THE INAUGURAL TRIP 12/2011

After a lot of applications and some last minute cancellations, we ended up a group of 12 volunteers, 7 from the US, one Canadian who signed up a month before we left, and 4 American/Kenyans including myself. Leading the group were two Doctors, Dr Allison Diamant and Dr Lillian Wu. They were extremely supportive, down to earth and very hands on with the final plannings. And so were the nurses. I couldn’t have asked for a better group of volunteers. I had some trouble with the logistics and planning of my home town Muranga. When I shared my frustrations with the uncooperative Kenyan officials with Allison during the flight to Kenya, she was very supportive and encouraged me to continue fighting for the people who actually needs our help, and ignore the unexpected and annoying obstacles.

A day before we left, I was overcome by nervousness, self doubt and excitement. What if I let my volunteers down? I suddenly felt the responsibility and the pressure. I felt very small and, who am I to take this on? And think that I could make a difference? What if something went terribly wrong? As it turned out, I had nothing to worry about. All the volunteers were absolutely great compassionate people who were joined together by a common purpose; to help the Kenyan people. And at the end of the day, that’s all that mattered. We didn’t have big corporates financing our project; we didn’t have any grants or money in the organization’s account. What we had, is each other, brought together by a strong desire to go out there and help; to face the unknown and unexpected; to make a difference. The comfort that I received from the group, the many hugs that went around, we felt like a family by the end of two weeks. One thing I didn’t want is a rigid routine for the volunteers, I wanted us to be flexible and go with the flow. I wanted everyone to have fun and be spontaneous in Africa. My biggest concern was safety and security for the group. I arranged to have security(police), at my parents’ home where we stayed, where they patrolled the compound all night with their AK 47s.

On arrival at JKIA airport, we were disappointed to find that one of our MD’s suitcases which was padlocked and was stacked with essential medications had been tampered with. The locks were missing and most of the medications were stolen. Oh My! Here we go….

On our first day to Muranga, our first location for the medical mission, I had planned to take the group to Olo Donyo Sabuk (The big mountain) off Thika Road. This is the place that Lord William Macmillan, a decorated American soldier from St Louis Missouri, called home till his death in 1925. When he lived here, he was visited twice by the then US president Theodore Roosevelt during his 1911 safari at the mountain.This is an area that boasts paranomic views of both Mount Kenya and Mount Kilimanjaro and ofcourse the Chania falls while overlooking the beautiful green terrains of Central province fondly dubbed as the white highlands by the British due to the fertility of the soil. But we didn’t get to enjoy any of that, the rain drenched us and our van got stuck before we got to the summit of the mountain. I remember sitting there in the van as the darkness was setting in, afraid to venture out of the stuck van praying to God. “Oh please, don’t let this happen. We can’t get stuck, we have work to do”…..I pleaded in my prayers. It was nerve-wrecking; we were stuck in a park full of animals. As the darkness set in, so did the sounds of the night, the sounds of the animals. I was afraid we will be ambushed by the many buffaloes that roam the mountain, or the leopards or even worse, deadly snakes. My brother’s Lexus SUV saved us from the rough terrain and down the mountain we went. You could almost hear the group’s collective sigh of relief.

And the mission began, each morning by the time we were getting up, I was informed that a huge crowd at Gaitheri’s St Peter’s church “our medical mission site”, is already lined up waiting for us. Gaitheri, is a small village where I grew up, in Muranga district in Kenyan’s central province. During our stay here, my Dad had to open the gate very early each morning since Allison took a run every morning and most of the others took a walk around the villlage before breakfast. The villagers had a field day watching a Mzungu “white person”, running through the village in shorts, a site almost never seen before. They will tell this story for years.

We quickly got into a routine to keep the flow going. The patients first went to a triage table where they were all screened for Diabetes and Hypertension, and their temperatures and pulses taken, and basic demographics like age and sex. And then they proceeded to another table where we collected more medical history and chief complains, before they lined up to see any of our Doctors and finally to the pharmacy where they got their prescriptions filled up. By far the pharmacy was the busiest and most popular corner. Some patients would skip the doctors’ corner and go straight to the pharmacy where Nadia was quick to say, “no doctor”, and send them back to be seen by the MD’s. And then one older man passed out amongst the crowd.

