Where does the time go???

I was doing such a good job of blogging (by my standards anyway...which are quite low when it comes to blogging) and then all of a sudden it's been 10 days since my last post. Sorry Per! Anyway, I have been busy with project stuff and unfortunately wasn't feeling too great last week, but all is well now.

For the past week or so we've been working on data collection. We went with a couple community health workers to do home visits. It's amazing how people just invite you into their home when you show up on their doorstep unannounced. I certainly wouldn't do that at my house in the Wedg. We wandered the hillside and met with women and their children. I got harrassed by a bunch of electrical workers since everyone seems to think that yelling "Mazungo" (whitey) is completely appropriate whenever I pass. I guess political correctness hasn't reached Kenya. We ate matoke (basically mashed cooked bananas) at one of the CHWs houses. I must say, I felt a sense of accomplishment since I don't like bananas but managed to finish my whole heaping pile food. Everyone (except the person who provided our lunch of course who remained oblivious to my plight) was laughing as I choked them down with my water bottle always in hand.

We also had a couple community meetings with mums and community health workers. We did some focus groups and surveys. We also did a bit of health teaching. Unfortunately, no one seems to understand me, even English is the national language. Generally speaking though, people peak Swahilli and whatever their native dialect is. Anyway, apparently they say I talk out of my nose rather than my mouth. They say all americans do. Aw well, I keep trying and they all keep politely nodding their heads at me with completely expressionless faces...until someone translates.

Some traditional birth attendants we met told us about boiling blood to give to pregnant women who eat soil. Sort of amazing that they figured out a treatment that works...obviously it's like that throughout history. Eating soil is called pica and you have it when you are anemic...hence the blood as a treatment. We encouraged them to send the women to hosptial for iron pills though. They were an intersting group of women and open to share. They are really working for the safety of the women they care for which is great though occasionally misguided.

Well, that about sums up what we been doing for data collection. In other news, I got scolded (sort of not really) for running in the rain. It rains warm big buckets from 4-5 every day. Most people flee to whatever shelter they can find, including, incidentally, semi truck wheel wells which I realized as I was running by and they were yelling at me to come and sit with them. Apparently people here don't like the rain and think it's dirty. I enjoyed it.

We also went for a little night time stroll with the public health officer and a pastor who I realized, in hindsight, was probably brought along as a guard of sorts...he's a big broad shouldered man. When we first got to Kisii and were trying to decide on a topic, Kapar (the public health officer), informed us about how prostitution is a huge problem in Kisii. Being that I'm all about empowering women and girls, I immediately started asking how old they are, if they are trafficked, would they be possible to work with etc etc. I was told by my program mentor that working with these girls was not an option (enter sad face from me) but, Kapar did agree to take us for a walk. Let me tell you, it is sad. They are YOUNG, probably 14-18 year old, though I'm sure they lie about their ages. They are everywhere at night, incredibly friendly and are more than willing to talk, though I doubt much of what they say (at least when it comes to identifying info) is true. They get paid 100 shillings, about $1.20, for each guy they are with and they organize themselves into little unions to protect each other. They pay the street boys to be their security guards and look after them. Many are pregnant or have kids and many are elder siblings trying to provide for their younger sibs. Some have parents, who of course don't know how they make the money they bring home for the family, and some are married...or were married too young and ended up without options. It was quite interesting and eye-opening, but even more so, it was incredibly sad. We even went to a brothel which is apparently busier during the day than at night since at night they are out on the streets. It was just off the main road, up a few stairs and all there was were tiny rooms with animal print walls (zebra) and a small bed with animal print bed spread...I felt so dirty and disgusting just being there. Kapar, our guide, has been reaching out to he community for about 10 years or so trying to provide harm reduction strategies. He knows many of them and they all know him which is why we were allowed to see the brothel and talk with the girls. He works out of a one room office where 5-6 staff members work and spends his time on a wide range of public health projects from water quality, to child prostitution, to street boys to sanitation and community health worker programs...and still had the time to take us on a tour and have a cup of tea. It's impressive. The people working for others here are generally, very impressive!

