Wednesday, July 13, 2011

our friend Hope...our immigration laws at work!

Copy and paste to watch this video about our little friend.

Monday, July 11, 2011


Our travels home were smooth and all the bags arrived with us back in Seattle at about 5pm today! 9 hours to London...9 hours in London walking, riding bikes and eating!, and then 9 hours to Seattle. July 10 has been a long we chased the sun around the globe!!

We are tired and really disoriented. But we were greated with so much love and attention!! Thank you to those of you who did amazing work on our yard...filling pots, trimming plants, weeding! Wow. It was amazing to come home to such obvious care and attention to detail. Thank you to those who brought food and flowers. Thank you to Mick and Carol for helping to pick us up and for bringing along food and treats. And to Alison and Myles!...amazing work and effort. The house looks so perfect and you made so many thoughtful preparations for us. You outdid yourselves. Thank you so much!

It is quite an odd feeling to be back. Thanks for making the landing softer...

Wednesday, July 6, 2011

kwaheri kenya...home sweet home seattle!

We really are down to the wire! Warren is in an almost giddy mood...bags all out, munching on dried cranberries, demanding that we bring out more clothes to use as padding around other things(Ali and Erika, you know the mood!) All cupboards are empty...contents on living room floor...chaos. John is in the midst of it all trying to study for finals??, but happily watching the progress that means he is on his way home! People are coming by to say goodbye, see what we are giving away, have tea one more time, leave contact info...

It feels surreal. The year has gone by so fast!!?

I notice that as the reality slowly sinks in and I can allow myself to believe that we will be there soon, I have some weird things coming into my mind...toasted rye bread, cake??(today I saw a US style bd cake while watching our nightly dose of House, and remembered that I LOVE them), Sonrisa Happy Hour!, Agua Verde, Varlamos, our bed!, our bathroom...Why these things? They seem so random. And this doesn’t count people, places and the fact that I get the sense that summer is really sort of showing up in Seattle now!?

Warren and I had a last hurrah sort of day in Nairobi on Tuesday. We had lunch with some Kenyan friends, shopped for a few more things to bring home, did a few errands...It felt sad...bittersweet. Nairobi is familiar and comfortable now and we have our favorite little haunts. I can picture how to make a great life here.

I love the concept of the “angle of repose”, that maximum slope where something will stay before it slides. There we were on Tuesday...Now we have started sliding!

See you soon!

Friday, July 1, 2011

stop making sense!

A friend of ours here in Kenya posted this on his Facebook wall today:

I discovered these new Kenyan laws today. Sitting on a flower pot in the CBD-5000/= Spitting on any footpath or blowing the nose aimlessly other than into a suitable cloth or tissue-10,000/= Making any kind of noise on the streets-10,000/=

As a reminder...10,000shillings is approximately $120! The average wage here in Kenya is not more than a few dollars/day.

A few days ago I was going through paperwork looking for an email address. I found some orientation papers we were given upon arrival here last August. Part of the information included some tips on avoiding fines in Nairobi. A few laws to be aware of:

Pedestrians crossing roads in Nairobi when traffic light is red: fine 10,000ksh (shillings)
Motorist moving on when the traffic light is red: fine 10,000ksh
Pedestrians crossing the road while talking on their mobile phones: fine 500ksh
Boarding/Alighting at non designated matatu stops: fine 10,000ksh (matatus are the local mini bus, main public transportation)
Unfastened seat belt: fine 500ksh
Worn out tires: fine 10,000ksh

Making any kind of noise on the streets!!?
If you stop at a red light here the cars stream around you and honk obsessively!? While this is happening people are darting between cars, talking on their phones, jumping on and off matatus while the matatu is moving, certainly not wearing seat belts! And tires?? Cars aren’t even aligned straight! And in all this chaos...beware not to sit on a flower pot, blow your nose or spit!

But no worries, the cops don’t have cars, making it hard to chase you down and they happily accept bribes if they do happen to catch you.

Despite all this craziness...I had lunch with a friend today and told her all that I love about this place. I feel kind of nauseous walking through the market knowing that it is one of my last visits and the end of my ability to say..."I know it doesn't cost that much, I live here." Earlier this week Warren and I took a spontaneous last visit to the animals on the Mara. We heard of a good deal and went for it. As we drove out of our camp it was like the animals had set up a finale and a farewell! There must have been 40 giraffes...beside us, behind us, in front of us...on the road, running ahead, popping up out of the trees! The zebra were running alongside us, an ostrich sort of raced us, there were wildebeests, lots of birds...It was almost like you could hear music...but it was made up of hooves, rutting noises of wildebeests, bird calls, breathing...Wow.

I had a moment when I thought that I should get the camera...then realized it just needed to be taken in. I won't forget.

Wrapping Up

It’s the last few weeks of our time in Africa. I continue to see patients in the Casualty/OPD/ICU. Interesting cases continue to come in

Case 1:
45 y/o male treated at outside clinic 3 days ago for malaria. Symptoms for malaria are sketchy and patient received IV quinine and coartem tablets. Patient c/o skin blistering past two days. On arrival the patient has what looks like deep second degree burns over more than 60% TBSA. The skin is friable and easily sloughed off with gentle pressure. Mucus membranes are involved as well. No early signs of infection are noted and the patient is treated like a burn patient and admitted to the ICU. The patient is aggressively managed with fluids and burn care. The patient develops some evidence of pneumonia and is intubated. After one week of care the patient dies in spite of ICU care. This is a case of drug induced TEN (Toxic Epidermal Necrolysis), and is a good reminder that the drugs we prescribe can be helpful. They can also be dangerous and actually lead to death.

