Once a week the COs visit any FACES patients who have been hospitalized, and I’ve now been to the provincial hospital (aka “Russia” because it was built by the Russians) twice with them. I’ve talked with other residents who have rotated in Africa, and was expecting the crowded, open wards often with 2 patients to a bed, someone with active TB coughing on their neighbor with advanced HIV. I wasn’t surprised by the family members at the bedside who provide much of the nursing care, making sure the patient gets food and is able to get up to the bathroom. It’s hard to see, but I was expecting it. What I wasn’t expecting was the degree of anonymity that patients experience there.
In the US, medical teams are structured to have a group of 3-5 residents, interns and medical students following up to around 20 patients. They are supervised by an attending physician who is responsible for overseeing the care of these 20 patients. We tell med students that their goal on the rotation is to be the experts on their patients – to know more about her patient and her medical history than anyone else on the team. As a senior resident is can be disconcerting how little time you actually spend with the patients – your day is spent thinking about them and teaching the rest of the team about them, carrying out tasks in order to provide them with good care and help them get well – but you often miss the intense experience that you had as an intern and medical student of getting to know your patients as individuals (not that it never happens anymore, just less than before).
When we arrive on the ward at Russia, usually there are no medical staff there. We search out the nurses or the interns and ask them about the patients on our list. Frequently they have no idea who we are talking about, with some prompting about the circumstances of the hospitalization and some chart review they can give us a few details. Then we go into the ward to find the patients, and we often have to yell out their names to find them, because again, no one is exactly sure who they are. The information about the patient’s course is often confusing and obtained piecemeal – we check whatever med might be hanging when we get there and surmise he is being treated for malaria. We ask the patient if she’s had a transfusion yet – the reason for her referral 2 days before was a hgb of 5 (severe anemia). The answer is no.
Often the clinical officers haven’t met the patient before, and they get a bit of background from notes taken during the clinical meeting where very brief case presentations are given (so and so referred for admission for PCP). Because I don’t speak Swahili, I also don’t get all the info they glean during the brief conversations with the hospital staff and when we leave I am left with many, many questions. Why is the patient in the hospital at all if they’re not being treated for TB or getting IV antibiotics? What’s the working diagnosis at this point? What more will be done before the patient is discharged? Who really is following up on the patient and making management decisions, if the intern assigned to the ward doesn’t have the answers?
One of the Medical Officers at FACES was telling me that during his internship at times he was expected to cover up to 80 patients with only one other intern (and as an intern I’d feel sorry for myself when our service was busy and I had 8 patients!). It’s not unexpected then, that no one can take the time to get to know these people, to learn their stories or get a glimpse of their lives aside from being sick. I just wish there was some way that when we were there we could make the patient feel like someone actually knew them and was aware of what was actually going on, to make the experience of being in the hospital just a little more personal. And maybe we do – at least we come, we know their name if not their face, we ask what’s going on and how they’re feeling. We bring them their medicines and tell them to come to the clinic once they get out, we'll do what we can to help them out.
Tuesday, October 30, 2007
Expat Life
The neighborhood where I live here in Kisumu is called Milimani, which I am told means up on a hill in Swahili. I live on the edge of the district, but as you venture further in you see it is a neighborhood of huge, ornate mansions and gated compounds complete with 24hr guards. The people who live here are Kenyan Indians, who are often local business and hotel owners, and Europeans and Americans many of whom work for NGOs, aid organizations or various foreign government affiliated enterprises. Very few Kenyans live here; there is no pretense that this is a “mixed” neighborhood, with wealthy African families scattered amongst these non-Africans who clearly have the deepest pockets in town.
It’s an odd experience being here for 5 short weeks; you want to set up a life for yourself because really, who wants to sit alone at night watching the bad Mexican telenovelas translated into English that pass as prime time TV in Kenya? But on the other, with such a short time you can’t really begin to understand the social and cultural context in which you find yourself. The expat community is used to transients who come and go, and as a foreigner in a new place it can be easy to slip into a social scene that is welcoming and easy, but remarkable for lack of actual Kenyans.
Many expats live a life here that is luxurious to a degree that most couldn’t imagine living in their home countries. Servants, guards at the gate, cars with drivers – who could live like that at home? And yet the salaries that many expats earn here can support that lifestyle. The ironic part, to me, is that there are a lot of these expats who live in these fancy places, who have the means to go out for a fancy dinner then out to party every night of the week if they want to, are here in affiliation with some kind of foreign aid organization or governmental entity. How does it happen that people come here with good-hearted aims of helping people and improving people’s lives and yet away from work they live this life that would be out of the question if they weren’t in a developing country? Now, this is not to say that everyone who is here working in an aid capacity lives this double life, far from it. It just strikes me as so odd that this scene exists as it does at all. I guess it's normal when you're away from home to crave the familiar and to try to re-create elements of your life at home, but sometimes parts of that life are so strikingly different from where you are that it feels weird to try to make them happen.
It’s an odd experience being here for 5 short weeks; you want to set up a life for yourself because really, who wants to sit alone at night watching the bad Mexican telenovelas translated into English that pass as prime time TV in Kenya? But on the other, with such a short time you can’t really begin to understand the social and cultural context in which you find yourself. The expat community is used to transients who come and go, and as a foreigner in a new place it can be easy to slip into a social scene that is welcoming and easy, but remarkable for lack of actual Kenyans.
Many expats live a life here that is luxurious to a degree that most couldn’t imagine living in their home countries. Servants, guards at the gate, cars with drivers – who could live like that at home? And yet the salaries that many expats earn here can support that lifestyle. The ironic part, to me, is that there are a lot of these expats who live in these fancy places, who have the means to go out for a fancy dinner then out to party every night of the week if they want to, are here in affiliation with some kind of foreign aid organization or governmental entity. How does it happen that people come here with good-hearted aims of helping people and improving people’s lives and yet away from work they live this life that would be out of the question if they weren’t in a developing country? Now, this is not to say that everyone who is here working in an aid capacity lives this double life, far from it. It just strikes me as so odd that this scene exists as it does at all. I guess it's normal when you're away from home to crave the familiar and to try to re-create elements of your life at home, but sometimes parts of that life are so strikingly different from where you are that it feels weird to try to make them happen.
Monday, October 29, 2007
Oranges and Bananas
Election season is here in Kenya, and the scene is really heating up. The presidential elections come around every 5 years, and in recent past have been really contentious, at times violent. In its 40+ year history of independent governance, there have only been 3 Kenyan presidents: Kenyatta, Moi and the current one, Kibaki. For every election, each party with a major candidate chooses a party symbol that is listed on the ballot, I’m assuming to assist those voters who can’t read. 5 years ago it was the oranges vs the bananas in a fight for the finish, and the bananas won. Now the oranges feel it’s their turn.
