an interesting discussion 11/17/10

This morning our Personel director, Jackson, our Education Director, Chacha, and I had a meeting at St. Joseph’s Hospital in Migori. This is one of the two hospitals that we refer our patients to. We started by meeting the head doctor who gave us an hour long tour of the facilities. Then we met with the Chief Administrator. As most of my interest was in the medical end of things, our conversation quickly drifted away from the business of medicine.

                It turns out that Okumu, the administrator, had spent a month in Minnesota. He and I began discussing some of the differences between the US and Kenya and were trying to explain them to our colleagues who have never left this part of Africa.

“It is so quiet there,” Okumu began. “No music blaring, no roosters, no people yelling. There aren’t even any dogs barking!”

“No dogs barking?” asked Chacha in disbelief.

“No! If a dog barks at night the neighbors think it is a disturbance. You can be fined”.

“But, if it is not protecting your house at night, why are you keeping a dog”.

“As a pet,” I interjected.

Blank stare.

“As a friend,” Okumu explained.

“But, how do you keep the dogs from barking at night?”

“Well,” I explained, “often the dogs sleep inside the house at night.”

As Chacha took a moment to wrap his head around this concept Okumu got very excited. “Do you know what else?!? They have clinics just for dogs! Doctors that specialize in dogs. People even pay for dog surgeries”.

Chacha looked at me for confirmation. I nodded.

“And on top of that, when a dog gets sick they don’t walk the dog to the dog doctor. They drive it!!! They pick up the dog, put it in the back of the car, and drive it to the doctor!”

“It that true, Jackie?” Chacha asked

“Actually,” I replied, looking down sheepishly, ”my dog prefers to ride in the front seat”.

Our First Transport 11/5/10

Friday began as most work days do; a cup of coffee, staff assembly, and then to my office. About 10 minutes after sitting down Julian, one of our nurses, came in and said “there is a child in treatment room, can you come and see him?” His screams could be heard across the compound as I walked toward the clinic. It was at that point that Julian informed me that he had been given Penthidine (a strong sedative) more than 30 minutes earlier. This child should have been fast asleep. Instead he was sitting up on the bed giving everyone including his mother the evil eye. His arm was covered in blood soaked gauze.

As a second attempt to calm him we gave him some IV valium. That just made him angrier, because we had to start an IV. At this point the 45lb 8 year old had enough medicine to make me drowsy, so we couldn’t safely give him any more. Instead his mother held him on her lap, our student held his legs down and I braced the injured arm while Julian numbed and cleaned the gaping 4 inch long laceration. On inspection it became clear that he had severed a tendon in his right forearm. We could see one end of it, but could not find the other. It was clear that the cut would need to be repaired under general anesthesia. So, we made the decision to transfer him.

Matt was nominated to drive, so he got to have his first experience as extreme ambulance driver. I say extreme because the road between Matoso and Migori is little more than a 40km glorified cow path. It is littered with craters and boulders, not to mention cows, donkeys, goats, and children standing in the middle of the road.  All of this while trying to avoid the bicycles and motorcycles that are also careening up and down the hills. Oh, and driving on the right side of the car and left side of the road.

Everyone was very quiet as we piled in and started off for town, an hour away. The boy lay comfortable on his mom’s lap for the portion of the trip, then, the lidocaine began to wear off. One he was no longer numb every bump was painful with his arm sliced open. He cried each time the Land Cruiser hit a hole (which is about every 20 feet on that part of the road). He was trying to be strong, but it was just too much for him. As we pulled into Migori we found that it was market day, so the already busy streets were packed with cars honking and people pushing. So, Matt did what he needed to, and probably the only thing in the world that could have distracted the child. He put on the siren.

The boy’s eyes got wide as he whispered to his mother “what’s that?” “That’s us,” she replied. He sat in awe of the cool sound that was coming out of our vehicle and watched as people dove out of the way (not accustomed to an ambulance screaming down the street). A few moments later we were wheeling him into the operating room with his mom by his side. I’m told by his mother’s friend that he is doing very well and they believe he will have full use of his hand again.  All thanks to our great staff and a pretty cool, tricked out Land Cruiser.

The funeral of Salmon Bwana 11/7/10

One of the first days we were in Matoso our Program Director came into the cookhouse early in the morning. He informed us that one of the staff members, a security guard, had passed away. Now, I had never met him, but had heard that he was very friendly and a wonderful person to be around. He got a very severe case of malaria, was hospitalized for nearly a month, and then passed away at his home.

It is the Luo tradition to take the body to the mortuary and keep it there until all of the preparations can be made. This usually takes at least a few weeks. After that the body is brought back to the home and a funeral is held. I have certainly been to a few funerals in my time, but never quite like this one. Preparations started in earnest last week when our staff began planning. The body would arrive Saturday afternoon, so that is when the festivities would start. Matt and I were excused from the Saturday evening party (which lasted well into Sunday morning) but we could hear it from our compound more than a mile away. We arrived Sunday around noon. The services had already been going for 4 hours by then.

The family’s property is seated on the top of a hill that overlooks the lake. In the US this would be the best of the best as far as views go. The little dirt house was surrounded by shelters made of sticks and tarp. Hundreds of people crammed underneath in an attempt to stay out of the blistering sun. Around the canopies were many cooking fires set up for different groups. All of them were cooking ugali (the staple of Luo meals, it is the texture of hard palenta, made of maize meal and water, and almost completely flavorless. It is eaten with every meal and used instead of silverware), sumawiki (a leafy green vegetable), and something that resembled beef. Fortunately, our group also had tilapia which is common in Lake Victoria.

