Teaching Geography Workshop 5: Sub-Saharan Africa – Part 2: Kenya
BINKO:
Sub-Saharan Africa is a region of great natural beauty and great human
potential but it also confronts overwhelming challenges. Widespread
poverty, war and political turmoil have all contributed to making life
expectancy in sub-Saharan Africa lower than in any other region of the
world.
But it is HIV/AIDS that casts the longest shadow and exacerbates all of
the region’s other problems. In our case study, we’ll examine this terrible
epidemic in the East African country of Kenya. As we’ll see, medical
geographers focus on how disease spreads through time and space.
The diffusion of HIV/AIDS is dependent on human interaction.
Geography Standard Nine-- the characteristics, distribution, and
migration of human populations on Earth’s surface-- helps us
analyze how disease is spatially distributed through populations.
Our first objective is to identify how understanding population
movement can contribute to disease control. The physical
environment also plays an important role in Kenya’s HIV/AIDS epidemic.
A consideration of Geography Standard 15-- how physical systems
affect human systems-- illustrates how the physical environments in
which Kenyans live contribute to the proliferation of not only HIV/AIDS,
but malaria and other diseases, as well.
As a sexually transmitted disease, HIV/AIDS can be a difficult subject for
any teacher to address. Later in this program, we’ll visit Shirley Hutchins’
eighth-grade classroom. There, the climate of trust and respect allows for
mature discussion of this sensitive issue. We’ll see Shirley’s students
investigate, analyze and formulate strategies to deal with this serious
problem. Our second objective is to explain contemporary issues, in
this case the HIV/AIDS epidemic in Kenya, in the context of spatial
and environmental perspectives.
(\man sings solemnly \in native language\)
NARRATOR:
In this rural Kenyan village, a man has died of AIDS. Like so many
others, he died young-- only 35 years old. He leaves three children and a
widow. (\mourners singing \in native language\) Tragically this family’s
experience is not unusual. The National Ministry of Health estimates that
over two million people in Kenya, including 100,000 children, are all
infected with the HIV/AIDS virus.
(\people continue singing\)
WOMAN:
Future development of Kenya is at risk as a result of HIV/AIDS. For
example, child mortality rates had gone down over the years and are now
starting to go up again. HIV/AIDS is prevalent particularly among those in
their mid-20s to their mid-40s. This is the labor force of Kenya-- the most
productive people. These are the people earning the money and
developing the nation, and they’re dying.
NARRATOR:
Families are destroyed by the spread of AIDS. Thousands of children
have become orphans.
TRANSLATOR:
There’s my father and there's my two brothers.
NARRATOR:
Disease was devastating the societies of sub-Saharan Africa long before
today’s AIDS crisis. Lethal tropical infections, widespread poverty,
underdevelopment, war and political turmoil have all contributed to
making life expectancy in the region the lowest on the planet. Malaria, the
most widespread disease, infects more than 300 million people on the
continent and new drug-resistant strains of the bacteria that cause
malaria are spreading rapidly. Sleeping sickness, cholera and new killers
like the Ebola virus take proportionally more lives in sub-Saharan Africa
than anywhere else.
(\people singing \in native language\)
MAN:
A lot of diseases that we have in our part of the world are preventable
diseases-- diseases about which you can do a lot. If we had good
housing, if we had ample room for people to live, if we had enough and
good, appropriate food, if there was enough ample water and if we were
able to immunize all of the children under the age of five against the five
immunizable diseases and then be able to deal with the local, little
epidemics, I’m... I'm sure we can actually look after between 75 to 80% of
the diseases which are now prevalent in this part of the world.
NARRATOR:
In 1994, Dr. Bhachu was optimistic about future prospects for health care
in Africa but in the last eight years, an AIDS epidemic of extraordinary
magnitude has totally changed the landscape of medical concerns. SubSaharan Africa is now the site of more than 28 million of the world’s 40
million cases of AIDS. Within sub-Saharan Africa however, there is a
great variation from nation to nation in the rate of infection. Some of the
highest rates are in southern Africa. A few nations have not been
severely affected. Kenya falls somewhere in between.
