Sosoni Clinic, Day 2

September 22, 2012

Today was the last day of clinics.  Our work here is now over, except for an HIV/AIDS support group meeting tomorrow.  It's kind of odd, but kind of a relief at the same time.  It has been good to be here and to serve these people, but at the same time, it is pretty far outside of the comfort zone of our Western life, so there is a certain amount of "bucking up" we do to venture out into this wider world.  Sometimes I stop and think to myself, "I am standing in Africa," and I picture a map of the world and realize how far away I am from my normal life.

In one way, everything here has become normal.  The life we see of people in the villages, the mud huts and dirt floors, women walking and carrying everything imaginable on their heads is what you see all around.  It isn't like there are two worlds side by side (at least not that we see).  We don't travel to all part of Malindi, but the buildings leading into the city and the roads and stores all have a common aspect to life in the villages.  The walkway in the tourist market is mostly broken concrete and rubble, for example.  The hotel here is very comfortable for the standards of Africa, but still primitive by Western standards.  At least for me, I leave my expectations of Western standards behind and adapt to the surroundings that are here. 

In another way, it can never be "normal" and recognition of the poverty is continuous.  In the clinics, we also see children wearing rags for clothes, with shirts barely holding together. Whenever we hand out anything, there is a huge surge of people wanting to get whatever it is, because they have nothing.  Children don’t seem to be starving, but they have subsistence levels of food, no toys, and inadequate health care.  Many people have rotten teeth and toothaches because they have no dental hygiene.  They don’t have enough money to travel 10 miles to Malindi to see a doctor, and they can't afford the medicine if they do get diagnosed.  Several of the Kenyan volunteers are unable to pay for school tuition.  What they are lacking is anywhere from 8000 shillings ($100) for high school fees to 50,000 shillings ($700) for a post-secondary certificate program to help them be employable. An amount that is not a great sacrifice for Americans can change a life here.  How little it would take to improve the quality of life here.

For our final clinic day, I think everyone was tired and ready to come to the end.  Patience seemed a little short at time.  The number of patients seen today was double other days.  Although Amy and Anya were gone, we had three Kenyan health workers with us.  They moved through patients at lightning speed, for several reasons: they didn't have a translation delay, but they also did next to nothing to evaluate the patients beyond the patients' own statements. They didn't listen to lungs or heart, look in ears or throats, etc.  Their treatment was to hand out medicine that seemed to correspond to what the patient said was bothering them.  So medication was flying off the shelf and patients were flying out the door.  For the first time in either trip, triage was falling behind treating the patients.

Towards the end of the clinic, I was grateful to be called away from triaging to photograph the Imani Project volunteers handing out a bag of flour to each child.

 

 

After the distribution of the flour, I skipped out on doing more triage (since Mr. Baya was handing it :-), and I took a walk through Sosoni to photograph the sign for the primary school that was out on the main road.

Sosoni Primary School sign on the road through Sosoni

It was about a half mile out to the road, and I got to see some of the houses in the village in more detail than is possible from the window of the van as we drive along.  Everything is very humble

Buildings in the Village of Sosoni. The white colored wall is smoothed mud that is whitewashed.

Houses in the Village of Sosoni

 

The "toilet" behind someone's house - a sandy and rocky patch with walls for privacy for "short calls" (urination)

While walking through down the road, three people sitting in the shade called our "Welcome!", so went over.  They offered me a seat, and we chatted for a few minutes.  Their English was very good, and they asked if I came from America and where in America.  I told them "Washington" and they said, "Oh, Washington, D.C.!" (as everyone does). I explained about Washington state.  Then they asked about Obama and how he's doing in the election (as everyone does).  I said it was hard to predict.  The woman said everyone in Kenya is praying for Obama.  We talked about the Kenyan presidential election in March.  They thanked me for coming to their village; Sosoni is remote and does not have easy access to medical care.  I love the Kenyan people.  Everyone is friendly and welcoming; it is hard to imagine a more gracious people!

 

My New Kenyan Friends - Kitsao, Julius and Mapenzi

The ride back was almost our last van ride!  We have two more tomorrow to go to the HIV/AIDS support group.  I can't say I'll miss that daily experience any, although I do enjoy watching the countryside from the windows.  If only we could stop and take pictures!  Taking photos from the moving van is not good, but not entirely without success.

