Thursday, June 26, 2014

Sad Update - Traveling With Kids in Kenya

The baby died two nights ago.  Last night another patient who I'd be hearing about for weeks also died.  He had super complex problems, even in the US it could have happened but it means that in the last two days since Dr. J started working on peds he has had five patients die.  Five patients!  Each one I shed a tear for.  I can't help it.  I don't know if it is the pill or just the fact that I'm an emotional being but I just feel like each child deserves their own moment of sadness.  Dr. J told me he allows himself to feel sad while he is standing there with the parents but then he has to put it behind him for the day because there are so many patients on the wards and so few doctors and nurses and he needs to focus on the patients he still has living.  Right now he has a great intern and that guy is a gift to work with.  He has a great nurse as well but she is currently covering 32 patients...some of whom at home would be sick enough to be in the PICU where the ratio at most would be 3 patients to 1 nurse, at most!  His registrar, his Kenyan resident counterpart is ok.  Personality wise he is fine but he's been cutting out every day at noon.  It drives J crazy.  When Dr. J told him they'd lost three patients over the night he said, "What can we do, they were sick enough they should have been in the ICU."  (I mentioned before there are only six beds in the ICU, all of which are filled).  It is as if he's washed his hands of the responsibility.  It is sort of a common problem here but it is difficult to know what drives it.  A lot of the Attendings (Dr. J's Attending is not actually not one of these...he rounds in the morning, goes to clinic, but then he actually comes back after clinic to make sure things have happened while he was gone, so that is actually really great) only do morning rounds a few times a week and spend the rest of their time in the clinic so it is definitely something modeled from up top, but I'm just looking at this system from the very outside, (not even working in it from the outside like Dr. J is) so I have no idea if it is money thing (I've heard they only make money working with their private patients), just a what you do thing (sort of grandfathered into the system), or just a frustration thing (because honestly I think it would take a special kind of person to have patients dying at these rates because of lack of beds, nurses, resources, ICU slots and stay positive and invested over the long term).  I don't know.  I keep praying every night for the patients in the ward.  I keep praying for the doctors and nurses. I keep praying for doctor J.  I even keep praying for the relationship between Dr. J and the Registar.  Yesterday Dr. J told me he's going to invite him out for lunch.  It can't hurt to make friends and maybe he can get him to stay a little longer each day to help if they are buddies.

Sort of on a weird side note, tomorrow we are on lock down in the compound.  There is a political rally scheduled by the opposition party in town so they've asked all the IU house people to stay at the compound at least for Friday then depending on how things go maybe for the weekend. A bunch of people are bummed out because it means they might have to cancel their weekend plans and for the pharmacy students who had to cancel last week because the lake they were going to had had some tribal violence at it, it is a double blow.  We'd already intended to stay close to town this week because we spent a ton of money on safari last weekend but we were hoping to do some things in town so fingers crossed the rally stays peaceful and we are off lock down Saturday.  Dr. J will probably be late tonight trying to get all his patients set for the possible long weekend.  Maybe if things are good  he can check on them sometime after Friday since I'm pretty sure he was going to be getting a new Intern this week as well.  Seriously Kristin I wish I would have given you more than that one weird awkward hug when you left.  How were you doing this everyday?  I don't know what we are going to do if we get locked in the compound for the whole weekend.  We have a bunch of dental students here with us, pretty sure I've mentioned them before.  Last night they had a wild late night drinking party, but I think if another one of those breaks out Adrian might clear the kitchen with a broom.  Our window faces the back of the compound and we heard dogs all night but Adrian's faces the dining hall and he thought the party was from a bar up the street.  Now that he knows it was here I'm sure he won't stay silent.  Our weekend saving grace, yesterday we had Indian catered in from this super yummy place Jill took us to before she left and the pharmacy students told us they've been ordering take out from them on all their weekends stuck here and that there is no delivery charge.  So there you go.  Indian for the SAVE!

Tuesday, June 24, 2014

Not Every Day Is Going to be Happy but Yesterday Was Pretty Bad - Traveling With Kids in Kenya

Left To Right Our Family, Zach (med student here for the summer),
Jill, Kristin, Corrine
Yesterday evening Gigi said, "I wish we could go home.  All of our friends are leaving and it is getting really lonely without them."  The thing is she is sort of right.  The beginning of our trip coincided with the second half of Kristin, another Med/Ped resident's, trip, the one month Corinne, a surgery resident, was here, and the one month that Jill, a pediatrician who works with the program was here doing cross cover.  These ladies are just so nice and amazing.  We've done quite a few trips and dinners with them and I can attest that we probably wouldn't have made it through most of our hikes if it weren't for them and all their help.  Throw Mo in the group who we will lucky have for another month and you just have a group of amazing, fun, helpful people to hang out with.  In a short time I just felt exceptionally close to these people and I was really sad to see them go.  On Sunday we dropped Kristin off in Nakuru before heading home.  On Monday Corinne left at like in five in the morning.  Jill could see I was pretty sad about the whole thing.  It didn't help that Captain E threw a huge temper tantrum in which he spent a good part of the morning berating me.  It is one thing for your kid to keep yelling he "hates you".  It is something else for him to do it in ear reach of other people, hello awkward!  That kid just does not deal with disappointment or correction well at all.  At school when we had all his evaluations done they put him on the Aspergers spectrum.  Dr. J did not agree but since then we've had several serious talks where we have discussed how this very well may be a possibility, but that is a story for another day.

