July 17, 2007

Last week was a fairly productive week at the clinic. I finally made some progress on a couple of the projects I have been working on, so hopefully I will have finished them before I leave. One thing that I am trying to initiate is a kids’ club for the HIV-positive children who visit the clinic. They are in and out of the clinic a lot, and often get sick, so I thought that it would be good for a bunch of them to get together for something a bit more positive and fun and go on small outings and field trips. I am trying to coordinate it with a pediatrician who seems quite interested in the idea, so hopefully we can find some funding and recruit some patients. I spent another afternoon on the pediatrics ward in the hospital, but this time more to spend some time with the kids than to do anything medical. I brought some crayons and paper and they had so much fun. There was this really sweet little girl who had her eye surgically removed, and was feeling kind of down, but she was easily distracted by the colouring. The kids only spoke Swahili, which was too bad for me because they were talking away to me and asking me questions, but I obviously couldn’t respond very well.

I had an amazing weekend in Masai Mara (it’s the northern continuation of the Serengeti). We were picked up on Friday morning and then drove for about 6 hours on the WORST road I have ever seen. For the most part we weren’t even on the road because there were so many potholes the size of kiddy pools. Instead, most of the cars drive on the dust shoulder. The drive was really interesting though because we passed through a lot of small towns that are pretty run down, and obviously quite different from Nairobi. During the second half of the drive we passed a bunch of Masai (a Kenyan tribe) villages. I had no idea that so many of them still lived so traditionally. I would look out the window and see a man wrapped in traditional cloth, with a handmade weapon, walking across a huge space of empty land with his herd of cattle. The men have earlobes that are stretched so that you could almost fit a hand in the hole- apparently they start to stretch them out as a sign of becoming a man. It is worth doing a quick google search to see what I am talking about. We also passed by some of their villages. They still live in mud huts, and sleep on the ground. The whole thing looked like a photo shoot from National Geographics.

We made it to the park in time for an evening drive, during which we saw some animals, and then we spent the night camping at our site. Our tent was a piece of crap, but it did the job. The campsite was right beside the park (which isn’t fenced) so there is always a risk of animals strolling on to the campsite. Luckily we had some Masai men as guards. One of them told us a story at the camp fire about how he has had to kill lions to protect his cattle. I felt pretty safe with them at the camp site, but when you wake up in the middle of the night and see the silhouette of a man with a spear, it can be a bit startling.

The rest of the safari was great- we saw the sun rise over the savannah, lots of animals (giraffe, elephants, lions, hyenas, impalas, hippos, buffalo, wildebeests, zebras etc.) , and I even got a video of a lion eating a zebra. It was nice to spend a few days outside of the city to see another part of Kenya, and actually be able to breathe!

July 19

There has been quite a bit of hype around here lately about a bunch of tremors that have been happening. I was lying in bed the other night and my room started to shake, and the stuff on my desk started hopping around. Apparently after that tremor, there was crank call into the media saying that everyone in a high rise should evacuate because a big earthquake was about to hit, so all of these people were grabbing their valuables and driving away in their cars to avoid disaster. Luckily I don’t have tv or radio here, so I was pretty oblivious to all the chaos, which is good since it turned out to be a scam.

I spent some more time on the pediatrics floor yesterday and saw a ton of stuff- neonatal sepsis and meningitis, jaundice, a boy with unexplained lower limb paralysis that couldn’t be investigated because his family couldn’t afford an MRI, a child with nephrotic syndrome (kidney problem) who had EXTREME edema and swelling- she almost couldn’t see out of her eyes they were so puffed up, another poor abandoned child- she was so sweet… I actually was thinking about how I could take her with me, which I know is irrational, but you look at these kids and just wish you could do something for them. It was a really interesting day, but it got to me a bit, more than other days have.. not as easy to shake off when I left the building.

