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.  

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 :)