Uhuru!

So it's been about a full week since successfully climbing Mt. Kilimanjaro.

Sorry, I cut right to the chase. No build up, no suspense in making you wondering if I made it or not. My sincerest apologies.

I tried writing a nice, flowing entry about the whole experience when I got back but I realized too many wonderful thoughts and feelings were spinning around my head to allow true justice in writing. I typed, deleted, retyped, deleted some more but could not produce anything I felt happy with writing. So, I simply decided I would just jump in and create this entry through free flow writing.

Anyways, I decided only about 2.5 weeks ago that I would actually sign up and climb Mt. Kilimanjaro. I had packed as though I would but I never had a set plan and I was honestly on the fence...up until I booked. Kind of wild considering the task at hand: climbing the tallest free standing mountain in the world.

Summit of Kilimanjaro peaking over the clouds on the drive in.
Yeah, that's a big mountain.

The simple fact is this: aside from loving the outdoors, hiking and camping, I realized that over the past three months, I have seriously lacked any feelings of accomplishment. That's not saying anything beyond exactly what I said. It is just the truth. With that, it came time to strive for a goal, work towards an area of achievement, literally reach the tallest peak.

All of a sudden, this climb became a little more overwhelming with so much at stake. Not only was I attempting to climb to unfamiliar altitudes but I was placing much more to attain on Uhuru peak. Call if foolish, but it truly all occurred subconsciously. I certainly wouldn't want to make this climb any harder than it needed to be, however, it was the reality behind this journey.

Well, on May 17^th, I boarded a bus down to Arusha, Tanzania to meet with my guide and prepare for the next day's ascent. Long story short, after a little police and immigration officer shake down at the Kenya-Tanzania border, I bribed my way across and was able to start my adventure as planned. That story can be continued in detail, at a later date, over a nice, cold beer if you're interested.

Without further adieu, I began at the Machame gate on May 18^th, packed up and ready to go. Most groups are comprised of a guide, a cook and however many porters are needed to load the gear up the mountain. First off, I had the hardest time wrapping my head around the fact I needed all these people to accompany me up the mountain; however, it's just the way it works when you want to climb Mt. Kilimanjaro. I felt it was silly for someone else to carry my gear since I carry all my needed gear each time I hike and camp at home; furthermore, these guys already carry upwards of 40lbs of gear without having to bear the load of my stuff. With that, my pack weighed in around 30lbs with everything minus a tent and food (I did carry approx 3-4 liters each day).

Porter with an insane amount of gear.
I said they must have exoskeletons to be able to carry so much.

Anyways, the nerves were already in full swing and I was trying my hardest not to work myself up over the unknown that the next 6 days held and this powerful peak that was set before my eyes.

Day one: Machame gate to Machame camp; distance 7 miles; altitude gain 4000ft; time 3.5 hrs; final altitude 9,350ft above sea level.

It was a beautiful trail through the rainforest. I learned really quickly that this was unlike a “normal” hike where it's up and down; this is a constant ascent and it requires some pacing. Needless to say, I had sweat my face off and knew the next day would require a change in style.

Rainforest trail

View of summit from 1st camp; exciting and nerve wracking at the same time

Day two: Machame camp to Shira camp; distance 3 miles; altitude gain 3000ft; time 3 hrs; final altitude 12,500ft above sea level.

Fantastic hike. Left the rainforest and entered into the moorlands, where the ascent was steep and rocky. Some really great foggy parts that left you only able to focus on the trail ahead, which then turned into beautiful vistas of Mt. Meru when clear. I got into the groove of hiking/ascending and was feeling great!

Mt. Meru when the clouds cleared.

 Sunset was obviously fantastic and the backdrop of Uhuru peak was becoming closer. I'll say although amazing to hike closer and closer to Uhuru peak each day, it was definitely a challenge to mentally keep yourself focused on the day's hike at hand and not become overly concerned with the end point, which was miles, days, and thousands of feet of altitude away.

