Lake Nakuru National Park

Kate at Kericho Tea House gardens

James & Terence Potter

"New" Village Park "Resort"

Stoney Tangawizi, favorite Kenyan soda

Thompsons gazelle

So many flamingos & pelicans!

Thompsons gazelle

Marabou stork

Cape buffalo with eggret buddy (our guide said it likely had been wounded by a lion)

"Let's discuss this guys"

Baboons

Thompsons gazelle

Grumpy Cape Buffalo

Curious Cape Buffalo calves

Peter changes a flat in the park

Greater white pelicans

Yellow billed stork

Sacred ibis

Common zebra

We're "on vacation" now & have no further volunteer responsiblities!  We are "playing."  On Saturday, three of us drove to Nakuru, Kenya, about 300 km away.  It's one of the oldest cities in the country.  Our goal was to visit Lake Nakuru National Park, Kenya's 2nd most popular park & famous for its flamingos & rhinos!  Our driver was Peter, a local taxi driver we've gotten to know through frequent trips between Migori & Bware.  We stopped a couple times along the way.  First we stopped to buy soapstone craft items from vendors along the road and again in Kericho, famous for its tea plantations (one of Kenya's biggest exports),  at the fancy Kericho Tea Hotel for chai & toast while sitting on a patio overlooking fabulous flower gardens.
Six hours later we arrived in Nakuru & Peter helped us find lodging for the night at the New Village Resort, a misnomer for it wasn't "new" & it certainly wasn't a "resort."  However, we ate dinner at Kokeb, a nearby Ethiopian restaurant.  It was one of the best meals we've eaten since we arrived!  We liked the food so much, we decided to return the following day for a "full English breakfast" before our return trip to Migori.  It was delicious too!
On Saturday evening in Nakuru it drizzled but we went out exploring anyway.  We enjoyed the throngs of peope on the streets doing their shopping after work.  Then we stumbled upon the Nakuru Sweet Mart, a pastry shop described in Lonely Planet's "Kenya" guidebook & just had to go in!  We picked out several treats from their display cases, then enjoyed chocolate cake with chai.  Yumm.
Sunday morning we were up before light so we could get an early start at the park.  We  had such a positive experience hiring a guide at Ruma NP that decided to hire a guide.  Justice rode in our car and knew exactly where to go to see the animals.  We saw lots!  Starting with baboons scampering through the parking at the entrance.  There were many different types of water birds:  Greater & lesser flamingos, greater pelicans, spoonbills, egrets, yellow bill & maribou storks, sacred ibis, Egyptian geese.  We also saw hundreds of Cape buffalo, Rothschild & Masai giraffes, zebras, waterbucks, Thompsons gazelles, impala, warthogs, vervet monkeys and a few rare black rhinos.  Although we were tired on the long drive home, we were pleased with the chance to see so many animals.
Today we're resting up, packing & repacking for our departure tomorrow with all 6 Physician Asst. students for our wildlife safari to Masai Mara National Reserve.  While there, we hope to see elephants & lions.  You can expect to see a blog describing that trip on the weekend after we return to Nairobi.  Cheers!

Lake Nakuru from Baboon Point 

Asante sana!! We distribute newborn layette kits!

Ray of Hope team including Teresa Gipson, MD, ROH founder

Today was our LAST volunteer day, so this morning we traveled back to Bware one final time.  We participated in a long, community meeting with representatives of BBEKAS, a consortium of six area schools, and members of BUCHWA, the community health workers with whom Kate & I worked closely.  Our team presented results of the school health screenings  conducted over the past 6 weeks (screening results are provided in my "Odds & Ends" blog).  We gave each school a written referral for each child we believe needs follow-up care...50% of the nearly 2,000 children screened need follow-up!

Tristan, Shelby, & Darla listen to health screening results 

Disability Survey:
Kate presented results of the disability survey she & I conducted over the past 4 weeks:   48 total home visits, including 24 visits to elderly, 13 visits to children, and 11 visits to middle-age persons.  Primary causes of disability in each group included loss of mobility due to arthritis and stroke (elderly), and lack of early identification & referral of problems (children).  Many disabilities seen in middle-age persons were untreated conditions in childhood (for instance a child with club feet which were never treated).   BUCHWA members then commented on survey results and generated a list of suggestions for consideration by future Ray of Hope health teams.

Linet, BUCHWA member, translates into Kiswahili as Kate presents disability survey results

Distribution of Supplies:
The meeting concluded with distribution of school supplies to the 6 schools.  The supplies included:  pencils, pens, notebooks, colored pencils, scissors, toothbrushes, toothpaste & dental floss, laminated posters for learning English-since English is one of the national languages, blank "Certificate of Accomplishment" forms, etc.

