Kenya: video documentary

[You can play a short, 6 min, version of the FACES documentary here. Viva YouTube!]


It feels good to be doing creative work again. I’m excited to spend my time brainstorming about sequences, soundtracks, what clips to take out of the 10 hours of raw footage I have to work with. The process is amazing in itself: to be able to ask people probing questions about why they do the difficult work they do, to discover the intricacies of the community in which we work, to have a large group of children climbing over you to see what your filming, to climb the rocks of an island and battle thick swarms of lake flies to take footage no one else has. People are also generally excited to be filmed; it helps them feel appreciated and important for the work they do. Then I get to take all of this and turn it into a narrative that tells a story, constructed to emote what I want.


Rose-colored glasses aside, I also have to deal with the very frustrating aspects of being in Sub-Saharan Africa: the only equipment I have to work with is the stuff I brought with me, on my back. Don’t get me wrong: it’s crazy in itself that I own and carry all of the equipment I need and am producing this documentary, from start to finish by myself and with my own money. I’m proud I can do this (though I wouldn’t mind some help, especially with funding!) Still, I need to deal with some crazy situations, which make the adventure… well, more of an adventure. While on the islands, I had to make sure my batteries didn’t run out (no electricity) and that nothing fell into the water, since we spent 4 hours on leaky wooden boats every day. When the kids climb on me, I need to make sure that the camera doesn’t get dropped or otherwise broken. There is no one but me to fix it. And after digitizing only a small fraction of the clips I think I might use, m hard drive ran out of memory. All 100 gigabyes have been used, which leaves me no room to render or export the sequences I create. So I spend excruciatingly long hours digitizing, then backing up to DVDs, which I run out of. There are no blank DVD-recordable discs to be bought readily in Western Kenya. (Though I bet I can pay some of the guys who pirate DVD movies to get some blank discs… I know where to find them.) Everything has to be planned out just right so that I have the clips I need on the hard drive to make the sequence. All these challenges are time-consuming, but in the end they add to my experience and help me plan for the next time (i.e. bring a damn external hard drive!).


As is inevitable with documentaries involving NGOs and health care workers, people’s speaking skills are highly variable. There is very little of the interviews that looks good or sounds good on screen. I can probably only use 10% of what was filmed, and even then I need to cut out a ton of um’s and stutters and repeated statements. While doing the interviews, which are fun in themselves, you can tell who the good speakers are: Reson gives clear but long and comprehensive narratives; Steve can eloquently describe the touchy-feely philosophy of the organization, and Kwaro, given some time to prep, can give a succinct speech with the stats and facts that you need. All without stuttering. And with a decently loud voice. A few aspects of Kenyan culture don’t mix well with these interviews: people speak with very soft voices and tend to talk in overly formal circles, saying the same thing several times in only slightly different ways. I think that this is why Kenyan meetings are long and boring. And why a lot of my interviews are long and boring. And why Kenyans often complain that amerikans are too loud and direct.


Fortunately, Kenyans like to sing, especially at FACES. So to make up for the soft voices that speak in circular statements, I have some great footage of staff meeting songs and Kids Club chants. Good music, good singing, beautiful scenary, interesting work: this is what is saving the documentary from being ordinary.

Kenya: FACES Home Visit

Home visits represent to me the quintessential experience of being a doctor. I get an amazing diversity of background and information about a patient from observing them in their home environment rather than in the clinic. I get the privilege of seeing how they eat, how the sleep, what they do during the day, how they interact with their family, roommates, neighbors. I can assess their sanitation and safety. It much more adequately satisfies the part of doctoring that is a bit of an anthropologist … but goes much further than the anthropologist by synthesizing the information into an intervention that is best suited for that particular patient / subject / person.

