The Report Card Is In

Nope, not for me. When I was tromping through the bush on a praticularly muddy day last June, I met a young man named David. He was newly orphaned and part of the orphan program. We were doing home visits.

What we found at this home was a 16-year-old tending his own farm, going to school, and caring for his preteen sister. His English was better than mine. His corn was growing better than all the neighbors'. When he invited us into his two-room mud home, it was spotless. He explained that it was a school holiday and that was the only reason we had found him at home.

We were offered the one chair that he had at the little table that took up almost every inch of space in the larger of the two rooms. He told us that his little sister slept at the home of a neighbor, but he was still responsible for feeding her. That meant that neither of them ate much of the time.

David did not know how he was going to survive in the future. Only primary school is free in Kenya. He is a high schooler who needs school fees, a uniform, and books, all out of his own pockets. His current school year had been paid for. After that there was no money coming in. He would have to quit, though he really did not want to.

I asked him what he wanted to be. A doctor, he told me.

As I hiked away from David's mud home after leaving him with a bag of powdered vitamin supplements to add to his porridge (when he had any) I thought to myself that if this kid wanted to be a doctor, then a doctor he should be.

He lives on his own, caring for and feeding his younger sister and farms to bring in their only food, all while going to school when most others would have given up long ago. He was obviously as smart as a whip, but beyond that he had that intangible something that great people are made of.

I had realized a ways into my East Africa trip that the needs there were great, and the best I could do with my meager funds was find one situation where I could make a large impact.

After I got home, I wrote the check to get David through the next year of high school. My sister did the same for David's sister, Rose. This means they have all of the books, school supplies, and school fees that they need, and no longer go barefoot.

My friend Davis who is living at the seminary until March is helping to organize all this. He went to David's school to find him the first time to tell him about the funding. Davis said that kid was so overwhelmed he was shaking and coudn't speak. It was during that visit Davis saw the deplorable conditions of David's school and yanked him out of there. Four kids to a desk, sixty to a classroom.

He now attends a much nicer school that is geared toward the sciences (perfect for someone wanting to go into medicine) that even has a chemistry lab and keeps very close tabs on the progress of the students. They moved David back down a grade level because they felt there were a lot of holes in his knowledge base from the sub-par schools he had been attending to that point despite being such a good student.

The report card for his first semester in the new school arrived in the mail two days ago. He is ready to move up to the next grade level after Christmas! He got very good grades in all his science classes, a C in English (the kid is probably bored to death - I told you his English is better than mine) and his best grade of all was in agriculture. Little wonder - the kid runs his own subsistence farm!

I have to admit, receiving somone else's report card was a little strange for me. It felt pretty darn adult to be looking over someone else's grades to give them my stamp of approval.

Enclosed with David's grades was a letter from his little sister Rose to my sister and her family who are paying for her schooling. She mostly thanked them for the money and detailed what it had been spent on. But there was one line in particular that to me said it all.

"Thank you for helping me to be proud of myself."

Their mother died in 2005. I find myself thinking about her often, that hopefully she has some peace, wherever she is, that her children are being looked after.

Leaving on a jet plane...

When leaving Kenya, I first took a bus all the way back to Nairobi. It was only seven hours and the road was mostly paved, so it was pretty much a cake walk.

I stayed overnight in Nairobi with the family of a good friend at school (my brother from another mother as he likes to say) that somehow managed to spoil me rotten in the less than 24 hours I was there. His brother took me to dinner with a bunch of his friends who were all grad students at Columbia doing their summer internships in Kenya, Uganda, and Somalia.

Nothing like an evening around some of the brightest people from your country to make you feel like an idiot and an underachiever. No, I didn’t ride around with AK47s to spread the message of reproductive health to the contested region of Somalia or infiltrate Uganda’s most infamous refugee camp. I hung out at a hospital and sold paperbacks on a street corner.

The bus back across the border into Tanzania was once again less than a good time. At least I'd become savy enough to actually acknowledge the guy hitting on me at the bus station at 5:30 in the morning just enough for him to happily volunteer to figure out which of the nine million buses I was supposed to be boarding (in the dark, among a couple hundred people crowded onto one sidewalk with all their luggage) and get my now impossibly heavy bag laden with gifts for home loaded into the undercarriage.

I was better armed with an attitude not to mess with when arriving at the border crossing the second time around. There was a tiny little Japanese girl on my bus who was completely discombobulated and still sleeping off her jet lag. I saw a staff member from our bus leading her OFF OF THE MAIN STREET and followed many paces behind to save her if necessary. He led her to a cell phone shop and told her that the bus company needed her passport number recorded there.

At a cell phone shop? I don’t think so! As soon as she handed over her pass port (they actually had a ledger to enter in people’s passport numbers to make it look professional) they told her she needed to pay them 500 shillings. Um, and what would that be for? Minutes on her phone?

I stepped in, started yelling like I knew what I was talking about, and ripped the passport out of the guy’s hand. The four men started yelling at me about the bus company needing the info and how we weren’t going to be allowed across the border now (yeah, because that’s why the 50 other people on our bus kept on walking straight down the main road to the visa office where they paused for 30 seconds before being sent across the border).

I grabbed my tiny friend by the arm and dragged her and her passport away before they really got angry. After three months, I felt like I’d gotten pretty smart at these games! Everybody is running a racket on the side. I’m sure these guys gave the man from our bus a nice cut for every mzungu he lured to his shop and tricked into giving them a pile of money.

After sprinting off of my last African bus with glee, I took a 40 minute taxi ride to the Arusha airport and enjoyed a gorgeous view of the base of Mt Kilimanjaro the whole way. It was overcast. Again. Well, at least I’ve seen the base twice and can tell that the sucker is huge judging by the width!

After an excruciating eight hours at the Arusha airport waiting for my flight (looking at the clock at least twice a minute for several hours), I was finally able to board my plane for Amsterdam.

And then we sat at the gate. And then we sat some more. Finally an announcement from the cabin: there was not enough jet fuel in the entire country of Tanzania to get us all the way to Amsterdam, so we’d be spending an hour and a half on the tarmac in Cairo to get the necessary fuel.

Now we still had to stop in Dar es Salaam before we left Tanzania, so there literally was not enough fuel in the entire country to get us all the way to Amsterdam. I thought it a fitting end to my trip. No electricity, no food, no medication, and nothing on time. Why on earth would I assume that the country would be able to make planes work?

After sweltering in Cairo at three in the morning (the lights looked really pretty from the sky - I actually want to go there now) and a sprint (literally) through the Amsterdam airport (I had been told back in Arusha that I would miss my connection to MSP by minutes and decided to test that theory), I was on my way home. I was soooo antsy on the flight, and I am never like that. I have never been so ready to be home.

After an uneventful trip through customs, my dad was standing there waiting for me right where he promised he’d be.

I was a little sad that it was an icky, rainy day because I thought that they sky should burst into sunlight with the Hallelujah Chorus being sung in the background. I insisted that I be taken straight to El Loro for a cheese quesadilla on the way home. If other people had a problem with the fact that I had been wearing the same underwear for three days, that was their problem. My food dreams were coming to and end right then and there.

And honestly, I slipped right back into regular life like I’d never left. I had no return adjustment issues whatsoever. Many people when returning from developing countries have trouble with American excess. Well I’ve always had trouble with American excess. I think now I actually feel better about what little role I play in it. When I got home, all I wanted was some eyeliner and a cheese quesadilla and had both without any guilt. I work hard for what I have and I don’t live extravagantly or spend wastefully.

