My role at Maua Hospital

Roger: MY ROLE AT MAUA HOSPITAL

So far Donna has done most of the writing for the blog, but I wanted a chance to include my personal perspective on our work here at Maua hospital.  Before we came, I spent a great deal of time trying to figure out how I could best contribute to the program here.  I have spent most of my practice and teaching career focusing on areas of pediatrics that had little to do with this acute care tropical setting.  Then a preliminary report came out from the World Health Organization and the UN concerning maternal and child mortality in developing countries.  The report showed that over the past 7 years the death rate in mothers and in children age 1 to 5 had been cut in half, but the death rate in newborns and small infants had remained the same.  This finding has stimulated a worldwide effort focused on the newborn.  


The many articles I read and the encouragement of a former partner Dr Lloyd Jensen, helped me to decide to concentrate on saving the newborn.  I went to workshops to update my very rusty skills, and planned presentations and workshops.  Most of the newborn deaths here in Kenya, and in all parts of the world, are due to 3 causes, birth asphyxia, infections, and prematurity.  Birth asphyxia means that before, during or after birth, the baby’s brain is deprived of oxygen, causing either death or severe brain damage in survivors.  I have concentrated on giving lectures and hands on workshops to medical staff, interns, nurses, and nursing students on helping babies breathe.  The teaching aids and medical supplies we brought have been a great help, as well as has the Neopuff, a special machine that is used in newborn resuscitation. I will be giving this machine to the hospital when I leave, so I hope I have taught them how to use it well. I have also worked in the pediatric ward and the nursery, attending rounds and doing one on one teaching.  


Maua has been one of the most rewarding experiences of my life, challenging and difficult at times, and one that I could not have done without the help of Donna, the prayers of all of you back home, and many times a fervent prayer for help and guidance.

Mission to Maua – Healthcare

Kenya’s healthcare system falls far short of the need.  Doctors are in short supply (only one per 10,000 Kenyans) and only 1,000 of them work in public hospitals.  Most Kenyans can’t afford private health care or the many hidden costs of public hospitals, so fewer than 40% visit a hospital when sick. The average life expectancy is 53 years.  The government is making efforts to offer greater accessibility to health care by building district hospitals and rural dispensaries, staffed by nurses or clinical officers. Yet, one third of clinical jobs are vacant and medicines are in short supply, if available at all.  The government health care system is plagued by “corruption, staff shortages and poor facilities” according to the Kenya Anti-Corruption Commission. 

The closest district hospital has no doctor on nights or week- ends; sometimes not at all.  They frequently run out of medicine and offer a poor option for health care for people in this area.  This leaves Maua Methodist Hospital to fill the gap, even though it severely strains the resources of Maua Hospital.   When the district hospital had no insulin for diabetic patients, they sent them to Maua, which in turn diminished Maua’s supply.  Two near-by highway accidents last week brought scores of victims to Maua Hospital because the closest hospital with a doctor on duty is an hour and a half drive away.  The district’s doctor doesn’t perform C-Sections, so patients needing that surgery come to Maua. 

Maua Methodist Hospital is struggling financially.  At the end of 2010, MMH had a deficit of almost  $100,000. The hospital depends on patient fees or patients’ government insurance for maintenance and operating costs.  Methodist Churches in the U.S., U.K., and Germany and other donors fund various projects both at the hospital complex and in the community outreach programs. Volunteers in Mission teams help spruce up the antiquated buildings.  The main problem is that in a time of 12% inflation, rising food prices, and drought, many patients are just unable to pay their fees.  The hospital has worked hard to reduce expenses and to ask for pre-payment or evidence of government health insurance before admission. (except, of course, in a life or death situation.)  Efforts are continuing to make the hospital’s financial outlook more stable.

The nursing shortage is another problem for Maua Methodist Hospital.  More than thirty nurses have resigned within the past year in order to work at government hospitals.  The appeal of easier work and shorter hours and giving them the option of opening up their own private clinic, for the same salary is too hard to resist for some.  Some clinical officers, trained at Maua Methodist Hospital, are also leaving to assume government posts. 

