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2013: Jigger Outreach in Kenya

MMK’s trip this year was OUTSTANDING!!!! It was full of surprises- laughter, joy, sadness and occasional tears here and there. The team was diverse and from many professional fields. This was not your typical Nurses/Doctors combo medical mission. We had a Pharmacist, pharmacy students, Data Analysts/administration, Social worker, oh and even our own Camera man. Our group was made of two Canadians (Dr Martha and Greg), three New Yorkers (Chris, Megan and Michael), joined by Dr Alfred Saigero, our Kenyan MMK MD, and a whooping 9 of us from UCLA (Stefani, Lauren, Cassie, Sherrie, Lexy, Nadia, Fred, Mark and ME), Go BRUINS!!!

Heather Hasson from Figs Scrubs donated these amazing and very comfortable scrubs for all our team members that everybody loved. From the very beginning; there was some excitement in the air, like everyone was spreading their arms ready for the adventure, ready to embrace Africa, ready for the unknown. Everyone was so enthusiastic about the trip and couldn’t wait to get started. I had a different itinerary this time and was going to venture into remote territories that I had never been before and I was a little nervous of the unknown.

Hamomi Children’s Center was our first stop, a children’s school catering for mostly AIDS orphans and poverty stricken vulnerable children outside of Kawangware slums. Who could resist these beautiful angels smiles? We dewormed them and brought some goodies like toothbrushes and toothpastes, probably their very first toothbrush. Most of these kids are being raised up by single mothers, grandmothers, aunties or other relatives, having being impacted by the deadly AIDS phenomenon that continues to sweep across Africa like a storm. Most of the women in these slums acquire HIV, not as a result of their individual high risk behavior, but as a result of their partner’s sexual behaviors that are exacerbated by alcoholism; a major consequence of poverty in this high risk environment. Talk about social injustice?

Unlike the West, women in Africa are usually placed at risk of contracting the HIV virus when they get into a monogamous relationship or get married. The economic disparity which is worse on women who are faced by unequal power relations and domestic violence, further places them in a very vulnerable position where they can not negotiate for safer sex from their partners. Their husbands engage openly in infidelity, tolerated by the society with the girlfriends dubbed “mpango wa kado”, a swahili word which means “a sidekick plan” It’s a culture of silence; where women are fully aware that their spouses are having extra marital affairs, and yet they are afraid to confront them due to fear of domestic violence. Indeed domestic violence is entwined with HIV vulnerability, while poverty, delayed testing, delayed HIV treatment and lack of health care access results in poor outcomes. Hence, there are too many young children left without parents and are being raised by relatives. But watching the kids laugh and play, completely oblivious of the disadvantaged life they are predisposed to, completely warmed our hearts.

We made a pit stop to Kenyatta National Hospital, the oldest and largest hospital in Kenya. KNH is a public referral hospital for the Ministry of Health. Here the team distributed brand new text books to the School of Medicine donated by Valerie Walker of UCLA Global Medical Libraries, formerly Operation Medical Libraries.

We were also ecstatic about working with Michelle Kiprop, a UCLA alumni that operates a clinic in a village outside of Eldoret. Michelle had invited us for a jigger outreach in a community of Turbo. This community had suffered unimaginable sufferings during the 2007 disputed presidential election related violence explosions that killed hundreds of innocent people and displaced thousands. This is the place where women and children were burnt alive that had sought refuge in a church which was set ablaze. Some of the community leaders shared their horror stories with us, like this man who lost his wife and first son during the violence. There was a lot of pain, a lot of grief, a lot of indescribable trauma; but there was no bitterness, no harboring resentment. The community had risen above that with a lot of resilience and strength that you can only find in Africa. So I haven’t exactly extracted a jigger or seen one since I was a little gal. Matter of fact, I have been infested by a jigger myself and I do remember extracting jiggers from my siblings and from my late dear grandma so I am pretty familiar with jiggers/chiggers. But I was aware this was something my team of volunteers had never experienced before.

“Jiggers/Chiggers” are tiny parasites that thrive in poor, unhygienic conditions mostly seen in dirty and dusty surfaces, that imbeds themselves to a human’s skin usually on the feet or toes and causing pain and suffering to the infested patient. They affect the person’s ability to walk and function, are detrimental to the overall health and can cause systemic infection (sepsis), and even death. Yeah, I was shocked too. Infested children bring the parasite to schools, infecting other children and spreading the jiggers throughout the community. There is a stigma associated with jiggers and the infected person is mercilessly mocked, teased and isolated by their peers.

