'Facing Mount Kenya'

Meet Majel at Jom Kenyatta airport!! We drive out towards Naro Moru along the Nairobii-Thika superhighway, past a group of galloping giraffes (this road borders the Nairobi National Park), and later, the Del Monte Fruit farm in Thika-  emergency stop for pink guava flavour.  The landscape changes and is different to anything I’ve seen before –very flat and sparse - valleys, euphorbias, the odd house --  the Aberdare National Park stretching away to our left and Mt Kenya to the right (swathed in cloud today which hanging weirdly – you know there’s something BIG behind…). In Nanyuki we pick up Cyrus, who will be our guide for the next five days.

We have lunch at the Trout Tree Restaurant – built in a magnificent old fig tree – a mass of pulleys, ropes and step ladders, with beautiful wooden tree stumps, and bar taps screwed into the trunk (- all the brainchild of a Canadian Mzungo, apparently.). The garden below is a lush jungle of banana leaves, amazing trees and lilies – and beyond lie the trout pools which are home to over 80 000 rainbow trout. Fish man fishes us out two into a bucket – crunch time is a knock on the head and then straight in with a knife. All systems are go, and in five minutes unfortunates 1&2 appear chargrilled on wooden plates with butter and lime – wow! We also have smoked trout, smoked over sawdust made from ‘merry oak’ from the woods of Mt Kenya National Park. Bonus feature, a colony of beautiful Colobus monkeys have decided to settle here – black helmet of fur, comedy nose and moustache, and very beautiful and expansive plumed white tails (help them to ‘fly’ between trees…).

Onwards, to the Blueline Hotel – I wear a jumper, for the first time since I arrive in Kenya, and there are no mosquitoes!! Many species of amazing succulents, and a family of busy weaver birds in the peppercorn tree). Cyrus briefs us for the expedition, and Ann (goalie for Black Cat girls, climbing with us) arrives from Embu.

Mountain Morning 1, and the summit is clear. What an incredible profile. Our team of porters – Daniel, Patrick and Kamiro arrive and we fill the van with supplies, it’s all so exciting!! First stop, though, is the Equator at Nanyuki (6398 feet) – there is a queue of American Mzungos waiting to have their picture snapped, and some overfriendly ‘curio’ shop owners (at least, until you convince them you ain’t buying). Equatorial water demonstration (water turns clockwise 20m North of the line, and anti-clockwise South – yes, it’s true!) – flows straight down over the line itself. On into Mt Kenya National Park, to the Sirimon Gate where we will begin our trek. Kamiro (58) the cook seems to be famous among the well-initiated here – he reminds me of a very sprightly tortoise and has an amazing face (no teeth though –  sugar cane causes him difficulties). He, Daniel and Patrick load a seemingly impossible amount of gear and food into their own bags, and our large ones, and tie them together with string (all we carry is daysacks, hardly seems fair…) – the loads are SO heavy and they are bent double.  Cyrus carries the box of eggs tenderly. All are wearing trainers, and Daniel has on a pair of pin-striped trousers.

 Three hours of walking takes us to ‘Old Moses’ Camp 1 – we pass through the start of the ‘Afro-Montane’ habitat, complete with baboons and black eagles, fresh buffalo and elephant tracks, and an ever-changing forest of red cedars, African olives, Bamboo, Rosewood, old man’s beard and junipers. Keeping eyes peeled for the elusive Mountain Bongo. Happily we miss most of the rain, but it is certainly cold enough up here, about 5 degrees. Kamiro pumps up the kerosin stove in the dark kitchen,  and we have hot chai and popcorn. There are mysterious hunks of meat hanging up on nails (cold enough here to keep well) – this is for the porters, apparently – Kamiro cooks us tilapia and roast potatoes (goodness knows how!), and there are passion fruits and tomato fruits for pudding… The weather closes in and it really is cold! -many more bowls of chai are consumed, and we have hot water in our bottles for sleeping with (along with precious camera battery – to preserve life)

