It's a Hard Knock Life

Actually, life for the 62 orphans at Dala Kiye is better than most children living in Karungu.  Dala Kiye which means home for orphans in Luo was started by the Camillians in 2005 due to the fact that there was an over whelming need for proper care of HIV positive orphans.   The children of Dala Kiye have 3 meals a day, a roof over their heads, beds to sleep in, clean water that comes from the tap, foster mamas to watch over them and give them their medicine, and they go to school.  All these things seem pretty basic but for many living in the Karungu area there are shortages of food, roofs that leak, water that comes from the lake, and school fees that go unpaid.  It is difficult to come to the realization that these children have a really nice life at Dala Kiye but what brought them there is HIV.

Playing with the children is one of my favorite things to do when I am not working in the hospital.  We color, and also play Frisbee and football (soccer).  There are always lots of smiles, hugs, and laughter when you go to Dala Kiye!

I wish I could share all the children’s stories with you but I want to tell you about Alphonse because the moment I saw him, I fell in love…. just look at that face. Alphonse Ronny was born on August 6th 2006 to Beatrice Akinyi Otieno, a single mother, in Migosi village of Nyatike district. He is the last born in a family of five.  Alphonse’s mother, a peasant farmer, died on July 16th, 2008 of HIV/AIDS related complications.  Alphonse’s and two of his siblings were left in the care of their 75 year old maternal grandmother, Siprina Anditi. Alphonse’s condition worsened after the death of his mother prompting the grandmother to seek medical intervention at St. Camillus Mission Hospital. Alphonse was diagnosed with HIV and initiated on ARVs (Antiretroviral drugs) on November 18th 2008. His grandmother, also a peasant farmer had no stable source of income and had difficulty providing food, shelter and clothing, as well as, administering Alphonse’s drugs appropriately.  Alphonse came to Dala Kiye, St. Camillus Children’s Welfare Home on August 31st 2009.  He is currently is enrolled at B.L Tezza Primary School and, is a happy and playful 3 year old.

I also want to share Mercy’s story with she has the best disposition of anyone I have ever met, she is always happy.  Mercy Adhiambo Obiero was born on  April 14th 2002 in Okayo village in Migori District and is the last born in a family of seven children. Her father was a casual laborer who died in 2006 while her mother was a peasant farmer who died in 2007.  Mercy was five years old when she lost her parents and was left in the care of her paternal uncle who also cared for Mercy’s six other siblings and two of his own children.  Mercy started developing frequent health complications which prompted her uncle to take her to St. Camillus Mission Hospital.  Mercy was diagnosed with HIV and was soon enrolled on ARVs on May 28th 2008.  Mercy’s uncle and aunt were very willing to care for her but found it difficult to provide for such a large family. At times Mercy’s uncle was forced to delegate the responsibility of administering Mercy’s drugs to her other siblings who would sometimes forget.  Mercy came to Dala Kiye, St. Camillus Children’s Welfare Home on October 11th 2008. Currently, Mercy is enrolled at B.L Tezza Primary School and has the most beautiful smile (sorry Mom, she wins).

Wishing you a very Happy Easter! Let us rejoice and be glad.

Welcome John “Jack” March Wade!

While I have been witnessing the miracle of birth these last few weeks in the maternity ward, my sister Alyssa and brother in law Chris welcomed their own baby boy on February 26th weighing in at 7 lbs (or 3.2 kgs for the rest of us)!  I am so excited to be an aunt and so happy for my family. Babies are such a gift.

Although, just like life in general, it is hard not to compare the experience my sister just went through to the experiences of mothers here in Karungu.  I must admit, I was slightly aghast when I first saw the austere looking birthing table in the maternity ward.   But giving birth at St. Camillus Mission Hospital is a lot cleaner and safer than giving birth at home which is still commonly practiced.  Two weeks ago, inspectors from the Kenyan Ministry of Health visited the hospital and were impressed with the maternity ward’s environment & resources.  The fetal heart Doppler which was introduced by Christy (my CMMB volunteer predecessor) is a big plus because we can get an accurate fetal heart rate, and that means the difference between a good or bad outcome.

The differences in having a baby here vs. in the US or even Nairobi start way before a women comes to the hospital in labor.  Pre natal care is available at the hospital’s Maternal Child Health clinic, which includes counseling and testing for HIV.  So instead of having an ultrasound to find out if it is a boy or a girl, pregnant women here find out if they are HIV negative or positive.   If they are positive, it is actually a good opportunity for them to start treatment and for their babies to receive PMTCT (prevention of mother to child transmission) treatment after birth.

