Mission to Maua - Week 6

With its ideal climate and gorgeous scenery, one might think of Maua as being a kind of paradise, but there is a dark side to Maua too.  Not only is there extreme poverty, but people seem to have a total disregard for the environment (and in such a lovely setting!)  Many people just throw their papers, food, and bottles on the ground wherever they happen to be.  Multiply one person’s habit of throwing stuff on the ground by the hundreds of people working, living, or passing through Maua, and you have a really trashy looking village.  Add the noise and activity of scores of motorcycles, cars, and matatus, and sometimes Maua is just not a pleasant place to be. Those are the times I really appreciate being at the hospital compound; it’s almost like an oasis with all the trees, fewer people, security guards that smile and wave at you, and the chapel front and center as you walk in.  It’s not spotless, but neither is it trashy. At other times in Maua, like today, a Sunday, the noise and traffic are less and there are smiling people walking around in their Sunday best, saying hello, shaking hands, and inviting you to their church.  It’s the ideal time for a walk and also for Roger taking pictures.

Miraa, or ghat, is a very serious problem in Maua.  Miraa is a tree that grows in the hills throughout the area.  The bark from the new shoots is washed, stripped of its new leaves and chewed to get an amphetamine-like effect.  If chewed long enough, it can give a feeling of alertness, contentment, and ease of conversation, effects that can last up to 24 hours.  Miraa can be addictive and can lead to aggressive behavior, nightmares and hallucinations.  Miraa is also easy to grow and as prices of coffee and other agricultural crops have decreased, farmers have switched to miraa, a crop that gives higher and more or less guaranteed returns. Miraa is illegal in the US, Canada, and many European countries where it is considered a controlled substance.  However, it is legal in Kenya, in the UK, and in Somalia where it is ingrained in their culture.  Because miraa loses its potency in 48 hours, there is a rush to get it to a private airport in Nairobi where it will be flown to Somalia, and the UK.

In Maua and smaller towns around here, there is an urgency to package the miraa twigs in bundles, wrap them in banana leaves to preserve their freshness, load them into vans and  trucks to speed them on their way to Nairobi.  Drivers admit to driving the 110 miles to Nairobi at speeds of up to 120 mph. Reports are that they get a bonus for rapid delivery. The miraa trade generates other money into the economy as well.  Women who gather and sell the special banana leaves, and women who sew the sacks for the bundles of miraa also earn a little extra income.

The advantage of more money in the economy is more than offset by the negative effects on society – more drunkenness, more prostitutes (and AIDS) and more fights with knives. The hospital averages about ten difficult patients who have been injured in ponga (machete like knives) fights, due to miraa.  Sadly, the local farmers and villagers only get a token amount for their role in the miraa business.  It’s the middlemen and the moneyed Somali traders who are reaping the greatest profit from this drug trade. 

Mission to Maua Week 5

We are aware that the days are getting longer and longer in Pocatello.  Here, the sun still comes up at 7:00 am and goes down at 7:00 pm.  It has not rained for two nights however, so we must be moving into the dry season.  Altogether, Maua has had 40 inches of rain since mid-April.

We have three new medical students and a new doctor, all from the University of Texas, Galveston.  Three of the four are of Korean ancestry and the other of East Indian ancestry. They are all US citizens and have lived in the US most of their lives. I wonder if there is a different kiswahili word for Asian. I suspect that wazunga means anyone who is non-African.  It is strange to me that everyone can tell that I am a visitor solely because of the color of my skin.  In Maua, any white person must be at Maua Methodist Hospital because there are no tourists here.

Last Sunday we had the wonderful opportunity to deliver some of the medicines we brought to Mboroga Dispensary at Ntugi.  These medicines had been requested by a nurse from the area, Mary Mbai, (Roger had once worked with Mary in the Rwanda refugee camp.)  We were met at the Methodist church near the dispensary by Mary’s family and a delegation of church leaders.  The church service was a very traditional one in English combined with a rousing celebration including music by three choirs, and dances by a women’s group and a youth group.  They even pulled Roger and me up to dance with them!

Following the service we walked to the site, donated by a church member, which will house a small home for the infirmed elderly and also a multi use conference center. This is a project of the Mens Fellowship of the church.  Adjacent to this project is the new dispensary, built by the Kenya government.  Also, and still under construction are a maternity wing and additional clinic rooms.  Eventually, when all is completed and operational, the dispensary will serve a population of 150,000 people scattered throughout the valley.

Because the dispensary is so new, they are awaiting the government certification required before they can receive medicines.  Presently, they are depending on other dispensaries to donate the little supply they have, so they are especially thankful for the medicines that we brought.  Roger spoke with the two very capable nurses about their vision for the dispensary and how they looked forward to using the medicines.