This was as close to a code as we got; we carried the poor man to a table and screened him. I thought he was hypoglycemic since we had asked people not to eat for Diabetes testing and its way past lunch time, but as it turned out, he was just dehydrated. We didn’t have any IV fluids so he got to drink a liter of water mixed with oral rehydration salts and we were to take him to the hospital which he vehemently declined.

I was later informed that the reason he declined to be taken to the hospital was because of the cost of health care. Even though MMK was going to pay the deposit for him to be admitted to the hospital, by the time he was discharged, the man was afraid he would have had to sell his farm and cows and goats, which is all he had, to be able to afford the bill. Sad but true.

It was very nice to see my former elementary/primary school teachers amongst our patients, and other people who I grew up with. All the patients were so very happy when we arrived and we quickly got started. And every night, Allison our team leader, will get us together for a “huddle”, where we all discussed the findings of the day, and how to improve the flow the next day. In Muranga, we saw 500+ patients within two days, the majority of them were women and children and older males. More than 65% had chronic conditions of Hypertension and Diabetes. More than 75% had musculoskeletal issues like joint pain, cervical neck pain, shoulder pain or wait, the most common was, you guessed it… chronic back pain. These people transport huge gallons of water from the river tied up to their backs and other heavy merchandise. Most of them work in their farms and rely on their crops for survival where they use Jembe (hoe) and panga (machete), tools which are indigenous to this region used to cultivate the land and remove weeds from the crops. These essential tools demand of the user to twist their postures in unimaginable positions and they are literally on the farm from morning till dusk. In the long run, this constant bending and twisting eventually causes chronic backpain. I still remember how my grandma used to complain everyday during her last years of how her back bothered her. We had brought some canes with us and gave them out to the elderly that were unsteady and walked with support of a stick.

And then we proceeded to Wamba, a small remote village in Samburu district under the Rift Valley Province past Isiolo on your way north to Marsabit or Turkana. Like the Maasai, the Samburu are nomadic pastoralists, moving from one place to another following patterns of rainfall in search of fresh pasture and water for their animals. It is still amazing to me how the Samburu have maintained the authenticity of their culture by sticking to their ancient traditions and defying modern trends and technology, simply content and happy living in their manyattas (mud-walled, grass-thatched huts).

Wamba is as remote as it gets. Most Kenyans have never heard of Wamba. It was a rough road driving over there and we were lucky it did not rain, we couldn’t have possibly been able to get out of the there if it rained. There were no good roads but just some rough tarmacked terrains that appeared to look like a road. We were bumped up and down in the van for what seemed like eternity while escorted by a police escort for our safety. The area is bare, dry and hot, with a lot of dust that made some of us sick. We stayed in Earth Watch, where we enjoyed a late dinner before starting our journey to the mission site, a classroom in Wamba. We found the locals waiting for us, having walked for long distances to get to the site. It almost makes you feel guilty. And it was amazing to watch the locals. Most of the women carried their children on their backs. Since the locals walk for long distances under the harsh Samburu heat, they carry a gourd around their necks that is filled with cow milk for when they get thirsty.

Water, is a very rare commodity in this area. The Samburu people walk for miles on end in search of water. This place is dry and doesn’t get much rain like other areas so the locals depend on streams for water, and Uaso Nyiro river commonly dubbed as “the brown river”, go figure.

And when they need to take a bath, down to the river they go. They share this river with hippos and huge dangerous crocodiles, and yet, even though they are aware that they may die while taking a bath, that is the only way for them to get clean. So next time you are complaining about your shower not having enough pressure, think about the Samburu people who have to dodge the crocodiles and the Hippos in order to take a bath.