Case 2:
30 y/o otherwise healthy male presents with severe dyspnea. History includes shortness of breath for approximately 10 days, with relatively acute onset of symptoms. Patient was admitted to a nearby hospital for the past week and discharged home on no medicines feeling poorly. Patient states he was treated for Tb while hospitalized but knows little about medical details. He comes with no charting/papers/meds on the back of a motorcycle. The driver, supposedly his brother, is nowhere to be found. VS on arrival= SBP59, HR 130, RR 50, afebrile, O2 sats on 15L mask maybe 83%. Patient c/o central chest pain and SOB. Patient can barely talk. PE significant for massive bilateral elevated JVP, symmetric wheezy lung sounds, soft abdomen, and no significant LE findings. Initial tests= CXR enlarged right heart shadow c/w right heart enlargement & increased haziness in area of central pulmonary vessels, EKG sinus tach with right axis deviation and right heart strain, quick look ultrasound shows massive right atrial enlargement and minimal pericardial fluid. Therapy so far includes fluids, intubation, lovenox, and dopamine. This is a case of massive PE with an initial week of mismanagement at nearby hospital for pneumonia. So far risk factors are unclear and the patient is fighting for his life in the ICU.

Tuesday, June 21, 2011


My kitchen floor had monkey prints yesterday! I haven't seen a monkey here for awhile, and I must have been in the house when he/she made their visit. What are they doing? Darting in and out, not really causing any mischief besides leaving footprints? Weird.

Warren came home from the hospital yesterday with a great story. He took care of an older French lady who has lived in Africa for a long time... about half her life and she is in her 80's. He was busy with her, as she was quite sick...but in between he was able to ask her how she came to live in Africa. Her answer..."i had a lion..."!! No kidding, this is why she came to Africa. She was living in France when a person came around who had a small lion cub and was using it for money making purposes...allowing people to pose for photos etc. The French woman found this offensive and worked it out to buy the lion. Eventually the lioness got quite large and this was becoming a problem. Someone she knew suggested that she come to Africa...and she did. They had a large penned in area where the lioness could be during the day. She couldn't let her run free as she would have killed the neighbors pets etc. But she kept her fed and content...her words, "lions are really very lazy". And the lioness slept in this woman's bedroom at night! She died of old age in her 20's. Her description of this lioness was much like a person talking about their cat...the sleeping, the laziness, and the comfort. Wow.

Our friend Carol suggested that maybe we should ask every person we meet if they have ever had a lion! Perhaps this is more common than we know!!?

Of course I had a million more questions about this woman, she also had a leopard for awhile! Too bad Warren had to focus on trying to help her with her health problems. She must have so many stories!

Tuesday, June 14, 2011

and now back down to 3....

Erika left last night. We took her to Nairobi and she flew toward London just after midnight. Apparently there is an ash cloud over Eritrea that makes the flight longer right now?? What is this? Our news sources here are quite limited, but isn’t the volcano problem in S. America?? I don’t get it. In any case, it is morning now and I am able to see that her plane landed. She has a plan to take the speed train to Paddington Station and walk to Trafalgar. I hope it works out. That would be a nice way to pass the layover.

Erika was here with us for more than 5 months! It seems strange to see her room empty and it is odd to wake up to just the 3 of us again. Thankfully we only have a few more weeks or we would all be feeling pretty low. Before Erika left she said goodbye to her soccer team...there were many calls back and forth looking for “coachie” so they could arrange a last scrimmage on the “lower field”. She played her last pick up BB with the men on Sunday, always the only female on the court. We had our last walk to the fig tree on Sunday morning, a place she has loved to go for sun and quiet.

During her time here she has followed doctors on rounds through the hospital, spent time in the OR, worked in the dental clinic, babysat, made relationships with locals, hiked, traveled, read, slept, ridden motorbikes, made friends...People were coming by to say goodbye for the past few days. This time out from all that is her life at home will probably show up in lots of different ways, many she won’t see until she gets home and goes back to familiar things. It feels like a lot has come together for her here. We feel so grateful that she could take this amount of time and that we could have her with us for this large piece of the year. John cannot imagine it any other way!

As far as returning home she likes the prospect of being on roads that don’t make her car sick every time she gets in the car, having “town” close to home...rather than an hour or more away, exercising on flat ground and at sea level, just paying the set price and not having to barter, driving a car...seeing friends and Alison...and our house and dog.

We walked in the door after dropping her off to find monkey prints coming in through our bedroom window, down the wall and onto the floor! No other detectable mischief noted, and the cookies were still on the kitchen counter?? Not sure what that was about, but we were left with no doubt that we are still in Africa! Only a few more weeks and we will be on our way home as well.

the fig tree.

last shot in kijabe.

nairobi traffic!

the airport.

Friday, June 10, 2011

Edge of the Earth

There is a place where herds of camels circle by the side of the road, where large land turtles drink from roadside puddles, and the distant hills are Ethiopia. This land has known years of war and even now in peace the outside world offers very little help. Basically, this is a place unrecognized by the Western world. There are medical students training under less than optimal circumstances here, where only a few years ago they might only get one lecture per week. My colleagues here at Kijabe Hospital have made a commitment to help these students and I recently spent a week lecturing and doing patient care with fifth year students. At the same time my surgeon friends were doing scores of surgeries; one of my friends did 36 surgeries, 15 of them gallbladders. There is no one in this country who can take out a gallbladder if our team is not in town. Open fractures stay open for months, until we can fix them. Every day in clinic there are at least 2 or 3 large goiters that haven’t been assessed or treated for years. There is slow progress being made and most of it comes from indigenous efforts and money from the diaspora. The entire medical infrastructure is in slow creation, out of rubble and chaos. To be a small part of this building process was amazing.

