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The MMK Summer 2014 Trip

It has taken me a while to write about our 2014 summer trip to Kenya. I will blame it on my now 2 year old son who will not let me sit down with my laptop. But I did not want 2014 to end without reflecting on the trip we had, cerebrate the amazing volunteers, and remember the wonderful Kenyan people that we encountered. Extra-ordinarie trip The Crew It was an extra-ordinary trip for many reasons. For starters, this trip had a group of repeat volunteers and almost all the nurses came from UCLA. The UCLA Nurses were Zoe Armas, Agnes Tan, Megan Bertrand, Tracy Stockstill, Monette Gomez, Kevin De Leon, Lexy Davidge and James Harkcom. The exception was Vanessa Whitney who came to us from UC San Diego. Dr Martha Ingles, her husband Greg Erikson, and Lexy Davidge were repeat volunteers and joined us for the second year in a row. It was such an honor to have them come back to Kenya again. The Canadians brought along their 18 year old niece Shakti Baker, the youngest MMK volunteer ever.

The locations We visited three different locations; Kimanjo hospital, Wamba village and Kiltamany village outside Samburu National game park. MMK was going back to Wamba village, one of the villages we had visited in 2011 and I was excited and couldn’t wait to go back to the area. Kimanjo hospital is run by our own MMK Kenyan Doctor Alfred Saigero. Since graduating from Nairobi University as an MD, Alfred worked for the government and was shuffled back and forth through the districts just like any other new doctor. Even though I personally speak to Alfred regularly, I couldn’t keep up with his whereabouts. Within a year, he had worked in three different hospitals, first in Embu, and then Meru and then Nyambene district hospital. It was in Nyambene that members of his Maasai community approached him and asked him to move back to his home town of Kimanjo and head the local hospital because they could not find anyone willing to work in the area.

The Missing Passport

But our trip did not start smoothly. On the day of departure, Zoe could not find her passport even after tearing her house apart. That morning, just as I was getting ready to finish packing my suitcases, Zoe called me in tears and my whole body just froze. She couldn’t find her passport and had to drive all the way to San Diego for a replacement and was hoping she will make it back in time before departure.

It was a heart wrenching phone call that left me paralyzed in the couch for hours after I hanged up the phone, completely incapable of focusing on anything else. I kept praying to God that she will make it back. I couldn’t even imagine the stress she was going through rushing through late afternoon traffic back to LA from San Diego to make it for our 6pm flight.

(Zoe Armas, on the left)

