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!