Stolz, Amanda

Public Health



Kenya-Descriptive epidemiology of neonatal mortality in western Kenya

The objective is to assist a Kenyan researcher in an evaluation of neonatal mortality in a demographic surveillance site from 2003-2010. The database is well-established and includes both rates, timing and causes of neonatal deaths in this rural area of western Kenya where malaria is holoendemic and HIV prevalence is high. The project will document changes in the epidemiology of neonatal mortality over time in an area with high under-5 mortality (approximately 200 per 1000 live births). The second objective would be to further categorize neonatal mortality in the area in terms of completing a survey of practices related to neonatal illness, including health-seeking and cultural practices.

Expect the Unexpected: A Case of Contrasts in a Developing Country

When I first arrived in Kisumu, Kenya, things were more developed than I thought they would be.  The local airport, though small, was bright and efficient, the main road was well-paved, and there was a lot of traffic.  However, the things that I told myself I expected, like the varied traffic including cars, pedestrians, animals, bicycles, vans, motorcycles, and tuk tuks (which look like a well-enclosed golf cart), surprised me more as time went on.  The mix of modern conveniences with a slower pace of life provided a contrast that I did not anticipate.

The shuttle transportation system to work was one of the first ways I experienced this strange fulfillment of my expectations in a different way than assumed.  I had been told about the shuttle and given its schedule before I arrived, so I expected to be picked up at the nearest shuttle pick-up at 7:45 and leave work at 5:30 on the same shuttle every day.  While this generally happened, it was surprising to observe the erratic changing of shuttle size from a 6-person to 15-person vehicle in an attempt to adjust to the going and coming number of shuttle users because of temporary projects and employees who sometimes used the shuttle but sometimes drove.  I was equally surprised at the overall success of this system.  It was also interesting to see that one could leave work at four different times throughout the day beginning late morning and going until 6:30.  This accommodated the errands that employees had to run as well as allowing people to come in for meetings then work at home the rest of the day or just for general flexibility in their schedules.  Seeing work be results based rather than on a 9 to 5 structure was something I somewhat expected but did not think about how it would be accommodated for.

Another area where modern convenience met developing country struggles was office technology.  The internet connection, for example, was almost unbreakable in connectivity, but it seemed to speed up and slow down with disregard to amount of users or to the signal strength indicated by anyone’s computer.  Similarly, there were occasional power outages that lasted a few seconds and occurred sporadically, but did not affect work because of backup generators.  Despite the presence of internet connection and backup electricity which ensured constant computer work, things such as office supplies were in limited stock.  Something I would take for granted in an office in the United States such as a stapler, tape, or a hole punch, was only found at about one fifth of the desks in the office I worked in, even though at least half of them needed these items on a regular basis.  I had assumed that “more developed” things such as internet connection and reliable electricity would be more difficult to find than things like office supplies.

When it came to health issues in Kenya, these contrasts of having modern technology while lacking what I perceived before as essentials became less happenstance and more troubling.  When I visited health clinics, each clinic seemed to have what it needed in terms of refrigeration for vaccines, for example, but the supply chain for vaccines was less reliable and less well understood by the clinic staff than the refrigeration technology.  I heard varying answers as to why a current vaccine shortage might be occurring, such as the vaccine was short for everyone across the district, but at other clinics, the vaccine shortage was not a problem, so the staff did not guess that there were problems in the district.  Neighboring clinics, however, did work around these shortages by borrowing vaccines from each other if there was one clinic that received more than it needed.  The localized technology and communication was not necessarily the problem, but rather long-distance communication and supply chain issues in the regional ministries of health were.

I later got a more personal view of the healthcare system.  While tossing a frisbee with some new acquaintances, one of them suddenly dropped to the ground and started having a seizure.  The rest of us barely knew her, did not know that she had a seizure a few months before, and did not have any medical training.  Luckily, one of us had a car and the best hospital in town was nearby, so I and another person were able to hold the woman having the seizure down while the man with the car drove it as close as possible so that we could carry her into it and get to the emergency room quickly.  The same man who had driven was also able to contact three physician friends who all came to advocate for the woman with the seizure.  The reality of three things that I already knew about Kenya hit me at once: there are no ambulances or 911; payment is needed before you leave the hospital; and as good as the care can be for emergencies if you go to the best hospital, the cause of seizures cannot be determined here.  While at the hospital, the woman had an MRI, but an EEG could not be given and interpreted properly.  I learned later that the same was true in the capital city of Nairobi, so although the woman was fine for the moment after the seizure, she had to return to the United States to determine the cause. 

During my internship in Kenya, I learned that many things must be considered when measuring the development as well as the healthcare system of a country.  I also learned that development does not progress in the orderly, or even somewhat orderly, fashion that I had assumed, but rather there is always a mixture of exceeding and failing to meet one’s expectations.  I am grateful for a lesson that will follow me in my future travels.


Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

May 2019



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