It Shouldn't Be Like This

(Please note: this blog post is not for the faint of heart)

I have no idea what to do. Nothing I do is right. Everything here is wrong.

This blog post probably won’t make much sense as it is a rant of fury and sadness and guilt and frustration. Life here can be so incredibly horrible. I can’t imagine being an African woman living here. I don’t know that I would survive or that I would even want to survive.

At one of our site visits today I met a woman who came for cervical cancer screening. She is a widow. She is a mother of seven small children. She came to the clinic today because she has had malodorous bloody, watery vaginal discharge for the last three months. She has never experienced these symptoms previously and she has not been sexually active for over one and a half years (and yes, I actually believe this patient). She was seen at a neighboring dispensary and given treatment for cervicitis (for a presumed STI – which I don’t think she has) and told to follow up at the health center for cervical cancer screening.

 The instant she laid down and spread her legs for the exam it was obvious that there were some much bigger issues here. Her entire uterus was protruding from her vagina, raw, infected, and exquisitely tender. She said she had been trying to push it back in, but is kept prolapsing back out of her vagina and it was becoming too painful to push it back in. My diagnosis: complete pelvic organ prolapse with a secondary infection and irritation of the uterus/cervix due to environmental exposure. I try to gently clean her with some sterile saline, but this is clearly futile and a cervical cancer screen is clearly not going to be very effective or useful at this point. She needs to get to a larger hospital to be seen by a OB/GYN and be evaluated for surgery.

So what am I supposed to do? Do I just tell her she needs to go to the hospital? I think she knows that already. The hospital is far away (about 45 minute drive) and she doesn’t have money. I know that if I tell her to go to the hospital that she won’t make it there. She will sit at home for another three months, in pain, probably scaring away any potential help by the ever-increasing odor that is emanating from her vaginal area. I don’t know what to do. So I call the district hospital reproductive health guy that I know and ask what I should do. He tells me to bring her to the hospital and that she will get seen and treated there. Ok. I don’t think about things much farther than that. I know that this woman needs help far beyond what this little health clinic can offer and that she probably won’t get it if I simply tell her to go to the district hospital. And I know that she shouldn’t have to live like this, that if I were in her shoes, I wouldn’t want to live even one more day in this condition. So I take her.

Of course I forgot about that little “law” about taking people to the hospital. Apparently, if you bring someone to the hospital, you are responsible for them – for their hospital bills, food, lodging, etc. I begin to realize the error of my ways as we get closer to the hospital… as we stand in line for registration… as it’s pointed out to me by a colleague. Now what? I don’t know. I thought I just needed to bring her to the hospital and she would be taken care of. That’s what I was told in simple terms and so my mind was just working in those simple terms. Duh – forget you were in Africa? Apparently so.

So I back peddle. I say, “hey, let’s get her evaluated by a clinician here; they can come up with a treatment plan and estimated costs; I will give her money for transportation home tonight; she can follow up at the health clinic with one of the nurses who I can then communicate with about creating a plan for her.” My colleague shakes his head and says to me, “You knew this. You knew that if you bring someone to the hospital, you are responsible for paying for them.” He’s right. I knew. I guess I was “supposed to” leave her there and verbally refer her to someone else. But I just couldn’t imagine going home and leaving her in that state. I tried to hold back tears the whole ride home. How does one live with that? Abandoning the patients who clearly need help? I just couldn’t imagine living like her. Or perhaps I could – and that’s the problem. I could imagine how horrible it would be to go home at night with a uterus hanging out of my body, raw and infected and painful and smelly, once again turned away from a health center where I was asking someone, anyone to please help me.

I finally arrive back home and climb out of my car, which now reeks of infected vaginal secretions. I then remember that I didn’t just irrationally make this decision by myself. I called the district hospital reproductive health guy to ask what I should do. HE TOLD ME to take her to the hospital. So I call him up and tell him how I was told that either I pay for her treatment or she wouldn’t receive any care. He informs me that the hospital policy is that patients will receive care regardless of their ability to pay. They can get treatment and then bills can be sorted out later if the person can pay. I call up the nurse and tell her that this is what I was told and ask her to call me after the patient is seen by the clinical officer.

The next phone call goes something like this:

Nurse: “The patient was found to have pus in her urine so she was told to get some antibiotics for an urinary tract infection, but the pharmacy is out of stock and she doesn’t have any money so she was only able to get Tylenol.”

Me: “She has pus in her urine because her entire cervix/uterus/etc is infected because it has been hanging outside of her body for three months! Did anyone examine her?”

Nurse: “Let me have you talk to the lab tech.”

Lab tech: “Yes, the patient had pus in her urine, so she needs treatment with antibiotics.”

Me: “May I ask who saw the patient please? And what is their phone number?”

Clinical officer: “Yes, the patient had pus in her urine, so I prescribed antibiotics for a urinary tract infection.”

Me: “Did you examine the patient?”

Clinical officer: “She had pus in her urine….”

Me: “Did you examine the patient?”

Clinical officer: “The patient didn’t have money to buy gloves so I could not examine her. If a person needs a speculum exam, they need to purchase the materials. This is a district hospital – that is how it works here.”

Me: “Did you even ask the patient what was wrong? Or the nurse that I talked to about what this patient’s problem is? She has grade 4 pelvic organ prolapse. Her entire uterus is hanging out of her vagina. You didn’t need a speculum to see the problem. You didn’t even need gloves to see the problem. She just needed to lie on a table and open her legs a smidge and you would have seen that the problem was bigger than a urinary tract infection!”

Clinical officer: “She didn’t have gloves so I couldn’t examine her. Don’t worry, I told her to come back tomorrow with money.”

