The final days and returing home.

Nov. 30, 2008. We left from the Poenarus by Land Rover at 830AM, a little later than planned en route to Ndabibi, a 2-hour drive initially by very nice highway followed by progressively worsening and dusty dirt roads. In the end, I am not certain the last few miles really qualified as roads! We were constantly battling car-losing potholes, smothering dust and heat, and frequently competing with large herds of Masai cattle and/or sheep for the narrow space available. Many times we actually nudged our way through these herds, close enough to the vehicle that we actually got dumped on! That’s driving in Africa! We arrived at our destination the Ndabibi church right on time. Many people had already gathered outside and many, many children were playing around the outside and singing inside the church. The church itself measured about 12 by 28 feet, and was built of an interwoven network of sticks and branches filled in with dried mud and cow dung. Sounds pretty crude, and it is, but it has been standing for the past 30 years! Only in the past 2-years has Dr. Poenaru been involved and helped fund-raise to put a new roof on the church and find sufficient funds to pay a fulltime pastor. The seats were 5-foot long by 12 inch wide simple benches and it was quite obvious that any decorum around the church, including the pulpit, were hand-made. The floor was dirt. The roof was corrugated iron, and the windows were simply spaces left in the walls. There were no lights and the ambient light through the windows was sufficient.
Prior to the service, we were invited to the parsonage, a mud hut behind the church, consisting of a combined main, sitting, eating area about 6 feet by 8 feet and an adjacent small bedroom. Again, the floor was dirt and the roof corrugated iron. Two handmade couches were on each side of the main room and these were fashioned with material backs but rough lumber seats. The cooking area consisted of a propane tank with a small burner on top and the cutlery was contained in an empty plastic ice-cream container. Oh yea, it was very rudimentary, yet this pastor was well educated and spent 4 years in Moffatt Bible College before being attracted to this humble place. Not all of the people in the area are supportive of his ministry and he his humble abode is regularly robbed or threatened by opposers.
Before we went inside the church again, there was a beautiful serenade from the 4-6 year old children. Their voices were accompanied only by a home-made skin drum. And this was the only musical instrument for the whole service. We also had recitals from the teens, the young women, and the older women’s choir. Let there be no doubt, they are a musical people! The note-finding, harmony, and rhythm was a spectacle in itself. The service went on for about 2 hours including a sermon by Donald in a South Carolina drawl and simultaneously translated by the regular pastor, who incidentally was recovering from typhus and he still looked pretty drawn and weak.
Following the service we were invited on a tour of the church property to see the plans for a new building, the pastor’s garden, and the comparable sized garden area meant for the congregation. Interestingly, even though the land was free for their use, they had not cultivated it at all, unlike the pastor.
After our tour we were invited back to the pastor’s hut and were served a typical Kenyan meal of stewed lamb, cabbage, veggies, and chipatta bread. This was followed by chai tea, all of which was quite tasty and hit the spot by about that time!
On our way back to Kijabe we stopped again at the SOPA Resort (erroneously referred to in a previous entry as Naivasha Resort); this time there were no animals to be seen so we sat around the pool and enjoyed mango juice – yummy!! We took an alternate route through the Rift Valley and once again passed by the IDP (internally displaced persons) camps. This leads through Maui-Maui, a trucker village on the main highway through the valley where drug-resistant HIV is rampant. It looked like a dump! More pleasant sites along the way included Lake Naivasha, including Crescent Island where “Out of Africa” was filmed. We also saw Elsamere where another well-known movie, "Born Free" was filmed. I also spotted a huge flock of pink flamingos along the shore of the lake but it was too far for a good look or picture. I saw 2 camels, zebras, gazelles, giraffes, and warthogs. Lake Naivasha is a protected unique biosphere which has plentiful fish when the waters are high, but when the water is low it becomes very alkaline, promoting the growth of crayfish and other critters that appeal to the flamingos. It was also accidentally populated by papyrus from WWII float planes flying between the Nile and Lake Naivasha.
We arrived in Kijabe via a less-travelled route, a short cut that Dan was aware of, but a little uneasy about as car-jackings are apparently a common event along this section. Fortunately we saw nothing out of the ordinary.
We had our final supper with the Bransfords at 6PM and shortly after I decided to skip th shop-talk in favor of finalizing my bags.


