Blog 5: A week of clinics in review – Saturday Feb 22

The sun is still below the horizon, and as I slowly wake to consciousness, I feel the hard plastic netting on my arm from the mosquito net, the very firm foam/particle board mattress beneath me, and slightly scratchy sheets on my legs. I smile as I realize I’m still in Kenya. The clang of a metal door is the culprit that pulls me from sleep, and I quietly curse the one team member who is up, trying to get out of their room, and waking the rest of us at 6am, on the only morning in Mikinduri that we can sleep in. Oh well, TIA (This is Africa). Behind the sound of metal you can hear a cock crowing, a neighboring cow crying to be milked, and the chords of a church keyboard. Pretty soon, the other two churches nearby will start their musical selections as well and the tinny, over-synthesized keyboards will begin to compete. The voices that you hear over the music though, is heavenly. I can imagine the people in the church are swaying along with the music, standing and shuffling their feet, while the choir is likely dancing up and down the aisle. It’s a beautiful way to start a Sunday, albeit earlier than I’d like.

My second week in Mikinduri has passed, and though very different from the first week that I spent in the schools, the people I got to interact with made it just as special. Our team of 19 Canadians, 35 Kenyan professionals, and 30 Kenyan students came together to see over 4000 patients in the morimo (medical), miago (dental), and metho (vision) clinics! That is a record number of people in one short week for us. It helps explain why we are all so tired, but satiated, each having collected a few stories and warm memories, in addition to helping so many. We have sent about 10 people to the hospital, all emergent cases. One woman had appendicitis and was accompanied by nurses Marion Jones and Kathy Murphy to Chaaria Mission Hospital, where the woman had emergency surgery and the surgeons discovered a tumor. Team members describe Chaaria Mission Hospital favorably, as the busy surroundings are all influenced by the Italian surgeon, Beppe Giado, who has been working tirelessly for years. He rarely takes breaks and if you ask him how long he has worked there, he says it is 8 or 9 years. He’s been saying that since my first year to Kenya, so it must really be more like 14+ years.

There was an elderly woman who came in with her feet and legs covered in sores, hidden by plastic shopping bags. The wounds, caused by elephantiasis, were cleaned and bandaged, and she was sent to Meru District Hospital to get an ultrasound to ensure her veins were still functioning. Margaret Gallant and Kathleen Mitchell both went to Meru with patients. In Meru Hospital, the feeling is not as hopeful as Chaaria. In Meru, people are all waiting. There are so many people, just sitting and waiting: for the doctor, for a lab test, to pay, just waiting. Unlike the hustle of Hollywood medical dramas, the Meru hospital is a void of urgency, and I might even say hope. The facility has so many doctors, working very short hours, seeing so few patients, and full to the brim of bureaucracy. We have to send a Kenyan nurse to help navigate the long halls, and a Canadian as well to ensure the patients get attention (and pay). Even at that, one man with very high blood pressure was sent home rather than admitted. We eventually took him to Chaaria where he was immediately seen. Meru hospital is wrought with apathy.

We sent a young child (5 years) to Meru Hospital to get an initial consultation and suspect that he will be sent to Nairobi National Hospital for surgery. The child has both male and female parts, but neither fully formed, so when the child tries to relieve himself, the stream just drips out. This is the first time he is seeing a doctor, as I can only speculate that the parents were either ashamed, accepted his condition, or didn’t have the funds to try to correct it. These are the cases that justify the clinic. Even if many of the people who come to the clinics are only slightly sick, just hoping to get seen by the mazungo (white person) doctor, we are really here to weed out the cases like the little boy’s, who’s whole life can change.

In medical, the first person the patients see is Nora Fleming, a sweet Islander with a quick smile. She does the weights and measures for the babies, an emotionally tough job considering most babies burst into tears when the first white person they’ve seen takes them from their mother and stretches them out on a cold scale. Nora can get most of the babies smiling before handing them back. This is a job Islander Desiree Leary tried one day and considered quite difficult, not from the mechanical actions, but the emotional impact of having kids burst into tears because of you. I’m even cautious when approaching the kids in the halls, though I’ve learned every child loves peek-a-boo (from a safe distance).

