Zanzibar

This post comes after the end of internships one, not before.

So, a total of six of us wanted to go to Zanzibar for a few days over break here. My friend Stephanie and I had a slightly shorter itinerary than the other four, because she flew back home on the 16th and I had to meet my mom at the airport on the 18th, while the rest of the group had a little more time to kill. We all rode an overnight bus to Mombasa together on Wednesday night, then we split up: Steph and I got a flight from Mombasa to Zanzibar, while the others went down the coast a little farther by land then caught a sailboat into Kendwa, a village on the northern tip of the island of Zanzibar.
First, I must say something about overnight buses from Nairobi to Mombasa. They are not pleasant. I slept very little thanks to the bumpy roads and the constant starting and stopping- even in the middle of the night the Mombasa highway is packed, bumper to bumper traffic because it’s such a major route for distributing goods shipped in through the Mombasa port. Then, when we arrived in Mombasa at about 6 in the morning, we had to sit and wait in the bus station for a while until it got light enough to be safe to walk outside.
Mombasa is HOT. At seven in the morning, as Steph and I wandered in search of a cab to take us to the airport, we were already drenched in sweat. It just doesn’t cool off in Mombasa, at least not in December. We found a taxi and set off for the airport. A short 45 minute plane ride later, we were at the Zanzibar international airport. Which is roughly half the size of the Central Wisconsin Airport, but with none of the security features. As we walked toward the door with our luggage, we noticed a cardboard sign with “CUSTOMS” written on in in Sharpie. Under the sign sat a friendly looking toothless old man. Turns out “customs” in Zanzibar means waving a polite greeting to the old guy then heading on your way. The heat in Zanzibar puts Mombasa to shame. As we walked out of the airport into a tropical sauna, we were attacked by about seven thousand cab drivers. I stuck with my usual selection tactic for this sort of situation: find the tallest guy and get out of there.
“Which hotel can I take you ladies too?” Hmmmm, it’s just that we don’t exactly have reservations anywhere. Steph had heard that a hostel called St. Monica’s was pretty cool, so we had the taxi take us there and hoped they had an open room. We were in luck. The room was amazing, small and cozy but with a private balcony. Bednets and ceiling fan included, all for $25 per night. St. Monica’s happens to be the site of the last slave market in Africa. As part of our overnight package we got a tour of the cellar below the hostel where slaves where kept until market day, and the cathedral built in honor of a British guy that worked to end slavery in East Africa.
Stephanie and I spent our afternoon just wandering Stone Town. It’s a perfect town to just let yourself get lost in. The architecture was fantastic. Brief cultural lesson: all along the coast of East Africa from Somalia as far south as Mozambique there is a common culture referred to as the Swahili culture. Aside from the Swahili language, these groups share the mixed influence of East Africa and the Middle Eastern and Arab traders that settled there for centuries. Stone Town is a perfect manifestation of that cultural mix. It was impossible to walk more than a block without running into an ornate mosque dating to the 15th century or some equally interesting building. The buildings are all very tall and close together, and the streets narrow cobblestone, so it feels like trying to get through a maze. A lot of the street scenes seemed more reminiscent of Europe than Africa, at least until a lady babbling away in Swahili offered you “good price for khanga, best in town”. For dinner, we had traditional Swahili food at an inexpensive local restaurant called Lukmaan’s near our hotel. Swahili cuisine is absolutely fantastic. The best food I’ve had in Africa. It’s all about spicy rices and curries and seafood. We went to bed tired from all the traveling and wandering, but highly content.
The next day was rainy. It was a true Storm Over Paradise!!! (couldn’t help myself) Steph and I wanted to find cheap public transport to get to Kendwa, where we would meet the rest of our group for a few days of relaxing on the beach. You’ll notice that “cheap” is a consistent theme throughout this vacation. I’m quite proud of what we accomplished in the end.
Anyway, the least costly way to get to Kendwa from Stone Town is to take a dola dola. They were described to me as similar to Kenya’s matatus, but that’s a lie. A dola dola is in fact a pickup truck with an extra long bed with benches running around the perimeter and a tarp overhead. These benches could seat about 12, so of course we piled 28 people in and set off. The island of Zanzibar really isn’t too big, so the drive to Kendwa was only 30 or 40 km. But it took a long time to get there because of frequent stopping to let passengers off and on. And the rain continued the entire way.
A soggy Stephanie and I found our resort in Kendwa, a beautiful place right on the beach. We checked in just as the rain was letting up, and went to dip our toes in the Indian Ocean. For those of you who’ve never seen it, the Indian Ocean looks strikingly similar to other oceans. Which is to say, it’s gorgeous and I love it. That night we did a little cooking of our own (to save money, you know) on a jiko, which is basically a tiny portable charcoal grill. The next day was packed full of Zanzibari adventure. We got up and walked toward the village a few kilometers to the north of all the Kendwa resorts, since everybody in our group firmly believes it’s important to see how the locals live and get out of the spotlight of tourism. High tide hit when we were about half way there, so we enlisted the help of a boat taxi to help us get around the cliffs. The village was everything our resort was not: dirty, on a rocky stretch of beach with a ton of seaweed. Barefoot, and sometimes naked, children approached us and showed us their skill in cart wheeling over the sand dunes. It was impressive; I’ve got a video to prove it. We ate lunch at a local food stand. It was delicious but I’m shocked that none of us suffered from adverse gastrointestinal effects.
After lunch we went snorkeling with a friendly guy named Romeo who charged us $3 per person for the whole afternoon. He sat on his dhow boat and worked on his tan while we flippered around. He may or may not have had any licensure to guide a snorkeling expedition, but it was a lot of fun.
After dinner all of us just hung out on the beach and looked at the stars. With no light pollution and a clear sky, it was quite a view.
Next morning Steph and I caught a dola dola back to Stone Town for two more days of shopping at the markets and visiting historical sites, as well as just reading in the shade at the beach. We’re both capable of spending many hours at a time doing this. One of the cooler touristy things we did was a spice tour- you go out to a spice farm and see how various spices are grown and harvested and you taste a lot of tropical fruits. At the end we ate a lunch made with all the spices we’d seen in the morning.
I feel like I talk about food a lot, but so much of it was so good, so I’m going to give you one more highlight. Every evening, street vendors cover the huge garden on the waterfront in Stone Town. The food is cheap even by our standards and unlike anything I’ve ever had before. There were dozens of men operating these pressing machines that squeeze the juice out of sugarcane, then they add lime and ginger and ice to the juice, which makes for a very tasty and refreshing beverage. Then there’s the Zanzibar pizza, which is not pizza in the American sense of the word. It’s a piece of dough topped with spices and meat and vegetables, then the chef cracks an egg over the whole thing, scrambles it up, folds it into a dough- omelet pocket sort of a thing, then grills it. It’s heavenly, even if it sounds strange. There were fresh seafood stalls everywhere selling lobster, crab, tuna, squid, octopus, basically if it came from the sea you could buy it. A popular dessert was the “banana nutella chocolate pancake”, which I think speaks for itself.
Leaving Zanzibar was sad. As Steph and I walked back to our hostel that night, with the sound of evening prayers drifting out from mosques all over the city, I felt at peace. It had been a very good vacation. Zanzibar is a place I’d visit again in a heartbeat. The people are far friendlier and more accepting to strangers than Kenyans. Also, I was forced to speak a lot of Swahili since English is not as common in Tanzania as it is in Kenya, but the people of Zanzibar talk slowly and have good grammar, which is useful for a beginner like me.
Finally, Tuesday morning Steph and I headed back to the Zanzibar International Airport. We were asked “Do you have anything illegal that you should declare?” and we passed through security. We had a few hours to kill just wandering in Mombasa before our night bus back to Nairobi, where I am now, for the time being. My mom is arriving in two days (two days!!!) and we’ll be off to explore Mt. Kenya, Maasai Mara, and the south coast of Mombasa.
I have exactly one complaint about Zanzibar: there’s no electricity. Some hotels have generators but they use them sparingly. We spend several long, hot nights looking up at our idle ceiling fan and hoping for a breeze that never came.

End of Internships and Closing Seminar

This is what happens when you commit to writing a travel blog because your friend made you, then you neglect it for several weeks: you find you have a lot to say. Following are two very long posts. If you find them interesting, read away.

The last week in Ukwala was hard- I didn’t feel at all ready to leave. Lucy and John had become a real family for me and I was far happier than I ever expected to be working at the clinic. Luckily for me, my last week was a busy one so I didn’t have too much time to dwell on my departure anxiety.
I’d spent a good deal of my time at Matibabu working with a few different maternal- child health initiatives, mostly infant vaccination campaigns but also the well- child and antenatal clinics. Apparently, in Kenya, this qualified me to help with the process of childbirth, so during my last week in Ukwala, I was called upon to assist with four deliveries. Of actual human infants, mind you. I should come clean here though- I’m exaggerating when I claim I helped with four deliveries. One was a set of twins, so it was in fact three deliveries that yielded four babies.


