Can't Think of a Better Title

Though not a day passes that I don’t think of and miss home, the longer I’m here, the more I love Mutomo and Kenya.  This past week marked 5 months in the country.  When I first arrived last October I had frequent nightmares about snakes (I still do sometimes).  Now I find myself having nightmares about having to leave Kenya.

The delivery room.

Equipment for neonatal resuscitation.

This is the vacuum machine they use to pull out babies' heads if the delivery is too slow.

Maternity beds for women in 1st stage of labor (0-9cm cervical dilation).

Baby Collins and his mother.

I’ve been on maternity ward now for almost 2 months, and I have a few more deliveries under my belt.  It can either be really busy, or completely dull… such is the nature of maternity.  A couple weeks ago we had a baby born who suffered asphyxia during a prolonged delivery.  Initially he seemed okay, but then during morning rounds we discovered the baby twitching in slight convulsions.  His mother reported that he’d been doing that all night long (but she didn’t say anything!).  We monitored his closely throughout the day.  Later, it was noticed that he was developing some difficulty in breathing.  The child was immediately put on supplemental oxygen and started on anti-seizure medications.  We were worried for a bit, but I’m happy to report that the child did well.  After a few days, he showed no signs of seizure activity. 

Aside from the seizures, Collins (that’s his name) was also having trouble feeding well.  I had to spend a bit of time coaching his mother on how to feed him properly.  Never in a million years did I ever think I’d be given a woman tips on breastfeeding.  Mother and baby were discharged home last weekend, both healthy. Before they left, I took a photo of them together and printed copies for the mother.  Most people here don’t have cameras to photograph their newborns, and I think she was happy to have a photo of her baby.

Sadly, not all the stories end so happy.  Just last night we had a premature baby die.  He was delivered prematurely at around 29-30 weeks.  His mother did kangaroo care, in which the baby is kept on the mother’s chest, skin-to-skin, 24/7.  This helps regulate body temperature, bonding, feeding, and weight gain.  Initially the baby seemed to be doing well for being so premature.  Typically, a fetus’ lungs are mature at around 35 weeks gestation, and yet he was breathing very well.  The mother was not able to produce breast milk, so we began supplementing with formula in a syringe.  The next day, though, he began having episodes of apnea, and by the evening our two gynecologists knew that it was only a matter of time before he died.  During labor, the membranes ruptured very early and delivery was delayed.  It’s believed that the baby aspirated meconium and developed a respiratory failure due to infection.  It’s sad to know that this baby probably would have survived in the U.S., but here there is no mechanical ventilator available, and most people can’t afford to seek care at the more advanced hospitals in Nairobi.

The hospital has been low on supplies lately.  Last month we were completely out of normal saline, a standard IV fluid.  That may not mean much to someone not familiar with healthcare, but let’s just say that a hospital running out of normal saline is like KFC running out of chicken.  Our pharmacists had to go to town and buy IV fluids from the local chemists (pharmacies).

Standing over the Rift Valley.

View of the Rift Valley.

Last week I took a four-day trip to the northern part of Kenya.  I was accompanied by Fr. Dan, a friend I met back in the U.S.  He has been studying in San Diego and Washington, D.C. for the past few years, but recently returned back home to Kitale, Kenya.  We journeyed through the beautiful Rift Valley, a massive stretch of fertile land which spans the entire country and produces most of Kenya’s food.  It was a nice change of scenery from the usual dry climate of Mutomo.  The roads were lined with forests of pine trees, and the weather was extremely cold and windy… I think it’s the first time I’ve worn my sweatshirt since arriving in Kenya.

On our journey we stopped for a day in Lake Nakuru National Park.  I saw the usual buffalo, zebras, giraffes, warthogs, and baboons.  But unique to this area are the flamingoes.  The birds are really a beautiful sight, dotting the shores of Lake Nakuru with pink.

With Fr. Dan and his mother.

