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!).

A Day in Mutomo

 Tomorrow marks 3 months in Kenya.  There hasn't been anything too exciting lately to report, so I thought it would be good for me to paint a picture of a typical day for me in Mutomo. 

My alarm clock sounds every morning at 6am.  I grab my flashlight, open up my mosquito net, scan the floor and my sandals for scorpions and other insects, then climb out.  The first thing I do is take my 100mg tablet of doxycycline for malaria prophylaxis.  I proceed to get ready for the day:

I take care of toilet duty.  It takes about half an hour for the toilet tank to refill, so I’ve learned to use my flushes wisely: flush for solid waste… save my flush for liquid.  I head to the washroom to make my face all pretty for the day (shaving and washing my face).  It’s usually humid here, and my face will be wet with sweat again in a few minutes.

I can’t eat anything for an hour after taking my medication, so I wait for breakfast and head to morning Mass at the church next to the hospital.  The service lasts about half an hour.  The church is usually filled with school children.  There are two priests at the parish: one with very good English, and another who is incomprehensible.  So depending who the priest is that day, I may spend the half hour engaged in the Mass, or daydreaming.  The kneelers aren’t padded for comfort like they are in the U.S., so for about five minutes every morning, I kneel in pain, praying that I won’t have arthritis by the end of the year.

I head back home hungry for breakfast, which usually consists of some combination of toast (if we have electricity), fruit salad (watermelon, papaya, pineapple, mango, oranges), bananas, or homemade banana bread.  When I brush my teeth after eating, I don’t use the tap water for rinsing my mouth and toothbrush, so I have to pour a few drops of pre-boiled water into a glass each time.  If the electricity is working, this is usually the time when I check my emails and skype with family and friends online.  Whenever I have a chance, I try to charge all my electronics since the electricity is not always reliable.  

Main corridor through the hospital.

I leave home and make the two-minute commute to work.  Kenyans have a different perception of time than Americans… which is a nice way of saying they are always late.  When I arrive at the hospital, there are usually one or two nurses who have not yet arrived, but we usually begin without them anyway.  Before beginning the morning report, the nurses take a moment to pray together for God’s help through the coming day.  The people in Mutomo in general are a very spiritual people. 

We then begin report on all the patients, which is usually very simple.  Only a few seconds are spent on each patient, and a typical report goes something like: “So-and-so had a fair night.  Blood pressure was___.  Temperature was___.  Heart rate was___.”  And that’s it!  In the U.S. we might spend 40 minutes reporting on 5 patients.  Here we spend five minutes reporting on 40 patients!  I often slow down the report, asking questions like, “Is the patient still in pain?”  “Are they still having difficulty breathing?”  “Is the nausea, vomiting, diarrhea controlled yet?”  I wonder what some of the nurses think of my questions… a waste time maybe?  We do a quick round of the ward, checking on every patient, making sure the lights are all off (to save the cost of electricity), and making sure all the windows are open (to increase ventilation and prevent TB). 

Doing ward rounds with the clinical officers.

We then go about the day’s duties, preparing for the doctors and clinical officers who arrive soon to do ward rounds.  We gather information for the rounds, checking the vital signs of patients who’ve been unstable, making sure all the lab results for the previous day were recorded, etc.  Ward rounds take place only on Monday, Wednesday, and Friday, and are done either by a medical officer (a doctor) or a clinical officer (something similar to a nurse practitioner in the U.S.).  We review every patient on the ward and discuss the way forward for their care.  On days which are not rounding days, they see only patients which the nurse requests to be reviewed (which is everyone if I have my way).  Once rounds are over, new medications, tests, and lab requests are ordered in the computer system.  This is the time when the nurses will start to take their morning tea break.  Since I’m not accustomed to drinking so much caffeine, I don’t usually drink tea during work hours (to avoid the hassle of frequent bathroom breaks). 

Waiting area in the outpatient department, empty on a Sunday.

The garden area outside the hospital's general office.

