We’ve reached the end of our course—and what an amazing journey it’s been. Time really flew!
Together, we learned about different public health aspects, how culture affects health, and how to create positive change, not just in Kenya, but around the world. A big thank you to our students for their energy, great conversations, and for staying active on social media even on busy days. We hope these lessons stay with you in your careers.
Instead of us wrapping things up, we’ll let the students share which visits meant the most to them.
Asante sana! Thank you for being part of this journey. Kwaheri, and see you again in 2026!
We wrapped up our time in Kenya today with a visit to the Sheldrick Wildlife Trust, which has been working since 1977 to protect wildlife and their habitats. At the Nairobi Nursery, we got to see how caregivers hand-raise orphaned elephants, giving them 24/7 care that’s as close as possible to what they’d get from their elephant families in the wild. The midday milk feeding really drove home everything we’ve been learning about how human actions, environmental care, and community health are all connected.
What struck us the most about the Trust is how they tackle everything—from stopping poachers to providing veterinary care to educating communities. It’s exactly the kind of comprehensive approach we’ve been seeing throughout Kenya. We’ve seen it with gender-based violence tied to failed cabbage crops from climate change, community conservancies trying to balance people’s needs with protecting wildlife, and creative health programs dealing with HIV and maternal mortality. The elephant orphanage shows the same thing: you can’t solve one piece of the puzzle without understanding the whole picture.
These baby elephants start at the Nursery, then move to places like Voi, Ithumba, and Umani Springs before eventually rejoining wild herds. One of the biggest takeaways for us from Kenya is that good public health work has the same core elements as good conservation work: genuine care, getting the community involved, sticking with it long-term, and remembering we’re all in this together. Those baby elephants at Sheldrick are proof that with the right care and support, even the most vulnerable can not only survive but thrive and become independent. And that is what we are aiming for in public health too.
Our last full day in Kenya began with a meeting at The Nature Conservancy followed by a walking tour of the Nairobi National Museum. Both experiences allowed us to gain a deeper understanding of the connection between culture, the natural environment, and population health outcomes. Today’s activities served as a crucial reminder about the importance of preserving one’s culture and surrounding environment as a means of protecting and promoting health.
Founded in 1951, The Nature Conservancy (TNC) serves as a global nonprofit and has grown to become one of the most efficient and extensive environmental organizations in the world. Through climate-centered strategies- it aims to protect land, fresh water, oceans, coastlines, and forests. TNC works in over 80 countries/territories and in 2007, the TNC-Kenya office was established. Kenya is rich in biodiversity and has a large portion of protected natural areas. However, 65-75% of wildlife live outside of federally protected land and marine areas – leading to an inevitable clash between human and natural communities. TNC-Kenya serves as the liaison of conservancies by strengthening governance, diversifying economies, and improving natural resource management. By aligning their mission with the 2030 Sustainable Development Goals (THE 17 GOALS | Sustainable Development), TNC-Kenya is working toward supporting private sector and community conservancies to better improve their wildlife management and development capacities.
Due to developmental pressures and hunting, Kenya has seen an almost 70% decline in its wildlife over the last 40 years. For the people of Kenya, who live closely with wildlife, conservation has become a well-involved effort for all communities. Through the Wildlife Act of 2013, conservancies have become a recognized way to use land for conservation in Kenya. Additionally, this recognition offers community landowners various improved resources, access to additional income, and incentives for land leasing.
TNC established an “umbrella of conservancies” which include individual organizations and regional groups. Conservancies have multiple methods of ownership: community, group, private, or co-managed oversight. Community conservancies are established by community members on shared land – these form 51% of the total conservancy system recognized by the Kenyan Wildlife Conservancies Association. Group conservancies are formed through multiple private landowners who share borders, by combining their land to one large lot to focus needs on conservation. Private conservancies are those started and managed by a single landowner, and co-managed conservancies are agreements between the government and an individual or a governing body to manage a public piece of land for the effort of conservation and protection of Kenya’s vast wildlife.
Kenya is incredibly biodiverse, with over 35,000 species of flora & fauna and magnificent wildlife that call East Africa their home. Kenyan wildlife and natural resources have been harmed by various influences throughout history, such as deforestation and ivory poaching. Thus, leading to the endangerment or extinction of multiple species. Today, climate change is a pressing problem to the people of Kenya. As droughts and flooding become more extreme, livestock and crop yields are decreasing at an alarming rate. Water quality and quantity is decreasing and human-animal conflicts are becoming more frequent due to these extreme environmental conditions. Though TNC supports efforts to reverse the effects of climate change, and many of the conservancy lands are working toward controlled grazing and improved water management practices, global external factors that impact climate are being felt regularly by those who live in Kenya.
While many effects of climate change are immediately visible, some consequences are less obvious. Gender-based violence (GBV) is one such indirect but increasingly common result of climate change that is disproportionately affecting women’s lives in Kenya. The connection between climate change and GBV follows a complex chain of events. Older women who depend on cabbage farming for income are seeing their crops fail due to prolonged droughts or flash flooding caused by climate change. With no crops to sell and families to feed, these women are forced to turn to transactional sex as an alternative source of income. This survival strategy then exposes them to violence from male clients who mistreat them and family members who judge them. According to Dr. Ruth Marsha, a public health specialist at TNC, this pattern became evident when HIV rates began rising among older women in the affected regions. Traditionally, HIV diagnoses are more common among younger women, but the increase in transactional sex among older women driven by climate-related crop failures has led to a notable shift in HIV demographics, with older women now showing increased infection rates. This example illustrates how climate change creates a devastating cascade: environmental stress destroys livelihoods, forcing desperate survival choices that increase both violence against women and their health risks.
