Since I have been here I have had so many questions. Why is it ok to beat your wife, why do people play into corruption, why do we sacrifice our patients health because we don’t want to “make them feel bad”, why is female genital mutilation still culturally acceptable? The response I always seem to get is “don’t worry my friend, this is Africa”. I cannot explain how tired I am of hearing this expression. My response back is, ok, I understand this is Africa, but, just because we are on this continent does not give us an excuse to compromise patient care, or, turn a blind eye to what is morally wrong, not to mention illegal.
Since I have last blogged I have had so many “this is Africa” moments. Just recently I was invited to work at a health camp in Kisumu Kenya. I was invited by the organization I worked with over Christmas, Maisha. Because it was termed a health camp, I was under the impression there would be other health care providers present. I was mostly wrong. There was a dentist and a hygienist from the States, as well as a Kenyan pharmacist and one other nurse. When I realized there was not a doctor present and I would be doing consultation, ordering labs, and prescribing medications I had mini melt down. In the states I am no way qualified to do this, but, hey, this is Africa, nurses become doctors. After I set some strict boundaries for what medications I was willing to prescribe the health camp began. I refused to prescribe anything that required consistent follow-up or more in depth lab work. Mostly, I was prescribing antimalarials, antibiotics, deworming medicaiton, pain medication and antifungals. Anything that I thought required more attention I immediately referred. I was definitely unconformable with the situation but I am so thankful to have worked these last several months at Tabaka Mission Hospital. I am beginning to realize how much I know about tropical medicine.
Maisha Medical Clinic.
Children playing with my stethoscope. We had a mini
class about listening to breath, bowl, and heart sounds.
One of my beautiful patients.
Another one of my beautiful patients.
In addition, to working at Maisha’s health camp, I also had the opportunity to work in Nyalenda. Nyalenda is one of the largest slums in Kisumu. Maisha has an outreach program where they visit HIV patients; they make sure they are taking their medications and bring them food. HIV medication is paid for by the government, but, often these patients are too poor to visit a doctor or pay for any other medications. It’s sad because these patients’ problems don’t stop at HIV. There are a lot of other comorbidities that go along with this illness. In addition, all these patients are living in conditions that harbor and manifest disease. I would be surprised if any of them are tuberculosis free.
Although, I had never worked directly in a slum, I knew most of these patients would have other health concerns; therefore I packed my backpack with available medications, and set out with Maisha on their home visits. Since most of their patients were bed ridden we were required to walk through the slums to their individual shacks (shack is even too nice of word to describe their homes). These people live in little shacks crammed together, where the walls are crumbling around them, and they have no running water, electricity or ways of containing sewage. Walking in, the first thing I noticed was the smell, a stench of rancid, burning garbage, rotting animal corpses, and putrid water; the smell of a community in decay. The few foreigners that were with me were shocked by the conditions these people lived in. They couldn’t believe people lived like this, in fact, I could tell they were so uncomfortable I knew they immediately wanted to leave. Not to say that this experience wasn’t eye opening for me, but, I have been here long enough to know the only way to approach a situation like this is with blinders. I had specific patients to see. Being in dismay about my surroundings would not help my patients or my emotional stability, so, you are forced to press on. Like I had mentioned I expected these patients to be suffering from other conditions, so, I packed a bag of the donated medication from Maishas’ soon to be health clinic. You would have thought I solved the space time continuum, the Maisha social worker couldn’t believe I was back packing into the slums with a mini pharmacy. I guess no one had ever thought of that before. What a concept, bringing donated medicine and aid to people who truly can’t afford it.
Walking into the slum.
Nyalenda.
Nyalenda.
Nyalenda children.
I’m really not trying to criticize Maisha in any way by saying these things. But the harsh reality is organizations in developing countries lack resources, staff and the biggest thing, money! They are truly doing their best with what they have, but, it can always be improved. Maisha has so much potential if they could hire the appropriate staff. This is why I am such a supporter of investing long term in organizations such as Maisha, Tabaka, or even CMMB. Everyone’s willing to open their wallet when a disaster strikes but what about donating toward long term goals, long term education, long term health care or community development. By investing in their futures hopefully these organizations will grow and become self-sustainable.
Working in the slums was an experience! It was extremely heart wrenching but I really enjoyed it. There were a few situations I was extremely moved by. It always amazes me how thankful patients are. In addition, I was able to witness a church from Oklahoma City initiate a feeding program that would feed over eighty patients a day. One experience really affected me though. Short and simple I was visiting a patient who had HIV; her medications were paid for by the government, but, if taken without food they made her extremely ill. Maisha helps provide food for her and her family, but, it is not nearly enough to sustain life. However, her issue that day was not a lack of food but a lack of charcoal. The main food staple here is ugali, which is literally boiled water and maize flower. Without charcoal she had no way to cook her food. When asked about how much the charcoal cost she responded about 30 KSH. 30 KSH is about 40 cents. When you think about it 40 cents is the difference between her eating, taking her medication and surviving. 40 cents can mean the difference between life and death. If that’s not a sobering experience I don’t know what is.
