04 February 2011

Kenya: Gone on Safari

Work's finished and it's time for safari!  Please take in the last official post of our trip.

The last few days were spent finishing up at the hospital and the clinic in the village.  Rounds, treating malaria in the clinic, and watching the clinic's new reception being built were the main events of note.  We even had dinner last night at Brenda's, prepared by her two sisters and mother - boy was it amazing.  Daniela, Brenda's 2 year-old daughter, even has her English up to speed.  We'd ask her "How are you?"  She responds, "I'm fine."  (Those are the most commonly known phrases by the kids here.)  We've definitely explored Kenyan and Indian food to the fullest, and I actually look forward to some Indian food when I return home.  Never thought I'd say that.

It is difficult to capture all the appreciation we have for your support and prayers throughout this trip.  Through your donations we purchased and gave out all our children's multivitamins, handed out toothpaste and toothbrushes to those who needed them, re-stocked about 18 different medications (antibiotics, phenergan suspension for nausea/vomiting, children's tylenol, etc.), handed out glasses and gave reading glasses to the Tenwek hospital crew, left a number of medications from home for emergency use only, gave coloring books, crayons, workbooks, pens and lollipops to roughly 150 kids, and even purchased cooking supplies for one of Brendas' mothers.  Their smiles showed their appreciation, but from us we say "thank you" for your open hearts.  We truly cannot thank you enough - what an honor and a blessing.

This has been an invaluable learning opportunity for me, as a repeat trip to a developing country, challenging my patience and shaping my attitudes.  There are so many projects here, intended to serve the population in poverty, where the ball is actually being dropped:  there is still a huge need for reliable transportation (well-maintained vehicles and smooth roads), the effective distribution of bed nets to those who truly need them, closer access to clean drinking water, and an increased emphasis on the prevention of the spread of HIV.  For the failures, there are plenty of successes as well:  motorbikes now fill the roads getting citizens to and from their destinations quicker, internet access has exploded keeping people better informed on current events and public health measures, anti-retroviral medications are available to those mothers who deliver in the hospital to try to prevent vertical transmission of HIV, and more community health workers are devoting their work-week to improving the health of Kenyans.  There are plenty to build on.  One of the most valuable lessons revolves around respecting what you don't know.  We don't know everything.  Especially when we don't live in the community we're serving.  And a clear and open mind with respect to this can bring one closer to success.

There is a plethora of projects going on here, and the main need for improvement is in the coordination between them.  Filling in the small holes.  Connecting the dots.  Adding the last few small pieces to the puzzle.  And I hope to help with that. 

The true soldiers and "saints," really, in all this, are Josh, Brenda, and Aduda.  Josh, the Bonyo's Kenya Mission #1 here in Kisumu, who ensures the clinic operates smoothly for those in and around Masara.  Brenda, the social / community health worker who gives her time to educating pregnant mothers and young schoolgirls on STI's among other public health measures.  (And let's not forget her father, "Papa Joshua," the clinical officer who offers his experience and charisma to her endeavors.)  Aduda, the former salesman, who believes so strongly in preventing HIV spread and educating those living with TB and AIDS, that he travels by public transport to the villages for surprise home visits to ensure compliance.  I have learned from their actions, and can only hope to support their work further in the future.

In the end, I've learned that the health of all peoples boils down to education.  If you don't understand that germs are on your hands, even if they don't look soiled, you will not prevent the spread of many diseases, especially diarrheal illness.  If you don't understand proper baby-feeding techniques, then you'll continue to feed fresh cow's milk directly to your newborn which can be harsh on their young gut (yes, this happens).  If you don't understand that forcing baby teeth to fall out with nails (yes, as in "hammer-and-nails" - this happens too), then infections will continue to hurt young children.  Expanding the public health educational efforts, and simply expanding the number of children able to complete secondary school, will drastically improve health in this area. 

Finally, what I take from this particular trip is the desire to use all the many little luxuries I've been blessed with, that built the foundation of my knowledge, to strive with extra effort to reach my full potential.  Most children here can't even focus enough in school due only to hunger.  How can I not take advantage of all I have, to do my absolute best?!  It would be a disgrace. 