And things there aren’t all bad. Even though people live with less, many of them are happy and successful in their own right. The culture is rich, their faith is strong, and darnit, they know how to throw one good party.

Kenyans don’t need a different shirt for every day of the week or indoor plumbing to feel that they have made it. If they can educate themselves and their children and afford a reasonable amount of medical care when necessary, they are satisfied. They have something intangible that Americans have trouble capturing and encorporating into their own lives.

Though there are many (too many) I came across who come nowhere near that level of self-sufficiency, my image of Africa has been changed from one of abject poverty to one of life. There is plenty of death and struggle to go along with it, but people there live at a level that we Americans, with all of our stuff, will never be able to achieve.

The Medical Scene

Here is a semi-comprehensive list of the crazy, fascinating medical situations I saw/watched during my days at the Maseno hospital (most of which are never encountered by real doctors throughout their careers in the developed world - woot for being well-versed in tropical medicine!):

1. A three-year old the size of a baby, pooping worms. They were upwards of 6-8 inches long and white!

2. The induction of a woman well over nine months pregnant with her eighth child by sticking a catheter up her into her uterus and tying the other end of it to her thigh to keep it taut to force her muscles to dilate.

3. A little boy (named Washington - I blew up a balloon for him and took him for a walk around the hospital yard to celebrate my 4th of July in patriotic style) with an abscess that took over his entire foot and oozed puss in amounts I before hand didn’t think possible. The Kenyan doctor shoved gauze pretty much inside his foot as his form of “bandaging.”

4. A lady with shingles all across her abdomen - she looked like she was going to pass out from the pain every time she moved. She also had HIV/AIDS, just like pretty much every other woman there.

5. A guy with tetanus. We had to keep him in a dark corner room with the door shut at all times because light and stimulation made him go CRAZY. We couldn’t have him thrashing around and freaking out with all the swelling going on around his brain.

6. A woman and her 15-year-old son, Jennifer and Daniel, with jiggers on their feet so bad they couldn’t walk.

Both mother and son were developmentally disabled, something common within our orphan program (which also dealt with single-parent homes unable to keep the kids fed). Women with disabilities are used for sex and often have children they cannot care for, many times with disabilities themselves.

Daniel's toes rotting off.

Both of them were rail thin, and Jennifer particularly was severely malnourished and was in the hospital as much for that as for her jiggers. Once we stopped the jiggers from spreading (that does not equal healed) and Jennifer had gained enough strength, they got to go home. Daniel ran to the jeep he was so happy to be getting out of that place where everyone poked his feet all the time.

7. A young man with rheumatic heart disease caused by a rheumatic fever. This was my very first day going on rounds, and I was shocked when the med students let me go right on up to him and listen to his chest like I actually belonged there (a feeling I started to get used to as I did indeed have an all-access pass to the hospital). He had two different murmurs going at the same time in different valves. It would take valve replacements for him to live - something that doesn’t happen in rural Kenya and probably not in Nairobi unless you’ve got the big bucks. He was sent home to die.

8. Rampant TB. Oh man, if I test negative the next time I have to get a TB test, I will be beyond shocked.

All it takes to have TB in your system is to breathe in one single TB spore. Where I was, especially in the women’s ward, everybody was coughing and hacking all the time and about 95% of them had TB. It is something that goes along with and is made much worse by AIDS. Just because I will probably be testing positive for TB from now on doesn’t mean it’s active. The odds are actually slim that it would be active, but for me not to have it in my system would be a shocker.

9. A chest X-ray that was so bad it made every doctor, including the Kenyans, give a great big stunned “Holy Shit” every time they held it up to a window to check it out.

Normal chest X-rays are supposed to be a healthy black. This one was almost completely white with little flecks of black in it. White = TB, and this lady was told immediately that she had HIV before they even had a chance to test her. TB that bad has to have something else helping it along.

10. Thrush. A lot of it. It’s a yeast infection of the mouth and any person (they were always women) who came in with it was automatically given and HIV test (which was always positive). Thrush is another condition that goes hand in hand with HIV/AIDS.

11. A hemorrhagic fever (similar to Ebola). This two-year-old little girl, Rose, came in practically dead. She had a raging fever and was pretty much non-responsive at that point. She hadn’t eaten in a long time and I doubt her mother was able to get much water past her lips.

They knew it had to be a hemorrhagic fever because they took a blood draw from her back and it never clotted. The tiny spot where the needle went through her skin bled for days. Dr. Hardison and the Kenyan doctors poured over old volumes on tropical fevers but she died before they ever got close to figuring out what was wrong. One of the Kenyans really thought it was black fever but Hardison said it absolutely wansn’t. Like so many others, we’ll never know.

12. Three different kinds of meningitis. I think there are only four, so that’s almost a complete set.

On my last day there, I saw the woman who was the worst off of them all. One of the most obvious signs of meningitis is a stiff neck. This lady was writhing in her bed, making sounds I have only otherwise heard come out of animals, with her jaw clenched, head jutting forward, and neck so stiff I had no idea how she could breathe.

Any time you tried to move any piece of her body, she sounded like a wounded animal. All she could do was grunt. I couldn’t imagine the pain. Dr. Hardison stuck a tongue depressor between her teeth to try and pry her jaw open so he could take a look at her throat and mouth. The poor woman snapped the frigging tongue depressor in half with her teeth. Those things are wood. We tortured her only long enough to dig the bigger shards of wood out of her mouth so she wouldn’t swallow them and slice her throat open on the way down. If she lived it would be an absolute miracle.

13. And last but not least, a lady who was on death’s door, the most stereotypical emaciated image of AIDS I saw during my three months, and pregnant.

Her sister brought her in because she was almost dead and wanted to find out if there was anything else to do for her. Her eyes were completely sunken into her head and her face was all cheekbones and no flesh. I’m thin folks, and I looked downright husky next to this woman.

During her initial exam, Dr. Hardison was pressing on her belly as doctors always do and gave an astounded “there’s a baby in there!” It takes a lot for someone who works in that hospital to sound surprised (see #9). They knew she was at least 20 weeks because they could feel the baby up by her belly button when they pressed. After a sonogram on our portable kit, the head measurements showed the baby to be at 7 months gestation. 7 months.

Her belly was concave, she was so thin. They fact that there could be a baby inside of her that far along may be the single most incomprehensible thing I saw during those months. Considering the fact that she didn’t have the strength to chew food, I have no idea how she could have possibly mustered the strength required to give birth. I assume that both mother and child are gone now.

The common thread through most of these situations?

AIDS, AIDS, and more AIDS.

It was less prevalent among the men and (thank God) the children, but almost every single woman who came through our doors was infected. Women have a higher likelihood of being infected because they are a receptor during sex. That combined with a culture where women are seen as sexual objects with no rights over their own bodies and married men tend not to be faithful equals a disaster for those unfortunate enough to be born female.

The Kakamega Rainforest

The next morning we ate breakfast at the Vike (more toast!) and headed out for the rainforest. The lady at the front dest set us up with a cab driver to take us there. We thought he was completely ripping us off with the price he was charging, until we were a half hour down the dirt road (my head hadn't hit the ceiling that much since I'd been in Tanzania) with no end in sight.

When we finally got to the park headquarters, we were matched up with a guide named Humphrey who took us on a nice little walk through the woods.

This nice little walk turned out to be five hours long. We got to see a lot of really exotic butterflies and birds and many species of monkeys different from the same old, same old we saw every day around Maseno.

Now I am a true Minnesotan, and I spent a good chunk of my childhood wandering around the woods at my cabin. I love the woods more than just about anything, but oh my goodness Chris loved it more.