One special initiative that’s been getting a lot of attention in Nyanza Province is that of male circumcision. The CDC in partnership with the Kenya Ministry of Health recently released official recommendation for male circumcision to reduce the spread of HIV and improve general reproductive health and hygiene. This recommendation was met with a good deal of skepticism in Nyanzya Province, which is largely considered “Luo land” because the Luo tribe does not recognize circumcision in its cultural values. However, a number of free clinics have been set up throughout western Kenya, and I was offered the opportunity to observe the educational talks that preceded the circumcision (I didn’t get much out of that, as it was all in Luo) then help with the procedure itself. Let’s just say that I wasn’t exactly struck by a clear “Wow, circumcision must be what I’m meant to do with my life!” feeling, but all the same it was very interesting to learn about the cultural and medical significance of the procedure and talk to patients about their conceptions and motives for going ahead with it.

Another temporary program that was cool to get involved with was the distribution of “essential care packages” to HIV/AIDS patients. These were packages put together by donations from USAID and a number of other organizations. They included an insecticide- treated bednet, a water purification system (to prevent diarrheal diseases, which are a leading cause of death for AIDS patients in this region), a small basket of food grown in the community garden set up by Matibabu, and a few other things. Though the work I did for this project was largely clerical- ticking a patient’s name off the list and handing over their package, it was still pretty rewarding and involved a lot of contact with community members, so I enjoyed it a lot.

ALSO during my last week at the clinic was World AIDS Day, which involved dozens of celebrations all over Kenya. The Matibabu staff sent a group to the Ugunja gathering, and I opted to tag along. It was a hot day out in the sun, with tons of organizations setting up VCT booths, blood drives, informational booths, and running skits and talks. The skits tended to be humorous, and for the most part I really respected the quest speakers. They talked selflessly of their personal struggles against AIDS and of everything they were doing to help their peers learn the importance of getting tested. One man really upset me though; he spent at least half an hour talking about how he was certain his wife infected him through witchcraft. I guess everybody’s entitled to their own opinion.

My last full day at the clinic, Thursday, had to be one of my favorites of all. I was invited to go on a field visit with a few of Matibabu’s outreach workers. The four of us borrowed a fleet of bicycles that would probably qualify as antiques and set of for the remote villages surrounding Ukwala. We must have looked like a gang from The Sandlot, peddling around town. I certainly felt I was the essence of cool. We had a goal to visit ten homes that day, a goal one of the nurses told me was unlikely to come to fruition. Our fist stop was about a 45 minute bike ride from the main clinic, though it’s hard to estimate what distance this would translate to because Kenyans take a nice leisurely pace. No hurry to get anywhere, just enjoy the ride I guess.
Our first clients for the day were a middle aged couple and their son. All three were “positive”. That’s how people refer to HIV status, just “positive”. The stigma still runs so deep that a lot of people are too anxious to seek testing or treatment. All three had defaulted from ARV treatment and were firmly opposed to returning to Matibabu for further evaluation. This was extremely frustrating for me to see as an outsider. I’ve been very impressed with the effort put forth by Matibabu’s field workers. They scour the most remote areas of the district, seek out patients, and bring the care and drugs to them. Patients that would in the US be placed in a nursing home, but who obviously have no access to such facilities in the impoverished parts of rural Kenya still get care, because outreach workers come to bathe them, cook and clean, whatever needs to be done. And yet sitting before me were three stubborn defaulters. The issue at hand was not the cost of drugs- they’re free to all patients in Kenya needing assistance. Nor was it the logistics of travel- Matibabu had offered to help arrange transportation to the main clinic to re- commence ARV therapy. No, it was “What will the neighbors think if they find out we’re going to the clinic?” We sat in their hut for well over an hour, progressing from politely requesting they make an appointment to demanding to begging. No luck. Then, again frustrating to me, the ultimate conclusion was “Well, I guess if this mzungu came all the way out here and wants me to come to Ukwala, I’ll do it.” As much as I was glad that something finally worked, I was disappointed and ashamed that it was just my race that did the trick. Shouldn’t Kenyans be listening to other Kenyans, not just outsiders like me? I hadn’t done anything but listen and observe, the field workers are the ones who trek out every week, working so hard to deliver care to unwilling patients.
The rest of our visits that day followed roughly the same pattern: nobody wants to admit they have AIDS, that they’ve defaulted from treatment, that they should return to the clinic and get help. The field workers spend an hour coercing, we leave feeling we’ve accomplished something, but only a small something. We made it to three homes of the ten we’d hoped to visit that day.
Just as we were heading back to Ukwala around 5, it started to rain. Hard. We took shelter in the hut of the last patient of the day, and the storm passed in about a half hour. The roads were a complete mess. Mud a foot deep. It was impossible to ride our bikes, so we pushed them, stopping every few yards to scrape out the mud that clogged the tires. We came to a huge hill, and starting shoving our bikes up, making progress just inches at a time. The village kids that ran up ahead of me barefoot found my efforts to be hilarious. I was sweating hard and probably looked like a complete idiot. The nurse told me the kids were so thrilled because “now they see you’re a person just like them”. By the time we got home, dusk was settling and I was exhausted. I walked through the door dripping mud everywhere. “Oh, so you went to the field today” Lucy said by way of greeting. Yep, I sure did. I learned a lot in the field, but I couldn’t get over the frustrations I felt, that no matter what the community health workers do, there will be patients that don’t get the care they need or just suffer in silence rather than face the scrutiny of their family and friends.

Friday it was time for me to get to Kisumu, since I had an early morning bus back to Nairobi on Saturday. I stopped by the clinic in the morning to say my final goodbyes to the staff. There were hugs and jokes all around. The head clinician, Dr. Fred, requested that I leave a recording of me saying “Good morning, Dr. Fred!“ so he wouldn’t have to forget the sound of my voice. I’ve made a lot of wonderful friends and gained a lot of insight from the staff of Matibabu, I could never thank them enough.
Saying goodbye to Lucy and John was one of the most difficult obstacles I’ve faced over the course of this semester, way worse than saying goodbye to everybody at home because this time it felt a lot more permanent. The company car gave me a free lift to Kisumu, where I dumped my luggage at my friend Amanda’s house then we left together for another student’s house where a farewell dinner was being hosted in honor of all ten of us stationed in the Kisumu area. The food was amazing and it was fantastic to see the other students again, to discuss with them how hard it was to leave our internships and host families. A lot of us were really lucky to have wonderful experiences during the internship phase, but leaving was not easy. Furthermore, most of the students were flying back home on December 12; I just chose to extend my stay so I could do some more traveling, first with my friends from the program, then with my mom when she arrives. That’s a lot of goodbyes to have to deal with.
Saturday afternoon we got back to Nairobi and went to our respective host families there to rest up until the following morning when we had to check into the Methodist Guest House, the hotel where our final exams and closing seminars were to be held.

The closing seminar was a three day ordeal at the guest house, a chance for us to catch up with all the students who had been working in different parts of the country, take exams and finish term papers, and relax a little bit before heading home. Our final exams weren’t too terribly difficult but were a good way to reflect on what I’d learned over the course of the last three and a half months and to put my internship experience into the context of development. Our closing seminar activities included a lot of everybody talking about their respective internships and the challenges they’d faced as well as discussing what to expect when we go back home and how to deal with “re-entry shock”. The very night our program- related activities concluded, a group of us set of for the island of Zanzibar, but that’s another post.

Vacation

Hello everybody! The last week at the internship was amazing, I'm now back in Nairobi and done with final exams. I want to share a lot more details BUT I'm taking a well deserved beach vacation to Zanzibar, so you'll just have to wait until I get back.

A Kenyan Thanksgiving

Thanksgiving is one of my favorite holidays, so I was pretty bummed about missing out on everything at home. Thursday I actually felt the most homesick I have since my first week in Kenya. Luckily, I have some wonderful friends here in the MSID program, and we decided to get together over the weekend for an American- style Thanksgiving feast right here in Kenya.
My friend Amanda, who stays in Kisumu, has a fabulous host family that graciously offered to let us take over their house all day on Saturday for cooking and catching up with everybody. I was especially excited to get to see everybody since I stay so far away from the rest of the group. I love my internship and my family and couldn’t possibly be happier anywhere else, but it sure was nice to see some familiar faces and be able to talk about the challenges of working for a Kenyan organization.