Once the mothers go into labor, getting to the hospital can be a challenge, their options are walking, motorbike (having contractions & sitting on the back of a motorbike on a bumpy dirt road – yikes!), or if they can afford it, a taxi. Then after they make to the hospital they are seen by the nurse/midwife, only if there is a complication is when the doctor is called.  So, yes, that means I help deliver babies – it is truly a miracle especially without pain meds!  I usually clamp and cut the cord (since the dad waits outside), suction the baby, wrap he or she up, and give a few welcoming words while the midwife finishes with the mom. 

It is amazing – no matter where you live!

Baby Jack, Happy 12^th day on this earth & I can’t wait to hold you!

Greetings from Kenya

Where do I begin, there is so much to share. I landed in Nairobi 2 weeks ago and was greeted by the smiling faces of Kayla, Angela (an Italian volunteer), and Fr. Hubert (a Camillian priest). I spent the next 2 days amidst the hustle and bushel of Nairobi. It was exciting to see this other side of Kenya…very different from quiet Karungu. There were so many people, big buildings, lots of fast moving cars and matatus (a 14 passenger van carrying at least that many), and of course motorbikes. I looked both ways about 3 times before I would cross the street. Some of the highlights included: shopping for kangas at the Maasai market (beautiful printed fabric that is multifunctional – it’s used as a skirt, blanket, towel, baby carrier, you name it), seeing the evolution exhibit at the Kenya National museum, and feeding the giraffe’s at the Giraffe Centre in Karen. Although, feeding the giraffe’s was a bit slimy, I was excited to see my first “big time” animal. The last time I was here (AAA Part I) I was only witness to the cows, chickens, donkeys that freely roam around Karungu. Oh, and don’t let me forget, on the way to Nairobi to see the Ortho surgeon, I saw a dead zebra on the side of the road :(…it was definitely one of those only in Kenya moments!

On Tuesday we met Lauren and Christy and the five of us set out on a little beach holiday to Mombasa. Having been there before, Lauren and Christy led the way, and to reach our final destination, Diani beach, it took an 8 hour bus ride, a little walking, a ferry ride, and 2 matatus. Having lived in Kenya for a year, Lauren and Christy could co-author a travel guide book called the VERY Rough Guide to Kenya but it was an experience I will never forget. Coming from the US just a few days ago, it was like jumping into the deep end of third world life. But I will always be grateful for that experience, especially since it involved one of the most beautiful beaches I have ever seen. There was the finest white sand and the clearest blue water. These next four days weren’t just a chance to have a little fun in the sun but also an opportunity to reconnect with my fellow CMMB volunteers before we took separate paths. Lauren and Christy’s time in Karungu is finished and they headed back to the states while Kayla also returned home for a short while. Angela and I made the journey to Karungu that Sunday.

It was quiet a home coming…there was lots of excitement, jumping around, welcome home signs, and hugs given by the neighborhood children. When I returned to work on Monday, there was the best surprise. I went to the Peds ward and I saw little Silermina Atieno sleeping on her bed. Her mother, Jane, shook my hand and we exchanged a smile. I was amazed as I watched her sleep, it was like looking at a totally different child. The Silermina I knew in October was an 11 month old severely malnourished baby with second and third degree burns on her legs. The burns on her left leg were so bad that her leg was amputated, I can remember that day so vividly. I didn’t think she would survive because the risk of infection was so great. But it turns out, Silermina is a survivor! It is still difficult to imagine her life in the future. Life here is a challenge in itself, let alone with a disability.

I leave you with the slogan of Valentine’s Day, as per Fr. Mario: “I love you more than yesterday and not as much as tomorrow.”

I am "coming home!"

It feels like yesterday that I was sitting in the x-ray room of St. Camillus Mission Hospital staring up at the xray of my broken radius unsure of what would happen next.  I remember so vividly asking, “What is God’s plan?”  Now, as I reflect back on the past 2 & 1/2 months, it is all so clear.  I got to spend time and make memories with the people I care about most and gain a greater understanding of what it is like to be on the other side: a patient.

Before I continue I would just like to take this opportunity to once again to thank my parents for coming to my rescue.  I think part of the reason I became a nurse is because I have the most caring, thoughtful, and loving mom.  So thank you for taking be to the hospital, going with me into the city for my follow up MD appointments, taking me to physical therapy, and cutting up my meat at dinner.