The kid is from LA and apparently he hasn't seen many trees before. Or birds. Or butterflies. I'll give him the monkeys, but I don't know how one person could take 45 pictures of every bird they saw for five hours just because they had a shiney blue spot on their wing or a speckled tail. Somebody please show the kid a blue jay or a cardinal so he knows that he doesn't need to go all the way to Africa in the future to see pretty birds.

Toward the end, Humphrey had us climb up one of the bigger hills (small mountain in my opinion) for a view of the rainforest canopy. I get hardcore elevation sickness, and seeing as we were at 4,000 feet and had been walking and sweating and sweating and walking for hours already, I parked myself next to the trail when we were almost to the top and told Humphrey I would enjoy the view from there.

Humphrey was a bit taken aback that I didn't want to go to the top and kept insisting it was so close (this from a man who did the whole hike in rubber boots that were way too big for him and with no water) until I firmly assured him that I didn't care what the top looked like. My view was plenty good from where I was at.


When my counterparts came back down, Humphrey led us into a cave in the side of the little mountain. It was man-made from a time when they used to mine something there. All we had was a little pen-light attached to somebody's keys, but I was really excited about the prospect of getting to explore a cave so we went for it.

The bottom of it was even and had a lot of standing water. We were somehow able to make it all the way in without falling and hurting ourselves. At the end, Humphrey flashed our tiny light upward and I saw rows upon rows of beedy little eyes staring back at me.

"ARE THOSE BATS????????"

"Yep."

"DO THEY BITE??????????"

"Yep."

I love all animals and wildlife. I can catch a snake with my bare hands with the best of them and trap spiders and let them outside rather than stepping on them. The bats were actually really cool to look at, with about a hundred of them all hanging upside down in neat rows right there in front of us, their eyes reflecting the light we were shining at them.

But the more we moved the light around, the more they started getting out of their little rows and flying around.

Now, all I could think was that I had not successfully survived nearly three months on my own in East Africa, including a Kenyan border crossing, only to get bitten by a bat with rabies right at the end. The moment Katie reached for her camera, I was outta there. I'd be angry if I was woken up by flashing lights in the middle of a good night's sleep. I didn't want to wait around to see how 100 bats would feel about it.

The going (without a light) was much harder than the coming. My shoes and pants were absolutely soaked by the time I made it out and my hands were covered with a slimey white substance from trying to guide myself along the cave wall. But rabies free I remained!

Our cabbie picked us up at our arranged time and took us back to Kakamega where we decided to be brave and take matatus home. Several flapping chickens and a police interogation later (I was terrified of the police and really got scared when this one came tapping on my window and started asking my name and other information) our series of matatus brought us back to Maseno and I took one good long shower.

A Journey to Kakamega

The one example of a man wearing pale pink trousers I was able to capture on film. This guy sold ground nuts and other goodies at the Kisumu bus station to people waiting for their buses to leave. Men round these parts seem to think it is their color.


Toward the end of our stay, my two med student friends and myself headed out for an overnight in Kakamega.

The city of Kakamega is a less than two hour bus ride away from Kisumu and is in close proximity to the Kakamega Rainforest.

The bus fare was only 100 shillings (about $1.50) and judging by Chris and Katie's Lonely Planet guides, there were quite a few guest houses (meaning hotels) within the city for good prices. Each of us had been wanting to explore a bit beyond our little area but were short on money since we were all close to going home, so this seemed like an excellent option.

We boarded a real live bus (rather than one of the cracked-out minivans) and suffered through a slow uphill chug to Kakamega with 30 people overloaded in and forced to stand in the aisle. Whenever we passed a police checkpoint, they would all crouch down to their knees, falling all over each other, so the police wouldn't notice how far over capacity we were and force people off. They had already paid their fare so the heck with dignity - they weren't getting tossed for anyone.

Someone tell Greyhound about the Kenyan rip off of their good name. The Kisumu bus station was a place I visited every Sunday to find a matatu back to Maseno after feeding the street boys. It was much less like my personal version of hell on earth than the Dar bus station.


When we got to Kakamega, we literally pulled out the map of the city in the Lonely Planet guide(those things really are worth the money) and started walking toward the guest houses. We got a little lost when going for the first one but did find the second one at the edge of town and decided to call the Vike (vee-kay) our home for the night.

The Vike was a mighty nice operation for this part of the country. It had (gasp!) multiple floors and showers in the rooms that didn't involve buckets. We had come fully prepared for the three of us to share a room in order to save money, but when we found out it was only 400 shillings per room (about five dollars) we got two. Both rooms connected to the balcony where we could take in this breath-taking view of Kakamega. It's fascinating to me that one of Kenya's largest regional cities with relative prosperity could have such a bombed-out Sarajevo look to it (minus the bombs). Despite the view, we were in the lap of luxury with our amazing find of a guest house.

We spent the evening in the restaurant downstairs eating large amounts of food while sitting on a leather couch and watching tv. It was the night of the World Cup finals, so we were particulary thrilled to have found a place where we'd be able to watch it.

After Chris and Katie ate huge chicken dinners and I relished in my toast and porridge, we parked ourselves on that couch for another three hours so as not to lose our spot for the game. The problem was that the couch was almost directly under the tv, so watching it was like staring straight up at the ceiling. Yet we persevered, and had someplace comfy to sit to take in the game when the time finally came.

The place was packed by the opening face off (Wait, do you call it that in soccer? I have to use every hockey term and concept in the book to be able to understand this sport!) and the mood was actually very tense. Since the three of us had been almost giddy after a decent meal and our version of a night out on the town, we shut up real quick because we didn't want to get jumped for cheering for the wrong team. Chris had been all gung-ho for Italy, but whispered his cheers and looked over his should after doing so to make sure he hadn't set off any locals.

It turned out to be a fun game, unfortunately including the head-butt heard round the world. Since watching the World Cup had been a big part of my African experience, this was the perfect way to take in the final in style.

Here is a view of some of the amenities of the Vike guest house. Take a good look at the shower head in relation to the toilet!

What I got to see every day in Maseno...

***All photos were taken during a ten-minute span during which I had the opportunity to take many, many more.

The Skinny Little Runner Boys Build a House

Toward the tail end of my stay in Kenya, a group came to stay at the seminary and do three weeks of volunteer work. They actually came through Youth Encounter, the organization my mother works for, so I knew that I would be there at the same time as them before I even left the U.S.

I have to tell you that I was a little bit apprehensive about this group for one good reason. They were an all male high school cross country team from Illinois.

We all remember those high school days, so I'm sure you can understand my concerns. Fortunately, my fears were completely unwarranted because they were a group of all around great kids.

Here is a glimpse of what we at the seminrary dubbed "The Skinny Little Runner Boys" did on their second full day in Maseno.

Pastor Tom, who was spending his sabbatical at the seminary, paid for a widow he encountered to have a new house built. I wish I had a picture of it, but her previous mud house was laying in a pile of chunks on the ground. Hard rains will do that to the best of well-built mud houses and Kenya has both a short and long rainy season.

The widow and her three children were very poorly off. They had no family and at that point were receiving no support from anyone else in the community.

Rural Kenyan houses are built out of sticks and mud. The sticks make up the frame, and then several layers of earth mixed with water to the right consistency are slathered on to make the walls. There are several layers done at different times so thay they can dry properly. The final layer is made up of cow dung. It's the protective layer so just think of it as siding. (and yes, you slap that on with your bare hands as well)

These skinny boys from Illinois worked their tails off all day to first haul water in buckets from a creek (up a rocky hill, mind you) to fill up three oil drums before they could even start with the house. Then they had to attack the woman's yard with hoes and pickaxes to dig up enough dirt to mix with the water.



