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.
Wednesday, September 16, 2009
Tuesday, September 15, 2009
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!
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!
Monday, September 14, 2009
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.
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.
Sunday, September 13, 2009
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).
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).
Saturday, September 12, 2009
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.
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.
Friday, September 11, 2009
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...
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...
Thursday, September 10, 2009
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).
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).
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