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.