Bye Bye.

Why is it that your schedule always gets super busy when you have no time left!?!?! I leave tonight, so naturally, I have 8 million things to do before then, including visiting about 4 different people at 4 different places in the city. chaos!

I'm not ready for this either. I'm having so much fun, understanding so much more Kiswahili. Getting around by myself...and now I already have to go. When I told people I was going to Kenya for 5 weeks, they said, "Wow, that's a long time!" But no, it really isn't. Last time I was here for 3 months and that didn't seem long either. Alas, I must go. School starts on Monday. :( I'll be jetlagged for the entire first week of class, but it's totally worth it! Can't wait to come back. Maybe next time I'll stay for a couple years...

We're about to take off so, sayonara (wrong continent, najua) Africa. Kwaheri ya kuonana (bye and hope to see you again).


(not my photo)

That's an Awful Lot of Blood!

Saw this guy lying in the road near Karen roundabout leo. I think he was hit by a care and I think he was dead. There was an awful lot of blood. Just saw briefly as our matatu was passing. Someone was already attending to him. I kinda wanted to jump out the window to see/help? but the patatu had the bar accross the middle of the window specifically to prevent people from jumping out the window without paying.

Happy Birthday to Me!

Yay for my birthday! Just hung out today. Tootled around town. Visited UoN engineering nerds. :) Went to Carnivore for a late lunch with some friends. We went specifically for the nyama choma, but were dissapointed to find that the nyama choma chef's are on break from 3-6pm!!! Sigh. So, we had to pick something else, which was also good, but not the full Carni experience. But at least I can say I've been there now. :) Better luck next time.

Just Teach Them Something.

By Grace today. School Administrator/teach for 4,5,6th grade was out. So, when the students finished the assignment they had been given, I was told by the 1,2,3rd grade teacher, "Just teach them something. Math, English, anything." Shoot. Just teach? Well, I thought to teach math, but soon realized that not only were there a combination of 4th, 5th, and 6th grade math students in the class, but even the ones in the same level were not on the same page of the book. So, when I asked the 6th graders which page they were on, one said "The three of us are on page 17." but then someone else piped in, "Well, I'm only on page 6!" and others, "We're on page 20." So, I just said, "Well there's now way I can teach you a math lesson if you're all on different pages, just just work the problems where you left off last time and ask questions if you need help."

Kayole!

Spent the day chillaxin' at Stanley's Dad's house in Kayole (near the JKIA - Jomo Kenyatta International Airport). It's kinda cool here. A very urban scene.


View from Baba Stanley's apartment complex ("Baba Stanley" means Stanley's dad).


Apparently, this guy is boiling a goat head in that pot. I'm told it makes a good soup.


Reception antennas.


Up on the roof/3rd floor (the complex is not finished yet).

I would not be at all upset if we ate the rooster for breakfast. I'd even slaughter it myself. I was sleeping like a rock, 'til 7am when he tought to begin his morning chior practice! Oooh I was mad!


He was told to fix the iron. Yay for Electrical Engineers. Unfortunately, he didn't have his preferred screwdriver. As he tried to describe the importance of the screwdriver to me, he put it in terms I could understand, and stated: the screwdriver is the engineer's stethescope.


Posin' with the neighborhood. I think they're all looking at me tho... :{


Family shot! Baba Stanley, half-sis, Stanley with half-bro (Cosmos), step-mom.


One of the pimped-out Eastlands matatus. Apparently there's a new one in Kayole that's so tricked-out that the conductor doesn't even have to hussle to get passengers. They just pull up and watu pile on. It has a plasma/LCD screen on the ceiling and even one of the back of each seat. The purpose of these screens is for music videos....Hmmm, I wonder where these matatus are parked when not is use? I know I'd steal one if I had the chance. Then again, they're likely running 24/7.

I think the polici pretty much hate the matatus...they give the police too much trouble and disregard most traffic laws. For instance, they are not supposed to drop or collect passengers at certain places because it congests traffic. This evening, on the way back to Bomas, our matatu, leaving the main stage in town near Kenbanco House, decided he would pick passengers in a "no load zone", which also happened to be right in front of a police officer. So, the police hits the side of the matatu with his baton/stick thing. The conductor makes some astonished face accompanied by an exclamation of "Ay!" or "Hey!" in response, while he lovingly inspected the 'wounded' door. As a result of his grumbling and his continued efforts to load passengers, the vehicle received another emphatic, whap! Again, resulting in more (probably rude) remarks from the conductor. Luckily, the driver entered traffic before this went any further.

