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