Women are also affected directly by policies implemented at conservancies that protect forests against deforestation, meaning that women are unable to cut trees to use for firewood for cooking. The delay in cooked meals has led to an increase in domestic violence against these women as traditional gender roles reinforce the idea that meals should be ready after a day’s work. This increase in violence against women demands alternative energy solutions. It is necessary to understand how climate change is directly affecting the livelihoods of women, specifically those in LMICs.
We visited the Nairobi National Museum that houses beautiful and fascinating collections of human and animal history, art, and culture from Kenya and other parts of eastern Africa. Kenya is globally recognized as the cradle of mankind, due to the archeological and paleontological discoveries of early humankind in this region of the world. The museum gallery traces the evolution of the human race through fossils and early remains of tools. We learned about early hominins, or human ancestors, such as Australopithecus Afarensis and the first official human species that appeared around 2.4 million years ago: Homo habilis and Homo rudolfensis.
As we continued through the museum, we saw more exhibits dedicated to Kenyan culture. As a boy to man initiation ritual, circumcision is performed in sanitary conditions with about a two-three week recovery period. In most communities, this procedure allows for the introduction into roles of leaders, warriors, and marriage. This ritual is also performed for women;however, the conditions are much less sanitary. Women have been known to suffer from female genital mutilation with lifelong chronic pain, risk of infection, shock, tissue damage, and the chance of infertility. With an increase in social justice movements, communities are now embracing forms of alternative initiation in girls and young women that celebrate their coming of age without putting their quality of life in danger. Overall, the museum successfully preserves and displays key elements of Kenyan culture. Allowing for visitors to engage with its rich heritage and understand its impact on past, current, and future humans, resources, and wildlife in Kenya.
Because roughly 80% of Kenyans are dependent on natural resources in their daily lives, the Kenyan government is keen on policies targeted at mitigating the effects of climate change. Humans and wildlife alike are experiencing changes in weather patterns and season predictability, which in turn decreases food security, increases the spread of zoonotic diseases, and makes income generation volatile.
The push for climate health that we see from the Kenyan government and TNC is a stark contrast to the ideas of climate change in the United States. As current US policymakers push for less climate centered interventions and decrease funding targeted at environmental and land protection, more citizens seem to think of climate change as an imaginary problem. Though many communities in the US have recently suffered from unprecedented climate disasters, climate centered policy is still not a goal of the US government nor a central concern for the livelihood of many people.
Unfortunately, climate change is a problem that may not be addressed fully until more communities, and those in power, are directly impacted. Unfortunately, the lack of climate action in high income countries affects the rest of the world. As it was stated at TNC, “When the West sneezes, we all get a cold.” There is a generational shift in understanding climate change as a barrier to health. As future public health professionals, we must recognize the impact of climate change and implement innovative and sustainable solutions for the future of human, animal, and environmental health. In this realm, the United States can learn from countries like Kenya who are putting climate and health at the forefront of their policy and goals for posterity.
Today’s visit to The Nature Conservancy and the Nairobi National Museum emphasized that preserving culture and conservation is deeply connected in promoting health and social progress. Our visit with the TNC team highlighted the relationship between conservation, community, and climate change. The museum highlighted the diverse Kenyan culture, from early human origins to transitions from traditional to modern practices.
At both organizations, we recognized the increasing importance of climate change as not only an environmental crisis, but as a crisis of human rights, specifically amongst marginalized communities such as women and girls. TNC is using community centered conservation strategies to address these challenges, which include improving natural resource management, expanding reproductive health education through conservancies, and advocating for new climate centered health policies.
With a greater influence on the protection of culture and advocacy, communities in Kenya are leaning towards non-harmful and non-life changing rituals for men and women that preserve culture, but also protect animals, the planet, and promote health and human rights. Through this movement, and organizations like TNC and the Nairobi National Museum, education is enforced, traditions and cultures are celebrated and preserved, and the past is used as a means for developing a more inclusive, and equitable future for all species and the planet.
Destiny Fuqua, Bethsy Harrigan, Lena Lutz, and Leigh Anne Robertson
Our second full day on the Maasai Mara began with a game drive on the Nashulai Conservancy, a lesser known treasure where tourism revenue is reinvested into local education and development. Nestled next to Maasai Mara National Reserve, Nashulai spans 5,000 acres of community-owned land and prioritizes sustainable tourism and community-led conservation.
While the wildlife is the same, the experience felt completely different from our experience on the national reserve. We enjoyed a more intimate and serene encounter without marked pathways and the traffic of other safari vehicles. Giraffes gracefully browsed treetops, zebras and wildebeest grazed in harmony, and impalas darted through the grasslands. A favorite encounter was a warthog darting towards the bushes with its tail held high. The peaceful setting of Nashulai allowed us to feel truly connected with the environment.
