What can you carry on your bicycle?

This is a post I have been planning since September, but I've been waiting to complete my photo collection.

I am constantly amazed by the items that people manage to carry on their bicycles in Kenya. Most of the items below would not fit in the trunk of my toyota!! However, one lesson I have learned this year is that if a person only has limited resources and money, he/she manages to improvise in fantastic ways to become as efficient as possible.

Soooo here we go!

Grass for thatching


A table, a bucket and a few bags of goods


A child (where is his helmet???)


Sugarcane


bundles of wood


And my favorite....
A bicycle!

A need for affordable primary care

I received a phone call this morning that a patient with pulmonary TB brought her children in to be screened for TB. One of the main objectives of my child contact register project is to get patients to bring their exposed kids in for screening so the fact that someone actually did was great news. However, I encountered a bigger problem when I arrived at the clinic - mom and kids were HIV negative. Why on earth would this possibly be an issue? The original mission of AMPATH was to provide affordable healthcare and support to HIV infected individuals in western Kenya. The organization has succeeded with this and currently manages >160,000 HIV infected individuals and counting. In other words, if you have HIV in Eldoret, your clinic visits, medications, lab studies, and imagining is free. So a child exposed to TB in the home who is HIV infected can see his/her clinician and be sent for a chest x-ray for free (a savings of approx 6 dollars).

What about if your child is HIV negative? Well prepare to wait in a long line at either the sick child Emergency Room or the Pediatric Acute care (only open 2 mornings a week) to have a clinician see the child for a fee. Then the clinician will probably send the child for a chest x-ray so it will be necessary to pay 400KSH for the test. To put things into perspective, a 30 minute bus ride costs 20KSH and a lunch costs 80KSH so these medical costs add up quickly.

Fortunately, this issue is well known, and AMPATH has just started shifting to a primary care model to incorporate HIV negative patients. It will be interesting to see if a test like a chest x-ray will get waived for a HIV negative child who has been exposed to pulmonary TB at home.

In the meantime, I feel a bit torn. Of course I want the clinical officers to encourage pulmonary TB patients to bring their children in for screening if they are symptomatic. Isn't a chest x-ray a small price to pay if your child's life is at risk? Conversely though, if they can't afford the suggested screening, what are the emotional consequences of telling a parent their kid might be very sick but they can't do anything about it due to financial constraints?

I couldn't answer this question today so when the mom told me she could only pay for one x-ray, I contributed the rest to get the second. Luckily, both kids were TB free and mom (and I) are relieved. Here's to hoping that a more sustainable solution is on the horizon!

Adventure at the market

For the past several weeks I have been determined to buy a chicken at the market. I've been buying all of my meat in the frozen section at the supermarket which is expensive...not to mention I'm skeptical of Kenya's meat packing quality control. The chickens at the market are ALIVE when you buy them so you really get to see them in action!

Here are the steps on how to buy a chicken at the market:

1) Pick out your chicken! The market has about 30-40 cages full of chickens so you just need to find a vendor who looks friendly and will tolerate picture taking. Then it's time to find the chicken with the most meat. This involves holding the chicken to assess the weight and feeling under the feathers to figure out how meaty the chicken is.


2) Hand the chicken over to the vendor so that he can kill it. I'm not going to go into this process since it may disturb some of you.


3) Find a fun way to cook the chicken! I chose to make beer can chicken which is so easy and absolutely delicious. All that is needed are a few spices for the outside. Then stick a 3/4 full beer can into the chicken and balance it in the oven!


I don't have a picture of the final product but it was sooo tasty! I will definitely be buying another chicken soon.

Tumaini Family Planning

The Tumaini children's center held a family planning outreach session for the girls who live on the streets on Saturday. The organization does its best to reach out to the street kids. However, the girls are a difficult population to work with because it takes longer to gain their trust and the issues that they need to discuss are often extremely sensitive. The Tumaini outreach workers have been working hard since December to introduce the idea of family planning to the girls and encourage them to attend Saturday's session to receive counseling and a depo provera shot (a form of contraception that will prevent pregnancy for 3 months).

The burden of having and raising a child on the street is incomprehensible. In Montreal, focus groups with street girls have demonstrated that street girls unanimously felt that their lifestyle was incompatible with pregnancy. However, the concern for pregnancy does not always translate into disciplined contraceptive use. In Kenya, it is not culturally acceptable for women to suggest condom use because it is believed that the man is responsible for making this decision. Furthermore, many of the street girls are raped which obviously leaves the girls with no say. To complicate matters even more, once pregnant, girls will often resort to homemade abortive measures which can be extremely harmful (one of the common techniques in Kenya is to drink bleach).

The outreach session was very well received and we were able to administer >20 pregnancy tests and about 10 depo shots. The Tumaini outreach workers first talked to both the boys and the girls regarding family planning. Interestingly, although the boys often hurt the girls, they are also very protective and want to know everything that is happening to their fellow street children. After the combined talk, the girls came to the outreach tent and we had one of the visiting obgyn residents lead a discussion with them. Then they individually met with the doctors for counseling and the shot if they were interested and gave consent.