Ride to the Airport When Fred, an MMK volunteer and a good friend of my family came to take us to the airport, I couldn’t find my car keys to transfer my son’s car seat to his vehicle. I know this is not an excuse and I will get vilified for writing this but against my better judgment, I carried my son in my arms and got in the vehicle. After all, we were only a few minutes drive to LAX and we were going to Kenya and most people do not use car seats there opting instead hold their kids in their arms. Yeah, I know its not safe. But to my defense, I had an extra car seat in Nairobi that I left behind from last year’s trip…. We live very close to LAX so what could go wrong? Apparently everything. Just as we were getting into the airport and going through the police check point, one of the cops waved our vehicle down. We couldn’t believe it. In the US, having an unrestrained child in a moving vehicle is considered child endangerment and a very serious offense. We knew they will not let us leave the spot without a car seat which we didn’t have, and a huge ticket. There were two cops, one on the right and one on the left. Vanessa was next to me on the back seat wearing a volunteer T-shirt and my boy was nursing a storm on my arms. Fred just started mumbling something about how we were an organization going for volunteer work in Africa. The cop on my side kept looking at me saying repeatedly; “that child is unrestrained” as if he almost couldn’t believe what he was seeing. "That child is unrestrained"....I did not make eye contact and did not say a thing. What was I thinking? We are not in Kenya yet. Finally, the other cop on the right waved us away. We couldn’t believe they let us go, without even a ticket. Zoe made it to LAX from her frantic drive to San Diego and back with a new passport. But it was too late for her to board the flight. They had closed the counters downstairs and she couldn’t check in even though we were upstairs and had still not boarded. She called me from downstairs and said, “am here, but they will not let me come upstairs”. I felt sad knowing that she will take the long flight to Africa alone. She promised to find the next flight out of LA to Nairobi which cost her over a thousand dollars. JKIA arrival With all our pre-trip meetings, we somehow managed to forget to mention that the arrivals at the Nairobi airport can be an unpleasant ordeal going through immigration with the medications and medical supplies. We had since discovered the best thing is to just walk through the airport confidently and avoid staying in groups and lurking around, where you become an obvious target of scrutiny and sometimes harassment. And that is exactly the predicament the MMK group landed into. The troubles started brewing when Kevin was suspected of being with some two Asians who were already in trouble with the immigration officers. But a veteran with Kenyan systems, Lexy confidently walked straight out through the doors and nobody stopped her, but the rest of the group was just hanging around suspiciously near the exit when they were all summoned back and requested to open their suitcases and “declare their goods”. That’s when it all started going down. My damage control efforts were being thwarted because I couldn’t get the group together for each time I tried to get Kevin over, the immigration officer would insist that he has to stay with the Asians. How was I to divide myself to represent two groups with two different immigration officers who were already upset that we did not disclose we had the medications in the first place? We finally managed to convince the officer holding Kevin that he belongs with us not the Asians and we walked out of there unscathed with no bribes requested or offered. When we finally got outside, Lexy was waiting for us beaming and came rushing to give me a hug saying “It feels like am back home, am so glad to be back”. Kimanjo Hospital

As always the case with MMK’s outreach trips, the biggest challenge is getting the medications, the supplies, and the volunteers belongings to fit in our hired vans, well; plus the volunteers. But off we went to our first location, Kimanjo hospital. The hospital started as a dispensary or small clinic, the most basic level of formal healthcare facility in Kenya. Dispensaries are usually staffed with a community nurse an equivalent of an LVN in the US. But nearby Kimanjo dispensary, a beautiful resort, The Santuary of Ol Lentille, was built. The foreigners resort owners lobbied the government to upgrade the dispensary to a hospital. After all, what good is a 5-star resort if you cannot convince your high paying guests that if they get sick in the jungle there is a hospital a mile away? The resort was able to obtain donations for nice hospital equipment including hospital beds, had a solar electrical system installed, and even expanded the buildings. They even purchased an ambulance “for the hospital”. But the way it works is the ambulance is always at the resort, and not the hospital. The locals can call the resort and request for the ambulance but the community has to raise the money for the gas. I found it troubling and hypocritical that the ambulance is stationed for the guests at the resort instead of the hospital where there was need for transport. But again, the resort has to keep a certain appearance for their clientele…sigh!

Kimanjo hospital was the only health facility within a 90 kilometers radius, two hours from the nearest town of Nanyuki. From a distance, the hospital was eco-friendly and beautifully constructed. But when you walked inside, you quickly realized that this was a ghost facility. There were minimal supplies, the pharmacy shelves were all empty, the beds had no bedsheets or linens, and the place looked abandoned except the doctor’s office where there were tons of patient’s files, evidence that patients do walk through this hospital doors. After the building was completed in 2013, the government could not find a doctor willing to work there. It was then that the community approached Dr Alfred and begged him to come back and work there. Alfred wanted to help his community and was willing to come back, however, his supervisor would not approve his transfer, again, due to lack of a replacement. Alfred had to go over his supervisor’s head, all the way to the district, to get approval for transfer. He was finally back home where he belonged helping his own people. But his joy quickly turned into frustrations when he realized he had no supplies, no staff and sometimes not even a salary. At one time, he had to personally go all the way to Nanyuki district hospital to demand for the salary of the nurse and the security guy (watchman), when he realized that they had not been paid for months prior to his arrival and were threatening to quit. When someone got sick and needed to be transported to the hospital, he had to raise money first from the community so he can get the ambulance that was conveniently parked at the resort. In a community ridden with poverty related diseases, female genital mutilation, rape of young girls, agemates wife swapping practiced amongst the Maasai, high maternal and infants deaths, and high incidences of sexually transmitted diseases among the Morans, Alfred knew he had a lot of work ahead of him. Living in a community where women preferred to have babies at home instead of the hospital, he was on call 24/7 where the villagers would come wake him up in the middle of the night when birth related complications arose. Kimanjo outreach The harmony in this community was tangible. The faces of the patients had bright smiles, despite their difficulties and their illnesses.