Michelle had requested for scalpels, needles, forceps, pickups and knives for extraction, basins and dettol (antiseptic for pre-treatment soaking), spirit/alcohol, antibiotic ointment for post treatment, and gauze with tapes. I quickly pointed out that the only way I know how to remove a jigger is with a needle or safety pin, (the African way). So I improvised my tools and obtained 10cc syringes with 18 gauge needles. Armed with needles and syringes acting as my lever, I was ready to fight the jiggers. But nothing prepared me for what we encountered. Little babies about a year old infested with jiggers with toes that were necrotic. Adults that had jiggers spread all over their feet, shins, hips, hands all the way to their elbows. It was devastating and most of my team were tearing up. I even got to extract a live jigger parasite.

Every mission I encounter patients that leave an impact in my life. And in Turbo, it was this little gal who must have been a little over a year, who was infested with jiggers to the point of necrosis. She cried and cried as I courageously tried to extract them. She had multiple of them and with each open hole, she was shrieking loudly and it was just too unbearable. When I finally finished the first foot, I sighed, more with sadness than relief. But when I looked at the second foot which was equally infested with multiple jiggers, I couldn’t do it anymore and had to ask Michelle’s local clinicians, who were jiggers experts (yes, they do have jigger experts), for assistance.

There were other sad cases, like looking at an elderly man infested with jiggers all the way from the feet to the knees, shin, ankles, hands and elbows. But my team was brave and were able to pull up to the task and did exceptionally well in performing procedures they have never performed or witnessed before. Mark, an Orthopedics expert had to treat this man who came in with a huge non-healing probably diabetic ulcer that was like a huge crater around the shin by performing an I & D (Incision & Drainage) on the spot.

He also extracted this little boy with multiple jiggers while Lex comforted the boy, who cried and cried throughout the ordeal. And you could just see Mark, tearing up through the whole time, but never skipping a beat or allowing his emotions to be seen. Martha was a pro, and we kinda gave her the hard cases because we knew she could handle it. At the end, it was a great experience, knowing that through inflicting unimaginable pain, we have extracted parasites that were affecting the patients’ quality of life and thus improved their health. Most importantly, we hoped that by watching us, the locals will learn to extract the jiggers, discern the stigma associated with jiggers infected persons, and continue to support and remove each other’s jiggers.

Nakupenda Shompole….. Our next location was in a remote community in South Western Kenya near the Nguruman escarpment called Shompole and the neighboring community of Entasopia. Shompole lies on the edge of the Great Rift Valley on the side of the Nguruman escarpment entrapped between two alkaline lakes, Lake Magadi of Kenya to the north and Lake Natron of Tanzania to the south. The main source of water is the Ewaso Ng’iro (Brown River), which originates in the Mau forest to the north and flows into Lake Natron of Tanzania. (The Ewaso Ngi’ro’s water is permanently brown; thus the name brown river). The only way to get to Shompole is by taking a road from Nairobi to Lake Magadi where the road ends; literally. There were no more identifiable or marked roads from Lake Magadi to Shompole. We somehow found a way to make our vehicle pass through the desert’s rough terrains, going in circles across valleys and valleys of dusty roads, until about three hours later and having been shoved up and down by the rough driving, we finally arrived at Stopover hotel hungry and exhausted. The drive was painfully exhausting, my boobs that were by now engorged due to lack of nursing were swollen and painful, and each bump made my boobs move up and down; a movement which came with excruciating pain that I had to bite my tongue to stop myself from screaming. But if I thought I had it bad, all I had to do is look across at Greg, who was having an equally hard time. Unaccustomed to the Kenyan driving in invisible roads at breath taking speeds, he had to keep reminding the driver to “pole pole”, which means slow down.

We couldn’t have wished for a more remote and isolated area than this. This was the junglest of the jungle, hands down!

