What Teddy Does....Part II

Teddy has been very active lately. 

Well....not so much "active" as he has been "present".  Take a look:

He helps me pack for my trips to Nairobi.

He watches TV on the computer.  Teddy, not so close!

He takes beauty naps.

As you can see, nothing has changed with Teddy.  As my Kenyan colleagues would say - he is "quite fine!" 

Ancient Ruins

Recently I had the opportunity to visit one of Kenya's national parks: the ancient Gedi ruins.



The entryway to the great Mosque

 The word "Gedi" means "precious."  The Swahili city was founded in the late thirteenth or early fourteenth century, reached its peak in the mid fifteenth century, and then was finally abandoned in the early seventeenth century.  The population is estimated to have been ~ 2500.  No one really knows why the city was abandonned: disease, emigration, war....   The area is thought to have been very prosperous though, based on the amount of trade that was happening in the area at that time.  Also artifacts that have been found at the site suggest the Gedis traded with people from all over the world: beads from Venice, coins and a Ming vase from China, an iron lamp from India and scissors from Spain.



Entrace to the Palace



Gedi had a mosque, a palace, a cemetary for priests four wives and many houses. These houses had bath tubs inside and squat toilets.  Huge, deep wells supplied water to the community. The material used to construct the buildings and the city walls was made from coral reef from the nearby ocean.



Remanents of the wall that surrounded the city




Our guide said these trees are infected by some sort of fungus - giving them this strange and eerie appearance.



Crumbling houses

A Matatu Story

Last Friday, I decided to try something new. 

I had discovered that I was low on some groceries and needed to make a trip to Nairobi to do some shopping.  Unfortunately, traveling to Nairobi by car (hiring a driver) is very expensive.  So, I decided to take advantage of the very affordable Kenyan matatu transportation system.

Matatus are like taxis; except they are vans or mini-buses that travel specific distances; for example - from Bomet (Tenwek) to Nairobi for a set fee.  These vans theoretically should seat only 10-14 persons, but because of...well I'm not sure why...but in Kenya the matatus can fit a lot of people inside.  Thus, it's strictly limited to a small carry-on type situation.  Any large bags will be strapped to the top of the matatu - at the owner's on risk, of course.  Matatu drivers are typically considered to be a little crazy because they drive fast and they make stops between Point A and B to pick up and let off passengers, but the van only stops for a few seconds. 

So, why would I want to try this?  Well - because it's cheap.  The equivalent of $5.88 to travel to Nairobi via matatu versus $100-150 by hired car. 

It was a good time to try it because I could travel light on the way to Nairobi - and there were two Kenyan colleagues also going - so I could safely assure I wouldn't end up in Zanzibar or somewhere.

So, my colleagues and I caught a taxi to the Bomet "matatu station," where we
were immediately surrounded by "agents" solicting travellers for their matatu.  In these scenerios, it's nice to be with my Kenyan friends - I can hang back, act like I don't speak English and just follow them around.  Honestly, it's a little intimidating when 4 people are all asking," Where are you going?! Do you want to go to Nakuru? Kisii? Nairobi?" 

Luckily, we three go the back seat of our matatu - this proved advantageous because we were able to put up a "united front" against anyone who might have tried to sqeeze in between or on top of us!


The view from back of the matatu: At highest capacity, our 10 seater van held 15 persons - not counting that one time when those three guys hung onto the open door/side and for a block or two.  Not bad - I didn't have to sit in anyone's lap, nor was anyone required to sit in mine!

The ride was actually quite enjoyable.  From the inside of the matatu, my driver didn't seem crazy at all.  I don't know if I got lucky or if there is something about being in the matatu that alters your perception about the safety of said matutu.  Also, the seats moved independently of the matatu - that was both surprising and fun - like a ride within a ride.  I don't recommend it if you get motion-sickness.

The only alarming part was when we got off the matatu.  When you are ready to get off the matatu, you signal the driver by telling the pther passengers.  Since we were in the back, we had to quickly crawl over all the other passengers, as the matatu paused on the side of the road.  I'm just glad I didn't take someone's head off with my bag or worse - fall on top of someone.

In the end, we made it to Nairobi safely and it was a great weekend.  In fact, I found a great book on funny travel signs that seemed to fit right in with my adventures! 

Here's a few of my favorite signs.....