In Kitale we toured Fr. Dan’s home town, met with his family, and visited the farm where he was born and raised.  I was also treated to a lot of great food (and some not so great).  Nyama choma (roasted meat) is a popular dish in Kenya.  I had yet to taste it, so Fr. Dan took me to several places which serve this Kenyan version of BBQ.  Most of the local restaurants are nothing more than a dirty wooden shack, but I pushed my fears of cleanliness out of mind, said a quick prayer (“Please, God, don’t let me get diarrhea”), and plunged into the meal.  I wasn’t disappointed; the food was great! (except for the goat intestines).  Also common here is roasted maize which people sell on the side of the roads.  For only 20 kshs (about 24¢) you get to enjoy a big cob of hot BBQ corn… we stopped for this three times during our drives. 

Githeri, a Kenyan staple dish of maize and beans.

Fr. Dan's family farm.

Roasted maize!

Nyama choma...

...and more nyama choma.

On the return trip to Mutomo, we took an alternate route to bypass Nairobi and it’s chaotic traffic.  I was glad we did, for the landscape was the most beautiful I’ve seen so far in Kenya.  The roads were bordered by lush forests, and plantations of tea, coffee, and pineapple carpeted the rolling hills as far as the eye could see.

Got to cross the equator and visit my home hemisphere for a couple days.

Tea plantation

And more tea!

We returned to Mutomo just after 8pm, and not a bit too soon.  Less than an hour after our return, the first rains of the second rainy season came tumbling down, accompanied by lightning and thunder.  It rained all night and continued well into the next morning.  The people of Mutomo are undoubtedly very excited.  Now that the first rains have fallen, they will start planning crops in their shambas. 

However, during the storm, a tree branch fell and hit the power lines to the hospital houses.  For three days now we’ve been without electricity.  Normally I would just rely on solar power for lights at night, but with the constant cloud cover, even the solar batteries are dead, and I’ve been forced to use my “torch” (flashlight) to cook, use the bathroom, and find my bed at night.  You don’t realize how much you depend on electricity until you don’t have it anymore.  Even now as I’m writing this I am sitting at the convent next door, freeloading on their electricity to run my computer.  Hopefully we’ll have power by tomorrow!

Here are a few more photos from around Mutomo:

The last Sunday before Lent.

Can you spot me?  I'm the mzungu way in the back.

Another Saturday at the market.  Bought some bananas and avocados.

Bought some potatoes from this lady.

The FOOD Blog!

 If you ask me what I’ve been up to the past few weeks, I would say, “Ninakula” (“I am eating”).  During my first three months here I ate mostly local Kenyan food every day.  I actually really like the food here, but after eating the same thing every day for several months, I’m ready for a change.  Usually I pay someone to cook for me twice a week, but lately I’ve been learning to make more of my own food.  With the limited variety of foods here, it takes a little creativity and resourcefulness to come up with ideas to cook.

A dish of lentils, avocado, and tomato.

Huddled against the wall to escape the rain.

Just a couple weeks ago I hosted all the neighbors at my house for a homemade meal of chicken, soup, stuffing, and guacamole (the avocados here are about twice the size of our California avocados).  It was a great dinner, except for the fact that halfway through the meal we had the biggest storm I’ve seen yet, with crashing thunder and lightning that lit up the evening like daytime.  The rain came in sideways with the wind and we were all forced to crowd to one side of the table to escape the wet.

Anita's apple pie.

The next day Anita cooked us a feast of curried chicken, meatballs (for our Swedish neighbors), and smoked salmon, along with an apple pie for dessert.  Jenny (the gynecologist resident) provided cinnamon rolls which she baked from scratch.  As if that weren’t enough, just a few days later our Swedish gynecologists cooked yet another meal of fried rice with sausages, an avocado salad, chickpeas, and sweet potatoes.

Per and me excited for cinnamon rolls.

Stress Free Resort

After everyone else had had their turn at cooking, our Swedish dentist, Per, decided it was his turn to host a meal.  Not knowing how to cook himself, he treated us all to an evening out for dinner at Stress Free.  It was a delicious traditional Kenyan meal, with chicken, goat, potatoes, chapatti bread, kale and spinach, tomatoes, and fruit.

Dinner at Stress Free

Shopping for food for American breakfast.

