By Robyn Rogers
“Don’t make friends with the food.”
The sheep was a Christmas gift to the Kenyan family that lived next to the wazungu, a Swahili word for “travelers” that is loosely and non-pejoratively applied to white people. In wooly peace the sheep placidly grazed in the backyard, obliviously wiling away its final hours of life. Equally oblivious were the wazungu children next door, not understanding that this gift was intended to be on the Christmas platter dressed with vegetables, not under the Christmas tree dressed with a bright red bow. With the innocent attraction children feel toward animals, the wazungu kids formed an attachment to the sheep. But the wazungu children were about to learn a lesson in the transitory nature of Kenyan life. The short-lived friendship ended gruesomely when the traumatized children happened upon their new friend in mid-slaughter in the neighbors’ backyard.
“So don’t make friends with the food.” My Kenyan colleague Dr. Kiarie emphasized the moral to his story with a large finger pointed in the air. “That is an important rule in Kenya.”
Sitting at the desk opposite, Dr. Kiarie’s assistant Francis Njiri leaned back in his chair and nodded his agreement. “I do not understand why Americans let animals live like people. They wear clothes and sleep all day. When you see a dog here, you get scared and hit it if it comes near you. In America you’re supposed to be friends with it. If you see a dog, you’re supposed to say (breaking into a falsetto voice) “Oooh, a dog! Hiiiii, dog!” He paused, held my gaze for effect, and then flashed an impish grin. “I do not understand.”
“Do dogs have hard lives in Kenya?” I asked.
“They live like dogs.” Francis answered simply. I rather guiltily extinguished thoughts about my pampered fluffy feline-child luxuriating on my down comforter back home in Seattle.
Do not bother asking a Kenyan the names of his animals. They don’t have names. They are “cat” or “dog.” Even whether the animals are regularly fed, with pet food or anything at all, is not at all assured. Like most everyone in Kenya, the animals work for a living, and survival is not assured. Dr. Kiarie marveled at the idea of Americans giving insulin shots to diabetic dogs. I told him about pet medical insurance, doggie intubation and hip replacements, kitty echocardiograms and dental cleanings. I had recently read that canine ACL repair was a billion dollar business in the US. Dr. Kiarie and Francis looked at me as if I had just told them my intended medical specialty was cat cardiology.
“Just kill it and get another one.” Dr. Kiarie said.
While sitting in a coffee shop nursing a beautifully huge cup of black coffee, I penned this musing about what the Kenyan approach to animals said about the Kenyan approach to life. Then a maintenance man outside the window pulled my attention away from the page. I watched him carefully dust each individual leaf on a Jurassic Park-sized potted tropical plant. “That plant gets treated better than most humans in this country,” I thought aloud.
I had earned this lazy morning in the coffee shop by pushing hard during the last month or so. My work in an HIV clinic had turned into a crash course in African AIDS medicine, including electives in organizational politics and cross-cultural communication. I was getting profound lessons in all three. Even deep in the Kibera slum, a place where even dogs had a hard time living like dogs, many children were vibrant and delightful. They grinned coyly, grabbed my hand, giggled as they played with my penlight. Others were so sick it was hard to believe they were alive, especially when the attending physician exclaimed happily, “Oh, looking so much better than last week!” Once, I found myself standing in the exam room, fighting emotions borne of a rather unfortunate combination of hormones, homesickness, chocolate deprivation, and overwhelming cultural and medical immersion. For one terrifying minute I thought I might burst into tears. The grandfather of the emaciated AIDS orphan, 11 months old, only 6 kg and battling HIV and tuberculosis, asked me gently, “May I have your contact information in America, please?” I gave it to him, and wrestled with the urge to hand over my entire wallet as well. The 50 shillings he was struggling to come up with for oral rehydration solution amounted to less than one US dollar. Sometimes it is easier just to hand over the money. I could not do that a million times over. Even if I could, it would not fully meet the need.
“It is very hard. You want to do so much but you can do so little.” My Kenyan medical student friend Mwendi shook her head in sympathy. “We see children like that every day. It is very bad.” We discussed the issue while crammed into a matatu, a Kenyan public minibus. We were on the way to the home of our friend Carol, another Kenyan medical student.
“At the hospital, you have to work with your hands and your head,” she continued. “Because the patients cannot pay for anything more.” Outside the window we glimpsed the slums, acres and acres of corroded tin roofs baking under the midday sun. Long past the slums and surrounded by farmland, we disembarked on the side of the highway and began walking down a tree-lined dirt road toward Carol’s house.
Carol met us halfway and greeted us with hugs. “Thank you for coming so far!” she exclaimed warmly, and we reciprocated the thanks. Inside her family’s two-story home, she had a phenomenal spread of food waiting for us. Remembering what we had ordered at lunch together a few days earlier, she had prepared numerous hand-made Kenyan dishes that kept us coming back for more. Then we started on the business of the afternoon, which we had been referring to as our Cross-Cultural Medical Summit to discuss the presence in Africa of the pharmaceutical industry, a.k.a. “big pharma.” In other words, we poured some orange Fanta and started watching The Constant Gardener.
