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.

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.

September 25, 2006

Back In Mombasa

This has been a very busy week.

We went back to the clinic early in the week, it was Jess's last chance to see the people there and to say her goodbyes.  We took out a lot of cleaning materials - liquid soap, bleach, towels - which we used to clean up the place a little. It made us feel good, because they have the staff to run the place, we are mostly helping out in small ways and learning a lot of tropical medicine. But this way we felt like we were contributing. We said our farewells the following day, which was very sad for Jess, as well as me, since I started thinking that my trip is nearly half over.

We also went on our safari, which was four days, three nights, and took us through three parks - Ambaseli, Tsavo West and East. It was very beautiful, there were so many changes in landscape and people and places. That was the best part, driving through so much territory we wouldn't have seen otherwise. Of course there were the animals - lions, giraffes, elephants, hyenas, warthogs, zebra, cape buffalo, wildebeasts, gazelles, impalas, lots of antelope of different species, and loads and loads of birds. It's amazing to see all of these animals in their natural habitats, we really had a great time.

We're back in Mombasa for a few days - Jess flies back to the States tomorrow, so we are just having an easy day. She's quite sad about leaving, and it makes me sad to think about leaving in 3.5 weeks. Time does fly, especially here. Mombasa is such a lively city, there are people everywhere, markets along many streets, and the whole place just moves. It is the kind of place that people come to visit and end up staying.

I'm back to the clinic for awhile after Jess leaves. Friends from the US (my host's family) arrive shortly, on my birthday, so I'll be back to Mombasa for that, and periodically from then on. I'm looking forward to being back at the clinic. After the first nervous night, it became like home, and I'm wanting to work on my Swahili, and take lots of walking tours of all the nearby villages. I'm excited about that.

So, until next time, keep safe. Be welcoming to Jess in the States, she'll be sad and missing Africa.

Recipe Of The Week


  • Potatoes
  • Tomatoes
  • Onion
  • Rice
  • Chicken
  • Garlic
  • Packet of Seasoning
  • Vegetable Oil

Cut the chicken into small pieces. Set aside. In pan, begin cooking tomatoes, potatoes, garlic, and onions satte style in oil. Seperately. cook rice in pot - 1 cup rice for 2 cups of water; if possible, cook over charcoal cooker to get the African effect. Begin mixing in chicken into vegetables as potatoes begin to soften, mix in seasoning as well.  Cook until nicely done.

Update On The War Against Roaches

Kokotoni Clinic, The Kitchen - A decisive battle against the roach hordes has been fought. Aided by the miraculous discovery of both spray and powder roach killer, large numbers of the fiends were overtaken and destroyed.

Casulties on the human side remained limited to a fairly severe headache and the loss of about three hours hiding in the shadows of the kitchen. Officials tallies of roach casualties totaled a large confirmed pile of them, which was swept in the cantine (simply a hole in the floor).

Powder was also spread all all along the walls in hopes that it will be carried back into the source, which is suspected to be the house next door, of which inhabitants are nonchalant about the issue.

Further updates will be made as possible.

September 19, 2006

A Safari To Remember

Jess is leaving in a week, so we did the tourist thing and took a safari. We went to a park nearby Mombasa called Shimba Hills.

 The park itself is really fantastic. It isn't the usual savanah plains with animals everywhere. It has hills and lots of trees and underbrush, so you really have to look for the animals. We stayed in a lodge called the Shimba Lodge, which was right off of a watering hole and was very rustic. Very nice.

Driving about, we came across a huge bull elephant in the road, which was exciting. We had giraffes crossing in front of us. There were baboons and cape buffalos, and we were lucky to see the sable antelope, which are very rare and only found in that park. We even came across some interesting birds-we watched an African fishing eagle doing its work, and a crested kingfisher sat on a limb maybe five feet away from us to pose. The animals were really fantastic. This weekend, we are going to Tsavo Park, where there are many more animals. This is the park that the movie The Ghost and The Darkness was based on, about the true story of the two lions who ate their way through 140 workers building a railway. Needless to say, we won't be hiking this trip.

Back at the lodge, we had very nice service, it's quite pleasant to be pampered, if a little unusual. It's not our typical thing. Then came the best part.

There is a walkway into the trees, which is lit up at night. I decided that it was probably about as romantic as a person can find, and decided to ask Jess to marry me there. I bought a beautiful Kenyan tanzanite ring here, and it was quite nice.

Oh, and she said yes.

