tag:blogger.com,1999:blog-74860023593048887582024-02-07T03:25:00.776-08:00carlisles to kenyaChristinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.comBlogger23125tag:blogger.com,1999:blog-7486002359304888758.post-18245159581574395322011-04-29T05:05:00.000-07:002011-04-29T05:05:45.051-07:00Lake Nakuru<div style="margin-bottom: 0in;">Our weekend trip to Serena Mountain Lodge just teased our appetite for wildlife. So on our final weekend in Kenya we squeezed in another quick trip to the wildlife park at Lake Nakuru. We arranged to travel on Friday evening, have a tour of the park on Saturday morning, and return to Tumutumu Saturday night. We traveled with Kris and Lucy, a couple of British medical students also working at Tumutumu Hospital.</div><div style="margin-bottom: 0in;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">Typical matatu and patrons</td></tr>
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</div><div style="margin-bottom: 0in;">Our objective: see amazing animals as quickly and cheaply as possible. Per Google Maps Nakuru is approximately a 2.5 hour drive from Karatina. We priced hiring a car and driver and instead decided to engage the most common method of public transportation: a matatu. Matatus are 14 passenger vans that travel between communities at a nominal rate. They are notorious for being over crowded and their drivers are notoriously aggressive and reckless. When debating whether or not to travel by matatu Matthew often said “More people die in Kenya every year from vehicular accidents than die from malaria”. </div><div style="margin-bottom: 0in;"><br />
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<tr><td class="tr-caption" style="text-align: center;">Rooster in Matatu</td></tr>
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We were determinied not to visit the ATM machine during the trip and only use the shillings in hand. We through caution to the wind and decided to travel by matatu.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">The trip to Lake Nakuru took 6 hours on 3 different matatus. Highlights of our journey included a passenger carrying a rooster in her lap (quickly revealed by sound and smell), an hour delay in Nyeri as we waited for our van to fill, and a deteriorating highway riddled with potholes. The highway itself was so poor I'm not sure what difference a private car would have made... I'm certain the asphalt was poured without the proper gravel subgrade. It was an exhausting journey.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">When we arrived in Nakuru we checked into our hotel and we had a nice dinner at a Chinese restaurant. It was a lovely and welcome meal – good food and good company. At 6:30 the next morning our tour guide met us at the hotel with an open top van. We were oogling at the animals of the park by 7:30. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">And then it was all worth it! Lake Nakuru is well known for the variety of birds it attracts, most famously, pink flamingos. But in addition to spectacular birds we saw loads of baboons, zebras, giraffs, hyenias, rhinosorases, cape buffalo, warthogs, empalas and antilopes. We saw them laze about, get in fights, feed each other and play with each other. All quite close from the safety of our open top van. The only regret is that the lions and the lepords, which are present in the park, did not make an appearance. </div><div style="margin-bottom: 0in;"><br />
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<tr><td class="tr-caption" style="text-align: center;">White Pelicans</td></tr>
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</div><div class="separator" style="clear: both; text-align: center;">We stopped for a snack break at an overlook at 'Baboon Hill'. We climbed out of the van with our packed lunch and before we knew it a baboon had snuck up and stolen our bread and biscuts! So much for sandwiches! Obviously we were not the first victims... they had practiced well and are known for stealing bananas and other goodies right out of the hands of distracted tourist</div><br />
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<tr><td class="tr-caption" style="text-align: center;">Matthew and I with Kris and Lucy at Baboon Hill.</td></tr>
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</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX00B5UoIjbKuSAhNnIUkMNSf5NKTdavpq638xn0oKoXRpRqFCihsmsgL3RU3RKjpTQcKe2VK0bdm6RdyGR1tMKt2gmwZEo5Um_xK6N0MMfw4AKVATkrl5eG4kfsArxvQ4j2bFrlsBASc/s1600/IMG_4631.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX00B5UoIjbKuSAhNnIUkMNSf5NKTdavpq638xn0oKoXRpRqFCihsmsgL3RU3RKjpTQcKe2VK0bdm6RdyGR1tMKt2gmwZEo5Um_xK6N0MMfw4AKVATkrl5eG4kfsArxvQ4j2bFrlsBASc/s200/IMG_4631.JPG" width="150" /></a>The animals were fantastic and such a wonder. It is easy to see how they are personified in in 'The Lion King'... they each have such distinct character and habits.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Our return matatu trip only took 5 hours. This journey featured a sick passenger, vomiting out the window adjacent to Matthew. We were also seated on the back row and which meant little leg room with the wheel well and spare tire under our feet. The trials of being jostled around the back of a matatu was enough to make us admit our age and that we just weren't interested in this type of travel in the future... the extra expense would be worth the comfort of a safe journey.</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-23202110755951558672011-04-24T06:44:00.000-07:002011-04-24T06:44:01.980-07:00Worship at Tumutumu<div style="margin-bottom: 0in;">Christina and I have had the opportunity to worship with the people of Tumutumu Presbyterian Church. This has definitely been a cultural experience for both of us and departs from our traditional Presbyterian services back home. Both of us have worshipped outside the US before, but it is always a blessing to share the intimate act of worship with new community.</div><div style="margin-bottom: 0in;"><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzW0NiTmsnWWpD-y3JGxfx_O90Nn70BxRaQRNMQQ7f3DSf74jzyOPt5iU0iYcQTJfgpMVvvOTwNFq6tinGb1p29bonEcfP72zY8c7IHp810RqiQMeu8qa9ILWO9ya11DH5KxGgHxktUXY/s1600/IMG_3589.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzW0NiTmsnWWpD-y3JGxfx_O90Nn70BxRaQRNMQQ7f3DSf74jzyOPt5iU0iYcQTJfgpMVvvOTwNFq6tinGb1p29bonEcfP72zY8c7IHp810RqiQMeu8qa9ILWO9ya11DH5KxGgHxktUXY/s400/IMG_3589.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tumutumu Presbyterian Church</td></tr>
</tbody></table><div style="margin-bottom: 0in;">Africa has always been a place of music, rhythm, and dance, and the church service was no different. Most of the service consists of clapping, singing, and even dancing in the pews. The service starts with serveral songs before the leadership arrive in the church. After their arrival, general announcements are performed and visitors (like us) are introduced. A time is given for testimonials, which are generally given in a song representing their dedication to Christ. A time of prayer follows and then the reading of the scripture. A leader then gives a brief sermon (usually preceeded and followed by more singing.) and then performs the benediction.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">On Sundays, the Tumutumu church has two services- a 9AM English service and an 11AM Kukuyu service. Often the music flows from the end of one service to the begining of the next. (This sometimes made it difficult for Christina and I to know when to leave.) Most of the music was in swahilli although a few English hymns were attempted. The Africans had some difficulty with the rhythms and pitch of the hymns, but what they lacked in talent was more than made up for in passion and volume. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">We were able to attend the Good Friday service at Tumutumu and it was quite a departure from our traditional somber service. There was only one service that day and it was in Kukuyu. It was a joyous noise that arose from the little church and it was well attended. It was somewhat difficult for us to follow the sermon, but a few of the lines were punctuated in English- "there is no life without Christ," and "The American's are used to 1 hour of worship. Today will be 3 hours!" Many of the people around us helped us through the motions to the songs and although we did not understand the language, we easily felt The Spirit.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">We also attended the Easter Sunday service and although many hymns were sung, Christina was upset that we didn't sing "Jesus Christ is risen today." The sermon was surprisingly taken from the Old Testiment and we are pretty sure that the word "Easter" was not actually uttered through the whole service. Perhaps as lively as the services are, every Sunday is considered Easter. Or at least celebrated as exuberantly.</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-68452045800810628712011-04-24T06:42:00.000-07:002011-04-24T06:42:44.483-07:00Case Presentation 3<div style="margin-bottom: 0in;">(If you are squeemish, please do not click the pictures below.)</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Patient is a 47yo male with no past medical history who presents with one month history of rash. He denies any "hotness of body," nausea, vomiting, or other symptoms. He states the rash started on his hands and feet and have now spread to the rest of his body including his face and scalp. The rash is itching and sometimes painful. He has come in now because his feet have started cracking and weeping. The patient's vital signs are within normal limits and he denies any other systemic complaints. His DTC was negative as was his VDRL. His hemogram was normal. Please see pictures below at your own risk.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3F4U5SLj-ElHR7wBLt4OoVTuG7WtuB6S_1sOhXqXqy1eByu61tg8KfYyM3bvmTVn6m15gmOM3NQWm1lsZP7X_jf4Ib9Gj8iRm67GZ_sAXzScJRJcoOs77Iq3gR_bZ4gKz26MReZkK7U0/s1600/IMG_1371%255B1%255D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3F4U5SLj-ElHR7wBLt4OoVTuG7WtuB6S_1sOhXqXqy1eByu61tg8KfYyM3bvmTVn6m15gmOM3NQWm1lsZP7X_jf4Ib9Gj8iRm67GZ_sAXzScJRJcoOs77Iq3gR_bZ4gKz26MReZkK7U0/s200/IMG_1371%255B1%255D.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi352O_nsnsyRNhEFKbpESGMf6kePiFjL2VcAMKxBlpTARxvmTSuUrzses_2YUEy2L7elNFdnGIaL1hlds6DtSygygJABOC3DcQFgWLOjR9hk2OZXblEsuFlZZ37gIe7vWL48luFR4LPB0/s1600/IMG_1367%255B1%255D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi352O_nsnsyRNhEFKbpESGMf6kePiFjL2VcAMKxBlpTARxvmTSuUrzses_2YUEy2L7elNFdnGIaL1hlds6DtSygygJABOC3DcQFgWLOjR9hk2OZXblEsuFlZZ37gIe7vWL48luFR4LPB0/s200/IMG_1367%255B1%255D.JPG" width="200" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghiZog3p7aZ7IGYQAUwMat2bpnrcN1nAsSlWKFq2sYlDQdb4rSzNEodQMLiZg7U1kRKFqNOwvt1ffZo4sCXfnbboK2pFWEaguAt0ZbxVXFxyIzm2BukLiwN7HKeT4i7ybQzi9e2Bsnu2s/s1600/IMG_1368%255B1%255D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghiZog3p7aZ7IGYQAUwMat2bpnrcN1nAsSlWKFq2sYlDQdb4rSzNEodQMLiZg7U1kRKFqNOwvt1ffZo4sCXfnbboK2pFWEaguAt0ZbxVXFxyIzm2BukLiwN7HKeT4i7ybQzi9e2Bsnu2s/s200/IMG_1368%255B1%255D.JPG" width="149" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgObDUMWYAYo6Haak2qer0mv6yfoDQl6VpCSTca_99NZ65_8DDlKlzt6MsLbcwRA_qukFA2-Hp_xiImyOb7jNOayXI6RiNCeTZsYySPCRv0AZPBklJK5TOdt660OSpXK1oE1ly0AyZsqro/s1600/IMG_1369%255B1%255D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgObDUMWYAYo6Haak2qer0mv6yfoDQl6VpCSTca_99NZ65_8DDlKlzt6MsLbcwRA_qukFA2-Hp_xiImyOb7jNOayXI6RiNCeTZsYySPCRv0AZPBklJK5TOdt660OSpXK1oE1ly0AyZsqro/s200/IMG_1369%255B1%255D.JPG" width="149" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil0eEqE7c9IqHSVKAzbBMFHEZE530JSdUlmSLCgrLvcy8sHyad4yR1y4WZedU07ZwQgi9Z7cc8_6WXvntMmKVkRRQ3kjVMDNTrmTsPws_q7ez-5AcY_GX_mg1DBOpOI5OtIlETRX8nefU/s1600/IMG_1366%255B1%255D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEil0eEqE7c9IqHSVKAzbBMFHEZE530JSdUlmSLCgrLvcy8sHyad4yR1y4WZedU07ZwQgi9Z7cc8_6WXvntMmKVkRRQ3kjVMDNTrmTsPws_q7ez-5AcY_GX_mg1DBOpOI5OtIlETRX8nefU/s200/IMG_1366%255B1%255D.JPG" width="149" /></a></div><br />
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</div><div style="margin-bottom: 0in;">Discussion:</div><div style="margin-bottom: 0in;">This is a case of Norwegin Scabies. When I first saw it, I thought about syphilis, but with the negative VDRL and the lack of other symptoms (such as a preceeding chancre), we took that off the list. This is pretty much the worest case of scabies I've ever seen. He also has a bacterial superinfection on his feet too. We wanted to start him on Ivermectin and dicloxicillin, but unfortunately the pharmacy doesn't carry Ivermectin. In those cases, we write a prescription and the family members have to pick the medication up at an outside pharmacy. To my knowledge, we are still waiting for the Ivermectin...</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Another point this brings up is in infection control. There are very few measures taken on the wards to keep patients from infecting each other. The doctors all walk around with individual hand sanitizer, but I'm pretty sure the nurses wash their hands a few times a day (mostly before eating). There are some gloves available, but they are often difficult to find, and each glove used are charged to the patient. So our patient is probably sharing his scabies with the rest of the ward.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">It makes me itch just thinking about it.</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-20164205118744626582011-04-24T06:14:00.000-07:002011-04-24T06:31:39.346-07:00Mobile Clinic<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCE_3RKY81DMyJa32sTWYusn9FBsEd2Lwwck-Z97xKLhtjxYp0LIRtnIkgGiaLeZJAvr7_bS_87mYddEHdouS1NiHQStNjTzJgJAB9r20YeB7yShVaSLS21EzWigSDhednHRBsrBpSTkY/s1600/IMG_4242.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCE_3RKY81DMyJa32sTWYusn9FBsEd2Lwwck-Z97xKLhtjxYp0LIRtnIkgGiaLeZJAvr7_bS_87mYddEHdouS1NiHQStNjTzJgJAB9r20YeB7yShVaSLS21EzWigSDhednHRBsrBpSTkY/s320/IMG_4242.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Gatithi Medical Clinic</td></tr>
</tbody></table><br />