A family I worked with in the slum.
Prescribing a patient antibiotics. Picture taken inside
his home.
Being here for five months now I have also had the pleasure of working with immigrations. When I first arrived in Kenya I was granted a tourist visa which lasted three months. The plan was to apply for my work permit and when grated I would not have to worry about renewing my visa or immigration laws. Having a work permit would allow me to legally live and work within the country for a year. But nothing can ever be easy in Kenya; after all, this is Africa.
When I realized no progress was being made on my work permit I went to renew my visa for another three months at the immigration office in Kisumu. If I walked into immigrations with the feeling of any self-righteousness it immediately disappeared. The first mistake I made was I went to immigrations by myself. I sat down in front of the immigration officer and simply told her I wanted to renew my visa. She immediately responded saying "we don’t do that". Innocently, I asked why? She proceeded to tell me that it was none of my business and by asking questions such as this it’s in violation of Kenya’s national security. Wow… that’s not a good way to start off with an immigration officer! She then asked for my passport. I handed it to her along will all my documents stating I have applied for a work permit and I’m still waiting to be accepted. She took one look at my passport and saw my visa had already expired. She made no comment on the documents I presented her with about my work permit. All she said was, “you are living illegally in the country” and proceeded to call her colleague. Calmly, I tried explaining to them according to immigrations in Nairobi and my NGO I was not in violation of my immigration status, because, I was in the process of receiving a work permit… which is the law here in Kenya. However, they wouldn’t listen to what I was telling them. All they kept telling me was, that I was here illegally, and then proceeded to call me dumb and blind because clearly my passport says I should have been out of the country by now. It was completely degrading and if I was in the States I would have snapped. Once again, I calmly tried to show them my documents about my work permit and tell them I was not in violation of my immigration status. I simply needed a stamp in my passport. The name calling and the yelling continued until they finally told me that I am not in Nairobi nor was my NGO here to protect me, then they threatened to arrest me. At that point, I got up, took my passport out of their hands, and walked as fast as I could away from immigrations. Once again any self-righteousness gone, situations like this make you realize it doesn’t matter what your skin color is, what country you come from, or even what NGO you work for, at the end of a day people here are corrupt and subject foreigners and even their citizens to harassment such as this to increase their personal salaries.
After that pleasurable experience in Kisumu, I immediately took a bus to Nairobi where I went to immigrations with a CMMB employee. In Nairobi renewing my visa couldn’t have gone smoother. Once everything was all said and done I was asked, “Why did you go to Kisumu to renew your visa?” I responded, “Because it’s closer than Nairobi.” My colleague then told me that was a mistake, because, the immigration office in Kisumu is the most corrupt office in Kenya. That would have been nice to know before nearly getting arrested.
After my trip to Nairobi I was relived to arrive back at Tabaka, I was tired of all the drama. Since I have been here I have remained relatively healthy but shortly after my Kisumu and Nairobi trip I became ill. At first I thought maybe I was getting a stomach flu, but, when I almost collapsed during doctor rounds I knew it was a little more than just a stomach bug. My entire body began to ache, my neck hurt, my head felt like it was going to explode, I had a fever, and some serious stomach discomfort. Immediately, one of the doctors put me on antimalarials, since symptomatically it looked like I had malaria. I finished the medication, but my condition did not improve, it actually got worse. I had never been so sick in my life ,and, I had no clue what was wrong. Worried, I had every doctor working on my case. Eventually I had several blood tests, one being a Widal test. Sure enough it came back reactive for Typhoid. How the heck do you get typhoid when you don’t drink the water and you are vaccinated against it? Somehow I managed. I was prescribed Cipro and my body is finally starting to feel better. However, the doctor who originally diagnosed me with Malaria had a lot to say about this typhoid diagnosis. He said “not possible” and I am trying to “overdose” myself on medication. What?!?! Who deliberately tries to overdose themselves on antibiotics? I was completely insulted; I’m not your typical uneducated patient that thinks everything a doctor says is correct. Plus, I know how to interpret these lab results and how an illness such as this should be treated.
I am finally back at work. But, being sick for two weeks, lying around like a sloth, gave me a lot of time to think about every possible way I could have contracted typhoid. I am thinking I got it from the fruits or vegetables; they are washed in the water that comes from the tap. So much for eating your veggies! Since I have recovered people keeping telling me “pole pole my friend (sorry sorry), but, this is Africa!”
This child is named Nicholas. Look at the raw emotion
expressed in this photo. His story could take up its own blog
post. I spent several days working with him. This is day one.
Nicholas the day I left. I wish I could spend more time
working with him. But, we are still able to communicate
on the phone. I hope to see him in July.
Maisha children.
Hippos in Lake Victoria. Photo taken in Kisumu.
Fishing boat in Kisumu.
I was also able to see the family my family sponsors.
They are doing well, however, Lawrence is a little
sick.
