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October 28, 2006

Culture Shock In The US

So, arriving back in the US has turned out to be almost as much of a shock as arriving in Kenya. Once you've become accustomed to a certain thing, suddenly reemerging can be quite a change.

Leaving the airport was the first sign of trouble. Most vehicles in Kenya have a governor that prevents them from going more than 80 kmph (48 mph). So, suddenly going 75-80 mph is a little frightening. Besides, I'm used to matatus swerving all over the road, and not only do I have to resist the temptation to do so, but I also expect everyone on the road to suddenly come into my lane.

Sleeping was another issue. I didn't sleep but maybe 2 hours on the plane, so I was up for about 46 hours nearly continuously. Then, after sleeping maybe five hours, I was up at 0530, and I didn't sleep until 1030 the next morning at all--another 30 hour stretch. Fortunately I did fall asleep for six hours before I had to go to work.

Work was interesting. I struggled for awhile just to remember my locker combination, and then my password to get on the hospital computers. Most of what I was expected to do at work fortunately came back pretty quickly, so I had a decent night at work. I didn't have any unexpected surprises, at least. Then again, that could change anytime. Tonight I was floated to another floor--my second night back. I am kind of waiting for the big welcome-back slap. I am also a little curious about getting tested for TB--that will probably be required for me.

Trying my life back on felt a little strange. I'd done my financial planning well, and remarkably I had no outstanding bills waiting for me. Heck, I managed to save some money while away. I didn't have any food, so that had to be remedied. I had about 150 messages in my work email, which of course I ignored my entire trip. I had to check out my work schedule for the next couple of months, and I had four paychecks to look through and count the pennies Duke possibly might be trying to take.

It's just strange in general to be back. It's so quiet, I miss the noise and bustle. It seems so deserted, I keep looking for all the people walking along in the streets, and along the roads. Speaking of roads, I keep wincing, expect massive potholes, but the roads are so smooth. I found myself wondering if I had the mosquito net over me well enough. I dreamed about Kenya today, some strange dream concerning money. Buying food was strange; I kept looking for food that either doesn't exist here or I won't be cooking anyhow, and I had this odd inclination to shop like I was cooking in Kenya.

And the first thing I did upon arriving at my place was to wash all of the clothes I took to Kenya. All of them, even the ones I had washed by hand.  Then I had to go through the giant pile of mail. I guess that's a result of taking seven weeks off from your life.

I expected to miss Kenya, and the first day I didn't. I went out to eat sushi with Jess. She ended up getting food poisoning from that (ironic getting sick here instead of Kenya), and I had to nurse her through the fun. Then yesterday I felt a little sad. Today, though, it's a full-on feeling: I officially miss Kenya. As different as it might sound, I am homesick for a simpler yet more complex place that isn't my home. But that is how Africa gets you. There's nothing simple about that equation: home away from home, strange yet primal and instinctual, and distinctly a dart into your soul. You don't have any choice but to miss Africa.

And miss it I do.

Final Recipe: Chipati


  • Wheat Flour
  • Oil
  • Salt
  • Warm Water

This will be the final recipe that I can post, having learned no others. This is a pretty straightforward recipe, although it can be time-consuming. First, you heat the water. Add a small amount of salt to it, about a teaspoon. Taking about 6-8 cups of flour, add the water in slowly, as well as about 1/3 cup of oil. Knead the living crap out of this dough; fold it and press. Add water as needed. Eventually, you will have a dough that doesn't stick to the sides of your bowl, and of which you can pinch off a little, plus you'll have worked up a good sweat; that's how you know the dough is ready. Make balls about the size of baseballs or oranges. Take each ball, and roll out into a flat, round shape, like a big pancake. These should be the size and shape of about a medium pizza. Then, take a spoonful of oil, and smear it all across the top. Cut the entire thing in half, and roll it straight up. Given its half-circular shape, it will make a little tower. Tuck the last flap into the thicker end and stand it, like the London Tower. Next, start pushing the tower into itself, starting towards the base, so that the tip of the tower is pressed into what develops as a bun last. Do this with each ball, ending up with two buns from each. This whole process was done to mix in more oil. Next, take each bun and roll it out again, into about the same size and shape as the previous pancakes. You should have a heated flat pan prior to doing this; do not make it very hot, you want the dough to cook slowly. Cook each cake individually, leaving it in the pan long enough to whiten the dough and have little spots of brown; as they cook, spin them lightly and gently with your fingers. You'll end up with what looks very much like tortillas, which is probably about right. However, you're not done yet. Once you've cooked all the dough, take stacks of about 6-8 of the "tortillas" and place them back on the pan. Smear the top one with oil, and then flip the entire stack. Smear this top one with oil, and repeat the flip. Now the top one has been oiled and cooked, and looks browned, so flip it by itself and smear its other side with oil. Then, flip the whole stack and repeat. You'll be able to cook each one this way, removing them after you've oiled and cooked each side. It's not as complicated as you might think.

Once you've cooked these chipatis, you can eat them. Kenyans traditionally eat most foods by hand, and chipatis are great as eating utensils to pick up rice, beans and other foods. And as closely related as they might be to tortillas, they have a much better taste.

What I Learned In Kenya

I've been back a few days, and so have had a little time to reflect on the lessons taught to me in Kenya. A few of them are here:

