The day after 2/8/11

I decided to write an entry for the “A day in the Life” section of the PA professional journal. While writing it, I was disappointed that it could not be as colorful as I wanted it to be. So, here is the day after “A Day in the Life”.

5:00 awoken by the only car in the village blaring its horn

6:00 awoken by pigeons playing “king of the hill” on my tin roof. (scuffle, scuffle, scuffle, slide). Go outside and throw rock at said pigeons

7:15 awoken by alarm clock

7:30 down largest cup of coffee I can find. God bless our French press!

8:00 Staff assembly. The entire staff forms a circle. Every person must shake the hand of every other person. Then we sing a song in Dholuo and stand around awkwardly waiting for any potential announcements. People slowly begin wandering off to work.

8:30 Agree to catch a ride to our remote clinic in Ochuna at 9. Begin collecting necessary materials.

9:00 all ready for Ochuna

9:45 actually leave for Ochuna

10:15 Arrive at Ochuna dispensary (two concrete buildings and a grass hut, none of which has electricity). Greet staff and meet my translator for the day (a young friend of one of the staff). Said translator promptly asks me how he can get a visa to the U.S.  . . . sigh

10:30 Set up our public health student to administer surveys for the mothers in our malnutrition group.

10:35 Establish rapor with families in program (ie. play with babies)

11:00 Prenatal exams with only a stethoscope and a measuring tape. Have to inform a woman that she is having twins. “Are you sure?” “Well, either that or the baby has two heads.” She doesn’t seem impressed with either option.

12:30 Measure and weigh babies in malnutrition program . . . play with babies

1:15 Enter Ochuna dispensary data into quarterly report. Spend 15 minutes convincing translator that the calculator on my computer will give the same answer as the one on his phone. More questions about US visas.

1:30 catch ride back to Matoso in the ambulance. Almost hit cow, donkey, and child on the way.

2:00 tuna salad sandwich – I love you, Joyce (our cook)!!!

2:30 Staff meeting complete with extensive condom discussion and near fisticuffs over who is more to blame for AIDS, men or women. Then we pray.

4:30 Back to the house to try to figure out what the heck just happened.

5:15 Hard core workout in my house involving a jump rope and some hand weights. Hi, Jackie, the 1980s want their exercise back.

6:00 Voice of America on the shortwave radio and a beer on the porch with Matt and the cows. Perfect ending to a perfectly typical day.

African Time 1/14/11

Matt was gone for the weekend and I was not looking forward to spending two full days alone here on the compound. So, when Nancy invited me to her sister’s wedding Sunday morning, I figured it would be fun. Weddings are not very common here. Funerals are huge events but courtships are generally as follows: boy meets girl, boy’s father gives girl’s father agreed upon number of cows, everyone considers boy and girl married. So, I was very interested to see how Luo weddings worked.

                Nancy called me Saturday night. “We will meet you at the gate at 7:30.”

“In the morning?!?” I asked.

“Yes, we have to be to the wedding by 10.”

Okay, seven-thirty it is. Knowing that we would be functioning on “African time” I got to the gate about 7:45 and the car pulled up at 8. It was what the Kenyans call a cockroach; a small hatchback sedan. I was the sixth person to get in. Along the way we continued to pick up people until we reached Sori. At that point we had 11 in the car. Three in the front, four in the back seat, and four in the trunk. At Sori everyone got out. “Is the wedding here?” I asked.

“No,” Nancy replied. “The bride and groom are not ready yet, so we are going to wait here and then follow them to the church.” At this point it was 9 am. We sat outside of a store for a while and had a soda. Every 20 minutes or so someone would make a phone call, yell a little, roll their eyes, and then hang up. After an hour and a half, one of the women suggested taking a walk to the lake. So, we paraded down to the shore to see the omena (little fish) drying in the sun. Then we walked up to the market to buy some vegetables. Then they decided that I needed a kanga (wrap) so we found a stall selling kangas and haggled for one. Then we walked to the shop where they sew the ends of the kangas and got that done. Then we sat around and had another soda. Finally, Nancy jumped up from her chair. “There is the car!” So we all piled back in to the cockroach. It was 2:30.

About a half an hour into the drive, the car pulled over. “Is the wedding here?” I asked again, silly me.