Our first patient was a toddler with second degree burns who had accidentally sat on boiling water. In a community where emotions are always kept curbed, this kid did not once flinch. When the volunteers saw the burns, you could clearly see the pain and shock in their eyes but not on the kid. Dr Ingles quickly tended to the burns and did a follow up the next day. The most common cases we saw in the area were trichoma, upper respiratory infections, pneumonia, and other tropical diseases. There was a woman with a breast mass, that was most likely cancerous, and all Alfred could do was treat with zinc oxide barrier cream and antibiotic paste. There was a man that was seen by Martha with complains of chronic rib pain that he has had since “he got into a fight with a buffalo”. Say what? A buffalo? And you lived to tell the story? Martha had to fight hard to keep a straight face. Indeed this was one lucky man.

And this time around, MMK was prepared for malnutrition as we had tons of ready to drink formulas and pediatric shakes that really came in handy in these poor communities. There were lots of Morans coming in with STD’s, no surprise here. We were just happy to see that they were coming for treatment because they usually don’t. In a community where the natural habitat is shared by both people and animals in such close quarters, such confrontations are inevitable as the animals try to protect their tuff in the same environment. Indeed, the year before we came across a man in Shompole who had been stepped on by a giraffe. Such confrontations were echoed by many other patients who had reported various encounters with the animals. That night, we stayed in an eco-friendly open and unfinished resort in Lewasho, which Agnes and Monette dubbed their best accommodations ever. At night, we could hear the hyenas and the elephants pass close by the resort and there was really no fence dividing our resort and the animals. It was surreal. We had to take showers…bucket baths, in open space, delivered by the morans. How cool is that? The place was unbelievably nice. And the best part was the food. Our chef was one of the best cooks in the world, I kid you not, am yet to find someone who can cook that good. He is a renowned chef that has worked in many Kenyan resorts and served celebrities such as Bill Gates. The only reason he remembered Bill Gates was because he received a huge tip from Mr Gates.

The Visiting Journalists They say that a nation is judged by the way it cares for its most vulnerable citizens. But the Kenyan government seems more concerned of being judged by its tourism. On our second day, we came across a group of American journalists from different travel magazines who came from different states across the US. In an effort to promote tourism, the Kenyan government had invited these journalists as its guests and paid their expenses to come and explore the country. There were at least a dozen journalists who were just driving around in chauffeured vehicles enjoying the local safari hotspots and exploring the country in luxury. Naturally, they came over to see what we were doing in the area. As I watched their Jeep drive away through the showers of dust, I couldn’t help but ponder about misplaced priorities. I know that tourism is important, but couldn’t the government be better off using that money on the inadequate and lacking health infrastructure, saving the vulnerable communities where the majority could not even meet their basic needs? Before we left Kimanjo, we were able to donate solar lights to the locals that were donated to MMK by Unite to Light non-profit organization.

The goat Meat MMK group had hired a dentist for Kimanjo outreach from Nanyuki and as it turned out, half the patients had some dental issues. The dentist was kept pretty busy and he pulled over a hundred teeth within the first day. And we didn’t once ever hear a scream even though the dentist didn’t have any local anesthesia. On our second day in Wamba, we were all surprised when the community literally gave us a live goat as a token of appreciation. As we worked, they slaughtered and barbecued the goat meat under a tree, the African way, and called us for the feast. Most people are not used to such tastes except if you are Lexy. Lexy is always eager to try anything local and even drank the cow blood against my advice. Monette struggled to eat the goat meat but we all could see she did not like it but did not want to appear rude so she forced herself to chew.