While I was recuperating I received lots of beautiful drawings from the kids in Karungu saying, “we miss you Amanda, come home soon.” So cute.  Kayla sent the notes and some Obama chewing gum.  I also received so many nice cards, flowers, and gifts from family and friends at my “other home.”

I am truly grateful for having the opportunity to attend my sister Alyssa’s baby shower and see the baby Wade bump.  What a fun party and a rare opportunity to spend time with Alyssa since she is a California girl.  My family spent Christmas in LA for a joint Ailleo – Wade Christmas which was another cool opportunity and their Christmas tree was the best! 

These last few weeks I have been stocking up on toys and treats for the kids and people in Karungu that were so kind to me.  I went to my last PT session yesterday and I have regained full range of motion and strength in my arm.  The only reminisce of the ordeal is a scar on my left forearm better known as the railroad tracks..but at least it’s a conversation piece.

I am excited for what the next 5 months have in store & able to get back to the mission at hand: helping others! 

Hope everyone is having a happy 2010!

Amanda’s African Adventure, Interrupted

Most of you know by this point that I am writing this from the comfy confines of my bedroom at 17 Bote. Two weeks ago, Sunday, my life took an unexpected turn. Kayla, Lauren, (two other American volunteers) and myself were walking to the Sunday market in Sori, the next town over from Karungu. It was a beautiful and busy afternoon, lots of people heading to and from the market on foot, motor bike, and car. We had headed out that day with the intention to purchase some goods for a family that was admitted to St. Camillus Mission Hospital due to an infestation of jiggers. This is actually a whole other fascinating story, which is described in detail in Kayla’s blog www.kaylainkenya@blogspot.com.

But getting back to me…I was walking along the side of the road and a man on a motorbike with a wood door attached to the back of it zoomed by me. The wood door made direct contact with my left arm….ouch! All I remember is seeing dust and the back of the man on the motorbike with that darn wood door. I remained upright but just kept repeating “I have to go back, I have to go back.” I tried my best to remain calm, I was in Kenya after all, Kenyans are the definition of stoic. After the quarter of a mile walk back to the hospital (thank God we didn’t make it further), I almost went down after slipping in mud outside the hospital gate…that’s when the tears came.

It was quite fortuitous that Lauren was with me because she is also an x-ray technician so she opened up the x-ray department for me (it is closed on Sundays), talk about VIP treatment. Unfortunately , the x-ray revealed a displaced mid-shaft radius fracture…no good! Viola, the Matron (nurse manager), and Zelpa, a nursing assistant, not only gathered the supplies to make a splint and brought me pain medicine but they also shared with me reassuring words and were a calming presence. Dr. Jimmy assisted with splint application, Kayla got ice, Lauren researched orthopedic surgeons in Nairobi, Christy gave moral support – it was truly a team effort by both the Kenyans and the Americans!

I just want to take this opportunity to thank, Kayla because she did a lot more than just get ice. She was a friend, nurse, and surrogate mom; she got up at 4AM to make sure I took Motrin, washed my hair in the sink, packed my stuff for the trip to Nairobi, gave moral support, and was all around awesome. So after calling my parents and Richard (director of the volunteer program) from CMMB, we made a plan to go to Nairobi for further treatment.

The next day, Father Emilio (Director of St. Camillus Mission Hospital) came through and got me an appointment with an orthopedic surgeon who was recommended by his “sophisticated Italian friend” as he put it. I was thinking – okay, sophisticated, sounds good and hoping that translates into - she has done her research. Everyone I saw that day told me, “pole (sorry in Swahili) or I am so sorry” which is the Kenyan way of saying , how are you? - so lovely.

We left for Nairobi early the next morning. Father Julius made the 8 hour journey with us, only stopping once to refuel. We arrived at MP Shah Hospital just in time to see Dr. Krishnan. Once he saw the x-ray, he gave me two options: 1. Plaster can be applied for 8 weeks and there is a chance the bone won’t heal properly or 2. Surgery can be preformed. Dr. Krishnan recommended surgery. Wow, I knew I wasn’t going to have surgery in Kenya but I was still hoping that maybe the break wasn’t that bad. So he ordered an x-ray that could be emailed so I could show it to a MD at home before I made decision to stay or return home. Dr. Krishnan placed a new splint on my arm and as he did it he said, “I am preparing you for travel."