Ok, here's some picts. (None of our night time stroll though as I didn't take my camera which made all the girls were quite sad as they all wanted a picture with me and my long soft hair...I've never had so many people hug me and pet my hair.)

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"Time Management is the Enemy of Africa"

The title of this post is a direct quote from the public health officer we are working with...in reference to our day. Today we were supposed to meet with 21 community health workers at 9am, observe their meeting until 10 and then work with them til 11ish. At 1030...only 2 had arrived. Ultimately only 10 made it and it took us a couple hours to run through a 6 page survey. We are learning! some things go well, others not so much. But they are a wonderful and enthusiastic VOLUNTEER team who are the back bone of the healthcare system here because they are in the community meeting people every day. The government should really take advantage of the resource they provide and pay them...at least something...and certify them so that they are recogonized. would go a long way I think!

So we are getting in the full swing of working on our project! Best part about that is that we get to go out into the countryside and visit with mums, their kiddos and the community health workers. We visited a local community. chatted with some very open moms (they told us all about putting lizard poop on the umbilical cord because it was tradition...awesome thing was that no one knew why lizard and not another animal. They thought it was funny they'd never thought to ask that...). They were a lovely group. We then got to wander around a bit through the lush fields. Saw passion fruit, giant avocados and even got sent home with a bunch of sweet bananas (and by bunch I don't mean a bunch of six like at the store...I mean that they chopped off the whole bunch from the tree and gave it to me...because who doesn't need 50 bananas) lovely, welcoming people!!

I've added to the slide show....

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Settling in....

Not a whole lot exciting to report. We have settled into our project and are in the process of working as quickly as we can to ge things moving! 6 weeks really isn't a lot of time. After a lot of back and forth and being told I couldn't do a number of the projects that I was thinking about, we settled on looking at neonatal sepsis. For those who care to hear about medical stuff...read on...otherwise feel free to skip on by.

*****Medical interlude******Anyway, nearly 50% of deaths in kiddos under 5 years old occur in that first month of life. This is around a million newborns per year and likely even higher since upwards of 50-60% of moms in developing countries deliver at home and never present for care. The most common cause of death is infection which is both preventable with appropriate care and counseling and treatable if identified early enough. Anyway, we are looking at the practices in this community (such as applying cow dung to the umbilical cord, unsanitary delivery practices and feeding newborns herbs and other things) that lead to an increased prevalence of infection in the community. We actually just saw a little one with sepsis and neonatal tetanus (so sad) who was delivered at home and whose mom put both cow and lizard dung on her cord to dry it. When she started getting sick, she was given tea leaves. Sad thing is, when you ask mom, it becomes apparent that socioeconomic status and gender inequality were the true precipitating factors. Dad refused to pay for a hospital delivery (it's pay per service here) and refused to give money to take the baby to get health care when she started getting sick. It's funny to me how many people in the developed world perseverate on their birth plans and natural deliveries...This is what a natural delivery looks like in the real world. It's not all birthing tubs and Enya piped in in surround sound. But, I digress and to those of my friends who going for the natural birth...I support you... just please make sure that your midwife is certified and a hospital is close by in the event that, God forbid, anything go wrong.*************End of Medical Interlude*************

so other than the project, not much exciting though as I type this we are having our first big rain and thunder storm and incidentally, the transformer just blew and sparks just flew in front of my window...no power or internet...so not sure when I'll actually be able to post this.

The president came to visit yesterday to celebrate 100 years of the Catholic church in Kisii. He had lunch at where I'm staying (it's the Catholic Guesthouse) but I stayed out of the way. Watched the marching band and all the excitement but wasn't too sure about joining in at lunch. The funniest part has been that over the past week, in order to prepare for his visit they have re-painted every wall and gate, recovered chairs, and re-done all the side walks...looks great here now.

ok, that's about it for me...here's a few picts...

