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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.


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