Mountain Morning 2: hot pancakes at 6am – today we climb to Shipton Camp. The weather is clear again and you can count the snow-capped peaks, all 50 of them... Kikuyus believe that their god ‘Ngai’ lives on the summit, and build all their houses facing it (they are buried too with their head towards it– all described in Jomo Kenyatta’s autiobiography ‘Facing Mt Kenya’…) We climb in the early sun past the summit of Tabletop Moutain to our left and out of the scrubland (badly damaged here by poachers in a fire which ravaged this side of the mountain) - mountain chatts warble, and I’m still hoping for an elephant, or at least a hyena… Slowly the cloud passes below us and the sky is BLUE! Banana skins are lobed over shoulder to feed the rock hyraxes (like very large, hopping guinea-pigs – ever so stupid, with a tendency to stop and twitch nervously in the middle of the path). Also many mountain mice, and incredible birds – my favorite is the turquoise blue-black sunbird – they have hooked beaks for nectar. The landscape becomes increasingly bizarre – giant lobelias, and tall and hairy giant groundsel with green-purple ostrich feathers. With the thinner air it is a hard last push to Shipton’s hut at 4200m, but we have made good time, and I am allowed to help make the porter’s ugali (and beef stew, of course!) – ‘mzungo food’ is cheese toasties, though.

We sit around the kerosin stove all afternoon for warmth (I am wearing all my clothes). Kamiro is boiling chicken - water boils here at 90 degrees - there are lots of cheeky chats who flutter around (rich pickings for them here, including the hanging hunk of beef which has travelled with us). Later we take biscuits out in search of the ‘tame’ rock hyrax, and can see our summit point,  Lenana ( the name of an old Masai chief, who had two sons, Nelion and Batian… these two highest peaks are said to resemble the black and white of an ostrich feather, hence the nickname ‘Mountain of the Ostrich’). Early bedtime with another hot water bottle - we are SO well looked after and the stove is never off (actually becoming slightly problematic - it keeps exploding with a giant plume of flame – bad for the eyebrows, but it’s nice and warming…). The porters stay up in the kitchen and we can hear them talking loudly- ‘eh, eh’ (Masai affirmative…).

Mountain Morning 3, and Majel has had an interrupted night due to our dorm mates - the mice- one felt the need to squeak in her ear…  I sleep pretty badly too, maybe it’s the thin air. 6am brings a spectacular sunrise and I go out in the freezing air to ‘make photo photo’. Kamiro is melting the oil (solidified) to make the pancakes, and we have weetabix with hot milk. I am still wearing all my clothes, and washing doesn’t really feel like an option – the water is FRESH, to say the least (even my suncream has frozen).  What an incredible blue sky!! We do a morning acclimatization walk to two turquoise lakes. During the afternoon the rain sets in and some more weary clients arrive with their group of porters – 2 of them are crying and sick from the altitude - how strange, as none of us 3 are feeling anything. Patrick renames me ‘Magicko’ – meaning tall… The other group of porters let us share their jiko (stove) for warmth, it is really very cold.

(Funny old life as a porter – slogging up and down, carrying massive loads, to arrive and spend all your time freezing and cooking all the food you have carried for your clients (it is obviously somewhat of a competition to present your offerings as elaborately as possible) - endless plates of popcorn, ‘bisquits’, hot chocolate, fruit -  while you eat plain ugali and a cut off the beef hunk, when they have gone to bed…..)

I sleep deeply until 2am, when a mouse runs across the neck of my sleeping bag… 2.30 am is chai and bisquit time (sadly the milk has run out, and the hot chocolate…) and we leave at 3 for a headtorch ascent of Lenana – so exciting!- ‘pole pole’ (‘slowly slowly’) in step behind Cyrus, crunching on the frozen ground. Our headtorch beams pick out the shadowy forms of giant lobelias, groundsel and frozen glittery succulents, and the sky is FULL of stars. We reach the scree slope and climb steadily for 2 hours,  it is very steep. Break at the snowline (feeling a little bit sick!) – still pitch black  and extremely cold, and it is just possible to make out the dark forms of Nelion and Batian high above. (Another summit group is some way below us – you can see their headtorch beams flicking around  - stupidly this makes me feel rather competitive…) From here it is just one more hour and Cyrus times our arrival perfectly as the sun breaks the horizon at 6 o’clock – WOW!! What an incredible view. A huge ridge hung in cloud curves downwards towards Naro Moru, a sea of cloud conceals the peak of Kilimanjoro behind, and Batian lies in front, with a huge horizon and the many other snow-topped peaks lit up in orange by the sun. The Kenyan flag is flying at the summit, 4895m. Flipping awesome.