A few people had arrived on Friday to get some initial prep work done. For example, the turkey we bough was alive when we received it, so there was that to take care of. By the time I got to Amanda’s house early Saturday afternoon, about ten people were already busy cooking, chopping, or running back and forth from the market for more food. Everybody had an assignment: mine was apple pie. At home it’s not too tough to throw together an apple pie, but it’s a completely different undertaking here in Kenya. There’s no real temperature control on the ovens, so I had to keep a very close eye on the pies as they were baking. Also, there was no pie pan, so I had to rig one up out of about a million layers of aluminum foil shaped roughly like a shallow bowl. Everybody else was also forced to improvise traditional recipes. There was no cream of mushroom soup, so for green been casserole we had to cook some mushrooms with milk. No canned pumpkin so we bought a fresh pumpkin at a market for pie- making.
At the end of a long day cooking, we had prepared a feast that we could really be proud of. We had all the requisite Thanksgiving foods: turkey, stuffing, mashed potatoes, sweet potatoes, rolls, fruit salad, vegetable salad, pasta salad, green been casserole, apple pie and pumpkin pie. Everything had been made completely from scratch. Oh, and since a few of us brought Kenyan friends or coworkers to dinner, and we wanted to provide dinner for Amanda’s family in exchange for letting us use their house, we had a total of 30 people to feed. All afternoon we were worried about not having enough food, but in true Turkey Day spirit, we instead had a refrigerator full of leftovers. The Kenyans present admitted they loved the food, though they did wish we could have thrown some ugali in there. After dinner was over, we had several heaping towers of dishes to wash and only a few liters of water to do the job, since there was no running water at the time. Finally, everything was cleaned up and we were able to just hang out and catch up with each other.

Sunday morning before I had to catch a matatu back to Ugunja, we went to a market in Kisumu (the largest open air market in East Africa, in fact) for a little bit of shopping and just to take in the sights. You could buy just about anything there: second hand clothing from the US, khangas (lengths of African printed cloth), spices, smoked fish fresh from Lake Victoria, cooking utensils, bootlegged DVD’s, weird things I couldn’t even guess the purpose of. We walked around for a while but it was very hot and very crowded so we didn’t last too long. On the way out, I got stuck in a jam between a few Kenyans, separated form the rest of my group. Luckily for me, Lucy had warned me that this particular market was “swarming with crooks” so I checked my pockets right away after I detached myself from the crowd. Yep, cell phone gone. I yelled to my friend Emily to stop the men before the got too far away. We listed to the advise of our program advisors: if you catch a pickpocket, make a big scene. So we yelled, loudly, for him to return the phone. There was no way the guy would have listened to a group of mzungu girls, but we attracted the attention of a few Kenyans who eventually convinced the guy to give it up. He looked spiteful and threw my phone down to the ground. I was just relieved that everything worked out fine.

I headed to the matatu stage a few blocks for the market and found one heading for Ugunja. I don’t think I’ve done justice to matatus yet, so here’s a quick overview. A matatu is a popular form of public transit in Kenya. In Nairobi people use them mostly to get around the city, but in the rural areas you can use them to travel long distances between cities. They’re roughly similar to utility vans and are meant to seat 14 people, but there’s not enough profit with 14 passengers, so it’s usually closer to 20. The matatu I took from Kisumu to Ugunja had 24 passengers, two of which were adorable African children that sat on my lap, one on each leg, the entire ride and chatted away in Swahili while I nodded and threw in a “Sawa Sawa” once in a while. Every matatu has both a driver and a conductor. The drivers job is to drive, the conductors job is to collect fare and, whenever the matatu slows down to below 30 mph, throw open the sliding door and hang out the side of the matatu to try to convince more passengers to get on. I can’t begin to count how many times I’ve been hassled to get on a matatu heading the opposite direction from where I’m walking. They try to convince you that you don’t actually want to go to your intended destination, you want to go somewhere along their route. The conductor is also responsible for stacking people to maximize the number of passengers they can fit in. They get cranky whenever heavy people get in line because it cuts down on their income. Anyway, I waited about an hour for my matatu to fill up, then we were finally on the road headed for Ugunja. I noticed a small hole in the roof of the vehicle, right above my head. It didn’t bother my much until it started raining. Heavily. On my head. The kids on my lap got a kick out of that.

I alighted at Ugunja (Kenyans use a lot of very British expressions. You don’t stop or get off a bus, you alight) and found a piki piki to take me the rest of the way to Ukwala. I say I found a guy, but that’s giving myself too much credit. Instead, two dozen drivers swarmed around me the second I got off the matatu. I pointed to the tallest one, since he was easy to pick out, and told him to take me away. Since it had been raining, the road to Ukwala was washed out and it was a scary and muddy ride, but I made it home safely and before dark, all for the equivalent of $3 from Kisumu to Ukwala. I told Lucy about the pick pocketing episode and she said I would have been “doomed” if she hadn’t warned me. She also told me that smart women keep their phones and money tucked in their shirts so people can’t get to them. For the first time, I left the house for an overnight trip and when I got back she didn’t think I looked too thin. “I like this Thanksgiving of yours. You eat a lot and get fat, so you can be strong Africans”.

Life Lately

My favorite days at Matibabu are Wednesdays. This is because every Wednesday I join one of the other nurses in going to Nzoia, the other Matibabu clinic about twenty minutes away from Ukwala. I think I’ve mentioned these trips in an earlier post, but I wanted to give some more details about what I do at Nzoia. Also, the example of the Nzoia clinic is a very useful one for me to illustrate the differences between what a student volunteer is able to do at a clinic in the US as compared to rural Kenya.
The Matibabu clinic at Nzoia is much smaller than the Ukwala clinic and seems to have two full- time staff members: a pharmacist and a clinical practitioner. Similarly, the town of Nzoia is very small and has no electric power whatsoever, which means no refrigeration. So, you can’t keep things like food or sodas, or vaccines for that matter. Thus, or objective every Wednesday is to provide early childhood vaccinations to the kids of the Nzoia area as well as doing antenatal checkups on pregnant women.
I’ve never tried, but I’m pretty sure in the US I couldn’t just walk up to a pharmacy with an empty cooler and say “Today, I think I’ll take eight doses of tetanus toxoid vaccines, a dozen measles, and hey, throw in twenty pentavalent while you’re at it”. As it turns out, that’s exactly what I do here in Kenya. It’s difficult to know how much of each vaccine we offer to take to Nzoia each week because the patient flow is unpredictable. My first week here, we saw two babies and one expectant mother. Today we had well over a dozen babies and several antenatal visits. One thing that struck me as really funny was that I (or anybody really) can walk right up to the refrigerator that’s shared between Matibabu and the government health center in Ukwala and grab whatever vaccines I need. On the other hand, we were about an hour late arriving to Nzoia last week because we needed to bring some extra child health cards, which were locked up in a cabinet that nobody could find a key to. The cards apparently required better security than the drugs.
At Nzoia, I do my best to make myself useful, but the language barrier issue comes into play once in a while. When I’m supposed to be weighing babies to make sure their growth is on track for their age and catch malnutrition early, I mostly have to point at the scale and say “hapa”, which means “here”. Not very eloquent. I was just starting to think all the Swahili I learned in Nairobi was useless in a practical setting. Most people don’t have daily conversations about things like “How old are you now? Where do you stay? What time would you like to go to the market? That price is far to high for those bananas.” However, this is exactly the vocabulary I need for the infant health visits- we need to record their age in months, their village or sub- district of residence, their birthday, all the sorts of things I am capable of asking. It’s almost insane how accomplished I feel having a successful conversation in Swahili!
I’ve found that I’m able to take on a number of clinical tasks that an undergraduate student probably wouldn’t be allowed to do back at home. I give injections, draw blood, help give stitches, just to name a few. At first this was really overwhelming and I was terrified of making a mistake, but I’ve become surprisingly confident in myself.



Other updates on life:

Lucy was near tears the other night. She thinks I have hookworm because “your appetite seems fine but you just aren’t adding enough weight”. I think that when I’m not around she secretly schemes to sneak extra calories in anywhere she can.

One of the lab technicians, Albert, is very good at his job. He can “find a vein” better than any phlebotomist I’ve ever seen, even on babies and elderly people. He’s extremely kind and compassionate with his patients. One elderly lady that’s a regular patient wanted to give Albert a token of gratitude for his contributions to her health. In the US this might be a short thank you note or a small donation to the healthcare center. In Kenya, you give a chicken. I was minding my own business taking midmorning tea in the “break room” of the lab when I heard a strangely familiar soft clucking coming from the corner. I pushed aside a box to see what the noise was, and a chicken flew out into my face. The best part of the story is that at the end of the day, Albert needed to find a way to get his new pet home. He decided the best course of action would be to transport her in a box. Unfortunately, there were no spare chicken- sized boxes at the clinic, so Albert had to cram her into one that was a bit too small. He then walked down the driveway of the clinic and toward his house, the box tucked under his arm shaking and squawking all the way.

The other day I proudly took the DVD of my rafting trip into the lab so all my colleagues could see just how brave and adventurous I am. It seems I got a DVD that didn’t copy right or something, because all of the narration sounds like it was done by the munchkins and it looks like we’re all wearing lime green and turquoise clothing and floating along in fuchsia rafts. Somehow, that really doesn’t detract from the main point of the video though.

There are no cockroaches at my house in Ukwala because our cat eats all of them. The cat is called Paka the Cat, Paka being the Swahili word for cat. There are these yellowish geckos that crawl all over the walls, which the cat also likes to chase. Recently, Lucy informed me that the cat is pregnant, and if I’m really, really lucky, she’ll come give birth in my room. She also told me that as soon as the cat realizes that I’m her friend, she’ll invite herself into my room all the time. I wasn’t too worried about ever seeing the cat in my room, as I am not exactly a cat person (anybody who knows me can verify this) so I didn’t think Paka would pick up too many friendship signals from me. Then the other night, I awoke to a scratching sound at my window. I was terrified since Lucy and I were talking about all the cattle- stealing bandits that have been on the loose around Ukwala lately. I quietly slunk out of bed, tip toed to the window, pulled back the curtain to find… Paka the Cat stuck in the window, half in my room and half out. I preferred the out option, so I did my best to gently guide her back outside. Paka was having none of that, and latched onto my skin with her claws. Every night since then I have had a loud, meowing roommate.