After the game drive, we visited the Nashulai Conservancy College located in the Maasai Mara where their model of education centers around sustainability, cultural pride, and community-driven public health. This grassroots community initiative has evolved into a well-established institution, where 70% of students are native to Narok County and surrounding regions, and women’s empowerment is central to its mission. Hands-on, real-world training is conducted in a demonstration kitchen and supply production building where students, especially women, are taught practical health and sustainability skills. Product developments include eco-friendly sanitary products and elephant dung soap, generating income and dignity for local women while supporting student scholarships. The college’s River Restoration Project, an environmental conservation effort led largely by women, highlights how environmental conservation ties directly to public health by ensuring clean water and a healthier ecosystem. Nashulai Conservancy College holds three core goals: to celebrate and protect Maasai culture while challenging harmful norms, to conserve wildlife and the environment, and to dismantle poverty through education and entrepreneurship. Achievement of these goals is evident with 80% of graduates employed or running their own businesses. The integration of cultural resilience, ecological preservation, and community health makes Nashulai a great example of how education can drive sustainable development.
Spending time with the college students was a truly enriching experience, as we had the opportunity to share information about our university, our course, and public health. We were able to provide oral hygiene kits for the men, thanks to the generosity of Dr. Nicolaas Geurs, Dean of the UAB School of Dentistry, and personal hygiene kits for the women, courtesy of the Sparkman Center for Global Health and Global Health Interest Group (GHIG). The students’ genuine appreciation and excitement reinforced how simple yet essential resources can make a profound difference in their daily lives. Their resilience and drive to create sustainable solutions for their communities made the experience unforgettable, emphasizing the transformative power of education and collaboration.
After lunch at the Oldarpoi Camp, Assistant Chief Patrick welcomed us to his Maasai Village and shared cultural practices of the Maasai. We learned that the traditional practice killing lions to achieve marital eligibility has evolved to men symbiotically living with animals and promoting conservation through survival expeditions into the wild. We also learned about three main forms of village communication, blowing a ram’s horn, lighting a fire in the village center, and beating drums, along with traditional gender roles within the Maasai culture. Women build and maintain houses, cook, and care for children, while men protect the cattle and community.
Patrick blew a horn, and the Maasai traditional dance welcomed us. Each UAB scholar paired with a Maasai dance partner. Some of us donned the Maasai cloth and necklaces and even participated in adumu, the jumping contest. The higher the jump, the stronger the man.
Maasai and some UAB students dancing together
Houses in the village are strategically built in a circle to protect cattle in the middle from elephants and other predators. The houses are made from cow dung, with layered roofs of plastic and grass to keep out the rain. Women cook outside for safety and start fires without ignitables. Maasai warriors, women, and children create and sell bracelets, necklaces, earrings, and bowls as a major source of community income. Many of us found beautiful and unique items to purchase in support of our new village friends.
Trees are deeply rooted in spiritual power and hold a special significance in Kenyan culture. Traditional tree ceremonies are often used to perform rituals that connect the human and spiritual worlds, ask for blessings, and heal ailments. We learned about the special powers of the mumps tree on USIU-Africa campus and about the village’s sacred fig tree at the tea farm.
It was a special honor to participate in a tree planting ceremony of our own at the Oldarpoi Mara Camp. Important guests are given a tree to plant in honor of their visit before leaving the camp. We gathered around classmates Jarrett Lemieux and Trin Mosley who planted a tree next to a plaque commemorating the “UAB School of Public Health 05/25” visit. We watered the plant and were assured that the little tree will be cared for and grow along with our impact on public and population health.
We had a special surprise after the tree planting ceremony. We boarded the bus, and Sam drove us back to the Conservancy for a reception. Imagine our surprise as we walked through a tunneled pathway under the setting sun, down into an observation room carved into the side of a hill before a lighted waterhole! We spent over an hour enjoying refreshments, whispering, and marveling at two jackals and resident turtles, frogs, and toads. What a happy surprise and another meaningful view into the heart of conservation and community in Nashulai!
Today we had the opportunity to go on a game drive in the Maasai Mara National Reserve (MMNR), where we spent much of the day discussing The Big Five – elephants, cape buffalo, rhino, lions, and leopard. This term originally referred to the five most challenging animals to hunt on foot. Even Teddy Roosevelt traveled to Kenya after his presidency to hunt these animals. While we were fortunate to see elephants, lions, and cape buffalo, the leopard and rhino remained elusive during our drive. Leopards, often found resting in trees near water sources, are known for their ability to disappear into the landscape, while rhinos are increasingly scarce and tend to stay hidden in dense bush. Observing these animals in their natural habitat underscored the vital conservation efforts now protecting them instead of hunting them. The Maasai Mara, once a hunting ground, is now a thriving wildlife refuge thanks to initiatives that balance conservation with local traditions. The Maasai people, whose cultural identity is closely connected to the land, play a crucial role in maintaining this delicate balance. The landscape has changed, but their involvement remains essential in ensuring that the region’s biodiversity continues to flourish.
Despite the beauty that we witnessed today, conservation in this region faces significant challenges. Wildlife conservation faces significant challenges in enforcing reserves like the Maasai Mara National Reserve. Rapid growth in the human population and in the tourism industry are leading to increased pressure on reserve boundaries. Funding and resources for monitoring illegal activity is subject to shifts in political prioritization, public opinion, and cultural tradition. The fact that the MMNR, about 580 square miles in southwestern Kenya, exists is a massive feat. In addition to the MMNR, there are 15 private conservancies that add another 560 square miles of protected lands that border the MMNR. These conservancies are owned and operated by local Maasai with a common mission of conservation. The camp that we are staying at is in one of these conservancies, the Nashulai Maasai Conservancy. Tomorrow we will have the opportunity to participate in a game drive on the conservancy property and meet with Maasai who live on these protected lands.