Politics in Kenya is passionate; much of the fervor with which candidates are followed stems from tribal affiliation. There are about 40 tribes in Kenya, but of the 3 presidents, 2 have been from the same Central Kenyan tribe (Kikuyu) and the other from the Kalenjin (also from Central Kenya). Kisumu is a very Luo town, and this year there is so much hope and excitement for one of the candidates – Raila Odinga – a Luo. The Luo are the second largest tribe in Kenya (though I’ve seen some sources say third largest), but there is a strong feeling of alienation from the political machine. Many complain that after independence, the government was set up in a way to favor certain tribes like the Kikuyu, while disenfranchising others like the Luo. Of course, I heard all this from the Luo perspective, so it’d be interesting to hear how the Central Kenyans describe the whole situation.
In any case, Raila is the candidate from ODM, the Orange Democratic Movement. Not really sure what the orange part means, whether it came before or after the ballot symbol, but it gives a good excuse for people to dress in their Halloween best. People here have so much hope that he’s not like the other politicians, that he won’t stand for the corruption and graft that have tainted the government in recent years. To hear them tell it, Raila can do no wrong and will be able to swoop in and make all this better. Of course, as former Minister of Roads, and having recently travelled on some pretty bad ones, I have some doubts about his potential for overall efficacy. And really no one could live up to all the high hopes being built around here.
The political debate is starting to sizzle, with the 3 candidates variously accusing one another of extreme corruption. The first lady, Mrs. Kibaki, has given many mudslinging speeches calling the competition criminal and corrupt and all around bad guys. Interestingly, though, many regular Kenyans say the same about her husband’s government. Many people feel really frustrated with Kibaki because one of his early campaign promises last time around was that he would serve one term and then step away. And yet here we are, he is running again. Another big issue is that the Kenyan constitution has not been changed or updated since independence, and power is densely concentrated with the president, rights of women aren’t well address, and all around people want to make some changes. Kibaki promised in his last campaign that there would be a new constitution within something like 100 days, and yet only recently he refused to sign a newly drafted constitution. Talk about power… So the Luo around here aren’t happy with him for many, many reasons. But Nakuru where we just spent the weekend is a Kibaki town. Our cab driver told us what a great leader he is, how he’s done so much for the country, etc. Having only heard about politics from the Kisumu Luo perspective, I had to bite my tongue to keep from arguing this guys merits, or lack thereof.
In Nakuru there were lots of billboards encouraging people to use their vote (selling of votes has been a big problem in the past). The most interesting one was a billboard telling people to vote by the issues, not by their tribe. It’s great that that sentiment is put out there, though clearly tribal alliances are a huge factor. In Kenya, the Luo are one of the only tribes who do not circumcise their men or their women. Most other tribes have some sort of puberty/initiation ritual that involves circumcision for men, though female genital mutilation is being pressured out on many fronts, though it still exists. Tribal politics are such that people will actually debate whether an uncircumcised man is fit to be president. Crazy. Some have said this is the most contentious campaign ever, and they’re anticipating things will get a lot worse before the December 27th election.
An interesting corollary to all that political chatter is the Barak Obama bit. Barak’s father was Luo, from near Kisumu. So you can imagine how people around here feel about him. When talking politics, the second thing out of people’s mouths (after talking about how Raila will save Kenya) is, “so, do you thing Barak has a chance? Are you for Barak??” His autobiography is sold in the supermarket under African authors, people wear Barak tee-shirts, he is truly a homeland hero. He even came and was publicly HIV tested at the public hospital in Kisumu to encourage Kenyans to be tested and to learn their status. I guess the cult of personality is big in politics everywhere, but in Kenya it definitely dominates which unfortunately all too often ends in crushing disappointment, since these are only regular guys subject to the same pressures and temptations as everyone else.
Politics in Kenya is passionate; much of the fervor with which candidates are followed stems from tribal affiliation. There are about 40 tribes in Kenya, but of the 3 presidents, 2 have been from the same Central Kenyan tribe (Kikuyu) and the other from the Kalenjin (also from Central Kenya). Kisumu is a very Luo town, and this year there is so much hope and excitement for one of the candidates – Raila Odinga – a Luo. The Luo are the second largest tribe in Kenya (though I’ve seen some sources say third largest), but there is a strong feeling of alienation from the political machine. Many complain that after independence, the government was set up in a way to favor certain tribes like the Kikuyu, while disenfranchising others like the Luo. Of course, I heard all this from the Luo perspective, so it’d be interesting to hear how the Central Kenyans describe the whole situation.
In any case, Raila is the candidate from ODM, the Orange Democratic Movement. Not really sure what the orange part means, whether it came before or after the ballot symbol, but it gives a good excuse for people to dress in their Halloween best. People here have so much hope that he’s not like the other politicians, that he won’t stand for the corruption and graft that have tainted the government in recent years. To hear them tell it, Raila can do no wrong and will be able to swoop in and make all this better. Of course, as former Minister of Roads, and having recently travelled on some pretty bad ones, I have some doubts about his potential for overall efficacy. And really no one could live up to all the high hopes being built around here.
The political debate is starting to sizzle, with the 3 candidates variously accusing one another of extreme corruption. The first lady, Mrs. Kibaki, has given many mudslinging speeches calling the competition criminal and corrupt and all around bad guys. Interestingly, though, many regular Kenyans say the same about her husband’s government. Many people feel really frustrated with Kibaki because one of his early campaign promises last time around was that he would serve one term and then step away. And yet here we are, he is running again. Another big issue is that the Kenyan constitution has not been changed or updated since independence, and power is densely concentrated with the president, rights of women aren’t well address, and all around people want to make some changes. Kibaki promised in his last campaign that there would be a new constitution within something like 100 days, and yet only recently he refused to sign a newly drafted constitution. Talk about power… So the Luo around here aren’t happy with him for many, many reasons. But Nakuru where we just spent the weekend is a Kibaki town. Our cab driver told us what a great leader he is, how he’s done so much for the country, etc. Having only heard about politics from the Kisumu Luo perspective, I had to bite my tongue to keep from arguing this guys merits, or lack thereof.