Back to NBO

1130-1300: boat to Mbita

14-1445: ferry to Lwanda

1500-1730: matatu to Kisumu

1730-2030: William's house until our EasyCoach leaves. We had joked that the first time we visited him, he gave us a place to sleep. This time he fed us. Now he just needs to give us clothes and we'll have our basic needs covered. As we were leaving, it was pouring, so he gave us a jacket. haha. what a guy.

2100-0400: EasyCoach to Nairobi.

Time for bed. Zzzzzzzzzzzzzzzzz............

Do you realize that the amount of time it took us to get from Nairobi to Mfangano, I could have gone all the way from Seattle to Nairobi! Ay caramba!

More Gross Medical Stuff...&...The Efforts of a Village

THE GROSS (but actually super cool) MEDICAL STUFF:

Sites of the day:

*epilepsy (partial complex sz) in a 10yo. Reported symptoms: tired --> lies down for 30-60minutes --> wakes and is confused and speaks jibberish.

*febrile sz (5yo & baby)

*Polio (17yo boy): Pt reported that he'd had this for 2yrs. Unusual to get polio at age 15. We tried to get more information about where he lived to see if there was any correlation with a recent outbreak or anything, but we were not very successful. He was very reluctant to tell us what area he was from. MD treated with PO (oral) Naproxen for pain & topical anti-inflammatory for right knee. We can only treat his symptoms. The damage from the Polio has already been done. (Right-sided weakness and muscular atrophy. His right knee had very significant patellar swelling. It was very pronounced and nobby-looking. I guess a good way to describe it might be like a baseball sitting on top of a twig, or something. Very distinctive Polio walk/limp. Basically, his right leg is totally deformed and weak, so it kind of drags along while he supports himself with the Left leg and a walking stick.) I reall wish I would have taken a picture of some of these things, but here's a pic from the web of the effects of Polio. I couldn't find the pic I wanted, but this is a good diagram of the muscles effected by Polio:



*vaginal yeast infections (many causes for this kind of stuff, but one way is from sitting in bad water, such as a lake, puddles, etc, to bathe, wash clothes or dishes, etc). We saw this kind of thing a lot in Dominican Republic.

*more tinea capitis. By the way, this (ringworm) is a fungal infection. Round patches with defined and slightly raised edges:


Ringworm (tinea capitis)

versus

Folliculitis. Patchy and more irregularly shaped.

Once these pustules start to dry up/scab over, it is a little more difficult (for a newbie) to distinguish from Ringworm.

*Shingles in a 25yo woman (down her Left leg). Likely HIV+ because she's so young. Also, commonly Shingles is seen on the back around the rib cage, but it can occur along any nerve pathway...and if you know your nerve pathways (which I don't) you can easily identify it was Shingles because it follows that path exactly. The husband a dark patchy rash accross his face (nose, forhead, and cheeks. Likely HIV dermatitis).

*umbilical hernia


Today was my last day at the med clinic. We returned back to Mfangano on the 430pm boat, which naturally, left around 530pm. I've been "mzungu'd" to the max over this side, but maybe the cherry on top of all the "mzungu-ing" was from the boat conductor. Someone else on the boat has something like "Now, where is this mzungu going?" And the conductor defensively responded: "This is our mzungu! Go find your own mzungu." So now I proudly hold the title of Mfangano's Mzungu. :)

IT TAKES A VILLAGE:

As we were walking up to the shamba, there was a big gathering of people by the airstrip. Some sort of meeting apparently. We later learned that a relative of Stanley's was among them. Well, by that I mean he was the main event. As it turned out, the gathering was an intervention. The guy's mother told on him to the community youth group because while he should be in university now, he prefers playing pool all day and has no motivation to work or go to school. So, his fate was to undergo interrogation and caning by the youthgroup, who then proceeded to develop a plan of action for him. His sentence: he has been assigned a teacher by the youthgroup and is to be woken at 6am each morning for studying. Needless to say, he's not at all happy about this and ignores all of our probing question regarding "Tell us what happened Thursday evening? Where were you?"

These types of interventions are the typical mode of getting someone back on the right track. Not too long ago, ome parents were accused/known to be neglecting their children (leaving them in the house, not being good parents). The village found out, brought both the mother and father to one of these sessions, and they were both caned and severely scolded for their parenting (or lack thereof).

