Hippos and Protecting the Gonads of Africans

Over the weekend, I was able to travel up to Lake Baringo NP. This place is famed the world over for its winged wildlife. Home to hundreds of different birds, the place definitely lived up to its billing. However, for me, the most fascinating thing I saw, I could barely see. As the matatu trip itself wore me out, I was in my tent pretty early. At some pint during the night I was awakened by a deep, cackling, burst of a "roar". Not having ever heard this in my life, I still had serious doubts that this came from a bird. So, peering out from my screened tent, I saw a massive, hulking creature the size of a Honda CRV... 10 feet from my tent. Now, I had been warned that hippos might be on shore during the night, and was further warned to NEVER take a flash photo, as it would turn hippo on me and try to crush anything in its path back to water. I decided to listen to this bit. I was still able to unzip the cover and get an unfiltered view of my first hippo, who was hiding behind it, a baby hippo. Now I really got nervous thinking about it charging me if the wind happened to blow a leaf into its eye or something. Thankfully, its so hot here that not many leaves remain on the branches for that to happen. It managed to eat its fill of grass and then retreat back to the water. Over the course of the night, I must have seen 10 hippos, all within 100' radius of my tent. It was truly breathtaking to see these hulking creatures evolve out of the darkness, lit for moments by the full moon peering through the branches. Waking up the next morning, me, Lydia (the other volunteer) and the 2 Israelis we met at dinner at the "Thirsty Goat" camp restaurant, went out on a boat tour of the lake. While I can say that bird watching does not thrill me like a certain trampling death from a 2 ton animal outside my tent, the place was teeming with so many birds that it floored me, nonetheless. Eagles diving into the water for fish, lizards sunning on rocks, teams of swallows and other crazy looking birds made it worth getting up at 06:30 after having not slept much. If people could please email me more ways to say "amazing", I would be appreciative.

A side note, Israelis must be the toughest people on the planet. The ones I have met have a total disregard for conventional means, personal safety, and tact, especially when it comes to personal space. A few Kenyan touts (people responsible for convincing you that their bus is better than the one you are already on) who were trying to pull their arms away from the bus they were entering found this out real quick. Strangely, this was very similar to my first Israeli female encounter at the Cambodian border, the verbal lashing so amazingly abusive that she almost got the whole lot of us stranded. At least that one was in English, so I understood the pounding the Cambodian took. This however, devolved into a Hebrew lashing no one but the 2 Israelis knew the specifics of, but everyone certainly knew of the meaning. Needless to say, they got on the right bus... the one they wanted. My respect for them continues to grow.

Now on to the gonads. It seems as though the biggest therapy achievement that I will have here comes in the form of an idea I had about why so many clubfoot babies were crying uncontrollably after corrective casting treatments. It has been frustrating Vitalis immensely. Upon viewing the methods, I happened to notice a lack of space for the boys' essentials between the two casts. So, after looking back on the reports for only two weeks, it was fairly easy to see that bilaterally effected males (needing casts on both legs) were the ones coming back with the casts removed by their parents. So, a simple bar included in the plaster mold, holding the legs enough apart to allow for some gonadal freedom has seemed to do the trick. Vitalis can't stop smiling every time he now uses it, calling it the "Meella" (Miller) method." It feels good knowing that it will be used after I leave.

My lasting gift to Kenyans? Healthy gonads.

Nuts, isn't it?

A Bit About Africa

About the environment of my town and life. I have started to count the progressive layers of dust I acquire on my walk just from my home to the main road. Averaging about 2.5 layers (every time a car drives by, the wind blows, or a butterfly flaps its wings in Mongolia), I think. In general, if you offer an African a better/more efficient way of doing things, they will very politely nod and say "yes, yes, that is a good idea!" then go back to doing it the same way. All of Kenya is on what I call AST, African Standard Time. Its somewhere between half-past that and a quarter of this. No one wears watches, which may be the culprit. What they say one minute will certainly change in another, and if you alert them to this fact and ask for clarification, you are going to get a 3rd answer. Basically, I just do what I want and think is best, and no one really minds.

There is a scarcity of jobs. So much so, that probably a 3rd of the people working for the hospital are designated as volunteers. They have gone through school, but with there being no jobs, they work gaining no income from the government, and rely on small gifts from patients and the paid therapists.

