guys complain.
The boot is open so I get in, and promptly fall asleep. I got up at 5 am to get to the airport and have already spent two hours in vehicles. A bag of maize makes it more comfortable.
Eventually we stop at the “Port.” It’s a dusty nothing town in the middle of nowhere. Not the port.
“Hapa si port!”
“Hapa ni Port Victoria.”
Good god. Luanda didn’t work for me. Now Port isn’t working for me. This just isn’t my day.
“Port Victoria” sounds like it should be some old British outpost or something, with grand houses and a nice place to drink tea on the water. What it is a dusty, waterless town in the middle of nowhere. There’s a non-sandy beach somewhere nearby though it isn’t part of the town.
Google Maps can’t generate a route from it since there’s no road, technically. I’m 100 km from the “port” I want to go to. I start walking. Then stop. I look around for someone reasonably educated to avoid making all the mistakes I’ve been making all day long.
Out here, most people aren’t all that well educated and aren’t used to dealing with non-locals. A bad mix.
I find a guy with shiny shoes. He speaks educated English.
I explain to him that I want to go to ferry port. He proceeds to give me a route with six changes. It’s complicated by not undoable, and spares me having to go all the way back to where I came from.
First, I I’ll have to take a motocycle taxi 20 km to a neighboring town, then change to a cockroach, then to few buses. The motorcycle guy tries to make conversation with me about mundane topics. I’m too annoyed to engage him. I stop replying.
Feigning happiness gets exhausting. At this point, I’ve been in motion for nearly four and a half hours. Just drive. He is ripping me off. 700 for this trip is just way too much.
We get to Siaya, home of the nyatiti. There are no nyatitis to be seen anywhere. Of course. Because even in Siaya, people don’t care about it.
I didn’t have any expectations of seeing people playing nyatiti on the streets of Siaya. For the record.
There’s a cockroach there. He tells me I can take it.
“Are you leaving now?” “We are waiting for a few more people.” The car is empty. I start walking. I can hitchhike it to Bondo. I note that there are no cars. It’s hot. 3 pm is the hottest time of the day. I have no water and Bondo is 20 km away. I can do this.
Cars come by, they ignore me. Eventually, a preacher picks me up and drives me a kilometer or so. He is friendly and wants my number. I give him a fake number.
I keep walking and cars keep passing me by. The cockroach still hasn’t appeared and I’m 10 km in. On foot. Which means he is still waiting over there.
I get another ride from an electrician who says he’ll take me all the way in to Bondo, saving me a lot of trouble. He’s nice enough and doesn’t talk about Jesus, which is cool. Not talking about Jesus is a sign of character to me. Trump never talks about Jesus but he’s an awful individual. Hm.
Now this post is rambling. No one is reading this. I can write just about anything at this point.
Dude negotiates a price for me on the matatu, which is kind of unnecessary, but he gets it to a real price of $.50. At least I have some backup if they try to rip me off. Sure enough, the guy tries to rip me off. I call him on it and he coughs up the money.
The lady next to me compliments me on saying “asante” as if I’m straight off the boat. For some reason, this annoys me. Generally, at this point, anything could annoy me, but after arguing with the matatu tout over a few coins in Swahili, you’d think that I would be able to say thank you.
Most whities that come out here are religious people. They capitalize on dumbness, it helps them do what they do because there are people who are just midline educated and have no work prospects and want to feel as they have control over some particular space. So having a semblance of power over white people, however benign, is a premium. “He doesn’t know ugali. The poor guy. I will teach him.”
I find this type of pandering annoying, and find the ways in which white religious people exploit it to be offensive. It’s the little things that count.
For the whities, it’s a cash cow. They take some pictures of them “helping” poor people, then go around to churches in the states to raise money for their “projects” but the cast majority of the money goes to supporting the missionaries themselves. The smiles and feigned ignorance of the ways of the savage are simply a means to an end.
But I digress. I run into so few missionaries in Nairobi that they always stick out to me here in Western Kenya.
I go on, get out at a stage and realize that if I don’t drink water anytime soon, I’m going to suffer heatstroke. The bus is ready to go to the port. I casually tell the guy to wait without indicating what I’m going to do. I go buy some water, chat with the lady and drink some. When I come back out, the bus is still there full of people.
“Twende” and we’re off.
We’re driving for a while and the tout taps me on the shoulder for money. I have him 50 bob and he just stairs at it. “How much is it?” “200” he says.
“That’s too much. Pesa mingi sana.” People laugh. I think he’s trying to rip me off and stew on it for a while. I realize at some point that the port is significantly farther away than what was described to me. It was probably a fair price.
