Kendu Bay

Discussing our upcoming trip to Kendu Bay.

The final destination and, by happenstance, the birthplace of President Obama's father. We did make the pilgrimage. Apparently he was a troubled man who died quite young.

We met with M.P. Rege on Saturday morning and then toured the Kendu District medical facilities. Our first stop was the newly designated District Hospital. It had been the sub-district hospital but when the district was divided last year, it became the major facility for the area. Not that that changed anything. The funding remained the same and there was nothing available to upgrade nor to add surgery to its capabilities. It is a sad, chaotic, disorganized, poorly run place. There is one physician sent there as part of his government service who has little interest in the place and the work and he freely admitted that. He plans to be there only three days a week and return to Nairobi to build his private practice. There are two Clinical Officers, equivalent to our Physician Assistants, but these two are not well trained and rather poor clinicians. More on that later. Our tour took in the now sub-district hospital and that was wonderful, organized and with a devoted staff. We were most impressed. How well they practice medicine is something we will have to discover. On we went to the rural clinics of which there were four. Two were being constructed and we could obviously not make any judgements. One, which was right on the lake shore in a small fishing village, was a lovely large facility built by the Japanese. Sadly it was staffed by an incompetent nurse but fortunately she saw perhaps 5 patients a day. I did tell them that the clinic should be closed, the nurse retrained and sent where she could be supervised. The final facility was at the opposite end of the district and was busy. It, too, was run by nurses and will require much work but it was needed and could not be abandoned.

We spent the week at the District Hospital and each day it became more discouraging as the practice of medicine was atrocious. Patients wait long hours to be seen which was not necessary. They were sent immediately for the few lab tests that were available and generally were treated for all possible ailments despite negative tests. No attempt was made to obtain a cogent history nor to perform a physical examination. Usually they got treated for malaria, pneumonia and typhoid. It was not surprising that the pharmacy had run out of most medications and did not expect a re-supply for two months. This meant that patients had to purchase the drugs in town if they could be found. The World Health Organization estimates that 25% of drugs in Africa are counterfeit so that adds to the terrible outcomes that occur. Similar circumstances exist on the inpatient units.

The last visit we made was to the Seventh Day Adventist Hospital a few miles out of town. A large complex that had been established over a century ago. It has a close affiliation with Finland ( I will find out more when I go back as to how that came about). An excellently organized facility which has Clinical Officers and Nursing Schools. We were invited to teach there and likely will but our major effort will be at the District Hospital.

Sadly I could not take pictures as my camera battery died and none were available but when I go back in January, I will rectify that so that you can get a better sense of the reality that exists there. It is a very sad sobering thought that there is more equipment in Lewiston-Auburn, Maine than exists in the whole of Kenya, a country of 28 million people.

This will be the last post until I return to Kendu Bay in January. I wish you all a wonderful holiday season and the time to reflect on all the blessings that we have had in our lifetimes.

As I am in the process of establishing a charitable foundation to assist us in our work, I would ask each of you, if you feel it appropriate to share this Blog with friends and relatives.

Ukwala & Matibabu Foundation

The top picture is of me teaching at the Ukwala Clinic and underneath is me again on the road to Kisumu

Onto the second site-the clinic and soon to opened hospital at Ukwala, a small town north of Kisumu near Lake Victoria. First into their Nairobi office to meet the country director, Daniel Okala, a diminutive man bursting with ideas and enthusiasm. It was impossible not to get caught up in them and imagine phenomenal health care rolling out from this center. A discussion about my possible role and then back to Kenyatta airport to catch the flight to Kisumu and from there the ride to Ukwala. Naturally no one was there to meet me but, whipping out my trusty mobile phone, I was able to contact dear Winnifred and about 30 minutes later, the driver did show up. Seems they were in Kisumu buying water for me. Heading north on a real tarmac road, dodging potholes that threatened to swallow the car, the driver, probably about 20, wanted to overtake anything in his path. After about 90 minutes, we swung off onto a dirt path and followed the same drill. Around dark we got to Ukwala and I was deposited in the Parish House where there were quarters for the volunteer staff. Met and had supper with the area priest, a delightful man with, sadly, severe rheumatoid arthritis. Meanwhile John who had traveled by bus was stuck somewhere and did not make it to Kisumu until midnight and stayed overnight there. Evidently the gendarmes were out in force checking on vehicles to be sure they had the proper inspection and insurance documents and were not overloaded. Since few of them had any of the necessary certificates and most were overloaded, there was a long line of vehicles taking devious circuitous ways around the roadblocks. He did finally get to Ukwala the next day at lunchtime.

Onto the clinic-a good facility and well run. Met the doctor who was frosty. I do believe that she was concerned for her position. I worked with the clinical officer in the morning and there were very interesting patients to care for-malaria, infant with HIV and kwashiorkor, young man with granuloma inguinale. On the walk back to the parish house where John was waiting, I noticed a government clinic across the road. It appeared well staffed. In the afternoon we walked out about 2 kilometers to see the new hospital that was being built. Lovely location in a large field with a good view of the surrounding hills. It was quite large, a cement structure, built in tukal style with a diameter of about 100 meters. It had 10 patients rooms with one bed each but could expand to two beds/room. Each room was being equipped with tv and Internet connection. Two nurses' stations with total visual contact. This is to be a pediatric unit and there are plans to expand to a 200 bed women and children's hospital. Wonderful design and idea but what I believe is a waste of resources for the reality of the area that it was in. You could build a more practical structure at less cost and use the monies to purchase diagnostic equipment and an adequate supply of medication. They have received money from their American sister foundation, Tiba, and the Clinton Foundation as well as Pepfar money. Still, from my experience, those sources tend to dry up and you are, all to often, left with nothing to continue. One year in Darfur we were functioning on $250,000 and the next, we were expected to expand services on $150,000.