While we were touring the dispensary and other buildings under construction, others were preparing a big dinner for all of the people there.  We were honored guests and they certainly made us feel welcome.  Several people made speeches regarding their role in the project and we were given some gifts representative of Kenya. Then everyone adjourned to the open area where Roger handed over the medicines, contributed by so many of you.

When I say they made us feel welcome, it’s hard to explain how vigorously they did so.  Those women are strong! They grab you, hug you, and shake your hand – all with almost bone-breaking strength.  I fear that many of them expect a follow up letter or phone call.  As we drove away, several of them were singing and dancing and waving good-by. We’ll certainly not forget them.

Maua week post # 4

(Blogmaster's note: the photos enclosed are not of any patients in the clinic, but must be occasional visitors outside?)

There are several options of getting from one place to another, other than walking.  One mode of transportation is the motorcycle. We are amazed that so many persons fit on one motorcycle – often three or four, but the record we saw was five! The motorcycle is often free but the driver sometimes picks up paying passengers. Another type of transportation is the matatu – a car or van that crowds in more people than you ever thought possible and goes to a particular destination, dropping people at various spots. The matatu fee is very cheap, only KS50 (68 cents) to go up to 20 miles.  Trucks, buses, and private cars occupy the main highways, but motorcycles, matatus and foot traffic are the only ways to travel on the more remote roads.  Even paved highways are not especially fast.  If there are not many pot holes to slow you down, there are speed bumps.  Speed bumps, used instead of the speed limit signs we see on our highways and placed before city limits and school crossings, are effective.  Driving at night can be very hazardous. It’s almost impossible to see the speed bumps or the people walking along side the road.  In addition, some truckers are anxious to get to Nairobi as soon as possible and drive at suicidal speeds.

Several of you have asked what we eat.  Our diet is similar to what we eat at home, but with the addition of fresh pineapple, bananas, papaya, and other fresh foods available at the informal market.  Two small grocery stores offer a minimal selection of items but we are able to buy milk, juice, and bread there.  We’ve yet to try any of the local “butcheries” (meat markets) so our meat selection is either canned or frozen. “If you can’t cook it or peel it, don’t eat it” is our motto in order to avoid digestive problems.  We also pay special attention to the water.  We get well water from a near-by tap, but then either filter or boil that water.  It’s hard to remember to use this purified water for all drinking purposes, even to brush your teeth!  But so far, we have stayed healthy, even though our diet is simplified compared to what we eat at home.  Knowing that some of the people here in this area only have one meal a day makes us grateful for any food, even if it isn’t gourmet.

We are fortunate to have friends who welcome us to the area as well as to the hospital.  Dr. Claire  (they just use the title and first name here) is in charge of the Palliative Care Dept and of the Medical Store.  Sister Barbara (they call all senior nurses “sister”) is the acting principal for the School of Nursing.  They kindly invited us to go with them to Meru National Park last Saturday.  Meru National Park is not as famous as Maasai Mara, the destination of so many safaris, but it features many of the same animals and is only an hours drive from Maua.   Meru Park is also more unspoiled, pristine, and uncrowded.    We saw only three other parties in the park that day.  We must have visited at the ideal time; the scenery that had been brown just three weeks before was now a spring green, and the mountains were still visible in the background.  Yet the grasses were not yet so tall that they obscured the animals.  In only one day, we saw elephants, giraffes, zebras, cape buffalo, ostriches, gazelles, hippos, and many more.  We did not spot any lions or other cats, but were assured that they are there – somewhere.  I felt as if we were on a movie set and Roger, of course, took over 300 pictures.

                                               

The medical community at Maua Methodist Hospital is very hierarchical, and Roger has had to tread carefully to fit into “the system” but also to contribute his ideas and stimulate discussion among the doctors, interns, and nurses.

Roger had begun preparing for work at the hospital months before we came.  He noted that World Health Organization statistics showed that child mortality declined by 50% in the last ten years, but infant mortality had not decreased at all.  So Roger began re-training in care of the newborn while we were still in Pocatello, Thanks to Dr. Lloyd Jensen, other pediatricians, and the nurses at PMC, Roger updated his skills and did research on care of the newborn.  He also used some of the funds raised to buy special medical equipment.

It took a tragedy to illustrate the need for special newborn care.  The nurses and interns were devastated when they failed to resuscitate a critically ill baby.  That is when the Charge Nurse told Roger that the nurses and interns  needed some special training NOW.  Roger brought Resusci-Babe (a special mannikin of a new born) and a special breathing bag for newborns to the ward and began discussions and practice on newborn resuscitation.

Since then, Roger has scheduled seminars on care of the newborn with each of the departments at the hospital where small groups can have hands-on experience and all the discussion they want.  He spoke to all of the student nurses about the importance of newborn resuscitation, then saw the senior student nurses show up the next day to experience newborn resuscitation techniques for themselves.