The dental clinics were full this week, each dentist pulling at least 40 teeth per day. That is strenuous work for Richard Holden, an Island dentist, not accustomed to that many patients in one day. By Wednesday though, he was a pro, meeting his 25 patient quota by lunch, a number that was set by his business partner Bill Allen who came to Kenya multiple times. Different Canadians worked in dental to help keep the instruments clean and the patients moving: Catherine Mitchell Bailey of Mississagua, and Sam Murphy and Charlee Holden from PEI.

Cheri Butt of Mississagua has been steering the ship in Vision, with her fluctuating team that has included Islanders Marjorie Gallant, Margaret Gallant, Ben, Sam, Kevin, and Isaac Murphy, Charlee Holden, and Desiree Leary. Kathy Murphy of PEI is running the medical clinic, as naturally as if this were her regular day job. Her team hails from all over Canada: Marion Jones (Saskatewan), Kathleen Mitchell (Halifax), Bea Hawryluk (Vancouver), and Ida Louis (Toronto).

I’ve been working up in registration with the help of one of the Murphy boys. It’s a careful balance at registration to ensure there are enough patients to keep the doctors busy and see as many people as we can, but not so many patients that the doctors are too tired for the next day. Typically all of the patients arrive by 10am, some waiting 7 hours before being seen. When possible, we ask half the patients to come back after lunch so they can go do their shopping in the market rather than wait at the hospital grounds all day. The last part of the day is spent going through the receipts and counting the money that is collected. It was suggested by the community that we charge a small fee (50 cents for children, a dollar for adults) so that the people take some ownership of the process. Of course, if a person cannot pay they are let in for free. This means, however, that a Canadian must count each of the disgusting, dirt-encrusted bills. After fingering the money, you want to take a full shower, but instead use hand sanitizer and avoid touching your face until you can get home to thoroughly wash. (Ask the boys, as this is a task I have now happily delegated).

Ida Louis, our resident physiotherapist, has been busy this year with a line as long as 14 people waiting to talk to her. One woman came in who had a stroke and the neglect from her family would make you cry. She was left at home and her muscles basically withered away to the point where she can no longer walk. She will have to do intense work to start using her legs again, that have nothing physically wrong with them. With the rehabilitation center at Mikinduri Hospital, it is now a joy to see so many disabled people coming to the clinics, as we can refer them to the Rehab clinic for long-term, meaningful help. Previously we could give them a wheelchair and hope for the best. Now, they can see occupational therapists, physiotherapists, and receive fitted prosthetics.  A much more ideal situation.

This has been a long blog, but only is the beginning of what I want to say, to attempt to share the experience at clinics of the last week. The team has worked so hard, coming back after a long day to pack pills into little bags (to distribute to the patients), or number the forms (to keep a count of the number of patients). 

Blog 4: Friday Feb 21st, For a Pair of Glasses

Everyone in the clinics stopped and stared when the 6ft tall mazungu (white person) went running across the hospital grounds shouting ‘stop her’. Cheri Butt, a Newfie transplanted to Mississauga, on her 6^th trip to Kenya, has been running the vision clinics with equal parts efficiency and fun. Between 200 and 300 patients each day funnel through the vision clinic, most hoping to get reading glasses, some coming for distance testing, some extreme cases requiring referral for cataract or other surgeries, and for the remaining few, sunglasses or a hat. Most people suffer from eye problems because the fire in the center of their huts produces great amounts of smoke and the dry red dirt paths they walk on are dusty.