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Nairobi to Kisii

Blog Post Number 2...look at me go! So I'm currently sitting outside in the sun on the expansive grounds of an old plantation house which is now a hotel...it's a pretty good gig I've got going on at the moment, but work is definitely on the way. I'm in the town of Kericho for the weekend. It's known for its tea and, literally, the tea fields stretch as far as the eye can see. Green, prefectly manicured bushes only interrupted by the red tile roofs of the workers living quarters. It's quite beautiful. I've been relaxing, watching some monkeys play and sipping tea. I did even go for a run and, turns out, running hills at altitude, much harder than running the flats at sea level. Apparently it's the area where their marathoners train...

Anyway, since last I wrote, I've been on the moved. We travelled from Nairobi to Kisii (about 5 hours) which is a beautiful drive that takes you into the Rift Valley. I was totally mesmerized by my surroundings. The endless plains dotted by herds of goats and cows ushered onward by the local Maasai people. The gazelles, the impalas and ZEBRAS!!...I got to see a herd of zebras. so cool! I think my partner John thinks I'm a bit weird. He kept asking if I was bored by the drive but seriously, how could you be. Apparently you can be though because he's never been on drive before and he was clearly not enthused. Oh well, I'm easily amused. Maybe it was all the driving when I was little when my parents would challenge my sister and I to the silent game (ie whoever stays quiet the longest wins...my parents were sneaky weren't they) that caused me to be able to sit quietly and just stare at my surroundings while driving. Who knows, but I was quite the champ of that game.

Kisii, where I'll be living the next 6 weeks, is on the western side of Kenya up in the hills with lush greenery all around rather then the vast plains of the Rift Valley. The town is busy, tons of motorcycles (boda bodas) zooming around...generally speaking, all vehicles are zooming around. Blind passing, swerving in and out of traffic, 20+ people per van with the requisite live chicken on another passenger's lap (yes,that was my bus ride today)...it seems traffic rules are more like traffic suggestions...and you can always bride the police to let you off if they pull you over. I settled into St. Vincent's Guest House...I can effectively lock myself into my room 3 times over which should make my dad happy...and that doesn't include the gate, the wall with barbed wire or the guard.

The hospital is empty because of the strike...no patients to be seen which is weird for a place that is usually at 120% + capacity. It's a bit of a national crisis and now they are threatening to fire all 25,000 workers. (to get around that the nurses are coming to work, signing in and then not doing anything). It's all a bit crazy but the nurses and workers have a point. Working conditions are terrible. 2 nurses to 70+ in the paeds ward, no gloves, 3 kids to a bed...quite sad.

No other major events to report...except the minor bombing that killed 4 people and injured 40 in Nairobi...you know, just a minor event (fyi-that's sarcasm...it's a pretty big deal). I'm far from there but, nevertheless, the program has their eye on me. Also, interestingly, it took me 7 banks, a 20 minute call to ETrade and waking Per up at 630AM to get cash. Nevertheless, problem solved and crisis averted.

Here's some picts (I'm dying to take more of people but my partner tells me there is a lot of superstition around what photos will be used for...alas)

