So, as some of you already know, I'm at home now, back on Tera firma. There really isn't all that much else to tell you about the summer except for our last adventure to the Masai Mara - an extension of the Serengeti, bordering Tanzania.
We left Lwala quite early in the morning - still full from the previous night's feast. but "when you're in kenya, baby, you eat," so we took some final photos (i'll post photos soon, i promise), and split some freshly picked and cooked Rabwon (sweet potatoes from the garden). In Kisii we met David - our "eccentric" (Grace, that was for you) safari guide. The drive to the Masai Mara was quite beautiful - and it was great to see more of the country side. We saw a bunch of coffee and tea plantations - which were really quite the site - gigantic fields of lush, green tea leaves, spotted with the occasional worker, giant basket in hand, plucking off the top leaves. The agriculture in Kenya is governed by the land that's available. near Lwala, the land and climate is simple unsuitable for tea and coffee - but quite perfect for bananas, sugar cane, and maize. As we got closer to the Masai Mara, the land became quite arid, speckled with Dr. Seuss looking cactus's.
On the drive we saw a lot of Masai with their herds of cattle and sheep, some antelope, and even two HUGE giraffes, just having a snack on the side of road. After five hours of driving, we arrived at the camp site - a beautiful area with gorgeous vegetation and giant platform tents (Dre and I were in a tent for 4 - but had the whole place to ourselves). Our tent was quite the palace with it's own sink, toilet, and shower.
It was nice to feel like we were finally on vacation. For two days we could just relax and do whatever we wanted - and that was quite nice. On our first drive out, we saw baboons, elephants, antelope, buffalo, and lions. It was very exciting! To find the harder-to-find animals, you really actually just look for the other safari cars (giant white mini-vans with pilot seats and detachable roofs - it's a strange sensation to watch an animal in its natural envnt ... surrounded by 10 other safari cars - kind of like a big zoo). When we came across the lions, we had no idea where they actually were at first. We were told they were in the grass, and sure enough, after 10 minutes of waiting, we would see a tail flick up, or a giant black paw bat the air. Eventually they arose from their slumber to get up, look around, and then flop back down. Just big ol' cats... being cats.
On our second day, we spent the entire day in the park, standing in our safari car, holding on for dear life, as David, our guide drove around looking for the animals - and animals we saw indeed. We saw hundreds of wildebeests and zebra (apparently they're good friends and always hang out together) - which was really a beautiful site. We saw elephants bathing at a watering hole, we saw more lions, this time two males and three females - there was some sleeping, there was some lazing, there was some mating, only to be followed by some territorial strife (back off, this is my lioness) etc. It was very exciting! The lions are PERFECTLY camouflaged within the grass. To a point where our guide would never get out of the car if the grass around us was too tall because he was afraid there might be a lion that he couldn't see. We also giraffes, hippos, crocodile, lizards, vultures (yes, they really are that ugly), and ostriches (sorry folks, riding of the ostriches was not allowed this time around).
After the park we headed to the Masai village to learn a little bit more about the masai tribe. It was an interesting visit, manufactured as it was, and we learned a fair bit about this warrior tribe - it was really interesting. The masai that have held on to their cultural traditions are very dramatic to look at... it's every thing you read about in books from their traditional red wraps (symbolism for fighting lions), to giant holes in their ears, burn scars for decoration on their skin, beaded jewelry etc. Apparently, for extra identification as Masai, they also knock out two of their lower front teeth. Pretty intense. They sang and danced for us, had a jumping contest, showed us their homes (made of mud, sticks, and cow dung, beds made of sticks and cow hide), made fire from two twigs etc. The masai are a polygamous tribe with sometimes as many as 7 wives for one man. Families may own as many as 150 cows, so the families are always moving (at least once every five years) to find new grazing land for their cows and sheep - they pick up everything, their huts, their beds, their children, and move - all the time. It takes about 3 months to build a new house - and it is always done by the women alone.
At the end of that day, we were too pooped to pop (be forewarned, there will be poop jokes and puns abound for the months to come... i believe i've earned it). We retired back to the camp for dinner - only to watch some very crafty monkeys pull a mission impossible-dive-bomb-roll to steal some of our bread from dinner (sneaky little buggers...). We slept well that night, despite the monkeys jumping on the tops of our tents.
For our final morning drive, David warned us that "this was nature... I can't control the animals... we're likely to see nothing at all..." but, oh, david - ye of little faith. After seeing a remarkable sunrise (which inspired many renditions of the Lion King theme song), we came across a fresh kill. Cringe as you may, the two national geographic inspired medical students were fascinated. We found a zebra with it's colon in full view (i'll spare you the rest of the details)... just a couple hundred yards later, we came across another kill - a wildebeest (or what used to be a wildebeest) with pretty much only its horns remaining. Meanwhile, the herds of wildebeest and zebra were still close by, just looking around as if to say, "hey, have you seen bob?" "I though he was with you..." (and we kept saying, "trust us guys, you might want to get out of here..."). As if this was not exciting enough, we got word of more excitement up and over the hill ... to sheer amazement we found 3 cheetahs lazing in the grass with bulging, full bellies. They were just yards away from our vans. They continued to clean one another, then got up, checked us out, stretched themselves down the length of one of the safari buses... and then loped off into the distance. It was a fantastic morning!
After which we were headed back to Nairobi, where Dr. Dre and I indulged in hot showers and disposable razors... cleaned up, but still in quick dry clothing, we indulged all of our American fantasies at the hotel restaurant... and ordered our first pizza in kenya... only to be followed by brownie and apple pie sundaes. Apparently, we missed home a lot.
I am now home, letting culture shock sink in and dissolve little by little. I still think twice before getting water from the faucet or brushing my teeth without bottled water. The summer in Kenya was an incredible experience - one i won't even attempt to explain now, as i know i cannot do it justice in just one paragraph on the blog. Pictures will be posted soon which i think will help a lot. As soon as they are, i'll give you the link, and hopefully that will give you a more complete idea of the past 2 months in Nyanza Province, Kenya. They were a good two months indeed.
I hope you all are doing well - and I cannot wait to hear about how you have been. Wherever you may be headed, ichiop maber and Oriti!
-Jobaby
Sunday, July 29, 2007
De-worm 550 kids? Don't mind if we do.
Kids in Kenya are tough. Period.
As I last wrote, I was counting on monday as my grand finale - the De-Worming Day. Once I left the internet place in Kisii, Dr. Dre, Ian (a great Canadian student who is working for Real Medicine this summer to evaluate Lwala and its needs for assistance) and I proceeded as if failure was not an option - and let's be honest, when is it ever? We bought 2 10 L jugs of water for the Andingo School (after discussing the water situation with Omundi we decided that since the Andingo School would be purchasing a rain cistern for drinking water within the next few months - they have already raised the money for it - we could bring them bottled water for the first de-worming day, and Lwala could drink their own rain water since they already had a very large cistern and it had rained quite a bit in the past 3 days. Mono Ber (that is good)), and charcoal for some mean cake making (though there was a slight incident when the good people of Nakumatt tried to sell us "long lasting fire balls" as opposed to charcoal. right. Can't pull the wool over these eyes, thank you much.
Keep in mind, with our 20L of water and other groceries for the house (fresh mangoes, bananas etc) we had to take a taxi home to Lwala b/c there was no way for us to make it all the way on a Matatu and then on a 5.5 mile walk home. The taxi cost about 1200 Ksh (approx. 15 USD) and we weren't even sure if it would make it down the entire road to Lwala since it had rained so much previously. At one point we were nearly run off the road by a giant truck trying to pass a matatu while it came around a sharp turn. Yes, despite the metal spikes they place in the road to slow you down, or the frequent police checks on the road, the only road rules in Kenya are that there are no rules. Our taxi driver was swift with his haggard, rusting station wagon stallion, and made it to the side of the road just in time, but it was close.
Back on the homestead, dr. dre and i went to fetch water for a quick shower - earlier that day, a water testing company had been testing the water pump to see if it would be possible to install a solar powered panel that would pump water all the way up the hill to the clinic to deliver running water (currently the clinic uses water from a rain cistern - just think about that - a medical dispensary without running water). The pump had been created with the help the United States NGO Blood Water Mission in February 2007. We are all very excited about it. The water testing company brought some bad news, however. In addition to the water being contaminated with e-coli (we imagine that when the well was built the casings had been left in the field, prime targets for cow mannuer etc.), the well was also 10 meters short of its appropriate depth (it needs to be 70 m, and it measured at 60m). The original drilling team claimed to have drilled a 70 m well, so now, our most recent concern is that perhaps it was 0riginally 70 m, but the well has since started to fill in, or even perhaps some debris was left in the well by the first drilling company and has now begun to sediment for 10 m. goo! The water testing company eventually left (after shocking the water with Water Guard - a chemical treatment that makes most water safe to drink) with their hands up in the air. Dr. Dre and I found that once we started to bathe, though, the testing company had left us with something else - the water smelled like pure chemicals (water guard should not smell like this). To this day, we don't know what or why the water smelled like it did, but so far my hair has not turned orange - and i have yet to grow 3 arms - so we're hoping it's a fluke. Nothing is easy here.
Anyway - on to the important news. We did indeed succeed in baking a cake that night - thanks to the help of the lovely Grace Ochieng' (we decided we'd need to borrow a little experience just to ensure that we wouldn't fail) - though it took much longer than expected (we still need to work out our milk ratios). So we let Omundi go to bed without telling him about the cake. He woke in the morning, outraged that no one would tell him what the cake was for. Finally, I said it was for all the children who gave me their stool samples. And then he was pissed! "But Jobaby! I gave you MY sample! Why can't you make me a cake??!! Give me a cake, I gave you my poop!" Finally we let the cat out of the bag and presented the cake to Omundi as an early birthday cake. He was pretty pleased, I must say... and with a big Omundi smile, he said, "yes, you succeeded - you did not fail." It was a great way to start what was already going to be a great day.
Why so great? Well, it was deworming day, of course. With our 10 L of water placed on our heads and our containers of Wormex (Mebendazole tablets) in our hands, we set out for the Andingo School. Upon our arrival it was organized chaos as usual (since the school is so new, it doesn't have quite the same order as Lwala's primary school).. and we set up camp in a classroom made of mud and twigs. Grace and Dr. Dre were a HUGE help in the process as we called children one by one from the roster I had received from the Headmaster when I started my project. We watched in sheer awe as little 5 year old children knocked back all five pills at once (5 because the proper does is 500mg but we could only find 100mg pills). Those who could not swallow would chomp down on the pills and chew them like candy. Thus my conclusion that children in Kenya are TOUGH.