A couple of weeks before we were to depart to Kenya, the clinical officer in Shompole called Anthony Ndegwa, who runs the Shompole dispensary called and said he had some very bad news. The hotel we were booked called Oloika lodge had somehow been blown away; gone with the winds, just like that. My mind was racing, how do I plan another location in such short notice? I had already emailed the itinerary to my team, and now I will have to tell them we can’t go to this one place because the hotel was blown away? I kept asking Anthony to look for an alternative hotel. Surely there has to be some other hotel close by that we can stay…right? The challenge of travelling to remote places for medical missions is finding decent accommodations. Nobody goes to these locations so why should I expect a hotel business in the places I choose? But Shompole was an exception. There was one luxury $150/night per person hotel on top of Ngurumani escarpments called Shompole Loisiijo lodge, and the $150 rate does not include the park fees required to get access through the gate for the hotel was inside the conservation park. It was too expensive, it didn’t make sense. Even though there is Conservancy park and wildlife, this was no Maasai Mara where hotel prices are in this price range. This place was too remote. Who goes up there anyway? I later came to find out that Bill Gates and other celebrities stay in that hotel while in Kenya, gets there via helicopter of course, and choose the hotel because of its discreet and quiet location. And I can see why they would come here; it’s like having a whole game park to yourself when you are in the lodge since there are no other hotels close by so you are pretty much guaranteed privacy. Angelina Jolie and Brad Pitt should have come here instead of going to Diani beach Mombasa, where they were first photographed together as a couple in April 2005, resulting in insane media coverage. Well, Anthony called me a couple of days later and said he had found a “great hotel”, with spacious rooms and with “all my requirements” of bathroom inside the room (not outside in the bush), hot showers, mosquito nets, quiet environment, and a hotel that will provide catering for our meals. I was ecstatic. All will be well after all, I sighed in relief…..Oh how wrong I was! Our guide Ben met us in Lake Magadi “to show us the way” to Shompole. Remember, there are no identifiable roads so we need a local to help us maneuver our 3 vehicles through the bushes safely. We felt like we were driving for hours through the same sceneries of dusty terrains in and around the massive desert. When we enquired how far away we were, Ben repeatedly assured us that “it is just here", “seriously, almost there”. Except that “just here” ended up being more than three hours away. That phrase became a huge joke between the team as it dawned on us that the locals really have no concept of distance in relation to time. The locals including 6 year olds walk everyone and for miles. And in order to make it through the long journeys, they have to convince themselves that the destination “is just here”. Classic! There were no other motor vehicles in this area; we were sharing the desert with wild animals so it was nice to occasionally interrupt a baboon meeting that Ben told us happens in the middle of our path everyday at 3pm. And where else can you see zebras, monkeys, antelopes, warthogs, wildebeests, giraffes and other random animals, on your way to work? Nice!

The dust in Shompole was overwhelming. There were clouds and clouds of dust, worse when one of our vehicles was ahead of us. I didn’t know which was worse, sucking a mouthful of pure diesel fumes from a belching vehicle’s exhaust pipe in Nairobi or choking through the films of dust coming our way from the van ahead. But if I thought this was bad, all I had to do is look outside the window to see the little Maasai boys grazing herds and herds of cows that were just swallowed by the dust. The long and painful journey gives an impression of isolation and neglect, a text book example of Kenya’s wide economic disparity. Shompole was a poor community with unimaginable poverty, where everyday the residents will wake up early and start the never ending tasks of looking for water, firewood and/or food. Indeed, I have never witnessed poverty like this before in my life. Even their manyattas (huts) were poorly made and almost falling apart.

And then we arrived; Stopover hotel. I won’t get into much details but the hotel turned out to be a huge disappointment. They did not have enough rooms after all and had arranged for my team to split between two locations across two rivers about 30 kms away from each other. When we arrived, the owner assured me that the other rooms we were booked into were just “here behind”. Behind turned out to be 30 kms away. At the end, we all decided it will not be worth the drive to the other hotel and we squeezed into the rooms available.

This is the place where we encountered some serious bug attacks. Our first night, there were so many random bugs that I stayed awake afraid to close my eyes. I used my little head lamp from the jigger outreach since the generator had been switched off at 11pm, fighting a loosing battle. I finally got out of my room to borrow some Deet from Lovely Lex who was next door to my room. The whole time I kept thinking; if this is bad for me, how about my team who have never ever been in the jungle before? It was a vicious cycle, I would get out of the bed and sweep the buys away using a hotel towel, (don’t worry, I had my own towel), until the bed was clear for me to get in. But about ten minutes later, the bed was swimming with bugs and I had to get out again and start sweeping them out. I had had it. I couldn’t take it anymore. What was the name of the expensive hotel up the hills again? Thank God for google. I found their website and couldn't wait to wake up so I can call the hotel. I was willing to pay whatever it will cost. I started calling at 5am, no answer. I called and called repeatedly trying all the listed numbers. By 6.30am, a woman called me back. She works in the hotel and had got my many messages. I was thrilled. I introduced myself and said I had a team of 18 with me and we needed rooms today. I was happy to have someone answer me and I went on and on about how I couldn’t sleep because of bugs at the stopover hotel, and I can’t stay another night here; pretty much begging her to accommodate us even though its short notice ..….and blah blah blah. Surely, Bill Gates can't book the whole hotel if he was in town?

