Transportation Interlude

So before I begin my second part of my holiday, I'd like to take a moment to put Kenya's transportation into perspective.

Before we dissect the nature of the buses and matatus, the medium to which they travel upon needs clarification. Kenya's roads are the furthest thing from an interstate in the States. The best road you may ride upon will still be littered with potholes and can make the strongest stomach nauseated. 

Furthermore, if it's the “best” road, that means approximately ¼ of Kenya's population will be simultaneously driving on that same stretch of road. Insanely dense congestion, total disregard of “rules of the road” (which honestly I don't think exists as a saying here), and dreadfully close encounters with death are all common occurrences.

Borrowed, yet painfully realistic, photograph of Kenya traffic.

However, there is respite from the concrete jungle commute! Head into the beautiful country hills, the vast stretches of Rift Valley plains, the inner “bush” of Kenya and there isn't another vehicle to be seen for miles. But there is a price to be paid for such tranquility...and that price is manifested as the worst roads in the world. Tarmac is just a wishful thought. Inaccurate to even call them potholes, small craters make up the majority of the road surface (everyone tested their center of gravity, tilting upwards of 20 degrees...with plenty of turned over trucks to display tipping points). Cows and goats dictate the traffic patterns.

Next, one must ask, “What kind of incredible vehicles can make such a journey.” 

Answer: beat to hell Nissan buses and war-torn matatus.

Matatu definition:10 passenger van equivalent to which approximately 20 people are squeezed into. They are usually painted bright colors, boast all sorts of slogans (Messiah; Big Daddy; Amoeba Frank; Big Wet....the list goes on), and of course have the loudest techno/reggae theme music.

While trying to find a worthy picture of matatu...
I found this cartoon that basically sums it up

Mombasa driving the 99%

My favorite experience was riding from the Diani-Mombasa ferry to Diani junction, approximately a 30 minute ride. I find one matatu going where I need, however it's already jam-packed. “No worry, brotha!” is the “all aboard!” I slam myself into the middle of the pack, backpack on some old Muslim guy's lap, my face squashed into his traditional kufi (hat), holding onto him and a nearby mother so I wouldn't be catapulted out the door (which my rear end was hanging out of already.)

P.S. CMMB, I'm sorry you have to read this. I PROMISE I'm taking all necessary precautions.

Anyways, the Matatu was this neon pink tank with honestly 22 people aboard and Dragostea Din Tei (better known as the Numa Numa song) BLASTING. While careening down the road (remember how the roads are), I'm begging the good, sweet Lord to get me there. I turn my head out of the kufi and find my other handhold (mother) full on breast feeding. Now this is an experience.

Aside from matatu madness, those previously mentioned Nissan buses hold their own adventure.1 in 5,000 buses are comfortable and most likely to pass department of transportation standards. On my 28 hour bus journey home from Lamu, I was fortunate enough to ride upon Vanga express (who I think touted “Masha'Allah” on the windshield). Whether burnt by cigarettes, stained from God knows what, or completely dismantled, each seat proudly showed its battle scars from overland Kenyan travel. My actual assigned seat had no back and a neighboring seat back was suspended from the overhead luggage racks with a rope. Nice, a swing! Additionally, you could study the exposed, intricately welded frame of the bus and muse on how well it would hold upon roll over.

Beater bus I was lucky enough to ride on.

Getting you there on a prayer!

Needless to say, the ride was memorable. Standing room only, people sitting on old crates of Coca Cola or burlap bags filled with produce, stopping every 15 miles to pick up another passenger who loaded maize, doors, huge bundles of charcoal, tires, wicker furniture into the bottom or on top of the bus.

We have plenty of room!

I can't complain however because I spent less than 20 dollars for a round trip, cross country bus ride (approx 1000 miles). I also, as my dad puts it, I got exactly what I paid for! Thank you Kenya for the amazing experience.

Going Coastal!

Time for holiday!

“Holiday” simply means vacation. Maybe that was obvious to everybody else but I know when I first heard, “So-and-so is on holiday and will be back next week” I was curious to what holiday said person was celebrating while everyone was busy at work.

Anyways, that special time to celebrate the Holiday of Ricky came last week and it was glorious.

As things have been increasingly hectic and challenging in the medical ward, a trip to the beach was just what the doctor prescribed. I had my eye on Diani beach, a popular getaway on the southern coast of Kenya, near Tanzania. Pristine beaches, palm trees, bath water warm Indian ocean. It was an easy decision. 