FUCKING HELL! I’m sorry to curse on this blog, except that I’m not. She can’t come back tomorrow. She lives miles and miles away and can’t afford transportation and has seven kids at home alone and she was just treated terribly by you. There is no way she is just going to pop back in tomorrow with a bunch of money for gloves and a speculum and whatever else you think you need. She needed you to listen to her for a couple minutes and maybe just take a small look. She needed someone at the hospital to HELP HER. But no, she was turned away because she couldn’t afford to buy a fucking glove.

And of course now I feel like I should have stayed. I felt like I had done too much and caused a problem and now I feel like I did too little and abandoned my patient. But I still think she should have been taken care of regardless of whether or not I was there to watch and make sure that an exam was done and that an appropriate management strategy was developed. This patient should have been taken care of at the hospital. But she wasn’t. She’s wasted an afternoon, will arrive home late to her children, and will have nothing to show for it expect maybe even less faith in her ability to get care. Why bother going to a hospital here? You won’t get the care that you need. You’ll just waste your time and money. Better to suffer silently at home. That’s shit. That’s absolute shit. People shouldn’t have to live like this.

I’m pissed off at myself, at the clinical officer, at the hospital, at the system, at the global community for allowing this to happen. I’m sad that this woman will return home tonight, without any treatment and without any hope. And I’m overwhelmed that she’s not the only one.

My New Nickname

Granny. That’s the name my little troop has bestowed on me. For real? I may be the oldest one in the group, but I don’t think I’m THAT old yet. But apparently my love of trip planning and my penchant for cooking up a storm of food to make sure all my little chickies are full has been interpreted as maternal, even so far as to be GRANDmaternal. I suppose that’s better than my new Dholuo name which means “she who knows how to eat fish”. We really need to work on these nicknames!

A Walk in the Woods: Kakamega Forest

Kakamega Forest used to be part of a larger forest that stretched across the continent of Africa. Unfortunately, due to human encroachment, all that remains of this once magnificent forest are small patches of forest reserves in Kenya (Kakamega), Uganda (Bwindi), DRC, etc. Nonetheless, the forest is incredible.

The forest houses 9 different species of monkeys. We saw at least four and I got to spend a lazy hour watching a troop of black and white colobus monkeys in the trees above me. I think they were just as interested in me and I was in them. A couple brave souls kept peaking their little black and white faces out from behind the leaves to stare at me, slowly inching closer and closer, and then getting scared and scurrying back up the tree. I gently clutched my car keys, hoping they would realize that I didn’t have any food and we could stay in this mutual standoff of “look but don’t touch”.

The forest also houses 35 species of snakes. Eek! But don’t worry, only 18 of them are poisonous. Our guide then proceeds to inform us (I think he was trying to reassure us) that there are snakes everywhere, we just don’t see them because they run away from our vibrations. There are even snakes living in the tree house that we are sleeping in. In fact, if you don’t have rats in your home, you most certainly have a snake. Never before did I think that I’d be wishing for rats in my home!

And the butterflies. I can’t even remember how many different species there are here, but they are everyone and they are beautiful! From spotted brown ones that really do look just like leaves to scarlet red ones to tiny white ones… they swirl around the air, gently landing on you and then fluttering away. I love them. My grandfather used to say that when you see a butterfly, it is a loved one who has passed away coming to visit you. So whenever I see these beautiful creatures, I always feel like I’m in good company.

Of course there are patches of forest with less pleasant insect encounters. Like the row of guava trees that have dropped their now-fermenting fruit, creating both a putrid-sweet aroma and swarms of fruit flies. And the safari ants…. We are lazily walking through the forest, looking up at the trees, chatting away, when suddenly our guide yells out “RUN!!” What?!?!? That’s not what you want to hear emanating from the mouth of your calm, soft-spoken forest guide. After a few minutes of frantically running through the forest, we stop and he tells us to check for ants in our pants. He reaches over and plucks an ant off my shoe. I find another one in my trousers. Tony finds two all the way up in his shirt. Safari ants. Swarms will quickly crawl up your trousers, bite and hold on, forcing you to drop your drawers to remove the little biters. Nasty little critters.

And naturally, every forest must have it’s token Viagra tree and breast-enhancing bugs. I suppose there are a few universal motivators in life – things that cross cultures and generations. Our guide kindly warned us not to place the bugs on our breasts because when they bite (causing the breasts to swell), it hurts like hell and you’re likely to start crying. Why do we do this to ourselves?

Happy Hiking!

Road Trip!

Road Trip!!!! Taking Mbuzi out for his first camping trip – let’s see how he handles it!

Of course first we’ve gotta prep. Planning and packing food and water, picking up a charcoal stove and a couple bags of charcoal, throwing a couple tents and blankets in the trunk, grabbing a machete and a shovel (for bushwacking and digging the car out of the mud, not for any more sinister activities!). Running around Mbita Town, grabbing all our supplies, I’m totally in the zone. I may look like a frantic flurry of activity to outsiders but I’m calm, focused, and absolutely loving life when planning a trip. Perhaps I should have been a safari guide, not a doctor. It’s not too late…

With the car stuffed to the brim with supplies and passengers, we head out. One hour ferry ride, 90 minute drive, and then navigating the insane traffic in Kisumu. Somehow we made it to the Nakumatt (giant shopping center) where we attempt to buy a more detailed road map. No such luck. But we were able to pick up a few ‘drinks’. So off we head, with a rough Lonely Planet map to guide us and a prayer.