Baobob tree, as seen en route



Sosoni Clinic, Day 1

September 20, 2012

All of our travels to clinics is done by van.  I don't think the van has had working shock absorbers or struts in ten years, so travelling on the dirt roads that connect the villages is a long, rough ride:

The van

 The road to Sosoni today had a few ruts.  I love the red dirt, though!

 

The road to Sosoni

 

African Time really hit us hard this morning for the Sosoni Clinic.  African Time is like "island time" in Hawaii; everything runs late and everyone is waiting.  The van arrived, but then we were delayed while Marlene tried to straighten out a problem with email from the Malindi Rotary Club about a well drilling project in the villages.  We finally got on the road and stopped at Musifini to pick up the Kenyan volunteers.  We sat there for a long time, and eventually learned that the van needed oil which was taking a long time for some reason.  We'd been told that the drive to Sosoni was about 15 minutes from Musifini, but we didn't arrive until about 40 minutes after leaving Musifini.  Then we waited while the arrangements were completed for which classrooms at the Sosoni Primary School we would use.  No one seemed to know what we were waiting for much of the time. 

While waiting we took advantage of prime photo opportunities:

Phil and Diane at Sosoni Primary School

American volunteers with Jackson, Helen, and a bunch of Kenyan children at Sosoni

We eventually got set up and got the classes started. 

I hadn't planned to take photos today since I have taken so many on other days, but I loaded up my telephoto lens. That allowed me to get "stealth" close-ups, because I was so far away from people, they didn't realize I was taking their picture.  I have not been able to use my 24-105mm lens (my primary and favorite lens) because something has gone wrong in the electronics, and the camera gives me an error most of the time when I try to use it.  Major bummer!  So my choices are wide angle (17-40) or telephoto (70-300).  I've been using the wide angle since I am usually close to the people I am shooting, but today I played with the telephoto.  I got some good portraits, like these:

 

 

 

 

It's very common for people to not smile when you take their picture. If you show them the first picture, though, they break into a smile for the second one:

No smile for the first photo

 

Smile after seeing the first photo

Diane had an interesting experience in the clinic today.  After getting medicine for one woman, she looked down and started talking.  She got up and walked away.  Jackson explained that she was a devout Christian, and she had just said a prayer as a thank you for the service rendered to her.  Diane sent Jackson to find her and give her a picture of Christ holding an African child.

 

The devout woman who said a prayer as thank you

Kadzifitseni Clinic

September 17-18, 2012

The last two days we have been holding clinic in the village of Kadzifitseni  (pronounced cod-zif-fits-enny) which translates to "go and hide" in English. The village is immediately next to the village of Pumwani (pronounced poom-wah-nee), which translates to "relax".  I'm guessing that people on the run would come to Kadzifitseni to hide and when they successfully escaped their pursuers, they stayed and hung out in Pumwani to relax.

Kadzifitseni Primary School

Our start at Kadzifitseni continued a string of forgetfulness that is plaguing us.  For three days in a row, we have travelled somewhere and forgotten something important at the hotel. On orphan day, a suitcase full of gifts was left under a bed, which took 45 minutes round trip to retrieve. On Sunday, Earline and Amy forgot to take a bag of medical supplies to visit Kitsao, a paraplegic orphan Earline sponsors, which took 90 minutes round trip to retrieve.  At Kadzifitseni we forgot a bin with medicines and supplies, which took a two hour round trip to retrieve.  Our dementia is costing us a lot of time.

Fortunately, we had two hours before the clinic started, as we set up and then taught the health kit classes and an AIDS class. We split into four groups again, with Cindy, Anya, Amy, and Earline teaching a class while I played photographer. It is interesting to see the difference from one village to the next.  While people at Karimboni were very attentive and engaged in the instruction, the Kadzifitseni crowd was pretty stoic and seemingly unimpressed.  Even when we took photos and tried to get them to smile, most just stared at the camera.  But their eagerness to get the health kit bags shows that they appreciate having them!

