Almost final thoughts and when not to take Ambien

After a couple days of little sleep in Nairobi and the overnight flight to London, I arrive Rome mid-afternoon fairly exhausted.  Rome, of course, is a very vibrant and exciting city and I feel compelled to spend at least sometime during the first day having a look around.  About 7:00pm I given in and head back to my room (which has a very nice view of the Pantheon) and collapse.  By 8:00pm I'm fast asleep.  I wake to some street noise and look at the watch and it appears to be 2:00am.  Sounds about right and I decide to take 1/2 an Ambien so I can sleep for another 6 hours and be ready for a full day.  A little while longer I notice there's light coming through the window.  It appears I was looking at the wrong time zone on my watch and it was really 6:00am.  Crap.  It appears that 10 cups of coffee and 2 pseudophed tabs will offset the effects of 5mg of Ambien - now, if that chest pain would just go away.  ;-)

Final Thoughts

My last post before leaving tonight for London and on to Rome.  It's been a very rewarding experience filled with daily frustrations and challenges but at the same time, a sense of satisfaction.  Even while being in difficult situations and uncomfortable environments I have tried to remember how fortunate I really am in comparison.

My plan for Rome is to spend the first 8 hours soaking in a hot bathtub to loosen some of the red African dirt from 6 weeks of accumulation. 

Thanks for reading.  I hope it has given some laughs and insights to a brief stay in Kenya.

Cheers

Misc photos

Ah, fresh choma.  1/2 kg please

Eles just leaving the road as I'm coming down the

Kenyan satellite technology or what to do with those old metal plates.

For those preparing for Harvard.

Kiara family - Dr. Kiara, my physician sponsor; Dad and Mom

What do your kids do during recess?  These kids go for KMs in search of water.

Final lunch with Ruth and Jane

So, I leave my home for the weekend with hopes of escaping the 3:30am chicken alarm only to find it has been replaced by a mooing morning cow at the lodge.

Eles and Road trips

I was lucky enough to have some transportation (Sunny) while I was at Ukuu this time and was able to explore some of the area around Mt. Kenya.

The infamous Sunny at Castle Mountain Lodge

To the right is my banda (hut) that I stayed in, to the left is the swimming pool that the eles have taken over as a watering hole in the evening.

Herd of about 25 with babies

They would come in late afternoon to use the salt lick and roll in the dust for 1-2 hours.

After the salt lick, they would move up the hill to drink from the pool.

Cold at night so they would start a fire for warmth.  Could hear the animals just outside the room during the night.  

Nice hot meal at night while watching the elephants play just below the lodge.

Cooking lessons

The food here is very fresh and quite good but some things are a bit lacking.  Last time I was here they pretty much boiled the meat until it was jerky-like.  Given the meat selections I can see why.  I offered to cook a bbq but knew the meat would be tough as hell.  In the morning before work, I took a number of pieces and added papayas and mangoes with a bit of salt and let it sit all day to soften the meat.  It turn out pretty good.  The problem is that Kenyans don't plan anything except funerals.  You eat at night when they get a chance to prepare what ever is available.

Dada has cancer and they have had consultation with a nutritional person for foods.  She has suggested adding fish for protein.  Good idea expect nobody has a clue on how to cook fish.  Two hours is a bit much for a filet.  They are fortunate to have a freezer here and the fish is frozen before cooking.  The first time I had fish, the girl took it from the freezer and cooked it for about 3 minutes on each side.  Yummy frozen and raw fish - I have enough worms, thank you very much.

Tonight I am showing Mama how to cook fish.  Thaw for one hour, make a batter with egg and spices, coat with flour and cook three minutes each side.  Not sure how the open fire cooking will go but I'm certain it'll be better than the sushi before.

Ok - language barrier time.  I fix this very nice piece of fish and tastes pretty darn good with the spices I've mixed in (there is a horseradish type root here) and Mama tells me that fish makes her vomit.

From cluckin to cookin in 30 minutes

Well, once again the traditionally gifting of the chicken was done with the expectation that I take it home to America and slaughter it for my family.  The chicken last year has been a real thorn in my side (if you've read previous posts) and wakes me frequently at 3:30 am.  I have no intention of having 2 chickens when I come back next time.  I tell Ruth we are eating the chicken for lunch.  For those of you a bit squeamish, consider not looking at the photos.