  • Washing Clothes: I got quite good at washing clothes the old fashioned way: by hand. The first few times, my clothes didn't get all that clean, so for a few weeks I looked a little rough. However, I got better at it, and by the end you wouldn't have been able to tell that I was washing my clothes by hand. Even the socks were nice and white. Also, this is good for your forearms. It builds them up. Prior to this trip, I was a fan of the David Gabbo Methodology For Clothes Washing theory, developed by the French. In this method, all you need is a backpack, the deeper the better. Once clothes are dirty, shove them to the bottom of the pack. Eventually they will work their way back to the top, and by then, they will be nice and clean.
  • Bathing: I developed a good system for bathing. The house I stayed in did have running water in the tap, but it was brutally cold. So, I usually washed my hair under the shower head. Then, I would take water I heated on the little gas stove to a boil, add it to a basin of cold water from the tap to reach the perfect temperature, and, while standing in the basin, pour the water over my head using a bowl. This feels great following the icy shampoo job. Also, this works well for clothes washing if planned properly--you can use the nice warm water to wash your clothes following the bath.
  • IM Shots: Prior to my trip, I had little experience administering intramuscular (IM) shots. This changed because of the trip. Even better, I was able to look past the American shyness for pain and just administer the meds as should be done: brutally painfully. Here in the US we are far too concerned for patient comfort; in Africa they just stick the needle in and push. Interestingly, if you read about the meds that I was administering, such as Quinine, it's not usually recommended that they be administered IM, and if as a last resort they must be given IM, you should dilute them heavily and even give half in each buttock to spread out the pain. That's a lot of unnecessary business apparently, so it's best to just avoid recommendations and give it as painfully and quickly as possible. Also, some sources suggest that IV drugs should be avoided as much as possible anyhow, especially in a place where determining which exact disease is more of a guessing game due to the lack of labs. However, I found that a lot of patients don't feel like they've been treated unless you give them an injection. Pills just don't do it for them, they're suspicious of fraud and sugar tablets.
  • Kids: When the little boys see the daktari and run away terrified, they're not faking their fear. It's because they remember him circumcising them. Then they had to walk around for days in pain, wearing a little dress. They should feel lucky, though, at least he used sterile technique and Lidocaine to numb the area first. That is more than they would have had if their parents had gone the traditional route and let the village circumcisor with his single rusty knife do the work.
  • Mosquitoes: With the threat of malaria and dengue fever very real, avoiding mosquitoes is a priority. I learned the best way to do it is to wear cream repellent in the evening and sleep under a mosquito net. Here, it's important to remember that if you lay with a part of your body against the net, they will bite that part relentlessly. Even a toe. They will bite that toe until you wake up in pain and move away from the net. Likewise, if even a single mosquito gets into the net, he will bite you as many times as mosquitoely possible in a single night. You will wake up in the morning wondering what happened, how you got those fifty bites, and then you will see the mosquito, so engorged with your blood he can no longer even fly. Actually, the mosquitoes that bite are all female...not that I'm suggesting anything, it's just a fact. Mosquito coils are also very nice, which I unfortunately found out three nights before I left. They do an excellent job of clearing house of mosquitoes, and they smell like incense. However, they do have some effect on humans, so it's fortunate that they burn out sometime during the night, as my head was so stuffed up by morning it felt as though it was going to puff. The next night, I didn't put the coil next to the bed and that worked fine.
  • Foreigner Tax: Businesses in Kenya saw that I obviously wasn't Kenyan and therefore charged me as much as four times the normal cost. This was legal and even posted. There was the resident charge at Fort Jesus (100 shillings) and the nonresident charge (800 shillings). A good way to avoid the nonresident charge is to print up a form that states that you are a volunteer for some organization for at least a couple months. The organization doesn't matter, just as long as the form looks legit. Believe me, it'll impress most people, if you make it look nice. Make sure it's signed, and if you can find a real business that has a stamp you can borrow, you're really doing good. Also, in the shops, they will take advantage of your ignorance of the normal charge for items and charge you a ridiculous rate. For example, I paid 450 shillings for tea that cost 70 shillings across the street. Feel free to return the item along with a little hostility for your money back; remember, they actively will rip you off if possible. Don't take it personally, though, when you are ripped off, just remember it the next time. It takes a few times to learn to avoid it.
  • Eating: Kenyans don't use forks to eat. Whether they eat greens, beans, rice, or whatever, most of the time they use their hands. Ugali, which is cooked corn meal and has a slight jelly-like texture, is rolled into small balls by hand and used to pick up other foods. Also, chipatis can be used to neatly pick up wet foods. Eating by hand not only takes a change in mentality but practice, but before long becomes quite easy until you don't even notice there are no forks on the table.
  • Your Mouth: Be very careful about what you say. This is applicable in all places, but here it is all the more important. For example, it's best to never talk about your wages or costs of things in the US with someone in Kenya. You do make more than just about anyone in Kenya, and the fact that the US or Europe has a much higher cost-of-living isn't relevant. Something that seems cheap to you, like a $20 flashlight, is pretty expensive for someone who makes $60 a month. Because people are so friendly in Kenya, and conversation is quite easy, it's not hard to espouse your views and opinions. However, people in Kenya have a completely different perspective of the world and everything in it than in the West. It's dangerous to assume that people will agree with you just because you are following your moral code. Morals and values are different the world around, and it never hurts to listen and respect. Moreover, learn the values of the place you are in. For example, Mombasa is a Swahili area, and as such has a strong Muslim value system. For the ladies, it's best not to be scantily clad, although I can't tell you how many Western women I saw with plenty exposed walking around. That isn't acceptable, even if it is the coast and it's tropical. Think of how you are viewed by the masses around you.
  • The Squat: For those who went with me to Honduras during nursing school, this is old news. For the rest of you, life hasn't been experienced unless you have had the chance to do the Squat, also known as the Sumo Manuever. In Honduras, we squatted over the toilet because it was fetid and disgusting. In my little house, squatting was necessary because the toilet bowl was embedded in the floor, with the tank above on the wall. There was nothing to sit on, so you had to assume this strange position, with your legs splayed slightly out, and with an arm backward to hold against the back wall. Awkward as it may sound, it did get easier with time, although it does tend to deepen your appreciation of a toilet seat, especially a clean one. At least I had a toilet, in particular one with running water. Most of the houses in my area were mud, and they had a little pit latrine outside the house. This is exactly what the name suggests--it was a pit indeed. There are plenty of folks without even this luxury; for them, the bushes are the only option. This of course has a lot to do with all of the diarrheal and worm diseases we saw in the clinic, being directly related as these wastes tend to make their way to the drinking supply. In the area I stayed, there was no running water, and so most people bathed as well as took their water from lakes in the area--prime spots for diseases like bilharzia. Needless to say, I didn't eat at any of homes in the area.
  • Packing: You guys were right. I didn't need all the clothes I took. Turns out that washing clothes by hand actually discourages washing clothes in general, and really, no one noticed when I wore the same pants for a week. Furthermore, I only wore the same two pairs anyhow, despite the availability of other pairs. I did take a bag that was stuffed with gauze and other medical things, which came in handy as an empty bag later to stuff all my souvenirs in.
  • Groddy Old People: You see this a lot. There are older white men with younger black women, and older white women with younger black men. It is pretty gross when you realize the purpose of these companionships, which were explained to me as often being marriages. I guess when you're an old dude and you want some hot young chick, and you know you haven't a chance to get one in the US or in Europe, at least you can buy that love with money in places like Kenya. I was told these younger Kenyans see these older people as a way out of poverty and so tolerate them. Quite sad.
  • The Mind: Keeping an open mind about everything turned out to be quite important. Kenya is so different as to almost be another world, and rules that apply in the West don't apply there. So, as I said before, it's important not to come to somewhere like Kenya with preformed opinions of how you think it should be. Also, a good poker face comes in handy, so when something really surprising come along, you should be able to keep your eyes in your head, because those doozies are out there and can be expected. Although you don't have to have an open mind towards the old people coming looking for a fresh young love. That's just gross.