In Nakuru there were lots of billboards encouraging people to use their vote (selling of votes has been a big problem in the past). The most interesting one was a billboard telling people to vote by the issues, not by their tribe. It’s great that that sentiment is put out there, though clearly tribal alliances are a huge factor. In Kenya, the Luo are one of the only tribes who do not circumcise their men or their women. Most other tribes have some sort of puberty/initiation ritual that involves circumcision for men, though female genital mutilation is being pressured out on many fronts, though it still exists. Tribal politics are such that people will actually debate whether an uncircumcised man is fit to be president. Crazy. Some have said this is the most contentious campaign ever, and they’re anticipating things will get a lot worse before the December 27th election.
An interesting corollary to all that political chatter is the Barak Obama bit. Barak’s father was Luo, from near Kisumu. So you can imagine how people around here feel about him. When talking politics, the second thing out of people’s mouths (after talking about how Raila will save Kenya) is, “so, do you thing Barak has a chance? Are you for Barak??” His autobiography is sold in the supermarket under African authors, people wear Barak tee-shirts, he is truly a homeland hero. He even came and was publicly HIV tested at the public hospital in Kisumu to encourage Kenyans to be tested and to learn their status. I guess the cult of personality is big in politics everywhere, but in Kenya it definitely dominates which unfortunately all too often ends in crushing disappointment, since these are only regular guys subject to the same pressures and temptations as everyone else.
Lake Nakuru & Menengai Crater
It’s been a while since I’ve written; I got very caught up in preparing my massive HIV dermatology presentation for FACES Continuing Medical Education. It went pretty well, I think, despite several potentially disastrous AV glitches, and despite learning at the 11th hour that my presentation would be given not only to clinical staff, but to all FACES employees, including the data analysts and front office staff. I found the whole idea of me giving a derm talk kind of ironic, since I feel like at home I see a rash in clinic and always think, “hmm, a rash, whatever could that be?” Now I’m getting called in to look at skin several times a day, and I find myself saying “oh, yes, most likely psoriasis…” Hard not to feel a bit like a big fake, but oh well…
In any case, this past weekend I went on a fantastic trip to Lake Nakuru National park with 4 others – Megan, Jolene & Jolene’s non-medical friends Marieline and John Michael. Nakuru is Kenya’s 4th largest city, and is about 4hrs east of here, in the central Rift Valley. Getting there was quite the bone-shaking adventure – the Nakuru road is absolutely horrendous, 4 straight hours of potholes and ruts and other road quality nightmares. And this is the road that leads from Kisumu to Nairobi! Kenyans complain bitterly about the state of their roads, and initially I thought it was one of those reflex complaints (like Americans and taxes), but no, Kenyan roads are really, really bad. I’ll say it again, really, really bad.
On Saturday we set out early for a game drive around Lake Nakuru National Park. Nakuru is quite a bit higher in elevation than Kisumu, and it was actually pretty cold. And it rained all day. But it was cool to see the phenomenal landscape in the mist, and I think the animals may have been out and about more than they would be on a typical scorcher. Nakuru is the only national park in Kenya surrounded by a fence, and that is to protect the rhino population that was reintroduced after poaching pretty much decimated the local rhinos. Now there are a bunch of black rhinos (which aren’t black at all, but have a pointy upper lip & eat bushes, and are notoriously shy) as well as quite a few white rhinos (surprise, surprise, not white either but are distinct from black rhinos because of their flat upper lip, good for munching on grass). The introduction scheme seems to have worked well because we saw white rhinos all over the place, including a really cute baby one (unusual to see said Tim, our guide, because supposedly rhinos only have one offspring in their entire 45 years of existence. Though I don’t really trust that since there’s really no way around extinction if you only replace half the population each generation).
In any case, this past weekend I went on a fantastic trip to Lake Nakuru National park with 4 others – Megan, Jolene & Jolene’s non-medical friends Marieline and John Michael. Nakuru is Kenya’s 4th largest city, and is about 4hrs east of here, in the central Rift Valley. Getting there was quite the bone-shaking adventure – the Nakuru road is absolutely horrendous, 4 straight hours of potholes and ruts and other road quality nightmares. And this is the road that leads from Kisumu to Nairobi! Kenyans complain bitterly about the state of their roads, and initially I thought it was one of those reflex complaints (like Americans and taxes), but no, Kenyan roads are really, really bad. I’ll say it again, really, really bad.
On Saturday we set out early for a game drive around Lake Nakuru National Park. Nakuru is quite a bit higher in elevation than Kisumu, and it was actually pretty cold. And it rained all day. But it was cool to see the phenomenal landscape in the mist, and I think the animals may have been out and about more than they would be on a typical scorcher. Nakuru is the only national park in Kenya surrounded by a fence, and that is to protect the rhino population that was reintroduced after poaching pretty much decimated the local rhinos. Now there are a bunch of black rhinos (which aren’t black at all, but have a pointy upper lip & eat bushes, and are notoriously shy) as well as quite a few white rhinos (surprise, surprise, not white either but are distinct from black rhinos because of their flat upper lip, good for munching on grass). The introduction scheme seems to have worked well because we saw white rhinos all over the place, including a really cute baby one (unusual to see said Tim, our guide, because supposedly rhinos only have one offspring in their entire 45 years of existence. Though I don’t really trust that since there’s really no way around extinction if you only replace half the population each generation).
Early on in the day we raced across the park - at Nakuru you can only drive on the roads, no off-roading allowed – in search of some lions. Before long we came across a gorgeous female up in a tree, looking bored & sleepy and only about 30 feet away from the road.
About 100ft back we could see a male eating some kind of carcass, which we could smell better than we could see it. After a bit the female hopped off her tree branch & strolled into the middle of the road right in front of us.
After some paw washing she moseyed away. Then her big male friend came to check out her tree, though he was a bit on the klutzy side hopping up. Soon a second male appeared from the bushes – we waited for some kind of angry man-lion showdown, but they seemed barely curious. The first guy got down on the ground, and the second approached and the 2 brushed heads like friendly cats sometimes will with one another. Of course I missed that photo opp. Eventually we moved on and came across the female now up in yet a different tree. It’s actually quite unusual for lions to climb trees I guess – Nakuru is the only place in Kenya with tree climbing lions, much to the leopard’s chagrin since they are usually safe from lions when up in the trees. We drove past her spot a couple times during the day, and she was always up there, snoozing away, occasionally watching a herd of gazelles not far off but looking very unmotivated to chase anything. The last time we passed we saw that the big male was now sitting about 50ft away from the base of her tree; she was playing hard to get, not really giving him much encouragement, but he eventually moved out into the open and flopped down on the ground like a kitten in a sunspot. Tim thought she was likely a young female in heat, and these 2 males were suitors vying for her attention. A bit unusual for a female to be travelling away from a group of other females, but maybe she was just setting out on her own. We watched a while, wondering if we’d see some lion action, then decided to leave them to their courtship in privacy (actually being closely watched by at least 5 vehicles at all times!)
