Kenyan Power

I’ve been back in the OR a little bit lately because the OB/GYN is back from leave, and a mzungu orthopedic surgeon is now operating once a week. Wednesday was a full day of cesarean sections, hernia repairs, and mending of broken bones in various ways. Good fun.

Here's the OR, in case anyone hasn't seen it yet:



Adding to the fun was the fact that no fewer than 15 times did the power go out that day. When this happens, the OR is pitch dark, the ACs shut off, everything. It’s pretty amazing how quickly those rooms heat up without AC, and it makes me thankful that we’re not in a place where there are no ACs in the OR. These dark spells last for about 20 seconds, at which point the backup generators kick on and all is well again (for about 30 minutes or so). It’s a little unnerving to have someone’s body open and all of a sudden you can’t see your hands in front of you. As you might imagine, the best thing to do in that situation is to just stop everything and wait for the power to return, so not to cut anything vital.

I’m not sure how the power grid here works; I know that in the US there are often outages when everyone’s ACs are working overtime, but there just aren’t many ACs here to begin with, and very few people run then during the day (it’s very expensive). I guess the simplest explanation is that the power grid is poorly designed.

Anyway, the surgeries were interesting. The guy with the femur fracture required a lot of traction to get the bone in place so a rod could be placed in the middle of it, and I was the biggest guy around (surprise, I know), so I was called in for the job. If you took a picture and photoshopped out the blood and the bones and inserted a placid lake, you would have thought I was waterskiing, I was leaning back so far. Someone at the head of the table had to hold his shoulders so I didn’t pull him off of the table. Ahh, the subtle art of orthopedics.

Friday Night Ritual

No matter where you live, the weekend is highly anticipated. We are lucky enough to be able to have a beer on the beach whenever we are home.



It's a nice view. Happy weekend to all!

Recess

You know how American parents always say “my child has so many toys but he only wants to bang pots and pans together!”? Well in Kenya, they take that seriously. Despite ample play time, our school has very few real toys. The ones we do have were donated by tourists and they are quickly broken or get very dirty since we have no way to keep the dust from blowing in the classroom.

It doesn’t matter to the kids, however, because they have an awesome time with what’s available. Plastic soda bottles make great sand toys:



The boys also love playing with the spare tires that someone donated after they wore out. They race them, slam them into trees, and chase after them when they roll down the hill:



And then there was the time that the maintenance men cut down some branches and just left them in the playground. We’re not sure if they forgot or were just being lazy but the kids co-opted them into a great jungle gym for a while:



They played on the branches for 3 straight days until a little girl fell off directly onto her head (she was fine). Then I took matters into her own hands and recruited the gate man to help me drag the branches off the playground. The other teachers thought I was insane since no one here does anything that isn’t in their job description, but I was annoyed that the matter wasn’t being handled promptly and now one of the kids had been injured. I think they were shocked that a mzungu woman was dragging branches around but the gate guard and I got the place cleaned up pretty quickly.

For the most part, however, I am learning to let the kids play with whatever they find. The first few days I was concerned that they were playing with garbage, running on the playground with lollypops in their mouths, and whacking each other with sticks but then I shrugged off the American and embraced the Kenyan. These kids are growing up perfectly fine just using their imaginations and what’s on hand.

Lost in Translation

Often on Sunday afternoons, depending on the tides, I’ll head out to the beach to snorkel a little bit. There’s a decent reef a few hundred yards off of the beach, though you have to walk through a minefield of sea urchins and stonefish during low tide to get out there. The Beach Boys use these prickly creatures to their advantage. Whenever they see a mzungu walking out to the reef alone, they shout, “very dangerous! Stonefish! If they sting you will be a man without a future!”. They then hurry over to the startled tourist and “escort” them to the reef, and then demand payment for their services. En route, they often regale the foreigner with tales of woe to increase their payment, when in reality, they’re just 20 year old men who don’t want to get a job. Several have asked us for gifts, medicine or told us that we’re lying when we say we’re volunteers. While we have sympathy for the poor of Kenya, these guys are not the poor, they’re the lazy.

If they can’t get you to buy something using friendly tactics, they generally try to annoy you enough that you pay them something to just go away. Sadly, countless tourists have fallen for this trap making this a lucrative job since you do nothing but run your mouth all day long.

Anyways, as you may have gathered, we’re pretty over the Beach Boys, so we tend to talk to them a little in Swahili, act slightly cold-shouldered, and they generally get the point pretty quickly that we’re not giving them anything.

This past Sunday, I went out and a guy of course began warning me of the stonefish and offered to take me out. I responded with, “rafiki, tafadhali, ninataka kutembea pa moja”. (Friend, please, I want to walk alone.). He continued walking a few steps behind me, but I was definitely giving him the cold shoulder. I then told him in English, “ I don’t want or need your help, please leave me alone!”. Still a few steps back. I tried the Swahili again, and he continued to follow. Finally, we arrived at the snorkel spot and he asked for “kitu kidogo” (something small). I told him that I wasn’t going to pay him and he can’t just demand money from people who don’t want his help. I dove in and he walked dejectedly back to shore.

After my dive, I told E the story and she commiserated in the Beach Boys being really annoying. Then she asked me how I told him I wanted to walk alone.

Me: “Ninataka kutembea pa moja”.
E: “M, ‘pa moja’ means ‘together’, ‘pekee yangu’ means ‘alone’”
Me: [Facepalm] “Well now I just feel bad.”

The poor Beach Boy much have been so confused. I coldly told him “I want to walk together to the reef”, and then a few minutes later told him to leave, and then with increasing anger said that I wanted to walk together. I guess I need to hit the books a little more.