Dec 1, 2008. This was departure day and I was ready; my bags were packed at least 3 days ago. But before we left though, Ivan and I were invited to make home visits on some palliative care patients in and around Kijabe. After what seems to be a typical more-than-relaxed African style, our 9AM pickup happened at 10AM as the agreed upon arrangements had actually not been made! We finally got arrangements for a driver and he picked up the hospital ambulance and in turn me, Ivan, and teo community nurses, both named Maggie! We headed into the Rift Valley to the community of Longonot which happened to be home for our driver. Longonot is best described as a widely apread-out community on the grassy plains of the Rift valley, right below Kijabe. We were taken to the shamba of Susan, a 52 year old woman with recently diagnosed esophageal cancer for which she required an esophageal stent in October. Her main problems were reviewed as well as her medications. She was examined and advice was dispensed. It was an excellent learning opportunity for Ivan and me as well as a good chance to provide feedback to the community nurses. The community palliative care service is in its infancy here and though they are trying hard, it is clear that much needs to happen yet. Susan’s main complaint was described as vomiting but in fact she was merely spitting up excess mucous, without associated nausea. Her pain was upper abdominal burning sensation and she was using morphine every 6 hours with some benefit. The morphine being used was made into a solution by combining it with Paracetamol (Tylenol), and it was delivered from the hospital to the patient by the visiting nurse. Other medications being used included vitamins, metoclopromide, sugar tablets and a liquid glucose solution. We recommended changing her morphine schedule to a more usual 4-hour schedule with prn breakthrough dosing as well. Susan was very grateful for the visit, especially of 2 physicians, and white at that! Ivan was able to leave a prescription for one of her medications by simply writing it on a scrap of paper for the local chemist.
Our next stop took us further in towards the bas of the mountain on which Kijabe is located and then along a winding dusty, dirt road up the escarpment towards the crest of the mountain! It was very picturesque with many vistas and picture opportunities as well as the usual competition with herds of cattle or, more commonly, donkey carts carrying water or firewood. All along the road there were people walking, some carrying a head-bound load of wood (typically it appears that this is usually the woman followed by a man with a much smaller cargo such as a jug of water), water, leaves, potatoes, etc. At one point we stopped to take a picture of the view and I was quickly approached by 2 young boys quite obviously wishing to have their picture taken. I obliged and they seemed delighted with the result; too bad I could not leave them a copy.
After climbing through the spectacular scenery which included the crater of Mount Longonot, several other crater-like large hills, and an ever-panoramic view of the Rift Valley, we finally reached the top of the mountain and corssed the Mombasa-Kompala highway to arrive at another small village. Here we visited Gladys, a 92 year old woman who had suffered a fractured hips 2 years ago and a stroke 3 months ago which left her speechless, unable to swallow, and unable to move her left side. It was a sad situation for sure; she was being cared for by her family and had had a nasogastric feeding tube (which she apparently oftened removed) and a foley catheter. Because of her immobility she had developed pressure sores on both of her hips and the family felt they were improving so had stopped changing the dressings. She appeared to be in pain as she was repositioned for our inspection of her ulcers. We provided some advice including the wisdom of continued use of a very uncomfortable NG tube, the need for pain medication, and the need for wound care. I could not help but think that if I were ever in that situation, I would certainly not want the intervention of a feeding tube, especially nasogastric.
We then left the nurses at their village near Kijabe and returned to wash the dust off. The shower was a welcome opportunity just before saying our good-byes to the Bransfords, to Justus, Dan, and others. Mike (Adkin) picked us up and we loaded an incredible amount of luggage and 4 of us into his VW to head out for Nairobe. The route was the usual rally-style race, previously described. We stopped to check in on his daughter who decided to join us for supper along with her mother (Janet) at the Mediterraneo restaurant. I had Nile perch and prawns; excellent and a spot that Veronique and I will hopefully enjoy some time.
Following supper we headed out for Jomo Kenyatta International Airport; the traffic was mind-boggling! It took us an hour and a half to get to the airport which, as the crow flies, probably was less than 15 miles. Again, the apparent numbers of people not only driving but also walking was mesmerizing.
We arrived on time, after 3 security checks, and boarded on time. However, our flight was delayed because one set of luggage that was checked in had no passenger who boarded with it. So, the crew unloaded the baggage until they found this luggage and removed it from the aircraft for obvious reasons.
Our flight to Heathrow was uneventful and it was nice to be able to sit around the Executive lounge, have a shower, have breakfast, etc., all included in the World Club Traveller package; man, it's the way to go!
See you later to day; unfortunately I was unable to find some perfume for Veronqiue as her specific one is not available in the duty-free shops at terminal 5.
See you later today!!

Celebrating Bethany Kids at Kijabe

Nov 29, 2008. Today has been interesting. We attended a celebration of Bethany Kids, this being their 4th birthday. The energy there was quite powerful and contagious. They organized a couple of ice-breaker games and this was followed by a large meal of rice, home-made cole-slaw, mixed veggies, potatoes, gravy, and barbecued lamb (they cooked 2 just outside the facility!). During the meal we introduced ourselves; there were about 75 people, employees of Bethany Kids. After the meal people were selected to give speeches, including Ivan and Donald, the American pastor who has been here all week on a job interview as director of development for the organization. This was followed by some singing and then we headed home where I decided to crash for awhile. I slept for 45 minutes then heade out to the Poenaru's to update my blog and check my mail.
Tomorrow we were to go to Nukuru Game Reserve, but this will not be possible. Instead we will be going to a church in a very poor village, (?Embru)...more on this another time.
I am not certain if and when I will have internet access again after today as we will likely have an early start tomorrow and a late return. On Monday Ivan and I are supposed to do housecalls before we depart for Nairobi and our return home. There is a good chance I may not get access until Heathrow at the earliest; when we passed through coming this way I was not able to access the net there, so????

Nov 27, 2008. Today is my Dad’s birthday; he would have been 89 years old! I can’t even really imagine what he may have looked like at that age, but would have been happy to see! I’m sure he is still looking down and amazed at the experience I have had in the past 2 weeks; maybe he has even read my blog!!
Speaking of which, today went as planned so far. Ivan and I spent most of the morning at the hospital teaching in a Palliative Care Course being put on today for some local pastoral care trainees and their teachers. I found out about this week so had to prepare a talk on end of life care, aimed at the pastoral care group. My topic was not too difficult to prepare; I was able to do a powerpoint presentation this morning before the session and it went very well. We both received thanks and applause for our presentations and lots of questions were asked generating a good discussion; the whole thing took about 2 hours +.
After this we went back to Millie’s for lunch – sandwiches, fruit juices, fruit salad (with every meal), and cookies. I should tell you about the Bransfords again.They have been in Kenya for 31 years as missionaries. They are the kindest and most caring people I have met in a long time. It is fair to say that they have not had a single meal without company in the time I have been here. Millie simply informs us when the next meal is being served and we are expected to show up. So, with few exceptions, I have had nearly all of my meals there. She apparently loves chocolate, so this morning I gave her the 2 boxes I had brought and she was thrilled. The guest house I am living in is part of their property (in reality they own none of it as it is all owned by their church). I have previously described it and won’t repeat.
Last week she did some laundry for me (including ironing!) so now I can make it the rest of the trip with no further laundry. Look out when I get home!!
This morning I also gave the rest of my candy to Mercy at the hospital. She was absolutely thrilled and said, they are just in time for Christmas!!
The end is now in sight and I am so eager to be back home it’s not even funny.
Ivan has to go to Nairobi in the morning but I’m not certain whether I’ll go or not this time; I may try to get I on another round at the hospital. There is also a possibility of housecalls tomorrow or Monday. On Saturday there is a celebration of the 4th birthday of Bethany Kids and this is expected to carry on for 4 hours.. On Sunday, Mike Adkin has decided he wants to take Donald and me to Nukuru, and another major large animal area (especially rhinos, white and black) – I’m game! On Monday, Mike will take us to Nairobi in expectation of our at around 11PM. En route we will meet at a restaurant and share a meal with his daughter at a resto close by.
This afternoon I have chosen to be a bit lazy and try to catch some mid-day rest for a change. I mailed letters to Genevieve and Julia today from the Kijabe post office – stamps were 95 shillings (about $1.30 each). I have no idea how long it will take.

