Featured
Women in a remote area of Kenya travel great distances — sometimes on foot, sometimes with small children — for surgery to repair obstetrical injuries and for treatment of a neglected tropical disease endemic to Baringo County.
Northeastern students Abigail Binkley and Abigail Williams spent their fall semester in Kenya on co-ops that explored the ways education and culture can help prevent the medical crises from occurring in the first place.
“The preventative approach and the educational approach are going to (bring about) the biggest changes in the community,” says Williams, a fourth-year student majoring in evolutionary biology and anthropology.
For their co-ops, Williams and Binkley, a third-year student majoring in biology with a minor in global health, held research positions at the TERMES Center in Chemolingot that was established several years ago by Northeastern professor and global health expert Richard Wamai.
Binkley focused on the burden of the neglected tropical disease visceral leishmaniasis among women of the Pokot tribe of childbearing age, 12 to 49 years.
“I’m looking at social, cultural, biological and environmental factors that might increase their risk of getting it,” Binkley says.
Williams focused on obstetric fistula and similar gynecological injuries that stem from childbirth, conducting in-depth interviews with six of 15 women who underwent surgical repairs at Chemolingot Sub Hospital in April, which was the first time the local hospital had offered the procedure.
For her research, Binkley surveyed over a dozen women. She gathered demographic information and asked about their understanding of preventive strategies such as bed nets and insecticides that guard against the bite of the female sandfly that transmits visceral leishmaniasis.
“There’s a huge knowledge gap,” Binkley says.
It’s a gap she attributes to the area’s isolation, high poverty level and low rates of education among Pokot women, most of whom never attended school beyond first grade — if they went to school at all.
The stakes are high, Binkley says, adding that “the disease is 95% fatal if it’s left untreated.”
A 17-day treatment is free at the Chemolingot Sub County Hospital associated with the TERMES Center, which Wamai established to help eradicate visceral leishmaniasis among the local people.
The women who Binkley interviewed had all received treatment despite challenges including distance and other family obligations.
When interviewing one woman, Binkley says, “I realized that she had to walk the entire way with her two children, so that must have taken days. And in that state she was probably very ill.”
“When you are infected you have an enlarged spleen, which is very uncomfortable sometimes,” she says. Other symptoms include an enlarged liver, severe anemia, fever, fatigue and weight loss.
Williams held key informant interviews with clinicians, community health promoters and traditional birth attendants as well as running focus groups for married men about people’s attitudes and knowledge of obstetric fistula.
This type of fistula is a serious childbirth injury caused by obstructed labor that results in a hole forming between the birth canal and the bladder, rectum or both.
Highly stigmatizing, the injury can lead to urinary or fecal incontinence, depression, infection and social isolation, as well as loss of income since people don’t want to associate with afflicted women.
“It’s a big issue in this community because of child marriage and early pregnancies,” Williams says. “When a woman’s pelvic bones are undeveloped, the baby cannot fit and it gets stuck.”
Female genital mutilation (FGM) is also a major culprit because the scarring that results from the procedure prevents the baby from being able to exit the birth canal, she says.
Both child marriage and FGM are outlawed in Kenya, but the practices are hard to regulate in the remote and medically underserved areas where the Pokot people live, Williams says.
“They live very far away from each other,” she says. “At 11, 12 or 13 they’ll undergo FGM and then they immediately will get married and start having children a year or two after that.”
“There’s a lot of misconception about these types of injuries,” Williams says.
“One woman I talked to didn’t know what she had until there was a fistula training session hosted” at the African Centre for Community Investment in Health (ACCIH) associated with TERMES, she says.
“She had lived with it for over 45 years,” Williams says. “She had six kids while having this injury.”
Attitudes toward FGM are changing with education, she says.
Williams says older men invited to focus groups stopped having their younger daughters undergo FGM once they realized the role the procedure played in their wives’ obstetrical injuries.
The government and public health officials also are “trying to flip the narrative” that only girls who have undergone FGM are suitable for marriage by discouraging a new generation of schoolboys from selecting brides who have had the procedure, Williams says.
Binkley and Williams, who both plan to attend medical school, divided their time in Kenya between field research in Baringo County and academic projects in Nairobi, where they were among the few undergraduates presenting their findings at conferences.
“It’s been a nice opportunity,” Williams says. “I really did enjoy working in the rural health community. It’s been a very different opportunity than any other shadowing or medical job I’ve had in the U.S. so far.”
In rural Kenya, the students forded rivers on trucks and by foot and used interpreters to translate interviews from English to Swahili to Pokot and back.
“It’s one thing reading about” global health challenges, Binkley says. “But when you’re actually in the field, you can really see the struggles that they go through and the lack of resources.”
“It really makes us want to do so much more,” she says. Even though she arrived back in the U.S. in November, Binkley says she plans to make up posters that use photos to get the word out about the causes of visceral leishmaniasis.
“I want to keep helping with the prevention measures,” Binkley says.