It is absolutely freezing (about minus 12, plus wind chill), and poor Majel finally succumbs to the inevitable and starts throwing up – the sun has finished arriving and it’s time to leave. Quite scary seeing what we came up with our eyes closed! The perfect sunrise turns into a perfect morning, not a cloud to be seen – Cyrus hasn’t had a run of weather like this for a long time – and we arrive at Shipton by 8am, an hour ahead of schedule. I wash for the first time since Blueline, and risk removal of the thermal leggings. More hot weetabix and pancakes on offer, though Majel’s in no mood to eat (she has been sick several times since), and Ann and I feel a bit weird, too…but it is genuinely ‘warm ’in the sun, and a family of hyraxes come out to sunbathe. The other group of porters are still waiting for their group to arrive and set up a breakfast table outside, complete with masai shuka tablecloth (they think they are winning the secret competition). Make the long step back to Old Moses in the sun - life is good and the bags are light! Patrick lets me make the chapattis, this is amusing, apparently...

Last Mountain Morning - we leave for the gate leisurely  and arrive ‘pole  pole’ after 11am  - soldiers from the ‘Kenyan Wildlife Services’ (they are hunting poachers) give us a lift to the tarmac in their 4x4, where Kioni and Oti are waiting for us. Back in Blueline at  Naro Moru,  I am very sad to say goodbye to Daniel, Patrick and Kamiro and more tired than I realized. And in great need of a hot shower (this is not immediately forthcoming, TIA). PYJAMAS, soap, oh boy.

A few days in Nairobi

I catch a matatu into the depths of Kibera, fascinating. Home to 200, 000, this is Kenya’s biggest slum. Humongous rubbish piles, thousands of corrugated iron houses stretching for miles, crowds of people (especially as today is church day); plus endless stalls – fruits, hot chapos, boiled eggs and mandazi, butchers selling choma meat with hanging carcasses, h air salons and kinyozis (barbers). Very dangerous here at night, and even in the day… Ushirika clinic is a 24/7 medical centre built by Moving Mountains in 2003 – it offers medical consultations, drugs and maternal services at a cut-off price of 1000Ksh. During the morning we see many cases of malaria (the mossies DO seem pretty hungry round here…), and one guy who was properly beaten up last night by thugs – probable broken wrist – injected with morphine and sent to Kenyatta hospital…

‘Carnivores’ for lunch, with Hannah and Charlotta! This is Kenya’s most famous place to eat nyama choma, and has also been voted one of the world’s 50 best restaurants. ‘A beast of a feast’…literally. We sit among banana leaves and cacti, at a table set with gourds, banana leaf mats and zebra seats (although the serving of game meat is no longer allowed here). At the entrance is a huge smoking BBQ pit (all lit up in red; like something out of ‘Raiders of the Lost Ark’), and the meat is basted on real Masai swords. The waiters (dressed fetchingly in zebra aprons and boaters) appear constantly at your shoulder with the next sword of roasted delicacy – you just have to keep saying ‘no’ to keep up (alternatively you can knock over the flag on the table for a break, or remove it for complete surrender). Before the meat is brought you are given maize, soup and bread, and ‘Dr Dawa’ appears with his ‘medicine’ (‘Dawa’ in Swahili), which is a cocktail of vodka, lime and sugar, stirred with a bamboo stick twisted in honey… We have a multi-storey tower of sauces to accompany each meat (the waiter reminds us which each time) – fruit (for ostrich), wild berry, garlic, marsala, chilli, mint… plus matoke (mashed green bananas), sukuma, salads… The iron plates are sizzling hot, and are filled constantly with crocodile (a sweet, fishy chicken flavor!), ostrich (my favourite), oxen balls, chicken gizzards; plus perfectly cooked lamb, beef, pork,chicken, turkey, you name it… (*Ahem*, veggie must be officially set aside, for one day only; besides, this stuff is *so* dead already…). Trick is to try a little, then move on, for digestion’s sake - we eat from 1 – 3.30pm. Just as you surrender, icecream and Kenyan coffee is served. Next door is the equally famous ‘Simba Saloon’, which hosts amazing live Jazz nights – all of Kenya’s biggest musicians come to play here. All in all, a once-in-a-lifetime culinary experience, and I have never been so full in my life…