Nov 26,2008. Today we travelled to Nairobi again, this time for a lunch and meeting with the Advisory Ctte for Kenya for Bethany Kids. They were an interesting mix of individuals (MD, professor of law, criminal investigator (special interest in ocean piracy!), and an architect). Ivan presented a case for providing help for the children of Joytown and was received well. Next step is for this group to approach the appropriate government officials to try and persuade them to allow this to proceed. We’ll see!
We had lunch at the Java House, a franchise much like Starbucks. Food was excellent and I was able to enjoy more, fresh mango juice! I am continually amazed at the determination, genuine concern, and energy of Ivan for Bethany Kids.
In addition to this meeting, we visited a parent’s support group, newly established in September of this year by a parent of a child with spina bifida who had surgery in Kijabe several years ago. The child is now 14 years old and doing very well. She was the product of a teenage pregnancy which cost the mother the rest of her education at the time; she would return and complete her high school education some years later and went on to study social work, all paid for by doing bead work! As a result of her experience she felt the need to establish a support group; she had been misinformed by others that her child’s spina bifida was the result of the fact that hers was a single-mother pregnancy and she had considered termination at some point during her pregnancy and spina bifida was the punishment! It was understandable that when she was eventually correctly informed at Kijabe that this was nonsense and her child’s condition could have been prevented by prenatal folic acid that she would want to inform others, including married women and those with teen pregnancies like hers. So, with a $1000.00 gift from someone in the US she rented a place in the slum area of Nairobi where she lives, and sought out other parents. In the past few months they have provided information to these parents and started to think of ways to become self-sufficient, such as beadwork, dressmaking, internet café, etc. We bought a few items to encourage them on and spent 2hours chatting about achievements, ideas for self-sufficiency and their dreams for even better things for their children. Another hopeful moment in the unlikeliest of places!
To get there we drove through one of the big slum areas of Nairobi; wow, it is actually beyond my ability to describe, other than to say abject poverty takes on a whole new meaning for me! It is an area with drug-resistant HIV in the prostitution business prevalent in all slum areas. We were told to keep our windows closed, as anything in the car was considered fair game as we negotiated the heavy pedestrian traffic! I could not bring myself to snapping pictures as it seemed so superficial in that setting. Enough said. And, we were informed, this was not the worst slum in Nairobi; there is another which I did photograph from the air which is said to be not only the worst, but also the largest slum area in all of Africa! (?Kebir)
We got back at 415, just in time for Ivan to meet with local hospital officials to update them on the progress of this and other ongoing visions.
I will describe the ride to and from Nairobi as it is an experience in itself. The route is (eventually) a 4-lane highway which has at many places a 4-foot cement median. Traffic is very dense and I don’t mean just vehicles. There seems to be an almost continuous line of people walking to and from, who knows where. Also, there are many donkeys along the route, some just grazing, others pulling home-made car-tire-wheeled carts, usually loaded with some produce (bananas, corn, cabbage, potatoes, firewood, etc) for the many side-of-the highway markets. Most of these markets are not all really beside the road, they are actually often set up on the shoulder of the road, within a foot or two of the asphalt. Others are off the road a bit more and selling things like sheepskins, whole or as hats, etc. There are also furniture markets, trinket markets, souvenir markets, etc.; It is a bit dizzying to see it all. And the pedestrians are continuously negotiating the highway traffic in very risky fashion; they all made it safely in my experience, including the scramble over the median! The vehicle traffic is a bit of a distraction to all of this of course. There are 2 speed limits in force. One is for private vehicles and is 100km/hr, the other is for PSVs (public service vehicles); the mass-transit vehicles are privately owned and known locally as matatas; most are Toyota minivans, adapted to carry probably 18 people or more, as far as I can tell. Most vehicles in Kenya are reconditioned vehicles from the Arab states, specially adapted for conditions in Africa with heavier suspension and fool-proof locks like I have never seen before. The matata passengers are truly packed in like sardines There are predetermined areas where they are continuously pulling off onto the shoulder of the road and dumping or loading passengers and their cargo which is sometimes tied to the top or the back windshield wiper. They waste little time at these express stops and slip back into the fast-lane traffic very daringly; just this week one of them overturned near Thika killing 7/9 passengers onboard at the time. They are often painted in bright home-fashioned decorative colors and given names like “The Hearse”, etc. Used to be that not only could these matatas carry passengers on the inside but many would hang to the outside as well; however, apparently there were so many mishaps, commonly including death, that rules now forbid this practice. The highway is also busy with trucks of many shapes, sizes, and descriptions hauling all matter of cargo from the local corn to oil, bananas, cabbage, petrol, etc. They are all spewing black diesel smoke and lumbering along as the road to Kijabe from Nairobi is almost continuously uphill, going from a elevation of about 5000 feet to over 8000 feet just before Kijabe. There is a descent then into Kijabe which is at 7000 feet. So, there is a need to pass these dirty, stinky things, while at the same time trying to avoid the pedestrian, matata, and donkey traffic negotiating the shoulders of the fast lane. Of course, this need to pass vehicles because they are in front of us happens in the city streets as well in Nairobi and the daredevil tactics are a little mind-boggling at times. Now I understand why I was warned that my greatest risk here was not malaria, etc, but traffic – no kidding!
And then there are the police blockades along the route, attended by heavily-armed (automatic guns), and assisted by tire-busting middle-of-the-road barriers! The idea is to stop mainly commercial traffic and check for permits, cargo, etc. and should something be out of order, it usually requires payment (in cash) on the spot! Just another of the widely-accepted corruption rampant throughout Kenya.
So, tonight we are invited to the Poenaru’s for supper again at 630. I imagine Ivan will provide an update to Dan on today’s negotiations.
Tomorrow, it’s off to Nairobi again, for Ivan. I will likely stick around Kijabe as I need to prepare a talk for some pastoral care students on end-of-life care for tomorrow afternoon. On Friday, or Monday, Ivan and I will do some house-calls on palliative patients.

