Life in Embu, and my first safari...

Today I start on General Medicine – wards 1&2 female, and 8&9 for the men. The wards are sparse and there is little privacy. Generally patients are admitted because they are immunosuppressed, or have complications from this; there are also cases of TB, meningitis and malaria. An 18-year old girl has developed confusions and convulsions – she is in end-stage renal failure and is due to be referred to one of the 2 national centers for haemodialysis. The difference with the UK is that she will only receive one session (as opposed to the regular ones provided in the UK), and then it depends…on money, mainly, as always. The diabetic clinic is much the same as an English one (except quite a few of the cases are hyperglycaemic as they haven’t been able to get hold of any insulin). Dr Gitari reigns supreme here – I have been fore-warned by the interns on ward 10 – he is MUCH scarier than Dr Chapi, and poor intern Hussein gets it in the neck for all 5 hours of the ward round, not much fun for anyone.  The general med clinic is extremely busy (it usually lasts at least 6 hours) so 2 interns share each small consulting room but it is all in Kiswahili as most of the patients’ don’t understand English. A few don’t even speak Swahili and come with a translator for their local tribal tongue.

I bake with Hannah and Charlotta as we are planning a birthday party at Toto Love – 40 cupcakes by eye (as no scales) but they turn out good! We ice them in red and blue (the colouring is rather salty!), and the 3 birthday people get double sweets on top. Carefully transported down the hill with a pile of balloons. Unfortunately as we are trying to sneak in the kids are waiting and there are tears and beatings as the housemother tells us they have not taken their afternoon nap as promised…Wasn’t part of the plan L. However, peace is restored and cake and squash go down v well – we sing to the 3 (with the monkey verses too – they know so many songs!) Blue icing everywhere, especially Derek, the baby. We play musical chairs, and bowling outside using Tusker cans and an avocado stone. (Tusker is the local lager apparently so-called as the head brewer was killed by a charging elephant). It is so difficult as the children are so spread out in age and it is such a tiny space (there are 20 kids – 12 of them girls in one tiny bedroom sharing 7 beds)  - there is absolutely no personal space and people just end up getting upset.

Today I visit Gatwe Primary school with Kioni and Michelle (another English volunteer who is here for a few days). We catch a matatu to Kidogo town and stock up on supplies for a family of 3 girls who Moving Mountains are supporting – maize, rice, sugar, salt, and cakes! Gatwe school has 300 pupils and 9 teachers. The head and deputy teachers, Agnes and Grace are there and are extremely committed to improving the school. It is a line of classrooms roughly made from wood with tin roofs and earth floors – dusty and hot in summer, and cold when it rains. Moving Mountains are in the process of building new classrooms using interlocking bricks (made by the boys at the rescue centre – they don’t need any cement to construct) and there is a lot of Kenyan scaffolding in place (i.e wooden sticks which are bending alarmingly!). It is the Easter holidays but the older classes are here for catch-up lessons. They are summoned to line up and sing to their visitors (loudly!) – we are made very welcome and have to make an introductory speech to the assembled crowd (I am ‘Joy’, as per…). The 2 older girls (12 and 11) in the supported family are here and we walk with them back to their home (they were relocated by the charity from the paper shelter in Embu slum where they were living without their parents and now just about manage for themselves in the first brick house which MM built. Younger sister (7) is not in school today and she comes out to meet us. They are gorgeous girls.

Matatu ride back – 8 of us in small car (even the driver shares his seat) – I can’t see anything but it feels like the ‘runaway train’ ride at Alton Towers, only faster and definitely bumpier (suspension is non-existent, even the windscreen has cracked from the jolting) – prevents even me from drifting off into my usual snooze…esp when the driver stats texting with one hand – still he seems to expertly navigate the potholes. Petrol smell rises. Anyway, we arrive back in Embu, TIA.

Lillian is frying the onions when we arrive. Today I am allowed to stir and serve up the githeri (wearing one of Lillian’s kangas). We mix up maize with red millet to be made into uji flour – hole in bag = nightmare – masking tape job. Many of the boys here sniffed a lot of glue before the centre was started, and a few of them have been permanently damaged by it and can’t talk properly anymore.

I am waiting for my exam results at Issaak’s, and decide to buy lunch there – against all vegetarian instinct I bravely order Matumbo, a local delicacy, this is tripe which has been boiled and then fried with vegetables. It is very nice (and a large plateful costs me 1 pound), but I don’t need to have it again. (Happily, medschool say I can ‘proceed’ to 5^th year, phew!!)