Ruth comes up the walk with something moving in the basket.

A chicken to take home to add to your collection.  Yeah, I don't think so!  Going through customs at London, Rome, Madrid, and Miami on the way home.  What's the chance of sneaking this through?

Beat this Foster Farms.  30 minutes to the frying pan.

Three very satisfied health care workers during lunch.   I'm the white/sunburned guy in the middle.

Side note:  The first time I came to Ukuu, Mama, who only has seen Muzungos on TV, was concerned last time that my skin color was changing.  I was very white when first arriving but had tanned during the stay.  She was concerned I was browning.  :-)

Life at home

Mama fixing dinner

Special dinner - BBQ

Reminds me of days at camp Cabrini.  I am grateful to have a room and it is better than most people have here.

From last year when I cooked BBQ for the family.

The shower can be an electrifying experience.  My bathroom at home is being remodeled while I am away and I can't wait to use it - hope it doesn't turn out like this!

The walk to work.

The once considered safe drinking water before the helmenthic experience

Clinic photos part 2

When the electricity is on we use the microscope or by sunlight if no power.  If no power or sunlight, come back tomorrow.

 I would have bet this kid was sick.  Mom came in to be treated and I saw this 2 month old and insisted she be evaluated.  No fever and no malaria but a little dehydration.

 Cuties

 It's not cheaper by the group but they come in with the whole family sick.

Now this kid didn't look sick when she came in but had a temp of 104.0 (I took it twice) and had malaria.  We give starting doses before they leave to help with compliance.

Often grandmothers are left with the responsibility to take care of the children.

Worse cases of scabies I've ever seen.  The whole body was involved and multiple blisters covering the hands and feet.

Mom and baby

Kids along the way on the walk home.  It's about 187 degrees out and they still wear those hats!

It's bring the kids to the clinic day.

Yeah, stickers don't work for everyone.  It is a good way to see the back of their throat.

So.......... you've had this pain for 60 years????  Ah, the magic ibuprofen - one a day for 3 days.

Clinic photos

Waiting room for test results

You don't need a MRI or thousands of dollars of tests to tell that this kid is sick.

Many kids but when they are less than 3 months I worry.

It's common to see 6-10 kids waiting to be seen.

I'm convinced that an axillary temp is higher than a rectal or oral.  They come wrapped in blankets and 3 layers of clothes.

Sometimes it gets noisy with all the kids.  When it does, I tell Ruth to have all the moms get out their boobs and quiet them down.

Hard at work.  Notice the top shelf, it has 5 L bottles of tylenol and decongestant that we fill with old bottles brought back from previous pts.  That old amox bottle is now a paracetamol bottle.  Nothing like sharing the germs around.  There was a recent outbreak of mumps (6 pts), chicken pox (4 pts), and one case of measles that I saw.  I don't remember these since I was a kid.

Beautiful setting for the clinic

My ass kicked by an 80 year old woman

So, I come home after a long day of sitting on my butt followed by some goat BBQ and jump in the shower.  I get out and hear the sound of chopping wood.  Mama is the only one here besides me so I know it is her getting wood for the evening meal.  I'm thinking "what the hell is an 80 year old woman chopping wood at 7:30 pm?" and go to help.  She's out there with a solid metal axe weighing about 30 pounds wacking away faster than I've seen any fireman on a roof do.  I decide to do the manly thing and offer to help.  After one piece of wood, sweating like a hog on the way to market and hoping I can find an albuterol inhaler, I give the axe back to Mama and she finishes up.  I can hear her chuckling in the background but she does give me a big asante sana (thanks very much) as I carry my few sticks back.

I should bring Mama back and enter her in those cage fighting events. 

Mama and me or didn't I already finish high school?

Mama had 6 or 8 kids (it's hard to keep track of who belongs to what family) and was the disciplinarian for the family.  Apparently she thinks I'm one of her kids and I get the third degree anytime I'm away from the house and not at the clinic.  It's even worse now that the girl has gone away and the father has gone to Nairobi for his treatment and I'm the only focus.  I'm using the old trick of "I don't understand" because of the language barrier when I go out but she's catching on.  If there wasn't bars on the windows I'd sneak out at night.  Mothers ..............

Sunny goes for a road trip ....... new girl quits ...... buy me a soda ........ what's the LD50 of tylenol for a chicken?