In complete contrast I went to an extremely ritzy dinner party at night. A friend in my class did her undergraduate degree at McGill with a guy from Nairobi who she was quite good friends with. She gave him my contact info when she heard I was going to be in Nairobi, and he called and invited me to a dinner party he was hosting- which was really nice of him. He stays at his parents’ house, which is probably one of the most beautiful homes I have ever seen. They live in one of the nice suburbs outside of the city- their property was huge, full of elaborate gardens. They had a really nice outdoor dinner area- so much delicious food and about 10 people cooking, serving, and providing drinks from the bar. All of his friends were really friendly- most of them were born in Nairobi, but went to prep school in the UK, then to university in Europe or the states. There were a few other medical students, a guy who plays some big role in the Kenyan coffee trade (I learned what the best coffee in the world is… apparently it’s a specific Kenyan bean and brand, and he has worked in other countries with coffee so claimed not to be biased), a film producer and photographer who works with national geographics, and the survivor reality show, among other things. Overall, a very interesting crowd- but I found it hard not to feel a bit guilty having steak and wine and genuinely enjoying the luxurious surroundings, after seeing some pretty tough living conditions in the day.

Today I had a meeting with the pediatrician I am working with to develop a Kids’ club at the HIV clinic. I think we have figured out how we are going to try to make it work, so I spent the rest of afternoon/evening starting to write up a proposal so I can get it finished and hopefully distributed to some potential sponsors before I leave. I think the idea is really good, and I know the patients would really enjoy the program, but it’s hard to say much of the plan will materialize- especially if I’m not going to be around to follow up, and the funding is a bit of a challenge.

I am still feeling a bit restless at times- I miss being able to walk around on the streets and go for a run if I want to... so I went and bought a skipping rope today to alleviate some of the restlessness. It turns out that skipping is pretty boring… but depending on how things go I might have some pretty impressive tricks by the time I am done here.

fell in some dirt

July 20

I spent a really interesting day in the Kibera slum with some people from a clinic there who were distributing food to HIV patients on antiretrovirals who needed nutritional support. I feel like my back is almost broken after lugging all that food around though. The slum itself is massive- about a million people living there, all crammed together in these tiny little shacks amongst dogs, laundry, goats, children, shops, and garbage absolutely everywhere. It good to see though, since a lot of the patients who come into the clinic come from similar living situations. All of the children say "How are you?", and follow you around for a bit. I am exhausted now though, not just from the walking and food-carrying (and the early start), but I think more because the whole scene was very overwhelming. I stopped by the clinic after, and on my walk back on the dirt road beside a busy street I wiped out :( It was actually pretty funny because it's so dirty and dusty I literally got covered in dirt. I look like a wreck.. it was a bit embarrassing. So I am going to go home and clean up and hopefully have a bit of a nap before heading out for dinner tonight with some friends.

my backyard

home sweet home

little baby elephant at the orphanage..awww

me about to kiss a giraffe

me, rosie, mary and other friends at Casa Blanca

July 6

I am starting to feel a lot more comfortable here, now that I have figured out how to get around and have met some really great people. I have been getting along really well with a Dutch girl Mary and another medical student, Rosie, who are both staying in the hostel as well. Yesterday I arranged to go to the hospital with Rosie to do rounds on the pediatrics ward and to take a look around the hospital, which is huge. It was pretty shocking. I saw some extremely sick children- conditions and diseases that I will probably never see in Canada. We did rounds with a really nice young female doctor from Somalia who was very attentive to us and explained the patient information and answered any questions we had. It took a couple of hours to get through the first room because it was so packed. A room that would typically have 4 patients in it in Canada held about 16 patients and their families. The hospital itself is extremely run down and dirty, but I was very impressed with the staff- for the most part they were very compassionate and put a lot of effort into helping each patient as much as they could, given their tight resources. It was a pretty tough morning. Although many of the kids are treated and recover, some of the stories are so heart breaking. There was one little boy who was probably about 9 who was curled up in a ball under his blankets in the back corner of the room. His mother had died of HIV, nobody knew where his father was and his aunt had abandoned him. He was HIV positive but could not be started on antiretrovirals because there was nobody to look after him who could consistently get the medicine for him and make sure he was taking it properly. They weren’t sure what was going to happen to him or where he would go. He was refusing to eat or take the medication he needed for his vomiting and diarrhea. I was surprised at how common it is for children to be abandoned in hospital. There were at least three other children in a similar situation. We also went into the malnutrition room which was full of these tiny babies who had nutritional problems ranging from rickets, to Kwashiorkor (like you see on tv when the children are all skinny except for big swollen bellies), and general wasting due to lack of food. One of the babies was so severely dehydrated that he had gone into shock and was unresponsive. Most of the other patients were in for pneumonia, TB or meningitis. As difficult as it was to learn about the very sick children, there were several who had fully recovered and were running around playing, and laughing.

