Pictures

Pictures from clinic:
The reception desk


Rosie in pharmacy









My house and garden

and living room

Teen Clinic

Today I worked in the young adult clinic where patients range from 11 to 26 years old. I saw three patients who were newly diagnosed with HIV. When talking about their reaction to the news, each of them was apparently unmoved, almost dismissive. One woman even said to me, "Its what you expect living here." I asked the clinician I was working with about it, not sure if their guarded reactions were simply because they were talking to me, an outsider. Sadly, though, that is the reality and part of why prevention efforts are so difficult. Too many young people have grown up with AIDS being an ever-present (and untreatable) part of life and can't really see a way to avoid it - there is almost a collective depression around the topic, which is why clinics like this one are so important. Most of their community outreach workers are recruited from among their clients - volunteer kids who are unable to afford going to school (school is only paid for by government through sixth grade) and go out every day to set up VCT (voluntary counseling and testing sites) tents in their neighborhoods. They are very effective at convincing their friends to get tested - this one little clinic runs over 1000 rapid HIV tests per month. What's amazing, though, is how little education on prevention there is - very few clinics are allowed into schools (for legal reasons, I am told... the parents wouldn't approve) and though there is some education in school it is apparently quite minimal.

The saddest of all though are the young children - 11 through 15 who have been living with AIDS for their whole life. So many of the kids have been through so much - stigma, multiple illnesses, loss of their parents - that by the time they are in their early teens they just seem stunned. Most of them are very small for their age, don't do well in school, and many are orphans. There are definitely lots of services out there to help them but seeing them and talking to them is a sad testament to how much damage has been done to a whole generation of kids by this disease.

Rain

Wow. Yesterday the rains officially started - I don't think I've ever seen so much water dumped from the sky in such a short period of time. I watched the storm with a large crowd of people after ducking into a store - you could barely see five feet through the wall of water. After an hour or so it let up and we headed out. This was the most fun of all - the streets were now rivers with water at times over two feet high and flowing fast. All the traffic that had stopped for an hour (pedestrian, vehicle, and bike) was now filling the mud and rain drenched sidewalks in a vibrant mass of humanity and hilarity. The market that lines the sidewalks was still going on as people literally slipped and slided into the piles of fruit and fish (wet banana peels and mud do not make a good combination). I think there was a competition between matatu drivers to see who could create the biggest waves - a large splash, particularly if it hit a bunch of pedestrians, would get a cheer from the audience on the sidewalk. It was one of my more amusing walks home - and for the first time I didn't arrive home hot and dusty... I was soaked and muddy, and very entertained.

Meetings

Every meeting starts with a group song, a prayer, and a "clap" (a "clap" means someone gets up and leads us in some form of chanting and clapping that lasts anywhere from 5 seconds to a few minutes). Today we had an all day retreat/planning meeting to talk about goals for the clinic for the next year. The clinic is still pretty new and growing quickly (they hired ten new staff in the past month) and the staff is all quite young (the clinic directors are probably mid-30's) so its fun to be part of something so new and dynamic - and actually feel like I have something to contribute. We took breaks in the middle of the meeting to play games (that's what's happening on the right - "Simon Says"). One of the guys in clinic borrowed my camera so they could put pictures on the web site (their IT department = one person) so sorry some of these are blurry but its fun having his view of the meeting and his fellow staff members. We were at a little retreat place about 15 minutes outside of town - which we got to by (surprise!) squishing all 52 staff into 3 vans - its very fuel efficient. They have a LOT of meetings (which are generally not the most efficient things) but the monotony is relieved by lots of joking and clapping.

my 'hood

April is the beginnning of the long rains - they haven't yet started in earnest - just a sprinkle here and there, the occasional thunder, and loss of electricity that presages what sounds like some impressive showers. It has gotten a bit cooler though - my first week it was in the 80's during the day and HOT (not humid though - we are up over 1100 meters so its pretty dry). This week it rarely gets out of the 70's - and they all think its so cold! One of the women in clinic couldn't believe I had on short sleeves and no jacket the other day. Even when it was in the 80's, people were wearing thick jackets in the middle of the day - and didn't seem bothered at all. The picture to the right is a road near my apartment, running by Lake Victoria - it shows the red dirt that sticks to everything!

The lake is about five minutes down the road from where I live - I run past it in the mornings. Most of the water in close is overgrown by plants which apparently have done a lot of damage to the ecology of the area - but there are still hippos - and fishermen eager to take the mzungu (me) out to see them.

clinic

The past few days in clinic have been ridiculously busy. We are seeing a steady stream of patients - over 300 the other day and still at meetings there is talk about how we aren't seeing enough, especially kids. One of the problems is many parents are reluctant to have their children tested or, if they are, to disclose their positive status to them. Access to medications for HIV is still a relatively new phenomenon here and as a result there is a lot of denial. Ten years ago, people didn't want to know their status because there was nothing they could do about it. Its changing but slowly. I imagine this is what it was like in the US in the late 80's and early 90's before there were drugs for AIDS.

