Nairobi

I got off the bus at the round-about near Westlands—lucky for me, my fellow passenger Lillian, and witness to the accident, got off with me and was so kind to wait around with me until I was properly situated. Rachel met me a few minutes later with her mom’s car—an older, yet exquisitely maintained, Volvo sedan. She was also with her three year old son and nine year old daughter. Her son said nothing to me, her daughter spoke like an adult and was a lot of fun to talk to.

We went to Carnivore, along with a few other Hubert Fellows from Nairobi. I think the first time I had heard about this restaurant was on the Canadian show “Travel Travel” back when we used to only get one Canadian channel up in Montgomery Center.  And it had stuck in my head since then. I almost went there four years ago when I was on my way through Nairobi to go to Kampala but decided against it. I’m glad I waited because I don’t think it would be as much fun without friends to share the experience.

It’s huge; an entire campus onto itself. There’s the restaurant and a nightclub and even more that I didn’t get to explore. The restaurant is a flat fee—about $30 for all you can. If they included drinks, it would have been even better but still, great time. Basically, it’s sort of a five course meal. They bring you appetizers, soup, a salad (one small plate for all to share, but, eh, it’s called Carnivore for a reason), meat and then dessert. The apps and the soup, were the best part from a pure culinary perspective, they would have been good anywhere. The meat is spectacular because of what you’re eating and not really how it is prepared. Although the chicken sausages were really, really good.

A few years ago, Kenya passed a law which essentially removed some of the wild game from the menu: if you want zebra, gazelle, etc, you’ve got to go to the South African version of Carnivore. Still, I had enough meat to last me a while: chicken, pork, beef – pedestrian. But I ate a cow nut—not verbatim how it’s listed on the menu. I won’t go out of my way to eat it again. I also tasted crocodile, ostrich and camel—none which were terribly delicious or anything I’m going to seek out on a regular basis. But the experience is great. You have a flag in the middle of the table and the servers have the meat on skewers and just keep circulating throughout the restaurant to the tables with the flag up until you are completely stuffed with meat.

Next day, I met up with Brian (friend from med school and Nairobian—mnairobi) and moved to his family’s house for a few nights. Here I was treated to traditional Kenyan hospitality. I was welcomed into the family, served more food than I could ever eat and made to feel so comfortable. Brian also took me around the Central Business District (CBD) and showed me all sorts of sights including the Kenyatta International Conference Center (KICC) where we sweet talked the woman selling tickets with Swahili to give me a resident rate! And what a view from up on the top of the second tallest building in Nairobi. We saw Mt. Kenya and the Nairobi National Park and we also were looking into the national stadium when Kenya scored the winning goal over Angola to keep hope alive in the qualifiers for the African Cup.

On Sunday, we spent the morning at Church and then had a leisurely afternoon lunch at the local restaurant. We then went on a  big walk of their neighborhood and I got a chance to see Nairobi. And then for dinner, I can’t forget the meals—I was treated to some traditional Kamba dishes cooked to perfection, and, naturally, in gigantic portions. So many thanks to Brian, Faith, Dolly and Mama na Baba Kilonzo.

Out from Kisumu

I brought to East Africa my travel backpack and a small duffel bag, with the intention of over the course of my travels I would give (almost) everything away. I’m going to try and document throughout the course of this—the things I drop off and to whom.

I left Kisumu on Friday morning to go to Nairobi. Early on in the month, Orliani, the guard at my second home, had asked me for my shoes. And I had told him I would think about it. As I left the house, I dropped off a little package at his chair, with my leather dress shoes (this was their second trip to Africa), a few pairs of socks, and a pair of pants. He thanked me a few times and said how he was travelling home at the beginning of the next month and would bring me back a Masai bracelet. I told him I would not be returning and he said, “If it’s God’s plan we will meet again.”

The bus ride to Nairobi was awful and broken into two parts. The bus I was on had only 4 passengers and we left right on time. But 30 minutes into our trip, I hear a long blast on the horn, the brakes are put on lightly, and then the brakes are slammed on hard and we skid to a stop. Before the bus stops, there’s an unmistakable knock against the front of the bus. We had hit something. (This is a real story, and the way things are in life out here, before you read ahead, make sure you want to know this.)

Your guess is as good as mine—child, bicycle, car, goat, dog, hand cart, motorcycle, cow, anything really.

The rule of the road is to not get out of the car when you hit someone—you drive straight to the nearest police station because people are sometimes killed for hitting a person with a car, and then a mob strikes when the driver or passenger get out to help. I stayed on the bus, and then I saw a crowd gathering around the bus. And then I heard someone say it was a little school girl. And I saw the crowd was not threatening the driver who had stopped, and gotten out of the bus. I figured, I should get out and see if there is anything I may be able to do.