 

 Earline teaching a Health Kit class
 

 

Women who received their Health Kit bags

The medical complaints also are quite different here versus Karimboni.  Karimboni seemed to be dominated by eliphantitis and swollen testicles.  Although we are only a few kilometers from Karimboni, we had only a few reports of the parasitic swelling so common in Karimboni.  On day 1 at Kadzifitseni, the theme of the day was chest pains and "pains around the waist".  Day 2 was dominated by toothaches.  Diane reported that in several cases she had, there was a really rotten tooth that needed to be pulled.  On day 1, many people were anemic and needed iron.  Diane prepared a few iron doses for day 2, and then had no anemia at all. 

Some of the villagers don't have a good sense of what is relevant to their complaint.  The first woman I spoke to on day 2 told us that she fell down while carrying firewood on her head, and it landed on top of her.  Now she has chest pains…10 years after falling down.  The next lady said she fell out of a tree and was stuck in the chest by a large branch.  Now she has chest pains…17 years after falling out of the tree.

Some people have very serious problems, though.  We had several people with jiggers -- sand fleas that burrow into the foot, lay eggs, and then burrow out when they reach the larval stage.  This is a serious problem in many parts of Africa.  Earline and Anya worked for over an hour to get out the worms and then dress the wounds.

 

A girl with many jigger wounds

 

Earline applying gentin violet, an antiseptic

 

Lots of people wanted to be seen, more than we could possibly see, of course.  This trip we have a better story to tell when we have to stop seeing people.  The medicines that the Imani Project has purchased are left with the community health workers, so the villagers will still be seen and get their medicine.

 

People waiting to be seen at the clinic

 

Kenyans do not use family names in the same way that westerners do.  The second name is a tribal name, and so can be many different names.  It is common for children in the same family to have different tribal names.  That would make doing family history work a challenge! Henry has been telling me the translation of the people's names as they come through.  Amani is a common name; it means "amen".  We had two named Furaha, which means "happiness".  Baraka means "blessings" and Zawadi means "gift".  Some other names are a little stranger, such as Changawa, which means "At least".  Kaingu means "a small cloud".  And then there are names that make you wonder why parents choose them.  Baya is a common name, but it means "bad".  One woman was named "Mashaka", which means "problems".  One girl had a last name of Mzungu which is the word for "white person".  "White Person" would be a tough name for an African to have in middle school.

At each village, the Imani Project gives out corn flour to the children, but we have never seen this happen because we are always busy with the clinics in the afternoon.  This time, Francis sent someone to fetch me so I could take pictures.  When I arrived, a large group of children were sitting under a tree, and Francis had them say thank you to the Imani Project in unison (Asante, asante, asante, asante sana!" which is "thank you, thank you, thank you, thank you very much!")  I got a video of them and photos.

 

Children with their corn flour

 

Children with their corn flour 

 

Anya and Earline work on wounds and burns

 

A stooped old man at the clinic

 

The American volunteers after the clinic

 

 

 

Karimboni Clinic, Day 2

September 13, 2012

Today was the second and final clinic day at Karimboni. This makes the fourth village total that I have been at for medical clinics (three in 2010), and each village has been fairly distinct in the trend of complaints.  At Kaembeni, we saw many coughs and body aches.  In Na'andu, we had many people who complained of fainting due to lack of water and lots of ringworm.  At Karimboni, a common complaint from the men is swollen testicles and lumps under the skin around the waist and groin.  Dr. Amy's theory is that this is due to parasites carried by mosquitoes that call elephantiasis.  Karimboni is on the Galena River, so this must be a localized problem. Once the swelling gets established, it requires surgery to correct, and we don't have the medicine to kill the parasite, so there isn't much we can do for these men.

Yesterday we had two old women carried to the clinic by a group of other women.  Four or five women carried another women in a large blanket and set her down on the ground.  We had a lot of elderly men and women at this clinic, especially on the first day.   

 

 

Old woman carried in to see the doctor

As always, Diane likes to hand out candy and little toys to the children.  We have a lot of little "helicopter" toys that you spin with your hands and it flies.  Today was windy, so two of them ended up on the roof of the building.  One man put a boy on his shoulders who used a big stick to drag the toy within reach.  When you have no toys other than a big stick, it's worth the extra effort to salvage a 10 cent Oriental Trading goody.