Roger is also seeing other pediatric cases.  In only two weeks, Roger has dealt with malaria, pneumonia, asthma, kwashiorkor (severe malnutrition) and mother/child blood incompatibility.  He is excited that he is able to work with the medical staff here and to provide some crucial medical care.

I have to be more flexible in my role. A lack of medical training and inability to speak kiswahili present some barriers, but I have been able to explore the types of outreach projects done by Maua Hospital.  So far I have visited some of the families of AIDS orphans helped by Giving Hope.  I also observed HIV/AIDS classes at primary and secondary schools, supervised by the hospital’s Community Health Dept.  The department also sponsors Palliative Care for cancer and AIDS patients in their homes or communities and I plan to visit those too. When not visiting and observing outreach projects, I work in the Medical Store helping to sort out and identify medicines and also work for Community Health assembling packets of drugs for the Palliative Care patients.

Church and community fund raising efforts for medicines and supplies are much in evidence now.  In addition to Resusci-Babe and a special resuscitator, there is a special needle used to re-hydrate a patient through the bone marrow, a needle that has already saved a child’s life.  Other medicines and equipment are awaiting classification and inventory at the Medical Store. 

Maua Week 3 (with photos)

Donna writes about their thrid week in Maua:


AIDS is a terrible problem in Africa and so is the problem of AIDS orphans. Giving Hope is an organization that works to help AIDS orphans by going into the communities  where orphaned teen-agers and siblings are already living, and bringing the these families together in supportive groups They are then connected with mentors and social workers and offered resources such as food, housing and vocational training, empowering them to be self-sustaining in 2 – 3 years.

 Last week, Roger and I had the opportunity to accompany a social worker to visit some of the orphaned families.  We met several of the teen-age heads-of- household and listened as they told us (through an interpreter) of their vision for the future and how they are working to improve their lives and that of their siblings.  These seamstresses, mechanics, farmers, and tree farmers are given a starter kit to begin their business and checked on periodically by the social workers to see how they and their siblings are doing. This approach of empowering orphans to stay in their own community and keeping the family together is a much better solution than placing them in an institution or, worse, abandoning them to struggle by themselves.   I wonder how many 17 – 20 yr olds in the US would be able to take on such responsibilities.

Religion is much in evidence in Kenya – from the many different churches,the throngs walking to church to the religious services here at Maua Methodist Hospital.  In addition to the 5:00 am Pentecostal service, there are also the more traditional chapel services at 7:30 and 8:00 each day.  Prayer is said before or following many of the activities.  Doctors and nurses pray before starting the hospital’s Morning Report.  We prayed before the immunization clinic, and following each visit to an AIDS orphan. We are reminded  and appreciative of the prayers and support from the Pocatello UMC members.  Your covenant to pray for us at 9:00 pm  means special prayers for us here at noon, Kenyan time.

Bible study for the wazungu  (white people) takes place at the Savutos each Thursday night.  It is a chance not only to explore the meaning of scripture but to get better acquainted with those we may not see on a daily basis. Other wazungu here at MMH include three medical students (from Denmark and the US), a peace corps worker, and an occupational therapist from Germany.

Last Monday, we met with Stephen Gitari, director of Community Health.  We expressed our interest in rural health and in the mobile clinic. Roger was especially interested in the dispensary clinic, where they treat clinical patients in addition to giving immunizations.  It turned out that the team was leaving in 30 minutes for the only dispensary clinic of the month and we could go along if we wished.  Stay flexible, right?  We managed to get everything together and joined the others, headed for Kawiru, site of the clinic for the day.  Kawiru is warmer, drier, and affected by the April drought.  Their corn is only 1/3 as high as the corn around Maua, and many are concerned about having enough food for the year.

Mothers and babies were waiting for us when we arrived, some of them having walked as much as 5 km to get there.  After a student nurse gave a talk on nutrition and hygiene, the team began giving injections against DPT, TB, pneumonia, and the oral vaccine against polio.  The babies were all plump, cute, and healthy-looking.  Except when reacting to a shot, they seemed content in their mothers’ arms.  I helped give the polio vaccine to a few babies, but since I could not read the charts or talk to the mothers, we mostly just observed and commented on what was happening. Mothers who had not already received mosquito nets were given one. We were pleased to see that these mothers knew about the importance of immunizations and the mosquito nets, and that they made the efforts to ensure good health for their babies. 

During the afternoon, Roger was asked to help see some of the sick patients who had shown up.  He was happy to do so and in the nine patients presented to him, he saw cases of malaria, pneumonia, asthma, and bronchitis.   It was the first time I had watched Roger treat patients other than our grandchildren and I was impressed with his tenderness and thoroughness.  Altogether, the clinic team saw 85 patients.  It was a long, full day and we didn’t get home until 6:00.