The men also carried with them a small wooden stool that they use to take breaks during their long walks under the shades of the trees. No one owned a car here, they walked everywhere. And when they are waiting or are in a meeting, they squat. They can squat for hours. They also dress for the weather just covering themselves with some light bright clothes shukas, which they wrap loosely around their bodies with their breasts exposed. The women shave their hair which I think is totally unfair since the morans (warriors), braid and dye their hair with red ochre pigments, derived from naturally tinted clay containing mineral oxides. The women applied the same red ochre to their bodies all the way to the neck but not to their faces…odd!

The Morans live in the forest and not among the communities. Occasionally, we will spot them walking on the roadside. You will instantly recognize a moran when you see one. They keep their long dyed hair in braids and dress in more colorful attire than other members of the tribe, and always carry their weapons of spears, shields, lots of knives, bows and arrows, and a club (rungu). Their bodies are slender, shiny, strong and they stand fearless and arrogant, always ready for battle. They are looked upon with great admiration and respect and are a source of pride for their communities. The moranhood started with initiation of circumcision until the moran marries and has a family. There are several rites of passages for a Samburu boy to undergo in order to become a moran which starts with circumcision and killing a lion with their bare hands among others. In another world, I would have married a moran, no pan to my husband. I kid, I kid…..but seriously, you have got to admire these young warriors. What they have to go through to obtain the moran status….that’s another story for another time…..

On the 2nd day at Wamba, some morans came from the forest to be seen by the doctors. Most of them did not want their pictures taken but we managed to convince some to take a picture with the group. Tony from Florida purchased and traded his many knives with the morans’ weapons and even dressed like them. If he was born among the Samburu, he would definitely be a moran. I remember when we stopped at Archer’s post at an ATM when he got out of the van armed like a moran. The look on the locals was pricesless. You could literally see them gasp, take another look at him and then look at each other with disbelief and amusement. It was a priceless moment, a moment I will never forget….

MMK main objectives are to identify and treat chronic diseases of Hypertension, Diabetes and HIV screening. Clinically, there were very few cases of Diabetes and almost no hypertension in this region as compared to Muranga. Obviously, this is related to the diet. The Samburu main diet is milk and blood from the cows supplemented with roots, vegetables and tubers dug up and made into a soup and they only eat meat on special occasions like circumcision and other major ceremonies while in Muranga, almost every meal consists of potatoes and other carbs like ugali (corn meal), and meat. Almost everyone consented for HIV testing but Jeremy was totally amused when this man brought his 15 wives to be tested, in small groups, yet he refused to get tested himself. Oh, did I forget to mention the Samburu are polygamous? Ha!

The Samburu people have a lot of upper respiratory problems probably related to the dust (environment). Their hygiene practices are poor due to lack of water leading to frequent preventable eye and ear infections. The children suffered mostly from otitis media, gastro-enteritis, conjunctivitis, tinea corporis, tinea capitis, tinea versicolor, upper respiratory infections and lots of ringworms. Go figure!!!!

What was striking to me was almost everyones’ last name started with an L. And I am not even kidding, the names were almost similar. Here are some of them; Leakono, Letinino, Leakouo, Loongonyo, Lempisikishoi, Lemartile, Lekalau, Letirok, Lepoora, Lepoopa, Letinini etc….and on and on and on….They laughed at my attempts to pronounce their names. Indeed there were some light moments, like when Jeremy quickly picked up a Kenyan thing; where almost all Kenyans start a sentence with “me I”. Oh and he adapted it well. Everything he said started with “me I am going to sleep, me I want sausages for breakfast” Nancy and I were hysterical.

After the mission, it was time for safari. We stayed in Samburu Sopa Lodge, a beautiful nice resort located inside the Samburu National park. On our first safari day, we were graced by the presence of a huge herd of elephants. The elephants were fearless and the male guarding the group menacingly walked towards our van and we had to quickly back up only to realize there was another huge elephant behind us. We stayed still and silent, you could almost hear a pin drop. They were crossing the road heading to the Uasho nyiro river for water. After all of them crossed the road, the male elephants guarding the group proudly and majestically walked away. And we breathed again. We saw lots of other animals but we wanted the lions. We drove around the park looking for lions and leopards but we didn’t spot any. At the end of the day, we were driving back tired and hungry, no one was talking and some people were dozing off, when I spotted a lioness sitting right on the side of the road, as if it was waiting for us.

