Several people have asked if they can send me something for Christmas. Really, it is crazy to send gifts here! It costs me money to pay the customs, and someone has to go to Migori during the work day to pick up packages from the posta.
If you are truly motivated to give this holiday season, I would be most grateful if you would donate to Lalmba. Mention my name if you like. I promise, this is the best gift for me.
Or send a check to Lalmba Association, 1000 Corey St. Longmont, CO 80501
To give you an idea how your donation can help, here are some of the medical projects (actually a very small sample) that Lalmba is working on, and I am involved in, in Kenya:
Receiving blankets and soft towels for the newborn babies in Maternity. It is considered bad luck to prepare much and bring things to the hospital, so some women arrive with nothing. I am buying these in Matoso Center, used, at 50 shillings each (about 50 cents.)
Expansion of services to adolescents, those young people ages 15-24 who are most at risk for new HIV infection, unwanted pregnancy, sexual assault, and trading sex for food. We hope to create a welcoming corner in the compound where youth can gather, talk with trained peers and each other, and have easy access to a nurse for accurate health information and confidential services like sexually transmitted infection screening.
Digital thermometers and blood pressure cuffs so that each nurse can have their own.
Proper scales and height measurement for infants, children, and adults.
Possible in the future: adding care for HIV patients in Ochuna. Currently they have to travel quite far for care. (We provide primary care and anti-retroviral drugs to about 500 children, adolescents and adults living with HIV in the big clinic in Matoso.)
Lalmba does good work. See the website for more information.
Friday, during a funeral that most of our staff attended, a mama arrived late in the afternoon carrying her sick child, about 5 years old.
She told me the child had been sick in the morning with fever and malaise, but then seemed to get better.
By the time the nurse was called and arrived from the funeral 5 minutes away, he had time to try to start an intravenous line, but as he was putting it in the child took her last breath. He was able to get a little more history: apparently the mama left the child at home feeling okay, but when she arrived back home the child was unconscious and appeared short of breath. (In retrospect, she was having Cheyne-Stokes respirations, the deep sighs that signal death is imminent.)
I found the mom, keening alone on the floor, with the body of her dead child on the bed beside her. All I had to offer were murmurs of sympathy and a shoulder to cry on, so that is what I gave.
We suppose she had severe malaria, which kills so many of the children here. We will never know for sure. All I know is that another funeral will be held. One of too many funerals.
So, I live right on the shore of Lake Victoria. We hear the waves at night. Unfortunately, we also live very close to the people of the small center of Matoso. When people here have a funeral they always seem to hire loudspeakers, microphones, and music, and the speeches, music and sermons go on all night long. This week there have been two nights where we were not able to get much sleep due to noise from a funeral on an adjoining property.
After Thursday night’s festivities, I decided that I needed to get away for at least one night.
I am staying at a friend’s compound even closer to the water, and about 30 minutes walk from Matoso. It is so gorgeous here, and so very quiet.
This morning I woke up and enjoyed the antics of the vervet monkeys that live here.
They climbed on the cookhouse roof, looked in the windows, played peekaboo with Tamara, and sprang wildly from treetops to the ground to the roof and back.
One of the monkeys playing on the solar panels atop the power house.
We fed them our banana peels. There’s a baby with its mother and the baby is about the same size as the kitten born a few weeks ago to the feral cat in our compound.
This property is more rural and next to some very rocky hills called Got Kachola. I’ve always known that the monkeys hung out on the hill but I didn’t know they came down to the compound here. The compound is very lush and there are so many Bougainvillea plants of different colors that the owners have had planted here.
I hope my pictures can partially do it justice. Of course I can’t show the wonderful expanse of rocky shoreline beach and property that they have but I can show you glimpses.
I decided today that the enormous skies here in Africa will be one of the things I miss when I go back to the US. When I emerge from out of the low place in the road, onto the top of a hill and I can see for miles all around, it is a wonderful feeling. And from the back of a piki-piki, my driver with no helmet and no glasses but his down coat tightly zipped up, and me with hat and sunglasses but gloriously bare arms, I feel I could ride to the horizon.