<div style="margin-bottom: 0in;">This week, both Christina and I were able to help out with the HIV mobile clinic. Basically it is like the Comprehensive Care Clinic that has been loaded into a land rover. On the day we helped out we stopped at Gatithi, a small town about 30 minutes outside of Tumutumu. There is a small clinic there that is still under construction. There we unpacked large boxes of medications, patient files, equipment, and other various paperwork. We even took our own table and chairs. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH18aBPCKWoH7MYvzVPQQsVeB1T-fHPFlqPYkwfHcbJbmVrQr8iHkkgdQOtJ9lmlM-KbaNZghMSQ_kNnrCb7YZPccyo7I9f3zuni2jQAyhHJnikVaP_B4ft5UVgo7Zi95ffvTNbNSQvu0/s1600/IMG_4229.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH18aBPCKWoH7MYvzVPQQsVeB1T-fHPFlqPYkwfHcbJbmVrQr8iHkkgdQOtJ9lmlM-KbaNZghMSQ_kNnrCb7YZPccyo7I9f3zuni2jQAyhHJnikVaP_B4ft5UVgo7Zi95ffvTNbNSQvu0/s320/IMG_4229.JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH18aBPCKWoH7MYvzVPQQsVeB1T-fHPFlqPYkwfHcbJbmVrQr8iHkkgdQOtJ9lmlM-KbaNZghMSQ_kNnrCb7YZPccyo7I9f3zuni2jQAyhHJnikVaP_B4ft5UVgo7Zi95ffvTNbNSQvu0/s1600/IMG_4229.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BjaDVFWUqLM1FfQ21A8UWgNoKHqaSdT0CyyrtPWDXOVNdzKtTX_UftzMZs8QeGbohm1vmTWwhVszKY8IV9lqG9SNqRbAbVd5HQ1tfrf9bjsJ5RIb_crPONgqchnMYKgPvLxXeS0waM0/s1600/IMG_4244.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a>The idea of the mobile clinic is to create a satellite of the CCC that is more accessible to the patient population. Even though Tumutumu is only a 30 minute drive, many people do not have cars and do not have the money to pay for the matatu to the hospital. Without this service, many of the people would be non-compliant with their medication regiment, an act that would not only be dangerous for them, but also for the rest of the community. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BjaDVFWUqLM1FfQ21A8UWgNoKHqaSdT0CyyrtPWDXOVNdzKtTX_UftzMZs8QeGbohm1vmTWwhVszKY8IV9lqG9SNqRbAbVd5HQ1tfrf9bjsJ5RIb_crPONgqchnMYKgPvLxXeS0waM0/s1600/IMG_4244.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9BjaDVFWUqLM1FfQ21A8UWgNoKHqaSdT0CyyrtPWDXOVNdzKtTX_UftzMZs8QeGbohm1vmTWwhVszKY8IV9lqG9SNqRbAbVd5HQ1tfrf9bjsJ5RIb_crPONgqchnMYKgPvLxXeS0waM0/s320/IMG_4244.JPG" style="cursor: move;" width="320" /></a>The people walk from their homes to the clinic and line up hours before the team arrives. The patients check in with a nurse who weighs them, takes their vital signs, counts their pills, and provides teaching on their medications. Education is really stressed and patients are expected to know what medications they are taking and at what times. The nursing staff is fairly aggressive and will chastise those patients who fail the quiz. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicJZ7AXKCp7cWLZJI3tZmCoFQNhqx94-WjlUQn8MSCMbjU8I9aNGv3lvehkHSmh7HbEuhX2FY_YQmyFYM75T540uJSmTQAEzm3xH5rRs3offWwnIdTWH8UnGAaBrMXVhQvxAzO774zuF4/s1600/IMG_4228.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicJZ7AXKCp7cWLZJI3tZmCoFQNhqx94-WjlUQn8MSCMbjU8I9aNGv3lvehkHSmh7HbEuhX2FY_YQmyFYM75T540uJSmTQAEzm3xH5rRs3offWwnIdTWH8UnGAaBrMXVhQvxAzO774zuF4/s320/IMG_4228.JPG" width="320" /></a>From there, the patients see the doctor and describe any symptoms they might be having. Mostly the patients were complaint free, but occasionally we would treat a simple upper respiratory or skin infection. There were also a variety of muscle and joint complaints although no seriously ill patients. After seeing the physician, the patient goes to the mobile pharmacy and picks up their HIV medication and any other antibiotic or pain medication prescribed. This is where Christina worked and it kept her pretty busy. The pharmacist provides further counseling and education on their medications. Again, all the anti-retroviral medications, multivitamins, and antibiotics are free to the patients and provided by USAID. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><br />
The mobile clinic is a great addition to the CCC and an invaluable resource to the patients it serves. We saw about 50 patients, many of which were either pediatric or elderly and would not have the time or the energy to get their badly needed medication. It was also a great opportunity for Christina and me to see the patients out in the community and to see the patients in their home environment. The poverty was sobering. There were fewer nice suits and dresses, which you see a lot of at Tumutumu, and more tattered, second-hand clothing (one 45 year old gentleman had an "Ohio State Grandma" sweatshirt). It was a chance to reach out to the community at large and witness their daily struggle first hand.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-BrZh3poefkd2uYXMXxzm5KNNHQpkGi_Fms3EEQ03lX166hisNrGf0OWjFi5MysmMKX1py6Kxz76fOXvJmL9ST7dGtuV7k-d9Wqv6uJ18gCaYj98QzUSaZGRVOPPdOtNa-ezNysbKX6Q/s1600/IMG_4236.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-BrZh3poefkd2uYXMXxzm5KNNHQpkGi_Fms3EEQ03lX166hisNrGf0OWjFi5MysmMKX1py6Kxz76fOXvJmL9ST7dGtuV7k-d9Wqv6uJ18gCaYj98QzUSaZGRVOPPdOtNa-ezNysbKX6Q/s400/IMG_4236.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Matthew and a Medical Officer evaluating a patient.</td></tr>
</tbody></table><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3sCSr2UiYaJ0AEPyH8L2e4uEcbNxyBjHL93ZE2KlL43eZOlHZdwiZXdMwBsJ6MDIpymbFt8FcB2ofLtiJhFuzvcDFA9WyFoF6ekREp8rYbdjaTWBLiSSrBcFNmH5BkQBlu5cj8LAw3_I/s1600/IMG_4233.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3sCSr2UiYaJ0AEPyH8L2e4uEcbNxyBjHL93ZE2KlL43eZOlHZdwiZXdMwBsJ6MDIpymbFt8FcB2ofLtiJhFuzvcDFA9WyFoF6ekREp8rYbdjaTWBLiSSrBcFNmH5BkQBlu5cj8LAw3_I/s400/IMG_4233.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Patients waiting to be seen.</td></tr>
</tbody></table></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4r0W8clJk3_DKUQ7DquRTQwn3-M8h3pwP-b3Hu3HNCWm_1BGuncZ7GDrjG2MEaOoFYOXRyx9h7X7D8TXj-YmKI-Kf7xAXsXFx64DGfnqqyr-XeGU3DXW4vwj0uyxkXDr7tDTAVAmTxJQ/s1600/IMG_4237.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4r0W8clJk3_DKUQ7DquRTQwn3-M8h3pwP-b3Hu3HNCWm_1BGuncZ7GDrjG2MEaOoFYOXRyx9h7X7D8TXj-YmKI-Kf7xAXsXFx64DGfnqqyr-XeGU3DXW4vwj0uyxkXDr7tDTAVAmTxJQ/s400/IMG_4237.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Patient signing a compliance contract stating that he understands the medications being prescribed and will take the medications.</td></tr>
</tbody></table><div style="margin-bottom: 0in;"><br />
</div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-43317944624065834992011-04-22T02:02:00.000-07:002011-04-22T02:02:53.330-07:00Kenyan Observations<div style="margin-bottom: 0in;">Just a couple of cultural differences worth mentioning:</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">The dress code always errs on the side of formal. If in dought, dress up. Any occasion that brings you to the hospital, whether a visitor or patient, is reason to dress nice. Even if it is an ill-fitting, third hand, dusty sports coat it is dressy and should be worn. I think everyone is confused that Matthew wears scrubs daily (though he was told to bring them). Scrubs here are only worn in the surgery theater by those preforming the procedure. They change out of those scrubs, into their suits and ties, before walking back through the hospital. Everyone from nurses to bus drivers to doctors are better dressed than Matthew and I every day.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">A couple of my favorite questions asked while I've been here: “How many tribes are in the United States?”. Its really an interesting question... yes, there are some unique cultures but I don't think it compares with their tribal identity. They are always shocked that I only speak one language and that that is common in the US. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">“How much did your husband pay for you when you were married?”. They Kenyans raise a combination of money, crops, and livestock to pay for their bride. They will enter into a contract with a family and spend time raising the money, which is their engagement period. Depending on how beautiful and wealthy and well educated the girl this sum can be as high as $3000 US, which is quite a lot for their standards. </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6VA7pmy2VN__IRTtygyp0vQ62oAo-xXo_PwEeqayG7bfBVwzCjKl8AMHz6QYdTsMUuzNxpO_6AyYg3rmzhT2JcTj5TKlKAm7zbsOmQTMb-xi18iHXdNPdNWlGeF91ieP1wgekMpRd-nA/s1600/IMG_3627.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6VA7pmy2VN__IRTtygyp0vQ62oAo-xXo_PwEeqayG7bfBVwzCjKl8AMHz6QYdTsMUuzNxpO_6AyYg3rmzhT2JcTj5TKlKAm7zbsOmQTMb-xi18iHXdNPdNWlGeF91ieP1wgekMpRd-nA/s400/IMG_3627.JPG" width="400" /></a>Food: We eat very well at the guest house. Breakfast is pretty international, toast, cereal, boiled eggs and sausage. Lunch and Dinner always brings more food than is necessary. Soup (usually a simple broth), two starches (usually a light pasta dish and potatoes), two meats (chopped beef in a gravy and either chicken or fish), and two vegetables (peas and carrots and a cabbage slaw). Fresh fruit for dessert. No cheese or yougarts. There is warm milk for the cereal at breakfast and in the tea. </div><div style="margin-bottom: 0in;"><br />
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</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Tea is at 10:30 and 4:00. Take your tea, take your time, enjoy it, do not be stressed about all the other tasks you must complete. Its amazing how that instantly becomes trivial and takes a back seat to the matter at hand: tea. Matthew gets frustrated that this is such a priority with nurses serving patients... tea before medications? Really?</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Though the finest coffee in the world is grown and roasted in this region of Kenya you won't find it is served among the people. It's far too expensive. Instant is the only option if you prefer coffee. Matthew is surviving quite well. And sleeping much more than normal.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">There is an interesting paradox between cleanliness and aesthetics. Everything is cleaned emphatically. Floors are mopped often, sidewalks are scrubbed. Much effort is devoted to keeping the hospital and any general living space clean. However, I can't say the same pride is always taken in construction of the facilities. I don't think a general design aesthetic is ever considered and the craftmanship of building projects is often poor. Paint jobs often reveal huge drips, linoleum tiles are askew with the wall and don't match up (often several un-coordinated tile patterns are used), concrete is poured inconsistantly and unlevel. Resources are obviously available, they just aren't always allocated and put together well. Regardless everything is well worn and used, and mopped and scrubbed.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">The Presbyterian Church has a strong hold over the region. It seems 2 of every 3 civic institutions we pass along the roadway are PCEA institutions (Presbyterian Church of East Africa). Chuches, schools, hospitals, orphanages... And they seem to be well used and populated institutions.</div><div style="margin-bottom: 0in;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiauFEYo7pdI0HEMXS9lettquV8J_cuHXH8ev1KwKaC7AUBNybu9lHXbSZAHRvYvl4tqiL65ayYJC698Cbxf9lN05mOcsssH4TCwN8J3pLro8Jfb0i8t94TtQL35CbFvWGfjKEQBEJwuGU/s1600/IMG_4230.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiauFEYo7pdI0HEMXS9lettquV8J_cuHXH8ev1KwKaC7AUBNybu9lHXbSZAHRvYvl4tqiL65ayYJC698Cbxf9lN05mOcsssH4TCwN8J3pLro8Jfb0i8t94TtQL35CbFvWGfjKEQBEJwuGU/s320/IMG_4230.JPG" width="320" /></a></div><div style="margin-bottom: 0in;">Though it rarely gets below 65 degrees here this is still their coolest season which means the winter clothes come out. Kids run around in parkas. Everyone wears sweaters and knit hats. It's crazy.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Everyone here has a cell phone. Unfortunately this culture has not adopted a cell phone etiquette. No one puts their phone on silent. Doctors, students, nurses and patients will answer their phone if it rings, regardless of what they are doing at the time. Very few smart phones.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Yes, our guest house has running water and power. But this is really a temporal condition. The power blinks or simply shuts down for 'rationing' at any time (the hospital has a deisel run generator which is often used). And I haven't figured out why water has become a problem... I see water in the tank behind the guest house... but we have been without water for a few days now. Sometimes everything is working great but often one thing or the other is out of order. An emergency bucket of water is always wise for flushing the toilet or taking a sponge bath.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">And my final observation... this is the first place I've ever been where no one has made a comment about my hair. No one has asked to touch it or inquired if it's naturally curly... nothing. I think maybe it far too common here to be considered special.</div><div style="margin-bottom: 0in;"><br />
</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-89964357451720868882011-04-20T08:59:00.000-07:002011-04-22T02:07:31.027-07:00Comprehensive Care Clinic<div style="margin-bottom: 0in;">Today I had the opportunity to help out at the Comprehensive Care Clinic (CCC). This clinic serves individuals with HIV and Tuberculosis. Mainly, this is clinic provides free medications to those with HIV and TB and follows up on routine concerns such as CD4 counts and treatment failures. As part of the CCC, community workers even visit the homes of patients to ensure medication compliance. The workers often go on daily runs and has a fleet of bicycles, motorcycles, and a vans to accomplish this task. Fortunately most people are very reliable and appreciative of the care that they receive.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">The clinic sees an average of about 50 people a day. Most of the visits are very short and consists of checking vitals, refilling medications, and occassionally checking CD4. However, a few patients do require additional testing to evaluate for pneumonia or other infections. These tests and their medications are all provided at no additional costs to the patient and is funded by USAID (United States Agency for International Development).</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHupmQeyoOGXNdhSJCZ5sAQ5v81VXCmdljPuzQrGP_mdOBhiMCMYd-7cPkslJST9APO-u9y5PSMN_G654-BxqgHpj6LZ7d8l6gU7irUOvbm3UU6iIYjzDOVqSAPM3aLBbuBQA_xbewXZU/s1600/IMG_4198.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiHupmQeyoOGXNdhSJCZ5sAQ5v81VXCmdljPuzQrGP_mdOBhiMCMYd-7cPkslJST9APO-u9y5PSMN_G654-BxqgHpj6LZ7d8l6gU7irUOvbm3UU6iIYjzDOVqSAPM3aLBbuBQA_xbewXZU/s400/IMG_4198.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Clinicians will take bicycles and motorbikes into the community to find non-compliant patients. </td></tr>