Wamba Village. After the Kimanjo outreach, Alfred accompanied us to Wamba village. MMK had been to Wamba village in 2011 and I was excited to go back wondering if I will see the Samburu girls I fell in love with years ago. The girls had such a huge impact on me that I still use their photos as my personal and MMK facebook profile picture. What can I say? The Samburu girls are strikingly beautiful. We stayed in the same quarters on top of Wamba mountains and it almost felt like coming back home. This place is serene, so peaceful, and so far away from civilization, a place to get lost in nature. During our first night, we were all amused and relieved to learn that the pipe line that delivers water to our hotel had been stepped on by an elephant and there had not been water for days and the pipe had just been repaired prior to our arrival. Welcome to Wamba!!!

In a community that animals live closely with humans, such incidents were common. We had some people who would come to us begging to be given priority to see the doctor since they wanted to go home before the elephants started their journey home and others who lived seven hours away and had to start their journey back at noon otherwise they will not be able to get back home. Considering how fast the locals walk, I can’t even imagine for far of a distance they can cover in seven hours. There was lots of laughter too when we realized that everytime we wanted to huddle or had a discussion or a group photo, one of our volunteers James was always missing. So the question of the date was, “where is James”? Wamba Clinic Wamba is a unique location because it serves so many different tribes. Even though most of the locals are Samburu, there were plenty of Borana, Rendille, Maasai, Turkana, Pokot….and many other smaller tribes. I had a field day trying to guess what tribe our patients were from during triage and by the end of the first day, I swear I could guess with a 90% accuracy the tribes of our patients based on their distinct looks, dress code, hair dye, height etc….Can you guese what tribe this woman is from her onarments and features?

The outreach at Wamba was challenging and emotionally draining. The lines were long and it didn’t help that the “entitled Morans” kept trying to skip the lines to the front, up until James made them go back on line, making the locals look upon with disbelief and then some amusement. No one ever dares challenge the Morans in these communities, not unless, ofcourse if you are a mzungu who really doesn’t know the rules of the land. Within our first few hours, we noticed how rampant domestic violence was. Practiced for decades, it was written all over the women’s faces, yet so secretive and so tolerated. We had various rib pain complains from women who reported that the pain was from the chronic beating from their husbands.

Our first serious domestic case was this young woman who was about three months pregnant and had been bleeding throughout the night after a battering encounter with her older husband who kicked her straight in the stomach. In a language that sometimes did not need any translation, with tears and terror in her voice, she managed to demonstrate exactly how it happened when her husband pinned her to the wall, punched all over the face and kicked her stomach. Watching her talk to Martha through a translator and relieving the terror was like watching a very scary movie.

This young woman had been beaten up to a pulp. At some point, I broke down in tears and had to step out from the room for I didn’t want her to see me cry. To this date, I still tear up when I remember this young mother. As a woman who has experienced domestic abuse from a previous relationship in Kenya, this was too close to home for comfort. I rushed behind the building and openly wailed overcome with emotions I had forgotten were still buried inside of me. That girl was me, twenty years ago, terrified to go home to a hostile environment that I had no control of at the time.

When Martha assessed her, there was no heart beat and it appeared that the beating had caused incomplete abortion. She was still heavily bleeding during the exam and her heart rate was in the 160’s and her blood pressure was slowing dropping. Martha knew that she had to be taken to a hospital capable of providing IV hydration and a dilatation and curettage (D&C) for the incomplete abortion. The problem was, the patient had been around all day but was too afraid to come up and speak to anyone and finally mustered the strength to tell her story when it was almost sunset. When Martha told her that we have to take her to a different hospital in another location, she panicked. She had to go home to her children and to her abusive husband, otherwise he was going to kill her if she wasn’t home when he got back. I reasoned with her and literally told her quite truthfully that if she went back home she might not make it by morning. It was a tough situation. We totally got it. Her fear and apprehension was not unfounded and we knew she was going to be beaten up again. It was an ethical dilemma. Maybe this time he will beat her up to death and we are setting her up for it. She had three small children at home. If we let her go home, she might die of septic shock from blood loss or infection anyway. I told her that she will survive another beating, but she might not survive without treatment. After many negotiations, we arranged for her children to be taken in by a co-wife and she agreed to come with us to the hospital. She was admitted overnight and we picked her up again in the morning so she can head back home to her kids and ….to her abusive husband. Greg Erikson was also completely torn by the domestic violence and was seriously contemplating of taking the poor girl to Canada. It wasn’t that easy, she just couldn’t get a visa. Greg was heartbroken. Monette was thinking of a domestic violence shelter. This place needed one like yesterday.