In exchange for the use of Sunny during my time here I purchase two new front tires and with great confidence set off on an adventure.  Now, Sunny is naive and never much been out of the hills and farm.  When I mention to the people here we are going past Embu town there is a look of disbelief as if I was sailing to the edge of the known world.  They were partly right.  The roads around Mt. Kenya are dangerously curvy on the downhills with long, steep inclines each followed by yet another set.  Sunny uses her transmission for 90% braking and forward motion to make the hills.  Each time half way up another hill I'd promise Sunny a rest should we just make this one as her transmission is now hotter than the mid-day African sun.  Of course it was all a lie and I'd coax yet another hill out of her before arriving at the lodge.

I get back home to find the new girl has quit.  I don't quite follow the reasons for this but do notice I am short two rolls of toilet paper, 1 new bar of soap, and 2" from the bottle of juice concentrate I flavor the rain/parasite water with.  Yep, she's gone as I hear the sound of chopping wood and find Mama, who is in her 80's, out getting wood for the evening cooking and heating.  Mama works 16 hours a day except Sunday when it is only 12 hours.  Kenyans don't use their knees when lifting but rather bend at the waist when lifting heavy objects and as a result, their gluts are harder than tempered steel.  You need a running start to give injections to these people.

There is a phrase in Kenya - "buy me a soda".  This fits a rather large and growing class of people who are expecting something for nothing.  The guy who installed my new tires (which were very expensive) wanted a soda, the 12 guys looking under the hood of my car all wanted a soda, there is a guy who stands next to a hole in the road and when a car passes he tosses in a handful of dirt (with wind erosion, the hole should be filled in 2025) and asks for a soda, yesterday I was relaxing and eating when a guy comes up and says he has seen me in Meru town and will I buy him a soda.  Enough of the &$(#(%$$ soda requests.  No problem with giving the guy who washes the car, serves food, keeps an eye on the car while I'm in the store, changes a flat tire, tips but these freeloaders wanting something for nothing are annoying.  It's a younger person attitude and I don't see it in the older generations.  Maybe foreign aid has a role in creating this mentality where people get something for nothing - I'm an advocate of more foreign aid but maybe more accountability is needed.

Two choices for the chicken:  1)  Give it Ambien.  2) Give it Tylenol.  The problem is I don't know the therapeutic dose of Ambien or the LD50 dose of tylenol for a 10kg chicken.

Haircut and an audience for 60 cents

The hair getting a bit wild I decide to walk to the market and see what options are available.  The "market" is the commercial center of Ukuu which consists of about 25 wooden shacks, a butchery, and a bar where you can seek blindness at 10 cents a cup.  I find the barber shack and make it clear I don't want the bald shave they do for everyone else.  There's not much to do in Ukuu so a few minutes after I sit down there are about 50 kids peering in the door.  Nicely done for 60 cents including tip.

Helmenthic horrors

I'm not usually grossed out but this one did it for me.  A couple items before the gory details.  I like to use a saline rinse to keep the old nasal passages clean and open.  Next, the drinking water source for where I'm living is rain water collected from the roof and stored in a 500 gal size tank.  I've been assured this is clean water is not to worry - in fact, I drank from it for two months last year without any problem.  I like to use bottled water for the nasal rinses just to be sure.  Last night I am showering when I look at the bottle I use for this purpose and I see something crawling.  A closer look and I see multiple parasitic swimmers inside the bottle.  It appears I may have switched drinking bottles with rinsing bottles and have been filling my sinuses with some flagellating organism.  Hmmm, will these creatures invade my brain and cause some delusional activity and will anyone notice the difference?  Or, will they just set up business in my GI system reeking havoc there?  Fortunately, I have access to deworming and amoeba medications at the clinic.  Guess who the first patient is going to be?

Do I get a commission???

It's been so busy at the clinic that there usually are 15-20 people waiting outside.  Yesterday a guy rolls up around noon on his bicycle and starts selling food to those waiting.  At 4:15 there were 10 babies yet to be seen with 5 pending lab patients still left.  Everyone would need a malaria test as they all had coughs - for some reason cough is a very common symptom of malaria.  Each patient takes a minimum of 5 minutes to evaluate and then the lab is another 40 minutes to draw, stain the slide, let it dry, and then view under microscope. Then 10 more minutes to hand out meds and explain them.  No way we'd be done until after 8:00pm.  Triage down the line:  "What's the problem?"  "cough, cold, fever for 3 days", "come back tomorrow".  I did see two that were pretty sick and sent the rest away knowing that they all have malaria.  Each day I tell people to come in the morning but they still come late afternoon.  They all want lab tests regardless of the 99% chance it will be malaria (I think I've only had 1 negative result so far).