The story for today is that I was just on the verge of tears all day Monday and Tuesday.  Monday Jill was still here and when she got back from lunch she came and gave me a hug, at which the tears of course spilled over.  So she went and talked to Dr. J and before you knew it he was watching our overly grouchy kids and I was walking up to the hospital with her to check out the Sally Test Center.  The Sally Test Center is totally amazing and I plan to write a post entirely just about that, but I also got to tour the pediatrics ward with Sarah Ellen, chat with the pharmacy students in the medicine ward, and go with Jill to see Mo in the CCU.  It was a nice break and it was amazing to see what has been built out here and also where there is still room for growth.  When we got home Dr. J headed back to the hospital and Jill and I had a great talk and then we headed over for dinner.

Dr. J wasn't able to meet us.  Switching to peds is a little bit more time consuming and also this week has been a little bit of a heart breaker.  When Dr. J finally showed up very late to dinner Jill told him she was glad he was replacing her so that hopefully this little girl they'd been trying to get over to hospice would actually make it.  (Jill needs to get home to her practice and her hubby but I think she was having a hard time leaving patients on the ward that she hasn't been able to resolve a place or a  plan for yet).

Yesterday after a nice lunch Jill or Silly Jillie as Peach likes to call her out of love, headed off for the airport.  We were definitely sad to see her go although after Dr. J got home from the wards late again last night and told me what had happened I was so glad she left Tuesday and not Wednesday because Tuesday on the peds ward was not a good day to be there and I don't know how Jill would have pulled herself away after the day Dr. J had yesterday.

Tuesday on the Peds wards was a day of sadness.  Dr. J said before he even got to work a baby had died on the ward.  Then while he was there they had another baby die.  He said the nurse came and got him to check on two very sick babies.  He ran over and one had already stopped breathing and the heart had stopped.  He had no idea how long the baby had been down.  He started CPR but even as he was doing the compressions in his mind he kept thinking, "We only have 6 beds with vents, they are all full, I don't even know if we have a vent to fit this little tiny babe, I don't even know how long the baby had been down."  In the end the baby could not be resuscitated and all he could do was tell the family he was sorry and stay with them while they mourned for a bit before the morgue attendants came to take the baby.  There is no privacy in the ward.  This family had to morn surrounded by others.  Dr. J said some tried to help comfort them but in general people just tried to give them the little privacy they could in a room where there are eight beds, two patients per bed along with the two moms who are the primary care giver and food source of the child while in the hospital, and a variety of other family members and friends standing around.  Then Dr. J had to head over to the other baby.  This one had come in that day with a bladder infection that had turned into sepsis.  They are pushing fluids and antibiotics and we prayed for that baby multiple times last night but Dr. J said when he left the hospital he just didn't know if the baby was going to make it through the night.  What a sad beginning to the week.  I really hope that we can have an uphill climb from here.  I pray that when Dr. J gets to work this morning that baby will still be with us, that the antibiotics can work, that the baby can have full recovery and will be able to go home soon.  I pray for the two families who lost their babies yesterday that they can have peace and comfort and that they can be reunited with their lost babies someday.  I pray for the doctors at the hospital, that they can work hard, that they can have their best wits about them, that they can do the best for each of their patients, and that they can continue to have heart even when they face some pretty hard odds.  Finally I pray for the beautiful little patients and their families at the hospital that they can get the best care possible here and receive both comfort of their bodies as well as comfort of their souls.

Thursday, June 19, 2014

Fireside Chat - Street Boys, Marriage Negotiations - Traveling With Kids In Kenya

Every week at IU house they have a fireside chat where they discuss different issues cultural/political/medical/social.  Last week they talked about the status of woman around the world and watched the preview to Half the Sky.  Who hasn't watched that yet?  If you haven't you need to get on it!  In my church currently their happens to be a small feminist movement.  As a whole it is not widely accepted and I will hear people say really negative things about feminist.  I understand that sometimes feminist can ruffle some feathers and maybe I don't agree with all their goals or tactics but in general there is so much work to be done that when I hear people make blanket statements against feminist it just makes me nuts.  I'm not going to lie, sometimes I just want to grab people and shake them hard and say, "Watch this movie and don't talk to me again until you have."  Anyway I missed last weeks chat so I don't know why I got off on that tangent, but this week I got the kids completely ready for bed, set them up with a movie, and then was able to sneak over for about 45 minutes of the presentation.  For those of you worried about my kids, it just happened to be in another house the kids no very well of the eight houses in the gated and locked compound in which we live.  They knew where to find me if they needed help but when I came back 45 minutes later they were still engrossed.