Masai Mara Safari

Nov 21,222,23/ 2008. This weekend we spent a pretty amazing time exploring the Masai Mara by safari from Serena Mara Lodge. The individual safaris included 2 late afternoon, 2 early morning, and one night safari as well as a visit to a Masai village. The animals spotted include a leopard, 3 cheetahs, a herd of elephants, many giraffe, numerous zebras, uncountable hippopotami, as well as hyenas, jackals, impala, Thompson gazelles, waterbucks, dik-diks, 3 prides of lions, 2 aardvarks, several foxes and rabbits, a white-tailed mongoose, numerous different tropical birds such as Egyptian geese, guinea fowl, egrets, tawny eagles, secretary birds, weavers, bustards, etc. I was amazed how we could drive by so closely to many of these creatures without seeming to trouble them very much. And to be amongst them on the plains of Africa amongst the scattered iconic acaica trees, equally prominent ant hills and the wide open blue and sunny skies made it pretty much surreal!
Equally interesting was our visit to a Masai village where we learned a bit about the history of these 5 million people distributed between Kenya and Tanzania. Their villages are protected by the thorns of entangled acacia tree limbs and inside they are a series of mud and cow-dung huts following the inside perimeter of the protective fencing. In the middle of the village there is a large fenced area for the cattle, but the goat stays in the hut, usually in the same room as the baby. Masai are polygamous, travel the plains of Africa by foot, and pass freely between Kenya and Tanzania. Their only passport is their traditional red garb. To mature from boyhood to warrior, a Masai boy must kill a male lion, by disabling the lion with his spear and then finishing the kill by inserting his hunting knife into the mouth and deep into the throat, twisting at the same time until the lion succumbs. I did not particularly find this an endearing tradition, but it sure conjures up a sense of fearlessness and bravery.
All of this at a luxury resort in the middle of the Masai Mara (Masai, after the tribe, Mara for the spotted appearance of the African plains dotted with trees, animals, ant hills, etc) was in stark contrast to the experience of the days leading up to this, and what will be happening for the rest of the week. I will be accompanying the general surgeon on rounds tomorrow morning, attending grand rounds, and then preparing for a teaching session in palliative care with a group of students from the local Moffat Bible College. The following day should be a clinic with HIV patients, and Friday and/or Monday will be housecalls to the homes of dying patients with palliative care nurses.
At this stage, I must admit I am missing home quite a bit, even though the hospitality here has been exceptional. More than 2 weeks away from home is much longer than I had guessed and I am looking forward to my return early next week!
Nov 25/2008. yesterday was a day of travel abck to Kijabe from Nairobi and meetings with Donald et al., the candidate for a development job at Bethany Kids Centre.
This morning, as planned, I went to early morning (630) ward rounds with Dr. Bransford, then went to grand rounds at the hospital on the topic of H. pylori (ulcers) by a gastroenterologist from Australia. Excellent presentation.
After that I walked home and have used today to mostly rest and correct some errors on the blog, as well as complete the pallaitive care call schedule...all sounds to much like work! Tomorrow Ivan and I are meeting with more people in Nairobi and will get to visit a support group there.

Nov 20, 2008. Today we started with a visit to the Kijabe Hospital to attend the OR with Dr. Bransford. We were able to see him do several dressing changes on one child who, through medical mishap, had a gangrenous arm. The mother insisted on coming to Kijabe Hospital as at the other hospital she was misinformed about why this happened and what the outcome would be (certain death without the appropriate surgery). She arrived in Kijabe about 2 weeks ago, had the appropriate ampuatation, is healing well, and today started moving the residual stump! It is a BIG news story in Kenya as the MDs responsible are now being sued. Lesley is an adorable 6 1/2 month old and her young mother, who was frantic, now is singing the praises of Bethany Kids at Kijabe Hospital.
The second dressing change was a small boy who had been burned in a serious fire, got no medical attention for 2 months because of poverty, and when he first arrived had so much scarring his left cheek was fixed to his left shoulder. This was freed up but he has a ways to go yet.
Third child had been injured by a missile, and required surgical debridement. She is doing very well also.
Then we proceeded to the OR where we watched a spina bifida repair; all went very well (photos will be posted later). I was able to see the hospital record of surgeries over the past year and saw that they performed 268 SB surgeries last year. I was told that Denver Neurosurgical Institue performs 1 case per month. this is a sad reality in all of Africa where folic acid is a non-starter; not even the food is fortified. No one takes prenatal folic as it is generally unavailable! The child's surgery whom we had the privilege of witnessing went well.
This afternoon we had an interesting visit to Hells Gate National park, a volcano spueing steam, and en route we were treated to many animals including zebras, gazelles, buffalo, ostriches, giraffes, and even some huge 'Pumbas"!!
We also passed by Lake Naivasha, a beautiful area.
Tonight we were invited to a traditional African family's home for supper. Very interesting. I also was given an African name - Kiprono (from the Kalengin tribe, Cao (?) subtribe) - cool!!
Tomorrow we leave for a 3-day Safari at Masai Mara; no more blogging 'til sometime next week!