Second Week - elephants, weather, Isabella and Kiswahili

It’s hard to believe that we’ve been here just a little over a week!  People have been so anxious to show us the many programs, services, and sites, that we can barely absorb it all. 

I saw elephants!  On the return from a trip to Meru, we came to a place that Bill Savuto said had been in the migration path of elephants before the highway had been put in.  He slowed down, we looked, and there they were! – four elephants, including two babies! - just 100 yards away and behind the electric fence separating them from the highway.  I’m told that sometimes they come right up to the fence, but I was thrilled to see them just where they were.

The weather here is ideal.  True, it is the rainy season, and it rains daily, but the rain only comes at night.  Isn’t that convenient?  I love to lie in bed and hear the rain on the roof, grateful that I am indoors and not outside in the down pour.  It doesn’t just drizzle like in Seattle, it really pours.  Last month alone, there were 30 inches of rain recorded here.  The temperature ranges from lows in the 50s to highs in the 70s. 

Our small house (which they call a cottage) is very comfortable.  We don’t have the labor saving devices such as washing machine, dryer, or dish washer, but we have another even better labor saving device.  Her name is Isabella.  Isabella comes Monday through Friday for four hours to help with the cleaning, cooking, washing or whatever we request.  The most valuable help however is with the shopping.  She can converse in kiswahili with those in the market and we all know that she gets a better price than we would.  Isabella is a single mom who raised her orphaned niece and is now raising her 11 month old son.  The hospital hires help for most of the staff here because so many of the local people need a job.  Isabella has been employed doing house work for ten years.

Although English is the official language in Kenya and is the language used in the schools, many people speak only Kiswahili or Kemeru.  So,educated people here are bi-lingual or even tri-lingual. All of the hospital staff speak English, but talk with each other in kiswahili.  Even when they speak English, some of them are extremely hard to understand, especially when speaking with a microphone. They might as well be speaking Kiswahili. 

Arrival and the first week

Computer problems have delayed more timely postings in this blog, but after a week, we are ready to begin posting. So here goes:

The drive from Nairobi to Maua was a long (6 hours) and bumpy trip, but we were enthralled with the beautiful, lush, green scenery – banana trees, rice fields, tea plantations in the valley and mountains in the background.

Throughout the entire trip, we saw hundreds of people walking along side the road – some in their Sunday-best, walking to or from church; others en route to or from market.  Kenyans walk a lot! 

We were welcomed by UMC missionaries, Jerri and Bill Savuto when we arrived at Maua Methodist Hospital, and also enjoyed dinner at their house that first night.  The Savutos have served Maua for ten years.  With  their help, we have learned much about the hospital, its programs and the people.

My original concept of Maua Methodist Hospital was misleading.  It is not just one building as shown on the brochure, but consists of twenty medical buildings plus staff housing on  the nineteen acre forested campus.  The hospital has 275 beds and treats 100,000 outpatients plus 12,000 in-patients per year.  In addition, Maua Methodist Hospital hosts a school of nursing and runs an extensive community-based outreach program.  Patients pay a small fee ($2.00 to see a physician’s  assistant; $4.00 to see a doctor) but some of the support comes from Methodist churches in the U.S., Germany, and the U.K.

Compared to the new Pocatello Medical Center, Maua Methodist Hospital is old.  It was built in 1928, but the buildings are surprisingly cheerful.  Each building is built around a central courtyard, which lets in sunlight and fresh air.  Unlike PMC, there are no private rooms here.  Up to seventy patients may occupy one large room or ward.

Roger and I don’t need an alarm clock here.  Each morning at 5:00am some of the nursing students and staff gather in the chapel, which is next to our “cottage” for a Pentecostal –type worship service.  We enjoy waking up to their beautiful singing, but figure that only God can understand their speaking in tongues.  We adjust our bedtime earlier to compensate for the early wake-up call.  We then attend one of the more traditional chapel services at 7:30 (staff) or 8:00 (doctors).

Physicians here wear a long white coat, which distinguishes them from the nurses, students, administrators and other staff at the hospital.  Roger had no white coat so he is wearing one he found in the closet at our cottage.  The problem is that it is quite small and that it says “Leslie Smith, MD” on it.  It bothers me more than it seems to bother “Dr. Leslie”.

Donna writes on May 2, 2011:


Roger and I arrived safely in Nairobi, an hour and half late - after being re-routed from SLC to Delta to American to British airways.  Miracle of  miracles, all six pieces of luggage arrived too.  After a night at the Methodist Guest House in Nairobi, we traveled with two drivers from Methodist Hospital to Maua and to the hospital compound, where we have very housing at the "Doctor's Cottage."  


Today is some kind of holiday  (Labor Day)  in Kenya so Jerri and Bill Savuto, missionaries from the US,  showed us around Maua and around the hospital.  Roger starts work at 7:30am tomorrow.




<< Jerri and Bill Savuto