VERONICA OUMA: As a geographer, I was interested in how AIDS had spread across
Kenya. I actually saw an article published in the paper about, um, the rate
of new AIDS infections every year and I said, "Wow, there’s all this
information. I can... I can map this."
NARRATOR:
The data Veronica mapped documents a process that geographers call
"diffusion--" the spread of a phenomenon over space and time. In 1986,
which was before the government began collecting information on AIDS,
there was a zero rate of reported infection across the country. In 1987,
infection of the population by the HIV virus was reported only in the areas
surrounding Kenya’s three major cities-- Mombasa, Nairobi and Kisumu.
But in 1990, the picture changed dramatically as rates of infection
continued to rise in urban areas but also began climbing in rural areas.
VERONICA:
What’s happening in the case of AIDS is that it tends to, um, diffuse, um,
hierarchically, which means, you know, large urban center, second
largest urban center, like that. At the same time, you’re also finding this
contagious diffusion, which is really the spread from the source region-be it Nairobi or Mombasa-- outward to the surrounding areas.
NARRATOR:
In 1993, the rate of new infections was approaching a saturation level, or
equal rate of new infection throughout the entire country. As the number
of adult AIDS victims grew, many women passed the disease on to their
unborn children.
MAN:
That child, she's unfortunate. She was delivered by... delivered by a
mother who was positive, and then she acquired HIV and then since then
she was growing well but now she’s suffering AIDS and from that, now
she’s suffering from tuberculosis. Now she's on treatment.
OUMA:
The spread of AIDS in Kenya is greatly facilitated by a weak and
deteriorating infrastructure that has promoted ill health, it has promoted
migration, poverty. Resources in rural areas are limited, so we have a
culture of migration into urban areas. This mobility has facilitated the
spread of the disease, as well.
NARRATOR:
Veronica’s diffusion maps summarize the results of human activities:
work, travel, migration and above all, sexual practices. In 1993, Kenya’s
AIDS education strategy was tightly focused.
MAN:
We have targeted specific high-risk groups. We work with truck drivers
on the trans-African route, we work with the sex partners of the truck
drivers, we work with the, uh, hotelkeepers or hotel owners where the
truckers stop overnight. We’re expanding this high-risk program to
include other highly mobile workers in East Africa.
NARRATOR:
But HIV/AIDS infections continued to mount, reaching 15% by the year
2000. Average life expectancy in Kenya had dropped from 60 years to 49
years. Kenya’s president finally declared AIDS a national disaster and
looked to his African neighbors for a better approach. In Uganda, he
found a broad-based and forthright education campaign had made a big
difference.
MAN
(\on loudspeaker\): Come to the health center today for HIV testing and counseling. To learn
more about this new service...
NARRATOR:
Aggressive campaigns to get people tested for AIDS, widespread
publicity about the disease and even television dramas all raised
awareness.
TV CLIP:
Well, it is true. I don’t have AIDS but I'm carrying the virus. I don’t feel
sick, but one day I'll become very sick and die. Don't ever believe that you
are safe. Learn the facts about AIDS.
MAN (\on record\):
§ Out there somewhere, alone and frightened... §
NARRATOR:
Reducing HIV infections from 14% to eight percent, Uganda’s example
shows how important an aggressive public education campaign can be
but eight percent is still a disastrous epidemic. Now a new strategy may
provide the weapons to finally win the fight against AIDS in Africa.
Until very recently, people fighting AIDS in Africa have assumed that
victims of the disease would not have access to effective drugs that
patients in the U.S. and Europe now receive. But in the last few years,
health advocates and political leaders including U.N. Secretary-General
Kofi Annan, have begun to campaign for low-priced drugs to treat the
infected.
