Everyone says fieldwork is the highlight of their Fellowship.
They post Instagram stories with wide smiles and breathtaking landscapes, share harrowing stories about road conditions or visa checks, and return home more worldly, more thoughtful, and more tired. I was ready to go. I wanted to be the one to leave my comfy Nairobi office and return more worldly, thoughtful, and tired.
In a word, my fieldwork experience was hot. Unlike my fellow East African Fellows who have become accustomed to being always a little bit damp, I live in breezy Nairobi, where the sun shines politely and the nights require light jackets. When I got off the plane in Mombasa, the scorching Swahili city on the Indian Ocean, it was nighttime and nearly 30ºC. I took off my jacket.
I work on a project called WHEELER, which stands for “Women in Health and their Economic, Equity, and Livelihood Statuses during Emergency Preparedness and Response”. WHEELER focuses on exploring the experiences of women healthcare workers during the COVID-19 pandemic. We focus on how the pandemic affected work, livelihoods, and gendered dynamics in two counties along Kenya’s coast, Kilifi, and Mombasa. Around the world, nearly 70% of the world’s healthcare workers are women, who are concentrated in frontline, lower-status, and lower-paid roles. Through WHEELER, we explore the specific challenges that they face.
Furthermore, the Kenyan system also relies on the work of community health promoters (CHPs), community volunteers that provide frontline preventative and health-promoting services to hundreds of households, linking communities to primary health facilities. It was only this October that President Ruto announced that the government would contribute stipends and health insurance to over 100,000 CHPs across Kenya. Recognizing the diverse experiences of healthcare workers, our research also focuses on exploring differences between paid and unpaid and rural and urban healthcare workers.
Here I was in humid Mombasa, ready to join our hardy team of research assistants in getting through the last two weeks of our data collection. Our surveys in Kilifi were complete and there were a few hundred left to go. I was very familiar with all 112 questions (yes, 112!), having completed some preliminary analysis on the first 800 responses, and I was ready to go.
On my first day, we visited a sub-county office beside a small school. All five of us squeezed into the office, explained the consent documents, and handed out the tablets. There wasn’t enough space to wait inside, so we found some plastic chairs outside, watching the children play until the first set of participants were done. Then we passed the tablets off to the next group and on and on until we had reached our target for the day. At some point, they gave us some cake. It was a calm, balmy day.
The next day, we dodged matatus and tuktuks through Mombasa’s Old Town to arrive at a level 3 healthcare centre (The Kenyan healthcare system has 6 levels that categorize the complexity of health services). It was bustling and lively and we zipped around, looking for anyone available to interview. I ended up stationed at the pharmacy. The pharmacist and I developed a rhythm; she focused on answering the questions, and I nudged her if there was a patient waiting. Halfway through, a CHP peeked her head into the office and asked if I wanted mehndi done. The three of us chatted as she painted spirals on my wrist. After I completed my surveys for the day, the data collection team and I ate viazi in the car, hiding from the sun.
The next week, we showed up to a hotel drenched in rain because we had heard that there was a meeting of Community Health Extension Workers. They were usually dispersed all over the counties, and this was one of our only chances to survey them. I was able to find a participant early in the morning, but she grew annoyed as the meeting started. Feeling uneasy, I sped up and we were done in double time. She didn’t smile when she left. That day, we didn’t meet our target.
Over the two weeks, I learned the uneven rhythm of the days. It was quicker to ask the questions directly, and I practiced different ways of asking each question. I learned to be supportive when the survey dragged just a little too long. I know, I know, but we’re more than half done! I learned that there were many more ways to understand a question than I realized and was reminded that multiple-choice could not contain the totality of human experience. I began to look at the survey questions not from the perspective of the researcher, but from the perspective of the healthcare provider. I learned to convey the importance of this work. I know you’re busy, I know the survey’s long, I know things are different now, but we are trying to make things better.
But despite the many limitations of a survey, asking these questions opened discussions. Healthcare workers shared what the pandemic felt like. How some would come home and immediately shower but still be avoided by their families. How they lost income and support. How difficult it was to balance work with responsibilities at home. And we would work together to fit it into the constraints of multiple choice. This was heavy work—it was uncertain and exhausting. I was impressed at the ease and confidence that the team had developed over their four months, and I tried my best to keep up.
When I returned home, I didn’t feel more worldly, but I did feel more thoughtful and tired. My thoughts and my experiences weren’t easy or clear cut, and I was simply happy to be home.
I thought a lot about my two weeks when I returned to Mombasa last month for our sensemaking workshop. The data collection team’s hard work had culminated in a spreadsheet of 2,500 responses from healthcare providers and our data analyst had done a basic analysis. Rooted in WHEELER’s truly participatory approach, these workshops brought together county government representatives, healthcare providers, and CHPs to sift through the data. Together, we dove into the tables to see what relationships were emerging and most importantly, why. Our discussions also provided deeper context and raised new, interesting questions that will be explored during interviews and focus group discussions.
Looking at the rows and rows numbers, I thought about the fifty people I had surveyed and where they had fallen in these tables. I thought about all the conversations that were missing from this data. And I thought about how these surveys would contribute to the ultimate purpose of this work. By sharing a bit about their lives and experiences during the pandemic, we can get a sense of what can be improved for the future. And for that, I am grateful.
Lauren Chang (third from the right) is currently working as a Gender Fellow at the Centre of Excellence in Women and Child Health East Africa, Aga Khan University.
The International Youth Fellowship is one of AKFC’s wide range of opportunities for people from Canada to exercise and express their global citizenship.