Next we stopped to watch some funny warthogs, which really are called pumba for all you Lion King fans out there. I giggled a little every time I heard it. Off in the distance we saw a female zebra with 2 half-grown zebras nearby. We were about to move on when Tim said, “oh, yeah there’s her baby trying to stand up for the first time.” Not really sure how we missed her giving birth while we were gazing upon a bunch of warthogs 40 feet away, but we did. Looked through the binoculars and sure enough there was a damp, gangly little guy lying in a heap while mom chowed down on the grass (curiously she didn’t seem particularly concerned about this life she just produced. The little guy tried valiantly to struggle to his feet and eventually managed a wobbly, knock-kneed, wide-legged stance, then fell down when he tried to walk. After many attempts he finally got up and staggered around a bit, trying to figure out how to nurse but seemingly aiming at mom’s tail. Really amazing.
From there we checked out Nakuru’s famous flamingos – often up to hundreds of thousands of them at a time on the shores of the lake (it’s a saline lake and they eat the blue green algae there). I guess the flamingos aren’t as reliably at Nakuru as they used to be since the lake is becoming more polluted and the salinity changing rapidly from water runoff and unpredictable drainage. This day there were a ton, though, and looking down at the lake from several hundred feet up, it looked like part of the lake had a lovely pink sand beach.
The day was rounded off by seeing lots of baboons, who are creepily human and yet not so, so much that you start to feel weird the longer you look at them. Also gazelles and giraffes and buffalo, pelicans and crazy, prehistoric Marabou storks. The one big thing we missed was the leopard, but supposedly there are only 4 in the park and they are nocturnal and quite reclusive, and can be really hard to spot. It was a really nice, breathtaking day in such a lovely place.
The next day before getting several teeth rattled loose on the return matatu ride, we took a taxi up to Menengai Crater, supposedly the second largest land crater in the world. It was really awe-inspiring, so vast and green (which has surprised me a bit, Kenya is overall really green) and semi-deserted. We made it up there before all the curio sellers did, so we were able to take in the view without anyone else around. Such a cool weekend, I’m still just awe-struck by the fact that all these crazy animals are just wandering around, doing their thing. I mean, really, that’s a real live lion just chilling by the side of the road.
Tuesday, October 16, 2007
On the Road
I always like to think about people’s perceptions of personal space when I’m outside the US. At home, bumping into someone or touching them accidentally – even a friend – always prompts a reflexive “oh, sorry,” as if hitting someone’s foot was a personal violation. People give others a wide berth on the street, when sitting next to one another great care is taken that no one is touching if it can be avoided. These personal boundaries are always so different in other places.
Here in Kenya, space boundaries are almost non-existent. Walking down a busy street, oncoming bodies will slam into you as they pass, no swerving, no flinching – it’s like a giant game of chicken all the time. Here there is no “oh, please, after you” when 2 people arrive at a door; when I’ve automatically stepped aside to let others pass, I’ve found myself standing there forever, waiting to merge into oncoming foot traffic. The other day I was in the supermarket looking at a display at the end of an aisle, and one of the supermarket employees ran right into me with a cart full of flour despite my trying to flatten myself against the shelves. I even saw it coming, but imagined he’d at least try to swerve. I’m starting to get used to it when I walk around town, anticipating the body blows and tight squeezes.
When we drove to Lake Baringo this weekend, I got many hours of terrifying firsthand experience with how the Kenyan sense of personal space plays out on the road. Michael, the lovely man who drove us there is sweet and considerate as can be. But behind the wheel he sped along a knife edge between pedestrians, bicyclists, farm animals and their grisly demise.
Now, Kenyan roads can be really dreadful – potholed and dusty, extremely crowded with cars and matatus belching black smoke, a cacophony of buses, motorcycles, bicycles and people. I started to get a little nervous when, on the road out of Kisumu he “honk-honk-honked” at a pedestrian walking by the side of the road, causing him to scramble frantically out of the way. Our car never deviated from the chosen path. Even when we were barreling down the shoulder, on the wrong side of the road, after dark with a precipice/sewer/thick undergrowth merely 2 inches away he would press on – honking at any pedestrian or bicyclist we encountered, expecting them to leap out of the way if they valued their lives. One slow reflex or misjudged scramble could have resulted in a very messy tragedy.
I white-knuckled along in the passenger seat, closing my eyes and preparing for the worst whenever things looked really bad. Several times both on the way there and back as we drove after dark we encountered cars pulled over – apparently broken down on the side of the road – with guys trying to flag down traffic. Michael would stomp on the accelerator, telling us that this could be a scam; we stop, they rob. I started to feel a little worried. Then, only about 50km out of Kisumu with home almost in sight we rounded a turn in the dark to see 3 or 4 young men standing on the edge of the road. As we approached, one of them stepped further out into the street – it seemed as though if we didn’t swerve he would definitely be flattened. Michael hit the gas and swerved… TOWARDS them!!! I closed my eyes and held on and imagined being hauled away for my involvement in the mangling of a Kenyan citizen. Somehow (I don’t know how because my eyes were squeezed tight shut) disaster was averted. “There should be police patrolling this road after dark!!” Michael railed, “those thugs, they were trying to force us to stop and rob us. That’s what we do to teach them a lesson, we swerve towards them.” So much for personal space.
We made it home in one piece, sweaty, gritty and dusty from the road. All I could think about was a hot shower and bed. Got home, flipped the switch that turns on the water heater located in the shower head, and it exploded with a burst of sparks and angry pops and blew a fuse. After all that, even a frosty shower really hit the spot.
Here in Kenya, space boundaries are almost non-existent. Walking down a busy street, oncoming bodies will slam into you as they pass, no swerving, no flinching – it’s like a giant game of chicken all the time. Here there is no “oh, please, after you” when 2 people arrive at a door; when I’ve automatically stepped aside to let others pass, I’ve found myself standing there forever, waiting to merge into oncoming foot traffic. The other day I was in the supermarket looking at a display at the end of an aisle, and one of the supermarket employees ran right into me with a cart full of flour despite my trying to flatten myself against the shelves. I even saw it coming, but imagined he’d at least try to swerve. I’m starting to get used to it when I walk around town, anticipating the body blows and tight squeezes.