Incredible sunset with Meru in the background

View of summit just up from camp

Day three: Shira camp to Laver tower to Barranco camp; distance 6 miles total; altitude gain to Lava tower 2700ft, descended 2150ft to Barranco camp; time 5 hours; altitude at Lava tower 15,200 ft above sea level, Baranco 13,050ft above sea level

Felt like I was hiking on the moon; boulder fields and just complete lack of vegetation (other than some lichen here and there). This hike was physically easier but stirred the nerves. The altitude at Lava tower was of considerable altitude and really proved to be a test of my acclimation. Although altitude sickness can begin at any altitude about 12,500ft, this was one of the highest points we would reach before attempting to summit a few days later; moreover, if I got sick here, I would know that my journey to the summit would require some slower hiking and careful evaluation of my physical condition. Luckily, lunch at 15,000 ft was delicious and I felt fantastic!

On the moon!

Looking back at Meru

Made it! Feeling good!

Hey!

View from Barranco camp

Barranco camp

Summit shot from camp

Summit sunset

Day four: Barranco to Barafu camp; distance 5 miles; altitude gain 2280ft; time 4.5 hrs; final altitude 15,300ft

The beginning of this hike seemed to psych out a lot of hikers with a grueling first leg. The trail ascended very quickly and was technical; definitely a challenging start to the morning. It took some mental preparation the day prior; staring the trail down and getting myself excited for the challenge. The hike went well and brought us not only higher but palpably closer to the peak...mainly because this was our base camp before our last hike to the summit! Some groups take a rest day in Karanga valley, which splits the day's hike in half and sleeps at a considerably lower altitude; however, the cohort of hikers we had created wanted to stick together and felt physically and mentally prepared to reach base camp a day early. We set up camp, nervously ate dinner and forced a few hours of sleep.

Morning's first climb. (I'm towards the bottom, center left...below yellow pants)

View back towards prior camp

Foggy boulder field

Felt great to make it to Barafu!

Day five (1^st half): Barafu camp to Uhuru peak; distance 5 miles; altitude gain 4000ft; 5 hrs; final altitude 19,341ft above sea level!!

After 3 hours of sleep, we woke up to begin our ascent to the summit at 1230am. The plan was to summit at sunrise and have our lives forever changed. The hike began well, a few steep parts and difficult gravel trails that truly left you sliding a step-and-a-half backwards with each step. The great part was we had a full moon to hike by and we were able to do the majority of the ascent by moonlight only. The night sky was absolutely incredible. I've never seen the stars like that. It almost seemed as though there wasn't enough room in the sky for all the stars, it was so densely packed. The milky way stretched far beyond the boundaries I have ever known it to stretch. Definitely provided much needed excitement to fuel tired and altitude-susceptible bodies. I felt great until I reached 18,300 ft. At that point, someone must have repeatedly struck my head with a baseball bat and then got me incredibly intoxicated...all at once. We all agreed our coordination began to lack, with goofy side-steps and poor motor judgment. Cognitively, I was completely there; and it took every ounce of cognition to stay determined and positive, blocking out that “mental chatter” of doubt and negativity, which creeps in easily when you're physically and mentally tired. I simply focused on each step and only that. I completely devoted my attention and determination to that single step because not only was that the only thing I was physically diminished to, but it was truly the only method that was going to allow me to summit. It was amazing, all of a sudden Stella point's “Congratulations!” sign came into view. 

I nearly cried. It wasn't even the summit, but it was the first peak we reached and it assured us we were nearly there and that whatever challenges of altitude we may have encountered were well worth it. Stella point was only about 20 minutes from Uhuru and a mere 300 feet in elevation lower.



 We reached Uhuru about 45 minutes before sunrise and to keep warm, we hiked down to crater point and saw some of the glaciers and amazing vistas. At 630am the sun broke the horizon and with those rays an incredible feeling of accomplishment warmed us all.

Unreal. Minutes before sunrise.

Success!!! 

Galciers

Beautiful, beautiful sun!

