Matoke & Mangos

My days start at 5.30am with a morning jog down to the Embu town – there is an aerobics class at the ‘gym’ here, Kenyan stylee! A free banana for all after class. I run past eucalyptus (you can smell them for miles) and Embu’s famous Jaracuranda trees, a bit different from my usual route! Definitely harder here too as the air is thinner. There is a swimming pool within walking distance – a bit of a Westerner’s haunt so pretty luxurious and deckchaired-up. I am trying to learn Swahili, and also photograph the yellow Weaver birds in the garden, this has not been a success so far (although the local cat seems to be doing alright at catching them).  The Easter weekend is a public holiday, so no hospital – I don’t know this means for the in-patients, but there’s certainly not going to be any ward work.

I go with Gilbert to visit his mother who is a farmer in the rural highlands –the land here is extremely fertile and is divided into shambas (small-holdings) of coffee, bananas, papayas, and at higher altitudes, tea. Agricultural communities here are primarily from the Kikuyu, Meru and Embu tribes. The road to Meru is beautiful and hilly, with so much lush vegetation and waterfall (and speed bumps! – best to follow the Matatu drivers who know where they are). It has rained so hard this morning that as we turn off the last long stretch of track is almost impassable, but luckily we arrive in our borrowed car! There is a recent burnt patch on the road – here a man was set alight for taking a machete to his wife. She owns 25 hectares of land and is managing to grow aloe vera, tomatoes, and tobacco, as well as the usual banana/coffee set. There is also a cow and some friendly goats, a fish pond, space for developing a paddy field, and several mud ovens for firing the clay bricks pressed in this soil. It’s a fantastic place, and the sun is mysteriously concentrated by the clouds here (maybe it’s the altitude) so it’s extremely hot. There is a small diesel mill (there is no electricity out here) for grinding maize, so other farmers can bring their own flour for a small price (everyone here works the land, and it feels much more remote than Embu). We eat ugali and sukuma and beans, all from the farm, and Gilbert’s younger bro fetches us sugar cane – you chew it and swallow the juice, amazing! More incredible flowers (one tree with white flowers is snapped off and a milky sap literally pours from the stalk – apparently this is a good wound healer); and a giant turquoise butterfly which moves too fast for my camera. In the car boot goes a stem of green bananas; they will ripen within 3-5 days if a teaspoon of salt is pressed onto the cut end. Today is Good Friday so we drive back via her church, where the procession for ‘The Way of the Cross’ has just arrived. Long-drop loo stop. The church is packed today, and we stay for a bit at the back. It is a lovely building, and all the African saints are painted around the walls. The first sermon is in the local language (I’ve got no chance) and lasts 20 minutes; the second is sung and lasts even longer!

The drive back is a bit tense as we are very low on petrol! We stop at Gilbert’s older brother’s house – he is an English teacher, and his 6-month old daughter Lititia is extremely cute and happy to chat. Proper sweet Kenyan chai and mandaazi. A cousin shows me the tea plantation – it’s almost ready for harvest (the top two leaves are picked along with the bud; these are sent locally to be processed). There are also coffee bushes, which are ripe when the berries are red, AND macadamia trees – amazing! Cousin climbs a mango tree and throws them down ‘for the road’ – you peel them with your teeth.

Easter Saturday, and everyone is invited to a local wedding between an Embu man and a girl from Australia. Service due to start at 10am, but TIA (‘this is Africa’) so it’s after 12 when the bridal car arrives. A group of hired women greet the bride and process the last section of road with her, singing and dancing and waving ferns. Great voices! The floor outside the church is strewn with fallen bougainvilleas – instant confetti! The wedding reception takes place in the field of a local college – there are white tents set up, and a catering company manages to feed the whole crowd with a beautiful African feast – Irio, matoke (a green banana stew), chapattis, pilau, and piles of melon. Entertainment comes from the Women’s Institute from Stephen’s (the groom) village, who sing and dance dance dance, pretty awesome. Slightly embarrassing as being white I am assumed to be a honoured guest of the bride and am insisted to sit at a table for shade and special treatment – I did try explaining that I had only met her that morning!

I can hear the drums from the church for Easter Sunday which go on all morning. There is a TV at the house too – hymns are being broadcast by Her Excellency the First Lady’s State House Choir. At the bottom of the hill is an orphanage for HIV positive orphans, called ‘Toto Love’ – there are 19 children at the moment, and the youngest is one. They are absolutely gorgeous kids, and I am properly welcomed and beaten up, my watch goes AWOL. They know a surprising amount of Christmas songs! (and more of the words than I do). Really a top place, gonna go back tomorrow.

Karibu!

Touch down to a rain-soaked Nairobi at 8am, 1^st April! I join the queue for my visa, this proves to be my first experience of Kenyan time, but hey, I’m in no hurry! A tense wait follows as it appears my bag has not travelled with me, but eventually it turns up mysteriously circling the next flight’s conveyor belt. I’m met by Oti and his van, and we drive into the town centre – can hardly keep my eyes open but there’s SO much to see! Great to be here! Red soil, people cycling, walking, street vendors selling bananas, sugar cane, incredible birds and bourgainvilleas, crowded Matatus… To much to describe. We reach the base house and park under the avocado tree. I meet all the staff – Eva, Eva, Rose, Kelly, Kelvin, Later I walk with Eva to the market, the start of the Kibera slum (the biggest in Kenya) – we buy green oranges and tomatoes, and chappatis from the supermarket (Kenyan time queue but nobody seems to mind). A evening powercut means dinner is by candlelight, a good thing as I don’t realize how many mossie bites I have!