After treating 101 children, all the children I had listed in my roster, the headmaster said, but wait, you are missing 40 more! You have forgotten about the pre-school. Fact is, i did not forget, but simply had never been told about them. The disorganization of random children lining up at the door, head-butting one another to get inside - seriously - was pretty frustrating. We also had no idea how old a lot of these children were - which is crucial for identification purposes since there are a lot of children with similar/identical names. The teachers would hold each kid by the head and say, "hhmm, this child is, um, 10." Sometimes the guesses were too outlandish to led slide by and we had to bargain with the teachers to get a more appropriate age. In the end, though, we treated 140 children at the Andingo School - which was really the main purpose - to treat all the children - regardless of the extra 40 that appeared unbeknownst to us. The Andingo school was tremendously appreciative - especially when we donated a small soccer ball (courtesy of Docta Bress) at the end of the day. Kate had noticed once that all the little kids used as a ball was a bunch of rolled up plastic bags shaped into a ball with some rope netting. It transformed organized chaos into pure chaos - but it was great sight to watch all the children chase this ball around the field.
Fairly exhausted and weathered, we raced off to the Lwala Primary School so that we could treat the pre-schoolers before they left for the day at lunch time. We brought our cups and our pills and we were ready for action. Upon pouring the first cup of water, Dr. Dre and her watchful eye caught something "unusual". As irony might have it, in our very first cup of drinking water poured from the rain cistern on De-worming Day, we found a worm. I wish I were joking. But there it was, in all its glory, swimming, wriggling through the water. The teachers said, "oh, we've always seen those. We just thought they were mosquito larva..." which is possible - mosquitoes mate in water. But still, probably not something you want to be treating.
We were slightly panicked. What we were we going to do?? The teachers were very helpful and rallied together some clean water from their own homes - and we managed to treat all of the preschoolers before lunch. The system at lwala was MUCH more organized and we whizzed through each child - amazed as they all chomped down on these pills as if it were nothing at all.
When we broke for lunch we were slightly disheartened by our new worm finding, and were still unsure of how we would get potable drinking water to the other 350 children that needed treatment. Back at the house though, we found an extra 20 L bottle of water that we had for our own drinking purposes - and it was clear what we would do. We divied up the water into 2 10L jugs and carried it back (on the heads of course) to Lwala after lunch. The teachers had also boiled some extra drinking water and some 90 minutes later, we had de-wormed the rest of the school. It was quite the scene... We left with clear on instructions on not drinking the water from the rain cistern until it had been properly cleaned and protected. damaris, the school's headmistress - a women who commands some serious respect - took it to heart, and i don't think a single person will challenge her on the issue.
By the end of the day, we de-wormed around 550 children. It was a strange feeling, as you give these children these pills, and you know what the pills are supposed to do, but you have no visual proof of their effects. The most gratification that came from the de-worming was the sincere Thank You's i received not so much from the teachers, but more from the parents and students. One student even stopped us later on that day as we were walking home to thank us for everything we had done.
When we got home, we wrote up a protocol for future de-wormings for the clinic to keep. Thanks to Dr. Young, the protocol is now typed up - and he even went through it with the nurses, calandar in hand, and the dates of future dewormings for the next few years have already been scheduled. We're pretty excited about that.
The one loose end that remained were the 20 or so children I found to be infected with an unidentified worm. The diagnosis came with finding larva (small worms) swimming through their feces - which would signal to any parasitologist "strongyloides" - which was my strongest assumption. I was discouraged from this, however, as most researchers and lab techs said "no, no, we hardly ever see strongyloides in this area- I highly doubt that 10% of your children are infected with strongyloides... it might be something else, but we don't know what." As a result, I shipped off some poop (seriously) to a researcher in Nairobi (no easy feat, let me tell you) - and am still waiting on the results. Two other lab techs in the area, though, agreed with me that what I was finding could certainly be strongyloides. Once we hear from our Nairobi contact, I will be in touch with the clinic to give them the go ahead to treat the listed 20 children (the trickiest element to the strongyloides diagnosis is that it requires a 7 day treatment with albendazole- hard for compliance and follow-up).
At the end of the day, we all congregated at Rose's house for our final meal. It was a feast indeed of chapat and gweno (chicken) - and of course Fanta soda. We had a wonderful time - and even learned some new facts about Omundi. Behind the perpetual smile on our clinic manager and friend was a whole history of life in the military - we had had no idea! Omundi had been a pretty big guy in the Kenyan military - serving as a section commander in Sudan as Kenya was providing relief to refugees. Finally, after a most harrowing event in which Omundi was one of 2 men to survive an attack on his section, Omundi left the military - it was a side of him we never knew existed - and it was incredible to hear his stories.
Back in Fred' Ot (house) we settled in for our final night in Lwala.. hip hop lullabies were provided by DJ Japollo's walkman and speakers, and we fell asleep to a favorite R&B tune, "marriage don't change, nothing but your name..." It was a great night, indeed. The next day we were off for safari - and i'll fill you in on that in the next posting.
Oriti!!!
Jobaby
As I last wrote, I was counting on monday as my grand finale - the De-Worming Day. Once I left the internet place in Kisii, Dr. Dre, Ian (a great Canadian student who is working for Real Medicine this summer to evaluate Lwala and its needs for assistance) and I proceeded as if failure was not an option - and let's be honest, when is it ever? We bought 2 10 L jugs of water for the Andingo School (after discussing the water situation with Omundi we decided that since the Andingo School would be purchasing a rain cistern for drinking water within the next few months - they have already raised the money for it - we could bring them bottled water for the first de-worming day, and Lwala could drink their own rain water since they already had a very large cistern and it had rained quite a bit in the past 3 days. Mono Ber (that is good)), and charcoal for some mean cake making (though there was a slight incident when the good people of Nakumatt tried to sell us "long lasting fire balls" as opposed to charcoal. right. Can't pull the wool over these eyes, thank you much.
Keep in mind, with our 20L of water and other groceries for the house (fresh mangoes, bananas etc) we had to take a taxi home to Lwala b/c there was no way for us to make it all the way on a Matatu and then on a 5.5 mile walk home. The taxi cost about 1200 Ksh (approx. 15 USD) and we weren't even sure if it would make it down the entire road to Lwala since it had rained so much previously. At one point we were nearly run off the road by a giant truck trying to pass a matatu while it came around a sharp turn. Yes, despite the metal spikes they place in the road to slow you down, or the frequent police checks on the road, the only road rules in Kenya are that there are no rules. Our taxi driver was swift with his haggard, rusting station wagon stallion, and made it to the side of the road just in time, but it was close.
Back on the homestead, dr. dre and i went to fetch water for a quick shower - earlier that day, a water testing company had been testing the water pump to see if it would be possible to install a solar powered panel that would pump water all the way up the hill to the clinic to deliver running water (currently the clinic uses water from a rain cistern - just think about that - a medical dispensary without running water). The pump had been created with the help the United States NGO Blood Water Mission in February 2007. We are all very excited about it. The water testing company brought some bad news, however. In addition to the water being contaminated with e-coli (we imagine that when the well was built the casings had been left in the field, prime targets for cow mannuer etc.), the well was also 10 meters short of its appropriate depth (it needs to be 70 m, and it measured at 60m). The original drilling team claimed to have drilled a 70 m well, so now, our most recent concern is that perhaps it was 0riginally 70 m, but the well has since started to fill in, or even perhaps some debris was left in the well by the first drilling company and has now begun to sediment for 10 m. goo! The water testing company eventually left (after shocking the water with Water Guard - a chemical treatment that makes most water safe to drink) with their hands up in the air. Dr. Dre and I found that once we started to bathe, though, the testing company had left us with something else - the water smelled like pure chemicals (water guard should not smell like this). To this day, we don't know what or why the water smelled like it did, but so far my hair has not turned orange - and i have yet to grow 3 arms - so we're hoping it's a fluke. Nothing is easy here.
Anyway - on to the important news. We did indeed succeed in baking a cake that night - thanks to the help of the lovely Grace Ochieng' (we decided we'd need to borrow a little experience just to ensure that we wouldn't fail) - though it took much longer than expected (we still need to work out our milk ratios). So we let Omundi go to bed without telling him about the cake. He woke in the morning, outraged that no one would tell him what the cake was for. Finally, I said it was for all the children who gave me their stool samples. And then he was pissed! "But Jobaby! I gave you MY sample! Why can't you make me a cake??!! Give me a cake, I gave you my poop!" Finally we let the cat out of the bag and presented the cake to Omundi as an early birthday cake. He was pretty pleased, I must say... and with a big Omundi smile, he said, "yes, you succeeded - you did not fail." It was a great way to start what was already going to be a great day.
Why so great? Well, it was deworming day, of course. With our 10 L of water placed on our heads and our containers of Wormex (Mebendazole tablets) in our hands, we set out for the Andingo School. Upon our arrival it was organized chaos as usual (since the school is so new, it doesn't have quite the same order as Lwala's primary school).. and we set up camp in a classroom made of mud and twigs. Grace and Dr. Dre were a HUGE help in the process as we called children one by one from the roster I had received from the Headmaster when I started my project. We watched in sheer awe as little 5 year old children knocked back all five pills at once (5 because the proper does is 500mg but we could only find 100mg pills). Those who could not swallow would chomp down on the pills and chew them like candy. Thus my conclusion that children in Kenya are TOUGH.
After treating 101 children, all the children I had listed in my roster, the headmaster said, but wait, you are missing 40 more! You have forgotten about the pre-school. Fact is, i did not forget, but simply had never been told about them. The disorganization of random children lining up at the door, head-butting one another to get inside - seriously - was pretty frustrating. We also had no idea how old a lot of these children were - which is crucial for identification purposes since there are a lot of children with similar/identical names. The teachers would hold each kid by the head and say, "hhmm, this child is, um, 10." Sometimes the guesses were too outlandish to led slide by and we had to bargain with the teachers to get a more appropriate age. In the end, though, we treated 140 children at the Andingo School - which was really the main purpose - to treat all the children - regardless of the extra 40 that appeared unbeknownst to us. The Andingo school was tremendously appreciative - especially when we donated a small soccer ball (courtesy of Docta Bress) at the end of the day. Kate had noticed once that all the little kids used as a ball was a bunch of rolled up plastic bags shaped into a ball with some rope netting. It transformed organized chaos into pure chaos - but it was great sight to watch all the children chase this ball around the field.
Fairly exhausted and weathered, we raced off to the Lwala Primary School so that we could treat the pre-schoolers before they left for the day at lunch time. We brought our cups and our pills and we were ready for action. Upon pouring the first cup of water, Dr. Dre and her watchful eye caught something "unusual". As irony might have it, in our very first cup of drinking water poured from the rain cistern on De-worming Day, we found a worm. I wish I were joking. But there it was, in all its glory, swimming, wriggling through the water. The teachers said, "oh, we've always seen those. We just thought they were mosquito larva..." which is possible - mosquitoes mate in water. But still, probably not something you want to be treating.