We distributed newborn layette kits to the Bware Dispensary clinic.  These kits included a blanket, 2 one-sies outfits, a newborn cap, & a bulb syringe.  Women who deliver at the clinic must pay 350 Kenya shillings (about $4.00 US) & provide a blanket.  This is a barrier for many women, so providing a newborn layette kit to women who need them, is an inducement to get them to deliver at the clinic instead of at home.  We want to say a BIG Thank You to all our friends, relatives, & co-workers who donated clothes, caps, blankets, & bulb syringes for us to bring to Kenya.  YOU made it possible to provide these special kits to the Bware Dispensary.  Your help was acknowledged today by all persons present with a round of applause & a chorus of "Asante sana" (or "Thank You" in Kiswahili)!

Free condom distribution

Kate checks condom supply

Ray of Hope team with BUCHWA & BBEKAS supporters

Odds & Ends

One of the many signs on Bware bldgs ("End malaria now") 

Wilma, the youngest child in our host family, with her teddy bear doll

Poster on wall, Migori District Hospital, announcing first-ever nationwide de-worming day for all Kenyan schools, 23 October

Our bedroom at the Oker home with mosquito netting

Oker home dining room with Wilma & Philus

Volunteer Program Coming to End:
Tonight we're both back in Migori.  We said goodbye to our host family in Bware last night.  Kate & I both traveled back here by piki-piki (motorcycle) but at different times.  I returned early this morning to meet a child & parent we'd referred to Migori District Hospital.  We wanted the child to see the physiotherapist because of club feet.  The PT examined the boy & concluded he may benefit from surgery because his ankles are not frozen but still have movement.  So he referred the child to another hospital for additional evaluation next month.  If surgery is indicated, the cost may be covered by a special program created by the European Union that helps Kenyans with physical disabilities.  Kate stayed in Bware longer in order to have one more day of home visiting with the BUCHWA community health workers.  However, she arrived here before dinner.  She's gone to bed because she has a cold which is going around the team.  I hope I can avoid it.

Kate provides antiworm medicine to nursery school kids

One of Kate's little patients

James got in on the act too

Bware Primary students help children wash hands before  meds

School Health Screening Results:
On Friday our entire team returns to Bware one last time to present results of our six school screenings:  total # screened-1,968; 50% of children screened will be referred for follow-up for one or more of the following problems:  21% dental issues, 12% signs of anemia, 12% ear health issues including wax build-up, 4% visual acuity of less than 20/20.  In addition, Ray of Hope may be able to use these statistics to leverage additional assistance from the Kenya Ministry of Public Health & Sanitation.

Wrap-up meetings:
In addition to the Friday meeting with the BBEKAS, the Bware-area school consortium, & BUCHWA members, we have an early morning meeting scheduled tomorrow with Dr. Daniel Agullo, St. Joseph Umbo Mission Hospital's Medical Director.  We'll discuss the results of the students' clinical experiences over the past 4 weeks.  Then, later tomorrow, Dr. Teresa Gipson,  RN, MD, MPH,  the American founder of Ray of Hope, will be here to meet the team & learn about our experience.  Although Kate & I know Teresa & have worked with her over the past couple of years, this will be the first time most of the PA students will meet her.

Rolling chapati dough

Frying up chapati

Lake Nakuru & Maasi Mara National Parks:
Our official volunteer commitment ends Friday afternoon, so Kate, Terence (one of the PA students), & I will take a weekend trip to Lake Nakuru National Park (~ 300 km away).  We've hired a cab & driver to take us there & back and we'll stay overnight at the Carnation Hotel in Nakuru (listed in Lonely Planet's Kenya guidebook).  Our hope is to be at the park shortly after sunrise Sunday.  The park is known for its flamingos, rhinoceroses (black & white), & elusive leopards.  We're excited!  We'll return here late Sunday, rest & do laundry Monday, then Tuesday morning, the whole team leaves for a multi-day tour of Maasi Mara National Park.  We'll stay in lodging inside the park & take multiple trips in AM & PM to different spots for animal watching.  You can be sure we'll have our cameras at the ready!  We depart Maasi Mara Nov 2, return to Nairobi for an overnight, then visit a new friend & explore the city before we depart for home Saturday night.