At night in the guest house kitchen – the rustle of cockroaches, plus GIANT spiders. Also, bed bugs DO bite…

Today I am a tourist (‘you will see many mzungus’, Oti informs me). We drive out to Langata and Karen districts, past the Nairobi National Park where baboons swagger along the roadside looking for unsuspecting picnickers. First is the David Sheldrick Conservation Trust, which raises orphaned elephants (from poachers, or victims of wells, mostly) and also black rhinos – with the aim of reintroducing them to the wild in Tsavo National Park. They come sprinting from the park for their milk (they spend the full day there and only meet humans for an hour at 11am) , very cute - they are weaned on 4 tins of SMA Gold per day, specially imported from England (one can’t help but think of the babies in Embu…) and grab the giant bottles with their trunks. The tiniest are swaddled tightly in masai blankets, tied with a rope belt. The keepers are with them 24 hours each day, and one sleeps in the straw with each individual each night (important, as they are their surrogate mother, and elephants really do die ‘from heartbreak’). Such funny, smiling, furry beasts with their comedy black-tipped spiky tails; v happy rolling, farting, pinching the keeper’s spade, trunk swingin…

Next; the Rothschild Giraffe Centre, where you can stand on a raised wooden platform to feed the residents at eye level (apparently they are on a ‘diet’ of 2 pellet handfuls per visitor…yeah right; anyway, ‘no food, no friend’, or even a horn-butt.. I)f you place a pellet between your teeth, a long purple tongue will delicately extract it (you can see how they fish for ants in the thorn trees) – how Romantic (although motives questionable) - up close and personal they really do have bizarrely long snouts.

Opt for the cheap lunch option, away from tourist prices – roadside ‘hotel’ (always tempting digestive fate) – beans and chapo for me, sawa, but Oti’s matumbo (tripe/intestine) is extremely well-‘plumbed’ and rather furry… Everywhere, everywhere you go, the red-painted stalls are advertising ‘barudika na Cola buridi’ (enjoy a cold coke) – in Kenya, there is always time.

Within the Karen district lie’s Karen Blixen’s original Colonial house, set in the beautiful grounds ‘at the foot of the Ngong hills’ (Ngong means ‘knuckle’ in Masai – the peaks really are similar, all 4 of them!). Loved seeing it all for real (I finished reading ‘Out of Africa’ last night!) – there are the lion and leopard fur rugs she shot, the stone mills outside where she sat to grind flour with Kamante, the oil lamps used to signal her mood to Denys Finch-Hatton… would have been quite happy to wander but the tour guide is painfully slow as he goes through literally every item of furniture, in each room, as ‘orrrrriginal’ or ‘not orrrrignal’… I nod lots.

One of the last chapters in ‘Out of Africa’ is called ‘The Giraffes go to Hamburg’ – about 2 giraffes captured and sent from the port of Mombasa to a travelling zoo in Hamburg’ – “gentle amblers of the great plain; cantering side by side; crowds will laugh at the long slim necks and the graceful, patient, smoky-eyed heads; little noble heads that are now raised, surprised, against the blue sky of Mombasa…”)

Last is the Nairobi Park Animal Orphanage – normally they feed here in the afternoons, but today everyone’s full, and not chatting, either, ah well. Not much to see. Patricia the warthog is sun-bathing though – unbelievably brown and ugly – I find her far more funny than is fair…