Nov 19, 2008. This morning Brenden and I were given a grand tour of the Bethany Kids Centre. This organization came into being in 2003 and rapidly expanded to 64 beds; today there were 68 inpatients. The Centre attracts patients from all over Kenya and many more are showing up from Somalian refugee camps. The original idea was a general pediatric addition to Kijabe Hospital. Rapidly it has become and area of expertise in management of hydrocephalus and spina bifida, an emergency situation requiring urgent surgical management. The need is there for significant expansion; one of the two surgeons has over 200 cases on his waiting list of less urgent matters such as hypospadias and other non-life-threatening conditions. The hope and will is there to bring it to pass. Even the funds are falling into place. Now remains the important decision of building a new facility or simply continuing to expand the current hospital. Important transition time for all here and the various international sponsors.
We made rounds with the one of the spiritual care women this morning, Mercy Ng’Ang’A, who dispenses hope like it grows on trees. She brought us to all the amazing little patients, some waiting for surgery, some on their way to recovery already, and with variably hopeful Mamas. And it is the latter that Mercy especially focuses on to encourage them to maintain hope for better things for their children. The patients are a mix of Christians and Muslims and Mercy made no exception in her message and prayers, even though (a few) of the Muslim women were clearly not impressed by her Christian principles. All of the patients accepted us willingly and were eager to have photos and to see themselves on the viewing screen after. The older children were clearly amazed, befuddled, and amused by the pictures. Many asked to have a copy and I spoke with Mercy to allow me to send back a CD of the images. She will gladly see to it that the parents get a copy, likely when they return for a clinic follow-up visit.
There are many Somalis in this ward, probably 30% of the patients. Many of them spoke either Swahili or a local dialect making communication difficult. The Kenyans almost all were quite fluent in English. In addition there were a number of Masai women and their children present. Aikadir, a Somali male refugee, was eager to tell his story, taking us back to the tribal conflicts in the early nineties, followed by a brief reprieve, and then the continuing violence which still wages today. He wanted us to understand that the favored countries for emigration to included Canada and Australia. He was aware of the large Somali population in Toronto. He made it clear that, though Canada was a strongly preferred, the wait time was measured in years, making it difficult to maintain hope. He provided me his name and cell number in case I could have influence. He was not even close to the opportunity to emigrate yet, saying that once they are selected, they are then placed in internationally sponsored camps where the more well-to-do and educated are separated from the peasants; this because the educated had learned respect for life and other fellow humans, whereas the peasants knew only pillage and plunder as a way to advance themselves making it dangerous to mix the two populations. This young man was very aware of the unrest in his home country and showed no desire to return but wished only to be successful in his immigration, preferably to Canada.
One little patient had been admitted to a hospital in Nairobi for an infection requiring intravenous antibiotics but things went terribly wrong resulting in a gangrenous right arm. Mama insisted on treatment at Bethany Children Centre and her child will survive, but without her right arm.
Following a full morning of emotional interaction with many patients Brenden and I decided to lunch at the hospital cafeteria. The menu was in English and Swahili, and the choices were variable though the actual choices available were quite limited. We decided on stew by a process of elimination, and ordered fries on the side, just in case. Brilliant idea as the stew was made from what looked like octopus or squid, but in reality was animal small intestine! It was so gross smelling I could not try it, though Brenden actually did. I managed a few fries and a bottle of very tasty mango juice. We returned home around 1PM and I decided to rest and recuperate from the morning and the meal while Brandon returned to the hospital with many donated items from his Oakville school students. They (the children at his elementary school, where he is the principal) actually were able to raise over $10,000.00 besides the items donated. Like me, he has been blogging his experience with access being encouraged in the classrooms back in his school; he has received many sympathetic responses.

Nov 19, 2008. This morning Brenden and I were given a grand tour of the Bethany Kids Centre. This organization came into being in 2003 and rapidly expanded to 64 beds; today there were 68 inpatients. The Centre attracts patients from all over Kenya and many more are showing up from Somalian refugee camps. The original idea was a general pediatric addition to Kijabe Hospital. Rapidly it has become and area of expertise in management of hydrocephalus and spina bifida, an emergency situation requiring urgent surgical management. The need is there for significant expansion; one of the two surgeons has over 200 cases on his waiting list of less urgent matters such as hypospadias and other non-life-threatening conditions. The hope and will is there to bring it to pass. Even the funds are falling into place. Now remains the important decision of building a new facility or simply continuing to expand the current hospital. Important transition time for all here and the various international sponsors.
We made rounds with the one of the spiritual care women this morning, Mercy Ng’Ang’A, who dispenses hope like it grows on trees. She brought us to all the amazing little patients, some waiting for surgery, some on their way to recovery already, and with variably hopeful Mamas. And it is the latter that Mercy especially focuses on to encourage them to maintain hope for better things for their children. The patients are a mix of Christians and Muslims and Mercy made no exception in her message and prayers, even though (a few) of the Muslim women were clearly not impressed by her Christian principles. All of the patients accepted us willingly and were eager to have photos and to see themselves on the viewing screen after. The older children were clearly amazed, befuddled, and amused by the pictures. Many asked to have a copy and I spoke with Mercy to allow me to send back a CD of the images. She will gladly see to it that the parents get a copy, likely when they return for a clinic follow-up visit.
There are many Somalis in this ward, probably 30% of the patients. Many of them spoke either Swahili or a local dialect making communication difficult. The Kenyans almost all were quite fluent in English. In addition there were a number of Masai women and their children present. Aikadir, a Somali male refugee, was eager to tell his story, taking us back to the tribal conflicts in the early nineties, followed by a brief reprieve, and then the continuing violence which still wages today. He wanted us to understand that the favored countries for emigration to included Canada and Australia. He was aware of the large Somali population in Toronto. He made it clear that, though Canada was a strongly preferred, the wait time was measured in years, making it difficult to maintain hope. He provided me his name and cell number in case I could have influence! He was not even close to the opportunity to emigrate yet, saying that once they are selected, they are then placed in internationally sponsored camps where the more well-to-do and educated are separated from the peasants; this because the educated had learned respect for life and other fellow humans, whereas the peasants knew only pillage and plunder as a way to advance themselves making it dangerous to mix the two populations. This young man was very aware of the unrest in his home country and showed no desire to return but wished only to be successful in his immigration, preferably to Canada.
One little patient had been admitted to a hospital in Nairobi for an infection requiring intravenous antibiotics but things went terribly wrong resulting in a gangrenous right arm. Mama insisted on treatment at Bethany Kids Centre and her child will survive, but without her right arm.
Following a full morning of emotional interaction with many patients Brenden and I decided to lunch at the hospital cafeteria. The menu was in English and Swahili, and the choices were variable though the actual choices available were quite limited. We decided on stew by a process of elimination, and ordered fries on the side, just in case. Brilliant idea as the stew was made from what looked like octopus or squid, but in reality was animal small intestine! It was so gross smelling I could not try it, though Brenden actually did. I managed a few fries and a bottle of very tasty mango juice. We returned home around 1PM and I decided to rest and recuperate from the morning and the meal while Brandon returned to the hospital with many donated items from his Oakville school students. They (the children at his elementary school, where he is the principal) actually were able to raise over $10,000.00 besides the items donated. Like me, he has been blogging his experience with access being encouraged in the classrooms back in his school; he has received many sympathetic responses.