Animal House

We are being invaded by many creatures, not just insects. M found himself face to face with a very bold baby lizard the other day (that's the black speck standing on the hat):



We have lizards all along the walls of the house and you often see them crawling into hiding spots in our closet. Houses here aren’t really sealed like American houses and there are no screens on any of the windows so entry is pretty easy.

Kenyans also seem to have opposite opinions from Americans about which animals are “indoor animals” vs. barnyard animals. Many families keep their cats and dogs outside almost as strays but house their livestock (chicken, goats, and cows) inside with them at night. Livestock represent their savings and prosperity while cats and dogs are basically just another mouth to feed. The idea of a housecat or a lapdog is completely foreign to them. And while M agrees with them on the cats, we do miss our Baker boy when we see the dogs all around Diani looking so skinny.

The Ants Go Marching (Through Everything!)

I returned to the coast on Friday afternoon after an enjoyable ride down from Nairobi with Jamie, Linda, and 3 college girls who came in from the US to work with Linda in her slum ministry over the next few months. It was really fun meeting everyone and sharing our experiences with the girls. Linda and Jamie have much more experience here than I do but I was able to describe to them some of the things that Linda and Jamie don’t do like ride matatus or getting harassed while running.

We had a nice weekend that included a uniquely Kenyan meeting of a “wedding committee” (more on that later this week) and of course I unpacked and got ready to return to school.

Returning to the coast from Nairobi pretty much always means sweating. You go from 5,000 ft above sea level and 75 degrees to sea level, 95 degrees, and 98% humidity. You get seriously, seriously sweaty almost instantly. Not like, ooh, I’m a little warm. More like sweat rolling down the backs of your legs, your arms, and your neck while you’re doing nothing more than sitting in a chair. Like you stick to every chair you sit on and you have a bum shaped wet spot on your skirt when you stand up (yeah, it’s awesome and not at all embarrassing). And my personal favorite, if you reach up to touch the hair touching your neck it’s so damp that you can ring it out. I haven’t worn my hair down in Diani in 2 months and I’m pretty sure that streak will continue until April when the heat allegedly breaks. You drink water all day long and never have to use the bathroom because you dehydrate that fast. Even the Kenyans are hot at this point; the weather is basically the first topic of conversation with almost everyone. I am still happy to be avoiding the blizzards in the Northeast but it’s definitely an adjustment.

While the humans are suffering, the insects (wadudu in Kiswahili) are thriving! Any tiny speck of food is instantly swarmed by ants, and this morning we had no fewer than 10 flies at breakfast. We ate in less than 10 minutes because as we’ve learned, eating slower just draws more flies.

The upside though is that I’ve learned new skills. Ever wonder how to get ants out of your sugar? I know that you’re thinking, “you throw out the sugar” but that’s a very American answer. The Kenyan answer is to heat up the sugar bowl! They crawl right out and run away.

Those black specks are ants in the sugar and there are thousands:




Know how to stop a line of ants in their tracks? Sprinkle baby powder across your doors and windows, they won’t cross that line and it smells good!

Can’t keep ants out of your baking? Prepare everything in bowls on plates filled with water! Having fun yet?

There are even ants in Tanzania that bite so hard you can use them as sutures in the bush. Actually, they’re more like surgical staples. Let them use their huge, scary pincher jaws to bite closed your wound, and then separate their heads from their bodies!

Anyway, it’s become sort of a game to stay one step ahead of the insects. The one insect that has so far outsmarted us though is the mosquito (pronounced mos-skwee-toe here). Most of the time, M is completely immune but I seem to collect 3-4 bites per day. I think we’ve mentioned that we’ve got separate twin beds (it’s cool, we pretend like we’re my grandparents) but there is an unexpected benefit of this. You see, M’s feet actually stick way, way out of the bed and this lifts up the mosquito net:



M, being immune, has no problem with this and rarely even gets a bite. On the rare occasions that we have shared a bed when we travel, I get eaten alive as M’s feet give them a convenient little entry under the net. It’s basically a decision between me staying up all night swatting mosquitos and him staying up all night since he doesn’t sleep at all unless he’s more stretched out. So, as much as it’s weird to have separate beds, I guess it serves the purpose of preventing me from contracting malaria so it’s probably worth it.

Here I am under my net!


Hope you all have a great week and stay warm!

Sad Medicine

Yesterday I was talking with one of the pediatric nurses (Yasmin) with my research advisor about some of the patients in our study. As a reminder, this study recruits women when they were pregnant, a bunch of tests are performed to determine if they have various infections (i.e. HIV, malaria, schistosomiasis, hookworm, etc.) and then follows their children every six months after birth with medical checkups. We were curious about the dropout rate in the study, as it seems to be pretty high. We asked Yasmin if she knew why patients stopped coming, and she said that it’s because of the high divorce rate among the Digo people. Apparently when a couple has children, if they divorce, the children automatically go to the father, and the father then generally hands them off to his mother, which is often far away from the hospital, and even if they live nearby, it is usually not communicated to the grandmothers that the children are in the study, so they stop going.

The research project has been going on for over a decade, and this is the first time my research advisor has heard about this. I have a feeling that the Kenyans conducting the research here knew about this, but it was normal to them, so they never thought to bring it up. Goes to show you how you can’t take anything for granted.