We were slightly panicked. What we were we going to do?? The teachers were very helpful and rallied together some clean water from their own homes - and we managed to treat all of the preschoolers before lunch. The system at lwala was MUCH more organized and we whizzed through each child - amazed as they all chomped down on these pills as if it were nothing at all.
When we broke for lunch we were slightly disheartened by our new worm finding, and were still unsure of how we would get potable drinking water to the other 350 children that needed treatment. Back at the house though, we found an extra 20 L bottle of water that we had for our own drinking purposes - and it was clear what we would do. We divied up the water into 2 10L jugs and carried it back (on the heads of course) to Lwala after lunch. The teachers had also boiled some extra drinking water and some 90 minutes later, we had de-wormed the rest of the school. It was quite the scene... We left with clear on instructions on not drinking the water from the rain cistern until it had been properly cleaned and protected. damaris, the school's headmistress - a women who commands some serious respect - took it to heart, and i don't think a single person will challenge her on the issue.
By the end of the day, we de-wormed around 550 children. It was a strange feeling, as you give these children these pills, and you know what the pills are supposed to do, but you have no visual proof of their effects. The most gratification that came from the de-worming was the sincere Thank You's i received not so much from the teachers, but more from the parents and students. One student even stopped us later on that day as we were walking home to thank us for everything we had done.
When we got home, we wrote up a protocol for future de-wormings for the clinic to keep. Thanks to Dr. Young, the protocol is now typed up - and he even went through it with the nurses, calandar in hand, and the dates of future dewormings for the next few years have already been scheduled. We're pretty excited about that.
The one loose end that remained were the 20 or so children I found to be infected with an unidentified worm. The diagnosis came with finding larva (small worms) swimming through their feces - which would signal to any parasitologist "strongyloides" - which was my strongest assumption. I was discouraged from this, however, as most researchers and lab techs said "no, no, we hardly ever see strongyloides in this area- I highly doubt that 10% of your children are infected with strongyloides... it might be something else, but we don't know what." As a result, I shipped off some poop (seriously) to a researcher in Nairobi (no easy feat, let me tell you) - and am still waiting on the results. Two other lab techs in the area, though, agreed with me that what I was finding could certainly be strongyloides. Once we hear from our Nairobi contact, I will be in touch with the clinic to give them the go ahead to treat the listed 20 children (the trickiest element to the strongyloides diagnosis is that it requires a 7 day treatment with albendazole- hard for compliance and follow-up).
At the end of the day, we all congregated at Rose's house for our final meal. It was a feast indeed of chapat and gweno (chicken) - and of course Fanta soda. We had a wonderful time - and even learned some new facts about Omundi. Behind the perpetual smile on our clinic manager and friend was a whole history of life in the military - we had had no idea! Omundi had been a pretty big guy in the Kenyan military - serving as a section commander in Sudan as Kenya was providing relief to refugees. Finally, after a most harrowing event in which Omundi was one of 2 men to survive an attack on his section, Omundi left the military - it was a side of him we never knew existed - and it was incredible to hear his stories.
Back in Fred' Ot (house) we settled in for our final night in Lwala.. hip hop lullabies were provided by DJ Japollo's walkman and speakers, and we fell asleep to a favorite R&B tune, "marriage don't change, nothing but your name..." It was a great night, indeed. The next day we were off for safari - and i'll fill you in on that in the next posting.
Oriti!!!
Jobaby
Sunday, July 22, 2007
De-Worming in T-1 (we hope)!
Misawa Uru!
So before I write anything else... there are two big accounts that I forgot to mention in my last entry.
Number 1: On our last walk into Kisii, andrea and I had a nice 5 mile jaunt -almost at the main road - quite peaceful indeed... when we came upon four boys aggressively striking the ground with their garden tools... they paused to greet us with big smiles ("Hey Msungu!") and we waved, walking closer to greet them properly.. until we saw what they were actually striking. They lifted it with great pride... and there it was, a GIANT, black, white bellied, snake - at least 2 meters in length - hanging dead over their garden hoe... they howled at our shocked faces - and took off with it back towards home - no doubt to burn it with joy. Good thing. We hates the snakes. And that's a normal morning in kenya.
Number 2: The lab tech saga. Well, Eunice continued to return every day, taking great ownership of the lab - and insisting on "assisting" me with my work. It was a very difficult balance, because while she wanted the work very badly, she simply was not qualified... and we are not in the place to train her. Everyday, we'd end up singing "guess who's back... back again..." because no matter how many times I tried to explain to her that she needed more training, she would continue to return. Then one day, a man named Samson showed up, boasting quite impressive lab skills. We decided to give him a try - but when he explained that one of the ways to get a pin worm infection was via inhalation of the eggs, I realized he made Eunice look good. I spoke to him about his level of training, and he confessed that he just wanted a place to work - a place to get more experience. Eunice expressed the same sentiments "why won't you just let me stay and work? home is not good. Just let me stay and work". It was a tough situation to be in, as I am not the person who decides whom to hire... I tried to explain this and i think they finally understood. As much as i urged them to get more training, it was pretty futile - where would they get it? how would they afford it? would it even be adequate? I think i will forever look at our own education in a very different light. As much as we complain about having to study - our opportunities and level of education is not to be beat... nor taken for granted. I hope always remember that.
Ok, enough with the life lessons - and back to none other than THE POOP. This past friday was, I am proud to say, the final day of chieth (feces) collection. Can I get an amen??? The project went well, and I received near 100% compliance almost every day. The most recent challenge is 2-fold. 1. i have found about 20-25 children to be infected with a certain type of larva that swims around in their poop. Yes, ew, is appropriate. Any good microbiology student would astutely proclaim that larva in poop indicates strongyloides stercalis infection. But most lab techs and researches in the area say "no, no, you rarely ever see strongyloids in this part of kenya." I have been in touch with an american doc doing research in Nairobi and he has no idea what i could be finding (perhaps I have found a new worm? shall we call is the Rieselius?) - because he insists that strongyloides is just not found that commonly here. Well friend, I think I have found it. I have tried sending him poop samples multiple times, but typical typical, each time has been foiled. CRAP. (cheesey pun intended). We're really in a tough place.. strongyloides treatment is different than your regular de-worming - and is quite involved and complicated. At the same time, letting strongyloides lie can be quite dangerous as the infection can disseminate into parts of the body like the liver and heart - bad news all around. So what do we do? Our new lab tech (who seems fairly legit) was quite certain it was strongyloides, but no one else will make a diagnosis for sure. Our hands are tied.
Challenge number 2 is the actual de-worming which we hope to initiate tomorrow (just before andrea (dr. dre) and I head off on our romantic safari for two... more on that later). Theorectically, it should be easy. One pill, and your done. In Kenya, however, the pills we need (mebendazole 500 mg) - are only sold in 100mg pills. right. So, now we are giving these kids 5 pills each. at once. ok, ok, not too bad - but now here's the catch - where do we get enough clean water for all 550 kids to swallow these 5 pills each? All tricky, challenging problems - but nothing we can't solve, we hope. I think we'll stock up on some bottled water for the Andingo school (the new school with only 100 children) and the lwala school will drink their collected rain water (the Andingo school has yet to be able to afford even a rain cistern). Onge Wach (no worries... no problem)... we'll make it work. And hopefully, the clinic will be able to sustain this - always something we have to think about "well, this works for now, but what will happen when we leave?"
As another part of my project, i have agreed to teach some lessons on worm infections, how to treat them, and how to prevent them. Dr. Dre and I taught one lesson at the Andingo school and it went incredibly well. We even had about 20 mothers in attendence. They had lots of great and challenging questions - and once we had satisfied their querries on worms - they launched right into requests for a lecture on HIV and AIDS. So, we oblidged... and gave an impromptu lesson and Q&A session on the topic. Afterwards - we exchanged songs and games with all the students - and ended up leaving 2 hours later with many, many thanks. It was a really great experience. There's a real difference at the Andingo school - i think we are truly the first Msungus to visit them - so unlike at Lwala's School, they express a different sort of appreciation.
What else? Last week we also had a wonderful weekend with the Lwala Women's group - singinging dancing and basket buying. They weave the most incredible baskets that we are all bringing back to the US to sell... some of the undergrads set up an american account for the Women - so we can deposit the money that we get for the baskets directly, and the women can withdraw it here in Kenya to support their group. They are a remarkable group of women - and it is terrific to see them in their element, singing, dancing, empowered, laughing... the baskets will be for sale upon immediate return to the US (July 27th) - which is so so soon - amazing to believe - and quite sad as well... i think i will really miss our neighbors and friends here.. though it has also been a long time away from home and I am excited to come back...
... before we leave, though, Dre and I are determined to make another cake. Earlier this summer, as Omundi made his famous Mandazi (better than doughnuts doughnuts) and i studiously tried to learn the recipe - he cautioned - "but bwana... if you try.. you will fail. You lack the experience. You will just fail" Never one to believe in failure, i set out to bake a cake with Dre for Abbi (a vandy alum's) birthday - and it was SO promissing... but alas, we were out of charcoal, and the fire never quite got hot enough - and the cake never quite cooked through - we ate it anyway - and had a great time with it - but Omundi took one bite and said "AY! BWANA! you FAILED!" and turned up his nose, refusing to eat anymore. Well, Omundi... these girls never quit. Not today. Today shall be our day! Dre and I are are going to try for cake attempt 2 as a thank you for all everyone has done for us... and hopefully the cake will be received as a thank you indeed - not, "NO thank you"... i'll keep you posted.
And sadly, right after the deworming day, and final big meal (which is normally at the Ochieng' household - but this time, Rose the nurse would not take no for an answer - so this time we'll have dinner at her house - chipatti for sure) tomorrow night, dre and i will depart for our romantic safari for two ... in the Masai Mara... ontuesday morning we're pretty excited... platform tents, showers, and a toilet - we'll be living in the lap of luxury for two whole days. And hopefully we'll get to see some pretty great sights... can't wait.
I'll be home July 27th and can't wait to get in touch with you all... miss you more than you know.
- Jobaby....
So before I write anything else... there are two big accounts that I forgot to mention in my last entry.