 

Retrieving a toy helicopter that flew on the roof

 We were planning to only do clinic time and not teach today, however after discovering that there were hundreds of people who we would not be able to see in the clinic, we decided in the afternoon to do another Health Kit class.  Since everyone was busy in the clinic, I taught this class with Henry translating.  I had been a little nervous since my knowledge of the medical details doesn't go very deep, but we are mostly teaching basic concepts so it was pretty fun.  The people were very engaged in what we were saying, especially with diarrhea issues.

 

Phil teaching a health class

Amy examines a child

 

Cindy examines a man

Some of Diane's patients:

Karimboni Clinic, Day 1

September 12, 2012

Waking up in Kenya is an amazing experience.  It starts to get light around 5, and the sun rises at about 6 (and sets at the other 6).  As soon as the sunlight begins, the birds burst into song.  The birdsong is varied and continuous for the next few hours.  This would certainly get me out of bed if it wasn't for the eye mask and ear plugs that let me continue sleeping until about 7.  One of these days, I need to get up earlier, I promise.  Bird photos aren't going to take themselves, you know.

This morning was our first clinic day at the village of Karimboni. Karimboni is one of a series of villages spread out over a 10km area, with 540 households.  The local officials said that with an average of 10 people per household, that would make at least 5000 people. Karimboni is much further away than the villages we visited in 2010; it takes over an hour to drive there by bone-jarring, rattling van, speeding down the dirt roads that connect the villages.

 

The van that jars our bones

 

Since we had only an hour yesterday to set out the medical supplies for the clinics, it was a bit of a frenzy this morning to get everything ready.  We got a late start, however, and arrived at Karimboni an hour late by American time, which is right on time (if not a little early) by African time.  Once we arrived, it took a bit more time to get things set up for the clinic. We didn't begin until about 90 minutes later than scheduled.  First days are always like that.

The dispensary building at Karimboni where we held clinic

The first part of the day was reserved for classes.  We had planned for six classes of 25-40 women to teach about TB, diarrhea, and the health kits, while Marlene taught a class for men on AIDS.  These classes would be taught by Earline, Amy, Anya, Cindy, Diane, and me, with a Kenyan volunteer translator teach.  Not as many people were there for the morning, however, so Diane continued to set up medications and clinic supplies, and I took my video camera, camera, and extra lens in hand (and pocket) and recorded the teaching and distribution of the health kits.  Knowledge is power, and many people were empowered to live healthier lives today.

 

Cindy teaches a health class

 

Anya teaches a health class

 

 

Marlene and Jonathan teach the men's AIDS class 

 

The clinic began about noon.  Marlene and I conducted triage, where we interviewed the patients to record their complaint, a limited history, and their blood pressure and temperature.  The patients then queued to be able to see Amy, Diane, or Cindy who evaluated their conditions and decided whether we had medications that would help them and gave advice on how to care for their medical needs.  Meanwhile, Earline worked to clean and dress wounds.  Everyone who was seen had a triage form filled out.  I would like to tell you how many patients were seen today, but some of the triage forms went missing.  First days are like that.

 

 



Earline treats a wound with the help of Jane

  

Diane treats a woman with Jackson translating

 

 

I learned something about myself today: apparently I am quite frightening to children.  The people in Karimboni were  more willing to have their pictures taken than other villages I've been in.  Even adult women shyly approved me to take their picture.  Children are as eager as always, and they love to see their own pictures after.  One little boy, about a year old, was toddling around at the edge of Marlene's AIDS class.  I crouched down and raised my camera, thinking that he would have no idea of the camera.  Surprise! He immediately let out a blood curdling scream.  Later, I was showing children their pictures, and some other child saw the back of the camera and started screaming.  Am I that scary?
 

Kenyan children love to see their own photos

 

That's not a smile; just after this the screaming began

 

At the end of the day, we are back in Sabaki.  Our dinner was served with a surprise: 

 

Tonight Elvina served us in almost royal finery:

 

We ended the evening by sorting through a few more health kits for quality control and listening to some music courtesy of my iPod and the "Boombox" magic system that turns a plastic storage bin into a speaker.  Brilliant!  I am finishing writing this while sitting outside, enjoying a pleasant breeze, a star filled sky, and the occasional mosquito trying to bite at my legs.  Having exercised my malaria medicine, it is now time to go to bed. 

 

The "Boombox" attaches with a sticky pad and the vibrations turn anything into a speaker!

 

Other people we treated at Karimboni: