Letting Go of Kenya, Embracing Jordan

As I mentioned in a previous post, I have been spending a lot of time this past week comparing my experiences in Jordan to their equivalent ones in Kenya. To an extent, this makes sense; this is the second country to which I have traveled wearing my “public health hat.” It’s only natural that I find myself saying (to myself, or aloud): “In Nairobi [insert word or experience here] was like this,” or “wow, this is very different from what it was like in Kenya.” However, while it is a natural instinct for me to make these comparisons, I realized this week that this is an activity I need to be careful about doing too frequently. Just as I urge people to not generalize “Africa” as one country/experience, I need to heed my own advice and purge the overarching mentality that any foreign country is poorer, less developed and more needy than America.

To help better understand the distinctions between Kenya, Jordan and the US, I took a ride on the Google train, visiting Index Mundi (hopefully this is a legitimate source) and UNICEF’s country profile pages.

Demographics
As of July 2012, the population of Jordan was 6.5 million [One year later, the true number of people living in Jordan is likely closer to 7 or 7.5 million, due to the influx of Syrian refugees]. As of 2009, approximately 1 million of those people live in the capital city of Amman. More than 2 million of Jordan’s total population (approximately 33%) is of Palestinian descent, either those displaced by the Israel/Palestine conflicts in the 1940s and 1960s, or their descendants. Nearly all hold Jordanian citizenship. Many live in one of ten permanent refugee camps (served by UNRWA, the UN organization I am working for this June and July), while the rest have settled throughout the country. The country is over 90% Muslim.

Economic Indicators
I then moved on to economics – or at least the numbers I could understand [I’ve included a table below, to make sense of these numbers in a clearer way]. A 2002 estimate stated that 14% of Jordan’s population fell below the poverty line; a 2010 estimate puts that number at 15% in the US, while 50% of Kenya’s population fell below the poverty line in 2000 (though that rate is likely lower today). The unemployment rate for 15-24 year olds is high in Jordan, at 27%, while the US fares slightly better, at 17.6% (both numbers as of 2009). Only the total unemployment rate is listed for Kenya, at 40% (as of 2008, though the rate is unchanged from 2000’s estimate).

That about does it for economic indicators that I can interpret without the assistance of a smarter person. Other indicators include: % of public debt, stock of domestic credit, distribution of family income – Gini index, and household income or consumption by percentage share…all of which might as well be written in a different language for the extent that I understand them! However, I think unemployment and poverty rates are valuable measures, and in this case, highlight the vast differences among the three countries.

In a table, for easier reference:

 

US

Jordan

Kenya

% of population below poverty line

15% (2010)

14% (2002)

50% (2000)

Unemployment Rate

17.6% (15-24 year olds)

27% (15-24 year olds)

40% (total population)

Health Indicators:
The maternal mortality ratio is the number of deaths per 100,000 live births due to pregnancy-related complications of any kind (including death during pregnancy, childbirth or the 42 days immediately following pregnancy termination). It is a common way of measuring the quality of a country’s health system.

In Jordan the MMR is 19, in the US, it is 13, while in Kenya, it is 490. The Under 5 Mortality Rate is the chance that a child will die before their 5th birthday. In Jordan, the U5MR is 21, it is 8 in the US, and 73 in Kenya. The percentage of births that were attended by a skilled attendant among the poorest 20% of the population is 20% in Kenya, while it is 98% in Jordan (US data not available, though I imagine is in the high 90s). Life expectancy in Jordan is 73; it is 79 in the US, and 57 in Kenya.

In a table, for easier reference:

 

US

Jordan

Kenya

MMR

13

19

490

U5MR

8

21

73

Life Expectancy

79

73

57

% of births with a skilled attendant in poorest 20% of population

n/a

98%

20%

From both an economic and health perspective, Jordan is notably stronger than Kenya. This is apparent everywhere I look. The roads are full of expensive cars – the other day, I spent a few minutes waiting for the traffic light to change watching the stream of BMWs, Mercedes, Lexuses (Lexi?) and Audis pass by almost uninterrupted by a car more than five years old – people, notably women, are incredibly well dressed, homes range from mansions to modest apartments on tree-lined streets filled with children, and restaurants and coffee shops are full at all hours of the day, and Burger King, KFC, Papa John’s, Popeyes, and Hardee’s line the strip malls. Jill and I met a MSF intern for dinner earlier this week at a restaurant across the street from a large mall. I had to run in to grab change for the cab driver and was greeted by an H&M, American Eagle, Starbucks, Louis Vuitton and Crabtree and Evelyn. I’ve no doubt that had I walked any further I would have been met by rows of even more familiar stores. However, as if they aren’t expensive enough at home, it’s not even worth it to step foot inside here in Amman. My grad-school pocket book has already taken a massive hit since arriving.

Booming economy aside, the reality is, the two health projects I will be working on in Jordan aren’t the same as those of many of my classmates in African and Southeast Asian countries. There are no water and sanitation initiatives, no mass vaccination campaigns, no programs directed towards reducing maternal death, or increasing the number of skilled attendants at birth, or improving the quality of care for orphaned children. The first part of my practicum will be spent working on behalf of a population in a protracted refugee situation (more on UNRWAs work to come) where the epidemiological transition has already occurred. This means that the health needs have shifted from communicable and infectious diseases like malaria, TB, and HIV/AIDS, to non-communicable and/or “lifestyle” diseases like diabetes and hypertension. The focus is now on addressing the risk factors of NCDs, and of long term disease management and care. Along with the demographic transition, the epidemiological transition is an important milestone in the lifecycle of a country as it develops.

The second project I will be involved with in Jordan (again, more details to come), will be dealing with a displaced population of Syrians who happen to have made their way across the border. This work would not be relevant, had there not been a crisis in a neighboring country.

My time in Kenya was incredibly important to me for many reasons, not the least of which is that it helped steer me toward the path I’m currently on at Columbia. It helped shape me into the person that I am today, and the experiences that I had there will always be important to me for those, and so many other reasons. However, it would behoove me to begin the practice now (as I forsee a lot of traveling in my future), of approaching each trip with an open mind and appreciating all aspects of the new culture I have the opportunity to immerse myself in, rather than constantly comparing it to another.

I spent so much time listing these statistics because I was wildly uninformed prior to my trip here – and I think it’s reasonable to assume that many of you all are also, if not UNinformed, at least under-informed. I think it’s important for those of you who plan on following my adventures abroad to have this tiny bit of perspective, which will hopefully help make my posts that much more interesting and relevant!  My short time in Jordan thus far has helped me realize the strength and prosperity present in this country and I am so excited to spend the next several months here! I promise there will be pictures soon!!

Sources Cited (better safe than sorry, no?):

http://www.unicef.org/infobycountry/kenya_statistics.html
http://www.unicef.org/infobycountry/jordan_statistics.html
http://www.unicef.org/infobycountry/united_states_statistics.html
http://www.indexmundi.com/jordan/economy_profile.html
http://www.indexmundi.com/jordan/demographics_profile.html
http://www.indexmundi.com/united_states/demographics_profile.html
http://www.indexmundi.com/united_states/economy_profile.html
http://www.indexmundi.com/kenya/economy_profile.html

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2 thoughts on “Letting Go of Kenya, Embracing Jordan

  1. I like this article. You remind me that although public health in Africa, and specifically water and sanitation, is my first love, there is so much I can learn from other situations. It’ll all come back to pay dividends.

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