</tbody></table>It was a good chance to see many different members of the community. Even some of the Tumutumu hospital employees frequent this clinic. The patients were all very friendly and grateful to be seen. Often times working in the emergency department is a thankless job... it is nice to be able to provide care to patrons who truly appreciate it. </div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-39840340326613650202011-04-20T08:56:00.000-07:002011-04-20T08:56:46.797-07:00Case Presentation 2<div style="margin-bottom: 0in; page-break-before: always;">Patient is a 57 yo who has ISS and TB who presented with confusion and decreased intake. The family states the patient was started on medication for the above diagnoses about 2 weeks ago. Patient has become more and more confused and has not said anything in the last 24 hours. He seems to have "hotness of body" and hasn't had anything to eat or drink in 2 days.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">When we evaluated the patient, he was not febrile but was minimally responsive to pain and verbal stimuli. He was tachycardic and appeared very dehydrated. He was found to be tachypneic and his oxygen saturation was 92%. The patient was given IV fluids and started on Co-tramazole, Ceftriaxone, and Acyclovir. ECG was performed to evaluate his tachycardia. Complete hemogram, UEC, and chest xray were ordered and a lumbar puncture was performed.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Discussion:</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtdlTT9T6Gg-1S4GhDJKY8A1im44w73QKIhre3SBPEhV5IAz276Iey_pP2ZsfauzfK-sg2ZHV7Uzxn5E1sKAXrBzlOhyphenhyphen2g2ImEpskctKJfiw68Je00XAu1IEERFtURVlQgXF4JwtUBnSs/s1600/IMG_1378.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtdlTT9T6Gg-1S4GhDJKY8A1im44w73QKIhre3SBPEhV5IAz276Iey_pP2ZsfauzfK-sg2ZHV7Uzxn5E1sKAXrBzlOhyphenhyphen2g2ImEpskctKJfiw68Je00XAu1IEERFtURVlQgXF4JwtUBnSs/s320/IMG_1378.JPG" width="239" /></a>There are a few points that I would like to discuss about this patient. The first is the fact that the patient is "ISS." This stands for "immuno suppression syndrome". There is such a stigma here in Kenya against HIV that even doctors can't discuss this openly with patients. It goes so far that you cannot order a rapid HIV test. Physicians instead order a DTC-diagnostic testing and counciling. Even the HIV clinic has a euphamistic name- the Comprehensive Care Clinic. Apparently if it was called the HIV clinic no one would come. That's not to say that we don't have a stigma in South Carolina as well, but I feel that in SC we can speak more openly about the subject.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2vSyWyI2hsthQQ-2d0-ZDccQCK-dtLDang6n0k-IXKo6bhSv96VH2aXXsPHOxOe0hgoDBiA5ei5qHpjucYQU4v9JNbJLNO9CnpMnIHn6-b2VeshvJjv1EAXQN2jTeJ-v896Z157jlQ0s/s1600/IMG_1379.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2vSyWyI2hsthQQ-2d0-ZDccQCK-dtLDang6n0k-IXKo6bhSv96VH2aXXsPHOxOe0hgoDBiA5ei5qHpjucYQU4v9JNbJLNO9CnpMnIHn6-b2VeshvJjv1EAXQN2jTeJ-v896Z157jlQ0s/s320/IMG_1379.JPG" width="239" /></a>This is one of the sicker patients that I have seen here. In the emergency department he's what we would call an easy admission. With the limited resources, it makes it very difficult to treat the acutely ill. We were able to obtain an EKG, but this took several hours. The machine is not very portable and is almost on par with putting the patient's hands and feet into buckets of water. Acutally there are clamps that are attached to the limbs, and the precordial leads are held in place by bulb-suction devices. The leads are printed out one at a time and the clinical officer has to cut them all out and tape them onto another sheet of paper to place in the chart. The process takes anywhere from 30-45 minutes from start to finish not including the cutting out (and you thought it took awhile to get one at Richland). </div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Oxygen is often difficult to get onto the patient and tanks have to be wheeled to the bedside. This takes a lot longer than you would really want and sometimes makes me nervous, but often there just isn't a tank available. These tanks are not very portable which means if a patient is needs O2 they can't go anywhere. Even getting a simple chest xray is impossible. Forget a stat CT- that requires raising funds and a day of travel. Sometimes I forget how easily these diagnostic studies are obtained at home.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd3q8saKgbRMV10-tFwSeCjwgs-2Ekoq4oNWkrV6lMwImiRLpLM3cJFCLdZ7dpaI9W2nNTSd22Q09C-ccBZjT_VPtRwqC-kTQcFiJkEqNgMjCffhjzDECcmrZnQlGrRbhCU0RZK5ni4XM/s1600/IMG_1380.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd3q8saKgbRMV10-tFwSeCjwgs-2Ekoq4oNWkrV6lMwImiRLpLM3cJFCLdZ7dpaI9W2nNTSd22Q09C-ccBZjT_VPtRwqC-kTQcFiJkEqNgMjCffhjzDECcmrZnQlGrRbhCU0RZK5ni4XM/s320/IMG_1380.JPG" width="239" /></a>The patient is currently being treated for TB and I asked about placing him in isolation. Basically there is no isolation here. The doctors practice on the theory that it is basically endemic to Kenya. "Everybody has TB here, just not everyone shows it," is what the intern told me. To which I replied, "I don't have TB!" She simply shrugged and told me not to breath too deeply.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">We were able to obtain CSF and it was actually negative. I was able to walk the clinical officer through his first successful LP (or more likely he succeeded despite my misdirection). The lumbar puncture kits are very simplistic and they cannot get an opening pressure or perform cultures. However, they can obtain cryptoccal antigens studies and these were negative as well. Still, we threw everything but the kitchen sink at this guy. In addition to antibiotics, patient received IVF and tea through NG tube. Apparently it is customary to place an NG twice a day to make sure the patients get tea time.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">Over the last few days, the patient has done very well. He is now off oxygen and has vastly improved, although still confused. We still don't know the underlying eitiology of his illness although the current theory is either sepsis (unknown sources) vs IRIS- immun-reconstitution syndrome. I am glad to see him improve everyday even if he has no idea who I am.</div><div style="margin-bottom: 0in;"><br />
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</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-13118340865739793042011-04-18T07:01:00.000-07:002011-04-18T07:04:10.825-07:00Nature Walk at the Mountain Lodge<div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2PNlN77mA2M0nS4o_imSZ_b3vNT5vo5_3Oi69gwFvrD80AoLGxRQBhjTuz6wgNAFXgOOHa8tkvtXhMikj5S7926i3Pz4-YMGCbqG_MMHbnzAf_r2YJ6ET05IZRZA9EEGrdbJIkmFyNH4/s1600/IMG_3855.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2PNlN77mA2M0nS4o_imSZ_b3vNT5vo5_3Oi69gwFvrD80AoLGxRQBhjTuz6wgNAFXgOOHa8tkvtXhMikj5S7926i3Pz4-YMGCbqG_MMHbnzAf_r2YJ6ET05IZRZA9EEGrdbJIkmFyNH4/s320/IMG_3855.JPG" width="240" /></a>On Saturday afternoon while at the lodge we went on a nature walk. A guided tour through the very forest from which all the animals lived and traveled before gathering at the watering hole. Does that seem a bit crazy? Don't worry, no need to fear, an escort would follow with an assault rifle in case danger finds us.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We were scheduled to take the hike in the morning but it was delayed because the guard was unavailable. He had be called away to free an elephant from a snare. A snare is a trap set by poachers in the forest. Illegal poaching for the ivory of elephant tusks is a big problem in the park and the enforcement officers are thinnly spread across the large area.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Our guide gave us lots of interesting educational facts about plants and animals and I'd like to share those that stuck with us.</div><div class="MsoNormal"><br />
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</div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie8ho1qXH2hs0C3OW6DxoNoqjPQD77dAOA-yOXnPksiY-s7abgLstxuUyQWapIVyAt-Oqf1fNcSOTF_m70_kJxHphjbXzkbJ9pSwLIqboZE2noYIzDZorle0Nme0uI4B87KtaeIBTVgbs/s1600/IMG_3881.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie8ho1qXH2hs0C3OW6DxoNoqjPQD77dAOA-yOXnPksiY-s7abgLstxuUyQWapIVyAt-Oqf1fNcSOTF_m70_kJxHphjbXzkbJ9pSwLIqboZE2noYIzDZorle0Nme0uI4B87KtaeIBTVgbs/s200/IMG_3881.JPG" width="200" /></a>Elephants are long lived in very close-knit familial groups. They can live up to 70 years and eat as much as 200 kilos of foliage a day. They feed 16 hours of each day. By way of a poor digestive system they are responsible for sewing many of the seed of the forest in their depositions. What I found really interesting about these tremendous creatures: they mourn the loss of a family member and will actually gather debris to cover, or bury, their loved one.</div><div class="MsoNormal"><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLcda35ZCgjJ9gDlrFoxIej7QTzH67i2pS2W5u6sacP92LDcfIqDpr1KyY9SJePukReHg0Uix3zowsxm5bLwOu42Zi6FZzjdTtnzmcOdxhghwX0AopsC1iBss7DWAN6KxGEFGh8fucJKQ/s1600/IMG_3819.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiLcda35ZCgjJ9gDlrFoxIej7QTzH67i2pS2W5u6sacP92LDcfIqDpr1KyY9SJePukReHg0Uix3zowsxm5bLwOu42Zi6FZzjdTtnzmcOdxhghwX0AopsC1iBss7DWAN6KxGEFGh8fucJKQ/s200/IMG_3819.JPG" width="200" /></a></div>Those cape buffalo are an irritable species. They travel in groups and their aggression prevents them from being domesticated. A lone male cape buffalo is one of the most dangerous animals to run into in the forest, they will attack unprovoked. If you are so unlucky your only hope is to climb a tree. If none is near, lie flat on the ground. Hopefully he will just turn you over several times with his horns and stomp on you. This is the only way people have survived a meeting.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdAhdkxXcMZHEXo9LG4myZZyHX5v8nvsDv0EkbgZhIpgTEGKLzFbJ0ZoR_iREaL82H1j7I0IfBeg7gU-iAmEjwT8DQRvm1CaIjnuxdg9TRQDfyi_dcl4KyRbGZPrgg39ghWke9__J4YVg/s1600/IMG_3857.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdAhdkxXcMZHEXo9LG4myZZyHX5v8nvsDv0EkbgZhIpgTEGKLzFbJ0ZoR_iREaL82H1j7I0IfBeg7gU-iAmEjwT8DQRvm1CaIjnuxdg9TRQDfyi_dcl4KyRbGZPrgg39ghWke9__J4YVg/s200/IMG_3857.JPG" width="150" /></a>The difference between the forest and the bush is that the bush has been deforested. This is a huge problem in Kenya where many people gather wood for building fences and fire. The old growth rainforest that we walked through has a beautiful clear, low understory. By comparison the bush is thick and dense with woody shrubs. It will take 600 years to return to a mature forest.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">And I have to mention the Strangling Ficus. This is a close relative of the beautiful banya trees we found in Hawaii. But in this species seedlings find life in the crook of existing trees. Then the roots form around the existing trees, using it as a crutch to reach the light quicker. Eventually they completely devour the first tree and strangle it. I think this is the same ficus you find consuming the temples of Angkor What in Cambodia. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSSES0wLyBJYA_Fy82_WLFROZp2Fmvx7WQD6JZZ4_ttwCiX8pNW4LO6p-Kxx7gUO5c-xMOotrt8tCyyboHQj3d61ZK_AA4ED7GRhhc8Br3-zIhhwwgsrdMnyjSub0drXImIdyoMV32Tck/s1600/IMG_4184.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSSES0wLyBJYA_Fy82_WLFROZp2Fmvx7WQD6JZZ4_ttwCiX8pNW4LO6p-Kxx7gUO5c-xMOotrt8tCyyboHQj3d61ZK_AA4ED7GRhhc8Br3-zIhhwwgsrdMnyjSub0drXImIdyoMV32Tck/s400/IMG_4184.JPG" width="400" /></a></div><br />
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Kenya is named for Mount Kenya, the country's second highest peak at 17000 ft. (Mt. Kilamonjaro, south of Nairobi, is taller). Mt. Kenya was an anomoly to the early western visitors because it sits nearly on the equator (off by 11 miles) and still retains snow and ice on its peak year round. The name is derived from this contrast of black rock and white ice which many local tribes (each in their own language) called “ostretich tail”, which also has the same contrast. The tribal word for this, per whichever of the eastern tribes the westerners were near, was something similar to Kenya. 42 distinct and seperate tribes, each with their own language and culture, lived in the boundries of present day Kenya. Instead of choosing the name of one tribe to identify the region they chose the one landmark they all identify with, Mt. Kenya.<br />
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</div><div class="MsoNormal">The hike concluded with tea time in the bush. We came around the corner of the trail to find they had set out cups and saucers. We sat on a log and enjoyed our afternoon tea. I found it rather charming and picturesque. Quite a fine hike.<br />