Another not-so-fun fact:

About 5% of mothers in this study are HIV positive, and obviously one wants to reduce the risk of transmission to the unborn child, which can be effectively done by giving the mother a drug called AZT in the later stages of pregnancy. However, it was found that 30% of children born to the mothers at this hospital were HIV positive, when with proper AZT treatment, the rate should be less than 5%. Yasmin said that even though AZT was free, the mothers often didn’t take it. Apparently they can’t be picked up at the normal hospital pharmacy, or be dispensed by Yasmin in the privacy of the clinic, but rather there is a separate window where all HIV medications are picked up, and only after several other tests. The stigma of being seen at that window prevents proper care.

The drugs are dispensed by the CCC, or Comprehensive Care Center, which is a country-wide program set up to treat HIV/AIDS, funded by PEPVAR and USAid. It is definitely a well-intentioned program, but like so many others run by the government, it is bloated and inflexible. They have their template for how they set up shop in a hospital, and they don’t deviate from that. One would think that once told that their location is preventing patients from getting the proper care, they would figure out another solution, but no, they are how they are. So, about 10 babies have been born with HIV over the course of this study due to bureaucracy. Really sad.

E is still up in Nairobi helping out with the kiddos, but I'm happy to report that she's returning on Friday!

Change of Plans (aka Aunt Ellie to the rescue)

We were supposed to leave yesterday to drive home to Mombasa but we had a little change of plans. Chris started feeling some familiar pains on Saturday; this is his third bout of pancreatitis in the last 6 months. He was hospitalized and although this isn’t a life-threatening condition, it’s extremely painful and we expect him to be in the hospital until at least the end of this week.

We knew M had to head home because his lab advisor is in town but I have some flexibility in my schedule so I offered to stay. We have 8 kids under 15 (Chris and Jamie have 5 and Linda and Jim have 3) so having an extra adult on hand allows Jamie to spend time at the hospital with Chris. Plus, Linda and Jim can continue on with their work while their kids are at school (Chris and Jamie's kids are homeschooled).

Below are M and Z, the youngest at 3 years old. Z is hilarious and is fond of saying things like “hims bumps hims head on the ceiling” about M. He also said, “your head is like a hedgehog, no no no, like a sea urchined” about M’s hair. The most famous Z quote though is actually about the slums though when Linda took him one time: "It smelled harrrible in dere, I'm about to fhrow up." He's hilarious.



Let me tell you, going from no kids to 5 is a handful! The kids are very well behaved but they’re energetic and there are a few who miss Mom and Dad a lot. Two nights ago I had M’s help and we sat on the couch while they ran around and played a game of capture the flag and some sort of fake war game. I’m more accustomed to the chaos than M from teaching kindergarten so I laughed when he said “um, should we stop them?” I informed him that they’d do this until they were tired or someone cried and as long as they were playing nicely (and loudly!), we should let them carry on. They collapsed like puppies after an hour and we didn’t have to entertain them!

Last night's bedtime was a little stressful since it was just me and the requests for water, potty, and food got a little out of hand but everyone was settled and sleeping at about 10.

This morning I led a mass cleanup of the house on the Baptist compound and though the troops were less than happy, the house is more workable and everyone has their own clothes sorted into drawers instead of just pulling things in and out of the suitcase they are sharing. The lack of organization had placed me at a huge disadvantage since I would pull out a clothing item and of course it didn't belong to the person I was trying to coax into dressing. Now I am on top of it and I think that should cut down on the wearing of dirty clothes.

Mealtime is another thing I'm rusty at since I haven't babysat for a while. Trying to fix a simple meal for 4 kids (I make G the oldest pretty much fend for himself), ensure that they eat it, and get the minimum number of fruits and veggies to fend off scurvy is complicated since I don't know their preferences. I am on the hook for some surprise dessert tonight since I used the "if you don't eat your carrots, you can't have dessert" line at lunch today. That could end up being a rookie mistake but I'll figure something out.

Really though, joking aside, I’m thrilled that I can pay back Chris and Jamie in some small way for their generous friendship to us over the last 5 months. Plus, I have already earned Mean Auntie Ellie status when I banned brownies for dinner last night. So things are looking up from here!

Now I've Seen Hell

I went to Huruma and Githogoro, two Nairobi slums, last Thursday. And it’s like nothing you’ve ever really seen because it's absolutely hellish.

This visit was one of the main reasons we joined Chris, Jamie, and their family on the roadtrip to Nairobi. Over New Years, we met some family friends of theirs, Linda, Jim, and their 3 kids. Linda and Jim live on the Baptist missionary compound in Nairobi and work with the slum and media teams. When Linda offered me the chance to see the slums, I knew I could not pass it up because I felt like it’s a really crucial part of the story of Kenya.

Over a million people in Nairobi live in slums or kijiji which means that 1/3 of the people living in Nairobi live in slums. Pick any huge problem and it’s here: lack of water, electricity, medical care, and nearby schools mean extreme hardship for the people who live in the slums. Compounding the problem is unemployment since the few jobs available to slum residents are typically a several hour commute through notorious Nairobi traffic. And those are just the resource-related problems. Rapes and other violent acts are extremely common and the lack of toilets means that most human waste is put into plastic bags and just thrown outside the houses. So there are the human dignity problems as well.

Linda works directly with local churches so that she can be introduced to connectors within the slums and to increase the safety of her work there.

Our first visit was to Rose. Rose is HIV positive and had been moved that day to a home for the elderly within the slums. She is about 45 years old but looks about 85 and probably weighs about 70 pounds. Rosemary is a woman who works on the Baptist compound and has been accompanying Linda in her slum work for the last 2 years.