The next few hours are tense. I’m not accustomed to the highway driving in Africa – the one lane that is supposed to accommodate two lanes of traffic, the insane passing on these narrow winding mountain roads…. I find myself in perpetual conflict: am I brave enough to try to overtake this slow moving lorry or do I sit behind it, breathing in it’s horrible exhaust and run the risk of not making it to camp before dark? Oh, and the speed bumps! Seriously, they come out of nowhere and are in the most inopportune places – oftentimes at the bottom of a steep hill – and they are rarely painted so you don’t see them until you are just about to bounce over them. I may have bruised the tops of my passengers heads a few times on unexpected speed bumps. Pole sana (So sorry)!

After a harrowing ride, we finally make it to Kakamega Forest and try to find our hostel. It’s just grown dark as well pull into the forest. We see a man on the side of the road. Probably just an ordinary farmer, but we’re utterly convinced that he’s sketchy and refuse to stop and ask him for directions. Which means we proceed on to what appears to be a ghost town. Dozens of seemingly abandoned houses scattered through the forest. No lights. No sounds. No welcoming committee to the hostel. Sketch! We’re sure this place in haunted now. We retrace our path and try another road. This time we find a hoard of children and a father who seems less sketchy, so we have him squish into the car and he escorts us back through the haunted village, through the sketchy gate that we avoided last time, and finally to the hostel – with people!! Phew. Made it.

An Athlete

The measure of an athlete is not how fast or how far she can go. The measure of an athlete is how strong she is, how much she can endure… when she is not winning, when she is hurting, when she keeps hurting... and when she keeps fighting… for no one but herself.

I was injured almost three years ago. I went from training for triathlons and playing any sport I could find to having difficulty getting through the workday. Over the last few years I have struggled with this injury, physically and psychologically. One of the more difficult elements of this injury was that I felt like I was loosing an important piece of my identity.

For years I have clung to my identity as an athlete. It was something I could always come back to, something that made me feel like everything was going to be ok. I could always count my legs and a pair of tennis shoes to take me away. I could go fast and I could go far. And then suddenly I couldn’t.

The last few years have been a roller coaster. At points I have pushed and pushed, demanding that I get better, insisting that I will one day run fast and far again. At other points I have throw my hands in the air, finally accepting that not everything can be fixed, that sometimes you need to recognize what you cannot do and then refocus on what you can do. Trapped in my black and white thinking, I felt like there were only two possible answers: either cling to this shadow of my former athletic self or accept that I was no longer an athlete.

I felt cheated. Why did I, an athlete, have to have athletics taken away from me? Why not someone who didn’t care about running and biking and climbing all over? Why not someone who identified themselves by their art or their music? Why me? Oh yes, I went down that road.

And then I learned a new word: reframing. Rather than be angry that this happened to ME because I was an athlete, I reframed the argument as “Thank goodness I was an athlete because at least I know what is a training hurt and what is a bad hurt, I know how to exercise, I know my body.” I told myself that as bad as it might seem, if I hadn’t been an athlete, it would have been even worse.

But I was still thinking that my identity as an athlete was a thing of the past. It taught me what I needed to help me through this, but it was no longer a part of me.  That doesn’t mean that I gave up trying to heal as much as possible; I was still committed to following up with my doctor, to trying new approaches, to doing my physical therapy exercises, to doing whatever little athletic things I could do. I just released the hold on my identity as an athlete. And it was liberating. I felt at peace.

And then one day it snuck back in. I’m not sure exactly when or how. Perhaps it was in the middle of my physical therapy routine; more likely it was in the shower (that seems to be when I get most of my inspiration). But one day not so long ago, I realized that I still AM an athlete. I cannot run for even five minutes without causing pain that will last for days. I hurt doing many routine activities like driving or dancing. I don’t like going to the gym and seeing all the machines that I cannot use.  I haven’t used my tennis shoes in years and struggle with a few laps at the pool. I cannot play recreational sports much less compete. I cannot run fast or far. I cannot run at all. And I may never run, bike, play volleyball or rock climb again. But I AM AN ATHLETE.

You see, I realized that I didn’t really know what an athlete was. I thought an athlete was someone who could run, bike, and swim fast and far, dive for a volleyball, jump for a frisbee, train until their shirts were drenched in sweat and their muscles ached, outmaneuver an opponent, get a personal record, win a race.  I thought ‘grit’ was about waking up early to pound the pavement until you nearly collapsed, then finding the strength the bust out a few dozen pushups and crunches, and waking up the next day to do it all over again.

I didn’t know that what really made an athlete were the in-between moments. The moments of defeat… of injury. The discipline of knowing when to push and when to rest. The wisdom of seeing the race not in terms of minutes, hours, days, weeks, or months, but in terms of years and decades. The patience. The perseverance. The struggle, not for the personal record of a lifetime, but the personal record of today – be that a 2 hour marathon or a walk around the block. I didn’t know that ‘grit’ was about trying and failing and failing again, about finding your own measure of success and pursing it with focused determination.

I finally realized…

The measure of an athlete is not how fast or how far she can go. The measure of an athlete is how strong she is, how much she can endure… when she is not winning, when she is hurting, when she keeps hurting... and when she keeps fighting… for no one but herself.

I finally realized that I am an athlete.

(Well, I never said I was a stylish athlete.)

Thanksgiving: Mbita Style

Thanksgiving is hands down my favorite holiday. It’s one of the few holidays we have left that is not overly commercialized. I actually thank Christmas for overshadowing Thanksgiving because while all the marketeers are focusing on Christmas starting November 1^st, its little brother gets to slip by without all the glitz and glamour. Sure, you can think of it at the stereotypical American holiday: a day when we stuff our gullets with overly rich food and celebrate a day when the native people saved the white man from starvation only to be brutally run off their land. But I like to think of what it most currently represents: a day to come together with your family and friends to give thanks for all your blessings.