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</div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4xBAsG3oVF6TZ4CnbZJGciJamFWQ0-BW023dARdkWA7wcGkrSmIdhQLB0J5RXo9JM7PJjLu3kKj86ZPUK0_GpjMFSvXtlqdDlt_0OdeHVvJ_PAvDiYQxvSLWEQ8ZopOgEAq2SrrYzr68/s1600/IMG_3867.JPG" imageanchor="1"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4xBAsG3oVF6TZ4CnbZJGciJamFWQ0-BW023dARdkWA7wcGkrSmIdhQLB0J5RXo9JM7PJjLu3kKj86ZPUK0_GpjMFSvXtlqdDlt_0OdeHVvJ_PAvDiYQxvSLWEQ8ZopOgEAq2SrrYzr68/s320/IMG_3867.JPG" width="240" /></a> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4hcRMraotjKNd7H-X3mikJoWZlLc9k6JS2UjISMquiFJB1Ow3qGnTcvzAKZvseQ4iSjCY0nVbyUCWQ6e0W47BETjPcqomwUG0ZSvX59SWhmaUcX6k-imn6cdxJFYR3RfDnu4hygl_Ep0/s1600/IMG_3876.JPG" imageanchor="1"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4hcRMraotjKNd7H-X3mikJoWZlLc9k6JS2UjISMquiFJB1Ow3qGnTcvzAKZvseQ4iSjCY0nVbyUCWQ6e0W47BETjPcqomwUG0ZSvX59SWhmaUcX6k-imn6cdxJFYR3RfDnu4hygl_Ep0/s320/IMG_3876.JPG" width="240" /></a></div></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-44749203236568309652011-04-18T06:50:00.000-07:002011-04-18T06:50:07.742-07:00Serena Mountain Lodge<div class="separator" style="clear: both; text-align: left;"></div><div class="MsoNormal"><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL6qdPinOTEQM1Ov2fI88_Nz0_LH634a8PDFJR75wH9UGIsxVqemPXl0GhYXOHRJnnw07iTn2f9L4ZcDSUx9_CQIWZPodYBUeaECO9qudqXhEl9mH5TywVjXn5_v30bE6WvY3vWQY92EQ/s1600/IMG_3680.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL6qdPinOTEQM1Ov2fI88_Nz0_LH634a8PDFJR75wH9UGIsxVqemPXl0GhYXOHRJnnw07iTn2f9L4ZcDSUx9_CQIWZPodYBUeaECO9qudqXhEl9mH5TywVjXn5_v30bE6WvY3vWQY92EQ/s320/IMG_3680.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A view of the hotel from our room's balcony</td></tr>
</tbody></table>We were encouraged to arrange a stay away from Tumutumu in order to get a broader view of the region. Given the distance that we traveled it would be a shame not to see any wildlife. So we arranged a weekend stay at Serena Mountain Lodge which is located in Mount Kenya National Park, only an hour's drive from Tumutumu. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The hotel is built in a semi-circle around a natural water hole at the boundry of the bush and the rainforest ecosystems. The structure is raised 15 feet from the ground to provide protection from the animals. And did we see animals! The watering hole attracts various wild animals native to the park. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaa0HSrAlRd26Qmr3smxpyY0-RlWEwF9SNR71SpKMB_qEUyMOFQI4p0TQSXuLOKGA6hlqB0jLw8BDtLmwWTMiizLxEDV8Bghg-2A7CNrN5rZLIqqDJQ1cGlXR0_yYnLZLzJajTyBi4ylk/s1600/IMG_3807.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaa0HSrAlRd26Qmr3smxpyY0-RlWEwF9SNR71SpKMB_qEUyMOFQI4p0TQSXuLOKGA6hlqB0jLw8BDtLmwWTMiizLxEDV8Bghg-2A7CNrN5rZLIqqDJQ1cGlXR0_yYnLZLzJajTyBi4ylk/s200/IMG_3807.JPG" width="200" /></a>I think we underestimated this feature. A zoo would be the closest thing to compare it too, but this doesn't quite fit. At the lodge no animals are confined to cages and there is always the element of surprise! What will wander out of the bush next? Just another Cape Buffalo or and Elephant? Believe me, the chance visit of a monkey on your room's balcony is better entertainment than TV. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHdW9mdNrBnpwxMfb3WPvdTgqKbjMmx74albgeM-VFamVH0Jp7W7bqmSOgxhckke1v8_l3H_X5RiT65ncxYSKPp-t82uiAp0dgu06Yczjvfjm0fAhzKnpYjAq18F-tI19FSXs8aaNIJFA/s1600/IMG_3809.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHdW9mdNrBnpwxMfb3WPvdTgqKbjMmx74albgeM-VFamVH0Jp7W7bqmSOgxhckke1v8_l3H_X5RiT65ncxYSKPp-t82uiAp0dgu06Yczjvfjm0fAhzKnpYjAq18F-tI19FSXs8aaNIJFA/s200/IMG_3809.JPG" width="200" /></a>All the rooms face the watering hole with a balcony, a jungle gym for monkeys. Our first words of advice upon arrival - “Always be sure to latch your door shut, the monkeys will make a mess if they get in your room”. At 7200 ft elevation the temperature is always pleasant, cool and shaded to sit out and watch the animals. Mount Kenya, only about 25 km from the hotel, the perfect backdrop. The hotel guests take all their meals at the hotel, which are included in the price of the stay. The location is so remote – at the end of a dead end road into the park - it's several miles drive to the nearest community or restaurant. </div><div class="MsoNormal"><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGauhMVd7LBBjtSzxIYrOp31E1W_9QdEpuYTkdHj5rDj58J-Z8wde1clBXWD1Ssg3ULr7IJw6wmwI9rIZcOWtQcePEVl6oRlbLaaIEPJm-2BqyUSR1lk1df28dZrCr51ryXOyosQP-t80/s1600/IMG_3795.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGauhMVd7LBBjtSzxIYrOp31E1W_9QdEpuYTkdHj5rDj58J-Z8wde1clBXWD1Ssg3ULr7IJw6wmwI9rIZcOWtQcePEVl6oRlbLaaIEPJm-2BqyUSR1lk1df28dZrCr51ryXOyosQP-t80/s320/IMG_3795.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"> Wildlife Tunnel</td></tr>
</tbody></table>It was a great weekend. Besides the delicious, 4 course meals, the comfortable bed and pillows, and a shower that is not too hot and not ice cold, we loved watching the animals! We saw: Cape Buffalo, Worthogs, Bushbuck, Egyptian Geese, Elephants, Baboons, Monkeys, Antelope, and Ground Pigs(?)... A couple of the nice services of the hotel to help you see the animals: they have an underground tunnel to allow you to get closer to the animals on their level. And they will wake you up at night if an animal comes to the waterhole that you want to see – at dinner time they take your order. “Please wake me up if a leopard or a hyiena is sighted. No need to disturb me for a cape buffalo, they were around all day.”</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">If you're headed to Kenya and can't afford a safari we highly recommend this alternative. It was so nice to learn more about the local habitat, wildlife, and environment.<br />
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Now, what I'm sure your all waiting for, a rundown of the animals we spotted:</div><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieIuES8T4H3qzWXLiuBweE1tLwSWGT-omhUdS_WZRybEaSAu9tbU1EIoRDIuPo0PhUE0_Bf-xRSctuW0rH1yHRBW3KsKP-NN7xoa8HLeSLT2z0Hz48vdgSHDFs0lyITDSV8duDQnyBs4Q/s1600/IMG_3833.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieIuES8T4H3qzWXLiuBweE1tLwSWGT-omhUdS_WZRybEaSAu9tbU1EIoRDIuPo0PhUE0_Bf-xRSctuW0rH1yHRBW3KsKP-NN7xoa8HLeSLT2z0Hz48vdgSHDFs0lyITDSV8duDQnyBs4Q/s320/IMG_3833.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Cape Buffalo</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2jhQzP6XeoSREs-A4xRSaTCBYV9jK50sOb4l24-GB-64izGSS9Js91zJQBsb777YRxPF4fthp88l8phfBz3jfNTCVlQGum8hcXPv_vbTP1ukdwu1DmmtZ5EksoyoItyS4oXfY-5qXXo0/s1600/IMG_3695.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2jhQzP6XeoSREs-A4xRSaTCBYV9jK50sOb4l24-GB-64izGSS9Js91zJQBsb777YRxPF4fthp88l8phfBz3jfNTCVlQGum8hcXPv_vbTP1ukdwu1DmmtZ5EksoyoItyS4oXfY-5qXXo0/s320/IMG_3695.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Baboons on the move...</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9DTz9JMQxW2Ah1Ox9NdI5lnKCYxHh8YAgZcQLluioIw7rNawxzkiM8RonMiUkK_Lwjej4uVM6FZbPlksnzz2Tqobfdi1Mv9YS7nbp8TV_PMk50nfhVF7Hk2oBcqqAC1iGWoSLgoIMF1I/s1600/IMG_3710.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9DTz9JMQxW2Ah1Ox9NdI5lnKCYxHh8YAgZcQLluioIw7rNawxzkiM8RonMiUkK_Lwjej4uVM6FZbPlksnzz2Tqobfdi1Mv9YS7nbp8TV_PMk50nfhVF7Hk2oBcqqAC1iGWoSLgoIMF1I/s320/IMG_3710.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Warthogs</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjNYt0yUVAeo1lzUtcXbH2try8UOqn93VyKCjje9MY4Tt-7J39_5P7KTu9idqhZtz3HI6bosC_tdR5Vtt_AHhhbWLwyMtt3QBO8QPYBgATjWZq8C5vAjuHTu0f_emWNqKn3H1I_QVb9kE/s1600/IMG_3797.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjNYt0yUVAeo1lzUtcXbH2try8UOqn93VyKCjje9MY4Tt-7J39_5P7KTu9idqhZtz3HI6bosC_tdR5Vtt_AHhhbWLwyMtt3QBO8QPYBgATjWZq8C5vAjuHTu0f_emWNqKn3H1I_QVb9kE/s320/IMG_3797.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bushbucks (a female)</td></tr>
</tbody></table><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjNYt0yUVAeo1lzUtcXbH2try8UOqn93VyKCjje9MY4Tt-7J39_5P7KTu9idqhZtz3HI6bosC_tdR5Vtt_AHhhbWLwyMtt3QBO8QPYBgATjWZq8C5vAjuHTu0f_emWNqKn3H1I_QVb9kE/s1600/IMG_3797.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"></a></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkyZ-W73Q_UUFuMzZgysOac04T7niJkn8cs_pdH_ZbP6uT1gpo3U2xVUi9ddgHCNMxOSMdNhGJ9u2YNpDyK5YDx9RJo6ryfW4rvBIbCa4D9TgYK4ww2p_H-Er_Oqra8j_1O3-wfjVnuTY/s1600/IMG_4131.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkyZ-W73Q_UUFuMzZgysOac04T7niJkn8cs_pdH_ZbP6uT1gpo3U2xVUi9ddgHCNMxOSMdNhGJ9u2YNpDyK5YDx9RJo6ryfW4rvBIbCa4D9TgYK4ww2p_H-Er_Oqra8j_1O3-wfjVnuTY/s320/IMG_4131.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Male African Elephant</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNRmhC6k7sdrnpjSe2-kQdTL3_w_bvE3zNgM4z2rCE6SAHLrRKuzfxq_RMPgIvtAUmm4xSTuct6nv4RxnHCYjvuj6GvIPIIq48ZVcSJCGU_DFgS9hJBDR9eJ-rdxqJu3qMXL5KgWQHlj4/s1600/IMG_3958.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNRmhC6k7sdrnpjSe2-kQdTL3_w_bvE3zNgM4z2rCE6SAHLrRKuzfxq_RMPgIvtAUmm4xSTuct6nv4RxnHCYjvuj6GvIPIIq48ZVcSJCGU_DFgS9hJBDR9eJ-rdxqJu3qMXL5KgWQHlj4/s320/IMG_3958.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Monkeys (on our balcony!)</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeXDJOiUvD5zqb1FCTWhN2kc20d9mDXPweyCxtoex_5CkmwqJLW4rpA7tgptTnSaSTbrC3dPU4xKmGrUhSxEmdQ0EC1zPfAZ6ZDeYlqvYOSWTM7kIkOD7kN_Lwgy7_6BkYLfLy5PlFI3g/s1600/IMG_4026.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeXDJOiUvD5zqb1FCTWhN2kc20d9mDXPweyCxtoex_5CkmwqJLW4rpA7tgptTnSaSTbrC3dPU4xKmGrUhSxEmdQ0EC1zPfAZ6ZDeYlqvYOSWTM7kIkOD7kN_Lwgy7_6BkYLfLy5PlFI3g/s320/IMG_4026.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Elephants by the waterhole at night!</td></tr>
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<div class="separator" style="clear: both; text-align: center;"></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com2tag:blogger.com,1999:blog-7486002359304888758.post-24996601504521027442011-04-17T22:56:00.000-07:002011-04-18T06:34:54.787-07:00What We're Reading<div class="separator" style="clear: both; text-align: center;"></div><div class="MsoNormal" style="text-align: left;">I always like to pick up a good book before we get on an airplane. But this venture especially has allowed for more reading besides just the time in transport. When traveling to a foreign country I especially like to learn something about the history and culture we are to be immersed in. </div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;">So, how to find writings from and about Kenyans? I began this investigation by refering to the 'Literature' entry in the Lonely Planet guide to Kenya at Richland Public Library. African literature often runs in to the problem of lanuage. Some prefer to write in their native tribal tounge. Others find it necessary to write in English in order to increase readership. Several authors were mentioned in Lonely Planet, some with Kikuyu publications, some in Swahili, some in English, some whose work had be translated from Kikuyu to English... availablilty of many works is often limited...</div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;">A search of the authors in RCPL system produced only 2 hits. One was a novel written for children, a 150 page tail. It is quite a moving story about a Kenyan boy who befriends the grandson of a British expat, all set around the time of the Mau Mau rebellion. I really enjoyed this simple story and can't remember the name of the book! Sorry!</div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_3cjNa0gkx_6IpewYebZYyGNekIsUz6Jl7cdKohi_v3icD5jAbvj05wXhGUUQf1fIQAzP7IbtOiFpilo4fNbvwepzFaiDO6ZsFXxEqY5HIVgZ9YjHp6XK1uTyzAdjEiTa1QOgcmHndG4/s1600/IMG_1352.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_3cjNa0gkx_6IpewYebZYyGNekIsUz6Jl7cdKohi_v3icD5jAbvj05wXhGUUQf1fIQAzP7IbtOiFpilo4fNbvwepzFaiDO6ZsFXxEqY5HIVgZ9YjHp6XK1uTyzAdjEiTa1QOgcmHndG4/s320/IMG_1352.JPG" width="320" /></a>The second hit was “Gods and Soliders, The Penguin Anthology of Contemporary African Writing”. This is a book of short stories and articles, both published and unpublished, written within the last 10 years by Africans. The entries are organized by regions. Some are small works of fiction, others are political commentary, some discuss issues of African identity and voice in literature. After language, the problem of grouping a collection of writings under the title 'African' is that each country is so different. Many share similar stories of western colonization followed by a struggle for independence. But the details of each story are so complex relative to their political makeup, tribes, geography, and culture. Many very intriguing works from a contininent searching for a voice. However, it did not give me the insight into Kenya specifically that I was searching for...</div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;">A book that has been suggested to me by a fellow Tumutumu volunteer is “Britian's Gulag: The Brutal End of Empire in Kenya” by Caroline Elkins. The book is a detailed account of the MauMau uprising in rejection of British colonialism, gathered from interviews of both Kenyans and Brits. The book is huge and it sounds a bit dry and dense for me, but perhaps a few chapters would shed light on that time in Kenya.</div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWsUEn7sQ9xf96UvGxn-m1jG4qDNukw8ob2HNDMjVeEBD7CHT4Wh3GLuszFFO2PnY3hcGRAQUnFb7YRlAl0q40AZRKRIVU_5usAjhVPD0THrW-0ir_hdmAPpTKfhNG-7Hp1fw5-6LJHEU/s1600/IMG_3656.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWsUEn7sQ9xf96UvGxn-m1jG4qDNukw8ob2HNDMjVeEBD7CHT4Wh3GLuszFFO2PnY3hcGRAQUnFb7YRlAl0q40AZRKRIVU_5usAjhVPD0THrW-0ir_hdmAPpTKfhNG-7Hp1fw5-6LJHEU/s400/IMG_3656.JPG" width="400" /></a>As previously mentioned, we consulted our friend Sarah Cooper Searight on an appropriate reference for ministry she suggested Henri Nouwen's “Gracias! A Latin American Journal”. Though the culture of this book is Catholic and the local is South America, many of the issues of poverty transfer well to our setting in rural Kenya. We hesitate to use the word “mission” to describe our trip... it can have such negative connotations. But the tone of this journal and his approach to ministry is alligned with our philosophy.</div><div class="MsoNormal" style="margin-left: 0.2in; text-align: left;">'“It is the change from selling pearls to hunting for treasure.” Indeed, not too long ago the task was seen as selling the pearls of good news to the poor and ignorant people. Now a radically new perspective dominates... to search with the poor for the treasure hidden in the ground on which they stand. It is the shift from spiritual colonialism to solidarity in servanthood...'</div><div class="MsoNormal" style="text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf06cL_BJkk7odajkPILGyC8MDMEOhc3Gxbi1nlFIxsmkrLLgsn-u-yuUJ8-svE9WbfSQArHzmNzb7aQQuVYLhFNZLGnmsDVA0rBZDnwHxyxpo9WO09jE5RoBOny9voKgYQJlJer2JoEc/s1600/IMG_3641.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf06cL_BJkk7odajkPILGyC8MDMEOhc3Gxbi1nlFIxsmkrLLgsn-u-yuUJ8-svE9WbfSQArHzmNzb7aQQuVYLhFNZLGnmsDVA0rBZDnwHxyxpo9WO09jE5RoBOny9voKgYQJlJer2JoEc/s200/IMG_3641.JPG" width="150" /></a>So many exerpts speak to us and this place. We have been reading it aloud daily during our time of devotion. We highly recommend it!</div><div class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal" style="text-align: left;">Matthew has been brushing up on his knowledge of tropical medicine by referencing “Principles of Medicine in Africa”, borrowed from Dr. Daniel Everett, a physician from the states also staying at our guest house. He says it has a lot of infectious disease information and some about more common problems such as diabetes and heart failure. It's a little out of date, but it's nice to have something to reference for the diseases that aren't often seen in the US.</div><div class="MsoNormal"><br />