Nov 18, 2008

Nov 18, 2008. Today was another interesting one. Ivan had a meeting in Nairobi so Brenden and I went along for the opportunity to explore a little bit of Nairobi while he met. We were dropped off at the Village Market, basically a mall with a good selection of many things including souvenirs. We spent a couple of hours making a couple of choice purchases and then headed by foot to the Java House where we met with Ivan, Dr. Bransford, Oscar (a Kenyan administrator who works at Kijabe Hospital, and the assistant to Kenyan US ambassador to discuss matters related to the mission here in Kijabe and try and solicit whatever support might be available from that source. A very interesting discussion for certain and what amazes me most of all is the effective networking that seems to be going on amongst the various stakeholders in current and proposed projects to aid and assist some very desperate and disadvantaged people. It is truly touching and yet mind-boggling to see the determination of all concerned to achieve the most possible for disadvantaged Kenyans.
On our return home we were stopped briefly by armed military that were simply checking on our destination. When they realized we were associated with Kijabe Hospital they were quick to see us on our way.
On arrival in Kijabe Brenden and I stopped a the hospital to meet Mercy, who will give us a more complete guided tour of Kijabe Hospital and especially Bethany Kids Centre, the main purpose of my visit here. This project started in 2003 and has expanded from its initial 17 beds to a current 64 beds; however, on our visit to day there were 75 patients!
The hot African sun sure takes a toll, so on arriving back in Kijabe I decided to rest and write for my blog. I am trying (with great difficulty) not to take a very tempting nap as I am certain it will play havoc with my night!
Tonight we go to the Bransfords for dinner, but prior to that Brenden and I will likely go to the Poenarus to check our e-mail again.
Brendon decided to run when we got home; he lasted only 15 minutes and returned with considerable difficulty breathing; we are at 7000ft and that sure is obvious when we walk uphill (all the time here on the side of the mountain!), and it is apparent I am not ready to have my little Kenyan run yet.
OK, so only 15 minutes shouldn’t wreck my night…

Nov 16, 2008

Well, here it is, Sunday, day 4 already, and after a very comfortable sleep, we have had a delicious breakfast of homemade granola, fresh pineapple, bananas, and passion fruit. Again, it was most interesting to absorb the after-meal discussion of the goings-on, the plans, the visions, and the dreams. Each day I am left with little doubt about the sincerity, compassion, determination, and cooperative spirit of the many players from around the world, seemingly so casually gathered around a homely breakfast table and discussing real needs of a desperate population for whom they are already making a huge difference.
After breakfast we were invited to an outdoor church service wherein seven young teenagers were baptized. Though I don’t always seem to have a strong religious faith, this was truly a moving ceremony. The attendees were from the Rift Valley Academy which is comprised of students of the various missionaries and others in this area. Apparently there are few native Kenyans enrolled as the fees are prohibitive. This was followed by an amazing meal at the newly opened cafeteria. I asked for a tour to get some photos for Genevieve and we all were shown around this impressive facility.
Following this, we were invited to Dr. Dan Poenaru’s home where we met his wife and 2 teenage sons. They chose to move here about 5 years ago, Dan returning about once a year to work at Kingston General Hospital, ostensibly to allow him to be able to continue to live her in Kijabe. At Dan’s place his wife (Dita) told me of a baboon fight which happened in the lower part of her backyard an hour or so before we arrived. Though this is apparently not usual, it certainly made a great story! From this place we were able to connect to the internet and keep in touch a little today. Their home is located on a hillside overlooking the Rift Valley which, at his time of the year (rainy season just finished), is very green and lush, surrounded by volcanoes, the highest of which is a two-headed volcano known as Mount Longonot. In the valley we spotted to large areas occupied by white tents, the new home of many Internationally Displaced Persons (IDPs). Story is that they were displaced by the recent violence in Kenya, were offered a small sum of money per person (approximately $150.00) to return to their native territories, but instead pooled the money and bought the land on which they now live in tents! Large covered trucks could be seen heading in their direction, presumably local or international humanitarian efforts to help them survive.
When we left Dan’s at around 530PM, Ivan offered to take Brenden and I to the Kijabe Hospital. I have seen pictures before, just like most, but to walk through this hospital was a very emotional and unforgettable experience. Bethany Kids Hospital is a portion of the Kijabe (General) Hospital. Presently, the crowded pediatric ward has 65 beds, and presently there are more than 75 patients literally crammed into whatever floor space could be found; no such thing as private rooms, or for that matter, privacy at all. Each child is accompanied by a parent who stays continuously to comfort and provide much of the basic care. There was, really, barely space to walk between the cribs and surrounding parents. And, we were reminded, these were the lucky ones! Two of the most common pediatric conditions treated here are spina bifida ( a condition present at birth wherein the spinal column does not fully surround the spinal cord, sometimes leaving it fully exposed) and hydrocephalus ( a condition wherein the normal circulation of fluid from the brain down and around the spinal cord is variably blocked, again at birth, causing a dramatic collection of spinal fluid within the brain, compressing it against the bony skull; in infants this results in a very large head, but as the skull bones fuse and the head enlargement can’t continue, the increasing pressure pushes the brain against the inside of the skull with devastating effect and inevitable demise). The sites around the wards were pitiful, to say the least, but the parents eyes beamed with hope. My emotion as we left was overwhelming and I felt angry to think of the nature of encounters I have become accustomed to in my day-to-day practice of medicine in Canada; and we bitch about the inadequacies of our system but, by comparison, it is like riding a Cadillac while the system here is like a donkey ride.
Tomorrow we will leave bright and early for Joytown, an orphanage for physically and mentally disabled children, as well as a guided tour of Feed The Children in Nairobi….

