The Source of the Nile & Hungry Hungry Hippos

Driving from the village of Kisienya to the town of Kisumu makes you feel a bit like a Joad – straight out of Steinbeck’s Grapes of Wrath.   We piled into the old Nissan van a bit before nine, ready for our big “outing” to the city.   The term “city” is a relative one, but if Rand McNally and National Geographic deem it map-worthy, then I suppose do too.

The roads are terrible.  

Let me rephrase that:  REALLY REALLY AWFUL.

Riding in a van over these roads is, I think, probably much like the experience of being a passenger in a toy Tonka truck being guided by a three year old through a pile of unbalanced rocks.

It’s bad.

Despite all the bouncing and jolting (and my head being thrown against the side of the van every five minutes), we did cross the equator!   It was remarkably anticlimactic, but I did get some pictures and take the time to wonder which way a toilet would flush if it was placed EXACTLY on the equator line.   Clockwise or counter-clockwise?  

These are the things I think about.  

It’s sad.

Just past the equator, as we started coming down out of the mountains (very “Deliverance,” I know), we had a spectacular view of the source of the Nile, Lake Victoria herself.   

We made it to Kisumu without any vomiting or skull fractures, which was fairly amazing.   Emily and I both gave ourselves a pat of the back for that.

Shortly after, we stopped at the Kisumu Museum, where I refused to enter the “Snake Park,” but gladly observed giant tortoises and crocodiles.  

After a quick stop at Nakumatt, the grocery store in Kenya where all the fashionable lizards hang out, we headed to Impala Park – a reserve right on the banks of the Lake and a perfect spot for picnicking.     We were a little horrified when the entry fee was $15 US Dollars for Americans, and $2 for Kenyans, but again – we’ve learned to expect a heavy tax for being American.  

We sat by the lake and picked at our lunch, when suddenly we heard loud snorting.   It took a few minutes, but we finally figured out that about 20-30 feet from us, in the tall grass at the edge of the lake, was a hippopotamus.   We couldn’t seen him, but he was most certainly there.   Normally that would be a little unnerving, but at this point in the trip almost nothing surprises us.  We went on picking at our lunch. 

Impalas wandered around much like deer do in the US, half wanting our food but half wanting to keep to themselves.   Monkeys bounced around not far away, and came running when a guy in a uniform appear with food.  

After about an hour of wandering around the park (part of it was set up like a zoo – something I didn’t expect to see in Africa!)  we climbed aboard a small powerboat for an hour-long boat tour of Lake Victoria.    Within five minutes, two hippo heads appeared at the surface about 25 feet from the boat.   WHOA!  

Call me ignorant, but I really didn’t know that Lake Victoria had hippos.    I snapped pictures and just generally sat there with my mouth hanging open.  

Beyond the Hippos, the scenery was beautiful.   Mountains line the horizon on one side, and the lake extends on the other side as far as the eye can see – well into Uganda and Tanzania.   Somewhere far in the distance, Victoria Falls probably roared.   Someday I’d like to see that.   For today, I settled for just dipping my big toe into the source of the Nile.

Lyanaginga

I turned the corner for the last mile of my run and the children were waiting for me. Judith and David were on their way to school and this time David, the four year old, had a messenger bag. I knew he would never make it with his bare feet and the bag so I scooped it up, tucked it under my arm, and we were on our way. We were flying down the hill much faster than the day before picking up other children along the way. We even picked up a little girl named Emily. I am the only person that runs here, black or white, so there's been a lot of buzz in the neighborhood. They call me “the athletess”.

At the clinic, I have learned more than I could have imagined. Evans, the clinical officer in charge was amazing and became somewhat of a mentor. We continued to give quinine (antimalaria) injections and antibiotic injections each day. I also got to attempt an IV placement for a young child with severe malaria. The vein moved around like a little worm in the boy's hand and it didn't help that the needle had been bent in the package. Evans said the warped needle would have to do and ended up using his arm for the site. I can't believe we're practicing these procedures on these poor children that are already in so much pain but many of them don't even shed a tear.

I think the toughest part of this week for me has been the HIV testing. On day one, I saw a man with lesions on his arm undergo PITC, or Provider Initiated Testing and Consulting. The results came back negative. I have never seen such a smile. The next case was a young woman of 34 but looked about 42. She complained of a rash on her legs so again PITC was administered. She was not as lucky as the old man before her. Positive. I sat directly across the table from her while she became emotionless. No questions, not a word, and definitely no tears. I still can't believe they let me in the room. There were more infected patients at the week progressed but each one was just as difficult to watch.

