So this is kind of a catch all for the last few days.  First off, walking and driving in Kenya is flipping crazy.  No rules. None. You can do whatever you want. No repercussions, except possibly death.

Not a matatu but we saw this on our way to the Island Camp.

 There are no traffic lights, well technically there are traffic lights that they put in about 2 years ago but stopped using them because people driving couldn’t understand what they were supposed to do and the lights actually led to more accidents. Most of the roads are unpaved, combine that with the rainy season and it makes for a good time.  Corruption is too big of a problem to enforce speed limits so they put speed bumps to slow the pace of traffic.  I don’t think I have ridden in a van that has shocks yet. 

 

My walk to or from work almost always involves walking through or around a herd of cattle, sheep goats and/or chickens.  

My walk home.

 I discovered that a short horn blast means get the hell off the road, while a longer horn means “I am going to hit you with my motorized vehicle, you may as well accept it”  And since they are dirt roads for the most part, the road sometimes is the same as the sidewalk.  Forget about parking spots, just stop somewhere, get out do what you need to do and pray that you aren’t boxed in or now part of the sidewalk.  Also there are these yellow striped vans that are called matatus, they are slightly smaller than a conversion van and pack literally 20+ people inside and eloquently call themselves taxis.  It is extremely cheap to go anywhere in one of these but literally you have people laying across, sitting on top of and hanging out the window or door just to squeeze in.  I haven’t been hit by a moving vehicle yet, but in due time my friends.  

He still supports the Sen.

Walking through town is always an adventure.  There is little to no infrastructure for water or waste.  It is common to see people passed out along the road (high rate of alcoholism in Kenya), orphaned street kids sniffing glue to get high….it is really sad to see but they don’t stop.  Even when playing soccer or offering to trade for food or candy, the glue bottle doesn’t leave their hand.  It’s also nice to see that one of the most corrupt countries in the world roots for one of the most corrupt teams in college football.  (Gotta be a little self deprecating after the Senator took the fall this week, thanks for all the FB comments and e-mails, assholes)

I broke my own rule about not eating at restaurants that don’t have running water.  I was working at a satellite clinic in a town called Turbo with the Watalamu Repair and Maintenance business to gut and remodel an old office to turn it into a pharmacy.  Around lunch, which it turns out can be anywhere between 9am-4pm, the supervisor of the remodel group asked me to join him for lunch.  He’s an American that has been living in Kenya for 5 years and eats pretty much only Kenyan food now.  After washing my hands with clothes detergent and a kid pouring water out of oil can over the sink basin that drained into a bucket, I sat down to eat something that resembled collard greens and Beijing street meat.  I survived, and it only cost 90KES ($1.02 USD) including drinks for the two of us.  It would have been cheaper but our skin color usually adds a little bit to the total bill.  The Kenyans I was working with ate at the same place the day before and paid 25 KES each for the same meal.     

This past weekend, we went to Lake Baringo about 3 hours east of Eldoret.  Some new medical students joined and a total of 9 of us went to Kokwa Island to camp.   

 And by “camping” I mean an all inclusive resort and this was my view from the “tent”, 

and I was awoken each morning by birds and had coffee sitting outside my door 15 minutes before sunrise.  It’s owned by some kooky old Englishman who takes great pride in top level service and making sure his guests are having a wonderful time.  The resort was really well run and had a sunset booze cruise that ended with a short hike to the top of another island just across the lake from us. 

Sunset at Lake Baringo

The resort is on a peninsula but the Kokwa Island is also home to 750 villagers after you pass through two security gates and 15 foot high security fences.  So I decided to hike around the local village and had a man named Jonas take me to the top of the extinct volcano.  Pretty tough hike in 95+ degree heat over loose lava rock but really interesting to see how primitively people still live.  Unemployment is 95% in the village and most people are sustenance fisherman/farmers.  The few people on the island who have jobs work at the resort or at the boarding school home to 215 students.  I was in awe that people still lived without electricity, running water and essentially cut off from the rest of society.  Now, of course I realized that people lived like this but reality hit me when I met some of the villagers.  The tribe in the village has been there for thousands of years and the people don’t seem to want it any other way.  Their chief and council of elders settle disputes and the share of profit they get from the resort is divided evenly.    Jonas introduced me to his family and asked for me to take a picture with them and send a copy when I return home.   