So I climb down the stairs to the road and I’m expecting to see a mangled body of a girl under the wheels of the car. But instead I see a six year old girl walking down the road, crying, with blood staining the left side of her dress and a huge skull fracture with at least 3cm of asymmetric “lump” in the left temporal / parietal area.

It would seem fortuitous that this accident occurred just outside of a clinic / hospital so a kind woman grabs the girl and takes her to see the clinical officer who is way out of his league here. Meanwhile, the bus driver and the conductor are laying down branches to warn cars of the accident scene and calling the police as well as their manager and insurance.

Five minutes later, I’m talking with some people in the crowd and they say the girl is back, that the clinical officer is not trained nor equipped to deal with this situation. So the girl and this woman are just standing on the side of the road waiting to take a bus to get to town so she can potentially have her life saved.

I look at the driver and this was a friendly man and a caring man, and I say “Turn the bus around and take her to the regional hospital NOW.” He says, “I’ll be charged with a crime if I move the bus.” I yelled at him that the priority here isn’t your life, but her life and if she dies, he’ll have a whole lot more trouble. He just walked away at that moment.

So I sent someone to get the girl’s family, told the woman to sit in the shade with the girl and talk to her, and I stood in the road and stopped the first car that came by—a few cars went right on past despite seeing an accident scene and a bloodly little girl. Eventually a matatu came to stop—it was packed and couldn’t take her, but at least now I had faith someone would stop. The next vehicle was a pick-up, I waved it down (and stood in front of it) and it pulled off to the side. The woman with the girl, and a few of her colleagues, knew what to do—they jumped in, and braced her, and told them to the hospital as quickly as possible.

She was alert, speaking appropriately and had reactive pupils ten minutes after the accident but she had been hit hard by the bus. She was about 30 minutes out from the hospital and then who knows how long before she would be evaluated by someone competent. I can only hope for her.

Work Wrap-up

I spent my last Monday (March 21) in the field—my first trip out to Lwak since week one. I went with Godfrey (Deputy IEIP branch manager and my immediate boss) and we were tasked to meet with George (head of the field teams) and Peter (head clinical officer), the two gentlemen who will be tasked with implementing the strategies which we had developed over the past two months. The meetings went very well and we covered all of the details we needed—thankfully, everything that was planned was deemed possible and the few issues that arose were addressed on the spot and reworked to function better in the IEIP field and hospital systems. This was a successful day, and part one of my hand-off process. I needed to make sure the field teams agreed with the new algorithm and process and had all their concerns properly answered.

Tuesday, the woman whose job I had been doing while she was on maternity leave, came back to take her job over. Talk about good timing. She and I sat for about 6 hours as I went over and over all the thought and work which had been done in her absence. She grasped the scope of the changes we had made and was verbally appreciative for my work. We repeated a few of the key components and I handed her my to-do list—which was getting longer by the day. She had a few questions, I answered them and that was it. Half of my project was successfully out of my hands.

Wednesday was the big day. This was the day that we flew the woman out from Nairobi who was not on maternity leave, but whose job I had also been…assisting with for two months. Essentially, we had been making rapid changes to the protocols in Kisumu and she was isolated out in Nairobi without much of a clue (and didn’t seem to mind or have much interest in learning what was new—this is really what is worrisome).  And so she arrived.

I sat down with her and my other coordinator (who I had worked with yesterday) and I reviewed essentially all the same information. I explained the raw data, the projections and the budget—except with a focus on Nairobi (Kibera – name of the area). I got a lot of attitude from her most of the time, although attitude here is not what we think of in the US, it is way, way more passive aggressive. “If you say so,” “That’s acceptable, I guess,” “I wouldn’t have done it that way,” “But what about…” and other ways of just slowing down the process. Look, you just made about $3000 over the past two months and never showed any interest in developing changes. Eventually, after working through a lot, and helping her to vocalize her real problems with both me and my two bosses, I think we got on the same page, and I think she’s going to do a fine job here.

She stuck around on Thursday, an additional day, after learning how much work had been done and how far behind in comprehension she was currently. I worked with her for a few more hours and we got together a little more and started to understand one another. It was an exercise in patience.

