Rafting on the Nile

On Friday, 13 of us headed to Jinja, Uganda to take on the Nile. The Nile has many class 5/class 6 rapids. Usually in other parts of the world people are unable to raft 5/6 rapids successfully because it is often too shallow and too dangerous. The Nile is deep though so flipping onto rocks is not as much of a concern.

Anyway, many of us were still a bit apprehensive so we asked for a 'no flip' boat. Many of the guides will flip boats on purpose for added thrill, but since drowning wasn't really on our agendas, we opted for the 'mild' experience.

We started the trip with some safety training - learning how to get down, what to do if we flip, and how to get back into the boat safely.


Then we were off! Starting the day off with a class 5!

The nice thing about the Nile is that there are calm pools of water between the rapids so we actually spent a lot of time lounging in the raft and swimming where the guide told us it was safe. (the crocodiles also like the calm areas!)

Our guide did a phenomenal job keeping our boat upright. However, I wanted to experience the thrill of flipping one time so I switched to our other group boat for the last rapid. We went over a class 5 and suddenly we were all flying out of the boat. I managed to hold on to the raft for a bit but then the raft ended up bouncing again so I found myself surrounded by waves, taking every opportunity to get a good breath before the next wave took me under. This only lasted about 10 seconds until I was in a calm pool of water and grabbing onto a safety kayak, but of course if felt like much longer. It was scary but definitely one of the most amazing things I have ever done!!

We all made it back safely sans crocodile bites or schistosomiasis (well at least so far!) :)

The next morning we celebrated with a famous Ugandan breakfast...egg, tomato, onions, and avocado wrapped in chapati!! (chapati is similar to indian naan or a thick crepe) YUM


More pictures

One year ago...

I was interviewing for the FICRS program in Bethesda! Wow time flies.

If you are at the interviews and have specific questions about the Eldoret site, please feel free to contact me at Szkwarkd at gmail.com. Good luck to all of the finalists!

Mountain Biking in Iten

This weekend a group of us headed to the Iten High Altitude Training Center. Runners from all around the world come to Iten to train so the facilities are amazing. Luckily, they also let normal people in to relax, mingle with the runners, and use their equipment/facilities.

We decided to rent mountain bikes from the center in the morning and headed for Bugar Forest.

Making our way towards the valley...


Huts in the distance...


Ngooooombe! (cows)


Kids and dogs chasing us...I think they could probably run faster than I can bike!

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