I am woken by an almighty thunder crash and lightening storm – honestly like a bomb going. Crazy rain at the moment (the roof is leaking so we have to put buckets out), and power goes off and on most evenings – v frustrating! Also, no water in Embu town centre since the weekend (something to do with difficulties in Nairobi…?). I’m still boiling up water every night here, but luckily it’s still coming out of the tap!

I make the 125km journey back to Nairobi in a matatu billowing black smoke – names include ‘in god we trust’, ‘jurisdiction’, ‘legacy’, and various other concerning titles… (There is a sign in the windowscreen corner which advises the driver in case of accident to ‘accept no liability’, great). This is rice territory (100% Grade 1 Mwea Pishori, to be precise) and paddy fields stretch away for miles in all directions, well irrigated by overflowing channels, and punctuated by solitary umbrella-shaped trees and white cow egrets, and goats who treat the fields as a PYO. We stop at a shop where several huge sacks are loaded into the boot, the bumper sags, but I like the smell of the dry rice. (Torrential rain shower starts and water comes fast through the roof onto me and my phone, which stops working…if only I had a bowl of rice…). Lots of donkeys work here – usually grazing free, or harnessed up in pairs and 3’s , spindly legs splayed out in opposite directions with massive loads – they always have such sweet eyes, although having a cart tripping up your hooves all the time must be irritating.  The Thika highway leads us back into the outskirts of Nairobi – I wait for a pickup at the postoffice for an hour which is a little daunting – the Kenyan way of attracting your attention is a kind of whistle through your teeth, and this happens a lot. Massive downpour and lightening strikes. Joseph Mungai pulls me into a taxi, I am quite relieved. It is a crazy 2 hour drive back to the office as the traffic is literally appalling – the road is  flooded deeply in places and flows strong enough to break down gates and houses, and the pavements are non-existent- still, no-one complains and people just wade on through in good humour. I am very tired. We stop at Kibera for some food at ‘Mama Liaza’s café’ which is a shack inside the main slum – there is a big smoky fire in the backroom and we are given chappatis, chai and tilapia (lots of bones, and a long tail!).

I drive with Oti to Hell’s Gate National Park, about 2 hours from Nairobi so we leave while it is still dark. ‘Coco de rasta’ is playin on the radio. We reach the edge of the Great Rift Valley – a stunning ‘trough’ which begins in Tanzania and continues to all the way to Ethiopia. It is 60 miles wide here, and seperates the Masai and Kikuyu tribes. ‘Lady Margaret’ hill lies in the centre (after Princess M), so  I am told by the vendor whose stall we stop at for photos – he undertakes to tell me the whole history of the valley (think he may want me to buy something) and I think we may never get away. Euphorbia trees poke out of the top of the greenery here – they secrete milky white latex. We descend into the valley along a winding road built by Italian Prisoners of War (they were allowed to build a small church at the bottom) – there is a truck upsidedown in the gulley beside us, with the driver standing on the axel – at least he’s obviously not hurt! Lake Victoria lies to our left, and Naviasha in front – we pass 2 settlements of displaced people (from Navaisha), and massive greenhouses (Kenya suuplies most of the flowers to Europe – express roses from here appear the following day in Tesco). Chai and tomato fruits for breakfast!

I hire a bike at the entrance – it is 9kms to ‘central tower’ inside the park, past Fischer’s tower where you can rockclimb. Hell’s Gate is so-called for its hot spring s and geysers which are used for geothermal power. Safari is originally a swahili word meaning ‘journey’ or trip. Thomson and Grand gazelle bound away with their white bottoms (different to impala who have no markings – groups of males are known as ‘loosers’!), zebras call to each other, warthogs (so called because of the wart-like processes under their eyes!) run with straight upstanding tails –when they walk they relax them…, blue starlings are turquoise blue with orange bellies, buffalo watch me go past (I have been warned to stay away from lone ones – I think this one is and speed up!), and so many birds call, including the African hoopoe (which make a sound like flowing water) and the giant Griffin Eagle. Giant blue wasps and dung beetles fly past – the males roll the dung and the females lay their eggs on it – the ball can then be buried and serves as a food source for the babies when they hatch (unless a bat-eared fox gets them first – he listens and can hear them 4 inches down!). Joseph a park guide catches me up and we turn off the main track as he can smell giraffes (and babies, too!) (they smell like peas, apparently…!!) – here the track has completely collapsed from all the rainfall, but we can see leopard prints in what’s left. After beating through the bush a bit, sure enough – there are a family of 4 masai Giraffes (sitting down – it will rain this afternoon…) (they have a distinctive flower marking), including a baby. Just SO exciting. I get off and push the bike towards them – they are all watching me, and this is probably the highlight of my day. When they run they are incredibly graceful, and seem to move in slow motion. They eat acacia and the whistling thorn which is everywhere – this plant  is protected from the giraffe’s tongue by cocktail ants (they shake their tails and get pretty aggressive when you knock on their house) which bury them selves in the fruit pods and leave small holes (these holes are what whistle in the wind, hence the name!) .As we are watching a family of warthog break cover from their shelter in an ardvark hole so funny, they reverse in – mother first, then the 3 babies, and daddy at the front).