On the positive side, 2011 saw the beginning of a new medical internship program at MMH and the current four interns are well educated, hard working, and will make excellent physicians.  The Nursing School continues to produce eager, knowledgeable students.  Medical interns, clinical officer interns, pharmacy interns, and student nurses all complement the staff at Maua.

Maua Methodist Hospital has come a long way since 1928 and is working to modernize its facilities and services today.  MMH was in ministry offering health care then and it is in ministry offering health care now.  With God’s help, a lot of prayers, and a lot of support, Maua Hospital will continue its ministry well into the future.

Education in Kenya

The Community Health Dept is addressing the AIDS problem not only through treatment, but also through prevention.  A pilot education program is sending Jill, from Seattle,  and James, from Maua, both registered nurses, into area schools to present classes on reproductive health and prevention of HIV/AIDS.  I had the chance to accompany them into six different schools and to observe both the prevention classes and also the schools themselves. Even though we were there for these special presentations in the six secondary and primary schools we visited, I was able to observe some vast differences between Kenyan public schools and our schools in the US.


Fifty to sixty students fill a classroom in Kenya’s primary schools and students sit three to a desk. Students learn by rote (which I believe stifles creative thinking) and learn basic reading and writing skills. They will also learn English, which, when added to their mother tongue of Kemeru and Swahili will make them tri-lingual.  Students at both primary and secondary level are very quiet, well disciplined, and sit still, even in an auditorium, outdoors on the lawn, or in a regular classroom. The classrooms seem difficult to work in: blackboards are so old it is difficult to read the writing; there was no electric light in one dim room, and classroom supplies are scarce.

Schools in Kenya are not really free.  Primary students must pay $33.00 and secondary students at day schools, $44.00 - $55.00 per year.  Those students in secondary boarding schools pay $250.00. In addition, students must pay for their uniforms and some school supplies.  As a result, many children are not in school because their families cannot afford the fees.

Teachers require three years of higher education at a teachers college to be certified, but schools in hard-to-serve areas sometimes hire an uncertified teacher with only a high school diploma. A projected teacher shortage shows that 71,000 additional teachers will be needed by 2012.  Teachers earn $88.00 – $150.00 a month while an uncertified teacher might earn only $44.00 a month. The teachers union is working to increase pensions and “hardship” allowances for those teachers in hard-to-serve areas.

The literacy rate for Kenya is 70%, but in the Maua area it is only 35.9%. The government made an attempt in 2002 to offer primary education that was actually free, with no fees.  However they had to restore the fees within a year because the government just didn’t have the revenue to sustain free education.  The government still spends over half of its budget for public schools even though it doesn’t pay the full cost of education. 

 

A major scandal involving fraud and embezzlement of public school funding was recently reported.  A government investigation revealed that $42,000,000 of “free learning money” never reached the schools. Over 100 people, including top civil servants are involved.  As a result, the UK and other international donors have indicated they will withdraw their donations, then re-direct them through non-state channels. The Kenyan government vows to prosecute the offenders and recover the funding. 

Pediatrics at Maua Hospital

It is hard to adequately describe the pediatric ward here.  The closest picture I can come up with is that of a battle-field.  The immediate enemy is disease, but we’re also fighting malnutrition, fear, and lack of education, and always, always poverty.  We don’t have adequate weapons to win all of the battles, only the skirmishes.  There are 8 beds to a room. The place becomes even more crowded because the mothers or caretakers have to stay with the children at all times, feed them and give them their cares.  The ward is dilapidated, at times not too clean, and many things don’t work any more.  The nurses are critically short-handed, and the hospital is critically short on finances.  

Given all these constraints, what the hospital accomplishes here is nothing short of a miracle. The intern that I have been working with is exceptional.  He is bright, conscientious, and deals with mothers very well.  My hope is that he will decide to go into pediatrics.  Right now we have 20 acutely ill patients on the ward, including some patients that would tax the ability of a tertiary hospital to care for them.  There are 8 patients in the sick nursery, including 5 premature infants.  We have lost a couple of the preemies because we exceeded the capacity of the hospital staff to care for them.  At times I have felt that I was in over my head, both with the numbers of patients, their emergent needs, the unfamiliar diseases, the difficulties with language, (Most of the patients do not speak English) and huge cultural differences.  On the other hand I am having one of the best clinical experiences of my life.  