Also, if a man is found to be beating his wife, he's caned as well.

Therefore, it takes a village. I wish we had this kind of community support in the U.S. I think we'd have a lot fewer problems if we had more people being accountable for each other.

Would you like Ringworm with that?

Today, lots of tinea capitis. It seems to be so common here that the doctor can practically Dx it while the patient's still walking into the room. Also a lot of back and leg pain (likely d/t poor body mechanics when lifting, working, cooking, sweeping...there's not a lot of "bend at the knees" here). Also,

*4+ edema x2 years? unknown origin. Dx: not a clue. no idea why this guy has such bad edema. Rx: Lasix (loop diuretic. basically make your body get rid of water. He hopes that this will get the fluid out and relieve the edema.)

*growth remove from a woman's back. the MD cut it with scissors (rather than using a scalpel). He said that with the scissors it would bleed a lot less.

*Ooh, I did a wound dressing today! :) The boy had an ankle wound. Pretty deep, really old and crusty kind of. Maybe a few centimeters in diameter.

*a woman with shingles. Unfortunately, she was only 25-30yrs old. You get shingles (which comes from the chicken pox virus that lies dormant in a nerve root in your spine) when your immune system is compromised (i.e. you're under a lot of stress or something). Generally, shingles appears in your 50s or 60s. When you get it this young, chances are you have HIV or some other immuncompromising illness.

*Here was something bizarre. A woman with a big rash all over the left side of her neck, and huge lumps on the right side of her neck (enlarged lymph nodes). The right side is very tender. It was concluded that the enlarged lymph nodes was probably Lymphoma. The rash on the left...unrelated? who knows?

*40yo woman on Depoprovera x8yrs. She states that for the past 6yrs she's had breast tenderness just before she's due for the next injection, but she does not have a monthly period. Hmmm...not sure what that is.

Oh! Also, I triage patients today! By myself! (though with a translator for the people who only spoke Luo). I liked this! Probably, my triajing was a little more thorough than necessary, but of course I had to practice all my patient interview skills! :) I loved this because I really felt like I was doing something useful rather than just watching like I normally do. (I triaged this woman above, so I don't know what the Dx/outcome was.)

I have also noticed that a lot of women are (unknowingly) complaining of menopause symptoms. Their complaint are, "I am having times when I become very hot a few minutes and then it goes, etc, etc". Then we look at their age...48yo female. Oh, R/O menopause.

Wounds, pus, and fungus! Yum!

Today begins the medical clinic. I am joing a team from Charleston, SC. There are 14 people on their team, including: 1 MD, 1 PA, 4 RNs, 2 PTs, and the rest are non-medical people. We've set up the clinic in the preschool building, and turned it into three rooms (triage, doctor's "office", and pharmacy.

It's so interesting to see that kinds of complaints people come in for. The doctor has said that people really just want to go home with something (i.e. medication) because then they really feel like they've been treated. Also, he stressed the importance of actually touching the patient: listening to their heart/lungs, if they have bakc pain-examining their back, etc. He said that the experience in going to the doctor in Kenya is often one where the doctor does not even touch the patient and just prescribes, and the patient leaves wondering, "How does he know what's wrong?!?! He didn't even touch me!". (Now, he may have known without having the touch, but not all people know that, and it is much better bedside manner to actually connect with your patient and make them feel cared for in their own mind, i.e. beyond just giving them pills.)

Anyway, today I sat with the MD to observe while he treated and learn about what to look for and how to treat here. Today we've seen:

*tinea capitis, tinea varsicular, & tinea corporus (ringworn), which I think can be contracted from Lake Victoria (i.e. swimming & bathing in the lake). Essentially every kid brought to the clinic had tinea capitis.

*hives

*"chest pain woth cold" - this was a very common complaint. Sounds like bronchoconstriction to me. Possibly asthma symptoms as well. Lots of people have asthma here, likely d/t all the dust and the deisel trucks exerting coal black smoke.

*stomach pain

*I watched the MD drain a cyst. This patient was really happy to have this gone! It was on his right wrist and he'd had it since he was a little boy (maybe age 27-30 now?). MD used an 18g needle & 10mL syringe. ETOH swab the area, then insert needle and draw out fluid. Actually the contents of the cyst was more of a clear jelly consistency. It was really thick so it too some effort to remove.