Our first serious illness in Wamba was a lethargic toddler with high fevers above 102.F. He was severely sick and dehydrated and couldn’t keep anything down, not even breast milk. But as remote as Waba is, the hospital actually had intravenous Tylenol in stock which is what we needed to bring the fever down. We started an IV access on him and immediately started him on anti-Malaria drugs. Malaria was determined to be the most likely causative cause of his severe illness. We took turn monitoring the toddler all day long and by the next day he was turning around for the better. At one time, the poor kid pulled out his IV and we had to start the process all over again, with one of the volunteers finally making a makeshift arm board to prevent him from pulling out the IV.

The toddler’s mother stayed along while the husband was hovering nearby, not quite near them but never far apart. Just like the Maasai, the Samburu men are always a hundred meters away from their wives for they would rather be caught dead than walking hand in hand with their spouses. This man was almost 80 years old with missing teeth while his wife was in her twenties, the 5th wife. After spending some time with us, she later confided that her rib pain was due to frequent daily beatings from her husband as she removed the below the neck beautiful ornaments that were hiding ugly scars and multiple bruises and swelling, around her shoulders and her upper back. We almost fainted in horror. This was the tip of the iceberg for me. I couldn’t take it anymore. I immediately went to him while he was chatting with Wamba clinical officer and Alfred. All I could ask him is why; “why are you doing this to her?” I had some not very nice words for him where I challenged him to go find a lion or another man to fight him to prove his manhood. He thought I was crazy. In a community where men especially elders have all the power, I bet no woman has ever spoken to him like that. He just smirked at me which made me even more angrier. After our confrontation, the clinical officer started speaking to the man’s wife in the MAA language. I later learnt from Alfred that he warned the wife about sharing the communities’ secrets with “the Americans”. Even though at first it felt like a good idea to confront the old wife beater, I immediately was stricken with horror. What have I just done? I just signed her beating for the day. My outburst will cost her an even more enraged beating tonight. I knew it the moment I looked at her and saw her teary eyes filled with terror.

In the meantime, Zoey and Vanessa encountered Robert, the town hustler, who convinced one of the volunteers to give him a pair of shoes that he later sold for a few Kenyan shillings. Everywhere we went, Robert was there and we just couldn’t get rid of him. We also met a short elderly missionary from “gasp”, Los Angeles, who had lived in Wamba village for more than a decade and said she did not even own a car, she walked everywhere just like the locals. She spoke fluent Swahili and the local MAA language and seemed so at home in Wamba that LA seemed to her like another lifetime.

On our second clinic day in Wamba, we encountered Oreyia Lekurio who had walked for more than 60 miles away to our clinic with obstructed labor pains and uncontrollable vaginal bleed. A mother of 8 children with no control of her reproductive health, she confided to us that she did not want any more children but can not decline her husband (or his age mates), when they come knocking through her manyatta (traditional hut). She had been in labors for almost two days and only came to the clinic when she started bleeding. She looked dejected and crowned in painful abdominal pains. Her demeanor was quiet with dark pinned eyes that spoke of untold suffering. She looked older than her estimated age of 25 to 30.

