Dr. Rhiana Menen is the very definition of a caregiver. She’s a surgeon for the St. Luke’s Health System, where she has changed the lives of countless families. And her passion for bringing care to medically underserved populations has also taken her far from Idaho.
"And it felt like, “Oh, this is why someone wants to become a doctor, so that you can make this difference in the world,” she said.
Menen was describing one of her first visits to the Ugenya District of Kenya. That’s where, as part of the Tiba Foundation’s initiative, she and other caregivers offer health and sexual education and distribute menstrual kits to young women.
But, during one particular trip, Menen and her colleagues noticed that many of the young girls getting on the back of so-called "boda boda" scooters. Soon after, they learned that many of those same girls become victims of sexual assault, or worse.
“And so that's where we started to think of that transportation piece as an intervention point,” said Diane Dodge, executive director of the Tiba Foundation.
That’s how the Boda Girls initiative came into being.
Dodge and Menen visited with Morning Edition host George Prentice to talk about Boda Girls, the life-affirming response to their efforts and their upcoming return to Kenya.
“Wow, that was so amazing!”
Read the full transcript below:
GEORGE PRENTICE: It is Morning Edition on Boise State Public Radio News Good morning. I'm George Prentice. Dr. Rhiana Menen is here… a surgeon… a caregiver at St. Luke's. On a daily basis, she brings hope to people's lives for a living. It is a rare day when I'm at a loss for words. But when I first had the chance to be introduced to Dr. Menen, all I wanted was to know more. When she started talking about an effort called Days for Girls, I just had to know more about her visits to Africa. And we will learn about it together. But first, let's say good morning to Dr. Rhiana Menen.
DR. RHIANA MENEN: Good morning, George.
PRENTICE: To be specific, we are talking about providing sexual and health education, as well as menstrual kits to developing nations. How did this come onto your radar?
MENEN: So, I trained as a surgeon; and as someone who's involved in women's health, I care passionately about women's health and international medicine. This wasn't on my radar at all. So I began traveling to Kenya with the Tiba Foundation in about 2016 after I had just finished my residency and my fellowship, and I got involved in traveling internationally. My father is Indian. He was born in India, and came to this country in his 30s. And so, when I was a teenager and a preteen, I had the opportunity to travel to India and Hong Kong and around Asia, and realized how different the life I was seeing outside of the United States was. And that was part of my mission in becoming a doctor, to be able to one day make a difference on a global scale. I think one thing that people don't know is how much work goes into becoming a doctor, not just personally, because of course, that's true. But also, there’s the community and institutionally. So, it takes high school, then four years of college, which a lot of us get grants and loans for that, and then four years of medical school and that's again, grants and loans. And then a five to seven year residency where we learn how to be surgeons; and that is subsidized by Medicare and by grants as well. And so on a community level, on an institutional level, the United States has invested in making great doctors. And that's not the case everywhere. So in the developing world, often there are thousands of patients per one doctor, and even more rare per specialist. I always knew going into surgical training that that's something I wanted to do. So in 2016, I again was able to connect with one of my mentors from residency who had been working with the Tiba Foundation for a long time. And so that's when I made my first international trip to Kenya.
PRENTICE: I'm sensing that you had some idea, at least on paper, what to expect. But can you share with us what had to be a life changing moment when you arrived?
MENEN: So when you're in these 16 years of training, it's all about getting through it. And I think that we don't, as trainees, think enough about what does it mean to have this gift of this training? And so just the breadth of the patients that you see… the kind of diseases that I would never have seen in the United States and just the kindest people in community health. So when a loved one shows up to the hospital, their entire family is there. They bring them meals, they walk them around. They're grateful and trusting of care in a way that I hadn't really experienced before. And it felt like, “Oh, this is why someone wants to become a doctor, so that you can make this difference in the world.”
PRENTICE: Talk to me about the distribution of menstrual kits. Why is that so integral?
MENEN: Again, as somebody who had spent a long time among women, it's just something you think people figure out. But these girls and women were not figuring it out. So in many, many developing countries, girls are not able to go to school if they're menstruating. So they miss a week of school, or a month, because they don't have access to menstrual supplies. So they're sent home. They're encouraged to get boyfriends in order to buy these disposable kits. They get pregnant, they drop out, they get diseases. And so just this one solution…there's one gap… is leading to early pregnancies, lack of education and kind of a lifetime of poverty for girls who don't have a solution to something that we take completely for granted.
PRENTICE: I am absolutely floored by that… something that is so second nature to Western culture, to address in a moment. But what I'm hearing from you is that it's a downward spiral. You're sent home from school. You're lucky if you graduate. And it goes downhill from there.
MENEN: Yeah, and they don't graduate. I'll just speak to the region that we work in in Kenya: the average education level is eighth grade. And so what we know from developing communities is that every year a girl stays in school translates to better income in her lifetime. It means that she can also put off childbearing, which is much more safe for both the mother and the baby. It means that she can get married at a later age. So these are huge impacts…just the ability to stay in school can have the downstream effect.
PRENTICE: What kind of resistance did you meet or… didn't meet?
MENEN: That, that was kind of organic and shocking
PRENTICE: Shocking-good, I'm going to hope
MENEN: Shocking good. In 2019, we went for a surgical and operative camp, as we call them. So a group of prescreened patients who know that they're coming for some kind of general surgery. And a friend of mine from Boise had provided us and donated 200 of these menstrual hygiene kits. And what's really amazing about them is that they're they last three to five years. It kind of just solves the problem. They're washable and they're in a backpack, and so they're discreet. They're able to be hung on a washing line and look like a wash cloth. And so very discreet and very easy to use. And then it's paired with this 45 minutes of health education. You know, this is a normal woman's body. This is a normal man's body. Menstruation is a reflection of a healthy body. This is how a baby's made. You know, this is a normal functioning body. Apart from that, they're also taught things like self defense and self esteem. The ability to say, No, that doesn't feel good or I don't. I'm not comfortable with this. A lot of these girls have never heard that they're allowed to say no. And so this whole program together is kind of the full package of of learning. And so when I brought these 200 kits, I also brought along senior in high school from Timberline and a junior at BSU who had been trained in these distributions. And these two young women, you know, showed up at the hospital and word got out. So what you said, it wasn't even an organization. Word got out that we had these kits at the hospital and the principals from the local girls schools were busing girls in and they were answering really important questions like How is a baby made? And if I'm bleeding, does it mean I'm dying of AIDS? So really important scary questions. And then some really exciting, interesting questions like is it really true that girls in the United States get to drive? And so it sparked this entire cultural exchange that we never would have seen.
PRENTICE: Dr. Menen, I'm going to ask you to introduce us to another voice here, a colleague of yours, and someone very much at the forefront of this initiative.
MENEN: I am very pleased to be here today with Diane Dodge, who's the executive director of the Tiba Foundation, and that is the organization. We are the U.S. fundraising arm for the work we do at the Matibabu Hospital in Kenya.
PRENTICE: Diane Dodge, good morning.
DIANE DODGE: Good morning.
PRENTICE: Tell me about Tiba. Tell me about that word, “Tiba.”.
DODGE: It's word that actually comes from a larger word: Matibabu. And our partner in Kenya is called Matibabu Hospital…the Matibabu Babu Foundation keep us in the middle of that work. And what it means is “treatment” or “health.” And that developed out of a relationship that started in 2004, when the two organizations developed to bring health care to rural communities in the western part of Kenya.
PRENTICE: Diane Dodge, what we're learning here is the acceptance of this knowledge.. of this education, of this help. And I think that that's the real takeaway for me: how accepting the folks that you are interacting with in Kenya.
DODGE: You know, it's pretty amazing how an interaction with a volunteer from the United States who comes to provide their vacation time and their efforts. Who does capacity-building with the community and in the hospital. And how when they leave, they feel like they got so much out of it, like, “Wow, that was so amazing”, the friendships, the experience of being there. But the Kenyans are also just so grateful for having that interaction and the skills and all of the connections that are brought to that.
PRENTICE: Dr. Menen, you told me a bit about something that you saw in Kenya in working with some of the young women: you were noticing a fair amount of them were getting on to the backs of scooters. What was happening there?
MENEN: Yeah, this is called a boda boda, which is a motorcycle…a taxi.
PRENTICE: A boda boda?
MENEN: Boda boda. And that is a very common form of transportation in the area in which we work. We had begun to distribute these menstrual hygiene kits. And at the end of one of these sessions, these two girls hop on the back of a boda boda and drive away. And the principal at the girls school turned to us and said, “That is just so dangerous. Those girls are so vulnerable.” And we, Dianne and I, looked at each other and wanted more information. We said, “Why?” She said, “Because these girls get assaulted, they get taken to fields. They don't make it to school, they don't make it home from school.” And so that's where we started to think of that transportation piece as an intervention point.
PRENTICE: What can I assume, then? That men were driving them away into trouble?
MENEN: Yes, that's what we heard. And it's interesting when there are not a lot of other, there aren't other taxi services, there aren't other options for them. And so and just to put it in perspective, transportation is pretty expensive also. So in a community in which the household income is maybe one to $2 a day, taking a dollar or two boda boda ride is quite expensive and prohibitively so and so girls who are trying to get to the hospital. Women who are trying to access family planning. We have that. We provide it multiple who are really at a disadvantage when deciding whether to deal with household expenses or getting their medical care or getting the girls to school safely.
PRENTICE: So tell me…what can you do about this? Because it sounds like it's a pretty deep problem that's embedded in the culture.
DODGE: That's right, it is an embedded problem, and the women there are very resilient and very creative, and while we were there working on this question with the group, we came up with a solution called the Boda Girls. So the Boda Girls came out of this view where we were listening to what women were saying, and they were talking about all sorts of different points where they felt like there was some opportunity they couldn't quite reach. And we realized that a lot of those opportunities, the key was transportation. Who knew? People have been working to make, you know, empowerment programs for girls for quite some time, knowing that it raises the whole community, know the whole community, but didn't see that transportation is such an issue, especially in rural areas where safety can be an issue. The cost of getting a ride can be an issue. And so Boda Girls is a new program that we're launching soon when we go to Kenya in April and we will have 12. It's a pilot with 12 women who are between the ages of 16 and 30, and they will be providing a key to a whole lot of opportunities because in at the end of this year, what we see as far as bright, there's 87 primary schools in the area. They'll all be divided between these boda drivers who will go and give the reproductive health lessons each week. They'll be distributing the menstrual kits, encouraging the girls to stay in high school and even think about college or businesses like they have. They will also give about 5000 free rides to the hospital. So any woman who wants to come to the hospital for an ultrasound right now, most women never have an ultrasound, so they don't even know if they have complications.
If they want a cancer screening prenatal care, they can get a free ride to the hospital. Another big thing that will happen is we expect a lot of girls to stay in high school and finish. So right off the Boda Girls will get insurance provided for their whole family because they're a Boda Girl. So it gives them something that they walk into their family with to say “Everyone of my family is going to have health insurance all year long because I'm a Boda Girl.” And so we're trying to shift the woman's position in her own family structure. And then the other amazing thing that happens is that women learn a business that traditionally only men could be boda drivers or culturally, that's what happened. A boda driver earns a minimum of $4 a day if they're lazy, people say, but you know they can earn up to ten dollars a day. So that's the power of this. This program is at the end of the year, they will have earned enough money to buy their own motorcycle. There are about twelve hundred dollars apiece, and they will also be trained as a community health worker, which pays the Kenyan Ministry of Health pays. So it's pretty sustainable in that way. So we want to start with this pilot and then expand every year. Each year, the girls will be mentoring other girls to join the program and in that way, develop a sisterhood and a and a a women's collective that's taking care of each other.
PRENTICE: So I can't write fast enough. So the young women will be boda drivers.
DODGE: They'll drive. I mean, right now they are starting to learn how to drive a motorcycle. Do you know how crazy it is? Have you ever seen a country where women couldn't drive and then they could drive? What that does to all the little girls in the community and think, wow, maybe I can have my dream, whatever that dream might be. They’re learning how to drive right now.
PRENTICE: What is your website? Because there's there has to be more to learn and to and to connect. What what's the best website for people to connect to?
DODGE: The best way to find out about the Boda Girls is the Tiba Foundation. It's tibafoundation.org.
PRENTICE: Dr. Rhiana Menen. Ok, I think I just heard April.
MENEN: We're going April 1st. We go to launch the boat of girls and we could not be more proud and excited.
PRENTICE: And so when you say “we,” have you got colleagues? Have you got friends? I'm going to guess that you're pretty convincing to get other people to to join the team.
MENEN: This last COVID year has been so difficult and that we weren't able to travel to Kenya, and so we kind of pivoted our efforts in program development. You know, it's a humbling experience. As a surgeon, I can go and, you know, do 20 surgeries and help 20 people with this project. As Diane has pointed out, the depth and the breadth of the people that we can impact and really change the idea of what it means to be a girl in this community and be proud to be a girl in this community is really overwhelming. So as you can hear, we're excited and I think our excitement is contagious because we have a lot of people in Boise and all over the world who are helping to join us to fundraise for this project.
PRENTICE: She is Dr. Rhiana Menen, and Diane Dodge is executive director of the Tiba Foundation. Great good luck to you and safe journey,and thank you for giving us some time this morning.
MENEN: Thank you, George.
DODGE: Bye, bye.
Find reporter George Prentice on Twitter @georgepren
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