There were plenty of other things I learned, and so I'll add on as I think of them. Overall, it was a very educational trip, and taught me as much about life as it did about medicine.

October 24, 2006

Last Thoughts From Kenya

So, it’s come to the end of my trip to Kenya. What a journey it has been.

The past week has been quite pleasant. I spent most of it in Kokotoni. I was reading my journal of the first week in Kokotoni, and there is such a remarkable difference in my attitude about the village, and about my little house there. The first night, we were in a completely foreign environment. There were loads of huge cockroaches, and we couldn’t lock our front door. A highway with terrible potholes went by the place fifty meters or so away, and all night trucks banged away along it. A five in the morning, the loudspeaker on the mosque next to the clinic and the house came one with a call to prayer by one of the worst singers to ever hit the soundwaves.  So, there was a tangible sense of discomfort that first evening.

Returning to the house last weekend for the final time, it was a bit like going back home. Arriving in the house elicited that sense of arrival you get when you step into your house. Being back at the clinic meant being surrounded by friends. So, instead of being justly uncomfortable in the village, I was quite happy there. I spent the week hanging around with the daktari and his family. It rained quite a lot, there weren’t many patients for most of the weekend. Naturally when the rains stopped, large numbers of patients with malaria and typhoid started pouring in. We visited a nearby town, Mariakani, which had been turned into a swamp by the rains. The doctor and I even came by matatu to Mombasa, where we visited a local beach and a nature trail. Nothing like a tour of Mombasa by matatu with a local; if there is one thing I can’t figure out, it’s that system of taxi-buses, going all over the city, I can’t seem to grasp where they all end up.

So, Monday was my final day in Kokotoni. It went as usual, there were a steady stream of malaria patients, while one small boy had a big abscess we drained on his belly, and another had a bean in his nose we removed. But there was a deep sense of sadness. I had packed my bags, which wasn’t too difficult, since I’d given away a lot of my stuff to people there, in part to make room for souvenirs. I also had a large amount of food stores, but since the daktari’s wife had made nearly every meal for me, little had been used, so that was donated to her. At the clinic, there were a lot of sad goodbyes and promises to visit again. My ride was coming in the late evening, so the daktari’s wife showed me the long and complicated process of making chipatis, which are essentially tortillas with a Kenyan flair. At some point, the van taking me to Mombasa arrived, and abrupt and quick goodbyes were made to my friends, the daktari and his family. It’s probably better that way; it would have been awkward to have broken down sobbing like a schoolgirl in front of them.

It’s a little strange how comfortable I had become, in no small part due to the support and encouragement of people I’ve come to know here. The house became my home away from home, the staff became my friends, and Mombasa and Kokotoni became more and more familiar as the time went on.

I’ve given a fair amount of thought to what I have accomplished here. I came here to learn about tropical diseases and medicine, and to see another culture and place. As for the medical part, I did have that experience—I saw a lot of diseases that I would have never seen in the US, and experienced the intense disparity of health facilities that much of the world experiences first hand. Beyond that, this trip has shown me much more. I know that abject poverty exists in the US—despite our wealth, we’ve not eliminated it, but cover it better. Here it is everywhere, it is on every sidewalk, it is along every road and in every town. You can’t pretend that it doesn’t exist, you can’t just live your life imagining that everyone has the same sort of lifestyle and material excess that you have. At the same time, having this knowledge of such poverty and need in the world gives a responsibility, one to act on that knowledge. It’s not enough for me to return to my life in the US and just go back to it, having done nothing to try to change this. I wrote earlier that one of the first reflections I made was there is so much need that it is overwhelming. Taking that a step further, how is it possible to do nothing to try to alleviate that need?

A comment that a friend of mine made really was true for me here. Africa is a place that visitors can either hate or love. If you come here with your mind made up of what it is and is not, if you hear the stories of dirty streets and violent crime and terrible poverty, that is what Africa will be for you. You won’t see the forest for all the trees. But if someone comes to Africa with an open mind, then the beauty and earnest potential, the energy and uniqueness of this place becomes obvious. Africa is like a virus, it gets in your blood.

So I have had much more of an experience than simply the medical aspect of it all. I’ve learned a lot about life, about the world, and about myself, and that was far worth the money, time and effort put into this trip.

An Interesting Conversation

I had an interesting conversation this weekend with the daktari and his brother. Two deeply powerful subjects came up, almost in a nonchalant sort of manner.

First of all, the subject of mob justice was broached. Now, looking back, I must point out that one should choose their debate partner on a subject such as mob justice carefully, in particular if that partner advocates something like mob justice. Fortunately, I was talking to the daktari, a friendly and laid-back person, and we had a few beers to lubricate the conversation. I tried to point out that no one deserves to die for stealing, especially in a place with so much poverty that stealing is inevitable. As this wasn’t persuading the daktari or his brother much, both of whom still thought it fine to torch someone for stealing a cellphone, I tried to talk to them about economics. I informed them that while I understood that when people have nothing, $50 cellphone is worth a lot. How wrong I was. It’s not about the value of what is stolen, that could be $5 or $500. What causes people to lynch thieves here is the principle of the matter.

Even though both guys agreed that the real problem with mob justice is people falsely convicted and killed (indeed, a trick of gangs in Nairobi is to turn the person calling after the thief into the thief), they couldn’t be convinced of the problems of mob justice. Eventually I accepted a difference in culture and understood that I wouldn’t be able to change their minds about this issue. Such is the way with politics.