Travis, the father of two of the boys, showed them alllll up by taking several buckets up the hill on his head, Kenyan woman style, after receiving a demonstration from one of the mamas.


This wasn't exactly the soft black soil we're used to in the Midwest. It took some muscle.


The best part was when we got to "mix" the mud. After the front yard was completely torn up into loose dirt, the water was poured over it and we all had to jump in and stomp our hearts out. When that announcement was made, the boys all stared at each other and then at the dirt with utter disdain. They could haul water in huge buckets until they couldn't feel their arms anymore, but they didn't want to get dirty.

Me on the other hand - I was a sand box kid. I liked digging for worms and part of the appeal of playing catcher was that I had an excuse to get really dirty.

I had my shoes off and went flying into the dirt heap before any of the Runner Boys had time to start nominating each other for duty. It went well past mid calf and was gloriously cold and slimey.

The boys were not about to stand on the sidelines after I went jumping in with gusto, and I soon had an entire cross country team stomping around with me. If anyone has ever seen the grape-stomping episode of I Love Lucy, it worked the same way, only much harder due to the thickness of our stomping medium. Before long my calves were absolutely burning and I was quite sure I'd had my cardio in for at least a week.

By the time the mixing was completed, the women's group from the local parish had shown up to help with the actual mudding. For the next several hours, armfull after armfull of mud was thrown on the inner and outer walls and smoothed over. There were a few dozen people working on this one little house and it was great fun to watch.

The bright blue is their women's group uniform.

It got mighty crowded on the inside with all the sets of hands that showed up to help - a good problem. The woman who the house was being built for had done the previous layers on her own, including hauling the upwards of 30 required buckets of water from the creek, a task that had the boys absolutely drained and in physical pain after their first trip up the hill.

The best part of this was that by showing up, the women's group was in a way adopting this woman and her family, telling her she had their support. For someone with three small children and only the maize she grows in her yard for food, community support is what will make or break her. She should be ok now that the parish is aware of her situation and has already made an effort to take her under their wings.


And for the record, these Skinny Little Runner Boys went for a five mile run promptly after finishing up this day of hard labor.

Drugs and Hallucinations

Before traveling to another country, many people choose to sit down with a travel doctor and figure out all of the different immunizations they will need and pills they should take with them so they don't end up dead from some tropical disease their body was previously unexposed to. OK, so maybe not dead, but it's still a good idea to cover the bases with a doctor.

When I went and did this, I found out that there are several different types of anti-malarials to take and I had a choice to make. Some you take only once a week, some are daily, some cause hallucinations, and others light sensitivity. Being that I am pretty much the whitest white person ever, I went with the newest drug out there, malarone, which was not supposed to make me get burned any faster (I was going to the equator after all and didn't want come home with an advanced case of skin cancer) and was not supposed to cause any hallucinations. It was more expensive and a daily pill so I had to get 90 of them (the pharmicist looked at me like I was insane when I brought in the prescription) but I decided to stay on the safe side.

The verdict on malarone:

Light sensitivity? Not a problem.
Not having a proper nights sleep for two months? Never again.

This wonder drug caused me to be awake for at least three hours (that was if I was lucky, it was often more like five) during the night, every single night from May 21st on (yep, I went back and counted). That means I stared at my mosquito net for hours on end for two months straight. When I got to Kenya I started taking it in the morning rather than right before bed as I had been, which helped in that I was awake for those hours contiguously rather than in bouts of an hour at a time from 10pm to 7am.

The worst part, however, was that the disclaimer about hallucinations was for me entirely false. For the last two weeks, I spent my nights in LaLa Land.

For some people on these anti-malarials, the hallucinations for them just mean really cracked-out dreams. Well my dreams have always been that way (and I always remember them), so that was nothing that concerned me. What was troublesome was the little old man with the stooped back who used to stand outside my window and taunt me (in really good English) while I was AWAKE for those three to five hours a night. My elderly friend had a really cool walking stick and a hobo's bag, with his look being rounded out by a long stringy beard reaching halfway down to his belly button.

At least I had the presence of mind to realize that my friend wasn't real, but at two in the morning when it is pitch black (the neighbors who had electricity weren't going to waste it by keeping lights on at night), it is unsettling at best to have someone who is very real, but isn't, but is, but isn't (but is???) talking to you and knowing things about you strangers shouldn't. I have taken care of people with schizophrenia while working in Anchorage, and believe me, I have a newfound appreciation for their false realities. It is so real.

This combined with the strange electronically produced music, the light show I watched on my wall one night (like being inside a kaleidescope) and listening to people from other dorms mess with our plumbing in the middle of the night and hearing every word of their non-existent conversations (we were locked in from the inside) leads me to tell you that I would personally not recommend malarone. At all.

On second thought, there was the night I spent writing the great American novel in my head...
It was shaping up to be a darn good book. Lots of deep insights and carousels. I guess I'll have to find another way to tap that particular brand of creative energy.

Food

Now for those of you who know me, I have never been a big eater. I went into my African experience with the mindset that I was just going to eat whatever was given me and make the best of it. I've had plenty of experience with that (I was force-fed until high school when my parents finally admitted defeat) so I didn't expect it to be a big deal.

Why oh why, then, did I spend the last month and half literally DREAMING about food? The absolute worst dream took place in a kitchen where every single square inch of counter space was covered with cookies and bars, so fresh out of the oven they were all still on cookies sheets. I grabbed a plate and started stacking them by the handfulls. But every time I tried to get to the ones with butterscotch chips, still soft and warm on top of the stove, something or someone would distract me. I stacked every other kind of cookie higher and higher on my plate from all ends of the kitchen, but the ones with the butterscotch chips were always .... just ... out ... of ... reach ...

It's enough to make you wake up in a cold sweat.

And why was a person who has never really been that into food that desperate for a friggin' cookie? I ate starch, and only starch, for about three months.

I must qualify this by saying that I was never underfed or in any way deprived of food. In fact, I actually came home weighing more than when I left (which is actually the most I have ever weighed in my life). I think most people would consider it ironic to go to a continent so often conotated with starvation and come home heftier. But in actuality, my body was trying to hang on to everything that came into it and store it as reserves because it was so kerflummexed about what the heck I was feeding it that it didn't know when or if conditions would improve.

There is not a lot of variety in the East African diet. There is also no flavor. Please realize that I am Midwestern, so for me to say no flavor, I really mean no flavor.

In Maseno, I would walk into the dining hall promptly at seven each morning to find a loaf of unsliced bread sitting at the mzungu table. The first person there would slice 'er up and we would each choke down enough to last us to lunch. Homemade bread is actually my favorite food, but I have yet to have any in the over four months since I've been home, if that gives you an idea of how monotonous this is. We Americans are spoiled (spoiled!) by variety.

With our bread we had the option of some unprocessed peanut butter (like soup at the top of the jar and in chunks hard enough to knock someone out at the bottom), some jam sugary enough to make you go diabetic inside of an hour, or the ever popular Blue Band butter substitute which we affectionately referred to as Grease. That is how it looked (though they did manage to find a somewhat yellowish food coloring to put in it), tasted, and felt on the way down. Someone at some point bougt a bottle of honey in Kisumu that was promptly inhabited by ants, which we kept on the table for entertainment purposes.

