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Abigail Binkley

Footpaths to Survival: A Patient’s Journey for Kala-azar

August 2024


Although I have only been in Chemolingot for a short time so far, a town in Tiaty West Sub-County of Baringo County, it has become strikingly evident just how remote and desolate some of the villages and homes that make up this community truly are, and the impact that this makes on locals’ daily lives. One day, or journey rather, particularly stands out to me. On August 13th, Abigail Williams, my colleague, Mwatela Kitondo, our field coordinator, and Jairus Kayolei, a CHP/teacher at one of the nearby schools who helped with translation of the local language, and I embarked on a trip to a female’s home in Lorwatum, a village near the main town of Chemolingot.  

 

My research focuses on understanding the risk factors for visceral leishmaniasis (VL), particularly among women of childbearing age. VL is a parasitic disease transmitted by the bite of a sand fly that is 95% fatal if not treated. It inflicts those infected with an enlarged spleen and liver, prolonged fever, severe anemia, fatigue, weight loss, and more. While at the Chemolingot Sub-county Hospital (CSSH), I have been able to understand some of the biological trends associated with VL acquisition in women. However, visiting female patients with a history of VL and interviewing them at their homes gives me a greater sense of the sociocultural and household factors that may increase VL susceptibility. This day marked my first time going to one of the local’s homes to carry out my research. Therefore, I had very few expectations.  

 

Early in the morning, we set off on our journey in our essential four-wheel-drive truck that lets us go anywhere in Tiaty, where most destinations include driving on unpaved, rocky roads. I was told that the village we were visiting that day was one of the closer ones. Yet, I soon came to realize that my definition of “close” was far different from that of the Tiaty region. In the beginning of the drive, the pothole-filled and obscure dirt paths, rather than roads, were situated nearby scattered homes, with people giving us curious and confused looks, likely surprised by the rare sight of a car. As we ventured deeper into the village though, the scenery became increasingly remote and the jarring car ride left me gripping my seat more than ever. Counting the 10 homes seen every 10 minutes that dwindled into zero struck me how isolated these communities are. Just as I thought we were almost at our destination, I was stunned to turn the corner and meet a fast-flowing river, at least 15 meters wide. If we had stopped the car there and walked the rest of the way, it would have taken us hours to arrive at the home. If we drove through the fast water, we risked getting stuck–or worse. We boldly decided to press on and carefully made it across the river on four wheels. Eventually in our drive, we came across another river crossing that was no longer possible by wheels. Therefore, it was time to abandon the truck. All four of us, hand in hand, braved the river’s swift current, like roots intertwined, grounding each other as we made it across.  



The river we crossed by foot


By the time we arrived, I couldn’t help but think about the woman I was about to speak with – the woman who had to walk these same paths on foot, not for research, but for survival. The journey was challenging enough for us on a vehicle, yet the barriers the families face here go beyond distance and into the realm of staying alive when in need of healthcare – and that is exactly what the woman I interviewed revealed to me. A single mother to two young children, she lives in a small stick house with a thatched roof. When she noticed symptoms of VL, she had no idea what was wrong at first. She also did not have the funds to support a hospital visit, prolonging her to seek out help. Eventually though, the fatigue and pain became so severe that she could no longer take care of her children, compelling her to make the trek to the hospital. She recounted having to walk for two entire days to reach the CSSH, with both of her children. The thought of a sick woman or child navigating that terrain under the blistering sun, perhaps at night or during the rainy season, was harrowing. Yet, she still did not have enough money to stay at the hospital for the full 17 day course of treatment. This led to her returning home, only walking back to the hospital for inconsistent treatment when she had the extra money. She spoke to me that she still believes she has VL, despite it being over 6 months ago that she first went to the hospital, and now, her young child also is infected, alone without his mother at the hospital, and left with no choice but to share a bed.



The woman's home, filled with cracks


The inside of the home, pictured above



While this story was heartbreaking, it is, unfortunately, the norm not only for this woman but many in the villages nearby. Something as simple as driving to the hospital in the United States is one of the highest luxuries as contrasted to here in Pokot. This experience made me extremely aware of the disparities in healthcare access in rural communities. Even more so, it puts into perspective the strength and resilience these people have. As we left the Lorwatum Village, I carried with me a redefined image of the poor healthcare infrastructure in this area and an even stronger urge to ensure that our work leads to real, meaningful improvements and insights on what needs to be changed, specifically for those who are neglected. Little did I know that the trip there, the physical expedition to the woman’s home, would not only reveal to me the rugged landscape but also the challenges faced by some locals who for them, healthcare is not simply a service but rather a faraway dream.



Goats seen entering the woman's home


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