After the patients see the Kenyan optometrist and get tested for reading glasses (if they are over 40), they go to our distribution center to receive the prized spectacles or a hat, most likely from Islander Marjorie Gallant. As the quality of donated glasses we received this year improved tremendously, (through a generous donation from Vogue Optical), a few patients are becoming pickier. Typically when you hand the pair of glasses to the patient and they put them on, suddenly able to see clearly for the first time in years, their whole face changes. They point out trees off in the distance or the sharpness of your face. One person, a pastor, from my first trip to Kenya even exclaimed that he could now read his bible again, no longer needing to preach only from memory.

On the day the clinics paused, however, the raucous was caused by an eighteen-year-old girl who was picky and persistent. As the story was told to me, she was given glasses, left, and came back to try to exchange them. To keep the clinics running efficiently, Cheri asked the girl to leave as she was given the correct prescription also because she was not our typical destitute client. This girl could afford to buy her own glasses. A short time later, Cheri found the girl poking her head through the window trying to have a secret conversation with the Kenyan volunteer, and again Cheri chased the girl out. Shortly later, she saw a different Kenyan volunteer with a pair of glasses, walking out of the clinic. When Cheri saw the volunteer deliver the glasses to the girl, Cheri was not pleased. She immediately chased the girl down the hilly, rocky clinic to the front gate, shouting for someone to stop her.

The lone Kenyan security guard standing at the gate (his coworkers at lunch), was holding the wrought iron gates shut, keeping the people out that were already seen in one clinic hoping to go to another, or were just curious about the wazungus (group of white people). As the girl came running through, our security guard chased after her, leaving the gates wide open. All the people flooded in.

It took 45 minutes to regain control of the grounds. This involved walking up to each person, asking them through a translator why they were there, sadly telling them the doctors were full, then escorting them at a sulking, slow, sauntering pace to the gate. We did this for every person. You would think after people saw the same process for the first 10, or even 20 people, they would give up and leave, but no. We had to go to every person and individually explain the situation, encouraging them to come back early in the morning.

 The girl was never found and we had a rumor start that someone’s wallet was stolen (the ‘only’ explanation for a white person to run across the clinic). All of this over a pair of glasses!

Blog 3: Preweek in the Schools with Robots

Feb15, 2014: 

During this pre-week while waiting for the team to arrive, I spent the next four days, Tuesday through Friday in Kenyan schools introducing the 7^th and 8^th grade students to Lego EV3 Robots and learning about how they approach problem solving. While there, I got to see how a school operates. Children get to school by 7am and study until the teachers arrive at 8:30. Lessons are intermingled with time to study and there is a break around 10am for the students to eat breakfast and another at 1pm for lunch. Students study until 5pm then head home. Last year, I spent time in the school and was struck by how well the children study on their own while the teacher is grading or on break. In Canada, they would not be left unsupervised, but in Kenya the teacher could be gone for the entire afternoon and the students would stay in the rooms and study. They don’t get a chance to study outside of school, so they use all the time they have at school. I can only speculate the reason for this is that most live in a one-room dwelling with their families with no electricity, so they can’t study after dark.

I was at Kagwuru and Kinwe Primary schools, both of which have feeding programs sponsored by Mikinduri Children of Hope. The parents help cultivate the food on school property and in exchange their children are fed breakfast and lunch. Some of the children rarely have an additional meal. In addition to providing nutrition to help keep them focused, the meal allows the children to stay in school for the afternoon rather than walk home for lunch and generally stay there.

While in school, there was a cacophony of noise from the classrooms next door. The occasional chicken ran by. Then it was time for break and a hoard of children stand in the doorway watching everything that is happening. The students in the room I’m in are unphased and don’t even notice the disruption. They have an amazing amount of focus.

In Kenya, discipline is still something done with a stick, and I had one teacher proudly explaining to me the way he canes particularly bad students and the unusual punishments he comes up with. It was hard to hear and I eventually had to make up an excuse and leave. However, it’s hard to judge their way of doing things as the students there want to learn and study quietly. It’s hard to say the same of Canadian children. Can you imagine the bedlam after leaving a nursery class or 1^st grade for the afternoon? It would be Lord of the Flies before even getting to the island!