*HA (headache)

*cough

*club feet

*athlete's foot

*soccer injuries x3 (knees)

*one man with a foot wound x2yrs. Very infected --> very swollen ankle. He was prescriped ABX (antibiotics) x 1month (received Cipro - ciprofloxacin).


Here's a couple pix:


patients waiting to be called to traige. Two pastors are preaching to them.


patients waiting after triage to be seen by the doctor/nurse/PA.


view of the "doctor's office". There are four stations. 2RNs, 1PA, 1MD for treating patients.


Pharmacy. I was impressed by how many medications they were able to get!

Can't wait for the next day of clinic!

More adventure!

11am boat to Mbita. Then, guess what?!?! I got to ride on the back of a motorcycle up to CGA (Christ's Gift Academy). I loved it! (except when we were trying to go up a hill and we got stuck in some loose dirt an almost tipped over).

CGA is a really nice school. It is nursery through 8th grade (day school, not boarding) with about 280 students. They started with nursery school and have been building their program for many years now, so the very first children in the nursery school are not in high school. Apparently students from CGA have some of the best high school exam rates and get accepted to good high schools. :)

This is where the medical clinics will be held.

I don't really know what else to say about this, I am just amazed by this school! It looks really nice! It has beautiful classrooms, a beautiful view of Lake Victoria, and it just looks very established.


view from the school grounds.

Mfangano Island

Island in Lake Victoria. We eat lots of fish here! (talapia, Nile perch). Sooooo good. Fresh from the lake.

Houses: 2-3 rooms. Corrogate tin roof. Dung & mud walls & floors. No plumbing. No electricity (yet...coming soon!).

Latrines: hole in the ground.

"Shower": a stick built enclosure about 6 feet tall. method: bucket of water. (of the better way is bathing in the lake!)

Cooking: outdoors with a fire.

The Shamba Set-up:

My friend is from a polygamous tribe (Luo. Western Kenya is "Luo land"), so his dad has four wives. The father lives in Nairobi with the fourth wife. The other wives live in Mfangano, each with their own house. In this tribe, the first wife's house must face the Shamba entrance (btw, a shamba is basically your property). Also, every son builds a house on his father's property, but it does not have to be on the same shamba where the wives live, but it must be on land that the father owns. However, the sons houses are built according to birth order (no cut-sies!). In this family, there are a total of 10 boys. Typically, the youngst son in the house inherits his biological mother's house (i.e. my friend is the middle child of three (the second boy) in his mother's house, so he will inherit her house).

Here's a little diagram of this Shamba's format (sorry it's kinda small):



Well, this morning we had good intentions to go to church, but...we failed. Good ol' African time. :) Church started at 9am, but we didn't even bathe until 0830. Then we had to take tea & chapati. We finally left the shamba around 1030, and
1) passed through town/market (specifically Sena) to charge our phones (there are kiosks with generators here)
2) bought some nyama ya mbuzi (goat meat)
3) 11am-2pm: went visiting at another friend's brother's to see their new baby (3 days old!!!). Sometime between 11 and 2, we concluded that we'd missed the sermon.

Around 2pm, we meandered back to the shamba in search of a little shade. Goodness the sun shines hot here!

Later in the afternoon, Stanley, Constance, Caroline, and I took an eventful/entertaining walk parkway up the mountain. I was toured around the other shambas, and still have no idea who belongs where or to whom. These families are big! I really got "mzungu'd" a lot during this walk. One little girl in particular was facinated. She kept waving and saying "mzungu! mzungu!" Then as we were walking away, her mother said, "Ok, she's gone. You can come home now." and the girl replied, "No, momi, she is still going!"






visiting with the baby.


meandering down the airstrip.


view from the hillside.

A little nursing this evening:
* Advised a boy on his sickle cell condition (when I looked it up later to verify, I found I'd told him exactly the right thing!
Thanks memory!)

