Jeeves Goes to Kenya

The Ultimate Chapter, The Final Farewell

2008-08-11T21:52:00.005+03:00

For those of you loyal readers who have all but given up on the epilogue to this African saga, I have finally gathered my wits about me for a brief moment to at least note down a bit about the experience State-wide. As some of you know, I have begun my fellowship in Hematology/Oncology. It has been a tumultuous beginning, and unfortunately, the night is darkest before the dawn and that dawn will not even begin to peak its head for another 10 months or so. Therefore, this night will be one of the longest that I will have known.

More than just the challenges of initiating myself into a field I know almost nothing about, immersed in a caustic environment, yet again separated from my wife, is the culture shock of the medical system itself. I experienced this contrast before when I began my ER rotation after returning from my sojourn in the Himalayas in early 2007, treating and diagnosing patients w/ nothing but my physical exam skills (pitiful though they may be, but surprisingly better than that of my Kenyan colleagues), some rudimentary diagnostic instruments like my stethoscope and a single otoscope/opthalmoscope for the entire camp, and of course the collective experience of myself and my colleagues. After I returned from that experience, I was immediately thrust into the most defensive field of medicine - the ER - where $1000 work-ups for a simple headache were commonplace, where 95 year old demented folk were admitted to the ICU. At the time, it was more a curiosity than a shock because I had really been only on vacation from the American travesty of a medical system during my time in India.

Now, however this transition back to the US is a bit more awful. Here we are in supposedly the richest country in the world where we routinely condemn people to death because they cannot get their cancer care covered. At the same time, we will spend literally millions of dollars on another person so that we could possibly buy them a few more months of misery. The discrepancies are disgusting and typical of the American medical system where everyone is to do what he can, and just because we can do something it means we must do something, and when somebody protests then the full force of the academic hierarchy comes crashing down upon you to highlight your ignorance and inadequacy as a member of the team. Such is the reality that greets me after the challenges and triumphs of my time in Kenya.

Still, the choice of pursuing this field at this institution was mine. Yet, the current reality does not at all serve to be the last taste of this blog for my beloved readers; it is only to demonstrate the importance of having pursued this escapade across the world in the first place.

The accomplishments in Kenya could not have been realized without the support of so many people. Dr. Dave Leonard was the first one to have identified me as a potential recruit for Lalmba at a party celebrating our successful completion of a crash course in Global Health. He and his wife were lecturers for that course and he served as sort of a reluctant recruiter; reluctant in that he did not know if someone such as I with such a short time of commitment would necessarily be a good fit for the organization. Then Dr. Marc Seidman decided I was worth an interview after talking to me on the phone, and voila it Hugh and Marty also thought me worthy enough to send me over for what they considered such a short time.

However, thanks to Hugh and Marty and their faith and confidence in my abilities and their satisfaction with our progress at the site, they were willing to send me back a second time to ensure a stable transition for the new volunteers. As a consequence of the intervening political crisis, our evacuation from Matoso, and my missing my plane flight back to Kenya, I now have the dubious honor of being the most expensive volunteer in the history of Lalmba.

Of course the success of any project cannot be exalted without the heroes who have blazed the way prior to my arrival and who will continue building on what little foundation that I have added in my short time. In this particular case, the names of Paul and Darcie Meierbachtol will be ones to remember as those who were able to take up the mantle and pursue the smoothest transition one could hope for from one medical director to another.

The expatriates often get much of the congratulations with regards to the work. However, they are simply an instrument for movement. The actual movers are the Kenyans themselves. I try to always emphasize to them and to anyone else who will listen that it is their dedication to the clinic that really keeps it going.

And the well wishes, concern, and encouragement of my family also made this journey possible. Without Dad's ability to facilitate communications during the political crisis and everybody else's good vibes pulling for us to make it out safely, things could have been much hairier. And to go along with that, the hospitality of Tom and Marge Tucker and Holly and Tony in Arusha made our escape that much easier to handle.

And to PJ and Howard, who's compassion and generosity support the fulfillment of such adventures. Their faith in the greater good and the concept of "pay it forward" have been an inspiration to us. I plan to continue to embrace their vision.

Finally, last and arguably the most important person to make all of this possible - the establishment of a streamlined HIV/TB clinic, the initiation of a consistent teaching curriculum, the encouragement to start computer training, in short all accomplishments and even goals to be pursued - is Professor Amy Jeevan, Chair of the Modern Languages Department at the University of Indianapolis and the most wonderful woman in the world. Without her constant encouragement, her willingness to work a whole year in a new job with barely any back-up, her acceptance of my need to go back to Kenya to finish my work despite the political tumult, and her understanding that this was an innate urge of mine to fulfill this dream of international travel, health care, and intrigue, and of course her financial support as my sugar momma, none of the progress during my time there would have been made. Really, she was the the keystone of the whole operation.

It is to all of you that I dedicate this last chapter. And from this vantage point as traveling doctor, I bid thee farewell, as I now fully commit myself to the future of hematology and oncology.

Thanks for everything.

Transition

2008-06-15T01:05:00.004+03:00

Reverse culture shock is definitely a documented phenomenon. For some, it is so severe that they are unable to even live in their home country after a relief work experience overseas. In my case, it has always generally been mild. The consumption orientation of societies especially the States, the waste, the chosen ignorance of my home population, they are all hard to stomach after 8 months in Africa. However, after having returned to the States so many times following trips to so many other countries, the gravity of the reverse culture shock even after a trip as long as this past one has definitely been mitigated and much easier to weather. Of course, it is also much easier to glide back into one's culture when you have someone as supportive as Amy and as joyful as the dogs to help you along in the activities of daily life.

Overcoming jet lag turned out to be a quick process. Despite my insistence on youth both emotionally and physically, the effects of transoceanic travel have become harder to simply brush off. Yet, on this return, a visit to a party that forced me to stay awake and the novelty of physically playing video games on the new Nintendo Wii console for hours on end allowed me to transition to this new time zone within 2 days. Consequently, I could not use jet lag to justify my perpetual need to sleep and nap; Amy would have to simply deal with the fact that the normal Jeevan has returned in all of his somnolent splendor.

Initially, the starkest contrast was the infrastructure. The fact that there were paved roads, so many cars traveling at seemingly insane speeds, no chickens, goats, and cows running around in the middle of I-70, a lack of significant potholes threatening to tear off axles, the ubiquitousness of street signs - these were all such a shock to see. Granted, Kisumu is a fairly well developed city but it cannot even compare to the infrastructure of our basic suburbs, especially after it got looted and razed in the aftermath of the elections (the city has recovered significantly from those events, fortunately).

Overall, I got mostly used to the abundance, the drive to consume everything in sight like a bunch of parasites, the speed of life, the necessity of getting so many things done regarding the start of my fellowship. Yet, even as I write this the one thing that I still have trouble fathoming is the amount of day light that we have. In the first few days, I was amazed that we would be in bed by 9 pm or so reading and it would still be light out. Even last night when we were out to dinner with friends, I was judging the time that we should leave the restaurant by the amount of daylight that was outside. When I suggested that it was time to go based on my observation of a deep twilight, all 4 of us were surprised to note that it was 10 pm. Jeez. The regularity of the diurnal cycle in Matoso was so consistent - sunrise at 6:30 am, sunset at 6:30 pm - this enormity of sunlight is not only disconcerting but it also foreshadows the paucity of natural illumination that I will experience in the winter. I'll probably need a light box in St. Louis just to accommodate this reliance on a steady sun cycle that I've developed on the so-called "Dark Continent." I definitely won't be calling it dark when winter comes around this year.

I am glad that I left some time after my tenure in Kenya to allow for a transition to this life state-side. Realizing now how much preparation both mentally and logistically that needed to be done for my move to St. Louis, I would have liked even another month to spend at home with Amy and the dogs, my nuclear family. Probably, I could have picked up some moonlighting to replenish the savings that were drained to facilitate this contribution of blood, sweat, and tears to this worthy cause. I am so glad to say that Lalmba Kenya and I worked so well to accomplish worthy goals, and that Paul and Darcie are such excellent people with whom to leave a legacy that will be nurtured to even greater heights.

The Voyage Home

2008-06-07T19:20:00.004+03:00

I apologize for the delay in this entry. I try not to flatter myself, but I would presume that at least some of you loyal readers would be interested in my transition back to the rat race that characterizes the American lifestyle.

My misgivings about African transport are well justified and the return legs of the trip on the Dark Continent were typical of that third world experience. After bidding all my adieus to the staff and Paul and Darcie on the morning of my departure, Marico, Nancy, and I boarded the Landcruiser to drive to Tanzania. My flight was actually the day after our departure from Matoso, but considering that it was relatively early in the morning, we figured it would be better for me to spend the night in Musoma so that there would be no delay on my part to miss our flight. Before reaching the hotel, we stopped at the airport so that I could verify the departure time. No one spoke any English which is often the case in Tanzania but eventually I did find the flight schedule. It said that departure would be at 10 am.

We went to the hotel where we dropped my stuff off in the hotel room. Then we decided to have a bite to eat before Marico and Nancy headed back to Kenya. None of us had anything to eat that day. We ordered our food, and then lo and behold 2 hours later we actually receive something to eat. And believe me the quality of the food was not worth the wait. It was a similar experience at the Nyanza Club in Kisumu. It seems that if you eat in a "fancy" hotel, service is supposed to be atrocious.

I slept well, woke up, and had my first hot shower that did not come out of a bag. I ate the provided breakfast and met my taxi to take me to the airport. When I got there, nothing was going on. There was no one waiting, no one to take my ticket, no one that had anything to do with getting passengers on a plane for travel. The taxi driver suggested that we go to the Precision Air office that was nearby. And so we did.

When I got there, the person did not speak any English and the taxi driver had to help translate for me in his broken English. It seemed incongruous that a person who has computer skills, who interacts with people who book international flights at least to other destinations in East Africa like Kenya and Uganda where not everybody speaks fluent Kiswahili, where the instructions on the tickets and manifests are all in English had more difficulty communicating with me than the Taxi Driver who does not necessarily need English in his field of work.

Finally, the lady gave me a ticket that had a different time on it. I stopped at the airport again to verify that I had not made a mistake. Indeed, the schedule at the airport and the actual schedule were 3 hours different.

The people at the hotel took pity on me and actually let me nap in my old hotel room despite the fact that they had already made it up. This long part of the story is to highlight the many facets of "TIA" (This is Africa) - incompetence and disorganization juxtaposed with friendliness and kindness. What an interesting place.

At the airport, the people charged me extra for my bags because I exceeded the weight that they normally allow. These rules disregarded the fact that I was an international traveler. I actually did not even have enough money for the charge. So they took everything except for approximately 2 dollars and just re-calculated the weight for the other passengers that were underweight and it all worked out. Jeez.

Once that plane took off, I was able to breathe a sigh of relief. Getting to Dar Es Salaam was going to be the most difficult part and it was. The rest of the trip home went fine. The Dar-Amsterdam flight was so empty that I could stretch out in the row; the Amsterdam to Detroit flight was completely full; the Detroit to Indy flight was full but very short. And then I was able to see Amy for the first time at the baggage claim. The prize at the end of the journey for a weary traveler. However, I think Amy would have preferred a shorter hug so that she could breathe.

The Last Members’ Day

2008-05-05T16:46:00.002+03:00

Yesterday was my last get together as a member of our Members’ Day. It was a nice party and it lasted pretty late for our normal soirées. We didn’t get back to the compound until past 10:30 pm.

Typical of African time, all the participants did not get there until about 6 pm even though work ended at 4:30 pm. We sat outside drinking soft drinks and talking. Finally, Paul opened our “meeting” with our Members’ Day song that he composed at our last meeting. We danced and enjoyed ourselves for the rest of the night.

Nancy & Co. prepared a send-off meal for me. It consisted of typical Luo fare – rice, ugali, sakuma, and boiled chicken. At the end of the meal, as the guest of honor, I had the privilege of eating one of the chicken feet. Darcie took a picture of me with it in my mouth. It looks pretty damn funny. It didn’t taste like much. There was hardly any meat on it. It was weird to eat the foot especially with the inner talons still attached. They remove the outer ones.

Then we just danced the rest of the night. The whole of mother nature and father sky was cooperating with the send off. The sky was alight with as many stars as I’ve seen in a very long time here. With the rainy season, the clouds prevent enjoyment of the cosmic splendor. Even a large portion of the milky way was visible. Darcie invited us down to the lake edge where we saw a fireworks display of fireflies. And in the distance we could see the city of lights created by the boats fishing for omeyna (a type of very small, bad tasting fish) with their lanterns. It was definitely a time for reveling.

At the end of the evening, there was much speech making. Everybody had some amount to drink except for me. As some of you know, I dislike beer. Anyway, I had done my fair share of Members’ Day drinking the week before. That is for another story. But with the booze, came the longest and most meandering toasts I’ve ever heard. I think it took an hour just to listen to everybody articulate their fuzzy thoughts. It was fun, albeit prolonged.

That was one party. We have another one in the works for Monday. The beginning of the official goodbye. At “greeting” on Tuesday morning will be the ultimate farewell. Parting is such sweet sorrow.

Rain, Rain Go Away

2008-04-30T21:56:00.001+03:00

We are in the middle of the rainy season here. And what a season it is. Every afternoon we get rains that range from a slight drizzle to a torrential down pour. The entire compound is a mess of mud, soggy grass approaching the level of swamps, slippery sidewalks of slime, and bovine urine run-off. It’s a total mess.

The overflow of the rain was getting so bad at the upper compound that some of the clinicians were in danger of floating away. Or at least their furniture was. Their entire rooms were flooded with water. They were standing in water, cooking in water, their kids were sleeping in water, and some of them had to sleep on tables because they couldn’t sleep on the floor. Luckily, Tom Tucker from Agape, took his tractor and dug large drainage ditches on the sides of the road directly above the compound that re-directed the flow of water away from our Lalmba staff.

Often the rain has gotten so bad that it doesn’t even come down, it assaults you in horizontal sheets of water spikes. The water will bathe your feet as you are trying to sleep inside your room within the confines of your mosquito net. It will shower you as you deposit your dishes in the kitchen sink. It will blow windows open knocking condiments off tables and endangering your precious electronics.

And that’s on a good day.

The other day when the rain was coming down so hard that I ate dinner with my headphones on to mitigate the attack on my eardrums, we had an easy time of it. However, one of Jenifer’s trees fell down onto one of her buildings causing some damage. A papaya tree in front of the Tuckers’ house collapsed and took another tree with it. The tree was dead and so they had to cut it away and now the Tuckers’ entrance looks much sadder without the arborial decoration. And while Jackson was about to eat his dinner, the metal roof on his house blew clean off! Here he was about to enjoy a meal and then suddenly the entire inside of his house is exposed to the elements. He had to rush around like a headless chicken to rescue his furniture and such and place it in another one of his buildings. Now, he has a temporary replacement roof that leaks making his original home more protected from the outside but nevertheless uninhabitable until he can get another iron roof.

There is so much water here that the ground is completely saturated. In the middle of the day when it is dry and 85 degrees, water will still be leaking out of the ground on to the sidewalk trying to find its way to Lake Victoria where it will be welcome. Twice before, there was so much water flowing on the walkway towards our houses outside the cookhouse that we named it the Lalmba River.

When we returned from a trip to Kisii for supplies the other day, the drive from Migori took us almost 2 hours because the road was so overwhelmed by all the water. Numerous bridges were covered with water. One section of the road was entirely submerged in almost a couple feet of water just below our running boards. Daniel, in seventeen years working as a driver for Lalmba, had never ever seen that much water over this section of road. He was not concerned about the many semi-washed away bridges but this sight was definitely a new one on him. Sometimes being the first volunteer at so many things is not what it’s cracked up to be; the possibility of being the first one washed away into the depths of Lake Victoria by a flash flood is not my idea of fun. Stupid rain.

My Animal Fiefdom

2008-04-25T05:08:00.000+03:00

As many of you know, the animal kingdom has not been the most kind to me during my stay here. Pigeons climb on my roof scratching away so loudly that I cannot sleep. They try to build nests right outside my window cooing and flapping their wings at dawn. The cat that I bagged and removed to a far away village came back to continue to plague us – granted it took it 3 months to find its way back but the bottomline is that it’s back. Chickens come uninvited into our cookhouse and jump onto our sink and fridge when we try to chase them away. Rabid bats find there way into our homes to hang out and give us the willies. All in all our coexistence has not been that of mutual tolerance.

Not wanting to let these silly creatures get the best of me, I asked Jenifer to get me some PVC pipe from Migori so that I could make a blow gun using the technique I learned from my young friend Devon in Arusha. Jenifer obliged me and I embarked on constructing my instrument of fear. While I was in Arusha our targets were plastic bottles and tree trunks. Consequently, there was no harm in using nails as our blow darts. However, even though I want my sleep uninterrupted by annoying cooing and my meals undisturbed my feline yowling, I am not a sadist wanting to maim these bothersome creatures. So, initially I try to use seeds with paper. But that didn’t work. Then I went back to the nail method. They definitely flew very well and would have been very effective in ridding myself of these pests. But like I said, I wanted a nonlethal method. Finally, I decided to tape wads of paper over the nail part. I tested it on a cow and it worked great! He just snorted and went on his way. Now I could deter my opponents with nondeadly force!

Paul saw my initial success and he created a blow gun for himself also. Currently, between the two of us, any creature threatening to impose itself on our serene existence will receive the full force of our Mizungu wrath. I have successfully pelted chickens, cats, goats, cows, and pigeons. And today, Darcie pointed out that the entire periphery of the cookhouse is free of these terrible animalian menaces. Unfortunately, I did not think I would be so effective and had planned on honing my hunting skills. Now we must start to roam the compound looking for our prey. Such is the life of the great, brown hunter.

Darcie will be writing a companion piece and she will even have pictures (but don’t believe every word she says!) ayearinkenya.blogspot.com

Wedding

2008-04-22T21:14:00.000+03:00

This event happened a few weeks ago. Nancy had invited me to her youngest sister’s wedding. Nancy and her family were going to take a cockroach at 6 am on the wedding day to get there. Joseph, who was also invited, and I decided against that ridiculously early departure. We figured we would take a transport from Otho and walk there at a more humane time of day.

We got to Otho around 9:30 am. It’s about an hour walk. We were told that the wedding would begin around 11 am. However, TIA. Through some of the conversation that was around us, Joseph concluded that he should make some phone calls. We discovered that Nancy and Evans were still at their home at Sea Lodge! They hadn’t even left for their own sister’s wedding yet.

So, we decided to save our money and wait for them. The waiting took awhile and a Matatu showed up, and so we decided to use that to get to Lwanda where the wedding was being held. We got there around 11:30 or so. Nothing was going on. The stupid wedding did not start until almost 1:30 pm. Joseph and I just sat there for another two hours. Nancy and Evans didn’t arrive until almost 1 pm.

Then the place got packed. It was so crowded that the ventilation became non-existent. People had crammed themselves outside the windows, stifling any chance for air movement.

Nancy’s Dad showed up with his three wives. Then the awful, loud, boring, repetitive Luo music started up. The groomsmen, the bridesmaids, flower girls, and little usher boys, or whatever they are called, all walked in this slow gait to the rhythm of the music. They would only take a step with each measure. In addition to all the waiting prior to this march of the slowpokes, I had to now sit there and endure this soporific procession to repetitive Luo music.

During this ceremony, I was also stuck with holding a baby. The hall became so crowded that the mother decided to sit on the floor. People were squished so close together that she had little room for holding the baby in the middle of this crowd. Earlier, I had taken some pictures of the baby and the aunt, who I initially thought was the mother, for they made a very picturesque couple. It didn’t mean that I wanted to be stuck with the baby worrying the whole time whether it was going to expel some noxious fluid on me from one of its many orifices. Jeez!

As a result of this unsought-after maternal responsibility that was thrust upon me, Joseph borrowed my camera and became the resident photographer – well 1 of 4 or 5. And he had this cool responsibility shooting pictures and I was stuck there with this little kid. Thankfully, it wasn’t crying. Actually, it started but then I was spared having to console it. I quickly gave it up to the mother.

After the seemingly endless procession finally concluded, the pastor embarked on a ministerial tirade that also felt like it would last forever. It definitely went on for over an hour. Probably, the experience would not have felt so interminable had I understood even a single word. The audience laughed occasionally, and so it seemed that there was some fun to be had.

Eventually, my patience was stretched to its maximum. I had breathed nothing but body odor for four hours, listened to this uninspired music that sounds like every other Luo composition, and endured this inability to move because of this 10 pound baby sitting on me, and so I finally sent a text message to Joseph citing that I was hungry (and I was because I hadn’t eaten anything yet that whole day) and asking when would this thing end.

He and Nancy rescued me. We were first in the food line, and in the end we got lucky and hitched a ride back to Matoso with the hired car Nancy and Evans used to get to the wedding in the first place.

And that, boys and girls, was a traditional Luo Christian wedding.

For those of you who will continue to need your Africa fix, Darcie has also created a blog for their trip out here. The address is ayearinkenya.blogspot.com And you can also subscribe by e-mail.

Enjoy!

KEK

2008-04-05T01:46:00.002+03:00

This blog is about Kenyans Exploring Kenya, a trip I decided to join. In my case it would be IEK, pronounced “EEK,” or Indian Exploring Kenya. The main reason for going on this trip was for the experience. It turned out not to be fun, just as I suspected.

At the outset, “African time” struck our departure which actually turned out to be in my favor. Despite having gone to sleep early on Thursday night, I woke up at 6:35 am. Nancy had said that the plan for latest departure would be 6:30 am. No one woke me up. Well, lucky for me “TIA.” We actually did not leave until 8:30 am. I took the back seat with the hope that it would be all to myself. I was right. All the women stayed up front. Their aversion to the bumpy rear was justified. There were numerous occasions when I caught significant air on a bump and crashed down so hard on the seat that I feared further damage to my back. Jeez.

We drove north passed Kisumu. We stopped at Raila Odinga’s house in Bondo. He was not there. His caretakers wouldn’t let us in.

We then drove to his childhood home where his father is buried. There is a museum on the site. It was interesting. I discovered that Old Man Odinga was the first Vice President of Kenya, then jailed by Kenyatta and replaced by Moi. He was also an unsuccessful presidential candidate in 1992. Perhaps, it’s a good thing he didn’t succeed – he died two years later. Or perhaps that’s why he died.

After visiting that site, we drove to Sio Port. It was a harrowing journey. The rain up here was much worse than in the South. The roads were a mess – well, more so than normal, if you can imagine. The mud was so thick and slippery that the whole Big Fish, a vehicle that can comfortably seat 35 people without luggage, would fish tail. Perhaps, the bus was trying to live up to its name. Several times the driver requested that the bus be emptied of half the occupants so that he could drive with a lighter load. The rain had cut so many gouges in the road that I was standing during much of this part of the journey. We would hit bumps so hard that my knees served as shock absorbers for my careening body.

When we finally arrived at Sio Port we ate at a Hotel. I did eat some cereal in the morning before we left, but we ate nothing else until passed 10 pm that night. Then we partied until about 2 am. I danced and got into the music. At one point, the beat lent itself to some Bangra style jumping up and down. In that moment, I was dancing with one of the waitresses who was quite a good dancer. When I had transitioned back to the more subdued gyration, the two of us got a lot of congratulatory whoops, claps, and amused laughter. It was a nice time.

After all that dancing, I had to shower. It was being used in an olfactorally offensive way, while I was cleaning myself off. That was a new experience…

We slept in the restaurant. They moved all the furniture and cleaned the floor of all the mud tracked in. We laid the mattresses down and just slept side, by side, by side.

In the morning, we woke up at 6 am so that the restaurant could prepare to be opened for business. We did very little. The plan was to go to Port Victoria and possibly take a boat to Uganda. Unfortunately, the roads were so bad that the driver decided against that. Consequently, we drove directly to Busia, the Ugandan border town.

Busia was like Sirari (the border town near here between Kenya and Tanzania) except bigger. Lots of trucks going back and forth. We were allowed to cross illegally. Most everybody did some shopping. All the transactions were in Kenyan Shillings and in English for the most part. I took a picture in front of the Ugandan Immigration sign to prove that I can add another country to the list of places I have visited.

Then we drove to Kisumu. The plan was to camp on the beach but that fell through. We did stop by the campsite and hang out. But then we decided to stay at some sort of church institution. They had their own mattresses and a place indoors to stash us. That was nice. It rained so much more that night and I’m very glad that we did not have to camp. The noise on the metal roofs was deafening.

We ate. I asked a lot of different people about how many KEK’s they’ve been on and which was their favorite and which was their worst. It seems that the overall consensus was that this KEK was the worst one. Lucky me.

That evening, I hung out with the women mostly. One of the interesting things about the trip was the loss of the work-related hierarchy. Although it was Marico and Jackson (management) who got rooms at the hotel, overall the relationships between all the Kenyans reverted to a more egalitarian basis. With hat phenomenon was also the assumption of the traditional gender roles – the women cooked and washed the dishes, the men just sat around and ate. Similarly, I dropped the role of medical expert and assumed a posture of meek Mizungu accompanying the Kenyans, completely out of his element. I deferred to everybody else regarding all the decisions and goings on. At one point, I ate a banana on the bus. I didn’t know what to do with the peel, for there were no obvious trash receptacles. Like I said, TIA. I had asked Joseph and after some consideration, he just threw his out the window. I felt uncomfortable with this littering. Eventually, I spotted something that potentially could have been a trash can. As I got up to throw the peel away, Joseph grabbed it from me and tossed it out the window. He told me, “You shouldn’t be so bothered by such a small thing.” Hmmm.

Then that evening, I ate beans and rice in advance of the final preparation of our own food. I liked it, I was hungry, and it was available. However, when the main meal was prepared, I declined a plate citing that I was already full. All the women kind of clucked around me like mother hens and Nancy said, “This kid has to eat something or he’ll be hungry in the morning.” From Medical Director to “this kid” – a funny change in role.

Our last day saw us in the Kenyan National Museum – Kisumu branch. It was small. There were some archaeological artifacts showing some of the old traditional tribal customs and wares. The Luo had and still have a culture of marijuana consumption and they had special pipes for that that are still used. Like the Ibo from Achebe’s book, traditional, communal beer consumption was also practiced. They had a multi-mouthed vessel for that purpose. They also had this exhibit called the Ber Gi Dala – Good [times] in the Home. The staff seemed pretty enthusiastic about showing me the homes of the multiple wives, the role of the different buildings, etc. They kept repeating that this was the traditional Luo homestead. I didn’t understand why they seemed to perceive it as a fact of the past. What I saw is exactly what I see around here. The structures of the animal coop, the granary, the Tukul – all of them are exactly how things are in Matoso. Weird.

It rained like crazy again that night. I escaped the vehicle as quickly as I could. The driver had to hurry to catch me to bid me good bye. Man, what a trip.

The Relief

2008-04-01T04:51:00.002+03:00

Last week, I traveled to Kisumu to pick up the new volunteers. The trip there was interesting. Our plan was to leave at 6:30 am because we had to go to Homa Bay to drop off some of the staff. Both Marico and I agreed on this time of departure. However, typical of African time, Marico did not come to the clinic until 7 am and we didn’t leave until after 8 am. TIA (for those of you who have seen Blood Diamond).

I slept for most of the first half of the trip. In fact, we stopped off in Migori to have the brakes adjusted. Apparently, everybody had gotten out of the car to wait while the mechanic jacked up the car and worked on the brakes and they just left me inside. I didn’t even wake up until we stopped in Rongo because the brakes had been tightened too much and were overheating. We pulled over and Peter woke me up by knocking on the window to offer me a warm Coke. I wondered why we were drinking sodas in the middle of our trip. Finally, someone explained to me our recent mechanical misadventures and the reason for our current pit stop. My guess is that that was the first time that the mechanic worked on a car with a sleeping Mizungu inside.

The road to Homa Bay was very bad. When we reached the diocese, I saw a chameleon. Those of you who are familiar with chameleons know that they move in slow motion. The previous chameleon I saw moved so slow that he was stopped. I lay a twig on his back and he didn’t even react. This one was a bit more animated. He would walk in his jerky manner and if I tried to pick him up, he would very slowly turn his head and open his mouth in the most menacing way he could. If I strained my ears, I think I could hear him hiss. His movements were so slow, I was tempted to stick a pebble in his mouth as he tried to ward me off with his frightening chameleon yawn. Eventually, after about 30 minutes, he walked to the curb where he very quickly his underside yellow like the paint. That was cool. Then he climbed a tree and finally disappeared into the leaves, no doubt turning himself the green of his surrounding foliage. It was pretty cool to see a chameleon up close in action – well as action-packed as a chameleon can be, I guess.

Then we drove on a short-cut to Kisumu. We did some errands, meeting with the CDC, shopping at Nakumatt, etc. I stayed at the Nyanza Club. It’s an old colonial hang-out with a swimming pool, clay tennis court, racquetball courts, restaurant, and lodging. It was a nice place. Quiet. The service at the restaurant was lousy. I had to wait 45 minutes for my food. I also had to ask 3 times to get me some stupid water. Thankfully, the food was tasty. In the morning, there was a continental breakfast served. The waitress asked me if I wanted anything from the kitchen. Based on my experience the previous day, I declined. I didn’t want to have to wait until lunch to get my breakfast. Plus, I would miss meeting the new volunteers at the airport.

Marico and I both forgot when the actual arrival time of Paul and Darcie would be. So, we figured we would arrive an hour early and just hang out. Lucky we did, for P&D had already arrived 20 minutes before we got there. Their original flight was scheduled to arrive at 10:30 am but instead in the infinite wisdom of the Kenya Air authorities, they figured it would be better to depart almost 2 hours earlier. Had P&D not arrived obscenely early to the airport to ward off any delays by traffic, they would have indeed missed their flight because they were on-time. In the end, P&D greeted us not the other way around. They waved at us from the outdoor café where they were sitting. Since, I had expected them much later, I was wondering who these people were who were waving at us. Paul walks up to the gate and I ask him, “Are you Paul?” And he replies, “Yes.” That was a bit of a weird introduction. I had imagined something more like being the figure of rescue for these people after their long journey. Instead, they encountered a bewildered and tardy individual. Oh well. TIA.

Paul and Darcie are a great pair. They have good ideas and are settling in well. H&M were excited to be part of P&D’s in-country orientation, as they have not done anything like that in many decades. It was fun having all 5 of the Mizungus at the dinner table.

Well, now H&M have left for the States. I dropped them off in Musoma yesterday. It will be the 3 of us workers now. Already, the transition seems to be working well. So well, that P&D are in the clinic and I have the opportunity to write this blog. Already the closing signs of this chapter in my life are appearing. It will be an interesting denouement.

Masai Mara

2008-03-23T23:04:00.001+03:00

Two weekends ago, Hugh and Marty treated me to a trip to the Masai Mara. As our loyal readers know, this trip was snatched from our very fingers when Amy and I were here. Literally on the morning when we were going to pack the car and leave, we heard that “Migori is in war” and that we could not travel. Instead, we spent that weekend playing cards. From watching lions to searching for the queen of hearts. What a let down.

H&M empathized with this disappointment. And as a result, they thought that it would be nice to try to make it up to me by taking me there. Of course, my better half was still missing, teaching French in Indiana. They did explain to me that were it in their power to teleport her across the ocean for our weekend, they would have done so. Alas, our rudimentary African technology fails us again. There was no transporter to facilitate a trip for 2 couples. Rather, it was one couple with a spare wheel. But it was better than nothing. And it was definitely better than nothing.

The road that we take is the one the locals in this area would use. It’s dirt all the way. We drive into Migori and promptly drive out again. It takes us through the Kurya area and into the Transmara which is the Maasai dominated area right outside the park. I realize now that the road conditions to the park and in the park would necessitate longer times of rest for Amy to allow sufficient time to recover from the violent jostling experienced by the bumpy roads. Consequently, despite the assertion of some people that a 3 day visit to the Mara is sufficient, if one wants to thoroughly enjoy the park as well as not create the need for more hip surgery, our original plan of 6 days was indeed wise.

We left at 8:30 am and go to the Mara around 12 pm after buying some supplies in Migori. Our plan was to improvise the whole way. During the week, H&M had tried to reserve lodging. However, their efforts were thwarted by the insistence of the Masai Mara hotels to ensure that their contact numbers are either wrong or unlisted. Therefore, despite many phone calls, we departed for our safari with no knowledge of where we would sleep.

Thankfully, as the Irish would say, and Hugh and Marty being Irish said it, Hugh kissed the blarney stone, i.e. he can talk himself into and out of anything. This ability meant that we were able to stay at the luxurious Kichwa Tembo Tented Camp for a reasonable resident rate – affordable for a 2 night stay, not if one wanted to stay for 6 days. The digs were nice! I have pictures of them that I will post on the web when I get back. Needless to say, comfort and food were not an issue. It’s full board, by the way.

At the camp, they have resident, domesticated warthogs. I think their job is to mow the lawn. In fact, Marty suggested and I agreed that we should get some warthogs for Matoso so that our grounds will forever be groomed. All they do is eat grass and they are otherwise completely benign. Perhaps, they could even guard the place. I concur with Marty that they would have been a great addition to the compound. Unfortunately, litters wouldn’t be born again until August and we were unsuccessful in pinching one from the park. Still, it could be an assignment for the new volunteers - a present for Marty on her arrival, perhaps. I will mention it to them.

The days were full of driving, including the day of our arrival. We enjoyed watching the animals very much. Sitting in the car in the middle of a herd of elephants watching them do their everyday activities is both relaxing and exciting at the same time. We could spend hours just being one other animal in the Mara spending time with everyone else. Granted, we are animals in a metal SUV, eating the stuff that we bring in rather than the grass around us. It’s also a bit exciting because we are indeed in the wilderness. These animals are wild and at one point one of the African elephant females was flapping her ears at us, a sign to us to back off. Hugh promptly obliged by reversing the truck but the herd of elephants was big enough that most of our paths to escape towards the main road were blocked. In fact, the exciting-ness of the particular situation increased when Dad called me on my cell phone. Since I was negligent and didn’t turn it off, it rang. After more than 2 weeks of no communication with each other, as they were in Thailand, I had to whisper, “please call me back in 3 or 4 hours. Bye.” No explanation, nothing. Dad probably wondered what the hell I was up to.

In the early afternoons and evenings, we would enjoy gourmet meals prepared by the hotel. They were very good. Between Amy’s cooking, Marty’s cooking, and the meals at Kichwa Tembo, I gained about 10 pounds since returning to Africa. I guess that fast metabolism of mine is starting to slow down. Oh well, I’ll just have to exercise like everybody else to maintain this wonderful Herculean figure of mine.

In the end, we saw lots of ungulates like gazelles, impalas; giraffes, elephants, hippos; a single crocodile; 3 lionesses; cheetahs including one (it could have been a leopard) trying to chase down a warthog lunch. That was pretty awesome. We were also entertained by some Maasai warrior dancers. That was an interesting spectacle, too.

So, overall it was a great experience. It wasn’t six days in the Mara camping with Amy, but it was nonetheless a wonderful time. We had 2 days in the tented camp as opposed to the one that we had originally reserved. We didn’t get to see a Rhino but now there is a reason to come back.

A Week of Firsts

2008-03-01T20:28:00.000+03:00

Well, I have finished my first week of work here. Despite the fact that a separation of 2 ½ months from my family is a long time, it has become clear that it is an extremely short time for the sort of work that we are trying to accomplish here. In just the few days that I have been here, we have had meetings that have unearthed challenges regarding funding, community support, organizational support from other NGO’s and the government, and resources for certain programs. I definitely have my work cut out for me, let alone the new volunteers who are coming in.

On the plus side, the changes that we instituted last year prior to my departure have beared fruit. At one time when seeing more than 20 patients a day was a cumbersome ordeal, we can now see more than 30 without breaking a sweat. In my absence, they even established a new record of 57 patients in one day. And even with that load, their record keeping, data acquisition, and care (I hope) was maintained at a high quality. A very encouraging accomplishment for them and secondarily for me. I am a bit disappointed that I was not here to witness or be a part of that milestone.

As for other firsts, I have established a new record for the “Evil” level on my Sudoku, as well as another top score on Bejeweled for my palm. It’s been almost 2 years since I have even been able to establish any type of high score on that game. Getting the top score was a very pleasant surprise. Similarly, I am the “Snake Master” on my snake game on my cell phone, another position that has evaded me for a long time. And when Joseph and I were doing yoga the other day, I was able to touch my feet in one of the stretches. Alas, I cannot still touch my feet when I do the forward fold. I guess it’s still something to aspire towards.

After finishing Coyote Blue this morning, I can firmly say that Christopher Moore is my favorite author. He is the first and only one to achieve this discintion. Even though others have written masterpieces that I consider my favorite books of all time, and Moore has yet to accomplish such a singular achievement, his opus is so entertaining, educational, insightful, and action-packed that even his inferior books are for me worth a re-read.

In addition, I am now the first volunteer in Kenya to have his own flushing toilet. It’s in my room, no less. I christened it for the first time 2 days ago. And earlier, I took the first shower in my bathroom also.

And most significantly is the accomplishment of two opposing politicians successfully creating a coalition government on a continent renowned for resolving its political issues by trying to liquidate their opponents. One could probably argue that this event is the first occurrence of its kind in recent global history. Had we had such forward thinking in 2000, perhaps we wouldn’t have a quarter-million Iraqi bodies on our national conscience.

But I shall not bring us down on this week of firsts. It should be one for celebrations – big and small. We certainly are happy here, especially for my new high scores.

A Fool’s Departure, A Hero’s Welcome

2008-02-28T22:24:00.001+03:00

The day prior to my departure was a melancholic and lazy day. Even the sun felt the pain of our impending separation and decided not to come out the whole day. The night before, we had a great big Indian feast with the chair of Amy’s department and her family. Unfortunately, the combination of rapidly changing weather patterns, the continued challenges at work, and perhaps the overexertion from preparing such a large meal finally got to Amy and she fell sick with a cold. That meant that in addition to the doom and gloom of the day itself, she was sick also. Phooie.

Around 8 pm, I decided to check into my flight. As I was filling out all the online information, it bleeped at me that my flight had already departed and that checking-in was not possible. Obviously, I thought this was a mistake. I fished out my itinerary that was mailed to me and Amy was the first to spot the discrepancy. Jeevan, the bungling fool, was supposed to be on the flight at 1:10 on February 17^th not 1:10 on February 18^th as I had convinced my self. I was trying to check-in to a flight 7 hours after it had left! At the time of the discovery, I should have been cramped into a seat at 35000 feet over the Atlantic on the way to Amsterdam! Wonderful…

There was not much to do that night. Hugh and Marty had already departed for Europe, it was a Sunday and the travel agent could not be contacted. I informed Marc, the overall medical director of the mishap, and we both concluded that whatever pursuable remedy there was would have to be postponed until the next day. I finally relaxed after repeatedly chastising myself and we enjoyed the rest of our extra evening together.

The following day was a rush in the morning. I contacted the travel agent but she wouldn’t arrive in the office until 11:30 m EST. The next flight that would allow me to maintain the original itinerary so that I could travel with H&M to Musoma was going to leave at 1:10 pm that day. So, I ran to the airport, hoping that the agent could pull of a miracle and if that failed perhaps I could talk myself onto the plane. Well, neither thing happened and I was still grounded.

So, we returned home and we enjoyed yet another extra day and night together. Initially, the one travel agent had said that booking me on the flight that I tried to make would cost almost $5000. However, Georgia, the main travel agent we dealt with, was able to re-arrange the whole itinerary so that I would leave on Tuesday and arrive in Musoma on Friday thus allowing me to reach Matoso on Friday also. Despite the SNAFU that I created myself, the itinerary would only be delayed by 2 days. So, if anybody wants to make whatever travel arrangements, it is likely he/she would have an excellent experience with Georgia Terry of James Travel Points (well, you know, good service should be complimented).

The rest of the trip was relatively uneventful. I hung out in Dar. I stayed in a nice hotel. I had one more hot shower before arriving in Matoso. A bit of a pleasant surprise.

The flight to Musoma was pretty cool. It was a prop plane but we cruised at 25000 feet. I was able to see Kilimanjaro, Ngorogoro crater, and the Serengeti plains from the air. Unfortunately, the cloudiness and the dirtiness of the windows prevented me from taking any reasonable photographs. It was neat nonetheless.

I arrived in Musoma, took a taxi to the bus stand and took a matatu to Sirari, a border town where Marico was going to pick me up. The matatu ride was an interesting experience. We crammed 27 people and their luggage into this mini-van that originally was probably meant to seat 8. The trunk was closed with an external lock so that it wouldn’t fly open. Thankfully, the inability for it to close properly ensured that there was proper ventilation in the vehicle. I was crammed in so tightly that I literally could not move any part of my body below my waist except my toes. I’m glad the ride was only 2 hours.

When we reached Sirari around 1 pm, we all jumped out. I walked past one gate to the Tanzania immigration building. I again filled out one of those stupid blue custom forms that I had already filled in at Dar Es Salaam. They stamped my passport. I then walked past another gate. When I passed the gate, I could see the Lalmba vehicle. It was a site for sore eyes. After all this traveling, I finally saw something that represented my home away from home. Jackson and Marico were there to meet me. We embraced – a nice happy reunion. They then lead me to the Kenyan immigration building where I filled out yet another stupid blue form and received a stamp for my efforts. We then happily jumped into the car and drove off to Migori.

In Migori we ate lunch, we talked about the situation in Kenya, we bought a few things and then around 4 pm made our way to Matoso. When we reached it, I saw Joyce walking home from work. We reached the clinic around 4:45 pm and so everybody was heading home. The first words out of her mouth were “Hi! How’s Amy?” So much for the good doctor’s home coming.

However, I did get the hero’s welcome when I got out of the car in the compound. Nancy, Juliana, Jenifer, Prisca all greeted me with big smiles and big hugs. Everybody was very glad to see me and that I had made a successful return trip. Sammy, Isiah, and Daniel also greeted me heartily and embracefully. It was a happy reunion.

Wilkister then came out of the clinic and mentioned that they had some very sick patients. I worked until past 6 pm helping Willis with them. This 15 year old patient was vomiting blood, barely able to walk, and extremely cachectic. He had this liver that reached all the way across his midline and to below his umbilicus. It was huge, hard, nodular, and not a pleasant site. He was certainly going to die and we explained it to the brother telling him that the best course of action is to take the kid home and make him comfortable. That patient would eventually die that evening itself.

The next morning, I was woken up to help suture a kid’s scrotum. He was gored by an unhappy cow who did not like his grazing interrupted. The skin had been ripped and separated such that it revealed the right testicle. Thankfully, there was still skin left to suture together. I was able to successfully do a nerve block of the superficial scrotal nerves and the scrotal branches of the pudendal nerve. I was amazed that it worked so well. I was able to sew everything up so easily that the kid almost fell asleep during the procedure. As Hugh said, when I groggily made my way up to the clinic to assess the situation, “No rest for the wicked.” He probably meant wickedly handsome and talented. At least, that’s what I’ll tell myself.

Well, it looks like “I’m in it up to my neck.” (reference anyone?) We’ll see how well this doctor does now that he’s back in the thick of things.

To return or not to return: That question has been answered.