Lunch would be rice and beans or rice and super dry Kenyan corn (maize) or a few whole fish, eyes and bones included. If it wasn't rice, it was plain boiled potato. I have always hated potatoes in this form and I swear to never eat them again as long as I live.

I don't eat meat so on the fish days I would pull out the communal bottle of hot sauce purchased in Kisumu for my plain rice or potatoes. For dinner we would at least usually get some type of vegetable similar to collards to put on the rice. It sorted of tasted like ... something.

I would feel an absolute emotional defeat when they brought out the bananas - cooked. Cooked bananas taste exactly like and have the same texture of plain potates. If we wanted fruit we could go buy it ourselves. If we wanted something sweet (besides the diabetic coma-inducing jam) we visited Ruth's shop across the street and bought some mandazi (fried bread like a non-sweet donut).

That being said, there are some things I miss. Ruth's mandazi, which I started purchasing in lieu of bread and grease for breakfast while they were still hot, were the only thing that got me through. It gave me enough fat to finally stop craving other foods for a few hours. Sometimes we had fried cabbage with our rice and I've actually ventured to make that a few times since I've been home (and people, I don't cook).

I miss the sweet little bananas I would buy on the street every day while sitting at my book stand. They were about the same length as an adult finger and wonderful. Toward the end of my stay, the avocados were ripe and we would buy a few and some tomates, bring them back and mash them up with our hot sauce and make some darn good guacamole. Bananas, avocados, papaya - the stuff we get here is just quite frankly inferior.

Despite all those small goodies, my body was literally starving (despite the weight gain) from the almost complete absence of fat in my diet. Since I don't eat meat and dairy there pretty much doesn't exist, I was really starting to feel the effects.

On the way home from the airport, despite the fact that I had been travelling for three days straight without a change of underwear or a shower, my dad brought me straight to El Loro where I had the best cheese quesadilla of my life.

A Birth

Now I am a person who has alwasy been horrified by the concept of child birth and everything that goes along with it (especially having four older sisters who have all had kids), but after a few days at the hospital and getting to be a part of all of the gross/interesting/extraordinary things going on there, it became my secret wish to be able to see how the Kenyan women deliver babies.

Ruth, a woman who works at the seminary and runsthe duka (shop) right across the street where I alwasy bought my mandazi was very pregnant with twins while I was there. She was having her babies by c-section, and her estimated due date was about a week after I arrived, so I expected that if anything, I would get to see Ruth's c-section. She and I became good friends while I was there, and we spent a lot of time talking about labor and delivery since my mother had herself had twins and also a baby who died not long after birth. Ruth had a four-year-old daughter (named Nancy after the American seminary director) and had lost a son during childbirth after her. The little boy had also been born by c-section, but he was overdue and there were complications that made it difficult to get him out and he died in the process.

Ruth was terrified of losing these two babies. She thought of them as God's way of replacing her lost blessing with two new ones, but as her due date approached and she was continually encouraged to schedule her c-section, she just couldn't do it. In her mind they were safe inside of her, and as strong and realistic as she was about all other aspects of life, she just couldn't bring herself to schedule the point where she lost her baby boy. While they were inside of her she felt like she had some control, but as soon as the procedure to get them out would begin it would be out of her hands. I almost suspect that she was preparing herself to lose them, and wanted to keep them with her in whatever way she could for as long as she could.

I went with Ruth to her doctor appointments and got to see the babies on the little portable sonogram kit the hospital had. They seemed to be good sized by measuring their heads. Instead of encouraging Ruth, I think it made her more nervous. The doctor insisted that she schedule a c-section when she was a week overdue, but under her calm exterior I could see the panic in her eyes and she wouldn't do it. Despite the fact that a big part of the reason her son had died was from being so overdue, she just couldn't do it. Her head told her one thing but her maternal fears were less rational.

So back home we would go, for her to have me tell her again and again how much my twin sisters weighed when they were born and how healthy they were, etc. etc. etc. I fibbed a lot during those conversations because my sisters did spend almost a month in the hospital and could have very easily not made it, and our Kenyan hospital was no where near up to par with the 1973 American hospital my sisters were born in. These facts would only have caused the poor woman more terror in her heart, so I didn't feel bad about my omissions.

Unfortunately for me, Ruth finally scheduled her c-section for the day I left Maseno (about a month after we first thought the babies should be arriving) and I wasn't able to be there with her. But fortunately for Ruth, the story has a happy ending. Victor and Tracy were born on July 18th, a perfectly healthy (though small) boy and girl to round out their family.

Ruth is not your typical Kenyan woman in that she has opinions and willingly and confidently expresses them (and has a husband, the dean of the seminary, who doesn't beat her for it). She told me that three kids is plenty for her. This is pretty much unheard of in a place where people never think about how many kids they will have. Preparation for the next one begins when they get pregnant, which makes trying to plan for a ball park figure a pretty abstract concept.

During my second to last week in Maseno, I did luck out when a woman went into labor during the daytime while I was selling books out on the street corner in front of the hospital, and things progressed quickly enough that everything was over and done by the time we needed to head back for dinner.

To gain a picture in your mind of the setting for this experience, reference this post where I describe the hospital.

I headed over to the maternity ward with my med student friends Chris and Katie when we heard there was a hot one. Neither of them had seen a birth before either and they were practically giddy. The lady who was about to give birth, Susan, was laying writhing on a hospital bed with another woman in a bed a few feet away, waiting for her turn. It was Susan's first birth, and she was quite obviously in a lot of pain. There is no pain medication at this hospital.

When there aren't even basic medications, the concept of an epidural is laughable. All child births are natural. As explained in a previous post, nurses have a tendency to beat the women in labor if they are taking too long to encourage them. It's brutal. There are no husbands to be seen anywhere near the hospital, much less in the delivery room, and if you have a female family member to accompany you, they get to wait outside the wide open windows to listen to you scream for however long it takes as Susan's sister did.

The nurses were smirking and rolling their eyes at Susan because she was making so much noise over her contractions. Obviously it was her first child and not her fifth or sixth. They pretty much ignored her while she was writhing on the bed. Chris rubbed her back and talked her through the contractions. I think that was fairly revolutionary. As Susan struggled and cried, the Kenyan doctor arrived and we turned our attention to the lady in the next bed.

This woman was there to be induced with her eighth child. She was overdue with no signs of labor. To induce her, we and all of the many Kenyan nursing students there gathered round to watch the doctor stick a cathater on up in there (the blood was pouring) and then use a funnel to fill the balloon on the inside of her uterus with water so it would stay put. He then took the other end of the cathater and tied it to her thigh. When he was done with that, he stretched out her leg until it was flat on the bed and remarked that all we had to do now was wait a few hours.

Pardon me while I pull my jaw off the floor.

My two oldest sisters have been induced with all four of their kids and I am darn positive that this is not how it works here. Inducing labor in modern medical settings involves giving drugs to bring on contractions, not inserting a cathater into someones uterus and then using the weight of their own leg to stretch it out so they dialate. Necessity breeds creativity. It was horrible and really, really cool to watch all at the same time.

Of course while the doctor was performing this "procedure" not one of the Kenyan staff ever acknowledged the presence of the woman whose vaginal area they were messing with, and the doctor proceeded to tell Med Student Katie that she was a bad woman because she had been married three years and hadn't produced any children. It is her role in life after all. I asked him how many kids he had and he said one with his wife, and (shrug of the shoulders)maybe some others. This is one of the stories I now use to describe African male machismo. Women are there to spread their legs and be "productive" and the men are just there to enjoy it.

