On Poop

I don't even know how to start but I feel it is vital to write a post about this. It is an indispensible component of the Africa experience. You can not talk about your time in Africa without talking about this important bodily function. Those of you that know me, understand that I hate the word "poop" and talking about it. However, when you live in rural Kenya, it becomes a part of your daily vocabulary, especially when you and your mzungu friends are sick.

For example, diarrhea is a common part of the Kenya experience. No matter how hard you try to eat cleanly washed food and drink bottled water, you will inevitably eat or drink something that causes you to run to the bathroom. This was me last week. It got so bad that I couldn't even keep water in me for more than 5 minutes. I became concerned and called Alyssa to my hut so we could evaluate my stomach issues. She freaked out and thought I should go to the hospital. I just wanted to sleep and take more antibiotics. She finally told me that if I had one more liquid stool that night, she would drag me to the hospital. In her defense, I was probably getting super dehydrated. After finally being able to sit up in bed, I ate Uji, which is delicious Kenyan pooridge, rich in nutrients. It was the first substance that didn't go straight through me all day. I ran to Alyssa's hut and exclaimed, "My diarrhea is gone!" We celebrated by high fiving, screaming "Yayyy!" and then drinking more water.

The next day, our friend Pete had a similar experience and had to run to the bathroom during lunch. We made him go to Elgon View and get Cipro as we figured he had a bacterial infection as well. Alyssa also started feeling terrible on Friday so she, too, started the antibiotic regimen. Thus, the past week has been filled with phone calls, texts and face-to-face conversations of the consistency of our stools. When someone has diarrhea, we ask how frequent, what color, consistency, etc. When someone comes out of the bathroom and exclaims they had a solid passing, we jump for joy and give pats on the back. It's like we are potty training all over again, rewarding each other for making it to the bathroom in time or having a "normal" stool.

Thus, poop has become an essence of our experience here and have no qualms talking about it with one another. At the moment, we all woke up without diarrhea and are currently sitting at a coffee shop, not taking antibiotics. Hopefully this is the upward climb and we can look forward to more normal, solid stools and less poop talk. Although I am sure we will still be celebrating being "healthy" for the next two weeks here.

A Bad Day

Throughout my past year in public health school I studied maternal and infant deaths, what causes them, their rate and prevalence in countries such as Kenya and the United States. It was higher in Kenya with about 45 neonatal deaths per 1,000 live births. In the United States, it's 6. The number is also probably higher in Kenya as most women do not deliver in health care facilities and therefore, their infant deaths are not recorded. An intelligent professor of mine once said, "Statistics are people with tears washed away." I sat in class, took notes and had a heavy heart for such travesty in a developing nation, but last Thursday, I witnessed one of these statistics.

I woke up around 8 AM not feeling the best. As most of you know, I was diagnosed with a bacterial infection (food poisoning) on Wednesday so I figured I just needed to pop some antibitiotics. It was our last day visiting St. Damiano, a private, Catholic hospital on the edge of Bungoma. We were hoping to help out in the antenatal clinic and say good bye to the nurses who had been so kind to work with us. I took my first dose of Flagyl that morning and headed out with Alyssa around 9. By the time we arrived, I was feeling worse. I hadn't eaten anything and my stomach was in knots. Maurine met us there and asked if we wanted to go to the Theatre; i.e. operating room. She mentioned there was a cesarean section happening.

I immediately started to feel better at the thought of witnessing my favorite procedure: a birth. We dressed in OR scrubs and boots and eagerly headed towards the sound of the cauterizer. Just as we entered, the 2 doctors were removing the baby. They handed him off to another doctor who brought him over to the warmer bed. No crying. This was typical, I thought, with c-section babies and from what I had seen in the past. They neede some stimulation and a little foot tickle.

2 minutes later, still no crying. The doctor was rubbing the infant as if he was washing a t-shirt; vigorously and rapidly. Still no sound. Then out came the oxgen mask. I was starting to get worried. Then CPR. Then intubation. I couldn't watch. I suddenly felt weak and walked out to the room in between the OR and hallway. The only sound I could hear was the mother's vital monitor. Beep, Beep, Beep.

"I should be hearing a baby cry," I thought as I sunk down to the floor. Alyssa came out to check on me and looked confused, "How long do they have?" she asked. I just shook my head. As they kept working on the baby for about 10 minutes I kept praying for a cry, a wimper, some sort of life. I couldn't go back in the room.