During British colonial rule, shifts in land use displaced families and fragmented communal lands. Newly installed fences cut through areas where Maasai people had traditionally coexisted with wildlife. This led to the disruption of migration routes and a decline in animal populations, leaving them susceptible to poaching and interrupting traditional Maasai ways of life. To address this loss and the restricted movement of migratory species, the MMNR was originally established in 1948, and continued beyond Kenyan independence. The goal of the Reserve has always been to curb human encroachment on wildlife ecosystems and facilitate a structured framework for tourism in the region. The Serengeti-Mara ecosystem, renowned for its wildebeest and zebra migrations, spans from northern Tanzania into Kenya, with Tanzania’s Serengeti National Park just across the border. Roughly 25% of Kenya’s portion of this ecosystem is protected by the Reserve, while the remainder benefits from a patchwork of legal agreements involving local authorities and privately-held conservancies. Unfortunately, the conflict between humans and animals persisted after Kenya’s independence. Over the 40 years following independence in 1963, Kenya’s human population quadrupled while its wildlife population shrunk to a quarter of its original size. In recent years, the Reserve and its adjacent conservancies have demonstrated increasingly positive results despite these historical challenges. Currently, MMNR’s lion population has doubled what it was a decade ago, and increased tourism now generates around $4 million in revenue annually.
During our trip to the Mara, we recognized striking parallels to conservation efforts between Kenya and the US, particularly in the ongoing work to protect the Cahaba River back home in Birmingham. Like the Maasai Mara, the Cahaba River supports diverse species and has deep historical significance. Challenges such as habitat loss and pollution threaten its health, much like the pressures faced by African wildlife due to land degradation and human activity. The ongoing efforts to restore the Cahaba’s ecosystem through water quality initiatives, habitat preservation, and community involvement reflect a shared commitment to protecting vital natural spaces. By exploring the approaches used in both regions, we can gain insight into how conservation strategies differ yet align in their goals. Whether it’s ensuring the survival of endangered species in Kenya or maintaining a clean and sustainable waterway in Alabama, these initiatives highlight how preservation is crucial in maintaining environmental public health.
The Cahaba River is Alabama’s longest remaining stretch of free-flowing water, and it is a source of drinking water to one-fifth of Alabama’s population. It is one of the most biodiverse waterways on Earth, named by the Nature Conservancy as one of eight “hotspots of aquatic biodiversity” in the U.S.. Suburban development along the Cahaba River poses immediate threats to wildlife, particularly from sediment pollution and stormwater runoff, and destabilizes the natural habitats in the Cahaba River by collapsing stream banks, reshaping stream beds, and increasing algae growth in the water.
Unlike the MMNR’s national protection, the Cahaba River, despite its importance as a drinking water source, relies primarily on community-based organizations for its conservation. There are laws that regulate stormwater management and polluting industries, but these laws are not adequately enforced. Across the state, riverkeeper organizations voluntarily monitor sources of pollution. They warn local communities of spikes in contamination and take legal action when possible. The Cahaba River Society is one of the most active conservation organizations in the Birmingham area. They engage the community in environmental protection efforts through stream cleanup, canoe trips, school partnerships, and activism. In the Mara, the national government takes the lead on protecting wildlife and enforcing those protections on the reserve. The conservancies supplement this enforcement. Wouldn’t it be interesting if we had conservancies that were located around sensitive areas like the Cahaba River, where local communities are invested in preserving the environment, like we see the Maasai people doing around the MMNR. Perhaps by adapting elements of the Maasai model, where knowledge and community investment create sustainable conservation outcomes, we can enhance protection of vital resources like the Cahaba while maintaining a balance between humans, their activities, and the environment.
Camryn Durham, Jarrett Lemieux, Ashley Logan, & Natalie Parks
Lake Victoria is the world’s second-largest freshwater lake. Communities in this area depend on the lake for cultural traditions and economic survival. Fishing and trade form the backbone of the local economy. Despite the importance of the lake, there are immense environmental and water quality issues. Residents who live nearby continue to wash their cloths, bath, and draw their drinking water directly from the lake. Homes and commercial spaces are built along its shoreline in flood prone areas with ineffective sewage treatment infrastructure. Fishing operations currently lack proper monitoring to ensure sustainable practices. The lake serves as a major drinking water source for the region and despite water treatment efforts, water must still be boiled before consumption to ensure safety. Meanwhile, climate change is leading to rising water levels in the lake, increasingly threaten homes and business.
The environmental pressures extend beyond human concerns. Hippopotamuses, who live in and around the lake, face growing difficulties as residential and commercial development encroaches upon their traditional grazing areas, disrupting their natural habitat and behavior patterns. Rising water levels also are having a detrimental impact on their habitat reducing the vegetation that hippos rely upon. Although hippos are herbivores, they are extremely territorial and can be aggressive towards humans when provoked. They are extremely fast swimmers and in Lake Victoria, hippos can be seen on the shores adjacent to local people washing clothes, bathing, and fishing. We were surprised to see that people lived and worked in such close proximity to wild hippos.