Number 1: On our last walk into Kisii, andrea and I had a nice 5 mile jaunt -almost at the main road - quite peaceful indeed... when we came upon four boys aggressively striking the ground with their garden tools... they paused to greet us with big smiles ("Hey Msungu!") and we waved, walking closer to greet them properly.. until we saw what they were actually striking. They lifted it with great pride... and there it was, a GIANT, black, white bellied, snake - at least 2 meters in length - hanging dead over their garden hoe... they howled at our shocked faces - and took off with it back towards home - no doubt to burn it with joy. Good thing. We hates the snakes. And that's a normal morning in kenya.
Number 2: The lab tech saga. Well, Eunice continued to return every day, taking great ownership of the lab - and insisting on "assisting" me with my work. It was a very difficult balance, because while she wanted the work very badly, she simply was not qualified... and we are not in the place to train her. Everyday, we'd end up singing "guess who's back... back again..." because no matter how many times I tried to explain to her that she needed more training, she would continue to return. Then one day, a man named Samson showed up, boasting quite impressive lab skills. We decided to give him a try - but when he explained that one of the ways to get a pin worm infection was via inhalation of the eggs, I realized he made Eunice look good. I spoke to him about his level of training, and he confessed that he just wanted a place to work - a place to get more experience. Eunice expressed the same sentiments "why won't you just let me stay and work? home is not good. Just let me stay and work". It was a tough situation to be in, as I am not the person who decides whom to hire... I tried to explain this and i think they finally understood. As much as i urged them to get more training, it was pretty futile - where would they get it? how would they afford it? would it even be adequate? I think i will forever look at our own education in a very different light. As much as we complain about having to study - our opportunities and level of education is not to be beat... nor taken for granted. I hope always remember that.
Ok, enough with the life lessons - and back to none other than THE POOP. This past friday was, I am proud to say, the final day of chieth (feces) collection. Can I get an amen??? The project went well, and I received near 100% compliance almost every day. The most recent challenge is 2-fold. 1. i have found about 20-25 children to be infected with a certain type of larva that swims around in their poop. Yes, ew, is appropriate. Any good microbiology student would astutely proclaim that larva in poop indicates strongyloides stercalis infection. But most lab techs and researches in the area say "no, no, you rarely ever see strongyloids in this part of kenya." I have been in touch with an american doc doing research in Nairobi and he has no idea what i could be finding (perhaps I have found a new worm? shall we call is the Rieselius?) - because he insists that strongyloides is just not found that commonly here. Well friend, I think I have found it. I have tried sending him poop samples multiple times, but typical typical, each time has been foiled. CRAP. (cheesey pun intended). We're really in a tough place.. strongyloides treatment is different than your regular de-worming - and is quite involved and complicated. At the same time, letting strongyloides lie can be quite dangerous as the infection can disseminate into parts of the body like the liver and heart - bad news all around. So what do we do? Our new lab tech (who seems fairly legit) was quite certain it was strongyloides, but no one else will make a diagnosis for sure. Our hands are tied.
Challenge number 2 is the actual de-worming which we hope to initiate tomorrow (just before andrea (dr. dre) and I head off on our romantic safari for two... more on that later). Theorectically, it should be easy. One pill, and your done. In Kenya, however, the pills we need (mebendazole 500 mg) - are only sold in 100mg pills. right. So, now we are giving these kids 5 pills each. at once. ok, ok, not too bad - but now here's the catch - where do we get enough clean water for all 550 kids to swallow these 5 pills each? All tricky, challenging problems - but nothing we can't solve, we hope. I think we'll stock up on some bottled water for the Andingo school (the new school with only 100 children) and the lwala school will drink their collected rain water (the Andingo school has yet to be able to afford even a rain cistern). Onge Wach (no worries... no problem)... we'll make it work. And hopefully, the clinic will be able to sustain this - always something we have to think about "well, this works for now, but what will happen when we leave?"
As another part of my project, i have agreed to teach some lessons on worm infections, how to treat them, and how to prevent them. Dr. Dre and I taught one lesson at the Andingo school and it went incredibly well. We even had about 20 mothers in attendence. They had lots of great and challenging questions - and once we had satisfied their querries on worms - they launched right into requests for a lecture on HIV and AIDS. So, we oblidged... and gave an impromptu lesson and Q&A session on the topic. Afterwards - we exchanged songs and games with all the students - and ended up leaving 2 hours later with many, many thanks. It was a really great experience. There's a real difference at the Andingo school - i think we are truly the first Msungus to visit them - so unlike at Lwala's School, they express a different sort of appreciation.
What else? Last week we also had a wonderful weekend with the Lwala Women's group - singinging dancing and basket buying. They weave the most incredible baskets that we are all bringing back to the US to sell... some of the undergrads set up an american account for the Women - so we can deposit the money that we get for the baskets directly, and the women can withdraw it here in Kenya to support their group. They are a remarkable group of women - and it is terrific to see them in their element, singing, dancing, empowered, laughing... the baskets will be for sale upon immediate return to the US (July 27th) - which is so so soon - amazing to believe - and quite sad as well... i think i will really miss our neighbors and friends here.. though it has also been a long time away from home and I am excited to come back...
... before we leave, though, Dre and I are determined to make another cake. Earlier this summer, as Omundi made his famous Mandazi (better than doughnuts doughnuts) and i studiously tried to learn the recipe - he cautioned - "but bwana... if you try.. you will fail. You lack the experience. You will just fail" Never one to believe in failure, i set out to bake a cake with Dre for Abbi (a vandy alum's) birthday - and it was SO promissing... but alas, we were out of charcoal, and the fire never quite got hot enough - and the cake never quite cooked through - we ate it anyway - and had a great time with it - but Omundi took one bite and said "AY! BWANA! you FAILED!" and turned up his nose, refusing to eat anymore. Well, Omundi... these girls never quit. Not today. Today shall be our day! Dre and I are are going to try for cake attempt 2 as a thank you for all everyone has done for us... and hopefully the cake will be received as a thank you indeed - not, "NO thank you"... i'll keep you posted.
And sadly, right after the deworming day, and final big meal (which is normally at the Ochieng' household - but this time, Rose the nurse would not take no for an answer - so this time we'll have dinner at her house - chipatti for sure) tomorrow night, dre and i will depart for our romantic safari for two ... in the Masai Mara... ontuesday morning we're pretty excited... platform tents, showers, and a toilet - we'll be living in the lap of luxury for two whole days. And hopefully we'll get to see some pretty great sights... can't wait.
I'll be home July 27th and can't wait to get in touch with you all... miss you more than you know.
- Jobaby....
Saturday, July 14, 2007
Hookworm, Roundworm, Whipworm, Oh My!
So, it's official: "I'm in the shit" (copyright JNB-slash-rushmore). The project is in full swing, and day in and day out, my day is as follows: Wake up at 6:30, help with chores. Shove a tripple decker pb&j sandwich down my throat (I miss my lazy mornings of chai and chipathi!), and head off to school. By 7:45, I am coaxing young teenagers to hand over their poop. Literally. I am now at the Lwala Primary school - I had previously been at the small, new, Andingo primary school, where I thought there would be a riot if one of the little kids didn't get a sample kit - and I have started my collections with the oldest children (13-16 year olds). The allure of the Msungu has worn off a bit at Lwala since they have seen all the Msungus that come live with the ochieng's every summer - so really, I don't have much going for me. Instead, I usually get my friend Harrison (my 13 yr. friend and neighbor) to say in Dholuo "Remove your feces, bwana!" (bwana is the equivalent of man, buddy, or dude)... and everyone titters and giggles and quickly pulls their sample kits (created and designed by yours truly) out of their school uniform pockets and throws it in my handy dandy shopping bag and runs away. And that's how it goes just about every time.
Then it's off to the clinic (which is always very confusing to everyone who just greeted me as i walked to school) where I greet the 30-some-odd patients who are already inline waiting to be seen by Rose and put on my lab coat (which is so big, it's more like a lab dress) and get to work. I look at about 18 samples a day - and from 8:30 am-1:30 pm I stand hunched over our field microscope, squinting one eye closed, propping myself up on the table with my elbows, maybe holding my breath a lot. I don't break (which is baffling to the rest of the clinic staff who always - always - breaks for tea) because, let's be honest, poop waits for no one, I have to look at the samples while they are still fresh - yes, fresh.
Really, it's just like a smelly game of "Where's Waldo". There is a lot of fecal debris that resembles what you might think would be a worm or ova - but really is just a decoy. Tricky Parasites. By this time, however, I have trained my eye quite a bit so that I feel quite confident in my ability to find those suckers. And find them I do! As Antigo Montoya would say, "allow me esplain - no, there is too much - allow me sum up." These kids have got worms. I would say about 80-85% of the community has some sort of helmintic parasite - be it hookworm, ascaris lumbricoids, trichuris trichuria, or even strongyloids or even schistosomiasis (which is really hard to see)... and keep in mind, I am only doing a direct smear which is the least sensitive detection technique (but is also the cheapest and fastest) - so whatever I am finding is a decided underestimate.
Once i get through all my samples, I put together the sample kits for the next day, clean up (bleach is our friend), and stumble back down to the main house for lunch. Then it's off and running again to the school to weigh and measure a new batch of kiddos. Thankfully, Andrea (or Dr. Dre as we like to call her) has been around and has been a real savior. She helps me out with all of the weighing and measuring, sample kit preparing - and basically keeps me laughing and happy - it's a pretty great deal. She's also been a huge help at the clinic with her physical exam knowledge (which is far greater than mine) and her general craftiness. For example: thanks to Andrea and Ben (recent vandy graduate) we now have internet at the clinic (which is CRUCIAL for communications re: patient care, patient records, clinic needs etc). A computer had been donated to the clinic by a vandy undergrad - and needed to be defragmented etc and hooked up to the internet. Dre and Ben took on the job. But as soon as they opened the computer, they realized there was a password and they had no idea what it could be. Plan Foiled. They did not give up, however. Sleuths they be, they went to "password hints" and received the prompt that had been set up by the previous owner of the computer. it read: "what life is all about." In all seriousness, Dre turned to Ben and said, "Try 'love'." Needless to say, that computer is up and running, loving its new home in the solar powered clinic - where there is no running water, but I'll be damned, there is internet.
By the time we come back home, we basically sit and rest, do Jo's boot camp, help with dinner, possibly bathe (so over-rated... it's not like I'm dealing with dirty stuff all day), hang out, eat, eat, eat, and sleep. The days are quite exhausting, but also pretty great.
There is a lot of excitement about the upcoming de-worming. When I receieve consent forms returned by the children, I often find detailed questions written on the back from the parents (as such, I will be teaching a class about worms, how you get 'em, how your get rid of 'em etc). I also met a parent on the road the other day who had a number of questions for me. After answering them he thanked me profusely for what I was doing. I, in turn, proceeded to thank him, for allowing me to do what I was doing. We continued to exchange thanks (thank you... no thank you...) until we had to go our separate ways on the road. The funny thing is, this is really something all of Kenya supports - in fact, I think the government will even pay for de wormings. When I child goes to the hospital - they are automatically de-wormed. Problem is, in a place like Lwala, you don't get much attention from the government, and you don't make many trips to the big hospitals. So, instead, they get some crazy Msungu who decided to come in and look at poop for a summer. go figure.