The potential benefits are immense. Drugs will slow the transmission of
the disease. Drugs will prevent deaths and help to preserve the labor
force and drugs mean that a generation of children will not grow up as
orphans. (\playing upbeat tune\) If the anti-AIDS campaign in Africa
succeeds, it could be an inspiration to fighting other diseases that have
long denied the people of Africa an opportunity to reach their full
potential.
(\man singing upbeat tune \in local language\)
GIL LATZ:
In the developing world, infectious diseases are responsible for almost
half of all deaths. The most prevalent: malaria, tuberculosis and AIDS.
Geographers are quick to point out that the victims of these diseases are
not equally distributed. 90% of the world’s malaria cases afflict Africans.
The highest concentration of AIDS is also in Africa, home to 13% of the
world’s population but nearly 70% of all AIDS cases. Why are these
diseases so prevalent here? The risk factors include substandard
nutrition and sanitation, lack of education, low income and unstable social
conditions. This set of risk factors reads like a textbook description of the
impoverished condition of the majority of Africans. So the developing
states of sub-Saharan Africa are caught in a tragic double bind.
Economic development is required to remove the underlying risk factors
for these diseases. But the financial impact of the diseases are so severe
that they cripple economic development efforts. For instance, it is
projected that South Africa’s gross domestic product will be 17% lower in
2010 than would have been the case without AIDS.
The international community surely has a role to play, especially now that
it is known that in the case of malaria, a billion-dollar investment in
prevention can have a $3 to $12 billion annual boost in the combined
GDP for sub-Saharan countries. The entire sub-Saharan region faces
difficult political and economic development issues. But the efforts to
meet these challenges are doomed to failure unless the devastating
epidemics of AIDS, malaria and tuberculosis are brought under control.
HARDWICK:
One important field of human geography is population geography. It
focuses on the spatial distribution, growth, composition and movement of
populations. Many of these factors combine to have a significant effect on
a population’s health. Medical geographers pay particular attention to
where medical facilities, diseases and resources are located.
Populations that are concentrated in urban areas are more susceptible to
certain diseases. We saw in Kenya how AIDS proliferates in an urban
environment. In cities like Delhi with large migrant populations, a lack of
adequate sanitation leads to the spread of diseases like hepatitis. In rural
areas, malaria continues to be a problem worldwide. Even wellintentioned development projects, like farm irrigation, may provide
breeding opportunities for the mosquitoes that spread malaria.
Medical issues can be a Catch-22 in poor countries with growing
populations. Hope for improving the lives of people there depends on
comprehensive social and economic development. But a population
plagued by debilitating disease must first get healthy before such
development is possible. It's not a pleasant reality, but it's undeniable that
today the countries that most need health care resources can often least
afford them.
BINKO:
As demonstrated in this case study, disease offers a profound challenge
to humans throughout the world and a unique opportunity for the student
and scholar to apply the skills of geographic inquiry. In West Point,
Mississippi, eighth-grade teacher Shirley Hutchins leads her students
through a series of exercises intended to reveal the complex connection
between disease-- in this instance HIV-AIDS-- and the human and
physical characteristics of the region. She begins with a series of
questions and discussion aimed at drawing conclusions about how
physical and human systems interact, as well as implications for the
future of the region.
As you watch the lesson, notice that Shirley gives students several
options for organizing, analyzing and presenting their information. These
include writing and presenting a mock newscast, creating a Venn
diagram comparing U.S. and Kenyan cultures, and composing a letter to
the Kenyan minister of health.
Providing multiple options helps students share different perspectives on
the problem at hand. In viewing Shirley's lesson, see if you can identify
strategies for helping students develop plans to solve local and
regional problems that have spatial dimensions. Raising controversial
or sensitive subjects like HIV-AIDS does pose obvious risks. But the
benefits include heightened student attention and participation and
enhanced teaching opportunity. The decision to raise such topics may be
a difficult one, and must be made within the context of your own
classroom, school and community.