How time flies

Gilbert takes me to the Dallas Dispensary for my first day – it is a 45 minute walk, and there is a trick to moving without attracting too much attention. The clinic was built with money from USAID and the Kenyan Government in 2007 (although it has been closed on and off since due to local disputes over ownership), and is run totally by nurses. Registration costs just 20 Ksh (still too much for some, though), and many of the drugs are free or subsidized. It’s a very impressive service, and well-equipped with a basic lab for microscopy (provided there is power!) and a pharmacy; services include HIV testing and counseling, a TB clinic, general consultations, ante+post-natal clinics and family planning, and child immunizations. I am the first intern who has visited here – introduced as ‘Dr Joy’, as usual… There is always a queue outside from 8am, but by 11 most people are at work so it is quiet. This fortnight there is  also a government funded programme to give all children under the age of five Vitamin A (to protect against ‘night blindness’); there is also a box placed outside the door filled with small bags of maize and beans (‘together to fight malnutrition’).  The Dallas community is a mixed population of local residents, plus some 20, 000 people living in the slum (primarily a Muslim population) – lots of TB cases, also cholera and typhoid due to the overcrowding. 

I sit in with the HIV counselor Joyce (she swears I am 16) who explains the tests to me – there are 2 (instead of the original 3 which created a ‘tie-breaker’ situation), same day antibody tests. It’s a 15 minute wait for the strip card to register, a bit like a pregnancy test – scary. There is a government campaign to encourage people to ‘know their status’ (‘Gjue hali yako ya HIV’) so testing is very important. The risk of MCT (‘mother-to-child-transmission) when exclusively breastfeeding is 60% (only 50% if ARVs can be used); however today we see a positive mother with, her baby who at 9 months is officially negative – what a relief! (Children testing positive at 6 weeks are retested at 9 months in case of false positives due to the mother’s conferred immunity). This centre advertises the importance of the strict use of condoms and there are free dispensers around (they are empty, but a nice thought!) – there are also free condoms supplied by the Japanese for several support groups which meet here – including one for HIV positive patients, and a commercial sex worker’s group. (Another statistic - 45% of women in Kenya are pregnant or are already mothers by the age of 19!) Male circumcision is done here (much safer than in the traditional ceremony which is done without pain relief – boys usually spend the morning in the river to numb the pain…); and interestingly this could be a moderately effective AIDs ‘vaccine’, reducing the risk of transmission by over 60% ,  and allegedly preventing over 3 million deaths in 20 years.

Today is the TB clinic, with Dorothy the nurse. Each patient who comes has a named box of (free) drugs to cover both the intensive and continuation phases of treatment. All patients are followed up regularly, as this is a communicable disease (as in the UK). So many people!

I visit the Dallas slum with Regina who is one of 50 Community Health Workers trained by the clinic– each are assigned a number of households within the slum  - roles include the mobilization of patients to attend clinic,  taking HIV drugs and food in for the sick, and addressing issues with sanitation etc. There are two ‘swamps’ within the slum (which seems endless) – these lie very close to the houses which is a problem - (when water supplies dry up they are used as a water source, which is obviously dangerous.) There are many people digging on the roadside – they are laying pipes here to create access to clean water which is great news (although it’s very muddy now -  ‘sorry sorry’ – the Kenyan response for anything which goes wrong, regardless of whether of not it is that person’s fault!). Sanitation is a massive problem here, especially during the rainy season when the piles of rubbish cannot be burnt (they are well grazed by cows and goats though).

I go back to visit the interns on ward 10 – it’s still ‘peak’ pead season and very busy! A nutritionist friend explains the new feeding programme for HIV-positive mothers - since a month ago, an NGO organization has undertaken to provide funding to supply all the mothers here with a 9 month supply of ‘AFASS’ Nestle milk (‘affordable, feasible, acceptable, safe, sustainable ….’), a water filter and thermos flask to prepare the solutions. (The milk comes in tins, each costs around 900ksh and will last only for several days – so each mother will need about 80 tins (she should pay for the last 3 months herself, until the baby is 1 year old)). This fulfils the recommendation by the WHO, and so far has been extremely well received by the mothers here as a replacement to exclusive breast feeding (which obviously carries a risk of MCT). (A baby has just been born on 13 – Veronika the sister comes to tell me that it has been called ‘Joy’!). Also visit the medical superintendent Dr Muli to finish my placement - his secretary always seems to find me one big joke which is becoming a bit disconcerting (doesn’t do much for one’s confidence when ALWAYs being smirked at - it will be nice to go around unrecognized, I do think…!)