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Karibu Nairobi

Karibu (Welcome) to Kenya! While I'm not the blogger in the family, I promised Per I'd try to post updates from my time here in Africa. So, I figured, sitting here in the 80+ degree weather listening to the wind rustling the palm trees was just as good a time as any...sounds serene doesn't it! Actually, I'm mainly listening to heavy machinery grading the soon to be new road outside the grounds of the apartment complex I'm staying in...it is one loud engine...and, inside the grounds, I'm listening to a lot of banter between moms and their kiddos in Swedish and Chinese. Apparently, the Chinese are investing heavily in developing Kenyan infrastructure (ie the new road) so there are a lot of Chinese here to manage projects. As for the Swedish, there are 10 or 11 Swedish families that live in the complex while they are adopting Kenyan babies. They have to live in country for 6 or 9 months. The kids live with them much of the time and this ensures that the Kenyan government can perform "home" visits while making it an extensive adoption process to reduce any chance that the kids will be "adopted" for purposes of exploitation. Anyway, I arrived 5 days ago after a relatively easy journey. I'm having more difficulty getting over my jet lag than I usually do when I travel which has resulted in a lot of 3AM internet surfing. When I do get to sleep I'm having some weird mefloquine dreams...I was convinced my mosquito net, which was tied up in a knot hanging over my bed, was a number of human skulls that were trying to attack me...creepy. I'll remember to take my med on a full stomach next time! From the sounds of what I did on my first day here, you'd think I was in Seattle. I went for a run around the arboretum which was designed by the British and is full of both native and non native trees. The smell of Eucalyptus was lovely, however, the smell of raw sewage in the creek that runs alongside the trail, not so lovely. It was Sunday and there were probably 15-20 different groups having church services in the park. Kids running around and playing, singing and praying together...pretty awesome way to worship if I do say so myself. After the arboretum, we (I'm staying with a research director at the moment named Ben) went to a concert called Blankets and Wine with a couple of his friends...think Saint Michelle winery summer concerts with a little more funk. It was fantastic reggae/jazz music and good dancing...Ben's friends (both Kenyan) told him they were surprised I could dance...which is a HUGE compliment for a white girl with no rhythm, especially when dancing with a bunch of Africans with, let's just be honest, alot of rhythm.














The rest of my time here, I've been getting oriented to my program and getting to know my partner. For those of you that don't know, I'm here for 2 months through my residency program. Each year 4 seattle children's residents come to Kenya for 2 month blocks. We are paired with Paediatric (see how I used the British spelling there) residents from the University of Nairobi and travel together to a rural part of Western Kenya called Kisii. While there each pair works on a community project together and spends time working in the hospital as well.

My partner's name is John. He has been guiding me around the various hospitals and organizations this week. He is super nice and very social so I think we'll get along just fine...which is good since we'll be together a lot over the next 8 weeks. He is married to another doctor and has an adorable daughter named Natalie. There are definitely some cultural differences that have become evident as we've been getting to know one another. While this can make things more challenging, I think the partnership really makes the program. We both have a lot to learn from one another.

We have spent some time in the public hospital (Kenyatta National Hospital) which is overflowing because all government health care providers are currently on strike. KNH employs some government providers but also has it's own union of workers who are not on strike...they went on stike last year and bargained for a 100% increase in pay. Because KNH is the only public hospital still functioning, the poor from all areas around Nairobi are flooding KNH for care. The paediatric ward admitted 37 patients the other night...I complain when I have to admit 10-12. All 37 were in one room, some 3 or 4 to a bed. 1 nurse, 1 intern and 1 first year paediatric resident (and of course the patients mother's) caring for them. Many have fevers, pneumonia, diarrheal illnesses. One was cyanotic (blue), dyspneic (short of breath) and in florrid heart failure. He was sitting up (makes it easier to breath) trying not fall asleep so he could keep breathing, even though he'd been awake all night, breathing. Another, was being bag-mask ventilated because she had no respiratory effort. The resident had been trying to get ahold of the consultant (equivalent of an attending or supervising doctor) for the ICU for 1-2 hours to try and get the child appropriate care but no one was answering. The consultants are only there on occasion because the pay is poor so they have to take jobs in private facilities as well in KNH. All the while, the child's grandmother was sitting quitely next to her, resigned to the fact that the child was going to die. That was only 2 of the 37... It makes me mad and frustrated that there are such disparities in the world (and even across the street as the private children's hospital down the road from KNH looks very much like Seattle Children's). It was not an unexpected scene. I've worked in other developing countries. But it is morally wrong. It's not ok that people with money or people who are lucky enough to be born into a country that has the resources and policies in place to provide for its own, have access to all that they need. While the poor, particularly the extreme poor of developing nations must be resigned to watch their grandchildren die in front of their own eyes. Never speaking up, never yelling at the staff to do something/anything to save the child, never exclaming the injustice of it all...just sitting, watching, praying and saying thank you to an overburdened, underresourced staff with no options.

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