What else? The spring has been protected! Thanks to the hardwork of some of the undergrads, Dr. Young, the Ochieng's and some very strong men and women laborers, a good chunk of the lwala community will now have fresh, uncontaminated, running spring water. That was really a big accomplishment.
The undergrads leave on Monday and morning and then Dre and I head out the following week - it's pretty crazy to imagine how fast the summer has gone. Fred has started his project and i think will really be some valuable information - he is basically conducting a study that will look at the clinic's accuracy in diagnosing malaria. Consider the following story. A 70 yr. old woman came in the other day presenting with bursts of fever, back ache, stomach ache, and mestrual spotting/missing her period. She was inititally to be treated for malaria. right. Hold the phone, but ma'am, you do not look like a 70 yr old woman. Right again. Turns out, she had a few friends lie for her and say she was 70 so that she could be seen at the clinic for free (children under 5, people over 70, HIV/AIDS, and TB patients are all seen for free- the rest pay 50 shillings - less than one american dollar). She is in point of fact, 50 years old. And she has menopause. Not malaria. I think the news came a quite a pleasing surprise, in fact. And our friend was sent home with advil, not chloroquin.
ok, so kudos to you if you've made it this far in the blog... I am very impressed. I guess I'll quit now because there is much to do in kisii today, so I think I'll head out. I miss you all like you could never understand. It has been a fantastic and challenging summer - and I am so happy that I am doing what I am doing. At the same time, I will be a very happy Msungu to be able to see you all again and explain the summer in person.
much love,
jobaby
ps: i just received confirmation that my IRB was approved... booyakasha.
pps: the fame of the msungus still has not worn off as we head past schools and homesteads on our 5.5 mile jaunt into town. They all come careening out, sprinting to the road to shake our hands. They scream Msungu, and we respond as if that were our first name. Now, however, I have started to level the playing field... and I scream back, hey! Jeretang! which means "hey black person!" (yes, this was culturally approved by Fred and Grace) - and it always gets a good laugh from the onlooking mothers and children near by.
Then it's off to the clinic (which is always very confusing to everyone who just greeted me as i walked to school) where I greet the 30-some-odd patients who are already inline waiting to be seen by Rose and put on my lab coat (which is so big, it's more like a lab dress) and get to work. I look at about 18 samples a day - and from 8:30 am-1:30 pm I stand hunched over our field microscope, squinting one eye closed, propping myself up on the table with my elbows, maybe holding my breath a lot. I don't break (which is baffling to the rest of the clinic staff who always - always - breaks for tea) because, let's be honest, poop waits for no one, I have to look at the samples while they are still fresh - yes, fresh.
Really, it's just like a smelly game of "Where's Waldo". There is a lot of fecal debris that resembles what you might think would be a worm or ova - but really is just a decoy. Tricky Parasites. By this time, however, I have trained my eye quite a bit so that I feel quite confident in my ability to find those suckers. And find them I do! As Antigo Montoya would say, "allow me esplain - no, there is too much - allow me sum up." These kids have got worms. I would say about 80-85% of the community has some sort of helmintic parasite - be it hookworm, ascaris lumbricoids, trichuris trichuria, or even strongyloids or even schistosomiasis (which is really hard to see)... and keep in mind, I am only doing a direct smear which is the least sensitive detection technique (but is also the cheapest and fastest) - so whatever I am finding is a decided underestimate.
Once i get through all my samples, I put together the sample kits for the next day, clean up (bleach is our friend), and stumble back down to the main house for lunch. Then it's off and running again to the school to weigh and measure a new batch of kiddos. Thankfully, Andrea (or Dr. Dre as we like to call her) has been around and has been a real savior. She helps me out with all of the weighing and measuring, sample kit preparing - and basically keeps me laughing and happy - it's a pretty great deal. She's also been a huge help at the clinic with her physical exam knowledge (which is far greater than mine) and her general craftiness. For example: thanks to Andrea and Ben (recent vandy graduate) we now have internet at the clinic (which is CRUCIAL for communications re: patient care, patient records, clinic needs etc). A computer had been donated to the clinic by a vandy undergrad - and needed to be defragmented etc and hooked up to the internet. Dre and Ben took on the job. But as soon as they opened the computer, they realized there was a password and they had no idea what it could be. Plan Foiled. They did not give up, however. Sleuths they be, they went to "password hints" and received the prompt that had been set up by the previous owner of the computer. it read: "what life is all about." In all seriousness, Dre turned to Ben and said, "Try 'love'." Needless to say, that computer is up and running, loving its new home in the solar powered clinic - where there is no running water, but I'll be damned, there is internet.
By the time we come back home, we basically sit and rest, do Jo's boot camp, help with dinner, possibly bathe (so over-rated... it's not like I'm dealing with dirty stuff all day), hang out, eat, eat, eat, and sleep. The days are quite exhausting, but also pretty great.
There is a lot of excitement about the upcoming de-worming. When I receieve consent forms returned by the children, I often find detailed questions written on the back from the parents (as such, I will be teaching a class about worms, how you get 'em, how your get rid of 'em etc). I also met a parent on the road the other day who had a number of questions for me. After answering them he thanked me profusely for what I was doing. I, in turn, proceeded to thank him, for allowing me to do what I was doing. We continued to exchange thanks (thank you... no thank you...) until we had to go our separate ways on the road. The funny thing is, this is really something all of Kenya supports - in fact, I think the government will even pay for de wormings. When I child goes to the hospital - they are automatically de-wormed. Problem is, in a place like Lwala, you don't get much attention from the government, and you don't make many trips to the big hospitals. So, instead, they get some crazy Msungu who decided to come in and look at poop for a summer. go figure.
What else? The spring has been protected! Thanks to the hardwork of some of the undergrads, Dr. Young, the Ochieng's and some very strong men and women laborers, a good chunk of the lwala community will now have fresh, uncontaminated, running spring water. That was really a big accomplishment.
The undergrads leave on Monday and morning and then Dre and I head out the following week - it's pretty crazy to imagine how fast the summer has gone. Fred has started his project and i think will really be some valuable information - he is basically conducting a study that will look at the clinic's accuracy in diagnosing malaria. Consider the following story. A 70 yr. old woman came in the other day presenting with bursts of fever, back ache, stomach ache, and mestrual spotting/missing her period. She was inititally to be treated for malaria. right. Hold the phone, but ma'am, you do not look like a 70 yr old woman. Right again. Turns out, she had a few friends lie for her and say she was 70 so that she could be seen at the clinic for free (children under 5, people over 70, HIV/AIDS, and TB patients are all seen for free- the rest pay 50 shillings - less than one american dollar). She is in point of fact, 50 years old. And she has menopause. Not malaria. I think the news came a quite a pleasing surprise, in fact. And our friend was sent home with advil, not chloroquin.
ok, so kudos to you if you've made it this far in the blog... I am very impressed. I guess I'll quit now because there is much to do in kisii today, so I think I'll head out. I miss you all like you could never understand. It has been a fantastic and challenging summer - and I am so happy that I am doing what I am doing. At the same time, I will be a very happy Msungu to be able to see you all again and explain the summer in person.
much love,
jobaby
ps: i just received confirmation that my IRB was approved... booyakasha.
pps: the fame of the msungus still has not worn off as we head past schools and homesteads on our 5.5 mile jaunt into town. They all come careening out, sprinting to the road to shake our hands. They scream Msungu, and we respond as if that were our first name. Now, however, I have started to level the playing field... and I scream back, hey! Jeretang! which means "hey black person!" (yes, this was culturally approved by Fred and Grace) - and it always gets a good laugh from the onlooking mothers and children near by.
Saturday, July 7, 2007
The Project Has begun!
Well, since I last wrote, it has been a big couple of days. We have all been quite busy - running around, traveling between the clinic, kisii, kisumu, and back. The vandy undergrads have been quite busy teaching classes at Lwala Primary School, starting up the spring protection (they are protecting a local spring where about 200 people go to get water multiple times a day), workng with the women's group and helping with the clinic. Andrea has been at the clinic every morning, and then helps me (bless her heart) in the afternoons. I have started my project (more to follow) and Dr. Bill has been doing it all, overseeing everything and taking house calls as well. And ya wa tho, we have seen a lot.
The first was the man who had been to the clinic when we first arrived, insisting that the Msungus (kate and I) amputate his foot. He had some pretty severe pitting edema in both feet/ankles (which we suspect might be from Diabetes - tough to imagine managing such a disease in such a setting as Lwala)... and had gotten "pricked by a small stick" which currently stands as a complete circumferential avascular necrosis ulcer that wraps around his entire enkle, spanning about 4-5 inches. It was by far the most gruesome wound I had ever seen. Andrea and I gloved up and helped DR. Young clean out the wound and redress the bandage. I think our patient was so appreciative of Dr. Young's attentiveness, despite his pain and limp, he walked on out of that clinic with a huge smile. he now returns everyday for proper wound redressings and debridement - and we plan to take him to kisii on monday to go the hospital for consultation on what can be done (which may have to be amputation).
Our presence in the village/at the clinic is quite tricky. Dr. Young can both make the decision and the pay the bill to take someone to kisii, but what happens after we leave. The clinic doesn't have an ambulence - and recently, we have just been using Omundi for emergency travel. For example:
The other night while I was helping to make chipati in the kitchen, a man stopped by to speak with fred. Not knowing what he wanted, we invited him in, made small talk, etc for about 15 minutes - until we finally realized that he was here because he had been bitten by a snake... wulalalalalalalao. So polite and cordial, smiling, even, while he felt the poison climbing up his leg. We consulted a favorite book (where there is no doctor) - b/c doctor young - as great as he is - doesn't deal with many snake bites in the OBGYN dept's of NH. We knew he needed to get to kisii for antivenom (about 1.25 hour drive) - but it was dark, and late at night - every kenyan agreed that it wasn't a good idea. So we had to wait. So we did, and by the next day, his entire leg was swollen - we brought him to the hospital - and found a great physician who was quite helpful... and our man was admitted over night and seems to be doing well... had we waited any longer, however, he probably would not have made it, says the kenyan Doc.