Day 5 (2^nd half): Summit to Mweka camp; distance 9 miles; altitude loss 9250ft; 5 hrs; final altitude 10,100ft above sea level

After celebrating our successful climb to the summit, we slid back down the terrible gravel trail to Barafu, grabbed a quick nap and some food, and then continued our descent to Mweka camp. Not only did I mentally check out, feeling as though all that needed to be accomplished was, but I underrated the difficulty of continual downhill hiking. Not even after 4.5 days of uphill hill hiking did my legs hurt as much as they did during descent! It was great descending however; not only did that killer headache gradually subside as I entered regions of more acceptable atmospheric pressure but we gradually came back into the moorlands and saw signs of life again. Shrubs, insects, flowers, trees and a variety of birds (not just ravens) welcomed us to lower altitudes. We camped that night and understandably slept like babies.

Goin' to Mweka!

More hospitable altitudes

Camp :)

Day 6: Mweka to Mweka Gate; distance 6 miles; altitude loss 4700 feet; 2.5hrs; final altitude 5,400 feet above sea level.

This was a nice, gradual descent through the rainforest again and it proved to be an excellent, relaxing way to conclude the hike. I was able to have some nice conversations with my guide and caught up on some topics we didn't really get to discuss during ascent (mainly because I didn't want to talk during the huffing and puffing associated with altitude acclimation.) Upon reaching the gate, hawkers pushing t-shirts, paintings, Masai garb didn't miss a beat. I was worried I wouldn't have contact with a desperate peddler that doesn't take “no” for an answer upon my arrival, for I missed their company on the summit. I inquired if the t-shirts were complimentary since I actually successfully climbed Kilimanjaro, however the price remained the same $15 with no humor appreciated. Interestingly enough, a tour group of Germans were at the gate (for what reason, I don't know) and were all enthralled with the group of us that came off the trail, taking pictures and asking questions. Again, the reason why a gaggle of tourists were at this random park gate remains unknown, however the fanfare was kind of endearing.

Peaceful descent

Nice last view of the summit

Heath, Han and I. All smiles!

Overall, I can say this was one of the hardest mental and physical challenges I have done. The endurance and determination required certainly pushed me. Beyond that, it was, as I have described to family and friends already, the most spectacular physical, mental and spiritual journey I have ventured on. For lack of better words, when you get “into that zone” of hiking and pushing forward, you realize it's simply you, God and the mountain. That's your reality and it's beautiful. Honing your will and determination to overcome all the aforementioned challenges teaches you so much about yourself. The main lesson I learned was that instead of setting your sights, hopes, desires and efforts so far ahead—placed upon a peak ( ie: the future)—if you fully devote yourself to each, singular step required, that goal, no matter how seemingly far and unobtainable it may seem, will be achieved.

Reaching the summit, Uhuru, became a namesake experience. Uhuru, in Swahili, means freedom; and when I saw the sunrise and began to realize these amazing life lessons, a true feeling of freedom came over and has thankfully remained with me. I am so incredibly thankful, not only for the success, but the entire experience I was afforded.

With that, if you ever have the chance to make this journey, do it!

Hussein (my guide) and I...freezing...but feeling great!!

Hospital update

So I want to let you know, there aren't going to be fun pictures (or any for that matter) in this post. Sorry.

I just wanted to briefly write an update for how things are going in the hospital. It has been quite some time and I've loaded you up with plenty of non-hospital posts over the last couple of months. 

First off, I will admit the most rewarding (and sometimes only rewarding) aspect of working within the medical ward is the chance to make an individual difference in someone's life. That may seem obvious, but when trying to work at a broader level within the hospital, sometimes one forgets about the "little things," which I've come to learn are the biggest things. 

I'll recount some of the most memorable instances.

L.A. (yes, I will try to uphold HIPPA even in the bush), a young woman in her mid-twenties, was admitted for "psychosis" earlier this month. Sometimes the diagnoses originally stated are frustrating because they overlook some really crucial medical problems. In this case, L.A. was not suffering from psychosis or anything of that sort; rather, she had developed a serious case of meningitis and had an acute onset of confusion and change in personality. With some diagnostic tests and rule-outs, we found out she was afflicted with TBM, or Tuberculosis meningitis. Not common at all back in the States, it has definitely taken some time to adjust my mindset towards these conditions rather than other "common" disease processes. Anyhow, with a little sedation, time, patience and anti-TB medications, L.A. recovered relatively quickly and began "acting herself" per family. She went from being drastically confused to a patient who could hold a conversation, follow commands, and act like a normal twenty-something year old. Aside from it being especially nice to see the marked improvement, it was really rewarding to help her overcome a disease that can become fatal very quickly (and has for many of our patients in the past). L.A. happily went home and I hope to see her in a few weeks for follow up!