</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com2tag:blogger.com,1999:blog-7486002359304888758.post-55384928036744167772011-04-17T00:16:00.000-07:002011-04-17T22:54:08.563-07:00Geo-tagging<div style="margin-bottom: 0in;">I'd like to take a brief moment and talk about my latest obsession in photography. While Christina works on perfecting her framing, white balance, contrast, and composition my concern is different- mainly where is the picture being taken. While I was travelling recently, I found that my phone has the ability to Geo-tag. For those of you who are not familiar with this, basically some cameras and phones have the ability to attach GPS coordinates of longitude and latitude to the picture being taken.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;">I realize this may not be that important to most people. I also realize that most people aren't as nerdy as I am. That's OK. We can't all be perfect. To me this has been like putting a digital push-pin on the map of places I've visited. Instead of finding an interesting picture, I often find myself thinking, “Do I have a picture that I've taken in Chicago? No? Well, let me take a random picture in the airport so that it'll show up on my map.”</div><div style="margin-bottom: 0in;">Right now, I don't have any data access on my phone. I looked into the cost and basically it's about $15 US per kilobyte. For me to use my phone as I normally would this month, it would cost me in the ballpark of $1,500US. So I'm leaving the phone off. However, it still picks up the GPS signal. So I guess I can check Africa off the list. Maybe we'll get to Australia some day...<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinMdekJU8a87DYvjM8UNI1VBYy_cfr6sxduEtsMxJCzmAI9PdTRttgBzYzdUZF6IDadV4cRNlNM0Pn3D9mONuj9ZrF5NdF_NYD-a2LUP4esZ7iYrAwzLDCbDUpgr9i3gpbu4wVnbOrTAc/s1600/IMG_1330.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinMdekJU8a87DYvjM8UNI1VBYy_cfr6sxduEtsMxJCzmAI9PdTRttgBzYzdUZF6IDadV4cRNlNM0Pn3D9mONuj9ZrF5NdF_NYD-a2LUP4esZ7iYrAwzLDCbDUpgr9i3gpbu4wVnbOrTAc/s320/IMG_1330.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">London Geo-Tag</td></tr>
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</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-13364783626814602862011-04-17T00:14:00.000-07:002011-04-17T00:14:44.565-07:00Case Presentation 1<div style="margin-bottom: 0in;"><b>Case 1 </b></div><div style="margin-bottom: 0in;">25 yo female with no PMH presents with convulsions. She has been in her usual state of health until the day of presentation. She has spent the day travelling on a bus from the Rift Valley to Karatina. She states she packed her own food and did not eat anything offered to her on the bus. On arrival to Karatina she had a convulsion as described by the fellow travellers. Patient was admitted and was witnessed in hospital to have several more convulsions that started with facial spasms and generalized to tonic clonic convulsions. The convulsion lasted for "a while" and was broken by giving 30mg of diazapam slow IV push. Patient returned to baseline and was noted to have brusing on her tongue.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><b>ROS</b>: + for HA on and off for the past month, relieved with paracetomal. No HOB, no blurriness of vision. Otherwise negative.</div><div style="margin-bottom: 0in;"><b>PMH</b>:-</div><div style="margin-bottom: 0in;"><b>FMH</b>:-for epilepsy</div><div style="margin-bottom: 0in;"><b>Social</b>: Denies EtOH, tobacco, drug use.</div><div style="margin-bottom: 0in;"><b>Medications </b>:none</div><div style="margin-bottom: 0in;"><b>Allergies</b>: NFDA</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><b>PE</b>: T36.7 P80 R20 BP: 140/60</div><div style="margin-bottom: 0in;">General: Well developed African female, NAD</div><div style="margin-bottom: 0in;">Head: ATNC</div><div style="margin-bottom: 0in;">Eyes: Conjunctiva pink, sclera anicteric, PERRL, EOMI</div><div style="margin-bottom: 0in;">Neck: No menignismus, Fullness of R thyroid with no appreciable nodules.</div><div style="margin-bottom: 0in;">CV: RRR, no MRG; peripheral pulses present, symetric; cap refill <2sec</div><div style="margin-bottom: 0in;">Resp:LCTAB</div><div style="margin-bottom: 0in;">GI: AB S/NT/ND/BS+</div><div style="margin-bottom: 0in;">MS: FROM</div><div style="margin-bottom: 0in;">Skin: No rashes/bruises/lesions</div><div style="margin-bottom: 0in;">NEURO: CNII-XII intact; sensation intact B/L; strength is 5/5 throughout; no dysmetria; abulation without difficulty; A&Ox3</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><b>A/P</b>: 25yo with new onset convulsions</div><div style="margin-bottom: 0in;">Obtain full Hemogram, UEC's and Pregnancy Test. Order CT head for masses/bleeding. Admit for observation. Diazapam PRN for seizures, PCM for headaches. Re-eval in AM.</div><div style="margin-bottom: 0in;"><br />
</div><div style="margin-bottom: 0in;"><b>Discussion</b>:</div><div style="margin-bottom: 0in;">This was an interesting case for me, not because of the medical aspects itself, but it brings up some important social issues. As is probably evident in the case, Kenyan's don't really use the term seizures, but convulsions. It's really a minor difference, but there are many of these language problems I've run into during rounds. They tend to call congestive heart failure (CHF) congestive cardiac failure (CCF). Fevers are hotness of body (HOB). A basic metabolic profile (BMP) is equivalent to a urea, electrolytes, and creatinine (UEC). They are very subtle differnece and it's not difficult to adapt, but they use abbreviations as commonly as we do and I feel I slow down discussion some by asking what each of these mean.</div><div style="margin-bottom: 0in;">As mentioned above, the patient had an enlarged thyriod that was picked up on physical exam. After more discussion with the patient we found out that it was evaluated several years ago at an outside hospital. She was told then that she needed her thyroid taken out. This I actually seemed very familiar to me. I can't count the times that patients have been told they needed a procedure, a scan, an xray, or just follow-up and haven't- either because they were scared or just couldn't afford it. Strangely, I felt reassured that somehow all people are alike. <br />
<br />
</div><div style="margin-bottom: 0in;">The patient did very well and had no more seizures throughout her hospital stay. However, the CT was never performed for 2 reasons. One was that she was afraid of what the scan might due to her. The other was that she and her family could not afford the test. While many of the service Tumutumu provides are cost-reduced (such as medications, laboratory tests, and meals) any of the tests obtained outside of the hospital (such as CT's, MRI's, Ultrasounds, and EGD's) are paid for in advance by the patient. Ultrasounds cost about 2,000 shillings (about $25 US) and CT's cost about 10,000 ($126). Although that doesn't sound like much but the average salary in Kenya is $730 US. Often patients have to call family and friends to help come up with the money. Often this can delay the test (and often diagnosis) by days. </div><div style="margin-bottom: 0in;">Our patient ultimately decided that she did not want the test and wanted to be discharged home. This comes up alot here and seems to be to be a real contrast to how we practice in the US. Here in Kenya, if patients want to stay, the doctors are not really apt to forcing them out. If they want to go, there is no discussion on leaving against medical advice and documenting risks as we would in the US, patients are just discharged. That's not to say that the patients aren't informed, it's just that there isn't much malpractice out here to worry about. <br />
<br />
</div><div style="margin-bottom: 0in;">I really hope that the patient does well, and hope that she follows up in clinic. I think many patients are lost to follow-up because of distance, time, and cost. I guess like many things out here in Kenya, it's out of our hands.</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-68745528094557825752011-04-15T00:23:00.000-07:002011-04-15T00:23:43.276-07:00The Pharmacy<div class="MsoNormal">One of the questions I was frequently met with as I prepared for this trip, and a question I liked to avoid, was, “So,<span style="mso-spacerun: yes;"> </span>Matthew will be seeing patients in Kenya, and what are <i>you</i> going to do?”.<span style="mso-spacerun: yes;"> </span>It distressed me a little.<span style="mso-spacerun: yes;"> </span>I was assured that I was needed and that I would be put to work but my exact function was unclear.<span style="mso-spacerun: yes;"> </span>I had this fear, with such a loosely defined role, that I would be only superficially needed, or that I would have time on my hands.<span style="mso-spacerun: yes;"> </span>I've had jobs like that and nothing is worse than watching the clock, waiting for lunch or the end of the day.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This is why I have been so pleased with my position helping out at the pharmacy.<span style="mso-spacerun: yes;"> </span>One major pharmacy serves both the out-patient needs and the wards.<span style="mso-spacerun: yes;"> </span>The unit is always busy and I have always felt needed.<span style="mso-spacerun: yes;"> </span>My first afternoon was spent learning the system and becoming familiar with the drugs – the commonly used trade names vs. the generic names.<span style="mso-spacerun: yes;"> </span>All of which are a little different than what is used in the US.<span style="mso-spacerun: yes;"> </span>My tasks range from restocking shelves to filling prescriptions.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Most often I account for which medications and how many are distributed to which patients in the computer system.<span style="mso-spacerun: yes;"> </span>The hospital uses a hybrid system of processing drug requests.<span style="mso-spacerun: yes;"> </span>Most orders are handwritten and logged in the computer.<span style="mso-spacerun: yes;"> </span>The pharmacy then reviews and verifies the orders and reconciles any discrepancies.<span style="mso-spacerun: yes;"> </span>It is a somewhat tedious task that often reminds me of creating a plant schedule where size, number, common name and scientific names are specified, a common task during my time as a landscape architect.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I am most grateful for the people I work with in the pharmacy.<span style="mso-spacerun: yes;"> </span>Everyone is unfailingly kind and patient.<span style="mso-spacerun: yes;"> </span>They are always interested in teaching and never bothered by my endless questions.<span style="mso-spacerun: yes;"> </span>Everyone who comes to the counter, patients and staff, is interested in the white girl, often greeting me with a smile and welcome.<span style="mso-spacerun: yes;"> </span>It is truly a reflection of their culture that this has been such an easy transition.<span style="mso-spacerun: yes;"> </span>After a few days here I have begun to feel comfortable (with my handmade cheatsheet of drugs), familiar enough with the rhythm of the day that I am able to anticipate the next task.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The one regret is that I don't deal much with patients.<span style="mso-spacerun: yes;"> </span>The mystery of this place is that three different languages are commonly spoken: Kikuyu (the tribal language wildly spoken in the central highlands), Swahili, and English.<span style="mso-spacerun: yes;"> </span>And then there is another variation that is a hybrid of Swahili and English.<span style="mso-spacerun: yes;"> </span>The pharmacist (there are 2 working in overlapping shifts) exclusively interact with the patients and staff in Kikuyu.<span style="mso-spacerun: yes;"> </span>This leaves me in the dark.<span style="mso-spacerun: yes;"> </span>They make jokes that I am not included in (maybe they are about me!).<span style="mso-spacerun: yes;"> </span>But also, comments from staff and their exchange with physicians and nurses are always beyond my comprehension.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">An unexpected benefit of this position is that finally Matthew and I are working in the same world.<span style="mso-spacerun: yes;"> </span>I know this sounds silly, but the endless talk about his work is now a little more of our common work.<span style="mso-spacerun: yes;"> </span>Though much of it still is tedious and goes without comment from me it is nice that we are vested in the same interest of patient care and a well run hospital system.</div><div class="MsoNormal"><br />
