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!