Environment & health
Victoria Brown, Class of 2015, authored this essay for Engaged Environmental Communication and Scholarship, the capstone course Prof. Leslie taught as part of the Voss Environmental Fellows Program in Spring 2016. Here, in her own words, Victoria reflects on what engaged scholarship means to her.
I walked past rows and rows of women, some sitting in front of their goods on the red clay and others on top of upside down Coca-Cola bottle crates. As I moved through the market, I could feel the stares and hear people repeatedly shouting “muzungu, muzungu” (white person or foreigner). I smelled sweat, dirt, and dried fish. My eyes moved from small, bruised tomatoes in buckets to large plastic bags filled with spices. Piles of packaged foods and objects like machetes or shoes contradicted my presuppositions of what a market looks like. Instead of pushing shopping carts through grocery store aisles, women balanced large plastic bowls on top of their heads as they carried their babies on their backs. I was in a world I did not recognize, one where people had access to soda but not clean water.
I traveled to Kimana, Kenya two years ago to assess the effects of the recent closure of an American-funded clinic that offered comprehensive medical care and health services to approximately 100,000 people. I worked with a group of researchers from various universities to develop a survey that focused on public health issues, which we administered to those in the Mbirikani Group Ranch largely inhabited by the Maasai. This semi-nomadic tribe has clung to their traditional way of life, making them a symbol of Kenyan and Tanzanian culture. The survey connected health issues with those of culture, hygiene, maternal health, and infectious disease. My work in particular focused on how domestic violence, sexual assault, and female genital mutilation amplify women’s health burden and stemmed from Maasai gender roles. With this work, we hoped to shed light on pressing public health issues, as well as how Maasai lifestyle change after they had lost access to the medical care provided by the clinic.
Although the purpose of my trip was to conduct research, I found myself reflecting more on my observations of Maasai daily life, like the few vegetables at the market, rather than on my study per se. Later, I learned this apparent lack of produce is in part due to the Maasai lifestyle and the recent transition to a more agricultural life. The Maasai live under a communal land management system and move their livestock based on seasonal rotation. According to traditional land agreement, no one should be denied access to natural resources like water and land. Each section manages its own territory with reserve pastures that the warriors fallow and guard. However, during dry season, section boundaries are ignored and men graze their herds far from their settlements to find water and vegetation.
In the 1990s, the Maasai began to shift to an agricultural-based lifestyle due to increasing population, land reform programs, and severe drought as a result of climate change. The Kenyan and Tanzanian governments have urged the Maasai to adopt more sedentary lifestyles and have also restricted them from accessing national parks and reserves. The Maasai demanded grazing rights, as they believe that using the land for crop farming is a crime against nature because cultivated land is no longer suitable for grazing. Commercial farmers, encouraged by government policies, have converted the best dry-season land into cropland, which removed natural vegetation and rapidly used up soil nutrients.
Imposed concepts of development by the global economy and international organizations have constrained food production and posed socio-economic and political challenges for the Maasai. Traditionally, the Maasai lifestyle centers around cattle, which serves as a measure of a man’s wealth and cultural status. Religious beliefs assert that God gave them all the cattle on earth, which lead to rustling cattle from other tribes, a practice that has become less common. A Maasai’s diet consists of raw meat, raw milk, and raw blood from their cattle. Normally reserved for ceremonies, blood is rich in protein and good for the immune system but its use in the traditional diet is waning due to the reduction of livestock. Despite their historical dependence on their cattle, the Maasai were forced to adopt new ways of sustaining themselves by cultivating maize and other crops because their plot sizes are now too small to accommodate their herds for grazing. Consequently, their diets now incorporate elements of Kenyan cuisine, which is largely grain-based and includes a few vegetables like sweet potato and cassava. The environmental repercussions of this transition have led to a depletion and contamination of natural resources, for example: overuse of water, agricultural use of pesticides, and overgrazing animals leading to soil degradation. Human and animal waste contaminants remain near people’s homes or run off into nearby water sources affecting the quality downstream. These socio-economic changes imply a greater health burden through subjection to chemicals, crowding, greater pollution in urban areas, and inequitable access to food. Although I provide some historical context linking Maasai agricultural practices and health, it is no way comprehensive or demonstrative of the multiple factors that have led to Maasai life today.
I observed this burden firsthand during my fieldwork, where we entered the lives of the Maasai and attempted to genuinely connect with people in the community, even if only for a month. On fieldwork days, I would wake up before sunrise to the echoes of a ringing metal triangle. For breakfast, I helped prepare scrambled eggs and was shocked by the pale, white yolks. I later learned that this is due a type of carotenoid, primarily lutein, which is related to chicken nutrition. Sorghum, a grain used as feed in Kenya, has less pigmentation than yellow maize and therefore determines the pigment of egg yolks. Our scrambled eggs had specks of color from green peppers, tomatoes, and onions, unlike the breakfasts of many Kenyans. Eating these egg “whites” was the first time I could see how the food chain plays out in my own life, feeling a closer connection to the land than I ever experienced growing up. Yet, it also highlighted the role of larger, structural issues behind food production and health that perpetuate diets high in fats and sugar.