This Thanksgiving was a bit untraditional for me. No family around. No other Americans even. No days off work. No free turkeys in the grocery store if you buy a certain amount of groceries. But that didn’t stop this little American from recreating her favorite holiday in her little hide-away-town in Kenya. Oh no, she did it up right. With a crowd of over 30 people: Kenyans, a couple Brits, a couple Dutchman, a Swede, and my favorite little German roommate.

After starting off with a 7-hour work day, I ran home to start peeling and mashing potatoes, layering sweet potatoes with butter and cinnamon, rolling out pie crust,  etc. We had the works: turkey, homemade gravy, stuffing, pumpkin pie, pecan-turned-walnut pie. A can of cranberry sauce even made a surprise guest appearance compliments of a new British arrival!

Yummm.... gravy. 

Everything was a bit “thrown together”. Pies were baked in pots; several precious minutes were spent running back and forth between my house and a neighboring house that harbored a small oven, things like evaporated milk were replaced by whatever milk could be found, and dishes were borrowed from half a dozen friends and neighbors. Friends also chipped in by bringing a couple chickens, a precious pumpkin, and of course ugali (a traditional Kenyan dish of maize meal that no Kenyan in his right mind could go to bed without eating). In just under 7 hours, we had a traditional Thanksgiving feast adorning our dining room table.

There's no room! People are spilling out the door!

And then the guests starting trickling in…. 2….4…. 10… 20… 25…. 30! I stopped counting at 30. Our little living room was packed with people. And what better to do with a couple dozen people who don’t know each other and have come together to celebrate a foreign holiday? ICEBREAKERS! Uh huh oh yeah Big Booty! That’s right, after a quick round of introductions, we broke the ice with the one and only icebreaker that I remember from my college days: Big Booty.

Big Booty 101: All participants stand in a circle; one person is designated as “Big Booty” and the others count off. The “Big Booty” song is sang to start off the round and then people have to call out their number and the number of another person who in turn then repeats their number and calls on another number and so on and so forth. The key is you have to remember your number and keep with the rhythm of the song…. Otherwise YOU become the “Big Booty”.

So at some point we had nearly 30 people, embarrassed out of their minds, clapping and singing out…

Ahhhhh Big Booty, Big Booty, Big Booty

Uh huh, oh yeah, Big Booty

Big Booty – Number 7

Number 7 – Number 12

Number 12 – Number 4….

Once our guests were thoroughly convinced they had wandered into a nut house, we again went around the circle and gave our thanks and started stuffing our gullets. And just as people began to think they were safe again… the dance lessons returned.

Sabina insisted on showing off the box waltz that I had taught her, followed by a bit of limbo, a congo line, and a touch of salsa. Then came my lesson in “Kiuno” compliments of Lindah.

Lindah: “Kiuno  means ‘waist’, so this dance is all about your waist. You gotta warm up your kiuno first, then you have to show me the force of your kiuno.”

I’m sure you can just visualize Lindah, smoothly showing off the force of her kiuno, as the little white American girl awkwardly pretends she has a kiuno to show off!

Me showing off the pie that will hopefully add to my African "kiuno"

Fortunately, the Kenyan Cowboy, Craig, came to the rescue with yet another dance to teach me: the Mbita Shuffle. Finally with a dance that acknowledges that these two white dancers don’t really have a kiuno or a “Big Booty” to flaunt, we kick and spin our way through the Mbita Shuffle.

When the laughter and dancing finally starts dying down, when the pies are demolished, when the eyelids start to droop, when the guests start trickling out, I finally sit down for what I think might be the first time all day. And I am eternally thankful.

 The German, the American, and the Dutchman

I am thankful for having the opportunity to be in this beautiful place, learning from another culture and sharing my own. I am thankful for silly dance lessons and for fresh pumpkin. I am thankful that even when my family is far far away, I am surrounded by loving, laughing people.  I am thankful for my dear roommate, Eva. Am thankful for you.

Flight Security - What?

With food poisoning symptoms just beginning to subside an 8 hour bus ride back to Nairobi was not on the order for the day. So we flew…

We wrote our names on a piece of paper, paid in cash, got our tickets and entered the airport. We walked through security. We walked onto the plane.  Not once was I asked to show my ID. Not once.

I had a wine bottle opener in my carryon luggage which I had forgotten about. The security opened my bagged, helped up the corkscrew and ask, “Is this for the captain?” What? He then imitated jabbing the corkscrew into his throat to demonstrate how I might kill the captain. He laughed and returned the corkscrew to me saying, “Next time just put it in your checked bag.”

Is this place for real? I just got on a plane, paying cash, without showing any identification, with a deadly weapon in my backpack. Wha??

Food Poisoning – Be Serious!

Oh Be Serious! You can’t be food poisoning from RICE! Oh yes you can… it’s a little bacteria called B. ceres.

Any med student how dutifully read through their “First Aid for Step 1” book while studying for their board exams knows this little saying to help them remember a sneaky little cause of food poisoning. I was just (un)lucky enough to get to experience it in practice.

I won’t regale you with stories of projectile vomiting for hours on end (well I guess I just did), but rather with the kindness that I was shown. Michael, the receptionist at the hotel noticed that I didn’t seem well when I checked in. When I didn’t come back downstairs after a few hours, he called up and started asking me about my symptoms. He then came to my room and gently said, “I’m not a doctor, but I think it was something you ate and I think I have something that may help.” He then made me a cup of lemon and honey tea and said he’d check back in an hour. The tea just provided fodder for the exotoxin but the kindness was greatly appreciated. When I wasn’t any better later in the evening, he went out and somehow found an open pharmacy to be me medicine. Again, not something that stayed down, but the kindness was greatly appreciated.

