Breakfast (with Kenyan tea!) – still by candlelight. Oti takes Eva and me to the bus centre in town to catch a Matatu to Embu (142km for 370 Kenyan shillings – about 2 pounds50). Crazy crazy place! My rucksack goes in the back and we sit and wait for the seats to fill; good Reggae music on though, and the touters tapping on the window keep me amused. The journey to Embu takes us 3 hours, and is fascinating! The road is new and pretty bump free. We pass countless villages with identical shops and kiosks covered in banana leaves selling papayas and tomatoes, mango plantations, paddy fields and rice and maize laid out to dry, incredible trees, small schools set back from the road, people driving cattle carts, bikes laden with green bananas to sell… Its very hot and I keep falling deeply asleep. We reach Embu and I get out at the main market place – crazy times, and the Mzungo is spotted! Embu is a small town but has loads going on, AND its at 1900m above sea level so the Kenyan team come here to train – wicked! Timo the taxi driver takes us to the house where I’ll be staying – it’s a 15 minute walk down the hill to Embu Provincial Hospital. A pink peppercorn tree and incredible flowers in the garden. Gilbert (who works for the charity ‘moving Mountains’, and is ‘the King of E-town’) walks with me back into town to map the place out, and we drop into the Rescue Centre for street kids which was set up by the charity a few years ago – along with the Black Cats football team made up from street kids from Embu. It’s a fantastic place. Couple of goats hang out. There’s a girls team too – I’m going to train with them on Saturday (once I acclimatize a bit!). Lilian the cook has made ‘Githeri’ (maize and beans boiled up with water and salt) – every day she makes it for 150-200 kids who come and wait at the gate for their plateful – needs a big fire, and an even bigger pot! I help her sort out the dried beans and maize for tomorrow – 9 jugs worth – it takes about 2 hours to pick out all the bad ones. I stock up at the supermarket – beans, and ‘Uji’ – this is Kenyan porridge with added ‘immunity’ (Aramanth and red sorghum), particularly recommended for people with HIV. Later Gilbert shows me how to cook ‘Ugali’ (a kind of cooked maize cake) and ‘Sukuma wiki’ (means ‘strech the week’ – green veg fried with tomatoes), really good! And an incredible, perfectly ripe avocado, wow! Giant crickets, and a gecko in the loo. Sort out that mosquito net asap!
I meet Dr Muli, the medical superintendent at the hospital, to arrange my placement – I’m starting with 2 weeks of paediatrics. Bright yellow weaver birds bicker loudly everywhere! There is one xray machine, one main theatre and one day case, plus various clinics and a few wards for inpatients. The lab can do basic blood films on slides. Patients have to pay for various treatments and investigations, which can limit what can be done. CT scans have to be done far away, and cost 7500 KSH (about 80-90 pounds, way too much for most). I join ward 10’s ward round – it’s the neonate unit, and there are currently 8 inpatients – most are premature and have respiratory distress or sepsis of varying degrees. Its all very basic – but there is hot water, needles, basic tubing and a few antibiotics and other drugs. There are 4 ‘cubes’ representing different degrees of treatment intensity – the most sick babies have their own incubators, the rest lie next to rusty heat lamps so it is very hot. Phototherapy for neonatal jaundice is treated by a UV light under a blanket. Lots and lots of plaster tape is used for pretty much anything – holding cannulas in, covering blood bottles to protect bilirubin samples from the light, patient identification labels, you name it. Tourniquets are improvised using the elastic rim of latex gloves, and oxygen is humidified using a bottle of water. Lots of flies, and I spy a cockroach on the floor (later tread on one in my shoe!). Most mothers are expressing milk by hand – the World Health Organization changed their feeding guidelines in 2010 which means that all mothers are now advised to breastfeed exclusively for the first 6 months, regardless of HIV status (this was primarily due to the increased mortality of infants from malnutrition as milk supplements are too expensive (800KSH per bottle!!) or can’t be prepared hygienically. One baby is especially sick with severe sepsis – nothing much can be done apart from changing to the strongest antibiotic and letting nature take its course… The ward round finishes and I walk to ward 16, past the main theatre (all the used scrubs are washed in the sink and hung to dry outside) – today is the weekly orthopedic list - there are 4 displaced fractures and an amputation, but none are emergencies so they have had to wait. Ward 16 is the main pediatrics ward, and its busy! The kids are all swaddled up with very cute matching balaclavas (today is the first day of the rainy season, so its ‘cold’…), and the mothers share their cots. All their cannulas are reinforced with cardboard to stop them tugging them out! Common cases are malnutrition and pneumonia. The intern (all medical students in Kenya do a year’s internship following graduation) explains that often babies are undernourished as the Kenyan diet is very high in starch but may be deficient in vitamins – frequently mothers will spend their extra money on bread to supplement the baby’s diet which does not good, but no-one has told them this). A baby with suspected hydrocephalus is given a referral for a CT scan, with any luck a missionary will cover the cost of this, but otherwise its unlikely to go ahead. A mother of a baby with meningitis is ‘rehydrating’ by pouring a bottle of fanta through his nasal tube. There is also a case of suspected TB, and a boy who nearly drowned in a bucket of water (although his mother denies this). The round finishes as lunch is served – a cup of rice and stew, to share with baby!
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