The doctor disappeared and we turned our attention back to Susan, who was making more and more noise by the minute. She started shouting "nimetoka, NIMETOKA" over and over again. This made me giggle because I actually understood what she was saying. In Swahili, to say that you are American you say "nimetoka Marekani" or that you come out of America. In this situation, Susan was simply screaming "come out, COME OUT!"

After all the nimetokas, she actually started screaming my name. Now you might find this strange since I am not the baby's daddy, nor had I ever met Susan before, but kali in Swahili means fierce or severe and is used to describe pain.

Pretty, I know.

Chris kept cracking up and giving me looks across the room every time she shouted it as he was vigorously rubbing her back.

Not long after, I pointed out that some stuff was starting to ooze out from between her legs. Chris and Katie and I stayed put, with hearts pounding and eyes as big as saucers. All of a sudden, the big scream came and the nurses ran into the room. I guess we in our inexperience thought that all the screams were important, but they knew what they were listening for.

All at once the top of a head was poking out. The nurses flew into action, grabbing the little tool table with the scissor and all the other instruments on it and throwing an apron on the first year nursing student who performed the delivery. No need to call a doctor. It happened so quickly you could tell that even the seasoned veterans in the room were surprised. The baby was already coming out before they had the nursing student in charge geared up.

I stepped aside to get as out of the way as possible and with one big push the baby was halfway out. Susan, in the heat of the pain, reached her hand down and tried to start shoving the baby back in. This was the only time the many nurses actually seemed startled or all that engaged in anything they were doing. The grabbed her arms and held them down until the baby was safely out about a second later.

The baby girl was a tiny thing and all gray and slimey. They wiped her off and wrapped her up and weighed her before putting her in a basinette in the corner and completely ignoring her. The basinette was behind Susan's head so it was not in her line of vision and they never once bothered to show her the baby. I had been fine during the birth, but this is when I became sooooo uncomfortable. The woman just gave birth for heaven's sake and you're not even going to hold up the baby in front of her so she can see it for a second or two?! It just felt so wrong.

All the focus was brought back to Susan as they stuffed big guaze pads up between her legs to stop the bleeding after the placenta came. Most of the nurses headed off into another corner to watch it be disected, which I admit I also watched with interest. The others called in Susan's sister who brought a bag with a change of clothes for Susan and two brand new, beautiful khangas to wrap the baby in. As soon as the bleeding had slowed, they had Susan sitting up and were changing her out of the hospital gown into her street clothes. About 20 minutes after giving birth.

When she sat up, Susan turned her attention to us and gave us tired but friendly smiles as she asked how she did and apologized for yelling so much. 20 minutes after giving birth. This is when Chris finally asked if she wanted to see her baby. She seemed to be pleasantly surprised that we offered and wheeled the basinette over to her. That also made me very, very uncomfortable. This was an educated woman who worked at Maseno University, and she didn't even feel that she had the right to ask to see her own newborn infant, despite the fact that the baby was about two feet away from her in that cramped room, just behind her so she couldn't see it.

She grinned from ear to ear when she first saw her little girl and she and her sister admired her but immediately started saying that she was much too small. The baby was 2.4kgs, and 2.5 is the bottom level for a healthy birth weight. This meant that the little girl would have to stay tightly wrapped in her basinette for warmth until she gained the extra tenth of a kg.

At about 30 minutes after giving birth, Susan was forced to stand and move herself into a wheel chair so she could be brought to the wing where the new mothers recuperate. Blood dripped from between her legs onto the floor as soon as she stood. No big deal, getting her out of there so their job could be done was the only important thing.

And what was the other pregnant lady who was working on dialating in the same room doing all this time? Turning her head as much as she could without having to shift the rest of her body and mess with leg/uterus contraption, watching the whole dang thing and taking in every scream. Poor woman had to sit and watch what she was going to have to go through in a matter of hours. I know she had been through it seven times before, but that still can't be pleasant to watch under the circumstances. That woman never made a single sound while she was being dialated or during Susan's labor, and she kept a very blank and untouchable facial expression, but I (and only I since no one else paid the least bit of attention to her) saw the look in her eyes as she watched the woman in the bed next to her struggle. If she could have, she would have run.

I was honored to take these two pictures, the very first pictures of this child's life, about 40 minutes after she was born. At this point the mother had already been wiped down, uncomfortably shoved into her dress, and forced to stand and walk a few steps between her beds and the wheel chair. And as soon as the initial shock of labor wore off, Susan was chatting and entertaining everyone else like it was any other day. It blew my mind.

I asked her what her baby's name was at the point when I offered to take the pictures, and Susan just looked at me like I was crazy. Who would know a thing like that already? I guess Kenyan women don't spend nine months pooring over baby name books in anxious expectation.

It wasn't until after I got home and was able to e-mail Susan's sister these pictures (which they were thrilled to receive) that I found out her name.

Meet Eleanor Chebet.

The Street Boys

Some of the most disturbing/heartbreaking scenes I ever witnessed during my time in Africa came on Sundays when I would grab a matatu (one of the cracked out mini-vans referenced in the Nairobi post) with Davis and whoever else was up for it that day to go feed the street boys in Kisumu. Davis, who is in Maseno for a year-long commitment developed this program to feed the street boys on his own and pays for the food out of his own pocket. He was overwhelemed by the needs of these children, living on the margins of society as beggars and thieves at an age when they should still have mothers tucking them into their beds at night.

Click on the following link to read my Bits and Pieces post where I spent some time explaining my first week visiting the street boys and more about what has become of the older street boys.

http://kali-thelife.blogspot.com/2006/06/bits-and-pieces.html

The street boys of Kisumu, which is the largest city in Western Kenya, come from villages in the area when their parents die or they are kicked out of their homes to fend for themselves after being considered nothing more than another mouth to feed.

Most of them sleep on the beach of Lake Victoria. They develop family groups (sort of along the lines of street gangs) as a means of family and protection. They form alliances to protect themselves and each other and to try to somehow stay fed. A little boy out there on his own isn't going to last long if he doesn't have someone else watching his back. The younger boys seem to end up being connected with older ones who provide some form of fathering and protection while they teach the little ones the ways of the street.

The youngest are about five.

As I am writing this, it is the first and only time I have cried about anything I saw and experienced over there. I have nephews this age. They are complete mama's boys. They like learning about animals and trains. They still cry when they get scared or scrape a knee. They have never once had to consider what it means to be all alone in the world, what it means to survive on their own, because they will never have to.

And these precious little boys I saw every Sunday, sniffing glue to escape the reality of their god-awful lives, will never know what it means to be taken care of. This is what it means to have no childhood.

Davis started out with only having a few kids show up, but as he proved his consistency by showing up every Sunday, rain or shine, the group continued to grow. On my first Sunday there we had about 25 kids. On my last Sunday, five weeks later, there were about 50.

After getting off the matatu in downtown Kisumu, we would head in the direction of the beach. The boys would be scattered along the sides of the road waiting for us and would gather around in a big whooping crowd to join us for the rest of the walk down to the beach. On my first Sunday, I could tell from a ways off that most of them were high. I don't even know how to explain how I knew from 30 paces, but they just very obviously were. Their swagger and bravado were not typical of young boys, even those hardened by the streets. I would quickly have four or five trying to hold my hand or hang on to my arm or some part of my body to "escort" me down to the beach each week, in the way that people stumble home from Joe's at about 2am, holding on to whoever is near them, just for the heck of it.

Once down at the beach, complete chaos would erupt. We would always have a Kenyan friend with us to shout orders in Swahili, and several of the now-adult street boys would be waiting at the beach to get the boys into a line. They did this in hopes that we would also give them some food, but Davis' goal was to feed the children, and the food usually ran out anyway.