Good thing I dressed to blend in.  It felt like I stepped back in time, had it not been for the resort less than a mile from where I was standing, I would have guessed I was in a whole different world.  

The island is known for its variety of birds.  We went on a boat tour one morning after breakfast and saw crocodiles, hippos and about 30 different types of birds I had never seen before. 

After we checked out Sunday morning we went to Bagoria National Park about 45 minutes away from Lake Baringo, Holy Flamingo.  Not kidding, over a million flamingos.  It smelled like it had no less than 15 million but that’s beside the point.  I felt like I was in a National Geographic article.  Combined with the boiling-hot hot springs, zebras, baboons, dik-diks, gazelles, ostriches and impalas this side trip was pretty impressive. 

I tried to keep this blog light and include some humor but I would be remiss not tell you about the horrible moral hangover I had after leaving the resort at Lake Boringo.  To get there, we traveled over, through and back over the Rift Valley upon which Eldoret sits on the western edge.  Lake Baringo sits at the bottom of the Eastern edge of the valley and suffers from severe drought.  We passed barren fields, dust storms, dry river beds and desolate people all along the way.  One sign that sticks out in my mind was a primary school’s road sign.  Right below the school name and information, it stated “On Earth, we struggle” This was a primary school’s motto?  Holy crap.  Reality sets in when you see something like that.  

Our safari van had to slow down to go over a rough patch in the road and a group of kids no older than 10 or 12 ran out to our vehicle and shouted through the open windows.  Now, I have grown accustomed to children asking me for money and food, but this was the first time I had someone ask me for water.  WATER!  I just spent a weekend at a resort gorging on food and drink and these poor kids ask me to spare some water.  I felt like a jackass.  Our driver handed them an extra bottle and continued on.  We all sat there in the van a little distraught.  There we were, each of us having come from not only 18+ years of outstanding education but also a great life in the greatest country in the world.  Everyone in that van will make 6 figures in the near future and we were just asked by a CHILD for a little bit of water.  We had lunch in the van with us and had food in bags “just in case we got hungry”.  Our next stop, everyone loaded up on bottled water, saved what wasn’t eaten at lunch and packed the food so we could hand out along the way.  Eventually we found some other kids looking just as desolate, playing in polluted water and walking down the busy two lane road without anyone looking out for them.  Our driver stopped and we handed out everything we had.  The kids were shocked that mzungus stopped and were giving all of these things to them.  We handed out maybe 5 liters of water, some sandwiches, chips and a few loaves of bread.  I know I am here for the overall experience, which includes these weekend getaways and opportunity to travel in Kenya.  I don’t want to get self righteous and condemn American imperialism and consumerism.  But goodness gracious, you don’t realize how bad it is.   I also know I have to face reality and recognize that poverty is real.  It is ugly. It is not going away anytime soon.  Aid alone is not the answer.  

I felt terrible today. I wondered what was going through the heads of the 6 year olds walking alone on the highway.  I wondered what the kids who asked us for water thought when the white people in the bus didn’t give them water but the black Kenyan driver did.  I was sickened by the condition of the towns were drove through and the lack of any semblance of health standards.  I was astonished at the reality of poverty.  No Paul Collier, Jeffrey Sachs, Tracey Kidder or Peter Singer book can prepare you for the reality of seeing it firsthand.   

At the same time, I was relieved by the fact that nearly everywhere we went, we received smiles and waves.  Children shouting “How are you, I am fine” as if it were a question not needing our participation.  I am glad we got the opportunity to shake the moral hangover.  I know everyone in the van wanted to do the right thing and anyone would help a child (or anyone) in need. It was a split second in time that we all froze.  I think it was overwhelming and juxtaposed with our weekend trip, it was too much to handle.  Hopefully I can rest a bit easier after making amends.  Hopefully we filled the bellies and warmed the hearts of those kids.  They probably have no idea how much they actually helped us.       