And some people think I'm not romantic...

September 16, 2006

In Kenya Now!

Jambo! Habari ghani! How are you? We're in Kenya!

So, it's been a very busy week, there has been so much to see and experience, so I won't get too detailed. In my last entry, I wrote a little about being here and how to contact me, so I'll just add a tiny bit to that.

The trip was even longer than I could have imagined it. Getting off the plane in Amsterdam, a person thinks, "Wow, that was a long trip," then realizes it is barely half over. The flight from Amsterdam to Nairobi was excrutiatingly long, even though it was only 9 hours. We were quite happy to get off, only to get back on to get to Mombasa.

 Our friend Rita met us at the airport; there was a moment when she wasn't there, it was past midnight and a little panic ensued. Still, it turned out well. We spent the night at her place, she took us around the next day to buy groceries and items we would need. She lives just a little distance from the beach, which is terrific. It is the Indian Ocean, and Mombasa is famous for its wide, white beaches, with only a few people around. And we drove around a little in Mombasa, as I mentioned, which is so interesting. This city is very alive and vibrant, packed with people and things happening.

The next day, we headed out to the clinic early, in a little village called Kokotoni. The clinic is called the Kokotoni Self-Help Clinic. It is owned by the community and run by a committee of leaders from the surrounding six villages. The committee is a bit shady, they seem like the mob, they have that kind of feeling. The doctor, who really is about the equivalent of a PA in the States, is very nice, though. He is relaxed and very informative.

Our first day, we arrived and briefly set up in a little house where we are to stay. The house is quite decent, a little living room, a little bathroom, a couple of bedrooms,and a little kitchen. Our neighbor is the doctor. We put our bags there, set up the water dispenser (we can't drink the tap water), and put our food in the kitchen. Then Abraham, the doctor, immediately put us to work. It was a little overwhelming, we were doing a wound change, administering IM shots (which we hadn't previously done), and so on within minutes of being in the clinic. Afterwards, we went back to the clinic, and headed out for a little walk. Abe found us and made it clear that we should have him along for any excursions we made. So we walked around a little, took a lot of pictures and went back.

That night was a little interesting. First, there was a large amount of culture shock to deal with. Our arrival here was very abrupt: we were leaning over, looking in, and then it felt like someone put a foot on our backs and gave a good push--total immersion!  Then, there was a large number of roaches in the kitchen which I had to crush (in the end, I decided it was better to leave the kitchen to them at night). We couldn't lock our door that night, and of course we were a little nervous. We were truly out in the bush--20 km from Mombasa, but that is a long distance on these roads, and a world away from Durham. Rest came slowly, and as we are near a mosque (there is a decent population of Muslims here on the coast), I was jolted awake when they rang out for the prayer call at 0500. That's just someone with no singing skills shouting into a megaphone, which apparently has a speaker in our house, it seems like. So, there wasn't much sleep that night.

But it was straight uphill from there. By the next afternoon, we were much more comfortable. Abraham is a very willing teacher, we've had lessons on all of the illnesses found here--typhoid, measles, bilhazia, pneumonia, RTI, UTI, and especially malaria, of which we see many cases every day. The clinic is not busy, but that is good as it allows both time to learn about the illnesses as well as take Swahili lessons from the staff (lab tech, pharmacists, CNA, cleaning lady). We have gotten very comfortable giving IM shots. We have learned the Kenyan method of cleaning and dressing wounds (just like the US way, only with about 1/10 of the supplies--that's the same for most procedures). We have seen a Kenyan circumcision (painful and worse), fungal infections that were unbelievable, and almost got to deliver a baby at 0330.

In addition, we've gone out into the community, and have seen how people live here.  It is fascinating. This is one of the poorest regions in Kenya. Poverty is accompanied by ignorance, and Abe has told us incredible stories, sad stories that often are preventable with basic knowledge. We have met many people, and have thoroughly enjoyed our excursions. It's unfortunate that I can't put up pictures at this point. And, we have gotten to ride in a matatu for the first time. These are van-taxis, packed with people. We were in one with 19 people! That was a little uncomfortable. I'll write more about the matatus later.

At any rate, I will be posting many more entries on what I see here. Our schedule for the next weeks is busy, because Jess returns in 10 days. We have planned a very nice safari, which will happen next weekend. We are in Mombasa this weekend and have some fun planned. We will go out on Monday to Kokotoni to visit the clinic so that Jess can say goodbye, and will cook them dinner. We will be there until Wednesday, then off for the safair! Of course, I have nearly five weeks remaining.