I'm thinking I should get a commission from the guy selling food or maybe set up my own food stand on the side.

Oh Sunny what have you done to me?

The "good mechanical condition" Chinese made pick-up, Sunny, decides to lose electrical power coming down a long hill.  I coast to an intersection of main roads where there are a few shops and lots of people hanging out to make the Matatu transfer.  I try to act like I'm just using my cell phone and there is no problem but after a while I have no choice to exit Sunny and see what I can do.  I'm surrounded by a number of guys soon after.  I quickly use my 10 words of Kimeru so to seem like a local but, of course, I'm whiter than the color of my vehicle.  A good thing about driving a piece of crap is that it appears you have no money.  A peek under the hood shows a loose cable to the battery and is resolved in a life sparing 10 minutes.  Of course, everyone who looked under the hood wants some schillings for their assistance.  I toss a 100 schilling note ($1.25) and tell them to split it.  Off I go.

Sunny and I started off so well.  Fickle girl.

Me and Sunny

Decided on another weekend get away.  A friend in the village says I shouldn't pay for a car as he has an extra and is in good mechanical condition.  Great I say, how about noon on Friday?  Well, 12:45 rolls around (which is early for a noon appointment) and in comes about a 40 year old small white pick-up by the brand of Sunny - I think Yugo took over this brand and improved it.  I figure what the hell, I can't hurt it.  I squeeze into the front seat with my knees wrapped around the steering wheel and head hitting the roof.  Now, everything is left hand drive here so it's even more challenging trying to pump the brakes (are brakes part of the mechanical system?  I should ask my friend), downshift and stay on the left side of the road without running into anything.  Fortunately, the river lodge I'm going to is only 70 kms away and the road is decent and I can average 40-50 kph without fearing a catastrophe.

This weekend is certainly going to be an adventure.  If you don't hear from me in a couple days, send out a search party on the road from Meru to Timau.  :-)

Malaria sucks

So, most of the time malaria is easier than treating a cold.  Quick test, some tylenol and antimalarial medicines and you are on you way.  The last couple days really have sucked with sick kids from malaria.  I come back to the clinic from lunch and find mom holding a 3 year old in her arms that only responds to painful stimuli but starting to arouse.  He's been sick for a day and had a seizure about 30 minutes before.  His temp is only 38.9C but this is after the seizure and expected to be lower after the muscle activity.  He is sick and needs to go to the hospital but what to do before he goes.  His gag is good enough to get oral tylenol down but what if he has another seizure.  The saline IV drips I bought last time are gone and could do just an IV but reluctant to give any IV meds if he is being carried down the road.  Maybe I could give some IM diazepam to possibly prevent seizures on the way but there's no way to monitor him.  Does he have just a febrile seizure that happened because of rapid rise fever or perhaps cerebral malaria?  Perhaps both.  Shitty choices to make.  I give him the tylenol and tell the parent to get him to the hospital as quick as they can.

Most of the time this is fun, sometimes not so much.

Disparity

Today I saw many sick children but one stands out.  A 9 year old boy that had been abandoned by his mother and left with some extended family member.  I could tell when he entered he was in serious condition.  In the ER, a code would have been called and rapid transfer to a children's center would have been done immediately.  He had been sick for about a week but it was obvious that malnutrition was a big problem as he was emaciated and weighing 19 kgs.  His respiratory rate was over 50 at rest and initial temperature 40+ C with a heart rate of 160.

Here the difficult part comes.  It's apparent this child needs to go to hospital but he hasn't been well cared for in the past and questionable if the adult will take him and pay for treatment.  I've seen it before so my approach is to evaluate, start treatment, give the full course of medications (in case they don't go to the hospital), and hope the child makes it to the hospital.  I treat him with max dose of tylenol, ibuprofen, and start the antimalarial meds and amoxicilllin while waiting the results of the lab for typhoid and malaria.