Hospital Rounds

Wednesday was Kenya’s Independence Day (they apparently celebrate 2 of these?)  So I had the day off and went on hospital rounds with two of the younger doctors I met here.  Mackenzie led me to the men’s ward.  Unbelievable.  All my senses hit at once, the smell of a poorly ventilated cement corridor with open bathrooms and emaciated patients with nausea and diarrhea.  The sound of moans and screams of those suffering.  The sight of 3 adult men emaciated (they say wasted) sleeping on one single hospital bed. 8 of the beds in a room.  The touch of a man’s frail hand as he reaches for my arm thinking I am a doctor.  I am usually OK in these situations, but something must have been off because one of the other physicians there told me to go outside if I was going to get sick or felt light headed. I insisted I was fine and shadowed Mackenzie as she evaluated and diagnosed 35 patients.  HIV, AIDS, TB, TB Meningitis, malaria cancer, psychosis; you name it, I probably saw it.  That was just the beginning.  

After an hour in the men’s ward, I walked over to meet Beth.  She is a pediatric physician.  As if the men’s ward wasn’t enough, the pediatric ward reminded me exactly why I could never be a doctor.  In the 45 minutes I followed her she treated and diagnosed patients all under the age of 2.  Beautiful, innocent children that are going to die because treatments aren’t available in Kenya.  Congenital heart failure, malnutrition, malaria, TB.  All treatable or eradicated in the US. This is a senseless loss of life.  I don’t want to dwell on this because there are many positive things that are happening at the hospital but what I witnessed today will certainly stay with me for the rest of my life.   

AMPATH

Alright. I guess I should explain exactly what I am doing here.  The University of Indiana Medical School partnered with a Moi Teaching and Referral Hospital in Eldoret, Kenya to enhance learning on both ends.  After the AIDS epidemic hit too close to home with the hospital in Kenya unable to treat one of its own medical students, Dr. Joe Mamlin (my neighbor and Noble Peace Prize nominee) decided that he was going to treat patients with antiretroviral drugs when everyone else in the US said it was not worth the cost.  At the time, the drugs costs around $2,500/mo and once a patient starts he or she must remain on the drugs for life…you can see why some people thought it was too expensive to treat 30M+ in sub-Saharan Africa currently living with HIV/AIDS.  Dr. Mamlin and his associates called this form of treatment and prevention program AMPATH (Academic Model Providing Access To Healthcare).  Combined with Pres. Bush’s PEPFAR announcement of $10B in aid targeted at HIV/AIDS largely in Africa, lead to AMPATH’s rapid growth.  They have treated 60,000+ HIV/AIDS patients through a network of 20+ clinics in western Kenya.  Given the Lazarus like effect of the treatment, people travel from all around Kenya and surrounding nations to receive treatment.  But remember, these patients need to stay on a strict drug regimen and therefore close to the clinic or hospital.  To support their family they need a job and want to stay busy.  That’s where my role comes.  AMPATH has a division called Family Preservation Initiative (FPI).  FPI’s main goal is to provide employment opportunity to those who are seeking work while in the critical phase of HIV/AIDS treatment.  FPI has several businesses, Cool Stream Restaurant, Passion Fruit Seedling Company, Imani Workshops, Wataluma Repair and Maintenance.  Through these and a variety of other community wide projects, AMPATH aims to make sustainable change in Eldoret and surrounding areas.  While I am here, I will be working closely with FPI but also having the opportunity to go to the hospital on rounds with some of the MDs, visiting the orphanage and travel to clinics with Dr. Mamlin as he treats patients in the most remote regions of Kenya. 

These businesses are great, but are supported through AMPATH’s grant and private donation money.  I have been asked to help implement a strategy that will steer Imani and Wataluma toward profitability.  The goal is to have these companies self-sustaining and eventually turn a profit that can be used for at large expenses for the hospital and grow enough to employ any patient seeking a job.  It is an incredible challenge and is certainly teaching me a lesson in patience.  I look forward to the challenges, opportunities and experiences ahead.