Tuesday, June 7, 2011

counting down...

The time in Africa is winding down for us. Erika leaves in a few days. As cliché as it sounds, I cannot believe it has been a year? It seems like the time has flown by. Is it partly that we haven’t had seasons of distinction, or that everything has been new and interesting, or that we didn’t have the long gray days of winter, or that it gets dark at 7 every day so the days seem short...??

Who knows…

Now we start to think of what we will miss and what we look forward to as we go home...kind of hard to guess what we will miss...We are sure of some things we look forward to! And we are also quite sure of some things we won’t miss...related to driving alone:

potholes everywhere, unmarked speed bumps...lots of them, high beams only, no street lights or white lines, pedestrians, donkeys and bikers in the road...even when pitch helmets, and possibly cars or bikes coming at you against traffic! What will it be like to actually be able to see where we are going and to feel like we can go out at night just for fun if we want to?

Remember the bandit story? I got a call the other day from the local police telling me they had caught some guys and they wanted me to come and “identify” them?? Imagine? Would you know what the 3 guys who threatened to shoot you or beat you looked like if you had pressed the pedal down and bolted?! And I still don’t feel comfortable going back on that road.

We got stopped the other day randomly. We were between two matatus (local mini bus transport) and the police claimed we were speeding. He didn’t have any way of measuring speed, just the desire to collect some money. The process can easily lead to having to drive to a court hearing, sitting in jail for an hour or two, and then still paying a bunch of money...this would be how you might avoid just giving them the money in the first ticket, just money direct...perhaps for the police to have lunch later. Warren started suggesting amounts that might make it possible for us to just keep going and get on with our day. It didn’t take long to agree on a stupid amount of money, but a pass to keep going...and this was worth it for us on that day.

John (and now Erika) rides motorbikes here. It is part of the deal...and a big part of life here. He loves it! It scares me. Many of you would think we are insane for allowing him to do this. Maybe we are, but it would be pretty crazy to bring a 17 year old here and tell him he couldn’t as well.

What it takes for me to get to the grocery store...distance, hazards...It will be amazing to have the option of walking down the hill to Safeway or QFC! Or even better...just to walk to a restaurant for dinner. John has lots of restaurant fantasies!

But, despite these complaints, driving is actually a luxury here...most people ride in matatus, driven at insane speeds and packed to double capacity. Many people die in these.

(We are grateful to already have a buyer for our car and one of our motorbikes.)

Back to what will we miss?

Today Erika said that she might miss Abraham more than anything when she leaves. Abraham is a local schizophrenic who arrives on our porch every morning. His toothless grin and HEARTY laugh make us happy. He sticks his head in the window over my sink and says, “Hi mama, how are you? Do you have chai?” We tell him that we will make tea and he sits down on the porch and waits. Abraham is very, very dirty...always in the same wiped out clothes and he brings a few “friends” along to keep him he sits alone on our porch. If he isn’t talking to us he is talking to them. He likes to enjoy a muffin and a banana with his tea...and he knows if there are 3 scoops of sugar in the tea...any less and he will say so. He can drink the tea immediately, near boiling point! He must have all the sensation burned out of his mouth! As he drinks it he tells us...”you are are good...” Who wouldn’t miss this? A happy person who shows up every day and tells you...”you are good”, for doing something as simple as making him tea...

more animal sightings...

africa is amazing...

Wow! Not a great way to go; only in Africa.

A 31 yo Kenyan man works in people’s shambas (gardens). He does a lot of digging and moves around the local area. Two weeks ago he is digging in a shamba on the edge of Lake Naivasha in the middle of the day. Lake Naivasha is one of the Great Rift Valley Soda Lakes that string along from Tanzania up to Ethiopia. It is a 45 minute drive from Kijabe and we like to go there every month or so. Now about hippos. They are plentiful in Lake Naivasha and one rarely sees them out of the water. They spend the day mostly submerged in the Lake, and come out at night to forage for food. They might even go 3-5 kilometers away from the lake at night looking for grass. Since they are in the lake during the day you don’t have to be afraid of them until the night when they can be up around the lake and if encountered on land can be very deadly. That is why everyone stays away from the lake edge at night, or has powerful electric fences to keep the hippos out. Back to our digging man. He is working away in the middle of the day and should have nothing to worry about. He has probably done this typical day a thousand times. The problem is babies. When hippos have babies the mom will sometimes hide the baby along the lakeshore in the bushes and go off foraging for food. Unbeknownst to our digger he is near to a hidden baby hippo. Momma is quite a long way off but looks and sees that a strange man is close to her hidden baby. This will not do and she comes running at a full gallop to “save” her baby. The poor digging man doesn’t stand a chance and is crushed in the hippo’s mouth all along his right side. His right humerus suffers an open fracture, multiple ribs are broken, there are large abrasions/bruises along the right side of the body. He goes home and doesn’t show up to our hospital for 2 days. Enough time for the wounds to fester and him to become septic. We try to save him for about a week, but in spite of OR debridement/ex fix, chest tube placement, antibiotics, intubation and local wound care, he succumbs to his injuries.

Friday, May 20, 2011

i almost forgot...

Today I realized that I had not blogged about our dinner with Jane! Such an amazing treat....