2008-02-23T21:09:00.005+03:00

The sojourn on the other side of the Atlantic was nice. Although the weather was not welcome, being with Amy at our home, eating well, having laughs, enjoying the antics of our crazy canines were a grateful respite from the immersion in uncertainty and recurring news of violence and upheaval that characterized Kenya prior to and after my departure.
The decision to leave Africa was a good one in that I was able to have the opportunity to enjoy myself without feeling the purposelessness while waiting in Dar es Salaam. I was able to help Amy with day to day errands, make the phone calls that she has not been able to deal with considering her busy schedule, and do some general catch up on the real life challenges that seem to always plague us on a daily basis.
After coming home there was much discussion between family and friends about the necessity of returning to Matoso. The uncertainty of stability, the lack of a provisional government, the potential challenges of lost supply lines resulting in food and medicine shortages, and the worst possibilty of physical isolation without means of any movement for fear of violent consequences were all on the minds of everybody including myself. However, Lalmba USA, within a few days of my arrival, did make the arrangements for all of us to come back to Matoso within the ensuing 4 weeks. We would return to the clinic as a group. The quick decision to return was made mainly because of the scarcity of airplane tickets. Had things deteriorated further, those plans would have been canceled.
As news of continued violence persisted, the decision to return persisted to be a difficult one. Our communications with Kenya continued to indicate that the Migori area was calm. All of the Kikuyus had been “liquidated” and the violent proclivities of the Luo in South Nyanza seemed to have been satisfied. The roads were opened, the medical transports had resumed, and obtaining medicines was without difficulty. Marico, the project director who had always given correct analyses and appropriate advice, continued to maintain that returning to Matoso was still a good plan.
Amy and I had discussed the decision to return at length. She was comfortable with the idea. Knowing what the situation was on the ground gave her the reassurance to support the thought of my going back to work here. When things initially prompted us to leave, she felt that an eventual return to the area was still warranted having seen the nature of my work and the positive attitude of the community towards me; when things were so bad that returning was too dangerous, she insisted that I come home; and when things had settled down and Marico advised that returning would not be difficult, she agreed that going back was still a good idea.
It was still a challenge to determine what the right course was. The detractors and supporters of the idea of going back was interestingly split along generational lines: those of our generation felt that going back was indeed acceptable, while the older ones felt that the risk was unnecessary. However, the problem was complicated. Of course, I felt needed. Prisca, our registrar, had called me with her own money while I was in Dar asking that I should come back soon. When I mentioned that Marico had indicated that things were too tenuous, she agreed, but still she hoped that my return would be sooner rather than later. Joseph had also called saying that I should come back soon. Both of them called me with their own money and considering at the time money was difficult to come by and cellphone cards were also a rarity, it is indication of their hope that I would return.
Moreover, I was afraid that they might think that my not returning would constitute a desertion. Despite the fact that it was a good personal (and financial) decision for the previous volunteer to not return, for some of the people here, there may have been that sense of abandonment. I’m not sure if that is the case or not, but I certainly did not want to augment the idea that the volunteers come and then when things are tough they abandon the same people they came to help. It was important to me that that not be the case.
Finally, as Murphy’s law dictates, the timing of this SNAFU could not be worse. We were on the verge of launching our new TB treatment program, we had just moved to the new PSC, and we were going to introduce the new PSC in-charge to the workings of the institution. Then suddenly I had to leave to ensure Amy’s safety and successful return to the States. Her job was of paramount importance – no job, no money, no ability for me to continue working for nothing. In light of the upheaval in the country as well as to the functioning of the clinic, I felt it was necessary to come back so that I could help make sure that these other programs could be reinforced and that they were also in a stable position for when the new volunteers come to take over from me. As everybody knows an organized transfer of responsibility is vitally important to the continued functioning and eventual self sustainability of any project. Plus, reinventing the wheel is no fun.
Therefore, the combination of these factors lead me to decide that returning was necessary to the satisfaction of some to the chagrin of others. Regardless of where anybody stood, all were supportive of my work and my choice. It was difficult even for me to come back after having spent such quality time with Amy and the dogs. But in this case, the call of duty was strong enough to wrench me away from the comforts of my home (the weather notwithstanding) and my family. And now this latest blog entry comes to you from Kenya.

P.S. - Oh yeah... if you look hard, under the picture at the top of the blog is a link to our Kenya photo gallery on www.smugmug.com. If you're too lazy to look for it, click here. And, if you like them, look at all of our photos: jeevamy.smugmug.com

The Voyage Home

2008-01-25T23:00:00.000+03:00

I write this blog from the comforts of my own home in Indianapolis. Yes, I have now departed the African continent. I hope that it will be a brief sojourn in the US to wait for things to calm down in Kenya before returning. In fact, as I write, we are making the plans for our return trip through Tanzania to reach the Matoso clinic.

When I reached Dar Es Salaam, I was all ready to head back to Matoso. Amy had successfully returned home; the Canadian couple with the two young children had arrived safely in Canada; and the African Pastor had established himself securely with his family in his original home town. All of the tenuous outliers of our original group of refugees had gone back to their proper places. Unfortunately, the unrest continued and the roadways to Matoso were still blocked. Food, cash, and supplies continued to be an issue. Thankfully, we were well stocked before the badness really hit.

When the repeat rallies took place from Wednesday to Friday last week, contact with Lalmba USA and Lalmba Kenya informed me that return was both extremely difficult, unsafe, and unwise. Consequently, I had to wait for more time. That was after one week in Tanzania already. Finally, when Monday of this week came, there did not seem to be any indication of resumption of normalcy in the area. In fact, over the past weekend, independent of the rally calls of the ODM (the opposition party), people again blocked the roads leading in and out of Matoso. They pulled down the polls that were to eventually support power lines (whenever the government decided that the polls should be more than wooden decorations on the side of a dirt road) and again all travel in and out was stopped. Even though personal danger was non-existent, the traveling would indeed be hazardous.

Overall, I had been getting increasingly restless in Dar Es Salaam. I couldn't communicate with Matoso via phone because both the cell network as well as the internet network were extremely unreliable, plus it is very expensive to communicate via phone for more than a few minutes. And I was not doing anything of import in Tanzania. At this point, the only way to get back to the clinic was to bike. Considering that some Kenyans had targeted South Asian stores in both Kisumu and Migori, both Dad and Amy thought this was an extremely bad idea. Others even pointed out that if I became a target while crossing the border whoever was with me would be placed in an unsafe situation also. Finally, we concluded that the time for just doing nothing was over. Along with Lalmba USA, we decided that my time would be better spent by returning home, communicating with Lalmba Kenya via phone, and spending quality time with my wife prior to our repeat separation during my fellowship.

It was a difficult decision to decide to come back. I realize that the civil unrest is extremely bad. Things flare up and die down and flare up again. Death by machete is not a fun way to go - it's bloody, messy, and slow. However, despite these threats to life and limb, it took some persuading to get me to come home. Things in Matoso in the PSC were at a juncture that this interruption could potentially be quite damaging. Had this happened one month before or one month after December 27, the upheaval in the PSC program would have been relatively mild. However, Lalmba Kenya had many goals for the new year for which we had set ourselves up to meet. I was an integral part of those plans to help pull them off. If I had had a crystal ball that would have told me that at the end of January all hell would break loose, I would have had the time and opportunity to successfully train the PSC in-charge thereby making me virtually redundant anyway. That means, new projects might be difficult to initiate but all of the changes made would have proceeded smoothly and the status quo would have been maintained without much difficulty. As foreign volunteers, our job is really to help innovate and implement and instruct. The Kenyan staff have a lot of experience in their own right, and our job is to improve function not bolster daily operations - at least not after over 20 years of Lalmba Kenya's gradual and successful development.

In addition to the practical difficulties of clinic operation created by my evacuation and inability to return, it was disturbing to me emotionally to think that I was abandoning the very people that I came to help. Granted, the staff of Lalmba Kenya agreed with the need to leave the area, especially with Amy around, as well as the caution regarding my return, but I felt that the bond that was created between me and them meant that I should continue in the trenches with them. But Prisca, Joseph, Nancy, Elizabeth, Marico - all of these people were of one mind that I should leave and only come back when things are better. I hope I can indeed go back sooner rather than later.

The trip home was disappointing. I could only stew in my own thoughts. The flight from Amsterdam to Detroit did serve as a bit of a distraction, as I was able to enjoy three decent movies: Balls of Fury, The Brave One, and 3:10 to Yuma. However, I kept wondering to myself whether I made the right decision. It definitely was the right decision by Amy and my family, but was it the right decision by Lalmba Kenya? When does the need of the few outweigh the needs of the many? How do we balance the degree of the need to begin with? Did I attach too much significance to my role there? Perhaps, we will discover that I was successful in making myself redundant even before the meltdown happened. That would definitely be a heartening ending to this story. However, I cannot know because I am not there and I cannot communicate effectively with them.

The arrival home was nevertheless wonderful. Amy met me in the airport. It was great to see her. She was so considerate even to bring my huge leather jacket, although I was already bundled up and prepared for the frigid Indiana weather. Once we got home, I was greeted with the most wonderful soup in the world - an amazing tomato soup with "wooden" rice with a mix of spices so superb that the taste just explodes in your mouth. The meal is great in itself but made better by the fact that it warmed me up as I slowly acclimatize to this horrible climate.

The dogs were all over me when I got into the car. Initially, I had approached the vehicle with my hood up and they were trying to protect their territory from this hooded stranger by barking like mad. However, once I dropped the hood, recognition was instant. Duke presented a torn up green toy to me as he always does when he is greeting somebody joyfully, and Domino deposited herself on my lap for the entire ride home. It was a very heartwarming welcome home.

In the end, I hope to go back. If I cannot, I hope that my work was not in vain.

Status: Refugee

2008-01-13T15:31:00.000+03:00

I am now safe in Tanzania. Amy has successfully returned to the States, and our two dogs have been liberated from the doggy boarding to reunite with their home. Below is a summary (almost 11 pages) of the recent experiences we have had fleeing the chaos in Kenya.

December 20th:

Amy arrives. She is extremely tired. We add to the stress of her travels by shopping at the Nakumatt Megacity in Kisumu. It is like a Super Target. We buy almost Ksh 20,000 ($300) worth of stuff, mainly groceries.

The ride to Matoso takes about 5 hours. Amy is so tired that she actually naps in the car. For those of you who know her, you will realize that this is a significant accomplishment since Amy can hardly nap – literally from the day she was born. At one point, she is so fast asleep that I have to prevent her lolling head from slamming into the dashboard.

We finally get to Matoso, ate a dinner that Joyce had prepared for us and saved, showered, and slept.

December 21st:

Amy is sick. She has nausea, vomiting, diarrhea, and a splitting headache. My excellent nursing skills consist of giving her some medications from the pharmacy, which she promptly throws up, holding the bucket that she vomits in, and then sleeping next to her while she sleeps also. Thankfully, she recovers and she has enough strength to go the Welcome Party that Joseph, Nancy, and Sammy have prepared for her. We have a good time, eating, talking, and dancing.
We go to sleep contented.

December 25th:

We celebrate Christmas by cooking the whole day. Amy had given me all my presents when we reached to Matoso. I gave her a small beaded necklace on Christmas. Our Christmas tree exists but it is only about 10 centimeters tall.

Christmas dinner is excellent (it better be after 8 hours of cooking). We made Indian food with two curries and chipatis. I helped about 40%. Amy might say 30%, but I think she should give me the benefit of the doubt – it’s Christmas after all. Joash, one of the guards, collected flowers for us as a gift. We also received some Christmas cards, too.

That day, Daniel came. We got together and made a list of everything we needed for the Mara trip. Apparently, New Years is very important to his family and he wondered if we could delay our trip a little. Considering, we had already made the reservations for the one night in one of the resorts, we said that we had to continue with the original schedule.

December 27th:

Election. Raila Odinga of the ODM party is winning the presidential race. The majority of the MP’s (members of parliament) being elected is from the ODM.

December 28th:

Odinga is winning by 2 million votes.

We have packed up everything in preparation for the trip to the Masai Mara. All of the material to be taken has been placed in the cookhouse ready to be loaded. We are very excited for our trip. The Luo people in the area are very excited about the election.

December 29th :

We wake up in the morning to make last minute preparations. Around 10 am, we are ready for Daniel’s arrival to load the stuff into the car and take off to Migori to buy our final provisions. Around 10:30 am, we get a call from Daniel that “there is war in Migori. We cannot travel.” Initially, we have no idea what this means. Then Joseph calls “All the roads are blocked. Do not travel to Migori. There is fighting.” Thus, our Mara trip is delayed. Oh well, we figure we will leave the next day.

Both parties claim that they are the victor of the presidential election. There is no president, yet.

December 30th:

Still fighting. Roads are being blocked. People are dying. The results are still up in the air. Then, in the mid-evening, it is declared that Kibaki has won by 200,000. Approximately 40 constituencies were very slow to submit their results. Almost all were from Central province, a Kikuyu/Kibaki stronghold. These are the delayed votes that seemingly allow Kibaki to win the election. Looks like Kibaki must have studied with Jed Bush after the American Election in 2000. Within 30 minutes of the announcement that he has won the election, Kibaki rushes to the State House and swears himself in as the 4th president of Kenya.

There are death cries in the night, ululating by the women. We wonder who died. The next day some said that people were crying about the death of democracy. Another person confirmed that there was a relative who was shot and killed in Homa Bay (where the diocese is as well as an MSF post; it’s about 90 minutes from house). Probably both contributed to the wailing.

Much confusion. Much fighting.

December 31st:

Work day for us. There is a group of men who start from Gotkachola (about 20 minutes walk from Matoso) and walk from village to village breaking and burning things. They pull the doors and windows off the fish seller’s building in downtown Matoso.

They eventually reach Mihuru on the other side of the bay. It’s a Ksh 50 boat ride from Matoso and about a 20-30 minute car ride. They are attacking Kikuyus. Some of them seek refuge inside the jail. One kid is shot and is taken to our clinic. No one calls me to check on the kid. He is promptly transported to St. Camillus. The ride takes longer than normal because the road blocks need to be moved to allow the car through. Each time the ambulance approaches the road block, the men guarding it want to check who is being transported. When they verify that it is a Luo person, then they allow the ambulance through. On the return, those same men will not allow the ambulance through unless they are paid. We decide that there will be no transports after this incident. Fuel is becoming a scarce commodity and we do not want to risk our drivers or vehicles to any mob violence.

I learn later that in Sori (near the hospital where the patient was taken), Kisii cops shot another marauding Luo person. In retaliation, a Luo cop shot the two Kisii cops dead and then joined the Luo mob.

We were in contact with Lalmba USA. They agreed that the best option was to stay put in the clinic and to not risk exposing ourselves to danger in a potential crossfire of mob violence. There were no threats to our safety at this point, but we wanted to still know what our best options were. They recommended that we stay in contact and that the fact that our phone and internet were available made things a little better. Unfortunately, both operate on the same cellular network, and if one goes, they all go. However, at this point, it seems that the advice we are getting is sound.

We had also tried to contact the US embassy in Nairobi. Initially, their lines as well as their website were non-functional. I was able to contact Dad who eventually connected me via international conference call to the Embassy in Dar Es Salaam in Tanzania. The Tanzanian also could not make any Embassy to Embassy contact either. At this point, I was wondering if the Embassy was compromised. He had no information with regards to that. Rather, he took down my information and said that he would have somebody from the Nairobi Embassy call us.
That person eventually did. However, consistent with the domestic administration, those people were totally useless. Odinga was supposed to have a large rally in Uhuru Park in downtown Nairobi that day. Everybody was worried that that might cause another string of violence. The American who called me back was ignorant of this fact. He had no idea what the potential fall-out might be. He had no recommendations for Amy who was supposed to fly out the following week. In fact he said, “I don’t care about January 8th right now.” We definitely felt like we were in great hands.

Things are not good. That kid we transported died.

January 1st:

The rally was postponed. Odinga seemed to hope for a cooling off period.

Both New Year’s Eve and New Year’s Day were quiet in the area. Everybody was depressed with the goings on in the country. No one celebrated anything. Daniel got his wish to stay in Matoso for the New Year, but I highly doubt that these were the conditions under which he wanted to spend it with his family.

The cellular network was out the whole day. We were unable to contact anybody. Even the radio was difficult to get functioning adequately. We did have access to a satellite radio and that signal was also unable to be accessed. What I feared about being incommunicado came to pass. No phone, no internet, no radio, nothing.