I promise the next update will include some humor.  Wednesday is Independence Day here in Kenya and this weekend I’m heading to an island camp surrounded by crocodiles, hippos and other African wildlife, what could go wrong there?

Welcome to Kenya

So the first day was a blur.  We unpacked and went to the kitchen and made plain pasta.  Later on, I met a few doctors doing their last rotations in Kenya.  Got to talking with them and they invited me out to Naiberi.  To be honest, it didn’t matter what Naiberi was, I was going to go just to see a bit of Eldoret outside of the IU Housing bubble.  Naiberi turns out to be a resort about 30 mins out of town off of a dirt road.  We took a taxi van out there, Cha Cha (our driver) is a really nice guy and helped us negotiate pricing with the guards at Naiberi (everywhere you go has guards).  Nice clean pool, great sunny afternoon and got a chance to talk with the different people working in the program.  Mostly doctors or nurses but a few outsiders including a French guy who works for Pfizer and is on a 6 month sabbatical observing pharmaceuticals in developing nations and a woman who has worked with orphaned children in Zimbabwe, Ghana, Burkina Faso, Botswana and now Kenya.  Anyway, the pool was great, food was descent, beers were somewhat cold (roughing it, I know).  The entire day cost about $15 USD.  Came back and had dinner with everyone.  Nice day to get acclimated to Kenya. 

Laying down to go to sleep was a different story, the dogs in the neighborhood like to sleep all day long, seriously I thought a few were dead when they didn’t move at all for 4 hours.  But when night rolls around, they looooovvve to bark.  Thankfully, I have a front row seat to their performance as my window faces the street and guard station.  So I am dragging from the +7 hour time change, listening to dogs bark all night and then have to deal with a rooster that thinks 4am is sunrise.  Thankfully I was already awoken by what seemed like the opening music to Angry Birds so the 4am rooster alarm wasn’t terrible.  I was pretty tired but dragged myself out of bed at 630am to eat and get ready for my first day working at AMPATH.  Pretty standard day, lots of introductions and program overviews.  

The highlight was going to the Imani Workshops (I told you all to read that book).  Basically it’s a crafts workshop that employs HIV/AIDS+ patients while they are in treatment at Moi Hospital (IU’s Kenyan partner hospital) and one of the businesses I will be working with to improve operations.  The employees made some really impressive jewelry, (I’ll take orders before I leave) and I got to sit and talk with a few workers while helping make some of the beads.  I was expecting some tough conversations along the way, but not right off the bat.  After talking about the USA and Obama, by the way they LOVE Obama.  One guy was telling me how he was distantly related to Obama’s cousin’s friend.  I heard another say he heard Obama was going to run for president of Kenya when he was done in the US.  Anyway, after pleasantries and telling them how happy everyone in America is with Obama (I didn’t want to break their hearts or get into politics in a limited vocabulary setting) one of the men asked me if I knew what AIDS was.  “Of course”, I told him we have the same number of HIV/AIDS+ people in the US as there are in Kenya (slight exaggeration 1.3M to 1.5M but grossly exaggerated as % of population).  His response, “Then why do rich Americans let Africans die when there is medicine that can save us?”  Whoa...

Talk about a loaded question.  This guy is receiving the BEST treatment possible in sub-Saharan Africa, actually getting the same drug cocktail (Antiretroviral..see Magic Johnson) as what is given for thousands $$$ per month in the US and his drugs are actually being paid for by “rich Americans” (PEPFAR and private donations).  I went the diplomatic route and explained that Americans suffer from disease too and do not have full access to any drug they want either.  He eventually expressed how happy he was that he was being treated at AMPATH but that question right off the bat was a tough one to answer.  I am sure I looked like a fool or at least stumbled through my explanation.  And I am sure that won’t be the last time I am asked a difficult question.  Practice makes perfect I guess. No major cultural gaffs to report.  Just give it a few days.  I am taking Swahili lessons while I am here so it’s only a matter of time before I say something stupid.