So in effort to make this a little adventure, I decided to couchsurf the southern coast instead of renting some hotel room by myself. If you're not familiar with couchsurfing, I will explain it in brief and then you can look it up online if you're further interested! Basically, it's an online community where fellow travelers not only offer insight or guidance into their local area for new travelers but also accommodations for one “to spend a night on their couch,” where this all becomes namesake. Besides this being a financially savvy way to travel, it most importantly allows for a mutual sharing of cultures, stories and traveling experience between host and surfer. I have done parts of the US and southern Ireland this way...and loved every second of it. Time for Kenya's turn!

In Diani, I stayed with two hosts over the course of 4 days and then met a third for lunch before I traveling to distant islands. My first was a young woman, Lizzie, who recently moved to the Diani beach area to start a business. Great guide to the beaches and local hangouts. Had a very nice, relaxing time.  

Lizzie and I

Camels at Rongo Beach; would have never found
this place without Lizzie's help!

My second host was a very nice local man who had been in the area for around a decade and lived right within the community. This offered an excellent perspective into daily living on the Kenyan coast. Definitely not all sunshine and roses like our thoughts of “coastal living” in the States. Even though he truly had little for himself and family, he opened his doors so willingly and was so generous. Can't thank him enough for showing me the little villages, local coconut wine, delicious Kenyan dishes.  

Nick and his wonderful family

A village tucked within the city of Ukunda. Another gem
I would have never encountered without his help!

So the beaches of Diani are nothing less than perfect. White sands stretch on for miles, the water is so calm and warm, palm trees line the beach with few houses/resorts in sight. Definitely not the Jersey shore.

However, I did notice a few peculiar aspects of Kenya's south coast. First, the “beach boys” are relentless and will hound you until you want to die. I know this is common all around the world's beaches...but it was incredible here. I had to start faking that I didn't speak any English or any common European language to shake them off. Difficult to relax under those circumstances. But no worries, I did it and did it real well.

My beach boy hideaway. 

Another oddity—which was pretty nauseating when it came to be understood clearly—was that I noticed A TON of old white guys around the resorts...with an equal TON of young African women. Well, long story short, there is quite the market for Europeans/Australian old farts to “vacation” and openly have lots of young Kenyan prostitutes!

Definitely smears the beauty of the south coast when you learn that little fact.

I emphasize openly because when I inquired further my host, Lizzie, she explained Kenya is painfully aware of the situation but the community/government doesn't do anything...because it's lucrative. That's that! The money from tourism just throws principle (and community standards?) to the wind.  

Well, to move on from that uplifting note, I met the coolest creatures ever! After randomly meeting a civil engineer, a hydrogeologist, and an environmentalist from South Africa (sounds like the beginning to a crappy joke), I joined them at a treetop bar, “Stilts” to enjoy a few Tuskers and feed the bush babies!  

Bush Baby!

All it takes is an old banana to make friends

When I had had my fill of Diani, I moved north to the city, Mombasa. There, I met another couchsurfer, Nick, for lunch and a quick tour of Old Town. Nick is a professional tour guide (mostly with safaris) so he was an excellent reference!

Awesome guide, Nick. Enjoying some fresh coconuts!

Ferry between Diani and Mombsa. Standing room only.

 Nick showed me around the winding streets of Old Town, keying me in to the great food and coffee shops. Jahazi was this quiet, little hole-in-the-wall Swahili coffee shop, tucked in some side alleyway. It was there, my eyes were eternally opened to the best cup of coffee in the world. Swahili coffee is an amazing blend of cinnamon, cardamom, and ginger. Throw just a dash of sugar and it has this excellent combo of spice and sweetness. To top it off, the owners were incredibly kind and willing to share their culture with me.   

Even with a good sense of direction, it's easy to get turned
around in Old Town.

My Old Town best friend

I also found myself blessed to share a nice cup of masala tea with this old woman who lived next door. This little, hunched over woman held post in front of the coffee shop with her straw broom, swatting flies and ants. When I joined her on the bench, she of course cleaned that spot meticulously, made warm welcome for me to sit, and offered me a cup of water from her pitcher. With that, I decided to share my coming order of tea with this beautifully, kind lady. When she received her cup of tea, she was overjoyed and then immediately went to her house and brought out some breaded treats. We exchanged no words in common language but there was no doubt we had kindled a nice friendship. In short, I learned that kindness and a sincere, sweet heart extends beyond all boundaries of ethnicity and language for she had been one of the nicest people I encountered during my trip.

As the sunlight waned, I made my way out of Old Town to catch my next bus. At this point, the first half of my coastal journey came to a wonderful close and I was thrilled for my upcoming adventures in the northern, port city of Lamu.

BUT! To hear more, you'll have to mosey on over to the next post :) 

Mazungo's Mandazis!

That is the name of my new mandazi enterprise. It has already been copywritten, trademarked, registered, patented...so don't even try to steal it. 

