Month: October 2017

One of my favorite parts of traveling is sampling the local cuisine and I often collect spices, recipes or cookbooks in order to re-create the meals at home.  Over the past year I’ve spent quite a bit of time working in Norway, Maine.  Though not what you’d call a food destination, the community there prides itself on supporting local farmers in both in their homes and in the local restaurants. I enjoy shopping at the neighborhood co-op, but even the commercial grocery store displays a wide variety of local items.  I was fortunately in town this year for the annual food festival held in August.  The festival showcased fresh produce, food trucks with Maine classics and information on food waste as well as how to support the vendors in the future.  As a bonus, it was headlined by Carolyn Costanzi and the Cobblestones, (you may remember her from an earlier post, Ob/Gyn by day, Rockstar by night). Because my travel to Kenya would affect my assignment there, she knew I would be spending 6 months in East Africa.  She said, “you should meet my neighbor, he’s from Kenya.  I’ll have party, invite everyone over.”  Who says no to that!  True to her word, Carolyn hosted several of us for dinner, complete with Western Maine grown fruits and vegetables, regional sausages and homemade ice cream.

In turn, Dexter and his wife Jenna, invited us over for to try a few traditional Kenyan dishes. Jenna, originally from Massachusetts, was volunteering in Kenya, when the couple met.  They relocated to the states where Dexter completed his dentistry training on the east coast and have now settled in Norway with their three children.  They each shared their personal experiences, and though they had not been to Mutomo, (or heard of it even) they described generally what my expectations should be of the country.  One of the most important of those…food! They prepared a meal of goat, ugali and kachumbari.  We also had chai (or tea, made with milk and sugar).  I greatly enjoyed the meal and truly appreciated their efforts to help me prepare for a smooth transition.

A frequent question when I first arrived was, “you know ugali?”  Thanks to them, I could respond in the affirmative. “Yes, yes I do.”  And, Kenyans love their ugali.  It’s a staple dish, made from maize meal and often served shaped in a mound or ball, ugali can be served with all meals.  Usually the question asked when ordering a meal is, “What would you like with your ugali?”  Up for a challenge, I even attempted to make my own ugali last weekend, which requires patience and forearm fortitude.  The maize mixture is poured into boiling hot water and stirred frequently with a wooden spoon until you achieve the correct consistency.  A restaurant (and I’m sure a home) will be judged by the consistency of your ugali.  I would describe it as somewhere between polenta and cornbread.  It’s soft, but firm enough to be cut with a fork or knife.  Mine is a work in progress, but I think it turned out well for my first try!

In Mutomo, I take most of my meals in the canteen which serves as the hospital cafeteria.  Ran by a local restaurateur, Nameless Café II, has a standard Kenyan menu.  For breakfast, I have an Andazi and chai.  An andazi reminds me of a beignet without the powdered sugar.  Only slightly sweet, it less rich than an American doughnut, but sweeter than bread.  A typical afternoon or evening meal will consist of nyama choma, cabbage, ugali or chapati.  Nyama choma refers to grilled or roasted meat that can be served in sauce.  Chapati is a wheat flour flatbread, which I would describe as a cross between naan and a tortilla.  Now a favorite side dish of mine is kachumbari.  Light and refreshing, it’s a tomato and onion salad, that may include avocado when in season.  It’s most similar to pico de gallo and at times includes hot peppers as well.

When I expressed concern about whether I would enjoy the food here, Dexter and Jenna reassured me that Kenyan food is very flavorful and filling.  And they are indeed correct!

Over the past year, one of the first questions I’m often asked after people learn I’m from the States, is about our last presidential election.  I traveled with friends to Thailand last fall and while on an excursion, the tour guide referred to us as the Obama group the entire time.  Now with Trump in office, people often ask what I think about him.  More specifically, “how did you all let that happen?” Abroad people seem more aware of American politics than Americans are of global politics.  I have not been here long enough to weigh in with an educated opinion about the upcoming Kenyan re-elections.  However, I did want to take the opportunity to share what I have learned thus far in case you would like to follow along.

The Republic of Kenya gained her independence from colonial British rule in 1963.  They adopted a democratic system that elects presidents to five-year terms.  Evidence of the country’s deep respect of the first president, Jomo Kenyatta, permeates most of the country, gracing street names (Kenyatta Avenue in Downtown Nairobi), university names (Jomo Kenyatta University of Technology and Agriculture), airport names (Jomo Kenyatta International Airport), just to name a few. His vision for Kenya included the east African tradition of Harambee (let’s all pull together).

The current president, Uhuru Kenyatta, is the son of the first president, Jomo Kenyatta and Mama Ngina Kenyatta. He is a member of the Jubilee Party of Kenya.  The major opposition party candidate, Raila Odinga, is the son of the first Vice President of Kenya and is endorsed by the National Super Alliance (NASA) coalition for the 2017 election.  Both men have been very active in politics throughout their careers and are credited with shaping the current democratic landscape of the country.