I had three amazing volunteers helping me take data and translate. It becomes a familiar feeling to sit and not understand a thing being said around you. Other people might be able to pick up the language and learn a few new words, but rather I find the feeling comforting and familiar, and just accept the not knowing. It is funny though when you say one sentence 10 words long and hear a paragraph of text in the translation. Sometimes I had to ask what exactly they said so I knew what the students were being told.

 

One surprising aspect of Kenya is how everyone here has cell phones.  Rather than spend money on telephone infrastructure, everyone uses a cell phone. That also means that internet is becoming easily available as data is transmitted over the same lines I spend the first week skyping with my UPEI students for every class. I wasn’t lecturing as the students all have projects they are working on, merely answering questions and having meetings with the groups. It’s so surprising to think how far the technology has come when my first trip five years ago, I was lucky to phone home twice during the entire month.

I spent my last day in the schools today at Kinwe, where there is a large nursery school. Valentines Day really does seem sweeter when there are 60 3 years olds crowding around just to shake your hand with great big smiles, laughter, and giggling all around. The only complication comes when it’s time to leave, I seem to gain a large entourage. 

It was a wonderful week and I am happy to say that the entire team has landed, as some were delayed a day in Montreal. I look forward to greeting part of the team in Mikinduri on Saturday and the delayed teammembers on Sunday. More updates to follow then. 

Blog 2: Laughed at in the Cafeteria

It is the fear of every school child: to be sitting in the lunch room having everyone laughing at you. This is what I experienced during the first week of my fifth trip to Kenya, though it wasn’t as painful as it would have been 20 years ago. Rather, it was oddly enjoyable. The subject of jeer: a peanut butter sandwich!

I went to two primary schools (Grades 1 – 8) during the last week to introduce the older students to a Lego EV3 Robot and document the students’ problem solving skills.  Kenyan students are primarily taught using memorization techniques and I wondered how they would respond to puzzles.

However, it was during the breaks with the teachers that were the most memorable.  There I was, in a concrete building with a corrugated, tin roof, concrete floor with a light dusting of dirt, the only source of light coming in from the door and solitary window, sitting on plastic lawn chairs behind big wooden desks. This was the staff room, teacher’s office, administration office, and break room.

The 8 teachers, mostly in their 40’s, were eating heaping mounds of rice and vegetarian stew. I was sitting there with a dry, sad peanut butter sandwich, unable to stomach the water that is used to prepare their dishes and thus unable to join them in their sumptuous meal. Trying to explain why I couldn’t eat their food was a tricky task, as it was certainly rude (anywhere) to bring out my own very different meal when such a delightful, warm dish was offered to me.

After my explanation, a roar of laughter erupted and furious conversation where I could pick out the occasional English words: stomach and peanut, and the Swahili words: maji (water) and mzungo (white person). It was at that moment that it dawned on me that had this event occurred 20 years earlier, I probably would have burst from the room in tears, but after 5 trips to Kenya, I was accustomed to this reaction to the differences in our cultures.

However, having spent a few days substituting in Canadian schools, being in the staffroom does not feel completely unfamiliar. The teachers enjoying private discussions in separate groups around the room, while I’m eating quietly, keeping to myself. Occasionally a question is directed towards me, to which all groups look over for my answer.

All in all, it was successful week. The children responded well to the puzzles and robots, and it was interesting to see how they attack problems. Meanwhile, the rest of our team was on an airplane, leaving Wed evening and some not getting in until late Saturday night. All have arrived safely and are on their way to Mikinduri, where we will begin our preparations for 9 days of medical, dental, and vision clinics.  Last year we saw 6000 patients in that time and hope this year will be as big a success. You can find more information at www.mikinduri.com

Blog 1: Arrival into Mikinduri

Monday February 10, 2014: 