An issue that we agreed more on was female genital mutilation, an issue that is very much alive here in Kenya, and even common in some tribes. It’s mostly found in the north, especially with the nomadic tribes from Somalia and tribes that have interactions with them. I recently read an article, written in such way as one might find a social article about which clubs are popular, titled, “A New Experience.” It was about men who were experiencing the pleasure of marrying a woman who hadn’t been “cut.” This really applies for Muslims here mostly, who are allowed by Islamic law to have up to four wives. Other non-Muslim tribes involved in this practice include the most famous Kenyan tribe, the Masaai, whose traditions I’m not familiar with.

Anyhow, the article deals with one man, whose first two wives had undergone the barbaric practice of FGM, and consequently couldn’t enjoy sex at all, finding it useful only for reproduction. He learned his lesson with his third wife and specifically chose her for not having been circumcised, and his life was great henceforth.

Another section of the article highlighted a meeting of Muslim scholars who were discussing the practice and its place in today’s world. They seemed to agree that not only is it not based on the Koran, but is not practiced by Muslims worldwide and seems to exist, and I quote, “to control a woman’s sexual desire otherwise “the women might go wild”.” Then apparently the scholars discussed the many possible health problems not to mention the psychological effect of this practice. In the end, no one was willing to condemn it. No one was willing to speak out against it.

No one was willing to state the true purpose of FGM—to subjugate women further, and to compensate male perversity by punishing women.

As for the daktari, he’s had many women come into the clinic for childbirth, where he would first have to cut open the stitches placed during FGM so they can deliver. If you are unfamiliar with this practice, I encourage you to learn more about it, and you will see the dilemma faced by women here.

As for a solution? Not a western one, I think, because this practice is engrained into the culture here. You can’t come and tell people to stop just because it clashes with your ethics. There is a ceremony, there is a cultural significance, that causes this practice to continue, as well as be encouraged often by women themselves. That ceremony will have to be compensated. Fortunately, that is happening, slowly but surely, where Kenyans are showing people that they can still have this “rite of passage” without any surgical trauma.

In the meantime, often as I see the many Somali women here, I wonder whether they were forced to undergo FGM, and my sympathy is unlimited for them.

October 19, 2006

Final Weekend In Kenya

Today I am heading back to Kokotoni for my last visit there. I will spend the weekend there, then depending on which day I can arrange a ride back to town with all of my stuff, I will come back Sunday or Monday. Kokotoni has been good for me, and it’s easy to imagine coming back next year or the year after, and bringing a group of people with me.


I imagine starting a sort of medical mission tour, bringing groups of nurses and doctors here to run small clinics and provide a small service to this impoverished area. Throughout my time here, I’ve had in the back of my head that I am really on a test run here, checking out the possibilities for a future group. Perhaps this trip has been to search out the medical part of the trip, finding a community in need as well as the facilities to host a medical clinic. Of course, I’m always looking for a good time as well, so I can imagine setting up little side trips to game parks, tours through Mombasa or villages, and things like snorkeling. The thing about Kenya is that there is this tremendous amount of potential here, with a huge population looking for work, and because this is such a beautiful and richly diverse nation. This country is like the US squeezed into a tenth of its size. It has beaches, deserts, mountains, forests. Besides that, it has something like 46 tribes, most of which have their own languages and customs. Try to argue that this nation is not as diverse of a landscape as the US.


So, maybe is has just been a pleasant daydream here, but I’ve enjoyed imagining bringing groups over for two weeks at a time. I could be here the whole time, coming early to scope out possibilities and set up arrangements, and meeting the groups as they arrive in the airport. The clear benefit for myself is that I could spend five weeks in-country, if there were two groups coming. Of course, I could play the dedicated worked, but honestly this is what I love doing, traveling into places like Kenya, so despite the work that I do, this is still very fun for me.


There is a lot of planning and designing to do, but I’ve got a foothold here now. I’ve got contacts, and I’ve got ideas. Those are the foundation to a good plan and a sweet time.


Until then, keep safe.

Wasini Island Snorkeling

I’ve just spent a couple of days in the Shimoni Village / Wasini Island area, per recommendation of a fellow traveler. It was quite fine. I arrived early, set out on a boat for long ride and quite a lot of snorkeling. The thing about snorkeling is that an hour is often about enough for a day, you don’t want to go out again and again. It’s pretty tiring for those of us not so used to swimming (or exertion in general). At any rate, the snorkeling was really fantastic. I have little to compare it with, mostly Jamaica and Hawaii a long time ago. Jamaica was just as beautiful and there we didn’t have to go out so far on the boat. But this was nice as well, and I got to travel on a dhou, which at a couple of points they even set sail and allowed it to cruise on nature’s power. Dhous are a traditional sort of boat, typically used in fishing.


I ended up staying the night. There was a small miscommunication between myself and the people who run the snorkeling outfit. Their website apparently hasn’t be updated for awhile, and so I was under the impression that two days of snorkeling ran $60. Later, it turns out that it is $60 a day. As this was unbeknownst to me, I stayed the night in the village (the only nonlocal, I found out), and went again in the morning. I stayed in a little banda, which is a litte hut with a bed and a bathroom. It was in the rainforest, so it was a little musty, but I enjoyed it thoroughly.


I imagine that I wouldn’t have gone a second day if I had known it would cost me $60, but other than that, I had no complaints. They provided lunch on the island, which is completely without power, running water or any vehicles. I had crabs harvested on the island as well as fish. It was a nice experience. Other than the fact that my “waterproof” sunscreen proved quite the opposite and I look like a lobster now, or one of the crabs I devoured.…

October 16, 2006

News Stories In Kenya

As an avid reader of papers here in Kenya, I’ve been noticing that there is a clear distinction from what appears here in papers to stories that would appear in papers in the US or Europe. Sure, there are plenty of financial and business reports, international and national news, huge quantities of political stories, in particular about corruption and scandals, and the usual fare of violence that I’m sure fills papers in every corner of the world. But there are stories here that are certainly unique here in Africa.