Nile Crocodile

This weekend 12 of us from the MSID program went to Jinja, Uganda to do some Grade 5 whitewater rafting on the Nile. It was quite a weekend to say the very least.
We were to cross the Kenya- Uganda border at a town called Busia. My little village of Ukwala is actually far closer to Busia than Kisumu is, so we agreed that I would just meet everybody else in Busia and we would cross the border and continue on to Jinja together from there. A few people even came from Nairobi and the Mt Kenya area; they had to take an overnight bus from Nairobi to Kisumu on Thursday night. For once I actually had the shortest journey of the group: it’s only an hour from Ukwala to Busia.
Thursday night Lucy shared with me the anxiety she was feeling because they might not feed me in Uganda, or worse, they might not serve tea. I told her I was pretty sure that Ugandans do eat, and if it happened that they don’t, I am a very proficient scavenger. Not completely convinced, Lucy had me eat extra dinner and take extra tea so I could survive the weekend.
On Friday, I was pleased to discover that my friend Albert, a lab technician at Matibabu, happened to have business in Busia that afternoon anyway, so he said he’d escort me into town and make sure I met up with my friends. Albert and I left the clinic around noon, took motorbikes to the town of Sega, about a fifteen minute ride. We could have gone through Ugunja, the other city not too far from Ukwala that I mentioned in my last post, but Albert wanted me to see another bit of the area surrounding Ukwala.
I should mention that I’ve learned a lot about hiring motorbikes since my trip to Kakamega last weekend. For instance, Lucy told me that you have to negotiate both the price and speed of the ride before you hop on. She said most drivers like to speed so they can complete more trips in a given day, and they assume young people like to drive fast anyway. I do not like to drive fast because I enjoy my health and safety more than the two minutes saved by speeding. Oh, and this week at the clinic we had a patient come in from a head- on motorbike collision. I helped dress the wounds and give stitches on the guys’ face and the experience was gruesome enough to make me take extra caution around the motorbikes. Also, Albert told me how much he pays for a ride to a variety of common destinations, so now I can tell if I’m being overcharged.
So, after Sega, Albert and I got on a matatu for the remaining half hour journey to Busia. Busia is a busy town that is half on the Kenyan side of the border and half on the Ugandan. Since my friends weren’t going to arrive for a few hours, we got lunch and walked around town for a while. The University of Indiana doing some HIV research in that area and has a lab stationed in Busia. Albert wanted to take me for a tour of the lab, which he assured me was the fanciest and most technical I’d every see. Well, I’ll admit that I’ve had the privilege of working in nicer labs than the one in Busia, but it quite a bit better equipped than Matibabu’s lab. The lab director was very friendly and told me to come back anytime I wanted to visit. Albert was absolutely amazed with the lab’s use of computerized patient records and the concept of assigning a unique identifying number to each patient: Matibabu records all lab tests in a ruled notebook. After we finished touring the lab, it started to rain pretty heavily, so Albert and I took refuge in a cyber café until the storm passed. When the rain let up we were walking back to the main road and a matatu full of a dozen mzungus flew past us. My mzungus!! I walked down to where their matatu had dropped them off, we bought our visas and crossed the border without any remarkable difficulty; finally, we were in Uganda.
My first impression of Uganda was that it’s very pink. The major cellular provider there is called Zain, a company that selected shockingly bright fuchsia for it’s logo color. There were buildings painted bright pink lining the streets of the Uganda side of Busia. Also, almost all of the bicycle drivers were wearing short-sleeved button up pink shirts (in a lot of towns you can hire a bike to drive you around just as you can hire a motorbike, but the bikes are usually for trips within, not between, towns). We couldn’t really figure out why all the bicyclists would have decided to identify themselves with pink shirts. The leading hypothesis was that some nonprofit organization had lot of extra pink bowling shirts to get rid of, so they packed them up and shipped them to eastern Uganda.
We found a matatu to take all 12 of us to the campsite of the Nile River Explorers, the company we booked our rafting trip with. During the drive we got to see some of Uganda. Everything was very green and lush, and the roads were far better than the ones in Kenya. Also, we noticed that a lot fewer people have gates and fences surrounding their homes. In Kenya, even in the rural areas, it’s common to see a metal or cement fence completely surrounding a property. There’s usually broken shards of glass embedded in the cement on the top surface of such a wall to prevent potential thieves from jumping over the wall. There were also a lot more of the quintessential mud huts with thatched grass roofs than in Kenya, at least in the parts of Kenya that are right along the major highway. These mud huts came complete with small naked children running around and screaming hello to the mzungus while women wrapped in lengths of cloth with traditional African prints cooked over fires in front of the homes. We could see gorgeous rolling hills and mountains during the whole trip.
It took longer than expected to get to the campsite because there was some confusion about its exact location. The guide that we’d booked the trip with called a few times to ask where we were, but that’s a really difficult question to answer when you’re in unfamiliar terrain in the dark. We finally arrived, starving and exhausted. We threw our bags into the dorm- style bunkhouses and headed over to the restaurant for a quick dinner and a look at the Nile before bed. We all agreed that this was one of the most “touristy” places we’d stayed at: almost all of the guests hanging around in the restaurant were American or European, and the restaurant served dishes sure to please a Western palate rather than traditional East African foods, but we couldn’t help but appreciate how awesome everything was. We were situated on an overlook just above the river, in the middle of the jungle. We all retired to bed pretty early since we had to get up early the next morning for an adventure- packed day.
In the morning, we were loaded onto a big open- sided truck to transport us to the source of the White Nile, where we would begin our day. As we waited for our driver to show up, we all signed away our lives on their accident waiver. “This is probably not covered by your travel insurance” one guide warned us. We met a few other Americans that were volunteering at a nearby clinic, so we chatted with them during the ride. We arrived at the Nile River Explorers home base, were served a nice breakfast of fruits, boiled eggs, and chapattis, and then were given some basic introductory and safety tips, then we suited up in lifejackets and helmets. We had to get back on the truck to drive a little farther to the start point, and finally, after two and a half months (or maybe 19 years) of waiting, I was ready to raft the Nile.
I was placed in a raft with a few other MSID kids and this nice Egyptian guy we met at camp that morning. Our guide, a South African named Kirk, got us in the water and told us a little bit about what to expect from our 30 km trip down the river. He said we’d go over four Grade 5 rapids and a lot of Grades 4 and 3 (the highest grade in whitewater rafting is 6, but most guides don’t even attempt those rapids) and we practiced flipping the raft and crawling back in so we’d be ready for when the currents flipped us. Then, we were off.
I have to say that this day probably ranks in the top five of my life. It’s difficult to explain how exciting rafting on the Nile is, but I’ll do my best. On the first big rapid, my group flipped. I was stuck under water for what felt like a really long time, but the company had about two safety kayakers per raft, so they spread out to pull the seven of us out of the water and get us back to our raft. There was one rapid, called Bujagali Falls, that Kirk warned us we were absolutely not supposed to flip over in. The area was shallow and rocky, and he assured us we wouldn’t like it if we had to swim it outside the boat. Luckily, he was a great guide, so we were able to paddle to steer ourselves clear of the danger zone and flop down the falls with successfully. During the stretches of calm water after a big rapid, we were able to jump out of the boats and swim around for a while. Oh, except in the areas where the big crocs hang out. In those places, they suggested that we stay close to the boat if we wanted to swim. We all decided to just stay put in the raft during those stretches. We didn’t’ see any hippos or crocodiles, the two most dangerous animals in the Nile, but we saw a lot of birds. We were served a lunch of fruit and biscuits from the lead safety boat while we floated down one of the calmer stretches.
The last rapid, the grand finale of the day, was called “The Bad Place”. By this point Kirk had ditched us to go work the video camera in one of the kayaks, so another kayaker named Bernard took over our raft. Bernard admitted that he hadn’t guided a raft since August and that he wasn’t sure our paddling was strong enough to avoid the Bad Place. This rapid was not too bad if you stay out of the surging wave in the middle, but doing so requires a pretty strong crew. Well, we approach the Bad Place hoping for the best, and in a way that’s what we got. Bernard was right, we were not strong enough to avoid the Bad Place. Instead, we got sucked right it. We were trapped in a strong wave for a LONG time- the boat didn’t flip but it was stuck, it couldn’t move forward or backward. Instead, it shook us all around, so bodies and parts of the raft were flying everywhere. At one point I looked up and saw some Ugandan kids on a cliff above the river pointing and laughing at us. Finally people started to fall off of the boat; Bernard pushed anybody that didn’t fall. We were sucked down very deep for a very long time, but the rescue kayakers collected us all when we finally surfaced. As we moved onto dry land, members of other rafts came up and told us they were “very scared” for us. Our other friends from MSID, who had been in a different raft, said they got really nervous when they tried to count to make sure we all came back up. The good news is, the video crew decided that was the best wipeout of the day and we made the highlights reel in the movie they produced and showed back at camp that night. I bought the DVD, so you can all see it when I get back.
After the rafting was over, we went back to camp for a barbeque and celebration. It had been a very good, but very exhausting day, so most of us were in bed reasonably early again. Today we just packed up and traveled back home. I’m tired but it was fantastic to see Lucy again. She missed me and has to fill me in on the Storm Over Paradise episode I missed on Friday night, so I better get going.