There is, however, a large effort in the community to educate and break down misconceptions about the virus. We had the opportunity to speak to the community health director for the district that runs many initiatives including in-home information sessions on child bearing, hygiene, HIV, etc. Evans reminded us that HIV is not a death sentence but everyone should be tested, often, to get the necessary treatment to live a healthy life. So I stepped up and took an HIV test. Just like the patients, the doc pricked my finger, placed the drop on the test strip and added a bit of buffer. I sat watching and within minutes I got my negative results. That's always a good feeling. I can now officially say I'm HIV free, worm free (they dewormed me, even though I am SURE I wouldn't have such things to begin with), and amoeba free. Ahhh.

The School Assembly

We had amazing rainstorms last night.   Our tin roof made the pattering of the rain sound pretty dramatic, and I woke up in the middle of the night wanting to go outside and run around in it.
Probably not a great idea, so I stayed in bed.
It was still raining this morning, which made the 5 km commute to school and the clinic rather interesting.   The dirt road gets very muddy and slippery, so most people seemed to take their time getting their mornings started.    We definitely weren’t going to be taking our usual motorbike ride, that was for sure.

After a lazy breakfast, the matatu showed up to collect us at 9 – this is one of those “suicide vans” that serve as small public busses and make Nairobi traffic a nightmare.  Here in Kisienya, though, they aren’t terribly common.  We climbed in, carrying our dead laptops, phones and cameras to be charged at the school (one of the few places with some limited electricity).  

The drive in was rather uneventful, but when we pulled into the Light & Salt Academy, we were greeted with an amazing sight.   The entire student body (maybe 150 students?) were standing in two lines outside the front gate, creating a path for us to enter.   Each child waved bougainvillea, and they sang as we crawled out of the matatu.
At first I wondered what they were all doing, but it became quite clear that this whole ado was to honor our visit to the school.   It was a most spectacular sight.   Most of the children were in tattered uniforms and ill-sized shoes.   Victoria, our hostess and the school’s headmistress, had told us that many of the children are orphans – parents here die regularly from AIDS, etc.   Apparently the school has already lost six parents this year alone.
They don’t have textbooks, pencils or paper, all the soccer balls are flat (a seemingly more serious problem than the lack of texts as far as the kids are concerned), and some don’t even show up at times for lack of adequate food.   Yet these children greeted us with huge smiles on their faces.

Singing, they followed us through the gate into the school grounds, and we all crammed into the small and muddy area in front of two of the classrooms.   Each class sang us song or did some sort of performance for us – it was amazing.   Then a woman with an African drum appeared and everyone started singing and dancing.   I’ve never seen a school assembly like it!

After a few songs, Victoria appeared with two bags full of school supplies we had brought with us from the Dollar Store in Seven Corners.  It turns out that these were a bigger deal than we ever thought possible.   Almost embarrassingly so, really.    Apparently at the end of the last school year, the teachers and administration had wanted to celebrate the top students in each class – the ones who had shown the most improvement and one ones who had received the top marks.  Even giving them a pencil would have been a big deal and motivated the children to continue to work hard.   But they literally didn’t have anything to give – not even pencils.   They told the children that they would receive something to celebrate their achievement in the Fall (and Victoria has spent the last two months worrying about what she could come up with to fulfill that promise).   Apparently our dumb little bag of supplies was exactly what she’d be hoping and praying for – and more.  
I don't even know what to say to that.
She called the names of the top three children in each class, and had the three of us present them each with pencils, pens, rulers, etc.    You should have seen the elation of these kids’ faces.   I really couldn’t believe it.
Half the time I honestly don’t even pick UP my pencils/pens when I drop them.   I chew them up and lose them regularly.  It’s embarrassing.

The whole thing lasted over an hour, and we were all so overwhelmed we didn’t know what to do.
I think it might have been the most amazing morning I've had in a long time.

And then we went to the clinic and saw patients.   

And now we’re home....exhausted once again. 

Polepole Pikipiki (slow down, motorbike!)

At 5:30am I was scheduled to meet Mbacka for a run. The family was a little hesitant to let me run alone so instead I would have my own Kenyan tour guide. I was ready by 5:25 but Mbacka, being African, he runs on African time. We missed each other so I nervously left on my own but had the run of a lifetime. It was market day so the villagers were hustling with morning chores and students were on their way to school. I could hear whispers coming through the trees from children saying “Mzungu! Mzungu!” and welcoming words of “Jambo” and “Habari” from everyone I passed. Two boys about the age of 8 or 9 decided we should race. I chased them down the path as I yelled “polepole!” which is Kiswahili for slow down. Old grampas and shopkeepers were cheering me on as we flew down the hill. I loved every second of it.