Rose's current condition is actually an improvement from a few months ago when she was blind. She has become a Christian in the last few months and Linda has been encouraged by how much more hopeful she has been in the last few weeks. Even though she had just lost her home on the day we visited, she was still in remarkable spirits. The home for the elderly doesn’t know about her HIV positive status so we were careful to not mention it. Linda is hopeful that living in a community as opposed to by herself in the slums will be safer.

As we discussed her health, several other women came up to discuss medical issues. Although we’re not medically trained, several of the diagnoses were quite obvious including a dislocated and fractured arm and shingles. We were powerless to do anything for these women because Linda’s ministry has very little money and of course dispensing so much as an aspirin will create a stampede. It was so frustrating to see problems that are solved so simply in the US with medication but I was somewhat prepared for that.

Our second visit was to several women with whom Linda does Bible study every week. On the way there, we ran into about 20 kids who followed us through the slum and eventually crowded into the home that the woman lived in with her grandchildren and goats. Yes, the goats live inside so they aren't stolen. And grandmas raising babies is extremely common since the HIV/AIDS crisis began.

The kids are so sweet but they run up and grab your hands and try to take off your watches or rings. They are used to wazungu (white people) stopping by for photo ops and to drop off food and sweets and leaving. Nairobi slums are notorious for Hollywood celebrities or sports stars (especially soccer players) showing up for 20 minutes before going to their hotels. The people here need all the help they can get but you can tell that the adults are very wary of outsiders for this reason. Why trust anyone will actually help you consistently if people usually leave?

There’s not much more to say except that I am continuously humbled by this place. I think the pictures probably do it more justice than I can:





This little girl was totally calm as I took her photo but when I said "Wewe ni mrembo" (you are beautiful) to her, she started bawling. She had never seen a mzungu before so the fact that I could talk, really scared her:

Gone Fishin'

For Christmas this year, E and I decided that we should forgo the more traditional gifts in favor of experiences that we wouldn’t be able to do once we left Kenya. E had the idea of going deep sea fishing, as it’s something that I’ve always wanted to do, and the Kenyan coast has the best in Africa, and some of the best in the world. Somehow, she convinced me that this was also a gift for her, as she would so enjoy seeing me catch the fish. I’m not sure about the logic there, but I am sure that I have an awesome wife.

We reserved a day with the Pemba Channel Fishing Club, an outfit south of Diani that was started in the good ol’ days of colonialism, and is currently owned by British Kenyans. We invited along our friend Chris and his 13 year-old son Gavin as a little Christmas gift to them, since it didn’t cost any more to have four on the boat rather than two.

We were picked up bright and early at 5 am on Jan 2nd, and then drove an hour south to Shimoni, where we were met by Steve, a Kenyan Brit who had been working with the company for 30 years. We enjoyed some fresh fruit and coffee as we waited for the crew to get the boat ready. In the open-air bar / sitting area were mounted marlin and many faded photos of fisherman and their massive catches. Though the odds were low, I couldn’t help but hope to add another photo to the wall.

We slowly motored out to deeper water and the crew put let out about seven lines at different distances from the boat. Some of the lines were aimed at smaller fish that could be used as bait, and others were for the prize: Marlin. Coming in, I knew that marlin were not caught very frequently, but these waters were as good as any for a shot.

We sat back and enjoyed a few drinks as the land slowly disappeared from view. About two hours in, something hit one of the lures, and Ali, one of the crew, grabbed a rod to see what was going on. Nothing was on the end, so he jerked it back and fourth a few times to try and coax the fish back to the lure, but to no avail. We spoke later and he said that it was a sailfish strike. The way sailfish and marlin hunt is to swipe at baitfish with their bills to stun them, and then circle back around for an easy meal. This sailfish stunned our lure, but then I guess decided that it wasn’t as tasty as it looked originally, so he moved on. Oh well, there are other fish in the sea.

However, for a while, it was looking like maybe there weren’t other fish in the sea. Fishing was quiet for the next two hours or so. At this point, I had to comfort E, as she was getting upset and saying that this was “the worst Christmas present ever” if I didn’t catch any fish. I assured here that I was having a great time anyways, but wanted deep down to catch something as well! Fortunately, not long after, one of the lures was taken and the fight was on!



After a few minute struggle with several spectacular leaps, I subdued a 12ish lb dorado (alternatively called dolphin or mahi-mahi). It was beautiful, and put up a great fight. Dorado are known for their amazing colors when freshly caught, and within minutes of dying, turn a dull gray. We’re on the board!

Our trip was six hours, so after nearly six hours had passed, it seemed like this was going to be the one and only fish. The crew started reeling in the lines, but another of the lines went tight. The crew kept saying that it wasn’t a fish, but I encouraged Gavin to take the rod and start reeling. The fight was a little weird, and it was more like deadweight, but soon enough, the fish was boatside and was brought in; we later figured out that he was fighting strangely because he was hooked through his eye. He was a nice 15 lb tuna! We then made out way back to the dock happy that we had a few fish for the dinner table.



We fed sixteen people that night with the fish, and still had enough for a few meals afterwards. The fish was delicious; the mahi-mahi just panfried with salt and pepper, and the tuna seared rare. We may not have gotten our marlin, but we had an awesome day out on the water with friends, several delicious meals, and a great start to the new year.

School Days

The new school year started on January 4th and there were some changes for the new term. As previously mentioned, there are three classes in the kindergarten: baby class, KG1 and KG2. During graduation in November, the baby class teacher was extremely late (even for a Kenyan) and barely made it in time for our kids to perform. Since I’d been away at Kilimanjaro, I asked Mary where Teacher Esther was. She told me that she wasn’t sure if Teacher Esther would be in attendance. When I asked why, she said “oh, she’s pregnant.” Oh. Of course.