Last night I went out with a group of people that I have gotten to know through Kevina. We went to karaoke which was a lot of fun (but I definitely didn’t participate). After that we went to a bar/club… Kenyans love dancing and really know how to. It ended up being a really good night - definitely a fun group of people. This morning I went into town with Mary so that we could book a safari trip to Masaii Mara reserve park for next weekend. We found a company which seems to be quite reliable, so we will be leaving on Friday to spend 3 days in the bush looking for lions, elephants, giraffes and zebras etc and camping out in the park at night. After that I went to the big Toi market with Rosie to try to find some warmer clothes to deal with the unexpected Kenyan winter. Tonight we are going to meet up with some friends that Rosie knows from the UK and head out to a nearby bar/lounge called Casa Blanca.

Overall things are getting a lot busier and interesting, and Nairobi is growing on me more and more every day. Kenya has such an interesting history and culture and learning about it while I am here immersed in it is quite an experience.

July 7

Today I went to an elephant orphanage where they save baby elephants who have lost their moms’, often because of poaching. After that we went to a giraffe park where you can climb up into a tree hut and feed the giraffes (I almost kissed one- you can see the picture). The giraffes are free to roam around the national park, but stop by the hut when they are feeling hungry. We also went to “Bomas of Kenya” which is kind of like an outdoor museum that displays how Kenyan tribal villages are set up. They put on a show of traditional dances from different tribes and regions of Kenya.

July 2, 2007

I had to take the day off work on Friday because of a horrific “illness” that I think may have been caused by rabbit I ate for Thursday night dinner. The power was out at the hostel, so I couldn’t see my food, and thought I was eating chicken. Whatever African bug I got, it by far outdid anything Canadian I have ever seen. It was a rough night, but I seemed to improve by the next evening after sticking to water and ginger ale.

I spent the weekend at Kevina and her fiancé Njoro’s house in Karen, which is about 30 minutes outside of the city. The area is a big contrast from where I am staying. The houses are huge and sit on massive properties with amazing trees and plants growing everywhere. They live right by the area where Out of Africa was filmed. I also learned that during colonial times only white people were allowed in Karen.

My trip to Karen started off pretty rough. I still wasn’t feeling great, but decided that I would be able to make the bus trip to meet up with Njoro near his work so I could get a drive with him. After standing at the bus stop for about 20 minutes, and realizing I had no idea what the hell was going on- I contacted a couple of people to try to figure out which bus to get on. Most people take “matatus” which are these white vans that usually have sound systems with extra base, whatever paint, sticker or symbol the owner feels like pasting on the car- and some times black lighting. As the van approaches the bus stop, the conductor hangs out the open door and yells out the destination of the bus in Swahili, then crams as many people into the van as they can. I decided to stick to the normal city bus- but ended up getting on the wrong one. I took a huge detour down towards the Kibera slums (thought to be the largest urban slum in Africa- housing over 1 million people) where I had to wait for the bus driver to get lunch before I could take the bus all the way back to where I started (arriving an hour later) in the heaviest traffic I have ever seen. I’m pretty sure there are no traffic laws in Kenya. There are no traffic lights (except right in the city centre), and often no lanes, or rules about turning at intersections- it’s all about who can be the most aggressive driver.

Saturday was a relaxing day. Faizil, another friend of Kevina and Njoro’s was also staying with them, as well as another Kenyan girl Rachel. We went for breakfast at a “mzungu” (white) java house, then Kevina and I went downtown to a Maasai (a Kenyan tribe) market where they sell a ton of stuff- giraffe sculptures, plates, jewelry, art- I got a cool little mask from Congo. That night we went to Patrick, Muratha and Kumbi’s place (other friends) where I helped make a big Pad Thai dinner with Kevina. One thing I’ve learned is that Kenyans LOVE meat (and drinking). Apparently the Pad Thai wasn’t meaty enough so the guys ordered in goat to supplement the meal. The purpose of the night was to discuss Njoro and Kevina’s wedding- which was really interesting because there are a ton of Kenyan traditions that need to be followed, and they need to have committee meetings to make sure that everything is being done properly.

