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!! :(