In the end, my buddy Dan, the manager of the Milimani Resort Hotel, our home for the last three weeks who says, "We live like lions."  They wander throughout the day, with no intentional direction.  But, when an antelope comes along, they eat.

There is no need for plans.  When the antelope comes, you'll be there.

The finale from Mom:

Hi all!  This will probably be our last post as we leave for the Masai Mara and safari early in the morning.  We said goodbye to all our friends at the clinic after seeing several more patients (all with malaria).  I presented our blessed shell to the social worker, Brenda, and we both got a little teary.  She has been such a wonder for this village bringing lots of programs which I think will have a great impact.  It has been a profound and moving experience to be here and I'm sure this will be with me the rest of my life.  There is such great need here (in my eyes) and I hope to be sharing some of our ideas for continued support of this village.  Each day in the village for most people is about surviving and basic needs.  We've been so warmly welcomed and Josh, our host, has taken good care of us.  I feel blessed to have made this journey and especially to have this bonding time with Travis.  He's a very good traveling partner as you won't be surprised to hear.  He's good at keeping his cool when I'm losing mine and getting frustrated.

Last night we had the honor having dinner with Brenda and her family which included her mom, dad, 2 sisters and 2 yr old daughter.  We had such wonderful Kenya dishes such as beef stew with rice, kale and spinach, roasted potatoes, tomato/red onion/cabbage salad, fried chicken abd chipati bread.  Quite fabulous!  And as if this wasn't enough, Brenda's mom presented me with some gorgeous Aftican fabric of yellow and purple.  I'd worn my new African-made dress with zebras which Brenda had helped me have made so her mom knew how much I love the fabrics here. That was an incredibly generous gift and I was quite moved.

Today, we've been taking care of last minute business and we took Josh to lunch.  He's been such a great resource this whole trip.  Tonight, we're having dinner at Dan (hotel onsite manager) and Stella's and we're very excited about that.  Got lots of packing to do and decisions about what I'll leave behind since I need lots of room for gifts, etc.  Ha! I'm thrilled about the safari and can't wait to see all the many animals there.  I miss you all so much and look forward to seeing you soon. Many thanks again for all of your love and support!


Asante sana for all  your prayers and support.  We can't wait to share in person when we return.

02 February 2011

Kenya: The Kakamega Forest + Democracy Now?

So, apparently almost the entire Arab world has decided in the last few weeks, that after an average of 25 - 30 years of autocratic rule, they want democracy.  Now.  In the three weeks leading up to my first trip to Morocco.  What timing!  How selfish.  With uprisings spreading to Yemen, Jordan, Algeria, and now rumors of Libya and even Nigeria being next, I figured it would be smart to change my vacation plans.  With the help of God (it could only be) and Nikki the kind Delta agent, my flight from Nairobi will now head to Lisbon, and then home after nine days of Portuguese espresso, nightlife, and port.  

But we are still one long week from being done here in Kenya.  My time with Dr. Allibhoy came to an end today, after a busy set of rounds.  We continue to see cases that are only seen in textbooks back home.  Today, a patient with cryptococcal meningitis was readmitted, our patient status post thoracentesis is still improving, and a post-MI patient appears to be doing well on day 1.  Dr. Allibhoy gave an excellent talk today on the latest in Acute STEMI management.  Here in Kisumu there is no cath lab, so no PCI can take place - thus, they use fibrinolytics.  I don't think I've seen fibrinolytics used for MI in my training in the U.S., so it's interesting to see that used here, and safely.  I've only seen it given in suspected embolic stroke.  Dr. Allibhoy does an excellent job of keeping up with the latest in Cardiology, collecting journal articles and attending annual meetings in Europe.  

I'm continually referred to as "Dr. Travis from U.S.," but out in the village I answer to Giles, Charles, Jarvis, or Trevor.  The "Tr" sound doesn't mesh well with native Kiswahili tongues, but I appreciate the efforts.

Yesterday's visit to Kakamega was beautiful and a refreshing break from the polluted air and busy streets of the city.  Mom's details will be below, and will hopefully include the amazing 8 - 10-foot python that had wandered into the local village and was beaten to death by a swarm of villagers, and then taken to be skinned by the Kenyan Wildlife folks.  It was the only snake, dead or alive, we saw yesterday, even though the forest has 27 species of snakes (25? poisonous per the guide).  We saw plenty of red-tail and Colobus monkeys swinging from the trees, and great views of the falls and land surrounding.

I'll leave you with a quick commentary on top of all this pro-Democracy anti-autocratic unrest in northern Africa and the middle East.  The sentiment down here is of course the same as the U.S. - Democracy = good.  No other way about it.  But how about when Democracy elects leaders that will not be friendly to the U.S?  This is what will likely happen in Egypt.  Then what?  Will the country then be unfriendly to tourists from the West?  From what I hear, the Muslim Brotherhood (majority in Egypt) is not similar to the majority of other Muslims around the world, and continue to represent an extremist view.  But they are who will ascend to power in Egypt.  At first, President Obama wanted to have "talks" with Egypt, but now the word from the State Department is for a transition to begin "now."  How is our country's leadership handling this?  Shall we bomb the hell out of northern Sudan to set them straight?  Or hold diplomatic talks with Egypt?  What's the course?  Is President Obama being too weak, or being smart?  In all honesty, the main thing about an Obama presidency that made me hopeful was his anticipated ability to work with international leaders and bolster the view of Americans around the globe.  Is he doing enough right now?  Of course, it depends who you read, and it's fascinating:

You can either read the caution-provoking article about Obama being the one who will be remembered as "the one who lost Turkey, Lebanon and Egypt."   Or, you may want to read support of Obama supporting Democracy, and practicing what he preaches.
Oh, and Josh still doesn't have the truck.
The better version from Mom:

Hello all!  Yesterday we took a trek through the Kakamega Forrest.  It's about 1.5 hours each way and our driver, Mark, had to drive like he was on an obstacle course on some of the journey as the pot holes are deep, wide and plentiful.  We made it and boy was it spectacular!  We began our 3.5 hour trek (about 10 miles) with our guide, Rachel, who was wearing sturdy leather-soled flip flops.  Our lst stop was to look at a 10 ft. dead python the villagers were skinning.  OMG!  I could not get close but Trav took a couple of pictures.  As we entered the forest, we saw a troop of blue-tailed, red-tailed, and white-tailed monkeys which was quite exciting.  It's the lst time I've seen monkeys in their natural habitat.  Rachel then told us of all the animals/reptiles there--27 species of snakes, 10 of them being poisonous (I went blank after that--ha).  Thankfully, we didn't see any.  We did see lots of monkeys as well as a breathtaking, beyond words overlook of the whole valley and some waterfalls.  Pictures can't capture the awesome beauty of this part of Kenya. We had the perfect day as it was overcast and nice and cool. There were fewer people around and I noticed that the whole area (forest and villages) was pristine with hardly any litter.  They seemed dedicated to caring for the area which was heartening. The kids were excited to see the mzungus and to have their picture taken.

We returned and boy were our feet tired.  After a lovely dinner of spaghetti and garden salad at the mzungu hangout, the Green Garden, we made our way home via tuk tuk since it was after dark.  Trav then began to try and change his trip plans. Instead of Morocco (with politcal unrest nearby), he will go to Portugal.  The communication system here is archaic and extremely slow.  After about 2 hours of trying to communicate with KLM about his desire to change his flights, the call was disconnected and we were about out of phone time.  So very frustrating to say the least.  We decided to call it a night and try again today.  I'm happy to announce that he was able to work out all the changes! And, we'll be on the same flight to Amsterdam so I'm pleased about that.

Today, I took it easy while Trav did hospital rounds.  I began to talk with Dan, the on-site manager of the hotel about differences in here and the U.S. Here people are very connected to family.  If a brother has a financial need, the family (which is usually large) helps thus making it near impossible to save for the future.  On the other hand, the family is a built-in safety net.  Dan has several other businesses so that he can earn extra.  He has driven us a couple of times into town and has helped Trav get some music CDs (which excites T).

It has rained a little bit and there are thunderclouds in the area so we may get more.  We're heading back to the clinic tomorrow even though the truck is still at the police dept.  I guess Josh will find another vehicle.  We only have 2 more days in Kisumu and are trying to fit in many things.  Sat. we leave for safari.  Awesome.

Love to you all!

Asante sana.