A last thought: there is much need here. There is so litle, you really should see the clinic, it is spartan. The meds here are so few, it is all they can afford. They know better meds are out there, and even in Kenya, but they haven't the money. So as Abe says, they do what they can with what they have. There is this sense of wanting to help, this temptation to give everything we have (which we will by the time we leave), and yet this knowledge that the need is so great, the deficit so vast, that it couldn't be enough. So, one must focus on the small things that they can do: bring a good thing to a few peoples' lives, do a few good things for some people, that is all two nurses from America can do here.

Kenyan Recipe of the Week

Eating is my favorite thing to do abroad. Here, I've eaten a lot of good Kenyan food: corn mash, rice and potato dishes, and so on. Since I'm the one cooking here, I'm also learning new recipes. I'll try to post one a week.


  • 2 cups Water
  • 2 cups Milk
  • 3 Kenyan Tea bags
  • Spices to Taste (either from premix, or own mixture including cinnamon and others-I use premix)
  • Sugar

Boil tea in water, make it nice and strong. Add milk when adequately strong. Add spices to taste, be careful not to make too strong. Add sugar to taste.

This is terrific in the mornings, we've had it every single morning here.

Life With Cockroaches

I think that it is important to write a short instruction on how to live with roaches, as I don't want to alarm our families.

They are around, that will remain a fact. We will look for traps, although I doubt we'll have any luck. There are plenty of little ones, but it the big ones that are interesting. These are often over an inch in length. From what I can tell, there are a couple of species. Some have a long head, very thin. Others have a rounded head.  They are all dark brown and shiny. It's best not to describe them to women, however interesting they might appear.

They come out en masse at night, especially when it's been dark for awhile. Here they fly, so who knows where they come from. A person can wait silently and motionlessly, and they might come out, but this is a very inefficient method of finding and crushing them. Besides, they are too numerous for this to work. Again, methods of destroying them are best kept to oneself, women do not find this interesting, nor want to watch.

Due to the lack of traps, a little improvision can be tried. Water traps are useless. I've considered making glue traps, but I don't have glue either. Food that can be trampled (bread, crackers, cereal) is best kept in a closed cupboard, although this is no guarantee against the small ones. Veggies can be washed, don't worry about that. In general, this part of the issue should never, ever be mentioned to women. Fortunately, I'm the cook, so I deal with that end of it all.

Despite patient crushing hunts and all my work, I found little success. I was forced to retreat, a little shaken, and have decided it's best just not to go in the kitchen at night. Or think about it much. Or talk about it at all, really.

September 09, 2006

Arrival In Kenya

So, we have arrived.  After a very, very long trip, we are in Mombasa! 

 Seriously, that flight was really long. Going through Detroit and Boston to Amsterdam felt like a full day. Then, you're thinking it's over, but no, it's only starting. The flight to Nairobi was about 9 hours, and that was closely followed by a flight to Mombasa. Needless to say, we were happy to have arrived, and were met by our contact Rita. We'll spend a few days at her place, and head off to the bush soon to start in the clinic Sunday.

We have been getting a tour around Mombasa, which is a little harrowing, and have purchased a lot of food. I, apparenlty will be the cook. We bought lots of fruit and veggies, and will buy more food soon in Kenya's version of Walmart (I know, it's terrible). It's quite a culture shock here, of course, and it will sink in more in the coming days.

 I will write much more later, there is so much to tell in one day, it's a little overwhelming, but we are in a bit of a hurry, so I'm just going to put my contact here.  I can be reached by dialing this number: 254-727-322-014.  We will be keeping safe and having a lot of fun.

September 07, 2006

Heading Off To Africa...

So, this is my last entry from the US. Assuming that I have access to the Internet (which I will), my next entries will come from Africa.

I was starting to think that this day wouldn't come. The last four days at work seemed three times that, and I was so happy to get out, I almost skipped down the hallway. It's funny, I will not return to work for seven weeks from tomorrow. That is a strange feeling indeed.

Everything on this end seems to be in order. I've hyper-managed my bank account to transfer $500 a week into my checking account, and have calculated the balance with my bills and paychecks, so that some weeks I even transfer money back into my savings account. It's really remarkably anal, but hey, I was bored. I paid my bills, I set up payments for the next two months, I called the credit companies to tell them I'm leaving, I've been vaccinated, had a hair cut, trimmed my beard, packed my stuff, all the stuff that one can possibly do short of just getting on the plane and getting the heck out of here.

