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