“No, we are taking a rest break. When we get to the church it will be very busy.” Oh, great, the Kenyan rest stop. Also known as a grove of trees on the side of the road. Unfortunately, we had all had two sodas, so it really was a necessity. We used the “facilities” and got back into the car. A motorcycle zoomed past with a driver and a woman in a nice dress holding a goat. The goat did not look impressed. The woman waved at us and everyone waved back. “That is my sister,” Nancy told me. I guess the goat and I were attending the same wedding.

After another half hour we came over a hill and saw a small church surrounded by a huge crowd. This was the wedding. The crowd parted for the cars to pull in. We got out and were pushed into the church. All of the family (myself included) was seated at the front of the church in the pews. Then the community was let in. You would have thought this was a Justin Bieber concert. People pushed and shoved and piled on top of each other to get into the church. At this point the car ride seemed spacious. When it was clear no one else would fit in to the place people started crowding around the windows to see in. I have never been claustrophobic, but I was having visions of a headline in the Fargo Forum “Fargo Native Killed in African Church Fire”.  It was now 4pm.

Finally at the end of the church I saw a young woman in a fancy dress. Awesome, the procession is starting, we can finally get to the wedding part. Little did I know the procession would last 45 minutes. Person after person came down the aisle dancing slowly. “That is my sister, and that is my sister, and that is my sister,” Nancy kept telling me. It turns out Nancy’s father has 4 wives and 40 children.

Finally the bride and groom were escorted in by their parents. They walked up to the front of the church, the pastor said a few words, they exchanged vows and started processing out. The ceremony was less than 30 minute long. All of this commotion for a half an hour ceremony? No music, no speeches (and Africans looooove speeches), no livestock? Really?!?

As I stepped out of the door the driver of the car grabbed my arm and said, “we are going to eat quickly and leave in 10 minutes”. Um, okay. Unfortunately, being the only mazungu there (or within a 60 mile radius) everyone wanted to talk to me and wanted me to take their picture.

“Jackie, come over and eat, quickly.” Suddenly I had a plate of beans and flat bread shoved onto my lap.

“Come wash your hands and then we will go. We need to get home before dark!” Now we are worrying about our schedule?

So, by 5:45 we were all back in the car . . . plus two more and a 50kg bag of beans. That’s right, 13 people in a hatchback. That may be a record, even for Africa. We sped back the way we came dropping people off at their respective stops. At 7:30, just as the last sunlight was setting over the lake, the car pulled up to the clinic gate. “Thanks for coming, Jackie! See you tomorrow at work!” They yelled as the car pulled away. I wandered down to my house and collapsed on the hammock. A 12 hour day for a 30 minute wedding. That really is operating on “African time”.

My Co-wife 12/22/10

The first thing you need to know is that the Luos are polygamous. Not in the weird hiding on a commune in Utah way that we think of in the US. More like the “Hey, how many wives does your dad have?” kind of way. Most men have at least two or three wives. That’s just the way it is. A few months ago the most famous Luo polygamist died. “Danger” Okuku had 136 wives and hundreds of children. He was considered a very successful man.

It is within this culture that I am regularly asked, “Jackie, why don’t you marry an African man?” My standard answer is that no Luo man would want to marry me. I expound on this by explaining that the man I marry will have only one wife: me. No second wife, no girlfriends, just me. This response is generally met with expressions of shock and disbelief. One man and one woman? How on earth could that work? This has initiated many interesting cultural discussions. They have ranged from dating culture in the US to questions about whether livestock exchanged in a dowry is included in a pre-nuptial agreement.

One of the most amusing of these conversations occurred this morning with Edwina. Edwina is one of our nurses and is one of the two other young, unmarried women who work here.

“We are waiting to get married. Right, Jackie?” She began

“Right, Edwina.” We have had a number of conversations about independence, building a career, and waiting to get married until you meet the right person. I consider her one of the most western-thinking young women in the area.

“When you get married, I’ll get married, too. You will find me a husband.”

“Sure,” I replied. “I will introduce you to some of my husband’s friends.”

 “No,” she countered, “I mean that I will marry the same man. Then we can be co-wives!” Oh, no. Not you too, Edwina.

“Ummm, I don’t think so. My husband will be MY husband. No one elses.”