Politics is especially important these days as the December 24th presidential vote looms. Everyone talks about PNU vs ODM candidates. Obama's family is related to the ODM candidate/tribe.

I treated a UN Sudanese peace-keeping force member today. 29 years old, Muslim, extremely bright, named Juma. Talking about the world issues with him was amazingly interesting. Learned that his imam in his Mombasa mosque loved Clinton and actively promoted integration and understanding with the US back in 92-93 when Bill was elected. He could not say what the imam thought about Hilary... he has been involved in war the past 8 years. He broke his hand playing soccer and will return to Sudan in 2 weeks to rejoin the peace force.

A Continuation of Awesomeness

I am running out of vocabulary for describing my experiences. Then again, I think Grisham and King might have issues describing them. Everyday holds new challenges, experiences and feelings. Today, me and Vitalis and our mobile clinic made our way out west to a small school for disabled children. Again, we are more like the front-line access to all medical care for the people we see, so diagnostic skills come in handy and truly determine what outcome they will have. When I say that a few of the kids came crawling in to our room, I mean it literally. Basically what we could figure for one of them, a 22-year old that has never received medical care, is that he developed scoliosis, had it become so severe that his pelvis rotated so far right in compensation that it likely occluded blood flow, causing muscle wasting, disuse atrophy or some combination thereof. He basically had a 2 foot crutch under one arm and and a used glove on the other hand and just scooted around. Normal arm strength and use. Crutches anyone? We basically borrowed a pair from another kid and he could 3 point gait with the best of them. Six years + of scooting around on the ground because no one told him, or was able to provide him with crutches. Sponsoring him is a no-brainer, as he would be benefited the most and easiest.

Its basically been like this in each of the clinics. The more I find out about a Kenyan's description of what is "provided" by the government, the more I realize there are always conditions behind them. Not much is provided by the government, its through donations. I am also seeing that all of the ministries and donor organizations really do benefit those in need. All of the buildings at this school were built/funded by organizations and individuals; a Scottish group and a Danish doctor and his family. That really makes the cynicism melt right out of you, seeing so many students sit in a proper building, learning despite all of the hardships.

I think I finally got a picture uploaded, though this computer won't display it. Please let me know if you guys can see it, so I can continue to try if its successful and quit if its not...

Lions, Rhinos and Gazelles Oh My!

Yesterday, I got to experience an African national park. A "lesser one", at that. Lake Nakuru is only about a 20 minute drive from where I am staying. It is known for its flamingo infestation. I, however, found it to be packed with gazelles, lions, rhinos, monkeys, baboons, zebras, and numerous other creatures I could not recognize. All in the wild. All sometimes feet from the car. Signs alert you to the dangers of getting out of your vehicle, but this is rarely enforced and even more rarely obeyed. Needless to say, I have some amazing pictures with me and various wildlife in the not too distant periphery. The other volunteer and I rented a friend of our hosts car for the day. The friend drove; for most of the way. After the standard African delay getting started, we arrived in our Toyota station wagon at about 09:30. Not exactly what I pictured to be our mode of transport, but it was very comfortable. I mean, immediately, we started to encounter wildlife. Monkeys on the gate, led to water buffalo around the lake which inhabited, oh, only a few hundred thousand flamingos. So many, that the shoreline was completely pink in most parts. We drove around and came to the southern end of the lake and BAM 10 rhinos! I have always wanted to see a rhino, so this was definitely my highlight. Literally about 30' from our car were white rhinos; blew my mind. After one got up from the ground (they were lounging in the shade), we quickly shuffled... um, dove back into the car and made it a little more safe of a distance. We then got lost on the park roads, but made it close to the airstrip, where we picked up a machine-gun wearing, Massai park ranger, who after about 30 minutes found us lions. Afterwards, we all had lunch alongside a large waterfall at the southern tip of the park. On our way out we stopped at a 1000' high overlook called "baboon cliffs." This is about the only thing here aptly named, as hotels are, and can be, nothing but restaurants. Anyway, the cliffs provided one of the most amazing views of nature I have seen, with the vast lake spread out before you with those pink shores flanked by undulating plains and hills spotted with wildlife. All this from a "second-rate" park. Massai Mara will have to really blow me away for it to top this.