Breakfast (with Kenyan tea!) – still by candlelight. Oti takes Eva and me to the bus centre in town to catch a Matatu to Embu (142km for 370 Kenyan shillings – about 2 pounds50). Crazy crazy place! My rucksack goes in the back and we sit and wait for the seats to fill; good Reggae music on though, and the touters tapping on the window keep me amused. The journey to Embu takes us 3 hours, and is fascinating! The road is new and pretty bump free. We pass countless villages with identical shops and kiosks covered in banana leaves selling papayas and tomatoes, mango plantations, paddy fields and rice and maize laid out to dry, incredible trees, small schools set back from the road, people driving cattle carts, bikes laden with green bananas to sell… Its very hot and I keep falling deeply asleep. We reach Embu and I get out at the main market place – crazy times, and the Mzungo is spotted! Embu is a small town but has loads going on, AND its at 1900m above sea level so the Kenyan team come here to train – wicked! Timo the taxi driver takes us to the house where I’ll be staying – it’s a 15 minute walk down the hill to Embu Provincial Hospital. A pink peppercorn tree and incredible flowers in the garden.  Gilbert (who works for the charity ‘moving Mountains’, and is ‘the King of E-town’) walks with me back into town to map the place out, and we drop into the Rescue Centre for street kids which was set up by the charity a few years ago – along with the Black Cats football team made up from street kids from Embu. It’s a fantastic place. Couple of goats hang out. There’s a girls team too – I’m going to train with them on Saturday (once I acclimatize a bit!).  Lilian the cook has made ‘Githeri’ (maize and beans boiled up with water and salt) – every day she makes it for 150-200 kids who come and wait at the gate for their plateful – needs a big fire, and an even bigger pot! I help her sort out the dried beans and maize for tomorrow – 9 jugs worth – it takes about 2 hours to pick out all the bad ones. I stock up at the supermarket – beans, and ‘Uji’ – this is Kenyan porridge with added ‘immunity’ (Aramanth and red sorghum), particularly recommended for people with HIV. Later Gilbert shows me how to cook ‘Ugali’ (a kind of cooked maize cake) and ‘Sukuma wiki’ (means ‘strech the week’ – green veg fried with tomatoes), really good! And an incredible, perfectly ripe avocado, wow! Giant crickets, and a gecko in the loo. Sort out that mosquito net asap!

I meet Dr Muli, the medical superintendent at the hospital, to arrange my placement – I’m starting with 2 weeks of paediatrics. Bright yellow weaver birds bicker loudly everywhere! There is one xray machine, one main theatre and one day case, plus various clinics and a few wards for inpatients. The lab can do basic blood films on slides. Patients have to pay for various treatments and investigations, which can limit what can be done. CT scans have to be done far away, and cost 7500 KSH (about 80-90 pounds, way too much for most). I join ward 10’s ward round – it’s the neonate unit, and there are currently 8 inpatients – most are premature and have respiratory distress or sepsis of varying degrees. Its all very basic – but there is hot water, needles, basic tubing and a few antibiotics and other drugs. There are 4 ‘cubes’ representing different degrees of treatment intensity – the most sick babies have their own incubators, the rest lie next to rusty heat lamps so it is very hot. Phototherapy for neonatal jaundice is treated by a UV light under a blanket. Lots and lots of plaster tape is used for pretty much anything – holding cannulas in, covering blood bottles to protect bilirubin samples from the light, patient identification labels, you name it. Tourniquets are improvised using the elastic rim of latex gloves, and  oxygen is humidified using a bottle of water. Lots of flies, and I spy a cockroach on the floor (later tread on one in my shoe!). Most mothers are expressing milk by hand – the World Health Organization changed their feeding guidelines in 2010 which means that all mothers are now advised to breastfeed exclusively for the first 6 months, regardless of HIV status (this was primarily due to the increased mortality of infants from malnutrition as milk supplements are too expensive (800KSH per bottle!!) or can’t be prepared hygienically. One baby is especially sick with severe sepsis – nothing much can be done apart from changing to the strongest antibiotic and letting nature take its course… The ward round finishes and I walk to ward 16, past the main theatre (all the used scrubs are washed in the sink and hung to dry outside) – today is the weekly orthopedic list  - there are 4 displaced fractures and an amputation, but none are emergencies so they have had to wait. Ward 16 is the main pediatrics ward, and its busy! The kids are all swaddled up with very cute matching balaclavas (today is the first day of the rainy season, so its ‘cold’…), and the mothers share their cots. All their cannulas are reinforced with cardboard to stop them tugging them out! Common cases are malnutrition and pneumonia. The intern (all medical students in Kenya do a year’s internship following graduation) explains that often babies are undernourished as the Kenyan diet is very high in starch but may be deficient in vitamins – frequently mothers will spend their extra money on bread to supplement the baby’s diet which does not good, but no-one has told them this). A baby with suspected hydrocephalus is given a referral for a CT scan, with any luck a missionary will cover the cost of this, but otherwise its unlikely to go ahead. A mother of a baby with meningitis is ‘rehydrating’ by pouring a bottle of fanta through his nasal tube. There is also a case of suspected TB, and a boy who nearly drowned in a bucket of water (although his mother denies this). The round finishes as lunch is served – a cup of rice and stew, to share with baby!