Carol loved this movie. “Do people know this movie in America?” she asked earnestly. “Because this kind of thing really goes on here. Do people know?” I assured her of the popularity of the film. While the quality of the bootlegged-via-camcorder DVD was not great, Carol and Mwendi pointed out the landmarks. That is Kibera, the biggest slum in Africa with over a million people. That is Pumwani Maternity Hospital, 100 beds and averaging 130 deliveries a day. They laughed at the scene in the medical records room when the clerk sneered, “If I do not have the patient’s file I do not have the report.” That is Kenyatta National Hospital, an experience they knew well! They nodded approvingly as Rachel Wiesz’ character Tessa pointedly asked the “big pharma” executive if the philanthropically donated pills had instead been converted into his limousine ride. Mwendi had not seen the film before. I had not seen it with the benefit of having traveled in the movie locations or knowing a few Swahili words.
After the movie Carol showed us her garden: melons, bananas, sugarcane, tomatoes any time of the year. With no end to the growing season, she planted what she wanted, when she wanted, all behind a high concrete fence to keep out garden-raiders. Then we went for a walk through the neighborhood, discussing the brutal commonalities of medical education the world over.
“The son of our American host traveled the world for three years. I asked him why and he said ‘To discover myself.'” Mwendi laughed. “In Kenya, you would never say that. You would never even think it!” She repeated it with a wink and a snort, “‘I do not know myself.’ I would like to say such a thing and go traveling too.”
“Yes, that is what is great about America. You can change your life anytime. Buy a boat, travel the world, go back to school like you have done.” Carol smiled approvingly as Mwendi nodded her agreement. “That is really good. In Kenya, you have to decide too young and that is it for your life.”
Of course Carol and Mwendi had a point, but like Dr. Kiarie and Francis, they were not typical Kenyans. Each was college educated, had traveled outside of Kenya, had seen Western lifestyles and the abundance that was so lacking in Kenya. They appreciated how it felt to see people in one country spend more on their pets than the average family in another country makes in a year. They had worked in a healthcare system that, however flawed, had a semblance of a safety net in the form of public hospitals, where those in relative poverty had access to at least some of what “big pharma” had to offer. In Kenya, people in abject poverty died on the hospital lawn not because of a lack of medicine, but a lack of cash.
The Kenyan government regarded its citizens the way Kenyans regarded their pets: replaceable and unworthy of great expense. To assume Kenyans felt morally outraged by American excess was to fall prey to my own projected American guilt. Most Kenyans had neither the time nor the energy to spend cataloging the ways in which they had less than those in the West.
Indeed, most knew less about life in America than one might have expected, because such knowledge was neither necessary nor helpful on a day-to-day basis. My accent was not often identified as American; English-speaking Europeans, Australians and Americans all sounded the same to them. Kenyans were fully aware of the injustice of unequal wealth, and they did not need the West to provide examples. They only had to look at their own police, their own government, even their own hospitals. Tribal tensions were fueled in large measure by the competition for limited resources and power. Nairobi was nicknamed “Nairobbery” with good reason.
Like Francis’s grin over vet bills and Mwendi’s laughter about “discovering” oneself, I generally found Kenyans to be more entertained than offended by what they knew about the American way of life. It was just too incomprehensible for them to take seriously. Against all American intuition and sensibilities, Kenyans were light-hearted people, not despite their hardships, but because of their hardships. The majority did not waste energy grappling with issues that were not directly related to their day-to-day struggle to survive.
Ironically, the absorption with day-to-day life is something Americans have in common with Kenyans: how often does one think while ordering a pizza that the price tag exceeded an average African’s monthly rent? On a fundamental level, we all want the same things: a stable income, a safe home, a healthy family, a good laugh with friends and the chance to find love and happiness.
The difference is that the “American Dream” imparts a sense of possibility, even entitlement. There is no comparable “Kenyan Dream.” Most Kenyans live harder and die younger, without the Western certainty that the government is supposed to provide a national infrastructure that makes life better. Consequently, they are forced to place more emphasis on each day’s challenges. Why linger on hardship? Why focus on what is not possible? “Just kill it and get another one.”
It was an interesting lesson for an American medical student whose day-to-day life was largely a down-payment on a future that felt secure and steadfast. My Kenyan friends, even those who were also working through medical education, seemed to have a different relationship with time, with hardship, and also with joy. They seemed to caution, “Work hard, but remember that life is short. If you can not laugh today, here and now, when can you? Tomorrow, everything may change. Everything may be gone. So enjoy what you have, while you have it. Indulge in a good laugh. It may be the only indulgence you can afford.”
And of course – whatever you do – don’t make friends with the food.
Robyn Rogers is currently a 3rd year medical student at University of Washington and intends to go into pediatrics. She wrote this as a journal entry while developing a cervical cancer screening program at a free HIV clinic in Nairobi, Kenya in 2006 between her first and second years in medical school. Her professional interests include cross-cultural and international medicine, infectious diseases, research and sustainable health program development. She can be contacted for questions or comments at rkrogers@u.washington.edu