Leaving Karero...

It was a busy week in Karero full of projects and patients.  We showed up to a beautiful site!  The clinic looked wonderful.  The community has taken such good care of it, creating walking and car paths and keeping it clean.  The rains came so we stayed a few more days than expected, which was really a blessing.  Mike and I put in windows using clear plastic instead of glass.  Mike brilliantly figured out a way to make the windows open and close to accommodate for the fluctuations in the weather.  Oh my wise husband!  The Maasai have given him a new Maasai name, Eloshordro (El – oh – shor –dro, you have to roll the “r”s with your tongue).  It means something like “the one who gives of his heart without asking.”  Typical Mike fashion, he works diligently and quietly and, before you know it, things are done!  He is an inspirational fellow that one.  The windows work really well to protect against the heat, wind, dust, and various animal noises.  We also tiled the bathing room floor as the concrete was quickly eroding from all the water.  And, we built a door for one of the rooms.  It was quite a site watching two westerners construct a door with old, run-down wood and some rusty nails.  We had some help from the locals and it turned out really well. 

It was a busy week with some complicated patients.  We went to the nearby boma to visit a woman who had had stillbirth at 8 months.  This was her second miscarriage. She was very dizzy, lightheaded, and weak.   Lab tests are limited in Karero without electricity and we have no way of getting hematocrit or hemoglobin, but I expected both tests would have been extremely low. She was so anemic that her tongue was white. We walked to her boma, brought her to the clinic where we were able to do an exam, give her some IV fluid, medication (vitamins, antibiotics, and analgesics) and to observe her for several hours while she rested.  It started pouring while she was at the clinic so she was stuck with us for several hours! She stabilized with foods, fluids, and rest.  I instructed to get to the clinic in Namanga for lab tests.  I checked on her the next day in her home where we shared tea.   It turns out she is the wife of the man whose head I sewed up the first night we arrived!  She was doing a bit better. As expected, she did not tolerate the vitamins I gave her... imagine prenatals on an empty stomach, yuck!  She was told to keep trying and to take with food.  I expect a slow steady recovery.  Her husband and all the other women in her boma were extremely supportive. I was told that after a woman gives birth or miscarries, she often resides in her manyatta (the house within the boma) for a whole month while the other women take care of her and the other children.  It is a beautiful lesson in community. Her husband was very grateful, and offered to slaughter a goat for us next week!  I told him it was unnecessary, but that he had to take care of his wife.  He agreed:) 