I’ve now been on the road for seven hours and have spent more that $15 of money I don’t have. I was hoping to take a nyatiti lesson this weekend but have spent it all on this stupid trip through Nyanza.
I go to get a soda at the hotel across the street from the port and ask a guy what time it is. A full hour till the ferry comes. By the time we hit Mbita it will be dark and I’ll miss the sunset by the lake, which, aside from work and money, is why I come here. Again, I stew on it, annoyed.
The watch guy asks me if I’m going to Mbita. He says he can get me a spot on the boat matatu that’s leaving now. “It’s faster. You can get there by six.” For 200 schillings. I already bought my ticket for the ferry but screw it, let’s go.
The boat matatu is fast. We are there in a mere 15 minutes. The ferry is absurdly slow. We see it crawling on the way. It was 5:30 and it had just left port. I wouldn’t have gotten to Mbita until well past 7:30. This was a good plan.
They at least give us life jackets but the ride is fairly scary nonetheless. No one here can swim to I’d probably die trying to save someone. I always think about these things.
After more than 10 hours of travel by plane, matatu, bus, motorcycle, foot and boat, I finally arrive in Mbita, run another gauntlet of motorcycle taxis and hit the gate before it closes.
Now, finally, I sit here by the lake and watch the sun go down.
Coming out here is complicated. I am reminded of a time of my life where things really weren’t so bad, compared to now, where things really can’t get much worse. Oh well.
We just spent the day driving around Kwale looking for snakes, and/or people who had been bitten by snakes. As the last post showed, snakebites are a persistent problem along the Kenyan Coast, with more then 5% of the households we survey indicating that at least one person in the household had been bitten in the past two years.
It wasn’t difficult to find them.
Snakes are universally feared all over Africa and the associations with witchcraft make it a common topic of discussion. Everyone knows someone who has been bitten. They often know all the details, including where it happened and what occurred following the bite. It’s never a happy story.
We went deep into Kinango, an extremely rural area west of Kwale Town and found a friendly lady who seemed to know everything about everyone. She was incredibly jolly, pulled out some plastic chairs for us to sit under and cracked jokes the whole time. I even got to copy her collection of Sangeya music which she had recorded on her phone (another post but you can hear some of it here) at some local music festivals. In total I got more than five hours of live Sengeya and Chilewa music. In the music world, these would be called “field recordings.” Here, this is just music she cooks and cleans to.
Switching back and forth between snakes and Sengenya (in Africa it seems to be possible to have multiple conversations at once), she told us about a kid who had been bitten two days previous. She even told us where to find her, so off we went.
The child was collecting firewood around a mango tree near her home, when she was suddenly bitten by a large green snake, not once but three times on the foot. The snake bit once skated away, decided it wasn’t enough and came back and bit her twice more.
Ants had moved into the dead tree and hollowed out the area underneath. Presumably, the snake moved in previously and came out to warm up during the day.
The mother thankfully took the child immediately to Kinango Hospital and treated was administered. The child was given a three day course of antivenom injections and charcoal was wrapped around the wounds to absorb any venomous discharge. Though the child complains of some numbness in the area, it looks as if there won’t be any permanent damage. Thankfully.
We were also told of an old woman who had been bitten more than 20 years ago, and was badly scarred, figured out where she was and off we went again.
As we pulled up a friendly young lady came out to greet us, and showed us the way to the house out back. In the distance, we could see an old lady walking with a limp. Otherwise, she was completely fit and seemed to be cutting her own firewood with a panga.
She brought us out some chairs and sat down to chat. In 1992, she had been out back collecting firewood (a pattern) and was bitten on the foot by puff adder, one of the deadliest snakes in the world. She was bitten on the foot, and became immobile for nearly a week. A series of witch doctors were brought in, who administered charcoal rubbed into small cuts in the skin.
Necrosis set in, and watery blood erupted out of the wound site. A large number of maggots appeared. Finally, someone had the good sense to take her to the hospital, where she spent an entire year.
The details were unclear, but it appeared that the gangrene was so severe that multiple infections were presents. They likely had her on intravenous antibiotics for an extended amount of time. Despite this, the foot did not heal. Some Christian missionaries came, and convinced her to convert to Christianity, which, she claimed, improved her condition. This is likely coincidental.
The doctors suggested a skin graft to improve the foot, but she refused. Necrosis was so deep that it permeated the bone and the foot is permanently curved as a result. The leg still shows sign of swelling even more than 24 years after the bite. In most cases, they probably would have simply amputated.