When we drove to Lake Baringo this weekend, I got many hours of terrifying firsthand experience with how the Kenyan sense of personal space plays out on the road. Michael, the lovely man who drove us there is sweet and considerate as can be. But behind the wheel he sped along a knife edge between pedestrians, bicyclists, farm animals and their grisly demise.
Now, Kenyan roads can be really dreadful – potholed and dusty, extremely crowded with cars and matatus belching black smoke, a cacophony of buses, motorcycles, bicycles and people. I started to get a little nervous when, on the road out of Kisumu he “honk-honk-honked” at a pedestrian walking by the side of the road, causing him to scramble frantically out of the way. Our car never deviated from the chosen path. Even when we were barreling down the shoulder, on the wrong side of the road, after dark with a precipice/sewer/thick undergrowth merely 2 inches away he would press on – honking at any pedestrian or bicyclist we encountered, expecting them to leap out of the way if they valued their lives. One slow reflex or misjudged scramble could have resulted in a very messy tragedy.
I white-knuckled along in the passenger seat, closing my eyes and preparing for the worst whenever things looked really bad. Several times both on the way there and back as we drove after dark we encountered cars pulled over – apparently broken down on the side of the road – with guys trying to flag down traffic. Michael would stomp on the accelerator, telling us that this could be a scam; we stop, they rob. I started to feel a little worried. Then, only about 50km out of Kisumu with home almost in sight we rounded a turn in the dark to see 3 or 4 young men standing on the edge of the road. As we approached, one of them stepped further out into the street – it seemed as though if we didn’t swerve he would definitely be flattened. Michael hit the gas and swerved… TOWARDS them!!! I closed my eyes and held on and imagined being hauled away for my involvement in the mangling of a Kenyan citizen. Somehow (I don’t know how because my eyes were squeezed tight shut) disaster was averted. “There should be police patrolling this road after dark!!” Michael railed, “those thugs, they were trying to force us to stop and rob us. That’s what we do to teach them a lesson, we swerve towards them.” So much for personal space.
We made it home in one piece, sweaty, gritty and dusty from the road. All I could think about was a hot shower and bed. Got home, flipped the switch that turns on the water heater located in the shower head, and it exploded with a burst of sparks and angry pops and blew a fuse. After all that, even a frosty shower really hit the spot.
Lake Baringo & Lake Bogoria - Hippos at last!!
Last weekend Megan and I decided to travel to 2 rarely visited lakes in the northern Rift Valley. Since they’re off the beaten track, getting there by public transit would have been quite the production and we decided to splurge and rent a car from one of our co-workers at FACES. We had a brief moment of delirium and considered driving ourselves but then came to our senses and were able to arrange for Michael, who works for KEMRI as a driver and mechanic, to accompany us and drive. After some unexpected last minute rental price re-negotiations we were on our way. We left a lot later than planned, and finished the last 2 hours of the 5 ½ hr drive in the dark. The descent into the Rift Valley is supposed to be spectacular; as we barreled along down windy roads in the pitch black I could imagine the scenery that was unfolding before us in the dark.
We arrived safely and checked into Roberts Camp – a campsite next to Lake Baringo popular with European camping safari groups; we stayed in a nice little banda. Two of Lake Baringo’s main attractions are the groups of hippos and Nile crocodiles that live there. I couldn’t wait. In fact, at Roberts Camp there are signs up telling people not to pitch their tents too close to the shore and to avoid leaving their tents after dark unless absolutely necessary because the hippos come out at night to graze and they’re really not very friendly.
The next morning we went on a boat trip for a couple hours around the lake. Despite having grown up on Lake Victoria, the grandson of a fisherman, this was Michael’s first boat trip (he had a traumatic childhood water experience). He was initially excited, then started to freak out and reconsider the sanity of our plan. We were finally able to talk him into coming along by showing him how to make that orange life jacket nice and snug. The Lake is beautiful, one of only 2 freshwater lakes in the Rift Valley; there are tons of birds everywhere, most unlike any I’ve seen before. I really need to get an African bird book – continue on my rapid course to early geriatric-hood.
Then, right off the shore at Roberts Camp we found a family group of hippos poking their eyes up above the water and eyeing us suspiciously. The huge male kept making angry snort-grunt-splashing noises, clearly displeased at our existence. Off in the shade there was one hippo by herself; we thought she might be sick, but then Megan’s OB-dar went off and we realized she was likely giving birth. Later that evening we walked past her from the shore and saw a teeny little hippo head right next to her.
We spent the afternoon lounging by the pool at the hotel next door, and had a nice dinner with Michael. Megan and I got up early the next morning and went on a cool hike up and over some of the cliffs nearby. From there we set out to Lake Bogoria, about an hour south.
Lake Bogoria is a saline lake with scorching geysers at the water’s edge; it’s known for its flamingos. The lake is surrounded by a national park, and pretty quickly we started seeing all those animals that you just can’t imagine actually live out in the wild. A couple of fat zebras were grazing at the water’s edge. We stopped to look at the flamingos and were about to get out of the car to take a closer look (you’re allowed to get out of the vehicle at Lake Bogoria) when we saw a cranky looking ostrich. We drove on a bit and stopped to get out. The flamingos saw us coming pretty much as soon as we opened the car door; they nervously started flocking away as we took a couple steps towards them. This edginess is understandable when you know there aren’t a lot of fish in the lake because of its salinity, and the fisher eagles have adapted by developing a taste for flamingo. Luckily didn’t have to see any of that.
We looked at the geysers along with a bus full of high schoolers, then as we headed back we saw some dik diks, Thompson’s gazelles, a warthog family (!) and another ostrich. Very cool. All in all a really fun trip despite the years taken off my life by the crazy drive out there and back; and I finally got to see my hippos!
The next morning we went on a boat trip for a couple hours around the lake. Despite having grown up on Lake Victoria, the grandson of a fisherman, this was Michael’s first boat trip (he had a traumatic childhood water experience). He was initially excited, then started to freak out and reconsider the sanity of our plan. We were finally able to talk him into coming along by showing him how to make that orange life jacket nice and snug. The Lake is beautiful, one of only 2 freshwater lakes in the Rift Valley; there are tons of birds everywhere, most unlike any I’ve seen before. I really need to get an African bird book – continue on my rapid course to early geriatric-hood.
Then, right off the shore at Roberts Camp we found a family group of hippos poking their eyes up above the water and eyeing us suspiciously. The huge male kept making angry snort-grunt-splashing noises, clearly displeased at our existence. Off in the shade there was one hippo by herself; we thought she might be sick, but then Megan’s OB-dar went off and we realized she was likely giving birth. Later that evening we walked past her from the shore and saw a teeny little hippo head right next to her.