The challenges are stimulating, the teaching is going well, and I have learned to repeat the Serenity Prayer often. “ Lord, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” 

Mission to Maua - FGM

Female Genital Mutilation, or female circumcision, is illegal according to Kenya’s constitution, but still widely practiced, especially in rural areas with strong tribal traditions.  FGM covers a wide range of procedures, from a small symbolic cut to removal of the clitoris and external genitalia.  Strong social pressures in the village lead girls, particularly girls not in school, to continue this rite of passage.  Side effects of FGM can be chronic infections, severe bleeding, infertility, life long pain during sex, and spread of HIV.  Over 90% of female patients at Maua Methodist Hospital have been circumcised.
The World Health Organization and the UN Human Rights Convention condemn Female Genital Mutilation, but the effort to stamp out FGM is sometimes perceived as part of a Western conspiracy to undermine African cultural identity.  Fortunately, Kenyan women’s groups and churches are offering an “alternative rite of passage” for girls who might
otherwise undergo female circumcision. 
 
The Women’s Organization at the local Methodist Church in Maua  is one of many church groups that have sponsored “alternative rites of passage” for girls in the area. The program is preceded by a meeting with mothers and grandmothers to help them understand and win their support of an alternative rite.  The adolescent girls participating then attend a two week program that will offer them an alternative way, without surgery,  to signal their passage into womanhood.  In 2008, ninety six girls participated; in 2010, one hundred forty girls did so.  The girls pay 100Ksh (about $1.20) each to show their interest and commitment before attending the program during their school vacation in December.  In alternate years, the participants meet for an evaluation and to help facilitate the next year’s program.  The goal of the Women’s Organization is to take the alternative rite of passage into the villages where Female Genital Mutilation is most entrenched.

Mission to Maua # 12 - Prime Minister, Volunteers in Mission

(Blogmasters note: the hard drive on my computer self-destructed recently, so I have been forced to use an older computer with older browsers, which are not entirely compatible with the newer blog formatting. Hopefully when my repaired computer arrives, pictures will be placed where I want them in future blogs. My apologies.)

Volunteers in Mission –Last week’s team from the Houston, TX area left Saturday morning and another team from Texas arrived that night.  While here, some of the twelve members worked on plastering apartments on the hospital grounds, others went to offices and on field trips learning about the hospital’s community health programs.  The remainder worked on the AIDS Orphans house.  Several in the group had been here before and it was interesting hearing their perceptions on how things had changed at Maua Methodist Hospital.  The climax of the week was the dedication service for the AIDS orphan house.  The receiving family, their working group, the evangelist (who led the worship litany and prayer), the director of Community Health, staff of Giving Hope, all the people associated with the VIM program, and of course, the members of the VIM team were all present for the dedication.  Kathie Mann, leader of the VIM team, had the privilege of presenting the keys to the family who will now live in their new home.  

This week the cycle will be repeated with new VIM team members, also from Texas. I enjoy getting acquainted with people in this new group, but look forward to welcoming the next team from the Oregon/Idaho Conference.  They will be bringing more of the medical supplies ordered by Roger before we left.

Prime Minister, Raila Odinga, came to Maua on Saturday.  We didn’t go to the stadium to hear him because no one knew what time he’d appear.  We weren’t the only ones who didn’t go.  Seven of the nine area MPs (members of parliament) also shunned the meeting because they feared their appearance would negatively impact their chances for re-election next year. Mix political party disputes with tribal disputes and you have a political situation that is beyond my understanding.

News of Odinga’s appearance was eclipsed by news of the death of Fazul Mohammed.  Fazul was the mastermind of the US Embassy bombing in Nairobi that killed 218 Kenyans and 12 Americans in 1998.  Somali government officers killed Fazul at a checkpoint in Mogadishu.  Victims’ families and survivors of the embassy bombing here are understandably pleased that Fazul is dead, but some say they would only be able to celebrate if the American government honored its pledge to compensate victims of the 1998 attack.