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</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-82776180101187900792011-04-14T23:59:00.000-07:002011-04-15T00:01:06.968-07:00Retreat<div class="MsoNormal">Childlike.<span style="mso-spacerun: yes;"> </span>Lack of Control.<span style="mso-spacerun: yes;"> </span>All is new a different.<span style="mso-spacerun: yes;"> </span>Routines and schedules are forgotten.<span style="mso-spacerun: yes;"> </span>We are here empty, starting anew.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">What was initally a frustration has become quite liberating.<span style="mso-spacerun: yes;"> </span>All the daily concerns and distractions of home are absent.<span style="mso-spacerun: yes;"> </span>No cell phones, no internet, no TV, no vehicles.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Think about that!!!<span style="mso-spacerun: yes;"> </span>This is what I've learned:</div><div class="MsoNormal"></div><ul><li class="MsoNormal" style="margin-left: .25in;">A phone call is not required everytime my husband is late or my hands are idle.<span style="mso-spacerun: yes;"> </span>He'll show up.<span style="mso-spacerun: yes;"> </span>I can be patient.<span style="mso-spacerun: yes;"> </span></li>
</ul><ul><li class="MsoNormal" style="margin-left: .25in;">I only really require 10 minutes on the internet once a day to check my email and cut and paste a blog entry (written the night before).</li>
</ul><ul><li class="MsoNormal" style="margin-left: .25in;">A book can be just as entertaining as the television.<span style="mso-spacerun: yes;"> </span>Chances are it's a lot more educational too.<span style="mso-spacerun: yes;"> </span></li>
</ul><ul><li class="MsoNormal" style="margin-left: .25in;">Walking is virtuous.<span style="mso-spacerun: yes;"> </span>The fresh air, a stunning landscape, and the sounds of the environment are worth the extra time and effort.<span style="mso-spacerun: yes;"> </span>There are never traffic headaches on our dirt path!</li>
</ul> <o:p> </o:p><br />
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</div><div class="MsoNormal">All we are left with is quiet.<span style="mso-spacerun: yes;"> </span>And it is so refreshing.<span style="mso-spacerun: yes;"> </span>Matthew and I, who I think have a strong relationship, have spent more time talking and listening to each other.<span style="mso-spacerun: yes;"> </span>Problemsolving.<span style="mso-spacerun: yes;"> </span>Creating.<span style="mso-spacerun: yes;"> </span>Sympathizing.<span style="mso-spacerun: yes;"> </span>Supporting.<span style="mso-spacerun: yes;"> </span>We have really made an effort to make time to communicate.<span style="mso-spacerun: yes;"> </span>To discuss issues and life in a way that our routines at home don't allow.<span style="mso-spacerun: yes;"> </span>Time to share and time to pray.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In this way it has become a retreat for us.<span style="mso-spacerun: yes;"> </span>A way of recentering our life, refoucusing our energies, a way of discerning what is really important and where we are being lead.<span style="mso-spacerun: yes;"> </span>It is a great way to begin this next phase of our life... as we leave the great community we've built in Columbia... as we become infants again in California.<span style="mso-spacerun: yes;"> </span></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-16601319417993414872011-04-14T23:56:00.000-07:002011-04-14T23:56:17.874-07:00Rain<div class="MsoNormal">April is supposed to be the wettest (and coolest) month in Kenya but since we've arrived we've had little rain.<span style="mso-spacerun: yes;"> </span>It's felt more like South Carolina in June!<span style="mso-spacerun: yes;"> </span>Dust from the red earth fills the air and sticks to your clothes.<span style="mso-spacerun: yes;"> </span>The driness concerns everyone.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">On Sunday afternoon the security officer at our guest house, Tony, took us for a little walk and showed us how desperate the situation was.<span style="mso-spacerun: yes;"> </span>He showed us the holding tanks for the water for Tumutumu Hospital and all it's supporting buildings (they have several guest houses for interns, medical students, nurses and doctors, and dormatories for around 60 nursing students).<span style="mso-spacerun: yes;"> </span>The water is carried by pipe from an adjacent river to this holding tank which then distributes to 3 large cisterns.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8LmccuHmf1mg-53AyeprUEq65uSMZAxH_xDDKL725E8TdHyOcSc-CPStQ4P0oMwdYen6ddnugUluSw-yNMuEawuZjvHYSdJU06Sq2F3ZWlS-bf2yOWPJphUg1Z9Dqp_XSVP3y-mP7pjw/s1600/IMG_3617.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8LmccuHmf1mg-53AyeprUEq65uSMZAxH_xDDKL725E8TdHyOcSc-CPStQ4P0oMwdYen6ddnugUluSw-yNMuEawuZjvHYSdJU06Sq2F3ZWlS-bf2yOWPJphUg1Z9Dqp_XSVP3y-mP7pjw/s400/IMG_3617.JPG" width="400" /></a></div><br />
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</div><div class="MsoNormal"><span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In times of drought in Kenya everyone is asked to ration water.<span style="mso-spacerun: yes;"> </span>Use the pit latrines instead of flushing toilets.<span style="mso-spacerun: yes;"> </span>Sponge bath instead of shower (or don't bathe!).<span style="mso-spacerun: yes;"> </span>Many people are helpless as they sit back and watch their crops dry up in the sun.<span style="mso-spacerun: yes;"> </span>So they eat less in anticipation of having a light harvest.<span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span style="mso-spacerun: yes;">In Kenya 80% of the economy relies on agriculture. On a side note there is a seed shortage in Kenya, due to corruption on the retail price of seedlings, that is also complicating the issue of agriculture in Kenya.</span></div><div class="MsoNormal"><span style="mso-spacerun: yes;"> </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Which brings up and interesting point in terms of landuse:<span style="mso-spacerun: yes;"> </span>every scrap of land is used to plant and harvest vegetables, which grow year round.<span style="mso-spacerun: yes;"> </span>Land used for recreation or aesthetics, like the church yard, often dually serves as a feeding ground for sheep and cattle.<span style="mso-spacerun: yes;"> </span>The land can produce in abundance and no one takes it for granted.</div><div class="MsoNormal"><br />
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</div><div class="MsoNormal">So thats why it was a joy, rather than a nuisance, when it started pouring yesterday afternoon as we were leaving work.<span style="mso-spacerun: yes;"> </span>The past two nights we've been woken at 1:30 to absolute downpours.<span style="mso-spacerun: yes;"> </span>The heavy clouds never produce a drizzle or scattered showers.<span style="mso-spacerun: yes;"> </span>Always it is big fat rain that pounds on the tin roofs.<span style="mso-spacerun: yes;"> </span>I hope this continues to be the season of rain for the welfare of this community.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I must share this side effect of the rain.<span style="mso-spacerun: yes;"> </span>It knocked out the power last night.<span style="mso-spacerun: yes;"> </span>Which meant now that there is plenty of water it was looking like we would face a nice cold shower (an electric heater warms the water right at the tap).<span style="mso-spacerun: yes;"> </span>As I was about to step in there is a knock at the door.<span style="mso-spacerun: yes;"> </span>Margaret, who was preparing our breakfast, boiled a couple of gallons and brought a bucket of warm water to our door.<span style="mso-spacerun: yes;"> </span>What a welcome blessing!</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-27175034158184350082011-04-14T03:09:00.001-07:002011-04-14T08:08:06.579-07:00First Impressions<div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgE-vQHBy63_lnOATpR5CI34sO10a3pd_zSMRb5SZBF1x8G9ocd6S8e1304SPsyXQsuZ3X-9XfoZ-vCvLBq3U1mRnqPX5eo61TjArWDF7NxWi98a1C8dXjUpM8XfVgmAweGKRGKKSiMx5s/s1600/IMG_1363.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgE-vQHBy63_lnOATpR5CI34sO10a3pd_zSMRb5SZBF1x8G9ocd6S8e1304SPsyXQsuZ3X-9XfoZ-vCvLBq3U1mRnqPX5eo61TjArWDF7NxWi98a1C8dXjUpM8XfVgmAweGKRGKKSiMx5s/s400/IMG_1363.JPG" width="400" /></a></div>4.13.11</div><div class="MsoNormal"><o:p><br />
</o:p></div><div class="MsoNormal">Tumutumu Hospital is definitely an interesting place to work.<span style="mso-spacerun: yes;"> </span>After spending 3 days in the hospital I have a somewhat better understanding of how this place and the Kenyan health system operates. Tumutumu hospital's inpatient service is divided into 4 teams- internal medicine, general surgery, pediatrics, and OB/GYN. I am currently placed on the internal medicine team. On the team is an intern, a clinical officer, a consultant, and often a foreign medical student. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The<b> intern </b>is a recent graduate of medical school in Kenya and serves for a year here at Tumutumu. She rotates through the 4 sub specialties in 13 weeks blocks. Basically she runs most of the service as an upper-level resident. Over the year, not only will she lead the medicine and pediatric inpatient services, she will be requried to perform deliveries, c-sections, appendectomies, hysterectomies, cholecystectomies, open reductions with internal fixation, ect. For most of the surgeries a consultant<span style="mso-spacerun: yes;"> </span>will not be present. After this year, she will chose either to practice medicine as a general practitioner or continue her training as a specialist. Obviously, this is a big contrast to the way we practice in the US and the interns are given a great deal of autonomy at such an early level in her training. And while she has a good knowledge base, the diversity of her education makes it difficult to go in depth in any particular field of interest.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The <b>clinical officer</b> serves in a role comparable to a physicians assistant or nurse practitioner. He has had 3 years of training in medical education and is now fulfilling a year of clinical duties. He is a hard worker and tends to do the brunt of the paperwork and minor procedures. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The <b>consultant</b> is basically an attending position. They have specialized into an individual field will oversee the intern. Often the attendings are very busy and will cover multiple hospitals in the area. Often times this means he will show up at sometime during rounding and often leave before or shortly after finishing seeing the patients. He is there to help in difficult cases or solve problems that may arise, but generally leaves the majority of responsibility to the intern. Currently our consultant is covering three hospitals and while he is very intelligent and knowledgeable about Kenyan diseases and treatment he does not have much time for formal teaching.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">As in the US, there are often medical students that rotate through Tumutumu. Their responsibilities are not quite as intense as the clinical rotations in the states. There is no pre-rounding on patients and no real clinical duties except to be present and participate in discussion if called upon. Currently we have a UK student who is fulfilling her pre-clinical duties after finishing her exams. She is very bright and engaged and often brings up salient points of discussion. She does not have that much clinical experience, but in her defense, she is required to have a minimum of 7 years of post-graduate training before receiving full privileges as a physician.<br />
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</div><div class="MsoNormal">Rounding starts at 9:00am-ish. Time is sort of relevant here in Kenya. As noted above, there is no pre-rounding and basically the whole team discusses the patient, recent labs, vital signs, and comes up with an appropriate treatment plan. We start on one side of the ward and walk from patient to patient until everyone has been seen. Once finished with the first ward, we take a tea break and then see the second. The second ward tends to be rushed because visiting hours start at 1:30p, so the team tries to see everyone before their families arrive. In general, we see about 30-35 patients per day, so the service stays pretty busy.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I think the team does very well with the resources it has. Thought goes into every patient in terms of evaluating the deferential, treatment of pain, cost of procedure/diagnostic test, and compliance on discharge. It has a well stocked pharmacy and decent lab (we can even get thyroid studies!) However, the hospital does have its limitations. Basically there is very little that can be done for the unstable and crashing patient. Without an ICU, there is no equipment outside of the operating room to intubate a patient. There are no monitors, no pumps, no Bipap. The lab does not have the equipment to measure HCO3 so no way to detect acidosis. I asked if they could run an ABG and the intern laughed. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Despite these setbacks, I think the treatment here is very good. It's definitely been a learning experience in how to make do with what you have. The physician's physical exam skills are expertly honed and I think it shows me what skills I've lost because of the ease of laboratory testing. I hope that I can impart some small amount of knowledge to them as I am very grateful for what they have taught me.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiaWmHMSQ_DkINkzM74ju4mGXDmWxVul2kMtQv7Y7HD1psDMu590BnTXNBk0Vj13Zw-Y3Qo9ERY1wT5zfFuyGNEPO2_OfEC-4L3Pj5XFEFkXEKxJEaX6SzmTsRtBoiiteX27K2L0WHELY/s1600/IMG_1376.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="298" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiaWmHMSQ_DkINkzM74ju4mGXDmWxVul2kMtQv7Y7HD1psDMu590BnTXNBk0Vj13Zw-Y3Qo9ERY1wT5zfFuyGNEPO2_OfEC-4L3Pj5XFEFkXEKxJEaX6SzmTsRtBoiiteX27K2L0WHELY/s400/IMG_1376.JPG" width="400" /></a></div></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-31473606293912050392011-04-12T07:54:00.000-07:002011-04-12T07:54:41.567-07:00Karatina Market<div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH41VRzXnQCFzr8eTjqAw3ukUNnEcTwmkNQgA75iGiQ2EvTka5kwCKovqutDQa2RDrqeFuqi3Pt9_b2S7io1xNTwGkypnGuGO3toZrBWZqT888ZSajKBqYGw1iXNCnEyleS4ZGKwdbkeE/s1600/IMG_3563.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH41VRzXnQCFzr8eTjqAw3ukUNnEcTwmkNQgA75iGiQ2EvTka5kwCKovqutDQa2RDrqeFuqi3Pt9_b2S7io1xNTwGkypnGuGO3toZrBWZqT888ZSajKBqYGw1iXNCnEyleS4ZGKwdbkeE/s320/IMG_3563.JPG" width="240" /></a>On this first weekend we soon ran into a funny problem at Tumutumu. Mainly, what's next? How American of us, to expect a planned itinerary as soon as we arrived! The hospital is closed on the weekend (except for the in-patients) and the Head Doctor, Dr. Kariithi, who is responsible for organizing us and appointing us positions at the hospital, wouldn't be in until Monday. So Matthew and I, who are rather goal oriented, would be without a mission until Monday. (Also, we would be without internet! Sorry Mom!). On top of which we were, temporarily, the only guests at the guest house. </div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">We asked around and expressed our desire to get out and see and do something on Saturday. So hastily we were shuffled from host to host. We received an impromptu tour of the hospital from Leah (see Matthew's post for details). Then it was arranged for a driver from the hospital, Paul, to take us on a driving tour of Karatina. There we met Carol, a nursing student of Tumutumu, who showed us around the Saturday market where an abundance of produce was sold: oranges and bananas, avocados, melons and mangoes, beans and lentils, onions, tomatoes and garlic, potatoes and yams....<br />