And that was the end. I arrived in February and was given a concept and a working draft of an algorithm. I learned the IEIP system of interviews, clinic visits and data collection, I researched and learned about the principles of TB surveillance, I sorted through raw data, I worked on the computer (a lot), I churned out projections, I obliterated a budget, I reworked an algorithm (and a budget), I spent the budget, and I transferred my knowledge to the current and future coordinators. Overall, I had a pretty awesome experience.

There are special thanks and acknowledgements which should go to the CDC Foundation and the Hubert Family for providing me funding to travel and work on this project. Thank you to CDC / KEMRI in Kisumu, Kenya for allowing me access to their plentiful resources. Thank you to Deron and Godfrey for their mentorship, as well as George, Peter, Allan, Ratwar, Janet, Rachel, Kenneth, Fred, Rhoda and so many others who helped me succeed.

Mama Sarah's

Rat leading the way

A week ago I mentioned to Rat that I was considering visiting Mama Sarah. I told him, I had been worried about just knocking on her door to say hello, but I had decided (with a single weekend left) that it would be a shame if I made it all the way out to her region without greeting her. After all, in this tradition, the greeting is everything. I also figured, I definitely wasn’t going to be the most annoying person to visit her compound (think Fox News and any media outlet owned by Rupert Murdoch, or really any media).  And I was going to bring a gift.

But what gift do you bring to Mama Sarah Obama? After a few months here, there’s really only one appropriate gift and that is an animal. The Luo people prize their livestock and so I figured I would see what I could do. I told Rat I wanted to bring a goat. And he laughed! And laughed! And recommended I bring something a little more practical, like fabric or something American. The conversation was lost and I figured that my trip to see Mama Sarah was over before it started.

I got a call from Rat on Tuesday and he said he had been thinking about our conversation and that I was right, a goat would be a great gift. (He later told me that while it was a great gift, it was an even better story for him to tell, that he went to visit Mama Sarah with an mzungu from America who brought her a goat). He had already talked to his friend in Kogero about where to find a goat. We were in business. Sunday was go day. Throughout the week I would get phone calls: I’m getting a goat, I can’t get a goat, the goat is too small, how much are you willing to pay for a goat, do you want a boy goat or a girl goat, we’re getting a big goat, and so forth.

Our goat

On Saturday afternoon we planned the trip, we were meeting in town at 5:30AM and on a bus at 6AM to Kogero—we’d get there at 8AM and take motorcycles to Mama Sarah’s compound. Hopefully we will meet our goat when we get to the compound and the price will be no more than 2000KES ($25). Oh yeah, bring a back-up gift.

The transportation plan goes without a hitch, we arrive before the town has awoken. We take chai and eat it with stale bread because they haven’t even started to make the breakfast breads yet and hop on motorbikes to Mama Obama’s place. We are driven up to the gate—it has been fenced in, otherwise I think the guys would have driven us to her bedroom door. We get off, and no goat. Not to worry, we are not all that timely here. I look at the sign on her fence, and it has visiting hours for M-F and Saturday (Sunday is not mentioned). Now me, I thought that meant that we were sunk, but Rat just walked up to the gate and greets the guy in Luo—he’s not Luo so they switch to Swahili and I follow along.

The conversation was long and not interesting, I thought about writing it out, but stopped. The gist was simple. Where is this mzungu from? (America.) Where are you from? (I just greeted you in Luo.) What do you want to do here? (Greet Mama Sarah and bring her a goat.) We did not have the goat at this moment, but we had faith that a goat was obtainable somewhere in this great little village and we had connections. I think the goat swung the conversation and the guard said, Mama Sarah is not up yet, but once the sun comes up and it warms up a little bit you will be welcomed on to the grounds. Oh yeah.

We walk into town and meet up with our goat connection—he works for the CDC which is an amazing network to be a part of. And he has to hop on a motorbike to get the goat. I give him the 2000KES and he gets going. Rat being a good man and accustomed to the ways of the mzungu and the mkenya had negotiated 1600 for the goat but figured he didn’t want to disappoint me by having the price increase and that the negotiated price might increase on the day of the sale. As it turns out, this wasn’t quite the case, but apparently, the goat we had bargained for was owned by the wife and she did not want to sell the goat. So our wonderful friend Vincent, went HOUSE TO HOUSE in search of a goat. As Rat said, “Someone who sells a coffin doesn’t bargain.” And if you’re going door to door and asking if someone has a goat, then you pay a desperation premium (200KES) and you get a smaller goat (the meat’s more tender).

So two hours of waiting, drinking tea, and just sitting, our goat arrives on motorbike. We meet the goat at Mama Sarah’s and we ask the guard if now is a good time to visit and he says yes. We enter, sign the security log and make a short walk up through her compound. It is very nicely taken care of and has a few animals grazing on the ground—no goats, but a few sheep which look like particularly close cousins to goats in this country.