And that is next. That is now.

September 02, 2006

Tying Loose Ends...

It's been a madhouse, tryng to finish up the last few things to do before we leave. The problem is, we both work the four days before we leave. So, really, today is the very last day that I really have to get things done, even though I don't leave until next Thursday.

Jess has compared this time to the time before Christmas, when you're running around, trying to get all the presents you need, all the little gifts from different places, which is very time consuming and just a little annoying.

Other than that, I think I'm really about ready. I got a haircut, which will likely be the last one for two months. I've testing the different time frames for events in my life. For example, I have paid serious attention to how long it takes me to work through a bottle of contact solution or a tube of toothpaste. I mean, really, it's important to know this, in order to properly plan. Now, this haircut time frame, it is a little different. I could say that I've just tested how long I could go without a haircut, but really, I've just been lazy. I just didn't get a haircut for about two months. So, I guess I can say that I should be ok in Kenya, without having to worry about it.

I took my first malaria pill. I'm taking Mefloquine. I was a little worried about it. Apparently one of the side effects is that it causes a little psychosis. So, I was waiting for the bugs to come crawling down the walls, that sort of thing. I didn't really experience any sorts of strange effects, which is disappointing in its own way. I had a friend taking the medicine in Ghana, she literally saw Jesus sitting in a tree outside her window. He was as real as the tree itself. She described the experience to me with a sort of humbled humor, the kind that you have when you know something isn't real, but it sure looks like it.

I went through my luggage, because it really was ridiculously overweight. I took out several articles of clothing, the sleeping bag, some other stuff. It is still heavy, but I can now get it off the ground. I had the clever idea to buy a couple of little duffel bags, which I filled with some excess medical stuff like syringes and so on that I got from my friend Amna. The plan is that I will drop all the stuff off at the clinic, and will be left with two empty duffel bags, which happen to be perfect size for overhead compartments on planes, which is essential when you have a lot of fragile souvenirs you're bringing back. Which of course is the purpose of having the two empty duffel bags.

Now, I just have to survive four days shifts. They will pass quickly, I'm sure of that. Then, it will be time to leave. It seems like just yesterday I had two whole months of waiting. If two months passed that quickly, four days won't even be noticed. Four days....

August 28, 2006

Contacting Me In Africa

A recent conversation reminded me about having a way to contact me in Africa. So, I did a little asking around about it.

Jess and I will both have GSM phones, for which we will buy SIM cards in Kenya. At that point, I'll post a number at which anyone can call. Of course, it is also possible to text me as well.

To buy a calling card, I would visit the website. There, you can buy a $10 card that will give you about an hour of calling time to a mobile phone, and longer to a landline. I've used the Caribone service, it works like a charm. They provide a number directly to you online, so there's no waiting around for any card to arrive. They actually have cards specific to Kenya.

Other than that, the best way of contacting me would be to email, or to fill out my Contact Form. That form goes straight to my email.

Anyhow, that should simplify the contact business. Looking forward to calls from the US!

The List Grows

I was working on accomplishing everything on the List of Things to Do. Apparently, working on the list is equivalent to planting a seed in the garden, then fertilizing and watering it religiously, because my list grew exponentially. I started out with a little list that I could put on a Post-It, and the next thing I know, I'm up to a 8x11 sheet, all filled out. In fact, the simple act of doing something on the list invariably brings to mind another three or five things I need to do. On the same token, time seems to be accelerating, as though the laws of physics were a moot point.  And to make it all the more stressful, I'm still forced to go to my job, and then stay there for full shifts (how dare they?). Then, I'm tired, and I must sleep, and the next thing I know, three more days are gone.

On that note, I did do some pre-packing. I am looking to having a backpack with about 20-30 lbs to take. I also will have a little duffel bag with medical stuff in it. So, I packed up all the clothes that I bought, the "light-weight" clothes, and all the little things I thought I'd need. It wasn't quite full, so I was fairly proud of myself. Then I tried to lift it, and could barely get it off the ground. I'm not sure yet what the weight limit for luggage is for the flight, but I'm pretty sure I've surpassed it. So now I'm going to have to go digging through it, and take out some of the clothes and things.  I guess I don't need seven pairs of pants (four are zip-offs: you can never have enough of those!), and maybe eight shirts are a little excessive. I might leave the sleeping bag at home, I'll have to trust that there will be a bed to sleep in, or at least prepare myself for the possibility of sleeping on a cold hard floor. The bag only weighs two pounds, so it still has a chance for going. I can't imagine how much my bag would weigh if I were going somewhere cold. No, I take that back; when I went to Finland to study in the winter, I had to take boxes, and they were crazy heavy. Since then, I've only traveled with what I could put on my back, not what I could stack on a slick floor and push.