Here in Kijabe we have a vegetable market of sorts. It isn't the best. The ladies liked it better when they could go door to door and just on Tues and Sat. For some reason this has now been made against the rules and so they have to spend 6 days/week sitting all day at their tables in this little market spot. I find it stressful to go there because I feel obligated to try to buy a little something from each person...there are probably about 8 ladies?? at any given time. Their products are not all it is the situation where you are thinking, "i need to buy tomatoes, i should buy something from her...her tomatoes aren't great...and those over there...where i already bought zucchini...are much better..." And on and on...The problem is, this makes a person like me want to avoid the place if possible and this is bad for business.

Anyway, I have become quite good friends with one of the vegetable ladies. When we introduced ourselves I was sure she said "jean", so I have called her Jean all year. Not too long ago, after being told by someone else that her name was actually Jane!? I asked her to spell her name. The accent makes it hard to discern between these two names. Sure enough, "j-a-n-e"...Jane. She has never corrected me. I am going to go with the idea that she probably can't really tell which I am saying...accents can be helpful!

A few months ago she came to me with a story about her granddaughter who was in the hospital...needing money to get out etc. I suggested that I could give her money to allow this to happen but maybe she could bring me vegetables...just to make it more like a transaction between friends. (So much of our life here is about people seeking donations from us.) She liked this idea and has brought us vegies several times. But the best thing happened...The transaction strengthened our connection. As a result, she insisted that she was going to have our group up for dinner when the kids were here...that meant 8 people! I tried to get her to wait so it wouldn't be so many, but she insisted.

It was a feast! Incredible Kenyan generosity and hospitality. I know we all felt totally humbled and honored...

Monday, May 16, 2011

seattle weather forecast.

Today a friend from home wrote and told me that it has not reached 70 degrees in over 190 days in Seattle??!? Wow. That is a long time...and 70 is not even a great target in my opinion. This is not good.

The closer we get to returning home the more we anticipate and the more we think about what we might miss. I know for certain that I will miss the weather. Kijabe enjoys some of the most perfect weather in the world. It has to be. We have sunshine everyday, most of our rain comes at night, I rarely need a sweater, never need a coat, and I have worn out a few pairs of flip flops because that is all I wear. I need to get out of this perfect weather place because my skin is getting too much sun! What a problem...

The Kenyans don't experience it quite the same as we do?? Not sure how this works. This is considered the "rainy" season...and the slight change in temperature is classified as "cold". Even when it was dry and a bit hotter we often saw people wearing down sorts of coats and children bundled like they were about to head out into the snow for a few hours. Warren has often removed balaclava type of hats from children's heads wondering if they have sort of grown with the hat on??, as it seems the child must have been a different size when it was first applied!

So apparently there is a lot to experience and perception, even with regard to weather. I doubt that a year in the sunshine is going to help us with having a positive perception of weather in Seattle when we return. We will have to readjust.

As we begin to anticipate all that we will find easy to adjust to upon our return(John talks about his favorite eating spots a lot!), we also think about what we will miss here. I am still obsessed with the sky...every day, and acacia trees, and the color of the air itself...I recently read a description of the African sky..."Everything stands out, as though...a fourth dimension of space has overlain the world."


Hopefully the impact of these experiences and perceptions will color our return and our life from here forward. One of my first goals is to find paint as similar to acacia bark as possible and fill my upstairs with that color! Since it looks different in every light.....should be an interesting challenge.

Ali and friends have reported in from Morocco. Their adventures continue.

Monday, May 2, 2011

another update from africa...

Alison and Myles have been with us for more than 5 weeks now! Katie has been with us about 4. It has been fantastic. It is hard for us to imagine that we will be back to our smaller group after Saturday, when they head off for more adventure in Europe and Morocco! We have shared a mtn climb, a beach trip, hikes, walks, runs, FOOD, animal spotting, piki riding, sports, games...and this weekend the kids went as a group to the Maasai Mara where they camped and drove to see elephants, lions, rhino, hippos...all with babies...and cheetahs and warthogs...etc etc. With some help from our friends and new Kenya connections they were able to do this for very little money. A huge treat!
Katie and Ali are going to leave here with hair twists, scheduled for tomorrow. This will make hair maintenance easy for the rest of the trip!
They have been great sports, tried everything, reveled in being here...and seem to think that Kijabe is the best place of all.
Times in Africa aren't without incident. And here in Kijabe we have recently had a terrible murder of a child and a break in at the hospital, not without some violence as well. The recent bombing in Morocco gave them a little they contemplate being there shortly.
But adventure includes just that...and they are ready for more! So off they go on Sat. And we will miss them!!

As for us...we have about 11 weeks left here!? John has started his last term of school and Warren has a teaching/training trip planned to another place in Africa. Erika will be with us until mid June. There are a few more guests coming and going and various things to finish before we leave.
We are starting to feel excited about coming home, with bits of realization that there will be hard things about saying goodbye as well. The time is going to fly by!

Warren has been doing a bit of mtn biking. Yesterday he arrived back at the house absolutely covered in mud! And his words were, "i have to learn, i am not 25 anymore...but i really do still think i am!" Apparently, and obviously!, he had taken some amazing falls...including one where he landed head first on a of head to rock. It was a good test for the helmet. After quite a long soak in the tub and a lot of work on clean up he seemed pretty ok. Learning that he isn't 25 will take some more time.

Wednesday, April 20, 2011

time out in mombasa....