A recent example was the story about lions from Tsavo National Park, one of the largest wildlife parks in Kenya, wandering from the parks to wipe out at least 60 head of livestock in nearby villages. That doesn’t exactly happen frequently in the US. Other wildlife related stories that I’ve recently read include a story about a tourist trampled in a different park by an elephant, when he surprised the animal while tromping through the beast. Talking about it with my friends in Kokotoni, who come from a region where people live in close quarters with elephants and other animals, they weren’t surprised; they talk about how elephants will throw a man into the air, then crush him underfoot. Then they press him into the ground and sometimes will break a tree off on him. Finally, just to make sure he won’t be back from his hole in the ground, they’ll keep guard over him for sometimes a week. Sounds bizarre, but then I just read of elephants in an Asian country who were rampaging around a community for weeks, destroying home and trampling people, because one of their own had fallen in a ditch and drowned, and hence deserved revenge. Elephants have an intelligence and a lack of a sense of humor that we don’t always appreciate.

Then there are frequent stories about what is called “mob justice” here in Kenya. This is where someone is suspected of being a thief, or is caught doing something bad, or maybe just happened to drunkenly pass out in someone else’s living room, as was in one case. A mob quickly forms in these instances, and before the cops can arrive and save the poor soul, they’re covered in tires and lit on fire, or stoned, and beaten to death with sticks. This of course happened in the US back in the day, by what we called lynch mobs, but it’s a little shocking to think that it still happens on a daily basis here. It’s not too surprising; for example, people here consider that a man convicted of thievery might get 6 months in jail, then he’s back on the street stealing from people. Only, most people have almost nothing in the first place, so it is a big deal to be robbed. Hence, it’s acceptable to take action, to be vigilantes, because it’s not only the best way to serve up real justice, it’s also a deterrent for others considering doing something bad. The problem is that these mobs form almost over nothing, and people get killed for petty little arguments that spiral out of control.

To continue along the socioeconomic line, I just read an article about a grand plan for building wealth here in Kenya. Essentially they want to try a plan like the one that helped out Asian countries like Thailand and Malaysia. While the article wasn’t all that interesting nor unique to Africa, what really stood out was how it stated that the average yearly income for Kenyans is 33,120 shillings, which is $453.70 a year ($37.81 a month). My respect as well as sympathy grew greatly, especially considering that it is not uncommon for people to work 8-12 hours a day, 6-7 days a week. From there, it’s sad to note that this means a large population in Kenya lives on less than a dollar a day. I’ve mentioned before the guys I saw working outside a big quarry. They take the discarded stone, crushing it into gravel with little hammers, and from what I was told, feel fortunate to make 50-60 shillings a day (75 cents). No wonder people here get lynched for stealing.

An interesting thought from this is the tension that festers between the Africans and Indians living in Kenya. Although Indians were brought here as laborers back in the 1800s, they’ve become quite wealthy, because they have a system of keeping their wealth within their communities. I’ve spoken with many Africans on the matter, and none of them lost any love for Indians, who they feel are very discriminatory against blacks.  The Indians own a substantial portion of business in Kenya, and I’ve heard many stories of huge wage discrepancies and poverty wages being levied on Africans. The huge quarry I mentioned above is owned by Indians, who have siphoned off all of the water for the surrounding community to use in the quarry, pay their black workers nearly nothing for hard labor; I can see the reasoning for dislike in instances such as this. In addition, the community, since they have no running water, must get their water from lakes and ponds filled with bacteria and parasites, which leads to the high numbers of diseases like bilhazia (Schistosomiasis), malaria, and dysentery in the area surrounding Kokotoni. I’m fortunate to have running water, but that’s because I live at the clinic, where water gets trucked in.

So, it’s interesting to read the papers here. It’s a wealth of information, from a perspective I never had before.

October 14, 2006

Management Skills

I am back in Mombasa, after spending a half week in Kokotoni.

It was interesting – I played a role that was unexpected.  A quick overview of the clinic: it is a community-run clinic, with a committee of ten members overseeing its management. Currently it is staffed by a PA, a nurse aide, a pharmacy tech, a lab tech, a receptionist, a cleaner, and a watchman. So, this week there was a big meeting of the committee about the roles of staff at the clinic. A problem had arisen where the staff was having questions about their roles in their positions, where basically they were competing to avoid having to do jobs. So, I was asked to assist the PA to write out job descriptions for each of the staff. In addition, I was asked if I had any impressions of the clinic. As it turned out, I did have some opinions. The clinic currently runs a deficit – meds are supposed to pay for themselves, although there is only a standard fee for each patient. However, there isn’t enough traffic, and the cash flow is negative about 10000 shillings a month. So, I told them I thought they needed to drop some staff – there is no need for 6 staff with a clinic that sees 8 to 15 patients a day – as well as a few other money-saving methods. I’m not sure they understood what I said, they mostly nodded when appropriate, but the PA translated the short version to them.

Regardless of what they decide to do with my advice and the job descriptions that the PA and I hammered out, I wasn’t totally comfortable with this particular role. I didn’t really come here to provide financial advice or staffing development. I was a little uncomfortable with it; one of the big problems is that the committee hired their own family members as staff, so it’s a little hard to critique staff when their mother is sitting right there. Also, I am in the clinic with these people every day, and I didn’t come to here to be a burr in their sides. So it’s interesting the roles that I have been able to experience; they seem interested in what I think about their clinic, and about the management. I’m used to corporate medicine – when I was hired, they handed me a manual, a book, about my role and about all the hospital protocols and rules. A Book. Here, there is nothing of the sort, so this is new territory for this clinic.

So, while definitely uncomfortable, it’s exciting to me that I might actually be able to help out the management of a rural clinic. I have mentioned before, the staff here is capable of seeing all the patients without my help, so mostly this has been a learning experience for me, and I haven’t been able to disperse much information or assistance to the staff. One day Jess and I scrubbed the whole clinic down with bleach, and it was a good feeling, knowing that we actually did something tangible and good for the clinic. That is kind of the feeling that I received helping the PA write out job descriptions, that hopefully this clinic will be better managed and hence have a better chance at surviving to help people. This clinic cannot run on a deficit forever - when meds can't be purchased, patients are dissuaded from returning or referring the clinic to people they know, so it is imperative that they are treated when they come. Also, it's important to consider that this is the only health care facility within walking distance of many people in the area - they come here from kilometers and kilometers away, walking or taking a matatu. This clinic is important to this community, and I really would like to see it continue.