Check back in a few days, I'll have some updates as I get into my role here.  

Day 1 3/4

 Warning: This is a fairly lengthy update, Ill try to keep it entertaining, no promises. 

I fully expected this trip to have some cultural snafus and gaffs but I didn’t realize how early it would start.  My 40 hour journey to Kenya started out fairly normal, 12:05pm departure from Columbus to JFK, simple enough.  Although, I had to remind myself repeatedly that I was actually leaving the country for 10 weeks and not a simple domestic flight.  4 hour layover, then back on a plane for 7.5 hours to CDG-Paris.  Flight was quick and painless… sat between a student heading to France to study abroad and a dirty techno hippie with dreads from Amsterdam (Despite my assertion that he should, he didn’t know Bouk, Henry or David).   

So I land in Paris and walk through customs but made a quick U-turn just to double check that my bags were actually checked all of the way through to Nairobi. BIG mistake, I was promptly greeted by France’s finest military personnel armed with M-16s and a glare that would make the Dos Equis man cower.  After trying to explain in English what I was trying to do, I realized that it was probably best that I walk in the direction the 4 gentleman were pointing and murmuring in French.   So I exited customs without further incident only to walk out and see a group of guys dressed in red track suits laughing and pointing at me, I walked by smiling as one of them asked “American?” I shook my head and listened to the laughter bellowing from the group.  I proceeded to have a conversation with the guys in the limited 19 word vocabulary that we shared.  Turns out, they are the Madagascar National Kick Boxing Team in France for a big tournament.   Now this is an opportunity I can’t pass up, the one guy who spoke any English pointed to the bar and I obliged.  Mind you, this is 7am Paris time but just past 1am in the US so it makes it ok.  One guy told me he had been to Kenya, the rest were most likely making fun of me but I will pretend like they were laughing with me, not at me (I could have taken them).  Finished my beer, and wished them good luck.  Check in at the gate where I meet up my friend Ryan MacNeil from ND who is going to Kenya with me.  We walk to security where I promptly set off the metal detector, stupid watch.  Walk through again, BEEEEEEP, stupid belt.  Walk through again, silence, whew - free and clear….not so fast.  A gentle but firm French policeman asked if he could pat me down as if I had an option.  Made it through security and ordered a cup of black café (no milk obviously).   What I received was a semi-solid cup of coffee grounds and tar mixture.  Not the best cup I have ever had but I needed something to keep me awake.  Finally got to my gate and relaxed for the 4 hour layover waiting for my flight to Nairobi.  An hour on foreign soil and I already look like a buffoon. 

Hopped aboard Kenyan Air ‘The Pride of Africa’, it was actually pretty nice.  25% full at best, I had two seats to myself and nobody behind me or in front of me.  I was exhausted and tried to fall sleep, not sure if it was the Malaria medication or the drink cart down the aisle, but I had several violent wake ups that were compounded by confusion in what the flight attendant was asking me.  So I got a bag of peanuts and started to eat but apparently fell back asleep mid chew as the next thing I knew I woke up to the unpleasant taste of half chewed peanuts lining my gums.  Flying in to Nairobi, reminded me of flying in to Vegas.  Not the bright lights of the Strip but the absolute pitch black of the desert followed by the sprawling lights of the residential area that appears out of nowhere.  After a brief delay looking for Ryan’s luggage that was mistakenly checked through to Eldoret, we found our driver and went to the hotel.  We stayed at the Heron Court Hotel, it’s a nice Western resort with overly pleasant staff, total for the room, 999 Kenyan Shillings (about $12 USD). Had a quick bite to eat and tried to catch some sleep.  Although I’d slept a few hours on the plane (apparently while eating), I’ve been traveling now for about 30 hours since I left Columbus.  5 hours of decent sleep later and we’re on our way back to Nairobi Airport to catch the 45 minute flight to Eldoret.  I wore a pair of shorts thinking it would be comfortable for the flight only to realize that nobody in Kenya wears shorts.  Pretty much everyone had on dress pants so we changed at the airport.  (You know, tried to blend in with the locals. Although somehow I still stuck out and we still heard murmurs of Mzungu, white foreigner),   Although we were scheduled for the 10am flight our cab driver picked us up at 7am, got to the airport and through security by 730am.  They booked us on the 8am flight, without us knowing and we were about 2 minutes from missing our flight.  Thankfully we got on board and arrived 40 minutes later in Eldoret. 