Anyway tonight's topic was on street kids in Eldoret.  The guy Francis who gave the presentation was the 9th child of 13.  His father was an alcoholic who either wasn't able to/or didn't care to spend much of his money on educating or feeding his children but the situation got worse when both of Francis' parents died when he was 12.  Francis then left for the streets where he joined other boys who spent their time sniffing glue or petrol stolen on rags out of people's gas tanks.  Francis says that when you are drunk on glue you can sleep anywhere and it reminded me of a documentary I watched years ago about Romanian orphans who were addicted to glue who said that when you were high off huffing you didn't need to eat.  Anyway Francis story has a happy ending.  There was a German missionary in Nairobi who one day was attacked by some street boys.  While he was there God told him that these were the people that he needed to help.  So he was able to get some land and start a school and a mission to help the street boys of Eldoret.  Since that time he moved to Nakuru where he could get permanent land to build a permanent mission to serve the street boys, but twenty years ago he was in Eldoret and some of the first boys he came across were Francis and his friends.  Francis says that because he was drunk on glue that when the German Missionary asked him if he wanted to go to school he said yes, but then when he sobered up he ran away from school.  He did this three times before he finally committed to stay.  He was able to get eight years of school and then some mechanically training.  Since that time he got a job working for AMPATH and on the side he is still helping with street boys, sometimes taking them into his home, sometimes sending them off to Nakuru to be with the German Missionary, sometimes just trying to give them a little hope and help on the street.  He had a really touching story and I really appreciated how you could send the hand of God working in his life.  I also found the story of how he met and married his wife particularly interesting.  

When he first met his wife he said that he had love for her at first site but that she told him there was no way that they could ever be together.  One, they were from different tribes, two, Francis was an orphan and had no one to speak for him, three, Francis had grown up very poor and with a very rough background and Rebecca had grown up stable and much better off, but Francis was persistent and after some time Rebecca finally agreed to pray about it and see what God said.  It took several weeks but then she told him that God had given her her answer and that she would open her heart to him.  At the time Rebecca was living with a married sister and when her sister found out she immediately sent her home to live with her parents.  Francis followed her there to meet her parents.  At the time her father asked him what he was doing and he told him he was just a friend who was stopping through and Rebecca had said that if he was ever in town he should stay at his house.  Everything was fine and the next morning Francis left.  But he didn't want to stay away too long so he returned again and this time he told Rebecca's father that he was actually her boyfriend and that he wanted to marry her.  This caused a huge problem.  As Francis explains it this is not the way things work in Kenya.  If you want to marry someone first you send your elders to talk with their elders and this is where the story kind of left "social conscious interesting" and got "anthropological interesting" .  Rebecca's father insisted that Francis have elders come and speak to him.  In Kenya a young man doesn't just come out and ask to date or marry a girl, instead he has his family come and even then they are not direct.  Francis had no elders left in his family but he was able to get some older friends to go to Rebecca's town and do this for him.  This is how Francis describes it:

Your elders come and they tell a little parable.  There was a calf that got lost and it came to your home.  And then the girls elders will say.  "What color is the calf?"  And then your elders will say, "bring out all the calfs and we will show you which one it is."  So the family will bring out all the daughters and they will point out which daughter is your girlfriend.  And then the girl's elders will say.  "How did the calf get lost."  And then your elder's will say something to the effect of, "well she was being watched by one of us but she must have been raised here because she recognized the scent and followed it home."  And then her elders will say, "who was watching her."  And then you will get to step forward.  Then a price is decided on for dowry.  Her elders will say, "that little calf is worth a lot to us.  She will bring us many other calfs into the herd.  If you'd like to take her, we will need ___ cows."  In Francis' case Rebecca's family asked for 5 cows, 1/2 of which must be paid before you can get married.

So Francis had to go back to his town and get together the money to pay for two cows.  In this case it wads 40,000 shillings he needed in order to buy two cows in her town, about $500.  Francis didn't have the money so friends rallied around him and helped him raise it and he was able to gather it so he could marry his Rebecca.

One of the sort of interesting things about this system is that it keeps more girls off the street as opposed to girls, because to every family a girl has the extra worth as she can bring in a dowry price.  Francis said that a lot of the kids that end up on the street are the sons of the very poor, single mom's, orphans, or widows.  In the case of a girl if your mother is single and wants to get remarried she can be easily accepted into another man's family because she will not have any claim to inheritance and can actually bring in opposed to a son who you would be financially responsible for and no man would want to give inheritance to a child that was not his own.