After about an hour, he is positive for malaria and negative for typhoid but his heart rate, respiratory rate, and temp remains unchanged.  Tough little guy but he is sick as hell.  I emphasis to the adult he needs to go to the hospital and cannot tolerate walking 10km in the sun.  I give her the medications in case she decides to go home instead.

The disparity is here.  Her reason to bring him to the clinic was that her well nourished 4 year old daughter (who weighed almost as much as he did) had a cold.  I guess it is admirable that she would even take him in but it is tough to see the terrible life he must endure.

A day in the life of ......................

Typical day:

0430:  Chicken makes obnoxious chicken noises and wakes me.

0440:  Chicken goes back to sleep and I toss and turn.

0528:  Fall back to sleep

0530:  Wake to the mulching machine used to grind vegetation to feed the cows.  I like the rhythmic sound of the machine.  Chicken makes chicken noise.  Hate the chicken.

0545:  Attempt to disentangle myself from the mosquito net and climb down from the top bunk of the bunk bed.  Hope the bed, which is designed for 120 pound Kenyans, doesn't collapse as I drop off the edge.

0550:  Bathroom events.  Hope the water tank is full otherwise cold bucket shower is in order.

0615:  Try to access the internet as morning is best time.

0700:  Served breakfast - something new everyday but always with strong tea mixed with 50% rich and fresh milk.

0800:  Off to the clinic through the shambas.

0810:  Arrive clinic usually to find it like an earthquake happened.  Kenyans like to wait instead of cleaning at the end of the day.  Put all the medicine bottles back and tighten lids that Ruth left all over the desk from the previous day.  Mop floors if we have water.

0815:  See patients

1300:  Walk home to have lunch waiting for me.  Again, a variety of foods but always fresh.

1400:  Return to clinic.  See patients.

1630:  Stop seeing new patients and tell those waiting to come back tomorrow.  Nobody leaves.  Finish up pending patients.

1700:  Leave clinic with people waiting outside in disbelief I am leaving.  Tell them "tono arojo" or see you tomorrow.  Take a quick peek to see if anyone looks like they are dying.  The staff works long hours and if I stay, they stay.  The nurse makes just over $100 per month for 6 day week and no holiday.  I figure they should go home at 5:00pm.

1715:  Sometimes hang out and relax or sometimes take the 3 km hike down to the tarmac and relax at Black Africa.  I have to admit I was first reluctant to go into a building called "Black Africa" being the only Muzungu around.  It's sort of a bar/restaurant where people from the neighboring towns go to have a beer or choma (bbq goat usually).  The people there are very friendly and I'm a big hit as I usually leave a 50 cent tip.

1900ish:  Walk back up the hill and wait for the peering eyes from the bushes whisper "muzungu, muzungu".  I usually roar at the kids and they scream and run away.  It's lost some of the affect since I do it a couple times a week now.  I'm still warned not to walk back up the hill as it could be dangerous but everyone knows I work at the clinic and it is doubtful anything would happen with so many eyes watching.

2000:  Served dinner at home despite tell them I'll be eating at BA.  Pick at a few bites while watching "in the name of love".  My family can't speak a lick of English but just love the Mexican soap opera dubbed by Japanese into English.

2100:  Try to crawl back into the top bunk without any collapse.  Read.  Hope the chicken has a heart attack while sleeping.

Code Brown - where the hell did that elephant come from?

I took the opportunity to escape for the weekend and rented a car and drove to a mountain lodge on the southern slopes of Mt. Kenya.  Beautiful place built during the colonial times and since have added some cottages.  It sits on sloping hills that come down to a clearing where, on occasion, the elephants partake in the salt lick and then drink from at one time was a swimming pool but now turned watering hole.  I was fortunate the first night to watch a herd of about 25 with 5-6 babies come from the dense forest and spend about 2 hours just 200 feet away from the lodge.  At night the jungle comes alive with all the night life and is eerily loud.  No electricity so it is pitch dark and I've never seen stars like are in Africa when the moon is dark and no lights are on - just incredible.

Getting to the lodge is a bit difficult the last 5 kms as it is dirt, steep, full of holes and rocks.  On the way back home I was in my tinny little toyota trying to avoid getting high centered or stuck in a hole.  I come around a corner and on the road about 70 feet in front of me is a full grown elephant and a juvenile.  The pucker factor increased dramatically when a quick math calculation revealed that I could reverse at 2 mph and the elephant could charge at about 30.  Hmmmm, this really sucks.  I've been on safari before and I've seen the guide rev the Land Rover engine to get them moving.  I give this a try in my 90cc engine.  I could have farted louder.  Should I honk the horn?  Nah, this would probably just piss them off and result in a worse situation.  I just sit tight and after about 10 minutes they finally move on and I pass without incident.