Meegan & BUCHWA members practice CPR

Darla, Tristan, & Linet explain correct way to use condom

Darla demonstrates self-breast exam on Tristan

Back at our Migori "home" on the St Joe's compound

Sunset from Oker family's farm, last night in Bware

People

Day 29-Migori

This is Kate. I have been in Bware for the past 7 days while James was working in Migori.  I was thinking that most of our entries have been about the place-time, the dirt, the rain, Kenya-the place.  It's really about the people.  The people I meet every day, the folk we visit, the women I walk with, the family I live with, the students. So let me write a little about them.

Our host family's kids

James & the Oker family kids

Our home-stay family.

We stay in Bware with Benson Oker, his wife Domatilla, and five children--Ruth, Collins, Philis, Paris and Wilma.  Benson is the principal at Bware Primary School, a pastor at Gat (God's Mountain) Pentacostal Church and a farmer.  His father, at 82,  is also a elder at the church and an active farmer.  Domtila is a homemaker.  She runs  a spotless home, cooks on a wood stove, keeps a small shop, and tends the children.  It is a dawn-to-dusk job.  We spend convivial evenings over dinner (evening tea) chatting across our several language barriers (English-Kswahilli-Loa) about culture, politics, and geography.  Philis, a sweet little girl with a huge smile and quiet giggle, and I spend a fair amount of time happily drilling "Maths".  That game has gone much better since I found and washed 10 nuts to use as counters.

The Community Health Workers.

I walk with Marseline, Daphyn, Margarete, Linette, and Grace.  They each know their districts (there are 6, I haven't met Janet yet).  There are no street names, no addresses.  When we walk down the road to Endembe then turn down the hill to a cattle path to find a wattle home with 2 skinny cows and an unswept yard, we have used their mental map of their own area.  The Community Health Workers  remember each person's name and what is going on with them.  They know where the sister or daughter lives.  They know who is going to carry the water and who will most likely accompany the patient to the hospital.  They remember the phone number for the piki-piki driver who will be willing to tie the patient to himself for the ride to Migori.  No charts, no GPS, all very effective memory.
I do not know if I add very much to their team.  I do have a flashlight,  blood pressure cuff and a stethescope.  I add some weight to their recommendation--"the misungu says you need to go to the dispensary".  I write stuff down.

BUCHWA member, Linette, & James visiting a client

Kate with a client & her mother in their home

Today we are walking to make a survey of disabled folk of all ages in the Bware area.  I am recording it to make the survey more concrete.  Other duties of Community Health Workers include:  Checking- in on pregnant women the way Maternal-Child Workers do everywhere, completing immunization sweeps (maybe carrying polio vaccine to administer at home), and providing HIV education and support (think adherence).  These strong, knowledgeable women are experts about health and the situations people find themselves in.

The people we meet.

Then there are all the people we pass on the road, paths, and trails.  Lots.  There are people everywhere.  Walking, farming, carrying water, stopped at this kiosk or that home.  Most everyone smiles and waves--so I do too.  Many reach out for a handshake, so I shake hands, 50 or 100 every day.  "Habari", they say.  "Nzuri", I answer.  Or maybe it's "Jumbo" or for a child "Shikimo".  Down the red dird road I go slowly by slowly--"Jumbo", "Habari", "Shikimo"-ing along under the clear blue sky and hot hot sun of Kenya.

Kate with Marceline, Dafyne, & Linette crossing a stream to make home visits on the other side of the valley

Time

Many patients & employees arrived at front gate by piki-piki

Several moms arrived with babies 

Three women waiting on grass in front of hospital gates-don't know what they were waiting for-just waiting

Wrote the following entry yesterday morning in my journal as I waited at the front gates of St Joseph Umbo Mission Hospital for one of the kids we'd referred to the PT specialist.  I did not know what time they would arrive, just that they would look for me at the front gate Weds morning:
9:25 AM Practicing patience, trying to accept Kenyan concept of time, waiting.  It's hard---given my culture's preoccupation with time, being "on time", not "wasting time", making appts for a specific time, trying to be early, not "late", apologizing if late, calling if going to be late.  A complex set of human interactions in my culture related to time.  Wearing watches-even here (few Kenyans seem to wear watches...maybe they do in Nairobi, but not here).  Clocks in homes run on batteries-or not at all.  Too many power interruptions for electric clocks to be useful.  Just watching the comings & goings of patients arriving on piki-pikis (motor cycles).  Lots of activity.  Now waiting in shad of covered shelter with stone benches elevated above entrance roadway.  Watching each arriving piki-piki for my patient.  Worried I won't recognize her.  Only met her once, but know she's 11 & her mother's coming with her & is overweight.  Not much to go on.  Just need to relax.  They'll be here.