That morning, Marg Tucker, one of the people who ran Agape, a vocational training program up the street, came by the clinic for some medicine for her husband Tom. When she came to the clinic, she was informed that there was a mzungu physician there. She decided to go pay us a visit. She first met Amy who was in the cookhouse at the time. I was still sleeping. When I came out, she introduced herself to me also. She was very nice and even said that we should have dinner together. In fact, she would later send a message through her guard (since we had no other means of communication) inviting us to dinner that evening.

That evening we walked to their project. We had to go through the Matoso Center to get there. While we walked, Amy’s presence attracted a very large group of curious children. They numbered over 100 chattering, annoying, dirty faced, Kenyan kids. At one point, a rock was thrown in our direction. We’re not sure if it was directed at us or a ploy to get rid of the children. Whatever the reason, it was a bit disconcerting. Thankfully, two adults were walking in our direction and they noticed the bothersome crowd and dispersed them with their chastisement. It was nice of them. They actually apologized to us for the irksome behavior of the kids. Their sympathy was a pleasant surprise.

While at the Tuckers’ Agape compound, we also met Karen and Mike who head the Agape project in Kisumu; Daniel and Lindsey with their two young girls who are evangelists in Kisumu; and Grace and Mitto, the latter being the Pentecostal pastor of the PEFA Church (Pentecostal Evangelist Fellowship of Africa) in the area. Actually, Tom Tucker doubles as both the head of the Agape training center here in Matoso as well as the local PEFA overseer.

Dinner was nice. Conversation primarily regarded the plans for staying or leaving. The Tuckers had the resources of their church behind them. They realized that evacuation by car at that point would be impossible. The roads were thoroughly blocked. It became a question of whether a chopper would need to be arranged or not. The conversation was quite concerning, as I was not considering evacuation at that time. I didn’t really think it was necessary. However, the Canadian evangelists had two very small children, and I had a handicapped wife just off surgery who needed to get back home regardless of the situation, and we could see the precariousness of the situation. We left that evening with an escort understanding that some sort of evacuation might be necessary.

People are burnt in a church in Eldoret. At least 30 people are dead. A baby or a child (depending on the report) who was attempting to escape the blaze was tossed back into it to be roasted alive by one of the mob surrounding the human bonfire.

January 2nd:

A work day. Amy hung out in PSC with me. We shelved our new consignment of ARV drugs. We hope that they will outlast the supply distribution crisis.

We had our official opening of the new PSC. It was a fun event. Amy and I made a “red ribbon.” It was a string extended between two trees. We added a very thin bow. Amy thought it looked a little sad, but it was the thought that counted.

Just before lunch, we had the ribbon cutting ceremony. Amy was the photojournalist. The whole staff as well as a few patients congregated for the impromptu event. It was fun, and we all had a good time. Thankfully, one of the cars was able to make it all the way to Otho, 5 km away, to purchase some soft drinks. It is routine for such celebrations for everybody to have one drink.

We had a grand tour of the “new” building. We actually just moved into the original clinic building built in 1985. However, it is much more spacious than our original building which has since been turned into a storage facility. Everybody had a great time. We concluded the celebration in the education hall where we all drank to each other’s health and the future of Lalmba Kenya’s Patient Support Center.

The affair provided a short sojourn from the melancholy that had overcome the villages from the election crisis.

Just after lunch, Tom Tucker called me to inform me that a chopper was scheduled for the next morning at dawn. This development was a surprise for me, as I thought the previous night’s conversation was generally theoretical in nature. However, it appeared that I was wrong. Amy and I made our way back to our hut where we packed EVERYTHING. Obviously, we were only taking very few things with us. But just in case there would be any problem with my return, I packed everything that I brought back into the bags. These preparations were depressing. I felt like I was abandoning the people who I came to help.

Once we packed everything, I informed my PSC colleagues that I might be leaving via chopper. I tried to get in touch with Marico, the project director, to inform him of the new developments. Unfortunately, his phone would not connect. Instead I told Jenifer that we might be leaving. Both she and Nancy agreed that a preemptive strategy of evacuation was sound. Those reassurances made me feel a little better about the decision.

When work was finished, Joseph and Nancy escorted Amy and I with our bags to the Agape compound. Prior to our departure, I got a phone call from Lalmba USA prior to our leaving the clinic. He had encouraged me that evacuation was fine by them and that they would support any decision I made that I thought would ensure our safety. He also said that he and Marty would go snowshoeing for the next 3 days and that their daughter would be the point of contact after that phone call.

We quickly sent an e-mail to the rest of the folks back home and then we left.

When we got to Agape, Tom informed us of the evacuation plan. There would be two trips. He was a bit surprised that I was going to accompany them. I told them that I wanted to ensure Amy’s safety. Unfortunately, this had not figured into their calculations and there was no room for me on any of the trips. Clearly, this was upsetting for Amy. She vowed not to leave me if things were getting so bad that evacuation was necessary. She did not want either of us to be in tenuous situations separated from one another.

Of course, this unanticipated situation muddied the waters a bit. I knew that I could likely take care of myself if I were the only foreigner left in the area. However, being the only foreigner in the area while the place tore itself apart would not have been the most ideal situation but it might be better than having no backup at all along with a handicapped wife at your side.
I tried to call Marico to get his input on the situation. Unfortunately, his phone was still not picking up. It turned out he was at a meeting for a local rally the next day. It was to correspond with the rescheduled ODM rally in Nairobi. In our area, it was to be a forced rally, i.e. if you were there you were with us, and if you weren’t, you were against us and we would find you to exact those consequences. Man, it seems that the Kenyans really like the Bush family method of doing things. I guess ignorance comes in all forms. Wow.

The chopper evacuation became further complicated by the plan to move us to a non-Luo, non-Kikuyu area that was still in Kenya. There was a mission there, and so far the area had been spared violence. One of the trips would go to Nairobi to a safe-house. Unfortunately, none of these options sounded very reassuring. We thought we would go to Tanzania. The non-Nairobi place was within 10 km of the Tanzanian border, but we didn’t know where we would end up in Tanzania and how that would help get Amy to an airport so that she could get off the continent. Furthermore, we also had no clue what kind of “safe-house” it would be in Nairobi. Considering that we did not feel any threat to our person in Matoso, this whole plan of evacuation seemed a bit shaky.

Finally, we were able to contact Dad. We discussed the situation with him. Marico also personally turned up on the scene having been able to leave the meeting at its conclusion. Both of them suggested that evacuation was the best option. By this point, it was determined that a third trip that could accommodate more people would be the better option and I could go with Amy. However, the two of us still harbored doubts about the plan after the chopper flight. When we were connected with Lalmba USA through Dad’s telephone call, Hugh and Marty (the founders) were unavailable as they were snowshoeing. Keren, their daughter, was at the helm. She didn’t have any further suggestions. Dad pointed out that it was clear that the Pentecostal Church had more resources at their disposal than Lalmba. Even though things were not very bad at the time, if they got worse, and the Tuckers had already left, then we would be in a significant jam. Marico also agreed with this assessment. Even if the destinations of the chopper were in tenuous locations, at least we would have strength in numbers and the support of the Tuckers’ church behind us. Thus, it was decided we would join the missionaries on their evacuation via helicopter.

That night we slept at Agape in anticipation of the dawn air evacuation. We forgot bug spray, the Tuckers forgot a bug net, and the bugs forgot that we needed a good night sleep and they buzzed around our heads trying to get a nice meal and continuously disturbing our sleep.

January 3rd:

No chopper in the morning. Rally is thwarted in Nairobi. It continues in our area. It fizzles out when they decide to help with the funeral of the boy who was shot earlier. However, there is violence in Macaulder where it is rumored another person is shot dead.

A military helicopter is available, as the private one was diverted to Eldoret. However, both Tom and Mitto were concerned that a military chopper landing in Matoso might give the impression that we were Kibaki supporters and would spell the end of the Agape project as we knew it prompting people to ransack it and destroy it as punishment for backing PNU.
In the afternoon, we received a call that it would be arriving imminently. At the time, I had actually gone to the clinic to check on things and make sure they didn’t need my help. Plus, I went to fetch some food, as the Tuckers were running out since they were feeding 14 extra people in addition to themselves. As I was leaving the compound, there were some young guys with spears and machetes who greeted me heartily. I waved back with similar enthusiasm and headed back to the Agape compound with their guard who was sent to retrieve me for the impending evacuation.

We collected all our stuff together to where the helicopter would land. After we had done this, we received another phone call informing us that the chopper would not come after all as there were mechanical concerns and that the flight would be postponed until the next morning. So, we spent another night at Agape, this time under the mosquito net. Sleep did not elude us as completely as the previous night.

January 4th:

No chopper. Rumors abound that the roads are ablaze with burning logs rendering it blocked to wheeled transportation. Tom sends me to the clinic to verify these stories. I discover that the fires had been set 2 days before. Tom concludes that all that should be left are smoldering remains. We eat, celebrate Karen’s birthday and Daniel’s and Lindsay’s anniversary, hop into the three vehicles and drive away from the compound.

Our first roadblock is reached in the Matoso Center. It wasn’t there when I had returned barely an hour before. We paid what we needed to and bid goodbye to Daniel, Ochieng, and Josey who were in the crowd.

The next two roadblocks were simple to drive around. Tom was right - all that was left of the bonfires were just smoldering ashes. They were easy to circumvent.

The final three roadblocks were significant requiring the three Luo men that we recruited to help get us into Tanzania to get out and help us get through. The first and third were a simple matter of moving stones. The second one was far more major. It consisted of three levels of stones. There was no possibility of driving around. Under a tree was the guard consisting of men with machetes. Our escorts got out and talked to them. After a little while they all contributed to move the rocks. Apparently, only the guards could do it since there were nails in the roads and they knew their location so as to not only move them from the path of the vehicles but also to not step on them. As we passed this barrier, one of the men with machetes called out “Jeevan!” waving his weapon in the air jovially and beaming at my greeting in response.
We get across the Tanzanian border and stop at the immigration office. We have to actually find the immigration official and fetch him from his home. He was apparently taking a nap.
The whole process lasts many hours. The Americans and the Canadians from Kisumu do not have their passports, although they do have copies of them. He tries to haggle for some bribe money. In the end, he settles for money to pay his transportation and his lunch to another town where he must get the passports stamped. It’s a hassle. There is added stress, as we leave from the office to our motel without our passports.

Our accommodations are more like camping in concrete. The Kisumu people are at a guest house where we discover there is a medical student from Indiana University doing a rotation. Our abode is a hotel with no electricity and toilets that require throwing water into them to flush them (just like in India). The showers consist of filling a bucket full of cold rain water and throwing it on ourselves. We get meals, though – at least we didn’t have to hunt animals to provide for ourselves.

We are safe but our plans from here on out are still uncertain. We need to get Amy off the continent. Luckily, Dad was able to change the flight to depart from Arusha. The Canadians are able to arrange through their church a private plane to come and get their passports from Kisumu. Eventually, they will fly to Nairobi on this plane and depart to Canada. Nairobi is still a scary place. A demonstration by women in the city was broken up by the police using tear gas, water cannons, and live ammunition. Amy and I are comfortable with the decision to make our way to Arusha.

January 5th:

We learn that a group of people are being dropped off at the motel in the evening and the car that is coming plans to head back to Arusha the next morning. They will take us for a fee, but we will have to go through the game parks and therefore pay those fees. Everybody recommends that this is a good option. . It will be more comfortable than a bus, likely the same price, and a shorter ride. We learn later that the buses sometimes don’t even make the whole trip, breaking down in the middle of the road. Furthermore, Karen and Mike know some other missionaries in Arusha with whom we could stay. They call their friends and they are willing to accommodate us. It looks like the next day’s trip should work out.

We take a nap.

We pack.

We take leave of our refugee comrades. They were extremely helpful in a very sticky situation affording us camaraderie, support, and advice when they were in short supply. Tom Tucker did not make a wrong call in the whole crisis leading us very well. When it turned out that we had to put all our eggs in that basket, it turned out well for us. Of course, Tom said that God gave him the wisdom to make the right decisions. Whatever the reason, we emerged unscathed.

Hugh and Marty have returned from snowshoeing. They contact us and agree with the trip to Arusha via the private vehicle.

January 6th:

We wake up at 5:30 am and depart. We pick up our boxed lunches that were prepared for us by the motel.

It’s a cool morning. We have a nice breakfast on the road.

Within 2 ½ hours we reach the entrance to the Serengeti National Park. We pay and take a few pictures. Our 6 day planned Safari in the Mara is reduced to a 6 hour drive through the park. It’s better than nothing, I guess. We were able to see giraffes, hippos (they wouldn’t come out of the water, though), wildebeest, water buffaloes, zebras, gazelles, impalas, elephants, monkeys, baboons, vultures, hawks, warthogs. No rhinos or lions, though.

At one point, a grill comes loose on the car. The drivers have to get out and strap it to the roof. Later in the trip, the fan or something also begins to malfunction, and they have to fix it.
We go through Ngorongoro Crater. The crater is fine to look at. A lot of Masai live in this area. We learn later that if we had time to spend there, we would have been able to experience very proximally the lions in the area. That would have been fun. Holly and Tony (the people we stayed with in Arusha) said that he lions will come within touching distance of the car, sometimes even getting on the vehicle. Hopefully, we will have that experience when I come back with the rest of the family.

We get to Arusha around 6 pm. I pay the driver. I find out that the weakening of the Kenyan Schilling with respect to the Tanzanian Schilling makes the drive more expensive than expected. However, we made it safe and sound. We cannot complain too much. Tony picks us up in his van. We meet their family. We talk of our adventures. Then we go to sleep.

January 7th:

Tony takes us to the airlines area. We buy my plane ticket to Dar Es Salaam. We withdraw some Tanzanian Schillings to help us get through the next few days. In the evening, Holly takes us to a Danish education center where she is investigating different ways of educating the Masai about HIV (that is her main work in Tanzania; Tony works in the business of “appropriate technology” making devices that are accessible to the population at large).

January 8th:

In the afternoon, we go to the Masai Market. It’s really just a general market. There are a lot of Masai specific things mixed in with just a bunch of African arts and crafts. It was interesting. We scope it out for the next day when we have to withdraw more money to buy a few gifts. Despite our escape, we can still get a few souvenirs.

In the afternoon, the 12 year old boy Devon and I walk to the top of the street to buy some hardware to make a blow gun and darts. It was a fascinating experience. He bought a 3 meter long pipe and a ½ kilo of two types of nails. When we got back to the house, he instructed me in the method of making a dart. It consists of creating a funnel out of a piece of paper and wrapping it around the nail. One then cuts “feathers” into the tail of the dart, i.e. the open part of the funnel. We have to make sure that the paper funnel fits into the tube snuggly. Then, we cut the tube to whatever length desired. Finally, everything is done. I inserted the dart into the pipe and blew on the end. Man, that dart flew! It struck the tree so hard, it made it bleed! Eventually, we would discover that we would have fairly decent accuracy with a 2 meter tube at up to 20 meters. Man, it was awesome. Then from 10 meters, I would shoot at plastic bottles. The darts would penetrate the bottles tipping them over, making them “bleed” all their water out of their “wound.” It was a cool two days of using a blow gun.

January 9th:

In the morning, we go to the Masai Market. We buy a few things, mostly jewelry. We are satisfied with our purchases.