We cycle on to the Gorge (this is technically closed as last week 7 teenagers died here in flash floods –it has been all over the news -  Joseph was the guide on this trip and had to let some of them go into the water, just horrifying). Today though, it is quiet and we walk along the bottom (it stretches 17km well into the masai lands) – tomb raider was filmed here (although I’m not sure how the crew managed with all the hot springs and quicksand!). There is lots of opsidian stone here – this is black volcanic glass formed from cooled lava, and the masai use it for spear heads. We climb up and reach the viewpoint which inspired the graphics for the ‘Lion King’ wildebeest charge – I stand where Scar pushes Mufasa… A naughty baboon sneaks up behind us. It is a hot cycle back, but just as fab.

Oti meets me with the truck and we enter the Kedong Ranch (800 000 acres of land in the Longonot National Park) which is apparently where we will might find lunch. The road is extremely bad, almost washed away by rain, and we drive for 14km seeing nothing. Then, at the top of a wooded hill, miles away, we can see a small house – and head for it – we bearly make it up the hill and nearly end up in the ditch but all is well. The gate is sinister and hung with buffalo skulls – it’s seemingly deserted – really quite scary, then a mzungo man comes out – he is German and ushers us inside. We have stumbled upon the house of Martha Gellhorn (the wife of Ernest Hemingway), who built this house in the 40s – it overlooks Lake Victoria and Crater Lake (the site of the flamingo migration), and Longonot volcano lies behind. This is Masai land and there are thatched huts dotted around. It is absolutely stunning. The german gentleman takes me on a tour of the land, how bizarre, and asks me what I would like to eat… Errrr…  Oti and I are seated at a table with roses, literally among a flock of Masai sheep, and ibis, and blue starlings, and a 5 course meal is presented (I was almost expecting human, but it is beautiful Tilapia from the lake with almonds, and apples). Afterwards I am shown to the stable and meet ‘Grey Wolf’, a beautiful speckled grey ex-race horse – I ride out with Issak as my guide (on Sandolin, another brown 6 year old) into the enormous park, down past Longonot volcano, and through herds of Hartebeast, gazelle, zebra. I CAN’T BELIEVE IT, we are trotting then cantering and it is just amazing. The ground is covered in african violets and whistling thorns. In the distance we see a group of 5 giraffes and head towards them – I go first on Grey Wolf and they just stand and watch, I go to within 50 metres, easy, before they head off. We ride around the hill to our left to look for ostrich (grey Wolf is pleased as he thinks we’re going home…), then, ANOTHER group of giraffes, 8 this time – Issak hangs back and Grey Wolf canters on behind them – they run away, as if in slow motion and I follow behind – IT IS PURE MAGIC. It is time to head back (the sun is very hot) and we pass through a herd of masai cows with the masai crouched in his checked kanga – his family are staying in the hut and come out to say ‘jambo’. A massive raincloud is gathering over Longonot and as we pick our way back up the hill the thunder rolls out – we make it back to the stable (complete with busy weaver bird tree) just as the first drops of rain fall. The german man (I still don’t know his name) urges us to hurry away before we get stuck and we drive away in the opposite direction to the way we came – this track will eventually take us back to the main road to Nairobi as long as we DON’T TURN OFF anywhere…. – there is a bunch of beautiful pink –tinged roses on the back seat of the truck.

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.

How many people can you fit in a matatu?

23, it seems, plus a chicken or two, and plenty of plantains. They’re really not that big inside, so this is impressive. .There’s a police presence on the road at the moment, as the main road to Meru is being used by Somalia people travelling across the border. Today I see some sights, with Jackson as my tour guide (a local boy). We climb Kawue (a bizarrely-shaped conical mountain used for radio signaling) – the route passes through farmland and coffee plantations and finishes with  a long steep climb, HOT! – but at the top you can see for miles around, including an impressive cloud formation concealing the summit of Mt Kenya (ah well!). People come to pray here, as it is so quiet. On the way down I meet my first chameleon, he is yellow and black striped, including his eyes. We catch another matatu to a stunning waterfall (and there’s a cave too, full of giant moths). The soil is SO lush here (the redness comes from the ‘laterite’ clay which is heavily enriched with iron and aluminum, due to the rainfalls and intense heat) and we poach a couple of guavas for pudding. Weaver birds make their nests here as circular bundles which hang from the banana trees. Later Jack takes me to his Youth Cimate change meeting, this is a very enthusiastic group who have already set up several local projects, including a plastic bag recycling scheme, and the planting of sukuma.