There was silence on the other end. as she politely listened to my outbursts, without once interrupting me. And then the answer came. The hotel was closed for renovations after being destroyed by the flood storm a month before we got there. I could hardly believe what I was hearing. Something is seriously wrong with this place. First it was the winds and now floods? So was there any other hotel she can recommend? Negative, there were no other hotels in the area. We were stuck at Stopover hotel. What is wrong with Shompole? The hotel we were initially booked was blown away by the wind and now this fancy and expensive hotel was damaged by the storm? Unbelievable!

My team was outstanding despite the challenges resulting in great outcomes and benefits to a much neglected community of Shompole stricken by poverty. We had an interesting triage. Where else do you have a patient coming with a chief complain of “my leg has been bothering me since I was stepped on by a giraffe?’ or “I was hit by a donkey?” There were many moments like that where we would look at each other and go “huh, what?” just to make sure we heard the patient right.

Others, not so funny; like this young boy about 15 y/o who presented to me with tremors and tachycardia of 130’s-140’s. He had a low grade fever, was diaphoretic and very fidgety. And am looking at him wondering whether he was just dehydrated with the blazing heat, or have an underlying heart disease, or was just septic. I kept thinking that he was going to code right in front of my eyes. After assessing him for a few more minutes and getting the same findings, the nurse in me escalated him to Mark who was quickly able to determine that the boy was high on drugs. I felt like a fool. I did not notice his dilated eyeballs. But my attention was quickly drawn to this pregnant 13 y/o girl who was laboring while we were there and we all thought Dr Martha will deliver the baby. This poor little gal was having active strong contractions and she never once cried out in pain or showed any emotion at all and had no pain medications. She had no clue what to expect of labor. She wouldn’t let Martha assess her because she thought Martha was “going to insert her whole hand inside of her uterus and yunk the baby out”. Martha quickly determined that she was hardly dilated and her labor was not progressing as expected. In the US, she would have had a C-section right away but this is the jungle. We were all so very worried and with good reasons. The statistics of maternal related deaths and injuries are outrageous, 1 in every 6 women in developing countries. According to WHO’s Women and Health reports, complications of pregnancy and childbirth are the leading cause of death for girls between the ages of 15 to 19 years old in developing countries. If this young girl even had some sort of complication, the delay in transportation to a higher level of care would be disastrous to her outcome, a delay directly related to Kenya’s poor infrastructure in this region and lack of transportation. At the end of the day, she did not progress and all we could do is pray for her. She is the girl in the blue “shuka wrap” in the picture below, lying down on the floor “waiting it out”. Good news is, after a very difficult labor, she delivered a healthy baby boy delivered by Anthony after we left.

And then there was this infant who must have been around 7 months old and was probably born under-weight and premature who was lethargic and unresponsive. He had a severe eye infection and there was pus around his eye lashes. I rushed him again to Mark who determined that the baby was just malnourished. I tried to have the mom breast feed the baby but he was too lethargic to latch on the nipple. I felt so helpless. Here is a baby that clearly could die due to lack of nutrition and it’s not like I could rush to the store and buy some formula. My baby was around the same age at the time and I was exclusively breastfeeding him. I had bought a can of formula in the event that the babysitter would run out of my breast milk while I was out on the mission. So I have a can of formula back in Nairobi which will probably not get used but this baby has nothing. I wanted to take this baby back home with me and held him into my arms a little longer overwhelmed with emotion.

Chris the pharmacist gave the mom cipro ointment for the eye infection and then loaded the baby with infant vitamins syrups. Then Chris suggested that I pump and donate my breast milk to the baby so when the mom said okay, I pumped furiously that night. Unfortunately we ended up going to Entasopia the second day, not Shompole where I had asked the baby’s mom to come. But around 5pm, almost at the end of our second work day there, I felt a tap on my shoulder. I turned and there she was.