Kenyans work an incredible amount - that is, if they are lucky enough to have a job - the rates of unemployment here are quite high. The stalls are opening on my way into work at 7 or 7:30 and many still open when I leave after 6 pm. The bicycle taxis are out all day - my "driver" today was telling me he often works 14 hour days (some of my most interesting conversations are on my commute - amazing how quickly one becomes accustomed to carrying on a complete conversation while swerving amid motorcycles and cars in the semi-darkness while perched on a little plastic seat on the back of a bike). Most of the clinic staff works 10-12 hour days. But no one ever moves very quickly or seems rushed despite the fact that the clinic is literally packed with patients waitng to be seen. One of the favorite expressions here is "pole, pole" - slowly, slowly. Its used often in place of "excuse me" or "watch out" (or maybe I just get it more often because my baseline walking and talking speed is 8 x as fast as the next person's). I saw nearly 30 patients today and felt far less rushed than I ever have in a day where I see half that many at home. Most of the clinicians are in their early 20's and it is hard to imagine how they will not all be totally burnt out in another ten years - they talk about it fairly frequently... and then joke that they are too busy to be burnt out and try to figure out ways to see more patients in clinic.

Lake Nakuru and Lake Naivasha

Serendipitously, we had a four day weekend (because of Easter) so I got an early and unexpected chance to travel - and go on my first safari!
The sign above says "Danger - wild animals crossing at night - slowly, slowly"... more on that later.

The traveling itself was a huge adventure. Roads in Kenya are not like those in the US. Though we were on "paved" roads, for large stretches the roads are not exactly maintained - there are potholes the size of a Civic. Also there will be intermittent road construction (marked not by bright orange signs but by a large pile of dirt in the middle of the highway) at which point the bus takes off onto an often smoother but incredibly dusty dirt road on the side. Though the norm is to drive on the left hand side of the road, that is apparently just a guideline - we passed people on both sides, often driving for long stretches on the shoulder or on the right. On the way out I rode in a real bus - which was a bit alarming at times when we were driving half off the road and tilting at a 45 degree angle! I learned on the return trip however that the advantage of the bus is that there is no danger of smashing your head against the roof when you go over potholes and you don't lose all sensation in your legs. On the way back I rode a matatu - 15 people packed into something slightly larger than a minivan - for four hours over very bumpy roads. To the right is a picture from the inside back row. I was glad to discover I could still walk at the end.

On the plus side traveling by bus is a great way to see the country and how it changes. We started in the hotter but lusher fields in Kisumu, moved up into the cooler mountains of the tea country, Kericho, where the vivid green tea bushes stood out against the red dirt roads, then back down into the drier plains of the Rift valley. Throughout we passed through tiny towns most of which are grindingly poor but enlivened by brightly painted walls (all advertising of course) and roadside markets (see right). Everytime the matatu stops, crowds of people come to the windows selling food ("sosej"'s (aka sausages) and yogurt in a carton are particularly popular) and anything else you can think of from men's underwear to purses to cell phone covers



In Nakuru, I met up with one of the pediatrics residents from UCSF who is working in a different town. It was nice not to be the only Mzungu for a bit. Lake Nakuru is a small but densely populated game park which is best known for its "flock" (?) of half a million flamingos (a small portion shown at right - or the pink splotches all around the edge of the lake behind me on the left). Not only an impressive sight but also an amazing sound - its a kind of humming, whirring, rustling noise that at first you hardly notice and then you can't believe you didn't because it is so loud. But the flamingos were just one part of it. The following is a list of what we saw: impala, zebra, cape buffalo, redbeest (type of antelope), hornbill stork, waterbuck, eland antelope, dikdik (apparently very hard to spot - a tiny little antelope), hyrax, giraffe, lizards, baboons, white rino, ostrich, warthogs (my favorite), egrets, mantal eagles, velvet monkeys, fish eagle, golden pippit , lots of other little birds, and a LION - just hanging out in a tree by the side of the road. All in all a pretty amazing experience - esepcially because we were only about half an hour outside the town - it was kind of like the "Disneyland" of game parks.

Next I headed over to Lake Naviasha. I rented a mountain bike to go riding around the lake which is dotted intermittently with private game reserves, including the estate of Joy Adamson (hence the sign at the beginning about animals crossing the road). It turns out the animals don't only cross at night - I started a small zebra stampede when I went through ( I was only fast enough to catch the last one running across the road to the left), also saw some antelope, giraffe, and my friend the warthog. Shortly after scaring the zebra, my cell phone started ringing - and it was my sister Katherine and mom! Very weird experience to talk to your family from the side of the road in Africa with zebra running by - but great :)

That evening I went out on boat safari to visit the hippos. They are big and ugly and luckily didn't do much when we saw them. Apparently, though, they sometimes stir up a lot of trouble in the campsites and there is electrified "hippo wire" at the base of the hotel/camp area where I was staying. I ended the evening sharing some Tusker beer (Kenya's national beer - it tastes like Coors and they think its the best thing ever?!?) with some Kenyans at the poolside bar at my hotel.

all in all not a bad weekend!

Pictures

Two of my first views of Kisumu. It captures it well - simple and friendly. Things are very high tech here.

okay, so i'm really not roughing it at all. This is the view from my front porch, where I can sit and eat my dinner, listen to the birds (or the trucks on the road outside), or fight off the swarms off mosquitos.