 In other news, the PA and I learned a little something about sewer systems in Kenya, as we unplugged a stuck toilet. It was a disturbing and aromatic experience, and I saw the largest, most disturbing spider down there that I have ever seen. Nothing cute and furry about this guy, just huge legs. Huge, terrible legs.

So, I'll be in Mombasa to see off my friends, who are returning to the States Sunday. Then I have decided to go to a little island just off of Mombasa called Wasini Island. I'll be staying in a little hut called a banda, where there is no running water, power from generators, that sort of thing. I'll be snorkeling for a couple of days. So much for working hard. Mombasa continues to grow on me, I've started to really get a feel for it, and I can walk around in its busy center without getting lost. I'm getting savvier at not being ripped off and at bargaining, and I love the crowds, the markets, the sultry, vibrant feeling of this place. I'm thinking next year will be a good time to come back.

 Until later, keep safe.

October 10, 2006

Thoughts On Poverty

Ah, I'm writing up a storm here in Mombasa this week. I guess that I have the opportunity and something to say as well.

I talked to my parents tonight, so I decided to write a little something about poverty, something we'd talked about. I've mentioned it before, but it takes awhile to get your head around this sort of poverty. It's a little different than what one can imagine thinking about from the comforts of the US.

It's hard to describe poverty here in words. When you first see it, there is this strange phenomenon that occurs. I think of it as the Disney Effect--it's like being at Disney Park, there is all these strange buildings and sights and you think that surely it isn't real. People don't really live in those mud huts. Those ladies aren't really gathering water from that fetid pond for drinking and bathing in. Those kids walking around in rags and barefoot aren't really inhaling glue from that bottle.

Then the effect starts to wear off. This takes some time; actually walking around in the midst of it can hurry along the breaking up of the illusion. You start to realize that people really do live in those huts. When you're invited inside, and there's this dirt floor, no electricity, very dark and smoky, you realize that this is a home, and that a large number of people in this country live in such homes. Then, there are the patients who come in barefoot with septic ulcers on their feet, and you realize that there are people who can't even affort as basic of footwear as flipflops. You have patients who come into the clinic for treatment of malaria or measles who don't even have the 200 shillings ($3) for the standard charge.

Seeing people walk around barefoot is an interesting example of this strange effect. At first I was shocked that I saw so many people without footware. Then somehow in my head, I had this subconscious decision that perhaps these people were walking around barefoot because they want to. See, that's how your mind deals with the idea that some people can't afford shoes and there's nothing you can do about it. You don't have the thought actually cross your head that they might like to walk barefoot, but somehow it gets in there. Only in the last week did I take a second look at it and think, my God, those people are walking around barefoot, and I doubt they prefer it that way.

Walking around Mombasa's center can be very revealing. This can be so much fun: there are little stands everywhere, people selling everything under the sun, and thousands shopping in the streets. There are spice shops, vegetable markets, and all sorts of shops for clothes and shoes and everything else. Yet everywhere, part of the very fabric of the city, is poverty unimaginable by most people in West. If you look carefully through the crowds, you start noticing the beggars lining the walls, first a few, then dozens, then more. You start noticing the street kids looking so dirty and ragged you almost can see them in some movie role based on, well, their lives.

Walking around in the bush is no different. If anything, there is even more poverty. The area around Kokotoni is one of the poorest in Kenya, and it shows. I had one child so sick from measles he could hardly move, and we almost turned the baby away because her family couldn't pay, until I ended up paying. Later the mother and child came back. The baby had recovered very well, but the mother had a bad case of malaria and needed to be admitted. Only her husband didn't want to spend their cash on that, so they went off to their fates. Again you see poverty in so many instances, children with terrible wounds and infections on their legs  because they have no shoes and because their families wait until it is nearly too late to bring them in. You see whole families living in tiny unlit huts. You see men, even boys, crushing stones in makeshift quarries into gravel, selling bucketfuls for 10 shillings each (16 cents); they might manage to crush five bushel buckets a day if they work real hard. That is reality here, a hard reality. Even the staff at the clinic has it rough; the nurse and pharmacist make 4000 shillings (less than $70) a month, and I make almost as much in each biweekly paycheck that the daktari makes in a year.

Again, one comes across the Disney Effect: this time, you see this sort of poverty enough, and it almost loses its effect on you. I remember one day I was showing the daktari and his friends my flashlight, a LED lamp that cost me about $20 in Target. They mentioned that it must have been an expensive flashlight, and I responded without thinking that no, it wasn't that expensive of a lamp, just 1500 shillings. Well, that's a lot of money here, a couple weeks of pay for many people. Whoops.

So, thinking about how to deal with this poverty is daunting as well. Corruption is much too common here. Just this week, there's a big deal about the previous dicatator/president Moi being sued by a businessman who gave him a 50 million shilling bribe, didn't get anything for it, and wants his money back. The interesting thing is that I read the article, and there wasn't hardly any mention at all that Moi accepted the bribe. That isn't what is making waves. So, rampant corruption will have to end, because it neuters the government's ability to fund roads, education, and all the other things that could end poverty.

I'm also a big believer in enabling people to save themselves. You can pour billions and billions of dollars into a problem, but if people don't stand up and take charge of their own lives, then it is a waste. I support organizations such as the Heifer Organization that requires people to be in charge of themselves. Something I struggle with here is a kind of apathy that people have. They know their government is corrupt, but hardly a word is said about it; there is almost an amused dismissal of it. Plenty of people are unemployed, but it's easier to blame situations and people than to be innovative, to work towards changing a situation. Of course, it's easy for me to stand on the side and say this; so, I am strictly making an observational point.

So, a final thought: this is but one tiny corner of the developing world. Not only that, but Kenya has an immense amount of potential, and many places aren't so fortunate. It's a little overwhelming to consider how much poverty is in the world, how many people live their lives hand-to-mouth. I think I said before; it's easy to arrive somewhere like Kokotoni wanting and expecting to make such a difference, and it takes experiencing it to realize just how little you really can do; there is just that much need out there.

Until later, keep safe.