She informed me that she woke up early and went to Shompole and waited and waited, until she saw some people coming from our clinic who told her where we were and then she came. Can you even imagine how many miles she had walked to get to us? Over a 100 miles, with a baby latched to her back. And the wonders of medicine, today the baby was responsive and he could open his eyes. I was thrilled to give the mom my milk but most important, I encouraged her to eat well and continue breastfeeding her baby. Anthony reports that the baby is now thriving.

Our days in Shompole were long and weary. The environment was very harsh to say the least. It was scorching hot and yet we couldn’t drink too much fluids since there were no bathrooms at our pop-up clinic so we only drank just enough to not get dehydrated. We fluid resuscitated in the evenings. The hot temperatures were worse on Greg (Canadian), who was sweating profusely while Ben our guide was shocked because he was still cold and wearing a sweater. He kept saying how cold it was and was telling us how his mom was bundled up with heavy sweaters because “it was too cold”. He cautioned Greg that if he were to pass out in Shompole, he would wake up in a hospital bed. Apparently, Maasai people wouldn’t understand why he is sweating so much when it is “so cold” so they would assume he is sick and would carry him to the hospital. Ha! I don’t think Greg wanted to take a nap in public after that story. On our last day in Shompole, the locals jumped into a maasai dance to show their appreciation. This was totally unexpected and took us by surprise. Some of my crew joined into the dance with the locals. It was so beautiful. The women had beautiful smiles and gyrated their beautiful ornaments and necklaces up and down as they danced and the men jumped away. Michael and Megan danced along to the beats.

The Maasai’s are great at dancing and everything is cerebrated with a dance. After the dance, Martha told me to tell Michael that he has just completed a marriage dance and now he is legally married to this elderly Maasai woman. And Michael was like, really? He turned to the woman and said, “what’s up wifey”? I was dying with laughter. Unfortunately, some of our volunteers got sick and I had to make a decision to leave the location a day earlier and head to Nairobi.

On our way back to the city, one of the vans ran out of gas. Urg! But our drivers are resourceful and drove with the Lexus to find gas. Michael and Kevin transported the gas with some water bottles. I doubt that would ever fly in the US. The Lexus, borrowed from my brother, broke down as well due to the hard terrain and the Shompole dust. I think he said I am not allowed to borrow it again but ofcourse that didn't hold.

While we were waiting for the gas, I looked outside the window to see Dr Mark Sugi surrounded by local Maasai men. Mark was showing them something in his MAC laptop. I just smiled and teared up. You do not need a translator to enjoy and share your company with others. Compassion and love needs no language.

Back in Nairobi, the group was tired, drained and a little….dehydrated. We ended up doing another outreach in Kawangware slums, without any pre-arrangement, since we left Shompole a day earlier than scheduled. Kawangware is a slum outside Nairobi, near where we had visited Hamomi children’s home earlier during our trip. Since this outreach was in the city, in a slum; I had to hire armed security “muscle” from the police for a fee. We arrived at the assigned spot and even before we were finished setting up, the masses were lined up waiting to be seen. The majority of them are mostly women and children. Nothing calls for an instant crowd than a group of Mzungus (white people), in a slum. It almost felt like everybody showed up instantly. We were overwhelmed and felt the pressure to work faster just to keep the lines moving. Our drivers somehow got the cue of the urgency and came over to assist us with translation and keeping the crowds in line.

This crowd was different. Unlike the Nomadic communities where most patients suffer from mostly infectious and parasitic diseases, here we found a lot of sexually transmitted diseases and lifestyle chronic diseases like hypertension and Diabetes. I must admit I was amazed at the needs in this community. I have always felt that since Kenyatta hospital is in Nairobi, my outreach locations need to be held where people have no access. But we found some very very sick people here who needed immediate attention, yet they are 15 kilometers from the city center. Is it because they just couldn’t afford to pay for a visit at Kenyatta? Poverty is debilitating and the evidence was here. There were others who came over just because their prescriptions had run out and were happy to receive free medications for another month or two.