D.O. was another inspiring case that occurred just recently. Another mid-twenties patient, D.O. arrived unconscious and very unstable after reportedly being poisoned with some organophosphate substance. With quick action, we were able to begin to reverse his poisoning with atropine, support his respiratory system (which was severely compromised from aspiration), and lavage his stomach to decrease the concentration of poison. Honestly, with severely limited resources (ie he should have been intubated immediately, along with tons of other treatments and medications) and his very critical state, I wasn't very confident in his recovery. However, (and this goes for multiple other cases) solely through the grace of God and the resilience of the human body, D.O. recovered really quickly and progressed from being unconscious and unresponsive to completely normal in 7 days. I watched him go home today. Amazing. 

Sadly, these cases are not the norm. We receive a surprising amount of critical patients and again, with limited resources, these patients don't recover as well. It's a hard transition, coming from a place where every ill patient received every possible treatment to heal them and avoid death. Here, death is much more common place and accepted. Understandably so, however it is still difficult to see stroke patients and cardiac patients arrive and deteriorate without much influential intervention. 

Although one would think that limited resources would serve as the biggest challenge, it honestly has become the secondary difficulty faced each day. I have found, consistently, that the largest and seemingly insurmountable challenge within the medical ward and hospital at large is lack of staff accountability. I can't reasonably explain why and how this happens, but it does...and it's frustrating beyond belief. Now, this actually becomes the biggest hurdle in delivering optimum patient care, even more so than the limited resources and hospital's physical capabilities. It has been mind blowing to watch various staff, seemingly lack a sense of care and responsibility, allow patients to deteriorate right in front of their eyes.

SIDE NOTE: I know this is really controversial and a heated topic, but it's the reality here. Sorry if this makes anyone uncomfortable.

Anyways, it has created a nearly impossible work environment where gaps in patient care become more prevalent (and accepted) than patient care continuity. I'm not naming names or placing blame, since that's honestly irrelevant at this point in discussion. Furthermore, with regard to my last post, the institution of a “nursing model” is truly unrealistic and I honestly spend each shift making sure the patients receive the care they need for optimal outcomes independently from my staff. It has definitely been a transition from a broad focus “me and the hospital” to a very individual “me and each patient.” Frankly, as long as the patients avoid needless suffering, that's all I'm concerned with.

With all of this in mind, I can easily and unashamedly admit that this has been one of the hardest things I have done. It is just the fact. Although having adjusted well to a vastly different culture/lifestyle and being away from family and friends, these transitions have been compounded by this extreme professional challenge (and a dwindling sense of accomplishment). Surprisingly, it has become easier, if not automatic, to admit the aforementioned.

I'm not quite sure what any of this amounts to and am sure I won't for a long time. It has simply become a day-to-day goal to keep focused on making those differences for each patient and praying I can create some sense of purpose and direction.

Please email with any thoughts, concerns, suggestions etc

Rick.cmalo@gmail.com

     

Holiday part 2

So from the point of leaving the lovely “Old Town” Mombasa, I launched myself onto a bus named deception. I bought a cheapo ticket to go to Lamu and found myself on this, surprisingly, fantastic looking bus....to another great surprise, I found myself the sole occupant of the back 5 seats. AMAZING! A comfortable night bus with the ability to lay flat and sleep?! This is an early Christmas day miracle.

However, I soon found out why this bus would be named deception. As we flew down the less-than-desirable Kenya back roads, I could feel every bone in my body rattle and every organ just barely stay put in it's respective place. The floor boards were nearly rattling loose, something above and to the back of me sounded like it was ready to fly off. At one point, when I was able to trick my tired body into sleep, I awoke to find myself a foot and a half off the bench seat...only to be slammed back down in a less coddling way.

Don't worry, it only continued like this for an additional 7.5 hrs.

Wow, I made it. I think?