And then just yesterday, a small child came to the clinic with his mother. The motehr says the boy is 4, but he looks about 2. Why were they there? This small, sweet little child, had rectal prolapse (for those not in the medical field - slash - those who have not taken first year anatomy, this when the rectal canal litterally collapses outside of the body... basically an inside out rectum .. now on the outside. It can be do to congenital defects or often, malnutrition.) He had had it since february. Rose tried to replace the rectum, but it was not feasible. So off to Kisii they went, courtesy of Omundi's Ambulence - and luckily, with the help of some valium, the rectum was replaced - and we hoped, soon to be fixed.
It has been an intense couple of days.
Also augmented by the fact that I started my project. On thursday morning, I arrived at the Andingo school (a small, recently built school of 100 children) - to pick up the poop. The teachers weren't there yet, so what else is there to do with 100 children who don't speak english? why you sing of course. That's right, The Princess Pat has made it to yet another african country - and is now sung daily - sometimes twice daily - and usually upon request. In fact, now when i arrive, a small child rings a very large bell - and all the children come running from their homes, the cornfields, the class rooms, and we sing. It's quite the image. For the past 2 days, I have had 100% compliance in poop deliveries whch is really quite incredible - when you think abuot how long it normally takes to even get a urine sample for a research study back in the states... I look at abuot 20-30 samples per morning - and it is very long, smelly, and tiring. We use field microscopes - which only have one eye piece and use a mirror and sunlight for light (the ligth microscope has not been used because the solar power has been out due to lack of adequate sun).. we don't have chairs yet, either - so we stand over the scope, cover one eye, hold our breath - and watch the worms swim by. Litterally. Most of the time, we see a lot of Ascaris lumbricoides (round worm) eggs - and a lot of things that look like they could be something - but probably are not - and my untrained eyes are just fooling me. We've seen one case of whipworm, 2 of hook worm, and a handfull of larvae that actually swim and curl across the screen (difficult to identify, but is almost certainly either strongyloides or hookworm).
We are only using a direct smear/wet mount technique which is not very sensitive - and means that I am probably missing a lot of cases. Out of the 50 kids I have looked at, I can say that probably 70% of them have some sort of intestinal parasite infection - and bare in mind, that's an underestimate.
I keep referring to "we" because i have had company in my little lab. A woman named Yunice who has been asking to vollunteer as a lab tech since we arrived. Apparently she has 3 years of schooling as a lab tech, and 4 years of experience. She wants to work very very badly, and is obviously willing to do a lot in order to do so (she looks at poop with me from 8 am till 2 pm)
The problem is, I am the one who ends up teaching her - and that is just wrong in so many ways. I am really not experienced enough to do so. I would love to have her train and get better, but I am not the person to be doing that training. It's sort of stressful, because i think she takes my word as solid gold when really what I am saying is "i think this is hookworm"... it's yet another case of the best intentions with quite inadequate training. It's very sad - and very frustrating.
A little hope (and more despair) was shed on the situation when I spoke to a real poopologist from Wash U who is based in Nairobi... Ilal Kanye, Dr. Jud! This guy knew everything - and is very eager to help - and has even offered to send me an experienced lab tech from nairobi to work with me for the next two weeks. It's no guarentee, but it is a hope. Talking to Dr. Jud was great - but also a little discouraging in that I realized how insensitive my direct smear technique is (I was doing only the direct smear to save on time and because that's what all the kenyan hospitals do - but apparently, that is quite inadequate). You'll really know the level of helminth infection if you do up to three different techniques on each sample - but unfortunately, I don't have the time or the money or the facilities to do all that. Wulalalalalalalo.
So hopefully, I'll be talking to Dr. Jud again today before he leaves town for a bit and we'll see what the reality is of the next three weeks - good lawd - three weeks and so many poops samples! The good news is, I am detecting worms/ova/parasites - at some level - period. So we know the de-worming will be useful and effective. The frustrating news is that I could (apparently) be doing it a lot better. The good news is I am showing hundreds of children and their schools and their parents that their health is a priority to us and the clinic.
So that's about where i stand. It's hard to write it all down - and we really are quite busy these days. We get up at 6:30 to help with chores (mopping, sweeping, dishes, breakfast making), then I head to the school, sing a song or two, collect samples, analyze them on our little field scopes till about 2 pm, scarf down lunch, head to the other school to weigh and measure kiddos there (though the teachers there were so excited they wanted to be weighed as well... and... sigh... they broke my scale!) then come home, get water from the water pump, help cook dinner (see this. Jobaby with a knife the size of her face peeling little bitty potatoes by candlelight, while passer bys grab her head and twist it around to check out her braids... the novelty has yet to wear off). and then we eat like kings (kate, everyone now knows to get the Blue Band butter out for me... and the salt too. But it's cool, apparently blueband is now rich in Vit A! No wonder these kenyans have such good night vision) - and i fall asleep sitting up ... then we pass out under a canopy of mosquito nets. it's pretty great.
so on that note, I must go... we have the whole crew in town (including dada, harison, and Anyango - who never come to kisii - and saw a mirror for the first time while they were here) - so a giant size plate of chips (french fries) is calling my name.
Abiro Nenu,
and much much love,
Jobaby
The first was the man who had been to the clinic when we first arrived, insisting that the Msungus (kate and I) amputate his foot. He had some pretty severe pitting edema in both feet/ankles (which we suspect might be from Diabetes - tough to imagine managing such a disease in such a setting as Lwala)... and had gotten "pricked by a small stick" which currently stands as a complete circumferential avascular necrosis ulcer that wraps around his entire enkle, spanning about 4-5 inches. It was by far the most gruesome wound I had ever seen. Andrea and I gloved up and helped DR. Young clean out the wound and redress the bandage. I think our patient was so appreciative of Dr. Young's attentiveness, despite his pain and limp, he walked on out of that clinic with a huge smile. he now returns everyday for proper wound redressings and debridement - and we plan to take him to kisii on monday to go the hospital for consultation on what can be done (which may have to be amputation).
Our presence in the village/at the clinic is quite tricky. Dr. Young can both make the decision and the pay the bill to take someone to kisii, but what happens after we leave. The clinic doesn't have an ambulence - and recently, we have just been using Omundi for emergency travel. For example:
The other night while I was helping to make chipati in the kitchen, a man stopped by to speak with fred. Not knowing what he wanted, we invited him in, made small talk, etc for about 15 minutes - until we finally realized that he was here because he had been bitten by a snake... wulalalalalalalao. So polite and cordial, smiling, even, while he felt the poison climbing up his leg. We consulted a favorite book (where there is no doctor) - b/c doctor young - as great as he is - doesn't deal with many snake bites in the OBGYN dept's of NH. We knew he needed to get to kisii for antivenom (about 1.25 hour drive) - but it was dark, and late at night - every kenyan agreed that it wasn't a good idea. So we had to wait. So we did, and by the next day, his entire leg was swollen - we brought him to the hospital - and found a great physician who was quite helpful... and our man was admitted over night and seems to be doing well... had we waited any longer, however, he probably would not have made it, says the kenyan Doc.
And then just yesterday, a small child came to the clinic with his mother. The motehr says the boy is 4, but he looks about 2. Why were they there? This small, sweet little child, had rectal prolapse (for those not in the medical field - slash - those who have not taken first year anatomy, this when the rectal canal litterally collapses outside of the body... basically an inside out rectum .. now on the outside. It can be do to congenital defects or often, malnutrition.) He had had it since february. Rose tried to replace the rectum, but it was not feasible. So off to Kisii they went, courtesy of Omundi's Ambulence - and luckily, with the help of some valium, the rectum was replaced - and we hoped, soon to be fixed.
It has been an intense couple of days.
Also augmented by the fact that I started my project. On thursday morning, I arrived at the Andingo school (a small, recently built school of 100 children) - to pick up the poop. The teachers weren't there yet, so what else is there to do with 100 children who don't speak english? why you sing of course. That's right, The Princess Pat has made it to yet another african country - and is now sung daily - sometimes twice daily - and usually upon request. In fact, now when i arrive, a small child rings a very large bell - and all the children come running from their homes, the cornfields, the class rooms, and we sing. It's quite the image. For the past 2 days, I have had 100% compliance in poop deliveries whch is really quite incredible - when you think abuot how long it normally takes to even get a urine sample for a research study back in the states... I look at abuot 20-30 samples per morning - and it is very long, smelly, and tiring. We use field microscopes - which only have one eye piece and use a mirror and sunlight for light (the ligth microscope has not been used because the solar power has been out due to lack of adequate sun).. we don't have chairs yet, either - so we stand over the scope, cover one eye, hold our breath - and watch the worms swim by. Litterally. Most of the time, we see a lot of Ascaris lumbricoides (round worm) eggs - and a lot of things that look like they could be something - but probably are not - and my untrained eyes are just fooling me. We've seen one case of whipworm, 2 of hook worm, and a handfull of larvae that actually swim and curl across the screen (difficult to identify, but is almost certainly either strongyloides or hookworm).
We are only using a direct smear/wet mount technique which is not very sensitive - and means that I am probably missing a lot of cases. Out of the 50 kids I have looked at, I can say that probably 70% of them have some sort of intestinal parasite infection - and bare in mind, that's an underestimate.
I keep referring to "we" because i have had company in my little lab. A woman named Yunice who has been asking to vollunteer as a lab tech since we arrived. Apparently she has 3 years of schooling as a lab tech, and 4 years of experience. She wants to work very very badly, and is obviously willing to do a lot in order to do so (she looks at poop with me from 8 am till 2 pm)
The problem is, I am the one who ends up teaching her - and that is just wrong in so many ways. I am really not experienced enough to do so. I would love to have her train and get better, but I am not the person to be doing that training. It's sort of stressful, because i think she takes my word as solid gold when really what I am saying is "i think this is hookworm"... it's yet another case of the best intentions with quite inadequate training. It's very sad - and very frustrating.
A little hope (and more despair) was shed on the situation when I spoke to a real poopologist from Wash U who is based in Nairobi... Ilal Kanye, Dr. Jud! This guy knew everything - and is very eager to help - and has even offered to send me an experienced lab tech from nairobi to work with me for the next two weeks. It's no guarentee, but it is a hope. Talking to Dr. Jud was great - but also a little discouraging in that I realized how insensitive my direct smear technique is (I was doing only the direct smear to save on time and because that's what all the kenyan hospitals do - but apparently, that is quite inadequate). You'll really know the level of helminth infection if you do up to three different techniques on each sample - but unfortunately, I don't have the time or the money or the facilities to do all that. Wulalalalalalalo.
So hopefully, I'll be talking to Dr. Jud again today before he leaves town for a bit and we'll see what the reality is of the next three weeks - good lawd - three weeks and so many poops samples! The good news is, I am detecting worms/ova/parasites - at some level - period. So we know the de-worming will be useful and effective. The frustrating news is that I could (apparently) be doing it a lot better. The good news is I am showing hundreds of children and their schools and their parents that their health is a priority to us and the clinic.