As I prepared for this time in Kenya, I was blessed to meet a few people who helped in my preparation and expectation setting for my time here.  One of those individuals, a fellow locum physician who I met in Danville, PA, is from Kenya and visits her family here often.  She informed me of the upcoming presidential election scheduled for August and passed along local information surrounding the campaigns that did not always make it to the international media outlets.  As I was scheduled to start in late September, I anticipated my arrival would be after all campaign fervor.   As luck would have it, for the first time in African history, the past presidential election has been overturned by the Supreme Court due to suspicion of voter/ballot tampering.  The election will be held again, this week,  on October 26^th.

On my arrival, I noticed the media coverage focused on the tensions between the two major parties and speculations as to which one will win out the second time.  In a recent turn of events, the opposition party has withdrawn from the race.  As of now, all candidates have been invited to participate on the next ballot.  The Independent Electoral and Boundaries Commission (IEBC) has a challenging, dynamic and contentious responsibility of presiding over a fair and just repeat election.  In the past week, one IBEC commissioner has resigned and the CEO has taken leave. Each night the news features video clips of marches and rallies both for the presidential candidates and against the IEBC. The country encourages her citizens to be peaceful regardless of the results, but will prepare for unrest given the precedent set in 2007 when the country suffered from violence between the parties following the highly contested presidential election.

I feel safe in Mutomo.  Located in Kitui County, it is sheltered from much of the political turmoil seen in larger cities like Mombasa and Nairobi.  Though not likely a site for protest or demonstrations, the people here are engaged in the process and we have discussed the topic often. I encourage you to look it up for yourselves, as the landscape is changing so rapidly, this conversation may be completely different in the days and weeks to come.  I hope that whether here in Kenya, or at home in the US, that we can learn to embody the spirit of Harambee and work collectively to improve the human experience for all of the world’s citizens.

http://www.nation.co.ke/news/politics/1064-1064-4f88toz/index.html

My first day of clinical orientation consisted of shadowing one of the other newer doctors on staff around for the day.  She has been here three months and has a fondness of the maternity services as well.  As with many small community hospitals, the expectation though is to “help out” all around as situations arise.  A typical day starts with Morning Prayer and announcements in the atrium, followed by morning report with the clinical staff before we report to our designated areas.  The physicians then round on the wards, for me this includes what’s equivalent to labor and delivery, the newborn nursery and postpartum. For those of you in the field, it is truly baby friendly here.  The dyad are kept together and cared for together unless more specialized infant care is needed.  Even then, as in the case of prematurity, the mother serves as the incubator in what’s called kangaroo care (infants are placed skin to skin on the mother’s chest and kept there for 24 hours a day).  I round with the nurses who offer insight into the policies and procedures of the hospital as well as translate for me. Most patients speak Swahili and some, only the local dialect, Kikamba.

After rounds, if there are no scheduled cesarean sections, I can assist in the minor theatre, a well equipped procedure room adjacent to the major theatre, or operating room.  Here patients are seen as referrals from the outpatient triage area and inpatient follow-ups.  The queue includes women, men and children.  These patients may be seen for variety of indications, including simple dressing changes or I&D’s, fractured bones, pre-operative consultations, skin grafts, pelvic pain evaluations or prenatal complications.  The attending physicians in the area are well versed in all aspects of medicine, with only the most complicated cases referred out to a larger hospital.  The day typically ends around 5 pm when the call person takes over to handle any issues overnight.  Like the other physicians and some of the staff, I live on the hospital compound, making this my shortest commute yet!

I must say, I was a bit overwhelmed after that first day.  The number of variables presented were steep, a new country, a new hospital,  new languages and a new medical culture.  Mentally and physically exhausted (as my sleep had not yet regulated) I came home and took a nap.  The second day was better; I led ward rounds and assisted a bit in the minor theatre.  I even scheduled a case for the major theatre the following week.  As with any new experience, each day builds on the day before.  I am grateful for the warm reception and the patience the other clinicians and staff have afforded me as I adjust to this new space.

*Daktari is Swahili for Doctor

I’m from Louisville, Kentucky.  All day, everyday.  My friends know I have great hometown pride.  As I travel, and as people ask me where I’m from, I usually say Kentucky (because no one understands how native Louisvillians say Louisville in the states, let alone abroad), which is sometimes met with a perplexed look depending on where I am in the world.  Outside of the states, my follow up response is, “like Kentucky Fried Chicken,” which more often than not sparks some recognition; however some people don’t know they are related, as the company has re-branded itself to the abbreviation KFC.  It’s amazing that wherever I go, from Brazil to Thailand to Kenya, KFC restaurants are present.  I’m not sure if they’re the most popular fast food chain abroad or if I see it most often because it’s connected to home for me.  Other than the Yum Brands home quarters (KFC, Pizza Hut and Taco Bell), Louisville has a few other claims to fame like the Kentucky Derby, Muhammad Ali, the Louisville Slugger, the Hot Brown and Bourbon of course.