Our guide and wildlife expert, Titus (a biologist from the region), also mentioned issues in the lake with invasive species. Specifically, he mentioned water hyacinth, which was introduced to Lake Victoria from South America. This plant grows rapidly and spreads quickly. It has no natural predators and becomes dense, clogging waterways, making the lake uninhabitable by some fish species by de-oxygenating the water. It also inhibits boating and fishing by locals. Environmentalist have tried to remove the plant to no avail and the Kenyan government introduced a type of beetle to kill the plant (Collis, 2000). Today people are learning new ways to make use of the water hyacinth. Currently, there is a company that produces a bio-ethanol cooking fuel from the plant, employing locals and making something beneficial to almost all members of the community.
Titus also talked to us about the economic and environmental impacts of fishing in Lake Victoria. Currently, Kenya does not enforce fishing seasons. Fisherfolk rely on fish for their income, so three shifts of fisherman are operating on Lake Victoria all throughout the day and night all year around. Titus and others in the community worry about over-fishing and what will happen when the fish are depleted. Aquaculture began on Lake Victoria in the 1980’s and has evolved over past decades as demand for fish has skyrocketed. Some fish species have already been fished to such low numbers that they are unobtainable. In response to this, aquaculture farms were implemented, where net cages are inserted into the lake, enclosing fish in a secure net while allowing free passage of water (Aura et al., 2021). Tilapia are raised this way and harvested every 9 months. We had the opportunity to see fisherman harvesting tilapia from one of the cages from a fish farm off the shore of Kisumu. As of 2021, we found out there were more than 5,300 fish cages in Lake Victoria (Aura et al., 2021) so fish farming is a big business. Though farming is a more sustainable fishing option, the locals worry for their livelihood and economic stability. Not all locals have access to the resources to be able to farm raise fish. Most rely on traditional fishing methods to catch wild fish. And with no policies or measures in place or being enforced, over-fishing will continue.
After our boat tour of Lake Victory, we headed north to the equator, the division between the northern and southern hemispheres. Here, Dr. Mulindi exhibited the Coriolis effect, in which water drains in different directions based on if you are standing north or south of the equator. For most of us, this was our first visit to the equator. Though the sun was hot, it was an exciting and once in a lifetime experience.
Both our tour of Hippo Point at Lake Victoria and our visit to the equator were stark reminders of the interconnectedness of humans, animals and our environment. Lake Victoria was home to many beautiful species of animals and plants, yet we saw plastic floating throughout the lake and pollution from nearby runoff. At the equator, the bright, hot sun was a blinding (literally) reminder that our planet is warning- and our actions as humans have consequences for our planet and the other species that inhabit it. Today was a vital reminder to us and others that we must protect our planet, find sustainable ways to utilize our resources, and ensure that generations to come are able to experience the beauty that we have seen in Kenya.
References:
Aura, C. M., Obits, J. A., Ombwa, V., Musa, S., Mziri, V., Osore, M., & May, L. (2021). Assessing cage fish farming practices in Lake Victoria, Kenya, for sustainable lake utilization and community well-being. Kenya Aquatic Journal, 9(1), 17–26.
Collis, B. (2000.). The Beetle that Saved Lake Victoria. https://www.abc.net.au/science/slab/hyacinth/
Destiny Fuqua, Bethsy Harrigan, Lena Lutz, and Leigh Anne Robertson
Yesterday we departed Nairobi and made our way to Kisumu (population 1 million), which is located in the western part of the country and borders Lake Victoria.
On our first day in Kisumu, we traveled to Siaya County, home of President Barack Obama’s grandmother, in western Kenya near the Ugandan lake border. This area is a high incidence region for HIV and TB, and the Centre for Health Solutions – Kenya (CHS) is working to improve health outcomes through infrastructure building and innovative evidence-based solutions. CHS closely partners with the Government of Kenya, on both the national and county levels, to deliver sustainable health services with ambitious 95-95-95 targets for HIV status knowledge (95% of residents with HIV will know their HIV status), antiretroviral therapy delivery(95% of HIV positive will receive ART), and viral suppression measures (95% of HIV positive will reach viral suppression).
Previously used paper medical records at Bondo Sub-County Referral Hospital
Dr. Paul Wekesa, CHS Chief Executive Officer, and the CHS team extended a big welcome to our global health scholars and led us to the Bondo sub-county referral hospital. Clinical Officer Francis Olilo showed us the direct impact of fully electronic medical record systems. The transition from paper to electronic records has increased efficiency via clinical dashboards, automated scheduling, and embedded machine learning to design interventions. This transition has provided important longitudinal data that allows CHS to track outcomes and to show improvements that CHS initiatives are making with the populations they serve.
Since the start of the CHS’s SHINDA project sponsored by PEPFAR and the U.S. Centers for Disease Control and Prevention, the incidence of new HIV positive cases has reduced from ranges of 5-8% to less than 2%. Siaya County was the first county to achieve fewer than 5 in 100 maternal to infant HIV transmissions among mothers who are HIV positive, from a baseline of 18 in 100. In addition, viral suppression rates for the overall population of more than 80,000 patients are 97%, surpassing the target of 95% for both the CHS and United Nations.
These phenomenal outcomes are possible through a differentiated service delivery (DSD) model. DSD allows CHS to meet patients where they are and ensures that healthcare services are accessible to all in Siaya County. One-way CHS utilizes DSD is by having both their own workers and community health workers deliver ART medications and any other necessary medications to the patient household directly.