Much of the day involved speeches. There is no TV in this part of Kenya and not many people even have radios, so funerals are the best way to reach large audiences. Some people got up and spoke about Salmon and his life, as would happen at any funeral. However, many of our staff used the opportunity to talk about AIDS prevention and treatment. They encouraged people to get on ART if they need it and counseled about avoiding resistance. They also spoke about the prevention of transmission from mother to baby. This is the best way to get the word out in this area. Then, some local politicians got up and gave campaign speeches. Some people preached, others asked the group for donations for the family.

By 4pm it was time to begin the burial. That’s when the drums started. A parade of people dressed in robes began singing and dancing their way to the front of the assembly. They pick up the coffin and carried it above their heads dancing it around the grounds. People continued to join the procession until there were hundreds of people following along to the grave. At the top of the hill the group crowded around and sang and danced as he was lowered into the ground. The singing got louder as they filled in the grave. It was at this point that one of the women in robes instructed me to dance. She would not take no for an answer.

So I joined them dancing in a circle around the grave as the drums got louder and faster. Then the mass of people started moving down the hill collecting more people on the way. The drums and singing were nearly frantic as people yelled and danced and celebrated. Never before have I been in the midst of that kind of energy. Everyone was dancing for the life that was. The wailing and crying had its time, but this was the time for joy. Even now, two hours later, I can hear the drums coming from the house. The party continues in honor of the late Salmon.

Sunrise in Matoso 10/22/10

So, I lived in Chicago for 5 years. For more than a year of that I lived in a little studio about 30 yards from the “el” track. Every 10 minutes or so it sounded like a 747 was landing in my living room. After that I figured I could sleep through anything. Then, I came to Matoso.

When one thinks of living in a place on the lake with no electricity, they generally think of silence. Or maybe the calming crickets and owls of a camping trip. Perhaps even sounds of loons on the lake. Then, there is Matoso. Here you go to sleep with the calming sound of waves lapping the shore, the occasional frog or cicada. Then, sometime just before dawn, it starts.

Morning begins benignly enough with the chirping of the little birds in the tree behind the house. Then, everything starts to go awry. First, the fish eagles start. We have four on the property, similar in size and appearance to a bald eagle; similar in sound to 40 seagulls sitting outside your window. Once I am conscious enough to realize that no one is being murdered outside my door I lay back down and wait, because I know it’s coming.

You see, the eagles apparently act as the wake-up call for the roosters. The roosters in turn wake up the dogs who feel the need to bark at all of the cows.  The cows then realize that they have not yet been milked and begin to not-so-subtly remind their keeper. This sets off the donkeys, because, well, they’re donkeys and they like to be annoying. It is at this point that the yelling begins. I don’t understand much Luo yet, so I have no idea what is being said. I assume it is something to the effect of “Hey! The eagles were especially loud today.” “Yes, they were, your donkey seems to be quite upset.” To be fair, everyone is up already, so why not scream at each other from boat to shore. It’s certainly easier than paddling back in. Then, there is the honking. There are only two or three cars in Matoso, so I’m fairly certain it isn’t the morning traffic jam. Maybe they are stuck in a cow-jam.

Good morning, Matoso. And thank you, Matt, for the ear plugs.

A tour of Lalmba Matoso 10/25/10

As we first enter the compound, you drive down into the courtyard. There are usually patients milling around as well as a few chickens and goats. Surrounding the courtyard are the immaculately kept admin. and medical buildings. Also, a few accessory building; education room, maize storage, and bike/goat room. Past the clinic is the “soccer field” where the staff children play on the weekends. They have made goals from branches and old fishing nets. I’m not sure if there are any rules, but it seems like a free-for-all to me.

Past that is our ex-pat housing. We have two houses and one tukul (a traditional house with a thatched roof). Our houses have solar lights and cold running water. Both are great luxuries here. We also have the most important building; our cook house. This serves as our living room, board room, kitchen, and dining room. Joyce does a lot of the cooking, which is wonderful. It seems to be her goal to make Matt and I be the first people to move to Africa and gain weight. There is this cake dish that somehow magically produces another kind of cake as soon as it is empty. We have made a few forays into the kitchen with varying levels of success. Tacos: excellent, brunch: amazing, beef butchery: not so much. Apparently it is good I didn’t go into surgery.

The most wonderful aspect of our compound is the view. We are surrounded by a “living fence” with just enough gaps that the people walking along the shore can marvel at our game of frisbee and the kids can yell “mazungu” (white person) to get our attention. Beyond the fence is Lake Victoria. The waves lap the shores and the traditional sail boats pass all day. There are islands a kilometer or so out and hilly peninsulas on both sides. And the sunsets we watch from outside my house every night look like something out of a Hawaiian postcard.  If only it weren’t for the Schistosoma, which makes swimming unwise this would be paradise.

About a mile up the shore is the Ongoro children’s home where 40 orphans live with four Mamas.  Nearly all of them lost their parents to HIV and 7 of them are HIV positive themselves. Yet, they are some of the sweetest, most well behaved, most well-adjusted children I have ever encountered. They truly are a giant family.  The kids were a little shy at first, but very quickly got over that. The best game for the little kids is playing with our hands. If you push our skin it changes color! After an afternoon of tag, soccer, and duck-duck-goose Matt and I decided that Ongoro will be our weekend workout routine. It’s not easy to keep up with 40 kids.

So, that is my home in Matoso. Karibu! (welcome)