* A friend called and it went as follows:
S - 2145: pt calls, when asked "How are you?", replies "Not good." Complaining of chest pain. (specifically states pain is located between throat and stomach). After questioning, reports 6-7/10 pain/c onset 15-20mins ago (while watching TV), radiating to back. States pain is not pressure or burning and that this pain has not beenexperience before. Reports clamy/sweaty palms, but not sweating from forehead. Reports pain does not change with breathing or movement.
P (provoc. & palliation) - no change when breating in/out or changing positions. caller/pt complaining of 6-7/10
chest pain for 15-20minutes
Q (quality & quantity) - not pressure or burning; reports clamy/sweaty palms, but not forehead.
R (region & radiation) - located between throat & stomach; radiating to back
S (severity & scale) - 6-7/10
T (timing & onset) - sudden onset 15-20 minutes ago while watching TV. no physical activity today, just drove.

O - pt sounds worried.

A - immediate thought is to R/O Acute MI, also considered heartburn (but pt does not report burning sensation), also considered muscular pain, but pt has not been active and pain does not change with breathing or movement.

P - advised pt to go to doctor right away, and also take aspirin if available. (however, pt was reluctant: stated he would look for aspirin, he is alone in the house, he has no car, his house is far from the road & a taxi won't come to his door, unwilling to ask neighbors for a ride to hospital). will follow-up with/call pt again in a few minutes.

E - 2230: called pt, who stated he was eating & pain reduced to 3/10. No aspirin taken. Stated he would "sleep it off" and if he still felt bad in the morning, he would go to the doctor.
NEXT DAY: called pt, who stated he was "feeling better". Did not visit doctor and seems to have not intentions to do so.
Have talk to pt about his concerns for a doctor visit, but was not able to decipher his specific anxieties regarding this.

Sorry again for the long post. Innit Ma ber (Good night, in Luo).

Hawkers, Kuku, na Boats

Long day. Long post. (sorry).

So, we continue...

Nakuru to Kisumu, arrived 0430.

Road conditions: not. so. good. There were some smooth parts, but just as soon as you start falling asleep. Ka-thunk! Potholes (or maybe "road craters" is a more descriptive phrase), and you have to start all over again.

When we arrived at the bus depot, we had to wait for Stanley's friend, William, to come pick us at 0630. At this point we learn that we don't leave from Kisumu until 1030 or so, and then that there's a boat later than 1300. So we'll have a place to sleep and eat before the next leg of our journey. I saw on the news that it's in the 80s in Seattle. Sigh. I'm missing the great Seattle summer...but it's worth it! :)

Oooh, we rode on the back of a bicycle (baiskeli). It was fun!

Left William's around 10am to the Kisumu matatu stage, boarded a big matatu, and sat. Of course we had to wait to be entirely full before we departed. While we waited, we were presented with plenty of opportunities to purchase...well, essentially anything: belts, candy, soda, shirts, underwear, sugercane, etc. We didn't leave until 1115, but then proceeded to mae several other stops to load MORE on the roof before actually 'hitting the road'.

Finally, we're enroute to Lwanda:

These conductors are funny! There are four or five on these matatus to help load lugages (and you know the roof is piled high with all sorts of stuff...bags, boxes, house building materials, chickens, grains, bananas (and yes, I did say chickens). At the stage two of the conductors were fighting to climb on the roof (I guess they get a comission for loading), but these guys looked funny. They were trying to nudge each other off the ladder, and one guy was cleary ahead, by about half a body length. It was funny because it was kind of a slow motion, leaning into each other trying to get the other to back down. They were finally convinced to come down, but then proceeded to argue for another 15-20 minutes about who was up there first. They were really interrogating each toerh (shaking fingers in their face and even giving little taps on the cheak). The rest of the guys were laughing at them and trying to hold off a fight.

"IN-FLIGHT" ENTERTAINMENT:

*One stop we made before 'hitting the road'*
Conductor: (to a woman at the stage) "Do you want to board?"
Woman: (hesitating and not making any moves towards the door) "I don't know."
Conductor: "Well, we can't bring a chair to where you are standing!"

*You Just Stay Silent.
Guy on road: (yells) "Mzungu!"
I ignore him.
Guy: "Mzungu!"
I ignore again.
Guy: "Mzungu!"
I turn and wave.
Guy: (in a dejected voice) "I call after you and you just keep quiet!"
What am I supposed to do? Dive out the window and run up to him like an overly-enthusiastic puppy?!?!

*Here's a fun fact. We're not allowed to overload the matatus (i.e. everyone has to have a seat), but apparently that's only theoretical and we still pack the aisle anyway. When we come to a police checkpoint everyone standing just squats down to hind while we pass through and then prompty stands up again after passing...haha.