Our part of Africa seems to have been crumpled at some point. When we travel to Migori, the county seat, about one hour away, we have to go up and down about 7 or 8 times. The hills are not especially high, and not terribly steep, but they just keep coming! The road is the worst at the low spots, and sometimes there is a bridge, or at least some concrete over a culvert, but the concrete often has huge holes, and the roads on either side of the crossing are extremely uneven and rocky. The way is sometimes slippery, sometimes uneven enough to almost tip the car over, and you definitely want to sit in the front if you are at all prone to motion sickness.
I would love to know more of the geology–we are not far from the southern part of the Rift Valley, where parts of East Africa are moving away from each other. For now, I will appreciate being on top of the world, when I am, and try not to get bogged down in the low spots.
Ok, Ok, I confess. The reason it has been so long since I posted, is I have been mesmerized by television shows. The Radison Blu in Freetown had movies, which I watched quite a bit during my 5 days there. After all, I was on vacation. Then, when I returned to Nairobi and had free wi-fi at the Flora Hostel, I figured out that I could download shows to my phone, from Netflix. (I wish I had discovered this so I had movies to watch on my 5 hour airplane trips to Sierra Leone.)
So, “free” downloads, from Netflix (which I could not figure out how to cancel and so I have been paying for and not watching for 6 months.) What is one to do? I downloaded all 6 new episodes of “The Code” which were available and then binge-watched them in every minute of spare time I had. And so I began my month of Netflix. Now I pay for the downloads using my trusty hotspot, but it does not seem to take much data—surely less than streaming the shows on my computer.
Even my Kenyan friends have noticed that I stay in my house more and am not showing up at football games or shopping in the center.
So today, I promise to begin afresh, and post something weekly. You may get random pictures, not necessarily related to text. Like today—what can I post to accompany this article?
Warning–the pictures are of creepy-crawlies. Go no farther if you are squeamish!
I have captured a few pictures of some of my fellow residents of the compound here—but the monitor lizard is too shy so you won’t see him. I have only seen him once, and he was hauling a— into the garden. The geckos are tiny and I haven’t figured out how to use the iPhone camera well for close ups. But nevermind, I will post what I can get.
When I left you, we were in the middle of Migori Town, surrounded by protestors, with the patient in the back, on our way to the Catholic hospital of her family’s choice. We made it to the hospital just fine and again, a gurney was brought after we convinced the registrar she needed to be admitted. She was unloaded from the ambulance onto the hospital’s gurney, and taken to the Observation Unit. After 20 minutes or so of waiting out on the porch (I got to hold the newborn baby girl who slept the whole time!), a nurse came out and said we had to go talk to the Clinical Officer. This is an even more highly trained clinician than the nurses, who provide almost all care here, and was clearly the Clinician-In-Charge of the entire facility that day. She told us, the patient’s mother and I, that while they agreed that the patient needed surgery, the Medical Officer on duty that day was stuck an hour away in Kisii and could not get through to the hospital due to—you guessed it–the protests!
The driver had a quick discussion with the mother and patient, and after a phone call to the first hospital to make sure they could do the surgery, we did the whole thing in reverse. The patient was bundled onto the gurney and then into our ambulance, we went back to town and through the young men protesting, (after only one failed detour down a narrow dirt street trying to find a “back” way to the other hospital), and made it finally to the original hospital we started with. After getting the patient settled into a bed in the maternity ward, the driver found the medical officer who was prepared to do the surgery. He assured us he was hoping to get started within the hour, and we left the patient’s mother talking to the administration about how she was going to pay for a unit of blood, should it be necessary. (The patient’s father was already on the road, coming to Migori Town.)
By now it was after 2 pm. The driver and I went back downtown to see if the post office was by any chance open—I knew there was a package there waiting for me to pay customs fees—and it was almost as if nothing had happened. Businesses along the main route had opened their shutters, the sidewalk vendors were again laying their wares out and removing the tarps they had placed over them, and cars again lined the streets and moved through the traffic of buses and motorbikes.
We got the package, went shopping and ran other errands, and picked up the our passenger who was also ready to return to Matoso. Along the bumpy road back, we ate bananas the driver had bought, and bread I got at the supermarket, and drank Fanta Passions in silence.
I was not scared for our safety (other than concerns that the patient would need a real medic and care on the way), but I was really, really glad to get home!