After enjoying a yummy Indian lunch, we headed to get the x ray. During that time, I made phone calls home to my parents and Richard to tell them what the doctor had suggested. Before I knew it, I was going to be on a flight to London at 1130 that night. Although it was difficult to leave a place and people I had grown to care so much for, I also knew I needed full range of motion of my arm if I wanted to care for others in the future. After stopping by the St. Camillus Seminary for a few hours where Kayla repacked my back pack to make it light as possible we ate some dinner. We then headed for the airport. I gave “see you later” hugs to Kayla and Fr. Julius and started the second leg of my journey.

The flight to London and then New York weren’t too bad, I slept and watched movies. Even though, I was only there 6 weeks prior, Heathrow airport seemed bigger, brighter….so first world. It was such a relief to reach NYC and see the smiling faces of my mom and dad (who cut their Florida vacation short to meet me and take me to the hospital). THANK YOU!

We went straight to the good old NYP Weill Cornell emergency department. I didn’t escape NYP for very long but it was so nice and comforting to see familiar faces. I got more x rays, they gave me a Vicodin (which totally beats Motrin), and I got a room in the fancy area – totally VIP. I received excellent care from Teresa and Dr. Stern. The word spread that I was in the ED because I had lots of welcomed visitors. It was unexpected that I got to see everyone so soon but lovely just the same. I saw the Ortho residents who said the fracture was boarder line and maybe didn’t need surgery, they applied a new splint, and had me follow up with Dr. Lorich, the Orthopedic surgeon, on Monday.

My mom and I made the trip into the city early Monday morning. I got one more x ray (this was the 4th time) and then saw Dr. Lorich who explained the need for surgery – he was going to place 2 mental plates in my arm. So surgery it was…yikes, I was going to be a real patient. We spend the rest of the morning and afternoon doing pre-op testing.

That Wednesday morning my dad drove my mom and me into the city for the surgery. Overall the whole surgical inpatient experience went really well – amazing things really do happen at NYP! The nurses were really nice; thank you to Anne, Kathy, Helen, Marie, Ella, and everyone else. The IV insertion took a few attempts but that’s okay because I have really bad veins, I am my own worst nightmare. The anesthesiologists were awesome; I got a nerve block and conscious sedation – good stuff. The nurses in the PACU were great and then I stayed the night on Baker 15, the short stay surgical unit. I received IV antibiotics and pain medicine but there were a few hours during the night which were pretty rough, the pain was terrible. I only mention this because now I know what it is truly like to be a patient and it is a lesson learned that I will bring with me in the future, just like St. Camillus.

Thanksgiving this year means a lot more to me than eating turkey and watching the Macy’s Thanksgiving Day parade. I am so thankful to God to have access to excellent healthcare, to me born into an amazing family, have fabulous friends, have this whole new perspective, and have the opportunity to return to Kenya.

Wishing you a very HAPPY THANKSGIVING!!!

The Key to a Happy Marriage

After dinner several nights ago a conversation started over marriage. The conversation arouse due to an article in the Daily Nation, a Kenyan newspaper. The article reported that Fr. Muli (a Catholic Priest) “sparked a rare debate during Sunday Mass when he raised the sensitive issue of marriage between two Kenyan men in London recently.” The article goes on to say that the “Fr. Muli said men were resorting to marry one another probably because the women had failed to provide what they should in marriage….the priest challenged them (women) further that they had to be more Godly and ‘more womanly’ to attract men for marriage.” WOW! The absurdity of this article is multidimensional and misrepresents the teachings of the Catholic Church. Although it is not as shocking for me, as it is for those of you reading this, because these last few weeks have been filled with discoveries that life here is vastly different.

There are several different customs and practices among the many tribes in Kenya. Karungu is in Luo Land (the Luo tribe lives mostly along Lake Victoria). Polygamy is culturally acceptable. I met an 18 year old named Frank last week whose father has 6 wives and he was one of 50 children. If the husband and wife separate, the children usually remain with the husband’s family. If your husband dies you marry your husband’s brother or cousin not only because the dowry is paid for but also for survival. At the same time, if you are HIV negative and you marry your late husband’s brother you risk the chance of infecting yourself and the children you will have with him. The HIV rate is the highest in the Luo tribe compared to the rest of Kenya.