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</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">Paul's tour of the city was interesting because he was the first person to discuss and address class with us. There are several apartment buildings which have water and electricity. This is where the upperclass people live. They are also the only ones with cars. Middle class residents live by the river so they can easily wash their clothes in the river because they do not have running water. He didn't discuss where the poor lived. The markets are even divided. Wealthier patrons shop in 'boutiques', or stores with permanent locations in the downtown area. If you can't afford the boutiques then you shop second hand clothing and shoes in the open air markets by the train tracks. There is a third market, the food market, where sellers (mostly lower class) come on Tuesdays, Thursdays, and Saturdays to sell produce.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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<tr><td class="tr-caption" style="text-align: center;">A Boutique Shop</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Market</td></tr>
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</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">So here we get a glimpse of what poverty looks like. I've seen it in India and Cambodia and Thailand and it has the same face here. It is dirty, it is crowded, it smells really bad. It is mismatched clothing and shoes worn through their soles. It is homes made of wooden slats and roofs of tarp and thatch. </div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">How do we reconcile this? I think this is what I struggle most with: I am here, a comfortable Christian, and even if I give all of my money and self to this place the problems will not be solved. That is still not enough. There will still be periods of drought when people go without food. There will still be disease and poverty. It begs the question what is the use? Why bother? Theologically, this is right up there with “Why do bad things happen to good people?” and “Why does evil exist in the world?”. I hate to disappoint you but I am without simple solutions to these too.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">There isn't an easy, trite phrase to make this all add up. I think just being here in fellowship has something to do with it. I'll refer to Nouwen again (as I think I often will in these posts) to share some insight on the problem:</div></div><div class="MsoNormal" style="margin-left: 0.2in;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">“The mystery of ministry is that the Lord is to be found where we minister. That is what Jesus tells us when he says: “Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.” (Matthew 25:40). Our care for people thus becomes the way to meet the Lord. The more we give, help, support, guide, counsel, and visit, the more we receive, not just similar gifts, but the Lord himself. To go to the poor is to go the Lord.”</div></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-61961446993315062432011-04-11T08:20:00.000-07:002011-04-11T08:20:44.550-07:00Matthew Weighs In...<div class="MsoNormal"><b>4.10.2011</b></div><div class="MsoNormal">After several days of travel, we can finally say that we reached our destination. We actually reached it on Friday, but this is the first access we have had to the internet since leaving Chicago. It was a fairly uneventful trip although a little exausting. I still feel I am having trouble adjusting to the time change and try to take naps whenever I can. </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We had the opportunity to take a brief tour of Tumutumu hospital this weekend and learn more about where we are spending the next few weeks. Tumutumu has approximately 100 inpatients and is housing medical, surgical, gynecological, pediatric, and maternity patients. There is a surgical theater (OR), xray, and ultrasound services that are available on the weekdays. The hospital has no ICU beds and all critically ill patients are transported to the nearby hospital in Nyerie- approximately 30km away. Still, Tumutumu is a referal center for the nearby area of Karatina and cares for the "sicker" patients.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There are only 2 nurses staffed at any time, but Tumutumu houses a nursing school on the hospital grounds and the nursing students do the brunt of the patient care. In addition the hospital hosts a variety of medical students for one month rotations (currently there are 9 Chinese medical students staying in the guest house next door.) The hospital is staffed by 3 physicians- an internist, a surgeon, and a gynecologist. The remainder of services needed a done on a consultant basis with the consultants visiting during the weekdays.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There is minimal staffing at Tumutumu Hospital on the weekend, so my first day at work is not until Monday. I'm not exactly sure what my capacity will be, but I assume that I will work with the Comprehensive Care Clinic, an outpatient clinic to treat the large population of TB and HIV patients. I asked one of the nurses to give rough numbers on how many people they see a day and the only estimate that I got was "a lot." </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Currently, I am struggling with my role as a physician and "missionary" here. I know this has a lot to do with the fact that I have not started work yet, but it still is a source of some anxiety for me. One of the joys of emergency medicine is that EM physicians are highly adaptable to most situations. While there is no formal emergency room here, I feel that my training will allow me to help out in a variety of areas here. And while I have had experience in treating both HIV and tuberculosis, I feel that there will definitely be a learning curve as to how best to diagnose and treat with the resources avialable. There are also a variety of disease that I have no experience treating (I honestly can't say I've ever seen a case of yellow fever or African sleeping sickness in South Carolina!). I expect to learn much from Dr Kariithi and the rest of the Tumutumu staff.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">My wife and I are currently reading a book by Henri J.M. Nouwen entitled <i>Gracias! A Latin American Journal</i> reccommend by our friend Sarah Cooper Searight. Nouwen is a Catholic priest who travels to South America to minister to the poor through the church in the 1970s. In <i>Gracias!</i> Nouwen describes the changing face of mission work. This passage spoke to Christina and I: </div><div class="MsoNormal" style="margin-left: .2in;">"It is hard for me to accept that the best I can do is probably not to give but to recieve. By receiving in a true and open way, those who give to me can become aware of their own gifts. After all, we come to recognize our own gifts in the eyes of those who recieve them gratfully. Gratitude thus becomes the central virtue of a missionary." </div><div class="MsoNormal">I hope that through this time I can help as I'm able and most of all be grateful for those that teach me through our fellowship.</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-42851405789565032312011-04-11T08:18:00.000-07:002011-04-11T08:18:29.142-07:00Drive to Tumutumu<div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6TbHAqMIjeWI8FiBwqslJcul2bZ4bxs0x7jYQj_Vuc1EJkro4yXj9OA4Sa8vSy_qaBM9gfO4VemwW1YzwBcEwkmTkdhxghEQqA2v5iNhGihhEpAflG8HYJ5uJx8tO6uZfB37XN31j4Is/s1600/IMG_3573.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6TbHAqMIjeWI8FiBwqslJcul2bZ4bxs0x7jYQj_Vuc1EJkro4yXj9OA4Sa8vSy_qaBM9gfO4VemwW1YzwBcEwkmTkdhxghEQqA2v5iNhGihhEpAflG8HYJ5uJx8tO6uZfB37XN31j4Is/s640/IMG_3573.JPG" width="640" /></a>Leaving the gates of the CHAK complex we were formally introduced to Nairobi. Having arrived in the dark and being confined within the cement walls of the conference center we finally learned the origin of all the sounds and smells of the street. Vendors and pedestrians of all sorts and social classes crowded the streets. This was more of what I expected.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">CHAK is located in a Western district of Nairobi. This particular Friday was also the last day of school before Easter break so the streets were especially crowded. Daniel, our driver, first informed us that cowards have no place on the road in Kenya. Agreed: I don't think I would last long on these streets. Traffic, which includes pedestrians, buses, cars, rickshaws and manutus (11 passenger vans, part of the public transportation system), all move with fluidity and aggression that is so foreign to us tame US drivers. It was an hour before we escaped the traffic of the city.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">Everyone said it was only an hour and half, maybe 2 hrs. from Nairobi to Tumutumu but our journey took 3hrs. I sat in the front and spoke with Daniel about everything we were seeing. Matthew was in and out of sleep in the back. Along the way we passed coffee and tea plantations, Kenya's main cash crops. Interestingly enough, we've only found instant coffee served here. Coffee, which is harvested when the beans turn red, should be ready to harvest in the next few weeks. Pickers are paid 100 shillings a day and every bean is picked by hand.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">Other crops we passed on our drive north to Tumutumu: pineapple, mango, bananas, pawpaw, timber, catfish, avocados and taro. Much of this reminded me of Hawaii. Pineapple thrive in this red soil, rich in iron. As large as Dole's Pineapple plantation was on Oahu, I think Del Monte's here in Kenya is larger... it went on and on for miles. The taro crops were much smaller though and the plant is used mainly as bird feed (taro is a staple to Hawaiian diets)! We also passed quite a few plant nurseries on the way. Families that can afford cattle keep small numbers, 3-5, and they are kept on a rope and walked to find food.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">This leads to a growing problem here: drought. Sitting almost on the equator the region has no warm and cool seasons, just wet and dry. April should be wet and cool but not this year – the region is thirsty.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3snN3TcIcJOA3wEzVqi2GmjzUhJD9CdL1017LgW_NXEIFIbumex4rs-AwPm3Q7CJnQ0hqGCRJBrtpPx6M4edYFjo9igvWAgSbbDkWG22MbDcSp6RIYGuZhi-cUpLZ7kSR9-XeW6K_fBk/s1600/IMG_3602.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3snN3TcIcJOA3wEzVqi2GmjzUhJD9CdL1017LgW_NXEIFIbumex4rs-AwPm3Q7CJnQ0hqGCRJBrtpPx6M4edYFjo9igvWAgSbbDkWG22MbDcSp6RIYGuZhi-cUpLZ7kSR9-XeW6K_fBk/s400/IMG_3602.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"> Guest House</td></tr>
</tbody></table><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">We passed through Karatina, a town of about 10,000 people, and drove another 5 km to the community of Tumutumu, much smaller town, which sits on a large hill. The hospital is the heart of the town and we arrived around 5pm. The guest house is lovely. Perched higher than the hospital it affords a nice view of Mt. Kenya on the horizon. We were warmly greeted by Helen, the innkeeper, and Margaret, who also helps with meals and upkeep. Tony is the security guard who mans the gate to the guest house. We settled in our room and then ate a delicious meal before surrendering to sleep once again.</div></div><div class="MsoNormal"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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<tr><td class="tr-caption" style="text-align: center;">View from our window West</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9KR6LcNVSu_R8ta6Gyx91LyRMkMYCQOlfnavL-mdxKx3R7xjMV4B2997Qr_-bhkQpUG4tmAVSn0BVxTHT5cJkCHbEo86QfZB760DrleaJqX2jDfa2WbcR2G_F2YzZE2bf1O48_hCZvn4/s1600/IMG_3550.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9KR6LcNVSu_R8ta6Gyx91LyRMkMYCQOlfnavL-mdxKx3R7xjMV4B2997Qr_-bhkQpUG4tmAVSn0BVxTHT5cJkCHbEo86QfZB760DrleaJqX2jDfa2WbcR2G_F2YzZE2bf1O48_hCZvn4/s400/IMG_3550.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">View from our guest house of the top of Mt. Kenya</td></tr>