It's a jungle out there

This weekend I decided to make the journey into the big city of Kisumu to visit a few of my friends that stay there. We had decided to do a day trip on Saturday to Kakamega Forest, a little sliver that remains from the rainforest that used to cover most of central and eastern Africa. We wanted to get an early start on Saturday so we decided it was best for me to go into town on Friday night. I was really concerned about getting to Kisumu, because everybody I asked was always very vague about the most efficient way to get to town. I did understand that I would have to take a motorbike from Ukwala to Ugunja, a town about 45 minutes from where I live, then from Ugunja I could get a matatu to Kisumu. Lucy warned me to excuse myself from the clinic early because she didn't want me traveling after dark, even though this part of Kenya is far safer than Nairobi. Luckily for me, a few guys from the clinic happened to be going into town anyway, so I got a free ride. They even dropped me off right at the supermarket where my friend was planning to meet me. I made a quick stop in the grocery store to stock up on supplies, since dietary staples like peanut butter and chocolate can't be bought in Ukwala, then met up with Marta, the lovely lady kind enough to share her home with me for the evening, as well as the "other Emily" on the trip and our friend Joe. The for of us squeezed into a tuktuk to get to the part of town where Marta and Joe live. For those of you not familiar with tuktuks, they are (supposed to be) three- passenger taxis that are sort of like enclosed motorized tricycles. Since that description probably wasn't satisfactory, I've included a picture.



This is a tuktuk. They're probably in my top three favorite forms of transportation these days, although if the roads are bumpy, which they all are, it can be a pretty unsettling ride.





We went to a swanky restaurant called Kiboko Bay, which was a definite mzungu hotspot, to watch the sun set over Lake Victoria. Oh, and we also got to watch a few locals bathing in the lake, which is a very common occurrence. As soon as it started getting dark, Marta and I went to her house to drop my stuff off and have dinner and watch Tormenta en el Paraiso with her family. As it turns out, all Kenyans outside of Nairobi are wild about that show. Marta joked that the best way to end the ethnic tensions and bring Kenya together would be to elect a Mexican president in 2o12. But I'm coming to realize that as much as everybody watches that show, very few people recognize that it's originally a Spanish-language soap opera. My mom, for example, firmly believes that it is set in Norway. You know, because there are so many tropical beaches in Norway. As a side note, most people here think I'm from either Germany or Swaziland. Anyway, after Storm Over Paradise, we went back to Joe's house to have tea because his mom got really offended that we only stopped by to say hello before, so we felt we owed her a nice long visit. Then we went back to Kiboko Bay to hang out in a group for a while. From this point on, my weekend got too wild to simply describe the succession of events that transpired, and I've always felt like I might have a hidden knack for creative writing, so I'm going to relate the rest of my weekend adventures to some popular films.

The Jumangi Experience: We got to Kiboko Bay and were just sitting down at a table when a security guard approached us. "You want to see a hippo?" he asked. Well, since I don't live right on the lake in Ukwala, I figured he was perhaps mildly crazy, but everybody else followed him. Sure enough, a hippo had wandered out of the lake and was casually munching on the grass by the guest houses behind the restaurant. Fun fact: the hippo is actually Africa's most deadly animal. They squash a lot of tourists every year, and they have huge teeth, so if they feel threatened they just snap the spine of whatever's bothering them. Needless to stay, we kept our distance. A few other mzungus were clustered around watching the hippo lumber around. Since it's pretty rare to see a hippo at a restaurant in the US, this was entertaining for well over a half hour. At one point it started running. You would not believe how fast hippos can run if they want to. The mzungus all scattered but came right back when the danger had passed. Eventually the hippo got bored and splashed back into the lake, so we chatted for a bit with some friendly Germans we had met, then turned in for an early night. Marta and I took another tuktuk back to her house, which was great until the driver got sassy and charged us 50 shillings above the price we had agreed upon when we got in.

The Fern Gully Experience: The next morning we got up really early and hired a fleet of motorbikes to take five of us into town. I was on the back of a motorbike that was carrying me, Marta, and the driver, and I felt a little wobbly as we zoomed down the bumpy streets, but we all arrived safely. We made a quick stop to get picnic lunch provisions, then found a matatu that would take us to a town near the entrance to Kakamega Forest, about a 45 minute drive for Ksh 150 ($2) per person. From that point we found more motorbikes to take us the rest of the way to the entrance. Once we got to the park, we tried to use our alien resident ID cards to get a lower rate for the entrance fee, but as usual, we failed. We're supposed to get the price Kenyans pay for museums, theaters, parks, etc with these cards but so far all they're good for is laughing at how terrible our pictures are on them. Oh, and I guess they make a pretty great souvenir. According to our guidebook, there was supposed to be a really scenic 7 km hike that lead to a waterfall, but apparently the Lonely Planet people don't check with the places they write about very often, because Park Ranger Moses told us that trail has been "impassable" since 1995. So instead we spent the morning hiking independently through the non-marked trails of the rainforest (Kenyans do not believe in maps), and I'll say that we saw some pretty great sights. We were wandering aimlessly, however, and decided to head back to the main office around lunch time to eat our picnic and start out on a new trail.

There are supposed to be about 400 species of butterflies in Kakamega Forest, but we didn't see nearly that many. This one is pretty, though.

In the afternoon we decided not to be such cheap students and hire a guide to walk around with us. Moses took us out for another hike. As it turns out, Moses is highly skilled at various bird calls, so he had the whole forest singing for us. He showed us a lot of different plants that are being exploited for medicinal use, and which plants would cause rashes and such if you touched them. We also so a TON of monkeys. It was so cool seeing the monkeys swinging around on vines and jumping between the trees. They were acting like monkeys are supposed too; it was way cooler seeing them in the wild than at any zoo or sanctuary.


There are seven species of primates in the forest, but no chimps. This is one of many, many monkeys I saw in the jungle. They're very playful. Also in the rainforest were a number of nice tropical flowers.

One of the trees Moses showed us was the strangler fig, which I also saw a lot of in the Everglades when I went there last spring. They attach themselves to other trees, then slowly grow around the host tree until it dies from lack of nutrients. What's left is usually a big hollow strangler fig tree that will act as a reservoir for water or a habitat for a variety of different animals. We climbed right in to one of the strangler fig trees to pose for a picture

The Motorcycle Diaries Experience: At about 3:3o our tour of the rainforest had come to an end. The rest of the group was heading back to Kisumu, but I needed to return to Ukwala. I was very nervous about the journey home, since nobody had any idea how to get from Kakamega to Ukwala. This seems like a good point to mention that in rural Kenya, geographical proximity has very little effect on how you get from Point A to Point B. I found a motorbike man that was willing to get me from the forest to the town of Kakamega, about a 30 minute ride. From there he helped me find a matatu that would get me a little bit closer to home, and set me off on my own. For those of you that know me at all, you realize that this was difficult for me because I like to know exactly what's going to happen, at exactly what time. So here I was, in one unfamiliar area, boarding a matatu bound for another unfamiliar area. I had no idea what to do after I got off the matatu, but I guess I accepted the fact that I'd have to piece my journey home together bit by bit, one stop at a time. Here's how my day finally concluded:

• Piki piki (the local word for a motorbike) from Kakmega forest to Kakmega town, a 30 minute ride
• Matatu from Kakamega to Mumias, another 45 minutes. The matatu conductor looked at me when I got on, asked me to marry him, and told me "I love you too much". The locals all thought this was very funny, but at this point I was still really anxious about navigating my way through rural Kenya and getting home before dark, so the humor was lost on me. Oh, and he didn't love me enough to charge me the same rate as all the Kenyans. I'm getting really sick of paying "mzungu price" for everything, even if the price I pay would still be considered low in the US. I guess everything's relative
• From Mumias, a kind gentleman that had been on the matatu with me told me it would probably be best to get a piki piki to Mungatsi. At this point, I still had no idea what I'd do once I got there, but I was learning to relax a little bit. I took his advice, thanked him profusely, and found another piki piki, this ride lasting about 40 minutes. From Mungatsi I found more motorbikes and explained that I was trying to get to Ukwala. Nobody was willing to drive me that far, but one man said he'd take me to Ugunja. Ugunja!! I know that city! Now I was really happy and able to just enjoy riding on the back of a motorcycle through the most rural and scenic parts of Kenya, because I knew I was close to home and I knew what to do from Ugunja. During that leg of the journey, which took another half hour or so, we drove through agricultural lands where people would be out ploughing their fields, harvesting sugarcane, cutting up wood to make charcoal, or washing their laundry in small streams. We went through a lot of hills and valleys on an extremely bumpy road. The driver asked me at one point if I'd like to drive the bike, but I politely declined. I'm not that adventurous yet. This particular driver had little concern for our lives though, because every time he'd see a fellow piki piki driver, he'd challenge them to a race. We were going 80 kph on a motorcycle that sounded like it was about to fall apart anyway, on a rocky dirt road. A few times we were completely airborne and I had the sort of "life flashing before your eyes" moment you always hear about.
• When we got to Ugunja, I found a final piki piki to take me to Ukwala and watched the sun begin to set as we zoomed through familiar territory toward home. I walked in the door a little before 7, covered in dirt and my whole face was red from windburn. Lucy took one look at me and said "So you've been on a piki piki now"

So, three hours, 700 shillings, and four marriage proposals later I was home safe with my wonderful family in Ukwala. Lucy said it looked like Marta's family didn't feed me enough and made me have extra food at dinner and extra tea before bed. I was exhausted from a long day but I think I learned a lot. For example, the back of a motorbike might just be the best way to see rural Kenya. Travel in this part of the world can be tricky, but it's best to take everything one piki piki ride at a time and you should make it home fine in the end.