Your tax dollars at work!  Last week a stack of 50 or so boxes sat in front of the Administration Building, waiting to be taken to the proper place in the building.  Written on the boxes was “Kenya Ministry of Health/USAID”, and also “from the American People”.  I don’t know what was in the boxes but was pleased that USAID (US Agency for International Development) was partnering with the Kenyan government to help a private hospital like Maua Methodist.

Mission to Maua-Giving Hope

I was happy for the chance to go with the director of Giving Hope to some more distant communities where the orphaned families live.  This time he wanted to show me some situations where the Giving Hope leaders work with others in their working group.  A working group consists of twenty families (representing about 80 people) and serves as both an extended family and a support group.  Family leaders elect their officers and choose their adult mentor, then meet on a regular basis to share ideas, problems, and be there for each other. The officers of working groups are also occasionally brought together for full day meetings at Maua Hospital to learn more about leadership, life skills, and opportunities for their communities

Working group leaders also get together periodically to help one family in their group.  The morning we were there, group leaders were in the field helping to weed the small farm used by one of the families. The working group also gets together whenever a new Giving Hope house is dedicated for one family in their group. We were able to visit a new working group that had come together just the week before.  They had already elected their leaders and, with the social worker’s guidance, were planning a project for their group.

We went to one area where there is rivalry, even hostility, between villages on each side of the river.  Giving Hope has paired mentors and families from both sides of the river into a working group, with the expectation that, by working together, the orphan families will encourage and model cooperation rather than the current rivalry.

We also had a chance to touch base with some of the recent graduates of the program.  They are doing well.  The seamstress has a small store where she also sells beans and other produce.  The girl working in her small farm plot will soon start a job as a teaching assistant, and the hairdresser had customers waiting for her services.  None of them will make a lot of money, but just a little income plus the subsistence farming will be enough for their families to survive and to be self sufficient.

I believe that Giving Hope is taking the right approach for these young heads-of-household by establishing a goal for their lives and giving them needed resources of food, housing, and start-up funds for their business or vocation.  Giving Hope is giving them the encouragement of professional social workers and mentors in their communities, and the support of other orphaned families in similar situations.  These orphaned children can then be healed emotionally and grow spiritually. With this comprehensive help, Giving Hope is empowering these families so that they will become self-sufficient within three years.  Once a family no longer needs their help, Giving Hope is then able to help other orphaned families. There are 42,000 orphans just in the Maua area alone.

Similar Giving Hope programs exist in other African countries.  For more information, contact their parent organization at www.zoeministry.org.

Mission to Maua #10 - Meru National Park

We were blessed with another chance to visit Meru National Park – this time with Bill and Jerri Savuto.  In some ways, this visit was similar; we saw giraffes, elephants, cape buffalo, etc. , there were few tourists, and the scenery was still green and beautiful.  In other ways, however, this visit was very different.

The first thing we saw, shortly after we entered the park around 7:15, was a new-born gazelle.  It was up on its feet, just tottering, then fell down.  The mother was about 50 yards away, probably trying to encourage it to walk.  The baby tried again, and fell again.  Suddenly, an eagle swooped down and almost carried it away, but the mother gazelle ran back and chased the eagle, which finally flew away.  The baby then resumed its walking and we drove on, hoping mother and baby would soon rejoin the herd.

On this visit, we visited the white rhino sanctuary.  In the 80s, poachers killed off all the   rhinos.  (Rhino horns bring good prices in the Orient.)  The Kenya Wildlife Service re-introduced rhinos into Meru Park in the late 90s, but they are in an enclosed area that is closely guarded.  We drove throughout the extensive area, and spotted rhinos at a distance, but just as we were leaving the sanctuary, we saw four rhinos next to the road and were able to sit and watch and photograph them.

We spent the morning driving through the park (You are not allowed to get out of your car except at designated areas.) oohing and ahhing at a variety of animals and birds, then stopped at a campground for lunch.  I provided the comic entertainment when I fell over backwards in my deck chair while holding my plate of egg salad.  It gave a whole new, literal meaning to “having egg on your face.”  The herd of impala provided the action though when a herd of a hundred impala sped through the area en-route to the river, just 100 yards from where we were sitting.