Moments of working in the Mother/Baby Unit flashed through my mind. Ecuadorian maternity wards followed. In the 100 live births I had seen, all the babies had cried. All had been the miracle of life.

Finally, after almost 20 minutes, the doctor and Maurine walked out and took off their gloves. I could barely ask the question, "What's going on?" The doctor bowed his head and shook it back and forth, "He didn't make it." As heartbroken, sad and shocked as I was I wanted to know why. He explained that the mother experienced antepartum hemmorhage (bleeding due to the distachment of the placenta). She had delayed her arrival to the hospital and by the time they had her hooked up to a monitor, the baby's heartbeat was barely audible. They decided to perform an emergency c-section but it was too late, the baby had been without oxygen for too long.

As we stood up to leave, I felt sick to my stomach. I quickly disrobed and walked outside into the fresh air. I didn't make it 10 feet before I vomited. Alyssa quickly came to my side and I started crying. I couldn't belive what I had just witnessed. In all my years working and volunteering with delivering mothers, I had never seen a stillbirth. And it was because the woman couldn't get to the hospital on time. Because the roads are covered with potholes and uneven terrain. Because she didn't have the education that if you bleed during pregnancy you should immediately go to the emergency room. Because poverty, in its many forms, has claimed the lives of too many mother and children.

Phrases

 This week is my last week in Bungoma. I'm both equally happy and sad. Happy that I get to travel a little around Kenya, go on a safari and head to Mombasa and surrounding beaches. Sad that I am leaving some amazing people and organization that has taught me so much and nudged its way into my heart. Today, I became a Life Member of the Kenya Red Cross Bungoma Branch. It involves a donation of $50 and then you are connected to the Branch for life through emails, phone calls and other means of updates about the activites taking place here in Bungoma. You also become an important stakeholder and have more credibility when it comes to decision making and idea generation. I'm really excited for this opportunity as I want and hope to stay connected to the Branch when I return to the US and for years to come. They already told me they will be sending me updates on future tournaments with the soccer equipment!

One of the aspects I will miss the most about Bungoma (and Kenya in general) are the phrases I've heard throughout my 6 weeks here. Some are inside jokes (sorry) but others I will try to explain.

"Hey guys, we need to switch buses. This one is kind of like...breaking down" -Joshua
This was our guide in Jinja. I really can't even explain it more. It was just really funny to hear the "kind of like...breaking down" part.

4 toasted toast
Can't even write this without cracking up. One morning, Pete, Ali, Alyssa and I made our way to our favorite breakfast spot in town to order our usual: four waters, COLD and spanish omeletes. This particular morning was a struggle with the wait staff as we told them in English AND Swahili that we would like 4, cold waters. 5 minutes later they come out with four plates with butter sandwhiches.
What/How/Why/Really?!?! The best part is "toast" does not exist here. So "toast"=one slice of bread and butter and "toasted toast"="two pieces of bread with butter in between. Eat/Laugh your heart out.


"Hilary? Do you have a mosquito net? (Yes, Ali) Okay, I just want to make sure you don't get gingivitis"- Ali 
Just so everyone knows, you can't get gingivitis via mosquitos. Only malaria. But thanks for being concerned, Al-pal :)

"So you're telling me that if a mosquito gets near me and sees this he will just, walk away?"- Ken
Most of our Kenya friends are absolutely stunned at the fact we can PREVENT mosquitoes from biting us. One day at the Branch, our sassy friend and income generating activities officer, Ken, asked Alyssa for some bug spray. She only had her Benedryl stick so he grabbed it and started rubbing it on his arm. Before she could explain that that was NOT bug spray, he said the quote above.

Alyssa- "Guys, it was totally like domestic violence" 
Ross- "Umm pretty sure you have to be married for that"
On Ali's last night a few of us went to our favorite hangout, Sharif Center, to play some pool. Apparently there was a bit of a brawl going on outside between some guy and girl and the above conversation happened.

"Sure!"-Maurine
This one I am going to miss the most. Maurine is my best, girl friend here. She's in charge of the health sector at the Kenya Red Cross and the nurse that accompanies Alyssa and I on our hospital visits. She's also become a near and dear friend. I will miss her and her "Sure!" greatly.

The below phrases are said by numerous people so I will just try to explain their meaning.