*Woman alights matatu and her bags are being handed down to her:
Conductor on top: "The rooster in this bag is dead."
Conductor inside: "Who's dead rooster is this?"
Woman: "The dead rooster in this bag is mine."
The rooster was in a wicker basket and was alive prior to riding strapped to the top of a matatu. I think I would have died too.

*There was a man who alighted wutg an almost empyt bottle of vodka. He didn't even know that was his stop so the conductors had to drag him off. Then he just stood by the road looking confused and swaying a bit. Ay caramba!

We arrive in Lwanda (at about 1400) to take the boat to Mbita (about 1 hour ride). Water is mostly calm. The boats are like long canoes (sort of like the Native American ones...not the aluminum kind) but they have a motor on back and are painted bright colors (like all public transit in Kenya).


Prepped for the crossing.


Lake Victoria! Fishing Boat in the distance.

Arrive in Mbita at 1500. and met a friend for lunch. The next (and last) boat of the day leaves at 1700. One this boat ride, we were entertained by a somewhat intoxicated man. I, being the only mzungu, was the subject of interest. He was convinced he needed my phone number and was using his best alcohol wisdom to explain to the entire boat why. ONe of these reasons was that if I was in a car accident, I would need to call him to be rescued. (I informed him that I would likely call the police, or a friend if that happened). Another reason was what if he fell off the boat and needed rescuing himself. To this I responsed that if he fell off the boat, his simu (phone) would no longer work, so having my number would do him no good.

Finally,about 1900, arrived in Mfangano. Just a short walk to Stanley's shamba. Phew, nataka kulala! (I want to sleep).


Sunset over Mfangano Island.

A Nice Evening for Travel

This evening we will be traveling to Kisumu via EasyCoach (like the Greyhound). We are to leave from town at 2130 and arrive in Kisumu around 10am. Then we will go from Kisumu to Lwanda. The ferry to Mfangano Island leaves at 1300. If we miss it, we have to wait until the next day. I think the drive from Kisumu to Lwanda is about 2 hours. Then the boat ride from Mbita to Mfangano is about 1.5 hours to cross (apparently if you take a speedboat it takes 5 minutes! I'm sure there is a considerable cost adjustment for this).

We have to travel to Kisumu at night because if we travel in the morning we will miss the ferry. We'll be staying in Mfangano Saturday night and then likely go to Mbita on Sunday evening. Medical clinics start Monday.

Departed from town at 2145. Arrived in Nakuru at 12am. The road was fabulous! Nice and smooth.

Our journey continues in the next entry because technically it's a new day...

Career Change?

Nilienda By Grace leo, tena. (I went to By Grace again today). This time, I taught Math. Well, the teacher taught the actual lesson, but then he had some other things he had to do (he is also the school administrator) so I helped them with their assignment…which included pretty much teaching the material again b/c most of them weren’t getting it. (though they say they understand, but then you look at their paper 15mins later and they’re still on #1a.) We were learning about fractions (changing a fraction → decimal; decimal → fraction; and fraction → percentages). It seemed that they are still having trouble understanding how to apply concepts to different problems. i.e. to change a fraction to a percentage you should multiply the fraction by 100, sindiyo?

ex: give 4/16 in percentage.

4/16 → reduce: divide top & bottom by 4 → ¼ → ¼ x 100/1 → 100/4 → 100 ÷ 4 = 25 → 25%

So I would explain that, but then they wouldn’t understand the next one. I heard the other week that sometimes even Master’s and PhD students aren’t able to apply a concepts like they should and that this is a problem with the Kenyan educational system. Students are just taught to memorize facts and whatnot, but they don’t really learn how to learn, or to grasp the concept of what they are being taught.

I guess we’ll see tomorrow if any of this information stuck. Tomorrow night → Mfangano Island (via Kisumu, Luanda, & Mbita).

Nerds

Not the candy. Today was spent in the company of so-called ‘nerds’ (myself included). For one thing, they are doing a school project while on break from univ. Well, I guess they’re not really nerds, but I consider them nerds kwani the brain required to do what they do is not a brain I possess. I was hanging out at University of Nairobi with my friend Stanley and his Electrical Engineering classmates (and 2 of the 14 group members are women). They’re building a (actually 2) robot(s) for a competition. Ay caramba! There are so many wires! They were trying to convince me that building a robot is easy (they claimed easier than nursing. Right, I’m sure. Though Stanley did make the point that you do have the flexibility to experiment while you are working, ‘I wonder what will happen if I put a wire here?’, without killing people). I agreed /c that, but maintained the position that my brain could never even begin to grasp the concept of how to build a micro chip or which wire to attach where on a mother (or whatever) board.