To answer some of your questions, I normally am up at 06:45 and at work for 08:00 taking a breakfast from my host family; 2 sisters: Emily and Rose. That is normally some cake-type things with Kenyan coffee. Right up my alley. I take a tuk-tuk or matatu (small bus) to and from work. I am actually based in a "large" provincial hospital, but I am sent into the rural parts of the area with a Community Rehab Initiative. We provide services, diagnoses, and referrals to people too far away, too poor, or both, in most cases. I finish at 3-5, and stroll around the town until diner, which is normally ugali (dense cornmeal ball), fresh veggies, and some meat or fish stew. It is actually prepared very well, taste-wise. They also seem to humor us with spaghetti, every once in awhile... There really is not that much to do, and I have already blown through A Thousand Splendid Suns, which is an amazing book, BTW.

The only day that is different is today, Monday's, when we hold a clubfoot clinic for children. Today I treated, via the Ponsetti Method, about 15 kids with various levels of severity. Some of them are fresh Spina Bifida surgery kids, some with hydrocephalus/MR/Down's, you name it. Obviously, I am learning from them at this point, as pediatrics is something I have never done before. But, I am able to throw in some knowledge every once in awhile, especially with wrapping/casting and alignment issues.

I will be in this setting for the next few weeks until the clinics shut down for December due to funding. I will then be moving into their outpatient setting, and this is where the Theraband will come in handy. I was oriented over there the first 2 days, and wow, the therapists have there hands, and well, their hands to help patients. They have a ramp and bars and a few pieces of antiquated modalities, that I am not sure are working right. Anyway, those of you in Austin, and who can and want to help with this could just run it by my sisters work at The Gables West Avenue, and then I will get them over here. Any help is obviously appreciated...

So, there is my life in a nutshell over here. Africa gives me such a range of emotions, a diverse set of feelings about the people, the places, and situations I experience every day here. More time will be needed for me to clarify in my self, exactly what these are and be able to put them into a coherent sentence for you. I believe my pictures will help you... later.

Oops... I forgot to ask...

To all of the medical people out there, I was hoping that you guys could help me secure some Theraband supplies. I am thinking a few boxes of the red, yellow and green or black would last this place a few years. Seriously. If you feel like you would like to help me get some, please give me an email. I am thinking about getting it shipped to my mom's and then getting it shipped DSL. Its basically plyometrics or bust over here, and a some TB would provide the most diverse treatment possibilities. Thanks!!

Firmer on the Ground

Well, I certainly did not think I would be writing about another amazing experience so soon, but yesterday was my first day in the field. Basically the entire health system here is stretched well beyond its limits. Compounding the problem is that most patients have no way to access the care, as they live too far from the hospitals and clinics and can't afford the $2 fare to get there. So, they have set up mobile rural clinics based out of trucks. So, we started out at 08:30 towards rural Kenya, passing the Menengai Crater along the way. The south outcropping which towers over the valley was illuminated through the mist and was truly breathtaking. After 30 minutes of bouncing around on the roads, we began our off-roading portion, going deep into a jungle farming area. Goats, sheep, jack-asses (of the 4-legged variety), and birds galore were everywhere. We reached the meeting point and over the next hour, people from around this portion of the Rift Valley closed in on us. They all patiently waited, some in the rain, for their turn to meet with Vitalis (a local PT), and me. PT's are basically responsible for diagnosing all issues in the field and make referrals to specialty clinics, pharmacies, labs, etc. We refer for surgical assessment and intervention. The Kenyan government pays for all services to those who can't pay, but those who don't know that care is available to them, don't seek it, this is most of the rural population apparently. So, thats where we really have an impact, as we initially diagnosed Down's, Epilepsy/Seizure Disorder, Diabetes, and numerous orthopedic issues. We made numerous recommendations and gave home programs for those who were appropriate and then provided a small amount of money for transportation to that facility, so that they can access our recommendations. Meaning-full work. After we had finished with everyone who had come, they had prepared us a meal to thank us. Rice, beans, I think cabbage, and stewed meat. It was all served in dirty pots on kind of clay plates with normal silverware. I would rather have had NASA-grade GI problems than have turned down their generosity. And, as of yet, no ill effects, thankfully.

