Adventures of an American RN in Kenya: A Visitor From Home

Students at Holy Family Primary School.

Last week, I had a visitor from home! My aunt Sheryl came to visit me for just over a week. We started our time here in Mutomo, where she got to try some of the local food (she actually liked the goat), meet some friends from the hospital and the church, and explore the town on market Saturday. One of the highlights of our time in Mutomo was a visit to Holy Family Primary School. One of the teachers, Sr. Rose, offered to show us around. However, once the children spotted two white people with cameras, we were instantly surrounded by dozens of excited, screaming students who then took it upon themselves to give us the tour.

Took my aunt out shopping for some African sandals.

We were taken to see every classroom, the dorms (most schools in Kenya are boarding schools), and the dining hall. The conditions in the classrooms are sparse and primitive, but still Holy Family has a reputation as one of the top primary schools in the area. I was very impressed with the students’ English. Children here speak Kikamba at home and only learn English and Kiswahili when they start school. It’s amazing to see these young kids already fluently speaking three languages. As we walked through the classes, they were trying to teach me more Kiswahili.

Fr. George, the parish pastor, had us to dinner at the mission house on our last evening in Mutomo.

After three days in Mutomo, we traveled south to Amboseli National Park, which sits just next to the Kenya-Tanzania border. In addition to the spectacular wildlife, buffet-style feasts, and luxurious hotel (with monkeys running the grounds), we were treated to views of Mt. Kilimanjaro, the tallest mountain in Africa. Clouds covered the mountain most of the time, but we were lucky to have a couple mornings when the mountain decided to peak through the fog. I’m glad I got the chance to see it before leaving Africa.

Most of the animals I’d seen before, but there were a few new ones for me, including hyenas and wildebeest. Amboseli is also home to large elephant herds, which I never tire of watching. I’ve seen elephants before, but never in such numbers. As usual when traveling outside of Mutomo, I experienced a bit of reverse culture shock. The hotel where we stayed is clearly meant to attract wealthy tourists. I’m not used to such posh accommodations, and I kept thinking how just one night at the hotel costs more than nurses in Mutomo make in an entire month! Always an interesting perspective to travel between the wealthy and poor sides of Kenya.

My aunt and I finished our tour of Kenya in Nairobi, where we visited some of the local museums, the elephant orphanage, and a nearby tea farm. Tea is one of the major exports of Kenya, and as I’ve stated in past entries, my new addiction. So I found it very interesting to see a tea plantation up close and learn about the production process.

In Nairobi went shopping at Nakumatt, the Walmart of Kenya.

Also put together some videos from Amboseli, the tea plantation, and elephant orphanage, along with some current Kiswahili/English popular music. Please forgive the shaky video.

Earlier in May, a friend from Mutomo, Paul Boniface, was ordained a deacon of the church. I travelled with a group from Mutomo to Kitui for the ordination ceremony. As usual, the Mass was beautiful, filled with music and dancing. And the best part: after Mass, there were vendors selling ice cream outside the gate at only 20kshs a cone! … and yes, I’m going to keep updating you every time I have ice cream in Africa.

During the Mass, the men to be ordained lie prostrate, a sign of submission and humility.

Fr. George, Paul Boniface, and me.

On the roads of Kitui.

Ice cream man!!

Last day with the maternity staff.

I’ve finally decided to conclude my time on maternity ward. Recently I had a dream/nightmare that I had somehow become pregnant. Being a man, I was of course very alarmed. I was surrounded by my midwife coworkers when I began to go into labor. “Eric, we’re going to have to do a caesarian section,” one of them informed me. “No!” I pleaded. “I want a normal delivery! I don’t want surgery!” But for anatomical reasons, a normal delivery was obviously impossible. Luckily I woke up before the c-section began. I think that dream pretty much confirmed that I’d already spent too much time working with pregnant women on maternity ward. I finished my time on maternity two weeks ago and have now returned to medical ward where I worked during my initial three months in Kenya. I’m excited to be working in my area of experience once again, but I will miss the fun I had working with my coworkers as a midwife… or is it midhusband? I don’t know which.