SHIRLEY
HUTCHINS:
Today, um, we're going to continue our look at sub-Saharan Africa and,
specifically, we're going to look at the country, Kenya. We do know that in
sub-Saharan Africa there is a problem with malnutrition, unclean water
and the lack of doctors. But the leading cause of death is AIDS. And let's
just do a little brainstorming here. Try to figure out why AIDS is such a
problem in Kenya.
BOY:
When the husband dies, the brother goes to take up the, uh, his wife and,
you know, the AIDS spread like that.
HUTCHINS:
Okay, let's put over here "marriage practices," okay.
GIRL:
It could be that they need money to support their family and they go
around and sell themselves to get it and then the person that they do that
with, they could have AIDS and they could give it to their wife or
somebody else that they were probably messing with. Okay, "sex trade
for money." Any other ideas? People might not know much about the
disease and so they might not know how to protect themselves.
HUTCHINS:
Okay, they may not know how to protect themselves. Now, let's just get
right into our case study.
NARRATOR:
After reading the case study, students break into groups. Shirley assigns
each group a different task relating to AIDS-- a CNN News report, a letter
to the Kenyan minister of health and a Venn diagram comparing and
contrasting AIDS in the U.S. and Kenya.
HUTCHINS:
Well, I looked at the different diseases that occur in sub-Saharan Africa,
and I thought that AIDS would be one-- ;[sic] because it's such a issue
here in the United States-- that my students could relate to more. So I
think that was, you know, one thing that sort of led to their interest, and
they really wanted to know more about it.
GIRL:
I'll get on the transportation page about the goods and stuff.
GIRL:
The men have more education and economic power than the women.
Yeah, in case the parents get divorced, the women don't know how to
work. They're not educated and that's their only thing to do. This is sad.
Very, very sad.
GIRL:
Yeah, we're going to talk about how...
GIRL 2:
Put some information in about the truckers and how they spread the
AIDS disease. How the women there give them disease and go back
home.
STUDENTS:
They go back to where they came from. But you've got to think... you got
to know somewhere in their mind they know they got it. You just got to
think... No, not really. They know that~ they have it in the country. The
country itself does, but the individual people might not know. From
outside the country don't know. And there's no way of knowing if the
individual person has it; they're not going to tell you. It's a possibility that
it could spread over here, too. Those mothers that are out there are trying
to provide for their families and stuff like that. Let's start our letter. We're
the reporter, and then we're writing down, like, questions to ask, like an
interview.
HUTCHINS:
You can interview. You can interview someone. It can be a commentary.
GIRL:
Where are we reporting from? Are we in Kenya, or are we just... Now you
in Kenya and I'm back at the, uh... Right here, we write her, "CNN."
GIRL:
I'm going to say, "One of the best doctors we have on our practice, Dr.
Edwards. "She travels to Kenya "to help different people with their
epidemic. Dr. Edwards, enlighten me..." I'm going to say, "Dr. Edwards,
enlighten me "on the different ways that you help people control their
AIDS epidemic."
GIRL:
If you were to post... post what, signs? (\all talk at once\) Advertise that
it's the awareness of AIDS or the awareness that should be taken... about
how easily... the AIDS virus... can be contracted.
GIRL:
It's just such a big problem. It's going to be on my mind all day, all
through school.
HUTCHINS:
Group one. Group one's scenario was that they're a reporter for CNN.
GROUP ONE:
Good evening, my name is Ebony Donald reporting live from, (\clears
throat\) from CNN. Today, our big story, we will be talking about the
country called Kenya. We will be talking to, um, one of our best doctors
we have on our practice. That would be Dr. Edwards. She travels to
Kenya to help different people with their epidemic. Do you let them know
what to do when they have a cut? I tell them to wrap it up. Since their
body... since the AIDS attacks the immune system, they won't be able to
heal as quickly and they don't want to... be around their children as much
because if their children comes in contact with their blood that they could
get it if they don't already have it.