So that's about where i stand. It's hard to write it all down - and we really are quite busy these days. We get up at 6:30 to help with chores (mopping, sweeping, dishes, breakfast making), then I head to the school, sing a song or two, collect samples, analyze them on our little field scopes till about 2 pm, scarf down lunch, head to the other school to weigh and measure kiddos there (though the teachers there were so excited they wanted to be weighed as well... and... sigh... they broke my scale!) then come home, get water from the water pump, help cook dinner (see this. Jobaby with a knife the size of her face peeling little bitty potatoes by candlelight, while passer bys grab her head and twist it around to check out her braids... the novelty has yet to wear off). and then we eat like kings (kate, everyone now knows to get the Blue Band butter out for me... and the salt too. But it's cool, apparently blueband is now rich in Vit A! No wonder these kenyans have such good night vision) - and i fall asleep sitting up ... then we pass out under a canopy of mosquito nets. it's pretty great.
so on that note, I must go... we have the whole crew in town (including dada, harison, and Anyango - who never come to kisii - and saw a mirror for the first time while they were here) - so a giant size plate of chips (french fries) is calling my name.
Abiro Nenu,
and much much love,
Jobaby
Tuesday, July 3, 2007
Ilal Kanye? (where have you been hiding?)
Ilal Kanye, indeed - a sentiment I have been hearing a lot from the schools I promissed to de-worm. Antiye, I respond (I'm alive)... but unfortunately, we're still dealing with the typical bumps in the unpaved roads of africa. Was supposed to start the sample collections today - but we we got home too late last night from kisumu to hand out sample containers to the children (it rained yesterday so the roads were a mess). Due to the rain, we ran out of solar power at the clinic, so I can't turn on the microscope. Tricky Business. So it seems project MIGHT start on wednesday, thursday more likely. Wulalalalalalo.
The good news is that no matter what happens, the regular de-worming days at the clinic will happen. It would be great to know the worm burden of the Lwala Community so that we could report on that and act accordingly, but most important is to DECREASE that burden regardless of what it is.
I have spent a few more days in Kisumu with my friends at Walter Reed and was quite proud of myself when I identified hookworm, whipworm, roundworm, and schistosomiasis mansoni all on my own in about 30 seconds flat. Hopefully we see some rapid diagnosis like that at the clinic - fingers crossed.
Life in Lwala is quite hectic these days - fred and I have been traveling back and forth between Kisii, Rongo, and Kisumu a whole lot more than we would like, but as always - it's worth it. We are hoping to send in our reports to the research institute this afternoon (weather and time permitting). We also have about 10 guests on the Ochieng' household... while katie (my kenyan kindred spirit) has left with Lindsey Young for safari, we still have our 5 vandy undergrads, Dr. Bill Young, my good friend andrea (aka Dr. Dre), and a guy named Ian - a canadian who works for Real Medicine... a non profit looking to link Lwala up with some great connections and medical supplies. \it's great to have all these people so eager and excited to help and to work for lwala - but it is a lot. Msungu Ochiko! (9 white people)... we are quite a sight walking down the road to reach the main road for transport. Quite a sight indeed. I think we are overstimulating small children left and right.
It has been an interesting dynamic amongst all of the Msungu. Now, with so many americans in the house, there is a decided sense of urgency to be productive at all times... to plan and to organize at each meal for the following hours or days. Quite the opposite of what my first few weeks were like in Lwala. It is difficult to reconcile... do you let go of all of your ideals to adapt and fit in with the surrounding culture and community - or do you say to hell with that, I am here to accomplish something, and nothing's going to stop me.
In other exciting news... Sukina maber ahinya! (my braids look so smart!) That;s right... hiked into Rongo over the weekend to get my her did. In a whimsical fit of lord knows what, I asked the hairdresser to do whatever she thought would look good. Well. Well, well, well. She gave me a kenyan do, indeed - most of the women here have it - and it looks gorgeous on them. It's basically cornrows that swirl up into a bun. On this here Msungu, however, it looks a little silly. Apparently, my head is slightly oblong and my scalp is whiter than the skin under my famer's tan. Regardless, this coupled with my accelerating language skills has fooled a couple people into thinking I actually might be a kenyan... not really - but they seem impressed... I'm having lots of fun with the language - and everyone is eager to help me along.
Hhhmm, what else? Bike taxi total: 3. Water carrying on head total: lost count... the braids add an extra challenge... but whatever... you ain't bad. I got that bucket-on-head technique down pat.
Ok, would love to write more but fred and I need to securipost our documents to Nairobi. Will keep you posted when i can.
And special thanks to JNB for one of the best packages ever - everyone is going to love the soccer ball and uno cards... don't know how, but you got it all right... and this here little lady is going to love her some kashi.
And to Lindsey and Kate - i saw lindsey's "husband" again in rongo today and he kept asking me where all my sisters were... I responded with a grunt and a click... ok, not really... but i tried.
big smooch
jobaby
The good news is that no matter what happens, the regular de-worming days at the clinic will happen. It would be great to know the worm burden of the Lwala Community so that we could report on that and act accordingly, but most important is to DECREASE that burden regardless of what it is.
I have spent a few more days in Kisumu with my friends at Walter Reed and was quite proud of myself when I identified hookworm, whipworm, roundworm, and schistosomiasis mansoni all on my own in about 30 seconds flat. Hopefully we see some rapid diagnosis like that at the clinic - fingers crossed.
Life in Lwala is quite hectic these days - fred and I have been traveling back and forth between Kisii, Rongo, and Kisumu a whole lot more than we would like, but as always - it's worth it. We are hoping to send in our reports to the research institute this afternoon (weather and time permitting). We also have about 10 guests on the Ochieng' household... while katie (my kenyan kindred spirit) has left with Lindsey Young for safari, we still have our 5 vandy undergrads, Dr. Bill Young, my good friend andrea (aka Dr. Dre), and a guy named Ian - a canadian who works for Real Medicine... a non profit looking to link Lwala up with some great connections and medical supplies. \it's great to have all these people so eager and excited to help and to work for lwala - but it is a lot. Msungu Ochiko! (9 white people)... we are quite a sight walking down the road to reach the main road for transport. Quite a sight indeed. I think we are overstimulating small children left and right.
It has been an interesting dynamic amongst all of the Msungu. Now, with so many americans in the house, there is a decided sense of urgency to be productive at all times... to plan and to organize at each meal for the following hours or days. Quite the opposite of what my first few weeks were like in Lwala. It is difficult to reconcile... do you let go of all of your ideals to adapt and fit in with the surrounding culture and community - or do you say to hell with that, I am here to accomplish something, and nothing's going to stop me.
In other exciting news... Sukina maber ahinya! (my braids look so smart!) That;s right... hiked into Rongo over the weekend to get my her did. In a whimsical fit of lord knows what, I asked the hairdresser to do whatever she thought would look good. Well. Well, well, well. She gave me a kenyan do, indeed - most of the women here have it - and it looks gorgeous on them. It's basically cornrows that swirl up into a bun. On this here Msungu, however, it looks a little silly. Apparently, my head is slightly oblong and my scalp is whiter than the skin under my famer's tan. Regardless, this coupled with my accelerating language skills has fooled a couple people into thinking I actually might be a kenyan... not really - but they seem impressed... I'm having lots of fun with the language - and everyone is eager to help me along.
Hhhmm, what else? Bike taxi total: 3. Water carrying on head total: lost count... the braids add an extra challenge... but whatever... you ain't bad. I got that bucket-on-head technique down pat.
Ok, would love to write more but fred and I need to securipost our documents to Nairobi. Will keep you posted when i can.
And special thanks to JNB for one of the best packages ever - everyone is going to love the soccer ball and uno cards... don't know how, but you got it all right... and this here little lady is going to love her some kashi.
And to Lindsey and Kate - i saw lindsey's "husband" again in rongo today and he kept asking me where all my sisters were... I responded with a grunt and a click... ok, not really... but i tried.
big smooch
jobaby
Thursday, June 28, 2007
Ya wa tho!
Misawa Uru,
So today is thursday. And once again, I am dealing with more IRB headaches (hence the title of this blog - which translates into the equivalent of "oh my god.."). In Kisumu yesterday, we finally got a straight answer from the Kenyan Medical Research Institute on what we needed to do for approval. It shouldn't be too bad, but it does mean more days in front of the computer instead of more days spent helping at the clinic or in the schools - or my personal favorite, looking at poop. The Vanderbilt IRB is a whole other story... and let us just say, walalalalalalo (which means "we're in trouble"... the more "la"'s you insert, the more worry you have).
So. Basically, I don't have all that much new to report other than I'll be back in Kisumu tomorrow to hopefully look at some more stool samples (practice practice practice). I hope to get this project started ASAP.
On tuesday, I actually went to one of the schools to start measuring children for malnutrition proxies. The school, while very excited to see me, was also very upset that I had not started collecting stool as promissed. I had explained about the microscope, but i think they were so eager for us to do something for their children, that they had gotten a little impatient. Completely understandable. As such, they insisted I measure every single child in the school (i think they were maybe afraid that I wasn't going to come back). 100 kiddos. Height, weight, age, and arm width. Typical: i could not get an accurate birthday for any child. The headmaster simply insisted he knew everyone's age, but it was clear that he was guestimating as each child walked in. Also typical - scale is probably about 5-7 lbs off. Hopefully the consistency of it all will correct for itself in some way.
What else? We have 10 msungus on the Ochieng' homestead now. Yep, 5 kids from vandy undergrad, Dr. young and his daughter, my friend Andrea (Dr. Dre), katie, and myself. I am not so sure that people really thought about what it would be like to have all these american's running around such a small place, but lord knows, we'll make it work. It is very different dynamic now, however, as meals that used to be sort of intimate family time now consist of "food for the army" and a lot of "planning conversations" to keep everyone occupied. Also, Katie and I being referred to as "Resident Experts" in Lwala... now THAT is a hoot. I guess the fact that we carry buckets of water on our heads and know how to n'gweno our kuon maybe led a few people astray... but as a so-called "expert" i guess I'll tell you a little bit about what a regular day in Lwala is like, since I don't think i have done that yet.
1. If we are not traveling (to kisii, rongo, or kisumu - and therefore don't need to get up extra early to beat the sun on a 5 mile walk to the main road), we usually get up when we get up. There's a lot of noise from roosters, cows, goats, and early-morning risers (most children get up around 5:30 or 6 to cook, clean, and get to school on time. If they are late to school, they are caned by the professors). We get up, use the pit latrine etc... and head down to the main house where we try to help with the dishes from the night before.