Their robot has to be programmed to pick up a small box and take it somewhere else. But it also has to be able to differentiate b/w different colored boxes (it’s supposed to pick the blue ones only). It also has to do this without any encouragement from its creators. So, when told to go, it must just know that it is to find however many blue boxes and bring them to a certain area. The boy robot is named ‘Tom’ and the girl robot is named ‘Stephanie’. The girl is prettier. She has a dark red plexi-glass frame, while the boy just has his wires sticking out every which way. I have not really ‘chillaxed’ for a while, and it was really nice to spend time with the univ. croud for a bit (a.k.a. ‘age-mates’).

Why am I a nerd?……………………..I bought a nursing dictionary.

SOAPE Note

S – 13yo girl states she has back pain following falling back into door/doorknob 1-2 days ago while playing with friends. States
she has pain with twisting and bending but not when lying still. Caregivers wanting to know if it’s fractured and if she needs to
go to the doctor.

O – pt sleeping on couch. When asked to ID pain site, points to upper lumbar spine. No sign of swelling, laceration, or other
deformity. Tender upon palpitation. (side note: pt may have scoliosis??? Did not get a good look, but spine looked slightly
curved)

A – suspected bruise to upper lumbar vertebra. Seems unlikely that this situation would lead to a vertebral fx.

P – recommend rest, ibuprophen, and ice (if possible) to minimize swelling and control pain. Have caregivers continue to monitor
pain level and site and report to MD if pain increases or persists for more than a few days, or if swelling or tingling/numbness
in extremities begins. Mentioned to caregivers that if bone is bruised, it may take slightly longer to heal completely than a
normal bruise, and they should continue to monitor for adverse changes. Pt given 325mg prior to my departure (no
ibuprophen available). Also mentioned to caregivers that another 325mg may be given if this dose does not relieve pain.

E – will re-evaluate kesho.

Big Church and Then Some

Today NPC celebrated its 50 anniversary, so church was held at Nyayo Stadium (where football is played). NPC has 8 branches (Karen, Valley Road, Buruburu, Kisumu, Woodley, Ngong). This was a huge, all-day service beginning at 9am. We stayed until 1pm. There was lots of singing, a sermon by Reverend White (who preached at NPC Karen the week before), and several other important people and government officials. Even President Kibaki attended!


A portion of President Kibaki's fleet.


A fraction of the congregation.

At one point in his Sermon, Reverend White proceeded to lie on top of the podium. He was preaching about keeping God’s fire burning in your life. Apparently, the lying down bit was intended to represent that we all will die at some point. Anyway, he’s kind of a theatrical guy/preacher. (Little did he know (or maybe he was looking for a bit of fame), his atypical dramatics landed him on the front page of Monday morning’s Nation).

Following this event, the sun had decided to join us for the weekend, and we enjoyed a swim in the pool (it’s part of the estate).

The evening culminated with a visit to the Safari Walk at Nairobi National Park. There’s a boardwalk that takes you through the whole thing, and there are some parts with great views! You’re never think you were in the middle of drought-ridden Nairobi. Of course we saw the animals too…lioness, hippo, ostrich, crocodiles, etc, etc…but that’s just like the zoo. These aren’t the wild ones (well, obviously they are, but they live in cages/’exhibits’ and are fed by keepers).




Kissing the ground? Eating? Head too heavy?

By Grace

I went to the children’s home again leo, By Grace. I organized and replenished their medicine cabinet, played with the kitten, and played with the children. In the afternoon, we went across the road to the field for games. It was basically just a big grassy grazing area.

I was also taught by one boy how to make, what he calls ‘mats’. It’s basically a place mat (or blanket if it’s big enough) made from yarn. He uses four pieces of wood nailed into a square. Then for the small ones, there are seven nails nailed part way into each board all around the edge. The yarn is looped around those nails to make the pattern.



Then after this (you make 8 loops around each set of nails opposite each other), beginning in one corner, you tie yarn at each corner of the squares made to make the pattern.