“So you are selfish.”

“Yes, when it comes to my future spouse, I am okay with being selfish.”

“But we are friends, and friends share,” she explained.

“That’s true,” I agreed. “We can share chai, shoes, nail polish . . . not a husband.”

“But that is how we do it here. It is our culture.”

“Which is exactly why I will not marry a Luo man.”

Matt’s take on the subject was somewhat different than mine. “Think about it, Jackie. It’s like having girls’ night all the time. And if you were with Edwina, then you would be sure you liked your co-wife. It’s like one big family. You’d have someone to talk with, to help with the children. If you wanted to go out there is always someone there to go with you.” Right, I’m sure that’s exactly how it works.

I had a similar conversation with one of the gentlemen on our staff. Though his arguments are probably not appropriate for this forum, let’s just say he has his own reasons for wanting more than one wife.   

Later in the day I was playing around on facebook and noticed an interesting ad on the side. “Find a foreign husband at afrodate.com”.  That may have been the first time I have seen facebook as promoting monogamy. It’s all about perspective.

Where the Pavement Ends 12/13/10

Friday morning I was walking up to the clinic and saw a sign on the door. “The clinic will be closed Monday in celebration of Jamhuri Day”

“Sweet,” I said. “Jamhuri Day! What the heck is Jamhuri Day?” I soon learned that Jamhuri Day is Kenyan Independence Day and we were getting a three day weekend. Matt and I had scheduled a meeting in Kisii on Saturday so it was the perfect opportunity to go the extra three hours to the Mara. The Masai Mara is the big game park near us. It is the Kenya side of the Serengeti and Kisii just happens to be halfway there.

We were so excited as we got up early to pack the car with our cameras and binoculars. We drove the two and a half hours to Kisii and had our meeting then started planning our trip. “Well,” Matt said, “there is this road that goes way out east and then back down, or there is another road that goes straight from here to the park. Should we try the shorter one?”

“Sure,” I replied. “Sounds good”.

The first hour of the drive south from Kisii was amazing. Not only was the road paved (yes, paved!) but it even had signs and a painted middle line. It was by far the nicest road we had been on in Kenya. We had the Ipod cranked up and it almost felt like we were in America. Then we got to Kilgoris. The tarmac abruptly turned into a dirt road. “I guess this is where the pavement ends,” I commented. Oh, I had no idea.

About 50 meters in we approached a giant mud hole. There was no way to go around it, so Matt powered the Land Cruiser in. It got stuck. As he was shifting back and forth from first to reverse trying to free the car a small crowd was forming to stare at the white people stuck in the mud. As Matt finally got the car moving it was sliding from side to side. “Please get out of the way.” He said to the people in frustration. Unfortunately, this only confused them as now the white people stuck in the mud were calling to them in a language they didn’t understand. He finally freed the car and we continued down the road. We should have taken that as a sign and turned around right then.

The road only got worse from there. Now, I have written about the roads in our area with the rocks and craters. This road made those look like a four lane interstate. The craters were canyons two feet deep and the rocks were boulders larger than me. We crawled along maneuvering as best as we could (By “we” I mean Matt. He was the one doing the hard work. I just sat in the front seat praying and trying not to puke). And then . . . it started raining. Now the craters were filling up with water making it impossible to tell which were a few inches deep and which approached the center of the earth. At points the road was nothing more than two meandering parallel tracks elevated a foot above a river of mud winding up and down the mountains. The car spun out three or four times, landing us perpendicularly across the road. Fortunately, we were pretty much the only people crazy enough to be on that road, so we never had to worry about oncoming traffic.

After about two hours of this my hands were aching from holding so tightly to the door handle.  I began wondering if we were ever going to make it. The rain had finally stopped, but the sun was quickly reaching the horizon. If there is one thing we know about driving in Kenya, it is that you don’t do it at night; especially on a road like that. As I contemplated our impending doom, I looked out Matt’s window. “Hey, is that a giraffe?” Matt slowed the car as we came around a grove of trees and there, right in front of us, was a herd of 12 giraffe. We were sitting there in awe, staring at them as they stared at us. Then they began to cross the road no more than 5 yards in front of the car. A young giraffe stopped directly in front of us, bent his neck down to the side, and tilted his head to look in the car. “Since when do they let the white people out of the park?” he seemed to ask. Once the giraffes and the zebras that followed them had passed we started up the car and moved on Not 10 minutes later we came around a curve and suddenly the whole savannah was spread out before us. We had reached the edge of the Great Rift Valley Escarpment. The rosy light of sunset mixed with immense relief made it the most beautiful site I can ever recall seeing. I nearly cried. “Wow, that’s amazing.” Matt said. “That totally makes the whole drive worth it”.

