A Sunday in Mutomo

The first day went well, though it’s a bit disorienting to be in a foreign hospital.  I worked on the medical ward yesterday.  Before starting work in the morning, I had a chance to study some of the medical abbreviations approved for use at the hospital.  Here are just a few:

Mutomo Mission Hospital. It's much bigger than it looks here.

OD = once daily

TDS = three times daily

BD = twice daily

QDS = four times daily

RTI = road traffic injury

Rx = treatment

COD = change of dressing

x/7 = x number of days

x/52 = x number of weeks

x/12 = x number of months

CCF = Congestive cardiac failure

HB = haemoblobin (spelled differently from U.S.)

It’s like speaking a foreign language!  They’re all different from the ones we use in the U.S.

Kenyan culture is mush slower and relaxed than in America.  The emphasis on punctuality and speediness is nowhere near as stringent here as it is at home. The amount of time I get for breaks is way too much!  I get 30 minutes for tea break, and another hour and a half for lunch… and the shift only lasts from 8am to 5:30pm!!  Working in the U.S. I usually spent 13 hours at the hospital, and only 30 minutes were allotted for lunch (plus a 10 minute break if you’re lucky).  I’m so used to the stress of running and rushing at home.  It will definitely take some getting used to. 

I’ve also noticed that the nurses here don’t carry or use stethoscopes.  I asked about that, and apparently it’s beyond their scope of practice in Kenya; interesting.

It’s going to take me time to learn the different procedure for everything in this hospital.  IVs (or “cannulas” as they call them) are similar to ones in the U.S., but the IV fluids come in plastic bottles here, and you have to poke several holes in them with a needle to start the flow.  IV tubing is saved and reused throughout a patient’s entire admission (unlike the U.S. where we discard them almost daily).  The names of drugs used are different.  There are some drugs which I’ve never heard of.  The most common medication used for pain control seems to be paracetamol.  From the name, I guessed it was related to acetaminophen (Tylenol), but I had to go home and look it up to confirm.  Morphine is not available here in Mutomo, and they have never even heard of drugs like hydromorphone, hydrocodone, oxycodone, etc., all the standard meds we use for pain in medical units back home.  When patients are admitted with anaemia (anemia), one of the most common causes which the physicians test for is malaria.

The documentation is straightforward, simple.  They use a cardex system here for charting.  Unfortunately there are a few bits of the charting that I won’t be able to do because I speak neither Kiswahili nor Kikamba (the local dialect, or “mother tongue”) to take a patient’s medical and social history.  For that I’ll have to rely on translators and notes from the doctors (which they call “medical officers”).  When taking vital signs (which are done only once during the day), I’ll have to carry my phone around to do metric temperature conversions until I get a feel for the number system.  The scale used used to measure blood glucose levels is completely different (and diabetes is pretty common here).  Fortunately I was able to program another handy conversion formula into my phone to figure out the blood sugars. 

I have SO MUCH to learn!  Please pray for me, that I can learn well and be of service to the hospital.

Mutomo Catholic Parish

I attended mass today for the first time since my arrival in Kenya.  The church is Mutomo Catholic Parish.  There are many Christian churches throughout Mutomo, and on Sunday morning you can hear the sound of singing congregations from every direction.  The music at mass was possibly the most beautiful thing I’ve ever heard.  There are no hymn books, but everyone knows what to sing.  Although the mass is done in English (thank God!), the music is still sung in Kiswahili.  There is so much energy in the music.  Everyone harmonizes together perfectly, and there is a lot of dancing and clapping.  No piano or organ, only a single drum.  I really wish I was able to sing along.  The English service I attended was made up mostly of young school children, so they had no shame in staring at me throughout the entire two-hour service.  Before mass began, one boy sat in my pew about halfway down the row.  He stared at me a while, then gradually scooted closer and closer until the church was full and we were all shoulder to shoulder.  He was curious about me and eventually worked up the courage to ask me questions: where was I from?  What did I do at the hospital?  I think a lot of them spent more time staring at me than paying attention to the priest.  After a long week in a foreign country, it was a comfort to be surrounded by the familiarity of mass again… I’ve never been so out of place, and yet felt so at home.

Simple... but I felt pretty good about myself for cooking.

Today was also the first time I’ve cooked since arriving.  I have so far been getting my meals from the hospital canteen, which is like a cafeteria.  Unfortunately it’s closed on Sunday.  So I was forced to venture into town on my own to the supermarket (which is about the size of an average American living room) and bought bread, 2 lbs. of rice, a vegetable called sukuma wiki (which is like collard greens), cooking oil, some sort of unrefrigerated margarine spread, tomatoes, and a box of milk (also unrefrigerated before opening).  The total was about $6 USD.  I also stopped by one of the outdoor market vendors for a bag of potatoes (about 50 cents for 2 lbs).  It took me a minute to figure out how to light and use the stove, and I kept my first meal simple: fried tomatoes and toast (plus an apple I bought from Nairobi).  Now I have to figure out how they wash dishes here.  Maybe soon I’ll take a trip to the local butchery to buy some meat and then learn how to cook goat.

