The Good Nurses of Busia County

Wednesday, July 10, 2013

When Aditi and I arrived in Busia, dust-splayed and weather-beaten on the shared backseat of a boda boda, we did not look like your average tourists.

The midday sun was at its height, and as we throttled down miles of dusty country roads, the wind kicked up streaks of earth that colored my clothes red and coursed through my hair. Sitting on the very back of the motorbike, with Aditi sandwiched in-between me and the driver, I grasped for the metal bar behind me with one hand, and with the other, waved at an ever-evolving panorama of fruit sellers, truck drivers and playing children. The looks I got in return were bewildered at best -- no one was quite sure how to place me.

Up to that point, I had been living in Kenya’s foreigner-saturated capital city of Nairobi for three weeks and had gotten used to a certain indifference at my presence. Few, if any, passerby on the street stopped to take a second look, and there was hardly any uproar at my belabored crawling into a crowded matatu with a cabin-full of locals. But out in Western Kenya -- a stone’s throw from the Ugandan border -- in a place that sees a negligible share of foreign visitors, Aditi and I were the only other mzungu that we saw during our two days in Busia.

The four women that we had traveled over 300 miles to visit in the border town were all registered community nurses who own and operate their own clinics. All of them were recipients of Kiva Zip loans, small loans of $125 lent by individuals from around the world that the nurses used to grow their businesses. But the reason that Aditi and I were in Busia was not to disperse the loans, nor was it to collect repayments. We weren’t educating on Kiva policies or training new borrowers on the Zip model. In fact, it was quite the opposite; we were the ones taking notes.

“When the government hospitals run out of malaria drugs, we are the only place people can go,” Fosca told me, a mother of seven and a widow of twenty years. I was sitting in the reception area of her clinic in the small rural town of Funyula, filling out a borrower verification form and talking fast so as not to take too much time away from her patients. Fosca was soft-spoken and amazingly resilient; she runs two businesses in addition to her clinic, a farm where she sells beans and corn and a brickmaking kiln. More impressive still, she singlehandedly put all seven of her kids through college. (“My last one is in university now,” she corrected me, “so don’t congratulate me just yet.”).

Fosca holding the visitor's book we would later sign.

Like many of the nurses I spoke with, Fosca used the Zip loan to stock up on extra supplies for her clinic. One of her competitive advantages has recently been in stockpiling malaria drugs. They are becoming increasingly scarce in the town and she builds her customer base by ensuring that sick patients can come to her and get the drugs that they need when they are not available elsewhere. She said, however, that this would not have been possible without a loan from Kiva.

“Without the loan, things would be like they were before,” she said, “slow.” Her patient base has increased from five a day to close to ten, and she has hired a new nurse to support the growing business. She estimates that profits have increased four-fold since taking out the loan.

But microfinance loans, for many of the nurses I met, were nothing revolutionary. Almost all of them had some experience with borrowing, whether it was through banks, relatives, or informal groups. But not all of them would do it again.

“I had a bad experience with a bank loan,” Janet told me, a nurse in the town of Nambale who began her clinic out of her home back in 2006. “The interest rates are just too high.” At upwards of 40% interest, bank loans in Kenya are a huge barrier for small business owners, especially for those at the bottom of the pyramid. Kiva Zip specifically targets individuals who are deemed “too risky” for traditional microfinance and provides them with capital that would otherwise be unavailable to them.

Janet at her clinic in Nambale.

With the help of a loan from her family, Janet was able to rent out a space for her clinic and, six years later, her business is thriving. The Zip loan she took out one month ago enabled Janet to buy more chairs for her reception area and a fridge that allows her to store sensitive vaccinations longer.

“I was happy to get the loan because I no longer have to ask my children for money to buy items for my clinic,” she told Aditi and me. She said that after she finishes repaying her current loan, she wants to use her next loan to expand the physical capacity of her clinic with an extension. But this was not just a future pipedream.

Janet led us out of her clinic and took us into the newly vacant adjacent building, which she had recently put a down payment on. She had already started converting it, outfitting the walls with large floor-to-ceiling shelves and installing a large glass counter in the front.

“This will be the pharmacy,” she told me. Her dream is to eventually own the entire property on which her clinic sits – not simply rent it – to ensure that the clinic will live on beyond her, and that the government won’t be able to take it away from the community after she is gone. Janet, like many of the Kenyans I’ve met – and like many of the Americans I know too – doesn’t entirely trust her government.

But it’s not just trust in the government; trust in one’s community is tricky too. On one hand, it is risky to depend on other people, but on the other, it is sometimes the only option that entrepreneurs have. Elizabeth, who used her loan to buy a glucometer to expand the services that her clinic offers, takes part in what is known as “table banking” with three women’s groups in her community.

“They fund better than bank loans and only charge 10% interest,” she insisted. But she also acknowledged the dangers. In table banking, a large group of individuals pools its money and each week rotates who it is sent home with. It is a useful system, but the model only works if members consistently contribute to the pool even after they’ve cashed out their large sum. “If someone doesn’t pay up, everyone is responsible,” Elizabeth told me. “And that’s trouble for everyone.”