(This is not our ambulance but it is very similar. Older, four wheel drive Toyota, but we don’t have fancy shades on the back windows.)
One week ago we had a lady in the Maternity wing who had delivered a baby the night before. When the nurse checked on her in the morning, there was bleeding that was more than normal, and the nurse diagnosed a cervical tear. Because we have no surgeon or operating theater, it was necessary to transport her to the nearest town with a hospital where she could have surgery.
I volunteered to accompany the patient, because hospitals like it if patients show up with a medical professional, not just the driver. Because it was a relatively busy Friday morning, I knew that I could be spared much more easily than one of the nurses. I cannot speak the language here well enough to see patients on my own, and so someone always has to translate. The woman’s mother came in the front seat, holding the newborn baby girl. They sat between the driver and another staff-member who just took advantage of the free transport to Migori.
I knew I was not going to be acting like a medic in the ambulance. For one thing, the ambulance is not set up even to hold a gurney. There is a bar on the right side of the back of the vehicle that at one time may have supported or attached to a gurney, but it is seriously deformed and non-functional . The way the ambulance works now is this: The 20 liter gasoline and water cans (two each) are pushed far forward, up against the backs of the front seats. The forward bench seat is collapsed against the left side, and the spare tire which normally lays on the floor of the ambulance gets tied to the left side with the tire helping hold the seat up. The remaining bench seat is where I sat, and a mattress was placed on the floor for the patient.(Largest rectangle below.)
A wire has been forced between the roof of the vehicle and one of the supports that holds up the roof. This is where the IV bag can hang. (Star shape below.) The wire would be in the perfect position for someone sitting on the forward bench to be able to hold the IV bottle still, but it is out of my reach from the back seat. I have one spare IV bottle and I brought a box of latex gloves and another IV needle and tubing in case the IV fails on the way. These are the only supplies.
We set out, and it is a very bad road for at least 30 minutes. We go up multiple hills, and down into their accompanying valleys. At the bottom of the valleys there is often a bridge over whatever water or waterway is there. The valleys seem the worst—the place where the dirt road meets the concrete of the bridge is often extremely rough, and the bridge is likely to be pot-holed especially at the beginning and end. But the hills are challenging , too, and very rocky where the rain has washed the dirt away. Of course, the loose mattress, and the patient, tends to slide a bit when the ambulance is going up or down.
The driver drives as fast as possible, as the trip takes an hour on a good day, and we want to get to the hospital. I am perched on the back bench, and the IV is swinging wildly. For a while, the staff passenger in the front seat stabilizes the IV bottle, but eventually she probably gets tired of reaching backwards and she lets go of the bottle. I try to hold onto the IV line, but not pull the line out of the bottle. The patient is bumping along on the bottom of the car, and I have to stretch my legs over her to brace myself and stay on my bench. Then I notice that the tire is wobbling quite a bit, and the rope holding it upright on the left side is beginning to loosen. Since it will fall right on the patient if it falls, I try to hold it still with my elbow. Sometime as all of this is going on, the IV begins to leak, and it is flinging IV solution all over the back of the ambulance and the patient. I have to ask the passenger to unhook the bottle from the wire and hand it to me, and I am able to force the canula back into the bottle as it was just loose, not all the way out. I decide to hold on to the bottle rather than re-hang it.
I check the patient’s pulse, as I cannot speak her language and she has her eyes closed. The road is way too bumpy to see if she is breathing. It is really the only way I can even slightly monitor her. God alone knows what I would have done if her pulse was weak or something worse. Now, holding the IV bottle and the tire, I notice the tire is even looser. I finally tell the driver to stop, and he comes back and ties the tire much more securely. I change the IV bottle to the fresh one and we are on our way again.
When we finally get to the tarmac we pick up speed and race through the small centers along the road. It is Friday, and there are some protestors out waving greenery in each of the centers. They are supporters of Raila Odinga, the candidate in opposition to the ruling Jubilee Party and President Uhuru Kenyata. They are peaceful, and we also notice more and more vehicles are now sporting greenery on their hoods or grills.
The driver is very familiar with the road, and knows which speed bumps he can go over fast, and which ones will break the axle. As we approach the edge of Migori, we drop our passenger at the main road into town, and we take a back road to the private hospital the driver knows—the closest one.