We get back to house. We pack, we eat. We take leave of our gracious host. Amy’s and my separation is coming soon…again. Finally, we drive her to the hotel from which she will take the shuttle to the airport. That is the last I will see of her for another 4 months.

I go to sleep soon, for I have to be awake at 4:45 am for my 5:15 shuttle for my 7:30 flight to Dar.

January 10th:

After I get to the airport, I discover that the plane is delayed 3 hours. Then at 10:30, I find out it is delayed another 2 hours. Then, I find out that the 11:30 flight is going to leave before ours. There is no justice.

I get to Dar. A CARE vehicle picks me up and takes me to the main office which is right across from the Indian High Commission and French Embassy. I hang out reading newspapers until Paul comes. He is the CARE country director of Tanzania. He finishes his work and drives me to his home.

We just talk and have a light dinner. His wife Nora will be arriving tomorrow from the States. She stayed on to see her youngest daughter of to Senegal.

Now, the situation for me is that of waiting. Being a refugee is pretty boring. In fact, most refugees say that the boredom is the most difficult aspect of life in the refugee camps. You have nothing with you – no books, nothing with which to write, sometimes no one to talk to, no schools, no intellectual stimulation. The camps are usually set up in barren wastelands. In our case, we had people to talk to and that whiled the time a bit, but still there is nothing else to occupy your time. Once conversation runs out, it’s time to take a nap, I guess.

The situation in Kenya is not improving. Another rally is being set up for this coming week. I hope that the cops do not continue to be trigger happy. Now there are rumors of Ugandan soldiers roaming around. I don’t what that means. Uganda one launched an unprovoked war on Tanzania. You can interpret what you want from that sentence.

Now, I just wait until I can get the go ahead to go back. January was going to be a fruitful month for Lalmba Kenya – Directly Observed Therapy (DOT) program, assessment of the efficacy of our newly trained Community Health Workers (CHW’s), stepping up to the challenge of discovering that an area was not giving HIV treatment like we thought and that we would have to indeed serve this larger area effectively increasing our potential patient catchment by 30% and more. Now, it might look like that when I get back it will be damage assessment and control. Other clinics in the area have run out of HIV meds. Those patients are coming to us. That means we might soon run out. Our sources for HIV meds are telling us that they can give us only 2 meds of a three medication cocktail. That’s like giving us nothing at all. The TB situation will eventually be even worse than that. Right now, it means that we cannot start anybody new on therapy.

Well, it seems that Africa strikes again. It is so sad.

Into Africa

2007-12-26T14:31:00.000+03:00

This blog is a unique treat for you readers. We have a special guest writer who is well known to many of you either in person or by reputation as...My Wife. Enjoy her impressions of her visit to the Dark Continent - duh, duh, duh, duuuuuuh!!!!

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Hello Everyone!

I just thought I would write some of my initial impressions of Africa, while the culture shock is fresh and everything is new and befuddling.

Perhaps the most interesting experience was to see how life changes as you move deeper and deeper into the country and out from the cities. Landing in Nairobi was a normal experience: the airport was big and our luggage was slow in coming. I had met a young Kenyan student studying in Austin, TX, on the plane, and he was kind enough to ensure that I got my luggage without trouble. He even called Jeevan to make sure I had made it to Kisumu alive and well. Once I made my way from the international wing of the Nairobi airport and crossed the street (without being run over by a taxi), I could already see a big change. The local part of the airport is frequented by mostly Kenyans and many fewer mizungu (white folk). There were only two mizungu on my flight to Kisumu, and it got me thinking that this is an experience every white person should have. Being absolutely "other" and foreign (more so for me as a blonde, white dwarf) is an intensely bizarre experience; not a bad one, just bizarre. I definitely can understand what Franz Fanon was feeling when he first went to Paris; it is an experience that is quite perturbing to your self-identity.

When I landed in Kisumu, it was a rather small airport at which the baggage claim consists of a sign "wait here for luggage." You are to huddle together like pigeons and wait until they offload the bags and push them to a cart over to you. Actually, it's the most efficient baggage claim I have ever been through! After retrieving my bag, Jeevan and Chacha, a clinic staff member, drove me back to Matoso. However, because it is a six-hour journey and because it is a 40-minute drive to Migori (the largest town near Matoso), we had to stop and do many errands along the way. I was grumpy and tired, but you do what you have to do, I suppose. My flight had arrived around 8am, but with the errands and such we did not reach Matoso until 6pm.

The road to Matoso is the most interesting thing I have ever been on. There is a stretch outside of Kisumu that I think could give children brain damage if they were to experience the ride too often. For 40 minutes or so (maybe it was only 10, but I swear it was longer), the road was made up of asphalt that had once been a lovely road but that had been ruined in damaging rains. It had broken into plum-sized bits and has remained such. The problem is that there is no avoiding them...that's the road! Other than that crazy stretch, it was paved roads until Migori, which would have been fine if there weren't goats, cows, people, and bicycles to constantly avoid. I am very glad I do not have to navigate in a place like this. Apparently, bikes are considered pedestrians, and pedestrians do not have the right of way. If there is a bike coming and you want to turn, you turn: they had better get out of the way. And, other people's cows and goats are expendable. Chickens more so. And, wild birds and other creatures may be stalked and chased down within inches of their lives - if they're lucky.

One of our errands was to stop in Migori so Chacha could gather the Lalmba mail and I'm not sure what else. In any case, we parked the car (which is a Land Cruiser ambulance, by the way) "downtown", the gathering place and a strip of huts masquerading as businesses. I was almost comatose by this point. Jeevan said I had been so deeply asleep before that when they stopped in Migori, he had had to stop my head from slamming into the dashboard - no shoulder belts here, just lap. I don't know if I believe him, but we stayed in the car. The villagers were very curious and made it a point to ensure that their paths crossed by the car. They would pass by and give a sideways glance, and shortly after, I would hear the word "mizungu". While Jeevan is technically a mizungu as far as being a foreigner, he is Indian, and people in larger metropoli like Migori don't seem to disturbed because there is a somewhat large number of Indians residing in Kenya (yay British colonialism). I, however, attract attention everywhere, even if I am just sitting in a car...my blonde hair is like the beacon of a lighthouse, saying, "mizungu this way, mizungu this way."

We finally arrived in Matoso after our trip to Kenyan Disneyland. That's how I like to think of Migori because in one of the hotels - what they call restaurants - there is a giant coke bottle on the terrace. When I say giant, I mean giant. I'm not sure if it's inflatable of plastic, but it's about 10-12 feet tall and maybe 4-5 feet in diameter. Maybe this was jetlag talking, but I swear it was there. I remember asking Jeevan why it was there, and he said, "why not?" I have to say, it did remind me a bit of that weird film "The Gods Must be Crazy", for those of you who have seen it, you'll know what I'm talking about....Ok, Matoso.

We arrive in Matoso, and I made the long trek to Jeevan's hut. Not that long in retrospect, but after 38 hours of straight travel in three calendar days over many time zones (how does that mess with your head?), I was on my last legs. I was then treated to a nice, short, cold shower. They do have solar-heated shower bags, but they were cold - ok, room temperature - by the time I got to them (no sun). It was a nice shower anyway. Then we ate the spaghetti that Joyce, the Lalmba volunteer's (Jeevan's) cook, made. Not bad considering they have probably never had such food. I don't remember much after that...something, something, something...collapse in bed.

Wake up with splitting head. Have to run to latrine ("choo") 100 yards away. Yay! Walking back...legs feel wobbly. Head hurts. Crawl in bed. Jeevan gives me ibuprofen. Feel yucky, stomach hurts. Jeevan gives me anti-nausea pills. Pray to God to make me sleep. Maybe need something to eat. Jeevan brings cheese. Open cheese. Puke at sight of cheese. Have to run and puke in bushes. Puke. Puke. Puke. Crawl back in bed. Pray to God to make me sleep. Sleep. Jeevan wakes me some time. "Some of the staff has been working for two days for a welcoming party for you. You have to come later. You have to dig deep, I'm sorry." Nod okay. Back to sleep. Jeevan wakes me at 4pm. Feel much better. Yay!

I don't know what was wrong with me, but a day of sleep did me well. When Jeevan woke me up at 4pm, we met Joseph, who works with Jeevan at the HIV/TB part of the clinic (the PSC). Joseph took us to the Sea Lodge, which is the local hotel/gathering place. As we walked through "downtown" Matoso, I drew wide eyes and dropped jaws. The word mizungu was mumbled several times, especially by the children who are not shy, and Jeevan said hello. They nervously responded and kept watching as we walked on. Nancy, who is the counselor at PSC, lives at Sea Lodge had prepared a special meal. I was nervous given my throwing up/bathroom incident earlier; I didn't want to offend anyone by not eating...especially since it was beef stew, which is expensive to make and for special occasions. Luckily, I really seemed fine. I ate my beef stew, my grits, my sukuma (kale or greens of some sort), and rice. It was quite yummy. I had sprite and beer too. Then we danced and had a good time. I used many of the same moves Gavyn has seen many times in the department. They thought it was great that a mizungu would let loose and dance so soon to music they don't know. But we all laughed and danced a little past dark (while we didn't have far to go, Joseph lives around the lake a bit, and it's best to get home before too late). Then, before we left, they wanted us to all sit down. Nancy started by saying that they were so happy that I came even though I was not feeling well and that I was so accepting of an invitation of people I did not know. They were happy that I was there with my smiling face and eating their food. Then she said that Jeevan is not like other mizungus and that he is their friend and that they are so happy to have him and that I must be like him too. That made me feel nice. Then Sammy talked and said similar things. Then, it was Joseph's turn. Joseph and Jeevan have really become friends, doing yoga together after work, etc. Joseph wanted me to know that Jeevan really is his friend and that he is a good person. I could tell that they were very sincere about these things, and I was grateful to be part of the moment. Then Jeevan said his piece, and I said mine. I thanked them for welcoming me so openly and kindly. Then we went home. That is perhaps the most generously I have ever been welcomed by strangers.

Since that was Friday, the clinic was closed over the weekend, but since most of the staff live in town or on the compound, several people stopped by to meet Amy Jeevan (that's how you know you are married.. you add the man's name to your name). Then, when they found out I was a professor, they were thrilled that Jeevan has a "clever" wife, and they said I am Professor Amy Jeevan. My title sounds better than Jeevan's: he's just Dr. Jeevan. Word had obviously spread about Amy Jeevan's presence since by Sunday I had met quite a few people.

On Monday I met the rest of the staff and was welcomed again during the "greeting". The clinic opens at 8:30, but everyone arrives around 8am to greet each other and for the morning prayer. It is a Christian prayer, but sung in the Luo language. It was beautiful, even though I have no idea what was going on. I think the idea of a greeting is lovely and that it will hopefully not be lost with "progress". The community is extremely connected here, and it made me melancholic for something we do not have easily in our fast-paced life in the US. While Dr. Jeevan was working, Professor Amy Jeevan spent the rest of the morning on Monday talking with Joyce about her family and helping her cook as much as she would allow. The clinic closed early on Monday because it was Christmas Eve, and Nancy stopped by to say hello to her "new friend". I had brought pictures for Jeevan, but I showed them to Nancy and Joyce. We had also showed them to Joseph and some others over the weekend. I have never seen people be so honestly interested in photos. It took a long time to look at 20 photos. They wanted to know why I was doing such and such and where we were... then, they would just look and study the photo. It's so nice to see people slow down and really experience things. It's a lesson for me.

The rest of the week we have pretty much alone. Christmas was a holiday, of course, as is today, the 26th. I showed myself to be a good mizungu and cooked Jeevan a nice meal. For breakfast we had pancakes. And, he requested chicken curry, potato curry (or gobiless "aloo gobi" - no cauliflower available), and chapati. I also made a vanilla pie with meringue topping. Not bad for no electricity! I think I worked all the calories off whipping the egg whites by hand. I cooked all day and treated myself to a gin and tonic (they have some booze here for special occasions). I must say, Martha Stewart would be proud of Professor Amy Jeevan. No measuring cups, no electricity, different ingredients...and everything turned out well! It's nice to know that when the apocalypse comes or when the U.S. finally uses up all our non-renewable resources, I can survive. And, as Jeevan said, he will survive as long as I will. One of the guards stopped by as well as the driver, Daniel, who will take us on safari. As he was leaving, he said my food smelled good and congratulated Jeevan on having a wife who can cook. That is the real Kenyan test for a woman: can she cook? I seem to have passed several tests: Nancy said I am beautiful; Joyce said I am clever (i.e. smart); Daniel said I can cook. Dr. Jeevan can keep me. Yay!

The 27th and 28th are also public holidays this year because of the elections on the 27th. Because people often work far away from their home village (as far as Nairobi), they must find transportation back to their village to vote, which is very important to them. It is quiet here this week then. But, Jeevan and I leave on safari on Saturday, and we will be gone for six days. If I don't get eaten by a lion, I'm sure I'll have more to write and photos to post when I return to the U.S.

Now that I have written a novella and most of you have long since given up, I will sign off for now. Hopefully, I will have much more interesting National Geographic-esque things to write next time. Less anthropology/sociology, more wild life discovery.

Hope you all had a Merry Christmas!

Professor Amy Jeevan

Bagged cats, dead flies, and screeching banshees

2007-12-13T15:39:00.000+03:00

I finally caught the cat. For those of you who don’t remember, there has been a black and white cat that has been plaguing me ever since my arrival here in Kenya. Initially, it was like a pet of the other volunteer. She would feed it and a second cat that also used to hang around. Unfortunately, that black and white cat was a nuisance, as she would make this high pitched mewling sound regardless of how much you fed her. When the other volunteer had left, I would chase it away by throwing things at it. It would indeed run away but like a battered woman it would come back for more abuse. Then, I thought if I just fed it once in awhile it would shut up and be grateful. That just made things worse. Finally, I decided to eliminate the problem. The first time, we rid ourselves of the cat, one of the guards had taken it to his home. The stupid cat came back to continue bothering me and have things thrown at it.

When I knew I would not be rid of it in any conventional way, I decided to trap it and give it to one of the guards who figured he could use it at his home to trap pests. Animals in rural Kenya are only kept for utilitarian purposes. There is no such thing as a pet around here. Anyway, now I had a plan in terms of how to get rid of the cat. The first time I caught it, we wrapped it in a towel and tied it up. It escaped and came back to the compound. The second time, we stuffed it into a box, taped it shut, tied it closed. And somehow she escaped again. As I had explained to Marc, the overall medical director, I am the cat’s catcher not its keeper. I was able to trap it again using the same techniques, but this time I was the stupid one to let it slip though the door when I had gone back into the cookhouse to stuff it into a sack that I finally procured. Now, the cat was getting quite weary of me. She would still meow that stupid high frequency cry of hers, probably just to annoy me, but she would not enter the cookhouse to be trapped anymore, no matter what type of bait I used – bread, milk, brownies, popcorn – nothing would make her come into the cookhouse of doom. Finally, a few days ago, I tried to feed her some milk in a bowl outside. She wouldn’t run away from me which was an interesting development in itself. And so I was able to give her the milk outside and maintain her attention by continuing to pour milk into the bowl. With my left hand, now covered in an oven mitt, I was able to grab her and throw her into the cookhouse very quickly shutting the door. At the time, I did not think there was any chance of success and so I wasn’t wearing my jacket to as a means of protection for my body. So, I donned my jacket, grabbed a broom, pushed the cat into a position where I could grab her again and stuff her into the sack. It was a win, win, win, situation: I got rid of the cat, the cat found a home where she wasn’t despised, and the guard got a useful animal. The guard’s home is 5 kilometers from here and I hope that is enough distance from here that the cat won’t find her way back. I have emerged VICTORIOUS!!!! I white bagged the black cat!