Education education!!!, Fred was amazing in teaching the locals of how to prevent lifestyle diseases and/or manage them. I started getting worried when we were two hours over our closing time and the crowds kept increasing. I had to do something. I provided everyone who was present with our assessment form and informed the driver that we couldn’t see anyone else that will come after that. But that didn’t stop them; I was soon bombarded with pleas as people kept on coming. I only made exception for the mothers with sick children. I knew we wouldn’t be able to see everyone in this area and it was getting dark and the cops were getting impatient. I had kept them way past their time. Unbelievably, some of the people tried bribing me to get more forms. Oh Nairobians! Our trip to Maasai Mara was one of the most successful safari and best adventures I have ever had. Although we had to balance work and fun, game drives in early morning, outreach during the day, then an evening game drive, and outreach before dinner at the hotel; the atmosphere was different. The Mara outreach was similar to Shompole, with the locals walking for miles to get a free health check up. It was a smooth outreach until this Maasai man came in and said he had Malaria. Ok, so we screened him for Malaria and he was negative.

He did not have any complains of Malaria symptoms but we screened him anyway. So we told him his blood test was negative for Malaria. He was not having it. He then blurted out, “I have Syphilis”. Gasp! We all looked at each other and directed him to Martha and Alfred. So Martha quickly determined that he had no symptoms of shingles and Alfred translated that. Then not to be beaten, he said he had brucellosis. And when that was ruled out, he named every disease in the books, from Typhoid, Gonorrhea, Kwashiokor…..and Alfred was just cracking up. Evidently, this man had over the years, learnt all these fancy names of diseases but clearly had no idea what they were otherwise he would have been a little embarrassed insisting he had syphilis or gonorrhea. He just wanted to get something for free and he felt he had to say he was sick. Alfred assured him of his wellness and set him on his merry way home. It was hilarious!

Kudos to our pharmacy team, led by Chris (Christine Kinney Randall), Michael, Megan and Lexy. They did an incredible job and provided great job aids and ideas for future MMK missions.

The girls, dubbed with the colorful Maasai shukas, also took the time to learn the Maasai jump. How high can you jump? Epic.....

Finally, my group had time to relax and enjoy the safari. And my, did we enjoy. Within 30 minutes of our first game drive, we saw a family of lions. How often does that happen? And it never stopped, luck was on our side. We were lucky to see the Big Five; the elephants, the lions, the buffalos, the rhinos and even the elusive leopard. I was especially happy for Fred who wanted to see a leopard on the last medical mission trip.

And now here come this young leopard that paraded around our vans, poised for the cameras, strutted its tail back and forth and literally did a whole show for us like he was on stage. It was such a treat that we all enjoyed. And when we saw a couple lion hugging and being affectionate, our hearts just melted. You see, deep inside, animals are just like us!

The group surprised me and bought me a ticket for an air balloon ride over the Mara. This was an expensive ticket, a $400 plus ticket, I was so overwhelmed that I cried. The experience was so surreal, being on the air, looking down at the animals spread out through the plains, an adventure I will never forget. We ended up having a bush breakfast in the middle of the Mara. And as if that morning adventure wasn’t good enough, I overheard the rangers talking on their radios regarding a lion that was out on the hunt for a buffalo.

But the rangers cautioned me against telling the tourists about the hunt since no one will want to finish their breakfast. I was like, you got to be kidding. They can have breakfast anytime anywhere in the world, but this might be their only opportunity to see a “kill’ in action. But I complied. I tried to hurry everyone back in the van without giving up the secret. And we got back just in time to see a badly half eaten animal that was freshly skinned with fresh blood still pouring out, the internal organs all visible. But the lion was gone by the time we got there. The half eaten animal was graphic especially for those not in medical fields, but luckily, we had already eaten our breakfast.

I was highly amused by Megan Monohan and Michael' Smith's obsession with the animals butts. While we were all trying to get the head shot, all they wanted is the butt. It was hysterical. I must admit they did a good compilation of Maasai Mara's best animals butts.

Back in Nairobi, we enjoyed the carnivore experience with the team; a must have for any foreigner. The exotic meats are irresistible. We all felt like a big family, sharing our experiences, sharing jokes and laughing at Lex eating oxi-balls, it was fun. Even my infant son Spence was smiling at all the happy faces around the big table. And even as I prepared to say goodbye to my team, I knew in my heart that each and every one of them will always be a part of my life, close to my heart; and I am forever thankful for their contribution to the Kenyan communities.

Notes by Millicent Mucheru, MMK Founder.

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