Okay, thank you, Dr. Edwards. Um... I am now on via satellite with a
foreign exchange student, Jeremy from Kenya, who is attending college
in Florida. It's better here in Florida because I don't have to worry about
someone dying every day. It hurts really bad to know that I have family in
Africa dying from AIDS. I am going to medical school to be a doctor, and I
hope one day... to want to treat, um, go there and treat in Kenya. That's
it, CNN News. All right.
(\applause\)
HUTCHINS:
Very good. And group two's activity was to write a letter to the Kenyan
Ministry of Health.
GROUP 2:
We have been researching how the AIDS disease has been contracted
from country to country and city to city. We think that... that the
government isn't doing a sufficient job. We have looked at the location of
major cities, railroads, and highways. We think that if you were to post
signs advertising the awareness that... that should be taken about how
easily the AIDS disease is contracted. The fact of the matter is that when
truck drivers or miners, et cetera, come here for work, they are exposed
to freelance sex workers they have... that has intercourse after the job is
over. They go back and spread the disease to other partners. We want
you to realize how major highways play a major role in this disease being
contracted. The best to do to prevent this disease is to notify your people
what's going on in their land. Sincerely yours, Researchers of AIDS of
West Point High School, Inc.
This highway goes through most of Kenya and we think that's where...
the highway and the railroads is where most of the freelance sex workers
get their, yeah, get their money. And we are the researchers of the West
Point Laboratory, thank you. (\applause\) All right, now my last group. Me
and my group members did a Venn Diagram on the cultural difference
between Kenya and USA. Okay, some similarities that we have are: In
both countries, AIDS are stabilizing, both countries have similar ways in
catching AIDS~ and in both countries they have prostitution. Some
differences are: In Kenya, parents disown their children while they are
pregnant. Polygamy is practiced by Kenyan men. Kenya has less
information about AIDS. There are more women infected by AIDS in
Kenya than in the U.S.
(\applause\)
HUTCHINS:
In closure, look at, maybe, some things that can be done-- and from what
we've learned here today-- to stop the spread of AIDS in Kenya.
GIRL:
Maybe, if, like, you don't have money to provide for your family, you could
try to get a job, or if they don't have many job opportunities, you... they
really need to stop sleeping around for money. And, um, if they do decide
to sleep around, they need to use a condom.
HUTCHINS:
Okay.
GIRL:
Um, what they can do is before they think about having sex, they can get
tested.
HUTCHINS:
Okay. Um, Demarcus.
DEMARCUS:
Besides the adults being educated, the kids need to be educated, too, so
they won't do the same thing.
HUTCHINS:
Okay, and I think that's a real important one right there, the education
aspect.
I think we've come to a... a point where we can say that AIDS is a
problem in Kenya. A lot needs to be done in Kenya; a lot needs to be
done as far as governmentally, a lot culturally needs to be done. But it's
not an impossible situation, is it?
As residents of this world, this planet, we need to have some idea of not
only where we're located, but what we're doing in those locations. The
children that I teach, who knows where they'll end up and they need to
know where those places are as well as something about the people in
those places. Um, we live in a very diverse world. It's our cultural
differences that make us appreciate each other. You know, if we're all the
same, then things get real boring real quick, but when we meet people
with different cultures, different ideas, religions, whatever, we all mix up
and we blend to make something good. And I think that's... they need to
understand that in the scope of the world geography can open that door,
it can open that door.
BINKO:
This lesson had real personal impact on Shirley's students. As one said,
"This is going to be on my mind all day"; and another simply, "This is
sad."
Shirley's students used a case study, maps and discussion with their
peers in order to gather, organize, and analyze the information on this
very serious problem. Their activities fostered a better understanding of
the physical and human factors related to disease in this region. They
have a deeper understanding of the cultural factors, including marriage,
education, and women's position in society, that have such great impact
on a country's health.
Shirley is to be commended for setting an appropriate tone and
cultivating a learning environment wherein students can maturely discuss
sensitive issues such as the sexual nature of disease transmission. As
tomorrow's leaders and decision-makers, they'll need these skills to
tackle local community and world problems.