Turquoise water, white sand, warm air, fresh fruit, monkeys, coconut dropping out of trees, rain, sun, bugs...fresh fish...constant requests for money, hawkers selling things we don't want or need, "mzungu, mzungu"(white person, white person), family friends, relaxation, exercise, snorkeling, reading, sleeping, sweating...walking, running, eating, drinking...talking, leading yoga sessions...
Our week of vacation in Mombasa...
Today we went into the old town of Mombasa where we saw the sights of movies and books...Swahili culture, slave caves, old forts and harbors, feral cats, dead rats, flies on fresh meat, spices of all colors including bright pink, burkas, an old Caprice Classic in the road...How did this get here?
We are staying in a true African beach chalet...on the beach, but not without ants, lizards, a cockroach or two, hermit crabs, monkey thieves, cats and fleas!? Today Warren asked that our mattress be changed out....hoping to get fewer flea bites tonight! Somehow he is getting eaten alive despite the mosquito net?? They have no interest in surprise.
Today I told Erika that I felt tired. She asked if I thought I might take a nap. I said,'no, i mean of this continent'. I was feeling wiped out by the day of travel and sightseeing, as in sight seeing...many sights, not all great. And an hour plus long wait for a ferry ride in incredibly hot conditions...with the ferry(s) in constant site...taking an assorted group of vehicles and people, but never quite getting to our line?!!?
Eventually we made it. It was a classic TIA episode.
But so was the fresh red snapper and garlic prawns that waited for us, cooked by our cook for the week, Hassani, who has whipped up an assortment of seafood and curry to die for all week long. So taking the bad with the good...we will enjoy another day of white sand and sunshine tomorrow, with plans to end the day at a restaurant inside a coral cave!

Thursday, April 14, 2011

kili images...

I tried. For some reason I can't get any more images to upload!? Oh well. Here are the Fisher nice!

Sunday, April 10, 2011

Hospital Stories

Hello to All,

In the past few weeks we have had some good outcome cases that came through the ED/ICU:

A 50yo diabetic/htn man came in with significant chf that brought him to the ICU. One of my colleagues was covering the ICU and at 4am I got a call that could I come and help with the case. On my arrival to the ICU the man was being bagged with difficulty, sat’s were low, and he had a bull neck that had difficult to intubate written all over him. After some fentanyl and valium and three unsuccessful attempts at passing the ET tube into the trachea I was fortunate to succeed on the fourth try. The cords never were visualized. The glide scope or an eschman would have come in handy. I put the patient on the ventilator at a rate of 20 breaths per minute and within 5 minutes his heart rate went to 30 with a widening QRS. I took him off the ventilator and bagged like crazy (difficult with high pressures) gave epi, bicarb, atropine and his rate came up and the QRS narrowed down to normal. Remember that we don’t have ABG’s to help guide acid-base decisions but I was pretty sure that he was Mr. acidotic. I put him back on the ventilator, this time with a rate of 30 per minute, and he maintained good vital signs. 2 days later he decided to pull out his tube and flew off the ventilator just fine. His repeat EKG showed an MI, but except for a hoarse voice he went home feeling fine in another 3 to 4 days.

Another man came in to the ED with decreased mental status and minimal respiratory drive. He was around 30 and we postulated he probably took an overdose of some pesticide; a relatively common scenario. He was admitted to the ICU and over the next three weeks developed pneumonia (likely aspiration/hospital acquired), was ventilator dependent to the point of needing a trach, developed an expanding pleural effusion that I relieved with a chest tube, but in spite of it all he finally decided to get better and was eventually sent home walking and talking like normal. I’m glad I didn’t take him off the ventilator around day 4 when he was showing no sign off neurologic recovery and I thought he would be one of those cases with big-time anoxic encephalopathy. I figured since he was so young I would give him a little more time.

I am looking forward to returning to my Northwest ED Family in a few months. I have missed you all and appreciate the support I have felt from home. Just a few days ago I showed my kids the video I was given from all you guys over the Christmas season; they were very impressed with such a huge effort and show of affection.

Thanks Again!


Thursday, April 7, 2011

top of africa!

sandra, warren, ali, erika, myles and john

Wednesday, April 6, 2011

it takes a village!

We did it! We summitted the big African mountain, and by summit I mean Uhuru! I had no idea what this meant before going there...There are two "summits". First you arrive at Gilman's Point, where the guides congratulate you as if you are finished...?? Then they ask if you want to continue to Uhuru, the real summit. We were all of the same mind...the top was the goal, so we continued around the crater rim...for 2 more hours!!! I think these were some of the hardest hours of our lives in terms of physical endurance and mental intensity. It was cold, we were tired (had been hiking for more than 6 hours already, starting at midnight) and we were HIGH...19000 feet high. Elevation provides a lot of new experiences and challenges for the body...
But we did it! And we are all so happy we did. So many factors have to work out when making plans like this, so to have it become reality made us really grateful.

It took 15 porters, a cook and 3 guides to get us up there! This sounds insane, and really it is...but when we realized what it would take for us to try and do this on our own, which isn't allowed anyway, we were able to understand it a bit better. Without guides and help with carrying, the trip would be totally different and almost impossible for people like us. We don't have the time or willingness to invest what it would take. We loved our group of support people and they seemed to be having fun along the way as well. The guides forced us to walk "pole pole"...very, very slowly!, the cook fixed us fabulous meals and kept us with safe drinking water, and the porters basically did the rest!...They seemed to race ahead and get everything set up for us, as if it was no trouble at all for them to physically run around at elevations where we found ourselves searching for air, losing our appetite and feeling a bit dizzy in the head. It is kind of embarrassing to require this much help, but we required a small village to make it up Mt Kili.