This is the attitude you have to have to practice medicine in Kenya.....


Another matatu story from blogdom:

http://satyabratadam.blogspot.com/2010/12/kenya-calling-mango-in-matatu.html

What's For Dinner?

A very common question that I receive is, "What do you eat for breakfast/lunch/dinner in Kenya?"  

To appease your hungry curiosity, I complied a photo diary of some of my recent meals:

My breakfast of champions:  This month I was lucky enough to find Frosted Flakes at the grocery in Nairobi - some months its the generic Sweetie Flakes.  Add a little milk from a box - and there's breakfast!

Around 1030 each morning, life at Tenwek slows to near-halt for tea time.  Chai has become my substitute for the Starbucks fix that I entertained in the US.  It is mostly milk and sugar with a dash of strong, black tea.

Tea in Kenya is not "drank" or "drunk;"  it is taken.  And it is best taken with mndazi - a Kenyan- version of the doughnut aka... deep fried bread!

This usually gets me through lunch - which I spend working.  At the end of the day, I go home for dinner.  For me, dinner is made possible by Sara, a wonderful Kenyan woman, who comes 3 days a week to my house to cook.   

Chicken Parmesian with salad, some fresh guacamole and homemade galic bread.  And a nice cold Diet Coke.  Suddenly, the day does not seem so bad!



Another dinner....fried chicken tenders with some melted cheese, wrapped in chapti (a Kenyan tortilla of sorts), with some spciy mustard for dipping. 

Aahhhh.... a breakfast buffet in Nairobi over the weekend: yogurt, mndazi, a doughnut and the real treat - bacon!

Dessert at fellow missionary's house: cinnamon chips covered with melted Nutella and sliced strawberries.  Unbelieveably delicious!

So, as you can see, the food is good here.....in fact, I should probably take another walk or two up the hill ......

Collegiate Pride

Our guest house here at Tenwek has found a wonderful way to bring in a little US culture. 

The guest house is a three-story building with rail- walkways that overlook the surrounding valley.  Sometime in the past, long-term missionaries and guests began decorating the outside of the guest house with collegiate flags, hung from the metal railings.  When I first arrived, there were maybe 3 or 4; we are up to 9 now.

The U of L flag was the most recent addition (courtesy of my recent trip to the US!).  I love seeing these flags as I walk up the hill in the morning - it always makes me smile.  And of course, they are wonderful for instigating conversations about .....

...the good...

...the bad...

..and the ugly...  ;-)

  ** Note the views expressed in this particular blog are not well thought out and are meant only to entertain or incite riot.  Complaints can be addressed to: Teddy the Cat, c/o Kenya.

Two Sides

Though I may not be on call, sometimes I get phone "consults" from the medical officers who are covering OB for me.  (It's okay - I am happy to have the help!)  This past weekend, I had a very disheartening case:

G1 at 31 weeks with HELLP syndrome: Platelets 28,000, ALT 800+, Creatnine elevated 3x the norm.  Also, with bloody vomitus.

Pluses: My very capable medical officer could do a C section on this woman; our Peds team is able to resusitate the baby if needed.  Anesthesia is available 24/7.

Problems: We don't have platelets here - so many times that forces my hand to deliver people that I might be ball-sy and observe for steroid administration in the US.  Babies at 30 weeks or less tend not to do well here, so I try to deliver them via C section, if possible. 

So, I recommended that this patient be delivered.  She was remote from delivery; so the decision was made to do an emergency C section.  Problem:  In the 3-4 hours it took to prepare the patient, discuss with anesthesia and actually do the surgery - no one checked fetal heart tones again and my medical officer delivered a still birth by C section.  Ugh.....!

In addition, she was anuric for 16 hours before I was consulted again.  By that time it was 5 pm on Sunday.  Her creatnine had steadily increased, now with increased potassium and she had suffered 2-3 seizures.  Eclampsia - my fave.

Pluses: The are two facilities that offer dialysis.

Problems: We are not one of those two facilities; so transport is required.  Transport at night is difficult due to poor road conditions and also, the business office is closed.  And of course, money is a concern.

So, now it is Monday morning and the patient is still at Tenwek.  She has had 50 mL of urine output after both saline hydration and blood replacement.  The issue with her discharge?  Her family had to pay her bill and they could not locate the funds.  So her discharge for transport was being declined.

What?!

A young woman in Acute renal failure - Anuric - needing dialysis - to Live, being declined transport until she pays her hospital bill? Talk about motivation to pay your bills.  Here at Tenwek, we pride ourselves on providing care to the poor and suffering - oftentimes at the detriment of the hospital.  It is not unusual to see patients hanging around the wards for days, even a week, after their discharge, while their relatives locate funds to pay their bill or petition the compassionate care fund (like a scholarship for very needy patients.) 

I have always thought this policy was stellar....unfortunately, the ugly "other" side is that there are exceptions to every rule.  I am sure that exceptions have been made in that past that maybe I don't know about, maybe the threat and grandour of the policy is to separate out the truly needy from the unmotivated.  I say this because - my patient's family did find the money - and she was out the door by noon - now 48 hours anuric.  With her bill paid.

I was happy - mainly because I had envisioned needing to chain myself to the big Tenwek sign, "We treat, Jesus heals," until she was released.  I'm glad it didn't come to that.

And then there was the fall out issue....our need to be more vigilant in checking heart tones before C sections.  Such a simple idea. 

Problem: We have no working doppler right now on OB.  We have one fetoscope.  All heart tones must be checked in OB. (Can't be done in OR).  But it should have been done.  So, I meet with the interns, the nursing supervisor, the in charge of nursing students....

It is again the other side of my job - the challenge not to become so distracted by the complications, the making plans, that the simple things are forgotten.   

Yet, among all these issues...there is the one that I am most thankful for: that this is one eclamptic that will survive.  In the US, that would never have been enough.  But here, despite all my complaints and urgings to be and do better, it is enough.

 ¹¹And the Lord shall guide you continually and satisfy you in drought and in dry places and make strong your bones. And you shall be like a watered garden and like a spring of water whose waters fail not.  Isaiah 58:11

Reflections from A Vacation

1. Banana splits are the best thing in the world.  Unless its cold outside, then the best thing is Starbucks. 

2. Whoopi Goldberg does not look good on a big screen Hi Def TV.  Seriously.

3. It is so much hotter in Kentucky than Kenya in July.  So.  Much.  Hotter.

4. I have been fingerprinted so many times that I now qualify for America’s Most Wanted. (Am trying to get a medical license in the US and my fingerprints have been “rejected” twice now for various reasons – so while in Kentucky, I had TWO fingerprint cards made.  Hopefully, one will be accepted.

5.  There is a new Frosty (berry) and a new Mcflurry (Rolo).  Eh.  I'm not convinced that they've defeated the Blizzard.

6.  I still love reality TV. 



"Shut It Down!"

7.  Wine making is way more complicated than I ever knew.  I visited some beautiful wineries in Massachusetts and Rhode Island and got a crash course in wine-making.  Of course, I have forgotten most everything, but it went a little something like this: grapes, growing season, exposure to elements, hand picked versus machine picked, pressed, yeast, fermentation, bottle turning, resting, label and sell.



At the vineyard....acres of grapes in the background



These fish are an interesting community art project I found in Westport, Massachusetts.  Local artists created 40 stripers to display around the community; they will later be available for purchase on ebay.  All proceeds will go towards environmental education.

8.  It is really not necessary to have 47 different kinds of laundry detergent and 27 kinds of toothpaste.  It's overwhelming.  I was ecstatic when I returned to Nairobi and found one type of American cake mix on the shelf.  Go, Betty Crocker! 

9.  Drinking water out of the tap is Awesome.  It's cold and clean AND free! It's a gold mine in your OWN house.  Rejoice, people - REJOICE.

10.  The worst road in the US is still better than the best road in Kenya.  See previous blog: En Route. 

11.  The word "home" is so fluid.  Kentucky is my home. Cincinnati is my home.  Now Kenya is my home, too.  Home is also wherever Teddy is.  :-) 

My housemate and I at my Welcome Home Party in Nairobi.

No...not the gates of Hell...it's the meat pit at famed restaurant The Carnivore.  A favorite place for tourists, this restaurants serves up massives amounts of beef, turkey, chicken, lamb, camel, oxen, croc, ostrich and pork on giant skewers - slicing it right onto your plate.  A flag sets on every table - when you've had enough, just surrender, by lowering your flag!



Awwww, Teddy!