The downside of home visits is that often you uncover complicated and difficult issues that you can’t solve. We as doctors are trained all the time to solve problems and “fix” people. This of course is very difficult and a stressful expectation, in any setting – be it clinic, the hospital, or the home. If you go by yourself to do the home visit, which is what I do in the US, you then have to figure out how to address the psychosocial and financial problems that you don’t have time or skills or resources to deal with. The nice part about doing home visits in Kenya is that you automatically go with a team. In fact, usually the community health workers often go by themselves, so they especially appreciate it when a clinician goes with them to help with management issues. It makes a world of difference to have a team. You feel so much better supported and able to focus on the issues that we are trained to deal with: medical and psychiatric management.

We went to visit Margaret (pseudonym), a 22 year old with a rapidly falling CD4 count (from 500 to 200 in 3 months) and failure to thrive. She had also been pregnant and miscarried at 7 months at home – one month before our visit. The clinicians had been concerned about her weight loss and falling CD4 count, so they initiated her on HIV antiretrovirals and TB medications. She stopped coming to her clinic visits and the staff were concerned that her family was not supportive, so we decided to make a home visit together.

It started out very strangely. I sat back and let Kendi, the clinical officer, Elija, the community health worker, and Nicolas, the nurse, take charge of the visit. I also wanted to observe how they ran it. The home was small but very neat. Margaret’s older sister kept the two-room home very clean: swept, laundry done daily, food on the table for Margaret. Her sister greeted us at the door and sat with us during the interview. She seemed supportive. Margaret, on the other hand, was lying on a couch, barely moving, with an imperceptive voice. Her face was completely flat. She expressed no emotion, except later, when I sat next to her and asked some more questions. For the first 20 minutes, the clinic staff sat on the other side of the room, bombarding Margaret and her sister with questions, many of which sounded accusatory.

“Why aren’t you eating?”

“Have you been taking all your medications? Show us what you’re taking?”

“Why haven’t you picked your TB medications?”

No one shook her hand, sat next to her, examined her. They mostly spoke with the sister. After the 20 minutes had past, my assessment was that Margaret was suffering from untreated severe major depression, almost a state we call catatonic depression- where the patient is so depressed that they don’t move or speak. She barely spoke, in a whisper, and gave simple one-word responses. When I sat next to her, shook her hand, and spoke with her with much softer tone, she started to cry. She shed tears in the near-catatonic state: no change in her flat expression but now she had tears and mucus running down her face. After she started to wet her much-too-big t-shirt, she grabbed her kanga, which she was wearing as a skirt, and wiped her face. She told me that she was unable to walk, unable to motivate to eat, and lay on that couch all day, not speaking to anyone, not doing anything. She just cried when I mentioned the miscarriage. She didn’t say anything about it. But at least I addressed the elephant in the room.

She had no cough, nothing focal except for muscular back pains. She looked very very wasted: her skin clung to her bones except where it was stretched out for her recent pregnancy. Her eyes looked ghostly and glowing white in the darkness of her home, which has no electricity or windows. I held her skeletal hands while she tried to stand up during my neurological exam. She was very weak and her muscles contracted, stiff and thin.

In retrospect, I suspect that her CD4 drop was in large part due to her pregnancy (it was checked during the start of her third trimester) and that she probably doesn’t have TB, though in a person who was not as severely depressed as her, I would definitely think more seriously of treating for it empirically. I think that she has severe untreated depression, and while the clinicians in Kenya are often reluctant to acknowledge and treat psychiatric conditions, I pushed the issue and hopefully she has started on her antidepressants. And hopefully the staff sees the importance of acknowledging, treating and counseling people on depression – not in the accusatory way, but in a supportive holistic way.

Kenya: name-calling

[photo at left: me addressing the FACES staff crowd during my CME talk on "cough and shortness of breath" in HIV+ clients]


The staff at FACES love it that I have a Chinese name. During the first staff-meeting (when I met everyone) I told them a story about my Chinese name and how people constantly mispronounce it, so now a lot of the staff are making an effort to say my name properly. They do much better than my non-Chinese American colleagues, who mostly don’t bother to try. Often in the mornings I will be greeted at the clinic with a hearty handshake and a “Hello Sophy Shiahua, How was your morning?” The Luo staff do a particularly good job pronouncing my name. Apparently Luo also has a bunch of tones, so speaking with specific intonations come naturally to those who also speak Luo.