Paediatric clinic – usual amount of noise coming from waiting room. Most are here for follow-up, a few are suffering from white-coat syndrome. I cut out the cardboard tickets which are given out for the date of next appointment. Interestingly, rickets has a surprisingly high prevalence in this area of Kenya – research is underway to investigate the cause, as no-one seems to know why… (Also, the risk for a Kenyan of developing a cancer is considerably lower than in the Western world (although prevalence is on the rise, probably as more and more of our culture creeps in) -  this is thought to be due to the diet here which is very low in fat and high in fibre (beans beans beans!) - long may it continue).

I boil arrowroots for lunch – sweet, with a mottle white & purple flecked inside, to be dunked in chai (as with many things!). You can also eat them with fermented milk, or ‘mala’ – this is a bit like sour yoghurt and is thought to be incredibly good for you (which it probably is! - probiotic central). The masai make it with cow’s blood and urine and leave it for several days to ‘mature’ in a galabash (gourd). If it works for them… (One can even go the whole hog and ferment the ugi porridge, although Gilbert assures me serving both together would be overkill).

Sofi plaits the top of my hair as an experiment to see if it will hold, she is generally unimpressed as it is far too soft and she has to pull it extremely tight, ow. She also calls me ‘baby face’. I’ll try not to mind.

I am joined for early morning aerobics by Charlotta, a german girl who is spending time at Toto Love. I’m sure I lose half my body water each time – I feel dizzy for the rest of the day. We are a comedy-duo running home, and acquire several co-runners. (‘Hello I am fine’ is standard greeting– bit confused? but friendly at least).

Sunday is church day, and the music and drums start early and go right on through. Everyone is in Sunday best. I walk to town to meet Coach Summi and the Black Cats – today is an away match against Kuayambora FC. No worries, we’re confident. Summi has hired an open-top truck to take the whole team plus supporters – its an hour’s drive and the speed bumps make for a interesting ride! I am the team photographer, but progress is impeded by my welcoming crew – who follow me across the pitch and round about. A mzungo is a good afternoon’s entertainment, although it’s very friendly. Anyway, I’m glad when the match kicks off. Two tense halves, it’s hot and dusty, and the refs aren’t playing fair… Big pep talk needed at half time. BUT: the boys play well, and final score stands 2:1 to Black Cats!  It’s nearly dark as we drive home – this time I sit up front (dunno what’s more unnerving, being able to feel the bumps or see them coming!). We are treated to an incredible view of Mt Kenya (finally, my first!) – it has the most amazing rocky profile, and you can see the twin peaks of Batian and Nelion. A flash of lightening forks right through the sky away from us – the storm will come to Embu later.

PS. I will try and upload some photos of the hospital soon, I’m just biding my time with the camera!

Kangas and 'Passion'

Ward 10 is especially busy as the new interns have started, and there is a rather fierce Medical Officer supervising the round who lectures us on the importance of protocol – luckily I am the only one who does not have a copy of the required text and therefore cannot be expected to know anything…  Plus I am distracted by the sight of a monkey out of the window! My name is so frequently misheard as ‘Joy’ that I am no longer bothering to correct people – it’s quite a nice name, and thoroughly approved of, so that is that. Lots of the usual pneumonias and malnutrition. Owing to the ‘cold’, the children are firmly inserted into thick flannel trousers, with thick woollen jumpers and balaclavas on top (still feels like vest-top weather to me though). There is the usual cocktail of medical abbreviations used by the interns, but they are different from home – for example, ‘hob’ means ‘hotness of the body’, for a febrile patient – easy! Old coke bottles are used to measure out the milk quantities and other medicines - for patients with malnutrition, a formula ‘F75’ or a stronger ‘F100’ is often prescribed – this is a replacement feed consisting of vegetable oil, dried milk powder, sugar and water, made up to a ratio. 