Sunday night we went out to celebrate Canada day! Some UN interns that Kevina knows through work were having a Canada Day barbeque up near the UN (quite far from Karen). On the way we passed by the US embassy which has the craziest security I have ever seen (I’m guessing because of the bombing). Unfortunately Faizil’s car broke down on the way, so we were very late. Kevina, Rachel and I left the guys to deal with the car and took some drinks up to a nearby restaurant until the car was fixed. We actually kept the mechanic in the car with us all the way there just in case something happened again. Some areas in Nairobi are much more dangerous than I was expecting. Everyday thugs, as they call them, highjack cars and mug people- so I was very happy that it was still light out when the car died. The bbq was fun- definitely more Kenyans than Canadians. Of course the occasion was celebrated by roasting a big goat (which is actually pretty tasty).

June 28, 2007.

My time at the HIV clinic has been very interesting so far. This week I have been spending the mornings (9-1) with the doctors during their patient appointments. There are two doctors Eric and Brenda- both are very nice and willing to take the time to explain things to me. Most of the patients are in to get their CD4 counts, to refill prescriptions (needs to be done monthly) or because of some sort of drug side effect or illness that has surfaced. The doctors see about 80 patients each day. I have heard a huge range of stories from the patients so far- from a 14 year old boy who came in on his own from school to get his medications, to an HIV+ couple wanting to plan for a family, a woman with late stage HIV who is unprepared to start antiretroviral therapy, a 6 month old infant just found to be HIV+- it has really become clear to me that anyone can be affected by this virus- regardless of wealth, age, sex etc. I have also spent some time in the pharmacy and the lab, following up on some patient visits to see what the next step in their care is.

I have been spending most of my afternoons in Dr. Mwachari’s office doing reading on HIV to familiarize myself with the drugs, opportunistic infections and other things related of the disease. Some patients show up with atypical presentations of opportunistic infections or response to treatment. In these cases, the files are put aside for me to investigate. The clinicians are very busy and don’t always have to research individual cases, so if any questions or confusing cases come up, I look into the cases in more detail to see if I can come up with any useful information. Everyone in the clinic has been very welcoming- although they are often speaking Swahili, so it is easy to feel a bit left out. I decided to walk back from the clinic today and had a school bus full of children pass by me yelling “mzungu” (white person) out the window. It’s either that or “how are you?”- the kids always yell that in unison to white people.

The hostel I am staying at is a very new scene to me. It is literally a nunnery. There is an entire building where nuns are trained and there is a church in the middle of the property. Although it is very quiet and secluded- I feel very safe here. I have my own room with a bathroom, and the gates are guarded 24 hours per day. Most of the people staying here are on religious missions, or are somehow related to the church. Luckily I have met 3 other girls around my age from England, Holland and the States who have been good to have around for company since we can’t really leave past dark.
Last night, Kevina, another Canadian I know indirectly through Christina came and picked me up and we went for dinner with a bunch of her friends. Today I went to a market with 2 other girls from the hostel. We were the only white people there. The Market was massive. It started out on an open road, and then slowly narrowed into an enclosed used-item and food market surrounded by slum-housing. I wanted to take pictures, but the last thing I needed was to draw more attention to myself.

June 24, 2007

When I arrived at the airport last night at about 10:00, I was expecting to meet with a ride that had been arranged to pick me up- apparently they were going to be holding a sign with my name on it. What I wasn’t expecting, was to walk out of the luggage area to face about 100 people holding tiny illegible signs. I was feeling a little self conscious with everyone staring at me. After walking through the crowd a few times, I still couldn’t find my ride. Tourist and taxi workers quickly caught on to this and started harassing me to sign up with their company. After speaking to a few airport security workers I determined which taxi company was the “safe” and official airport taxi- and signed up for a ride to my hostel. The taxi was more of an old beat up car with what looked to be half-chewed seat belts and zebra print seats.
I arrived at Flora hostel by about 11:30. It was pitch black outside, so all I could see of the hostel was a big gate, with two intimidating guards in big dark hoods patrolling it. I got out of the taxi to speak to one of the guards about my reservation, expecting to be let right in. What happened instead was that the guard told me they did not have my information and therefore I could not stay there. I would have to find somewhere else for the night. This is when things got a little scary. I was standing on a pitch black street in a city that I know very little about except that it is “dangerous”, with a zebra car as my only transportation, standing on the wrong side of the gate. I eventually convinced the guard to at least let me and my belongings into the driveway of the hostel where I could show him my booking confirmation and any other documentation that would help. After muddling through a bunch of my papers, and making a few phone calls, I was eventually allowed to stay… so I was put up in a room attached to the church… I am living at a nunnery.