"You've been lost": This means I haven't been around the Branch, hospital, Bungoma, restaurant, etc in awhile. They literally think you are "lost" until you return and then you are "found."

"It's okay": Hey Mark, is it okay if we deliver the certificates tomorrow? Mark- "It's okay"
                    I would like a Spanish Omelete. Do you have that? Waitress- "It's okay"
                  

The three Americans and Mark after the soccer tournament. I'm going to miss Mark and all of his "Mark-isms"

"How is you?!" EVERYONE. Children, piki drivers, women in their shops, people on the street, at restaurants, etc. I've tried to teach them it's "How ARE you?" but I'm pretty sure they just enjoy yelling at the mzungu.

Jinja

After that intense post, I thought I would lighten the mood and share my experience in Jinga, Uganda. Pete, a Fullbright Scholar living and teaching in Bungoma, Alyssa, Ali and I headed to Jinja two weekends ago to experience white water rafting down the Nile. IT WAS AWESOME. I'll give you a quick update on the weekend and then the pictures can explain themselves.

Jinja is about a 5 hour matatu ride from Bungoma town. We arrived there around 8 PM and got a taxi to the camp we were staying. It's called Raft Africa and they have a sweet set up. It's an enclosed compound with dormitory style rooms, NICE bathrooms with HOT water, restaurant, bar and office...all of which over looks the Nile River. Fun fact: the Nile's source is in Jinga and the river flows North to Egypt. Saturday morning we were taken to the spot where we would begin our adventure. After breakfast and the manager scaring us to death about getting trapped under the water, we got in the raft. Our guide was Joshua and probably one of the best (as we were told by a previous rafter). After practicing our paddling technique we actually flipped the raft over and he told was what to do if it happens in the rapids. Thank God because it happened twice. The first one was a class 4 rapid but there were two in a row. Our raft managed to stay upright during the first but during the 2nd, we were catapulted into the raging river. I felt like I was in a washing machine, underwater forever. When I resurfaced (yes, Mom I was wearing a lifejacket and helmet), I found myself under the raft and immediately freaked out (go figure). As I am trying to go under water and come out on the other side another rapid hits me in the face and I legit swallowed about a gallon of water. I resurface once again to find Ali by my side, screaming, "That was so awesome!!! Let's do it again!!!!" Meanwhile, I'm coughing my lungs out and gasping for air...a bit like I was dying. We get back in the raft and Pete is no where to be found. We look behind us and he is curled around the front of one of the kayaks in the fetal position. Moral of the story: we all survived and it was pretty exhilarating. The 2nd time we flipped is pictured below. It was more enjoyable as we were able to ride the rest of the rapid in the water, with our heads above, breathing. Enjoy the pictures! It was an absolutely amazing experience and I want to go back!!!!

Privileges

As a "White person" or mzungu in Kenya, we get a lot of privileges that most Kenyans do not and that we would not be afforded in the US. For instance, Ali, our peer from MN, had the chance to meet Mama Sara, Obama's grandmother, her first week here. When her friends asked her why she got to me her, she had no idea but the Red Cross had asked her to come along. I thought I would share some examples of this happening to Alyssa and I over the past 5 weeks:

1) The grocery store (any store, really): everyone has to put their bags in a cubby out front before entering the store. We get to take our backpacks, purses, bottles of water, food, etc in. They just wand us with a metal detector beforehand. This has even happened when we are with our Kenyan friends. They try to take their bags in and are stopped immediately and told they may not enter until they check their bag up front.

2) Hospital. Thus far, all 3 of us have gotten tested for Malaria. Ali was the only victim to this disease and had to pay for the treatment but none of us were asked to pay for the test. We also get our own room at Elgon View Medical Cottage (the clinic Dr. Amin owns) when we're not feeling well. All patients have to share a room but Alyssa and Ali got the entire labor ward (5 beds) to themselves one day.

3) Matatus (Ma-tat-too). Picture a run-down mini van with about 5 more seats crammed into the back and 20+ people in the entire vehicle. That's a matatu. They are common vehicles for transport in Kenya and will take you to the neighboring town or 9 hours away to Nairobi. They don't leave until they are jam-packed full and the conductor trys to tell you where to sit. For example, they wanted me to sit in the front and I told them, sternly, "No." The front seat is called the "Death Seat" and I was not about to try it out. They then allowed me to sit in the back, by the window, which is where I wanted to sit in the first place. We have also gotten away with paying for the empty seats so we can leave, instead of sitting there for another 1 hour+ waiting for matatu to fill up. Only wazungu do this, of course.