There isn’t really much treatment for food poisoning except time and trying to minimize dehydration. But when you feel like crap, are lying in a foreign hotel, and just want a hug from your mommy, a cup of kindness from a stranger means the world.

Unless of course it’s not actually food poisoning… five days in…. I think it might actually be a really bad case of giardia…. Hmmm.

Train Ride – Ode to Grandma Ivy

My Grandma Ivy is  what one might call a social butterfly. She makes friends wherever she goes, whether it be a trip half way around the world or a trip to the grocery store. She talks to people, she charms people, she befriends EVERYONE.

In line at a movie theater: “Oh, what beautiful hair you have.”

Walking through a restaurant: “Oh, that dish looks delicious. Which was is it?”

Sitting on a bus: “It sure is cold outside. Where are you headed?”

She finds a reason to talk to anyone and everyone and in turn manages to coax the wildest stories out of even the most staunch hermits. She emanates warmth and thus receives it back.

Some people say my grandmother and I are twins. We look alike (if you could stretch your mind across the decades that divide us). We act alike. We are certainly both social creatures. And I must say that I learned a lot from her growing up.  When I was a child I was fortunately enough to be her travel companion on several occasions. We went to New Hampshire, Boston, and Alaska together.

I watched her make friends everywhere we went. I watched how people warmed to her simple friendly chatter. And I loved her and thought the world of her. So it’s probably no surprise that a bit of her rubbed off on me.

I noticed the Grandma Ivy coming out in me on the train ride to Mombasa. I love trains – rolling through the landscape, walking back and forth through the cars, sitting in the dining car, feeling the wind in your hair as you stick your head out the window, meeting all sorts of people… The train to Mombasa is supposed to be an overnight train, arriving in Mombasa around 10AM. But as the train stood perfectly still from around 1am to 4am while I lay in my sleeper, it became more and more apparent that we would not be arriving on time. Sure enough, at breakfast we were informed that the train would be about 8 hours late. Time to get to work.

With nothing to do but stay on the train, I wandered the halls looking for stories. I met an Australian builder traveling around Africa for a year, a Finnish couple who just graduated high school and are volunteering in Kenya, and a handful of Indian guys working on reconstructing the rundown railroad we currently rode on. I chatted with an elderly British couple who have lived all over southern Africa for the last 20 years and who were great at spotting the elephants in the distance as we rolled through the national parks. I had a long conversation about cervical and prostate cancers with a couple middle-aged Kenyan men. I met a few Kenyan University student – one an aspiring analytical chemist, the other an aspiring musician/businessman. I hung out with a couple Red Cross volunteers and a few of the dining car staff. I debated global health strategies with a Guinea Worm consultant in Southern Sudan. I got a history lesson about the railroad from a retired Kenyan couple and sat down with a Dutch couple visiting their daughter for a few weeks.

And of course, I stuck my head out the window, looking over the rows upon rows of sisal plantations, the dry savannah spotted with acacia trees, the dilapidated train stations with little kids running and waving, the piles of burning trash littered with tin shacks an people presumably suffering with all sorts of respiratory problems.

But mostly, I channeled my inner Grandma Ivy. I didn’t notice just how much until I got off the train and started waving good-bye to people at the train station My travel companion just looked as me and asked, “Um, do you know EVERYONE on this train?” Well, maybe not EVERYONE. I can’t in any way claim to be the elegant social butterfly that my Grandma Ivy is, but as Joelle Ivy I guess I took a bit more than just her name.

Mombasa

While waiting for all this car nonsense to get sorted, I decided I needed to get away from Nairobi for the weekend. So off I went to Mombasa... the next three posts are about this trip.

Buying a Car in Kenya: Part 3

But of course I skipped a few details. Like registration. Like insurance. Like repairs. Like the stories that people come up with of how I’m likely to be swindled in ways that I never could have conceived.

Registration:

In order to make sure your car is not stolen or in some other way illegal and that all the import duty has been paid (usually worth about the value of the car), you must go to the Kenya Revenue Authority to check the registration against the Log Book (your little piece of paper that gives you ownership). I have this checked out by Jimmy, my car guy, and it checks out fine.

Insert story of swindling: But how do you know that it checked out? Do you trust this car guy? He could have a deal on the side. Don’t trust anyone. (OMG! Even when I think I’m going through all the nit picky little steps to make sure everything checks out I’m potentially being swindled! Jeez!). So of course I spend another day getting an independent lawyer to help me check out the car registration again – again, it checks out fine.

Insurance:

In Kenya, your annual insurance rate is based almost entirely on the value of your car. I was worried about making sure all medical expenses are covered for anyone potentially involved, etc. But here, the big expense of a collision is not medical bills but car damage. Of course. So it’s roughly 7.5% the value of your car. To ensure that people don’t overestimate the value of their cars and then total them or underestimate the value of their cars (which apparently never happens), your car has to be valued by the insurance company.

So we make all the insurance arrangements and then it comes time to purchasing the actually insurance. As you can guess based on the difficulties faced when paying for the car, this is not a straight forward story, but I’ll spare you the details this time.

More interesting story of insurance issues: As I’m making sure that the insurance covers all medical costs, I’m informed that the insurance doesn’t cover someone who is sick if they die in my car. Huh? I initially ignore this comment but later come to discover that this is actually a big deal in Kenya. If you pick up a sick or injured person to take them to the hospital, then you become responsible for them. You have to pay a deposit on their hospital bill and may be responsible for all their medical bills. And if someone dies in your car, oh man, is that bad. You have a big mess on your hands trying to prove that you didn’t kill them. No “Good Samaritan” laws here, just disincentives for picking up anyone in need. I think the moral of the story is “don’t help anyone”. So sad.

