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.