Reduced clinical waiting times, after implementation of DSD at Bondo Sub-County Referral Hospital
Combining DSD and electronic medical records allows patients to receive lab results and reminders about their next appointments via text messages. These innovations lead to decreased waiting times and overcrowding in health facilities, like the Bondo sub-county referral hospital, also reducing the likelihood of exposure to other illnesses while waiting to be seen by clinicians.
CHS opened Wichlum Beach HIV Prevention Center to bring services closer to the community and to workplaces. We saw a vibrant, bustling fishing center, where boats lined the shores in front of a long line outside this center. Patients served include fisher folk, sex workers, men who have sex with men (MSM), and those who inject drugs. As seen by the numbers of people gathered there, this prevention center is a key health provider within the community, offering a wide variety of services: HIV testing and screening, needle and syringe distribution, TB screening and treatment, condom education, and DREAMS referral (more on DREAMS below). And these are only a portion of the services offered here. Vaccinations are also provided at this center, where we heard an unhappy child receive a life-saving vaccine. This beach is not only a place of economy, but also a place of care and treatment for all connected by the ties of fishing on this shore.
Outside Seventh Day Adventist Church, Wichlum
After our visit to the Wichlum Beach HIV Prevention Center, we traveled to the DREAMS Center in Siaya County, where we had the opportunity to witness a powerful community-driven intervention designed to support girls ages 10 to 24 through their transition from girlhood to womanhood. Meeting weekly, the 67 active girls at the center focus on building financial, social, and emotional assets, with strong mentorship and guidance from a board of technical officers and local mentors. The center offers financial literacy education to these girls and women and, through their partnerships with both CHS and other beach-based intervention services, the DREAMS Center even steps in to assist with school fees when possible. One long-time member proudly shared her journey and the meaning behind the acronym, DREAMS: Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe. This safe and educational space is a testament to how local efforts can shape brighter futures, and I hope we can one day adapt this model for girls in the U.S., or even Birmingham—because as Dr. Wekesa, his team, and many other influential people on our trip have reminded us, global changes begin with local solutions. What a powerful way to see Global Health in practice! We are grateful to Dr. Paul Wekesa, the entire CHS team and Saiya County leadership for showing us the impact of policy change as they work together to find and implement lo
Day four of our journey brought us deeper into the world of healthcare innovation and public health research in East Africa, offering a firsthand look at the groundbreaking work being done in hospitals and academic institutions. We had the privilege of meeting with distinguished faculty members from Aga Khan University’s Nairobi campus – including Dr. Mansoor Saleh, a cancer specialist who completed his residency at UAB and led the development of the hospital’s Cancer Centre; Drs. Kendi Muchingi and Zul Merali with the Brain Mind Institute; and Dr. Rosebella with the Population Health Department – who shared insights into their respective fields and the advancements shaping modern medicine in Kenya. Through these conversations, we witnessed the power of medical education, data-driven public health initiatives, and groundbreaking research aimed at improving patient care. From cutting-edge technology in medical simulation to community-based health programs, the day provided a comprehensive view of how healthcare is evolving to meet the needs of diverse populations.
Several of us were particularly moved by two of the initiatives we learned about: the Centre for Innovation in Medical Innovation (CIME) and the Kaloleni/Rabai Community Health and Demographic Surveillance System (KRHDSS). CIME demonstrated how simulation-based training is revolutionizing medical education, streamlining medical training by equipping professionals with practical experience before they step into real-world clinical settings. Beyond treatment and acute care, the KRHDSS shed light on the role of community health promoters in Kenya – an approach vastly different from public health surveillance in the United States. These experiences highlighted the intersection of technology, education, and grassroots health initiatives around the world, prompting meaningful discussions about how healthcare systems can adapt and innovate to better serve communities.
Centre for Innovation in Medical Education
Our tour of CIME at the university was a fascinating journey into the future of healthcare training. As one of the most advanced medical simulation facilities in East Africa, CIME offers a cutting-edge environment where healthcare professionals refine their skills through realistic, hands-on experiences. One area that particularly stands out is the Birth Training Room. This space is dedicated to simulating obstetric and gynecological procedures. This is where medical practitioners exercise emergency obstetric care to enhance their ability to handle high-risk births and improve maternal and neonatal health outcomes. This facility also houses a simulated endoscopy room, where medical students practice endoscopic and bronchoscopic procedures. This gives trainees the chance to master minimally invasive techniques with precision.
CIME features an array of simulation labs, covering fields such as neurosurgery, ophthalmology, urology, angiography, laparoscopic surgery, and ENT procedures. Each lab station is designed to provide a high-fidelity training experience that ensures each healthcare professional develops confidence and expertise before working with actual patients. The facility also includes mock emergency and surgical wards. This is where students can engage in patient care simulations, disaster response training, and critical care procedures – all within a lifelike hospital setting. Building on innovation is the Dental Simulation Lab, equipped with state-of-the-art dental mannequins, which allows students to refine their technique in a controlled, yet realistic environment. These advancements reflect CIME’s commitment to simulation-based medical education, ensuring that professionals graduate with practical, hands-on experience that directly translates to improved patient care. CIME stands as a testament to how technology and innovation can revolutionize medical education, bridging the gap between theoretical learning and real-world application. This eye-opening visit showcased the future of healthcare training in Kenya, where precision, practice, and cutting-edge technology combine to create exceptional healthcare providers.