We saw another herd of animals late that afternoon.  This time it was giraffes.  Over fifty of them ambled from one side of the road to the other.  As we got closer to dusk, the animals got more active and the light got better for photographs.  Just before leaving the park, we finally saw a lioness! – the first cat we had seen in our visits.  We watched her for about 20 minutes.  She obviously was waiting.  She would get up, stretch, walk to another location (in the middle of the road at one point), then sit again.  She was a beautiful, graceful animal and we never tired of watching her, but it was getting close to the mandatory time that we were to leave the park, so we had to drive on.

Roger and I feel so lucky to have seen so many of these animals in their natural setting and without contending with hoards of tourists while viewing them.  We plan to visit two more national parks after we leave Maua but before we leave Kenya.  Nairobi National Park is almost in the city limits of Nairobi, and Lake Nakuru National Park is just a few hours drive from Nairobi. It’s just too tempting to pass up in what could be our only trip to Africa.

Mission to Maua # 9

The Volunteers in Mission team is here!  At least they are in Kenya, but not yet in Maua.  We are expecting them to arrive around 6:30 this evening – twelve members of the team from Texas.  Leading the team is Kathie Mann, a woman Roger knows from his General Board of Global Missions days.  While here they will build a house for an AIDS Orphans family, to be dedicated on Thursday!  When I asked how they could possibly build a house in four days, I was reminded that it will be a simple two room, wooden house, no electricity, no plumbing, that will blend in with the neighboring houses.  The foundation is already poured; they just need to construct the house.  Team members not working on the house may work in the Medical Store where all of the hospital medicines and supplies are kept.  

Roger and I are looking forward to meeting them and to accompanying them to Sunday School and church tomorrow.  We’ll be attending the Swahili service, which is very lively, longer, and has great singing.

The remaining three suitcases of medicines and equipment that we brought with us are now unpacked, stored, entered in the computer, and available for use by the hospital.  Dr. Claire, director of the Medical Store, wanted to wait until she was available to go over the supplies with Roger and enter them in the computer at the same time; today was the first opportunity.  Roger held back the specific supplies he will be using for teaching and serving on the wards for the next two weeks, but otherwise, the thousands of dollars of the medicines and equipment we brought with us from Pocatello are now safely catalogued and stored here for use by Maua Methodist Hospital. 

Mission to Maua: A Modern Lazarus

A Modern Lazarus

Three days ago in late afternoon, I walked over to the pediatric ward for my usual teaching session with the interns.  As often happens, our meeting was interrupted by an acute admission.  The story was that a mother had given birth as a home delivery two months prematurely to a baby who initially did well for a few days, then quit nursing and became progressively inactive.  The mother took the baby to a district clinic, and was told to take the baby immediately to Maua Hospital.  On arrival on the pediatric ward, the baby was breathing only intermittently, was cold and unresponsive.  The core temperature was 91 degrees and the incubator was not functioning.  I quickly found out that hospital policy was that babies over one week old could not be admitted to the nursery.  The charge nurse made a quick phone call insisting on transfer, and we bundled the baby to the mother kangaroo style, and rushed to the nursery.  By then the baby had quit breathing entirely and was limp and unresponsive.  We began resuscitation with bag and mask, and filled four rubber gloves with hot water and placed them around the baby for immediate warmth.  Although we maintained the heart rate above 60, over the next 1 _ hours of bagging, the baby made no respiratory effort, and remained completely limp and unresponsive.  We very reluctantly made the decision to stop our resuscitation.  We prayed together with the grieving mother, who had watched the whole effort.   Within a minute or so after the prayer the baby took a breath.  I thought it was just a terminal gasp, but then he took another, and another, and then began spontaneous regular breathing and moving all extremities.  The heartbeat became full and strong.   

    In fifty years of practice I can only remember one other such a recovery.  The initial failure to respond was certainly in part due to the low body temperature. That same low temperature may have helped save the baby’s brain from severe damage. The gloves filled with hot water certainly helped save a life, as did the expert bagging by the interns that I had just trained in resuscitation the week before. Yesterday the baby began breastfeeding, and the neurological exam remains normal.
 You might call it coincidence that the baby started to breathe within a minute or two after we had prayed for him and his mother.  I would call it a miracle. 