We had a very complicated patient the last night we were there.  A mama brought her two-year-old baby in at about 9pm complaining she had been having “convulsions” through the day.  She said she had about four convulsions without any other symptoms.  She had similar symptoms about 1 month ago when she was diagnosed and treated for malaria.  I assessed her and she was burning up with a fever of 39.1C, otherwise unremarkable.  She had a normal affect for a sick child, alert and responsive without any seizure activity.  Her blood slide was negative for malaria.  I diagnosed her with febrile seizures and covered her for infection with both septra and AL for malaria.  Her fever was reduced with paracetamol.  She was given clean water and instructed to push fluids and return in the morning for reassessment.  When she returned, she was afebrile, but very lethargic. Mama said she had had a few convulsions in the morning.  I was concerned that this was much more than just febrile seizures. Her typhoid test was negative.  There was no history of trauma and no family history, so far as we could tell, of seizure activity (but this is hard to determine!).  She had a small seizure in the clinic that lasted for about 1 minute, despite the anti-seizure medication that was given.  It was helpful, although very difficult, to observe the type and duration of seizure.  The child was postictal.  Our concern, obviously, was that this child would continue to seize and suffer irreparable damage.  She needed to get to the district hospital asap where they could observe her and perform more tests.  Tyson was expected to come to Karero to pick us up and he arrived just as I was calling him to tell him we needed to take this baby to the hospital.  I was really worried he would not make it due to the rains and the roads, but thankfully he arrived just in time.  Again, it was really incredible to watch the community come together.   The baby’s father was not around, but several men in the community came to discuss how they could get this mama and baby to the hospital.  Most people will not go to the hospital when referred because they cannot afford transportation.  The district hospital is in Kajiedo which is about 2 ½ hours from Karero.  They have to get a motorbike or car to come to Karero and drive them to the main road in Mal tisa, which is about 400 Ksh.  Then, they have to get a matatu (the local bus system which is terrifying – imagine 20 people in a small minivan with people hanging out the doors and on the roof travelling along bumpy roads!).  The matatu to Kajiedo costs about 200 ksh.  We all worked together to find a solution.   The plan was to drive them to the main road where they would then get a ride to the hospital.  Ester, the mama, baby, one of the men from the community, and another older mama came with us to Mal tisa.  I was a bit concerned about them making to to the hospital, so we ended up just driving all the way to the district hospital where the child was admitted immediately.  I was so thankful for the Kenyan doctor that we met right away.  We discussed the situation and we were immediately on the same page.  She was started on IV diazepam (valium), given IV fluids with dextrose, treated with quinine for malaria and was going to have more blood work and an EEG, if possible.  The hospital took the baby with the mama and they will take care of her, keeping her at least through Monday.  The baby had several small seizures en route to the hospital and was post ictal and sleeping the rest of the time in my arms.  The mama was having a very hard time observing all of this, as expected, as it is incredibly difficult to help a little one through a seizure.  Thankfully, the seizures were short and her airway was not compromised.  We all worked together to care for her and she made it safely.  My hope is that the seizures are secondary to a curable illness or electrolyte imbalance, but I am also concerned about epilepsy…especially if there has been a history of seizures in the past (again, hard to determine).   It will be very difficult if the result is in fact a chronic illness that requires frequent observation and continuous medication.   I hope and pray for the recovery of this baby.  It was a true experience of the challenges facing much of the rural population in Kenya.  It was also a tribute to how important it is to have a clinic in Karero where there are hardly any other resources.  I am not sure what the outcome would have been for this little one had they had no place to go, or had they walked four hours through the bush to the other nearest clinic.  Thank you to all of you who have helped create and sustain the clinic…you helped save a baby’s life.

We will not be returning to Karero during the remainder of our time here.  We will really miss living and working with the community.  I must mention that the use of alcohol in Karero has drastically reduced, if not disappeared.  Those women really made a difference when they protested last month!  All the stores have stopped selling alcohol.  We got to spend a lot of quality time with the ladies at the clinic as well as several members of the community.  We hope we can return there again to continue to work with the community….perhaps next year to build some housing for the ladies at the clinic???  Although, the Maasai women have informed me that I should have at least two babies by now so maybe that will have to come first!  We cannot express our gratitude towards Ester, Faith, and Joyce, as well as towards the entire community for welcoming and taking care of us while we were in Karero.  We cannot begin to articulate all that we have and continue to learn.  This last trip to Karero allowed us to go deeper into the community, and I believe it is a testament to time…time spent sharing, sitting, drinking chai, and lots of time spent laughing as we were trying to communicate in different languages.   It has been the exchange of stories that, I believe, will generate the most change. Perhaps we have all gained a little more global perspective, become a little more patient with that which we initially don’t understand, and gained a little more stillness with that which feels so uncomfortable.  This is my hope.

Now, back to Kimana!  We have only about 1 month left of our journey.   I have almost completely lost track of time, so it seems bazaar to make note of that timeframe. The money has arrived for more renovations and the building of the girls’ dormitory at Oloile!  We are going to be busy organizing, building, and teaching.  Thank you again to all of you for making this journey possible.  Peace to you all!

Reflection

Back at Tizi camp, this is likely our last trip to Mal Tisa and Karero.  This has been our little home away from home.  We spent the night discussing various strengths and challenges in Kenya.  That is to say, we have been wrestling with and talking about our experience of what we understand to be strengths and challenges.  I say this with great humility as a mzungu who has only been in Kenya for 2 months.  I remember struggling with something similar in JVC…struggling with owning and reflecting upon my understanding of my lived experience. I was working in an AIDS hospice, which was very difficult at times.  For months upon end I refused to acknowledge my own sadness and grief because I did not think I was “worthy” for such feelings. After all, who was I to be sad or to grieve when the real suffering was occurring in the lives around me.  Well, time (and many months of therapy) revealed to me the absurdity of this egotistical way of thinking and I finally embraced my own experience of the life I was living.  As I finally came to realize, who was I not to be sad or to grieve?