The nurses have given me a Kenyan name. The nurse mamas (older women) in Eldoret gave me the Luo name “Akinyi,” when I was last here in 2004, which means “she who was born in the morning.” They just guessed that I was born in the morning, which is correct. However, when the nurses here in Kisumu gave me the name “Achieng,” which means “she who was born in the daylight,” they said that it was more appropriate since I was born around 10 am (i think…) rather than in the dawn hours. I prefer either Akinyi or Achieng over the other nicknames I have been given here, like “Chinese Madam” and “Japan, Japan” and “Wing Chong Ching” which people call me all the time on the street.

Now my full name is (drum roll and deep breath, please)…

Sophia Sophy Shiahua Akinyi Achieng Pokey Resister Wong

Kenya: photo album

This is my online photo album of photos from Kenya. It includes clinic and work photos from Kisumu (FACES), Eldoret and Turbo (AMPATH), daily living, and adventures, such as to Kakamega Forest. I'll keep adding to it during the trip, so please visit the link periodically during May 07!

Kenya, April-May 07

Kenya: faces of FACES

Check out a slideshow of the fabulous staff at FACES, taken for a photobook i am putting together:

faces of FACES

Kenya: FACES Clinic & expansion of HIV care

[FACES Kid's Club - older kids posin on the staircase]

It is astounding how much HIV clinical care has expanded in Kenya since I was here in January 2004. At that time, I was in Eldoret, a smaller and more mountainous city about 3 hours by matatu from Kisumu. We were just beginning to roll out antiretrovirals (ARVs), and most patients who were on them had to pay out of pocket for their ARVs. Cipla was producing Triomune 30 and 40, the generic fixed-dose combination pill which includes d4T (stavudine), 3TC (lamivudine), and NVP (nevirapine), and ARV treatment suddenly became more affordable. Part of my project in Eldoret back then was to help link patients diagnosed with HIV in the hospital to be properly referred to the subsidized HIV treatment available at the new AMPATH HIV clinic, which was in the process of being built. That program in Eldoret was also starting to branch out to a few rural and more remote clinical sites.

You can read an article about the AMPATH program in Eldoret here: http://alumni.indiana.edu/magazine/kenya.shtml

Imagine providing HIV management and treatment in a place without roads, electricity or clean water. It is still like that in many places. But now these places are remarkably better staffed, better resourced and are seeing 10 to 20 times the number of patients. The Kenyan government has trained young medical officers in ARV management, and now Kenyan 20-somethings are running HIV clinics with 10-20 staff and managing huge public health programs. I’ve never witnessed such rapid development and growth in healthcare. And I am fortunate enough to be a part of it.

Back in early 2004, the AMPATH program in Eldoret had only a couple thousand patients involved, and only a small fraction of those on ARVs. We were just beginning to roll out Triomune for free or heavily subsidized rates. Of all the people who needed to be on ARVs due to advanced HIV disease, less than 1% of those people were getting it. Now AMPATH is serving 33,000 patients, runs several children’s programs and innovative farm-based nutritional and micro-enterprise programs. In Kenya, roughly 20% of the people with HIV who need ARVs are now getting ARVs. That means 80% still go without, but this is way, way better than more than 99% of people going without treatment. This is a result of a massive influx of attention and resource allocation by the Kenyan government, NGOs and global public health institutions. They’ve built clinics, they’ve provided lab equipment, we’ve trained thousands of clinical staff in HIV care. We’re in the middle of a 20-fold jump in treatment, and there’s still a lot more to do to get it to 100%.