Let's break the name down:


Mazungo = simply means, "white man" in Swahili. Basically, it's the only name I hold in Kenya. Wherever I go,"Mazungo!" is yelled from market stands, children playing in the fields, patients in the ward...it is just how it is. Now, this isn't meant offensively...and I definitely clarified that in the first week of being here. We all know greeting one another in America as, "white man!" or "black man!" wouldn't bode well. However, it's actually endearing and simply meant as a kind greeting. Very interesting.

Mandazi = a popular fried dough treat. Balls of dough are rolled out, cut into small squares and then fried in vegetable oil until puffy and golden brown. Delicious!


Anyhow, it has become a nice little weekend tradition to help the guys in the kitchen make mandazis for the hospital's little cafe. Manas (who taught me to ride the pikipiki), Mesheck (Manas' brother) and Dominick all work in the kitchen and are awesome. Simply put. They make great food and are fun to be around. Luckily, I was allowed to learn and now assist in the Mandazi making each Saturday. Good fun, good food, nice way to relax from the medical ward. 

My primary job is to fry these little guys until perfectly golden brown. So far, the masses have approved of my work and Manas markets my work as "Mandazis of America!" I think we're going to start a business back in the states. 

Below are just some pictures of the past few mandazi sessions:

All ready to be rolled out!

Mesheck's perfect technique.
Not too thin, not too thick

Mesheck and I

Mesheck!

Ready to be fried

Dominick and Manas. Hilarious.

In the pot! Well on their way to golden brown perfection. 

Bowl of finished Mandazis.

Adaptations

The following consists of nothing truly interconnected, but just various musings concerning my last two months. So enjoy the ramblings!

As I near the 2 month mark, it begins to become apparent some of the adaptations made during my stay. It has certainly been an interesting process: moving away from loved ones, changing jobs, packing all your year-long necessities in one hiking backpack and a small day pack, arriving in a brand new country (let alone a new continent), immersing oneself in a different culture....the list goes on.

By all means, it has its peaks and valleys. But honestly, that has allowed for quite the personal journey. I've experienced some of the most exciting personal moments shared right along with some of the most challenging. 

The initial move was, of course, exciting. Definitely an adventure coming to a country I have never experienced, settling into a unique community, gaining perspective on an area so very different from the US, and learning to live a much more simple lifestyle. It has been enjoyable learning these new things. 

Right from the very beginning, I will say that Kenyans are the kindest people I have ever encountered. The welcomes are so warm, smiles are eager, accommodations are readily available. It has certainly been a pleasure getting to know and slowly become part of a community so kind. I can only be extremely thankful for such a place to live. 

That friendliness has been so vital during some of the "valleys." There are certainly those days, especially after a grueling day in the ward, where I ask myself, "What exactly am I doing here?" I've found that a friendly face and a kind greeting pull you through those moments. Concerning that, the biggest thanks goes to the children. These little ones are the most sincere, the sweetest, and just down right wonderful to be around!  I credit many days being uplifted by playing soccer or tag with the kids, whether from Dala Kiye (the nearby orphanage..which will be discussed in its own entry) or the neighboring children by my house. 

Dala Kiye children. Soccer half-time photo shoot

Wild, neighborhood children. These kids are the BEST.

Obviously one of their favorite games (Yes, I caught him).

Another adjustment was towards, "African Time." It's real and it requires a real adjustment. I learned this quickly during my first days working in the OR. The nurse said, "Be here at 830 for when we open." I was there at 815 just to be prompt...and waited until 915 for the first person to show up.


Lesson learned. 


The next day, I arrived for the "830" start time at 9:00 anticipating African delay...and waited until 945. 

Moral of the story: I have to tweak the African Time formula until it's just right.

These are all just fun adaptations when moving into a different place and culture. I could write for days telling stories of different instances where I had to tailor my "American" ways to be flexible. 




However, as I said in the beginning, some instances prove to be more difficult. The primary example is the medical ward, where it is an absolute challenge to adapt my practice to a very different medical scene, limited resources, and the hardest being the extent to which we can treat the patient. Coming from the land of plenty, where our ER had all resources at the tip of our fingers, it has obviously been extremely difficult seeing very ill patients receive care limited by accessibility and/or resources. An example being a couple of recent stroke patients. The diagnostic test they need most is a CT scan of their head; however due to SCMH not having a CT scanner (understandably) and the patient's financial inability to transfer to a larger hospital in Kisii or Nairobi, the patient foregoes the scan and we manage the patient to the best of our abilities, even though the prognosis ends up being very poor.  

Another example is the huge challenge of caring for an ICU-equivalent patient with no monitors, no oxygen, and very limited medication choices (for the medical persons out there: ie no vasopressors for the severely hypotensive). Even with all the aforementioned resources back home,  this patient would still be a challenging case in the ICU. With that, it has required, if not forced, me to extremely adapt not only my nursing practice but emotional perspectives. 