That being explained (again to myself) I now embrace my understanding of my lived experience in Kenya.  It is hard.  Life is hard here.   There is development happening all around, but a bit of chaos throughout as various organizations work at different paces with many projects left unfinished. Most days are spent waiting, mixed with moments of hard work.  There are so many uncontrollable factors and the idea of a plan is laughable.  Poor roads, lack of supplies, unpredictable weather conditions, and, unfortunately, unreliability influence every project.  One thing holds true, the women work so hard.  They cook, clean, farm, chop wood, sew, make jewelry, and raise the children.  I struggle with the treatment of women, particularly in rural Kenya (as we have not spent much time in Nairobi so am unable to speak to urban gender roles). I can get behind clear role separation, but it is difficult to accept the lack of conversation about the role definitions.  Many of the women have no voice.  They have no options if the man drinks away the money or sleeps with other women.  There is no recourse.  I struggle with the tension between that which I can accept as “cultural” and that, which, in my opinion, is simply wrong.  I see hope in the younger generations and I believe the key is education.  I have started to teach health classes at Oloile Secondary School.   I am teaching these young adults about health, reproduction, contraception and disease.  We have started a health club, with the hope of empowering young men and women to become health consultants within their own families and communities.  My next step is to work with the young women to create a women’s group.  I would love to share discussion around individual and communal esteem so that women feel confident and entitled to stand up for their rights. I know there are exceptions to the rule, but I have seen only few of these exceptions.  Young females are at a disadvantage in society due to their gender as well as their age.  The youth grow up in a hierarchical system in which corporal punishment is liberally utilized…and without explanation. I often wonder if these kids and young adults know and understand why they are being beaten.  Do they really learn a lesson?  Do they learn not to be late because it is irresponsible and a reflection of character, or do they learn to be punctual so they are not beaten?  I think the latter.

And so are some of the challenges.  In the midst of the challenges, we are repeatedly overwhelmed with the hospitality and generosity of the people.  As I have mentioned many times before, there is bold spirit among the people.  Their resiliency and perseverance in the face of corruption and poverty continues to humble me.  It is beyond words. I always hate to generalize.  For every generalization, there are many contradictions.  But, I embrace my understanding at this time with an open invitation to learn and to grow in my insights. 

We are off to Karero now, going to check on the clinic and do a bit of work.  We are looking forward to visiting with the community and, of course, falling asleep to the sounds of hyenas.  My fear of hyenas has diminished a bit now that I have had my first black mamba sighting!  It occurred last week in Kimana and I am trying very hard to forget that snakes exist in Africa.  I think the Poisonwood Bible scarred me for life!  Anyway, we are off to the bush.  Hope to write again soon.

More pictures

Karero clinic before

Karero clinic consultation room before

Karero clinic after some cleaning, scraping, and painting

Consultation room after

Ahh, Mombasa

Dinner in Mombasa

Tyson's beautiful family - Tyson, Mama Nasieku,
(girls from left to right) Rachel, Siente, Nasieku

The rains have come

     Another silencing rain, the first in Kimana since we have been here. It smells of freshness. If renewal had a scent, this would be it.  Mombasa was breathtaking. The Indian ocean is clear turquoise and salty.  We sat for hours reading and talking, sipping drinks and enjoying fresh fruit by the water.  It was certainly a different experience of Kenya, one we were happy (and very privileged) to enjoy. We were both grateful, however, that the beach was not our only experience of Kenya.  We are now back to our home in Kimana, enjoying the comfort of family.
      It is like a summer vacation that is rained out and the whole family (or town) is stuck inside one room.  Everything stops as the dusty roads flood and huge drops fall continuously.  We made it to town before the rains, and now it simply pours.  We sit in the “Paradise Hotel” with about 20 other people, sitting in the dark with flies all around.  The hotel is a one-room restaurant with a balcony.  The door leading outside is open and a thin white sheet separates us from the water and the light that makes its way inside.  You can feel the warm humidity all around and just have to surrender to the stickiness that pervades every inch of your body.  Painted portraits, mirrors, posters decorate the wall.  The images range from country cottages, city streets, a white baby in a cup of lettuce (in the style of Ann Geddes, unfortunately!), and a life-size poster of a white Jesus proclaiming the way, the truth, and the life.  There is no rhyme or reason to the arrangement. In fact, I wonder if there was an effort made to make it as disorderly and freestyle as possible.   There is the smell of grease, fried meat, and dust.  Several anonymous voices fill the room with constant conversation. I can hear the Maasai.  There sentences always sound like songs, continuous without pauses.  Mothers yell instructions to the little ones and I can hear little feet dragging across the room.  It is perfect.  There is energy all around.

