Fighting AIDS in Obama's Ancestral Land

A chronicle of daily life in Kenya's Nyanza Province paves the way for medical breakthroughs.

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 The relationship between donor and grantee is often -- let's speak frankly -- an uncomfortable one, reflecting the imbalance of power. The philanthropic entity derives satisfaction from giving but wants some acknowledgment of that gift. The recipient feels obliged to put on an impressive show of gratitude, mindful that it relies on the approval and goodwill of its more powerful partner.

On the other side are the people of Nyanza -- poor, malnourished and in ill health. Almost two-thirds of this mostly agricultural community lives below the Kenyan national poverty line of around 60 cents a day. Nyanza's HIV/AIDS rate, at 14.9 percent, is more than double the national average. In one study, among men between 25 and 40 years old, it was as high as 40 percent; among women ages 20 to 30, the rate was up to 36 percent.

Young and old suffer from an array of diseases that include malaria, diarrhea, pneumonia, tuberculosis, anemia, jaundice, schistosomiasis, intestinal worms and chiggers. Hunger is so pervasive that thousands of parents -- who, according to local Luo tribal traditions, name their children for the season in which they are born -- call their children Akech, after the kech, or "hunger season."

So what do Nyanzans bring to the table to balance out this relationship?

They offer their life stories.

For 12 years, hundreds of thousands of Nyanzans -- including many of President Obama's Kenyan relatives, among them his 90-year-old step-grandmother, Sarah Obama -- have voluntarily participated in one of the world's largest and most comprehensive health and demographic surveys. At last count, 225,061 inhabitants in 385 villages in Nyanza -- including Nyangoma Kogelo, the birthplace of President Obama's father -- are enrolled in the study. Known by its distinctly unglamorous title -- the Health and Demographic Surveillance System, or HDSS -- it is an extraordinarily detailed chronicle of daily life in Nyanza.

Details Matter

One of the problems of AIDS research in Africa is the lack of reliable data. In Nyanza, says Dr. Kayla Laserson, a tuberculosis specialist who has led the CDC's HDSS effort for the past six years, "by following this big population, just letting life happen and reading it, we can measure the impact of various interventions. It's a really valuable resource."

Local interviewers visit each registered family every four months, asking up to 150 questions each time. They are interested in the minute details of daily life. Does the family have a radio? A bicycle? A cow? Where do they get their water? Are the children in school? Has anyone been ill? The birth of a child, the loss of a parent, a marriage celebration, those who leave for Nairobi to seek a better life and those who return in disappointment -- all is recorded in the shorthand of the HDSS.

Year in, year out, the tens of millions of data points that chronicle the ebb and flow of life in Nyanza form a platform for groundbreaking medical research that influences global public health policy. The HDSS has served as the basis for clinical trials to produce vaccines and drugs for diseases such as rotavirus, malaria, meningitis and tuberculosis, as well as for the development of methods to detect emerging global diseases like the H1N1 flu, reduce waterborne illnesses and address neglected tropical diseases.