A street in Mutomo.

In the afternoon I decided on going for a walk around town.  I passed by the church again to take a photo.  There were a few kids inside who spotted me and ran outside.  One of them was the boy who sat beside me during mass in the morning; his name is Kennedy.  They asked me to take a picture of them and were thrilled to see themselves on camera.  As I walked around town, I again drew stares everywhere, but people were friendly and gave me a smile and a “hello” when they passed.  My walk took me in a loop around town, through the airstrip, and back to the hospital.  When I returned to the hospital, the security guards spotted my camera, and they also asked if I would take their picture.  They even went back into their guardhouse to put on their uniforms and tuck in their shirts for the photo.  I didn’t realize seeing your picture would be so rare here.  If I can figure out a way to print them, maybe I can go back and give them a copy.  I might get a second job as the town photographer.

My new friends from church.

An intersection; kind of like the Times Square of Mutomo.

Goats and donkeys are tied up everywhere along the road.

The local airstrip where the occasional plane will land.

Security guards at the hospital... you can't tell from their faces, but they were excited.

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First Days in Kenya

Hello everyone!  I’ve made it to Kenya safely.  This is my fourth full day in the country, so bear with this long blog post as I describe my initial days.  My travel time, from the minute I left my house in L.A. to the moment I landed in Nairobi, was over 24 hours, including a 2 hour layover in Amsterdam (my first trip to Europe!).  It was a strange feeling as the first plane took off to see the California coast slip away and know that I wouldn’t see it for a long time.  I arrived in Nairobi late Monday night, where I was met by a cab driver holding up a sign with my name.  After a quick phone call from Damaris at the mission board, I was taken to my hotel where I tried to sleep.  Kenya is 10 hours ahead of California, so it’s been a challenge over the past few days adjusting to the jet lag, but I’m almost over it now.

My two days in Nairobi were spent meeting with the CMMB office staff and shopping for supplies I would need in Mutomo.  The staff at CMMB, and the Kenyan people in general, have been very welcoming and generous.  Everywhere I go I’ve heard “Karibu Kenya,” meaning “Welcome to Kenya.”  Luckily for me, everyone in Nairobi speaks excellent English, and everything is written in English.  I’ve been making an effort to pick up some Kiswahili (Swahili) words and am very excited to learn, but it’ll be a long time before I’m able to have a conversation with anybody. 

Some of the CMMB staff at the Nairobi office.

Nairobi is a modern city, though it’s still very different from cities in the U.S.  To say the traffic here is chaotic would be an understatement.  People weave in and out of the lanes, traffic lights often seem to be more of a suggestion than a rule, and pedestrians j-walk everywhere (even across the highway!).  When crossing the street, I find it’s best for me to just attach myself to a crowd of people rather than go it alone.  Cars here drive on the left side of the road, so when crossing you have to look to your right first.

Kenyan money

I’ve been getting accustomed to using Kenyan money.  They use Kenyan shillings here (Kshs).  The exchange rate is roughly 83Kshs/1USD, but the prices in Nairobi have been comparable to the prices in the U.S. 

 Among the many supplies I picked up in Nairobi were a fan, a modem for internet, and a new cell phone.  My friends at home will be shocked to learn I now have a smart phone.  I’ve never had a smart phone in my life, so I find it very ironic that I had to come to Africa to get one.  The modems for internet in Kenya are the size of a thumb drive, are wireless, and fit into a USB port, much smaller and more convenient that those in the U.S.  Also common in Kenya is the M-pesa system.  This is basically a way of loading money onto your phone.  Many Kenyans use M-pesa to pay in shops and restaurants, to transfer money to one another, pay bills, and even withdraw cash.  It’s a very impressive and innovative system and eliminates the need to carry large amounts of cash.

The modem I use for internet access.  You use the code on the scratch card to upload airtime which you then use to purchase data.

The drive to Mutomo was about 5 hours: 2 ½ on paved road, and 2 ½ on dirt road.  The paved road goes as far as Kitui town, which is the largest town in Kitui county (counties are the Kenyan equivalent of a state in the U.S.)  We stopped there to pick up some water and use the toilet.  It was the most primitive toilet I’ve ever seen: basically a small stone shack with a hole in the ground… but it works.  I was wondering what sort of toilets to expect when I reached Mutomo.  After Kitui, the dirt road began.  This road is very rough and made for quite a turbulent ride.  The distance on the dirt road was only about 70 kilometers, but due to the condition of the road, the car could only go about 20 kph (about 12 mph).  As we drove through the small towns along the way, the residents stared curiously when they saw me.  My driver explained that people here are often excited to see foreigners, and many people will use the word “muzungu” which means something like “white person.”  Not half an hour later, a group of children spotted me and got very excited, shouting “Muzungu, muzungu!”  That gave me a good laugh.

The main road through Kitui town.

The start of the dirt road. This was the smooth portion.