A couple weeks ago, Jenny got the idea that we should have an “American breakfast."  She discovered our breakfast foods when she visited California last year and had breakfast at Denny’s.  So last weekend we went to the market for groceries and prepared yet another giant meal: hash brown potatoes, scrambled eggs, and American pancakes (our pancakes are fluffy compared to both Kenyan and Swedish pancakes, which are thin like crepes).  It took the rest of Sunday to digest such a heavy meal.

  

Jenny's birthday dinner party.

Burger and fries.

Last Friday was the last day in Mutomo for the Swedish doctors.  Jenny’s birthday is in just a few days, so we celebrated her early birthday and their departure with one final dinner party.  Anita had a supply of ground beef in her freezer, so we decided to make another “American” meal (which means really heavy food)… hamburgers!  Dr. Marianne designated me the “grill master” since I’m American.  But we didn’t have a functioning grill, so I was forced to "BBQ" burgers on the stovetop.  Jenny made French fries to go along with the burgers.  It was a great meal.  The only thing missing was a bottle of ketchup.

The "grill master" at work.

Maybe hearing about all this food isn’t so interesting for all of you back home, but when you’ve been eating rice and cabbage for three months, it’s really exciting stuff.

Now that I’ve gone on and on about food, I’ll talk about something a little less appetizing: childbirth.  For the past couple weeks I’ve been busy on the maternity ward up to my elbows in uterus… well maybe not my elbows; just my fingers.  I’ve delivered a few babies so far with assistance, but I still don’t feel comfortable doing it alone.  Having the gynecologists around as I start on this new ward has been a huge help.  I have a long way to go, but I’m learning a lot.  I’m growing accustomed to assessing things like gravidity, parity, maternal blood type, fetal heart rates, apgar scores, and cervical dilation (which is actually really hard to feel).  

When a baby’s head is too large to deliver without the risk of a perineal tear, the nurses frequently do episiotomies.  I had to do one last week, though the scissors are of poor quality and it took a while to cut through the tissue.  I’ve started learning how to do sutures to repair the tissue after delivery, but I have yet to suture an actual patient.  So far I’ve just been practicing on a banana with instruction from Dr. Jenny.  I don’t know if I’ll ever look at bananas the same again.

I’m shocked when I see the cultural differences between new mothers in Kenya and new mothers in America.  At home, parents are very emotional and excited when they see their new baby.  People here generally aren’t very emotional.  When I show babies to their mothers, they usually don’t show much of interest: no smiles, no tears, nothing.  “Do you want to hold your baby?” I asked after we’ve assessed the baby.  Most of the time the answer is “No.”  I’m sure these women are happy to be mothers, but the lack of emotional display is always surprising to me.  I guess it’s just a cultural difference.  

Fathers are never ever present for the deliveries.  In fact, they rarely come to the hospital.  Usually the mother arrives on the public bus or on a motorbike and goes home the same way the following day.  The nurses here explain that that is normal.  I’ve told them that if my wife at home gave birth and I wasn’t there, I would be in BIG trouble.

It’s been fun having this latest group of Swedish volunteers with us.  I’ve really enjoyed working, eating, traveling, and taking long walks with them.  The doctors left yesterday and the dentist left today, but we have another team arriving in a few days, including two more gynecologists.  Hopefully I’ll be able to continue my education with them.

A day in the market.

Out for a walk to the water hole, one of my favorite spots around Mutomo.

Nairobi, Safaris, & Babies

We have a new group of Swedish volunteers in Mutomo.  We have two gynecologists, Jenny and Marianne, and Per, my dentist friend who was here in Mutomo back in October.  We’ve all spent a lot of evenings together eating, watching movies, and just sitting outside visiting beneath the stars.  It’s been nice having neighbors next door once again.  

 

Me with Sr. Mary, Anita, Per, Marianne, Sr. Esther, & Jenny

After working for over 3 months in Mutomo without taking time off, I finally took a welcomed 5-day vacation to Nairobi.  The journey there was a bit long: about 4 hours (2 on dirt road, 2 on paved).  I was lucky enough to hitch a ride with some of the hospital board members who were headed to Nairobi.  We also had 3 live chickens along for the trip.  They spent their last few hours of life clucking away in a cardboard box in the back of the car. 