</tbody></table></div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-4783737804578773052011-04-11T08:09:00.000-07:002011-04-11T08:21:42.179-07:00Charlotte-Chicago-London-Nairobi<div class="MsoNormal">Whew! We made it. Did we underestimate the toll of 2 back-to-back 8hr flights? Perhaps. Did we pack too much? Probably so. We're weary and jetlagged, but we're safe at our mission post in Karatina. This is not without much assistance from friends here all along the way. Here's the story.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Our journey began with a morning drive to Charlotte airport – a flight we were afraid we would miss due to the traffic! Not the best way to begin our trip. A quick flight to Chicago (comparatively), where we had a 6 hr layover. We then changed from American Airways to British Airways for our evening flight to London. The plane was not full, the seats were roomy, the movies were on demand, and the meal was great. We love BA! </div><div class="MsoNormal"><br />
</div><div class="MsoNormal">But things slowed town once we got to London. The jetlag had us both dragging, walking around Heathrow like zombies at 7am (which felt like 1am). The flight to Nairobi was another BA 8hr relay but less pleasant: the flight was packed and it seemed that everyone had fussy kids! Matthew slept, I did not. I think we were both anxious about all that lay ahead.</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjDR3GXPMiQMlnQYm7kP01cSKeDwhivTCnPoorUN5WZqDWoAA2tEbgSPESRheoHguzbk7gPbVBfCk9OeUA4wshR-MZb97ynW04PwihOe8iqScbeY0p2GLBYcNAbz1t_Hu9KMgj4cMlrVM/s1600/IMG_3491.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjDR3GXPMiQMlnQYm7kP01cSKeDwhivTCnPoorUN5WZqDWoAA2tEbgSPESRheoHguzbk7gPbVBfCk9OeUA4wshR-MZb97ynW04PwihOe8iqScbeY0p2GLBYcNAbz1t_Hu9KMgj4cMlrVM/s200/IMG_3491.JPG" width="200" /></a>Upon arrival Thursday around 9pm we quickly made it through customs. We checked only one bag and were pleased to find it followed us to Kenya. Before leaving the airport we converted our cash to shillings ($1=80 shillings). All of our accommodations and food for our trip must be paid in cash... amounting to quite a stack of bills. Both of us are so uneasy about such a stash! </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUh-zAhdmj2BhIbKuZGhLkkJ69b5r77RP-ScXCPZ-U7eAkNk1tBjKiSAdGBhb5EdFNMxh6vAnHqgNNqw1LgIM8WLielkoarpX8-YdrAlOLRmZQFQFQFy7VIrd2RlfO8AVI5CAqBqZsvZw/s1600/IMG_3485.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUh-zAhdmj2BhIbKuZGhLkkJ69b5r77RP-ScXCPZ-U7eAkNk1tBjKiSAdGBhb5EdFNMxh6vAnHqgNNqw1LgIM8WLielkoarpX8-YdrAlOLRmZQFQFQFy7VIrd2RlfO8AVI5CAqBqZsvZw/s320/IMG_3485.JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSYVj5mWgJZRndIgnS1XQH1yjWlkCTUW46W__VTSRHLOqOqLyM7iTOJfOGGrnLQPrTVXWH3aYNn26B87IY_YxTlHo3Kc9BcnRCYsnzRjClcbQVrnXZ4dcLr0RpE4p-8-5SBYyonj-0xiw/s1600/IMG_3484.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSYVj5mWgJZRndIgnS1XQH1yjWlkCTUW46W__VTSRHLOqOqLyM7iTOJfOGGrnLQPrTVXWH3aYNn26B87IY_YxTlHo3Kc9BcnRCYsnzRjClcbQVrnXZ4dcLr0RpE4p-8-5SBYyonj-0xiw/s320/IMG_3484.JPG" width="240" /></a></div><div class="MsoNormal"></div><div class="MsoNormal">A driver from our guest house met us at the airport, identified by a sign reading “Dr. Carlisle”. A 20 minute drive delivered us to CHAK (Christian Health Association of Kenya) guest house and conference center. Everyone was very welcoming and well-spoken. The room was very clean and efficient, complete with mosquito nets and warm water. Now safely in our room we went about the first order of business: filtering water to brush our teeth and take our malaria medication. We brought with us our backpacking water pump for the job.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFtTrS7BNvpmqA5Dz1V42HZBEMMYyQCDz_zQGzvd5lVnMJx-sHHpyZjI3Ge9IigUhIAfNmltLji0TIfPq6kSMhsOXD_KAsczIq-GXmgZowcAMBYoaAymlNIATuo-MgiKmaBgsMP1zbSl0/s1600/IMG_3494.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFtTrS7BNvpmqA5Dz1V42HZBEMMYyQCDz_zQGzvd5lVnMJx-sHHpyZjI3Ge9IigUhIAfNmltLji0TIfPq6kSMhsOXD_KAsczIq-GXmgZowcAMBYoaAymlNIATuo-MgiKmaBgsMP1zbSl0/s200/IMG_3494.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmtHC4Fef5h5eqABRs2FNC2OMQKMC7iKlwp1ySnlLVzlZ29VCPmm9CxLeu32SgYLjldkFFf6JFpB488Q28eQFnIyJIYt8vP1sXW-j_w9Z7CHo6hP_jUYEoyfTaAxObPc5_4U4tSpnXd4o/s1600/IMG_3499.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmtHC4Fef5h5eqABRs2FNC2OMQKMC7iKlwp1ySnlLVzlZ29VCPmm9CxLeu32SgYLjldkFFf6JFpB488Q28eQFnIyJIYt8vP1sXW-j_w9Z7CHo6hP_jUYEoyfTaAxObPc5_4U4tSpnXd4o/s200/IMG_3499.JPG" width="200" /></a></div><br />
</div><div class="MsoNormal">Our driver from Tumutumu was to pick us up from CHAK at noon. After breakfast we took advantage of the extra hours by napping and exploring the CHAK complex. The center trains medical professionals and hosts many international visitors and it is quite a nice facility. The Tumutumu driver arrived about 1:15, he was delayed in Nairobi traffic. Matthew and I enjoyed our first Kenyan meal while we waited – delicious! More on food later.</div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8t1Nd9bzV6yWY3xls9p446cOvbMEWSoqf4v2ACkzN_atBEPmCDwDYiLfvHxKdaw0rmEaNgTvRlDVBK1JycIf0ExDLJ2cxG-KFzE_VDu9rrgSfg327GfDEroT1Fn4kSUhZ3gVXEY02oa4/s1600/IMG_3496.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8t1Nd9bzV6yWY3xls9p446cOvbMEWSoqf4v2ACkzN_atBEPmCDwDYiLfvHxKdaw0rmEaNgTvRlDVBK1JycIf0ExDLJ2cxG-KFzE_VDu9rrgSfg327GfDEroT1Fn4kSUhZ3gVXEY02oa4/s320/IMG_3496.JPG" width="320" /></a></div></div><div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRjDMEMNprpuZ9r_o7zdjPit78vwvr7h572mBkC-AnmCLMAujYU53MC2ltOJGcxK2W_DvHUSAityakfZVJesiDe-ZwDh5_SAdmKHyyHPBk-Qo7zMxmkkgqnkONq7dp74kkXG1z2RHkvio/s1600/IMG_3501.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRjDMEMNprpuZ9r_o7zdjPit78vwvr7h572mBkC-AnmCLMAujYU53MC2ltOJGcxK2W_DvHUSAityakfZVJesiDe-ZwDh5_SAdmKHyyHPBk-Qo7zMxmkkgqnkONq7dp74kkXG1z2RHkvio/s320/IMG_3501.JPG" width="320" /></a></div><br />
</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com1tag:blogger.com,1999:blog-7486002359304888758.post-69535945536479814352011-04-04T21:17:00.000-07:002011-04-05T05:12:30.773-07:00PreparationWe leave Wednesday! We're hurriedly packing... but I thought I'd share a quick rundown of all the things we've done to prepare for the trip. (Mostly this is just a packing list posing as a blog post).<br />
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<ul><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSFbUvQdPMaDM3iRrl-NL2A9u4XBgD4lJBJmLmxnfCta7t2fLWl6V2WvU9x6M4QTmqu4HmVfj5iG9cSHBDIDvjaKWwByOsvY_52uTIjpGT4Zhlq-nie2Vy9h58bBZgHjUy1wgZ7Rbh2fA/s1600/IMG_3467.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSFbUvQdPMaDM3iRrl-NL2A9u4XBgD4lJBJmLmxnfCta7t2fLWl6V2WvU9x6M4QTmqu4HmVfj5iG9cSHBDIDvjaKWwByOsvY_52uTIjpGT4Zhlq-nie2Vy9h58bBZgHjUy1wgZ7Rbh2fA/s400/IMG_3467.JPG" width="223" /></a>
<li>Vaccinations: Yellow Fever (you can't get into Africa without this vaccine), Typhoid, Meningitis, Hepatitis A (and I had Tdap). We used the Passport Health Clinic and Richland County Health Department to get most of the shots. We would recommend the <a href="http://www.passporthealthusa.com/">Passport Health Clinic</a>, which is also recommended by the CDC, if traveling to a third world country. They gave us lots of good advice and a general orientation on how to stay healthy there. They were really helpful.</li>
<li>Kenyan Travel Visa: We had to actually send our passports to the Kenyan consulate in LA to get the travel visas. A little scary, trusting our passports in the mail, but they came back to us promptly and safely.</li>
<li>Documentation: plane tickets, travel insurance, and all the phone numbers, addresses and contact people we're relying on along the way.</li>
<li>Reading: We made a couple of trips to the library for travel guides and literature surrounding Kenya, Africa, and medical mission work. More on this later.</li>
<li>Medications: It would be easier to list the drugs we are leaving behind. We're taking a little bit of everything you can find over the counter. Prescription drugs include our malaria medication and Cipro in case of infection. And lots of bug spray to prevent mosquitoes from eating us alive and spreading disease. Another interesting suggestion we got from the clinic: taking garlic supplements to help repel mosquitoes. We began that regiment a month ago.</li>
<li>Snacks: Everyone we've talked to who has spent time in rural Africa suggested bringing granola bars, pop-tarts, and trail mix. I have to admit this doesn't seem like a necessity and we get pretty tired of this kind of food. This will be the last thing I try to cram in the suitcase.</li>
<li>Clothing: Matthew will get away with scrubs, Carharts, and button down shirts for the majority of the trip. My dress code is a little more specific. Long, flowing skirts only. No pants, definitely nothing above the knee. And no shirts that are too tight fitting, no shoulder exposure. We just ruled out 90% of my wardrobe. So I went ahead and bought a few loose tops and made skirts for the trip, more on that <a href="http://ordinaryart-ctc.blogspot.com/2011/04/skirts-for-africa.html">here</a>. The weather should be wet, with temps between 60-80 degrees.</li>
<li>Odds and Ends: fun things like flashlights and umbrellas, power adapters and sunglasses.</li>
</ul><div>And of course, there is much more.... but we really are trying to pack light. Hopefully we can practice this tomorrow. </div><div><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTxS6sGYyifzbyCpElK3LhQvg0yRjkSyj7lIGpRjW2lXnB_cMVgYCuOqxADuAq8Uu6-dKwL_EBWYAanqnBCQn1RtoAjU1kDWyezb7mn2S1Od7DeybQU6H5wvwEHEoiYvgEoFpy8th9PAk/s1600/IMG_3465.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTxS6sGYyifzbyCpElK3LhQvg0yRjkSyj7lIGpRjW2lXnB_cMVgYCuOqxADuAq8Uu6-dKwL_EBWYAanqnBCQn1RtoAjU1kDWyezb7mn2S1Od7DeybQU6H5wvwEHEoiYvgEoFpy8th9PAk/s400/IMG_3465.JPG" width="400" /></a></div><div><br />
</div>Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0tag:blogger.com,1999:blog-7486002359304888758.post-71360264437431987532011-03-25T05:18:00.000-07:002011-03-25T05:18:14.706-07:00The TradeMatthew and I are leaving for Kenya in two short weeks and this idea overwhelms me. I'm not sure that I expected to feel this way. It will be a great trip, a whole new set of life experiences. We're going to Africa! We love to travel. I wanted to feel peaceful and excited and confident, like a kid on Christmas morning. Why the hesitation?<br />
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There are so many things that are different and difficult about this trip. Mission work of a variety, and to an extremity, that is unknown to us. Ever since medical school this is something we've been called to do and now, finally, we have the time. We know we want to help, that we'd like to be of some good there, but we really don't know what it will look like. We've been volunteering and building houses and trying to do good things all our life, but never have we presumed to do so in a third world country where the nature of the work is as critical as healthcare. That's how this trip is <i>different</i>.<br />
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This is how it is <i>difficult</i>: It is just us. We are not going with a group of people, relying on a central figure to organize everything. I've made all our arrangements with the travel agent. I've coordinated details with our mission contact. I've double checked our vaccines and sent off for our visas. We're both pretty experienced travelers but never have I planned a trip with more detail, reviewing each step methodically.<br />
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I've been putting off an opening blog entry because everything I tried to write felt presumptive. Really, we won't know exactly what we'll be doing until we get there. Matthew has invested a lot in this skill of medicine and with faith we hope it will be employed. Beyond that everything is unknown. <br />
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So amid my procrastination I had this dream and I immediately awoke enlightened. Bare with me because dreams always sound silly in the light of day, but I promise I was being addressed, directly, about my anxiety about Africa.<br />
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Matthew and I are at a crossroads and we're debating about which way to go. One path is dark and looks suspicious but that path is more direct. The well lit sidewalk with busy people and storefronts would take us twice as long to reach our destination (not sure where we are going). We decide to take the dark alleyway which is stereotypically the place where bad people lurk and then violently attack you. And of course that is exactly what happened. Now, I'm a strong advocate against gun violence, and since this is my dream, that weapon doesn't even appear as an option of defense or brutality. It's just Matthew against this unknown assailant, turning about and wrestling in the dark alley. What does he want? Matthew's wallet, or his life? The attacker had the advantage of surprise on Matthew and had soon pinned him to the ground. Then everything slowed down at this point. Matthew stopped squirming and fighting long enough for the attacker to reach out for Matthew's glasses. Then the man tried on his glasses. They worked well. And then the attacker started taking off his own coat and he gave it to Matthew. This is when I woke up.<br />
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We assumed the attacker meant us malice and harm... we thought he wanted our wallets and our lives. But what he wanted was much more simple and basic. He wanted to see. And he wanted to make a fair trade. This is what spoke to me about the dream: our expectations, I think, are completely off base. Our fears and concerns are about all the wrong things. And the <i>trade</i> is significant. <i>Because I have this sneaking suspicion that we will take with us as much good as we will leave behind.</i> This is my hope and my prayer as we prepare for our adventure. A fair trade.Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com3tag:blogger.com,1999:blog-7486002359304888758.post-30879837006873213212011-03-08T21:46:00.000-08:002011-03-08T21:46:59.074-08:00Welcome!Thanks for visiting our blog. We hope to document our venture to Kenya in April 2011. Check again for more details of in the next few weeks...Christinahttp://www.blogger.com/profile/08948876157552253506noreply@blogger.com0