It is difficult to say what this all translates to in time, but as I continue to work, live and explore here, I'm sure I will have quite the interesting journey to look back upon next year.



I will definitely keep you all posted on the journey and new challenges that await! It has been exciting and will continue to push me to new levels, making me stronger, smarter and more flexible!   

As for now, I'm going to simply enjoy these awesome sunsets!

Preface

So, it's more than apparent I have been slacking on writing entries.

With a little thought, I realized I am slow to publish because I spend a decent amount of time piecing everything together, editing, polishing, making sure things are totally correct. That's all well and good, but I am not writing for a magazine or newspaper.

Don't feel as though you will be deprived of an entry with some forethought and decent grammar; however, I feel that a more dynamic entry, like a personally written email, would do better. I would not only be more compelled (and quicker) to produce entries but I can truly continue to paint a relevant, interesting picture of my stay in Kenya.

Feel free to comment and make this more like a discussion rather than a one-sided presentation! With that, be on the lookout for some new entries!

Doin' Work!

So it may seem odd I haven't written about my actual work yet, but I felt I needed some time to settle in, scope out my role and actually gain some understanding of the hospital and ward I'm working within. Now, a month into my work, I feel a post can do some justice.

 In the beginning, I rotated through each ward gaining general insight to the work required, the patient population and how each ward functioned. Initially, my role was not completely defined so this allowed me time to see where I could best serve SCMH. Through discussions with the nurse managers of the hospital, it was noted by both parties there was a need to build a stronger nursing department.

A plan was presented to both the nursing managers and administration through a small proposal I drafted up. It stated the overall importance of a strong nursing department and offered methods of encouraging and empowering the current nursing staff into becoming patient advocates and active participants in the management of patients' well-being. The entire idea behind this is with empowered nurses, vital collaboration with doctors can be had, the hospital works efficiently and patients are provided the best care, allowing optimum patient outcomes....the whole goal of a hospital! Well, it was accepted and decided that I should spend approximately 4 months in each ward to slowly initiate these ideas.

The first rotation began in the general medical ward, where the patients with complicated tuberculosis, extrapulmonary TB, malaria, meningitis, pneumonia, sepsis, AIDS and AIDS-related illness are admitted to. It has 40 beds and typically is at 85% capacity on most days. The severity truly ranges; some patients just need a few days for IV meds and recuperation, others are some of the sickest patients I've cared for (who honestly would be in an ICU in the states.) With a small staff—approximately 1-2 techs, 1-2 nurses, and 1 doctor/clinical officer—the workload is heavy and it's definitely a busy shift.

Medical Ward

So far, it has been challenging learning the limitations of rural medicine and beginning to understand the true needs of the department and hospital. I have definitely had to adapt my role as a nurse, not only for practice within a different clinical setting but how to evoke my best managerial skills as well. Regardless of any difficulties, the most satisfying part is seeing patients become well and go home with a smile on their face. 

My buddy, Zilpa! Went home happy and healthy.

Peter! We became good friends during his stay.
He drew a rough map, using rivers, rocks and hills as landmarks,
 to his house for me to visit.
Time to put my navigation skills to the test!

Honestly, time will only tell how my role at SCMH will make the greatest impact. My true goal is to not simply assume one role in one ward, but to create the most sustainable system of nursing; moreover, I hope the work accomplished can continue to grow and expand the nursing capacity well after I leave.

I hope this provides a decent overview. It's hard compiling the experiences of that last month into a concise, understandable post. Do ask questions and keep your eyes peeled! I will be sure to update.

Flies In Your Eyes

Orr in Catch 22 had it right. Flies in your eyes.

Except he forgot to mention your mouth...nose...ears...hair....pants. Flies are literally EVERYWHERE. I've never seen anything like it. In swarms, they appear out of nowhere and just engulf you. Your only hope is to close your eyes and swat your hands like a madman; hopefully you remain on path and escape the 4^th Egyptian Plague sequel.

Nasty, magnified visual of the culprit.

 The locals tell me the flies show up just prior to the rainy season. In it's own twisted way, these flies are a good thing.

No, my camera lens was not dirty. SWARMS!

I'll tell you one thing about these bugs, they are the dumbest insects. They fly with no direction and once they bump into something, they're dead. With that, floors become blanketed and fly-drifts appear in corners. The nurses station in the morning is covered. Everything that could contain a fly, contains multitudes of them.

If the same proverbial phrase of eating a pound of dirt before you die applies, I am far ahead of schedule. 

My fear. Just picked up and carried away into Lake Victoria.