Repairs:

Naturally any used car will need a few repairs and Mbuzi is no exception. I want to take the car to a mechanic and have it all done but my bartering with the car salesman ends up with an agreement that his guys will do the repairs as part of the purchasing price. Never do this! All the repairs were supposedly going to happen over the weekend. Monday arrives and nothing is done. Over the next week (while waiting for the money stuff to get sorted to it’s not really a huge deal as much as an annoyance), I visit periodically and find bits and pieces slowly being done. Eventually the shocks and exhaust are done. I’m told the headlight will be repaired “tomorrow”, I’ll get a spare key, etc. Fine.

Oh, and I’d like to practice changing a tire…

Good thing I practiced is all I can say cuz this would have been bad news out in the field. I find an old jack in the back of the car and labor trying to crank it up. Just as the back wheel is coming an inch off the ground, the car comes crashing down. Holy ****! Um… may I have a new jack, please? This one is completely shredded. I get a slightly newer jack and repeat the process – this time it at least cranks with a little less animosity. Oops… I forget to loosen the lug nuts first. Down it comes again. I loosen the lugnuts and discover a few are missing (actually, exactly one on each tire is missing) and jack it up a third time. Wait a minute – those nuts aren’t missing – they are just different. And no, they can’t be removed with the crank that I have. So how would I ever change a tire in the field with these on? Not sure. And of course the tool to remove these “different nuts” is not to be found.  And it’s getting late and starting to rain. Thus I leave with a promise that the lugnuts will be changed “tomorrow”. I write out a list of things to be done by Friday: fix the headlight, make a spare key, replace the lugnuts. Sigh.  

Morning of Take Off:

I thought I’d be in Nairobi for one or two days buying this car. Two and a half weeks later, I am finally ready to leave. The car has been picked and checked out by two mechanics, the registration has been checked (and double-checked), the payment has been made, the insurance as been bought, the repairs haven been done, and I have mentally passed from frustration to resignation.

So I show up early on the morning of take off (still sick to my stomach - read the post on Food Poisoning for details). The headlight is still out and now I notice that the fog light on the opposite side isn’t working either. The lugnuts have not been changed. There is no spare key. And the car has not been serviced in way too long (this was also supposed to be done… shucks). We take the lugnuts off another car, scrap the headlight repairs and the spare key and plan to service the car in Kisumu. Now onto the insurance issue that I discovered the night before…

Remember that little thing I mentioned about needing to have a “valuation” of the car for the insurance? Well, I was told that the insurance valuer would come out to the car lot over a week ago to the make the assessment. I assumed (how stupid of me) that this was done. The night before we hope to leave, I think to ask, “Hey what happened with the valuation of the car?” Oh, we need to do that before we head out of town. Right. So off we go to the valuation place… discover that the hazard lights aren’t working properly and that my insurance is actually only temporary insurance for a month until the valuation has been filed and any price discrepancies are remedied. So I have to return to Nairobi within a month to get my “real” insurance.

Jimmy (who will be driving me out to Kisumu with Mbuzi) and I swing by the store to grab a few car tools, with plans to get the remainder in Kisumu. Around 1pm, we finally leave Nairobi. I wonder what other little details I didn’t catch.

Buying a Car in Kenya: Part 2

Oh wait… picking out the car is only half of the story…

Question Three: How do I actually buy the car?

Answer: Funny you should ask… it starts with abandoning all plans of ever making it back to Suba and settling in to residing in Nairobi for an indefinite period of time (read: 2.5 weeks).

I thought I could simply make a bank transfer at Barcley’s bank, a sister bank of Bank of America. Not so. Plan B: Wire money from my account in the U.S. to the car company’s account in Kenya. This plan was all hunky dorey until I mentioned it to a British guy who has been working in Nairobi for the last five years. His eyes popped open wide and he looked at me with this mixture of terror and shock as if I was a green alien and not someone who suggested a money wire to an African bank account. Jeez. Call my dad, cancel the transfer, try to figure out another solution.

So now I’m on a hunt for a bank account so that I can wire the money to my own bank account in Kenya and then do a transfer domestically. In theory a safer bet I’m told. Of course that raises the new question: how does one open a bank account in Kenya?

The answer to most questions in Africa is of course “It depends”.

Expat Banking in Kenya 101:

As a resident (with proof of a valid work permit), you can open several different types of accounts. You can open a Kenya shillings account, and U.S. dollars account, a U.K. pounds account, or even a Euro account. At some banks you can even do this for free. If you don’t have proof of residency, most banks will turn you away; however, if you explain that you are travelling around Africa for awhile and would like easy access to your money, Barcley’s Bank (and possibly others) will allow you to open an account. You need to be “introduced” by a friend who has an account with Barcley’s or “pay a lawyer” a few bucks. However, at Barcley’s, you pay about $10 a month to keep the account open or keep about $2,000 in the account to keep it open for free.

Other ways to get large sums of money from the U.S. to Kenya: you can increase the limit on your debit card temporarily and take out cash from the ATM or bank, but this is limited by the local bank’s willingness to let you take out that much at once, the limited supply of cash at the ATM, and the size of your suitcase (when the largest bill is worth about $10, taking out thousands of dollars gets a bit bulky).

Final strategy: Money wire.