Our Kenyan friend and the adults would mold the boys into a single-file line while they shoved, kicked, and broke out in fisticuffs all throughout their ranks as they pressed toward the front. My first week there was the first time I have ever actually seen someone kicked in the face. For all these boys, it was their only guaranteed meal of the week. They were accutely aware that we had a limited amount of food in our bags. They had seen in the past how we would start tearing the bread in half if the supply got low before the line died down. These boys struck to injure and annihalte the competition. And when the food came out that's all they really were to each other - competition.

We fed the boys mandazi, which is a fried bread similar to a donut, a little bottle of juice, and little packets of Kenyan ground nuts for protein. As soon as the boys got through the line, they would hide the food deep inside their pockets and immediately try to shove their way back into the middle of the line to get another round before it ran out. You could tell who the tougher boys were because when they cut back into the middle of the mayhem, a few shouts of protest would occur but the other boys wouldn't dare mess with them. Our Kenyan friend and the street adults patrolled the line the whole time, pulling the offenders out, screaming at them not to trample each other, yanking the more violent ones away, and trying to pull the littlest ones out and bring them to the front so they were assured something. The weakest, smallest, and those with the lowest standing among thier street ranks ended up at the back of the line while others managed to sneak in again and again in front of them amidst the complete pandemonium. When I saw the looks on their faces as they stood on their tip-toes to see how the food supply at the front was holding up, I had to look away. It would take explaining all of the hows and whys of a broken world to describe that level of defeat on the face of an eleven-year-old.

By the time we got to the end of the line, the juice and packets of ground nuts would be long gone, and the mandazi would be ripped into ever-smaller pieces until that too was finished off.

As soon as the food was gone, we left. It wasn't safe for us to stay among those who knew we were capable of handouts. Every week, without fail, as soon as the line was through we would be surrounded by those with requests for money for this or that. With 50 of them standing there, you just can't start handing out money. They might be children, but they are also criminals who live by stealing, mugging, and whatever other means they need to survive. Usually before the last piece of mandazi was gone I would be on my way back up the hill.

Forming the line next to the fish shops

Shoving forward on one another so no one could cut in between people - this was scary to watch and made me question my own safety as things were always inches away from getting out of hand. Notice the boy with the long stick; he can use that to beat people if they get in front of him.

Lake Victoria - the largest in Africa - in the background

So strung out they never take the glue bottles out from under their noses. I cannot begin to describe what you feel the first time you see a ten-year-old high.

Some shove their food in their pockets and run off to eat it later in safety where they have less of a chance of getting jumped. Others are so hungry they can't wait. The little boy on the left has finally found a reason to take the bottle of shoe glue out from under his nose while he eats his mandazi. It is illegal to sell shoe glue to children in the country of Kenya, punishable by six years in prison, but as with most other laws in Kenya it is not enforced. The kids buy it for ten shillings (less than fifteen cents) and use it as their only escape from their daily reality of living in hell. We never took the glue away from them, because they would have just gone right back and gotten more and we would rather they use the little money they get from begging for food.

Twenty minutes of complete anarchy

This is Duncan, the leader of the street boys. Now in his mid-twenties, Duncan has been on the streets of Kisumu since he was eight. Davis met him early on in his time in Kenya and it is through befriending him that all outreach to the street community is possible. Comparable to American street gangs, in a system that on the surface seems to be highly anarchical, the street boys have a system of organization and ranks that runs deep. Duncan is the boss. If you want to get something done, be his friend. If you are not his friend, forget ever trying. You cannot walk into Kisumu without him knowing you are there. His eyes and ears are everywhere. It's a large major city, but no matter what day of the week or time of day you show up unannounced, Duncan will find you in less than a half hour. He's a complete crook and talks like the best of used car salesmen, but Davis realized long ago that Duncan is a necessary evil. You can be sure that there is a lot less pushing in line when Duncan shows up (epecially when he's holding a massive switch as he is here). When the street boys become too old to be cute enough to make any money from begging, they truely turn to the hard crimes they've been dabbling with for years as their only means of survival. The adults are very dangerous. Wouldn't you be if you didn't have any other way to feed yourself? All of them try to keep younger boys under their wings so they can keep their hands in the money the little ones bring in from begging and can send them on special assignments that younger children can more easily get away with. The system will never stop perpetuating itself.

This is one of the littlest ones, about five years old, searching through the trash in the shrubby area near the beach to find a bag to put his mandazi in. He'll go find a quiet spot to hide where he can savor his meal in peace. Today is a very good day for him.

Take a moment to compare this to your good days at this same age, and you may be able to begin to feel the injustice of this perverse scene. Leave me a comment - I'd love to hear the thoughts of others on this kind of poverty.

** If you are wondering where the street girls are, there are none. They don't last a month on the streets because that is where people go to shop for servants who they can keep as virtual slaves in their homes for years without ever educating or paying them if they are young and poor enough. Those who don't end up as house servants end up being bought and sold as prostitues. In some ways, the boys are the lucky ones.

The Mobile Clinic in Photos

Every week in the Maseno Orphan Program, Dr. Hardison and many other hospital staff do only brief rounds at the hospital in the morning and then set out to spend the day at one of five orphan program sites. While there are a lot of Hoppa Hoppas, inevitibly there are also many serious cases that people have been saving up for when the doctor comes. Every week, we end up taking people back to the hospital with us to admit them. Their stay will be covered by orphan program funds.

So this is what happens behind the scenes while I force kids to stick their feet in chemicals and the rest sit in class.

Again, these pictures are from a variety of weeks of different Saturdays.

The long line to see one of the doctors. We had several lines going in different areas depending on where the doctors got stuck based on space.

So much for patient confidentiality - the next person in line would crowd right up next to the table and chairs where the doctor and current patient were sitting, making sure not to miss out on their turn while I'm sure keeping their ears wide open. People in East Africa have no concept of personal space. None. So for them confidentiality and it being a bad thing to hang out around another person's doctor visit is an even more abstract concept. No matter how many times the frustrated Americans would ask them to back up, they would just keep closing in. The Kenyan nurses did not try very hard to keep them back either - I'm sure they thought we were being completely ridiculous.

This is the pharmacy table where nursing students and whoever else had a free hand would count out the pills prescribed by the doctors at the previous table. The doctors have a list of medications at their tables to pick from when coming up with prescriptions - the ones we get for free. The most adequate medication isn't always available, but this is certainly better than nothing.

The even longer line of people staring at the pharmacy table waiting for their perscriptions to be put into little plastic bags for them. On each bag, a picture representing a time of day would be circled (or multiple pictures as need be) to symbolize when the medicine should be taken for those who don't read. Despite trying to talk all of the patients through this, every single week people come back with horrible hypertension who ran out of their meds a week too soon even though the doctor wrote them exactly enough to get them through to the next mobile clinic. Dr. Hardison would explain through a translator until he was blue in the face but would inevitibly end up with his head in his hands out of sheer frustration. Modern medicine is hard in under-developed areas.

I kid you not that these are the medical records for this particular site. They are like college blue books that you have to take your essay tests in, only with a few more pages and cut in half. Every time the patient comes, the doctors read through the hand written notes from the previous visits and make new hand written notes. They won't treat them at the hospital unless they bring thse because this is what lets people know they are with the orphan program.