I visit ‘St Monica’s Special School for the Mentally Handicapped’. It is really a lovely school – very positive and caring (despite the problems with national stigma – children with special needs are sometimes hidden within the house for shame), and the children are encouraged to be as independent as possible. There are 120 kids, aged from 4 to 30 years, and most board full-time. I am shown the farm, the shamba, and the classrooms for woodwork, jewellery and needlework too (I come away with an new apron!).

I am invited to Lillian’s house for tea. She lives on the other side of Embu, near the Dallas community. There is a small shamba at the bottom of the garden, with 2 goats, 5 rabbits & chickens (and a new chick!). She is a great church-goer and the living room walls are lined with bible verses and prayers. We have tea and bread and sweet bananas and eggs. Erin her daughter is there (and brings her friends over too). It is dark by the time we leave and walk back towards town – so many children come to shake my hand, everyone is staring and laughing… Such a busy, interesting place – all the streets are full of people, music playing, dancing, many butchers and milk ‘bars’ (selling maziwa lala – ‘lala’ means the milk has ‘slept’…), people selling chargrilled maize and tilapia (twisted up in newspaper with salt). Back in town there has been an accident and no taxis are going – Lillian’s ex-neighbour comes to take me home on the back of his bike – there is a full moon and it’s a wicked ride!

Jenny from the kisok plaits my hair early before church. I only want the front bit done, but this takes some explaining… I sit outside her house – one room only but it’s separated by curtains; there are lots of pictures of ballet dancers. Next door the neighbor is beating her child with a large spoon, oh dear. It hurts, a lot!-my scalp has never had such an attack…but cool to try (although it falls out by the end of the day – my hair is just not the right consistency, as I am constantly reminded…)

I spend the afternoon at the Rescue Centre. This week the schools go back (lots of singing when you walk past! And counting – 1-10 is Moja  mbili tatu nne tano sita saba nane tisa kumi), and so it is fee-nightmare when all the children sponsored through the charity have to have the costs met and the term’s shopping done. Today there is lots of tell-tale left-over githeri – many of the usual customers have been chased home this morning as they attended without the required sum. Intense scrabble match (no threats from my side, though); there is one chess set too. I bump into Summi in town (the son of Joy, the patient with a SSC of the cheek) – nice to see him, but his mother is no better.

Sunday Black Cat home match against Dallas team – we win 4-2, no worries (tricky playing conditions as the pitch is pretty wet today, and there a big clumps of grass; still lots of them play bare foot!). By great luck and a bit of insider knowledge I have managed to acquire Embu’s very last ‘Harmabee Star’ (the Kenyan National Football team) shirt – the kit factory has gone bust so it’s a big deal. Poa poa. (The national motto is ‘Harambee’, which means ‘together’ - this is written on the flag; which is black (for the people), red (for the blood spilt in the world wars), green (for nature) and white (for peace); there is also a shield and crossed spears to show power and defense. I go to football training (strictly on best performance as under scrutiny of the boys plus the mass of spectators at the stadium) – a long run which is fine, then a match – 3vs3. Not so skilful, not gonna lie…

The guava season is upon us. Officially mangos are over now, but small sweet ones can still be brought in the market – about 10 for 25p (also yellow passion fruits, similar to their brown cousin but much less crunchy)! Mama Whyela has taken it upon herself to feed me – ‘you want to take githeri’ (a cup for 20 bob), baked sweet potatoes (SO sweet!), hot chappatis and milk, uji... I have discovered African honey, which is very dark and sweet, with a definite hint of BBQ flavor (and can be eaten with avocados – wow).