4) To go along with the hospital, we can basically walk into whatever business we want and someone will welcome us with open arms, give us a tour and any information we desire. I tried to imagine doing this in the US and realized I would be met with questioning glares, concerned voices and very cut-throat measures, usually involving setting up a meeting, filling out forms, etc. I enjoy the freedom of business in Kenya and am very grateful I am able to see and learn so much in this town and country. Everyone is willing to show you around and give you information, something I very much appreciate.

5) Meeting with important stakeholders. Yesterday, Alyssa and I were cordially invited to attend the County Health Sector Forum with important stakeholders from all the hospitals around Bungoma Country as well as a WHO employee, Steven, and the County Health Commissioner. It was an eye-opening, inspiring and educational experience as we learned about the deficits of health care services in Bungoma. We felt a little (okay VERY) out of place as we entered the room and were surrounded by suits and women dressed in their best. We were with very important people who were making very important decisions about the future of health care in their community and county. It was absolutely amazing to be an observer of the process and we thanked the County Health Commissioner about 20 times for letting us experience their meeting.

Furthermore, we learned a lot about the health care sector in Bungoma. In this conference and throughout the next 5-10 years, there are policy 6 objectives Bungoma County is focusing on, which include eliminating communicable diseases, minimize exposures to health risks and provide health investements. The stakeholders were divided into four groups and each group focused on 2 of the objectives. Alyssa and I sat in on group 4's discussion and here are some astonishing facts we learned:
1) Bungoma county has 2 out of their 11 hospitals that meet 75% of the requirements per the norms and standards of 2006. They are Bungoma District Hospital and Webuye Hospital. Keep in mind the hospitals they are discussing are public hospitals, funded by the government.
2) The hospitals are severely lacking health workers. For example, over 1,000 nurses are needed throughout Bungoma county, there are only 2 pharmacists per hospital but the target is 6 and ZERO of the four maternal/child health clinics are up to standards. Furthermore, many people are not utilizing the few available services because of distance and ability to pay.

This conference gave me an insight into the problems of the healthcare system and areas for intervention and improvement. I do not, by any means, have all the answers or comprehensively understand the infrastructure. I do believe that this meeting/conference is a vital step towards improving the health of Bungomans and all of Kenya. I don't even fully understand the US's healthcare system but I do know that if I am sick, there is a hospital that I can get to and will treat me regardless of my ability to pay. And with Obamacare, more Americans dream of free healthcare is becoming a reality. Sorry for the rambling but this is something I am passionate about and wanted to share with everyone back home! I feel very privileged for what I have and where I came from. And now I am setting out to help others receive important, vital and necessary health care.

Kick Jiggers Out of Bungoma

I am happy to report that the soccer tournament was a HUGE success!! Despite the teacher's strike we had 10 teams participate: 3 girls and 7 boys. Since a few secondary schools signed up, we had girls finals, primary finals and secondary finals. The kids were so excited to play with the new balls and receive trophies at the end. We started around 10 AM and the last game finished at 6 PM. Our DJ/MC, Oscar, was absolutely amazing and kept the crowd entertained all day with music, talent performances between games and lots of "Kick Jiggers Out of Bungoma" chants. Enjoy the pictures :)

We purchased 8 soccer balls, 24 scrimmage vests, a ball pump, 10 cones, 2 whistles, and a sturdy trunk with two padlocks. 

Me, Philip, Alyssa and Annette the day after we purchased the equipment. Everyone at the Red Cross was very excited to see all the new stuff. 

Morning of the tournament. Just getting over the flu. Red Bull consumed and ready for some soccer.  

Our awesome MC/DJ...Oscar!

At the very end of the tournament with Mark and Moryne. 

Hanging out with Pinacle Girls Academy while they cheered on their boys team. 

Action shot

Pinacle boys with their 2nd place trophy!

My Hut

Apparently it takes me 4 and 1/2 weeks in Kenya to learn how to convert a movie file to an appropriate size to upload. Enjoy my living conditions. The yellow barrel is my clean water and the black one is for my toliet. Also, for those of you anxiously waiting, updates on the soccer tournament will be posted kesho (tomorrow).