We spent the afternoon lounging by the pool at the hotel next door, and had a nice dinner with Michael. Megan and I got up early the next morning and went on a cool hike up and over some of the cliffs nearby. From there we set out to Lake Bogoria, about an hour south.
Lake Bogoria is a saline lake with scorching geysers at the water’s edge; it’s known for its flamingos. The lake is surrounded by a national park, and pretty quickly we started seeing all those animals that you just can’t imagine actually live out in the wild. A couple of fat zebras were grazing at the water’s edge. We stopped to look at the flamingos and were about to get out of the car to take a closer look (you’re allowed to get out of the vehicle at Lake Bogoria) when we saw a cranky looking ostrich. We drove on a bit and stopped to get out. The flamingos saw us coming pretty much as soon as we opened the car door; they nervously started flocking away as we took a couple steps towards them. This edginess is understandable when you know there aren’t a lot of fish in the lake because of its salinity, and the fisher eagles have adapted by developing a taste for flamingo. Luckily didn’t have to see any of that.
We looked at the geysers along with a bus full of high schoolers, then as we headed back we saw some dik diks, Thompson’s gazelles, a warthog family (!) and another ostrich. Very cool. All in all a really fun trip despite the years taken off my life by the crazy drive out there and back; and I finally got to see my hippos!
Wednesday, October 10, 2007
Happy Moi Day!
(I'm having internet issues, so I'll post more pictures later)
Today, October 10, was Moi day – a holiday in honor of Daniel Arap Moi, Kenya’s second president who was in power from 1978-2002. Kind of oddly, Moi is still alive so on the news this evening there were lots of shots of him at various events celebrating…him (walking around carrying what looked like a scepter – the broadcast was in Swahili so I’m not sure if any explanation was given for his regal attire).
All week long I been asking my Kenyan co-workers who one typically does on Moi day, but no one could really give me an answer. Since we had a day off in the middle of the week, and no traditional Moi day activities to attend, we decided to take a day trip to Ndere Island.
Ndere Island is a small national park not far off the shore of Lake Victoria, pretty close to Kisumu. We set off - Megan, a UCSF OB/GYN fellow working at FACES; Jolene, a med student from Stanford who is on a fellowship with FACES & the CDC; Maria, who coordinates a microbicide clinical trial through UCSF; and me.
Today, October 10, was Moi day – a holiday in honor of Daniel Arap Moi, Kenya’s second president who was in power from 1978-2002. Kind of oddly, Moi is still alive so on the news this evening there were lots of shots of him at various events celebrating…him (walking around carrying what looked like a scepter – the broadcast was in Swahili so I’m not sure if any explanation was given for his regal attire).
All week long I been asking my Kenyan co-workers who one typically does on Moi day, but no one could really give me an answer. Since we had a day off in the middle of the week, and no traditional Moi day activities to attend, we decided to take a day trip to Ndere Island.
Ndere Island is a small national park not far off the shore of Lake Victoria, pretty close to Kisumu. We set off - Megan, a UCSF OB/GYN fellow working at FACES; Jolene, a med student from Stanford who is on a fellowship with FACES & the CDC; Maria, who coordinates a microbicide clinical trial through UCSF; and me.
We drove about an hour out of Kisumu, along a pretty bumpy but luckily not overly muddy road through several villages. Pretty much everyone we passed along the way smiled and waved and shouted hello; it was nice to experience that friendliness and curiosity without the at times overwhelming feeling that comes along with lots of young men calling out “Mzungu! Mzungu! Hello, how are you?” while you walk down the street in Kisumu.
Once we arrived at the lakeside entrance to the park, we hired a boat to take us out to the island. Supposedly there is quite a bit of wildlife out there – hippos (I have yet to see one here in Kenya, much to my disappointment), impalas (not native to the island, but introduced), lots of birds, and the special spotted crocodile which is only found at Ndere. We saw an impala who watched us suspiciously from afar, quite a few birds, and tons and tons of dragonflies who buzzed around our feet while we tromped through the tall grass on the island. No hippos or crocs, though.
We had packed a picnic which we ate in the baking sun – there weren’t many trees on the top of the island. We had a nice hike, then came back to town and went for a swim in the pool where Megan lives. And it didn’t even start to rain until after we’d had a chance to swim a bit. Once I got home I ate avocados for dinner and passion fruit for dessert. All in all, quite a lovely way to spend Moi day!
Once we arrived at the lakeside entrance to the park, we hired a boat to take us out to the island. Supposedly there is quite a bit of wildlife out there – hippos (I have yet to see one here in Kenya, much to my disappointment), impalas (not native to the island, but introduced), lots of birds, and the special spotted crocodile which is only found at Ndere. We saw an impala who watched us suspiciously from afar, quite a few birds, and tons and tons of dragonflies who buzzed around our feet while we tromped through the tall grass on the island. No hippos or crocs, though.
We had packed a picnic which we ate in the baking sun – there weren’t many trees on the top of the island. We had a nice hike, then came back to town and went for a swim in the pool where Megan lives. And it didn’t even start to rain until after we’d had a chance to swim a bit. Once I got home I ate avocados for dinner and passion fruit for dessert. All in all, quite a lovely way to spend Moi day!
Tuesday, October 9, 2007
Rose
Today I worked with Philesia, one of the FACES nurses, enrolling new FACES clients. Whenever a person tests HIV positive at a VCT (Voluntary Counseling and Testing) site, they are referred for HIV care at one of a number of facilities. The testee is able to request the site where they will be referred, and since FACES has the reputation of providing good care and support services, many people want to come here. Prior to any sort of intake by FACES staff potential clients are required to attend an HIV info session during which Community Health Workers go over the basics of HIV, means of transmission, treatment and how to live positively. After that each prospective client is interviewed by a nurse who asks them about any symptoms they might be having, family members with HIV, and various other logistical details. If a person is sick at the time of intake, they are referred for immediate enrollment that day, otherwise they are started on PCP prophylaxis and multivitamins, and given an appointment time to return for full enrollment at a later date.
I attended this morning’s HIV info session prior to starting enrollment with Philesia, and there was one man in the group who seemed to have a lot of knowledge about HIV/AIDS. I guessed that he was positive and enrolled in care somewhere else, but had been referred to FACES to transfer care, or something like that. As we called people in for their interviews, this gentleman came in accompanying a woman whose name was on our list of potential enrollees. Also with them was their beautiful, big-eyed 4 year old, Rose.