I will visit Eldoret and the AMPATH program at a more rural site called Turbo at the end of this week. It’ll be really interesting to see how much it has changed.

FACES (Family AIDS Care and Education Services) is the clinic where I am now working in Kisumu. First, I should note how great it is to work at a place where people are incredibly welcoming and happy that you’re there. It creates a much happier, positive work environment. The staff at FACES seems to naturally create a constructive work community. Similar to AMPATH, FACES started with a partnership between a Kenyan medical site in Kisumu, and a US-based institution. In this case, it was the CDC and UCSF Ob-Gyn program. They had started with PMTCT (prevention of mother to child transmission of HIV) and microbicide projects, and then expanded their clinical care to include one of the biggest glaring health needs: HIV clinical care for adults. This is where the UCSF ASPIRE and internal medicine residents (like me) step in. We can actually be helpful in training folks here to manage complicated adult HIV cases.

Their family-based model is great in involving whole families and encouraging everyone in the family to be tested and treated as needed. It is much more holistic than dividing families up into internal medicine, pediatrics, and ob-gyn. It also includes home-based, hospital-based visits by staff, nutritional supplementation and counseling, as well as programs such as “Kids Club” and “Family Empowerment” workshops. [I attended the most recent Kids Club yesterday and got some really great photos and video of the kids. It’s not hard to get great pictures of kids- they love the camera. I’ll post some up.] FACES also has an integrated lab and pharmacy, so patients can get all these services on site, rather than having to trek around town to get blood drawn and their medications. The approach is so much more comprehensive than most of our out-patient clinics in the US. And they do it with a lot of people-power but not much in material resources.

The FACES clinic in Kisumu started out in September 2004 with just a few hundred patients and now sees over 4,000 patients, most of who are on ARVs, including children. It is truly inspiring to see how far HIV care in Kenya has come since 2004. They have a lot more to work with than what I had 3 years ago: a full formulary of medications, CD4 counts, HIV qualitative PCR (measuring the presence of the HIV virus), and they used to provide viral loads too. And it’s free for patients. The clinic has a very deliberate patient flow model which allows them to see about 200-250 patients every day. For the number of clinical staff, it is incredibly productive.

I’ve seen patients for three clinical days during my first week at FACES, and already I’ve initiated (alongside a clinical officer) several people on ARVs, diagnosed ten or more smear-positive malaria cases, managed people with extrapulmonary TB on ARVs. I’ve seen with Liz and Everia (a Kenyan FACES clinical officer) a young man stumble into clinic with left-sided pain and weakness and treated him for presumptive toxoplasmosis, a parasite that can create masses in the brain causing focal neurological deficits. I see about 20 patients a day… and I’m relatively slow! It’s a very very busy clinic. And amazingly, despite my newness to this clinical site, I feel helpful: seeing patients and helping clinical officers think about the differential diagnosis and treatment options, assisting with paperwork and getting the patients the treatment or investigations (labs and studies) they need.

You can read more about FACES at their website:

http://www.faces-kenya.org/index.php

I also have a number of projects that I created for myself and have been assigned to do by the rotation. Because the clinic is so busy, it feels a little crazy to add so many things on top of the clinical work. However, it is the diversity of my work that keeps me engaged. I think I would go crazier if I saw patients from 8 am to 6 pm every day without other work projects going on. This is not news, but I am once again confirming that I need a wide variety of creative, clinical and program/systems-level projects to keep me happily and actively engaged with work. Here’s my current list of projects, in rough order of what I personally think is most important. Pole, sorry, it's like showing you my to-do list, but at least you get an idea of what I'm doing here. You’ll hear more about them as they develop:

1. video documentary on capacity building and training at FACES (my own gigantic project)

2. the faces of FACES staff photo book (my own project)

3. CME (continuing medical education) session on HIV and pulmonary (lung) diseases

4. mentoring clinical officers and nurses

5. organizing the rotation for future UCSF residents with proper orientation materials and resources so that they are useful and get the most out of being here

6. less formal educational workshops for clinical officers; i will do one on a subject they choose

7. journal club (not my favorite thing to do because it is highly entrenched in academia, but it has become part of the rotation)

8. developing sections in the clinical officer handbook; i will likely tackle sections on HIV and pulmonary disease, diarrheal disease (my personal fave!)