“I don’t think I’d go that far. Eyes on the road, Sampias” I joked as I began to relax a bit.

A few more minutes down the road we started seeing signs for our lodge. We got to the front office and checked in. “I see you brought your own vehicle. Do you want to go on one of our game drives tomorrow or drive through the park yourselves?”

“Game drive.” We answered simultaneously and then began to giggle. As we walked back to the tents I leaned over to Matt. “I vote no more short-cuts without extensive research.”

“Agreed,” he laughed.

4:30 12/8/10

I was leaving my office Wednesday afternoon. It was 4:30 and everyone was going home for the day. As I walked across the courtyard Julian, one of our nurses, waved me over. “Jackie, they are delivering a baby in the ER”. Now, we don’t generally do deliveries at our clinic. We are in the middle of nowhere and we prefer to have them in a facility that can do an emergence C-section or resuscitation if necessary. However, if a woman comes in and we determine that they will likely deliver before we can get them to the hospital, we let them deliver here. This particular woman had been seen at another clinic in the morning and referred to the district hospital. She came to us instead.

                I walked back to the ER to find two of our nurses surrounding the woman. It was clear that her water had broken fairly recently (ewwww). Moline looked up from the patient and said, “The cord is prolapsed and the contractions are very weak, but she is fully dilated.” Great. Why does this stuff always happen at 4:30? You see, if a loop of the umbilical cord is coming out in front of the baby, it means that the baby is going to press on it as it is being born. If the delivery goes quickly, it is not a problem, but if the baby gets stuck it compresses the cord and cuts off its circulation (which is not good). Since the contractions weren’t doing much of anything and the labor wasn’t proceeding very quickly we decided we needed to transport her. “You coming, Jackie?” “Sure, why not.”

                So, Moline and I hopped into the back of the Land Cruised/ambulance and helped the woman and her mother in. The mother’s job was to hold the IV bag. Moline and I were to monitor the patient and keep her from falling over. You see, the road to St. Camillus Hospital in Karungu is very similar to the Migori road. It winds through the hills with craters and rocks littered at short intervals. Since we didn’t want the woman to deliver on the way, we put her in the best position to slow labor. We put a mat on the floor of the vehicle and had her sit with her knees and elbows on the mat, bottom up. Think of it as a modified “downward dog” in yoga. While fairly effective at slowing labor, it is neither stable nor comfortable in a wildly bouncing vehicle.

                We began the 45 minute journey with Daniel driving faster than I’ve ever seen him drive. It was clear he did not want to have anything to do with a baby being born in the back of his ambulance. Each time the woman began contracting Moline and I checked to make sure there was not a baby imminently arriving. As the trip went on the amount of blood in the back of the car started to get concerning. “I really hope this baby is patient,” Moline whispered to me just before the IV came loose. Now, we not only had a woman in labor in the back of the car, but there was blood spattered all over the inside of the vehicle as well as running over the floor and we had to change IV bags while bouncing along at 50 kilometers per hour.

                About 15 minutes from our destination the mother yelled and a gush of blood emerged. “Daniel!!!” Moline and I cried in unison. Dan pulled the car off the road, much to the confusion of the cows standing there. We opened the back of the car, got the woman on her back, and checked again. We were still okay; no baby yet. Daniel got us back onto the road, threw on the siren, and raced to the hospital. When we arrived, Moline jumped out to grab a stretcher and I helped the mom down on to it. We got her into the room and explained the situation to the nurses there who promptly did an exam and called for an operating room. “The cord is still pulsing, but the labor seems to be obstructed. We’ll get her in right away.”

Once it was clear that the baby was still okay, Moline and I got ready to leave. The doctor stopped us as we were walking out into the hall. “What? You’re leaving?” He joked. “You don’t want to stay for the C-section?”