We get to just outside the front door, under a few mango trees, and there are a number of chairs set-up. This is Mama Sarah’s receiving area and we are told she will join us briefly. We sit and are brought another book to sign, this one Mama Sarah’s reception book. It was started in October and is nearly full 6mo later. The goat gets tied up to a nearby tree and we sit and talk and look around.

After about 10 minutes, Mama Sarah comes out. She was dressed in a very graceful but traditional blue print dress with ornate gold embroidery around the collar. She comes to us and we stand to greet her and shake hands. I shake her hand last and greet her in Luo. She looks at me and asks if I have learned even Luo and Rat responds for me, since I’ve run out of Luo already, that we can speak Swahili together. She says that’s wonderful and greets us some more.

Rat, Mama Sarah and me

The vast majority of our (their) conversation was in Luo and I got very short translations for very long parts of conversation. When we spoke, I told her how happy I was to greet her and to get a chance to thank her for the support she had given our President. I was proud to have gotten the opportunity to vote for President Obama and I looked forward to the opportunity to do so again in the future. I thought he had done good and difficult work.

She expressed similar appreciation for my visit and said thank you for the gift. She agreed with me about the work President Obama has done, but commented that the wars were a concern for her. She was most grateful for the gift we had brought and she planned on having him for a meal soon.

In Luo, she discussed her life’s work with orphans—she helps them seek out education and employment. She said she was very thankful for support she had gotten from people from all parts of the world. We took pictures together, we said thank you again, I gave her my “back-up gift” (3 meters of a stately red and gold batik) and we were off.

Awesome day and a wonderful experience thanks to Rat, Vincent and Mama Sarah.

More pics: https://picasaweb.google.com/MatthewJMeyer/MamaSarahS?authkey=Gv1sRgCInE6aaOlonn_gE

A few pics and an article--

Some more pictures from Hell's Gate NP.

https://picasaweb.google.com/MatthewJMeyer/HellSGateNP?authkey=Gv1sRgCKj94L6Un6_kRg

And I liked this article, it's a little too much ("Here in Atlanta I carry around McDonald’s gift cards for encounters with homeless men and women, build Habitat for Humanity houses and donate 3 to 5 percent of our family’s annual income to charity."), but the sentiment is right on.

http://travel.nytimes.com/2011/03/13/travel/13prac.html?ref=travel

Housekeeping

Firstly, I will be trying to become a surgeon somewhere as of the end of June. I officially have matched. I find out where on Thursday around 7PM here. Go to http://med.uvm.edu/ and follow the links to the Match Day Live Webcast (or something like this). Depending on the internet, you may find out before I do!

Now. I called my sister on the phone last weekend. I hadn't heard from her in awhile and she hasn't (up to this point) taken the opportunity to call me, so I thought, I'll make sure she's ok. I got her on the phone and one of the first things she tells me is..."I stopped reading your blog."

Thanks.

She said it was mostly because she didn't get a shout-out. I didn't realize this at the time, but for my tens of readers, if  I did not include you in the shout-out section of the blog, it is not because I don't love you or appreciate the fact you're interested in keeping up with me and what I'm doing. Not at all. It's likely because I don't even know you're reading. So let me know, I don't want to lose more readers because of this misunderstanding. I actually thought I was over-estimating my readership by shouting-out to a dozen people, but I guess there may be a handful more.

And for those of you who didn't get a shout-out and are STILL reading, thank you for not being as much of a grump-face as my own sister.

Work Update 3

The big news is our / my / the project got final approval from our group of TB specialists and consultants the world over.  This includes a pretty significant deviation from the initial plan when I arrived, and I think that if I’m to point to one real effect I had on the project it would be this. I identified some inefficiencies and fallacies in the beliefs underlying the original algorithm and I helped to streamline a new algorithm. I think the data will be cleaner and the people who will actually implement this project will be much happier.

I just tried to explain a little bit of what I did, and it gets really boring, really fast so I’m all about telling the story, but send me an email or call me up and I’ll give details. Preliminary results will be available in a few months and then real results in a few years.

I’ve got less than two weeks to go here in Kenya, how quickly time passed. And at this juncture, especially considering that we just got the project officially off the ground, I need to figure out what work I should keep doing, and what work I should tidy-up and leave for the Hubert Fellow who is following me. Rishi if you’re reading this, this is you J Right now, I’ve decided its best for me to write this down, and this.

Time to get back to work.