April 28, 2004

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Palo Alto Online

Guest Opinion: Tala, Kenya, a world apart from Palo Alto, shares a vision for the future

by Ruthann Richter

Tala is a long, long way from Palo Alto, I kept thinking.

Tala is a rural village in Kenya that outsiders rarely see, where the drone of daily life moves slowly against a backdrop of hunger, quiet suffering -- and rampant HIV.

I arrived there in early March, covered in dust after the 68-kilometer trip from Nairobi in a rusted, rattling Toyota station wagon. I found an arid town with a single paved road, no running water, limited electricity and soil so rocky it takes four days to dig a grave.

They dig many graves, about two a week in this East African community of 7,000, where HIV lies hidden behind closed doors.

A friend, documentary photographer Karen Ande, persuaded me to accompany her to Kenya to see for myself the young faces of AIDS orphans and help her tell their story.

What I saw was worlds away from my life in pristine, pampered Palo Alto, where idle concerns -- what to have for dinner, for instance -- are life-and-death matters for people I met. There are few cars in Tala and no traffic or traffic barriers to divide neighbors.

Our first stop was Mama Darlene's Children's Centre, where about 70 children -- many of them orphans -- lined up in neat, red-checked uniforms to welcome us with a lively burst of songs and poems, in English and Swahili. It was overwhelming -- I just stood and cried for them all.

If there is hope for Kenya, it lives with people like Monicah Ngumi, a chubby-cheeked, 4-foot-9-inch powerhouse of a woman who founded the center in 1996. Ngumi, a former teacher in the Nairobi slums, collects neglected children, including handicapped youngsters who had been shut away. She feeds, educates and teaches them about HIV, a disease enveloped in denial, stigma, myth and shame.

"If someone is HIV-positive, they know they are going to suffer and die," she says over a lunch of beef stew in her closet-sized office. "Some hang themselves. They take poison. They kill themselves in different ways."

About one in five adults in town is infected, she estimates. Many are untested -- a visit to the nearest testing site would lead to social isolation. So HIV spreads, adults die, children are left behind. There are 1 million AIDS orphans in Kenya alone.

Muani and Kamene are orphaned cousins who have attended the school for several months. They are silent, pretty girls, both 8 years old, though they look to be 4 or 5. When they arrived they had the reddish hair of kwashiorkor, a kind of starvation, and were dispirited. Their mothers -- sisters -- died of AIDS in 2001 within a month of each other. Relatives often shun orphans because they are a financial burden. But Muani and Kamene had grandparents willing to take them in, a great hardship as they have five children of their own to support.

We visited their home, inland five miles off the main road, with Ngumi and her husband, Eliud Muema, a former hotel manager who assists at the school. We drove along rutted dirt roads, then through roadless stands of acacia and eucalyptus trees until the car could go no farther. Then we walked a half mile to the family's mud-brick hut, with a slanted tin roof and about 150 square feet of living space.

The orphans share a rough-hewn wooden bed with a tattered blanket. Food is scarce. They walk the five miles to school on empty stomachs, but get morning porridge once there, and a lunch. Dinner at home, when available, is some rice and beans or ugali, a cornmeal mush that is the Kenyan staple.

Their grandmother, 47-year-old Mary Nzula, greets us with a weak smile. She is feeling poorly. Her chest hurts and she has trouble breathing, she says in Swahili as Eliud translates. I privately wonder if she has tuberculosis, a common cause of death in Kenya, particularly among the HIV-infected. She was hospitalized in 2003 after a fall; doctors told her she was suffering from high blood pressure. She has mouth sores. Ngumi suspects she is HIV-positive and wants to find a diplomatic way to suggest she go for testing.

She guesses the woman was infected by her husband, a stonecutter who earns $2 a day chipping bricks in a nearby limestone quarry, using a rudimentary hammer and chisel. After work, he and other workers go into town for a local brew to soften the edges of their hard lives, and he may have mixed with an HIV-infected woman, Ngumi says. She is determined to bring HIV/AIDS out into the open. She has formed an innovative outreach team of 20 volunteers, a kind of traveling-theater group that performs songs and skits about AIDS in local markets and other gathering places. Patrick Nzesya, a trained HIV counselor, leads the group.

"When we give lectures, people don't like it," he says. "But the plays attract people. We're entertaining them and passing along the message at the same time."

It's an uphill battle. David Kimuyu, a nurse who directs a small private local clinic, says people hide from HIV. When someone learns they are infected, they "just stay at home," he says one evening, over a meal of grilled goat at a local restaurant. "Even today there are people who don't believe there is something called AIDS," a disease that kills 300 Kenyans every day.

Kumuyu provides palliative care, dispensing drugs to treat opportunistic infections. But life-saving antiretrovirals are hard to find and too expensive; even AZT, the old-line AIDS drug, costs about $42 a month, more than the average monthly salary. Kimuyu gives me a blank, unknowing look when I ask about protease inhibitors, the newer drugs used widely in the United States.

And so Ngumi toils on. She has ambitious plans -- to buy income-producing goats for the neediest families, to raise money for the children's secondary-school fees, to expand her outreach program, to open an HIV counseling and testing facility.... Needs are endless, resources scarce. She contributes what little she has of her own. She receives some funding from the Firelight Foundation in Santa Cruz and from the Global Alliance for Africa.

"I don't like failures," she says. "I look forward. I want the children to have great futures."

I realized I had heard that same "great futures" wish about our children in Palo Alto, and I felt very far from home.

Ruthann Richter, a resident of south Palo Alto, is director of media relations with the office of communication and public affairs at the Stanford University School of Medicine. She can be e-mailed at richter1@stanford.edu.

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