It sort of reminded me of something that Josie told me earlier about how when you get married as a woman you leave your family and become the responsibility of your husbands family for the rest of your life, I guess the price you gain with paying that dowry.  Jill has mentioned that this has some interesting effects when it comes to marriages here.  A lot of parents will not accept a daughter back if she no longer wants to be with her husband because after marriage she no longer belongs to them.  It is the super progressive parent who will say, "Ok, you can come home."  It probably keeps the divorce rates down here.  One of the guys we meet at the friend chicken place told me that in Kenya, marriages are forever.  That being said, in Kenya you can also legally take other wives, and if your other wife doesn't like it she may separate from you and just stay separated from you for years as opposed to actually divorcing you.

Monday, June 16, 2014

Umbrella Falls - Traveling With Kids in Kenya

Distance/Time from Eldoret to the Umbrella Falls - 35 minutes, it isn't so much a distance thing as it is a mostly on rough dirt roads thing.  Cost-5000 shillings for a seven passenger jeep and Taxi Max the guy who gave us the tour of the power plant and showed us where to hike.  We split this cost with the other adults in the car.  Cost to us, 2000 shillings.  

A few weekends ago Kristin asked us if we wanted to go to Umbrella Falls with her and group of other people.  She said something to the effect of, "We're going to a power plant on a waterfall but it is suppose to be really cool.  Do you want to come?"  The answer to this after five days of our mind numbing schedule is "OF COURSE".  Seriously guys I don't know what I'm going to do with myself when Kristin leaves next week.  She is sort of like the trip planner of the group.  We are going one one last weekend hurrah with her and she true to form has done a great job of making sure everything was getting planned.  Without her I fear we will just shrivel up into boredom.  We will surly miss her trip planning skills and her company although we forgive her for heading home since she's been here without her husband almost two months at this point.  

Kristin had Max meet us at IU house at around ten o'clock.  Of course at ten most of the doctors were still at the hospital rounding so we waited around another hour before everyone was there and dressed is hiking appropriate clothing.  It wasn't such a bad wait though.  Taxi Max is highly entertaining.  He is the cab company owner we call most often when we need to get around town and while blessed with a shrewd business mind he is playful and full of stories.  When everyone had arrived we all piled into the jeep.  It was not the first time I marveled at how this is the perfect time to be here with the kids (at least as far as fitting into taxis is concerned.  In a few more years we probably wouldn't be able to fit on one bench but right now the kids are small enough that we fit just fine.

The road out to the falls was pretty wild.  In town you get lots of paved roads but out in the country you are dealing with primarily dirt roads.  Max says they grate them down occasionally but there is lots of rain here and they get a lot of traffic from cars, jeeps, motorcycles, bikes, and foot as well as a whole host of animals that use them as through-ways.  Max says the joke is that Kenyan politicians don't ever have to worry about the roads because they just keep getting bigger and bigger cars.  Anyway we eventually made it.

Immediately my kids were drawn to the animals who call the area home and the water.  The adults didn't really want them near the water the animals really didn't want them anywhere near them.  At one point Cheetah was chasing a cow that wanted nothing to do with her and there was also a point we were a little worried a ewe was going to go after her when she got a little too close to her very new look baby for comfort.  Never fear mama sheep, we weren't going to let her get too close.   

This is just an outhouse which I guess I felt the need to document because it had nice purple doors.  

You can just barely see the falls here.
There was a beautiful little valley and on the other side there were some amazing looking more traditional houses.  Seriously those people have a great view from their front door!

Let's go down the hill to the power plant.

These doors hold the generators that for years powered all of Eldoret.  Now Eldoret has it's own power plants but one of these generators is still working to provide power for the people living in the area.  

We had to wait outside for a bit while Max ran back up the hill to get one of the workers to open the power plant up for us.  

The girls entertained themselves looking at flowers...

I just love streams.

In the plant.  There are two huge generators, one of which is still functioning.  These were brought in her using just man and animal power.  In the last few years one broke and they had to get the motor out.  Max said that even with modern machinery it was nearly impossible the thing weighed so much.  It took a crane and then even then they had to roll it up the hill.  

The girls got bored so I took them outside.

This was the first little point where Max took us out to get a view of the valley below.  I was seriously so freaked out by this ledge I refused to go out onto it.  Meanwhile everyone else had to stand out there with my kids and tell them to stop standing so close to ledge.  All the pictures of the valley that follow were taken by Captain E because mom hates heights and is a huge baby about it.  