Having the time with Ali and Myles is especially sweet. We are so glad they have joined us in Africa for now.

Monday, March 28, 2011

Sunday, March 27, 2011

moving on.

Ali and Myles arrived yesterday! It is so great to have them. Apparently the animals heard they were coming and came out to welcome them. In our walks/runs out and about today we saw baboons, monkeys, a chameleon lizard thing with three horns, a wandering tortoise...The baboons were out in force, as were the monkeys. We haven't seen this many in one day ever! The recent rains have made everything really green again. I think the animals like this too. Ali and Myles had amazing energy for the first day, fueled by the excitement of being here and the newness of everything?? Finally they felt the jet lag and the elevation and fell into bed. We were impressed!

Erika and I just returned from a few days in Ethiopia with a group of Seattle friends. We had a whirlwind tour of HIV/AIDS work going on there, all connected to many other efforts as well. It was amazing. It was a great distraction after our road episode a few weeks ago and a total change of pace. Just before that we had a road trip to Western Kenya with the same people. We thought we were going to see a clinic which might be an example of a self sustainable model...something we were interested in learning about. Instead we found patients lined up to see health care professionals...Communication has challenges! While the rest of the group worked at learning about the clinic from the perspective of funding etc. we saw an ever increasing line up of patients! When we got there 12-15 people were waiting. When we left there were about 30! I think this would have been the trend. But we only had a few hours. It felt like the edge of the world, on the shore of Lake Victoria and FAR off the beaten track.

In a few days we will leave for our climb of Mt Kilimanjaro! We are excited!

By the way, Erika had her hair twisted again. This time we went to a market in Nairobi. 4 women worked on her hair at the same time and it took just over 2 hours and cost half as much! Last time it took 2 full days!? She said it was painful the entire time, but the twists are back!

Tuesday, March 8, 2011

TIA....another version, not so nice.

Erika and I had a scary experience today. Erika wrote about it.

About 45 minutes after this episode we were in an amazing center called Comfort the Children, listening to about 8 handicapped children sing to us with all their might. It was amazing and beautiful...

It is like there is amazing beauty, love, touching courage and strength...and what seems to be a very thin veneer over great tension and potential violence.

From Comfort the Children we went to a nearby IDP camp...Camps that were built by the UN 3 years ago after post election violence here in Kenya. Tribal groups broke out with violent acts against each other and people moved back to areas where their tribal group is dominant. This caused homelessness all over the country because many of these people had not lived in the areas they moved to for generations. The UN put up tent camps, and many people still live in these same tents. 3 years of wind, rain, can imagine the tents. Habitat for Humanity has built many houses as replacement living structures, but then there is the issue of sustainability. Having a house doesn't mean you have the ability to make a living.
Most of these camps are just women and children. They have no idea what happened to their men...killed? ran off? Seems like he would have found them by now if he was alive and looking for them? Some of them have many, many children. They have formed co-ops and are raising chickens, renting land and growing small crops...But it isn't enough. One of the HS age girls was around today. We asked her why she wasn't at school. She had been sent home because she was behind on her school fees.

Some people wonder why they don't go back to the places where they had been living. You know, seems like life is settled down, back to normal...But who could go back to a place where you have learned that your neighbor is capable of killing you if stressed, not personally threatened by you, but persuaded that your "group" is to blame for something?

And as we learned today....considering the reality that all is not as it seems is part of surviving here. This is Africa.

Thursday, March 3, 2011

is it time yet....?

Sometimes it feels like it is time to go home....

Like when you get up early for a meeting, assuming that the focus will be on the fact that people are quitting at the hospital...including one of the main people in your department...with no notice! And it is never mentioned because it seems that direct communication, or using meetings for pertinent issues is not the way it is done here.

Or when you have to get ready for the day without any water...and you have to return to carry water so that you can flush your toilet and wash the dishes from last nights dinner...and when will there be water? "Soon, very soon...don't you have water yet?"
And in your mind you think..."prepare for 4 days!" It has been that long before...with the same "soon" business going on.

Or when your favorite people are leaving and going back to the Cameroon.

Or when you can tell that your kids are feeling lonely and counting the days, but are also anxious about returning home...

Or when you just miss your house and your bed and your COUCH and your FRIENDS! And predictability and efficiency and even cold weather and snow! And even your jobs! Warren said today..."i can't wait to get back to my job and my people..."
(how lucky are we that we can feel this way?!)

On the other hand...We still have a lot to look forward to. You are probably never more helpful than when you stick around as people are leaving! The hospital saw more than 500 people yesterday!? There is plenty to do.

Erika has coached the JV team to a successful season and they have had a great time.

John is soon to be headed off on a school trip where he will get certified in scuba Africa!

Our friend Libby has been here with us and is getting hooked up with organizations where she can use her soccer to empower girls...Her best hook ups came from getting a ball and starting to play...word spread. "That mzungu can play!"

Our Seattle church, UPC, is sending a group this month. We are going to get to see them and travel with them, learning about clinics in various parts of Kenya and hoping to get ideas to implement in projects elsewhere.

And we just heard that 7 college students from Seattle will be working in the Nairobi area this summer...some in the slums of Nairobi with our Kenyan friends, and some in an orphanage that is also quite close.

And BEST of all....It is only 24 more days until Alison will be here with us!, along with Myles...and only 27 more days until we leave for our climb up Mt Kilimanjaro.
So I am counting the days as well....and these are full of excitement!

In the meantime, it is time to go fetch some more water...

Sunday, February 27, 2011

living with monkeys...