Upon arriving at the hospital I was greeted by Sr. Mary, the hospital administrator.  She gave me a tour of my new house.  It is much bigger than I expected.  It actually rivals my apartment back home.  I have two bedrooms, a sitting room, kitchen, toilet room, shower room, and dining room, as well as a back porch.  I was so relieved to see that I have a flushing toilet, and they DO have toilet paper! (sigh of relief).  The hospital grounds are quite large with many houses, rows of water tanks, and a dumping area where rubbish is burned.  I’m told about 40 staff live in the hospital housing.

The front porch of my house.

The sitting room.

This is self-explanatory.

I was given a couple hours to unpack, then I was to meet at the house of one of my neighbors, Anita, for dinner.  Anita is a nurse from Ireland who has been living in Mutomo since 1999.  She is very welcoming, and put on quite a nice feast.  I’m sure she went to a lot of trouble to prepare the meal, and many of the items, such as cheese and ground beef, have to be brought in from Nairobi.  The dinner gathering was a nice chance to meet my other neighbors.  There was Marcus, (an OBGYN from Finland), his wife Kathy, Per (a dentist from Sweden), and Sr. Mary who is native to Kenya.  Between all of us it felt like having dinner at the U.N.  Marcus, Kathy, and Per will all be leaving in a couple weeks, but Per (who has been to Mutomo many times) will be returning again in January.

Bigger than my bed at home, and a better mattress too.

 After dinner I walked the 30 yards back to my house, clutching my flashlight and scanning the ground to avoid running into any snakes.  Sr. Mary and Anita say it’s unlikely I’ll even see any snakes (they are usually scared away by people), but for safety to carry a torch (flashlight) and wear closed shoes at night.  Thanks for making me pack those flashlights Dad!  I settled into bed for the night (beneath a mosquito net), then got up two minutes later to assemble the fan I’d bought in Nairobi (thanks for also making me pack that screwdriver!).  It’s not excruciatingly hot here, but warm enough that sleeping is mildly uncomfortable.  Thank goodness for the fan!

The shower room. The shower doesn't run. The bucket and scoop in the far right corner serves as my shower.

This morning I had my first Mutomo shower: a bucket of water with a cup to scoop… primitive but effective; I felt quite clean afterwards.  Water is a HUGE issue here since Kitui county is a very dry region of Kenya with little rain.  I am amazed at the resourcefulness of the residents in conserving water.  Every rooftop is designed to catch rainwater, which is then stored in a series of massive freshwater tanks.  They also have access to saltwater, which comes from underground.  This is mostly used just for washing the floors, dishes, and hands.  I am told I can also save the water I use from showering to reuse for laundry, mopping the floors, or filling the toilet tank.  I will also have to start boiling water to make it safe for drinking.  I’m lucky to live in a place with tank water.  As I drove through the towns on the way here, I saw many people walking down the roads carrying bottles by hand (or donkey) to fetch water.  I think some have to travel quite a distance.

I had a quick breakfast of tea and a hardboiled egg at the hospital canteen this morning for 40 kshs (less than 50¢).  The tea here is quite good.  I’m not much of a tea drinker at home, but I think I could take it up here.  The tea is made with boiled milk mixed with water.  It’s nice to have the option of the canteen for meals, but I’m hoping to learn to cook eventually. 

After breakfast I met with Sr. Mary for the grand tour of the hospital.  It is very well designed, much more navigable than the maze-like hospitals in the U.S.  The main wards are medical/surgical, pediatrics, and maternity.  They also have the theatres (operating rooms), outpatient clinics, and HIV center.  There is a pharmacy, lab, kitchen, sterilization center, laundry room, library, offices, isolation rooms, hospital store, records department, community education center, etc.  I was surprised to see that much of the hospital systems are computerized, though most of the nursing documentation is still done by hand.  (luckily I have experience reading bad handwriting from the doctors in the U.S.).  I must have been introduced a hundred times as we made our way around the hospital.  It will take me a while to remember all the names.

After the tour I met with Teresia, who is the director of nursing.  She is making arrangements for me to start in the hospital tomorrow.  I have the rest of today to rest up and get settled.  I’m looking forward to seeing the rest of town later this afternoon.  Mutomo’s Catholic church is right next door to the hospital, a 5 minute walk from my house.  There is also a mosque in town, which I have not seen but can hear during the call to prayer.  Apparently if I do my shopping in town, people will charge me more since I’m white (it’s assumed that I have a lot of money).  But I’m told if I like I can have someone do my shopping for me to avoid this issue.

The plan is for me to start on the medical ward tomorrow morning.  I’ll spend a few months there, then rotate for a few months to each of the other wards.  I’m excited to get the chance to sample all the areas of nursing, but a little anxious since I’ve had only medical/surgical experience.  But I’m in good hands.  There is a library with nursing books where I can brush up, and I will be assigned to a mentor in each ward to help me learn (and to translate Kiswahili). 

Wish me luck, and pray for me!