Things are getting done, though, slowly but surely. Honestly, the stress level isn't bad. I just had lunch with my doctor friend and her husband, and Jess and I were so excited to go after talking about what awaits us, we could have left right after the lunch.  It's true anticipation that I'm feeling, I really can't wait.

August 25, 2006

What To Bring To Africa

Here is a list of things that I feel is necessary to have on a trip to Africa:

  • Lightweight, quick-drying clothes, including a couple pairs of pants (ideally that zip-off into shorts) and long-sleeved shirts
  • Hiking shoes and probably a pair of running shoes, plus flip-flops
  • 1 week's worth of shirts and underwear (plan on washing your clothes, so bring a bar of laundry soap)
  • Basic cosmetic stuff (toothbrush, toothpaste, shampoo, soap, comb, maybe some other stuff, but most stuff can be bought)
  • Flashlight / Headlamp + batteries
  • First Aid kit (make sure it is good and thorough, this can be important - the CDC Med Kit)
  • Antidiarrheals, Rehydration Salts, other med stuff
  • Rain gear (jacket, bag cover)
  • Clock/watch
  • Camera
  • Mosquito net
  • Lightweight sleeping bag + 1 sheet for liner
  • GSM phone (buy SIM card in Africa, they're common)
  • Malaria Pills, like Mefloquine
  • Bug Deterrent, preferably cream
  • Towel, swimming gear
  • Travel Insurance
  • Sewing Kit
  • Water treatment pills, such as MicroPur
  • Power adaptors

Some stuff that is nice to have, but not a necessity:

  • Gifts for kids, like gum and stuff
  • Pocket knife
  • Storage unit for digital pictures
  • Bag full of extra medical stuff, like gauze and syringes (take in an extra bag, and use that empty bag to bring back goodies in)

If anyone has any other ideas on what to bring, please post.  I'm open to any suggestions!

August 24, 2006

Two Weeks And Counting...

So, it's crunch time. There are only two weeks left, and they are passing in a hurry.

It's a little like being on a roller coaster, heading up towards a high drop-off. You know it's coming, you can see it, and it's so slow, but yet such a progressive movement, there's no chance of slowing it down. Everything that happens between then and now is like a bump, a gear in the track: work, going out for dinner, trying to get everything done. All of these things happen and pass by, and each just represents one more event completed before the big drop-off.

Heading off for seven weeks actually requires quite a planning process, more than I expected. I got the big things out of the road early, like getting a visa from the Kenyan embassy, buying a mosquito net, those sorts of things. Suddenly, yesterday, I realized all the little things I was putting off. I had to cancel some accounts, I had to set up my online banking to operate without me, I have to write a schedule through the 22nd of JANUARY. I haven't even done a preemptive packing job yet to see if it's all going to fit in my bag.

I have a bit of a bad habit: I like to get a bunch of stuff done, then sit around bored as though there's nothing else to do, just waiting for time to pass. Really, there's always something else to do. For example, I need to get a prescription for my malaria prophylaxis. I just got around to asking for it last night. That doesn't mean I have it yet; no, I need to feel a lot more stressed about it before I actually get it and take it to the pharmacy. All this time, surrounded at work by numerous doctors with prescription pads in their pockets, and I still haven't gotten one yet. But that has been the way it has gone for nearly everything this month. I have a terrible procrastination problem right now. On the other hand, crossing the two-week border today, my stress levels had a real decent jump. Maybe I'll actually get things done now.

Probably not. After all, I still have two weeks.

August 21, 2006

A Cleansing In Africa

So, less than three weeks to go. I feel a little anxiety coming on. But anticipation is greater in this case.

 When Jess and I talked about our reasons in wanting to go to Africa, we both agreed that a large part of why we wanted to go was to become refreshed in our idealism about our jobs. As nurses, we don't necessarily always agree with what happens in the hospital. We don't always agree with the decisions about care that are made, the decisions about patients and treatments. I have to remind myself sometimes that it isn't me that makes these decisions, and of course it's always different looking at the situation from a professional perspective in comparison to a personal one. It's always different as a health care worker, in the inside, seeing what happens, seeing what drugs and treatments and machines do to patients, thinking to myself that I would do it differently if I were making the decisions. It would be different if I were looking at a family member. It's a continuous dilemma for healthcare workers, at least those who still want to think about it.