However, it seems that when one bothersome situation is resolved another one decides to take its place. Among the various Christian entities here, one of them is the Pentecostal Church. And for some reason, they have taken it upon themselves to be one of the most annoying groups on the face of the planet. They insist on blasting their loud, horrendous, screeching voices across the villages with the loudest and poorest quality loudspeakers that they can find. And they always make sure that the people who do the screeching are the worst screechers they can find. Not only do they have the voices of dying donkeys when they sing but those people even attempt to make their voice sound even more broken and disturbing during the song – I guess to make sure that no one can sleep around them. On numerous occasions, they will continue their appalling evangelizing until past 3 am on weekdays! I realize that there are very few sources of steady employment here, but weekdays are weekdays for everybody. It’s as if they are trying to avoid salvation by annoying the gods so much that they will eventually be banished from paradise to a place where their awful rendition of music will be appreciated as a punishment for the rest. They will definitely be welcome in hell as colleagues and collaborators rather than victims.

And if the shrieking Pentecostalists aren’t enough, we have had this unrelenting rain that comes off and on in downpours. Right now, it certainly doesn’t rain but it pours. When it strikes the metal roofs of our dwellings, it feels like your head is inside a snare drum during a drum roll. I have been awaken so many times during these torrents, and I cannot go back to sleep until it eases. For those of you who know my slumbering proclivities, you can imagine how bad this noise really is.

And the rain doesn’t stop its irritation at the noise but it contributes to one of the worst smells of decay that I have ever experienced. The lake flies have decided to come out and die on our doorstep. And in their death, they have decided that the rain and their corpses shall merge to create the most offensive olfactory concoction possible. The horrendous smell is stifling in and of itself, but we have had to endure it for 5 days now. We have had too much rain and too little sun for the rotting bodies to dry out and allow us to breathe fresh air. Maybe, I should have left the cat alone.

The Arrival of Royalty

2007-12-01T11:33:00.000+03:00

On the day of Hugh and Marty’s arrival (the founders of Lalmba; they visit Africa twice a year to check on things), I had a surprising encounter in the cook house. As I walked to the refrigerator, I was greeted with the unusual site of a charred table and smoke-blackened wall. Apparently, some how the hose to one of the stoves ignited. When I happened onto this burnt situation, the gas cylinder was still leaking. Interestingly, no one had used that particular stove recently. Furthermore, it’s amazing that nothing more exploded considering the second gas tank was right next to the leaking one and a third tank connected to the fridge was also nearby. I was also surprised that none of the guards noticed a fire burning in the cookhouse. Maybe, it was a spontaneous flash burn. We’ll never know for sure. At least the cookhouse still exists and it didn’t go the way of the rumors; when I started work that morning, somebody said, “I heard the cookhouse burned down. But I think I still see it standing.”

Hugh and Marty visited us with Carrole, the project director from Ethiopia. Their visit was nice and quite refreshing. It was a break in the routine of being the only person around in the evenings after work. Marty did most of the cooking while we were here and I ate extremely well. Hugh was a bit surprised that I wasn’t always hungry when I was alone fending for myself. He marveled at the amount that I did eat at meals, considering the quality and quantity of food is not comparable when Marty is not here. I just told him that my appetite is proportional to the quality of food. I am more hungry when there is good food and less hungry when there isn’t, and my metabolism compensates.

Among the many things that Carrole had told me about Ethiopia, the most disturbing is the fact that they have carnivorous ants there. I read this book here called Poisonwood Bible. It’s about the Congo. At one point in the book, everybody is running from the village because these carnivorous ants are on the march. They end up eating some of the livestock. Apparently, just before Carrole’s departure, the staff had to reassure the children in the orphanage because during one of the nights, these crazy ants devoured the chickens! Man, I’m glad I’m not in Ethiopia.

During the visit, all of the mizungus (foreigners) went to the children’s home. I discovered that our visit was 10 years to the day of the opening ceremony for the home. They had a visitor’s book that we filled out, and we saw H&M’s signature there 10 years ago that day. Cool. It’s neat when you’re part of history, even if it is to be a small event.

Their visit was fruitful. Much of their time was spent discussing budget issues. Amazingly, after every single meeting that we had, we decided upon a solution and plan of action. It seems that even though things operate on Kenyan time (30 minutes to 2 hours later than the appointed time), Kenyan meetings are far more productive than the American counterparts. Or perhaps, it’s just Lalmba Kenya where the management team is extremely competent and effective.

H&M were encouraged and encouraging about the changes made to the PSC. I’m glad that they also think that I’m doing a good job. And really, I’m just managing and doing some training. Most of the ideas and all of the actual implementation are by the Kenyans. Since I’m not bogged down with everyday worries and duties, I can concentrate on the big picture and help others see it so that we can come up with a solution together.

Well, now I’m the lone Mizungu again…until Amy comes for a visit. Then it’s party time in the Serengeti!!!

My observations of Luo culture

2007-11-23T19:01:00.000+03:00

These are some basic facts about the Luo people:

-They are polygamists. Almost all tribes in the country are polygamists. Here, the wives live together generally in harmony.

-They have no culture of circumcision. I don’t know if it’s cultural for them not to circumcise.

-Their last names are related to the time of their birth in the astrological, seasonal sense. Consequently, many people have similar names.

-Their language is Dholuo.

-They are a Nilotic people with a Nilotic language, i.e. of the Nile. They migrated south from Sudan and are presumed to be descendent from the original Egyptians.

-Many Luo also live in Uganda and Tanzania.

-Their people are “rabble rousers” but not violent. Many of the original famous revolutionaries were Luo. Apparently, the shield on the Kenyan flag is a Luo symbol. I haven’t verified that, though.

-They have a unique practice of wife inheritance, in that when one brother dies, the other living brother inherits his wives. This practice perpetuates the HIV epidemic.

-One can marry girls when they are as young as 14 years old. I don’t know if girls can be married at younger ages.

-Women are not allowed to inherit land. Therefore, a family must have a boy survive to adulthood. This prompts the birth of many children.

-Women do ALL the work: cook, clean, bear the children, raise the children, fetch the water, build the houses, etc. Therefore, a family is in very deep trouble when the woman dies.

-Traditional healers were popular, but their popularity has waned over the 20+ years that Lalmba Kenya has existed. However, people still use them. I’m not sure how effective they are, for we always get the failures.

-HIV prevalence here is between 30 and 40%. This region has always had one of the highest prevalence rates in all of Kenya.

-There are Luo in Southern Uganda and Northwestern Tanzania. In fact, we get many Tanzanian patients. It seems that our medical care is superior to that which is available in Tanzania.

-Many people only speak Dholuo knowing very little Kiswahili or English. This particular monolingualism means that these people can go nowhere in the world outside of this area around Lake Victoria.

Some general Kenya facts:

-They gained independence from the British in the 1960’s. After independence, they cooperated with the British to form their government

-Moi was the second president of the country. He was a dictator and disallowed fair elections. People did disappear during his rule, but he was not so violent that everybody feared for his life everyday. The first “fair and free” elections were in 2002.

-Primary school is up to Grade 8. It is supposedly free, but it seems that all of the ancillary costs of books, uniforms, etc. make it very expensive.

-Things are quite expensive in Kenya. In most developing countries, Westerners experience an increased buying power. Not here. Everything costs the same here as it does in the States.

-Kenya has one of the better and more stable governments, economies, and societies in East Africa.

If any of you look up more information about the Luo after reading this entry and want to send me your comments and thoughts so that I can compare them to my experience, I would be happy to receive those e-mails.

A tale of two patients

2007-11-17T19:00:00.000+03:00

Earlier this month we had an eventful day that led to some clinical dilemmas. Just as I was going to lunch, a patient arrived being carried by her family members. She didn’t look so hot and Dolith thought it would be a good idea for me to stick around. It was 1:05 pm. Well, it turned out that she had a ruptured ectopic and a surgical abdomen, and so we transferred her to St. Camillus. The road was very bad, and the patient had a rough time getting there as every bump undoubtedly caused her considerable pain. We didn’t have any narcotics to give her. Normally, I don’t go on these ambulance rides, but apparently there were two RCAR (Rescuing Children At Risk. It’s a program that takes care of children who are in dire straits, almost orphaned, gives them education, ensures their diet, etc. They have over 1000 kids in the program.) kids in the hospital and the management wanted to see if I could get them discharged, as they were being treated empirically without any diagnosis on the horizon. One had been there 5 weeks and wasn’t getting better.

When I received the records, the work-up was limited by the facilities and the therapy was driven by a shot-gun approach. Despite the “prettiness” of St. Camillus, their lab is not what I would have expected it to be. As internal medicine docs, tests are our friends and there were none at this hospital. They couldn’t even do blood cultures. When I was reviewing the records, there wasn’t much to go on, and St. Camillus did not have much more to offer, and so I had them discharged with the hope that there would be some way to diagnose the problem and possibly fix it.

Our next step was to proceed to St. Joseph’s hospital aka Ombo. This hospital has been here for a long time, since even before Matoso Clinic was even started. In fact, the first volunteers worked there for three months to get the feel of taking care of Kenyans before opening the clinic. These initial medical reports are fascinating from a historical perspective and they are all primary sources.

Well, I digress. We took them to the other hospital where I ordered a battery of tests, well, a battery of tests for them. In the end, I got about half of what I wanted. And we had to spend 8 hours at the hospital waiting for the lab techs to process them all. Wow. This is our referral hospital.

As expected, I was only able to narrow the differential diagnosis in these two patients. One had some issue with her gallbladder. Whether it was infected or not, she would need some sort of procedure or CAT scan to determine what to do next. The second one required a repeat ultrasound that we couldn’t get until this week. Regardless, they needed more detailed work-ups at the provincial hospitals – the referral hospitals for the province.

Now, the whole management of resources comes into play. The point of the RCAR program is to maximize the survival potential for the maximum number of kids, not to spend thousands of shillings on a few number of kids. As I was discussing the patients with the Lalmba medical director, we were trying some other therapies in the mean time trying to decide what the definitive course of action should be. Unfortunately, the patient with the gallbladder issue died a few days ago. We were having some issue with transportation and I was informed that she was not doing well. They were able to pick her up and bring her to the clinic. A brief evaluation revealed that she was dying. Thankfully, we were able to get her home so that she could die with her family. I learned that she died later that night.

The other one did get her ultrasound and it looks like she has lymphoma but needs a biopsy in order to confirm or discount this possibility.

The frustrating aspect of these cases is the lack of resources even at the so-called referral hospitals. They don’t even have full chemistries including bicarbonate, something that we use frequently to help determine the acid-base status of the patients. Part of the problem is the expense of automation. All these lab studies have to be processed by hand using special kits. And even then, they don’t necessarily get it right. Furthermore, it is much easier to manage patients when the resources of the patient are very limited. When a patient says, I cannot go to the hospital, then the options for us are fairly limited but straightforward. However, when we are spending thousands of shillings for further evaluation, it is difficult to know when to stop, when is such and such money too much money.

Well, I guess that is the nature of our work here. Sometimes you win some and sometimes you lose some. The wins feel really good and overall the work here is extremely gratifying, and the losses, well, one has to take them in stride. We can’t save the world, but we’ll keep trying one person at a time.

A day in the life of Medical Director Jeevan Sekhar

2007-11-12T21:04:00.000+03:00

6:30 am – Roosters start crowing. Then the donkeys start braying. They sound like somebody is killing them. The cows start mooing. I curse them and go back to sleep.

7:20 am – Alarm goes off. I curse it and hit the snooze button. It comes on again. Another whack on the snooze button. Then at 7:45 am, I extricate myself from the warm confines of my bed, emerge from the mosquito net, and stumble out into the wider realm of my bedroom.

7:45 am – I take my malaria prophylaxis and afterwards perform the morning hygenics.

8 am – Morning prayer by the Kenyan staff. Someone starts off in song, the others participate. Then there is an actual prayer done in Dholuo (the language of the Luo people). Despite the different denominations, everybody here is Christian and is happy to praise Jesus for their circumstances.

8:30 am – Go to the PSC (Patient Support Center – just a reiteration for those of you who may have forgotten the acronym explained in the earlier entries), warm up the computer and await the patients.

9 am – Often on a Monday, we are dealing with the critically ill who have stayed away from the clinic until the weekend has passed. I guess they don’t want to inconvenience us during our time off with their acute attempts to die. (We are indeed open at all times for emergencies. Few people avail themselves of those extended hours.) Some we send to the hospital, others we manage on our own and get them from unable to sit to sitting or unable to stand to standing and then they go home. We don’t have inpatient capability.

10:30 am – Break time!! The Kenyans have chai. I have a Coke and brownies (compliments of Joyce).

11:00 am – Back to work refueled and rejuvenated.

1:00 pm – Lunch time! We usually eat in about 20 minutes. I use the rest of our hour break to have a nice little Siesta. Ha! – you didn’t think there would be much European influence here outside of British colonization did you…?

2:00 pm – More work. The afternoons are generally slower, as the patients tend to cram themselves into the morning. As a result, with the new streamlined approach to patient care that we devised, we can theoretically see 50 patients a day with the current staff we have.

4:30 pm – End of work. I usually do my e-mail at this time or study snippets of Go that I can glean from the net.

6pm-8pm – The time to communicate with my family in the States depending on the day. Done either by chat via internet or phone (assuming the network is working).

8pm – Eat dinner, read.

9pm or so – Evening hygenics.

10 pm – beddy bye…

Kill bugs Vol. 2

2007-11-01T10:05:00.001+03:00

For the above, I depend on the spiders, the geckos, and the bats. Unfortunately, the spiders are scary ugly, the geckos relieve themselves in my room, and the bats might carry rabies. Oh well, beggars can't be choosers.

I have received some complementary remarks recently while I’ve been here. Both Moline (the current clinician in PSC) and Jackson had mentioned that it would be nice if I could stay longer. Moline went so far as to recommend that I stay and work here permanently in Kenya. Of course, it would never happen, but it is nice to know that I am appreciated and that people like my work. Perhaps, they say that to everybody. I’ll pretend they don’t.

Last week, we had a tough day. The dreaded ethical decision came up. Not one, but two critically ill patients who up on our doorstep in the morning. One with a septic wound with a blood pressure of 52 systolic (that is very low and I was amazed she could walk), and the other a lady with diarrhea and a BP we couldn’t obtain. Both had no means to pay for the transport to a hospital let alone any subsequent hospital bill.