If you look on a map, Eldoret is in the mountains around 7500’ elevation.  But when we stepped off the plane I realized that that John Denver is full of shit.  Flat as could be in all directions.  Thankfully our driver was at the airport early and took us about 10 miles into town and dropped us off at the IU (Indiana Univ) Housing for AMPATH workers.  After 41 hours of travel, I finally arrived to what will be home for the next 10 weeks.  We met with Dunia and Benjamin who welcomed us and showed us around.  We got cell phones and made a quick trip into the main part of town to get cash, cell phone minutes and find the Catholic Church (You’re welcome Mom! Mass is at 7, 8, 9, 1030 and 5 on Sunday so I really don’t have an excuse, I'll be sure to bring the bulletin home as proof).  I felt a bit weird withdrawing 20,000 Kenyan Shillings (KES) especially given the fact that that amount is nearly 50% of the average income in Kenya but we have a safe in the room, two guarded gates and I think its better to go to the ATM as few times as possible.  Aside from a few strange looks and stares, the busy city center was nice enough.  A total walk of about 20 minutes. Tons of shops and markets to buy whatever we need. 

View from our honeymoon suite

Ryan and I will be staying in a 12x9 bunk bed room and share an outdoor restroom with the people next to us.  The shower head is conveniently located directly above the toilet (time saver I am assuming).   

3 S's all at once!

Possibly smaller than my Miami dorm room 1st semester  Soph year (smallest room on Miami's campus)

 

Our room is called the Deja Blue Rose Bush Room.  For those keeping score at home, I met Ryan in Paris and am now staying with him in the Deja Blue Rose Bush room. 

If any of you have read the book I mentioned in one of my earlier posts “Walking Together, Walking Far” by Fran Quigley, I am staying next door to Dr. Joe Mamlin’s house.   For those who haven’t read it, shame on you.   We unpacked and got settled in.  We have all day tomorrow, Sunday, to relax and start orientation 8am Monday morning. 

Facts and Figures

As I am getting ready to take off tomorrow for my trip, I thought I'd share some points of comparison to better understand Kenya.

Population: 41 Million
Size: 360,000 square miles (Roughly 5 times the state of Ohio or twice the size of Nevada)
-- Only 8% arable land
Bordering countries: Somalia, Ethiopia, Sudan, Uganda, Tanzania
Government: Republic
GDP Per Capita: $1,600 USD (US = $47,400)
Average Income: Approximately $425
Unemployment: 40%+
 Percent below UN international poverty line of $1.25 USD/day: 19%
Percent living on less than $2 USD/day: 40%
Religion: Protestant 45%, Roman Catholic 33%, Muslim 10%, indigenous beliefs 10%, other 2%
Life expectancy: 60 years
HIV/AIDS+: 6.3% (11th highest in the world) or 1.5 million people (5th highest in the world)

I will be in Eldoret, Kenya in the western portion (Rift Valley Province) of the country near Lake Victoria.  Population is estimated at 250K but I am told it is much higher in actuality.

Sustainable Socioeconomic Growth in the Developing World

I posted a paper I wrote for a course in my MBA program located on the sidebar to the right.  It summarizes my beliefs on the role of NGOs, MNCs and Foreign Aid in developing nations.  For those interested in learning more about the hospital/organizations I will be working with, check out the book "Walking Together, Walking Far" by Fran Quigley,  its available on Amazon in Kindle ($9.99) and Paperback ($14.99).