Since I can be honest with Mary, I asked her how pregnancy = not attending graduation and she explained that she’d been fired because of the pregnancy. After I picked my jaw up off the floor, I asked why pregnancy was grounds for termination and Mary explained that since it’s a Christian school, being unmarried and pregnant was not acceptable and she was terminated. Apparently these rules are laid out as a condition of their employment so she did have fair warning but it is still shocking coming from the US. Of course the school should be able to uphold their standards but obviously it’s not something we’re used to hearing.

So, now we have a new teacher, Teacher Rachel. Mary is teaching baby class and after a few minutes of deliberation on the first day, it was decided that I would continue to help out in KG1. This has two benefits: first, I can help out with the 3 children who are repeating KG1 and second, Rachel is less familiar with the schedule so I can be a help to her. I’m sad to be separated from Mary but it’s nice to make a new friend and I see Mary at every break (3 hours/day).

It turns out that I am able to help out Rachel a lot since apparently she received no orientation or even direction about the most basic elements of our school day. In fact within 5 minutes on the first day, a parent called and she asked if she could call them back. When she hung up, she asked me what time school ended. Seriously, they didn’t even tell you when school ended? And/or you didn’t ask?

No one told her the schedule for snacks, breaks, or how to get school supplies either. She doesn’t know the school prayer or the hymn or even that the term was 14 weeks long. Perhaps most confusingly, no one told her what the children covered in baby class or how the alphabet is taught at our school (there are multiple systems basically revolving around pronunciation, it’s confusing). So, she doesn’t know the name of any of the kids and she thought they were all mute because she was singing the alphabet “wrong” for the first 20 minutes of class. I feel sort of badly because it’s her class but most of the kids know me and she’s deferred a lot of the teaching to me; this causes the kids to come to me with questions and or ask me for permission to do things. It sets up a strange precedent especially since I’m intermittently not there when we travel. Rachel is very happy I’m there though since she has 25 names to learn, two languages to issue commands in, and tons of assignments to write out. So, I’m glad I can be of assistance to her.

I think that it's pretty typical though for her to receive no instructions or training. People aren't all that concerned here with "hitting the ground running" because frankly, nothing is all that pressing to most people here.

The kids are still absolutely adorable and I’m actually practicing my Swahili a lot more. Since it’s the start of the school year, we have more kids who speak only Swahili since they tend to learn more English as the school year goes on. Especially in baby class, the majority of the kids speak only Swahili and I’ve discovered that the best approach is to pretend that I understand what they’re saying even if I don’t. I usually can tell whether they need an affirmative or negative response by their body language so this has worked out quite well. Also, they don’t appeared to be fazed by my asking Mary for a word mid-sentence like I did yesterday when explaining why we don’t throw rocks at each other’s heads.

Anyway, it was great to be back for a few days. M and I headed to Nairobi with our friends for the week to escape the heat and visit a local hospital where there are several missionary doctors for M to meet. It was sad to leave after only 1 week at school but it's a great opportunity for M and today I'm accompanying one of the women to the slums of Nairobi where she does ministry. It's weird to say you're excited to go to a slum but I'm pretty sure it'll be an eye-opening experience. Hope you've all had a great start to the New Year!

Medical Dealings

Real life restarted on January 4th. E is very glad to be back with "her kids" and I have returned to my research and clinical work.

I spent a recent morning in clinic with one of the medical officers (read: generalist physician). The usual suspects showed up: lots of hernias, hydroceles, keloids, etc. After the hospital’s surgeon left in the fall, the surgical caseload at this hospital has dropped dramatically, as only the cases that are simple and have a very low likelihood of complication are attempted, as the doctors and nurses have no backup if something goes wrong.

So, we were referring most of the cases to Coast General Hospital in Mombasa, which is the tertiary care government hospital for Coast Province (one of seven districts in Kenya). Coast General has many “consultants”; specialists such as cardiologists, pediatricians, surgeons, and the like. One patient was brought in by his son, who happened to be a clinical officer (read: nurse) at the hospital. The man needed a hernia repair, and the son said that he knew that they weren’t doing that surgery at this hospital anymore. They discussed how much money they had for the surgery, and after some math that I didn’t understand, the man was booked for surgery the next day at our hospital! After the patient left, I asked the doctor what the 6,000 KSH was in her math.

“That’s for us!”, she replied.
“I thought that the 2,500 for ‘theatre fees’ was the extent of the charges?”
“Oh, it is, but this is just a small corruption because I’m doing them a favor and I give some to the anesthetist, and some buys the normal saline.”

Apparently saying that someone has to go to Coast General is essentially ensuring a six month to one year wait for an elective surgery. The patient’s son fully understood this, and seemed delighted that the doctor would accept some under-the-table money to do his father’s surgery. From the doctor’s side, she otherwise has no incentive to take patients to the OR, as government doctors are paid a salary, and if she messes up in the OR, she can be charged with malpractice for performing surgery without a surgeon around. Corruption is so pervasive in this country that this isn’t surprising, and I honestly wasn’t even very upset by this graft. This extra fee seemed to me like a roundabout malpractice insurance. Though definitely not condoning it, but it goes to show how quickly one can become accustomed to a corrupt system.

Petra

The final major stop on our Israel tour was Petra, the ancient city carved into stone cliffs. Remember the Valley of the Crescent Moon in Indiana Jones and the Last Crusade? To be honest, I don’t because I don’t really like movies but apparently, according to M and A, that was Petra. The place was amazing, and deserves its own blog, mostly because of our guide, who was Borat (from the movie for those of you who are not familiar).