Having said that, I feel that it is important that I have a clear mind about what I do. I want to look at each patient in a fresh sense, not havng a collective of feelings about issues that don't pertain to that patient, that have built up from several situations where I had clashing feelings. It's essential to be open-minded, nonjudgmental, and I feel that my year and a half in nursing has really brought this criteria to my attention, being around some folks who are a little bitter, and seeing the temptation myself.

Probably more so for Jess (as a PICU nurse) than myself, there is this continuous spector of lawsuits that hangs around like a foul pallor. All it takes is an angry family and an emotionally difficult situation, throw in some helplessness and sickness, and the next thing a nurse knows, they're being sued. It's a situation that can haunt a nurse the rest of their careers, because being named in a lawsuit, especially one that the family wins, is never erased from a nurse's record. There are few jobs in the world where you can work so hard, try so hard, have so much to know and be proficient at, do everything possible to help and comfort and heal, and still have somebody looking for a scapegoat ruin your career.

Hence, a cleansing in Africa. Jess and I want to obtain a fresh perspective on our professions in general. I think that I have this idea in my head, this picture of a crowd of people, so thankful for any kind of care they might get, to have real gratitude expressed. I imagine these people, needing so much but having so little available, having such desparation for the smallest parts of medical care, and for the first time, I might have some skills that could help someone. As a friend who just returned from a trip to Ghana told me, rather than having too much being done for each person, there is so little that can be done for the masses. There's such a sadness in that, but then the satisfaction in knowing that perhaps you can help one person, or a few. That would be enough.

I'm glad that I will have someone to share this experience, because I can see that it could easily be overwhelming. On the other hand, that's what I'm looking for, to have this experience give me a good scrubbing.

August 17, 2006

What I Am To Do In Africa

Ok, I've received several emails about what I will be doing, so I guess I need to clear it up.

 As I noted before, I work with a great doctor at Duke Hospital, who is from Kenya. Her mom is still there, and has made an opportunity available for me. I will be working in a clinic, a very small rural clinic, outside of Mombasa, Kenya. This clinic is run by a PA alone. It apparently will be a short distance outside of Mombasa. Although this is hearsay, I believe that there will be all sorts of clinical issues walking through the door. It is a rural clinic, so anything from births to deaths to AIDS and malaria and all kinds of other interesting cases will be coming in the doors.

 As a nurse, I will be stretched to my professional limits, because I will be required to be involved in much more than what I could be allowed to in the Duke MICU. I have a great imagination that plays with situations that I will come across, but nothing of course is certain. But I will see and do and be immersed in more that I can imagine, and that excites me greatly (as well as slightly terrifies me). Honestly, though, I can't say for sure what sort of work I will be performing. Savin' lives, I guess, which is nothing new around here Wink

I will be leaving the US on September 7, and arriving late in the evening on September 8th. I will leave Mombasa on October 24 and arrive on the 25. All told, I will be traveling for a total of seven weeks and a day. I managed this by taking 6 weeks personal leave and by scheduling magic that gave me another eight days to travel.

 This is all a little vague, sadly. Of course, more information will be available upon arrival. It's three weeks and counting from today. Three weeks! Wow...

By the way, folks, please post.  I really like getting posts here on the blog. Sending money is cool too.


Costs of Volunteering

Money is a big issue when you are planning to volunteer in Africa. No, it's an absolutely huge issue. There are so many little details to take into consideration. First of all, and most obvious, it costs a lot of money to travel these days, especially for a long trip such as to Kenya. For Africa, September is the beginning of the low season of travel; I'm not sure when the high season starts, probably April or May. At any rate, it is cheaper to buy tickets in September than in August. Still, it cost me $1460 after taxes for my ticket, which was considered a very good price. I saw tickets prices that spiraled into the high $2000s or even more than $3000. I purchased my ticket from, as was recommended by my doctor friend. Once that was out of the road, I figured there wouldn't be much else to spend money on. I was wrong.

A list of costs:

  • - Health/travel insurance: $150
  • - Putting together a REAL first aid kit: $180
  • - Immunizations: up to $500 ($60 for typhoid, $120 for Hep A, in addition to Yellow Fever, Hep B, tetnus, and plenty for malaria prophalaxis)
  • - GSM ("unlocked SIM" or world) phone: $80
  • - Water Treatment Pills, Mosquito sleeping nets, other various necessities: $180
  • - Lonely Planet for Kenya: $30
  • - Tropical Med books: $90
  • - Pimsleur Swahili CDs: $40
  • - Clothes: $100

Basically, it's expensive. Fortunately, I already had a big backpack, most of the clothes I need to travel with, and some of the other essentials. Of course, there was the loss of income as well. I had to take a leave of absence, which I originally planned to be unpaid, but HR required me to use 30 hours of my PTO in order to keep my health insurance at the hospital. While that income will be nice ($600 a week), it will completely drain my PTO bank. In fact, the only way it's possible is because I'll actually be accruing PTO hours while I'm gone, and will use some of those hours by the end of the six weeks. In conclusion, the financial stake in deciding to volunteer in Africa can be substantial, and being able to swallow that cost is absolutely necessary. If the money is more important, don't do it. On the other hand, I believe all that money is tax-rebatable, so keep your receipts for everything.

August 14, 2006

Finding A Contact

I'm starting this entry from the last one. I mentioned my contact that I made in Africa, and this is the story of how it happened. I work in the MICU at Duke Hospital. There, I work with a doctor, a pulmonary fellow, who is from Kenya. Initially, I knew her as an acquaintance, but little else. I didn't really even know from which country that she was from. At the time, I was thinking mostly about visiting Ghana or South Africa mostly, and possibly Tanzania, although I felt it was too expensive to get around in Tanzania. From reading a Lonely Planet, I felt that Kenya was a little too crime-ridden, because it mentioned that in Nairobi, petty crimes liking having your bags stolen is fairly common. At the time of reading that, I assumed I would be spending my time in Nairobi, and didn't feel like dealing with that.

At any rate, I was telling a coworker one night that I was a little frustrated with the whole process of finding a right fit of an organization, and she told me that I should contact this certain doctor about it, as she might know of good organizations to work with. So I sent an email, and ended up speaking with her on the phone. As it turned out, her mom lived in Kenya still, and even better, worked with an organization called Choice Humanitarian, which as it turns out, was one of the more expensive "working holiday" organizations I complained about in my last entry. The exciting part was that her mom knew of a clinic that apparently is owned by Choice Humanitarian, but is run by a PA. She offered to contact her mom to see if there was an opportunity for me to come and work in the clinic, without having to pay any money to the organization. She also gave me her mom's email address. I went ahead and sent an email expressing my desire to come and work at the clinic. I didn't get a response, even though the doctor told me her mom had actually been excited about me coming. Eventually, I called this lady, whom I will call Mary for privacy sake. My first conversation with Mary essentially consisted of sorting out our communication issues, and then Mary informing me that she'd already worked out the details of coming to work at the clinic as well as where I'd be staying; basically, they were just waiting for me to buy my ticket and arrive. I was thrilled, to say the least. It was an opportunity that I couldn't have imagined and of course immediately seized.

Later, I was telling my girlfriend Jess about why I wanted to go. We were having a long conversation about work and life, and I was telling her about how I was starting to feel a little bitter and pessimistic about work, and why this trip was really allowing me to have something to look forward to. Apparently something clicked in her head, and it all made sense to her. Without any encouragement from me, she decided she wanted to go, and on her own initiative, spoke to her boss to get three weeks off. When I bought my ticket a few days later, she bought one as well. In the end, my friend at work, and through her, my contact Mary in Kenya, made all the difference to both Jess and I.

August 12, 2006

Volunteer Organizations

Volunteer organizations in Africa don't make it easy to get there and actually help, which is something that I figured out during the process of getting ready to go to Africa. Choosing an organization to go with was actually a long and arduous process. To begin with, there are very few organizations that are willing to take volunteers in Africa without charging an arm and a leg. There are lots and lots of organizations out there that take volunteers to Africa, don't get me wrong. Most of these organizations actually revolve around volunteers, and as such, it is a business proposition to them. My goal was to find an organization that at least would let me work without charging me a ton of money. After all, a ticket to Africa is $1500, and six weeks of represented $4500 that I was giving up. To have to pay $1000-2000 to an organization for whatever "services" they provide me was too much. I had a very hard time finding organizations that charged even less than $1000. Most organizations seemed to be really tourist companies in disguise. You paid a ton of money, some even $3000-4000, and the itinerary often included a day perhaps in a clinic, where you likely just observed some things. There usually was a village day, where you went to some village and they sang and danced for you. You might help build a latrine or something. The rest of the time was spent on safaris and such. I came to call these adventures "working holidays," because there was more vacationing than working, and it was designed to allow you the feeling of having accomplished something on your trip.