“Tempting,” I replied. “But I think I’ll leave that to you.”

Moline and I walked out as Daniel pulled the car up. “Where did you go?” We asked him. “To hose out the back of the car.” Ah, yes. Good plan. That will make the trip home much more pleasant.

Jackie speaks Dholuo 12/2/10

Lalmba has a fantastic community health outreach program here in Kenya. One of the biggest components is our “mobile clinics”. Every month the team goes out to 6 remote villages and provides well child exams, vaccinations, deworming, and prenatal exams. We set up in a church or large classroom and have community volunteers help with registration and weighing. I think this is such a great program and enjoy it so much, that I have become a regular member of the mobile team.

                When I am seeing patients at the clinic in Matoso I always have someone in the room to translate. I’ve only been here a month and a half, and my responsibilities keep me pretty busy. So, my Dholuo is still very limited and I need pretty much everything translated. On outreach, however, we do only well baby checks and there usually aren’t extra people hanging around to be my interpreter. There is always someone I can call over if the mother or I have a concern, but, mostly, I run solo. I now present to you the conversation I am having with the mother in my head.

“Good morning! Come on over and have a seat. Looks like it might rain a little. That’s okay, the gardens can certainly use it. Well hello there, little one. And who is this? Is it a baby boy or a baby girl? Oh, what a little sweetheart! And it looks like she is going to be 6 months old tomorrow. Well, happy half birthday, honey. How is her appetite? Any problems with breastfeeding? So we’re just going to check her out.” Insert some baby talk here. “Okay, her heart sounds great, lungs are clear. The little tummy is soft and her spleen isn’t enlarged, which means no malaria or sickle cell. Her eyes and mouth look good, no sign of anemia. No rashes, arms and legs look perfect. She’s doing fantastically. If you don’t have any questions or concerns, you can head over to the corner there and Peter will administer the vaccines. It was so nice to meet you both!”

And here is how it comes out (translated into English).

“Good morning! Welcome.” Points to chair. “Rain small. Good. Hi, baby. Name? Girl? Six months? Eat good?” Insert some baby talk here. Listens to heart. “Good.” Listens to lungs. “Good.” Presses on stomach. “Good.” Looks in eyes and mouth. “Good.” Inspects skin and limbs. “Good. Baby good. Question?” Points to corner. “There.” Makes shot gesture in own arm. “Okay, bye.”

At least they know I'm trying.

Dinner 11/26/10

As Thanksgiving approached Matt and I began discussing what we would do this year. We decided that, as we have a large kitchen and dining table in our cookhouse, it would be fun to invite the other mazungus  in West Kadem to Lalmba for a meal. Of course, we all worked on Thanksgiving Day, so we decided that Saturday would be good for everyone.

                As you may or may not know, turkeys are not regularly eaten in Kenya (or most of the world outside of the US). All of our guests assumed we would be dining on chicken. “Oh, no,” we replied. “There will be turkey”. Our program director was going in to Kisumu the week before Thanksgiving, so we figured that we could put him on the hunt. Kisumu is the third largest city in Kenya and has a fair number of foreigners. It also has Nakumat. Nakumat is Kenya’s answer to Walmart. You can buy food, furniture, appliances, and machetes all in the same amazing store. They also carry cereal, diet pepsi, and chips-a-hoy. Needless to say, we send a lot of orders with people for Nakumat.

                So, Marico left Matoso with instructions to get us a frozen turkey. Three days later we eagerly awaited his return. One of our staff knocked on the door, Nakumat bag in hand. We eagerly dug through the bags of ice looking for our prize. We found two turkey thighs. With 8 people invited to Thanksgiving, that was not going to cut it. We were going to have to get more creative.

                By now, it was Thanksgiving day in the US; two days from our festivities. I approached our head nurse after morning assembly and explained our problem. Julian knows everyone. Surely she would know where one could get a turkey. “Well,” she said. “You are going to Ochuna today, so ask Ezikiel to go up to the road and ask at the house there. They may have one, or it may just be a big chicken. If not there, you should stop in Bande and ask the lady at the produce stand there, she’ll know”. Okay, got it.

                Matt dropped me off in Ochuna for Chakola Bora (our malnutrition program) while he went on to Migori to pick up a medication shipment and the rest of our turkey day supplies. He would pick me up on the way home and we would get our turkey. I put Ezikiel on the hunt for a turkey.

