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.