While the differences are many, Fr. Julius (a Kenyan priest in charge of St. Camillus Dala Kiye- an orphanage for children with HIV) reminded me during our after dinner conversation that some things are universal: the bond between a husband and a wife. He drew two over lapping circles on a piece of paper, labeled one man and one woman, and shaded in the center. He said, “you see, you need to pull toward the common bond. Both the husband and the wife need to compromise to increase the size of this (the shaded center part) which represents the strong bond of union.” He then went on to talk about the upbringing of children and the conjugal rights, and how it is the fruit of marriage and not just the consequence. I just kept nodding my head and thinking to myself, okay Fr. Julius, please stop here, which he did – thank goodness.

He also told me the importance of doing a needs assessment, that both the husband and the wife should express what they need to be happy. He gave the example that if a wife is tired and doesn’t feel like cooking that the couple agrees that they use the microwave to prepare the food, obviously, depending if there is electricity. Just to give a little back ground, cooking is a several hour and labor intensive process. I am not sure this particular example translates exactly but I think the meaning behind it does.

Hopefully, I will be able to put all this great insight to use one day. God willing (a commonly used phrase here).

Here are some final words of inspiration by Fr. Julius which I think can be applied in marriage and in life, “with growth comes involvement, with development comes inspiration, and with expansion comes motivation.”

The Theater

I have a new and exciting career in the Theater…which is actually the OR. Since there is no Emergency Department (or Causality as it is known) at St. Camillus Mission Hospital, I have been assigned to the Theater and the Out Patient Department (OPD). The whole hospital has 135 inpatient beds with a Peds ward, surgical ward, maternity ward, and a medical ward. There is an ART (antiretroviral treatment) clinic, a TB clinic, and a MCH (maternal child health) clinic. The OPD is where the patients are triaged by Clinical Officers which are like PA’s or NP’s as well as where wound care and small procedures are done. I have been learning about cockers, sutures, anatomical forceps, anesthesia – yes, the nurses are the anesthesiologists, and the list goes on. I am definitely going with the flow and taking it all in!

Sterility is definitely a relative term: there are ants and other critters crawling around the hospital. There is not strict counting of instruments or gauze during a surgical procedure - but they haven’t left anything in a person, yet. The nurses who do the anesthesia have no formal training (one has a lot of experience – thank goodness). There is one monitor in the hospital which is in theater – the patients are monitored during surgery but there are a limited number of EKG stickers so sometimes they just use the pulse ox and BP. Charting is sometimes optional.

The nurses clean the theater, something they call dump dusting. We scrub the instruments, pack them in a drape, put them in these metal drums, and then put them in the autoclave. We empty the trash and get the laundry. We fold gauze for the whole hospital. The gauze comes in these big rolls, sheets are cut; then we fold them in 3 different ways - ones for OPD, maternity, & theater. I will never look at a 2x2 the same way again - I am going to have Methloquine induced vivid dreams about folding gauze. I definitely have a whole new perspective – I thought life was tough as an ED nurse!

The first case where I scrubbed in was for a 9 year old boy with an appendicitis – my preceptor Becky told me I wasn’t bad for my first time. I was drenched in sweat by the end of it – the sterile gowns are cloth so they can be washed & refused (& put in the autoclave), you wear a big plastic apron under the gown so you don’t get blood on yourself and these white wellies (boots) that can be washed. It’s a sweat fest. But the surgery went well so that is all that matters.

In the OPD, I assist with wound and burn care, remove sutures, and give injections to inpatients and outpatients. It is somewhat similar to an urgent care center but mostly the wounds and burns are much worse. The patients tend to wait before coming to the hospital and use traditional herbs first and western medicine as a last resort. Just yesterday I observed several people at the entrance of the hospital trying to convince a man to get out of the backseat of a car and come inside the hospital to see the doctor. It’s quite a contrast to think of how people at home would call an ambulance for a sprained ankle.

Currently there are 6 babies in the Peds ward with severe burns. Most houses are one or two rooms so there are open flames where babies and children play. Their mother’s bring them to the dressing room in OPD and it’s heart breaking to witness because the babies are not always pre-medicated. I keep suggesting and asking about pain medicine but I am still the new mazungu on the block. I hope and pray that I will have more influence as time passes, and I think I will because everything happens pole pole (slowly in Swahili).

Here are a few interesting differences:
• A nurse is called a sister (I am not sure if a male nurse is called a brother – I don’t think so).
• The nurse manager is called the Matron.
• A unit is a ward.
• There are RTAs (road traffic accident) instead of MVCs (motor vehicle collision) which is more inclusive of donkeys, bicycles and other various modes of transportation.

I also want to wish my sister Alyssa a very happy 31st birthday! And a Happy Halloween to everyone!