We were picked up at the hotel to be taken to the Jordanian border, where we would be met by our Jordanian guide, Abbas. One of the first things out of his mouth was:

“This Jordan, everything start and stop with our King Hussein. We are loving our king. He is very wise. If you have problem, you can look him up on the Facebox and he will help”.

Amazing.

During our 3 hour drive to Petra, I could generally be found hiding behind one of the bus chair silently giggling, as A and M went back and forth with Borat impressions. Some highlights:

“Jordan is very rich in chem-icals; phosfat and potass. We are not number one, but number four in potass.” [he’s talking about phosphate and potassium]

“I have one wife and it is excellent. But, if your wife gets sick, you can take another wife to take care of your wife and take care of you. Or, of you wife does not give you children, you take another wife. Or, if she is a bad wife, you take another wife.”

“We are hating the tourists. We try to help America and kill the tourists. Al-Zarqawi is Jordanian, but the government gave the green light to kill him, so we will kill him for you. We will help you with the war on tourists.”

Oh, terrorists.

Anyway, hilarity of our guide aside, Petra was amazing. It is an ancient city that was founded sometime in the 6th century BC and is a city cut entirely into a canyon. It was founded by a desert culture called the Nabateans and changed hands many times which explains why the architecture ranges from Greek amphitheaters to churches to pagan temples.



As we descended into the canyons (view above), the walls grew on either side, and around each turn, some crazy architectural marvel jumped out at us.



The Nabateans were big facilitators of the many trading routes crossing the Middle East at the time, and that is how they supported this town of 35,000 people (their homes are below).



More temples carved into the cliffs:


I don’t have too much more to say about Petra, as Borat didn’t give a real coherent tour, but fortunately, it didn’t need too much commentary. He was especially amusing to Koko because once he found out that she was Jewish, he included “you know what I mean” and waved his hand at her every time he made a reference to something Jewish/Hebrew. We almost never knew what he meant so that produced even more laughter.

The next morning we sojourned back to Tel-Aviv, had some delicious sushi, went to the airport, and began our journey back to Kenya.



Thus ends Israel 2K10. It was a wonderful trip and we were so happy to see friendly faces. Thank you to Dad, KCK, A, and Koko for making the journey!!

The Other Seas

After the Sea of Galilee and the Mediterranean (in Tel Aviv), we turned the minivan south and headed for the other seas, the Dead and the Red. After passing through Jerusalem, we started descending from 2,500 feet and the landscape quickly turned very stark and dry. I read that Jerusalem averages 22 inches of rain per year, and just a few miles to the west, they average 2 inches per year. After about an hour, we passed near Jericho, an oasis in the desert and considered to be the oldest city in the world. Unfortunately, there’s just so much to see in Israel, we didn’t have time to stop and look around.

Soon we passed the town of Quarum, on the northern tip of the Dead Sea. In the 1930s, a shepherd was moseying through some caves came across a cache of rolled sheepskins. “Score! I’ll have some new sandals made!”, he thought. Luckily the sandal maker was a little more observant than the shepherd, as the sheepskins turned out to be the Dead Sea Scrolls.

We then turned south and continued our trek along the western shores of the Dead Sea. The Dead Sea is the proud owner of a few superlatives. 1) It is the lowest point of dry land on earth, at nearly 1,500 feet below sea level. 2) It is the saltiest body of water on earth; about 10x saltier than the oceans. The Dead Sea is fed by the Jordan River, and it had no outlet, so the water evaporates in the dry desert air, concentrating the small amounts of salt contained in the Jordan River water.



Ein Gedi was our next stop; another oasis in the vast, barren expanse. Here, we were excited to try the must-do Dead Sea activity: Float in the water. I have to admit, I was looking forward to trying it, but I didn’t have real high hopes for it being that sweet. We changed into our bathing suits and made our way down to the water. The rocks around the water seemed smooth enough, but a few feet in, they were covered with what looked like rock candy. Because the water is supersaturated with salt, the salt actually crystallizes on the rocks. Fortunately, the depth increased pretty quickly, so we all just lunged out to the deeper water. It was like diving onto a pool float. You simply could not sink. When lying on your back, the water would push your legs and upper body out of the water. If you oriented yourself vertically in the water, as sure way to sink in fresh water, you bobbed like a cork, out of the water above the nipples. A bizarre, but enjoyable experience. We rinsed off and loaded back into the van, as we still had quite a ways to go for the day.





Next stop: Masaada. Built by Herod the great as a retreat/stronghold on the top of an isolated plateau overlooking the Dead Sea (view from the top is shown above), this town/palace was quite an engineering marvel. Because it was already mid-afternoon, we took the tram up from the base, rather than hiking, though as E knows, I strongly dislike not hiking when hiking is available. Though I felt like a cheater, we proceeded to tour the grounds. Herod was “a lover of fine things”, so this site originally had fountains and swimming pools, which as you can imagine, took some labor to maintain on top of a desert mountain. This complex contained two palaces, a synagogue, many storehouses and smaller houses, a church, and numerous other buildings. Here’s a picture of E and I relaxing in one of the Herodian hot tubs.



One of the cooler parts is in the northern temple complex, which actually spans three different levels of the plateau. We wonder how many workers took a tumble while building this part. In 67 AD, as the Romans were taking over the area, some of the last remnants of the Jewish army and their families bunkered down at Masaada, as it was pretty inaccessible. However, this did nothing to phase the Romans, who just built an earthen ramp all the way to the top of the plateau (1,300 feet), and eventually sacked the place. The Jewish men hiding out actually killed their families and themselves rather than being slaves to the Romans. This story is still a point of pride to Israelis. Fun fact: part of the oath of the current Jewish Army is “Masaada shall not fall again”.