Somewhere lodged into this list is the clinical work of seeing patients. I can’t decide how to prioritize that because it always becomes a priority once I commit to seeing patients on certain days. I’ve decided to see patients for at least 3 days a week and spend one full day and some half-days on my other projects.

Yikes! It’s a lot to get done in the next 3 ½ weeks. Time here always goes so quickly.

Kenya: wiki moja, first week explorations

[photo: me, baby Shawn, and mom Triza, who is also the pediatrics medical officer at the Nyanza Provincial Hospital]

*adjusting to life in Kisumu

I intended to have a restful first weekend in Kisumu. I was finally able to chill out after my long journey and busy tourism in London. I pictured myself lounging by the pool, reading and finishing my crochet amigurumi mushroom dude. No such luck!

But it was poa (cool) because I was able to meet up with my friend Kibachio, who happened to be in town for a Kenyan Medical Association meeting. He now is a Medical Officer in the provincial hospital of Embu, and apparently in charge of both the maternity ward as well as expected to help manage the HIV clinic. They were discussing the Millenium Goals in healthcare, since most countries have not yet met these goals. It was great to be able to meet up with him because 1) he is a all-around fabulous person with good energy and 2) he has really grounded, constructive insight to the politics and health care systems in Kenya. Despite his packed schedule at the medical meeting, he came out early to meet with me and catch for an hour or so. He also gave me 15 minutes to interview him on the topic of capacity building in Kenyan healthcare. I accompanied him on his errands in preparation to leave and met his friends Triza and Katana, who work for the district hospital and CDC-Kisumu, respectively. It’s helpful and normalizing to be able to hang out with friends here and meet more folks who are roughly in my peer group. Triza and Katana are young Kenyan doctors, about my age, and have a new baby. They are coming over to the cottage with their baby, Shawn, for afternoon tea today.

I spent the next few days incredibly jetlagged, probably the worst I’ve ever been coming to Africa or Asia. I blame my prolonged stopover in London for this. I had adjusted to Sophy-Standard-Time (SST) in London, which is the equivalent of going to bed at 2 am in London, which is 4 am in Kisumu. The problem with this is that I have to get up a 6 am on workdays so I can make the 45 minute walk to work, and arrive for 7:30 meetings or 8 am clinic. A few days of 2-4 hours of sleep was still not making me tired enough to sleep at a normal time in Kenya; this was bad jetlag. Part of the problem was the nasty crunchy foam mattress I was sleeping on, the suffocating feeling of a mosquito net over a small bed, and the insane amount of howling animal and insect noises at night. I was trying to spare my melatonin for my trip home (I sadly didn’t bring much and had used up most of it in London), but gave up and took some for the next 3 days to get some shut-eye.

*Kisumu is big and diverse

Kisumu is a big city. Way bigger than I remember Eldoret being. The largest market in western Kenya is in Kisumu. Apparently people come over from Uganda to buy stuff here. The market is so big that it has metastasized and spilled way out of the marketplace area into the public park, main road, and has established sub-markets in different areas of the city. This makes the city incredibly lively (which I like) as well as crazy and congested (which I don’t like).

If Liz wasn’t here for my first week in Kisumu, I would have gotten totally lost going to and coming from work every day. There is so much construction and craziness downtown that it makes it all the more difficult for a directionless person such as myself to get her bearings.

