Ward 10 is especially busy as the new interns have started, and there is a rather fierce Medical Officer supervising the round who lectures us on the importance of protocol – luckily I am the only one who does not have a copy of the required text and therefore cannot be expected to know anything… Plus I am distracted by the sight of a monkey out of the window! My name is so frequently misheard as ‘Joy’ that I am no longer bothering to correct people – it’s quite a nice name, and thoroughly approved of, so that is that. Lots of the usual pneumonias and malnutrition. Owing to the ‘cold’, the children are firmly inserted into thick flannel trousers, with thick woollen jumpers and balaclavas on top (still feels like vest-top weather to me though). There is the usual cocktail of medical abbreviations used by the interns, but they are different from home – for example, ‘hob’ means ‘hotness of the body’, for a febrile patient – easy! Old coke bottles are used to measure out the milk quantities and other medicines - for patients with malnutrition, a formula ‘F75’ or a stronger ‘F100’ is often prescribed – this is a replacement feed consisting of vegetable oil, dried milk powder, sugar and water, made up to a ratio.
I am getting used to being a general source of amusement, for the mothers at least – most of the small clients take one look at my mzungo face and burst into tears. Definitely not making any friends, especially when I have to take bloods and skin pricks (for malaria). (The blood this morning is not successful – the plastic glove fails massively as a tourniquet, femoral vein empty, patient cries, mother cries = traumatic). The lab here manages to churn out results which is impressive considering what we send them – the malaria screen requires a blood smear on a glass slide (of which you carry several in your pocket, along with a few needles) – this is labeled up with a bit of the omnipresent plaster tape, waved to dry (a lot of blood takes a LONG time), piled up (TOUCHING) with the rest and trotted over for a look under the microscope (if it’s not misplaced on the way). Blood films, as with all other investigations must be paid for (the main price list can be found next to the hospital sign on the main road) – a bed for a child costs 500 Ksh per night, and the mothers must also pay PER cannula and giving set - you pay at the patient cash desk. Receipts kindly have written at the top ‘wishing you quick remedy’, nice. The hospital is a ‘corruption free zone’ (signs to remind everyone of this are dotted everywhere) – there has been a problem in the past with doctors taking money privately (and many doctors here do seem to work 24 hours per day, government paid by day, private by night) but this is changing now.
I spend the day at the ‘CCC’ clinic – this is the ‘comprehensive care centre’ for HIV positive patients, who come fairly regularly to have their CD4 counts measured, and to receive vitamins and antiretrovirals. I sit with the nutritionist and we measure each patient’s height, weight and BMI. (There is a horrible cycle of weight loss associated with the disease which lays the patient open to opportunistic infections and reduced immune status – this corresponds to a reduced CD4 count etc, etc…) so it is important that patients can be counseled on the importance of good nutrition (for the overweight as well as the under!). It is a busy clinic – 52 patients in the morning alone. A US-AID programme provides the means for ‘Feeding by Direct Prescription ’for patients whose BMI is less than 18.5 – this is ‘unga’ (flour, reinforced with vitamins and various cereals), and in especially severe cases, ‘plumpy nut’ (a ‘ready to use’ food recently developed by the owner of ‘Nutella’ which has been very effective in cases of 3rd world famine – it’s a paste made from peanuts, veg oil and powdered sugar and milk – each packet delivers 500kcal and can be easily taken ,even by children). Sadly, a surprising number refuse to accept the prescription, there is still a huge amount of stigma and many do not disclose their status even to close family members.
Horror of horrors – a mosquito INSIDE my flippin net. He eats me for breakfast, and I can’t find him, squash him or do anything about it. The buzzing enters my dreams… The next night, THE SAME. There is obviously a campsite somewhere. Not cool. My back is MUNCHED.
I am learning to cook African style – Ndengu (a green gram bean stew with milk), Ugali, Mathukoi, Githeri. Phyllis (a competition winning Chapattis maker) and her daughter Easter teach me how to make PROPER chapattis (only problem is the final step requires a cast-iron chapattis pan and a fire, neither of which I will be able to lay my hands on at home). You make the dough with sugar and salt, then the chapattis are twice rolled and recoiled like a snail and left to rise, before dry frying in a stack, and finally refrying with oil. They fall apart in your hand, and should be eaten hot with a cup of Kenyan chai (made with a bag of fresh cow’s milk from the neighbour, and sweetened with sugar, tea masala, and cardamom).
The rainy season has officially started and there are frequent powercuts in the evening. This in combination with the fact that the laptop gives me frequent electric shocks (the ‘q’ key is especially problematic) does not make for peaceful facebooking... Instead I am reading ‘The Flame Trees of Thika’ by Elspeth Huxely – an autobiography of her childhood in Thika which is not far from here – lots of it is familiar! Bats here also squeak in the roof at night which is nice.
I make the mistake of ordering ‘passion’ at Morning Glory cafe (this is passionfruit juice, in case people were wondering!) – halfway down the glass I have a sense of misgiving (actually the misgiving happened quite quickly but I couldn’t be rude). Next day – raging headache and temperature. The hospital beds look pretty inviting, but I make it through the morning without hitting the floor, and all the way back up the hill to bed where I pass out for the next 4 hours. Let that be a lesson!
It is a long hot walk to town, but I stop at the rescue centre, where Lilian feeds me githeri. We shop in the market for Kangas (these are the beautiful African cloths which can be used for anything – as aprons, skirts, for carrying shopping, children…) The market is fascinating and has a hundred tiny alleyways selling salts, beans, rices, spices and anything else you can think of. It’s good to be with Lilian who seems to know pretty much everyone. We buy avocados and tomato fruits (they are extremely like tomatoes inside!).
Drawing is the name of the game at Toto Love today, but my stethoscope is pretty fun too. The children here have to wake up at 5am to take their antiretrovirals (the side effect profile of these is nasty which is why most have to be taken with food – the problems start when the food is not available…). I meet Scooby the dog who also is resident here – he has nice ginger eyebrows.
Thankfully the tsunamai alert for the Kenyan coastline has been withdrawn – the waves were due at 8pm but no show. A bit frightening!
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