Mzungu, how are you?

Life’s been pretty great here in Ukwala. Volunteering at Matibabu is going even better than I had expected- the staff is wonderful and so fun to work with. Here are a few updates for you, both on my life and Kenya in general:

• I thought my mom in Nairobi was determined to make me gain weight, but Lucy has taken the challenge to a whole new level . She made me weigh myself at the clinic so she can track her progress week by week. She also has a gradual scale for me to catch up to the amount of food she wants me to be eating daily. The first week I was here, she let me drink just one cup of tea, three times a day. We’re up to a cup and a half per teatime now, and I think next week she plans to go all out and get me up to six cups a day. That’s’ a lot of chai!!
• I washed my laundry the Kenyan way for the first time on Sunday. This involves filling several tubs with water (rain water collected throughout the week, no wasting the running water) and heading out to the back yard. A few tubs get powdered detergent added to the water, but some stay clean for rinsing. Then you bend over and scrub the clothes by hand. According to Lucy, this is “very easy” but my back was sore for hours. Lucy also decided that“ the problem with you people is you’re afraid to bend over” since we don’t have to do so to do our laundry, and they also use brooms and mops that are about a foot tall, so you have to do some bending to clean the house, too. O, there’s not a whole lot of skin left on my fingers, it got scrubbed off along with all the dirt from my clothes. I did laundry for about an hour and washed a pair of pants, two skirts, a few shirts, socks, sheets, and towels. Lucy did laundry for six hours and washed all of her family’s clothing, sheets, towels, and the upholstery covers from the six gazillion couches in the living room. She told me I did a good job for an American and that I’d be allowed to stay in Kenya, but I felt pretty pathetic comparing my efforts to hers.
• Also on the topic of Lucy (sorry but she’s the greatest and most interesting lady ever), she got the one thing she wanted more than anything else in the entire world the other day: a refrigerator. She sat me down and explained to me that now she can store leftover food for even a few days. I told her I was in fact familiar with the concept of refrigeration, but I think I wasn’t awestruck enough for her taste at the luxury of a new refrigerator. Unfortunately, the fridge is bad news for me because usually she makes a really amazing fruit salad for dessert (picture the sweetest pineapple, mangoes, avocadoes, bananas, and oranges coming together in your mouth. It‘s heaven), and since there’s no way to preserve the extras, I have to eat about six servings- no complaints. Now that we have a way to store things I may have to cut back a little bit
• There’s a shocking amount of malaria here. In the lab we often run a few dozen rapid tests per day, mostly for children under five years, and the vast majority of them are positive. People here are so accustomed to it though. I asked Lucy if she’d ever had malaria, and she laughed and thought for a while, and said “maybe twenty times or so” in all seriousness. The Matibabu staff will even drop by for a complementary test if they’re feeling a little under the weather. Oh, and it turns out in addition to resistance to the malaria drugs, a lot of mosquitoes are becoming resistant to the insecticide used to treat the bed nets (which very few Kenyans sleep under anyway), so a number of public officials are calling to reintroduce DDT to manage the issue. I really, really hope there’s another option.
• Today, I went to the other Matibabu clinic in Nzoia, about a twenty minute drive from Ukwala, to help with the immunizations for little kids there- somebody comes from the Ukwala clinic every Wednesday. The Nzoia clinic is a lot smaller, has only a few staff members, and isn’t as well stocked, so Martha (one of the nurses )and I weighed and measured and vaccinated babies under one year old all day today. A LOT of mothers brought their babies in- for 20 shillings (about a quarter), they got a dose of oral polio vaccine, vitamin A supplements, and any other vaccinations they were due for. The really difficult thing was that a lot of mothers had a hard time scraping even the Ksh 20 together, and a lot of the babies got a tick mark next to the “malnourished” line on their infant health cards. On the brighter side, a lot of the moms and kids were also really happy to be getting the care that they were, and I played my small part in lifting a few spirits today. After kids got injections and were crying in pain, the nurse or their mom would just point to me and say “Look, a mzungu” and the kid always promptly stopped crying in shock.
• Kenya is very, very mad at the Obama administration for suspending the US visa of a top Kenyan government official. I don’t know if that made news in the US at all, but it’s a huge deal here.
• Lucy and her friend Scholastica (great name, I know) have been trying to teach me some Luo language. They say it’s to help me communicate better with the locals, which is certainly true to some extent, but lately I’ve gotten the feeling that they just like to laugh at my terrible pronunciation. Like I said, I really brighten everybody’s day around here
  Every night at 8:00 Lucy and I watch Tormenta en el Paraiso, which is obviously one of the telenovelas that I mentioned in an earlier post. It’s got to be in the top five most unnecessarily dramatic shows ever, but Lucy loves it and I love her. Also, it’s great to watch her bicker with John about the show. He thinks it’s a waste of her time to watch, never mind that it’s the one hour of the entire day where she gets to just relax, and he says it makes her a bad wife because we don’t eat until nine because she’s watching her show. Again, disregarding the fact that John doesn’t join us at the dinner table, he eats about a half hour later in front of the TV
• There was a really bad nation-wide power outage last Sunday night. We had to eat by candlelight at my house, but on the news the next day there was a story about how hospitals across the country were suddenly stuck performing emergency surgeries and caring for premature babies by the light of a few cell phones. Yikes!

So, I'm just living the life here. Everything's wonderful and the time is flying by.

Arrival in Ukwala

Hey everybody. Sorry it took me forever to get a post up about my new family and my internship, but to be honest it's been an exhausting week and blogging has not been priority number one.

Last Sunday morning at 5:oo a.m. Joe the Trusty Taxi Man was in my driveway in Nairobi, waiting to get us to the bus station. There were four of us in the Jamhuri area that had to go to Kisumu, so we shared a taxi downtown to the Akamba bus station. Jane, our internship organizer, met us at the bus station. Interestingly enough, the man that gave a guest lecture for us on "Art in Africa" was also on the bus with his own group of students, heading for Kampala (in Uganda). The bus made pretty good time, and we arrived in Kisumu by about 1 p.m. We had a quick lunch at a local restaurant, and one by one families started arriving to collect their new students. Soon it was just me, Jane, and Betty, another MSID organizer, left in the restaurant. We grabbed another taxi to take us two hours further down the road to Ukwala. When we arrived at my new home, Jane and Betty pretty much just dumped me off: they stopped in to use the restroom, then headed back for Kisumu. My immediate impression of Ukwala and my house was that I'd have a lot of adjusting to do.

My front yard, complete with cows, chickens, sheep, and a mango tree. Unfortunately mangoes are not currently in season in this part of the country.

View from my bedroom window. My bedroom itself consists of a bed, a chair, and a mosquito net. No dresser, closet, mirror, anything. I will admit that sleeping under a mosquito net makes me feel like something of a princess- you know those canopy beds little girls sometimes have. Yeah, I never had one of those, I had to wait almost 20 years and go to Africa to live like a princess.

My family consists of Mama Lucy, Baba John, and their three sons. As it happens, none of the three sons are in the house right now- two are at boarding school around Kisumu and the oldest studies medicine in California. This seems like a good time to mention that boarding school here really doesn't have the same connotation as it does in the U.S. It's about the same price as public school and has far higher educational standards, so many families send their children away for high school. We do have three high school aged boys in the house, however: a herdsboy who cares for the animals, a house help boy who also works in the garden a lot, and an orphan that Lucy and John took in.

Lucy is about the best host mother a person could ask for. She's very warm and welcoming and absolutely hilarious. She, like Margaret (my Nairobi mom) is on a mission to make me gain weight before I go home. She has hosted a number of other volunteers, both through MSID as well as clinicians traveling independently to volunteer at Matibabu. John is considerably more quiet and reserved.

