Greetings from the LSU/SHIP team in Kenya!
Saturday, a day to relax for the first time since last Friday. Seven of the students/residents are on safari at Masai Mara Game Preserve, and the other three are touring the Kakamega Rainforest Reserve. Don, Amy and I are enjoying the rest and cool breezes here at home. Don and Amy plan to visit friends in nearby Webuye later today.
I thought I would let everyone know a little about our routine here. Our schedule on work days begins early; some of the girls are up at 5 AM running and working out. We gather for breakfast at seven, and have a student presentation or other clinical discussion.
At eight, we trek across the drive to clinic headquarters to begin loading equipment and medications. Sometimes we have a local patient or two, and watch the children playing on the grounds of Epico St. Jahn’s Academy (Mama Betty’s school). Rena Brittenham, our case manager at LSU Children’s Center, sent soccer balls for the kids, and they are very excited to be able to play with a new ball.
Kenya time can be a little imprecise, and travel time varies with the distance and conditions of the roads. We travel in what Bishop Reuben calls the “green fleet”, a Toyota LandCruiser, and a matatu, or van. When the whole team of volunteers and locals is loaded, it can be quite packed! We pick up some of our interpreters in Bungomatown, and generally arrive at the day’s site around 10 AM. After unloading and setting up, we are seeing patients by 1030.
Lunch break may come between 1 and 2 PM, which is about the time the patient arrivals begin to pick up. Afternoons can be very busy, and frequently we have to cut off registration to be able to be done and loaded by 530. Then the trip home again, which seems longer for the tired students. All of the meds and equipment must be unloaded and stored in the pharmacy.
We usually arrive home between 6 and 7 PM, where chai is waiting. A good cup of chai in the evening is great, and I may take up the habit at home. A hot shower and clean clothes feel wonderful; dinner is served about 730-800 PM.
I am not sure about the other team members, but I am in my bunk by 9-930, and I sleep like a rock!
A missionary physician once told me that no one comes to Kenya for the food, but what I have experienced has been quite good. Breakfast is usually fresh fruit, and bread with an excellent jam and butter or peanut butter. Sometimes we have mangazi; think deep fried biscuit dough. Mama Betty makes them about the size of beignets, but they are sometimes bigger. Mangazi is fantastic with your morning coffee or chai.
Lunch at the clinic site is whatever we bring with us. Snack bars, jerky and Slim Jims are popular, and some of the volunteers will make PB&J sandwiches. I will trade jerky with Mama Joyce for chapati, another fried bread; it looks something like a tortilla, but thicker, and quite tasty. A soft drink is provided; it usually isn’t cold, but no one complains. I have become quite fond of Stoney, a sort of ginger beer which I haven’t seen in any other country.
Dinner is long on vegetables–stewed kale, mashed squash, and lentils are common. There is rice with a little stewed meat; a couple of times this week we have had fresh tilapia from Lake Victoria. Kenyans use very little salt or seasoning; some volunteers bring Tony’s or hot sauce from home, which the Kenyans also seem to enjoy.
As I mentioned before, the Lubangas have put a lot of work into making the accommodations for the volunteers more comfortable. There are now new mattresses on the bunks, light and electrical outlets in the huts, and flush toilets and hot showers in the bath house.
There are four huts with thatched roofs. Each hut has bunks for four volunteers. The huts are cool enough at night, but I usually don’t need my blanket until about 3 AM.
The thatched roof “gazebo” (our term for it) is a nice, cool place to rest and relax, an impromptu exercise room for some of the girls, and a sort of common room for card games and conversation.
The main Lubanga home is the meeting place for meals, planning the day, and catching up on email. There is also a guest room for volunteers, where I am accommodated this trip.
The much improved bath house has a new roof, two flush toilets, and three showers with hot water.
We still obtain water from a had-pumped well, and use LifeStraw or SteriPen to make sure our American GI tracts will not be offended. Laundry is done in a five gallon bucket; I brought travel packets of liquid Tide, which seems to work well. Then rinse in another five gallon bucket, and hang your clean clothes on the line to dry.
Many of our patients are middle aged or elderly, and present with the aches and pains of a life of labor. We treat a lot of DJD/OA, and chronic injuries which did not receive attention when they occurred. There is some hypertension and a few patients with diabetes; this is apparently a fairly new phenomenon. Dr. Don thinks this is due to an encroachment of Western diet and lifestyle. There are very few smokers in rural Kenya; the COPD that we see is in middle-aged women. Most cooking is done over an open fire, but in an enclosed space, and years of cooking results in chronic lung disease.
Children frequently present with impetigo, tinea capitis (scalp ringworm), scabies and jiggers (sand flea larvae imbedded in the palms and soles). They also have upper respiratory infections, as in the US, but very of the little asthma, allergies and eczema that we see at home. Malaria is frequently worst in the young, and these children may present quite ill. There are some children with sickle cell disease. In the US, these children would receive specialized care that would allow them to live into adulthood. Without this care, these children’s lives may be quite short.
We have seen several apparent malignancies in advanced status, HIV, and surgical problems that cannot be handled by a mobile clinic. We refer these patients to the nearest district hospital (Bungoma, Webuye, or Kakamanga). The nearest subspecialty care is frequently at mission hospitals, often in fairly distant Eldoret or Tenwek.
There is one situation that reminds me of home. In the US, many patients will present to their physician, the hospital ED, or an urgent care clinic with upper respiratory symptoms, and will expect a Z Pack and a shot of Celestone. They can be quite put out if they don’t receive it. The situation is similar here with malaria. Some patients expect to be treated for malaria, and are upset when they are told that they don’t need it.
Overall, the LSU/SHIP team is having a great time, working hard, and learning a lot about tropical medicine and the Kenyan culture. We are always grateful for your prayers and support.