We drove to a different site in Maasai land each morning of data collection. I knew we arrived once I felt the paved road ending beneath me and we kicked the car into four-wheel drive. This Mars-like scape seemed to go on forever under a cloudless sky until the silhouette of Mount Kilimanjaro appeared on the horizon. We passed by leafless baobab trees that looked like roots in the air, jackals hidden in the brush, and worn Maasai men with their herd of grazing cattle, as dust trailed behind the Land Cruiser. In the Maasai community, women or mamas build their homes, bomas, out of cow dung and mud with thatched roofs, which are arranged in the shape of a circle. Women are responsible for supplying water, milking cattle, and cooking for their families. Men build a fence or enkang made of acacia thorns and sticks to prevent predators from attacking their families and livestock, which are mostly goats and cattle.
Each field day consisted of walking from boma to boma sweating in the dry heat, translating interviews back-and-forth, and waiting for the next meal. Once inside each family’s enkang, we would stand or sit wherever we could. Our soles were clogged with cow dung and flies barraged our faces. We asked the mamas questions about the state of their health and how that changed after losing their primary source of medical care. This exchange became so routine that I could identify the meaning of certain words in Maa as I followed along the 12-page survey we created. I would read a question aloud in English. For each question, Wiper would say “ama” to address the mama and they would respond “ayeh” indicating they were ready for the question. Wiper produced a series of sounds that I could detect was a question solely based on inflection. Meanwhile, I tried to match these sounds with what I could infer was their meaning. This happened over and over until reaching sensitive questions about issues that are highly stigmatized like HIV or gender roles. While tending to their children, mamas hesitantly responded and kept their eyes fixed on the ground when they felt uncomfortable.
We conducted our final interview with a mother, two girls, and a boy, who lived on Chyulu Hills. Chyulu differed from other sites in that it was mountainous and lush with grass. We went through the questions with our Maa translator Wiper and finished by measuring the children under five for malnutrition with a MUAC (Mid-Upper Arm Circumference) indicator, just as we had ten times over the previous day. As I put the indicator around the boy’s arm, I was afraid I would break it just by touching him. The circumference passed green, yellow, and orange. It was in the “red” zone, roughly the same size as five fingertips grouped together. This little boy sat at my feet playing with my shoelaces. He wore a Strawberry Shortcake shirt that was most likely tossed in a donation bin and wound up at the Kenyan market. He seemed accustomed to the flies at the corners of his eyes. He was severely malnourished. I had been watching him intently—I noticed he did not have a distended belly or copper hair, which I knew to be signs of a type of malnutrition called Kwashiorkor that resulted from a protein deficiency. Through Wiper, we informed the mother that he needed medical attention, but that was not the fundamental problem. He needed food, more than just a small bowl of grains I saw him share with his two sisters. We then explained to her the importance of a healthy, balanced diet—that is all that we could do.
At the end of our month long trip, we invited members of the Maasai community, including tribe leaders, to engage in a conversation about our research findings and how to improve their people’s health. As each person presented a different health-related topic, I paced outside of the presentation room practicing my part. With the help of my translator Joyce, I stood before the stakeholders to explain how gender roles influence public health. Backed by my research, I asserted that female genital mutilation and domestic abuse hurt women’s health. The men laughed. My eyes held back angry tears. I glanced down at my body covered in goose bumps in disbelief that anyone would dismiss their mothers, sisters, and wives’ wellbeing. Joyce silenced the warrior voice in the room and only accepted questions from women. The women unanimously agreed with our findings that promoted women’s rights and health. The male tribe leaders seated at the front of the audience whispered amongst themselves, as mothers and schoolteachers stood strong and advocated for themselves. Joyce reassured me that our presentation brought attention to the Maasai community’s need for more female education, open dialogue on gender issues, and improvement for female healthcare. Reflecting on this moment of gender inequality and health injustice makes my jaw clench. Yet, it motivates me to participate in work that impacts people, especially in regards to their health.
With my head resting on the plane window, I thought about all I had done and seen in the last month. The image of the little boy’s hands untying my laces was stamped in my mind. Recent investments in Kenya to advance agriculture, water and sanitation, social protection and health systems have not impacted nutrition status. Although the prevalence rates of wasting and underweight have declined over the past decades, stunting has increased. Nutrition is at the basis of life, which becomes more and more challenging to sustain when there is enough food being produced but just not distributed equitably.
At times, I found it hard to believe that I was living through these experiences. I drove past a young boy chasing after three giraffes with a stick. I learned how to make Maasai jewelry from recycled materials. We taught mamas the Hokey Pokey. I held a tiny two-week old baby boy inside of a dark boma that filled with smoke from burning wood used to cook food. These experiences reinforce my desire to make a difference for people—the Maasai people—and their health in resource-limited settings.
What I have seen and experienced is not unique. This struggle is the daily lived experience for millions all around the world. To make a difference in these communities, science, policy, partnership, and evidence-based health action need to work together. Over the past two years, I have continued with my studies in public health and the environment, started learning Kiswahili, strengthened my research skills, and decided to pursue a career in global medicine. Once I have my M.D. and more knowledge and experience in public health. I hope to give back to the community that impacted me so much.