It turns out that this man is HIV positive, on ARVs, but lives outside the city and gets his care somewhere else. The woman he was accompanying is his fiancée who lives in Kisumu. We asked for her referral letter, but she said she didn’t have it. She told us she was tested when she was pregnant with her son, who was born about 5 months ago. She was able to describe in detail the appearance of the rapid test, the 2 lines that show up when someone is positive, as she was. At that time for her, that was the end of it. She did not pursue HIV care, or look into ARVs for PMTCT (prevention of mother to child transmission). When asked why, she said, “I guess I didn’t take it seriously.” Today she had left her son at home, but he has not yet been evaluated to see if he was infected with HIV perinatally (more complicated a diagnosis to make in pediatric populations than adults, as I have learned).
We asked about Rose, and she said that’s why they had brought her in this morning, to be tested. Philesia went to the lab and got a rapid test. She asked mom what she would do if Rose tested negative, “nothing, I guess.” If positive? “I would accept that it is the way it is.” Philesia described that we would be taking a couple drops of blood from Rose’s fingertip, and dropping it on the test strip. If one line appears it is negative, two means it is positive. She told mom that we would ask her to read the test and tell us the results. Dad grabbed Rose’s hand to hold it still, and she immediately started to cry. Despite not having said a word, and likely not having understood any of our conversation which had all been in English, she seemed to have an idea of what we all knew was about to happen.
She screamed when we pricked her finger, and as we waited a few minutes for the test to finish running I asked mom about any symptoms she might have been having and gathered other data. I kept peeking at the test out of the corner of my eye, and when the first line appeared my stomach tied in a knot. The test finished. “Well, what is the result?” asked Philesia. “Positive,” replied mom.
I wanted to say something, but couldn’t think of any suitable words. “I’m sorry” seemed trite and stupid and not particularly helpful to anyone. I waited to see what Philesia would say, she’s given this kind of news to parents of a young child far more often than I have. “We will enroll both of you today, take these forms to registration and they will call you at your turn. You will need to come back with your son so we can test and enroll him, too.”
So that was it. We showed them where to go, and we called the next potential client.
I attended this morning’s HIV info session prior to starting enrollment with Philesia, and there was one man in the group who seemed to have a lot of knowledge about HIV/AIDS. I guessed that he was positive and enrolled in care somewhere else, but had been referred to FACES to transfer care, or something like that. As we called people in for their interviews, this gentleman came in accompanying a woman whose name was on our list of potential enrollees. Also with them was their beautiful, big-eyed 4 year old, Rose.
It turns out that this man is HIV positive, on ARVs, but lives outside the city and gets his care somewhere else. The woman he was accompanying is his fiancée who lives in Kisumu. We asked for her referral letter, but she said she didn’t have it. She told us she was tested when she was pregnant with her son, who was born about 5 months ago. She was able to describe in detail the appearance of the rapid test, the 2 lines that show up when someone is positive, as she was. At that time for her, that was the end of it. She did not pursue HIV care, or look into ARVs for PMTCT (prevention of mother to child transmission). When asked why, she said, “I guess I didn’t take it seriously.” Today she had left her son at home, but he has not yet been evaluated to see if he was infected with HIV perinatally (more complicated a diagnosis to make in pediatric populations than adults, as I have learned).
We asked about Rose, and she said that’s why they had brought her in this morning, to be tested. Philesia went to the lab and got a rapid test. She asked mom what she would do if Rose tested negative, “nothing, I guess.” If positive? “I would accept that it is the way it is.” Philesia described that we would be taking a couple drops of blood from Rose’s fingertip, and dropping it on the test strip. If one line appears it is negative, two means it is positive. She told mom that we would ask her to read the test and tell us the results. Dad grabbed Rose’s hand to hold it still, and she immediately started to cry. Despite not having said a word, and likely not having understood any of our conversation which had all been in English, she seemed to have an idea of what we all knew was about to happen.
She screamed when we pricked her finger, and as we waited a few minutes for the test to finish running I asked mom about any symptoms she might have been having and gathered other data. I kept peeking at the test out of the corner of my eye, and when the first line appeared my stomach tied in a knot. The test finished. “Well, what is the result?” asked Philesia. “Positive,” replied mom.
I wanted to say something, but couldn’t think of any suitable words. “I’m sorry” seemed trite and stupid and not particularly helpful to anyone. I waited to see what Philesia would say, she’s given this kind of news to parents of a young child far more often than I have. “We will enroll both of you today, take these forms to registration and they will call you at your turn. You will need to come back with your son so we can test and enroll him, too.”
So that was it. We showed them where to go, and we called the next potential client.
Rain
Is it going to rain? Beats me...So this is the beginning of the “short rains,” one of Kenya’s 2 rainy seasons. Lucky for me this time of year the rains tend to come every day, but only last a short period. Last Friday as I was packing up my things to leave clinic, I noticed that the huge sky had turned ominously steel grey. It started to feel a little chilly, which was a first for me in Kisumu.
I asked some of my FACES co-workers if it was going to rain, figuring I should hurry home since I had my computer with me. It’ll be a while, they assured me, so I hung out for a bit chatting about nothing much in particular. Next thing I know it’s pouring, crashing, flooding down rain. Serious drenching downpour. The dirt parking lot in front of FACES was submerged under a foot of water within 15 minutes. I was told it wouldn’t last long, and yet I waited and waited for over an hour, wondering how I was going to get home with my computer and no raincoat, umbrella or even garbage bag to cover me. Luckily I caught a ride with the truck that serves as an ambulance going to Suba, sitting in the back with a lady with a wracking, horrendous productive cough.
The next day, again the sky turned dark grey while I was at the grocery store, so I hopped a tuk tuk home, thinking how clever I was to beat the downpour. Well it never came. I waited and waited, but no rain.
The next day again the sky turned dark but I figured once again it was leading me on. And of course the rain fell in huge thundering sheets. What the hell?? Why can’t I figure out when it’s going to rain here?? And to top it all off, today it rained TWICE. Once when I was about to walk out to lunch, and again when I was in the (thankfully covered) vegetable market. I’ll take it as a practical joke being played by mother nature on a daily basis. But I don’t think I’ll leave home again without my umbrella.
Sunday, October 7, 2007
Intro to FACES - staff meeting
So, what am I doing here??