My internship itself is at the Matibabu Foundation, a clinic and outreach center started in Ukwala through a donation by an American doctor but staffed almost exclusively by Kenyans (aside from the volunteers that come in shifts throughout the year). I will readily admit that my first day at the clinic was quite a challenge. I arrived early on Monday morning, ready to get really involved with patients and "make a difference". The first obstacle I encountered was a language barrier. While in Nairobi we all studied Kiswahili, but I am very much still a beginner. However, even the minimal Swahili speaking ability I gained is virtually useless because the predominant language spoken in this area is Luo, the "mother tongue" of this region based on traditional tribal lands. In the U.S. day one at a new job would typically consist of an extensive orientation and description of the job and the responsibilities. This is not the case in rural Kenya. The rest of the staff knew an American would be arriving, but they didn't know the specific date I would arrive, how long I'll be staying, or my background and skills. So, the first thing anybody said to me was "What will you do here?" Hmmm, I was just about to ask the same question.

Me at a local restaurant with my new boss, Dr. Fred. He's a great guy and a wonderful physician.

I expressed some of my basic interests and goals for my internship, then was handed a cooler full of vaccines and showed a line of children waiting to be immunized. Apparently the staff was under the impression that I was a fully qualified doctor, which I obviously am not. Over the course of that first morning I was also asked my opinion on the diagnosis of a patient that presented with "fatigue, weakness, and persistent cough". In this part of the world, those symptoms could mean a lot of different conditions. Eventually I settled in with the nurse filtering incoming patients and taking vital signs. That was easy enough, but I felt like I was just getting in the way because I constantly needed somebody standing over my shoulder to help interpret for those people who don't speak Swahili, or who had a hard time understanding my own broken Swahili. Eventually I made my way to the diagnostic lab. I was warned by the country director of Matibabu that Richard, the lab director, really wanted me to join the lab staff. I was less than enthusiastic- I've spent a lot of time in labs and was hoping to do more with direct patient contact. To my great surprise and delight, that was possible in the diagnostic lab at Matibabu. Patients come into the lab with test orders from the clinician, we conduct the tests while they wait, then send them back to the doc with their results in hand so they can be accurately diagnoses and given an appropriate course of treatment. The lab staff are fun to work with and spending time there has given me a good overview of the major disease burdens of the area, namely malaria and HIV. I do finger pricks for dozens of small children every day, and most of the malaria rapid tests come back positive. It's difficult to see such little kids so sick with a disease that is so easy to prevent. Unfortunately, a lot of the HIV tests are also positive. The lab here has very different standards to prevent contamination of surfaces and lab workers, but that's just not something I want to discuss.

Observing a stool sample in the diagnostic lab for the presence of pathogens.

Other than my work in the lab, I'm still aiding in a child immunization project and general maternal- child health initiatives. The work week is technically defined as Monday through Friday, 8-5 and Saturday 9-12, but if there are still patients waiting at the official end of the day, the entire staff stays as long as it takes to care for everybody without a single complaint uttered. People travel a good distance to receive care at Matibabu and it would be inhumane to turn them away after they waited in the hot sun for hours. The work is rewarding though often still frustrating because of what I perceive as a lack of organization, and when I come home at the end of the day I am always willing to take as many servings of Lucy's delicious food as she wants to serve me.

Parting shot: my back yard.

Thoughts on leaving Nairobi

Today is Friday, October 23 (Happy Mole Day everybody). I'm leaving for my internship in Ukwala at 5 am on Sunday morning. The last few days I've been thinking a lot about the upcoming move. All along, I sort of viewed the classroom phase here in Nairobi as a stopover in the bigger picture of my experience here in Kenya. Even before I left home I was a lot more excited for the internship segment. Now that the time to move has actually arrived, however, I have some mixed feelings about the entire situation. I am still unbelievably excited for what I'll be doing in Ukwala and I'm anxious to see another side of Kenya. But recently, Nairobi has become more appealing (or is it just less unappealing?) to me. This may be in part because of the arrival of the rains, which I mentioned in a previous post. For our first several weeks here in Kenya, everything was brown. One of my very first impressions of Nairobi was that the city was nothing but an expansive dusty brown wasteland. With just a few days of rain I've been amazed at how lush everything has become. I was on a bus home from the city center the other day and was completely taken aback by how pretty and green one of the big public parks was.

Another important thing: my host mother here is amazing. She and our houseguest, Rosemary (the divorced woman featured in a previous post) are so much fun to talk to. I finally feel comfortable sitting around and having long conversations with them and they've really helped me understand a lot about life in Kenya. When I first arrived at my homestay I was frustrated because I felt like nobody in the house ever wanted to interact with me. The most contact we ever had during the day was around the TV together after dinner. I've since learned how to take the initiative to form a relationship with my family and my efforts have paid off. On Wednesday night my mom took me to a bar in downtown Nairobi to see one of her favorite bands play traditional African music. The music was great but even better was the time spent with my host mom. She's something of a celebrity in the Nairobi music scene; she loves to go out dancing and a lot of the members of different bands know her by name and came up to greet us at the table where we were sitting. Oh, and it must be a cold day in hell because Emily Barker was the first one on the dance floor. Yep, my mom decided it was time to dance within ten minutes of the start of the performance. I tried to explain to her that I don't dance well and that I certainly don't dance when nobody else is, but she was having none of that. So we danced the night away, came home late and even though I was so tired I just wanted to collapse into bed, she made me eat some ndengu (a sort of lentil soup) before I could go to sleep. "I just want you to add so much weight before you go back to America" she explained to me.

Now might be a good time to mention that Kenyans express a lot of their feeling for a person through food. For the last week or so my mom has been sharing her love for me by making huge quantities of my favorite dishes. She always insists that I take about 40 times as much as the rest of the family combined. She claims to be concerned that my next host family won't feed me enough, so I figure she just wants me to eat enough this week to last the next month and half.

Today I had to run a few errands, so at the same time I said goodbye to my Jamhuri neighborhood. I've received a number of complaints (despite my earlier warning that I accept only positive comments) that there aren't enough pictures on this blog. Which may be fair considering there aren't any pictures. Let's see what I can do about that.

So here we have a variety of snapshots from my neighborhood and the area near my house. I walk around here everyday on my way to school, or downtown or anywhere really. Notice the dirt roads... it didn't rain yet today so walking was fine but when it gets muddy these roads become very chaotic.

If you look in some of the pictures here you can see a good deal of garbage all around on the grass and in the gutters. Solid waste management is lacking in Nairobi, so people throw their garbage wherever they feel is convenient, then every few weeks somebody sort of rakes it into big piles to be burned. Unfortunately this makes the whole neighborhood smell pretty awful.

After living in this neighborhood for an seven weeks I really feel at home here. I think it will be interesting to see how my perspective on this area changes after I return from my internship. My host mom told me I have to spend at least a few days with her before I'm allowed to travel when we all come back to Nairobi in December, so at least I know I'm not saying goodbye forever this weekend. I should mention that besides my human neighbors, I share the roads with the herds of cows the Maasai bring into town to graze. The most important thing to remember when you're walking along and you see a herd of cattle: the cows have the right of way, always.

A Day in the Life

I’ve been here long enough that I should have done a post like this a lot earlier, but I’m on Kenya time now. So my average day starts around 5 am. I don’t have to wake up until 7 for school, but the compound that my house is in has three other houses. There are twenty Sudanese refugees living in the three bedroom house above mine, so there is somebody awake up there at pretty much every hour of the day. So anyway, around 5 a.m. one of the kids starts screaming or banging around, which sets off a domino effect of adults yelling at the kid, then other kids waking up and getting in on the screaming. I roll around and try to sleep a little more, even though experience tells me this will fail. The roosters that live on the street outside my house start crowing and by that point there’s no more delaying the inevitable. I get up and read or check my email or watch the morning news. I do not bathe, but more about that later. I greet the friendly family of cockroaches that live in my wardrobe as I get dressed. By a little after 7, my house help has breakfast out for me. Breakfast is white bread and jam, sometimes a banana, sometimes leftover chapati from the night before, and always tea. “Every time is tea time in Kenya”. It’s true, they’re not kidding. On the subject of tea, or chai as it is called in Kiswahili- it’s different from tea in the U.S. It’s always made with milk (always whole milk) and is spicier than tea in the US but it’s hard to explain.

I meet the five other girls that live in the Jamhuri neighborhood of Nairobi at a kiosk down the road from my house by 7:30. Within ten minutes or so my friend Emily is there. She’s supposed to be there at 7:30 just like the rest of us but never is. Then we set off for school. It’s about a 45 minute walk to African Nazarene University, where our classes are held. The first few minutes of the walk are enjoyable enough, but then we reach Ngong Road, which is the busy road we have to walk along for most of our journey. Kenyans haven’t though of sidewalks yet so we walk along the dirt paths on either side of the road with the other pedestrians. We get our daily recommended value of diesel exhaust within the first 12 steps or so. You know that one driver in the US that cuts everybody off and practically kills six different people and then gets irritated and acts like it’s everybody else’s fault? Yep, that’s every single driver in Nairobi. Just in case things get dull on the walk to school, there’s always the morning matatu accident or public brawl over matatu fare to keep things interesting.