Around noon is when the patients receive their medications.  This is one task which all the nurses step up to do, so this is when I usually decide to take my break and leave them to work alone.  Most days I make a sandwich with egg, tomatoes, and avocado seasoned with a bit of salt, pepper, and curry powder.  Two hours is actually a lot of time to kill in the middle of your day.  I head home, heat up my lunch on stovetop, eat, wash dishes, check emails again… and still only 30 minutes have passed!  I try to pass the remaining time reading up on different diseases and medications, working on hospital projects, listening to music, napping on my front porch, running errands in town, playing solitaire on the computer, etc.

Waiting to give the ward report to the nursing matron.

Back to work.  The afternoon is the time to finish up on anything from the morning that wasn’t yet completed.  I may spend time wheeling patients up and down the hospital for x-rays and surgeries, restocking certain patient medications, rounding on the patients again, managing new admissions, or simply sitting at the station updating the charts.  At last 5:30pm arrives, and with it the relief nurse (it’s usually more like 5:45).  We give another report, and are then free for the night. 

Mass is held in the hospital once every month.

After work, I have about half an hour left of sunlight.  The sunsets are usually very spectacular.  The clouds in the west burn bright purple and yellow, while the mountains to the east of my house glow a vibrant orange.  The first order of business once home is to shower.  On top of the layer of dust and sweat that I’ve accumulated, I’m also covered in who knows what germs from the hospital.  I take a plastic tub, pour in one scoop of water, then pour another half scoop over my head to wet the hair.  The water isn’t warm, but that’s okay since it doesn’t get too cold in the evenings.  Soaping up and scrubbing is never a problem, but I never completely get all that soap off when all I have is a wet washcloth to rinse.  Nevertheless, I always feel surprisingly clean after my bath.  For a while on the bathroom ceiling there were two spiders, one large, one small, which were always present in the corners, watching over me every night as I bathed (the closest thing to a pet).  At first I was a little disgusted by them, but I actually grew to enjoy watching them and even named them: Yogi and Boo Boo.  Occasionally the big one would catch an insect and I would watch it wrap it in webbing and eat it.  But the spiders have recently disappeared, so I shower alone now.

Once I’m all cleaned up I heat up dinner.  No microwave; everything is heated on stovetop (which has to be lit with a match).  The local diet consists of only a few dishes.  Despite eating the same thing week after week, I surprisingly haven’t gotten tired of it.  I’ve come to really love the food here.  My dinners usually consist of some combination of a starch (rice, ugali, potatoes, chapatti bread), a vegetable (green cowpeas, sukuma wiki, or cabbage), fruit, and sometimes chicken or goat meat cooked in a stew.  Again I wash the dishes… I don’t dare leave anything unwashed in the kitchen for fear of the ants.  On a few occasions I’ve come home to find the kitchen swarming with hundreds, if not thousands, of ants.  The tap water is cold, so if I need to clean any dishes really well, I have to boil water again.  When all this is done, it isn’t too late (maybe 7:30?), but the African sun and heat tire me out quickly, and I don’t stay up for too long.  I may spend my evenings visiting with the neighbors, maybe chatting online, playing piano (keyboard), or simply reading a book.

Time for bed, usually around 10pm.  I fire up the bedside fan, without which I wouldn’t be able to sleep.  After a quick peek beneath the bed to make sure there’s nothing alive down there, I turn out all the lights, make sure all the doors are shut tight to keep out the bugs, crawl into my mosquito net and tuck it into the mattress tightly, and pass out within one minute.  In eight hours, I repeat the whole process again.

Here are some more photos from around Mutomo...

The only public trash can I've seen in town so far.

Nobody seems to be using the trash can.

One of the local shoe vendors.  I recently bought a new pair for 1000 shillings ($12).

One of the matatus (buses), which are always overcrowded.

Posing with my kinyozi (barber).

As far as I know, the only piano in town.  I recently discovered it near the church.