The lady was born in 1948, bore ten children, one of which was born just as she was bitten. She was unable to breast feed or care for the child. Regardless, the daughter has two children of her own now.
Snakebites are bad news. In this woman’s case, the disregard for proper medical care simply made a bad situation worse. She is truly lucky to be alive. If she had died, it is doubtful that the Mgangas would have admitted any responsibility.
I sent our DSS out looking for snake bites, and they found them! We simply asked households if anyone in the household had been bitten by a snake in the past five years. More then 5% of them said “yes” and since we know the locations of the households, we were able to make this cool map. Note that the snake bites tend to cluster around two large areas and are noticeably absent from others.
Kenya hosts many varieties of extremely poisonous snakes included the Puff Adder, the Black and Green Mamba and the spitting Cobra. Snakes are universally feared here and often killed on sight by the locals.
Probably not. The popular news is widely reporting this figure based on results from a pilot study sponsored by Transparency International, a German NGO.
“In East Africa’s most prosperous economy, the average city resident pays up to 16 bribes per month, according to Transparency International. Locals have dubbed Kenya “ya kitu kidogo” — the land of the “little something” — a kind of homeland of the bribe. And on the streets of Eastleigh, Nairobi, the victims of those bribes point their finger at one perpetrator.” – USA Today
Aside from the popular press, it is even being quoted in scholarly works.
I grew suspicious as I only pay about two to three bribes per month. While bribery and corruption are persistent problems in Kenya, 16 seems rather excessive based on my experience there.
So I went digging. And found the original research. Turns out, as noted above, it is a pilot study, done with little funding, using a convenience sample pulled off people walking on the streets of Nairobi, or rather a single place where the researchers pulled people aside and asked them questions. The respondents are mostly in their 20s and educated.
The sampling design appears to be not a sampling design at all:
“The survey was designed to capture citizens’ interaction with the government institutions primarily, but the survey itself sought information on both the public and private sector. The sample was selected by cluster sampling from three clusters as follows: i. Micro and small enterprise operators (“jua kali”) sample, drawn from membership of microfinance organisations
ii. Corporate sector, drawn from the membership lists of industry and professional associations
iii. Random “street” sample. The survey was administered to a random sample in public places (restaurants, bus stops, public parks and residential areas etc) to capture people not represented in the other two clusters (e.g. public sector workers and the unemployed) The “jua kali” and “street” clusters were administered through personal interviews. The questionnaire was sent to the corporate cluster respondents by business reply mail and followed up by telephone. However, the response rate was extremely low and had to be complemented with personal interviews to obtain an acceptable response rate.”
I suspect, given the demographic of the respondents, they were hanging out around the U. Nairobi area in the CBD of Nairobi and NOT in Eastleigh as the USA Today article suggests. In fact, the report doesn’t mention Eastleigh at all.
The authors, to their credit, caution against the use of the results:
“The survey is a pilot study, whose primary objective is to establish the viability of empirical corruption research. It was not designed to provide a representative sample from which statistically valid conclusions about the urban population as a whole can be drawn. ”
So… while I get that there isn’t a whole lot of research on the subject, and any contribution is, well, a contribution worth examining, the results of this study should NOT be presented as fact, given the poor sampling design.
We can, of course, excuse the popular press, since they don’t care, but scholars should be extremely wary.
Because we shouldn’t deceive ourselves. The digital age has provided too many opportunities for people who shouldn’t necessarily be putting out records and flooded whatever market may exist, reducing opportunities for everyone.
It’s like the famous tragedy of the commons, “an economic theory of a situation within a shared-resource system where individual users acting independently and rationally according to their own self-interest behave contrary to the common good of all users by depleting that resource.” So, I just quoted Wikipedia. Strike two, maybe.
So here I am, acting in my own self-interest and behaving contrary to the common good, through my second collection of songs for Mark Maynard’s Saturday Six Pack Radio show. For those who don’t know, I wake up every Saturday, improvise a song and send it to him for airplay later than evening. It requires little work from me, no financial investment, and gives me something to do besides mope in my Nairobi apartment about what my life has become.
Enjoy (if you can). You can find it here on Bandcamp and even purchase it if you are feeling particularly sorry for me.
Here’s the video for the lead track.
- The Return of Yellow Fever (link)
- Historical Review: Problematic Malaria Prophylaxis with Quinine (link)
- A Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive (link)
- A Unique Perspective on the Making of ‘STALKER’: The Testimony of a Mechanic Toiling Away Under Tarkovsky’s Guidance (link)
- Lethality of First Contact Dysentery Epidemics on Pacific Islands (link)
and some nyatiti from Luoland: