Livelihoods, vulnerability and the risk of malaria on Rusinga Island/Kenya

Magisterarbeit zur Erlangung der Würde des Magister Artium der Philologischen, Philosophischen und Wirtschafts- und Verhaltenswissenschaftlichen Fakultät der Albert-Ludwigs-Universität Freiburg i. Br.

Vorgelegt von Philipp Weckenbrock aus Bad Oldesloe

WS 2004/05

Geographie

Acknowledgements

The realisation of this study would not have been possible without the help of many people. I would like to thank Prof. Dr. A. Drescher, HD Dr. C. Dittrich, Prof. Dr. R. Mäckel, Dr. G. Killeen and M. Quinlivan for their support during the preparatory phase of my fieldwork, which was partly sponsored by the Verband der Freunde der Universität Freiburg im Breisgau e.V. . In Kenya, Dr. U. Fillinger offered a lot of help, not only concerning the design of the fieldwork but also in many other matters, for which I am very grateful. Also many thanks to the other people at the International Centre for Insect Physiology and Ecology (ICIPE), in particular Dr. R. Mukabana. In Nairobi and on Rusinga Island, I received much assistance from the side of the Christian Children’s Fund (CCF), especially from I. Kiche and E. Wamai. It was always a pleasure to work together with the malaria team in general and the malaria volunteers on Rusinga in particular. Also, I would like to express my gratitude to the many people in Kaknaga/Ufira zone on Rusinga Island who, with their warm hospitality, friendliness and patience, made working there a very rewarding experience. Thanks to C. Dietsche and M. Bodenhöfer and to Prof. Dr. T. Krings, the supervisor of this master’s thesis. Furthermore, I want to thank my family for the fact that I could always count on their support, inspiration and patience.

Last but not least, a very special thanks goes to Dan Okombo, my research partner, host and friend on Rusinga Island. Without him, the fieldwork on Rusinga would not have been possible. This master’s thesis is dedicated to him and his family.

Index

1 Introduction ...... 1 2 Theory...... 3 2.1 Hazards in history: ‘Acts of God’ and ‘the violent forces of nature’...... 3 2.2 Vulnerability...... 5 2.2.1 Vulnerability in relation to poverty...... 6 2.2.2 The concept of vulnerability ...... 7 2.2.3 Strategies ...... 10 2.2.4 Rendering the World Unsafe? Bankoff’s criticism of the concept of vulnerability ...... 10 2.2.5 Linking hazard and vulnerability ...... 12 2.2.6 Concepts of risk...... 13 2.2.7 Vulnerability to diseases ...... 14 2.3 The livelihood framework...... 15 2.3.1 Assets ...... 16 2.3.2 Hazard context...... 17 2.3.3 Transforming structures and processes ...... 18 2.3.4 Livelihood strategies...... 18 2.3.5 Livelihood outcomes...... 18 2.3.6 The livelihood model ...... 19 2.3.7 Critique...... 20 3 Geographical context...... 20 3.1 Kenya ...... 20 3.1.1 Geography ...... 20 3.1.2 History and politics...... 22 3.2 Rusinga Island...... 23 4 Fieldwork and methods...... 26 4.1 The research area...... 26 4.2 The fieldwork...... 28 4.3 Difficulties and problems...... 29 5 Livelihoods on Kaknaga/Ufira Zone ...... 30 5.1 Assets ...... 30 5.1.1 Human capital...... 30 5.1.2 Natural capital...... 33 5.1.3 Social capital...... 35 5.1.4 Financial capital...... 38 5.1.5 Physical capital...... 41 5.1.6 Livelihood assets, three examples...... 44 5.2 Hazard context...... 44 5.2.1 HIV/AIDS ...... 45 5.2.2 Malaria ...... 47 5.2.3 Other diseases...... 47 5.2.4 Witchcraft...... 48 5.2.5 Dangerous animals ...... 49 5.2.6 Free roaming livestock...... 49 5.2.7 Drought...... 50 5.2.8 Population growth...... 50 5.2.9 Malnutrition and famine...... 51 5.2.10 Newly introduced species...... 51 5.2.11 Declining catches and the fishing ban...... 52 5.2.12 Soil erosion...... 53 5.2.13 Agricultural pests...... 53 5.2.14 A classification of hazards in the research area ...... 54 5.3 Structural context...... 55 5.4 Livelihood strategies...... 58 6 Risks and vulnerability in Kaknaga/Ufira Zone, the example malaria...... 61 6.1 Malaria ...... 61 6.2 The hazard of malaria on Kaknaga/Ufira Zone...... 63 6.3 The risk of malaria on Kaknaga/Ufira Zone ...... 66 6.3.1 Probabilistic perspective of the risk of malaria infection...... 66 6.3.2 Probabilistic perspective of the risk of undesirable outcomes ...... 67 6.3.3 Social perspectives on risk ...... 70 6.4 Perception of malaria ...... 71 6.5 Linkages between malaria and other livelihood components ...... 77 6.5.1 Links with assets ...... 77 6.5.2 Links with other hazards ...... 80 6.5.3 Links with the structural context...... 85 6.5.4 Links with livelihood strategies ...... 88 6.6 Strategies against malaria...... 90 6.6.1 Ex ante strategies...... 90 6.6.2 Ex post strategies...... 93 6.7 Vulnerable groups...... 94 7 An index for measuring vulnerability...... 96 8 Some implications for further research and the malaria project...... 99 9 Summary...... 102 10 Zusammenfassung ...... 104

Figures

Figure 1: Livelihood model...... 19 Figure 2: Level of education of all household members...... 31 Figure 3: Aspects of the life on Rusinga appreciated by the participants...... 34 Figure 4: Marital status of participants...... 36 Figure 5: Group membership of the participants...... 37 Figure 6: Livestock owned by the participants...... 40 Figure 7: Valuable belongings of the participants...... 41 Figure 8: Hazards mentioned by the participants...... 45 Figure 9: Main source of income of the households...... 58 Figure 10: Age of the persons who suffered from malaria during the previous year...... 67 Figure 11: Age of malaria-related casualties in the households...... 68 Figure 12: Sources of money to cover costs of treatment...... 69 Figure 13: Evaluation of different risks by the participants...... 70 Figure 14: Symptoms of malaria in adults as given by participants...... 72 Figure 15: Symptoms of malaria in babies as given by participants...... 72 Figure 16: Yes/no-questions about symptoms of malaria...... 73 Figure 17: Perceived causes of malaria...... 74 Figure 18: Perceived ways of protecting against malaria...... 75 Figure 19: Sources of information about malaria...... 76 Figure 20: Ex ante strategies employed by the participants...... 91 Figure 21: Bednet possession in the households of the participants...... 92

Tables

Table 1: Population size and density on Rusinga Island...... 25 Table 2: Savings and debts of the participants...... 39 Table 3: Examples for assets of the participants’ households...... 44 Table 4: Classified hazards mentioned by participants and outsiders...... 54 Table 5: Malaria as a disease of the poor...... 62 Table 6: Potential mosquito breeding sites on Kaknaga/Ufira zone...... 64 Table 7: First action taken when a member of the household falls ill with malaria...... 93

Maps

Map 1: Map of Kenya...... 21 Map 2: Rusinga Island...... 24 Map 3: Kaknaga/Ufira zone on Rusinga Island...... 27 Map 4: Potential mosquito breeding sites on Kaknaga/Ufira zone in June 2003...... 64 Map 5: Sites of anopheles larvae in June 2003...... 65

Appendixes

Appendix 1: Photos Appendix 2: Questionnaire 1 Introduction

Malaria is one of the biggest diseases worldwide. According to the World Health Organisation (WHO), every year, hundreds of millions of people are affected by the disease and more than one million die, most of them in sub-Saharan Africa. Even though malaria is very obviously a disease of the poor, so far, research on it has focussed mainly on malaria parasites and the vectors that transmit the disease while social factors have been widely neglected. This reflects the approach used in research on natural disasters before the emergence of the paradigm of vulnerability. Just like vulnerability analysis has proved very valuable in discussions of earthquakes, floods, landslides and other disasters in the meantime, it could contribute a relevant different perspective on malaria, too. Not all people are at the same level of vulnerability to malaria which gives rise to questions such as ‘Which groups of people are particularly vulnerable to malaria?’ or ‘Which factors make people more or less vulnerable to the disease?’. A framework that allows for a broad approach to these issues, in that it includes physical as well as social factors, is the livelihood model. It can be used to describe the livelihood context of people who live in a malaria- endemic region. An analysis of influences and interactions between malaria and the various other livelihood components can help to identify central issues that have negative impacts on the malaria situation as well as strengths that can be built on in the fight against the disease. Moreover, this broad focus also helps in putting malaria into perspective: In the real lives of people in rural Africa, malaria is just one amongst various hazards and hazards are only one out of many livelihood-aspects. This leads to the questions of how malaria is perceived by people in a highly affected area, which role it plays in their lives and to what extent it is a priority for them. The research area for this study was on Rusinga Island, an island with 20.000 inhabitants, which is situated in Lake Victoria in Western Kenya. Like in many other parts of the country, the vast majority of people who live on Rusinga have neither access to electricity nor to safe drinking water. Various diseases arise from unhygienic living conditions. Moreover, the rate of infections with HIV is very high. The extremely high mortality rate of young children is to a large extent due to malaria, which is one of the reasons why the Christian Children’s Fund (CCF), a large non-governmental organisation, in cooperation with scientists from the

1 International Centre for Insect Physiology and Ecology (ICIPE) and inhabitants of Rusinga, is running a malaria project on the island. It was within the frame of this project that this study could be carried out. In a first part of the fieldwork, the geographical distribution of mosquito breeding sites was determined with the help of GPS and GIS. The second part of the fieldwork consisted of interviews with inhabitants of the research area.

The complexity of issues and the various interlinkages between them is reflected in the following study: Very often, there will be references to topics, figures, tables etc. which are treated in other chapters. The structure of the study is the following: In the first part, the theoretical framework will be presented. As pointed out earlier, there are lessons from research on hazards and disasters to be learnt for the study of malaria. The way in which disasters are perceived and dealt with has changed considerably in the last centuries and decades and new approaches have been developed. One of these, the concept of vulnerability, is a useful tool for risk assessment. However, there are various difficulties, in particular those concerning the quantification of vulnerability. Partly based on the concept of vulnerability, the livelihood framework offers the possibility of taking the variety of issues which make up the context in which people live into account. The second part deals with the geographical, historical and political context of the research area. The focus of this part narrows down from the national level to Rusinga Island as a whole. Before the research area, Kaknaga/Ufira zone on Rusinga Island, is introduced, fieldwork and research methods will be presented and discussed in the third part of the study. In the fourth part, the livelihood framework is used to analyse the livelihood context of the inhabitants of the research area. Of particular interest for this study is the hazard context. This leads over to the fifth part in which one of these hazards, malaria, is treated in more detail. However, not only the hazard side of malaria, but also, more importantly, the perception of and vulnerability to the disease will be focused upon. Moreover, linkages between malaria and other livelihood components, strategies against malaria and groups of people who are particularly vulnerable to the disease will dealt with. The last issue is complicated by the fact that so far, there are no measures for vulnerability. In the light of the previous discussions and the empirical data, such a measure, an index of vulnerability, is developed and proposed in the sixth part of the study. As this study was carried out in the context of a malaria project on Rusinga Island, some suggestions for the project are given in the seventh part.

2 2 Theory

The concepts of vulnerability, risk and livelihoods are complex and subject to much debate. In the following, it will not be possible to discuss them in detail. Instead, the focus is on those aspects which are relevant in dealing with the topic ‘malaria on Rusinga Island’.

2.1 Hazards in history: ‘Acts of God’ and ‘the violent forces of nature’

The discussion about hazards, threats and disasters is as old as mankind itself. One of the oldest known accounts of a disaster is the one about the Flood in the Old Testament. Here, the catastrophe is portrayed as God’s punishment for sins of the humans. For centuries and millennia, such mystical-religious interpretations coined people’s perceptions of disasters. These perceptions had important implications for the role people could play in avoiding or mitigating catastrophes:

Wenn das Naturphänomen ausschließlich ein “Akt Gottes” ist, dann entziehen sich “profane” Präventionsmaßnahmen jeglicher Logik. Schutz und Hilfe ist nur vom Allmächtigen möglich. Als aufgrund wissenschaftlicher und technischer Errungenschaften zunehmend mehr physische Teilprozesse der Umwelt gedeutet werden konnten, haben sich Zeitgenossen verstärkt an den bis dahin meist ungeklärten Fragenkomplex „Natur-Mensch-Katastrophe“ herangewagt und dabei unterschiedliche Erklärungsansätze und Interpretationen zu Tage gefördert. (WEICHSELGARTNER, 248p)

With the increasing interest in and achievements of science following the period of Enlightenment, the scientific interpretation of natural events and disasters became more and more important. In the 19th and 20th century, the study of the interactions between humans and the environment was a main topic of classical geography (compare WEICHSELGARTNER). The main focus was on the physical aspects of natural disasters, i.e. on natural hazards and events, while social factors were largely sidelined or ignored.

Until the emergence of the idea of vulnerability to explain disasters, there was a range of prevailing views, none of which really dealt with the issue of how society creates the conditions in which people face hazards differently. One approach was unapologetically naturalist (sometimes termed physicalist), in which all blame was apportioned to ‘the violent forces of nature’ … Other views of ‘man (sic) and nature’ … involved a more subtle environmental determinism, in which the limits of human rationality and consequent misperception of nature lead to tragic misjudgements in our interactions with it. ‘Bounded rationality’ was seen to lead the human animal again and again to rebuild its 3 home on the ruins of settlements destroyed by flood, storm, landslide, and earthquake.” (BLAIKIE ET AL., 11)

The underlying reason for people settling in hazardous areas (and consequently suffering in disasters) was thought to be a lack of ‘modernisation’. This interpretation is based on the point of view of modernisation theories. Through their lens, underdevelopment is seen as an early stage in the development process. “Unterentwickelte Gesellschaften entsprechen

Übergangsgesellschaften auf dem Wege von der Tradition zur Moderne“ (NOHLEN, 524). According to this point of view, traditional beliefs, behaviours, technologies and structures are obstacles in the way to development and should be replaced by modern beliefs, behaviours, technologies and structures in order to create the basis for development. Reasons for underdevelopment were thus seen as mainly internal, i.e. inside the underdeveloped society. Lack of modernisation then had important implications for disasters and how they were handled.

Thus ‘industrial’ societies had typical patterns of loss from, and protection against, nature’s extremes, while ‘folk’ (usually agrarian) societies had others, and ‘mixed’ societies showed characteristics in between ... It was assumed that ‘progress’ and ‘modernization’ were taking place, and that ‘folk’ and ‘mixed’ societies would become ‘industrial’, and that we would all eventually enjoy the relatively secure life of ‘postindustrial’ society. (BLAIKIE ET AL., 11p)

However, modernisation theories came under increasing criticism in the 1970s and 80s. Main arguments include the ethnocentricity to take the industrialised (mostly) European and North American countries as role models for the rest of the world. Furthermore, the optimistic notion of growth as the cure for many evils was being challenged by publications such as the Club of Rome’s Limits to Growth and the Brundtland Report.

The 1970s saw increasing attempts to use ‘political economy’ to counter modernization theory and its triumphalist outlook, and ‘political ecology’ to combat increasingly subtle forms of environmental determinism. These approaches also had serious flaws, though their analyses were moving in directions closer to our own than the conventional views. (BLAIKIE ET AL., 12)

The most influential theories of underdevelopment which arose out of these points of criticism were the dependencia theories. According to them, the underlying reasons for underdevelopment can not be found in internal but in external conditions. Thus, poor nations are not underdeveloped because they are not integrated into a global economic system but precisely because they are. The existing economic system of the world is characterised by exploitation, which, according to dependencia theories, is the reason for both wealth and industrial development of some countries and poverty and underdevelopment of others. 4 Therefore, development and underdevelopment are linked to and based on one another rather than stages in a process. Even though dependencia theories were criticised, e.g. for being too one-sidedly focussed on external causes of underdevelopment1, they are the basis for a thinking which emphasises social and economic root causes. For disaster research this implies that the search for strategies to avoid or mitigate disasters should focus on social and economic factors rather than exclusively on modern technologies. Especially the research on hunger and famines moved away from the traditional focus on physical causes of disasters. In his very influential essay Poverty and Famines, SEN introduced the notion of entitlements. According to him, many food crises are not created by a shortage of food but by the inability of many people to obtain it. The problem is thus often a social/political one rather than a physical/biological one. This line of thinking, elaborated and applied to a more general context of disasters, was one of the important influences which led to the concept of vulnerability.

The study of vulnerability in the poverty and ‘development’ literature stems, in part, from the study of hazards and disasters, in particular of famine, and is related to similar conceptions of marginality, resilience, susceptibility and adaptability (Wisner 1993, Kirkby et al. 2001). The increased use of the term through the 1970s and 1980s can be related to the emergence of a new paradigm in the study of hazards and disasters at this time. This structuralist paradigm asserted that physical hazards are distinct from the disasters that they potentially cause, the required linkage being a vulnerable population (Wisner 1993). The older paradigm in the study of hazards, termed the behavioural paradigm, views the cause of a disaster as being ‘extreme forces of nature’, and the poor perception of hazards and risk. It believes in the ability of technology, prediction, bureaucratic organisation and modernisation to mitigate disasters (Bankoff 2001, Smith 1996, Blaikie et al. et al. 1994). The competing structuralist paradigm gives secondary importance to a ‘natural’ hazard as a determinant of a disaster (Blaikie et al. et al. 1994). (PROWSE, 4)

2.2 Vulnerability

The idea of vulnerability is based on the observation that "all persons at the same level of income do not suffer equally in disaster situations nor do they encounter the same handicaps during the period of recovery" (WISNER, 13). Thus, the central question is: What makes some people suffer more than others in crisis situations? When the term vulnerability came increasingly in use in discussions about development, it was often used as a synonym of poverty:

1 For a summary of the discussion on dependencia theories see Nohlen (1998), 171pp. 5 ‘Vulnerable’ and ‘vulnerability’ are common terms in the lexicon of development but their use is often vague. They serve as convenient substitutes for ‘poor’ and ‘poverty’, and allow planners and other professionals to restrain the overuse of those words. (CHAMBERS (1989), 1)

This use of the terms, though, is misleading as many authors have since pointed out (for instance WISNER, CHAMBERS (1989)). The confusion of vulnerability with poverty has led to the fact that for a long time, vulnerability ”remained curiously neglected in analysis and policy” (CHAMBERS (1989), 1). What is more, “[f]ailure to distinguish vulnerability from poverty blurs distinctions and sustains stereotypes of the "amorphous and undifferentiated mass of the poor"” (BOHLE (1993b), 17). By having a closer look at how it is related to and differs from poverty, though, it is possible to get a more precise idea of what the concept of vulnerability is about.

2.2.1 Vulnerability in relation to poverty

The relation between vulnerability and poverty has been widely discussed (compare

CHAMBERS (1989), WATTS AND BOHLE, BOHLE (1993b), PROWSE, WISNER). Both vulnerability and poverty are conditions, processes and concepts and both have come to be seen as dynamic rather than static (compare PROWSE,). However, even though poor people are often also vulnerable, poverty and vulnerability are not the same. Vulnerability can be seen as cause, result and component of poverty (compare PROWSE):

Cause: Vulnerability can be the cause of poverty in various ways. The most obvious one is that vulnerable people who suffer in a disaster can become poor as a result. Often, a crisis event such as a natural disaster, an accident or illness is the event which causes the impoverishment of a person or group of persons directly, through the destruction of assets, or indirectly, through the costs for coping and recovery (compare CHAMBERS (1989), NABARRO

ET AL.). Especially if the body, “the main asset of most poor people” (CHAMBERS (1989), 4), is affected, this can trigger the decline of persons and households into poverty.

[W]hat we now see is that the health of breadwinners, whether male or female, is critical for the well-being of the rest of the household; and that preventing disability in breadwinners, or curing it, can also prevent malnutrition in children. (CHAMBERS (1989), 5)

A less obvious but nevertheless relevant effect of vulnerability on poverty is that vulnerability can lead to risk aversion. The reluctance of investing in longer term projects and activities 6 which would offer greater benefits often hinders vulnerable people to escape from poverty

(compare HULME ET AL., PROWSE, NABARRO ET AL.). What is more, vulnerability can contribute to a sense of helplessness and resignation: "[C]losely related to the experience of vulnerability is the state of being resigned to always remaining poor" (ALIBER quoted in PROWSE, 11).

Result: Poor households tend to be more vulnerable than wealthier households (compare

PROWSE) because they lack the means to prepare for, cope with and recover from crisis situations.

Component: Many authors who attempt to break up the multidimensional concept of poverty into its components mention vulnerability as one of them:

[V]ulnerability in bad times, or timidity at all times, in face of exposure to DF [damaging fluctuations] (including risk) is an important, and sometimes neglected, component of poverty.” (SINHA AND LIPTON cited in PROWSE, 9. Compare also BOHLE (1993b) and WISNER)

Other examples for definitions of poverty that mention vulnerability as an aspect of poverty include the one used by the World Bank (compare HULME ET AL.) as well as definitions by poor people themselves. One of the findings of the Voices of the Poor series, which was carried out in 58 developing and transitional countries, was that poor people generally perceive vulnerability as a central aspect of poverty (compare HULME ET AL.).

An advantage of the concept of vulnerability compared to the concept of poverty is that it is more concrete and thus easier to target than poverty (compare WISNER). Moreover, vulnerability seems to be a priority for poor people themselves:

It can be argued that what poor people are concerned about is not so much that their level of income, consumption or capabilities are low, but that they are likely to experience highly stressful declines in these levels, to the point of premature death. This approach suggests that poverty can be seen as the probability (actual or perceived) that a household will suddenly (but perhaps also gradually) reach a position with which it is unable to cope, leading to catastrophe (hunger, starvation, family breakdown, destitution or death). (HULME ET AL., 9)

2.2.2 The concept of vulnerability

Many authors use the definition of CHAMBERS as a starting point for a discussion of the concept of vulnerability:

7 Vulnerability here refers to exposure to contingencies and stress, and difficulty in coping with them. Vulnerability has thus two sides: an external side of risks, shocks, and stress to which an individual or household is subject; and an internal side which is defencelessness, meaning a lack of means to cope without damaging loss. (CHAMBERS (1989), 1)

Several points here are worth noting: a) Exposure and difficulty in coping: These two aspects can be seen as representing a time dimension; ‘exposure’ refers to before and ‘difficulty in coping’ to after the onset of a crisis event. WATTS AND BOHLE added the aspect of recovery so that now, vulnerability can be defined as the difficulty of a person or group to anticipate, cope with and recover from a crisis situation. Thus, vulnerability has implications before, during and after an emergency. The emphasis is now on the crisis event itself rather than on its onset. BLAIKIE ET AL. define vulnerability ”in terms of [persons’ and groups’] capacity to anticipate, cope with, resist, and recover from the impact of a natural hazard” (BLAIKIE ET AL., 9). However, the bipartite differentiation in before and after the onset of a crisis event still plays a role (for instance in the differentiation between ex ante and ex post strategies) as will be discussed later. b) Internal versus external side: There is the danger of a misunderstanding in the second sentence of CHAMBERS’ definition: The external side of vulnerability should not be understood as referring to risks, shocks and stress themselves but to “the exposure to the effects of a … hazard, including the degree to which [people] can recover from the impact of that event”

(BLAIKIE ET AL., 57). The difference is that the concept of vulnerability only refers to the difficulty of people or groups of people to protect themselves (in CHAMBERS’ definition against a) a crisis event to happen and b) the crisis event’s effects). Thus, in a sense, vulnerability always refers to something internal. If the “external” side is understood to refer to risks, shocks and stress and both the “external” and “internal” sides are called vulnerability

(compare PROWSE) then this concept includes both the “old” notion natural hazards and the new notion vulnerability. Many authors stress that it is important to include in an analysis of disasters both a focus on the natural trigger as well as on vulnerability (compare BLAIKIE ET

AL., BOHLE (1993b), WISNER, CANNON, HULME ET AL.). One of the big achievements of the debate on vulnerability is that it helped to disintegrate the concepts of disasters and catastrophes and allows a more differentiated approach. It therefore seems disadvantageous to replace the very broad concept of ‘natural catastrophes’ by an even broader concept of

‘vulnerability’. Thus, one could claim that the new element of vulnerability (CHAMBERS’ ‘internal’ side) which is something inherent in human beings is worth being looked at in

8 isolation first before being linked to the external factors. The terminology which BLAIKIE ET

AL. use in their book ‘At Risk’ seems useful here. They propose to call the external side ‘hazard’ and only the internal side ‘vulnerability’. Taken together, the two aspects make up

‘risk’. BLAIKIE ET AL.’s approach to risk, hazard and vulnerability will be discussed later. c) Risks, shocks and stress: In the first sentence of his definition of vulnerability, CHAMBERS mentions ‘contingencies’ and ‘stress’ while he uses the terms ‘risks’, ‘shocks’ and ‘stress’ in the second sentence. In the terminology of BLAIKIE ET AL., this refers to the concept of hazard. Different terms can be found in texts about livelihood models (a further discussion on this in a later chapter). Examples include ‘Risiken’, ‘Schocks’, ‘Stress’, ‘Krisen’, ‘Katastrophen’,

‘Saisonalität’ (BOHLE (2001), 12), ‘shocks’ and ‘stresses’ in the livelihood model of CARE

(compare SANDERSON, 100) and ‘shocks’, ‘trends’ and ‘seasonality’ in the livelihood model developed by the Department for International Development (compare DFID, 9). As the term ‘risk’ used here comprises the concept of vulnerability, it seems more appropriate to talk about the vulnerability to ‘shocks’, ‘trends’ and ‘seasonality’ in the following. ‘Shocks’ carry the notion of suddenness and unpredictability while ‘trends’ are more predictable and take place more or less gradually over a period of time. ‘Seasonality’ or ’seasonal shifts’ are recurrent and predictable. Nevertheless, they are “one of the greatest and most enduring sources of hardship for poor people in developing countries” (DFID, 3). d) Individual and household level: Even though in principle, the concept of vulnerability can be applied to all levels of analysis, it is most useful at an individual or household level

(compare CHAMBERS (1989), BOHLE (1993b)):

The concept of vulnerability has been applied to a variety of levels and systems. Nations, cities, agricultural systems and organisations have been viewed through the vulnerability lens. The key point to note here is that within these systems or spaces it is individuals and households that are differentially vulnerable to hazards (Wisner 1993, p.127). It is at this level that an understanding of vulnerability needs to be reached because, as Dreze and Sen (1989) show, a lack of vulnerability at the national, regional or community level does not preclude extreme vulnerability at the individual level. (PROWSE, 6p)

Summarising the ideas discussed so far, vulnerability can be defined as the difficulty of persons or groups of persons to anticipate, cope with and recover from shocks, trends and seasonality. It can be seen as a cause, symptom and component of poverty. The concept of vulnerability is particularly useful for analyses on a micro level and thus a focus on individuals and households.

9 2.2.3 Strategies

Strategies are a very important aspect when thinking about vulnerability even though they are often ignored (compare BANKOFF, BLAIKIE ET AL.). “People must not be assumed to be passive recipients” (BLAIKIE ET AL., 61) and while their coping behaviour should not be romanticised it should neither be dismissed (compare BLAIKIE ET AL.). BLAIKIE ET AL. distinguish between eight different categories of coping strategies: 1. preventive strategies 2. impact-minimising strategies 3. creation and maintenance of labour power 4. building up stores of food and saleable assets 5. diversification of the production strategy 6. diversification of income sources 7. development of social support networks 8. post-event coping strategies (ibid., 64pp). In the more recent literature on vulnerability, strategies are usually divided into two broad categories: ex ante and ex post strategies. Ex ante strategies can be defined as forward planning to avoid emergencies from happening or to prepare for them in order to mitigate the negative outcomes (compare PROWSE). Ex post strategies, on the other hand, are employed to cope during and after a crisis situation. Of course, the ideal case is that a negative event does not occur and thus, many authors see ex ante strategies as particularly important (compare 2 PROWSE) .

2.2.4 Rendering the World Unsafe? Bankoff’s criticism of the concept of vulnerability

A discussion of vulnerability would be incomplete without referring to Gregory BANKOFF’s radical criticism of the concept of vulnerability. While he admits that the concept has enriched the debate about development, BANKOFF criticises it as being a continuation of a Western- centric, denigrating discourse starting in the times of colonialism:

Between the seventeenth and early twentieth centuries, this discourse was about ‘tropicality’ and Western intervention was known as ‘colonialism’. Post-1945, it was mainly about ‘development’ and Western intervention was known as ‘aid’. In the 1990s, it was about ‘vulnerability’ and Western intervention is known as ‘relief’. (BANKOFF, 27)

‘Tropicality’ refers to “[a] Western way of defining something culturally and politically alien, as well as environmentally distinctive, from Europe and other parts of the temperate zone”

(ibid., 21). According to BANKOFF, the concept of vulnerability is just a new dress for an old thought and continues to portray the populations of other parts of the world in an arrogant, patronising way:

2 For a further discussion of strategies see Devereux (1999), Prowse (2003) and Hulme et al. (2001). 10 '[T]ropicality', 'development' and 'vulnerability' form part of one and the same essentialising and generalising cultural discourse: one that denigrates large regions of world as dangerous - disease-ridden, poverty-stricken and disaster-prone; one that depicts the inhabitants of these regions as inferior - untutored, incapable, victims; and that it reposes in Western medicine, investment and preventive systems the expertise required to remedy these ills. (Ibid., 29)

The leitmotiv of this discourse through the centuries was to create a sense of otherness and dividing the world into ‘us’ and ‘them’, BANKOFF states. Even though the wording was more subtle today than it had been, for instance, in the times of colonialism, the new concept was still just a way of constructing a stereotyped image of ‘the others’. By being deeply rooted in and uncritical of Western thought, the author goes on to criticise, the concept failed to address the real problems of the people it claims to focus on. What is more, the ultimate goal was not to contribute to their safety but to the safety of Westerners.

BANKOFF goes a step further stating that to blame hazards for poverty and an inequitable distribution of wealth was, for ‘the West’, a convenient way of avoiding to address the issue of “an economic system created by and largely benefiting the West”. Moreover, “it also serves as justification for Western interference and intervention in the affairs of those regions for our and their sakes” (ibid., 27).

While BANKOFF in his article can be credited for claiming that more priority should be given to the ideas and contributions of the people who are poor or directly affected, he overshoots the mark in large parts of his essay. He is not the first to underline the problems of generalising names like Third World. However, while caution is very much necessary in their use and in spite of the shortcomings all the different terms have, they nevertheless are useful and necessary when writing in a relatively general and abstract manner3. His claim that the concept of vulnerability denigrates the people termed ‘vulnerable populations’ as being passive victims also goes much too far. Many authors have emphasised the importance of coping strategies and the fact that they should be incorporated in planning as well as implementation of projects in order to achieve sustainability (compare previous chapter). The criticism that blaming many problems on hazards distracts attention from the unfair system of global trade of which the West benefits seems to be justified. However, the very point of the concept of vulnerability is to focus on the underlying reasons for vulnerability rather than on hazards. The global economic system has been identified as one of the root causes of vulnerability by several authors (e.g. BLAIKIE ET AL.).

3 For a concise discussion of the term ‘Third World’ see Nohlen (1998), 184p. 11 Despite the fact that many aspects of his article can be put in question, some of BANKOFF’s statements are well worth being taken very seriously. In particular, care has to be taken to avoid ethnocentrism and patronising attitudes. Western scientists must be aware of the risk of an ethnocentric bias. Local culture, perceptions and strategies do not only deserve respect and attention but must play a central role in any effort to reduce vulnerability. Only in such a way can sustainability be achieved (compare NYAMWAYA). Probably the most important point to keep in mind is that respect is a precondition for any meaningful cooperation. This is not only, but particularly, true for cooperation between partners from Europe and North America and other cultural contexts.

2.2.5 Linking hazard and vulnerability

As discussed in the previous chapters, both hazards and vulnerability have to be taken into consideration in an analysis of disasters. The term disaster can be defined as an event in which a hazard occurs in an area with a vulnerable population (compare BLAIKIE ET AL.). As a matter of fact, disasters can only be analysed after they have happened so if the aim is to prevent them there needs to be a different concept: risk. ‘Risk’ is usually defined as the product of the scope and probability of an event, accident or catastrophe (compare LESER, DOUGLAS).

BLAIKIE ET AL. in their book ‘At Risk’ link the two aspects hazard and vulnerability in the concept of risk: “[T]he risk faced by people must be considered as a complex combination of vulnerability and hazard. Disasters are a result of the interaction of both” (BLAIKIE ET AL., 21).

BLAIKIE ET AL.’s definition of vulnerability is very similar to the one given in chapter 2.2.2 and ‘hazard’ is defined as

the extreme natural events which may affect different places singly or in combination (coastlines, hillsides, earthquake faults, savannas, rain forests, etc.) at different times (season of the year, time of day, over varying return periods, of different duration).The hazard has varying degrees of intensity and severity. (Ibid., 21)

The question concerning the definition of ‘hazard’ is if the concept of hazard should only comprise extreme natural events. As has been pointed out, the lives of many poor people are a

“permanent emergency” (MASKREY quoted in WISNER, 16): “[T]he risks from natural hazards are only a part of the dangers these communities face; there are often far greater and more pressing ‘normal’ risks of malnutrition and poor health” (BLAIKIE ET AL., 37). Also, as BLAIKIE

ET AL. point out themselves, the “naturalness” of many events can be put in question as they

12 often have social causes. There is a continuous spectrum of causations for different events ranging from purely natural to purely social (compare BLAIKIE ET AL.). While it is useful for the purpose of analysis, a separation of hazard and vulnerability is somewhat artificial as hazards can increase vulnerability and vice versa. The interrelations between these two aspects are very important and should be analysed carefully.

2.2.6 Concepts of risk

In the previous chapter, the definition of ‘risk’ as the product of the scope and probability of an event, accident or catastrophe (compare LESER) was given. However, this is only one possible way of looking at risk: From a positivistic, technical-scientific perspective. Often, this perspective does not help with explaining the actual behaviour of people in the face of risks. "Individuals respond according to their perception of risk and not according to an objective risk level or the scientific assessment of risk" (RENN, 66). In fact, the researcher’s perception of vulnerability, risk and hazard is not necessarily the same as the perception of the victims (compare BLAIKIE ET AL.). An awareness of this fact can help to avoid misunderstandings and is a basis for meaningful cooperation (compare NYAMWAYA). The contextual variables which affect the perception of the seriousness of different risks listed by

RENN do not only include how many fatalities or losses are expected by the potential victims but also the “catastrophic potential: … Low-probability/high-consequence risks are usually perceived as more threatening than more probable risks with low or medium consequences”

(RENN, 65). Other reasons play an important role, too:

Among the most influential factors are the perception of dread with respect to the possible consequences; the conviction of having personal control over the magnitude or probability of the risk; the familiarity with the risk. (Ibid., 65)

Social perspectives on risk acknowledge the fact that risk is a multidimensional concept and a complex construct reflecting cultural and social values. The technical perspective on risk, on the other hand, is very narrow in that it defines undesirable outcomes only in terms of physical harm. As RENN points out,

[t]he narrowness of this approach contains both its weakness and its strength. Abstracting a single variable from the context of risk taking makes the concept of risk one- dimensional but also universal. Confining undesirable consequences to physical harm excludes other consequences that people might also regard as undesirable, but physical harm may be the only consequence that (almost) all social groups and cultures agree is undesirable. (RENN, 61)

13 To reduce risk management to technical measures, though, would only make sense if all that societies are concerned about was physical harm. However, this is not the case. The probability to die from diseases like cancer in the United States, for instance, is much higher than the one to die in a terrorist attack. Nevertheless, the steps taken after the shock of September 11 were much more dramatic than the steps taken to fight cancer. “Context matters” (RENN, 77).

Our usual analysis of how people behave in face of risks is wrong, just because it abstracts a particular risk issue from the moral and political issues in which the person normally sees it embedded. We need a way of putting the isolated risk issue into the context of the larger system. (DOUGLAS, 50)

Social scientific perspectives of risk can contribute to risk management in different ways.

They can identify and explain public concerns associated with the risk source; explain the context of risk-taking situations; identify cultural meanings and associations linked with special risk arenas; help to articulate objectives of risk policies in addition to risk minimizations, such as enhancing fairness and institutional trust and reducing inequities and vulnerability; design procedures or policies to incorporate these cultural values into the decision-making process; design programs for participation and joint decision making; and design programs for evaluating risk management performance and organizational structures for identifying, monitoring, and controlling risks. (Ibid., 77p)

In order to avoid misunderstandings and be able to analyse risk more realistically, it is thus necessary to integrate different perspectives on risk4.

2.2.7 Vulnerability to diseases

Vulnerability to diseases has been the topic of much research on vulnerability (compare for instance CORBETT, BLAIKIE ET AL., PRYER, KRÜGER) as “health is a crucial aspect of vulnerability in general” (BLAIKIE ET AL., 101). It has important implications some of which go far beyond the illnesses themselves. Poor people are at a particularly high risk of falling ill:

Members of poor households tend to be especially vulnerable to ill health. Not only is undernutrition more common in poor households, but they are more likely to be living in environmental conditions which bring high risks of infections and vector-borne diseases. Socially and economically, they are vulnerable because of the difficulties they experience gaining access to and paying for treatment. (CORBETT, 58)

A case of serious illness can lead to the impoverishment of whole households and increase the poverty of already resource-poor ones (compare CORBETT). Beside the direct distress caused

4 Further discussions on concepts of risk in Beck (1998), Douglas and Wildavsky (1983) and Luhmann (1991). 14 by diseases, they can affect individuals and households in various indirect ways including expenditures for treatment, lost time and income of not only the ill persons themselves but also the one(s) caring for them (compare CHAMBERS (1989)) and, if the victim dies, ceremonial and funeral expenditures (compare BLAIKIE ET AL.). A very important aspect, which has been stressed by many authors, is the implications of a disease of breadwinners for the nutritional situation of children. In fact, “the cheapest way to prevent child malnutrition may often be to prevent adult sickness, and the most sustainable way to overcome the malnutrition of a child may often be to overcome the disability of an adult" (CHAMBERS (1989), 5). Considering the high risk of diseases, it is not surprising that there is a great variety of strategies to deal with health problems (compare CORBETT).

Examples of studies on vulnerability to specific diseases include the work of KRÜGER on

AIDS in Botswana and the one of EVANS on river blindness in Guinea. The main focus of this study is malaria.

2.3 The livelihood framework

Vulnerability is a concept that is very hard to capture: “Assessing vulnerability is like trying to measure something that is not there. It is an absence of security, basic needs, social protection, political power and coping options” (WEBB AND HARINARAYAN quoted in PROWSE, 21). While it is difficult to measure vulnerability as something that is not there, the livelihood framework offers a good ‘checklist’ (BOHLE (2001), 120) for recording what is there. Furthermore, it is a model for representing the complex ways in which the different elements that constitute livelihoods interact. It can thus contribute to put single issues into perspective and into a context. A major challenge of the framework is “that it forces users to think holistically rather than sectorally" (CARNEY, 7) about what influences livelihoods.

A livelihood comprises the capabilities, assets (including both material and social resources) and activities required for a means of living. A livelihood is sustainable when it can cope with and recover from stresses and shocks and maintain or enhance its capabilities and assets both now and in the future, while not undermining the natural resource base. (Ibid., 4)

15 The livelihood framework was developed during the 1990s mainly by the Department for International Development (DFID). It is meant to be flexible and open and has in the meantime been adopted and further developed by various organisations including Oxfam, CARE and the UNDP. Although the various livelihood frameworks differ in details, they all have the same main components.

2.3.1 Assets

Assets are the strengths on which people build to maintain their livelihoods. An important function of assets is that they can serve as buffers against hazards (compare SANDERSON, 96p, see also BOHLE (2001)). While there is no “one-to-one link” between assets and vulnerability, “there is a close correlation between people’s overall asset status, the resources upon which people can draw in the face of hardship… and their robustness… (including reducing one’s vulnerability)” (CARNEY, 7, compare also WISNER). Usually, five categories of assets are distinguished:

Human capital

Human capital represents the skills, knowledge, ability to labour and good health that together enable people to pursue different livelihood strategies and achieve their livelihood objectives. (DFID,7)

Beside the size of the labour force, education, skills as well as the nutritional and health situation fall under this category.

Social capital The element ‘social capital’ denotes the social resources people can draw on. It includes social networks, access to institutions of society, relationships of trust and the membership in more or less formalised groups (compare DFID).

Natural capital

Natural capital is the term used for the natural resource stocks from which resource flows and services (e.g. nutrient cycling, erosion protection) useful for livelihoods are derived. There is a wide variation in the resources that make up natural capital, from intangible public goods such as the atmosphere and biodiversity to divisible assets used directly for production (trees, land, etc.). (Ibid., 11)

16

Physical capital Physical capital refers to the basic infrastructure, including shelter, water, sanitation, energy, transport and communications, on the one hand and the producer goods (tools and equipment) on the other hand which people can use to meet their basic needs and work more productively

(compare CARNEY and DFID).

Financial capital Financial capital is the financial resources which people have access to in order to realise their livelihood objectives. Not only money in the form of savings falls into this category but also access to credits, pensions, other regular remittances etc. (compare DFID).

The livelihood assets are usually presented in the shape of a pentagon in the different livelihood models (compare figure 1). This pentagon represents the individual or group and is at the centre of every livelihood analysis. Analysing the asset status is fundamental to understanding the options open to the people as well as “the strategies they adopt to attain livelihoods, the outcomes they aspire to and the vulnerability context under which they operate” (CAHN, 2). The asset status, like the whole livelihood framework, represents the status quo and is subject to changes over time. There is no common measure for all assets and the “‘plotting’ of assets is necessarily subjective” (CARNEY, 7). Moreover, some assets are difficult to categorise: Savings groups like some other social networks, for instance, can be considered to be social and financial capital and livestock to be physical as well as financial capital.

2.3.2 Hazard context

The hazard context refers to external threats over which people have limited or no control. In the literature, it is usually referred to as “vulnerability context”. However, ‘vulnerability’ as defined in chapter 2.2.2 represents the difficulty of individuals or groups to avoid, cope with and recover from external threats rather than being identical with these threats. In the livelihood framework, vulnerability (being an internal characteristic of people rather than something external) is more inherent in the asset pentagon than in the external hazard context (compare chapter 2.2.2 for a further discussion of the topic).

17 The hazards which people are exposed to can be categorised into shocks, trends and seasonalities (see chapter 2.2.2).

2.3.3 Transforming structures and processes

Another aspect of the external context in which the individual/group is embedded are the transforming structures and processes. ‘Structures’ refers to organisations and ‘processes’ to rules, laws, regulations, norms etc. which influence people’s livelihoods. This element of the livelihood framework links the micro-context (usually individuals or households) represented by the asset pentagon with the meso- and macro-context up to the global level.

2.3.4 Livelihood strategies

The choices people take and the activities they carry out to achieve their goals are called ‘livelihood strategies’. These have been categorised differently:

Scoones (1998) identifies three types of rural livelihood strategies: agricultural intensification or extensification, livelihood diversification including both paid employment and rural enterprises, and migration (including income generation and remittances). Carney (1998) lists these categories of livelihood strategies as natural resource based, non natural resource based and migration, while Ellis (2000), in his framework, categorises livelihood strategies as natural resource based activities or nonnatural resource based activities (including remittances and other transfers). (CAHN, 3)

2.3.5 Livelihood outcomes

The element ‘livelihood outcomes’ in the framework refers to the aims people aspire to in their lives. This reflects the understanding that these aims are not necessarily the same ones for everybody. Even though this might sound obvious, it is not. The fact that measures like the GDP of a country are used to qualify statements about the ‘level of development’, wealth or poverty, quality of life, ‘decency of the standard of living’ (compare UNDP) etc. of different countries by various organisations proves that it is widely assumed that the livelihood outcomes aspired to by many people in the industrialised world are universal. This point of view is highly contested, though:

[W]e should not assume that people are entirely dedicated to maximising their income. Rather, we should recognise and seek to understand the richness of potential livelihood 18 goals. This, in turn, will help us to understand people’s priorities, why they do what they do, and where the major constraints lie. (DFID, 25)

It is true that maximising their income can be one objective which people try to achieve. However, non-material outcomes can be equally or even more important for many people

(compare CHAMBERS (1989)) as studies like MASLOW’s hierarchy of human needs indicate:

The need for self-realization, involving the giving and receiving of love, affection, and respect might be said to be the highest in the hierarchy. A lower one, on which the former is founded, may be an acceptable standard of living. Lower ones still may include adequate shelter and food for healthy survival, while other needs near the bottom of the hierarchy will include minimum security from violence and starvation. (BLAIKIE ET AL., 63)

An outcome which plays a very important role for many households is safety (compare

HULME ET AL.)

2.3.6 The livelihood model

Figure 1: Livelihood model. Adapted from KÖBERLEIN, CARNEY. 19 2.3.7 Critique

The livelihood framework has both been criticised for being too complex and for being too simplifying (compare CAHN). This reflects the difficulty of every model of having to abstract from a complex reality for reasons of clarity and at the same time including the most important factors. The livelihood framework tries to give an impression of livelihood systems while at the same time remaining clear enough to be useful for practical application (compare

CARNEY). Another criticism that has been voiced is that the framework is very much focused on the micro level and remains rather vague as far as the macro context is concerned:

Unter dem Stichwort 'transforming structures and processes' führt DFID dann eine Schaltstelle ein, die leider sehr vage bleibt...Dieses Element des Analyserahmens bleibt ... eher eine ‚black box’. (BOHLE (2001), 136)

Other authors claim that issues like culture and gender do not figure prominently enough in the framework (compare CAHN). However, there is always space for improvements and changes in prioritization. The framework is intended to be used flexibly. It can be rearranged and adjusted to be useful for different contexts. In fact, there exists a multitude of different livelihood frameworks which nevertheless have the most important features in common (see

CARNEY ET AL.). This flexibility can be considered a great strength of the model.

3 Geographical context

3.1 Kenya

3.1.1 Geography

The size of the Republic of Kenya, 580367 km², is roughly comparable to the size of France and Belgium taken together. Kenya shares land borders with Somalia, Ethiopia, Sudan, Uganda and Tanzania. The shoreline has a length of about 536 km (CIA).

20

Map 1: Map of Kenya. Source: CIA.

The country is one of the most popular African tourist destinations and many people associate it with palm-lined white beaches near Mombasa and Malindi, the Rift Valley and the savannah with its famous National Parks like the Massai Mara. Less well-known are the arid North of the country and the densely populated and hilly West towards Lake Victoria. Indeed, Kenya has an extraordinarily wide range of different landscapes due to geological and climatic factors. The main geological feature of Kenya is the Rift Valley which is part of the rift system stretching from the Sambesi River through the whole of Eastern Africa and the Red Sea up to the valley of the Jordan. The deep, wide Rift Valley is characterised by volcanoes such as the Menengai with its giant caldera and the Longonot and lakes like Lake Baringo, Lake Nakuru and Lake Naivasha. The considerable variety in temperatures and precipitation and the resulting land use and population density are mainly due to differences in altitude (from sea level to the summit of Mt. Kenya with 5199 m). The parts of the country at elevations between 1500 and 2500 m are characterised by a moderately warm and humid climate. There are a main and a minor rainy season with together 750-1500 mm of precipitation. Among the various kinds of crops which are grown in these fertile areas are tea, coffee and pyrethrum, all important cash crops. Even though altitudes between 1000 and 1500 m receive a roughly equal amount of rain, they do not have the same potential for agriculture because temperatures and evaporation are higher. The areas below 1000 m, which receive 500 to 750 mm of rain per annum form the border

21 between the pastoral zones and the ones with rain fed agriculture. Almost 80% of the country have a hot and arid climate and are, with precipitation of less than 500 mm per year and very high levels of evaporation, not suitable for rainfed agriculture. Therefore, many people in the hot and dry East and North live as pastoralists. Climate has a very big influence on population density with the hot, arid regions of the Northeast being inhabited by (less than) 1 to 5 people per km² as compared to 500 and more inhabitants per km² in other, more fertile parts of the country (compare HECKLAU). Particularly the West towards Lake Victoria is very densely populated. Kenya does not only have a great variety of landscapes but is also rich in different cultures. Out of the more than 40 tribes, the Kikuyu, Luo and Luhya are the biggest. Beside the official languages, Kiswahili and English, a plethora of local languages is spoken in the country. The majority of Kenyans are Christians but there are many Muslims particularly in coastal regions (about 10% of the total population) (compare CIA). Agriculture is the main source of living for more than three quarters of all Kenyans. Important products include maize, cassava, sorghum, wheat, bananas, sweet potatoes, legumes and fruit such as mangos, citrus fruits and papayas as well as livestock like cattle, goats and camels and poultry. The main cash crops are tea (Kenya is the fourth largest producer and exporter of tea), garden products and coffee with 28,3%, 16,3% and 6,1% of the total export respectively. With a share of 18% of the GNP, the Kenyan industry is the most important one in East Africa. Agriculture ranges at 19% and services at 63%. A very important source of foreign exchange for Kenya is tourism. In 2000, the country was visited by more than one million foreign guests (compare BARATTA ET AL.). However, Kenya faces many challenges. In the United Nations’ Development Report for 2003, the country ranges at position 146 (out of a total of 175 countries) of the Human Development Index behind Nepal, Pakistan and Zimbabwe. Diseases like AIDS and malaria are widespread and cost the lives of many Kenyans. In spite of high mortality rates and a life expectancy of just 46 years, the population grew at an average of 2,9% per annum between 1980 and 2001 (ibid.).

3.1.2 History and politics

Prehistoric findings like the ones from near Koobi Fora at the Lake Turkana and on Rusinga Island prove that the region was inhabited by relatives of our early ancestors, for example Australopithecus afarensis, Australopithecus robustus and Australopithecus bosei who lived

22 about 2 million years ago. In fact, it is assumed that the region has been uninterruptedly inhabited since the beginnings of human evolution (compare HECKLAU). In the course of the last millennia, Cushitic, Nilotic and Bantu peoples moved to the territory of today’s Kenya. Since the beginning of the early Middle Ages, Arab traders settled along the coast. Their trade routes extended to India and beyond. Out of the mix of Arabic and local Bantu cultures, the Swahili culture and the lingua franca Kiswahili, today the biggest African language, arose. The Arabs won the struggle for the control of the coast, which had lasted for more than 200 years, against the Portuguese, and remained in control of the coast until the arrival of the British and Germans in the 19th century. The Kenyan interior, however, was not penetrated from outsiders coming from the coast until the late 19th century. Between 1896 and 1901, the British built the 840 km long Mombasa-Uganda railway with the help of workers from the Indian subcontinent some of whom stayed in the country after the work was completed. The small railway worker’s camp Nairobi, a stopover along the line, later on became Kenya’s capital. With the completion of the railway line, the interior parts of the country became accessible to white settlers who expelled the people living there (mainly Maasai and Kikuyu) from the most fertile lands and established large farms. British colonial rule over Kenya lasted until 1963 when the Kenyan struggle for independence was successful and Jomo Kenyatta became the country’s first president. He ruled until his death in 1978 and was succeeded by Daniel arap Moi. Particularly Moi’s late presidency was characterised by a dictatorial rule, corruption and economic difficulties so his defeat in the elections of 2002 was celebrated as a second independence. The multiethnic coalition of opposition parties, National Rainbow Coalition (NARC), scored a landslide victory of 62,2%. The new president, Mwai Kibaki, declared the fight against the widespread corruption as well as reforms of the economic and educational sector to be the top priorities of his government. However, so far, the abolishment of primary school fees remains the only big electoral promise that could be realised.

3.2 Rusinga Island

Rusinga Island is situated in Mbita Division, Suba District, South Nyanza Province about 80 km southwest of Kisumu, the biggest city in Western Kenya. In 1983, the island at the mouth

23 of the Winam Gulf was connected to the mainland via a causeway so that today, Rusinga is strictly speaking a peninsula5.

Map 2: Rusinga Island. Source: Unknown.

Rusinga is of volcanic origin and the central parts are very hilly rising up to more than 1400 m (the level of Lake Victoria is at 1134 m). With 44,1 km² and 17629 inhabitants (according to the 1999 population census), the population density of 400 persons/km² is extremely high considering that there are only some fishing villages and a large proportion of the population live as subsistence farmers. Moreover, less than half of the total area can be used for agriculture because some parts of the island are very steep and unsuitable for cultivation while 6 others are used for roads, homesteads etc. (compare JÄTZOLD) . According to the classification used by JÄTZOLD, Rusinga lies in the “Lower Midland Livestock-Millet Zone with a (weak) short to medium cropping season and intermediate rains” (ibid., 134, 140). On average, there is annual rainfall of 800 to 1000 mm, which is distributed unequally over the year, with a main rainy season from March through May and a shorter second rainy season: “The second

5 In the following, I will nevertheless refer to ‘Rusinga Island’ as this is the name used in the literature as well as on maps. 6 In 1979, about 56% of the total area of Rusinga could be used for agriculture. However, the population density has risen considerably since then and erosion has progressed so that it can be assumed that today, a much lower percentage of the area is arable. 24 rains are feeble near the lake. They start in November and are too short for growing crops” (ibid., 128). Evaporation is high and the soils, developed on undifferentiated Tertiary volcanic rocks, and on colluvium from volcanic rocks are of low to very low fertility. These natural factors limit the agricultural potential of Rusinga. In fact, the area around Mbita has been called ”one of the driest and most environmentally marginal agricultural zones in the region”

(CONELLY (1994), 148). While from 1908 up to the 1920s there had been a drastic decline in the population of Rusinga due to a sleeping sickness epidemic, the number of people living on the island has steadily increased since.

Year Population size Density (per km²)

1907 3100 70 1910 2520 57 1923 2600 59 1948 3740 85 1979 9905 225 1999 17629 400

Table 1: Population size and density on Rusinga Island. Based on CONELLY (1994) and CENTRAL

BUREAU OF STATISTICS.

Environmental problems related to the high density of population include soil erosion and degradation, overfishing, deforestation and the loss of original fauna and flora (compare

CONELLY (1994) and chapters 5.2.8 and 5.2.12). The inhabitants of Rusinga are Luo. The migration of this tribe from the region of the Nile in Sudan to the shores of Lake Victoria started in the 15th century. Although they were originally cattle herders, most of today’s Luo live off fishing and subsistence agriculture. In spite of appeals by politicians from different tribes to overcome tribalism, tribal identities have played an important role in Kenyan politics. Many Luo feel that so far, they have been rather poorly represented in the process of decision making which takes place in Nairobi. In fact, many of

25 the most prominent Luo politicians have been discriminated against7. Up to the present day, some political observers claim, Luo representatives are put at a disadvantage when it comes to the most powerful positions in the state8. This aspect of Kenyan politics has very concrete implications for the land of the Luo: While in some other parts of the country, concrete roads, electricity and safe drinking water have been provided (and in the home region of the former president Moi even an international airport (in Eldoret) was built), large parts of the Luo population, including the inhabitants of Rusinga, are still without any of these irrespective of the fact that the parts of the country where they live are particularly densely populated. Also, the medical infrastructure is rather poorly developed which is one of the reasons for the high prevalence of diseases.

4 Fieldwork and methods

Literature on issues related to life on Rusinga is scarce. Most publications are based on fieldwork carried out in the 1980s. In the meantime, however, there have been various changes which affect the lives of the whole population of the island. The first contact of the author with the malaria project on Rusinga Island was established in the course of a seminar offered by Prof. Dr. A. Drescher at the University of Freiburg. This connection led to the possibility to carry out fieldwork in Kenya from June to September 2003. The malaria project, which aims at easing the malaria-burden on Rusinga Island is run by inhabitants of the peninsula organised through the Christian Children’s Fund (CCF), an international non-governmental organisation focussing on orphans, and international scientists working at the International Centre for Insect Physiology and Ecology (ICIPE).

7 During the presidency of Kenyatta, Oginga Odinga, a very prominent Luo politician, had to leave the ruling party in 1966 after allegations of plotting against the government. Later on, he was jailed several times and prevented from entering into politics. In 1969, Tom Mboya, a Rusinga born Luo who was widely regarded as a possible future presidential candidate, was murdered by a Kikuyu gunman. 8 The most popular Luo politician of today, Raila Odinga, who played an important role in the NARC’s election victory and refrained from running for presidency himself in favour of Mwai Kibaki (a Kikuyu), is being denied the title of Prime Minister which had been promised to him before the elections. 26 4.1 The research area

The research area in the western part of Rusinga Island was chosen for different reasons. Kaknaga/Ufira Zone (KUZ) has one shoreline exposed to the open lake and one shoreline facing the mainland. This influences the waves and ultimately the mosquito breeding sites created along the shore. In contrast to other parts of Rusinga, almost the whole research area is accessible as there are no steep slopes and dense woods. In spite of its small size, KUZ combines many of the geographical features of Rusinga which could be relevant for mosquito breeding: Beside the shoreline, swampy, hilly, flat, eroded and both sparsely and densely settled areas can be found. About half of the population live in fishing centres (Kolunga, Litare and Gumba) while the other half live in houses spread dispersedly over the peninsula. In addition to these reasons for choosing KUZ as the research area, a very important factor was the fact of being able to work together with Dan Okombo, the chairman of the malaria project for KUZ. He was of invaluable help in various issues related to the fieldwork.

Map 3: Kaknaga/Ufira zone on Rusinga Island. Based on map 2. 27 4.2 The fieldwork

The first part of the fieldwork consisted of the mapping of potential mosquito breeding sites in the research area. The aim was to include all potential breeding sites, irrespective of whether they were waterfilled or dry at the time of mapping. The geographical positions of the sites were determined with the help of a global positioning system (GPS). For every site, various kinds of information, including the presence or absence of mosquito larvae, were gathered. The data were subsequently entered into MS Excel and later on processed using the programmes SPSS and ArcView.

In the second part of the fieldwork, 108 standardised interviews with participants living in the research area were carried out. For every household, the female head of household was interviewed. There were several reasons for choosing this target group: First, a woman and her children can be viewed as a minimal social group (compare CHAIKEN). Many women are married polygynously and there are varying degrees of support by the husband. What is more, a high percentage of the women interviewed are widows. Second, it is usually the mothers who first notice a disease in their children because they spend much more time with the children than fathers. Furthermore, women are generally considered to be more vulnerable than men (compare BLAIKIE ET AL.) The intention was to target poor households9 (with a special focus on women and children) from all parts of the research area. It proved more efficient and also more reliable to select the sample based on the knowledge of malaria project chairman Dan Okombo than on external indicators like the appearance of house and compound. During the time when the questionnaire was prepared and the interviews were carried out, the author spent 6 weeks living in the research area. Some of the questions in the questionnaire reflect insights gained during the participatory observation in this time. The questionnaire consisted of 41 open and closed questions10. Most interviews were carried out in the local language Dholuo and translated into English by a young woman from the area.

Qualitative data were categorised (compare MAYRING) and, together with the quantitative ones, analysed with SPSS.

9 For the reason that poor households can be assumed to be more vulnerable than wealthier ones (compare chapter 2.2.1) 10 Compare appendix 2. 28 In addition to the interviews with the female heads of household, several free expert interviews as well as semi-standardised interviews with shopkeepers on KUZ could be carried out. While not all of the data gathered in these interviews are presented in the following chapters, they all helped in developing an understanding of many of the various issues related to life on Rusinga.

4.3 Difficulties and problems

The preparation of field work in Western Kenya can be very time-consuming and difficult. Even those data which exist are often hard to find or lack important information. For instance, the source of the only detailed map of Rusinga Island (found in the library of the ICIPE) could not be determined. Moreover, in depth information on climate, soil and many other factors important for an analysis of the geographical context could neither be acquired at Mbita nor in the nearest bigger town, Homa Bay.

During the first part of the fieldwork, various difficulties occurred. Without a detailed map, it proved very difficult to cover the whole research area systematically and exhaustively particularly before the harvest when the high sorghum and maize plants obstructed the view. Only thanks to Dan Okombo’s excellent sense of orientation and profound knowledge of the area was it possible to map the potential breeding sites on all parts of the peninsula.

The second main part of the fieldwork was even more prone to difficulties. First, the representative sample can be queried due to the fact that it was based on a subjective assessment rather than on objective criteria. However, care was taken to carry out interviews in all parts of the research area. Second, there was the language barrier which had to be bridged with the help of a translator. The translation of the questionnaire into Dholuo was double-checked by several native speakers of the language. Nevertheless, it is possible that the meanings of some words differ from their English equivalents. Furthermore, it can be assumed that expectations, fears, hopes etc. of participants influenced the answers they gave. This bias could only to some extent be diminished by control questions.

29 These and other difficulties some of which are addressed in the following chapters limit the reliability of the information presented in this study. However, the author hopes that the tendencies shown can contribute to a better understanding of the livelihoods on Rusinga in general and linkages with the context of malaria in particular.

5 Livelihoods on Kaknaga/Ufira Zone

The main emphasis of this chapter will be put on assets on the one hand and hazards on the other hand. This is not to deny that the macro-context plays an important role for the livelihoods and the malaria situation on Rusinga. In fact, the transforming structures and processes directly and indirectly influence the livelihoods of households and individuals in a variety of ways. However, the focus of the fieldwork carried out was on the micro- rather than on the macro level.

5.1 Assets

5.1.1 Human capital

In the national population census of 1999, the Subdivision (the lowest administrative unit of the Kenyan administrative system) Kamasengre West on Rusinga, which is roughly identical with the research area, Kaknaga/Ufira Zone (KUZ) (based on the zoning system used by the malaria programme), had a population of 2492 and thus a density of 489 persons per square km. It can be assumed that both figures have risen in the meantime (compare table 1). The households of the participants of the interviews have an average of 5,14 members (ranging from 1 to 14 persons). The percentage of children up to the age of 15 is quite high (51,2%) whereas there are only few people who are more than 60 years old (4,1%). In particular the rather high proportion of children influences the mean dependency ratio11 which lies at 3,28 (ranging from 1 to 8).

11 Household members per breadwinner. 30 Access to education has improved after the fees for primary schools were abolished by the new government and today, most of the children visit primary school. However, there are still costs for school uniforms as well as books and other materials. The female heads of household interviewed spent an average of 5,42 years at school, 19,4% had visited no school while 3,7% had finished secondary school. The literacy rate among the participants is 65,7%12. This compares with a national average adult literacy rate of 83,3% (UNDP). The relatively low rate of literacy amongst the participants can be partly attributed to the fact that only women were interviewed. In male-dominated cultures like the one on Rusinga, females generally get less education than males. However, at least on the national level, gender differences in education seem to be less striking in Kenya than in most other African countries (compare UNDP). Out of the 555 persons living in the households of the participants, roughly 400 are going to or have gone to school.

300

252

200

100

81

33 0 22 Number of persons st fin st finished sec. leschool a a v r is r e ted p he ted sec. l u d n p k r. r nown s . ch sc s o h ch o o o l o o l l

Figure 2: Level of education of all household members (n = 555).

12 This percentage is based on the proxy indicator of having reached Standard 5 (the fifth year of school). For a discussion of the difficulties in measuring literacy see UNDP (2003), 194. 31 The low percentage of persons who could finish secondary school shows how difficult it is to attain this level of education due to high school fees. Many people have skills in farming as well as in fishing. Some run little businesses selling vegetables and items for the everyday use (such as soap, frying fat etc.) by the roadside. Several indicators suggest that the general health situation of the inhabitants of the research area is rather bad: According to a study commissioned by UNICEF, the prevalence of

HIV/AIDS in Suba District lies at 34%, the highest percentage nationwide (compare NESOBA). Another big health problem is malaria (compare chapter 6). The mortality of children under the age of 5 is extremely high in the region in general and on Rusinga in particular: According to CONELLY, "South Nyanza has … the highest incidence of child mortality in Kenya"

(CONELLY (1994), 151; compare also CHAIKEN). A study carried out in 1998 found that out of 10 children born on Rusinga, more than 6 died before reaching the age of five. This was “5 times higher than the national average of 119/1000” (KENTAI). The main disease and main killer in this age group, according to the same study, is malaria. Beside HIV/AIDS and malaria, bilharzia, sexually transmitted diseases, tuberculosis and various waterborne diseases are prevalent on Rusinga Island. The nutritional situation, too, is tense. More than a third of all participants mentioned hunger/famine as a problem on Rusinga (compare figure 8) and various studies carried out on the island suggest the same (compare CONELLY (1994), CONELLY AND CHAIKEN, CHAIKEN). Changing food patterns, in particular a reduced input of proteins, are due to various interconnected factors. A very important one is that there has been a drastic increase in population density which has lead to a decrease in livestock (compare chapter 5.1.5). Cow’s 13 blood and milk which had been sources of protein (compare CHAIKEN), are now very scarce . The usual diet consists of a kind of porridge (Uji) prepared with maize- or sorghum-flour which is sometimes sweetened with sugar and often eaten for breakfast and a mash of maize- or sorghum-flour (Ugali) eaten with vegetables (bean- or pumpkin leaves, cabbage) and sometimes fish. The cheapest source of protein is Omena, little sardine-like fish which are boiled or fried. Sometimes, Tilapia or Victoria perch (compare chapter 5.4) are eaten. There is no butcher on this part of the island and very little meat is consumed. "These foods provide a feeling of fullness, but the caloric content is low and the diet lacks variety, providing insufficient protein, vitamins, and minerals" (CHAIKEN, 241). Particularly children suffer from malnutrition which can have serious long-term impacts including stunting, restricted performance of fine motor functions and impaired cognitive development (compare CHAIKEN,

13 Today, the bleeding of cattle does not seem to be practiced any more. 32 CHAIKEN AND CONELLY, SACHS AND MALANEY, GREENWOOD AND MUTABINGWA). Several people from the research area independently of each other reported they had seen children eating soil. This behaviour can be interpreted as an instinct-driven attempt of getting some input of minerals (personal communication with doctors). However, the fact that the people can defy all the difficulties and challenges in the daily life on Rusinga and make a living in KUZ shows an extraordinary strength and dedication which represent a kind of human capital not to be underestimated.

5.1.2 Natural capital

Because of the extremely high density of population on KUZ, land for settling and agriculture is very scarce. The situation is further complicated by the fact that in some parts of the peninsula, massive soil erosion has left parts of the area covered with barren rocks (compare photo 1)14. What is more, even the soils that are not eroded are not very fertile (compare

JÄTZOLD, CONELLY (1994)) and, consequently, the yields are rather poor. The climatic conditions, too, make farming difficult (compare chapter 3.2): After the dry season, it requires strenuous, time-consuming work to dig the fields dried out and baked hard by the sun. Most farmers can afford neither plough nor team and have to dig the soil using a hoe as the only tool. In contrast to some other parts of Kenya, the pattern of precipitation allows only one harvest per year. There are no permanent streams and thus only very limited possibilities for irrigating fields in the dry season. The only fields and gardens that can be irrigated throughout the year are the ones along the lakeshore. These, however are exposed to intruding hippos, a threat taken very seriously (compare chapter 5.2.5). Wood has become a scarce resource on Rusinga and the need for fuel has forced some people to purchase charcoal from the neighbouring Mfangano Island (compare CONELLY (1994)) and even Uganda. For most cooking, however, thin sticks from fast growing hedges that separate many compounds are sufficient (because people use thin aluminium pots which conduct heat very well). Many households have some bigger trees on their compounds which are not used for firewood but for building fences or houses. Other local materials that are required for building houses are soil mixed with water for the walls and cow dung for smearing walls and floor. Today, thatch grass for roofs has to be imported from other regions and has thus become expensive compared to corrugated iron sheets (compare chapter 5.1.5). On some parts

14 For a discussion of the causes that have led to the considerable extent of soil erosion on Rusinga Island see Conelly (1994). 33 of Rusinga (though not in KUZ), trees and hedges with long thorns suitable for fencing can be found. However, this material is scarce and very difficult to transport. Also, it is usually not sufficient to offer a good protection against hippos. The Lake Victoria plays a very important role in the life of the people. This is reflected in the answers to the question about factors that make life on Rusinga good. All factors which received 20 or more mentions are more or less directly linked to the lake.

50

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0 Number of mentions h water foo income/bufar fi s la other no mention ome/family shi up k mi e d n por n g s g t fr om othe siness

rs

Figure 3: Aspects of the life on Rusinga appreciated by the participants (n = 108, several answers possible).

In periods without rain, the only source of drinking water is the lake. Some people boil this water or treat it with chemicals available in some of the local shops in order to reduce the risk of waterborne diseases. Besides serving as drinking and cooking water, lakewater is also used to wash the body, clothes, dishes etc. as well as for irrigating lakeshore- and house gardens and watering livestock. A second aspect of the lake is fish (compare chapter 5.4). Fishing is the single most important source of food and income for the households of the participants (compare figure 9). Both men (fishing with hooks, floating nets, Omena nets and pulling nets) and women (drying and selling Omena, pulling nets) can find some kind of work fishing, processing and selling fish. For some, particularly in the fishing villages, fish is the only source of food and income while

34 the majority of households have other sources beside fish. Some jobs like pulling nets can be carried out by men and women, young and old and represent a way of getting at least some little income and food. The pay relies on the catch so if the catch is bad there is little or no money. Thus, earnings are very unpredictable and can range from nothing at all to 1$ (very rarely more than that) for a day of strenuous work. Often, pullers (Ochorros) receive pay in the range of 30 US cents and some fish which can serve as a supplement to the usual diet. Omena is an important part of the local diet and can be bought very cheaply in the fishing centres. Some sources of protein which were used in former times can not be used any more (compare previous chapter) leaving Omena as a very important component in the typical diet of the people (compare CHAIKEN). A third aspect of the lake as an asset is the role it plays for transport. During the rainy season muddy roads can leave traffic by boat as the only option. Even during the dry season, travelling and transporting heavy loads by boat is cheaper than by other means of transport. Transport on the lake can, however, be brought to a virtual standstill by dense floating carpets of water hyacinths (compare chapter 5.2.10).

Rusinga has a good potential for regenerative energies (compare MATTHEWS). Beside solar power, which some people are already using for lighting, radio and television, wind is a resource which is hardly used so far. The very reliable wind system on the island (ibid.) could not only be used to generate electricity but also to pump water up from the lake, for example for the purpose of irrigating fields. However, measures like this require know-how and a relatively high input of money and technology.

5.1.3 Social capital

Social capital is a very important asset for the people of KUZ. Of course, there are differences in the social capital of those who have been living there for a long time and those who immigrated rather recently because the building of social networks requires time. Another precondition is mutual trust. In the absence of institutions that care for the respecting of contracts and the protection of the weak, a lack of mutual trust is the reason why many projects are not carried out or fail. An example for this is the many old fishing boats lying at the lakeshore and deteriorating because the owners do not have the money to repair them. On the one hand, there is a high demand for boats and people who would be willing to finance repair works if they could then use the boat for some time. On the other hand, the lack of trust on both sides often prevents such forms of investment: There is neither the security for the

35 boat owner of getting the boat back after the agreed period nor the security for the investor that the boat owner will keep his part of the agreement after the repair work has been carried out. In cases of disagreement, it is usually the weak that lose out. Support in cases of emergency is a very widespread form of social capital for the participants (compare chapter 6.3.2). Much of the debts that people have are a result of crisis situations such as cases of malaria. The high rates of indebtedness (compare next chapter) are evidence for social networks. 26% of the participants said they received more or less regular support from people living outside the household, almost exclusively family members. Indeed, the extended family plays a very important role on Rusinga and there is a complex net of familiar relationships in which most of the inhabitants are embedded. The minimal units in this network are the mother with her children (compare CHAIKEN and chapter 4.2). 57% of all participants did not mention a husband as contributing to the household. One of the reasons for this is the very high percentage of widows15.

single 1

widowed married

52 55

Figure 4: Marital status of participants (n = 108).

15 As poor households were targeted for the interviews, it is not certain in how far these data are representative of the situation of the whole population. However, there can be no doubt about the fact that many women on Rusinga Island are widowed. 36 Two things are striking about the data presented in this graph. The first is the extremely high percentage of widows. While the fact that poor households were targeted for the interviews has to be kept in mind (the households of widows are usually poorer than those of married women), this alone does not explain why almost half of the women interviewed have lost their husbands. Not only the figures presented by UNICEF (compare chapter 5.2.1) but also the widespread fear of AIDS (compare figure 13) implies that this disease is the main reason for the deaths of so many husbands. The second point to note about the marital status of the participants is the fact that only one woman said she was single. The reason for that is that unmarried women usually live in the households of their parents. Also, most girls marry at a very young age. Even those women who are married can not always rely on contributions by their husbands. Many women are married polygynously and while some have to share the husbands with the households of the co-wives, others get no support from their husbands at all. Beside the social networks based on family relationships, there are some more or less formal groups in which more than a third of the participants are organised.

other group/org

6,5%

fisher's group 3,7%

women's group

23,1%

no group

62,0% CCF 4,6%

Figure 5: Group membership of the participants (n = 108).

Often, women who were born in the same area (and moved to Rusinga after marrying a man from there) are organised in self-help women groups. These represent a form of organisation 37 between groups based on family relationships and groups based purely on common interests. The CCF is the biggest NGO active in KUZ. Activities do not only include the support of orphans but also common gardening projects, educational campaigns etc.. Smaller community based organisations (CBOs) often consist of 5 to 10 members and are rather loosely organized. The situation in the research area reflects the increasing awareness of the need to get organised in order to take care of one’s own their interests can be seen at the increasing level of organisation in various spheres of life on Rusinga, e.g. organisations based on occupation groups: Bicycle taxi (Bodaboda) drivers, bicycle transporters of fish (Agents), boat and net owners in Omena and Victoria perch fishing etc.. An example for a big organisational challenge is the task of raising money for an ice factory to be built in Mbita to create the possibility of storing fish and thus reduce the dependency on the exporters of the Victoria perch. There is a very broad range of degrees to which these groups are institutionalised. The possibilities of political participation are limited. There are elections for local administrative posts such as the one of the Chief, Subchief or Councilor. However, many people on Rusinga reported that they did not expect much in terms of development from these bodies because of high levels of corruption. The same is true for positions like the one of the Beach Leader, who is responsible for matters related to fishing. These include (in theory) assigning times for bringing out Mbota nets to the different boat owners, administrating fees which the boat owners have to pay and organising development activities for the fishing centres, for instance the construction of storage facilities for fish.

5.1.4 Financial capital

With a gradual shift from subsistence agriculture to a more market-oriented economy

(compare CONELLY (1994), chapter 5.3), financial capital plays an increasingly important role. All households on Rusinga, even the ones living off subsistence agriculture, need some money to purchase goods like salt, sugar, cooking utensils, clothes, medicines etc.. While only a small percentage of the participants said they had savings, more than half of the households have debts.

38 % of participants Average for Sum in KSh who have total sample in savings/debts KSh16 (n=108) savings 10,2 502 54200 debts 52,8 985 106400

Table 2: Savings and debts of the participants (n = 108).

It is very difficult to save money on Rusinga in general and in the research area in particular: People who manage to accumulate some savings are often expected to use these to support family members, neighbours and others in emergency situations, for instance cases of illness. Taking the health situation on Rusinga into account, it is obvious that there is always somebody who is in need of financial support to cover medical costs. While the strong social ties are a very important form of insurance and reduce vulnerability, they also mean that people have difficulties saving money. What is more, they can lose interest in saving at all or try to hide savings. Some participants of free interviews stated that there are young people who run away from home and hide in places where nobody knows them to escape this tight social net. Most interviewees who said they had savings kept them at their houses, only three had money on bank accounts. In fact, there are no formal saving schemes or institutions on this part of Rusinga and only a few in Mbita (which are often unattractive for small scale savers because of high fees, travel costs and other obstacles). For these and other reasons, most people prefer to invest in livestock instead of saving money. The restricted access to financial institutions also means that there are very limited possibilities to get formal credit. Many people borrow money from shopkeepers, neighbours, Omena sellers etc.. However, as most of the money- lenders are poor themselves, the amounts of money that can be lent are generally low. A local form of revolving credit scheme are harambee groups of women who meet at the house of a different member each time and donate some money. The sum of the contributions can make small investments possible, which would otherwise be unaffordable for them because of the difficulties of saving money. About 26% of the participants said they received financial contributions from persons outside their households, mostly family members (compare last chapter). It could not be determined how many of these contributions are made on a regular basis, though.

16 KSh refers to Kenyan Shillings. In mid 2003, the exchange rate for one US$ was roughly 75 KSh. 39 On Rusinga, livestock are probably the most common investment. In a study based on fieldwork carried out in 1985, CONELLY comments that ”the average herd size on Rusinga is only about seven animals [i.e. cattle] per household” (CONELLY (1988), 131). In 2003, however, only three out of 108 households had more than six pieces of cattle. The amount of livestock in the households has gone down due to several factors most importantly the scarcity of land.

500

400

300

200

100

0 Sum Cattle Chickens Pigs Goats Ducks Sheep

Figure 6: Livestock owned by the participants (n = 108, several answers possible).

This trend has implications for the local diet, in particular the supply of protein (compare

CHAIKEN, chapter 5.1.1). Some money can be made by selling animal products like milk or eggs. Yet, there are some disadvantages of livestock as a form of capital investment. In times when many people need cash, for instance before the harvest when most households have to buy food or when school fees (for secondary schools) are due, the prices for livestock go down as many people try to sell their goats or cows. Also, there is always the risk of livestock dying from diseases and the fact that livestock can become a burden for the farmers as pointed out in chapter 5.2.6.

40 5.1.5 Physical capital

Generally, the households of the participants own only few producer goods beside household items and basic farming tools (hoes, machetes). Land and houses are the most valuable belongings of most households and only very few have boats and nets for fishing. Almost all other valuables which were mentioned are of a productive nature, too (fishing hooks, pressure lamps used for Omena fishing, sewing machines or small restaurants). About half of the households own a radio and one household was in possession of a television powered by a solar panel and a car battery.

200

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0 Sum Houses Plots Boa Net B Rad Ot icycl h ts s io er valua e s s

b le s

Figure 7: Valuable belongings of the participants (n = 108, several answers possible).

Most houses in KUZ are made out of mud smeared with a mix of mud and dung. Only about 5% have concrete floors and/or walls. Corrugated iron sheets are the most common material for roofs (89%) as the material for thatched roofs (11%) is more expensive. Moreover, it does not last as long as iron sheets. Advantages of thatched roofs are that heavy rain does not produce noise like on iron sheets and the material insulates far better so the house does not heat up in the sun. On the other hand, insects and other unwanted animals can lodge in these roofs. In the mid 1980s, CHAIKEN found that “only about 20 percent of the households have a corrugated metal roof, and only 4 percent have cement walls” (CHAIKEN, 238). The change to corrugated iron roofs can be at least partly explained by the increase in population which led

41 to the thatch grass being used up close to Rusinga so that nowadays, the material has to be imported from other regions at the lake. As it is rather bulky, the transport costs are relatively high. Another reason is an improvement in the transport situation since the 1980s which has led to lower prices for iron sheets. 76,9% of the participants said they were living in their own house. In the fishing centres (Kolunga, Gumba and Litare), most people live in rented accommodation. The rent for a small one-room-house is typically between 300 and 500 KSh per month. In terms of infrastructure, KUZ is rather poorly developed. Only two mud roads are wide enough for vehicles. In late 2003, two Matatus (minibuses) per day connected Kolunga with Mbita via a roughly 10km long mud road. On market days there were several engine boats running between Kolunga and Mbita. Bicycle taxies, called Bodaboda are easy to find in Mbita and more difficult in Kolunga (usually only after they have brought someone to Kolunga). Their fare depends on the condition of the road and ranges between 80 and 150 KSh per person to go from Kolunga to Mbita or vice versa. Those who own bicycles (28% of the participating households) can cover the distance between Kolunga and Mbita in something between less than one hour and more than two hours (depending on the condition of the road). Others, who do not have a bicycle can take a shortcut through the interior of the island and reach Mbita in 1 ½ to 2 hours on foot. Mbita is connected to Homa Bay and other parts of the country by several Matatus per day as well as by small engine boats (also several per day) and a bigger ferry (not every day). Difficulties for transportation can arise when water hyacinths cover the surface of the lake (compare chapter 5.2.10) and when the roads are very muddy after heavy rains and Matatus can get stuck or even turn over. Access to printed information is limited due to the high costs of transportation. No newspapers were sold in the research area in late 2003 and there are very few television sets (one in the 108 households of the participants). However, roughly half of the participating households own battery-powered radios which are one of the most important sources of information (compare figure 19). In late 2003, there were around 20 small shops in the research area 11 of which were selling drugs. One is a specialised chemist’s run by a trained nurse. Beside everyday household goods and food, the shops sell items used for fishing such as hooks, material for repairing nets, floaters, pressure lamps etc.. There is no hospital or health centre in the research area (apart from the chemist’s) but there are one public and one private health centre within walking distance of Kolunga.

42 As mentioned in chapter 5.1.2, wood is the main source of energy in KUZ. Besides, many households have kerosene-powered lamps. Even though there is a good potential for regenerative energies (compare chapter 5.1.2), it is doubtful if a larger part of the population will get access to electricity in the near future. Likewise, there is no infrastructure to provide safe drinking water but it is up to the individual households to treat or boil the water from the lake and to collect rain water.

43 5.1.6 Livelihood assets, three examples

Some important components of the asset status of households on KUZ can be illustrated with three randomly chosen examples. Household A Household B Household C Average sample

Age (years) 30 73 29 39,3 Marital status married widowed married 50,9% married 48,1% widowed 0,9% single Years at school 7 0 8 5,4 Household size 6 5 5 5,1 (persons) Sources of Fishing, Farming, Fishing, 55,6% fishing food/income farming, Support from son Selling Omena 81,5% farming selling Omena 45,4% selling Omena 48,1% others Most important fishing Support from son fishing 40,7 % fishing source of 20,4% farming food/income 17,6% selling Omena 21,3% others Outside no yes no 26,9% yes contributions 73,1% no Livestock 3 cattle, 4 goats 1 chicken 1 cattle 6 goats 2 goats 4 chickens 0,5 others Valuable 2 houses 1 house 1 house 1,4 houses belongings 2 plots 1 plot 1 plot 1,4 plots 1 bicycle 0,1 boats 1 radio 0,2 nets 0,3 bicycles 0,6 radios 0,2 others Savings (KSh) 0 0 0 502 Debts (KSh) 500 0 1000 985 Group member no no no 38% yes 62% no

Table 3: Examples for assets of the participants’ households.

5.2 Hazard context

There is agreement among the participants of the interviews and outside observers on the fact that there is a rather wide range of hazards on Rusinga. However, some of the hazards mentioned by the interviewees do not appear in the literature on Rusinga while others which 44 are emphasised by outside observers are not reflected in the answers given by the participants. Likewise, there are differences in the evaluation of the risks by these two groups17 (compare figure 13). In the following, the most important of the various hazards are described. A further discussion of one of them, malaria, will be the topic of chapter 6.

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0 Number of mentions AIDSc di d depe drowningdroughtfaminemalariaother namedpr wi dis others ri s ang o tchc me/vi e stitution as erou nd on fis es r ol aft e s nc animals e hi n e g as es

Figure 8: Hazards mentioned by the participants (n = 108, several answers possible).

Diseases are by far the threat mentioned most often by the participants.

5.2.1 HIV/AIDS

HIV/AIDS is very widespread in the region. According to a study on the situation of young people in Kenya commissioned by UNICEF, 34% of the population of Suba District are infected with the virus (compare NESOBA). This is the highest percentage of all Kenyan districts where the study was carried out. Even though one has to be careful not to over- interpret figures like these because of the difficulties in gathering the data on which the percentages are based, it can be assumed that there is an alarmingly high level of HIV/AIDS

17 The two groups mentioned are constructs and must not be understood to be homogenous units. 45 on Rusinga Island. There are several local NGOs working on strategies to prevent the spread of the virus on Rusinga. However, various factors make this fight difficult: The high mobility of some parts of the population, especially Omena fishermen (Jabila) who often come from other parts of the country and move from fishing village to fishing village is a factor to be taken into account. Jabila are employed on a short-term basis and if they do not find work in one fishing village, they are forced to move on to another. Yet, Jabila can move to other fishing centres out of their own free will if they expect better catches, and thus earnings, there. On the one hand, they can earn a lot for local standards (5$ and more in one night) but on the other hand, it is difficult for them to save the money having no safe place where to keep it (they usually share one room with three other Jabila). The question if they do not save because they do not want to or because they lack possibilities for it will not be addressed here. The fact is that many of them spend the money they earn immediately. As they do not have to provide for their own shelter and food (which are provided by the boat owners who employ them), many Jabila spend their money on Changa, a locally produced alcoholic drink, and prostitutes. According to oral reports, they are often reluctant to use condoms (personal communication with inhabitants of the area). Other highly mobile groups include the Omena traders who purchase the dried Omena from the local women and transport it to other parts of the country. Prostitution: Beside prostitutes who moved to the fishing centres to carry out their business there, many local women are forced into prostitution. The very high percentage of widows (see figure 4) is an important factor which has to be considered here. The widows who are not ‘inherited’ by relatives of their deceased husbands (see below) are often forced into prostitution in order to provide for themselves and their families because they lack other income earning possibilities. It can be assumed that in many cases, their husbands have died from AIDS so many widows are also HIV positive when they become prostitutes thus further spreading the virus. Widow inheritance: Traditionally, the Luo of Rusinga practice widow-inheritance which means that the brother of the deceased man takes the widow as his wife. As mentioned above, the chances are that many widows are HIV positive and so they can pass the virus on to their inheritor who in turn can infect his other wives. The fear of AIDS has led many men to refuse to inherit the wives of their deceased brothers. These are then often left without alternatives to prostitution.

46 These and other reasons18 have contributed to a very high rate of HIV positive persons in this part of Kenya. Ultimately, the root causes of the high rate of HIV/AIDS are to be sought in economic reasons. While the awareness and fear of HIV/AIDS are very high among the participants of the interviews (compare figure 13), several factors complicate the fight against the disease: The stigma attached to carrying the virus leads to a reluctance of many people to face and openly discuss the disease and its causes. As a result, the deaths of many young persons are attributed to other, less stigmatised diseases like tuberculosis, malaria or Chiera (see below) rather than openly mentioning AIDS as a possible reason of death. This, in turn, can lead to the distortion of the perception of the actual high prevalence and risk of HIV/AIDS in the region. Chiera: Often, cases in which persons die after suffering for a long time are attributed to a disease called Chiera. The symptoms of the disease, including gradual physical decline, weight loss and ultimately death, strikingly resemble those of AIDS. The reason for getting Chiera is “breaking of Luo traditions” (personal communication with several persons from the research area). Thus, inhabitants of the research area can get into situations where they have to weigh the risk of AIDS against the risk of Chiera if, for instance, a man has to decide whether or not to inherit the widow of his deceased brother. The fear of Chiera and the repression of the threat of an infection with HIV can thus make people rather take the risk of the latter.

5.2.2 Malaria

Malaria is very common on Rusinga Island. Particularly children are at risk and the disease is one of the main killers of under-5-year-olds. A detailed discussion of malaria and its impacts on the life on Rusinga will be the topic of chapter 6.

5.2.3 Other diseases

As many households in the research area do not have a pit latrine, the situation concerning sanitation is bad. Waterborne gastrointestinal parasites are widespread and many people suffer from diarrhoeal diseases. Another waterborne disease which is highly prevalent in the area is

18 For a detailed discussion about condom use and other issues related to HIV/AIDS amongst young Luo in Tanzania see Dilger (2003). 47 schistosomiasis (bilharzia). The pathogen, a parasitic worm that has a snail as its intermediate host, can enter the human body through the skin when the person has contact with lake water.

Beside malaria, the main causes of deaths in young children, according to KENTAI’s study on

Rusinga, are diarrhoea and vomiting, fever and measles (compare KENTAI). Sleeping sickness (trypanosomiasis), which caused the population decline on the island in the early 20th century (compare chapter 3.2) is not a problem any more on Rusinga.

5.2.4 Witchcraft

Witchcraft (Juog) is taken very seriously by many people in the research area. Only two interviewees said they did not believe in witchcraft. Participants of several free interviews agreed on the following statements: One form of witchcraft is Nightrunners. These are persons, who, after the consumption of drugs, stay outside naked during the night and try to harm other people. While most of the time, they just create fear in their victims, they can also kill persons by strangling them in their sleep and destroy crops with the help of tamed hippos. Nightrunners can also tame other wild animals like crocodiles. During the day, they act like normal people. Sihoho is usually carried out by women and is said to be the most dangerous type of witchcraft. When such a woman (Jasihoho) looks at somebody’s food, the food turns bad inside the stomach of the victim who develops strong stomach aches and can, if not treated by a specialist, die a painful death. Witchcraft can also involve the stealing and bewitching of items belonging to the victims, burying bewitched objects in their compound or placing a bewitched object (often a dead animal or parts of it) in a place where the victim is expected to pass by. Several diseases are said to be caused by witchcraft. While the symptoms often resemble those of “normal” diseases like AIDS or malaria, diseases that are caused by witchcraft can not be identified and treated in conventional hospitals but only by healers specialised in treating witchcraft. One factor that makes many people very afraid of witchcraft is that it is all but impossible to protect against it. The only motivation for the witches being malice, everybody can become the victim of witchcraft and nobody is safe. However, many persons feel that those who are successful may raise envy and thus become preferred targets for witches. This perception can lead to the decision not to expose oneself through “suspicious” activities and investments.

48 5.2.5 Dangerous animals

While crocodiles can be found in many parts of Lake Victoria and even only a few km away from the research area, there were no reports about sightings of crocodiles there. However, snakes and scorpions seem to be common. The animals feared most, though, are hippos

(compare CONELLY (1994)). Beside the danger posed by them attacking people, hippos can create havoc in lakeshore gardens and fields eating and trampling crops. Some men sleep in small huts in their gardens to scare hippos away because it is very time-consuming and expensive to build a fence strong enough to keep hippos off. However, this is not only very unpleasant but also dangerous and thus hardly practiced any more. So big is the fear of hippos that it prevents many people from making use of their land along the lakeshore and cultivating a garden on this potentially fertile ground. Since the times of British colonial rule, it is illegal to kill hippos pre-emptively (compare CONELLY (1994)). As mentioned above, hippo intrusion in a garden or field is sometimes attributed to witchcraft.

5.2.6 Free roaming livestock

During the farming season, cattle and goats are kept on the compounds of the owners. After the harvest, they are released and roam freely all over Rusinga. The reason for this is that in the dry season, the goats and cattle cannot find enough plants to feed on in the compounds. In spite of the fact that the dung they leave behind is appreciated as fertilizer, many people feel that free roaming livestock are a problem. Feeding on everything they can find, the animals do not stop at plants in house gardens, small trees etc. thus destroying many plants and forcing people to abandon efforts of cultivating a garden in the dry season because fencing material is expensive and scarce. On some parts of Rusinga, there are attempts to stop people from releasing their goats and cattle after the harvest but in KUZ, no such measures have been taken so far.

49 5.2.7 Drought

Considering the heavy reliance on farming by many persons in the research area and the fact that artificial irrigation plays only a minor role19, drought is a very serious threat on Rusinga. While generally, the yearly precipitation follows a pattern of one long and one short rainy season with dry seasons in between, there can be considerable variation in factors like the onset or the amount of rain during the rainy season. For farming, the long rainy season is important as this is the time when the harvest for the whole year is produced. If the amount of rain, particularly at the time when the seedlings are still young, is not sufficient, the harvest will be bad and there will be less food for the household. Another result of little rain is that people have to use lake water as drinking water and thus are more vulnerable to water-borne diseases.

5.2.8 Population growth

The trend of a rapidly growing population and a resulting higher density of population has been addressed in chapter 3.2. The implications of this trend are manifold. Land for settling but particularly for farming is becoming an increasingly scarce resource. For newcomers, this means that they can hardly acquire ground on the island and have to rent houses. The lack of arable land is one of the reasons why most households experience a hungry season before the harvest (compare chapter 6.5.4). Cattle holding, too, has been reduced due to a shortage of land (compare chapter 5.1.5). Conflicts about land ownership lead to desperation amongst those who can not prevail: The only two participants who said that they did not like to live on Rusinga stated that the reason for this was that they were cheated out of their land by family members. Another effect of an increased population is the growing need for fuel. The trend has already lead to the deforestation of most of the trees on Rusinga Island, resulting soil erosion

(compare CONELLY (1994)) and thus a depletion of the natural resource base. The health situation also deteriorates as crowded conditions lead to an increase in diseases that are a result of unhygienic conditions. In Kolunga, for instance, there are only very few toilets for more than 1000 persons.

19 Some gardens close to the lakeshore are irrigated with buckets and there are very few manual and generator- powered pumps but no major system of irrigation channels or permanents streams that could be used for agriculture. 50 5.2.9 Malnutrition and famine

Malnutrition and famine are amongst the biggest concerns of the participants (compare figure 8). They can be caused by a variety of factors including shocks (e.g. diseases in breadwinners) as well as trends (decline of agriculture (compare CONELLY (1994))) and seasonalities (hungry season before the harvest when the households run out of stored food from the last harvest). The effects of wrong- and malnutrition are manifold and range from weakness and inability to work to higher vulnerability to diseases and impaired cognitive development in children (compare chapter 5.1.2). The whole issue is a central problem and linked to most, if not all, other components of the livelihood framework in some way or other.

5.2.10 Newly introduced species

Newly introduced species are one of the factors that have lead to environmental degradation by causing the loss of a great part of the original animal and plant life. The two most well- known examples are water hyacinths and Victoria perch. “Water hyacinth (Eichhornia crassipes), which originates from South America, was believed to have been brought to the region by Belgian colonialists as ornamental pond plants”

(MATTHEWS). The plant has spread very quickly and can bring transport on the lake to a virtual standstill by clogging waterways (compare photo 2). In the mid 1990s, Kisumu was virtually cut off from traffic on the lake because of water hyacinths (compare EARTH CRASH). Many local people said they feared crocodiles and snakes hidden between the plants. Besides, fishing with nets becomes impossible when there are a lot of water hyacinths on the surface of the water. There have been various efforts to control the spread of the plants but there are doubts about whether the successes achieved will be long-lasting. Another newly introduced species is the Nile perch (Lates niloticus) (often called Victoria perch). As mentioned earlier, Victoria perch is today one of the most important exports of the region and many households depend on it for making a living. However, there is also another side to the coin. The fish, first introduced to Lake Victoria by British colonial officials in the

1950s (compare THE AMERICAN MUSEUM OF NATURAL HISTORY, TED CASE STUDIES) has flourished there and, feeding on other fishes, contributed to the loss of many species in the lake. This has disrupted the ecological balance with results like algal blooms choking the lake

(compare THE AMERICAN MUSEUM OF NATURAL HISTORY).

51 It is not uncommon that Victoria perches weigh 100kg and more20. Obviously, big specimen like this can not be caught with the means suitable for Tilapia and other smaller fishes. While those who have capital to invest can make much money with Victoria perch many small scale fishermen have suffered from the fact that there has been a decline in the populations of other species of fish which they traditionally relied on (compare TED CASE STUDIES). The specialisation of large parts of the fishing industry and heavy reliance on Victoria perch may have made people vulnerable to a decline of this species:

The Nile perch may have caused its own doom: having eaten its way through all potential cichlid prey, it must now rely on a single species of small freshwater shrimp. How long will the shrimp hold out? No one knows. The fate of Lake Victoria, and with it the livelihood of the human populations that depend on it, hangs in the balance. (THE AMERICAN MUSEUM OF NATURAL HISTORY)

5.2.11 Declining catches and the fishing ban

Overfishing, too could lead to a drastic decline in the population of Victoria perch in the lake. Fishermen from Uta Beach in KUZ reported that today nets have to be brought out very far in the lake and pulled back for 6 to 7 hours while some years back, the same results could be achieved in half the time. Also, some people illegally use nets with meshes smaller than they are allowed to according to the regulations (compare EARTH CRASH). Authorities like the Ministry of Fisheries, which has an office in Mbita, are trying to counter the trend of declining populations of fish with measures like a ban on Omena fishing during the time of the main rains. However, the ban, intended to prevent young Victoria perch, tilapia etc. from being caught in the small-meshed Omena nets, is considered to be another seasonally occurring hazard to people’s livelihoods as it coincides with the hungry season when people need the cheap source of protein Omena most (compare chapter 6.5.4). Beside a reduction in the number of Victoria perches, the decline in catches around Rusinga Island could have to do with a change in migratory routes of fish after the construction of the causeway. This obstacle, which many people demand to be replaced by a bridge, “has interfered with the flow of oxygen and fish movement” (OYWA).

20 Even though a decrease in the average weight of Victoria perch has been observed by scientists (compare Earth Crash (2002)). 52 5.2.12 Soil erosion

Soil erosion is another aspect of environmental degradation which has been the subject of research. It is linked to trends like deforestation and the decline of agriculture: After the loss of much of the natural vegetation cover on Rusinga Island due to the need for arable land and wood of a growing population, stone terraces were used to protect the soil from being washed away during the rainy seasons. In the last decades, though, the trend of more and more men working in the fish business has led to a shortage of (male) labour in agriculture. One of the consequences has been that repairs of terraces, a work traditionally carried out by men, could no longer be carried out. Remains of old terraces can still be seen on many slopes on Rusinga (compare photo 3) but the soil has been eroded to varying degrees leaving slopes unsuitable for agriculture (compare photo 4)21.

5.2.13 Agricultural pests

Striga (Striga hermonthica), stem borers (mainly Busseola fausca and Chilo partellus) and other agricultural pests pose a difficulty for many farmers and can lead to considerable losses in yields. The issue was already mentioned by colonial officials in the 1930s but in spite of efforts to get the problem under control, agricultural pests continue to be a seasonally occurring hazard which many farmers (most of whom cannot afford to buy pesticides) feel rather helpless against (compare CONELLY (1988)). Striga (compare photo 5), a parasitic weed attacking the roots of sorghum and maize common throughout much of semiarid Africa, can cause losses of up to 70% (compare CONELLY (1988)).

Striga thrives in environments with low soil fertility and unreliable rainfall, as on Rusinga Island, and thus most seriously affects poor farmers living on marginal agricultural land who can least afford to implement control measures. (Ibid., 125)

Strategies to get the spread of striga under control include the use of manure in parts of the fields which are particularly heavily infested with the weed. However, manure has become a scarce resource after the decline of cattle farming on Rusinga (compare chapter 5.1.5). Stem borers, the larvae of a moth, are one of the insect pests prevalent on Rusinga.

21 For a more detailed discussion of the decline of agriculture on Rusinga Island and its consequences on soil erosion compare Conelly (1994). 53 Initial damage by stem borers occurs when the young larvae begin to feed on the leaves. More mature larvae bore into the developing stem, causing damage by extensive tunnelling. In severe cases of infestation, plant growth is stunted and grain production may be reduced significantly. (CONELLY (1988), 124p)

Like in the case of striga, a variety of possible methods to control stem borers exist yet various constraints have limited their success (compare CONELLY (1988)).

5.2.14 A classification of hazards in the research area

Of course, this is not an exhaustive list of all hazards to livelihoods in the research area but it includes the main ones that were mentioned in the interviews and discussed in the recent literature on Rusinga Island that could be found by the author. These hazards can be classified into trends, shocks and seasonalities22:

Classification of Hazard Risk mentioned by participants hazard (P), outsiders (O) or both (PO) trends Population growth O Scarcity of land O Decline in fish populations O Soil erosion O Deforestation PO Decline of agriculture O Loss of species O Deteriorating nutritional situation PO Spread of newly introduced species O Shocks HIV/AIDS PO Malaria PO Other diseases PO Wild animals PO Witchcraft P Seasonalities Fishing ban P Pests in agriculture PO Free roaming livestock P famine PO

Table 4: Classified hazards mentioned by participants and outsiders.

22 Not all of the hazards can be classified unambiguously. Malaria, for instance can both be considered to be a shock and a seasonality. 54 It is striking that while the participants named many different shocks and seasonalities that make life on Rusinga difficult, they did not mention most of the negative trends identified by outsiders. One possible explanation for this is that, compared to shocks and seasonally occurring hazards, trends are slower, affect livelihoods more indirectly and in general require people to take a long-term perspective. Many of the trends touch upon the issue of sustainability, a topic which, as CARNEY points out, poverty often forces people to neglect

(compare CARNEY (1998)). In some instances, long-term and short-term objectives have to be weighed against each other: The fishing ban, for example, is at once a measure to reduce the negative trend of declining fish populations and a seasonally occurring difficulty not only for the people involved in the Omena business but also for those who have to rely on Omena as an important part of their diet.

5.3 Structural context

The trend of an increasingly export-oriented economy on Rusinga Island (Victoria perch and

Omena, compare CONELLY (1994)) means that the wider economic context gains importance. Formerly self-sufficient subsistence farmers, the inhabitants of Rusinga nowadays are connected to the world market with its orientation towards supply and demand and have to adapt to structures over which they have no control. Particularly the growing Victoria perch industry has had an impact on the island which can hardly be overemphasised (compare

CONELLY (1994)). The increase in demand for Victoria perch has led to the development of a Kenyan fish processing industry starting in the 1980s.

In 1980 the NP [Nile perch] catch was 4,310 metric tonnes, or 8.9% of the total catch. In the same year Nile perch accounted for only 2.3% of the total marketed value fish caught in Kenyan waters, and 12.6% of the value of the Lake Victoria catch. By 1995, the total catch had approximately quadrupled to 193,789 metric tonnes. The NP catch, at 102, 546 metric tonnes, was amazingly 24 times its 1980 level and in 1995 accounted for over half (52.9%) of the total. The market value of the NP catch rose almost as dramatically, from Ksh. 1,725 per tonne in 1980 to 32,332 per tonne in 1995. This increase in value, at 1874%, was well ahead of the general increase in prices over the period, which we estimate to be 800%. The 1995 NP catch was worth 3.3 billion shillings, or 63.7% of the total fish value. (MITULLAH, 4)

In spite of the skyrocketing prices for and catches of Victoria perch, the majority of the people employed in the fishing on Rusinga (most of whom work as Ochorros pulling the nets) could not benefit from the wealth from their waters (compare CONELLY (1994) and MITULLAH). They are not only exploited by the owners of the fishing equipment, who keep the lion’s share for 55 themselves, but also the weakest link in the export chain of the fish: While the bigger profits are siphoned off later on in the line, the fishermen are in the weakest bargaining position due to the fact that they have no way of preserving the fish and thus have to accept the prices offered by the bicycle transporters (Agents). These in turn depend on the drivers of the trucks who wait at Mbita causeway and are the first ones who can cool the fish for some time in the ice in the back of their trucks. The issue of a lack of cooling facilities is being discussed among Rusinga fishermen and money is being collected to construct an ice plant in Mbita. However, the success of the project depends not only on the ability to find investors and raise enough money for the plant but also on the connection to the electricity grid. These and other issues require a substantial level of organisation and the overcoming of distrust and envy by the inhabitants of Rusinga.

As has been pointed out, Kenya has a weak economy for global standards. However, the country’s economy is the biggest one in East Africa. The same is true for the political influence of Kenya which is rather marginal for global but nevertheless quite significant for regional standards. This importance of Kenya can be illustrated with the fact that Kenya is the base of the headquarters of the United Nations Development Programme (UNDP) and has the region’s most important airport. These two institutions are both based in Nairobi. Also, most of the important national headquarters of political, economic and financial bodies are based in the capital. The difference to other parts of the country is considerable and some parts of Kenya, like Rusinga, seem to belong to a different country and a different time than Nairobi. As pointed out earlier, there were neither electricity nor concrete roads or safe drinking water on the Island in late 2003. Other indicators which point to the fact that Rusinga is part of the Kenyan periphery are the extremely high mortality in young children and the rather low literacy rate (compare chapter 5.1.1) compared to national standards. The reasons for Rusinga’s low level of development cannot be explained exclusively by its geographical remoteness as an island in the far West of the country in combination with the poor transport connections to the rest of the country. In fact, the latter is not only a reason but also symptom and effect of the peripheral importance of the whole region. It is true that Kenya is a rather poor country with limited means to provide a satisfying infrastructure to all its regions. Yet, this, too, does not suffice to elucidate why, for instance, there are so few concrete roads in this part of the country in spite of the high density of population. In order to understand the underlying reasons for these phenomena the issue of tribalism in Kenyan politics need to be considered (compare chapter 3.2). Another related factor that can represent

56 an obstacle for development is corruption. Even though there are indications for an improvement (compare TRANSPARENCY INTERNATIONAL), corruption still penetrates many spheres of Kenyan life. One example related to the hazard of a decrease in Victoria perch (compare chapter 5.2.11) is allegations that “government fisheries officers are collaborating with rich trawler operators in activities that have caused the fish depletion” (EARTH CRASH compare also MITULLAH). In general, the public sector plays a rather marginal role on KUZ and many services, including, amongst others, transport and health care, are provided by members of the private sector. As pointed out in chapter 5.1.3, groups based on profession are getting increasingly organised. Other organisations that play an important role on Rusinga are NGOs and churches. NGOs carry out educational campaigns, provide basic infrastructure like community centres or public toilets in fishing centres like Kolunga and contribute to an increasing level of organisation among the inhabitants of the island. One of these NGOs is the CCF. While the main target group for the organisation is orphans, they take a broad approach to improve the standard of living in their areas of activity. One of their projects is the malaria project which was created as a consequence of the insight that malaria is a central issue that has to be addressed if the high child mortality is to be brought down and the general livelihoods of the people strengthened. There is a plethora of different religious communities on Rusinga. They provide a social net as well as a sense of being part of a group to their members. Many of these communities are rather well-organised and even in the research area, so-called “crusades” are regularly carried out. For this purpose, a shade has to be constructed and generator-powered loudspeakers provided. The whole “crusade”, which consists of sermons, songs etc. usually lasts for one week and attracts many local people. The significance of culture on the lives of the inhabitants of Rusinga has been hinted at in different chapters. It has an important impact on many decisions taken by the people on Rusinga Island and is, even though often neglected in analyses by outsiders, a factor not to be underestimated. One aspect in which culture and its impact on everyday life can be seen are gender relationships. The Luo society is patriarchal. When a woman is married, she usually moves to the husband’s household. Important decisions concerning money, agriculture and other central issues are taken by the male head of household. Of course, he can discuss these decisions with his wife and in fact, 58% of the married participants said they took health-

57 related decisions together with their husbands while 27% said that their husband decides (11% of wives take health-related decisions alone)23.

5.4 Livelihood strategies

Most inhabitants of KUZ live off subsistence agriculture and fishing.

50

40

30

20

10

0 Percent fishing farming selling omena others

Main source

Figure 9: Main source of income of the households (n = 108).

Farming: Apart from the lakeshore where fields can be irrigated manually and which can be used throughout the year, there is one farming season during the main rains. It is usually the man who decides which main crops are grown while his wives are responsible for additional crops like vegetables. Men who have more than one wife (polygamy is common on Rusinga) give each wife a share of land according to the number of persons who eat from her stove. The staple crops are sorghum and maize. While maize is the more popular food as it is generally considered to be tastier, the advantages of sorghum are that the plant is more

23 Due to the high percentage of widows, almost half of the participants of the total sample said they took health- related decisions themselves. 58 tolerant to poor soil and irregular rain. Therefore, sorghum is the main crop. Many farmers intercrop the main crop with legumes such as beans or groundnuts. In the more fertile lakeshore fields cassava, beans, groundnuts, sweet potatoes, bananas, tomatoes, cabbage and other green vegetables as well as fruit trees such as mango and papaya are grown. Considering the density of population, many fields are not under cultivation. This is due to a shift away from subsistence farming to fishing. In a detailed study of the decline of farming on Rusinga, CONELLY (1994) explains the apparent paradox of agricultural disintensification at a time of a rising density of population:

Despite a steady increase in population since the 1930s, farmers on Rusinga Island in Kenya have abandoned many traditional intensive agricultural practices, including the construction of hillside terraces. At the same time, low crop yields have led to a chronic shortage of food on the island…Labor scarcity resulting from migrant wage employment and the growing importance of the fishing industry has been a major factor in the decline of agriculture on the island. The loss of soil conservation practices and serious weed infestations have contributed to the collapse of farm productivity. (CONELLY (1994), 145)

In particular the loss of male labour has had far-reaching consequences for farming: Hillside terraces are not being repaired and can thus not prevent the soil from being eroded during the rainy season (compare CONELLY (1994) and chapter 5.2.12). What is more, lakeshore fields and gardens cannot be guarded against invading hippos which can intrude in fields and gardens at night creating great damage for the farmers by eating and trampling plants. They are the main reason brought forward by farmers to explain why many lakeshore fields are not in use. These factors leave the intermediate zone as preferred farming land under cultivation. Even amongst those households who depend on farming as their main source of food, it is the exception rather that the rule that the harvest is sufficient to feed the household for one year. Thus, most households have to purchase food after their own stores are used up. The money for this food (the prices are highest before the time of harvest) can be earned through fishing, minor casual labour such as net-making, charcoal and vegetable trading, small repair works, fence-making as well as Changa-brewing. Old people often have to rely on the support of family members or resort to begging.

Fishing: There are three main types of fish which are important on Rusinga: Tilapia (Ngege), smelt (Omena) and Victoria perch (Mbota). Ngege is a good edible fish of about 25 cm length. It is caught with hooks or in drift-nets. While some of it is eaten freshly, it can also be preserved for some time if smoked or dried. Ngege is not caught in the same quantities as Omena or Mbota.

59 Omena are small (circa 5 cm) sardine-like fish caught at night. This work is carried out by Jabila, young men many of whom are migrant workers from other parts of the country. On the open lake, the fish are lured with the light of kerosene-powered pressure lamps, caught in tight-meshed nets and brought ashore. On the shore, they are sold to waiting women who then go on to dry them before selling them on to traders. Omena is the cheapest source of protein for the local population and is also exported in large quantities. It can be found on markets throughout the country and is a very important part of the local diet. Mbota which can grow to sizes of 2m and reach weights of 100 kg plays an extremely important role on Rusinga (compare CONELLY (1994) and MITULLAH). While in former times it was difficult to preserve large specimen, fish weighing more than 1 kg can now be transported to processing plants in cities like Kisumu or Nairobi. Mbota is usually caught in nets which are brought out on the open lake by usually unmotorised boats and then pulled back ashore by one team of pullers (Ochorros) on each side of the net. The pulling in of such a net can, depending on the place, take up to 7 hours. Usually, the catch is sold to waiting Agents who, on the carriers of bicycles, bring the fish to the causeway at Mbita where they sell it on to other Agents with trucks filled with ice who transport it to the processing factories. Some of the Victoria perch is exported overseas and can – at very high prices – be bought as far away as Europe and the United States (compare MITULLAH).

Diversification: While fishing is the main source of income for more households than farming, more than 80% of all participants said that farming was one of their livelihood strategies (77% said that fishing and/or selling Omena was one source of income for their household). In general, the vast majority of the households of the participants have several sources of food and income. Only 8,3% rely on one source while 55,6% have 2 sources and 36,1% 3 or more. Beside the fact that farming alone is not enough to support the households in a densely populated area like KUZ, to have different sources of food and income is a way of spreading the risk in case one of the strategies is not successful.

Migration is another common livelihood strategy. Many, in particular young people, leave Rusinga to look for better education (secondary schools are often boarding schools) or work in other places. Moreover, many young women leave their homes to join their husbands after marriage. Usually, these migrants maintain strong linkages to their homes (for instance through sending money to their families who live there) and some come back after some time (e.g. after retirement, the death of the partner, divorce etc.).

60 6 Risks and vulnerability in Kaknaga/Ufira Zone, the example malaria

6.1 Malaria

Malaria is one of the most serious diseases in the tropics with an estimated 300 to 500 million clinical cases and more than one million deaths per year. This means that every day, 3000 people die because of malaria. 90% of the victims are from Africa south of the Sahara and almost all of them are under five years of age (compare WORLD BANK). In spite of research on malaria and efforts to control it like the WHO’s Roll Back Malaria programme, morbidity and mortality from malaria have been increasing over the last decades (compare

GREENWOOD/MUTABINGWA). Reasons for this mentioned in the literature include resistances of the plasmodium to drugs, resistances of anopheles mosquitoes to insecticides, wars, environmental changes (such as the construction of dams, irrigation schemes etc.), climatic changes, travel and population increase (compare GREENWOOD/MUTABINGWA).

Malaria is a protozoal infection. There are four different species of the Plasmodium protozoa which can cause human malaria. Of these, Plasmodium falciparum is the most dangerous one because it causes malaria Tropicana, the most serious variety of malaria. The infection is transmitted to humans by the bite of female anopheles mosquitoes. There are more than 400 known species of anopheles mosquitoes of which only 60 transmit malaria and only 30 are of major importance (compare RIETVELD). The best transmitters are mosquitoes of the species anopheles gambiae. In the case of human malaria, the life cycle of plasmodium protozoa can be divided into two major stages: one taking place inside the human body and one inside the mosquito (compare

POSER AND BRUYN). The most characteristic symptom of malaria are bouts of fever. Other symptoms can include headache, malaise, fatigue, nausea, muscular pains and slight increase of body temperature at the beginning of the disease (compare RIETVELD). “Most severe forms of the disease result in organ failure, delirium, impaired consciousness and generalized convulsions, followed by persistent coma and death” (ibid.). However, “in highly endemic areas, such as in parts of Africa, persons who have been repeatedly infected with malaria acquire a degree of immunity to malaria which suppresses most clinical symptoms” (ibid.).

61 An interesting point to note is that it takes about 10 days from the time of the infectious mosquito bite to the stage where the plasmodium falciparum reaches the sexual stage in which it can be passed on to a mosquito biting the infected person. In the mosquito, it takes some more time before the parasite can be inoculated into a human host (compare RIETVELD). In malaria control, the task is to break the life cycle of the parasite. The various different approaches to achieve this goal include treating malaria in humans with drugs, the use of insecticide treated bednets, residual spraying with insecticides, spraying of anopheles breeding sites with insecticides, environmental management (for instance draining swamps), and others (compare GREENWOOD AND MUTABINGWA). It is worth noting that so far, there has been relatively little research on malaria from the social sciences and even though the importance of social factors are increasingly being recognised (compare SACHS AND MALANEY, BATES ET AL. (2004a and 2004b)), the focus still remains on the hazard of rather than on vulnerability to malaria: "The most important reason for the persistence of malaria in Africa is the presence of the vector Anopheles gambiae, although social and economic factors are also important" (GREENWOOD AND MUTABINGWA, 671). However, as a matter of fact, malaria, more than many other diseases, is connected to poverty. Table 5 shows that almost 60% of all deaths from malaria occur amongst the poorest 20% of the world’s population.

Table 5: Malaria as a disease of the poor. Source: WORLD BANK.

The fact that these persons do not have much money to spend on drugs is one possible explanation for the apparent lack of interest in malaria by the pharmaceutical industry: "Only

62 3 of 1,223 new drugs developed during the period 1975-1996 were antimalarials"

(GREENWOOD/MUTABINGWA, 670. Compare also MEDECINS SANS FRONTIERES).

6.2 The hazard of malaria on Kaknaga/Ufira Zone

There are various factors that determine the hazard of malaria in a certain area24. One of these is the mosquito emergence rate (compare KILLEEN (2000a)). Therefore, one indicator for the hazard of malaria is the density of breeding sites. While the aim of the first part of the fieldwork was mapping all potential mosquito breeding sites on KUZ, it is obvious that a map like this can never be complete. During the rainy season, every field can contain countless waterfilled holes, ditches and puddles. Dry riverbeds were only mapped as one potential breeding site even though they are often a chain of potential breeding sites. What is more, the situation is changing constantly. Most of the potential breeding sites are manmade and while some holes can fall dry or be filled in, others will be dug for purposes like irrigation, house construction etc. (compare photo 6). Also, the fact that the single sites differ in size has to be pointed out. Thus, a swamp can contain many more larvae than a container or a puddle.

24 For a list of aspects of the hazard of malaria in relation to mosquitoes see Killeen (2000a), 537. 63

Map 4: Potential mosquito breeding sites on Kaknaga/Ufira zone in June 2003.

When categorized, it can be seen that the majority of the potential breeding sites are manmade:

Type of potential Total Waterfilled Containing anopheles breeding site number in June ‘03 larvae in June ‘03

Swamp (a) 35 12 10 Puddle 115 13 7 Drainage ditch 39 8 3 Artificial hole 274 30 8 Artificial container 127 95 10 Others (b) 108 10 0 Total 698 168 38

(a) The swamps differ in size. The number given above represents the single swampy areas identified. (b) ‘Others’ include rock pools, foot- and hoofprints, riverbeds, tree ponds and concrete holes.

Table 6: Potential mosquito breeding sites on Kaknaga/Ufira zone. 64

While map 4 shows all potential mosquito breeding sites irrespective of whether they were waterfilled or not, contained mosquito larvae or not or other factors including if they were exposed to the sun (a precondition for being suitable for anopheles mosquitoes), the following is a map of the breeding sites in which anopheles larvae were identified in June 2003.

Map 5: Sites of anopheles larvae in June 2003.

Summarising this second map it can be said that anopheles mosquito larvae could only be found at the lakeshore and in swampy areas. The highest density of anopheles breeding sites

65 was found in the area around Kolunga, which is at the same time the area with the highest density of population.

6.3 The risk of malaria on Kaknaga/Ufira Zone

6.3.1 Probabilistic perspective of the risk of malaria infection25

In a survey carried out on Rusinga in August/September 2002, 358 out of 788 persons (45%) tested positive for malaria parasites. There were big differences in the prevalence rate for different parts of the island, ranging from 25 to 67%. In KUZ, 53 of the 105 (50%) persons tested had parasites in their blood (personal communication with Dr. U. Fillinger, the leading scientist in the malaria project). Two other analyses carried out in the region also calculate the average parasite prevalence rate on Rusinga at around 45%26. All analyses which differentiated between the parasite rates of different age groups found that the rates were considerable higher in children than in adults. In a malaria endemic area like Rusinga, many people who are infected with parasites do not show any symptoms of the disease due to partial immunity (compare chapter 6.1). There are no reliable data about the incidence of symptomatic malaria as there have never been any studies carried out in the area. Data from the interviews27 indicate that malaria is more common in children than in adults:

25 Compare chapter 2.2.6. 26 One analysis based on data from Mbita Health centre found an average prevalence of 45% in the population of Rusinga (personal communication with U. Fillinger, scientist at the ICIPE) while the second survey recorded by the local Ministry of Health office found an average parasite prevalence rate of 44% in 9555 tested persons. 27 All data concerning malaria based on answers given by the participants have to be put in perspective: No blood tests could be carried out to verify the answers. Thus, all of these data are based on what the interviewees understand by the term ‘malaria’. It is possible that some cases of malaria were not considered while cases of other diseases fall under the term ‘malaria’ in the answers given. However, as chapter 6.4 implies, the general knowledge about symptoms of malaria is rather high. 66 30

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5 3 0 Percent under 5 to 1 15 to 2 40 to 60 age u 0 to 14 year 5 to 39 year y 9 y ear 5 24 y 59 y nk ea s no yea and older rs e e wn r ar ar s s s s s

Figure 10: Age of the persons who suffered from malaria during the previous year (n=188).

33, 9% of all household members and 41,6% of all children under the age of 5 were reported to have had malaria during the previous year.

6.3.2 Probabilistic perspective of the risk of undesirable outcomes

Death: The most serious outcome of malaria is the death of the infected person. According to a study carried out on Rusinga in 1998 by Oliver KENTAI, the mortality rate in children under the age of 5 due to malaria was 183/1000 (18,3%) (compare KENTAI). This is much higher than the all-cause national mortality rate in under-5-year-olds of 119/1000. In the households of the participants, 43 children under the age of 5 were reported to have died from malaria. This amounts to almost three quarters of all reported fatalities due to this disease.

67 25 to 39 years

15 to 24 years

10 to 14 years

5 to 9 years

under 5 years

Figure 11: Age of malaria-related casualties in the households (n = 59).

A total of 59 deaths “due to malaria” were reported for the 108 households. While 59,3% of the participants said they have never lost a member of their household to malaria, some participants reported up to 5 malaria-related deaths in their households.

Financial loss: On average, the participants spent about 940 KSh on the treatment of malaria during the previous year28. The maximum spent on treatment (during the previous year) was 8500 KSh. Together, the households covered spent a total of 100000 KSh (equalling more than 1330 US$). This amount is already very high considering the financial situation and limited possibilities of creating some income (compare chapter 5.1.4). However, many authors who have analysed the costs of illnesses found that the costs of treatment were only a fraction of the indirect loss of money through lost income because of the inability of ill breadwinners to work (compare PRYER, see also CORBETT, SACHS AND MALANEY, BLAIKIE ET

AL.). In persons between the age of 15 and 60, roughly one quarter (25,4%) had been ill from malaria in the previous year. Even though the data do not include information on the severity of the illnesses, it can be assumed that this high percentage means a lot of lost labour and

28 Again, these data have to be treated with caution: Not only is it uncertain if all diseases of the whole previous year could be remembered correctly but there were also no ways of double-checking the amounts given by the participants. Furthermore, there is always a bias in answers concerning money because of hopes, fears and expectations on the side of the interviewees. 68 income. While not all kinds of work are similarly affected by illness (e.g. shopkeepers can even carry out their work if they do not feel well or at least have other household member replace them during the period of their illness), particularly the households with a high dependency ratio are very vulnerable to severe consequences of income losses due to illness in breadwinners. Especially the ability to carry out the physically demanding work of fishing and farming can be seriously affected by illness. As discussed in chapter 5.1.4, many households do not have enough savings to pay for the costs of treatment. A question which arises here is thus: How did they get the money for treating malaria?

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0 Number of mentions borrowing selling omena other work other ways given by others fishing sale of belongings

Figure 12: Sources of money to cover costs of treatment (n = 108, several answers possible).

This graph underlines the importance of social capital as a high percentage of the participants received support from others. Only few people had to resort to selling productive assets in order to finance the treatment of malaria. Most of the households were able to raise the money through working.

69 6.3.3 Social perspectives on risk

In chapter 5.2, various hazards for the life on Rusinga Island were listed. Even though not all of them play a role in the perception of the participants, there is a range of hazards which people feel exposed to. A ranking of different risks can help to understand the priorities of the participants and put the single risks, including malaria, into perspective. For more than three quarters of all interviewees, HIV/AIDS is the greatest risk, while 9 participants put witchcraft at the top of the list. Only two interviewees considered malaria to be the most serious threat. Also the average values show that HIV/AIDS is the most feared risk and malaria the least feared.

5,0

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2,0 Mean AIDS Dr Animal Witchcraft Malar oug i ht s a

Figure 13: Evaluation of different risks by the participants on a scale from 1 (lowest risk) to 5 (highest risk) (n = 108).

These numbers imply that, even though malaria is very widespread and the human and financial costs of the disease are high, it is not one of the top priorities for the participants. Some people interviewed even stated that they considered malaria to be a normal part of life.

These findings seem to corroborate RENN’s statement that the perception of a specific risk is, amongst others, influenced by the familiarity with this risk (RENN, compare chapter 2.2.6). The reason for this is not a lack of awareness of the threat posed by malaria: Even those who

70 said they had lost two or more household members to malaria on average ranked HIV/AIDS, witchcraft and wild animals higher than malaria. The evaluation of malaria by the participants has very important implications because, as

RENN states, "[i]ndividuals respond according to their perception of risk and not according to an objective risk level or the scientific assessment of risk" (RENN, 66). Considering the tight financial situation of most of the households (compare chapter 5.1.4), it therefore, for instance, does not come as a surprise that only relatively few people invest in ex ante strategies against malaria as will be discussed later (compare chapter 6.6.1). While it is possible to measure both hazard and (probabilistic) risks of malaria, the same is much more difficult for vulnerability to this disease. The reason is the uncertainty about factors determining vulnerability to malaria. In the following, various factors that are believed to influence vulnerability to the disease will be discussed.

6.4 Perception of malaria

A lack of public awareness of health issues is often considered to be one of the main underlying reasons for the vulnerability of the inhabitants of places like Rusinga Island to diseases (compare VARLEY). One study of the nutritional and health situation on Rusinga concludes: “All of the health problems discussed in this paper… are related to the issue of low public awareness of health issues” (CHAIKEN, 245). According to another author, “Ministry of Health personnel at almost all levels claim that the missing link in community health development is ‘lack of proper knowledge’” (NYAMWAYA, 190). However, the question is if the people of Rusinga Island are really ignorant about many malaria-related issues. A starting point for addressing this question is how ‘malaria’ is defined by the participants.

71 80

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0 Number of mentions T J H Loss F Feel Vomiti Ch StomaBody stiffneO i oint pains ev re e th dnes adache e ill er r ing cold s of appetite ng c s h problems s ss

Figure 14: Symptoms of malaria in adults as given by participants (n = 108, several answers possible).

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0 Number of mentions H D App Vom C YellowYellow eyesTwi bodyT Yell C O ot b iar hi ir ryi th l edn rh eti i ls sts body ow ng er ody oe ting s te l es ur a o s i s ne s

Figure 15: Symptoms of malaria in babies as given by participants (n = 108, several answers possible).

72 There seems to be a rather high level of agreement on symptoms in adults. Six symptoms were mentioned by at least a quarter participants. All of these, tiredness, joint pains, headache, fever, vomiting and chills, are, according to doctors (personal communication, compare also

RIETVELD) common symptoms of malaria as identified by Western medicine. The situation is different for symptoms of malaria in babies: Other than “hot body”, there are no symptoms that are generally associated with malaria (only two symptoms were mentioned by at least a quarter of all participants). This reflects the difficulty of identifying malaria in babies as opposed to adults and might be one of the reasons contributing to the high rate of malaria-related deaths in babies.

While the ability to name common symptoms of malaria is one indicator for knowledge about malaria, the ability to recognise them and differentiate between symptoms of malaria and symptoms of other diseases is probably even more relevant. After all, in real life, the participants have to be able to recognise rather than name them to be able to react accordingly.

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0 Number of affirmative replies Co bo c diar hea blood in sweightlosschi ontinuou u u ll gh ts of rhoea n dac s fe h s e too ver fever o feve l/ur i r ne

Figure 16: Yes/no-questions about symptoms of malaria. Bars indicate numbers of affirmative replies (n = 108, several answers possible).

73 The graph shows that among the participants, there is much more agreement on symptoms which are generally associated with malaria by doctors, too, than on symptoms which, according to doctors, do not indicate malaria (personal communication with doctors, compare

RIETVELD).

The previous three graphs imply that the knowledge of symptoms of malaria among the participants is relatively high. However, also knowledge of the way malaria is transmitted has important implications for people’s vulnerability to malaria as it is the basis for any protection against the disease. Here, too, the awareness amongst the participants is high:

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0 Number of mentions Mosq Cold temperaturePol Other caus D oesn't lu u ted w ito b know i ater e te s c au s se

Figure 17: Perceived causes of malaria (n = 108, several answers possible).

Less than 20% said they did not know the cause of malaria while 34,3% mentioned other causes than mosquitoes (some of them named mosquitoes and other reasons). However, almost three quarters of all interviewees know that malaria is transmitted by mosquitoes, which is a very high rate. Another, related issue is knowledge about possibilities to protect against malaria infection.

CHAIKEN considers this knowledge as crucially important:

74 If local people learn to prevent diseases through better sanitation, nutrition, and home treatment of common illnesses, then improved health and child survival will follow independently of other interventions in health care delivery, agriculture, or economics. (CHAIKEN, 245)

But is the knowledge about prevention strategies really low among the participants?

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0 Number of mentions BednetMos Av Av Cl K S O Does oi oi ear eep c afe dr ther qui d getti d s ing w n' to c tagna ompoundink cleanays t k bushes now oi ng c ing water l nt w ol d a ter

Figure 18: Perceived ways of protecting against malaria29 (n = 108, several answers possible).

Striking are the high awareness about the protection offered by bednets on the one hand (55% of all participants) and the high percentage of participants who said they did not know about any way of protecting themselves and their households on the other hand (42%). In fact, 94% of all participants who said they knew some way of protecting against malaria mentioned bednets. Awareness about other ways of protection apart from bednets was relatively low. Out of these other strategies mentioned, “avoiding to get cold”, and “safe drinking water” do not actually offer protection against malaria but against other diseases while “clearing bushes”, a strategy still recommended by some (e.g. school teachers: personal communication) is at the least ineffective and at the worst counterproductive (compare chapter 6.5.1).

29 The categories given in this graph reflect the answers given by the participants. Some of the methods named are in fact ineffective as protection against malaria, e.g. the use of safe drinking water or the avoidance of cold temperatures. 75 The question how knowledge about possible protection translates into actual strategies will be addressed in chapter 6.6.

Considering the poor infrastructure with respect to transport and communications, an interesting question is where the participants got the information about malaria.

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0 Number of mentions T Books Doctors F CCF Radio Others No i eac am hers ily/neighbou nfor m ation

rs

Figure 19: Sources of information about malaria (n = 108, several answers possible).

Not only were doctors the most common source of information given, but in general, the trust in information from them was also higher than the trust in information from other sources.

The data concerning the knowledge of the participants about malaria do not confirm the thesis of “low public awareness of health issues” (CHAIKEN, 245) as a main reason for the high vulnerability to diseases. Not only the awareness about symptoms of malaria but most also about the way of transmission and possibilities of protecting against malaria (particularly through the use of bednets) are rather high, particularly considering that the participants are from a rural context and have mixed educational levels30. The difficulties of access to information have been mentioned in chapter 5.1.6. Access to books and newspapers in KUZ is very limited so most information is passed on on a personal basis. Beside the main source of

30 For a discussion of the perception of malaria in a slightly different context see Nuwaha (2002). 76 information, doctors, family members and neighbours, teachers and organisations like the CCF play a role.

If a lack of awareness is not a main reason for the high vulnerability to malaria, there have to be other factors which increase the risk of malaria on KUZ either by increasing the hazard of malaria or people’s vulnerability to the disease. In the next chapter, the context in which malaria is embedded will be focussed on. For this purpose, the livelihood framework again offers a useful checklist.

6.5 Linkages between malaria and other livelihood components

6.5.1 Links with assets

Malaria and human capital Knowledge, a component of human capital, and its influence on people’s vulnerability to malaria have been discussed in the previous chapter. While a lack of information seems to be less relevant in the context of KUZ, knowledge is definitely of crucial importance as it is the basis for successful strategies. A related issue is education. There is a strong interrelationship between malaria and education. On the one hand, education can contribute to safety as educated persons generally know about ways to protect themselves against malaria: Those participants who know about mosquito nets as a way to protect against malaria had, on average, spent 7 years at school (against 3,4 years amongst those who did not name bednets). Likewise, the average level of those who did not know about any way to protect against malaria had spent an average of only 3,6 years at school. On the other hand, malaria can have a negative impact on people’s level of education, for instance due to the loss of time at school:

[I]n Kenya it was found that primary school students miss 11% of school days per year because of malaria, and secondary school students miss 4.3% of school days. Another study attributed 13-50% of medically related school absences to the disease. The adverse effects on schooling are likely to go far beyond the number of days lost per year, as absenteeism increases failure rates, repetition of school years, and drop-out rates. (SACHS AND MALANEY, 683)

According to information from the interviewees, every fifth child in primary school age in the participating households had had malaria in the previous year. However, it is not only through malaria-related absenteeism that the disease can have an adverse effect on education: “An 77 even more severe consequence can arise from the impact of malaria on cognitive development and learning ability” (ibid., compare also GREENWOOD AND MUTABINGWA and BATES ET AL. (2004a)). Another aspect of human capital is the overall health situation. While people with healthy bodies are less vulnerable to diseases in general, there is a vicious circle for those who are physically weakened: They are, for instance, more prone to falling seriously ill to malaria which in turn leaves them even more physically weakened (compare SACHS AND MALANEY). The consequences of malaria are not only dramatic on the micro- but also on the macro level:

The impact of malaria on economic growth rates through the mechanism of depressing the rate of human capital accumulation could be considerable… [However,] the overall impact of malaria on human capital development in children remains largely unexplored and unquantified.” (SACHS AND MALANEY, 683).

Malaria and natural capital The impact of natural capital on malaria concerns mainly the hazard side of the risk of malaria. At a very direct level, land which is free from anopheles breeding sites can be considered a kind of natural capital in itself. Water from rain and the lake is both an asset and the basis for anopheles breeding sites. Many people are unaware of the fact that boreholes which serve as reservoirs for drinking and use water at the same time offer breeding opportunities for the mosquitoes. The same is true for artificial ditches at the lakeshore used to water gardens and fields. The loss of much of the trees and bushes on Rusinga Island results in many potential breeding sites being exposed to the sun and therefore suitable for anopheles mosquitoes. Contrary to the widespread belief that clearing of bushes around the compounds is a way of destroying the habitat of mosquitoes and thus reducing the hazard of malaria, there was already very early evidence that these measures are at the least inefficient and at the worst counterproductive

(compare RIBBANDS). From an ecological point of view, ironically, diseases can have positive effects on the natural capital of an area. Heavy infestation with diseases like malaria can be a reason for people to avoid certain areas and thus turn these areas into retreats for wildlife and places of high biodiversity. For instance, it is partly for the reason of heavy infestation with Tsetse flies (which can transmit sleeping sickness) that Ruma National Park could be created in the

78 nearby Lambwe Valley). On Rusinga however, people are forced to make use of all the space available irrespective of the abundance of anopheles mosquitoes and malaria.

Malaria and financial capital There is an obvious vicious circle in the interlinks between malaria and financial capital: On the one hand, households and individuals with little financial capital are more vulnerable to malaria because of the limitations in preventing and coping with malaria. On the other hand, those who suffer much from malaria have great difficulties of accumulating financial capital as a result of high expenditures for treatment. Households with money can not only afford measures of protection against the disease (e.g. bednets) but also cope with it (send ill persons to a hospital etc.) without having to sell assets like, for instance, livestock and therefore recover faster. Indirect linkages are that money enables people to get access to education, information (through buying radios, books, newspapers ...) etc. which reduce their vulnerability to malaria. In contrast, the costs of treatment of malaria can be a major drain of financial capital: The average amount of money spent in one year on the treatment of malaria by the households of the participants roughly equals the amount which many people earn in one month (personal communication and participatory observations). The difficulty of saving money is not only caused by the need to use it for the treatment of diseases in the own household but also by the social obligation to support others in times of crisis (e.g. illness due to malaria). As pointed out earlier, this reduces the motivation of many people to save money or even to engage in activities which could yield profits (compare chapter 5.1.4). In the absence of formal credit schemes or programmes providing micro-credits, it is, at the best, difficult to get loans for financing prevention such as the purchase of bednets.

Malaria and social capital Social capital is the only asset which crisis events like cases of malaria can directly strengthen when social ties are created and consolidated through support in emergency situations. The malaria project, which brings people from the whole island together establishing structures of communication etc., is an example for an increase in social capital originating in the struggle against malaria. Yet, overexertion of social nets can lead to processes of disintegration as the examples of young people hiding from their families (compare chapter 5.1.4) illustrates. Social capital plays a very important role in the strategies to cope with malaria for the households of the participants as figure 12 illustrates. Vice versa, those who are – for whatever reason – socially marginalized are also more vulnerable to malaria.

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Malaria and physical capital Most of the houses on Rusinga are made out of mud with roofs consisting of corrugated iron sheets. The eaves are usually open to allow some air circulation inside the house. Mosquitoes can easily enter the houses through openings like these (compare BATES ET AL. (2004a)). Various aspects of the poor infrastructure can both increase hazard of and vulnerability to malaria: Potholes in deteriorating roads and blocked drains near roads are good potential breeding sites for anopheles mosquitoes. Moreover, the fact that there are neither facilities of drainage nor of irrigation increases the hazard of malaria through increasing the number of potential breeding sites. Most of the swamps could be drained with a relatively little input of labour. Due to the absence of safe facilities for storing drinking water and water for other purposes like watering livestock and gardens, washing etc., and without the knowledge of how to prevent places with stagnant water from becoming potential breeding sites for anopheles mosquitoes (such as covering them), people use containers and dig holes which can serve as anopheles breeding sites and increase the hazard of malaria (compare chapter 6.2). Without alternative sources of energy, the inhabitants have been forced to cut down trees and bushes leaving many potential breeding sites exposed to the sun and therefore suitable for anopheles mosquitoes. Both vulnerability and the hazard situation are linked to the restricted access to medical facilities. Vulnerability is increased by the resulting limitations in ex post coping strategies. Moreover, inability to treat malaria can result in high levels of persons with gametocytes (the stage in the lifecycle of the malaria parasite in which it can be taken up and consequently passed on to other persons by mosquitoes) in their blood. The density of persons infected with gametocytes is one component of the hazard of malaria. One big obstacle for seeking medical care is the lack of cheap means of transportation. The transport of a sick person can cost as much as the treatment itself even if the cheapest means of transportation are used (compare chapter 5.1.5). For this reason, many people are forced to visit informal private hospitals or medicate themselves. Another result of the difficult transport situation is the restrictions in access to information (concerning malaria as well as other issues) in places like the research area.

80 6.5.2 Links with other hazards

Malaria and HIV/AIDS There is a vast body of recent literature on possible links between malaria and HIV/AIDS

(compare, for instance, BATES ET AL. (2004a), UNICEF, SACHS AND MALANEY, GREENWOOD

AND MUTABINGWA) reflecting the far ranging implications that such links could have: “The high prevalence of both HIV and malaria infection in Africa means that even small interactions between the two could have substantial effects on populations” (UNICEF). This aspect is of great importance for Rusinga being one of the places with high malaria and HIV prevalence (compare chapter 5.2.1).

There is evidence that HIV positive pregnant women infected with malaria are more likely to pass malaria on to their unborn babies:

Despite initial studies suggesting no association between malaria and HIV infection, there is emerging evidence of an important relation, particularly in pregnant women. HIV infection may interfere with pregnancy-specific immunity acquired during first and second pregnancies and increases the chance of parasitaemia and placental malaria. (BATES ET AL. (2004a), 271)

Not only during pregnancy can HIV/AIDS influence the malaria situation though:

There is also a growing body of evidence that non-pregnant HIV-positive individuals are more vulnerable to malaria infection and to severe disease than those without HIV infection and that this susceptibility is related to the degree of immunosuppression. (Ibid., compare also UNICEF)

Moreover, it seems that the effectiveness of antimalarial drugs is compromised in HIV positive persons (compare BATES ET AL.) Persons infected with HIV/AIDS have a higher general vulnerability which includes a higher vulnerability to malaria. AIDS weakens the household of the infected person economically through costs for treatment, loss of the labour of the infected person and the time spent for caring. Often, it is the women who care for the ill which places an extra burden on them, both in terms of workload and psychological suffering. Also effects in the other direction are being discussed in the literature.

Increasingly, malaria is becoming a factor in the transmission of human immunodefiency virus (HIV), the virus that causes AIDS, as children with severe malaria often require blood transfusions, and much of the blood supply in sub-Saharan African countries is infected with HIV. (SACHS AND MALANEY, 684, compare also GREENWOOD AND MUTABINGWA) 81 Another way in which malaria can have an impact on HIV relates to an increase in viral load:

Acute malaria infection increases viral load, and one study found that this increased viral load was reversed by effective malaria treatment. This malaria-associated increase in viral load could lead to increased transmission of HIV and more rapid disease progression, with substantial public health implications. (UNICEF)

Malaria and other diseases One of the ways in which malaria is linked to other infections is by altering the immune system (compare SACHS AND MALANEY) thus increasing the biological vulnerability. Other linkages between malaria and other diseases are less clear:

Several large trials have shown that use of insecticide-treated bednets is associated with a decrease in anaemia and all-cause mortality that is greater than can be accounted for by the decrease in malaria infections alone. Although the mechanisms underlying this finding are not clear, it suggests that malaria is closely linked to other diseases perhaps by making individuals more susceptible to other infections. (BATES ET AL. (2004a), 271. Compare also SACHS AND MALANEY)

Malaria and witchcraft Several persons interviewed said that the symptoms associated with malaria can be the result of witchcraft rather than an infectious mosquito bite. This interpretation may lead to cases in which treatment against malaria is delayed because the symptoms which the infected person shows are attributed to witchcraft and treated accordingly. An influence of the fear of witchcraft on poverty and general vulnerability, which is little noticed by outsiders but nevertheless not to be underestimated, is that it can prevent investments by those afraid to expose themselves. Many people believe that persons who are particularly successful can attract the envy and hatred of others who might use witchcraft to make the successful ones suffer. If witchcraft is weighted heavier than other risks (compare figure 13), people can decide to rather accept poverty than to try and break out of it and become targets of witchcraft.

Malaria and drought While directly, drought can lead to a decrease in breeding sites and a corresponding lower hazard of malaria, the indirect effects of drought such as exhaustion of those irrigating their fields or gardens manually, malnutrition and the increase in expenditures due to the need of purchasing extra food, all increase the vulnerability of people, particularly farmers. Another

82 consequence of a lack of rain is that people have to use water from the lake as drinking water (compare chapter 5.1.5) which increases the risk of waterborne diseases and thus also the general vulnerability including the vulnerability to malaria.

Malaria and wild animals There are no obvious direct links between malaria and wild animals. A minor factor is that hippo footprints along the lakeshore, as found in the research area, can serve as breeding sites for anopheles mosquitoes. Indirect links include the loss of crops through hippos intruding in lakeshore fields and gardens and consequently a lack of food and loss of other assets. As mentioned in chapter 5.2.5, even the fear of hippos alone can increase vulnerability by preventing people from cultivating land along the lakeshore.

Malaria and population growth A rather general statement is that on a global level, population growth in malarious regions leads to a rising number of persons at risk to the disease (compare GREENWOOD AND

MUTABINGWA). However, the impact of population density on the hazard of malaria is not clear. On the one hand, there is evidence that higher densities increase the hazard:

Overcrowding might further increase vulnerability to malaria infection because high concentrations of carbon dioxide and other chemicals attract mosquitoes; the chances of mosquitoes infecting more than one person on the same night are higher. (BATES ET AL. (2004a), 271)

On the other hand, a higher population density might also decrease the hazard of malaria as the probability for each person of being infected is lowered if the proportion of people to mosquitoes becomes more favourable:

Malaria transmission is generally modelled from the starting perspective of individual humans and the vector biting densities they experience. Here we model malaria transmission based on the life histories of individual mosquitoes, which when combined with mosquito emergence rates relative to human population size and infectiousness, define the transmission intensity experience by any given human population. (KILLEEN ET AL. (2000a), 535. Compare also BEIER ET AL.)

Impacts of an increasing population density on general vulnerability are more obvious (compare chapter 5.2.8): It can lead to environmental degradation, a lower nutritional status, unhygienic living conditions and diseases, conflicts about landownership etc. all of which erode the asset status of the population.

83

While it could be assumed that malaria leads to a decrease in population because of high mortality rates, the opposite seems to be the case; Malaria does not only have an impact on mortality- but also, indirectly, on fertility rates: Historically, a decline in the fertility rate of a region has always taken place after the decline in the mortality rate. Therefore, according to the theory of demographic transition, lower mortality rates are the precondition for lower fertility and, ultimately, lower population growth31.

Another hypothesis, known as the ‘child-survivor hypothesis’, is that parents base their fertility decisions on a desire for a certain number of surviving children. In this theory, risk-averse households raise fertility by even more than expected mortality, in order to ensure a sufficiently high likelihood of the desired number of surviving children. This theory predicts that a high burden of malaria will lead to a disproportionately high fertility rate and an overall high population growth rate in regions of intense malaria transmission. (SACHS AND MALANEY, 682)

Malaria and environmental degradation As mentioned above, the loss of much of the natural vegetation cover, particularly trees and bushes, leaves many potential mosquito breeding sites exposed to the sun and therefore suitable for anopheles mosquitoes. Erosion has created many breeding sites in rock pools and riverbeds, particularly in the area around Litare (see photo 1). Water hyacinths can create anopheles breeding sites between the plants and the lakeshore if they are dense enough to prevent water movement from the open lake and thus create places of stagnant water. Again, there is the indirect link of environmental degradation leading to the loss of natural assets, a lower nutritional status (compare CONELLY (1994) and CHAIKEN) and a resulting increase in overall vulnerability.

Malaria and malnutrition There are direct ways in which malaria and malnutrition influence each other: “For example, children with malaria are found to have poorer nutritional status than non-malarial children”

(SACHS AND MALANEY, 683). Reasons for this phenomenon include the fact that vomiting and reduced food intake of children with malaria lead to malnutrition (compare BATES ET AL. (2004a)).

31 Compare Sachs and Malaney ((2002). For a critical discussion of the theory of demographic transition see Bähr (1997). 84 Malnutrition, in turn, can have negative effects on coping strategies against malaria in that it

“affects responses to antimalarial drugs” (BATES ET AL. (2004a), 272). It is obvious that malnutrition increases general vulnerability in various ways, most seriously through weakening human capital. Not only are malnourished people generally weaker and particularly vulnerable to diseases, but malnutrition during childhood can have impacts on both physical and mental development (compare chapter 5.1.1, SACHS AND MALANEY). Malnourished persons can not carry out the same amount of physically demanding work as persons who have enough food. This, however, can lead to lower yields and the vicious circle of hunger, weakness and diseases is perpetuated. Likewise, the weakening of a worker can be the result of a disease such as malaria (compare chapter 6.3.2, CHAMBERS (1989)).

6.5.3 Links with the structural context

The structural context of the livelihoods on Rusinga Island has an essential impact on the malaria situation there. This topic deserves a study in its own right. However, here, only some of the main factors can be touched upon.

Local level An aspect related to the dominant position of men in the local culture (compare chapter 5.3) is that usually, men are in charge of the households’ finances while it is often the women who are responsible for issues related to the health of the children. Steps that are taken to cope with a case of malaria as well as expenditures for prevention (e.g. the purchase of bednets) thus to a certain extent depend on the priorities of the husband (compare BATES ET AL. (2004b)). Moreover, culture has an impact on the perception and evaluation of different risks (compare chapter 2.2.6, RENN). This aspect also deserves some closer investigation. NGOs, in particular the CCF, are contributing to the spread of information about malaria (compare figure 19). Moreover, by creating an organisational infrastructure, they prepare the ground for coordinated efforts which could include educational campaigns and the draining of breeding sites.

National level Under the old government, the health sector was not only plagued by corruption (compare

TRANSPARENCY INTERNATIONAL) but also by moves towards privatisation which lead to

85 medical care becoming unaffordable for the majority of the population (compare KINUTHIA). Methods to collect user fees included “detaining patients for lack of money and … withholding dead bodies over unpaid mortuary bills” (SIRINGI (2003a)). Under NARC leadership, these practices have been abolished. Further reforms of the health policy include the aim of free health care for all Kenyans and a national health insurance (ibid.). Moreover, the new government has been trying to prevent negative impacts of international agreements like the one on trade-related aspects of intellectual property rights (TRIPS) as “Kenya and other African countries decided to reject a move by America’s pharmaceutical companies to limit the number of diseases that are allowed cheap drugs” (SIRINGI (2003b)). Also changes in other sectors could have an influence on the health situation:

Governments in poorer countries are increasingly recognising that non-health sectors, such as those dealing with sanitation, road building, or town planning, are responsible for transforming the physical and social environment and potentially have a much greater influence on health than the health sector itself. (BATES ET AL. (2004b))

In Kenya, the abolishment of school fees for primary school is one example. In spite of all good intentions, the situation on the ground is still bleak. In 2002, there were only 19,1 hospital beds and in 2001 188,2 medical personnel per 100000 Kenyans (compare

KINUTHIA). What is more, medical staff is often not well trained and sometimes unfriendly which makes public health centres little attractive for most people (compare BATES ET AL. (2004b)). For the provision with drugs, Kenya depends on foreign countries as Kenya does not have sufficient well-developed research facilities and industry. Thus, many scientists and also doctors leave the country in search of better conditions abroad (compare KINUTHIA, SIRINGI (2003a)).

International level When discussing national health policies, though, the fact that national bodies operate in a very restricting framework must be kept in mind. International organisations like the WTO, the World Bank and the IMF set rules which the legislation of countries like Kenya can not ignore (such as the agreement on TRIPs, the SAPs (Structural Adjustment Programs) etc..

These regulations have led to reductions in expenditures for health (compare BLAIKIE ET AL.,

KINUTHIA). The pressure on the government of Kenya and the dependency of these organisations is enormous, as, like many other developing countries, Kenya is highly

86 indebted32: “[B]y 1996/97 the government spent six times as much on debt servicing and repayment as on infrastructure provision” (ECONEWS AFRICA). Obviously, this amount of money could have a big impact if spent on health related issues.

Even though there is a definite shortage of research on the disease (compare MEDECINS SANS

FRONTIÈRES), the last years have seen “a pronounced re-awakening of interest in malaria in the richer countries of the world” (GREENWOOD AND MUTABINGWA, 671). An example for a big initiative that has arisen of this is the WHO’s Roll Back Malaria (RBM) initiative. The target of the campaign is ambitious: “The goal of RBM is to halve the world’s malaria burden by

2010” (MALARIA CONSORTIUM EAST AFRICA, 2). While RMB has been successful in raising the profile of research on malaria and control measures, not surprisingly, financing the goals could prove an obstacle difficult to surmount:

The population at risk from malaria in Africa is large, around 500 million, and increasing rapidly; thus the costs of even a basic control programme that will cover the whole population will be substantial, perhaps as much as US$2 billion each year for an indefinite period.” (GREENWOOD AND MUTABINGWA, 671)

According to the WHO’s Commission on Macroeconomics and Health (CMH), the costs are even higher and have to increase from US$ 2,5 billion per year in 2007 to US$ 4 billion per year by 2015 (compare WYSS). The question is how much of this money can be contributed by the people at risk themselves. Some implications concerning this issue will be discussed in chapter 6.6. As pointed out earlier, malaria is not a top priority for the pharmaceutical industry because the vast majority of possible customers are too poor to pay for expensive medicines (compare chapter 5.1.4). This leads to the fact that “we continue to use increasingly ineffective treatments like chloroquine, which was developed in 1934” (MEDECINS SANS FRONTIÈRES, 5). However, in the last years, there have been some achievements that give rise to hope. Particularly the development of artemisinin-based drugs has to be mentioned here (compare

GREENWOOD AND MUTABINGWA). Furthermore, the successes in malaria control through the use of insecticide treated bednets have inspired research to develop netting material which incorporates insecticides thus making re-treatment of nets redundant33. It can be argued, however, that steps like opening their markets for Kenyan products (as the

EU has for Kenyan sugar (compare MAYOYO AND OMONDI)) by the industrialised countries

32 According to the World Bank, Kenya had foreign debts of more than US$ 6,2 billion in 2002 (compare World Bank (2001)). 33 For a summary of “New developments in methods for malaria control” see Greenwood and Mutabingwa (2002). 87 could indirectly contribute even more to easing the malaria burden. After all, eradication of malaria in the industrialised world was to a large extent a side effect of economic development (compare SACHS AND MALANEY).

Not only does the structural context influence the malaria situation but also vice versa:

There are at least two broad categories of mechanisms through which malaria can impose economic costs well beyond direct medical costs and foregone incomes. The first is the effects that occur through changes in household behaviour in response to the diseases, which can result in broad social costs. These include such factors as schooling, demography, migration and saving. The second are macroeconomic costs that arise specifically in response to the pandemic nature of the disease and that cannot be assessed at a household level. These include the impact of malaria on trade, tourism and foreign direct investment. (SACHS AND MALANEY, 682)

Expenditures for malaria can account to a large percentage of public spending in health with a high percentage of all hospital visits due to malaria. SACHS AND MALANEY estimate the “loss from the economic growth penalty of malaria endemicity” in Kenya between 1980 and 1995 at more than US$ 5 billion (compare SACHS AND MALANEY).

6.5.4 Links with livelihood strategies

Malaria and agriculture Malaria is particularly prevalent in the rainy season, i.e. in the farming season. In this time of year, farmers are under pressure to get a lot of work done as quickly as possible so as not to miss the best time for the next steps. If there is a delay in one stage, this means that the whole schedule is delayed and a good harvest is put in question. A case of malaria can cause such a delay if a worker falls ill but also if a worker has to care for another person who is ill

(compare CORBETT). On the other hand, as the work consumes so much of the energy of the workers (compare TAAL) and time is so scarce, household members, in particular children, with malaria might be brought to a doctor too late. Households thus face a difficult choice between the risk of losing precious farming time and the risk of a serious illness or even the death of a household member. During the farming season, many households run out of the yields of the last harvest while the prices of the main staple foods rise because of the decrease of supplies (local crops are not yet available and the transport of products from other regions is costly and can be inhibited because of the difficulties in transport during the rainy season) and an increase in demand. Thus, some households are forced to lower their input of nutrition. This season is therefore

88 called “hungry season” (compare TAAL). A low nutritional status has, as discussed above, implications for the vulnerability to diseases like malaria (compare chapter 6.5.2). In the rainy season, because of the high prices for food and the high workload in agriculture which does not allow for any additional income earning activities, most households have little or no money to spend. In the case of a disease in a household member, the money-related restraints on medication are therefore particularly severe which can lead to insufficient, late or even no treatment at all.

Malaria and fishing Some activities related to fishing are carried out between dusk and dawn which is the preferred biting time of anopheles mosquitoes. People involved in these activities are thus exposed to an increased hazard of being infected with malaria. In the case of Omena fishing, the fishermen stay on the open lake for most of the time while the women who buy the Omena from them wait on the shore. There are many breeding sites of anopheles mosquitoes particularly along the shore close to Kolunga Beach (compare map 4) and many of them have anopheles larvae even during the dry season (compare map 5). As a consequence, the female buyers of Omena exposed to a very high hazard of malaria infection. Also Ochorros pulling the nets at night are exposed to anopheles mosquitoes and malaria. Pay in fishing depends on the catch. Persons who cannot work get no pay unlike workers in jobs which are paid on a monthly basis. Thus, the risk of malaria which is especially high for some people involved in fishing means that they are particularly prone to losing income because of illness. Again, not only an illness of a working person but also an illness of another person in the household, who has to be cared for or brought to a hospital, can be the reason for lost working time and income. Activities related to fishing are the main source of generating some income for most people living in KUZ. It is therefore not surprising that a large percentage of the participants said that they had got the money for treating malaria in household members from activities related to fishing (compare figure 12).

Malaria and diversification Livelihood diversification is a way to protect against crisis events such as malaria. As pointed out in chapter 5.4, most people engage in different occupations some of which yield food and some money. In comparison, the latter are of increasing importance as the economy on Rusinga changes from exclusively subsistence agriculture towards a monetary economy

89 (compare chapter 5.3 and CONELLY (1994a)). The possession of money enables people to access a greater variety of ex ante and ex post strategies against malaria. Moreover, daily jobs like pulling nets which are open to everybody (compare chapter 5.1.2) allow them to economise in a goal-oriented and flexible way: When money is needed, for instance to cover expenses for the treatment of malaria, people can engage in income-earning activities. This explains the high rate of malaria related expenses that are covered by work (compare figure 12).

Malaria and migration Migration can lead to an increased hazard of malaria in that people from other regions can introduce new strains of parasites. Against these, the partial immunity acquired by the population of the area, offers only limited protection. Persons who travel from malaria-free to malaria-endemic areas are biologically much more vulnerable to the disease than locals due to their lack of immunity (compare GREENWOOD AND MUTABINGWA). This immunity is lost after a relatively short period so people from Rusinga who return home after having spent some time in other places are now at a higher risk from the disease (compare SACHS AND MALANEY).

6.6 Strategies against malaria

6.6.1 Ex ante strategies

As pointed out earlier, ex ante strategies are considered to be of particular importance for many authors on vulnerability (compare chapter 2.2.3). However, in the decisions of the people, they seem to play a rather marginal role as compared to ex post strategies. The fact that preventive steps are generally less likely to be taken than steps to deal with an emergency has been commented on in earlier writing on health issues on Rusinga Island (compare

CHAIKEN). The question in how far resignation or fatalism play a role for the limited use of preventive measures can not be answered with the data gathered but would be an important issue for further research.

90 70

60

50

40

30

20

10

0 Number of mentions Mos Mos Av Av C K S O Does oi oi learingeep c afe drinkther qui qui d getti d s pr n' to net to c tagnant waterompoun t do any bus ote i oi ng c ng waterct ls hes ion ol d c t d hing lean

Figure 20: Ex ante strategies employed by the participants (n = 108, several answers possible).

Even though bednets are by far the single most important protection against malaria that the households of the participants use, about one third of the participants who said they knew about the protection offered by bednets (compare figure 18) stated that they did not use one themselves. To understand this, one has to consider that malaria is not one of the risks taken most seriously on the one hand (compare chapter 6.3.3) and the very tight financial situation of most households on the other hand (compare chapter 5.1.4). The limited use of other protection strategies than bednets additionally seems to be related to the widespread unawareness about alternative ways of protecting against malaria (compare figure 18). The same could an explanation for the fact that most of the bednets owned by the participants are not treated with insecticides, which, at an only slightly higher price, would offer a far better protection against anopheles mosquitoes and other insects than untreated bednets.

91 untreated net

30,6%

no net 54,6%

treated net 14,8%

Figure 21: Bednet possession in the households of the participants (n = 108).

In only 5 of the 108 households, all persons sleep under insecticide treated nets.

An interesting point to note is that 10 participants who said they did not use a net to protect against malaria (compare figure 20) do have (untreated) nets in their homes. This apparent contradiction can be explained by the fact that they are not aware that bednets offer protection against malaria but use them for other reasons (e.g. to avoid the nuisance caused by mosquitoes).

The discrepancy between the amount of money spent on protection against malaria and the costs caused by malaria every year (as reported by the participants) is striking: In 2003, an insecticide treated net big enough for several people was available at a price of 350 KSh in shops both in Mbita and in the research area. The costs for treatment of malaria in household members during the previous year, on the other hand, amounted to an average of around 940 KSh (compare chapter 6.3.2). Again, it seems as if it is the combination of an extremely tight financial situation and the fact that there are other, prioritised, issues people have to deal with which seems to be the reason for this discrepancy. Moreover, relatives and friends will be more easy to convince to contribute money in an emergency than for the purchase of preventive assets.

92 6.6.2 Ex post strategies

Also the choice of ex post strategies in the case of malaria is limited due to the economic situation of the majority of the inhabitants of the area and the poor infrastructure. Particularly the transport situation represents a severe limitation. The first strategy mentioned by the vast majority of participants is home treatment with medicine from a shop.

First strategy %

Medicine from shop 63,0% Health centre on Rusinga 9,3% Bathing ill person 7,4% Private hospital on Rusinga 5,6% Praying 5,6% Others 9,3%

Table 7: First action taken when a member of the household falls ill with malaria (n = 108).

The treatment with medicines from a shop has several advantages for the local people: For most, the nearest shop selling medicines is not only closer than the nearest clinic (an important point considering the high costs of transportation) but also much cheaper. Estimates for the costs of medicines from a shop have a mean of 50 KSh while the mean of the estimated costs for treatment at one of the two nearby health centres is more than 300 KSh. These estimates do not necessarily reflect the actual prices of medicines or treatment but rather the costs the participants expect. In August 2003, there were eleven shops selling medicines in the research area, eight in Kolunga and three in Litare. One of these is a pharmacy in Kolunga run by an experienced nurse while the others are groceries selling drugs beside household items and food. The average level of education of the shopkeepers is higher than that of the total population with eight out of 22 persons working in the shops having finished secondary school. However, there is the need for information on malaria and several shopkeepers suggested that trainings in health issues for shopkeepers would be a good idea. Only three of the 11 participating shopkeepers had received such a training while the others had the package inserts and the

93 people where they bought the drugs as only sources of information about the drugs they are selling. This fact might be one of the reasons why eight participants said they sold single malaria tablets and not only complete packets. Such insufficient treatment is one of the main reasons for the rising level of resistances in parasites against drugs:

Resistance of the malaria parasite to drugs develops when the parasite is exposed to suboptimum concentrations of drugs and is in most cases the result of inappropriate prescribing or non-adherence to treatment schedules. (BATES ET AL. (2004b), 369)

Such resistance is one of the main reasons for the deteriorating malaria situation (compare

GREENWOOD AND MUTABINGWA). Drugs like chloroquine, which used to be efficient for the treatment of and prophylaxis against malaria and were used very widely because of their cheap price (compare BATES ET AL. (2004)) are now useless in many areas of Africa (including Rusinga). As pointed out, the development of new drugs proceeds rather slowly (compare chapter 6.1). The situation is consequently the one of a race between quickly developing drug- resistant parasites and the introduction of new drugs. Chloroquine is the most famous example of a general trend to resistances in parasites to cheap drugs which leaves more expensive drugs as only effective alternatives. This trend increases the vulnerability to malaria particularly of those who are poor in financial assets.

Almost two thirds of all participants said they would take the ill person to one of the two nearby health centres (Kaswanga or Luore) as the second step while most of those 10 participants who mentioned traditional healers named these as the last resort after the failure of all other strategies.

6.7 Vulnerable groups

Due to the difficulty of measuring vulnerability as addressed in chapter 2.3, it was hardly feasible to determine groups of participants who are particularly vulnerable to malaria34. A possible way of measuring vulnerability will be discussed in the next chapter. However, a short list of groups of persons who, in the literature, are highlighted as being more vulnerable to malaria than others will be presented in the following.

34 Moreover, the uncertain reliability of the data concerning cases of and deaths due to malaria makes them unsuitable for the purpose of measuring vulnerability. 94 Children Particularly young children are at risk of severe malaria and death due to the disease.

In areas of high stable transmission of malaria, the incidence of clinical malaria peaks between 1 and 5 years of age, then declines rapidly as effective immune responses develop. ... Where malaria transmission is less intense, the peak age is later in childhood; and in low-transmission or epidemic-prone regions, vulnerability to infection remains constant across all ages because protective immunity is never acquired. (Bates et al. (2004a), 269)

Rusinga is an area of high stable transmission and the data presented in chapters 6.3.1 and 6.3.2 confirm the particularly high vulnerability of very young children35.

Females Females are more vulnerable than men due to biological (sex) as well as social (gender) reasons. While there are no indications that non-pregnant women are more vulnerable biologically than men, pregnant women are:

In malaria-endemic countries, pregnant women have lowered immunity to malaria particularly during first and second pregnancies. The low immunity is associated with increased clinical episodes, maternal anaemia, morbidity, and death. (BATES ET AL. (2004a), 270)

In terms of gender, some factors make women particularly vulnerable to malaria. On Rusinga, the fact that an increasing number of men work as fishermen leads to the women having to perform works in agriculture that were formerly the duty of men. This and the “women’s job” of caring for ill family members on top of the normal work increases the workload for females. Moreover, the ultimate decision on how money is spent lies with the men. For women this implies that “[t]heir ability to seek malaria prevention or care for themselves and their children is therefore hindered” (ibid., 273). Particularly widows (and their households) are vulnerable because of the greater difficulty of getting enough food and income (compare chapter 5.1.3). Not only the vulnerability but also the hazard that women living on the island are exposed to can be considered greater than for men as they are exposed to anopheles mosquito bites in the early morning hours when they wash dishes and fetch water by the lakeshore. This means that they are in a dangerous place (compare maps 4 and 5) at a dangerous time.

35 The statement that children are particularly vulnerable is a conclusion of the fact that the risk of malaria for children is very high while the hazard (of being bitten by an infected mosquito) is not higher than for other groups. 95 Migrants Persons coming to Rusinga from other areas are biologically vulnerable to malaria at any age due to the lack of immunity against the disease. These persons include work-migrants like fishermen, Omena traders and NGO personnel as well as women who move to the island after marrying a man from Rusinga and tourists. Also people from Rusinga who have spent some time in other places (for instance for work or education) are vulnerable on returning home as “[i]mmunity is not long-lasting and is lost in the absence of repeated exposure to infections”

(BATES ET AL. (2004a), 269).

Poor people The close linkages between poverty and vulnerability have been discussed (chapter 2.2.1) and so have links between malaria and a low asset status. Factors by which poverty increases people’s specific vulnerability to malaria include their generally lower health and nutritional status as well as difficulties in access to education and information, protection, drugs, health services etc.. In short, poor people are more vulnerable to malaria because of their difficulties of protecting against, coping with and recovering from the disease.

7 An index for measuring vulnerability

The difficulty of determining factors that increase vulnerability to a specific hazard and vulnerable groups, as addressed in the last chapter, is related to the problem of measuring vulnerability (compare chapter 2.3). If there was an index which could be used to compare the relative vulnerability of one group to the relative vulnerability of another group, it might be possible to isolate single factors that contribute to making people safe or vulnerable to hazards like malaria.

[V]ulnerability is a measure of a person or group’s exposure to the effects of a natural hazard, including the degree to which they can recover from the impact of that event. Thus, it is only possible to develop a quantitative measure of vulnerability in terms of a probability that a hazard of particular intensity, frequency, and duration will occur. These variable characteristics of the hazard will affect the degree of loss within a household or group in relation to their level of vulnerability to various specific hazards of differing

96 intensities. Thus vulnerability is a hypothetical and predictive term, which can only be

‘proved’ by observing the impact of the event when, and if, it occurs. (BLAIKIE ET AL., 57p)

While there is a definite lack of knowledge about which factors determine vulnerability against malaria, it is possible to measure the epidemiological risk (compare RENN) of different groups to malaria in terms of the probability of falling ill or dying from malaria or suffering other severe consequences. Also measures for the hazard of malaria, such as the probability of infectious mosquito bites per person, exist. In fact, these measures are widely used in malaria research (compare, for instance, KILLEEN ET AL. (1999, 2000a, 2000b), BEIER ET AL., GU ET AL.) and could serve as a starting point for determining the vulnerability of individuals or groups to malaria: According to BLAIKIE ET AL., risk (R) is a combination of hazard (H) and vulnerability (V). However, as an equation, their formula R = H + V is misleading. It implies that even if there is no hazard, the risk is as high as the level of vulnerability which does not make sense: If there is no hazard, there cannot be a risk to this hazard either. Likewise, in reality, there is no risk if there is no vulnerable population even if the hazard is high. In fact, BLAIKIE ET AL. point this out themselves: “[T]here is no risk if there are hazards but vulnerability is nil, or if there is a vulnerable population but no hazard event” (BLAIKIE ET AL., 21). Therefore, it seems advantageous to change the formula into

R = H x V

(risk is the product of hazard and vulnerability). In a case in which one or both of the components hazard and vulnerability are low, the risk is lower than in a case in which both hazard and vulnerability are high. As soon as one of the two components is nil, R is automatically nil too. For example, in an area without anopheles mosquitoes, there is no risk of infection even if the people living there would, if infected anopheles mosquitoes existed, be vulnerable to malaria (because they do not use prophylactics, bednets etc.). Of course, the two components H and V have to be weighted differently for vulnerability to different hazards. As BLAIKIE ET AL. note, there is a “spectrum of causation” ranging from

97 purely social to purely natural causes (ibid., 6)36. This also means that the equation is only valid to compare the risk of different groups to the same hazard. With existing measures for both R and H, V remains the only unknown quantity in the equation. It is therefore possible to measure vulnerability with the formula

V = R/H.

This implies that, for instance, of two groups at the same level of risk the one that is exposed to a greater hazard can be considered to be less vulnerable. Likewise, if the hazard is the same, the greater risk that one of the groups is exposed to can be attributed to the higher vulnerability of this group. To illustrate this: If the probability of infectious mosquito bites is the same for two groups of people but the occurrence of malaria is significantly less frequent in one of them, this must be due to the lower vulnerability of this group to malaria.

In contrast to other attempts to calculate vulnerability (compare, for instance, LIGON AND

SCHECHTER), the way proposed here does not try to include all single components that constitute vulnerability but rather to exclude those factors of risk which can not be attributed to vulnerability but to hazard. This pays tribute to the fact that vulnerability is an extremely multidimensional concept. The relational index of vulnerability is specific, i.e. it can be used to compare the vulnerability levels of different individuals or groups, e.g. groups living in different locations, widows against married women, different income, age or occupational groups etc. to one defined hazard and one defined risk37. The expressiveness of the index of vulnerability depends on the

36 As an example for a purely natural disaster, Blaikie et al. (1994) cite the case of Lake Nyos in Cameroon, where a cloud of carbon dioxide gas bubbled up killing rich as well as poor people in their sleep without any possibility of protection. The 1976 earthquake in Guatemala is given as an example for a natural disaster at the other end of the spectrum that had such a strong social component that it was called a “class quake” by a New York Times journalist (compare Blaikie et al, 6). In general, it seems as if vulnerability played a greater roll than hazards:

Evidence of the primacy of vulnerability as a determinant of a disaster is shown when one considers that between 1970 and 1985 over 97 percent of all the world’s major natural hazard triggered disasters and 99 percent of all disaster-related deaths occurred in the ‘developing’ world … and that in the 1990s at least 96 percent of the annual victims of natural hazards lived outside of Europe, Canada and the US. (PROWSE, 4p)

As the occurrence of natural hazards is spread much more evenly across the globe, the conclusion has to be that the high death rates in developing countries must be attributed to vulnerability. 37 The risk referred to here is probabilistic and quantifiable. The intention is by no means to question the relevance of other concepts of risk (compare chapter 2.2.6). For a discussion of different perspectives on risk see Renn (1992). 98 definition of the two other components. In the case of malaria, R might be defined as the morbidity or mortality rate or the probability of other severe consequences while H seems more difficult to define and could include entomologic and parasitologic parameters such as the entomologic inoculation rate (EIR) (compare KILLEEN (2000a)). Calculating the index of vulnerability requires these data on an individual or household level basis. The index tells nothing about the reasons for but only shows the relational extent of vulnerability. It can provide a starting point for addressing the question why some persons and groups of persons are more vulnerable than others and help to isolate single central factors which increase or lower people’s vulnerability to hazards like malaria. Obviously, factors that play a very significant role in one context do not necessarily have to be important in another one. Also, the fact that vulnerability is prone to changes over time has to be kept in mind. In spite of the shortcomings of this simple measure, it is hoped that the index can contribute to a more concrete idea about vulnerability.

8 Some implications for further research and the malaria project

Participatory approach: Considering the complexity of the interrelations between malaria and various other issues, it becomes obvious that local people must play a central role already in the planning of projects to a much greater degree than it is usually the case (compare

NYAMWAYA, CHAMBERS (1997)). After all, they are the best experts when it comes to keeping in mind the various issues that come into play. Moreover, they are the ones who can best decide which measures address the perceived priorities of the people and are realistic in the local context. A way in which this can be achieved are participatory methods as described in

CHAMBERS (1997). The role of outsiders in participatory approaches differs considerably from the one in more traditional approaches:

Outsiders do not dominate and lecture; they facilitate, sit down, listen and learn. Outsiders do not transfer technology; they share methods which local people can use for their own appraisal, analysis, planning, action, monitoring and evaluation. Outsiders do not impose their reality; they encourage and enable local people to express their own. (CHAMBERS (1997), 103)

The malaria project on Rusinga Island has participation as one of its aims and has practiced participation for instance through facilitating the creation of organisational structures. It can set a positive example for other projects by further strengthening participatory aspects. 99

Broad perspective and approach: One of the main points of this study is that malaria does not exist in isolation but is connected to many other aspects of people’s livelihoods through a plethora of direct and indirect links. For malaria projects, just like for any other projects in the field of development work, this implies that there needs to be a broadening of perspective and approach. This includes appreciating that it might be worthwhile for a malaria project to address issues which are “only” indirectly linked to the disease if they are considered to be of central importance. Examples from the Rusinga context include the difficulty of saving and getting credits. It seems worthwhile to consider a micro credit scheme for women in order to enable them to purchase bednets and generally strengthen the position of females in society. The complexity of influences between malaria and other issues must not be seen exclusively as complicating matters. It is also a chance to tackle malaria from different sides and through various channels. The strengthening of assets can brace people against the disease, mitigated other hazards can have an effect on the malaria situation and all levels of the structural context can play a role. Examples for the latter include the possibility of spreading information during “crusades” carried out by religious communities on Rusinga.

Put malaria in perspective: To appreciate the fact that malaria is only one out of many hazards and hazards only one aspect of livelihoods leads to several conclusions: a) Strategies need to be affordable and little time consuming. Particularly in the rainy season, when malaria is most prevalent, time and energy are limited resources. Therefore, strategies which serve various purposes at a time are best. An example for such a strategy could be the planting of trees. Ideally, positive outcomes of this could be the draining of swampy areas, shade, protection of the soil, firewood and wood for construction, income earning possibilities for tree nurseries and sale of wood etc.. b) Strategies which adapt to rather than change the daily life will be easier to implement. An example is the promotion of repellent substances like neem-oil which can be added to kerosene used in lamps. These are common household items and are lit during mosquito biting times. c) People are most receptive for information about malaria when they are directly confronted with the disease: Doctors and nurses are by far the most important source of information about malaria mentioned during the interviews. However, for most people the first place to go in a case of malaria is a local shop. Shopkeepers (who on

100 average have a relatively high level of education) are thus a very good target group for educational campaigns and can play an important role in spreading information. d) Just as it is true that a single approach to mitigate malaria is not enough to sustainably lower the burden of the disease, malaria control is just one approach to achieve sustainable development. However, it can play an important role in contributing to an overall reduction of vulnerability and a strengthening of assets. Not only can measures of malaria control play a role in an improvement in the general health situation for the people but combined efforts can also strengthen other assets like the social capital through networks and personal relationship, the human capital through the spread of information, the financial capital through lower expenditures for treatment and the natural capital through an increase in arable (formerly swampy) land. To keep this variety in positive outcomes in mind when carrying out and modifying malaria control measures can help to stay in line with the priorities of the people thus ensuring the motivation and dedication of all participants of the malaria project.

Test and refine the index of vulnerability: If the index proves to be useful in identifying particularly vulnerable groups, it can help in targeting them in projects. In further analytical steps, it should be possible to identify central factors that increase and factors that decrease vulnerability. On this basis, the struggle against malaria, which has so far mainly been a fight against the hazard of malaria, can be complemented by efforts to reduce vulnerability to malaria.

101 9 Summary

The aim of this study is to put malaria on Rusinga Island/Western Kenya into the context in which it occurs. While so far, research on malaria has focused mainly on the hazard side of the disease, social factors are of crucial importance, too. This is indicated by the fact that malaria is a disease of the poor, who generally have more difficulties in anticipating, coping with and recovering from malaria. These difficulties can be called ‘vulnerability’ to malaria. An analysis of people’s vulnerability to malaria can accomplish analyses of the hazard of malaria, which take factors like the density of mosquitoes infected with the malaria parasite into account. Taken together, hazard and vulnerability make up risk. Thus, vulnerable people living in a hazardous region are at a particularly high risk. One of the factors contributing to the hazard of malaria is the density of anopheles mosquitoes. A possible indicator for measuring mosquito densities is the geographic distributions of potential breeding sites. This was done in a first part of the fieldwork on Rusinga Island using GPS and GIS. Some of the findings were that the vast majority of potential mosquito breeding sites are manmade, that only few breeding sites actually contained anopheles larvae in the dry season and that all of these are situated either at the lakeshore or close to swampy areas. While it is difficult to measure the hazard of malaria in a certain region, it is impossible to determine the vulnerability of groups of people to the disease due to the fact that there is no measure for vulnerability so far. This can at least partly be attributed to the fact that there is a plethora of factors that have an effect on vulnerability. What is more, there are only guesses about what these factors actually are. The claim of many authors that ignorance of affected people about diseases and the ways they are transmitted played a crucial role in making them vulnerable to these diseases, for instance, was not affirmed in interviews carried out on Rusinga Island. The participants of the interviews had a rather high level of information about malaria. However, event though the awareness about strategies against malaria is relatively high, few households use these strategies. This seems paradoxical considering that malaria is very widespread in the research area and results in high cost both in terms of human suffering and financial and material losses. In order to understand the apparent reluctance of the people to address the problem of malaria, it is necessary to consider the context in which malaria is embedded. The disease is only one out of many hazards which the people on Rusinga Island face. Many of these hazards, in particular AIDS and witchcraft, are considered to be more 102 serious than malaria. What is more, the hazard context itself is only one aspect of people’s livelihoods. The different livelihood aspects can be depicted with the help of the livelihood model. Beside offering a good checklist for all the livelihood aspects, the model is useful in showing the interlinkages between these. In fact, as shown at the example malaria, most, if not all, livelihood aspects are linked to one another. Assets at the command of the households are of central importance. The limitations for many households on Rusinga resulting from a low asset status are a main factor restricting the strategies against malaria open to them. It is these restrictions rather than indifference or a lack of awareness that influence people’s decisions concerning malaria. In the absence of a measure for vulnerability, it is all but impossible to determine which single factors have a particular influence on people’s vulnerability to malaria. In an attempt to overcome this problem, an index of vulnerability is developed and proposed. This measure for vulnerability is arrived at by excluding those factors from the risk a group of people is exposed to which can be attributed to the hazard-side of this risk. The proposed index is mainly based on theoretical considerations and needs to be tested and refined. Eventually, it could prove a useful tool in determining groups of people characterised by a particularly high vulnerability to certain hazards. This, in turn, is the basis for identifying single factors that increase or decrease the degree of vulnerability to specific hazards such as malaria.

103 10 Zusammenfassung

Das Ziel dieser Studie ist es, den weiteren Kontext von Malaria auf Rusinga Island darzustellen. Obwohl sich die Malariaforschung bisher weitgehend auf die Gefahrenseite der Krankheit konzentriert hat, spielen auch soziale Faktoren eine sehr wichtige Rolle. Dies wird daran ersichtlich, dass es sich um eine Krankheit der Armen handelt, welche im Allgemeinen besonders große Schwierigkeiten haben, sich auf die Krankheit vorzubereiten, angemessen auf sie zu reagieren und sich von ihr zu erholen. Diese Schwierigkeiten werden als ‘Verwundbarkeit’ gegen Malaria bezeichnet. Verwundbarkeitsanalysen können Analysen zur Malariagefahr, wie zum Beispiel das Ermitteln der Dichte infizierter Anophelesmoskitos in einem Gebiet, ergänzen. Zusammengenommen konstituieren Gefahren und Verwundbarkeit Risiko. Verwundbare Menschen, die in gefahrenträchtigen Regionen leben sind somit einem besonders hohen Risiko ausgesetzt. Einer der Faktoren, die die Malariagefahr ausmachen, ist die Dichte der Anophelesmoskitos in einem Gebiet. Eine Möglichkeit, diese zu ermitteln, ist, die geographische Verbreitung potentieller Brutplätze festzustellen. Dies wurde in einem ersten Teil der Feldforschung auf Rusinga Island mit Hilfe von GPS und GIS durchgeführt. Ergebnisse dieser Untersuchung waren, dass die große Mehrheit der Brutplätze von Menschen geschaffen waren, nur wenige von ihnen auch in der Trockenzeit Anopheleslarven enthielten und diese alle entweder entlang des Seeufers oder nahe von Sumpfgebieten aufzufinden waren. Schon das Messen der Malariagefahr eines Gebietes ist schwierig, aber das Messen der Verwundbarkeit von Bevölkerungsgruppen gegen die Krankheit ist unmöglich, da es bislang noch keine geeignete Methode dafür gibt. Dies kann zumindest teilweise darauf zurückgeführt werden, dass eine scheinbar unübersichtliche Vielzahl von Faktoren Auswirkungen auf Verwundbarkeit hat. Zudem gibt es nur Mutmaßungen darüber, welcher Art diese Faktoren sind. So wurde die Überzeugung vieler Autoren, dass fehlendes Wissen betroffener Bevölkerungsgruppen über Krankheiten und ihre Ursachen ein Hauptgrund für Verwundbarkeit gegen diese Krankheiten sei, in den auf Rusinga durchgeführten Interviews nicht bestätigt. Die Interviewteilnehmerinnen hatten einen relativ gehobenen Informationsstand über Malaria. Obwohl jedoch im Untersuchungsgebiet Wissen über Strategien gegen Malaria recht weit verbreitet ist, wenden nur wenige Haushalte diese Strategien auch an. Dies scheint angesichts der Tatsache, dass Malaria im Untersuchungsgebiet weit verbreitet ist und schweres menschliches Leid und hohe finanzielle 104 und materielle Verluste verursacht, paradox. Um den scheinbaren Unwillen der Menschen, sich des Problems anzunehmen, zu verstehen, muss der Kontext, in dem sich die Krankheit ereignet, betrachtet werden. Malaria ist nur eine von vielen Gefahren, denen sich die Menschen auf Rusinga Island ausgesetzt sehen. Viele dieser Gefahren, insbesondere AIDS und Hexerei, werden als schwerwiegender eingeschätzt. Auch der Gefahrenkontext selbst ist nur ein Aspekt des Livelihood-Kontextes der Menschen. Dessen verschiedene Aspekte können mit Hilfe des Livelihood-Modells dargestellt werden. Dieses bietet nicht nur eine gute ‘Checkliste’ für die verschiedenen Livelihood-Aspekte, sondern ist auch geeignet, die vielfältigen Wechselwirkungen unter ihnen aufzuzeigen. Am Beispiel Malaria wird gezeigt, dass tatsächlich viele, wenn nicht alle, dieser Aspekte miteinander verbunden sind. Eine zentrale Rolle kommt den Livelihood-Assets, auf die die Menschen zurückgreifen können, zu. Die aus einem niedrigen Assetstatus resultierenden Einschränkungen für viele Haushalte auf Rusinga sind eine der Hauptursachen, warum viele Strategien gegen Malaria nicht angewandt werden können. Da es keine Methode gibt, Verwundbarkeit zu messen, ist es nicht möglich, diejenigen einzelnen Faktoren zu ermitteln, welche sich besonders stark auf die Verwundbarkeit von Menschen gegen Malaria auswirken. Als Versuch, dieses Problem zu überwinden, wird ein Index der Verwundbarkeit entwickelt und vorgestellt. Die Maßeinheit für Verwundbarkeit basiert darauf, diejenigen Faktoren vom Risiko einer Bevölkerungsgruppe auszuschließen, die der Gefahrenseite dieses Risikos zugeordnet werden können. Der vorgeschlagene Index basiert zu einem großen Teil auf theoretischen Überlegungen und muss noch getestet und weiterentwickelt werden. Falls er sich als geeignet erweist, könnte er eine nützliche Methode darstellen, Bevölkerungsgruppen, die gegen bestimmte Gefahren besonders verwundbar sind, zu ermitteln. Dies wiederum wäre eine Grundlage dafür, einzelne Faktoren, die den Grad der Verwundbarkeit gegen Malaria und andere Gefahren erhöhen oder herabsetzen, zu identifizieren.

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Appendix 1

The following pictures were taken by the author in June to September 2003.

Photo 1: Eroded slope near Litare

Photo 2: Water hyacinth (Eichhornia crassipes) blocking the pier at Mbita

Photo 3: Abandoned terraces in Kaknaga/Ufira zone

Photo 4: Soil erosion on Rusinga

Photo 5: Maize infested with striga

Photo 6: Mosquito breeding site in artificial hole

Appendix 2

CHRISTIAN CHILDREN’S FUND

A STUDY ON RISKS ON RUSINGA ISLAND – SUBA DISTRICT – NYANZA PROVINCE This study is carried out by the CCF Rusinga in collaboration with national and international scientists working at the University of Nairobi and the International Centre for Insect Physiology and Ecology (ICIPE). Its aim is to determine different hazards and the vulnerability of different households in Kaknaga/Ufira Zone on Rusinga Island. Participants of the interviews will take part on a voluntary basis and not be paid. There will be no pressure on them to answer the questions and they can refuse to answer any questions they do not feel comfortable with.

QUESTIONNAIRE

Date______Time______Interviewers______Interview Nr. _____ GPS coordinates of house S______E______

Part I: Livelihoods context 1. How old are you/when were you born? ______2. How long have you been living here/since when? ______3. What is your marital status? single, married, widowed, divorced 4. How many wives does your husband have? _____ 5. Do you have children? yes, no 6. How many people belong to your household? 0 to 5 years ___ 6 to 15 years ____ 16 to 25 years ___ 25 to 40 years ___ 40 to 60 years ___ over 60 years ___ 7. Have you attended school? yes, no 8. Up to which level? ______9. Have the other members of your household attended school? Up to which level? ______10. How do you get food and money for your household? ______11. What is the most important source of food and money for your household? ______12. Which persons of the household bring in food/income? ______13. Are there any contributions from people who do not live here (e.g. city, other country)? yes, no 14. If yes: who? ______15. What is the living arrangement of the household in this house? owns the house rents it for ______KSh per ______ other arrangement ______16. Do you have livestock? Which, how many? Cattle______Goats ______Chicken ______Others ______17. Do you have valuable belongings? Which, how many? Houses ______Land ______Boat ______Net ______Bicycle ______Radio ______Others ______18. Do you have savings/debts? Where, how much (less than 1000, 1000 to 5000, 5000 to 10000, more than 10000 Kenyan Shillings)? ______19. Are you a member of a group/organisation, for example a women’s group, a self-help group, a fisheries cooperative, …? Which? ______

Part II: Vulnerability context 20. Do you like living here? yes, no 21. What makes the life here good? ______22. What makes it difficult? ______23. What dangerous things are there, what makes people suffer in Rusinga? ______24. Which are the most serious threats? HIV/AIDS, Nr. ____ Not enough rain, Nr. ____ Dangerous animals (for example hippos, snakes, crocodiles, dogs), Nr. ____ Witchcraft, Nr. ____ Malaria, Nr. ____ Other threats, Nr. ____

Part III: Malaria 25. How do you know if an adult person has malaria? How do you know if a baby has malaria? Adult: ______Baby: ______26. Which of these problems are signs of malaria and which are not? i. Cough yes, no ii. Fever that comes and goes yes, no iii. Fever that continues yes, no iv. Diarrhoea without fever yes, no v. Headache yes, no vi. Blood in stool/urine yes, no vii. Weight loss yes, no viii. Chills, shivering yes, no 27. How can you get/what causes malaria? ______28. Since the end of last year’s rainy season: did any members of your household have malaria? yes, no 29. Who (how old)? ______30. How much money did you spend on the treatment of malaria since the last rainy season? ______KSh 31. Where did you get the money from? ______32. Have you ever lost household members to malaria? How old were they? ______33. Do you know ways of protecting yourself/your household from malaria? ______34. What do you do to protect yourself/your household from malaria? ______35. Do you use bed nets? treated (within the last 6 months), untreated, no 36. If yes: Who in the household sleeps under a bed net? ______37. Where did you learn about malaria?/Where do you get information about malaria? teachers books doctors, nurses neighbours, family members others: ______38. Which sources of information do you trust most? Teachers, Nr. ____ Books, Nr. ____ Doctors, nurses Nr. ____ Neighbours, family members Nr. ____ Others, (Nrs.)______39. If somebody in your household has malaria, what do you do first (and then)? How much do the different steps cost (including transport)? i. ______ii. ______iii. ______iv. ______Other steps______40. Do you do different things for different members of your household when they have malaria? no yes: ______41. Who in the household decides what is done if somebody of the household has malaria? ______To be filled in by the interviewer 42. Material of house: Walls______Roof ______43. Remarks ______