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.
Friday, July 1, 2011
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.
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
animals
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!
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.
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 dark...no 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 place...no 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 company...as 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 good...you 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...
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 dark...no 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 place...no 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 company...as 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 good...you 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...
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