Then Max had us hike down about halfway so we could get a better view of the water fall.  I was totally freaked out about the whole thing.  I thought I was going to puke and more than one time Kristin told me I didn't have to go through with it, but I was a little embarrassed about refusing to go out on the ledge so I kept following.  Something about when my foot is inclined, my mind just stops working. I for the life of me can't figure out how I'm going to get back up, and then when I do I'm like, "Ok duh, it isn't like you are just going to fall down this huge rock, you can use your hands or press your body kind of forward," but I'm such a baby and when I'm going down I just can never see how I'm going to return.  
This water fall was pretty darn amazing.  There was quite a bit of water coming down it and you could see why it would be a great place to generate energy.  I think in these pictures it is really hard to get a good idea of how tall the falls are but later when Dr. J goes behind them with 3/4 of our kids you can see they are over ten of him tall.

At this point Max took our group behind the falls.  This was too much for scaredy cat me so I volunteered to stay behind with Peach and Cheetah and take pictures of everyone behind the falls.  Of course at this point Cheetah became a total wreck and I was worried about how I was going to keep her safe on the edge of this cliff.  Dr. J to the rescue.  He tied Cheetah on his back and off they went.  At this point I was a little anxious about them hiking where it was wet and step but Dr. J is a mountain goat and figured the kids were probably safer with him then they were with me.   

Somehow Max got them all safely behind the falls and then back to me again.  Gigi and Captain E had a great time back there and were super excited to tell me about how cool the water fall was.  Cheetah got a little angry when they stop moving to take pictures but settled down pretty good after they got back and she was allowed out of the carrier.  Dr. J said it was neat but that it was a little slippery in places.  Our friend Mo told us later that people have actually slipped at these falls before and been seriously injured or died.  This is information I'm glad I didn't have at the time although I remember thinking while I was watching them take pictures that if one of them slipped and went down that they would really struggle to get out from under that pounding water.  Scary!  Peach and I had fun playing tic-tac-toe in the dirt.  This girl is just so easy going and friendly.  I really enjoy being her mother.  That being said, a little Peach story for you, today she was in a grouchy mood and at one point said to me, "I'm not going to be your sweet little baby anymore, I'm going to be a grouchy big girl."  Well alright then.  

Sunday, June 15, 2014

Saturday, June 14, 2014

Open Vegetable Market - Traveling With Kids in Kenya

Today we went to the open vegetable market.  It also happens to be the market that sells all the used stuff we discard.  No seriously, they box it up, the stuff that won't sell at places like Goodwill and ship it overseas where it is bought by someone middleman.  Then he distributes the stuff out.  One guy sells kids shoes, one guy does adults, one guy just had a bunch of polo fleece Columbia jackets.  I'm not really sure on the environmental impacts of this.  On the one hand there is the whole shipping of items and the fact that it seems to keep production of stuff here down...on the other hand it is reusing stuff and it does lead to a huge market.  I guess I need an economist to tell me if it is good or bad.  But today we walked down to this market.  It meant we walked almost the entire length of the downtown commercial area.  Dr. J told the kids he was looking for the kid who wanted to win the non complainer award.  They did amazing.  No one asked to be carried (although we carried Cheetah almost the whole time because she was just everywhere), no one cried, no one asked for a taxi, or said they were to tired.  Mom on the other hand was exhausted.  By the time we got to the market we'd be sucking in pretty serious exhaust fumes for probably twenty minutes.  There is one main road that goes through Eldoret and that road is the road that leads from Niarobi and Mombasa to the interior of the continent.  So anything dropped off at Mombasa is probably coming through our town on huge black smoke spewing trucks, driving on this two lane main road.  I seriously thought I was going to pass out.  But then we were in the market and sort of away from the road and it was better.  The vegetable market reminded me of other markets I've seen before.  Two things of note, it smells a lot nicer than the one in Amman, Jordan but it looks a lot worse.  The road isn't paved at all and we are in Monsoon season here so it was muck, muck city.  I saw some rain boots at one of the used shoes booths and seriously considered taking a look but the crowd was oppressive.  Almost as soon as we walked into the market people started pressing us on all sides and the call went out repeatedly, "Mzungu, Mzungu" which basically just means white people.  Can I tell you how weird it is for me to be called white person.  Seriously I wish I could take the town to Phoenix to give them a glimpse of how white people there think I am...oh well.  "Mother come and look at my wares", "Mother, are those all your children", "Mother, give me one of your babies."  This was the part we did not like the most.  There was this constant barrage of arms trying to take Cheetah out of our hands.  Most of it was done playful and with a smile but not all of it felt friendly and it was just so much touching that Cheetah froze up and pushed her head into our shoulder trying to keep her face away from prying arms and hands. Peach also got picked up a few times but she was able to laugh it off although when one guy held her a little too long she started to kick her legs until he put her down.  For her trouble he gave her handful of fish.  They looked sort of like sardines that had be left out to dry and were now sort of in a jerky state.  Peach had zero interest in eating one but she did really want to carrying one around as a pet and she did for pretty much the rest of the day until at lunch she put it down and Dr. J "accidentally" swept it up with the trash.  We did score some nice deals though.  For our trouble we got five large mango and probably ten oranges for 200 shillings, about two and half dollars.  Not bad when you consider we pay about 50 cents an orange in the regular store.  So it was sort of a toss up for us.  We loved the deals of the market and we liked being in the city with everyone, but we were a little uncomfortable with the scene our children caused.  I think if we return we will probably do so without the kids or return on a weekday when it is less crowded.  