Those are the Roman camps below:


Hilltop fortress: Check. We finished off the day by driving the rest of the way south to Eilat, on the northern tip of the Red Sea. The next day the boys went for a dive in the Red Sea, and the girls had a relaxing spa day, complete with Dead Sea mud wrap, which E describes as “being rolled up like a muddy burrito”. The diving was fantastic; very clear (though cold) water, lots of bright soft corals, lionfish, octopi, rays, and some huge moray eels. Though the Red Sea has some of the best diving in the world, and Israel is overall a pretty expensive country, the diving was about half the price that it is in Kenya. Go figure. We rounded out the day in Israel watching some American football games at dinner at an Irish pub on our vacation from Kenya. You could say we're more than a little blessed.

Jesus: The Road Trip

So if you’ve read the Bible, you know that Jesus was pretty well traveled so after 3 days in Jerusalem and Bethlehem we set out for a Tour de Israel. Luckily Israel is about the size of New Jersey and you’re mostly driving on superhighways between massive stretches of desert so this was fairly easy.

Our first stop was Caesaria, an ancient Roman port built by Herod the Great. This Herod guy liked to build and we’ll hear more from him later when we write about Masaada. So, Herod wasn’t content with just building a port on the sea, he built a palace over the sea. He basically built a giant pier that allowed his entire palace to be built over water and created a harbor. My Dad is a history buff so this was an exciting stop for him; the rest of us weren’t as excited by random piles of stones.



After Caesaria, we headed to Nazareth to see where Jesus was raised. Apparently Nazareth is using the same street plan as 2,000 years ago because the streets are barely wide enough for one car and then people park along them.



After some tricky navigating, my dad managed to get the car parked and we visited the Church of the Annunciation. The most interesting thing about this church is that each country appears to have donated an “icon” or image of Mary and Jesus. Below is Greece’s contribution.



Most countries went with simple depictions of Mary sitting with an infant Jesus and it was interesting to see how each country’s culture impacted their interpretation of the icon. America’s contribution looked like crumpled, 3D tin-foil so apparently Americans prefer the “Jesus as a superhero” theme to our icon. Also, many nations appeared to depict Jesus as their own race or ethnicity and while I fully acknowledge that religion is larger than race, gender, or ethnicity, it was also a little strange. I’ve always imagined Jesus being somewhat Middle Eastern looking though of course he might have looked African or European; I am fairly certain though that Jesus was not of Asian descent. The Japanese apparently disagree:



Next it was on to Tiberius and the Sea of Galilee before stopping at Akko to see a Crusader-era fort. Those Crusaders were also fantastic builders and we were treated to a gorgeous sunset before racing back to Jerusalem for Christmas Eve Service at a
Lutheran Church.



One thing that was very interesting to us was spending time in a country where Christmas was not a big deal. We take it for granted that Christmas is a holiday in the US whether you’re celebrating religiously or secularly. Christmas of 2010 happened to fall on a Saturday but things weren’t closed because of Christmas, they were closed starting at sundown on December 24th because of Shabbat (Jewish Sabbath). This meant that many establishments are closed or take special care to not violate the rules governing work on the Sabbath. Hotels for example install “Shabbat clocks” that turn on/off lights at appropriate times so Orthodox Jewish followers do not have to use light switches. Shabbat elevators stop automatically at every floor so that no buttons have to be used. I have to admit that it was inconvenient that Christmas wasn’t widely observed and it was a brief glimpse of life for people who don’t celebrate Christmas in the US and who have to take vacation days to celebrate their holidays.

Little Town of Bethlehem

After touring Jerusalem, on Day 3 we headed right next door to Bethlehem. However, these are not very friendly neighbors. Jerusalem is entirely in Israel, but Bethlehem is actually in the West Bank, which is controlled by the Palestinians. We had to hire a car to pass over to the West Bank, as free passage isn’t guaranteed unless you’re with a tour and Americans are not permitted to drive there per the State Department. Here we got our first glimpse of the giant wall that was built to decrease the terrorism between Israel and the West Bank. Lovely.



We first stopped for some coffee before going to the shepherd’s field (where the angels appeared to the shepherds, who were of course guarding their flocks by night). While enjoying our Arabic coffee, we noticed a tight cluster of very new-looking apartments on a hilltop, surrounded by a fence. Our tour guide informed us that this was another Israeli settlement, which was heavily guarded, as Israelis are persona non grata in the West Bank. A man stringing Christmas lights on a nearby telephone pole then shouted, “yeah, and they’re killing Palestinians with your tax dollars”. Eeek, tough crowd.

Tiny shepherds in a Catholic grotto near the fields:


The fields had some nice views, but were otherwise pretty unremarkable, save a church built by some Canadians in the 1960, which features a prominent maple leaf on the alter. Maybe they should add a Wayne Gretzky icon to class the place up a little further.

Now, on to the Church of the Nativity, which was built on the site where Jesus was born. Again, the story of a Byzantine church destroyed, Muslims taking over, and Crusaders rebuilding repeats itself. The main entrance, now called the “Door of Humility”, was actually made tiny to prevent locals from coming in with their carts and looting the church. The current church is decorated in Greek Orthodox style, with lots of icons and incense, so it reminds me of church from childhood, although obviously on a much grander scale. Adjacent to the main church is the “milk grotto”; the walls of which turned white when a drop of Mary’s milk fell. The fact that the grotto is made of chalk is a more secular explanation. There is a huge collection of letters from women who could not bear children, and after drinking a little of the chalk and praying, they conceived. Can’t argue with results. A bargain at $2 per bag!