Back to our story… After much ado about nothing, I returned to the money wire idea. I checked out the account at the bank to ensure that the account was a valid business account in the company’s name and had regular activity going on in it. I also verified the other wire details with the bank. You would think that would be adequate, yes? Of course not. When my father tried (for a second time) to wire the money, it was discovered that the Swift code for the bank of incorrect. Seriously? Seriously. So alas I had to return to the bank once more to verify what we determined was likely to correct Swift code (Didn’t I just ask you to confirm this for me yesterday?).

Side note: I’d just like to point out that all of this running around in Nairobi is no small task. The traffic in this city is the worst I’ve seen in my entire life – and I grew up in Los Angeles! It takes about two hours to get into downtown from where I’m staying. Another hour or two to the car place. And I like to get home before dark. So 4-6 hours of daylight are often spent sitting in buses. Transportation seems to be my primary issue here in Kenya.

So the wire is finally sent. Tracking numbers obtained. Tracking numbers show receipt into the Kenyan bank account on Friday afternoon. Call car salesman. No answer. Text car salesman. No answer. No answer until Monday afternoon after multiple harassing phone calls and finally a confirmation that the money was received and I can pick up the car. Hallelujah!

Buying a Car in Kenya: Part 1

Where do I start? I don’t know. Let’s ask. Hey, do you have any idea how to buy a car in Kenya? Sure, I know a guy… you should talk to “insert name here, almost always James or John”. Thus began my search for a lil’ four-wheel drive to carry me across the rough dirt roads of Suba.

The first question is of course: Do you really need a car?

The answer: Yes. Yes. Yes.

The explanation: I live in a place called Suba which is a pretty remote area (three hours of bus, then 1 hour by ferry from the nearest city, Kisumu). The roads are almost all sprawling rugged dirt roads. I think there are only about six cars in this place and about 100 motorcycles (I exaggerate, but only slightly). My work sites are spread out all over this area, several are about a 3-hour drive away. But the 3-hour drive isn’t so bad. What is challenging is that those three hours take 8-hours. The project vehicles have their routes each day and whoever needs to stop on that route jumps aboard. Which means that we have to stop and wait all along the way for everyone to finish their business - things like dropping off and picking up labs & medicines, training staff, etc. So I leave my house at 7am and get to my site for the day somewhere between 11am and 3pm. I get somewhere between 30 min to two hours at the site (usually after all the women have left), then head back (stopping again), and reach home around 7pm. Twelve hours of transport for 30min-2hrs of work at the site. Hmmmm. I’m pretty understanding about waiting in Africa. That’s just part of working here. But there are limits to my waiting abilities. So the choice arises: to buy a car or a motorcycle? At first, I figured I’d just learn how to ride a motorcycle, put another team member on the back, and head off to our rural clinics. Then I thought a little bit longer about potential consequences of riding a motorcycle over bad roads, 6 hours a day, for 7 months. Hmmmm. I’m pretty adventurous, but again I have my limits and I’ve seen the results of motorcycle accidents – not nice. Thus I am left with the option of purchasing a car.

The next questions are: What do you want and what is your budget?

The answer: I want something that will not leave me stranded in the middle of the bush and will not break the bank.

The realization: It’s difficult to find both. See, cars here tend to be about twice as expensive as cars in the U.S. because of importation taxes (literally doubling the price of the car!). My initial budget literally doubled after I spend several days looking at cars in my budget range… all of which looked like they would either die suddenly in a burst of exhaust and duct tape or slow to a crawl and simply refuse to move another inch.

So how do you buy a car in Africa? Well, I think I should start by asking, “How do you buy a car anywhere?” I literally have no idea what I’m doing. I’ve never bought a car anywhere… in the U.S., in Africa, on Mars. And I know nothing – read NOTHING – about cars. I wonder how much I can fake this one…

Fortunately, I was linked up with a great Kenyan mechanic who knew how to find, insure, register, fix, etc a car. And then I turned to my two favorite resources: my dad and the internet. Between the two, I figured out a few of the things I’m supposed to look at and looked at them in earnest!

You should see the looks on these care salesmen’s faces when this little white girl plops on the dirt to look under the car, opens up the hood and questions the repairs (it’s hard to miss green metallic slime seeping out of a radiator or duct take holding EVERY WIRE together). I can’t tell you much, but I can rate the tire tred, feel the lack of any shocks, guess that the suspension is off, and get worried that an engine is going to die going up a hill. I can now tell you something about the engine based on the color smoke spitting from the exhaust (granted it’s about a two word diagnosis for each color, parroting what my father told me to look for over the phone), and can tell you three different ways to raise the car a couple inches to get better ground clearance. Probably just enough to throw a bit of vocabulary around and look like I know nothing about what I’m talking about to anyone who knows anything about cars. But I’m as proud as can be.

And I found a car. A 2002 Toyota Rav4 with 4WD that I’m praying will get me to and from the bush for the next several months. His name is Mbuzi. So I’ve been telling my friends back in Suba “Nilienda Nairobi kununua Mbuzi” (“I went to Nairobi to buy a goat”) which baffles them all. He’s my sleek, sliver, little goat.

Let the driving adventures begin!

Sunday Morning Fishing Trip

As our boat speeds towards Bird Island,

Leaving behind a fluorescent green spray,

The sun peaks out over the mainland,

Heralding a bright new day.

I wanna catch me a big Nile Perch!

"Throw the lines in the water!" I let out a cry,

China teacups clang with the boat’s sudden lurch,

Reminding us it’s time for our good morning chai.

We cruise ‘round Bird Island to get a good look

Of cormorants perched on a scraggly tree,

Conjuring memories of The Jungle Book

With the vultures, Shere Khan, and Mowgli.