We arrive and the driver and I go in to see about getting the patient admitted. The registrar agrees to take her, and several staff members come out to get her. They load her onto a gurney and take her in. There is a conversation now between the driver and the mother, and they figure out that the driver forgot to discuss the destination with the patient and her family. They want to go to the Catholic hospital on the other side of Migori. So the patient is transferred back to the ambulance and off we go.
It is about noon as we enter Migori Town, and we are driving in the center approaching the bridge over the river that winds through town. It seems that all the vehicles are now festooned with greenery. There are lots of young men walking cheerfully up the street toward us, loud and happy-looking. Suddenly a loud noise startles me, and people start telling us to turn around. I cannot see what made the noise, but people are running in all directions. The driver starts to turn the ambulance, but someone relents, tells us to turn the siren on, and waves us through. The young men carry a cardboard box in the shape of a coffin, and they pass it over the ambulance. I don’t know until later that they are hoping that one of the members of the IEBC (the Electoral Commission) will step down, and that this represents his coffin, with him in it I am sure.
The semi-annual, regular dental visits that I have maintained all of my adult life was sacrificed to my hurried preparations to get to Kenya. The date for it fell a few days after my flight from SFO, and I just didn’t arrange to change the appointment. Thus, now that I have been in Kenya for almost 5 months, my teeth were really feeling dirty.
I found two sources of dental care near here. At Saint Camilla’s Hospital in Migori, Brother Bonaventure assured me by phone that they had a dentist who would enjoy seeing me because “He is like you.” I assume he is also an expat, or at least a white man. (You know, we all look alike so we must also enjoy each other. No, really, I am sure it is true. Tamara is 16 years younger than I and has longer hair, but we get called each other’s names all the time. When we are together, we are also asked if we are sisters. It is quite amusing, most of the time.) The second place I was told to go was Aga Kahn Hospital in Kisumu, a branch of the premier hospital in Nairobi. There, I was told, I could be confident that the equipment would be properly clean and the care professional.
I ended up at Jaramogi Oginga Odinga Teaching and Referral Hospital. I thought I was at Aga Kahn, because that is where I asked to go, and that the name had been changed to a less colonial sounding name. However, after I got home I found that Aga Kahn is on the other side of town, and that the driver had taken me to the wrong place. As you can see, the physical plant is adequate, with lots of old but well-maintained buildings, corridors outside but under metal roofs, and benches or chairs in the many waiting halls, both inside and out. The outside in front reminds me of the Stanford Medical Center in Palo Alto—I think.
While there, I did manage to get my teeth cleaned, but it was the roughest teeth cleaning I have ever had. Probably, I now realize, because it must have been a student using the tools and spraying water all over my face! But at least the suction only went down my throat once, and it didn’t get far because I have a well-developed gag reflex. Happily, my teeth are all intact and my mouth no longer hurts. Next cleaning in another 8 months when I get back to the USA. But I bet that one costs a lot more than 1000 shillings! (about $10.00.)
The fundis (a fundi is someone who can fix or make things. It is a great Kiswahili word to me…) were up on the steel roof replacing some panels with holes in them, and painting the roof with aluminum paint. They made this great ladder specifically for this job. They explained to me that they have two types of eucalyptus that they cut down to make this ladder. One is for the long pieces, and it does not split easily. The cross pieces are a different type that is more prone to splitting, so they like to wrap the nails around those when they are small enough.
They cut down the trees and trimmed off the branches, and then cut and shaped them to make the ladder with just a panga. This is a big knife, but I am not as skilled as these guys are in using it. It is truly impressive.
This ladder, made on site with materials close at hand and simple tools, is one of the things I love about Africa. People are so resourceful and inventive. So many times, if they do not have something, they either know they can live well without it, or they make it themselves. (This does not work with drugs, however. Uncle Sam, Unicef, WHO, etc., keep sending those drugs here!)
The gardener witnessed me wielding my panga, and paid me a lovely complement. He said, “Good, Dr. Ball, now you can be a panga-boy!” For those of you who know my record with knives, you can stop cringing now. So far, in several days of chopping down invasive vines around the compound’s perimeter, I have only cut one fingernail. And not even all the way through!