The morning continued with our trip to the clinic at Lyanaginga. Day number two. We arrived nice and early with our little lab coats on to get our hands dirty. We had no idea how dirty they would get. First on the agenda was a circumcision. Ouch. The “clinical officer” or the equivalent of a physician's assistant in the States is in charge of the entire clinic and would perform the procedure. He explained that he should normally have countless other pieces of equipment but that he would just have to make it work with what he had. We somehow managed the observation free of any major meltdowns and found out that the brother was next. They were about 8 and 7 years old, respectively.

After that he said that we needed to give the boys their tetanus shots and asked who was going to administer them. Me and Sarabeth. EEK! Turns out it's actually pretty easy. Straight shot right in the deltoid. No tears. Success. Then we moved to Quinine injections intramuscularly for antimalaria. Yup. The glutes. We saw a lot of bums. And I have learned the importance of safety with sharps. BEFORE I had injected, and before I filled the syringe, I pricked myself. I was pretty nervous which is why I fumbled but everything was fine. I recovered nicely and improved with practice.

The day continued with a delivery. With SB as the midwife, Dami, me, and only Evans (the clinical officer) in the room, our adrenaline ran high for the next hour. That would make only ONE trained professional. There was no electricity, no water, no blankets on the table, no towels, nothing to wrap the baby in....I could go on and on, but Rhoda successfully delivered a baby girl into Sarabeth's arms (see SB's post for more details!). We couldn't determine the weight because the scale didn't work and she didn't pick a name yet but Brenda thinks she might name her Sarah or Emily or Dami in our honor. Kenyans do that, she said.

I have now simplified the day into a few short paragraphs but it was a milestone for all of us. It reinforced the beauty and complexity of medicine and more importantly gave us the confidence to know that we are all capable of becoming successful physicians. It was overwhelming, emotional, and motivating all at the same time.

What about the pikipiki? That's local slang for a motorcycle. We've been riding them often since our arrival but today's commute home was an unusual one. With three to the bike to include the crazy man behind the wheel, we were a little too much to handle. I'm really glad I was wearing a skirt, too. I think we popped the rear tire and barely made it home. Poor pikipiki.

Amazing What You Can Do When You Don't Fear a Lawsuit

This is a new one:  We started today with two circumcisions.  

Never thought those words would come out of my mouth, but that’s what happened. 

Two motorcycles picked us up at the house around 8:30, and we piled on three to a bike.    About 8km of dirt roads later, we were at the village clinic and Evans, the Clinical Officer in Charge (similar to a PA) was waiting for us.  

It was day two for us at the clinic, so the basic orientation process was already completed.     Two wide-eyed boys wearing shorts and flip flops, one eight and one six, sat with their father outside the “injection room.”  

I’ll spare you the details, but the eldest bravely went first.   When it was all over, he still hadn’t shed a tear.   What a brave kid!   He gave a smile to his little brother a look only a older sibling can give – that “I did it and didn’t cry – now it’s YOUR turn” stare.    The younger boy was just as brave.  

Evans had Emily and I give the boys their requisite tetanus shots.   It was the first injection I’ve ever given. 

Evans then taught us how to give other kinds of injections, and we spent the next two hours giving patients injections of quinine (for malaria) and antibiotics for various infections.   

Meanwhile, a four year old in the next room went into febrile convulsions.   We learned how to handle those, talked about possible causes, and waited for the convulsions to subside.   

Shortly after 2:30pm a woman who had been in labor since 9am that morning was due for another exam.   We were told we could observe the delivery, and I was quite excited.    In the delivery room, there was a basic green hospital bed that had no sheets, pillows or blankets.   The room had a light socket but no light bulb.   An orange bucket sat under the bed, and an IV rack sat beside it – still holding the previous patient’s IV bag.   On the other side of the room was an old crib – lined with a piece of torn packing foam.     An old baby scale sat in the corner under a heat lamp that didn’t work.   Nothing in the room required electricity.    There were no towels, no nurses, nothing. 

The woman came in alone, and looked confused as to what three Americans were doing there.   We smiled at her, and she didn’t seem to mind our presence.    She climbed up onto the bare mattress and lay down.   Evans checked her out (she was dilated to 8cm) then looked at us and asked who was going to “be the midwife,” and Emily and Dami both pointed at me.  

Evans didn’t say too much too her, and he didn’t really react when her contractions began to get severe.   He told me to put on a pair of gloves, and the delivery began.   He stood by to offer guidance and direction, but I was amazed by how much het let me handle it.    The only time her really stepped in was when we realized that the umbilical cord was wrapped around the baby’s neck.   Evans jumped into action, unwound the cord, and then stepped back.   When the baby came out, she landed in my arms.   It was a beautiful baby girl.  

We had nothing to wrap her in, so I held her for a moment and waited for her to cry.   She did.   A nurse came in with a large scarf, and I wrapped her in that.   The nurse smiled at me and told me to “finish the job.”    I cleaned her up a bit, and patted her back until she coughed.   A friend of the mother’s appeared in the room with another piece of fabric, and I handed the baby girl to her. 