“So, you have to eat turkey on this holiday?” he asked.

“Yes, everyone eats turkey on Thanksgiving. It’s a tradition.”

“Do you eat it with ugali or rice?” These are the only two things Luos ever eat.

“Actually, neither.”  I went on to try to explain stuffing and mashed potatoes. Ezikiel listened politely and left as confused as ever.

Four hours later I saw the ambulance coming down the only road in Ochuna, packed to the ceiling with boxes. It had been a huge shipment, so Matt, Peter, Julian’s niece, and I would have to ride back to Matoso in the front seat. As we piled in it became obvious that A: it would be a rather uncomfortable ride, and B: there was no room for a turkey. That was okay, because we had yet to actually locate one.

                Friday arrived and we decided to go back to Migori for the supplies there had been no room for the day before. We also needed to bring a couple of staff members to pick up some supplies for the orphanage. After some more recon work, it came to our attention that the nuns at St. Michael’s convent on the way to Migori might have turkeys. “Ask for Sister Ester,” our nurse instructed us. “Tell her Jane sent you”. Sure, go to the convent/leprosy clinic to find Thanksgiving dinner. Why didn’t we think of that earlier?

                We pulled onto the compound and around the chapel to the back gate. The grounds keeper called for the head nun. We turned around as the beaded curtain in the door began to move. Out stepped the last thing we were expecting to see: an elderly white lady yelling at the grounds keeper in Dholuo. She was an Italian nun who had been in Africa for nearly 50 years and spoke no English. We were only able to communicate through our Dholuo speaking staff members. The sister found one of the African nuns to check out the turkey situation and then hobbled over on her cane and had a seat on the veranda with us. The grounds keeper brought out the first turkey. He held it up proudly and smiled a giant, and nearly toothless smile. “No, that one is too small!” She cried. “You won’t feed 8 with him.” Disappointed, the grounds keeper went back to flock and returned with another, marginally larger bird.

“This, this is your turkey!” She exclaimed petting its little head and possibly giving it Last Rights. We paid them the $17 they asked for (how are you going to haggle with a geriatric nun?) and agreed to pick up our quarry on our way home.

                After 3 hours in Migori we met up with our staff to head home. “Where are you parked?” they asked”.

“We’re just up the road”.

“Oh, because we have some heavy bags”.

                Matt and I saw 4 bags on the ground. “There is no parking closer, we can get it”. And we started walking. After a minute we looked back and saw 5 men with wheelbarrows full of supplies following us. I guess they weren’t exaggerating. We piled the bags of flour and boxes of milk in the back around our staff members effectively boxing them in and set out to retrieve our thanksgiving dinner.

                We got to the convent and asked for our bird. They had gently tied her feet and wings so she wouldn’t get away. As we walked back to the car Matt turned to me and asked, “What should we name her?”

“If you expect me to eat her,” I replied, ”she shouldn’t have a name”.

“But we have to call her something”.

“Fine,” I said. “We’ll name her Dinner”.

“Well it looks like you and Dinner will be riding home in the front seat together”.

“Great, that’ll make this so much easier.”

                So, I got in and Matt set Dinner on my feet for the 30 minute ride back to Matoso. I tried not to look at her too much. She seemed to be staring at me accusatorily. As if she knew what was in store. I told Matt that he and the hit men (Joyce, the cook, and Peter, the grounds guy) would have to do the dirty work without me. I could not witness Dinner’s offing.

“It’ll be just like the first Thanksgiving!” Matt replied.

“I’m okay without the authenticity”.

                I watched Matt carry her back to our cookhouse and I went up to hide in the lab. Twenty minutes later, with feathers still stuck to my feet, I got a text. “Dinner is dispatched”. It was done.
I returned to the cookhouse to find a basin full of feathers and something that looked enough like a “Butterball” to make me feel a little less queasy than I expected.   

                The next day eight very thankful Americans were gathered around our dining table eating a traditional Thanksgiving dinner. “I can’t believe you guys actual got turkey! And stuffing, and mashed potatoes. This is amazing! It feels just like home!” I like to think that Dinner knows how much happiness she brought this Thanksgiving.  And she was delicious.