2. we then have breakfast - usually either bread and jam/butter (we have made peanut butter a staple as well), or left overs from the previous day (rice and beans, ugali, eggs etc). Chai (tea - which is really hot water and milk with added leaves, coffee powder or milo mix) is also a mandatory part of breakfast.
3. Then it's dishes again... and maybe we'll head into town. Maybe we'll clean the house. Maybe we'll go to the clinic.
4. The clinic is always teeming with people - and is currently staffed by only one nurse (they used to have a clinical officer but he left for a government job and to be closer to his family - this is a big problem being so far away from large cities/towns - getting health workers who are committed to stay). As such, Rose, our nurse, is entirely overwhelmed. We try to give her a hand by taking temperatures and weighing people... but it's not easy... our language skills are not quite up to par to take a history, and if you think small children has Msungu fear to begin with, try coming at them with a sharp-looking instrument (aka thermometer). Still, rose seems to appreciate our help, so hopefully, we can continue with that.
5. Everyone always breaks for lunch. As grace once told me after a big breakfast followed by a very big lunch, "baby, this is Kenya - when there's food, you eat." And eat we do. No one eats between meals, so we have leaned to pack it in when we do chiemo (eat). I have now learned to say, "baby, don't cheat yourself" to anyone who is going easy on their food portions (bwana, kik iwondre) - it always gets a good laugh. Everyone in the family (including kids who come home from school) comes together at every meal - it's really nice. We usually eat ugali (maize derivative), sukuma wiki (kale), eggs, any left overs, beans, rice, lentils, etc. If we have gone to the market we might have some beef stew or goat. (Omundi loves his beef).
6. afternoons are similar to the mornings (although this week has been packed with trips to kisii and kisumu)... and usually around 5 or 6 we do some exercise - usually to the amusement of the kids passing home from school. Then, we go walk about 500-600 yards, and down a big hill into a big field to get our water from the pump that was dug for the clinic. Now that the rainy season is over, and the man-made well by our homstead is too low, we have to fetch our water from the pump. It's quite a trek - and heck yes, we carry it all the way back on our heads.
7. Then we take turns with the bucket - bath. It's a lot of splashing water all over yourself until you think the soap is gone. There's not much light at that point, so it's a bit of guess work.
8. by this point it's dark. We usually read, play chess, play cards, hang out, and/or help out with dinner.
9. We usually eat dinner between 9 and 10... and by 10:30, I am usually passed out, upright in one of the chairs... they don't call me geri for nothing. Dinner is similar to lunch - with lots of delicious warm foods, good family time, and a lot of laughter.
10. After some more cards and chess, fred, kate and I all head back to our house for group teeth brushing and bed-time nonsense.... and then we pass out under our wonderful mosquito nets. and that is prettty much our Day!
Other important notes to consider... we did indeed throw a surprise party for fred - and baked him a multi-colored multi-layered cake on the open fire... it was pretty impressive. The Ochieng' Cake recipe is not to be beat. I think we will head back to kisumu tomorrow (5 mile walk, 3 hour matatu, 10 minute bike taxi) to get some more help from the Walter Reed People. This has been the only facility where fred and i can find reliable teaching/training. The sad but very true reality is that the quality of medical instruction here is very poor. Most lab technicians are not well trained at all. As good intentioned as they may be, they really do not know what they are doing in many cases of microscopy - but are diagnosing infections at will. As a result, nurses or CO's who rely on the lab techs are doing the same. In the case of Lwala, we don't have a lab tech (because we have yet to find one with competant training), so Rose is forced to make a lot of blanket diagnosis. Anyone with fever and chills and joint ache : malaria. Anyone with intestinal cramping and diarrhea: worms. Bad LRI/URI : give antibiotics. It's very challenging to agree with, but at the same time, we all understand that at the moment, it is the best option. It would be worse to be stingy in the diagnoses and miss something life threatening. It is all very tricky.
And this blog is so very long. We have a pretty big trip back to Lwala, so i think we should head out. Hope you are all doing well - it's incredible to think that I will be home in one month. I look forward to catching up with you all.
Uchiop ma ber.
Jobaby
So today is thursday. And once again, I am dealing with more IRB headaches (hence the title of this blog - which translates into the equivalent of "oh my god.."). In Kisumu yesterday, we finally got a straight answer from the Kenyan Medical Research Institute on what we needed to do for approval. It shouldn't be too bad, but it does mean more days in front of the computer instead of more days spent helping at the clinic or in the schools - or my personal favorite, looking at poop. The Vanderbilt IRB is a whole other story... and let us just say, walalalalalalo (which means "we're in trouble"... the more "la"'s you insert, the more worry you have).
So. Basically, I don't have all that much new to report other than I'll be back in Kisumu tomorrow to hopefully look at some more stool samples (practice practice practice). I hope to get this project started ASAP.
On tuesday, I actually went to one of the schools to start measuring children for malnutrition proxies. The school, while very excited to see me, was also very upset that I had not started collecting stool as promissed. I had explained about the microscope, but i think they were so eager for us to do something for their children, that they had gotten a little impatient. Completely understandable. As such, they insisted I measure every single child in the school (i think they were maybe afraid that I wasn't going to come back). 100 kiddos. Height, weight, age, and arm width. Typical: i could not get an accurate birthday for any child. The headmaster simply insisted he knew everyone's age, but it was clear that he was guestimating as each child walked in. Also typical - scale is probably about 5-7 lbs off. Hopefully the consistency of it all will correct for itself in some way.
What else? We have 10 msungus on the Ochieng' homestead now. Yep, 5 kids from vandy undergrad, Dr. young and his daughter, my friend Andrea (Dr. Dre), katie, and myself. I am not so sure that people really thought about what it would be like to have all these american's running around such a small place, but lord knows, we'll make it work. It is very different dynamic now, however, as meals that used to be sort of intimate family time now consist of "food for the army" and a lot of "planning conversations" to keep everyone occupied. Also, Katie and I being referred to as "Resident Experts" in Lwala... now THAT is a hoot. I guess the fact that we carry buckets of water on our heads and know how to n'gweno our kuon maybe led a few people astray... but as a so-called "expert" i guess I'll tell you a little bit about what a regular day in Lwala is like, since I don't think i have done that yet.
1. If we are not traveling (to kisii, rongo, or kisumu - and therefore don't need to get up extra early to beat the sun on a 5 mile walk to the main road), we usually get up when we get up. There's a lot of noise from roosters, cows, goats, and early-morning risers (most children get up around 5:30 or 6 to cook, clean, and get to school on time. If they are late to school, they are caned by the professors). We get up, use the pit latrine etc... and head down to the main house where we try to help with the dishes from the night before.
2. we then have breakfast - usually either bread and jam/butter (we have made peanut butter a staple as well), or left overs from the previous day (rice and beans, ugali, eggs etc). Chai (tea - which is really hot water and milk with added leaves, coffee powder or milo mix) is also a mandatory part of breakfast.
3. Then it's dishes again... and maybe we'll head into town. Maybe we'll clean the house. Maybe we'll go to the clinic.
4. The clinic is always teeming with people - and is currently staffed by only one nurse (they used to have a clinical officer but he left for a government job and to be closer to his family - this is a big problem being so far away from large cities/towns - getting health workers who are committed to stay). As such, Rose, our nurse, is entirely overwhelmed. We try to give her a hand by taking temperatures and weighing people... but it's not easy... our language skills are not quite up to par to take a history, and if you think small children has Msungu fear to begin with, try coming at them with a sharp-looking instrument (aka thermometer). Still, rose seems to appreciate our help, so hopefully, we can continue with that.
5. Everyone always breaks for lunch. As grace once told me after a big breakfast followed by a very big lunch, "baby, this is Kenya - when there's food, you eat." And eat we do. No one eats between meals, so we have leaned to pack it in when we do chiemo (eat). I have now learned to say, "baby, don't cheat yourself" to anyone who is going easy on their food portions (bwana, kik iwondre) - it always gets a good laugh. Everyone in the family (including kids who come home from school) comes together at every meal - it's really nice. We usually eat ugali (maize derivative), sukuma wiki (kale), eggs, any left overs, beans, rice, lentils, etc. If we have gone to the market we might have some beef stew or goat. (Omundi loves his beef).
6. afternoons are similar to the mornings (although this week has been packed with trips to kisii and kisumu)... and usually around 5 or 6 we do some exercise - usually to the amusement of the kids passing home from school. Then, we go walk about 500-600 yards, and down a big hill into a big field to get our water from the pump that was dug for the clinic. Now that the rainy season is over, and the man-made well by our homstead is too low, we have to fetch our water from the pump. It's quite a trek - and heck yes, we carry it all the way back on our heads.
7. Then we take turns with the bucket - bath. It's a lot of splashing water all over yourself until you think the soap is gone. There's not much light at that point, so it's a bit of guess work.
8. by this point it's dark. We usually read, play chess, play cards, hang out, and/or help out with dinner.
9. We usually eat dinner between 9 and 10... and by 10:30, I am usually passed out, upright in one of the chairs... they don't call me geri for nothing. Dinner is similar to lunch - with lots of delicious warm foods, good family time, and a lot of laughter.
10. After some more cards and chess, fred, kate and I all head back to our house for group teeth brushing and bed-time nonsense.... and then we pass out under our wonderful mosquito nets. and that is prettty much our Day!
Other important notes to consider... we did indeed throw a surprise party for fred - and baked him a multi-colored multi-layered cake on the open fire... it was pretty impressive. The Ochieng' Cake recipe is not to be beat. I think we will head back to kisumu tomorrow (5 mile walk, 3 hour matatu, 10 minute bike taxi) to get some more help from the Walter Reed People. This has been the only facility where fred and i can find reliable teaching/training. The sad but very true reality is that the quality of medical instruction here is very poor. Most lab technicians are not well trained at all. As good intentioned as they may be, they really do not know what they are doing in many cases of microscopy - but are diagnosing infections at will. As a result, nurses or CO's who rely on the lab techs are doing the same. In the case of Lwala, we don't have a lab tech (because we have yet to find one with competant training), so Rose is forced to make a lot of blanket diagnosis. Anyone with fever and chills and joint ache : malaria. Anyone with intestinal cramping and diarrhea: worms. Bad LRI/URI : give antibiotics. It's very challenging to agree with, but at the same time, we all understand that at the moment, it is the best option. It would be worse to be stingy in the diagnoses and miss something life threatening. It is all very tricky.
And this blog is so very long. We have a pretty big trip back to Lwala, so i think we should head out. Hope you are all doing well - it's incredible to think that I will be home in one month. I look forward to catching up with you all.
Uchiop ma ber.
Jobaby
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