We walk 3.7 km each way to the FACES clinic. I know because I took a taxi home one day and watched the odometer. Amazingly, the whole way is paved with nice asphalt. I really feel like I’m in a big city because of this. The walk would not be so bad, and in fact is mostly pleasant and allows us great exercise, except for the fact that you have to cross (unprotected) an undivided highway to Nairobi and walk on rocky dirt patches in order to avoid being hit by a swerving boda boda (see below) or a speeding matatu (privately-operated “public” transport vans). The roads are quite busy here. You have to share it with a wild medley of transport forms: people, carts carrying huge loads of petrol, carts carrying huge loads of chickens or furniture, boda bodas, bikes, matatus, tuk tuks (three-wheeled gas-powered covered vehicles for hire as a cheaper alternative to taxis), taxis, large buses, construction tractors, trucks crammed full of people in the back, trucks crammed full of various other goods, and oh yeah- cars. And of course there are no real traffic signals.

I’ve seen few mzungus here, relatively speaking. I see them mostly at the fancier stores and at the CDC. It’s nice not to be in a heavily tourist city. I even met a crew of four young men from Southern-Central China here. Of course, I bumped into them at a store in the rice and noodle aisle. They said that they had been in Kisumu for two years, operating a vehicle repair shop. They said that life here is OK, they miss home, but they couldn’t make enough money at home with their skills, so they came here instead and are financially doing better for it. Go figure!

There is a huge South Asian population here, and the cottage I am staying at is in the upper-class neighborhood of Kisumu, called Milimani. Most of the families here seem to be very wealthy black Kenyans as well as wealthy South Asians (South Asians here tend to be merchants and owning class). Despite the obvious class schism, it is nice to have different cultures represented strongly here. Plus, it allows me to go out and get lots of yummy South Asian food ingredients, and buy delicious samosas, dal and dhosas for lunch.

As Kisumu is quite cosmopolitan, it also has a bigger diversity of tribes represented here. Despite the large Luo majority, the businesses and NGOs here have attracted folks from tribes all over Kenya. FACES ends up being diverse for that reason. In fact, some of the clinical officers have to get interpreters who speak Luo in order to interview patients. I’m not the only one…

*boda boda phenomenon

There is a new mode of “public transportation” in Kenya now: boda boda taxis, or bicycle taxis. Generally, they are young-ish men with big, old school Chinese-style bikes outfitted with a big cushion, extra handlebars and foot rests in the back. They weren’t around when I was in Eldoret 3 years ago. Liz told me that someone had recently institutionalized the boda bodas in order to address the extremely high unemployment rate among able-bodied young Kenyan men. Very smart. Though now there is a surplus of boda boda drivers. And people are saying that Kenyans are now going to get fat riding on the backs of boda bodas rather than walking on their own. Ah, the price of development.

*Kenya is good for my health (except for the diarrhea, see below)

My pimples are gone, my color has returned, I walk 4 miles a day at 1130 meters, swim 20 laps every day, take most of my weekends off, work almost normal hours at clinic, and cook almost every meal. It’s amazing what a more relaxed culture and work environment will do for you.

*diarrhea

Alas, my GI tract has become immunologically oversensitive and wimpy from being in San Francisco too long. After I had been in Kenya for four days, Liz kindly reminded me that heating up the tap water in the hot pot was not exactly boiling the water for decontamination. Oh. Duh! I had basically been drinking Kenyan tap water (and lots of it) for four days. Somehow I had forgotten that the little hot pot that heats up water to a near-boil doesn’t really kill the organisms living in it. It might fry them a bit, but not enough.

Needless to say, on Kenya Day Six, I started having bad intestinal cramps and gas. Lovely, especially during clinic. The loose stool started on Thursday, Day Seven. I am proud at least to state that my GI system is at least strong enough that I didn’t develop the full traveler’s diarrhea of awful cramps and 10 stools a day. However, I was hoping to stave off the antibiotics and condition my GI tract more (don’t want to contribute to fluoroquinolone resistance!) but after three days of cramps, gas and gnarly loose stool, I decided that it was time to break out the cipro. Sure enough, twelve hours after taking the first dose, I am gas, cramp and loose stool-free. Yay!