I was at the back seat and was surprised no one said anything and we were passing on so I shouted “lion”, but no one reacted and everyone remained quiet. I wondered if I was hallucinating and tried again, this time even more louder, “lion”. And then everyone joined, “stop, stop, lion”. By this time we were past it and the driver slowly backed up to where the lioness was, and it was an amazing scene. She just continued sitting down, un-phased by our presence. We took pictures being careful not to annoy her and she just looked at us. Finally, she walked away to the bush. That just made our day.

Back in Nairobi, our visit to Kenyatta hospital was even more interesting. After donating our “left-over medications” we were allowed to take a tour of the hospital. It was during the doctors’ strike so the wards were not as crowded as it is usually the case. The elevators do not work half the time and took a long time to arrive and yet had a long line of people waiting to get in so we opted to take the stairs. So how do they transport patients to a procedure? We wondered. In one ward, the nurse said they take care of 126 patients between the three of them. That gives a ratio of one nurse with over forty patients and no nursing assistants. We were dumbfounded. So how often do you take vital signs? Jen, from Denver asked. And the nurse just shook her head. She said patients only get their vital signs taken on admission during triage, and not again, unless, the patient becomes acutely ill. We are spoilt. I know there is no way I could adequately take care of 40+ patients. The only ward that had cardiac monitors was the ICU which was surprisingly equipped with modern cardiac monitors and ventilator machines. To place a patient in trendelenburg, they placed huge blocks of stones at the foot of the bed. And only the ICU and theater (Operating Room), was backed by a power generator in the event of the Nairobi’s frequent black-outs. So what happens if there is a code in another floor? I asked innocently. Well they have no code team or a rapid response team. As I have written before, Kenyatta hospital which is the only largest teaching and referral hospital covering the whole of East Africa, situated in Nairobi with a population of > 3 million people, only has a total of 31 ICU beds; 21 in main ICU ward and another 10 in a sort of overflow ward. This is where there are many documented cases of deaths in ER while patients waited for hours to be seen by a doctor. To qualify for an ICU bed, you have to be intubated.

Havilla Childrens’ Center in Kibera slum brought smiles into our faces. These children are mostly orphans whose parents have died of AIDS and they are being brought up by their relatives, grandparents or neighbours. They come here each morning for a classroom like education where they are provided 3 free meals.

Kristine from Denver had purchased shoes in various sizes for the children and Jen had purchased lots of clothes. We all contributed money and went to Nakumatt to buy food items and other essentials for the children. The moment we arrived, the mood was different. Only kids can have this effect on people. Their singing and dancing brought laughter and joy to all of us. They entertained us with dances and their beautiful innocent smiles were so infectious. After deworming all of them, they got the gifts of toothbrushes, clothes, shoes, and lots of candy.

According to Barnabas who manages the center, it was the best xmas these kids have ever had. That night, we enjoyed the exotic meats at the Carnivore and reflected on the trip before we left Kenya. I am very grateful to everyone who has supported my dream of making such a mission trip possible. We couldn’t have been successful without the collaboration of the Kenyan doctors that volunteered with us, Isaac, Esther and Alfred, and their org, MAA Health Care Initiative.

When I started this org, I had the dream of doing exactly what we did; help the poor and disadvantaged. I knew I couldn’t change the world but I was convinced that together with like-minded people, we can make a difference in someone’s else life. When I was doing the health education in Muranga, the locals were very interested in their health and participated in health promotion and asked me a lot of questions. But based on the questions they asked, I was shocked to find out how little they knew and they were eager to know how they can better their lives; their health. To the volunteers that traveled with me to Kenya, I have nothing but gratitude for your hard work, resilience, endurance and generosity. You have earned my respect and admiration….hands down! This was an EPIC trip, thanks to all of you.