Sitting in this hotel, I cannot help but think about how this little room is a microcosm of our experiences in Kenya.  The surroundings are often a bit disorderly and, occasionally, a bit unattractive in appearance.  But, the insides are full of spirit.  There is life in the midst of what may appear from a distance as lifeless.  There is bold spirit and relationship as thick as the humidity that permeates our surroundings.  We often find ourselves contemplating the slow change of pace in Kenya.  The rains make me realize that business life may operate slowly, but there is never a shortage or "slowness" of spirit.  There are always conversations to be shared and, of course, hot chai to drink.  Faces often stare at us blankly, but with curiousity.  The moment you say “jambo” or “habari” the stares soften into smiles and, almost, an awakening as if he or she did not realize they were in the midst of an intense gaze, and they respond with a sweetness that appears genuine and happy to make the aquantaince of someone new.  We are humbled and grateful to be surrounded by such a welcoming majority.
The reality is that I have had to rely on all my senses to understand this community and, when it comes down to it, I will only be able to access the surface this time.  I wish I knew the language better and I finally I have a little glimpse into what it would be like to be a minority who cannot communicate. We are so lucky so many people here speak English, but it would be great to be able to converse in the native language...ah, little by little we learn.

Back in Kimana

We made it back to Kimana safely and have enjoyed being back with Tyson's family.  It was like coming home.  We are grateful to have such a wonderful family welcoming us into their home and taking care of us.  Our work in Kimana varies daily.  We have been eager to complete some projects at Oloile secondary school, but we have had some setbacks or delays as we wait for additional funding for the projects that need to be completed.  It has been a long waiting process, but we are assured the funding is finally available and that Mike should be able to dive into the projects by next week.  The school is absolutely beautiful, but needs a bit more work in terms of repairs as well as new buildings.  I have been working at the Kimana clinic.  I have been able to spend some time working in the maternal/child/family planning clinic assessing expectant mothers, providing birth control, weighing babies, and doing HIV testing. In addition to working at the clinic, I have been preparing to do some health teachings at the school. I will be teaching health classes two days a week, mainly focusing on reproductive health, disease, and pregnancy.   I am eager to get into the classroom.  The teachers are happy to have a foreigner come and teach about reproductive health, especially some of the more conservative teachers.  One teacher explained that much of the reproductive health material is still very taboo and he personally prefers not to discuss these subjects.  This frightens me a little…but is not suprising. The same is true in much of America. 

We have decided to take a little time away to explore another part of Kenya, and to do a little processing away from the daily work.  We are headed to Mombasa tomorrow.  It is a bit last minute, but we thought this would be optimal time as we wait to start the work at the school.  It is hard to believe we have already been here for nearly 8 weeks!  We are eager to see another part of Kenya.  Of course mike is very excited to get into the water. I will write more soon.  Some sort of ant just crawled into my computer...we will see how this one plays out:)

Much love to all of you!