We run out of gas; then the power goes off. Somewhat limiting; plus I only have dried beans. One of the WORST noises I know is the whine of an approaching mosquito, especially when you can’t see it coming - yuck! In other news, I have been mistaking the local chipmunks here for squirrels, which are much more interesting.

So…, my time in Embu comes to an end. Mad! SO strange to be leaving, and not coming back. And so many goodbyes!! :(

It's a hard knock life

My first day of Obstetrics. Ward round and checks for breech presentations etc - baby monitoring is done using a fetoscope (a cone with an earpiece) – no fancy stuff here. Sometimes the mothers don’t know their delivery date, so clinically estimating the gestational age is important. An emergency admission with an impending uterine rupture comes in for a C-section – these are all done by the interns (but not me, hopefully!) There are also two mothers waiting to go into the labour room - the contractions are pretty terrifying but there’s very little support or sympathy which is hard to see. Mercy is 20 years old and this is her first baby. The delivery room is a frightening place, with a frightening sister – there are 4 beds (no sheets or nufin) and zero privacy, but thankfully today she has the room to herself. Not a whiff of oxygen or encouragement (as childbirth is considered a ‘natural’ pain), and the episiotomy is brutal (the nurse assures me she feels nothing but I can’t quite believe that from the noise she’s making) All pretty harrowing for her, and me. I get to deliver her baby boy (3.5 kg) and cut the cord – all is well and we wrap him up in a kanga by the heater, but poor Mercy still has to be sewn up…before being pointed to a cold shower and a cup of uji. Tough old world. The second mother staggers in as they are swilling the floor (and the token curtain) – think I’ve had enough for one day and carry Mercy’s baby for her to the post-natal ward (much to everyone’s amusement), as she has to carry all her belongings, bent half double…there is a bed for her but it’s half occupied with another baby – a shame as she can’t really sit down. TIA.

Braving the labour room again.  There is a miserable girl who delivered prematurely early this morning – her baby is now in the neonatal unit, but she is still lying on the couch with a retained placenta. Sparing the details, the removal is not pleasant, and requires the ingenious use of a third pair of gloves fashioned into arm protectors. I am offered to learn how to suture (by same frightening sister, she is called Veronika), but make my excuses… Also see a few amniocentesis procedures – there are a finite number of clean gloves today, for some reason, and also laboratory sample bottles, so the fluid is placed in normal glass jars. Two more emergency C-sections which I scrub in for (we are delayed as the theatre bed is broken, but a welder is summoned who zaps it up pronto in the corridor) - this hospital still uses the midline sub-umbilical incision (old-fashioned, even by Kenyan standards, but its consultant’s choice) – quick and simple, at least! All a bit different to home where layers of bright new surgical drapes cover the patient from head to toe – the scrubs are stained and have holes in – they are bundled up with masking tape into the sterile sets. Baby No.1 isn’t breathing but is resuscitated fine (he has a VERY long head which explains the obstructed labour!). There are two power cuts during the ops, but the generator kicks in fine. This procedure will leave the mother with an impressively large scar – I wince as the stitches are covered over with a few large bits of the usual plaster tape – will hurt to come off… I visit ‘my’ mother and baby from Monday’s birth on ward 14 – she looks very well and her baby boy is called ‘Mathugai’ –  it’s very nice to see them!

I visit the Embu-Mbeere hospice with Judy (the palliative care nurse) – it’s  about 10km from town, in the middle of nowhere, and is still very much under construction  - it should be a really impressive centre though when it’s completed in 2014. There are currently very few hospices in Kenya (all out-patient based, otherwise allegedly people would bring patients to the door and leave them…), and as yet, no recognized paediatric programme at all. Today the team goes through the new assessment form (detailed history including tribe, chief, etc), and drink tea, tea, tea…! (Fast gossiping in Kiswahili – the equivalent of ‘errmmm’ here is ‘nini’; I miss the rest of the conversation though).