Someone from a church also came and did a Bible study for them. He was talking about the creation story, and he had three points…not quite sure how they really tied in. The first was just for itemize what God made on the 1-6th days and that God what He had created was perfect and good, and He gave humans dominion over His creation. The second point is the one I am not too sure about. To me it seemed more like he was giving the ‘correct Christian answer’ rather than Biblical fact. He stated that, “God created everything because of/through Jesus Christ.” Hmmm…now, from what I know this doesn’t make sense. At the time of creation, what God created was perfect (Adam and Eve were not even embarrassed to be naked), so there was no need salvation or a savior (i.e. Jesus). Therefore, because the necessity of Jesus was not yet created/developed, how could God have created everything through Jesus Christ, who was not yet ‘invented’ because there was not yet a need for him. It was not until well after the Fall, when people were really running a muck that God determined the need for a savior…that is when Jesus came about. So I don’t think it was creation that was created through Jesus Christ, but rather salvation. The third point was that the creation demonstrates God’s power. No argument there.

It Rained Today

I felt like I was in Seattle today. It rained. It was cold. Not ideal.

Watoto (children), Queues, na Traffic

I visited a children’s home today. It is assisted in part by the Foundation for Peace (which we worked with in the Dominican Republic). It’s a really nice place in Ngong and the people who run it are really wonderful. It is a relatively new home and school but they are really beginning to expand and have aspirations to develop more. There are 18 children currently living there and most of them are total orphans (maybe 20% have one parent, but generally they live in a slum or are otherwise unable to care for their children). They have children in pre-school and kindergarten, 2/3rd grade and 5/6th grade at the moment. As they continue to build their school they will increase their child capacity and hope to become a full pre-school through 8th grade school. It was so much fun to see the work they are doing there and their excitement for what they hope to accomplish.

We mostly spent the entire day taking a few of the watoto to clinic for their monthly appointment. We did not arrive at the clinic until noon or so (after driving for about 45mins), so we were the last in line (with 30-40 people in front of us…almost entirely women and children). It took about 2hours for the children to be seen and another hour or so for them to receive their medications. We left around 3pm and commenced our, what seemed to me to be a very round-about, journey through town. We had to stop somewhere for something. I don’t really know what we were doing, but I think we drove for about 2.5-3hrs before we found our way back home. We probably really only had about 30mins of driving to do, but the jams lurking around every corner extended our travels considerably. At the sight of each jam as we turned corners, the one driving kept saying, “Ay, I shouldn’t have taken this road…” No problem, I like these kinds of adventures. I’ll be going back tomorrow to dig a hole.

M.A.T.A.T.U.

M = mal-adapted
A = all
T = terrain
A = anarchic
T = transportation
U = unit

A wild matatu ride leo (today). From town at 1730, there was a jam (to be expected) and the 125/126 matatu I was in, along with its intermittent base (it seemed to join the music periodically without regard to the actual beat) decided to morph into an ATV (all-terrain vehicle). In jams like these, 2-lane roads, like Lang’ata road, miraculously become 4-lanes, generally pioneered by matatus. Needless to say, some of these 4-lanes do not have the ‘luxury’ of tarmac, or even a flat surface to drive on. Ours was one who chose an alternate route, which consisted of the median/ditch. We were bouncing along like a kangaroo at a 30 degree tilt to the right (this was the first time I have been even slightly scared in a matatu, as visions of the overturned one from yesterday flashed across my mental screen – he had also chosen a haphazard route, resulting in a dramatic plunge into a large, concrete drain/ditch, leaving him almost entirely belly-up). Following however many metres of ATV driving deemed necessary (or more likely, physically possible) we proceed to cut off various other vehicles. The size of the competition by no means hinders forceful attempts to reintegrate with the 2 original lanes: semis viewed generally the same as motorbikes.

Don’t play chicken with a matatu…they’ll always win. Maybe some sort of kamakazi influence…or just a burning desire to obtain as many passengers as possible during ones’ shift? The conductor also provides assistance by leaning out the window and sweet-talking neighboring cars to let us in. For example, “Mama, mama. Hello, mama. How are you? Please (in a pitiful, mournful voice), we are trying to merge. Please, mama. Give us space.”

I breathe a sign of relief when we rejoin the main traffic for good (at least for my leg of the journey), and I arrive at my stage…where I am greeted by a heard of cattle.

Also learned a few more words:

Utoto = childhood / childishness
Ujana = youthfullness
Utu uzima = aldulthood