Today, I am in Nakuru town,trying to learn my way and tomorrow I will heading out to Lake Nakuru NP, a place known for its flamingos, rhinos and leopards.

I am trying to get my pictures up, but the internet is as slow as I thought it would be...

Feet On New Ground

Well, besides a couple of moments when I thought I had lost something or had left it on the plane, the trip here went off without a hitch. With my bags in hand, I was met at the airport by a man with my volunteer agency who was to take me to the home of the country coordinator. Stepping outside of the airport I was hit by the smell of pipe tobacco, strangely enough, and an amazing sense of where I was, AFRICA!! The drive to the home was in a mini-van-type vehicle, taking me through and around police roadblocks all marked with spiked cement barriers. Being late, I wasn't able to get much of an impression of the land at that point. But, the next day I was taken to the National Museum in downtown Nairobi (which was under renovation which made us divert to the snake park), and my first impression was "Holy Cow, Africa is more like Africa in my head" than I thought it would be. Smog as thick as Bangkok, people and animals roaming the streets in somewhat equal numbers, everyone kind of glancing at my skin, but everyone being so amazingly friendly. The warmth of the people that you hear about, is totally warranted.

The roads however, are an evil, evil thing. The best road is a New Orleans special. The 3 or so hour journey in a matatu (minibus with amazingly loud and amazingly bad 80's music) to my base in Nakuru was an adventure in itself. The actual paved portion was what I described above. The UNPAVED portion was like driving with no shocks across a road that had a 2x4 laid apart every 2 iches. It actually seemed to encourage the driver to speed up, as though if we hit bumps faster, they might somehow merge into fewer bumps. While Kenya can't hold a candle to Cambodia's deep crevasses which make you smack the roof of your vehicle, the sheer frequency of bumps and length of the drive easily places it number 1 on my "I need a back pill and a bottle of rum" roads to avoid.

Our arrival (there is another volunteer, but teaching in a nearby orphanage, which I will occasionally be visiting) in Nakuru was amazing. Partly because I could feel my butt again, and mostly because my host family (2 sisters, or sistah's as they say) is over-the-top nice and accommodating. I don't know if I have ever had daily maid and laundry service. But, that is certainly the case here. I am living on the 3rd floor in a building on the edge of the city. It has no running water, but thankfully a toilet. You just dump some water into the bowl after you are done, if you're wondering. Its kind of a sponge bath situation for showers. We are fed pretty well, and I had the national dish, ugali, last night for the first time. Its basically a cornmeal ball, tightly packed, that you can slice and then eat alone or with anything else. They seem to just put everything into a bowl and mix it all up. The meat is tough, but the fruit and especially the bananas are amazingly good. The boil all the drinking water and also use it to warm up our showers. Speaking of temperatures, its actually been quite cool. I was expecting temperatures ranging from 80 degrees to 2-feet-from-the-sun, but it has been in the 50's in the morning and generally cool with the wind in the evenings.

My volunteering has been awesome so far. The first day, after orientation to the facility in the morning, I gave a speech about foot care and exercise with diabetes on World Diabetes Day to about 120 Kenyans underneath a large thatch-roofed, open-air structure. I was seated at the table of honor in the front with the other speakers. I remember sitting there waiting my turn, listening to the Swahili being spoken, looking across the crowd, feeling the cool wind blow, and thinking "Wow, this is one of those truly meaningful moments in my life." I can probably name 10 or so moments in my travels where the intersection of special surroundings, things, people, feelings, and, most importantly, awareness create the most magical of moments. This moment was certainly one of them. I mean, getting to sit there, provide helpful information to a group of Kenyans in Kenya is not something I ever thought I would be doing. Until recently... Then, afterward, 3 patients came up to ask advice on a their ailments. They were so respectful and appreciative, to an extreme. These moments are what drive me to keep traveling. They are fleeting moments of pure life, invigorating me to try to do more, see more and be more.

So, today was my 2nd day at work and I got to cast a bilateral clubfooted 5 day-old baby. I guess I shouldn't have to say more about that. They are still orienting me, but it appears that it will be soon that I will be practicing full-bore.

So, wow, it seems as though so much has happened. Its only been 3 days.