A women's revolt

We made it back to Karero with the paint earlier this week (slightly different color again, but what can you do!). We returned to Karero to find a bit of an uproar among the women.  They finally united and took a stand against the men of the community.  As in many places of the world, alcoholism is a problem among the Maasai community in Karero.  The men purchase various types of alcohol from the local shops, including a somewhat lethal homemade mixture. They have been squandering their money on alcohol rather than spending it on food for the family.   So, the women all decided to walk out of their bomas together to leave the men to care for the children and animals.  They gathered at the local shops that sells the alcohol, surrounding them and forcing them to close.  They threatened to throw away all the alcohol. They came together in the night singing, praying, and yelling; calling women out of their bomas to join their struggle.  They spent the night together and sang into the morning.  We woke around 5am to songs in the distance.  What an amazing experience to witness!  I am so proud of these women. They were ultimately victorious, forcing at least one of the shops to pour out all its alcohol and promise not to sell in the future.  The women celebrated by slaughtering a goat for themselves. They found a common voice and made a positive change in the community.  Unfortunately, we returned to the shop a few days later and they were still selling alcohol. We hope the women will continue to stand against such ridiculous behavior and, hopefully, things will change little by little.

We completed the painting at the clinic. It looks so much brighter.  We left Karero yesterday.  We will return in a few weeks to check on things and do a few more repairs.  We spent last night at Tizi camp (the place we normally stay near Mali Tisa after we leave Karero before heading back to Kimana). I had a couple of adventures with some large cockroaches last night and this morning.  Unfortunately, Mike had to both fall asleep and wake to my screaming.  Last night, I lost my battle trying to catch a cockroach.  It fell down beside my feet and sent me running around the room a bit.  Then, I woke this morning to observe a large cockroach inside my mosquito net crawling right above my feet.  I screamed and jumped to Mike's bed.  Mike continues to remind me of these events and it is only 9am!  What can I say, it is not that I am afraid of the critters, but cockroaches are just gross little creatures.  I don't like them crawling on or near me.  I suppose it is better than snakes or hyenas...not sure, the jury is still out.

Last, but not least, it is important to mention that Mike spotted a local man wearing a Seahawks hat yesterday in Namanga.  Seattle sports are being well represented in Africa.  Let's hope for a better Seahawks performance this weekend.  Go Huskies!

Another week in Karero

It has been a busy week and I cannot believe it is already October! We are almost done painting the clinic, but we ran out of paint for the floor.  We actually bought the shop out of paint last time we were in Tanzania, but hopefully they will get more today.  We are headed back to Namanga and Tanzania today to stock up and then, hopefully, finish our project and head back to Kimana.  

It was a pretty eventful week in Karero.   The week started with an amazing rainstorm on Monday night.  It was a typical hot and windy afternoon when rain clouds suddenly blew in overhead.  Within minutes, the entire place was covered in water.  It reminded me of thunder showers in Houston where it would transition from sun to a rainy flash flood in a matter of moments.  The rain was so loud and forceful... silencing really.

A man appeared at the clinic during the storm.  A woman from his boma miles away had been laboring all day and was having pains.  Unfortunately, she could not get to the clinic by that time and we could not get to her due to the rains and the flooding.  We set out to her boma early the next morning.  Faith, Joyce, and I entered into the small dung and mud house where the woman had given birth.  She had successfully given birth to a beautiful and healthy baby girl, but was still in quite a bit of pain.  Her uterus was still about 2 fingerbreadths above her umbilicus and was not contracting back to where it needed to be.  I examined the baby who looked wonderful and strong.  I cleaned her, tied the cord, and encouraged mom to breastfeed as much as possible. Joyce and I both examined mom.  Joyce gave her some oxytocin and we both massaged the uterus a bit.  By the time we left, the uterus had already started to descend.  We checked on her later that night and she was much improved, smiling, and feeling better. The baby was breastfeeding well.  We were incredibly happy and thankful that they both survived the experience and were recovering.  They asked us to give the baby an English name.  We named her  “Mary.”  I think the name holds great strength.  

I  have much to learn about this traditional Maasai community, but over the last few weeks I have come to believe that the women possess great strength and fortitude.   I am still processing the complexities and challenges of its structure and gender roles.  More on this as I find the words.  We feel extremely blessed to be immersed into this community so quickly.  Working with Staff of Hope and Tyson, in particular, has allowed us to dive in and begin building relationships with the traditional Maasai community in Karero as well as the larger and more diverse communities in Kimana.  We are grateful to be able to work alongside members of the community, but also just to share in the daily flow and struggles.

More later. Must go now on the search for paint.  We miss you all and hope you are enjoying the fall.