I arrange to visit the paediatric occupation therapy department to see what’s occurring – lots of cases of cerebral palsy (from birth trauma, ah yes) and also delayed milestones secondary to rickets (again the reason for this strangely high prevalence in the Central lands is unknown– a recent study by Kenyatta University suggests it might have something to do with uncooked cereals in uji (most flours are a mixture of grains, some even have powdered omena!- and the high levels of phytates inhibit the absorption of calcium, even when the child is adequately fed)). APDK – The Association for the Physically Disabled of Kenya are due to visit here on the 31^st May which is pretty exciting – a group of surgeons will consult from very early ‘til late, assessing kids with cleft palates, club feet, spina bifida etc and referring them to centers for corrective surgery. Lots of swings and standing frames, and a small back area with a sink which serves jointly as a rehab centre for ‘ADLs’ and as a DIY mould-making room.

Today is ‘Labour Day’, a public holiday, and I go tilapia fishing with Nyambora and Ndwega in the lake behind Isaaks- technically this is trespassing and we are guiltily crossing the banana plantation when we are overtaken by a group of small boys who evidently have the same plan for their day off. Lucky they are here as they catch our bait for us - crickets (which are massive and rather off-putting; plus it is too hot to be running around...). Incredible, the tilapia bite for them like nothing else! - even in the shallows they nibble the line (despite the noise coming from the boys next to us who are swimming with a mosquito net to catch the ‘fingerling’ babies) –annoyingly they are remarkably good at removing the poor insect and spitting out the hook. I do catch one, though! -it is pink and silver…immediately feel sorry for it and donate it to the boy’s collection (strung on a stick). Would have been too small for fish marsala, anyway. The lake is beautiful, with enormous red and blue dragonflies all about.

It is hard to be a chicken here. There are so many shops advertising ‘day-old chicks’, which are raised to become ‘broilers’ – boiled and deep-fried kuku, v popular. Lucky birds reaching more senior stages are tied by their feet and carried about upside-down in bunches, they are remarkably docile about it, no flapping. The streets of Embu are wicked in the early evening – shoeshine huts, maize sellers grilling the cobs in roadside pits, women shredding sukuma, smoky charcoal fires. There are a few roadside ‘garden centres’ on the main road out of town where you can buy anything – mango trees, cacti, and bizarre trees with spread-out layers of leaves, like an inverse-Christmas tree. Massive sisal plants grow (I thought they were aloe vera at first) which are made into rope. Shop names are hand- painted and make me laugh – ‘nice and lovely’, ‘jolly precious fish + chips’, ‘victory snacks’, ‘lord’s super butchery’ (and ‘the roastful butchery’, too).  An alternative medicine clinic: ‘we treat, God cures’…

Lizard in the bath, slim and brown, a friend of the gecko. Horribly wriggly to get out. Massive storms at the moment, with lightening forks across the whole sky and TORRENTIAL rain – this means the power sometimes stays off for almost 24 hours which is frustrating! BUT after a heavy rain Mt Kenya can be seen incredibly clearly from the hill, snow topped peaks and all.

I buy a fab wooden spoon (actually it’s more like an oar, although not as big as Lillian’s which is the next-oar-up) at the market for making my own ugali. Ugali is essentially a large white polenta cake, but is surprisingly difficult to make properly – when done you should be able to turn it out as one big mass, leaving a thick hard crust on the pan which never comes off… Also barter hard for some small ebony carved animals – exhausting - the seller is at pains to prove to me the quality, ‘sister’ (real ebony secretes oil when you scratch it). Best purchase though is my first ever cocoa pod! – green-brown and furry on the outside, and rattles when you shake it. Inside is a sweet white pulp surrounding the cocoa beans (this can be eaten, or fermented and used in uji) - separated by string fibers into segments. (Chocolate though is a long way off – the beans have to be sweated, fermented and dried for many days…ah well).

Fav foods at the moment: avocado (which can be brought for 10 bob - about 7p - from Mama Whyela and are as big as 4 normal ones – the trees are LADEN with them at the moment), mazala lala (fermented milk), the oranges, and boiled arrowroot (or sweet potato, or left over ugali, for that matter). I also cook Kunde – this the name of the dish and also of the African black-eyed ‘cow peas’, which are stewed with onions and tomatoes (the base of every recipe here!), peanut butter and sukuma.