Elizabeth with the glucometer that she bought with her Kiva loan.

One of the reasons that Kiva Zip is so different from traditional microfinance is that it provides loans at 0% interest – a rate unthinkable in almost any other context. Another is that it does not depend on intermediaries—microfinance institutions (MFIs), money collectors, or informal groups—in order to deliver loans. Individual borrowers receive and pay back their loans over a mobile banking platform called M-Pesa, and money can be accessed instantly at any one of thousands of kiosks across the country.

But as I talked with the nurses about their experience with Kiva, one nagging question still remained. Not only were Aditi and I clearly outsiders to the town, we were also foreigners. If distrust is already so pervasive among Kenyan nationals, locals within the community, and even close confidantes, than what reason whatsoever did these women have to trust us?

The answer came to me at lunch at a local restaurant in the town of Bumala, where Aditi and I visited Mary, the first of the nurses in Busia to take out a Kiva loan. She bore the risk for the loan and it was only through her diligence and ability to pay it back on time that the other nurses could be endorsed as borrowers. At the heart of Kiva’s model is an underlying philosophy of trust – new borrowers must depend on the reliability of their predecessors to have the opportunity to take out a new loan, and in turn, those predecessors are able to graduate to higher loan amounts. When we went to visit Mary, she was already paying back her second loan, this one for $250.

Mary with her daughter and granddaughter at their home in Bumala.

At lunch, Aditi and I were served two huge plates of roasted chicken and potatoes ladled in tomato chutney and paired with a side of leafy greens. As the bill came and we got ready to see Mary, I took out my wallet. I paid for that meal out of my own pocket, the same as I had with every meal I’d eaten since being in Kenya. But more than that, I paid for all of my own expenses in Kenya. It was true of all Kiva Fellows everywhere – none of us received a dime from Kiva for the entire length of our fellowships. And that’s when it struck me.

As volunteers, what we lose in credibility due to not being salaried employees we gain by the very nature of our presence – our commitment to this experience means that we believe in Kiva’s mission, and more importantly, that we care deeply about the people that Kiva supports. In that way, we embody that philosophy of trust, establishing a crucial link between lenders and borrowers who may never meet in person, but in some small way can learn more about each other through us. More than anything else, it was the visit to see those nurses, to see first-hand how the Zip loan had changed their lives, that really convinced me of that.

When I saw Mary, I showed her the profiles of all the lenders that had contributed to her loan, and her face lit up. I was surprised to learn that none of the nurses I visited had ever seen their public profile online. None of them had regular access to the internet and on average they only checked their personal emails about once a month. But messages from Kiva, like the loans themselves, are delivered right to the borrower’s phones, and Mary was sent a message every time a new lender contributed to her loan. Likewise, borrowers are able to communicate directly with lenders by sending a text.

“I remember sending Trevor a message when he funded my loan,” Mary said. “I was so grateful for that.”

Many of the nurses were amazed at the fact that we had self-financed our own experience as volunteers with Kiva to make visits to places like Busia. I asked Mary if she thought it was strange that we had come to visit her – that despite having already received two loans from Kiva, we were the first representatives from the organization that she had physically met.

“It’s just like the lenders,” she responded, still staring at the faces of the thirteen individuals who trusted her to repay her loan. “But seeing your faces in person is like an added bonus.”

Near the end of our visit, Mary quickly shuffled us into her office and closed the door. Her eyes widened and she lowered her voice, like we were fifth-graders at a sleepover, and she was about to tell us a secret.

“My kids will never believe you came here,” Mary said, flashing a wide grin. “You’ll have to sign my visitor’s book for proof.” At that point it had become a familiar routine; Aditi and I signed the visitor’s book of each of the four nurses that we came to visit. Each time I tried to write something different. During the visit, I asked them countless questions about how the Zip loan impacted their lives that, when I left, I wanted to let them know how much they had made an impact on me.

When I handed the book back to Mary and turned toward the boda boda driver waiting outside, I thought about leaving Kenya in six weeks, about the stories I would tell friends back home of the nurses I had met in Busia. I wondered if they would believe me either.

*

This post is cross-listed on the Kiva Fellows Blog.

Scotty G. –   – (July 16, 2013 at 12:28 PM)  

YES! This is what we have been waiting for, to hear the intricacies of your work, and to meet the people most helped by your work. It is difficult to imagine being in your shoes, seeing their faces light up when they see their loaners and the condition they leave in and not swell up with tears.

Like you said, it's more than just dropping a dollar in a water jug at a charity function to buy yourself a little altruistic gratification, it's being there, among those who need your help and seeing the contributions made put to proper use.

You came dangerously close to quoting Dead Poets Society and saying, "I teach them but really they teach me", but this was bar none the most power piece you have written about your summer. If I had any requests for further entries, I would be curious to know more about how Kiva is faring from the loans they give out, the issues they contend with and how the information you provide Kiva helps them. Cannot wait to hear more!

monroeville travel clinic  – (July 19, 2013 at 1:49 AM)  

its really a nice feeling having some nurses around who would give a volunteer service in every place..these can enlighten all the people's feelings too..

Dr Purva Pius  – (April 29, 2017 at 1:44 PM)  

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