Sorry there are no pictures of the market.  I'm sort of in a moral dilemma with pictures right now.  I love documenting our trip and loving getting shots of the kids but I also don't want people to feel like I think their lives are like some show for my entertainment so I'm never quite sure when is a good time and when isn't a good time to take a photo.  It is probably for the best though that I didn't have my camera out because seriously with the crush of people it took both me and Dr. J's four hands to keep all the kids together.   

Tuesday, June 10, 2014

It is entirely possible I'm a bad parent and some people watching - Traveling with Kids In Kenya

The man who started this program Joe is still living out here.  His house is right across the street from the little block I live on and he has offered my kids and anyone living out here free reign of his yard.  I see him almost everyday at lunch or dinner and he always has a kind word for me.  Today he told Claire, "This lady, this lady here, she is just super, a real supermom."  "Claire, I think what he means to say is I'm super good at being super bad at this parenting thing," I told her later.  "I'm seriously concerned that for years after we leave people are going to be telling stories about that crazy couple with the crazy four kids and that baby who was already running away with no shoes on."  "Yes," she said laughing, "that may happen."  Today I caused quite a stir because it while I originally had Cheetah in pants and a long sleeve shirt (we are in the Monsoon season here and while climate change has kept the rains at bay we are maybe averaging 70-75 degrees daily) she insisted on changing into a sun dress after lunch and was walking around shoe less.  The Kenyans did not approve.  This is a culture where the more clothes on a baby the better.  Josie my nanny friend from next door even said to me, "You need to get some socks on that girl and a sweatshirt or she is going to get a cold."  There is a part of me that laughs at their over bundling and sort of dismisses it as a more traditional belief but there is no part of me that can deny that whatever Kenyans are doing they are making some amazing children.

Talk about some serious feelings of parental inadequacy going on right now.  The last two Sunday's I have been blown away by the Kenyan children in primary with us.  In the states my kids are already not the behaved but here oh my goodness, you could take the best kid in almost any Sunday School class and they would not compare to the group as a whole here.  I taught primary for almost 5 years and let me tell you, every Sunday was a little game.  I came prepared with games, fun, props, treats.  Shoot I still bring treats to my 12-13 year old Sunday School kids.  Here though the lessons are presented in a very straight forward manner, think English boarding school 1950.  The teacher stands at the board with the chalk in hand, reads points from the manual and writes them on the board, and all the kids hurry to write down the point that she's written in seriously some of the most beautiful handwriting I've ever seen.  Then she will ask a question to reiterate the point.  Every hand in the room goes up, a student is called on, answers, the teacher thanks them for their contribution, ask if anyone else has any questions or anything to add, and then moves on to the next point, repeat the whole cycle again.  I was talking to Jill about it, how they do this.  She says they aren't into corporal punishment here but even at a small age parents will set up expectations for kids and give them a look and stern voice if they do not meet them.  I saw exactly what she meant when a few of the kids didn't have their pen for talking notes.  "Children," the primary president said, "Notebooks without pens, this is very ridiculous.  Next week you will all have your notebooks and pens, right?" "Right" all the students responded, and I have no doubt very few of them will forget.  Meanwhile I was recently thinking about adding notebooks to my 12-13 year old class but thought, "Ah, then I'll have to haul them back and forth every week because I just can't expect them to remember them."  Well maybe I can and maybe I should.

Last weekend we joined a cardiologist and his family at the one 5 star hotel in town for brunch and swimming.  He'd heard we had four kids, he has four kids, so he came over a few days ago to check us out, then called around the next day to get Dr. J's phone number, and invited us to hang out.  They are a seriously great couple and are doing what Dr. J and I hope to do someday with our lives, working half the year in the states and then half the year out of the country.  The guys seemed to really enjoying talking medicine, the kids had fun playing in the pool and jumping in the bounce house, and Celeste and I had a great talk while watching the kids at the pool.  We had a good laugh about the different parenting styles on display.  The Kenyan parents were very close at hand, gently redirecting their kids away from anything they thought might be dangerous, messy, or disruptive.  We the American parents were also sitting pool side, but we were a further distance from our kids and tried to only intervene when absolutely necessary, like Cheetah's million attempts to leave the baby pool for the super deep, super slippery adult pool.  Then their were the European parents.  They were sitting very far away under an umbrella table and even when their son who had to be somewhere around Cheetah's age came to play in the baby pool they didn't really ever seem to look over our way until they were ready to go.  It was just interesting to see how different each culture dealt with the same situation. I wish that I could take all the best part of each culture and somehow meld them into the best parenting experience for my kids.  WHY CAN'T I BE AMAZING LIKE THAT!  WHY CAN'T I!!!!