I am happy that I was able to be a part of this event and I hope that Tumaini will be able to host another in 3 months to ensure that these girls continue to get their shots. Many of these girls were forced into living on the streets for a variety of reasons, and they deserve a choice to access health care and preventive services that can improve their quality of life. Family planning outreach is a small step towards this goal.

The Outreach Tent


Urine Pregnancy Tests


Counseling session with one of the docs and a Tumaini staff member


Some of the girls who attend the center regularly

Finally some rain

Last night was the first time it poured in 4 weeks. We are in the middle of the dry season and although the sun is lovely, the dust is another story. I feel like I am one big dust ball by the end of the day and the dust has been irritating my eyes so much that I have been wearing glasses for the past 2 weeks (those who know me well understand that it takes a lot for me to wear them!)

Anyway, I'm sure I'll regret saying this when the wet season arrives in March, but I was thrilled to walk through puddles and mud this morning!

I took this picture on my way to work this morning...the rocks on the right are the early signs of sidewalk construction. And look at all of that water!!

Kenyan Forests

One of my longtermer friends and her husband are building a house at the edge of the Kaptagat forest (about 25 minutes from Eldoret). I have been fortunate to visit their property twice this year to see how the house building is progressing and to walk the grounds to admire the wildlife. Yesterday, we crossed the road from the property to explore and enjoy the forest a bit more. The couple is also extremely passionate about forest conservation, and I always manage to learn something interesting about the history of Kenya's forests and the importance of protecting these precious regions.

Here are some facts:
Forests currently cover only 2% of Kenya's land region, however, they contain 50% of the nation's tree species, 40% of its larger mammals and 30% of the bird population. Unfortunately, the forests are in great danger due to uncontrolled forest exploitation. The proximity of Kaptagat forest to Eldoret makes it particularly attractive for individuals who sell wood and charcoal since they can easily transport the material to town and sell it. Forests in Kenya are important for many reasons - they trap and store rain water, regulate river flow and prevent flooding, they are major habitats of wildlife, and are traditionally important for cultural ceremonies etc.

Luckily, my friends are leading the effort in Kaptagat to encourage landowners to plant their own inexpensive trees on their land to use for wood and charcoal. This could be an easy way to discourage the community from destroying the forest yet maintain the source of income the community receives from the wood and charcoal business.

A tree that is estimated to be more than 1000 years old!




Butterfly


Villagers carrying wood from the forest towards the main road

Mom Visits Kenya - Part II

After our week in Eldoret, my mom and I joined one of my good friends from Eldoret, her husband and her parents for a grand tour of Kenya. The landscape, culture, and climate change drastically as you move around the country, and we wanted our parents to experience the many different wonders that Kenya has to offer. Here is a map outline of our trip:

View Larger Map

We started out in Masai Mara Game Reserve for a 2 day safari. The landscape was gorgeous and we were able to get close to most of the big five (minus the leopard who was well hidden behind bushes).

Big Five sans leopard

Lions

Cape Buffalo

African Elephant

Black Rhino

One of the most exciting/frightening events from the Mara was when the rhino above decided that we were way too close and she turned and started to charge! Our driver quickly reversed out of her path. Cool fact: rhinos cannot turn when they are charging because their vision is poor. They focus on their target before the charge but once they start running they don't realize that their target has moved. Useful advice if you are ever face to face with a rhino!

Other animal highlights:

Cheetah

Hippos

After the Mara we made our way to Nairobi and then flew to Mombasa. From there, we drove to Watamu, a small coastal fishing village on the coast of the Indian Ocean. We were very lucky to find an inexpensive private home to rent with a pool and a cook. Fish is not readily available in Eldoret so we made sure to have fish with almost every meal! In addition to stuffing our faces, we did a lot of relaxing and enjoyed some wonderful snorkeling in the Indian Ocean.

Lunch

Dinner

Snorkeling and the beach

We all agreed that we could have stayed in Watamu forever, but we had some sightseeing to do in Mombasa before our parents had to get back to the states. Mombasa, Kenya's second largest city, is a major port in East Africa and has been a prosperous trade center since the 12th century. Control for it's economic wealth was fought over by Arab traders, the Portugese and the Brits and it was also home to Indian traders as well as the Bantus (Africans who migrated from west-central Africa to the coast over 2000 years ago). The variety of cultures are visible in the Old Town's fascinating architecture. This was one of the most interesting places I have ever visited and I could get lost in the small alleys for hours without getting bored.

small alleyways and mosques

Fort Jesus

Thankfully, everyone made it back safely to either Eldoret or the US (without malaria or any severe GI distress!)

I am feeling refreshed, energized and ready for a productive winter/spring!

I have posted all of the albums from our trip here.