While I'm in Kenya I'll be working with FACES (Family AIDS Care and Education Services), a family-oriented HIV/AIDS care and treatment program based in Western Kenya.
http://www.faces-kenya.org/index.php
FACES was established in 2004 as a joint effort between the Kenya Medical Research Institute (KEMRI) and UCSF. FACES' family-oriented model of care focuses on identifying and enrolling HIV positive family members in care, keeping the family unit together and further strengthening the support that clients can provide among family members.
My first full day at FACES was Thursday, the one non-clinical day of the week. The day started with the weekly clinic staff meeting, a little bit of trial by fire since along with all other newcomers to FACES I got to stand up and introduce myself, including likes, dislikes, and most importantly *marital status*!! It was an interesting insight into Kenyan culture to hear people describe their likes and dislikes - unlike in the US where you'd hear people talking about themselves, "I like to spend time outdoors, music and hanging out with my friends" - almost everyone said something along the lines of, "I like the things that you can think of that would make one happy, and I dislike that which you would dislike". I'll have to think about this a little more and see what else I can learn about the Kenyan perspective on the world.
Listening to my new Kenyan co-workers, I was really struck by the emphasis everyone placed on talking about the respectful, family-centered care they provide. Working in medicine in San Francisco you can often forget the extreme social stigma that HIV+ people face in most other parts of the world. Despite the openness and acceptance that clients encounter at FACES, some of the clinical staff described hospitalized clients pretending not to know the FACES staff when they come to visit them in the hospital, not wanting to be recognized as a person with HIV by the other patients around them.
At the staff meeting updates were given on how many people are currently enrolled at FACES, the number of new enrollments, the number of people testing positive at VCT (voluntary counseling and testing) sites. In the few short years that FACES Kisumu has been providing services, over 5,500 clients have been enrolled. The rapidity of growth of the program is truly staggering - talking with some of the health workers who are in charge of enrolling patients, I was told that 10-20 new clients are enrolled daily. Between 200-300 clients are seen in clinic every day, and on a big day they can see 400 people! It's truly incredible, I can't imagine how they are able to expand and stretch their resources and services so fast without feeling completely overwhelmed. And yet, once someone is diagnosed with HIV and referred for services, the thought of turning them away is untenable. The staff is clearly aware of the enormity of the undertaking, and yet do not appear overburdened or overwhelmed. Though the clinic day technically starts at 8am, many of the registration staff and health workers who initially check clients in start the day at 6:30 or 7, since clients begin showing up at 5am and they want to be sure everyone is seen.
While I'm in Kenya I'll be working with FACES (Family AIDS Care and Education Services), a family-oriented HIV/AIDS care and treatment program based in Western Kenya.
http://www.faces-kenya.org/index.php
FACES was established in 2004 as a joint effort between the Kenya Medical Research Institute (KEMRI) and UCSF. FACES' family-oriented model of care focuses on identifying and enrolling HIV positive family members in care, keeping the family unit together and further strengthening the support that clients can provide among family members.
My first full day at FACES was Thursday, the one non-clinical day of the week. The day started with the weekly clinic staff meeting, a little bit of trial by fire since along with all other newcomers to FACES I got to stand up and introduce myself, including likes, dislikes, and most importantly *marital status*!! It was an interesting insight into Kenyan culture to hear people describe their likes and dislikes - unlike in the US where you'd hear people talking about themselves, "I like to spend time outdoors, music and hanging out with my friends" - almost everyone said something along the lines of, "I like the things that you can think of that would make one happy, and I dislike that which you would dislike". I'll have to think about this a little more and see what else I can learn about the Kenyan perspective on the world.
Listening to my new Kenyan co-workers, I was really struck by the emphasis everyone placed on talking about the respectful, family-centered care they provide. Working in medicine in San Francisco you can often forget the extreme social stigma that HIV+ people face in most other parts of the world. Despite the openness and acceptance that clients encounter at FACES, some of the clinical staff described hospitalized clients pretending not to know the FACES staff when they come to visit them in the hospital, not wanting to be recognized as a person with HIV by the other patients around them.
At the staff meeting updates were given on how many people are currently enrolled at FACES, the number of new enrollments, the number of people testing positive at VCT (voluntary counseling and testing) sites. In the few short years that FACES Kisumu has been providing services, over 5,500 clients have been enrolled. The rapidity of growth of the program is truly staggering - talking with some of the health workers who are in charge of enrolling patients, I was told that 10-20 new clients are enrolled daily. Between 200-300 clients are seen in clinic every day, and on a big day they can see 400 people! It's truly incredible, I can't imagine how they are able to expand and stretch their resources and services so fast without feeling completely overwhelmed. And yet, once someone is diagnosed with HIV and referred for services, the thought of turning them away is untenable. The staff is clearly aware of the enormity of the undertaking, and yet do not appear overburdened or overwhelmed. Though the clinic day technically starts at 8am, many of the registration staff and health workers who initially check clients in start the day at 6:30 or 7, since clients begin showing up at 5am and they want to be sure everyone is seen.
First Days in Kisumu
So this will be my first ever attempt at blogging, hopefully I'll be able to get over the self-consciousness of it all, as well as my technological shortcomings...
I arrived in Kisumu, Kenya on October 3. Kisumu is the 3rd largest city in Kenya (after Nairobi & Mombasa); it's in the Western part of the country, on Lake Victoria and not too far from the Ugandan border.
I arrived in Kisumu, Kenya on October 3. Kisumu is the 3rd largest city in Kenya (after Nairobi & Mombasa); it's in the Western part of the country, on Lake Victoria and not too far from the Ugandan border.
I've been here for about 4 days now, gradually getting adjusted. Amazingly my 2 day trip to get here went smoothly - except for the nasty pay phones in Heathrow that kept stealing my money. I even made my tight-ish connection from Nairobi to Kisumu, and when I unpacked my many bottles of Purell hadn't even exploded! Miraculous.
For some reason my sense of direction is totally off here in Kisumu, for the first few days I was always turning the wrong way and feeling completely disoriented. I've finally learned the way to walk to the clinic, though, and my internal compass is working a little better.
My first days have been a bit of a blur of many, many new names and faces, getting adjusted to trying to follow conversations that switch from english to swahili to luo midsentence, trying not to get lost, all compounded by some really horrendous jet lag. I got here on a Weds, and am now spending a very quiet weekend. I'm staying in the FACES flat by myself, so it's been a bit of adventure trying to find my way around and figure out what to do with myself without anyone to guide me. I've found a nice internet cafe close to the FACES Lumumba clinic where I'll be working, which is where I'm writing this. I'm hoping to get a chance to explore Kenya a bit on the weekends, and have been reading my guidebook and plotting my moves.
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