Anyway just in case anyone cares I did eventually get Cheetah out of that sundress and into a pair of long sleeved pajamas.  She has been falling asleep every night mid dinner and Dr. J and I finally decided it would just make our lives easier to take her over in pj's so we could just slip her into bed when we get home.  Our dinners have got a lot more busy.  When we first got here there were probably only ten other visiting physicians or so at the compound rounding out the more permanent staff.  Today ten dental students showed up with a couple of dental professors.  So far we've had a pretty tight knit group here and it was hard for me not to want to automatically see them as intruders but while trying to stay positive I did notice a few first day differences that we will have to see if the next few weeks change my mind about.

First off dental students are so young, I mean really, really young.  Most of the residents here are in their last year of residency, so they have at least three or four, or more years on the oldest dental student.  Shoot even most of the medical students here are older.  It seems like there is a certain type of person attracted to this type of work, and it is the type that maybe teaches for a few years, spends some time out of the country, moves through a couple of jobs and then finds their true passion in medicine. These dental babies almost seem to be on some great two week adventure, while everyone else seems to be in the mist of a life mission.  These are obviously generalizations based on very few interactions and I do have to say that the dental group leader is quite an interesting person.  She came up to me earlier in the day and told me about raising four kids in Tanzania, so there is definite passion there about serving in undeserved areas but from the students I haven't quite felt it yet, and being around the people here can be really intense.  Did I tell you about the high school senior who was here after writing a grant and fundraising to get money to work with street kids.  Like I said, life missions.  Finally I just found they way they sat at meals to be really interesting.  On the dental side you had all the students at one table and all the faculty and their spouses at another.  It is the opposite on the med side.  When the doctors come into dinner they all bunch together, often finding a spot closest to the most senior physician and mixing specialties. It doesn't take long for them to start bringing up patients.  "Today on the ward I saw this?  Have you ever seen this?  What do you think of this treatment?  I used this as an alternative?  What do you think of that?"  It is one of the great things I've observed here, even in their spare time they are always collaborating, always bouncing ideas off each other, always trying to see if there is something they missed, something they can do better, something else they should try.  I love being able to witness the melding of hearts and minds.  I just wish I could contribute in some way.    

Tiny Colorful Stores and Some Medicine Stories - Traveling With Kids in Kenya

Often Dr. J will say, "there are definitely differences but so much around here just feels like being in Mexico."  For those of you who don't know, Dr. J served a two year mission on the Yucatan Peninsula in Mexico.  It was a life changing experiences for him.  Previous to that time he had thought about going into politics or policy, after seeing the great needs of the people there he decided he needed to do something with his life where he could travel and help people with immediate needs like the wonderful people he met on his mission.  And so here we are now 17 years later and while we drive some of these roads Dr. J says, "This just feels like Mexico to me."  Within the city itself there is some wealth.  We happen to live in a quite nice compound, and I've heard that there is a decently sized middle class here, there must be because otherwise these grocery stores could not stay in business, but as you leave the city and move out into the rural farming communities you start to see smaller and smaller buildings.
All the highways leading into the city are lined with these colorful stores and business.  Sometimes they are made out of adobe and concrete, some of the smaller ones are just wood, or corrugated tin.  Dr. J likes to point out every time we pass by a butchery/motel.  Something about that just doesn't feel right :)  There are lots of hair salons where you will see a group of women sitting outside braiding other woman's hair.  On one of the main highways you find all the saw mills, woodworking shops, furniture builders, and welders.  They work outside so as you pass you have to roll up your window unless you want a mouth full of saw dust.  There are phone scratch card huts everywhere.  They usually only fit one person and our made out of the rough wood painted green.  Scratch cards are a huge deal here.  Very few places take credit card, carrying large amounts of cash can be nerve racking, but people can put money on their phone via the scratch cards and can then use it to make phone calls, get on the internet, or actually transfer to businesses like using a debit card.  Cell phones are a huge deal here.  This is a place where the expense and time to put in land lines is just not going to happen.  That step has been almost completely skipped here.  Meanwhile almost everyone I've met has a cell phone.  They are fairly affordable and my next door neighbor Claire (the AMPATH surgery director here) told me last week that she spends about 12 dollars a month for phone and keeping her Ipad connected to the web.  That is in comparison to to the almost 150 dollars her husband and her were spending in the US to have internet and data.  People of the US we are getting ripped off.  The fact that your phone company, cable company, and your internet company are all the same company and there are only like three choices is not serving us well.  