As frightening as this situation was, it wasn't nearly as dangerous as the drive down.  Just north of where I am a crop called "mira" is grown.  It's a bush and when chewed, causes a stimulant with mild hallucinatory effects.  You can tell the guys who chew mira as their eyes are buggering out, blink about once every two minutes, talk a mile a minute, and constantly cram more leaves in their mouth.  This is a lucrative crop and is exported to the Arab countries.  So, these stoned guys load a pick-up truck to about 20 feet tall and head to Nairobi down the treacherous road.  Usually on the wrong side of the road, going 150kph, horn blaring, eyes wide, green crap dripping from their mouth.  Appraently the mira drivers are well known to cause many accidents.  Give me the elephant any day over these lunatics.

I'm a lucky bastard.  I wonder how many lives I have left?

Frustration

My last visit I spent much of the time explaining to Ruth about appropriate antibiotic use.  It's terribly overused here and now that the Chinese have given the Kenyan government 40 billion doses of amoxicillin (of which about 40,000 are at our clinic) it is even more difficult to control.  Anyone who has a cough or thinks about coughing gets antibiotics and usually for a course that wouldn't be effective anyway.

So, I see a patient that appears to have a viral upper respiratory infection but needs to be tested for malaria.  I need to leave so tell Ruth to give the patient some tylenol and treat for malaria if positive.  Patient comes back 2 days later wanting more amoxicillin for their family as they have run out.  I check the card (every patient gets their visit recorded on a 3x5 card) and see that Ruth has given the patient antibiotics.  I ask her why and she says the patient has a cough.  rrrrrrrrrr Sometimes I feel more frustrated than a 13 year old boy surrounded by 16 year old girls.

Taking a holiday - rented a car and going to a mountain lodge to sit around and watch the elephants.

Monday - almost the same as home ....... except

Monday is a busy day, probably the busiest day of the week.  Today I saw about 30 patients and 23 of them were positive for malaria.  Of the 23, 21 were children under the age of 6.  It's almost like seeing kids with URIs -  a few tablets and off you go.  There are some that you can tell even before the exam begins that they are sick and it is uncertain about their outcome.  These I worry about.  It's probably only one or two a day but still very concerning.  I tell them to come back in a few days but rarely see them again - do they survive?  I'm not sure.  Sometimes I suggest the hospital for further treatment but I can see it in the mother's eyes that they cannot afford such a luxury..........

Sometimes Kenya makes me sad.

 The typical response to the Muzungu factor.

The New Girl and Toilet Seat Etiquette

Where I am staying is pretty comfortable for most people in this area but it is still very rustic by U.S. standards.  My family hires a live-in girl to help with the cleaning, cooking, etc.  When I was here before the girl was very shy and avoided me but we eventually became friends and she was of great help.  Upon my return the previous girl had been replaced by someone who gave me the "eye" when I first arrived like "who the hell is this white guy and how much extra work will I have to do?".  The living situation is that I am in the main house, the parents in their own area, and the house girl stays in a closet/bedroom.  Now, from my past experience, the house girl has her own place to shower and toilet and the main house is for my use unless visitors come.  Last time the toilet seat was broken and I sort of fixed it so that it worked as a "sitter".  Upon arrival it was off in the corner.  I fixed it again but the next day off in the corner again.  Hmmmm, I wonder why since I'm the only one sitting here?  I take out the leatherman tool and affix it properly so it can't be removed but one hinge is still questionable - fixed.  I get up one morning rather tired and sit down to find the seat up.  I know I left it down and I've heard strange noises at night and flushing so I'm suspecting she is using the toilet so she doesn't have to go outside but doesn't like the seat down and sits on the rim.  First time I've run across a girl who wants the seat up!  Never could figure girls out.

Life stops at 8:00 pm or WTF?