I landed alone in Nairobi late on Sunday night after 24 long hours of travelling and waited in the line to declare a lost bag, an expected step after 5 years of travel to Kenya. The only difference was that I entered a new airport after the last one burned down in a massive fire last year. My thoughts immediately went to the team-members who would be following my route in a few days, and realized the plans I had made to help them through the unfamiliar airport would have to be altered. I had only been in Kenya for minutes and my optimistic initial plan was already foiled. Here, we just sigh with a smile and say ‘This is Africa’. It’s a common chant when a simple task takes twice as long as it should, or a noon meeting starts around 1:30. To come on a KENCAN mission, you must be flexible as Kenya teaches me on a daily basis here.

I was driven by our reliable tour company to a different hotel then the team typically stays in, closer to the airport, less expensive, and a little less nice. Standing in the lobby to get a room, I was struck by the three clocks on the wall with plaques overhead. Somehow, it was 2:05am in Nairobi, 11:12 pm in London, and 6:00 at an unlabeled location. Ahh, I am happy to be back in Africa. As someone who notices details for a living (teaching engineering), I have learned to smile at these inconsistencies rather than be perturbed by them, as I probably would in Canada.

Four hours later, I got back in the combi, a combination van and safari vehicle, where the roof lifts up so you can stand and take pictures of the animals. For the first time, I was going to go to Nairobi National Park. Something the team would do as well when they arrived a few days later. Normally our safari is at the end of the trip, but we’re told a special surprise awaits us, so we should do the safari first. It was incredible! I saw more animals than I had seen in 4 years of safaris, and very different varieties. There were baboon, zebras, giraffes, ostriches, warthogs, and many types and sizes of the deer/antelope family. These were common to see on most safaris. But, then we turned down this one path and within 5 minutes, saw two hippos, a crocodile nose, a black rhino, then a lioness about to hunt the nearby zebra! What an unexpected and lucky find! Apparently black rhinos are the least common animals to spot. On previous safaris, I saw cheetahs, lions, and the rest of the big five, but the only animal I have left to see is the leopard, which are even more rare than the rhino (again, Kenyan logic applies here as to how both black rhinos and leopards are the most rare).   Additionally, I saw big birds, smaller than ostriches but larger than turkeys, with wings that actually fly. They looked like something Jim Henson would dream up with the bright colors and awkwardly long legs with fat bodies.

After 4 hours of fun, I left for Mikinduri, a drive that in Canada would take only a few hours but in Kenya is 4-7 hours. (Yes it varies that much). Every few miles on the two-lane Kenyan highway is a speedbump so large you have to stop to go over it. This is mostly due to the large number of towns all along the highway, with children and animals running alongside the cars.

Kenyan traffic is a cacophony of honking, radios, and the hum of people talking. A roundabout in Kenya can have as many as 40 cars in the one-lane loop, most not moving very quickly. Drivers in Kenya must be simultaneously aggressive and very defensive, and have a great awareness of the size of their vehicle. More than once, we drove through a gap between two cars that couldn’t have left a centimeter on either side. Many of the Kenyan buildings are painted brightly with advertisements, choosing to use the whole face rather than just a sign. However the ad rarely has anything to do with the shop. A butcher might have ‘Huggies’ diapers in white over a bright red background.

Over the last three weeks, Ted Grant, Founder of Mikinduri Children of Hope (MCOH) and Dr Ed Harrison, chair of the MCOH Medical Board, had great success in setting up opportunities to further the cause for disabled people in Kenya. There is a Rehabilitation Center that MCOH paid for that is now going to be the center for the entire county, where casts and rehabilitation equipment can be manufactured. Considering Mikinduri is a very small town, this is a very exciting resource to have. Ted and Ed are also furthering a Community Based Health Care initiative to bring the health system into the small remote communities far from the bigger towns like Mikinduri. They had a busy three weeks but were quite pleased with what had been accomplished.

See some safari pics here: https://picasaweb.google.com/mikinduri/2014MCOH?authuser=0&feat=directlink