Nov 17, 2008. This morning we got a bright and early start to our day with breakfast at 6:15 and then hit the road for Nairobi, about 50 km to the southeast. To say that a person’s greatest danger in Africa is being on the roads is a gross understatement. Dr. Bransford was our driver and has obviously negotiated the traffic before. Far as I can see, it is survival of the luckiest! But, then again, it works. The local roads here in Kijabe are red sand and unpaved and the recent rainy season has left large washouts in many places as the whole community is on the upper side of a hill overlooking the Rift Valley. The unpaved roads have large boulders reaching upward, and washout drains 12-18 inches deep in places. Interestingly enough, the more I try to describe the conditions here, the greater the resemblance to some of my experience growing up on the Northern Peninsula of Newfoundland, though I think it wasn’t as harsh there, even with the bitter winters – perhaps my memory is fading.
En route to Nairobi, we picked up Jane, a former student at our first destination, Joytown, just east of Nairobi. She lived there for eight years, graduated, and is studying to be an administrator. She is a soft spoken, well-informed, and resourceful woman whose criteria for admission to Joytown were her club-feet physical disability. Joytown is a government operated public school for the disabled, though its origin was with the Salvation Army. This year, it had 308 students with a waiting list of another 200. About one-third of its operating costs are provided by the Kenyan government, part of the balance provided by various aid agencies and gifts-in-kind, and about 30% of the cost is directed at the parents who typically are only able to pay one quarter of this amount. During our visit many of students had already finished the national term exams and returned to their community care persons, parents, etc. However, there were a few stragglers still around, looking rather forlorn and hopeless, for the most part. The school principal offered us a guided tour. The facility was a travesty to see, even though they were making a diligent effort to clean it up while we were there. A typical sleeping area for 36 physically and mentally disabled children was a room about 16 feet by 36 feet. Beds were literally touching, there were no privacy screens, the mattresses consisted of 4 inch white foam which was ripped and grossly stained, but being readied for reuse. A small number of mattresses had plastic covers. These mattresses were laid on a frame with a spring support, I am not certain what sort of covers were provided as they were not evident. The toilet facility for the same 36 disabled children consisted of one partially enclosed toilet and one hole-in-the cement floor. The shared shower area was adjacent and consisted of a cement-walled partially enclosed area with 2 rudimentary shower heads. It was the duty of one Mama to prepare all of these children in the morning to be ready for breakfast and to start classes by 9 AM; she started at 6:30, do the math. We then visited the tiny and poorly supplied and maintained classrooms making me wonder how anything meaningful could be taught in such conditions. And, although some disappear after enrolling supposedly because of the cost (though they are never penalized for not being able to pay), many of them apparently go on to graduate and as many as 25% will go on to further training such as Jane, who described her eight years there as enjoyable! The principal answered many questions but left the impression that she often did not really know what she was talking about. After having tea and treats we moved on to visit the Feed the Children facility in Nairobi.
This organization serves 2 main functions. It is an adoption centre for abandoned infants, typically from the slum areas of Nairobi. Children typically arrive by whomever has found them, often only a day or two old, are given a complete medical exam and as much information as possible about how they ended up abandoned is sought. Apparently this site was at one time the same, if not worse, than Joytown. An American couple felt compelled to do something about it in the late 90’s and in the past 8 years it has been transformed into as well-organized, and good a facility as you would find anywhere in Canada. At least 48 of the children there have now grown into young adults but have not been adopted, yet. The other 65 range in age from newborns to toddlers. They were very interested in their visitors, were more than willing to chat and play with our cameras (though we were forbidden to take pictures of the children), and the place seemed very much full of life with plenty of modern play facilities and open spaces, quite a contrast to Joytown. The second function of this facility is, as the name suggests, feed children. They are supplied with basic food supplies, mostly corn, soy, beans, and oil by a variety of world aid programs and the food is stored in a very clean, well-aerated, and organized storage facility. They provide food supplies to schools in the worst slum areas of Nairobi to allow a breakfast and midmorning meal. This represents the only meal these children actually get. They also supply similar rations on a monthly basis to AIDS-affected children. The receiver of the food must then convert the raw materials into edible food and this is done at the schools, typically by the parent-teacher associations who grind the corn, etc., on site. Though it isn’t exactly a typical North American meal, it certainly seems to an impact as measured by the sharp increase in graduating students in the slum schools. It had also been noted that young girls from the slum areas regularly missed 4-5 days of school a month. This was tackled by supplying 4 sanitary napkins per month per mature female for nine months (the duration of the school year) and has resulted in a marked reduction in absences and a similar increase in female graduates! Following our tour we were served a hearty meal of rice, beans, bread and juice before heading back to Kijabe. Though the road was rough in the back of the hospital ambulance in which I managed to catch a little sleep – the African sun is powerful!
Tonight we go to Dr. Dan Poenaru’s for dinner, and maybe a chance to connect to the internet again.
Did I mention that the vehicle we were in was an ambulance donated by the Rotary Club of Kingston!!

Nov 15, 2008

Nov 15, 2008. The Mayfield Hotel fare included breakfast, at which time we met up with another associate of Ivan’s (Pierre) from Belgium. We were met after breakfast at the Mayield by Mike (lives in Kenya) in his VW van, loaded all of the various packages and luggage on board and the six of us headed for the hills, Kijabe that is, at about 7000 feet elevation, and about 50 km northwest of Nairobi. On passing through Nairobi, it seems to be a bustling city with many new buildings appearing, however, there is plenty of evidence of shanty town living, especially on the outskirts. In addition, there are many markets lining the highway on either side with a potpourri of items for sale from fresh produce to crafts, animal hides, etc., and it seems to be a bustling industry. Brenden and I took pictures as we drove by these interesting sites which are riddled with bright colors and with a back ground of very impoverished looking housing and bright blue African sky. However, it seems to work! I was struck by the visual similarity to a previous trip to Marguerita , and by the intensely red soil, contrasting with lush green. Apart from the obvious tropical theme to the plant-life and trees, the red earth made me think very much of PEI! We stopped at the Kenya Wilderness Tours office to purchase our fares for a 3-day safari leaving on Friday this week, during which we will fly to a remote site in the Masai Mara and stay for 2 nights! More on this later, obviously!
Our arrival to Kijabe was prefaced by a very commanding view from 8000 ft elevation, of the Rift Valley. It is very impressive in its vastness and beauty, being surrounded by lush mountain sides that reach high into that blue African sky. Mount Kenya is somewhere in the distance, and is said to be the only mountain on the earth’s equator with snow at its peak! The most obvious peak is Mount Longonot, with a 2-cratered volcano.
On arrival in Kijabe, we met with Dr. Dick Bransford and his wife Millie (originally from the USA), our hosts for the next 2 ½ weeks. They are wonderful people who have made Kenya their home for the past 31 years. Brenden and I were welcomed like all the others in our party and we were led to our quarters, the guest house, just down over the hill from their main residence. This is best compared to a cement-construction cabin-like place with a tin roof, and windows which are carefully protected with security bars. It includes a decent sized sitting/eating/cooking area, with 2 bedrooms which share a common 3-piece ensuite. We feel very privileged to have this quiet zone to ourselves. It is equipped with everything necessary for cooking , etc. and Millie presented me with a banana loaf and cookies to go along with the tea that is also included in the guest house. We settled in quickly, unpacked our personal things and gifts and went immediately to the local soccer/basketball tournament, hosted by Kijabe, and with many teams from Nairobi. We then went to cheer on Philip, adopted son of Dick and Millie, who was playing in net for the winning team! Everyone was quite proud of his performance, especially in the tie-breaking penalty kickoff where he made the decisive save.
Following this, Brenden and I headed out on our on to explore some of the local artist market. The crafts are remarkable, all handmade by the artists who were present to sell their pieces – bartering is the expected tactic to achieve the fair and acceptable price. The artists were kind enough to allow me to photograph them in front of their work. Without giving away too much, suffice it to say that I managed to acquire nearly all of the souvenirs I intend to purchase.
At 6 PM we got the phone call that supper was ready and joined Dick, Millie, their 2 adopted sons (Philip-12 and Josh – 16), and Ivan, for a meal on the deck. By now it was dark and, as is apparently typical, very windy and quite cool when the sun disappears, because of the elevation.
After attending the first-half of a high school production of “Easier By the Dozen” we headed back to our quarters and after finally getting a chance to e-mail hone, Brenden and I headed for the guest house and I crashed by 1030; still not quite fully adjusted.

