Rafting and ward rounds…

Only one intern turns up for the ward round. The others are going to be in a sticky situation…  As predicted, consultant Dr Chapi returns the following day from his annual leave, and we are in for a shock – 5 hours in and still standing. Truly a feat of endurance – ankles swell, dry throats shrivel, eyes count frantically ahead to check number of mothers left (larger and easier to count than kids)…dismayingly there are 9… will I make it to the end without falling over?. Happily I am excluded from grilling, but everyone else gets it in the neck re protocol, proper (in his defense he is obviously a very kind man, and a very good doctor too). 11 o’clock is bread time for the mothers, and the tea bucket comes round too (sadly this passes us by); 1 o’clock is visiting time, and there is always a big queue of people waiting at the main gate – they are scanned in by the security guard (not sure he’s really necessary as most of them are only carrying rice and bananas - the only time he really comes into play is when a matatu arrives carrying prisoners to be seen in clinic. All in stripy pyjamas, and dresses for the women).

Lewis is a patient with severe malnutrition – so listless and sad, and he’s in a shocking state – completely skeletal. This is marasmus- severe wasting due to total calorific deprivation, as opposed to Kwashiorkor (which is protein deficiency – here the baby is usually oedematous, which can confuse the diagnosis). Another mother brings in her baby with measles – he was never immunized as she wasn’t able to read the record card. A few cases of rickets – soft fontanelles and widened ribs. All things that I would never see in the UK. It’s so difficult – the medicine is completely sound, but so often compromises have to be made  due to frustrating circumstances - poor quality xrays, lack of proper nutritional support, multi-drug resistant cases, missing lab results, mothers unable to pay for treatment. One girl is admitted to the acute room with a new murmur – she is pretty poorly and in heart failure. I thought there was an ECG machine here, but she will have to go to Nairobi for this. Dr Chapi rocks up and summons us to a departmental meeting (I have the feeling this has a lot to do with the ward round) - this time I am asked for my opinion, too… It is the end of my time on the paediatric ward, and I am sorry to finish.

I go on a home visit with the palliative care team – there are 6 of us in total, including a pastor and 2 nurses. Palliative care is mostly free in Kenya (unless patients are able to give a little for the more expensive drugs) and should be given ‘regardless of race, gender, tribe or religion’. The team’s caseload consists primarily of cancers, heart diseases and HIV. We drive out towards Meru in the back of a small van – during the ride the pastor ‘amuses’ us with the story of a patient he followed, who had a curse put on him by a women claiming he had stolen her chicken. (An ultimatum of 6 days was given for the chicken’s safe return, but since no bird was forthcoming the man mysteriously dropped down dead.) Wey! Sinister indeed. The son of the lady we are going to see waves us down on the road and leads us up the track – it is very green here with many shambas and steaming charcoal mounds, which are kept burning continuously for several days. The house is a simple wooden shack under a mango tree, and we sit outside under a bower of bourgainvilleas next to the fire place- it is very smoky. Joy Betty is the patient’s name, and she has a squamous cell carcinoma of her right cheek, which is extremely unpleasant for her, and painful (she first noticed the pain when chewing sugar cane, and has since been given radiotherapy and a blood transfusion without being told of the diagnosis – understandably this has been very upsetting, and expensive too). She is only 53, but has aged considerably – Summi the son (who is her primary and only carer) shows us the family photo album, and she is almost unrecognizable. The team are excellent and we spend nearly 3 hours with her providing counseling, cleaning the wound and prescribing drugs and adequate pain relief, before the pastor and Joy both say prayers and we leave. The team will return on Monday with a mosquito net.

Early morning sight of Mt Kenya on my run, wow. I do a ton of laundry outside, bucket style, and watch moles in the garden (at least, I can see the top of the soil moving and hear them snuffling – as soon as they realize it’s me they reverse down the hole, gutted.) We are having very heavy rain at the moment, with long evening powercuts (the hospital does have a generator which can back up the whole system for 24 hours, fortunately!). Phyllis and Easter arrive and tell me about the earth tremor this morning at 5am (4.6 on the Ricter scale, apparently!) – not that it made much impression on me at the time… I’m still learning Swahili, and inflict morning practice on the night watchman (he lives just below the house in a shack which he has built himself) – ‘habari yako’ – he replies ‘nzuri sana’ (‘sana’ is an affirmative, like ‘very’).  Sawa sawa. (Incidentally, the wise monkey’s name ‘Rafiki’ from the Lion King means ‘friend’).

I pass by Nyambura’s cake shop on the way into town to say hello. She’s got several demos on display – one is a wedding cake in a traditional pot shape (this must never be cut by the bride), another is a basket. The bride would also be given a wooden spoon – all symbols that she will go to the market and cook good meals for her husband. I am earlier than usual at the rescue centre and Lillian is making uji for the boys for when they finish football training (it is the school holidays so sessions happen most days) - she keeps some of it back to ferment for the next day’s mixture. The boys have all lost their spoons so githeri has to be sucked from the plate – too hot to handle. I am sent to the market for onions and sorghum (with one of the boys for protection – this is the big market which happens twice a week, and is very busy!), and manage to get some photos, too. Later, against good advice I attempt to cook omena – these are tiny dried fish similar to anchovies found in Lake Victoria which you can buy cheaply in the market (this should have alerted me) – they are really bitter and I have to pick them ALL out. How disappointing. Mama Whyella (who briefed me on the omena recipe) sells bags of fresh milk from her cow every evening at about 6pm (for about 30p) – this has to be boiled (the skin is very thick) and is very nice.    

 

I would have thought the mzungo joke would be getting old now, but no luck. I pass by and a wave of laughter usually follows. Takes a bit of getting used to!

This weekend I travel to Sagana with Charlotta to go whitewater rafting on the Tana river! The campsite takes all sorts, so it’s funny to be back in the company of mzungos – lots of ex-pats (with African nannies) which is quite interesting! And many English-speaking dogs too. We have our own shed, complete with resident gecko. There are pepper and guava trees (their bark is very smooth), and the river runs alongside, brown and sludgy – beware of the hippos, and crocodile, allegedly (it may just be a very large lizard) – but there is a long swinging rope bridge to take you safely across. A local wedding, traditionally flamboyant with about 30 pink bridesmaids, rocks up with the photographer, and we are both summoned to join their photos. David the cook makes us fishing rods with a stick and length of catgut, and assures us that we are very likely to catch large catfish in the river here (for lunch) – we try for an hour with a combination of old goat (meat) and soap (apparently they like the smell) but no luck. The one that took my bit of soap was HUGE, though. The rafting is INCREDIBLE!! In between HUGE class IV & V rapids with 4 metre drops, giant waterfalls, and rather a lot of action swimming (in so called ‘Devil’s Toilet bowl), we cruise past the most BEAUTIFUL landscape. Giant palm trees are hung with 20 or 30 weaver bird nests (small and incredibly neat bundles with a perfect circular hole at on end at the bottom (rather like an upside down pram – it is the males who make them, and if wife does not approve she drops it into the river, how upsetting), there are black and Egyptian eagles, ‘blueball’ monkeys, white ibis, purple agrets and darters, black fluffy flycatchers. Plus trees with giant woolly roots, river melons, hairy pineapples. Happily no hippos today. Local boys fishing seem to be having more luck than us with our soap. Just amazing.