I am getting used to being a general source of amusement, for the mothers at least – most of the small clients take one look at my mzungo face and burst into tears. Definitely not making any friends, especially when I have to take bloods and skin pricks (for malaria). (The blood this morning is not successful – the plastic glove fails massively as a tourniquet, femoral vein empty, patient cries, mother cries = traumatic). The lab here manages to churn out results which is impressive considering what we send them – the malaria screen requires a blood smear on a glass slide (of which you carry several in your pocket, along with a few needles) – this is labeled up with a bit of the omnipresent plaster tape, waved to dry (a lot of blood takes a LONG time), piled up (TOUCHING) with the rest and trotted over for a look under the microscope (if it’s not misplaced on the way). Blood films, as with all other investigations must be paid for (the main price list can be found next to the hospital sign on the main road) – a bed for a child costs 500 Ksh per night, and the mothers must also pay PER cannula and giving set - you pay at the patient cash desk. Receipts kindly have written at the top ‘wishing you quick remedy’, nice. The hospital is a ‘corruption free zone’ (signs to remind everyone of this are dotted everywhere) – there has been a problem in the past with doctors taking money privately (and many doctors here do seem to work 24 hours per day, government paid by day, private by night) but this is changing now.

I spend the day at the ‘CCC’ clinic – this is the ‘comprehensive care centre’ for HIV positive patients, who come fairly regularly to have their CD4 counts measured, and to receive vitamins and antiretrovirals. I sit with the nutritionist and we measure each patient’s height, weight and BMI. (There is a horrible cycle of weight loss associated with the disease which lays the patient open to opportunistic infections and reduced immune status – this corresponds to a reduced CD4 count etc, etc…) so it is important that patients can be counseled on the importance of good nutrition  (for the overweight as well as the under!). It is a busy clinic – 52 patients in the morning alone. A US-AID programme provides the means for ‘Feeding by Direct Prescription ’for patients whose BMI is less than 18.5 – this is ‘unga’ (flour, reinforced with vitamins and various cereals), and in especially severe cases, ‘plumpy nut’ (a ‘ready to use’ food recently developed by the owner of ‘Nutella’ which has been very effective in cases of 3^rd world famine – it’s a paste made from peanuts, veg oil and powdered sugar and milk – each packet delivers 500kcal and can be easily taken ,even by children). Sadly, a surprising number refuse to accept the prescription, there is still a huge amount of stigma and many do not disclose their status even to close family members.

Horror of horrors – a mosquito INSIDE my flippin net. He eats me for breakfast, and I can’t find him, squash him or do anything about it. The buzzing enters my dreams… The next night, THE SAME. There is obviously a campsite somewhere. Not cool. My back is MUNCHED.

I am learning to cook African style – Ndengu (a green gram bean stew with milk), Ugali, Mathukoi, Githeri. Phyllis (a competition winning Chapattis maker) and her daughter Easter teach me how to make PROPER chapattis (only problem is the final step requires a cast-iron chapattis pan and a fire, neither of which I will be able to lay my hands on at home). You make the dough with sugar and salt, then the chapattis are twice rolled and recoiled like a snail and left to rise, before dry frying in a stack, and finally refrying with oil. They fall apart in your hand, and should be eaten hot with a cup of Kenyan chai (made with a bag of fresh cow’s milk from the neighbour, and sweetened with sugar, tea masala, and cardamom).

The rainy season has officially started and there are frequent powercuts in the evening. This in combination with the fact that the laptop gives me frequent electric shocks (the ‘q’ key is especially problematic) does not make for peaceful facebooking... Instead I am reading ‘The Flame Trees of Thika’ by Elspeth Huxely – an autobiography of her childhood in Thika which is not far from here – lots of it is familiar! Bats here also squeak in the roof at night which is nice.

I make the mistake of ordering ‘passion’ at Morning Glory cafe (this is passionfruit juice, in case people were wondering!) – halfway down the glass I have a sense of misgiving (actually the misgiving happened quite quickly but I couldn’t be rude). Next day – raging headache and temperature. The hospital beds look pretty inviting, but I make it through the morning without hitting the floor, and all the way back up the hill to bed where I pass out for the next 4 hours. Let that be a lesson!

It is a long hot walk to town, but I stop at the rescue centre, where Lilian feeds me githeri. We shop in the market for Kangas (these are the beautiful African cloths  which can be used for anything – as aprons, skirts, for carrying shopping, children…) The market is fascinating and has a hundred tiny alleyways selling salts, beans, rices, spices and anything else you can think of. It’s good to be with Lilian who seems to know pretty much everyone. We buy avocados and tomato fruits (they are extremely like tomatoes inside!).

Drawing is the name of the game at Toto Love today, but my stethoscope is pretty fun too. The children here have to wake up at 5am to take their antiretrovirals (the side effect profile of these is nasty which is why most have to be taken with food – the problems start when the food is not available…). I meet Scooby the dog who also is resident here – he has nice ginger eyebrows.

Thankfully the tsunamai alert for the Kenyan coastline has been withdrawn – the waves were due at 8pm but no show. A bit frightening!