Day#2 here in Okwala-back to the clinic and there were only a handful of patients so that we were done by 1100. Across the street the workers at the government clinic were on the veranda reading and chatting as they also had little to do. At lunch John and I decided to leave at it was clear that, at this point in time, they really had no need of us. This was Friday, the 26th of August. Luckily the priest was leaving after lunch to go to Kisumu. We called our contacts there, clambered in Father Fred's car and off to Kisumu to spend the night and move onto Kendu Bay on Saturday. But, like "The Perils of Pauline" that adventure will have to wait until later.

IN THE BEGINNING

Day#1

The great luxury of the Flora is the ever-ready HOT shower and, after 10 minutes in Nairobi, you need it. The usual buffet breakfast, if one is lucky and I was, has some fried eggs instead of the ever present gruel and wonder bread. John was late and I was restless so I got a cab to take to the first place we were to visit, the Ushirika Clinic in Kibera. I had to get Kenyan schillings (they refer to them colloquially as "bob"). Now what I rather slowly discovered after 4 different ATM stops is that the Kenyan banks abhor MasterCard (which I possessed) and love Visa (which I don't). So by the time I got to the Clinic, there were John and Kennedy Obuya waiting for me. Kennedy is the chief of security for James Rege, the MP whose district includes Kendu Bay. We did tour the clinic and met the personnel (pictures included). and then made plans to visit Kibera itself the following day.

With Kennedy's help, I did get my "bob" and at 95 to the dollar you do feel flush until you actually buy something. Inflation is galloping here in Africa. In Kenya in July and August alone, inflation was over 30%.

Later around 1700 we did met with James Rege and and the mayor of Kendu Bay. We did arrange to tour the medical facilities there with him on Saturday. Then back to the Flora. Supper was over so we took a cab to the local version of Burger King/Kentucky Fried chicken, sipped our beers and discussed the plans for Tuesday.

Day # 2-Tuesday, August 23rd

We met with Kennedy and a Nairobi detective, Lawrence, who lives in Kibera. Kibera (pictures), although physically one huge slum is actually divided into villages and the various tribes congregate together in separate ones. The ones that are allied are closer together and separated from the other non-allied so the Luos are separate from the Kikuyu. These two are the major rivals. But, like brain chemistry, that is a very simplified version and there are many nuances. As you look at the photos, you will see the open sewerage running by and the children playing in and nearby. As for children, you can see how much like the Pied Piper, John truly is. A return to the Clinic for more discussion of their needs and then a visit to a government clinic just at the edge of Kibera. We met there with the"personal assistant to the prime minister" or so his card read and he promised to send us a report on which clinics he felt would be in most need and be most reliable. He never did!

Then back to the Flora. This time we did make it to supper.

Back in the Land of the Round Doorknob

A long trip and a long goodbye but only for a time and, perhaps, this time it won't be so long. Certainly not four years.

Forty hours on the road. The trip to Portland, a sad "aufwiedersehn" to my dear Gerda. The usual lousy movie on the bus but, if you leave the sound off, it ain't so bad as you can create whatever dialogue that pleases.

The airport, checking-in and taking off the belt, shoes and pockets. Through the body scanner-a bit more radiation to add to the rads that I have accumulated over the decades. A bit like the 1/10% benzoate of soda that now percolates through my vessels. The long flight to Frankfurt, a race through the endless corridors and moving belts to get to the short trip to Zurich. The same at Zurich. I used to get excited to get my passport stamped. Made it to the Nairobi plane with 15 minutes to spare and, mirabili dictu, the flight was only about 1/3 full. The shear joy and comfort of stretching out on two whole seats and actually sleeping.

No mishaps and the long line to get my visa-what a beautiful picture I take. Finally out the door and there were my friends waiting, Dr. John Ott and several others that played such an important role in facilitating this trip.

First though there was Bernard, a student whom Gerda has sponsored for years. Grown up and now beginning his third university year. Then a hand-off of a bag of clothes and books that I had brought.

Then there was Kennedy, an aide to James Rege, member of parliament, and he is very important to this tale.

Two students of John's rounded out the group and, of course, Winnifred, the representative of the Matibabu Foundation whose clinic I had promised to visit during this trip.

Greetings, handshakes all around and then off to the Flora Hostel, a place that Gerda and I stay at when we are in Nairobi. Run by the Carmalite Sisters, it is very tidy and the fee includes all meals. It ain't the Ritz but it quite safe.

Into bed and finally more SLEEP. In the morning we go to Kibera, a huge slum on the outskirts of Nairobi, reputed to be the largest in the world housing over 250,000 people, where we were to see a clinic, Ushirika Clinic, that we might support and work at.

So now I will sleep and then when I can I will continue with the story of this trip. Futher episodes to follow in the amazing adventures of Dr. Stephen.

Reserection

It begins again. Finally after almost 4 years, I will be on the road again. I leave tomorrow to Kenya where I will be for almost three weeks. This time I will be looking at several clinics around the country. The first will be in Kibera, a huge slum on the outskirts of Nairobi. On Wednesday, I will likely fly to Kisumu, a city on Lake Victoria and visit two clinic/hospitals one about 50 kilometers north and the other the same distance south. I will spend about a week at each to hopefully, decide which one(s) I want to devote my declining years to assisting. I will take pictures of all and post them when I can and I will write of my adventures as I follow Burton and Speke looking for my source of the Nile.

Stephen

still hoping

I am still negotiating with folks in Kenya and, hopefully, something will happen soo.

WAIT

I am still waiting for more information about Africa. Hopefully, soon.