Copy and paste to watch this video about our little friend.
http://www.youtube.com/watch?v=vQMysL7-M6s
Wednesday, July 13, 2011
Monday, July 11, 2011
home.
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 day...as 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...
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!
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.
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.
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...
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 equal...so 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...
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 equal...so 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."
Exactly.
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.
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."
Exactly.
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 pause...as 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 rock...top 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.
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 pause...as 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 rock...top 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 together...plus friends, relaxation, exercise, snorkeling, reading, sleeping, sweating...walking, running, eating, drinking...talking, laughing...games...Ali 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 me...no 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!
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 me...no 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 kids...together...so 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!
Warren
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!
Warren
Thursday, April 7, 2011
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.
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
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