Tina Muehlethaler worked with the Academic Model Providing Access to Healthcare (AMPATH) on a three-month practicum in the western town of Eldoret, Kenya. AMPATH is a working model of urban and rural preventive and treatment services for HIV / AIDS, and is Kenya's most comprehensive initiative to combat the virus and disease. Tina applied her nursing and health-promotion knowledge to two projects: developing and piloting the Primary Healthcare Program Community Health Assessment; and developing and implementing a curriculum for girls and women attending educational sessions at Tumaini, a newly opened drop-in centre for street children.

While carrying out project-related duties provided tremendous opportunities for learning, “by far the most enlightening experience,” says Tina, was the time she spent in “the barracks,” an area of clear land along the river on the outskirts of Eldoret, that was “home” to the street children. Here, she saw the reality of the multiple hardships the children faced on a daily basis: poverty, extreme hunger, abuse, rape, gang violence, and the addiction to glue-sniffing, which is pervasive in the community. Tina saw children as young as eight years old staggering through the streets because they were high on glue fumes.

Also working against the street children’s well-being is the public perception of them. There exists very little empathy for these children among the general public. Indeed, the authorities regard them as a nuisance, and the police routinely turn their attack dogs against the youngsters, often resulting in severe injuries. “It quickly became apparent,” she says, “that if any real change was to occur due to our efforts in improving the lives of street children, community education and engagement regarding the issue is imperative.”

Tina says that her experience in Kenya reaffirmed her passion for working with and for marginalized youth, young mothers and women. “The lack of health-care infrastructure, limited resources and funding, cultural differences and competing public-health priorities forced me to use my problem-solving abilities in the field and has begun to lay the foundation for my future work in resource-poor areas of Toronto.”

“Upon graduation, I wish to continue to pursue this area of interest and focus my efforts on working with the immigrant and refugee population of Toronto. I am also particularly interested in working with homeless pregnant youth. I aspire to push forward youth-engagement activities and advocate with and for this population in order to secure the same basic rights to health as fellow Torontonians.”

On her three-month Kenyan practicum, Jaameeta Kurji worked with the Western Kenya Proof-of-Concept Project, which is part of a unique initiative called Sweet Potato Action for Security and Health in Africa (SASHA). This cross-sectoral pilot project seeks to gain evidence on potential improvements to the health and nutritional status of pregnant women and young children by integrating an agricultural intervention into health-service delivery at antenatal clinics.

SASHA encourages pregnant women from two districts in Western Kenya to plant orange-fleshed sweet potatoes, which are higher in Vitamin A and other nutrients than the white-fleshed variety more common to the region. The project also formed pregnant-women’s clubs, which met monthly and provided a forum for disseminating information on health and nutrition. Through the clubs’ monthly meetings, the sweet potato vines were distributed to the expectant mothers, as were directions for their planting and care.

The singular approach of this project and its cutting across two key sectors – agriculture and health promotion – falls in line with the Adelaide Statement on Health in All Policies, which advocates including health and well-being as key components of policy development in all disciplines. Using the social determinants of health as a focus, SASHA achieves three companion objectives: it provides food security during lean periods (due to drought, etc.); gives pregnant women access to public-health initiatives and counselling; and empowers these women within their families and communities, giving them bargaining power when decisions are being made about what to plant in the family plot of land.

Within the districts, SASHA received strong word-of-mouth support and the communities mobilized around the endeavour. Ancillary benefits included the potential for growing enough of the sweet potatoes over time for them to become a source of economic self-sufficiency, as well as better nutrition.
Jaameeta worked closely with Dr. Carol Levin (Program for Appropriate Technology in Health, USA) to develop operational instruments for assessing the effectiveness of the initiative; these instruments were tested in the field.

Jaameeta identified two important lessons she learned on the SASHA project: the way in which being flexible can yield unexpected opportunities; and the importance of listening and being open to the wealth of ideas people can provide. She will be returning to Kenya in January to continue her work with the project and feels that the community connections made during her practicum will provide a strong foundation for her future work.

“The commitment and enthusiasm demonstrated by the community health volunteers should be recognised to motivate these individuals engaging in an exemplary service. I hope to work on these issues upon my return as I assist with establishing the cohort. I am excited about continuing to work on this project for my second practicum, and am considering it for a potential PhD.”