Nov 14

Nov 14, 2008. We arrived at Heathrow right on schedule and pulled into monstrous Terminal 5! We again made our way to the BA lounge area, had breakfast, and cued up for a full and relaxing shower; this and all the other drinks.food/etc. were all part and parcel of the airfare. However, unable to connect to the internet!
After a four-hour stopover in London, it was back on a slightly newer version of the BA Boeing 777, this time for the final leg of our flight to Nairobi.
We arrived about 10 minutes earlier than our scheduled arrival and were met at the airport by a Norwegian associate of Ivan (Noel) who had flown in an hour earlier. We were shuttled from the airport to Mayfield House for an overnight in Nairobi. It was basic, but quite comfortable quarters, fully furnished with mosquito netting.

Nov 13

Nov 13, 2008. Departure Day. This morning was a pretty typical workday from 6AM to 11AM but the excitement of the trip to Kijabe took hold when I arrived home to make final preparations. When the SUV was loaded we were on our way to our departure place point at Pearson Airport. Hugs and tears saw us on our way through the security area. After a very relaxing drink and meal at the British Airways Club Lounge, our flight left on time and, being seated in business class we were able to stretch out full into beds and catch some shut-eye. In-flight service was very detailed and comforting.
We are expecting internet service at Heathrow.

OK, so the time is getting really close. By now I feel like a pin cushion and my immune system has been more stimulated than ever in my life! Vaccination against tyhpoid, influenza, pneumonia, cholera, traveller's diarrhea, tetanus, diphtheria, and polio! And, starting tomorrow, malarone, to prevent the manifestations of malaria, should I be unlucky enough to get bitten. I will also wear (100%) DEET repellent to keep the pests at bay.
My bags are packed, and I am anticipating details, the camera, the charger, enough of the right clothes, reading material, etc., etc, etc.
My anxiety level is a little lower than I had expected it might be at this point, maybe a factor of the preoccupation with the preparation.
One more day before we depart for Toronto, from where we fly to Heathrow, and then on to Nairobi. Form Nairobi to Kijabe we will drive for about an hour. Kijabe is at about 6500 feet elevation, very warm daytime, cooler at night, from what I can tell.
And, of all times, I have developed a nasty cold!

Further to my last entry, I have not yet taken my typhoid vaccine; never seems to be a good time to take the chance of the GI side effects - this weekend I am on call for everything I do, and on Sunday Veronique and I will be leaving for Charlottetown until next Wednesday. This is a dual purpose trip, firstly to visit Genevieve and celebrate her birthday (23 today!) and secondly to attend the Palliative/Hospice Conference there this coming week.
Tonight I made an inventory of the many medications, mostly this represents antibiotics which the Kijabe Hospital seems to want the most.

Further anticipation

Today I have spoken with a colleague who has just returned from an African vacation where he managed to see a Cheetah, amongst other beautiful wildlife. he also described an interesting interaction with the Masai with whom he traded his wrist-watch for a Masai hunting knife...hmmm.

Further preparation: the vaccines!!

I have previously started vaccination against hepatitis A and a booster for B. I have also recently updated my tetanus vaccine. Today I have secured further vaccination in the form of typhoid vaccine from the Public Health Unit (for information purposes, the oral vaccine apparently has a longer duration of action, up to 7 years of protection; indeed, I prefer this to an injection, one of my personal peeves. I have also been advised to bring along Cipro, start Malarone 1-2 days prior to departure, to bring along DEET 30%, to consider mosquito netting ( the latter two available at Army Surplus or Trailhead in downtown Kingston), and maybe water-purifying tablets. mention was made by an earlier counsellor to consider rabies vaccine. In view of my prior history of a tendency to traveller's diarrhea, I have decided I will take Duokoral as a preventive measure. Naturally, I suspect the PHU may naturally be over-inclusive with the advice provided. Reality is that the greatest danger to my health would likely be a road accident, for which it is difficult to prepare.

Anticipation

This experience has been a long time coming. I have been encouraged to visit Kijabe for several years now by my friend, colleague, and mentor, Ivan Stewart, who has been involved with AIC Kijabe Mission and Bethany Kids for several years. I have received unqualified support from my wife and four children, and my colleaques at work have been very supportive with encouragement and medical coverage for my busy medical practice from which I will be absent for 2 1/2 weeks.
In preparation for my visit I have been exploring Kijabe online, have written and heard from the director, and have spoken with Ivan in person. We are in the process of collecting a variety of medical supplies and medications to be taken along for the hospital and outpatient clinic. In reviewing the online list, I have tried to use it as a guide to the most needed supplies. I have had a generous donation from Pfizer via Jodie Murphy, have managed to scrounge a number of pharmaceutical samples from my own practice, but hope to acquire more antimicrobial medications prior to departure.
It is exciting to anticipate the experience of a place I have only read about and to imagine the reception, the atmosphere, the surrounding countryside, and the fascination of meeting people who actually do this work day-in and day-out year-round.