Data Surveillance and Population Health
In Kenya, community health promoters are local community members recruited by health departments at the sub-county level who regularly visit with assigned households in their vicinity to discuss health topics. Their work ranges from health education and promotion to referring someone to formal care, if needed. These individuals are trusted community leaders, known well by the communities they serve. They are trained in culturally- and resource-sensitive health promotion practices and share these with their designated households. They are able to spot risk factors, illnesses, and injuries and encourage families to seek care for issues that may otherwise go unnoticed.
In 2017, the Population Health Department at Aga Khan University launched KRHDSS in partnership with the Sub-County Health Management Offices in Kaloleni and Rabai, two sub-county divisions in Kilifi County in eastern Kenya. Through this partnership, community health promoters receive additional training on data collection and management, then survey their households to track risk factors over time. In addition to the standard set of about 40 questions included in KRHDSS, other questions are sometimes included. The data collected may then be used to identify trends in exposures, behaviors, illnesses, and more throughout the communities involved. This information is brought back to community members through periodic report-backs, where community members themselves may identify root causes of these trends and propose solutions.
The information collected in KRHDSS may be used to inform community-level health interventions. One example of this is an ongoing food systems mapping exercise, in which the KRHDSS included questions about crops grown, livestock raised, and dietary patterns. While many people grew fruits and raised chickens, goats, and other animals, their diets often lacked these very foods. In the report-back event, community members described the reasoning behind such decisions: certain fruits and livestock are considered assets to be saved and sold when monetary needs arise, not as sources of sustenance. With this new understanding, future nutrition interventions may be tailored to more appropriately meet the needs of these communities.
Surveillance systems like KRHDSS are a key tool for the public health profession, as data is a critical tool in advocating for community health. The data collected identifies and contextualizes public health concerns; these data can prompt additional research, indicate the successes and shortfalls in health promotion efforts, and inform policy decisions. This is the first surveillance system in Kenya to collect household-level risk factor data in a systematic way. Already, researchers at Aga Khan University have leveraged this data to explore the impacts of climate change on mental health, identify cancer related knowledge among community members, and pilot measures for a longitudinal study on ageing.
In the United States, we utilize what we call the Behavioral Risk Factor Surveillance System (BRFSS). Every year, the CDC leads a nation-wide survey with several questions around different behaviors and environmental conditions. While there is a standard set of questions, additional questions may be added by states’ health agencies. The major difference: BRFSS is conducted by phone and KRHDSS is conducted in person by community health promoters. In fact, such a role does not exist in the American public health system, at least not in such a systematic way. Learning about the structure of the Kenyan public health system, with community health promoters playing a key role at the local level, made us wonder what a greater level of community engagement would look like in the United States.
Do the Good that You Can
At the end of our visit, one of the students asked Dr. Saleh how global health professionals persevere in the face of challenges, especially with regard to shifts in political will in settings which are already resource-constrained. His answer: Do the good that you can wherever you are, one person at a time, one day at a time. Dr. Saleh highlighted this by sharing the story of one woman with advanced breast cancer and how she was able to receive treatment through a clinical trial under his supervision. In Kenya, only about 20% of women receive a mammogram at any point in their lifetime. In contrast, about 80% of women in the United States undergo breast cancer screening annually. So those coming to seek treatment are usually in more advanced stages that what we see in the U.S. This is due to the lack of community-level knowledge of cancer identification and prevention as well as barriers in access to care. By the time this particular individual was referred to Dr. Saleh, the cancer had advanced to a debilitating degree. However, she was able to undergo experimental treatment at the Cancer Centre thanks to innovative funding mechanisms through research studies, and now her life has been extended and she is thriving. Had he not done all he could to facilitate the development and growth of the Cancer Centre at Aga Khan, this woman would not have received the care that she needed.We witnessed innovative approaches, from the cutting-edge training at CIME preparing skilled healthcare professionals, to the dedicated community health promoters of the KRHDSS making a tangible difference in their local areas, to the community-level work that was highlighted by Drs. Kendi and Merali that the Brain Mind Institute is doing to reduce stigma for those suffering from dementia. These experiences underscored that meaningful progress in global health often lies in consistent, localized efforts driven by a commitment to individual well-being.
Today we had the pleasure of interacting and visiting three new places to learn more about public health. We visited the World Health Organization Regional Emergency Hub with Sara Hollis; we met up with UAB SOPH Alum Frank Burkybile for lunch and ended the day with a walking tour of the United Nations Office at Nairobi (UNON).
In 2023, the WHO and the Kenyan government partnered to establish the WHO Regional Emergency Hub for eastern and southern Africa. This Hub is located near the Kenyatta University Teaching Hospital in Nairobi. This partnership creates a framework for collaboration between the WHO and Kenya’s Ministry of Health for recognizing the importance of preparedness and response in the face of health emergencies. Sara shared that there is concern about the future of the Hub and the potential for widespread impacts in preparedness and emergency response if funding is lost. This could impact the WHO’s ability to assist with emergency preparedness and response efforts in the region including infectious disease outbreaks. The impacts on human health and welfare could be devastating for these countries without the support of the WHO.
When we asked Sara how she came to be in this role at the WHO, she willingly shared her educational background in epidemiology and global health studies. She also talked with us about her career path that led to her employment with the WHO and, eventually, as Team Lead. She encouraged us to be flexible and open minded, and to engage in networking at every point possible. Sara shared that she received several opportunities by reaching out to potential employers and having informal chats over coffee. She made many contacts that she still relies on today through attending networking events and seminars while pursuing her degree at the University of California at San Francisco.