Holding a fetoscope, a device which I'd only read about in school textbooks before coming to Kenya. In the absence of ultrasound, this is what we use to listen to the fetal heart. It is the primary means of monitoring the fetal status in labor.

I’ve completed only three days on medical ward, and already I’ve seen some interesting cases. On Monday we had patient admitted after having tried to poison herself with an insecticide. Unfortunately, this seems to be a common issue in the area. I’ve seen multiple cases of attempted suicide with poison, though I don’t know the reason for the high prevalence. We spent a good while passing a nasogastric tube and flushing her stomach with half a liter of saline in order to clear the poison. She managed to survive, and is in relatively stable condition, though she’s currently suffering from severe pulmonary congestion (probably due to aspiration) and has developed some blind spots in her vision. Hopefully she’ll continue to recover.

Presenting a new BP machine to the medical ward staff last month. A parishoner from church at home was very generous to send two new machines.

I’ve also been caring for another patient with severe burns. I find myself having to stretch my memory back to nursing school to recall what I’ve learned about burns. At home patients are sent to burn units. Here in Mutomo, burn patients get sent to medical ward. The patient we have now is a young boy with epilepsy. During one of his epileptic attacks he fell onto a fire and sustained severe burns to his abdomen, face, and left arm.

Normally the dressing changes are done in the operating theater under an anesthetic. Unfortunately today the doctor was unavailable and had to cancel all the scheduled dressing changes. The wound was already overdue to be cleaned and was clearly dirty (you could smell it down the corridor), but still we were planning to wait until tomorrow to redress the wound in theater to avoid a painful procedure. But in the afternoon the patient’s mother reported seeing a maggot come out of the dressing. Another nurse and I decided to open up the gauze and were disgusted to find maggots swarming all over the tissue! We were forced to clean and redress the wound right there on the ward without any anesthesia. I’m sure I would have been screaming in tears, but with typical Kenyan resiliency the boy tolerated the procedure without any complaint.

I’ve seen several burns during my time in Mutomo, but this is one of the worst. The bone on the arm is actually exposed. The patient has a long recovery ahead, and I worry about infection. Besides treatment and recovery, there is the financial hardship: he has no medical insurance. I’m guessing he’ll be in the hospital and going to follow-up visits for many months. Tomorrow I’m hoping I can get one of the staff to speak with the boy’s mother about registering for insurance. Here in Kenya we have what’s called the National Health Insurance Fund (NHIF). For 180kshs per month (a little over $2), you get health coverage for yourself as well as your spouse and children! It doesn’t cover the entire cost of hospitalization, but it still takes care of a significant portion of the expense. Unfortunately, many people still don’t take advantage of it either due to the cost, or because they’ve never even heard of it.

I’m excited to report that my Kiswahili is continuing to improve. Though I don’t expect I’ll ever be fluent or even be able to carry a conversation, I’m happy to say my Kiswahili is making great improvement. I can exchange a bit of dialogue with my patients and even answer some of their question. With study and a good deal of help from my friends, my vocabulary is growing. My coworkers now often throw questions and phrases at me in Kiswahili and to my delight I’m able to answer.

I have this on my fridge to help practice my food vocabulary.

Here are some of my more useful phrases for work:

Uko na uchungu? Wapi? = Do you have pain? Where?

Unatoka damu? = Are you bleeding?

Mtoto anakula vizuri? = Is the baby eating well?

Umekunywa maji leo? = Have you been drinking water today?

Unafaa kutembea mengi. = You should walk more.

Anatapika? = Are you vomiting?

Unataka dawa? = Do you want medicine?

Nitaleta maji. = I will bring water.

For the past half year I’ve been looking at this tablecloth in my house, wondering what this phrase says. Just the other day I glanced at it and suddenly the meaning popped into my head.