20 January 2011

Kenya: Clinic Day 1

Jambo!  Greetings from Kisumu.  We arrived on time to Nairobi smoothly two nights ago and were greeted at the airport by our host, Josh (essentially Dr. Bonyo's Number One here).  On our way out of the airport, a zebra darted across the road - Mom's first big surprise here in Africa.

The following morning we headed to Kisumu via a 7-hour Matatu ride.  The road was much smoother than I remembered in 2007 - still a 2-lane paved road, but with much fewer potholes.  We caught an amazing view of the great Rift Valley and arrived in Kisumu in time for a walk to the Safaricom store to buy a mobile phone and the Nakumatt to stock up on some South African wine and Bond 7 (whiskey).  Then, carrying 3 5-liter bottles of water and our new alcohol stores, we enjoyed Mom's first tuk-tuk ride home.  

We are staying at the Milimani Resort Hotel and are well taken care of by Jackie and Dan, among others.  Our dinner last night included chicken curry and chicken masala with potatoes (of course) and a fruit cup.  Mom's been surprisingly adventurous with her diet and socializing with everyone...  

After sleeping a full 10 hours and Josh jump-starting the battery to the Bonyo clinic truck, we headed out to the clinic today for our first day there.  We spent only about 4 hours out there due to the late afternoon rains, but we treated malaria, chronic cough, acute gastroenteritis, dehydration, and chronic severe osteoarthritis.  Jeanine and Mercy are the full-time nurses at the clinic, and have already taught me a good deal of tropical medicine and about their local practices.  For the last elderly patient with arthritis, we gave her a steroid injection in her right knee to alleviate some of her pain (sorry Dr. Bones, I stole some of your supply for this! - I owe you one).  Our last patient of the day, had to be referred to the hospital - the little boy appeared lethargic and dehydrated after just a day of gastroenteritis.  He highlighted the fact that even a mild gastroenteritis can be extremely complicated by malnutrition.  The boy and his grandmother were transported to the district hospital in Ahero via motorcycle - "we" (Dr. Bonyo's NGO) paid for the ride.

The motorcycle ride was a little less than the equivalent of $1.  Each clinic visit can cost anywhere between $1.50 - $3.00, depending on the age of the patient and the services provided.  These "user fees" are the subject of pretty significant controversy regarding the delivery of healthcare in developing areas.  Some argue they shouldn't be levied on those already in extreme poverty in order to meet basic humanitarian goals, yet others argue for "user fees" in order to preserve quality healthcare in their areas, properly allocate services to those in need, and pay for necessary medications.  The clinic regularly buys anti-malaria medications and antibiotics from the local wholesale pharmacy, and these are not free.  Obviously, the cost of medications is included in the total price of the clinic visit.

Transportation seems to have changed a lot as well.  There are many more motorcycles for transport in the rural areas out near the village of Masara, and again the roads seem much smoother.  Of course, matatus and tuk-tuks are still prevalent.  There are still the semi-trucks that are over-loaded and traveling at 5 mph that need to be passed by faster cars and matatus - we've already seen two over-turned semi-trucks with contents spilled all over the side of the road, yet luckily with no obvious injuries. 

Socially, we've been a bit held back by our jet lag, but we hope to get out for dinner tonight.  My limited Kiswahili skills have come back slowly, with my vocabulary consisting of only fragmented phrases:  Hello, yes, no, thank you, thank you very much, how are you?, good, very good, and please.  After further lessons with Josh and Tom (Dr. Bonyo's step-brother), I hope to expand my Kiswahili to longer sentences and perhaps learn to be able to floss some pick-up lines.  I'll keep you posted.

Josh has been an amazing host, introducing us around to his friends, his little nephews, and even his mother.  He showed us his digs and his mother's shop as well.  Not only do we owe him for the priceless hosting duties, but we also owe him 3000 shillings for not having enough cash for the matatu ride yesterday.  Woops.

Tomorrow, I plan to work with Dr. Allibhoy at the local Aga Khan Hospital.  I'm not sure what that will entail, but we plan to meet up with him tonight to learn more.  Mom hopes to meet up with any social services folks they have working at the hospital and with Brenda, the social worker for Dr. Bonyo's NGO here.

Since I can't capture all the thoughts and feelings of my travel companion (Mom), she wanted to say a little something:

Jambo (which means hello in Kiswahili).  Trav and I just finished our lst clinic day and it was quite amazing.  The clinic has 2 nurses and we saw about 4 patients today including 2 children who each had dehydration and gastroenteritis--both very common here.  We also saw an elderly lady who needed an cortisone injection in her knee which Travis did so well that the woman said he did a better job than the doctor she'd seen before.  How about that?  We unpacked both our extra bags of supplies - the coloring books and stickers have already been popular with the kids.  Our nurse Jeanine already asked for one of our pairs of reading glasses, and we anticipate using many more.  It is quite sobering to see the incredible poverty here.  Most people live in a hut made of cow dung and mud with a corrigated iron type roof which makes it very hot.  Water pumped from the village authorized pump is not drinkable but most people don't take the time to purify it and drink it anyway.  We saw countless people using ponds of very dirty water to wash clothes and bathe.  Most people get around on bikes or motorbikes and there are very poor roads with lots of pot holes and only 2 narrow lanes  plus they drive on the left side of the road.  This makes getting around quite exciting (we have a driver thankfully).  I'm feeling well and the food has been pretty good.  We're sleeping well and everyone is very welcoming.  Oriti (good bye) for now.  

Asante sana for all your support and prayers.  Please be in touch.  Much love from Kisumu. 

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