Sara emphasized the importance of “soft” skills like leadership, strategic thinking, and communication for the future public health workforce. She gave several examples of how these skills have allowed her to be successful in implementing different initiatives. One of the most impactful things that Sara shared was the need for public health, as an institution, to talk more about the positive ways in which our work impacts communities. It seems you only hear about public health in the media when things go wrong. She challenged us to think more about how we can share the positive impact of our work. Communities never hear about “the pandemic that didn’t happen.” And she encourages us to explore Resolve to Save Lives (resolvetosavelives.org), an NGO begun by Tom Frieden, former CDC director.
After our visit to the WHO Emergency Hub, we had the pleasure to sit down with Frank Burkybile to discuss his global health journey. After graduating in 2012 with his MPH in Epidemiology and Global Health Certificate, Frank began his career with the US Government’s PEPFAR program. For several years, he led global HIV/AIDS programs with the Centers for Disease Control and Prevention (CDC) and later with the Health Resources and Services Administration (HRSA). After completing his time with the PEPFAR program, Frank began to manage malaria research with the President’s Malaria Initiative (PMI). Now, Frank works as a freelance health journalist located in Nairobi.
After graduating from the University of Toronto’s Dalla Lana Fellowship in Journalism and Health Impact program, Frank began covering global health and human rights related issues in Kenya. We learned that his work often reflects his own interests or opinions on current events. One article of his, for example, addresses the impact U.S. foreign aid cuts will have on gender-based violence rates in Kenya. Frank’s work is incredibly important, as we are facing a critical moment in public and global health history. Every article he writes serves as a translation between experts and those outside of the field. We encourage you to check out a few of his articles- even if you are a public health professional!
When we asked Frank what made him pursue journalism, he discussed his “multisectoral portfolio” that has allowed him to effectively navigate his professional life. This portfolio includes various skills that make him flexible enough to fit future employer’s needs but also allow him to continue to grow as a professional. While reflecting on his time at UAB, Frank stressed the importance of pursuing your own interests as a student. He told us how much he enjoyed competing in the UAB and statewide global health case competitions, as they prepared him for real-world scenarios. He also completed his practicum in Zambia through the Sparkman Center for Global Health with the late Dr. Moses Sinkala. He encouraged us to stay engaged and connected to UAB SOPH even after we graduate!
The last site visit included a tour of the United Nations Office at Nairobi (UNON), the only UN headquarter in Kenya. It is also the largest UN compound in the world, sitting on a stunning 140 acres. The UN was created in 1945 after the end of World War II to prevent future world wars with three goals 1) international peace and security 2) protect human rights and 3) promote sustainable development. The tour began with a stroll lined with the flags of the 193 members states of the United Nations, where we learned about the history of the UN as well as why the flags are ordered alphabetically: to promote and remember the equality of the member states. We stopped by a large sculpture of the bones of an index finger, a gift from Chile in 1988. The pointer finger is said to call attention to the injustices and crimes committed against our beautiful but vulnerable Earth.
The tour also featured a stunning garden in memorial of 1998 Al Qaeda bombings at the U.S. Embassy in Kenya and Tanzania, where around 200 people died. The garden is in the shape of the UN emblem, with a structure in the middle with the phrase “May Peace prevail on Earth” in the six official languages of the UN.
Our next stop on the tour was the infamous General Assembly room. Students had the opportunity to represent countries involved in the UN Security Council, including permanent members such as the U.S. and France. This provided a learning opportunity on how the voting process works. For example, permanent members have the authority to veto a proposal- even if there is a unanimous “yes” from the other members. It only takes one veto to shoot down a proposal! We learned that the hard way with our pretend proposed solutions! Our tour guide only asked one thing of our group, to let our guiding principle be humanity.
It is safe to say we had a warm welcome, or “karibu“ in Swahili, at our site visits today with valuable information on public health systems and the populations that they serve. We are incredibly grateful to have had the opportunity to speak with WHO members, UAB alumni, and learn more about the United Nations.
Today our group visited the African Fund for Endangered Wildlife (AFEW) Giraffe Center in Nairobi, a conservation and giraffe breeding program established in 1979. The center began with a focused mission: to save the endangered Rothschild’s giraffe, whose population had dwindled to less than 120 individuals in the wild due to habitat loss and poaching.
The Giraffe Center’s approach to conservation exemplifies the social determinants of health framework we’ve been exploring in class. The center’s educational displays provided information that explained that the Rothschild’s giraffe decline wasn’t random but resulted from specific social and environmental factors: colonial-era land use changes, agricultural expansion, and economic pressures driving poaching. The center’s comprehensive strategy addresses not only the decline in the number of giraffes through its breeding program, but underlying causes through community education and sustainable tourism practices. The center’s work has helped increase the wild Rothschild’s giraffe population to ~1,800 individuals, demonstrating how addressing social and environmental determinants in Kenyan communities can support conservation efforts.
Perhaps most relevant to our course themes was seeing how the Giraffe Center advances health equity principles through its community engagement and outreach. On its website, the Giraffe Center has multiple community education programs that address habitat restoration, sustainability, and other courses available to the community that foster wildlife conservation. As we were allowed to feed the giraffes, we recognize how this place embodies the interconnection between environmental sustainability and community well-being that forms the foundation of population health. The Giraffe Center offers a powerful case study in how conservation efforts, when designed with equity and community involvement in mind, can contribute to both ecological and human well-being across Kenya.
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