So, everything comes to a stop in Kenya at 8:00 pm.  There is this Mexican soap opera called "in the name of love" that is shown at that time and apparently can't be missed.  The funny part is that it is in Spanish that is dubbed to English by Japanese speakers.  English is fairly well understood in Kenya if spoken very slowly and clearly thus the dubbing is at about 50% of the speed normal English speakers would use and there is a 20 year old girl with Japanese accent for the 80 year old grandmother.  So it goes like:  Oh .......... please .............Erica ............ do..............not ...........waste.........your..........life..........on............Juan........Pedro........Santos.............Guiterraz

You can't get a beer, a taxi, or a life saving injection between 800 - 900pm.

Ok - I watch too.

The Speed of Kenya - pole pole

Kenya has surprising good technology in some respects.  Everyone has a cell phone and reception is available in most of the country.  Money is transferred from one cell phone to another thus eliminating the need to visit town or wait in long lines or use banks to a large extent.  Internet is another story.  I write this blog on a USB modem that connects to the internet via cell phone reception.  The Safaricom service comes with an ability to monitor the speed of the upload and download.  It appears my average speed is about 32kps - yes, that is a "k" and not a "m".  I'd like to attach photos to the blog but might have to wait until I get home.

Pole pole is kiswahili for slow slow and describes the lifestyle.  It couldn't be more true for the internet here.

Sex for 20 bob in a matatu

First, a bob is the equivalent of a penny in U.S. currency of 100 units per dollar or schilling in Kenyan currency.  Twenty bob is about twenty-five cents.  Second, a matatu is a van used for transport between towns.  It has seating for 12 but most often carries closer to 25 or more.  Often sitting in each others' laps or some other awkward and sweaty position.  This, combined with the frequent bumps in the road, results in a rather unique experience.

Sunday - Fire, Brimstone, and 800mg of Ibuprofen

Ok, so the clinic is sponsored by the MCK (Methodist Church of Kenya) and it is expected to attend church services on Sunday and especially so if you are the only muzungo in town.  I've learned from past experience it usually is wise to premedicate yourself with some anelgesic to best survive the three hour experience.  It is pretty much fire and brimstone service with amplified technology at an OSHA violating, ear damaging level.  Most of what I was praying for during the service was the electricity would go out and my tinnitus would subside, and that my heat exhaustion wouldn't become heat stroke.  Fortunately, the service would be interrupted by the occasional need to collect money, sell a chicken, or to sing a song and a short respite would be allowed.  I'm planning on a short trip next weekend.

Kenyan voices

My most favorite part being here is the walk to the clinic in the morning.  The area is rural and made up of shambas (small farms).  I walk down a trail bordered by coffee bushes, banana trees, and many other crops.  On the way to the clinic I pass by the primary and secondary schools where about 400 girls attend.  In the mornings they are all together and singing and clapping to African songs.  This never fails to bring a smile to my face and a feeling of contentment. 

Life at the clinic and communication differences - or please, just the facts

The staff and the patients are very nice but there certainly are some cultural difference.  Ruth, the RN, helps with the translation during the exam.  Now I'm a sort of "just the facts" type of guy and generally prefer to skip all the extraneous stuff but life is different here in Kenya.  Here's an example of a typical interview:

Me:  What's brings you to the clinc?

Pt:  After 2-3 minutes of communication to Ruth, "a cough".

Me:  Is that all?

Pt:  2 more minutes, "yes".

Me:  Do you take any medicines?

Pt:  2 more minutes, "yes"

Me:  What are they?

Pt:  2 minutes, "Amox"

Me:  When was your last dose?

Pt:  2 minutes, "three months ago"

and so on.

Conclusion of exam and treatment and sending the patient home:

Pt:  "I have a headache and pain in my joints"

Me:  (eyes rolling) Really, what part of "is that all" wasn't clear?  Lets test you for malaria and start over.

Kimeru language has words for yes and no but they are rarely used.  Everything is a story here.

Back to Africa or the return of the big, fat, white chicken

I guess the title needs some explaining.  At the conclusion of my last trip to Ukuu I was presented with a big, fat, white chicken (seems ironically fitting) that was expected to accompany me on the return to the United States.  I left it under the care of my host family which it is now waiting for me.  Given that it lives 4 feet outside my bedroom window and likes to remind me of it is still here at 400am, I think it's time to serve it up for dinner soon.  I'll try to post before and after photos.

If you haven't read the previous post about Ukuu, I'm back at the clinic for 5-6 weeks during January and February 2011.