Kenya: Karibu Kisumu!

(photo above: sunset over Lake Victoria as seen from the Pabari cottage in Kisumu)

I had a very typical foreigner-in-Kenya entrance to Kenya: By the time I had stepped out from customs onto the arrivals platform, I was assaulted by a huge swarm of touts trying to get me to take their unauthorized taxis and to go on under-the-table safaris. No peace for the travel-weary. I couldn’t even get to the ATM machine without a horde of people following me and talking at me incessantly. Luckily, I had been in Kenya once before and knew about the authorized taxis waiting out in a designated area. It just took me a while to break through the barrier of unauthorized drivers trying to get me to pay for an illegal ride.

My taxi driver, Francis, was a very interesting young man. In addition to driving his (licensed) taxi, he works for a Kenyan pharmaceutical company which was apparently doing trials on an HIV immune modulator. He spoke about wanting to go back to school in order to go to medical school and eventually become a doctor.

I then embarked on another very Kenyan experience (though middle-class Kenyan, as it was quite safe): a hot, dirty, bumpy nine-hour Easy Coach ride from Nairobi to Kisumu on very broken roads. It felt a little crazy doing this after an eight-hour overnight flight from London. The bus was packed to the brim, but luckily not overpacked and luckily I sat next to only one very lovely person (as opposed to a mother carrying two children, etc.). Caren was returning home to a rural town next to Kisumu after visiting her daughters and new grandson in Nairobi. Caren is a primary school teacher and has a fascinating family. In particular, her sister Eugenia was recruited by the Chinese acrobat school when she was 11 years old, back in the 1970s. She then lived, trained and performed Chinese acrobatics for six years afterwards. According to Caren, she was no longer very athletic after having several children. Eugenia now works for Kenya Air’s Chinese department; i.e. she books and arranges flights in Africa for Chinese folks. Caren was so excited to learn that I speak Mandarin that she used her last cell phone minutes to call her sister up and have us conversate. Eugenia’s Mandarin was impeccable. She spoke with all the right intonations, even after all these years. She had Chinese vocabulary that I could only guess at. I imagined a plump, dark-skinned Kenyan woman speaking in perfect Mandarin on the cell phone with me.

I arrived in Kenyan time at the Kisumu Easy Coach terminal: two hours late. I had scared Vero, our wonderful Kisumu-based UCSF/UBC liaison, earlier when I didn’t call her till I reached Nakuru. She was afraid that something would happen to the lone foreign female traveling by bus from Nairobi. I tried to call her earlier, but there was simply no phone to be safely found in Nairobi before we departed. Plus I was still carrying that insane load of luggage by myself. She was quite worried about me, so she and Liz waited at the Easy Coach station starting at 5 pm, when I was supposed to arrive, till nearly 7 pm, when I actually arrived.

Happily Vero and Liz helped me with my luggage into the clinic van, and drove me straight to the cottage that I am staying at for the next five weeks. It’s gorgeous. It’s tropical. It’s perfect. The woman who runs the cottage compound, Mrs. Pabari is a Turkish landscape designer. You can tell. She has an immaculately maintained tropical garden with plentiful flower and vegetable patches, koi ponds, frog ponds and a naturally heated lap pool. Not only am I in this lush natural setting, I also have a home with hot water, plumbing that works, electricity, and –get this- speedy internet access with an ethernet connection.

The only thing tough about this place is 1) the bugs, including mosquitoes and 2) the immense racket that the nighttime animals make. The random outbreaks of hornbills, bullfrogs, dog barks and howling contests keep this jet-lagged insomniac wide awake at night.

What’s gross? Ants one-inch long invading your home.

What’s grosser than gross? Killing a large ant and finding a swarm of smaller ants eating and liquefying its body within 5 minutes.