October 08, 2006

Finding Your Way In Mombasa

So, there is just over two weeks left for me in Kenya. My departure is really starting to loom in front of me. A conversation that I had with Jess comes to mind as I am relaxing this weekend in Mombasa.

This is the real thing, true traveling. We've traveled together before--Europe, Jamaica. This is the big cahoney, though. There is real potential for problems here, far more than we'd imagined. Unemployment here is greater than 50%; you see whole lines of people sitting next to walls, perhaps in the hope that someone will offer them something. Even educated people don't have opportunities here; the brother of the PA I work with is an accountant, out of work for more than a year, with no real hopes of getting a good job. People here are desperate in many instances, and desperation yields crime. Reading the paper here can be a daily shock. A word of advice, don't go to Nairobi, better known here as Nairobbery. Muggings, stabbing, hijackings, and wanton violence are daily fare. It's actually a little scary to read the paper, I had to stop doing it.

Not that this is unusual for Africa. Kenya is one of the most stable countries on this continent. I was reading about the economy of Zimbabwe the other day, where people cart their money around in wheelbarrow (Wheelbarrows!) because the currency is so worthless.  Somalia is falling into chaos, which is terrifying to the typical Kenyan, and violence regularly spills over the borders here as cattle raiders come and kill whole villages in Northern Kenya. You hear the stories from people, and you don't believe them, and then you see it on the news at night. It's sobering, to say the least.

From a traveler's point of view, this country is the real deal. In Jamaica, you have to watch your butt. You keep an eye on everything around you, and you keep your hand on your bag, but other than that, the most dangerous thing about the country are the drivers. You can relax in Jamaica, you can go to a little coast town and vacation there. Here you watch what is around you at all times. You don't go out after dark. You don't act naive and silly and attract attention. You certainly don't sunbath topless on the beach, which we saw in Jamaica. Otherwise you are a target.

I am not saying that walking around in the streets is dangerous; I'm walking around Mombasa today. I've never been in a truly dangerous situation here, I've never been threatened or encountered a hostile person. Kenyans are friendly, jovial, and very welcoming. Mombasa is a very lively, busy, and interesting place; I love it. You just have to be very careful. You can't let down your guard.

At worst I've had hustlers target me. I have had people in the streets come up to me, follow me, try to be a guide for a tip. Once, at a supermarket no less, I was hustled out of $1.50 (100 shillings) because some very nice older fellow talked to me for a long time, gave me his address, even gave me a present, and somehow convinced me it was cultural to reciprocate the gift with something (he wanted 500 shillings).  It's a strange feeling to know you're being hustled, even to be angry about it, and still feel obliged to hand over that bill. After all, it is customary to reciprocate a gift from a friend with something of equal value here. Only he wasn't my friend, and the bangles he gave me for my mom might have cost a shilling or two. But that's how people take advantage of a lack of or partial cultural understanding.

I really do like Mombassa. I love walking around in all the markets, with people selling wares from veggies and food to clothes, pirated CDs, and sandals made from old tires. I love seeing people from all over Africa and the world here, this place has an identity that can't be found anywhere in the US. It smells bad, it's loud, there are people everywhere, it's really great. So, you have to realize people here are out to survive. They can't depend on their government for support--it can't even keep up the roads or manage trash pick-up. You may not like to see people who have to steal to survive, but you can't blame them, they didn't create the environment that causes them to do so. It's survival here. There is no welfare.

I think that I've been blessed here in Kenya. I arrived to find a network of people already in place to help me. They've protected me from much of the dangers in Kenya. They've allowed me to become accustomed to life here, otherwise I would have had quite a little shock on arrival. From my host here in Mombasa to the daktari in Kokotoni, I have been supported, and even sheltered, at least at first when it was all so fresh. My trip here would have been much different had I just arrived and tried to get around by myself. So Jess and I were quite fortunate; I can't speak for her, but I'd say she had nearly a perfect trip, and certainly for myself the same.

So, as a traveler in Kenya, you just have to watch your back. Like my dad always told me before heading off somewhere, just know what is around you at all times. That is key advice for travelers in Africa. 

October 06, 2006

New Life

So, it has been an intersting week here in Kenya.

First off, I had my first experience with true Traveler's Trots. I ate some food from a street stand, something I have done often, but this time it caught up to me. I had terrible diarrhea and vomiting. I ended up having to take antibiotics (Flagyl), which helped. That just reminded me to be careful what I put in my mouth.Oh, and beer and Flagyl are not friendly towards each other.

Yesterday morning, I had my usual morning routine. I got up at 7 am, took a bath/shower (water heated on the gas stove and poured over my head), washed some clothes, made eggs and chai, and was getting ready for the day when the doctor showed up at my door wanting medicine I store in my fridge. There was a woman in the clinic who was getting ready to give birth. So I dropped what I was doing and hustled to the clinic, to find she was quite ready to give birth indeed. I'm generally useless when it comes to these things, but I put on gloves anyhow, and stood around. I'd go get things from different rooms, so that the family would see me going to and fro and find me to be important. I held her hand a few times as she squeezed my knuckles until they cracked. I didn't know how to tell her to 'push' in Swahili, so I just grunted encouragingly when it seemed the daktari was telling her to do so. She didn't really need either of our helping assistance, though. Without any pain meds, without really anything at all, just a waterproof pad placed on a mattress, she pushed forth a child. I was right there for that; I didn't necessarily catch it, but I helped untangle the umbelical cord from its shoulders, and I held it while the doc clamped and clipped. Then I cleaned it (her), and wrapped her in a pretty dirty cloth. That was pretty much all we did. We finally gave the lady an injection of pain meds, and her family came. Within an hour they had escorted her out the door. And that is how babies are born in clinics in Kenya, if the mother bothers coming to a clinic at all.

So, that was pretty cool.

Anyhow, I'm back from the bush, spending a few days in Mombasa. I'm thinking of taking a trip in a week or so to the island nation of Zanzibar, off the coast of Tanzania, it's cheap and easily accessible from here, and it apparently is quite beautiful. That is possible. I'll have to see how things go. You know, plans very often change here in Africa, it doesn't always work out as first planned.

Until later, keep safe.

October 02, 2006

A Sad Situation

I am back in Mombasa after a week in the bush. My friends from the US have arrived, so I am spending a little time here, although I will be returning to the bush shortly for a short time.