Chris and Katie, my two dear American med-student friends got to see their own patients after their first week of observing. They sat near Wanda, Frances, or Dr. Hardison in case they had any questions and to sign off on the prescriptions they decided on, but other than that they did the patient examinations on their own with their own translators. They were awesome they way they just jumped into this crazy world of tropical medicine with only one year of med school under their belts and did an amazing job of playing doctor. Here Katie is taking notes on a nine-year-old boy who was so frail and malnourished he looked like he was in pain from just breathing. He himself asked to be dewormed. They were the last patients seen on this day and showed up right at the end, so it must have taken quite a while to walk him in from wherever they came from.

And here is Chris getting his sripts checked over by Dr. Hardison before sending this lady to the pharmacy line. He was so gentle and thorough with people, it was so great to watch. He's going to be a mighty fine doctor.

Wanda, our gifted physicians assistant from Vermont was at Maseno hospital for a year while her husband worked as the business administrator for the programs with Professor Nancy.

Frances is a Kenyan doctor and the only Kenyan medical professional that I met who I have any respect for. He actually cares about the patients! I always had stickers on me, and if I wasn't around when a little one came through his line he would get up and leave to come find me to make sure that kid got a sticker (you can see it on this little boy's hand). He would great me every day with a "Kali, are you feeling kali today?" taking the Swahili definiton of my name (fierce), and thinking it was hysterical.


Wanda with Newton (like Sir Isaac, as he likes to tell people) and Chris, two med students at Maseno University who give up their Saturdays every single week to help as translators for the American medical folks as they meet with patients. And sitting for five hours straight telling Dr. Hardison that this old lady, as the last one, has pain here, here, here... it's not always that fun. They are just all around great guys. For the record, these guys were also the only ones in Kenya who never hit on me. Ever. And I love them dearly for it.

Jigger Dip

Here is a typical day at the Saturday Program's jigger dip station. The images actually come from two different Saturdays, but they pretty well paint the scene for all weeks and locations.

These are my charges who I have to watch as they soak. The teachers of each form check the kids and then send them over if they need to be treated. My job was to fit as many little feet into the tubs as I could at a time and make sure they didn't wiggle too much so their feet stayed firmly in the water. It's pretty hard to sit still for 20 minutes straight at this age.

These are chemicals only used on cows in the United States. To our American doctors' knoweledge, it has never been tested on humans, but the mentality is that these kids will proably never live to the age when most people get cancer anyway and it is worth the risk when compared to how much it improves their quality of life for the here and now and the years to come. If the jiggers burrow into the muscle tissue, the damage is irreversible.

This group was brought in by a very, very old grandmother who had five or six children under the age of five. By the looks of her, in this country she would have been in a nursing home or at least assisted living. The little boy on the right is an incredibly scrawny, undersized three-year-old. Based on his size, I was guessing the baby to be about nine months old. My jaw dropped when the woman holding on to him let go of his hands and he stood independently in the dip. He screamed like the end of the world had come for the whole 20 minutes his feet were in there and cried huge crocodile tears. I was almost beside myself trying to communicate to someone to get him to calm down because I didn't think his little body could handle all that screaming. His limbs were so thin and his belly so distended I didn't think he could safely expend that much energy. It was later when I saw him take a few steps that I wanted to go throw up. He wasn't a baby.

He was also three years old and didn't even belong to the old grandmother, but rather belonged to one of her neighbors. She, despite having all the other little ones to watch on her own, had walked all the way in with him to get him checked out along with her own. This blessed woman found someone else to watch her brood when we told her he needed to go to the hospital (children have to be accompanied by someone to take care of them and nag the nurses to pay attention to them otherwise they'd never be fed or medicated) and went and stayed with him for several days while he was hyrdrated and dewormed.

The Crocodile Tears

It is hard to tell in this photo but his belly stuck out further than the average Midwestern beer gut. This pretty much guarantees worms. When worms get into the system, they take all of the nutrition out of the food for themselves. You can see how this becomes a problem when there is barely any food going in in the first place. Deworming meds paralyze the worms, which spread out as far as they can when they get into the GI tract (part of the reason the belly sticks out so far) so that they can be passed. A few days later at the hospital I watched this little gentleman pass some mightly long, white worms. He was in much better spirits at that point.

Unfortunately, going back to live with whoever let him get that bad off in the first place, his odds are not good. At three years old and the size of a nine-month-old it would take a lot of good nutrition to catch up, and he'll most likely never get it.

This is the scrawny three-year-old I was comparing little guy to in the photo above. Each time, after all the feet were adequately soaked, I would call back all of the kids who had jiggers in their fingers for a separate soaking. If they have them on their hands it is bad news. It is fairly easy to get jiggers on the feet, but having an infestation in the hands means that the home is completely over run with the bugs, and that the kids are definitely not being properly looked after. Everybodies home can have jiggers. It should never be a problem if the feet are checked regularly and they are picked out. The kids who need their feet soaked live in homes that have some definite issues. The kids who have them in their hands live in a whole nother level of filth and neglect, often with caretakers who are mentally ill or who are too frail themselves to be caring for others. Unfortunatley, still others live with guardians who just don't care. While this grandmother obviously had all the love in the world for the kids she had in her care, she was at a phase in her life where somebody else should have been taking care of her. She will never be able to properly meet the needs of so many small children at this stage in her life.

As I've said before, when jiggers get into the muscle tissue, they cripple. While this is less evident on the feet, it is very obvious in the hands when the fingers start curling up. This is permanent, and the kids will lose the use of their fingers for life.

This boy crouched with his hands in the jigger dip for 20 minutes without ever twitching. The dip is a chemical and has to burn like crazy on the open sores. Somehow, this boy was so lethargic and beaten down by life that it didn't matter to him. He did what he was told without making a sound or so much as flinching until I pulled his hands out. Three-year-olds should not be that beaten down by the world.

Every week, there were always adults with some definite mental illnesses lingering around. I would go back and do them after the kids were done. This well over six-foot and muscular man was definitely schizophrenic. He was having some right good conversations with someone not present, and judging by his constant, jovial laughter it was a conversation worth tuning into. I talked to one of the head teachers who said that this guy lived by himself close by and just got a little "funny" when he became an adult, so they make sure he stays fed. His jiggers were the worst I ever saw. You can see at the base of his ankles how the skin looks like it is rotting. You should have seen his actual feet. Beyond that, he had them all over his knees, hands, and elbows. I got him to keep his feet in for most of the 20 minutes but he was too worried about missing lunchtime to do his hands. He just laughed at me when I suggested it. I guess fortunately for him, he's in such a happy alternative universe most of the time that he doesn't notice the itching and pain.

The woman whose legs you can see behind him had a thousand mile stare that never stopped. I had to physically turn her to face the correct direction on the bench and put her feet in the water. Her shirt was torn to pieces and kept slipping down, exposing her breasts. She didn't appear to notice. There were several children standing around watching these two, laughing and making fun of them in Swahili. My two charges didn't seem to notice they were even there, but I about lost it. The first and only time I have ever yelled at a child was in Anchorage when a kid was making fun of one of the adults with disabilities I was taking care of. I think I made him cry. I hope I did. I had half a mind to go after these kids with a switch like all of the adults here do, but tried to control my temper so I didn't look like the evil white lady and got a teacher to do it instead.

The worst part of this story? The woman in the photo was very pregnant. Who knows what dipping her feet in chemicals will do to her unborn baby, but worse, she is in no shape to take care of a baby in the first place. I noticed throughout my experiences with the orphan program that women with mental illnesses in this part of the world seem to be used as sexual objects for many opportunistic men. Within a year I expect that her baby will be in line for jigger dip as well.