Dr Alfred on assessment immediately determined that she was at least 38 weeks pregnant and had placenta abruptio and needed an ultrasound and probably a C-section in a HOSPITAL. She was hypotensive at 70′s systolic as a result of the blood volume loss and was tachycardic above 170′s. Alfred surprised the volunteers by detecting accurately the patient’s hemoglobin just by looking at the eyelids. She was this close to crashing, and was going into hypovolemic shock. How she managed to walk that many miles to our clinic without passing out is mind boggling. We immediately started her on intravenous fluids with Megan holding the IVF bag high with her hands, a tiring task. The clinic had no IV pumps and only had a single pole that was currently being used by a septic toddler who was getting IV tylenol for high fevers and IV antibiotics. After we stabilized her, Dr Martha and I drove her to a mission hospital that is run by Italians and she was immediately admitted. Dr Martha Ingles and I covered her initial hospital deposit bill while Traci, Lexi, Agnes and Megan were all fighting to settle the balance. The volunteers knew very clearly how Oleyia’s story would have ended if we were not in that place at that time and they couldn’t have been more happier to help. Before we left the village the next day, we stopped by the hospital to check on Oleiya. She had received blood transfusion and IVF overnight and the pain and bleeding was under control. She was whispering words of gratitude over and over again saying that we need to come back to her village so she could slaughter for us a goat; the ultimate sign of appreciation in this community that values livestock more than money.

Kiltamany Village Our next outreach was in Kiltamany village outside Samburu National Park, at a local elementary school. When we got there, it was a ghost town with no one in sight. But before we had finished setting up our supplies, people were everywhere and we had to assign someone just to keep everyone on line. It’s almost as if they sprung from the bushes, out of nowhere. It was here that we encountered a young ten year old very intelligent Samburu boy, who spoke eloquently in fluent English and offered to be our translator. We were all amazed. He told us he wanted to become a doctor. Naturally, we introduced him to Alfred who offered encouragement and advice. That night, while having dinner at Samburu Sopa overlooking a man-made water hole that was frequented by monkeys and hyenas, we were mesmerized when we saw a cheetah so close by. It took a minute of doubt, and then the group screamed simultaneously on excitement when we realized that it was indeed a cheetah when it proudly swung away to the darkness of the forest. That night, James set up camp in the dining area with his powerful lensed cameras, but unfortunately, the cheetah did not make a grand appearance again.

Our safari was full of surprises. For starters, there were two fighting giraffes that were literally knocking each other out. I really don’t know how to describe the fight, you just have to see it. They were walking side by side all over the jungle, almost as if they were intertwined. All we could hear were loud slaps as each giraffe fought off the other one using their long necks. I still chuckle about this every time I watch that video clip. And then there was a lioness that almost charged at us. We had been following it for a while, circling it as it moved aloud and I think at some time it became agitated and appeared as if it will jump inside the open roofed van. I still remember Shakti’s scream “It’s going to jump”, which was essentially loud enough to scare the lioness away. There were lots and lots of gigantic African elephants that we followed them as they peed, pooped and ate through the bushes.

Lost in Nairobi

Back in Nairobi, we had one last day that the volunteers spent shopping for souvenirs and taking in last minute sightseeing around the city. While we shopped around the Nairobi Hilton, it was time to get back to the vans as Kevin hurried to pay his bill. But we did not realize until we left the city center that we left Kevin behind. He was not in any of the two vans. We hurriedly went back to the sight and found Kevin. Poor Kevin was walking up and down frantically looking for the vans when he realized he had been left behind. But he did not panic even though he did not even have the address of where we were staying or even my Kenyan phone numbers. Even though we were only separated for a few minutes, Kevin swore it was more than half an hour, and felt like eternity to him. What was even sad is none of the volunteers noticed that he was missing, it was their driver Michael that noticed. Note to self, do a head count and provide everyone with our address and phone numbers.

The carnivore dinner was fun as Monette entertained the group by throwing a toast to each and every volunteer and reflecting on our experiences together. It is our last meal together and we absolutely enjoyed each other’s company for one last night.

It is always hard to say goodbye to the volunteers when it is time for them to leave for the US. But we all had

a splendid time together and bonded over our volunteer work. The volunteers are my heroes.

Written by Millicent Mucheru

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