I had a sad case this week. One morning, right after arriving in the clinic, a woman came in holding a little baby. At first I thought the baby was dead, it looked lifeless. Then it took a gasping breath, and moved a little. So, we busily started doing what we could to revive the child. The unfortunate thing is that we couldn't do much: we didn't have any medications to work with. We gave an injection of penicillin, as the lungs sounded terrible and we suspected severe pneumonia. We didn't have any medications to give to improve the child's breathing, medications that would have been standard in the US. We'd had some earlier, some epi, but we'd run out the week before and hadn't the money to get more. So, the baby was having agonal breathing, the rate maybe 8 times a minute, and needed oxygen, only there is no oxygen. There were some old tanks that were donated a long time ago, but of course were empty. We tried using an ambubag, with no O2, but we only had an adult mask, not a pediatric, so that was unsuccessful. Finally, we decided that we couldn't treat the child, and referred them to a clinic more than fifteen minutes on a terrible road away. The woman had no money, so we gave her the money to pay for a matatu to go to the other clinic. These matatus are minivans used as taxis, packed full with as many as 15 people. So we sent a critically ill child, who needed to be emergently intubated, away in a a matatu--a slow bumpy taxi.

I have to say, I have felt useless at work from time to time, when I didn't feel that I was contributing. But I have never felt completely helpless, unable to do anything, overwhelmingly helpless. This was how I felt then. As I watched the lady get in the matatu, I'm thinking that I should be going with her, to give the baby mouth to mouth, but then for what? When she gets to the clinic, she has no money, so they won't treat the baby anyhow, assuming that the baby survives the ride there. I just stood there like some survivor from a jet crash, stunned, and people around me went on like it was normal. Turns out it is. They see this type of thing more often than I can comfortably imagine. There are patients who die here from simple, easily treated problems because there isn't the money to buy proper medications.

So, I knew that this was out here. I knew that this happened in places around the world. I guess I just got introduced to it. And it didn't leave me feeling very good. I was looking around for someone, something to direct my anger at. There is a community committee who runs this clinic, and they are inefficient, uneducated, and likely corrupt. The doctor had to loan the clinic 5000 shillings, which is nearly half a month's pay for him, to buy essential meds. Am I to be angry at the committee? Should I be angry at myself, could I have done more? After all, what good am I here if I can't do anything? But in the end, there was just this dark submission to the reality that this happens.  It doesn't happen at Duke Hospital, this child would have been easily treated, but it happens here at Kokotoni Clinic.

Being in Kenya opens up a whole new reality, where the people running this nation are terribly corrupt, and the rest of the country suffers. I have had conversations with several people, where I ask why they as a people tolerate their governments blatantly stealing money from them, and when they are caught getting away scotfree. (An example, you can go to jail for a decade for stealing a cow, but steal a million shillings and you will only get a few months--they want the money to come back into circulation). These people reply that they have no rights, that the police are as corrupt if not more than the government so protests aren't possible, and that nothing can be done by the little man, because power and money really do speak here. So it continues, this corruption, this inefficiency, and hence this poverty. Not that I have a solution, but it certainly raises my appreciation for my home nation.

Anyhow, it's not been bad here, I just had a sad experience. There are a lot of shocks to be had here, a lot of eye-opening events. This is a different world, really, and I am frequently reminded of that. For example, I was talking with the doctor's (unemployed) brother, and was commenting that a good thing about Kenya is that with a little money, one call live a decent life. But he, who is a sharp fellow, told me that even something cheap, a bag of rice for 20 shillings, is only cheap if you have the 20 shillings. If you have nothing, then even a bag of rice is expensive. And that is the way to learn to view the world from a totally different perception, from a person who hasn't the 20 shillings. 

Anyhow, I will be returning to Kokotoni on Tuesday, and back to Mombasa on Friday to catch a ride to Malindi, a place up north I haven't yet visited. I have made good friends at the clinic, they call me now when I am in Mombasa, and I think they miss me. I miss them too, they've made my stay there very nice. They treat me as a guest, and something special, or interesting that happens in their lives. So, it is a good time there.

Until later, keep safe.

Recipe of the Week


  • Corn Meal
  • Water

This is a pretty simple dish, although it is very much a staple in Kenya and much of Africa. You start out with the water, maybe a couple cups, and bring it to a boil. Add a little corn meal to it and stir. Use a wooden spoon and fold it, rather than stir. As it cooks, add more meal, it will be absorbed. It will become less and less watery. Give it periods of sitting to cook, then fold it more and add more meal. You will know that you've allowed it enough time to cook when you can put your finger to it and it doesn't stick. Take it from heat and put it on a plate. Form it into an approximate square, and slice into chunks. Most food here is eaten without utensils, and ugali is very much a finger food. It it taken out in chunks, rolled into a small ball in the hands, and used to scoop food up. Eating with the hands is a foreign concept, which I haven't mastered by far.


Coming to a place with a substantial Muslim population, such as the coast here in Kenya, during Ramadan is always interesting. It is a time of a different culture to be certain.

I experienced it once before, in Tunisia. I remember all the food shops being closed in the afternoon--who is going to eat?--and then the whole place coming to life after sundown. I also remember how I found out it was Ramadan, stuffing a banana in my face in a busy bus station and then noticing everyone staring at me a little maliciously, and remembering something in my Lonely Planet guide about this holiday where people don't eat from dawn to dusk....oops.

Anyhow, knowing Muslims here in Kenya, I've tried a couple of days now to fast, with mixed results. Really, I have been successful, I've fasted very well between breakfast and lunch, although that period until dinner is difficult, I like a little snack here and there. And in my idea of fasting there are exclusions, in particular candy and water. Now I'm considering a method of fasting I've pioneered which I call mental fasting (meaning I've thought about it, which is still good, right?).

Really, though, as there are Muslims as part of the household I stay with in Mombasa, there isn't any real meal during the day. If you want to eat, you are on your own to scrounge up food. But the huge meal after sundown is quite a nice situation, for it's expected to be delicious enough to satisfy those who are really hungry from a day of fasting. Or for those who didn't fast but still have quite an appetite.

It's just not that nice to take your big lunch into a room with fasting people and eat it there. That is a little uncouth. Even for me.