Speaking of Claire and phones, her husband and I were chatting at lunch today and he told me that last week they launched an insurance company that they'd spent the last 14 months developing for the government that was almost entirely phone run.  In Kenya something like 80% of the population has no health insurance.  It is detrimental when people become sick.  Here if you can't pay, you don't receive services.  If you need an x-ray, you have to pay first.  If you need dialysis you have to purchase your catheter before they can start you.  If your doctors need a CT, an EEG, an Echo, an EGD  to help diagnosis you, you have to pay for that first before you can receive it.  There are some medicines that the hospital has that have been donated from the US, but let's say you need Maalox, hyper-tonic saline, Miralax, your family has to run out to the pharmacy and pick those up before you can receive them.  

A few days ago one of Dr. J's patients needed platelets.  The hospital had none on hand so he and nine other residents and students ran down to the lab to donate blood so he could get some.  If you need a procedure or surgery done you pay first.  You also can't leave the hospital until you pay and so sometimes patients are stuck waiting for money to be earned by family before they leave.  Sometimes it is even sadder than that.  Jill, the pediatrician we live with, was telling me that in the peds ward they have the Sally Test Paediatric center, a place where they give extra care and love to children who have been abandoned at the hospital by their parents because they have conditions their parents just can not afford to pay for.  This is of course is heartbreaking for everyone, but I don't want you to think it is all bad.  The Sally Test Center does their best to help these children and they also give as much support, information, and love as they can to other pediatric patients and their families.  I'm hoping that I'll have the opportunity to do some volunteer work there before we leave.  Anyway back to the insurance story, Tyler was telling me that the insurance they developed is mostly done via your phone.  You sign up on your phone, you make your payment on your phone using scratch cards, almost verify at the hospital using your phone.  Almost anything you need to do you can do with your phone.  Imagine the implications of a technology like that in a country where so few people have insurance but so many people have a cell phone.  They are hoping that with the ease and affordability of the plans they can get more people to sign up, their goal, a million people a year for the next three years.  Insurance isn't a cure all for all the needs here but it would definitely relieve some of the strain a lot of these families and are under.    

Sort of an amazing idea if you ask me.  Our phones at home are so amazing but I'd say 90% of all that amazing (at least in my case) is used purely for entertainment value.  I'm excited to think that maybe someday we'll be able to do more of our household things via or phones, like pay for our insurance, and schedule appointments with our doctors, and get kids report cards.  I mean cell phones aren't going anywhere.  Might as well take advantage.  By the way this is one of the things I love about being our here, I spend so much time surrounded by people both from the states and from here who see needs all around them and are trying to find solutions to fill them.  There can be frustrating moments.  Jill likes to say being out here is like being on a roller coaster.  Sometimes you ride the high of feeling like you are really making a difference here, sometimes you ride the low of feeling like the needs are too great, resources at a scarcity, and you are inadequate to meet the challenge.  There have been doctors from IU and other hospitals working here for 20 years and they have made amazing strides.  It is hard to imagine what it was like before they got here because I know they have done so much.  Even now though there are still so many needs.

At dinner a lot of times the residents will decompress.  Sometimes when they come in they look like they've just come out of a war zone.  "We need nurses and hospital administration staff to come out here to share their expertise with their Kenyan counterparts.  We need medications. (they often find themselves going to their third line choice or not having anything at all).  We need three ring binders to keep tract of our charts (right now they are just lose pages tied together with string).  We need a white board to know who is on call."  A few days ago Dr. J said, "We need gauze."  Often the floor is covered in vomit, pee, and saline.  It eventually gets taken care of but certainly not in a time line that would be considered appropriate in the states.  On that particular day one of Dr. J's patients who had been puking for hours tried to get out of bed to go to the bathroom, he slipped in the mess on the floor, fell and split his chin.  They looked everywhere for something to bandage him up and couldn't find anything, not even gauze.  Ironically here at the compound in my first aid kit we had both butterfly strips and gauze.  Dr. J says, "I wish I could do more, that I could do better for my patients."  I know it is a thought echoed by most of the physicians here.  One of our friends, another med/ped resident who is on the peds side right now was very upset a few days ago because she'd had to beg and plead to get platelets for one of her kids.  Then the nursing staff accidentally gave them to someone else.  "How can I go back to the lab and ask for more," she said.  "It was so hard to get the first dose."  It can be frustrating, but I think we all definitely feel like it is worth the effort and hope that we can stay enthusiastic and blessed so that we can be an instrument for good where ever we go.  


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