We have been hearing reports of snow in Seattle! And temperatures that sound painful...And it is late February! Yesterday was Alison's bd. When she was born there were daffodils blooming...Apparently not this year!?

Here in Kenya we are hot and it is very dry! The monkeys get more aggressive when it is dry, or so we have been told. A few weeks ago I was working at the kitchen counter with the door open and a tail appeared over the edge of the counter! I thought it was a dog...I don't think monkey on first sight of a tail! When I walked around the counter to tell the "dog" to get out...there was a decent size monkey staring back at me. We had a moment of stand off, and then it sauntered off..I am sure it was going for the fruit container visible from the doorway.

Yesterday I made chocolate chip cookies. We were all sitting in the living room while the cookies were still on the counter cooling. All of a sudden the spatula "fell off" the counter and we looked up to see a monkey bolting for the door with a cookie in it's hand!

I guess we will have to keep the door shut if we don't want to be sharing our food supply for awhile.

The baboons seem more around as well. Last week I was running along the same trail I always use. As I ran by a big barrel garbage can a baboon lifted himself out of it! Yikes! A bit disturbing. Male baboons are very large and not always so friendly. I think he was surprised to see me too...

Monday, February 14, 2011

TIA, this is Africa

Erika discovered that TIA refers to This is Africa...

Sunday, February 13, 2011

and one more from warren

Lately I have been helping to staff the school infirmary at Rift Valley Academy. This is the school that John, my 11th grader is attending this year. There are around 500 students at the school and most of them board. This past 6 weeks brought an outbreak of the flu, and as many as 50 kids were staying overnight in the infirmary with fevers, cough, congestion, muscle aches, etc. I would go and check on the kids, screening them for other possible illnesses. Something I hadn’t clued into was that a certain number of the students went home to their families over Christmas Break and were in Malaria endemic areas without using any Malaria Prophylaxis. One such child who looked every bit like the flu, except she wasn’t getting better as quickly as most other students, tested positive on a peripheral blood smear for Malaria. She was started on Malaria drugs but over the course of 2 to 3 days she descended into full blown Cerebral Malaria: unconscious, posturing, Glasgow coma score around 3, in our ICU. The miracle was that over another 4 to 5 days she came back out of the coma and was able to go back to her classes. To be sure, all the other kids were tested for Malaria.

Friday marked the 8th and final chemotherapy treatment for a woman I have been treating for Hodgkin’s Lymphoma since October. By “treating” I mean, I have literally been the person mixing and administering all of the medications. She came into our clinic with a swollen neck gland and after sending a small piece for pathology was started on a 4 drug protocol for treatment. She now goes off to the National Hospital in Nairobi for radiation therapy and has a great prognosis for cure. I didn’t plan on doing Oncology but you never know what the next week brings.

more wild rides...

Today we piki piki’d into the Rift Valley. John carried Erika and Warren carried me. And John showed us the way. (Yesterday we hiked up Kijabe “Hill”…top about 9000 ft and RT hike more than 5 hours. Our pedometers told us we had walked 13 miles when we got back…and our bodies felt like it!)

Our piki ride took us down from our home, through the hell hole that is Mai-Maihu...a truck stop town that fits all the images you have ever seen related to the spread of HIV in Africa...and then we headed out into the valley. John wanted to take us to a Maasai town he likes.Getting there involved riding on road track that was up to a foot thick with dust...a bit like riding a motor bike in deep and light snow on a rutted path...LOTS of it! We took a few tumbles. You can imagine how dirty we became! We passed a family of zebra, including a new one, and lots of Maasai children waving and calling out “hello, how are you?”. We drove through a beautiful acacia forest, had to ask some Maasai goat herders to direct us, and saw a small church service happening under an acacia tree…something that seems much more meaningful to me after my conversations with my Maasai friend Samuel, who speaks clearly about the sense of liberation he feels on account of his relatively new Christian faith.

When we finally arrived in Awaso (spelling?) it was a quiet Sunday afternoon. As an aside, I have heard people describe the nastiness of plastic bags in the ocean…how they congregate and swirl around and make an ugly scene on the sea. Here in Awaso we found something similar. Every bush, fence wire, branch...plastic bags stuck after being blown there by the wind...a garbage dump of plastic over acres of land. Horrible. The market John loves was like a ghost town, but we stopped in at the little “hotel”, the word for restaurant in most of rural Kenya, and had a coke and a mandazi, a sort of fried bread or donut. The TV was blaring away with an English speaking person telling about British rugby and then a rundown on the picks for best new shows/movies?! So weird. Most of the people watching don’t really speak English...and what do rugby, movies and advertising mean to them as they see it come across the screen?? Apparently the TV gadget itself is interesting enough?

By the time we got home we had one broken side mirror, a broken tail light, a few bumps and bruises, a lost tire worked its way out of John’s backpack due to all the juggling and jarring. I had a chat with the neighbor before coming in the house. When I looked in the mirror I realized that my face was covered in dirt as if I had used it for makeup! She had given no indication that I looked so ridiculous??

Yes Mark Kranwinkle...we lived to see another adventure!;)
Erika wrote about the rafting at

Wednesday, February 2, 2011

rafting the nile!

at the fig tree...

Africa at 6 months….

So here we are...half way through our African adventure. As is often the case...once you dive into something you only learn more about how much you will never understand or know! And that is surely the case here. We see people come and go and can imagine what they will tell their friends and family and we realize that our short glimpses hold so much that is inaccurate, partial, misunderstood…And we realize that this will also be the case with us…A year is a long time, but it is really a very short time. Cultural differences, language, relationships, restructuring of needs...these all take much, much longer if they can happen at all.