Initially, I didn’t know what to do. Joseph inquired of Management about what resources we could use for these patients. The goal of Matoso Clinic, as it should be, is to give the basic amount of care to the largest of amount of people – none of this ridiculous ICU stuff that we do in the States. However, similar to the States there are surprisingly legal implications to dropping people off at hospitals. In the case of the first patient, we needed to get her family’s consent to hospitalize her. If we did not and they didn’t want to pay for the hospital bill, apparently it’s their prerogative, and they could shift the responsibility of a multiple thousand or hundred thousand schilling bill to the Lalmba association. Plus, on that day there was a shortage of vehicles. In the end, I made the executive decision that whatever charity funds that Management was going to free up to subsidize the transport and the initial admission fee, we would use to pay for our own resource utilization. We slammed fluids and antibiotics into the patients and then gave them all their medicine free when they left the clinic. Man, what a stressful day. Resource management at its most critical, literally.

Surprisingly, one of the stories has a happy ending. The lady who came in with the septic leg, who we then discharged to walk all the way home after opening the wound so that it would drain, returned on Friday to attend the Q&A session that Joseph holds every month regarding HIV care. Amazing. It’s just a reflection of the hardiness of these Kenyan people.

Over the weekend, I learned how to drive stick shift. Daniel taught me how. Of course, I’m learning on the wrong side of the car, but hopefully I can adapt when I get to the States. The pedals are in the same order with the accelerator on the far right and the clutch on the far left. The gear shift is also in the same order. However, that means that First is furthest away from me with Reverse being closest. On a car driving on the Right side, First will be the closest and Reverse will be the furthest away. Therefore, even though the gears are in the same order conceptually, kinetically it will be the opposite, while the pedals will be the same.

Anyway, I was able to get up to 4^th gear and 60 km/hr. I only stalled out twice. The main challenge was trying to get into Third. For some reason, I kept putting it back into First and we couldn’t accelerate. After we figured out the problem, I could accelerate pretty well. Daniel suggests that when we next have to transport a patient to a hospital, I can learn about what it entails to admit a patient, and then I can practice driving on the way back. I look forward to it.

On the Beach…Matoso Beach

2007-10-29T19:08:00.000+03:00

I didn’t realize how long it has been since I’ve written in my journal and correspondingly since my last blog. Consequently, there is much to relay, and perhaps I will break this entry into two parts like Kill Bill – there will be a Vol. 1 and a Vol. 2.

On the food front, Joyce (the cook and the wash lady) has been making a lot of effort to make stuff I like. She has made 3 curries including a chicken curry and tried her hand at Fettucini alfredo that unfortunately did not come out well amd required the addition of Tabasco sauce just to be edible. However, she makes great brownies and this past week added chocolate cake to her baking repertoire that is extremely tasty.

Over the past few weeks, there has been much discussion about the direction of PSC and its improved functioning. It began with a discussion in the cook house by the 3 J’s – Jackson, Joseph, and yours truly (Jeevan that is). Jackson is part of management and Joseph is the real person behind the optimal functioning of the PSC. When Joseph relayed the woes and challenges of PSC, Jackson was quite intrigued by these facts of which he was seemingly unaware. He suggested that I present the same arguments to the rest of the Management staff the following day during our meeting. I did so, and they were in agreement with what we thought needed to be done. I pitched our project ideas in the setting of our move. They have built a new building here that is to be the “new and improved” clinic structure. The construction of the new building was a great idea from last year. The PSC people are to get the current clinic building. It is a win-win situation for everybody. When I described the set-up that we proposed for the current clinic building and how PSC was going to utilize it, I then emphasized to the management why certain rooms had to be such and why certain staffing were required in this manner, etc. In the end they were quite convinced of the need to support PSC a little bit more than they have in the past. I think things will go well.

The conversation then meandered into American politics and recent American history. I regaled them with stories of how Bush is bad, why the Iraq war is horrible, why our politics of intervention have always been destructive. They were very intrigued by my “stories.”

I’ve been studying Go, or as I sometimes refer to it – Japanese table war. I brought two books with me and I have completed reading them. The systematic learning of the game has definitely improved my playing. Although, one must admit that in order to play this game, there must be some study of the fundamentals. Some people say that the game is extremely easy to learn; well in the sense that there are black and white stones, and one must put them on the board to capture territory, and the person with the most territory wins. However, looking at a large 19x19 square board that is devoid of any game pieces is a daunting experience. It’s like looking at a blank page and being expected to write a novel or a blank canvas and being expected to create a visual masterpiece. The possibilities are endless – how does one even start? Well, apparently there are a few rules that one can follow to make the game a little less nebulous. Regardless, the intuitiveness of the game is a challenge.

I downloaded a couple of programs to help me compete against a computer. Despite the insistence of many that computerized Go lags far behind the ability of even average human players, I’m getting my ass kicked repeatedly. On one of the program, I am average at the 9x9 version w/o any handicaps. Now, I’ve improved to a 13x13 board with 2 handicap stones on the “weak” level (there is a weakest level that is the lowest - meaning that I’m not too horrible). It was definitely an intimidating first game when I graduated to the bigger board. When I finally make it to the 19x19 board, it will be a big accomplishment regardless of whether I have 9 handicaps or not. Like I said, this blank slate, this Japanese Tabula Rossa is daunting.

Another cool discovery on the Go front is the fact that Arpan plays the game. Playing against another human, even if it’s on the internet over thousands of miles, is a much better experience than the computer. He had mentioned that to play in person is an experience unto itself. The game has so much history and rituals attached to it (typical of the Japanese) that it is no doubt exciting to sit across from a person and place these simple pieces on this big, blank, piece of wood.

Well, that’s the end of Volume 1. Volume 2 will arrive shortly!

Another message from Hotel Matos-afornia 10/14/07

2007-10-14T17:20:00.000+03:00

A new experience for me these days is the lake flies. They are called flies but they look more like big gnats than flies. In fact, they act more like gnats, too: they hover in groups, land on doors and windows, climb on your head, try to enter your nose and ears – extremely annoying creatures but thankfully benign. They don’t bite and are mainly a nuisance. I am not sure what they eat or what their life cycle is like because they seem to just appear and disappear which happened the next day. Recently, while I was at Barak’s house (the head guard), I looked out onto the lake and I saw this dense, grey cloud over the water. I saw multiple ones actually. I asked Barak what they were, for I thought perhaps there was some kind of river bonfire going on. He informed me that they were a cloud of lake flies. I was amazed. If one didn’t know they were benign, I think I would be frightened for my life to see this plague of insects moving towards me. They move fast, too. I have pictures of them that I will include, eventually. One of these days, you will have a photographic blog.

In my quest to learn more about how to implement a program to start treating pediatric patients with HIV, I took a tour of a nearby hospital – St. Camillus. It is a hospital that is owned by the Camillian Fathers, a group out of Italy and operates under the auspices of the Catholic Church, although they don’t receive any money directly from them. It was founded in 1998. Man, that place is seriously state of the art for the area we are in. It looks like any facility out of the U.S. – well almost. The children’s home they have definitely looks like any First World facility. They have their own power lines extending from 2 large fuel powered generators. They have enough land for half-a-dozen new buildings, if they wanted. Their children’s home houses almost 50 full time “effective” orphans and caters to almost 2000 other children daily for food and social and academic support. Unbelievable. It made me feel that our outfit was insignificant and puny when of course it isn’t. But that first impression was impressive.

After researching the Camillian Fathers, I discovered that they do fundraising around the world. Considering the real estate holdings of the Catholic Church, the elaborate nature of their Churches, the notion of the tithe, I guess it’s not surprising that so much money is available to support this endeavour. I’m glad. That is one thing that I have noticed in general, the Catholic organizations do some good work.

The other volunteer, Tami, has left the Matoso Clinic to return to the US after finishing her tenure here and I am here alone – well the only foreigner here. In fact, the rest of the Matoso Clinic staff is concerned that I am left alone at the end of the days and on the weekends in the compound. I actually am doing quite well with regards to that. There is always so much to do - I am trying to learn Go, study French, and just enjoy the free time I have on those days and evenings. I am reading a lot which is something I always relish. And of course, I visit people on the weekends, too. In fact, I don’t think I’ve gone through a weekend without spending it at somebody’s house or having a nice time on the compound.

Well, as the other volunteer left, I had to fill in the role of person in-charge of the PSC (patient support center, where they care for the HIV/TB cases). While I was here just getting the lay of the land, the responsibility seemed pretty big. My trepidation over taking over was such that on that first day, I really didn’t want to face the day. However, the day was slow and we were able to have an impromptu meeting with the whole staff. We went over all the goals to make sure everybody was on-board and they seem to be taking the transition in stride and were appreciative of my openness of communication. So, I think things will start to go well.

Another participant in the pest control here is the bats. There are lots of them. They are always flying and don’t seem to ever stop. Consequently, I can’t ever get a good look at them. Since I have no power in my house, I am always at the PSC to do any computer work. I leave the door open so that people know I am in here. Often, a bat will find itself in the PSC building and will fly around our heads looking for a way out. Their echolocation is good enough that we have not had to help a single bat out the door. They find it on their own – maybe not right away but eventually.

Well, until next time.

9/28/2007 Club Matoso – The saga continues

2007-09-28T20:38:00.000+03:00

Our new mandate not only from the Kenyan Ministry of Health but also another NGO called FACES is for us to start doing pediatric anti-retroviral therapy. Currently, we are referring all of those patients out to the local hospitals (local being an hour away by a vehicle, assuming you can pay for the ride). Thus, they feel that kids are falling through the cracks and we should try to fill one of them. I’ve been working on it, and it’s going to be a monumental challenge. The main accomplishment has to be an easy to understand protocol. We’ll see if we can pull it off.

Normally, when I write in my journal, I sit on the porch of my lodge. It looks out onto the lake and since I face Northwest, I always have a good view of the sunsets. I just re-read a book called “Fup” and a character mentions in there “I have seen 10,000 sunsets in my life. Not one of them looked the same. What more can we ask for?” I can probably agree with that. The porch is a wonderful place to just sit and read or write or relax. The “sea breeze” blows pleasantly and the weather has been so far quite hospitable.

These past few days, we’ve been lucky to enjoy the full moon. There’s no ambient light or light pollution here because there are no power lines to the area, i.e. everything beyond Migori (the nearby “big” town) has neither electricity nor sanitation. Without the background brightness, we experience the full glow of the moon, and it is amazingly luminescent. From the front door of my dwelling, the moon casts shadows, and I could even read by its light. In fact, the night sort of appears to be a “Nuit Americaine” – almost like the day-time w/ a dampening filter. Nice.

Last weekend involved a lot of traveling and walking. On Friday, we went to Migori to get some business done. The ride on that bumpy-ass dirt road is a tiring experience unto itself. It lasts at least an hour in each direction, and the creative driving needed to navigate the track disallows any opportunity to rest in the car. Normally, I like long car rides, as I take the opportunity to doze. But on these trips, I cannot wait to get out of the car (and perhaps kiss the ground).

On Saturday, the plan was to take the “Big Fish” (seriously, that’s what it’s called – it’s a big green passenger shuttle; privately owned but serves as the public transportation in the area) to Migori and from there to go to Dollith’s house (one of the clinicians here) by Cockroach (a mode of transportation that involves piling 15 people (I am not exaggerating) into a hatchback; and so-called because they’re small, fast, and look like darting Cockroaches from above). Well, the Big Fish came earlier than normal and we missed it. Then we tried to walk to Otho, which I think is about 2 miles from us. It’s all uphill and Tami (the other volunteer) concluded that I was a wimpy walker because I couldn’t keep up with her 5’11’’ stried. Thankfully, Chacha (the Director of the Education Department) picked us up in a Lalmba Landcruiser because Jackson (Personnel Director) was also going to Otho.

Once in Otho, which serves as a sort of depot for the Cockroaches, we jumped into one, paid the 150 Kenyan Shillings (2 dollars), and rode the rest of the way to Migori. Once in Migori, we met up with Dollith and Wilkester (who I keep wanting to call Winchester even though she is not white, fat, balding, or fictional) and we piled into another Cockroach to Bondo. Then from Bondo we took the Kenyan equivalent of a cycle-rickshaw to Wilkester’s house. This mode of transport involves a single passenger sitting on the back of a bicycle and then gets escorted to his destination. The bicyclists are quite skilled and hardy for they must navigate the ruts and bumps in the road, ride uphill with an extra 150 pounds on the back (and no, I haven’t lost any weight, yet, despite the bad food), use only a single gear, and doing it all for only Ksh 50 for a 30 minute trip (80 cents). Jeez!

At Wilkester’s house, we enjoyed chai (it’s interesting how much Indian influence there is here). Tami understands far more Duoluo (the local language) than she speaks. Thus, when Wilkester’s mother-in-law greeted us, I was the only one left out of the loop since Tami could follow the entire conversation. I enjoyed myself in spite of being excluded from the conversation, for the grandma was quite fund and had a great sense of humor (when it was translated for me…). At one point, she noticed I was not drinking my chai. When I told her it was because it was too hot, she became very preoccupied with finding a way to cool it down. It was endearing. She sort of reminded me of Dadi (Dad’s Mom).

After Wilkester’s place, we headed to Dollith’s birth home where we had lunch. Before lunch, I expressed that I was a little tired. This comment prompted Dollith to insist that I go to sleep. It was unnecessary but it probably solidified my reputation as a wimp. For the most part, I just lay on the bed without sleeping.

On the way back, Tami and Dollith didn’t want to risk anything with me as far as the walk back, and they sent me again with a bike all the way back to Bondo. I’m glad, for the entire trek was uphill. Plus, the path we took gave me an excellent experience of the countryside. I saw a lot neat things and unfortunately a few malnourished kids also. Granted, Matoso is no huge metropolis but its rural-ness is much less than where we were visiting.

The Cockroach ride home from Migori to Matoso was punctuated, literally, by 3 flat tires. After the first, the spare got us to Otho. In Otho, we just hung around while they tried to repair the spare, as it went kaplooie also. Luckily, I had both signal on the cell and time, and Mom called at a perfect time so that we could talk.

Then, we resumed riding towards our destination crammed in like sardines, and the tired went flat yet again. However, the fact that I am writing this blog is proof that we made it home alive and I assure you, in one piece.

On Sunday, we walked a lot because we got lost finding Daniel’s (driver and registration dude) house. He had invited us for lunch. Lunch was actually quite good. We had fried fish. When I saw it, my stomach lurched. Hoever, it turns out I really enjoy the fish when it’s fried. Of course, I ignored the sacuma (spinach) and the Ogale (or Ugali – I don’t know how it’s spelled). A friend of Daniel’s was also there and he was quite conversational with us. For the most part, we discussed politics and a little about the rural Kenyan life and Luo culture. We ventured outside after lunch and we had a thoroughly enjoyable time under the shade of his trees and the continuous breeze off the lake. Man, it was a nice afternoon.

Well, there is actually more to write but I am tired. Therefore, I will sign-off for now. You, who decided to take time out of your busy day to read this, are probably sick of reading it now anyway. I’ll try to make the next one shorter.

Cheers!