I am not saying these types of trips are bad, they just weren't what I was looking for. I wanted something where I made a tangible difference, where I was in the thick of it, where people came to see me at a clinic and I helped them. I wanted to work, not to take a holiday, and to really accomplish something, not just have that perception. I did find a few organizations, very few, that allowed this type of trip as well as charged less than $1000. A list that I put together is found here. Still, I couldn't find an organization that I felt was truly professional, and that I felt would really allow me to work in the type of clinic I was looking for. I felt the worst thing that could happen to me is that I would get to Africa, and spend six weeks sitting around, not accomplishing anything. I was truly frightened of this prospect, that it would be a big waste of my time.

To compound my fears, a few friends of mine took a trip to Ghana, and as it turned out, the organization that they went with was disorganized. They spent their trip facing the situation that I wanted to avoid: spending a lot of money and sacrificing their time only to get to Africa and not be allowed to function as health care workers. At best, they were observers. In reality, they were on vacation. In the end, I found a different type of contact: a real person, offering a real opportunity to work in a real clinic. And it took off from there.

Preparations For Africa

I'm going to be writing a lot about how to prepare for Africa, since it is definitely the most interesting thing going on in my life right now. I'm going to start from the beginning, to chronicle what has occurred to get me to this current point in the trip, which is -26 days and counting. So this first part is how I decided to go to Africa, and how I got a start on it all. I think the reason that I first wanted to go to volunteer in Africa had a couple of causes. I really feel that I am responsible as a person living in a priveleged place as the US to go to help people as much as I can. I have always wanted to be able to travel with the idea of helping people. As much as I love to travel, all of my experience in doing it was strictly to be in a different place and to see different cultures. I wasn't able to help people, to do good if you will. I was there for my own benefit only. While this isn't a bad thing, it wasn't satisfying my need to be a help to people, to do my part for the less fortunate of the world. Nursing was a great vehicle for me to help, and part of the reason that I became a nurse was to have the opportunity to have a good humanitarian reason to travel. Also, I love to travel. I love the opportunity it provides, the sights that it allows, and the interactions that are possible. I love being somewhere long enough to meet people, to have a feeling for life as it is in another place, under different circumstances, under different cultural norms. It's exciting and eye opening.

Last year (2005), I had so much on my plate, just starting in an ICU as a nurse, all that. My travel opportunities were sparce, and I barely succeeded on achieving my lifelong goal of leaving the US at least once a year. I managed a short trip to Canada, and at no other time was I able to leave the US borders. So, at the beginning of this year, I decided, 2006 was going to be an extraordinary year for me. It was going to be a fantastic year, and one filled with travel as well as other things. I was very determined to make this happen. So the idea of going to Africa, which was already slowly being mulled in my head, started to pick up momentum. By late January, I had just made the choice, it was already decided, mostly subconsciously, and I was as surprised as everyone when I announced that it was something I was planning. I was probably more surprised than anyone, really, but there was nothing to do about it but start planning. The balls had started rolling, and there was nothing to do to stop them.

There was some heavy duty convincing to do, for my friends and family both. First, no one really took the idea seriously at first. There was also some resistance. After all, it's not every day that someone you know announces that they are planning on heading off to Africa for six weeks (a length of time that was also subconsciously determined), probably on their own if they can't find an organization. It's enough to make people uncomfortable. But like I said, it wasn't something that I could change. I'd already settled on the idea. I wanted to help people, I wanted to get out of North Carolina and be doing something, and I was terribly restless for the road. I initially planned on going by April, and I even went as far as informing my boss of this departure date, which made her uncomfortable for a different reason (scheduling). Soon it became clear that this was not possible, however, for logistical reason, so I decided it was better to go in September, and from then on, it was a go. So, I talked to my boss, and her boss, and the boss above that boss, and eventually was cleared by the Director of Nursing at Duke. I made the first week in September my departure date, and eventually that part of the planning was cleared. That left the actual trip building part, of course, but the foundation was laid.

August 06, 2006

Introduction To Aaron's African Adventure

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