Bodyweight squats at the Door of Humility:



Some nice stained glass:



Crusader mosaic icons:



We had originally planned to come back to this church for a midnight service on Christmas Eve, but after talking to some locals, apparently you have to show up many hours in advance, put up with hassles at the border, and have to be ever-vigilant for pickpockets, so we decided to just got to a church in Tel-Aviv instead.

That pretty much concluded our visit to Bethlehem. After visiting Jerusalem, Bethlehem wasn’t much to see, though the church was nice, and it was interesting to see how different the culture was on the other side of the wall. We recently read a Time magazine article about how the wall has dramatically decreased bombings since its erection, but it has further divided the Israelis and Palestinians. When asked what an Israeli looks like, most young Palestinians describe a person in fatigues holding an M16, as the guards at the border are the only Israelis with whom they’ve ever come into contact. Now, the majority of young people report that they cannot see a peaceable settlement of the land disputes. Not a great sign when the younger generation is much more conservative than the older.

In a different note, I went to the lab for the first time since before Christmas and was greeted with a big pile of Christmas cards! Thank you so much to everyone who sent them, it was great to hear from you.

We received cards from the following, and if you sent and you’re not listed, fear not, mail is extremely slow:

Grandma
Leslie and Rich
Holly and Karl
Mom, Dad, and Justin
Aunt Patsy and Uncle Mike
Aunt Kiki
Carole and Andy

Furahi mwaka mpya! (Happy New Year!)

M

Jerusalem: Day 2

Our second day in Jerusalem began with a visit to the “Garden Tomb”. One of the most startling things about visiting holy sites in Jerusalem is that they don’t look how you expect. So, where Jesus was crucified and buried 2,000 years ago has a giant church built right over top of it and doesn’t look like a garden tomb. This is further complicated by two more factors: first, ancient people didn’t write explicit directions or descriptions so we could follow them 2,000 years later, they wrote for people who knew what and where they were talking about, and second, it’s very challenging to excavate underneath the ruins of Jerusalem without starting World War III so archeological dating is tough. (wow that's a run-on sentence, don't judge me!)



This leads to sites like the “Garden Tomb” which was “discovered” in 1867 when a European tourist looked out his hotel window and noticed a rocky hillside that looked like a skull. In the Bible, Jesus was crucified on Golgotha which translates to place of the skulls. The site has a garden and a tomb and thus looks very much like what was described from 2,000 years ago. Like everything in Jerusalem, including lightbulbs, there are factions who believe this is the location described in the Bible and others who believe that the site where the Church of the Holy Sepulcher is located is the real site. Given that the Holy Sepulcher has been a church since the third century, it seems unlikely that the Garden Tomb is the real site but it was interesting to see how the site may have looked 2,000 years ago.

After seeing the Garden Tomb, we went to see the Dome of the Rock which only allows non-Muslim visitors during non-prayer times. We did not enter the mosque but the tile work outside is absolutely beautiful.



Koko, being Jewish, was not technically allowed to visit the site but she joined us anyway as you can see from the picture below.



We found it very interesting to see which groups prohibited which other groups or required screenings, etc. For example, anyone can go to the Wailing Wall provided they go through a metal detector but Muslims prohibit Jewish people from entering the Dome of the Rock compound. Jewish settlements are in the middle of areas that have been designated to the Muslims by peace agreements and yet defy orders to leave. The picture below shows one such settlement in the Arab quarter of old Jerusalem.



Everyone seems to have figured out a tenuous way to co-exist in old Jerusalem because it’s sacred to all three religions; any act of violence or destruction of a monument could prompt retaliation and it’s not worth it. The same cannot be said for other areas of Israel where people are fighting less about holy sites and more about land rights.

After the Dome of the Rock, we toured the tunnels under Old Jerusalem that basically run the length of the Wailing wall. These tunnels were excavated in the 1960s when the country of Israel took over control of Jerusalem. The tunnels show the rest of the Wailing/Western wall of the former Jewish temple mount. To the Jewish people, this is an important part of their heritage and demonstrates their claim on this land from 2,000 years (and more) ago. To the Muslims who have controlled the city for the last 1,300 years (except since the 1960s), these tunnels are the work of sore losers who are trying to collapse the Arab quarter of Old Jerusalem. As you can imagine, this quarrel is not likely to be resolved soon…in the meantime, let’s have a picture of M not fitting in the tunnels:





Dad, A, and M and their sporty yarmulkes:





Also, for some unknown reason, shirts in Hebrew supporting American professional and collegiate sports teams were quite popular in Jerusalem along with several great t-shirts with puns including my personal favorite, “Guns and Moses”. I guess the one thing that Israelis and Palestinians can agree on is that the Buckeyes are awesome:

Happy New Year!

Hope you are all enjoying a happy and healthy start to the New Year. We took a break from Jerusalem blogging to enjoy a day at the beach with some of our friends.



We went cliff diving and snorkeling at a beach a few miles from Diani. This beach is much less crowded and we had a great time.



We all commented on how surreal it was to be hanging out 'at home' in bathing suits on New Years but we're actually heading into the warm season in Diani.



To say that 2010 was a blessed and exciting year is a huge understatement. We feel so thankful for all that we've learned and experienced and are looking forward to 2011!