Nairobi felt like a completely different world from Mutomo.  It’s amazing that the two places are within the same country.  The gap between wealth and poverty is striking.  Also striking was the diversity present in Nairobi.  Kenya actually has a sizable population of Indians, as well as whites and Asians.  How strange to be able to walk around in public and not be stared at for being the only white person in town.

In Nairobi I stayed with a friend, Joe, who I met in Mutomo back in October.  Joe is from Ireland, but has recently taken a job as the medical director at The Mater Hospital in Nairobi, one of the leading private hospitals in the country.  On Sunday morning he treated me to a tour of his hospital.  It was a shocking experience to see such a modern facility after working so long in Mutomo.  The hospital is equipped with an ICU, cath lab, emergency department, multiple surgical theaters, CT scan, and even a dialysis center.  I was thrilled just to see that they had hand sanitizer containers in the corridors. 

After our hospital visit, Joe took me to a local Nakumatt (like an African version of Walmart) for groceries.  This experience proved even more overwhelming for me than our trip to the hospital.  I’m not used to seeing such abundance.  The scene was so foreign for me that I couldn’t stop laughing.  What a sight to see aisles filled with fresh produce, cheeses, deli meats, and fresh bakery bread.  That night we feasted on chicken stir fry, fresh salad (which I hadn’t had since arriving in Kenya), orange juice (also a luxury), and ICE CREAM!  On Sunday afternoon I sat reading a book on the apartment balcony and watching the kids playing on skateboards below.  I couldn’t stop staring; seeing kids so well-fed, well-clothed, with shoes and toys is not something you experience too much in Mutomo.

In Mutomo I am used to rationing water.  Although I treated myself to long, hot showers each day during my visit, I still cringed whenever I saw Joe leaving the sink running to wash dishes.  I also found myself forgetting to flush the toilet after each use (a habit I’ve picked up in Mutomo).  Despite the reverse culture shock, it was a real treat having delicious food, hot showers, and good company; Mutomo has taught me to appreciate all three.

At the elephant orphanage.

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The next day I met up with another American CMMB volunteer, Breanna, who is also working in Kenya.  The two of us met back in September for orientation in New Jersey, and decided a reunion in Nairobi would be fun.  It was certainly nice to spend time with another American.  Also with us was an African friend of Breanna’s, Alice, who lives in Nairobi and was nice enough to guide us through the city for three days.

During our time in Nairobi, we visited an elephant orphanage where baby elephants are rescued and cared for until they can be reintroduced into the wild.  We also visited Bomas of Kenya Museum (a cultural museum showcasing traditional Kenyan housing and various dance performances), a Massai craft market, and Carnivore restaurant.  I’ve heard that this restaurant has been rated as one of the top 50 in the world.  Basically, servers walk around the restaurant with giant skewers of different meats.  They continuously visit your table, serving you until you lower the flag that sits on your table, indicating that you’ve had enough.  I ate enough meat for a month, including beef, pork, chicken, lamb, turkey, sausages, and ribs.  Besides these typical meats, there were a number of exotic meats, including crocodile, ostrich meatballs, and ox testicle.  This feast ended with a slice of cheesecake!  For one night, I felt as if I was eating like a king.

Ready to eat at Carnivore!

MEAT!

Breanna and the turkey.

The following day we made a visit to Nairobi National Park for a short day-safari.  It was a fun trip, but strange to see a safari park in the middle of a city with skyscrapers in the background.  In the evening we visited a nearby shopping mall.  After a fantastic dinner of two large pizzas and frozen yogurt, we made a visit to another Nakumatt.  I know it sounds ridiculous, but this was one of the highlights of my trip.  With wide-eyed excitement, I ran up and down every aisle, stocking up on supplies (mostly food) to take back to Mutomo.  My purchases included a stack of chocolate bars, and couple blocks of cheese, apples, Nutella, trash bags, sandwich bags, shampoo, lentils, two large jars of peanut butter, etc.  I was amazed to find that a jar of Skippy brand peanut butter cost over $12!  I had to settle for a cheaper brand.  Dinner the next evening was a bit more exotic.  Alice took us to eat at a restaurant that served Rwandese/Burundese food.  We had grilled cow liver and intestines.  The flavor wasn't so bad, but the fatty texture made it a bit hard to get down... I'll stick with pizza.