At 430am we stopped and told, “LAMU!” I stepped off the bus (understandably confused and groggy) to find myself on a random pier in the pitch dark. I was told to head towards the end and I would find a boat to take me to the actual island of Lamu. Didn't have much of a choice at this point.

I did find said boat and made myself comfortable as we waited for departure. The boat was this old 30ft rickety wooden boat with this stinky, loud diesel engine situated right in the middle of it. Once we were all sufficiently smoked out and got moving, the 40+ passengers and luggage motored our way across to Lamu.

Travel weary passengers on our boat to Lamu

The arrival was honestly amazing though. The sun was rising over the bay and traditional dhows were quietly sailing by. Lamu came into sight and the beautiful front of old Swahili buildings were illuminated by the sun.

Traditional dhow for an early morning sail

Lamu is a historic, primarily Muslim port town dating back to the 1400s. The beauty of this small town is that this history is alive and well. Unlike “historic” areas in the States, where buildings are purposely restored and restricted, Lamu is a fully functioning city amidst the narrow corridors and old buildings, forts, and mosques. Additionally, no motor vehicles are allowed besides an old school Land Rover ambulance and one motorbike for the councilor. Otherwise, the alleyways are populated with donkeys carrying goods and people. Really neat sight.

Town square in front of the old fort

I met up with Peace Corps volunteers that I knew were staying in Lamu for their own holiday. Meg, a science teacher in a nearby secondary school, is who I had previously met back in Karungu weeks prior and learned we were going to be in Lamu at the same time. Really kind to invite me back to their place and meet everyone.

The PC was staying in this cool house, tucked away in the alleys behind the town square and fort. Unnamed, an ornate wooden door was the only clue you were at the right place. Upon entering, the foyer was casually decorated with traditional Swahili carvings and pottery. It wasn't seemingly decorated to impress mzungus but seemed to naturally acquired its character over time. The entire house was three stories with various terraces and open air rooms. The center was fitted with a fantastic atrium with palm trees and other flowering plants. Beds were semi-private, tucked in various corners and nooks. A true commodity was a functioning kitchen and bathroom (with flush toilets and shower). However, the truly incredible part was that I could stay here for only 600ks/night (ie 6.80 USD/night)!!!!

Common area, open air

Decorations throughout the house

Beautiful atrium in the house

Entrance to the house from foyer

Intricate lintel; "dhow eye" hangs above doorway, symbolizing good luck

I stayed a total of 2 days and was lucky to enjoy some really nice outings. One of the volunteers knew some locals that owned a dhow and had this whole cruise, beach excursion, fish fry all set up. That afternoon we sailed out to some of the remote beaches, dove into the incredibly warm Indian ocean, and then began preparing the delicious fresh fish for dinner. We enjoyed dinner on this “floating bar” which was this makeshift barge with little thatched huts on top that conveniently had a bar for anyone interesting in sailing out there. Dinner was incredible and we of course delighted in Tusker.

PC volunteers, Meg is second on the right.

View of boat while motoring towards the remote beaches

Anchored. Time to swim!

Raising the sails. "Am not afraid of storms" 

Old fort at mouth of port

Capt. Rick sailing the dhow. So much fun.

Fish fry. SO GOOD.

Sailing into the sunset. I could get used to this.

Dance party at the floating bar!

The next day I was able to wander through Lamu's labyrinth of a town, sufficiently getting lost but seeing some excellent areas.

From the pier

Preparing to head out to sea. Kenyan proud.

The oh-so narrow alleyways that comprises Lamu

Little Lamu buddy. Curious to have his picture taken
(note mob of children charging from the right...I escaped just in time)

Reaching the market district.

Brilliant mosque.
I loved how the Muslim prayers
 hauntingly floated through the alleys in the evening.

Little village tucked away behind the actual town of Lamu

String of donkeys carrying goods to town

Hands down, Lamu was my favorite part of the vacation and I would return without second thought. I loved the culture, the feeling of stepping back in time, and the peaceful nature of how Lamu functions and the beautiful beaches.

Oh and that statement has extra gravity being that it took 28 hrs of bus travel from Lamu back to the mission hospital. Yeah, obviously Lamu must have been pretty awesome.