Several people here have asked me to tell them more about my home state.  I typically describe it a relatively small state in the middle of the country.  Though each part of the state has its regional differences, I like to think Louisville is the perfect blend of the best parts of the South and the Midwest.  We say pop (instead of soda) and put spaghetti in our chili; we make a mean pecan pie and love to pass warm summer nights on the porch greeting the neighbors as they pass by.  Both regions of the country pride themselves on having a warm inviting hospitality.  We very well may meet you today and invite you over to our house tomorrow.

Everyone here has worked to make me feel at home and I have been blessed with great Kenyan Hospitality.  The staff and volunteers of CMMB made sure my dad and I were picked up at the airport, arranged to have dinner with us on our second night in country, helped schedule our trip to the National Park and made sure we arrived to Mutomo in one piece.  Two of the administrators of the hospital, Sister Mary and Anita, personally greeted us on arrival to the hospital compound.  And, David has been indispensable in my transition to Mutomo, making sure we had dinner each evening, acquainting us with the town and helping me figure out how to connect to the all-important Wi-Fi!  The night before my dad left to travel to Nairobi and then home, Anita said, I must have you two over to dinner tonight.  “We’ll have chicken!”  Well, we had chicken and then some… lamb chops, toast points, a variety of vegetables and potatoes.  Another volunteer joined as well, a dentist from Sweden, who has been coming here for about 6 weeks each year for 9 years!  Completely stuffed, we took the long walk home…one house over 🙂  I live directly next door to Anita.  And, we again marveled at the mighty Kenyan appetite.

As you can see, fellowship over good food with good company is universal.

We traveled to Mutomo from Nairobi on Monday morning.  The first part of the drive out of the city was comparable to any drive out of a major city.  A busy four-lane highway crowded with cars and motorbikes.  Green signs hung overhead listing nearby towns or countries, you could continue on to Ethiopia for example.  The traffic here is fluid, very few stop signs or traffic lights interrupt the flow.  There are intermittent traffic circles and speed bumps that slow the movement down from time to time, but let’s say crossing the street as a pedestrian is an adventure in and of itself.  Outside of the central business district, small vendor stands line the roads.  Some vendors stand in the middle of the expressway alongside the speedbumps selling fruit, water and soft drinks to drivers and passengers as they paused for only a few moments.

Soon we exited the expressway for a local highway, much like a state road.  We passed through more commercial areas, stopping once at a strip mall to purchase a few supplies before getting into the more rural part of the country.  The store contained limited food items and assorted household items like any other variety store.  We bought a large bottle of water and a few snacks.  As we drove further from Nairobi, the roads became smaller, the shops and businesses fewer.  After a little more than 3 hours time, we exited the paved road portion of our journey.  The road alternated from packed sand to red clay and back again.  Small towns popped up along the way, often school-aged children walked the sides of the road heading home from school, sometimes their commute can be more than 2 miles each way.  It was also common to see goats, cows, donkeys (usually carrying water) passing with their owners.  Our expert driver negotiated the road with its dips and turns masterfully while carefully avoiding the non-motorized traffic along the road.

The climate near Mutomo is dry, more like the desert.  There has been little rain this year, the few plants are mostly bare and brown. We can see small hills and rock formations in the distance.  Beautifully contrasting the mostly monotone background are the women dressed in bright colors.  The traditional dress includes wraparound skirts and shirts in various vibrant shades and patterns.  The hospital sits right in the town of Mutomo.  After passing several local shops and businesses, we enter through the gates of the hospital compound that will be my home for most of the next six months.

The hospital houses many of the staff onsite. The CMMB volunteers typically share a small two- bedroom house immediately adjacent to the hospital.  I will share the space with another volunteer when she is here, though she will split her time between Mutomo and Nairobi.  As I mentioned, there has not been much rain in the area this year.  The houses are outfitted with catchment systems that collect rainwater and store it large storage tanks.  These tanks are mostly dry now.  There is ground water, however this water is very salty and cannot be used for drinking.  The accommodations are modest but adequate.  Today there is no running water in the bathroom or kitchen.  But the toilet flushes!

Though I will be able to cook, if I desire, it appears as if most of the staff eats at the locally owned canteen on the compound.  Dinner our first night included, stewed beef and fried potatoes with a side of tomato, avocado and red onion salad.  Quite tasty. One of the staff members who was helping me getting acquainted with the facilities, was astonished when I marveled at the portion sizes.  I couldn’t finish the meal.  They were kind enough to wrap it up and keep it for me to complete the following day, which made me feel right at home.  I love leftovers 🙂

Karibu is the Swahili word for welcome