Breanna and I with a group of Massai at Nairobi National Park.

Ostrich at Nairobi Park... I was eating this for dinner the night before.

Warthogs

Two large pizzas!

...and dessert!

Kenyans always like to remind me that Obama's family comes from Kenya.

For the past few months I’ve been mostly without television.  Usually I hate watching the news at home in the U.S., but while in Nairobi I was excited to find two American news stations.  I happened to wake up one morning just in time to catch a replay of President Obama’s State of the Union address.  Being so far from home has really made me appreciate our country more than ever before.  Watching that speech at the Capitol filled me with such a great sense of pride in being an American.

Elephant at Tsavo East

I finally returned back to Mutomo, but was off again two days later for yet another safari trip.  Back in November I took a trip to Tsavo West National Park.  This past weekend I took yet another safari trip, this time to Tsavo East National Park with the two Swedish doctors.  The hotel accommodations were fantastic.  In addition to more hot showers, we were treated to buffet for breakfast, lunch, and dinner, and a swimming pool overlooking the park below.  Just below the hotel were two water holes visited by a steady stream of animals seeking water.  In the evening, a herd of buffalo showed up and took a rest while we watched them from our dinner table.

When we first checked into our hotel we were told to keep our windows shut when not in the room to prevent unwanted visits from the baboons.  We did shut our windows, but apparently I forgot to lock them.  After touring the park for several hours, we returned to the hotel to find that the windows were open, our bag of potato chips had been scattered about the room, and a box of cookies had been stolen!

I enjoyed this park much more than the one in Nairobi (it’s a bit unnatural to see a giraffe walking against a backdrop of buildings and an airport).  I was thrilled that we were able to see a large number of elephants, in addition to zebras, impala, ostriches, warthogs, and the buffalo… but I still haven’t spotted a lion in Kenya.

A huge cloud of birds flying through the park.

I guess I should talk a little bit about work (I don’t just go on safaris every week). Every Thursday at the hospital the staff gather for a one hour lecture on various health topics as part of their continuing education.  I was asked to deliver one of these lectures last month and chose to speak on sepsis and septic shock.  It was an appropriate subject since so many of our patients die of sepsis, which can often be identified much earlier than is happening.  Most of the audience seemed engaged in the topic, and I've even noticed some change in the practice of the doctors since.  I'm hoping I may get the chance to speak a couple more times throughout the year.

My first three months in Mutomo were spent working on the medical-surgical ward.  I just recently rotated and am now working on the maternity ward.  I remember back in nursing school that I swore I would never work in maternity, and yet here I am!  I wouldn’t ever choose it as a career, but I’m actually really excited to be experiencing such a different field of nursing from what I’m accustomed to.  In my first two days on the ward, I’ve seen four deliveries.  Sadly, one of those was a premature infant at around 24 weeks who only lived about an hour after delivery.  The mother had preterm, premature rupture of membranes several days ago and went into labor today.  The other three deliveries were very healthy. 

So far I’m not too much help around the ward.  I have a lot to learn about maternity nursing, but I’m finding that a lot of what I learned in school is quickly coming back to memory.  They say that pretty soon I’ll be doing deliveries on my own!  I’d forgotten how messy childbirth can be.  It’s not a clean and simple process like in the movies where a woman pushes twice and you have a clean baby appear.  In reality it’s a chaotic mix of blood, sweat, stool, urine, placentas, and amniotic fluid, with a good deal of screaming to go along with it.  There are no epidurals here, so the women just bear with the pain.  They are amazingly resilient.  They rarely complain about the pain.  I have no idea what childbirth feels like, but I think I would be screaming a lot louder if our places were reversed.  Today I stayed a couple hours late after work to observe another delivery.  The mother pushed for over an hour with little progress.  Finally Dr. Jenny decided to do an episiotomy and vacuum extraction.  This too was a messy procedure, and I left work with small traces of amniotic fluid on my scrubs. 

I have a lot to learn on this new ward.  Besides studying ecclampsia, stages of labor, maternal-fetal anatomy, and assessment of cervical dilation (yes I’ve been doing that too), I’m still studying Kiswahili.  There’s a new word I’ll be using a lot more now: skuma! (push!).