I’m still so overwhelmed I hardly know what to say.  

I absolutely loved it.  

Despite no electricity, light only from the room’s window, no sheets or towels or blankets…it worked.   

The room was a mess, and I looked a mess, but it was wonderful.  

What a way to end a “work” day.   I’m exhausted and emotionally drained but I can’t wait to go back to the clinic tomorrow for more!   Strange, I know.

Now’s it’s just after 9pm and I could fall asleep.   

It’s a clear night, and on our way back to the house we’re staying in, we saw the most spectacular night sky we’ve seen since we’ve been here.

I didn’t recognize a thing, and it felt wonderful.  

Goodbye Yellow Brick Road

Okay, so admittedly there aren’t that many yellow bricks in Nairobi, and I doubt there are many horny-backed toads in the mountains of Kenya, but I don’t particularly care.

We left the bustle and lights of Nairobi yesterday morning, and now call a tiny mountain village called Kisienya home.  Kisienya sits high up in the mountains of Western Kenya, very close to Uganda, and, at times, within eyesight of Lake Victoria.

It’s a beautiful little village, and there is much I’d love to share about it, but the number one thing worth mentioning is this:  there’s no electricity.   

Well… let me qualify that.  

There is some solar electricity, at least enough that a few lights can be turned on after dark if energy is conserved properly during the day, but there are no electrical outlets.    At the moment I’m running on computer battery power, so our posts for the next week or so will be spotty.  

The bus ride to Kisienya was much better than the one to Arusha.   This bus, at least, had shocks, and looked more like a greyhound bus than an old airport hotel shuttle.  

We drove for six hours, past herds of bored-looking zebras, and hundreds if not thousands of cows, donkeys and goats.  The drive involved the largest road through the Great Rift Valley.   It’s spectacularly beautiful, and I found myself feeling a healthy sense of insignificance looking out the window at the very land on which humankind first stood upright.     

The Rift Valley is filled with tea plantations, and scattered through the fields of tea are women hunched over, picking tea leaves with remarkable speed and dexterity.   On their backs are large bags of picked tea leaves, and slung around many of their fronts are babies.   Imagine working like that.

We passed numerous little towns, many of which consisted of a few homes made from bamboo sticks, mud and old pieces of fabric.    In on instance, I saw what was once a stone structure the size of the average Starbucks store.   The structure looked like it had been mostly demolished:  it had no roof, no doors, and only holes in the walls to serve as windows.   Yet nearly 50-75 people stood inside, singing.  

It took a moment to realize that a church service was taking place.

Due to not much more than blind luck, we managed to find our stop – a town called Majengo.    It was there that we met Brenda Mugofwa, our hostess for the duration of our stay.   Brenda is a friend of Mercy’s, and while she was raised not far from Kisienya she studied and lived in the States for nearly ten years.     

Brenda helped us collect our bags from the underside of the bus, and then drove us to her family’s home (our home during our stay).    We passed many mud huts on the way to her house, and wondered if our week would be spent in similar conditions.   When we arrived at her family’s home, however, we were pleasantly surprised.   The Mugofwas have a wonderful home – a farm, really – and one of the nicest in the area.   

Brenda’s mother, Victoria, one of the kindest and loving women I’ve ever met, ran out to greet us.    We were welcomed into her home with amazing warmth and kindness.  

Victoria and her husband, Michael, told us later that evening about how they came to live in this house.   In the early 90’s they had 25 acres in a neighboring village, but in the middle of the night after a controversial election, members of another tribe, angry with the election results, came to the property and burned everything they had.   The entire family – Victoria, Michael and their seven children – managed to escape with only the clothes on their backs.   They hid behind bushes until the violence subsided, and then made their way to what became a sort of refugee camp.  They lived in that camp until they could rebuild.    And rebuild they did!   They built a new home – a better home, and were very proud of it.   But then, about 9-10 years ago, an angry mob appeared and burned their home again.    Left with nothing a second time, the Mugofwas still managed to rebuild.   And today we are so thankful to be staying in what they built.    Their seven children have grown, but the Mugofwas have taken in children from the area that needed homes.   There are currently four children between the ages of about 12 and 18 living here, and the Mugofwas love them like their own children.   

Victoria and Michael run a grade school 5 km from their home – a school they started themselves called “Light and Salt,” and other time is spent managing their farm.   They own several cows, many chickens, goats, turkeys and geese, and they even have banana trees growing in the back.  

At the end of each day, the family gathers in the living room (by candlelight) to sit, talk, pray, sing, read from the bible, and give thanks for all they have.

What a wonderful way to end a day.  

As far as I’m concerned, it’s much better than watching television.   

Mzungu Braids