Our days are full of appreciation and pleasurable encounters. Many are also full of frustrations and complications. It is not easy to problem solve here. So something like finding a key to a locked room can be an impossible task, or things are breaking as fast as we can fix them… only to break again the next day, or there are constant needs coming to the door...And what is the best way to handle that?

Nonetheless...the sun continues to shine every day. The sky is amazing all the time. The acacia trees remain one of the most beautiful things I have ever had the privilege of seeing on a regular basis. We are warmly greeted by many acquaintances and what can now be called friends. Baboons are hanging out watching us when we run. And we enjoy ridiculous quantities of fresh fruits and veggies!

Erika already has a fan club of 9th and 10th grade girls. She is coaching them in soccer. They love having a young, enthusiastic and fun coach. It is really fun for her as well. She and I taught a class together last week. And on Monday Erika started to follow Warren at the hospital.

Warren and I helped John’s school get through a flu outbreak. At one point there were 70 sick kids...with about 50 of them in the infirmary! Unfortunately the flu symptoms masked the early signs of a bad case of malaria and a case of schistosomiasis! Kids get crazy stuff here when visiting their parents over holiday! Thankfully most everyone seems to be recovering now.

John took the SAT...same day, same time as he would have taken it at home...but 11 hours ahead. Nice to be done long before your friends get started! He has been helping Erika prepare for a real Piki ride...Soon they will be chasing giraffe together!

Saturday, January 22, 2011

christmas story follow up...

For those of you who read Warren's story at Christmas...the one about the girl they were able to facilitate cardiac surgery Sudan, with Italian surgeons!? is the follow up from Samuel(Warren's Kenyan colleague. He is able to communicate with her.

Hi all,
Am filled with great gratitude and joy as I write this. All your effort towards
Maria's medical care has been awesome. She is back home with her family and
tells me that she is literally running around.
Maria and her family are very grateful to you all that facilitated her surgery.
May the good Lord bless you. Have a great 2011!

Beth, from Boston, was the primary instigator in making this happen. She is an incredible woman who was here for a few months as part of her medical residency. She knew of the surgeons in Sudan, she found a sponsor, she offered up her own ID...copies of passport and credit card to be presented at the airport for proof of purchase...or whatever it is when you have to show who bought the ticket...risking the misplacement of this information. Maria is very fortunate to have come to Kijabe during the time when Beth was here. Warren and Samuel were able to do ground work here...both the US and the Kenyan connections were needed. Very cool to see a great outcome!

Warren, Erika, Joe, and our new Swiss friends who are here for a few months, all went to Uganda this weekend so that they could raft the Nile! Warren just texted me,"BACK AT TENT. WOW! SO WORTH IT. WE MUST DO THIS TOGETHER. MORE LEGIT THAN I GUESSED. BOAT FLIPPED 3 TIMES!"
John and I stayed back because he was signed up for the SAT today. We really should have bagged it and gone!!

Friday, January 14, 2011

hair kenya style...

It seemed like a good plan...get hair twists, as the Kenyans do! and have hair that won't require much of anything in terms of care for weeks, even months. Wow! 2 days and 16 hours later!?! Erika has a head of beautiful twists, an adaptation to braiding that gives a slightly softer and very incredible look. She also has 4 packs of synthetic extensions added in! If she can tolerate it, it should stay for up to 2 months. It is a lot. We will have to see how it goes. She is determined to stay with it at this point. It is fun to try it, and besides...after investing 16 hours of time into the process you don't want to take it out too quickly. Apparently the removal process is quite lengthy as well.
It does look quite amazing...and the Kenyans Love it! So she has started well, already participating in a very common cultural activity. She looks lovely.

Today we spent time in Mathare, a slum in Nairobi that I referenced earlier. It is quite the place, impossible to describe. But the children were there...ready and eager to begin their "how are you?" chant. Children are adorable, playful and ready for interaction everywhere. Such a gift.

Saturday, January 8, 2011

erika arrived!

Erika made it safely to join us on Thursday night. She has already managed to go on a hike, coach a soccer practice and get a bit sunburned...Watch out for equatorial sun, esp. when leaving months of Seattle winter! But all is well. Today she left on the back of the pikipiki driven by John...headed for a hike up Mt Longonot. Don't want to waste any time! I am sure she will be driving the pikipiki next time. I don't think she has been sleeping much...her body wants to be on the other side of the world. But there is a lot of new stuff to keep her attention during the day...and she will adjust quickly.
It feels great to wake up and remember that she is here with us.

Warren is adjusting to all new workmates. January in Kenya is like July in America in terms of working in a teaching hospital. All the new interns have arrived and the trained ones have left! It will take a few months....

The other day one of my local vegie seller friends came by because she had been experiencing pain in her ear for 4-5 days, leading to pain in her facial area and jaw. She looked tired and quite ill. She wondered if we could help her. Warren walked up as we were talking and I asked him to check her out. He looked in her ear and thought he saw something. It ended up being a tiny black Maasai bead?! Easy fix!
Who knows how it got there!? She seemed to have no idea. But we put it in an envelope so that she could show her friends back at the vegie market. Now this is a source of great amusement when we see them all. She is back to normal and feeling great. You never know...

Joe went to a neighbor's the other day and learned how to make butter from the cream we get from our fresh milk delivery. We have a very nice container of fresh cream butter in our fridge now. We used it on pancakes this morning...along with fresh passion fruit, mangos and bananas...Pretty nice.