We arrive at school and attend classes, which are typically interesting and engaging in a way nothing I’ve ever studied in the US has been. I think it helps that all the staff is Kenyan so we’re exposed to a biased but also insightful perspective of issues in East Africa and the developing world in general. At 10:30 there’s a tea break, of course, any time is tea time. Never forget that. Tea time is intended to last 15 minutes, so usually by 11 or 11:15 we’re back in class. Kenyan time is very lose and there’s really no point in ever scheduling something to happen at a specific time because it just doesn’t work that way here. Things begin once everybody is present and comfortable and has a belly full of tea. Lunch is at 12:45 (ish) and I usually order the delicious food that is catered right to school by the wife of one of our advisors, Simon. If not I go directly against the advice of program administrators and eat a 50 cent meal at a roadside food stand. I can’t even begin to speculate about how much nice new fauna is probably settling into my stomach.

After school gets done at 3:30 I usually go play soccer at the Jamhuri field or head over to the MSID office a few blocks away from Nazarene to study. The office features a nice library with some recent books but most of the literature is older than, well, me. Off-topic point: I am the youngest one on this trip and I get crap for it on a daily basis, which is fine. Anyway, by 6 or 6:30 I head home because I have to be in by dark, rules of my host mother and strongly suggested by the program anyway. Besides, there’s 6:00 tea to be had. Most days a friend or relative of my host family is over for tea, but the Kenyan tradition is to not fill me in at ALL regarding who’s in the house, so I make polite conversation with people I don’t know at all and usually just remain in the dark. The other morning, I was pouring my tea when I woman I’ve never seen before in my life walked out of one of the bedrooms, grabbed my by the hips, kissed me, and had some tea herself. I still have no idea who she was, but that sort of thing doesn’t even warrant consideration on my part anymore.

By about 8 most nights we eat dinner and watch a good deal of stupid TV. There are badly translated Spanish telenovelas, strange Nigerian movies, and Japanese dramas that I just don’t get. My personal favorite program here was Tusker Project Fame (season 3), which is like American Idol but so much better because it’s Kenyan and, at least at the beginning of the season, none of the contestants were remotely talented. My personal favorite performer, Alpha, won the season. Actually, the prizes for winning sort of intrigued me. Aside from a 5 million shilling cash prize (somewhere around $65000) and a recording contract, Alpha won health insurance and internet access for one year. I realize there’s a big push for universal health insurance in the US but the concept is practically nonexistent here. And internet is expensive and hard to come by. It seems to me these prizes actually have the capacity to really change the winner’s life.

After I can’t possibly watch any more television, it’s bathing time. This is a stressful part of my daily routine. Until a week ago, I came home from school brown every day because I was covered in dirt. Now I come home a darker shade of brown because I’m covered in mud. If there’s water for a shower, I’m thrilled. If there’s HOT water for a shower I practically start crying. If, however, it’s a normal day, my house help heats a few liters of water for me so I can bath out of a plastic tub. There exists a logistical issue regarding this kind of bathing. I have to conduct a sort of triage to assess what parts of my body most need cleaning on each particular day because the water will not be nearly clean enough to wash everywhere. The minute my hands go into the water it becomes cloudy. If it happens to be a hair washing day, I dunk my head in and the water is no longer transparent. You get the picture. I’m lucky that my house help likes me enough to warm the water though, a good number of other students get their bucket bath ice cold. I realized I’ve mentioned house help here a few times and there’s so much more to say about that topic that I’ll have to make it a separate post.

By the time that’s all done I’m exhausted so I do a little homework and go to bed. After I say goodnight to my cockroach friends, of course. I fall asleep to the sounds of the people in the house above me banging around some more.

That was long. If any of you actually read the whole thing, I’ll be impressed at your commitment. I welcome comments or praise but certainly not criticism.

Mefloquine Dreams

So obviously living in a country where malaria is one of the top five causes of morbidity and mortality, I have been doing well to follow my doctor- prescribed course of preventative antimalarial prophylaxis. My doctor prescribed Mefloquine to me, which is one of a number of drugs available for prevention of malaria. As it was explained to me, I was put on Mefloquine rather than any other drug because some are known to cause heightened photosensitivity, which would be a serious problem because I am both very near the equator and at a much higher altitude than I was in Wisconsin, so the sun is a good deal more intense. There is also a good deal of drug resistance, but apparently malaria in Kenya is still sensitive to Mefloquine. I also only have to take it once a week, so I had to carry a lot less pills than the once- a- day doxycycline folks. It seems as there were a number of compelling reasons to go for Mefloquine and to be honest my doctor didn’t really discuss any options with me, just handed me a prescription.
Here’s what they didn’t explain to me and what I probably should have realized before I departed: Mefloquine, according to the FDA, has an impressive list of side effects including “severe depression, anxiety, paranoia, aggression, nightmares, vivid dreams, insomnia, seizures, birth defects, peripheral motor-sensory neuropathy,vestibular (balance) damage and central nervous system problems”. None of those actually seem to desirable to me. I haven’t had any issues with my balance so far and I’m no more anxious than you all know I’ve always been, but let me tell you the vivid dream thing has happened to everybody here that‘s on Mefloquine. When you think of vivid dreams you probably think maybe a particularly intense dream once in a while, the kind where you still remember a lot of the details when you wake up. This is not the case. Sometimes it’s hard to tell dream from reality because there’s a very seamless transition from dream to waking and I’ll often remember word- for- word the conversations I had in dreams, or they’ll be really pertinent to what’s going on in my daily life.

So far I’ve been lucky because none of the dreams have actually been that unsettling, just strange. But there have been a lot of cases in which Peace Corps volunteers get sent home before the end of their contracts because they can no longer distinguish dream from reality or they experience serious mood issues. Oh, and get this: in the 1990’s there was an issue called the Somalia Affair. A Somali citizen was murdered while in the custody of peacekeeping troops from Canada. Mefloquine toxicity was implicated in the incident. Cases of this severity are few and far between and I plan on returning to the US with my sanity mostly intact, however.

It’s frustrating to be in a situation in which we’re constantly reminded about the dangers of living in Nairobi, or where we see cases of extreme poverty every day, and to have some stupid medication creating heightened feelings of “paranoia and depression”. It also really puts things in perspective, because as I dwell on disturbing, or even comical, dreams, there are thousands of people around the country that have no access to antimalarials. Or they get a drug to treat an existing case of malaria, but instead of one person in a household taking a full course of treatment, all five people that are sick in the house each take a day or two worth of medicine, so nobody recovers.

In related news, this may seem like a Debbie Downer post, but I am in fact still having a wonderful time here, I’m glad to be here and looking forward to helping at the clinic I’ll be working at even if my contribution is almost insignificantly minute. There’s a lot to take in every day and always a lot to think about.

A preview of things to come

Today at school, we had our last formal International Development class, wrapping up Professor Jama’s material in the academic portion of the MSID program. The rest of the school day was dedicated to briefing us on our last week in Nairobi and what to expect at our internships. Basically, next week we will have one more guest lecture on ethno-musicology, regular class on Monday, Tuesday no school because it’s a public holiday (there are a LOT of those here), Wednesday we have our Kiswahili final exam, then Thursday and Friday we have off to pack for our internships and work on our term papers for our other classes. I have a lot of work to do there, but we won’t talk about that for now….
For our internships, we are basically clustered in four different parts of Kenya. There will be a group in or near Mombasa on the coast, a group around Mt. Kenya in the cities of Meru or Embu, a few who will remain in Nairobi, and a group of us that will be in or near Kisumu in western Kenya. We are grouped this way primarily because it is logistically practical to have all of us in a few central areas, and also so that in the case of a national security issue, we are all either near international airports or could be removed from the country by crossing the border (ie into Tanzania or Uganda). But that is the sort of discussion that makes people very nervous, and the program has only had to evacuate students once in the past, following the 2007 presidential election. We were told that we have no reason to be worried about evacuation, but that Jama is a warden of the US Embassy here in Nairobi, so we will be among the first to know if any concerns should arise.
My internship will be in Ukwala, which I am told is a very, very small town in a very, very rural part of Kenya’s Nyanza Province, near Lake Victoria and the Ugandan border. Ukwala is about three or four hours from Kisumu, so my placement is actually about as remote as possible. Though I am considered part of the Kisumu group, I will be largely on my own. This is something that is both incredibly exciting for me but also makes me a little anxious. We will be at our internships for six weeks, and we’ll live with another host family for that period of time. I can’t think of another time in my life when I have been completely isolated from people I know for six weeks. However, my advisor Jane told me that my host family is wonderful and I’ll have a lot of opportunities to get really involved with my internship.
I will be working for the Matibabu Foundation providing health serviced to the rural poor in that area. I am lucky in that they are really letting me take charge of what I do for my time there. The organization focuses on women and children’s health, so I’ll likely work primarily in a maternal- child health initiative, a pediatric de- worming project, and HIV/ AIDS nutritional support and outreach. More details to follow once I actually start!!