A brief exchange with some omena* fishermen:

“How much for one of the girls?” they shout.

“Just give us some fish and we’ll call it even.”

“Wait! What? No deal! I’m out!”

We’ll catch our own fish with some moss on a hook.

Edwin dives down to find us a fish.

Placing the hook in the hole is all that it took

To snag us a fresh Tilapia dish.

Let’s all jump in for a swim around Takawiri!

But beware the bilharzia, crocs, and hippos!

Of these dangers you better be leary,

Lest you find yourself eaten the minute you doze.

Then back to the Lighthouse we speed

With the wind in our hair.

Captain Craig, take the lead!

Steer us home as fast as you dare.

*omena: a small fish, about an inch long, that is caught in nets put out at night by fishermen on Lake Victoria

Mbita Hospital

Oct 3, 2012

Judy (the health educator I work with) threw me up in front of about 30 people today and made me give the health talk in Swahili. My brain can only think so fast in Swahili! I made it through (and then she translated it into Luo anyways), but it really stretched my brain!

The rest of the day was spent screening women for cervical cancer using a method called visual inspection with aceitic acid. Basically, you take cotton on a stick to paint the cervix with table vinegar; then you look at it with a flashlight and see if there are any spots that turn white. White spots are concerning for pre-cancer and require follow-up and/or treatment. It’s cheap, easy, gives immediate results, and saves lives!

My favorite part of cervical cancer screening (at least today): when I get to hold the baby while the mom is examined by Sabina (the amazing nurse and project coordinator that I get to work with). One child was sleeping and then woke up in my arms, took one look at my ghost-like face and started screaming! A slightly younger one smiled at me, put his head on my shoulder, then peed on my lap. Haha. Speculum, please?

Safari Village

Sept 29, 2012

Determined to create a social life outside of work (although I enjoy that social life as well), and interested in discovering the tiny ex-pat community in Mbita, I ventured out to Safari Village today and found beautiful little get-away and a few lovely wazungu’s (white people) who live in the area. Sigh.

I enjoy having Kenyan friends – that is why I came out here after all – but I also know from my time in Tanzania, that it can be quite nice to have a few wazungu friends. I understand why immigrants from a particular place tend to find each other, creating their own this social spider web, which may be more or less integrated into the surrounding community. There are just certain things that we have in common, that makes the conversation a little easier, that makes for a fun travelling buddy, that validates the thoughts you struggle with but have difficulty expressing in a cross-cultural situation.

Don’t get me wrong, I think that struggling through those conversations and developing those cross-cultural relationships is important, but sometimes you just need mapumziko (a break) and someone who gets you. So I’m glad I found a little place that I can go when I need that little break.

Friday Night in a Tin Hallway

Sept 28, 2012

My first Friday night in Mbita and I’m going out! I didn’t think I would find anywhere to go out dancing in this little one lane town, but I had my feelers out for the social scene – however small it might be. Somehow I managed to find a German girl and two Kenyan guys who work at the insect research center here who were also looking for a night out.

We walk down the one lane towards the sound of African music. I start things off on the right foot by stepping directly into a giant cow pie. Lovely. After a bit of shuffling to remove my pie, we enter the “club”: a dark little hall constructed of tin sheeting, lit up with colorful plastic chairs and coca-cola sponsored plastic tables, complete with a stage and small dance floor. Live music fills the tin hall. As usual, the drummer is the coolest band member, banging out a rockin’ rhythm on a big plastic box. Young fishermen sip their sodas and beers, a few brave souls venture onto the dance floor… soon limbs are flying this way and that, the floor filling up with men dancing with each other*.

My new friends and I join in the fray, spinning each other to help block the advances of a few more assertive dancers. The music soon takes over my body and I lose any sense except the sense of movement. I love to dance. It just makes me feel completely free. But I really love to dance in Africa. I should say it’s the music, the beats, the open air… but if I’m being completely honest, it’s the freedom that comes with already being labeled as different. I am totally free to move however the music moves me because I can chalk up my weird dance moves (I said I loved dancing, I never said I was any good at it!) to being a foreigner. No one has to know the truth that the weird moves are uniquely mine! So it’s just me and the music.

*Note: Unlike in the U.S., straight men in East Africa frequently hold hands and dance with each other. You’re “not allowed” to be gay here (it may even be illegal) and it would be extremely dangerous to come out as gay, so there is no question in people’s minds about why two men are dancing with each other. Also, it’s mostly the men who go out dancing, so if they didn’t dance with each other, they’d usually be dancing all alone!

"Resting"

Suba I absolutely lovely, but… what do people do here for fun? On the weekends? When you finish working? As the weekend approaches, I’ve been asking everyone this question. The unanimous response: we rest.

Rest by doing what? Do you go swimming? Hiking? Dancing? I already know the answer, but I don’t want to believe it yet. We finish our housework (the cleaning seems endless) and then we sit around and watch TV if we have one or watch the day slip away.

Sigh. I suppose I should learn how to “rest”. But honestly, I just can’t. I’m scoping out the ‘town’ trying to figure out how to entertain myself so that I don’t go through my entire stock of books in my first few weeks here. Could I join a fishing crew? Learn how to sail a dhow? Brave the hippos and go for a swim (people seem to think this is crazy)? Get someone to teach me how to ride a motorcycle? Figure out how to make yogurt?

I need a project, a hobby of some sort – something other than just work (because I’m not supposed to be a workaholic this year and because there is only so much work that can be done – I just need to wait on stuff!). I’m sure I’ll find things to busy myself with, but it’s going to take some action on my part – totally different than San Francisco where “stuff to do” simply falls into your lap. And perhaps I will practice “resting”.