Mission to Maua #8

(Blogmaster's note: Computer problems have prevented my posting these materials form the Boes until today. My apologies to all.)

As the world observes thirty years of the onset of AIDS, I am impressed with the way Maua Methodist Hospital has expanded its ministry to help AIDS victims and the survivors.  Two-thirds of the 33.3 million people with HIV live in sub-Saharan Africa.   Maua Hospital is addressing the AIDS problem in a comprehensive way, including preventive education in schools, on-going medical help for AIDS patients, and support for AIDS orphans. (Six thousand children become orphans per day due to the AIDS pandemic in Africa.)

This week I had the opportunity to accompany the Palliative Care team to see HIV/AIDS patients who have a difficult time traveling to Maua Hospital.  We went to a remote rural area where fifty patients had appointments for medical checks and medications.  Several were waiting when we arrived. 

 The Palliative Care team consisted of a nurse, two clinical officers (roughly equivalent to a physicians assistant, but with more training and more autonomy), pharmacy technician, and a woman to keep track of the records and the fees. Each patient had to pay the small health insurance fee, have vital signs taken by the nurse, then go into the next room to see one of the two clinical officers.  There, the CO would take the patient’s history, discuss their treatment, do any necessary exam, then write a prescription for the medications needed to keep the patient stable.  The patient would present the prescription to the pharmacy technician and pick up enough medication to last until the next month or next appointment.

The patients ranged from a 73 year old to a three day old.  It was heart-breaking for me to see the children come with their mothers  - both mother and child with AIDS.  A three-year-old toddler, a five year old, ten year old – all there with AIDS.  I asked the nurse what their future was and he said it was a bright future as long as they faithfully took their meds.  However, he feared that international donors will eventually withdraw or decrease funding.  Should that happen, there would be no way for the Kenya government or the patients to afford the life-saving medicines.

The three-year-old became fascinated with my hands while waiting for his grandmother.  He turned my hands over, then over again, ran his fingers over my hands, and just stared at me.  We laughed because we figured that he had never seen white skin before and he wanted to see if my hands were white on both sides.

The CO spent a lot of time with a 14 year old boy who had not been coming on a regular basis because his grandmother was unable or unwilling to bring him.  So the CO worked with the boy teaching him to be responsible for his own treatment and clinic visits.  The boy seemed very shy and I hope he is able to shoulder this life-saving burden.

The hopeful sign of the day was the three day old baby.  The mother had had prenatal care and the required HIV test.  Because she was HIV positive, she was given Nevirepine in order to prevent transmission of the virus to the baby.  The baby would also be given Nevirepine for a few months, but here was a healthy baby because of the mother’s preventive care.

Some patients showed up without an appointment; others who had appointments didn’t show up at all.  Some patients won’t follow doctor’s orders, such as the woman who wouldn’t give up drinking alcohol, others get mixed up on how many pills to take. The nurse said that more women than men are patients because men don’t want to know their HIV status.

After giving efficient, compassionate care to fifty patients, the team was tired and we packed up the records and medicines, loaded them into the truck, and headed back to Maua Hospital.  AIDS patients had been able to get treatment at this “mobile clinic”  without having to spend the time, energy, and money to travel to Maua.
The Palliative Care program is another way that Maua Methodist Hospital is reaching out to patients, providing care otherwise unavailable.

I also had the privilege of going with the director of Community Health to a food distribution for grandmothers taking care of their orphaned grandchildren.  Food prices are increasing and these grandmothers have no source of income, so they welcome the food distributed through the AIDS Orphans program.  This time we were only able to give out maize; bean prices are too high to be included.  But it was nice to see the sixty women singing and dancing in anticipation of receiving the food, see the distribution, then watch the women slowly walk back toward their homes.

 Through the Palliative Care effort combined with the Giving Hope and AIDS Orphans programs, Maua Hospital is helping both the AIDS victims and the AIDS family survivors.  

US Ambassador, rain, room to sit and a recipe

(Blogmaster's note: This post has been inserted in the chronological order in which Donna intended it to appear.)


Mission to Maua - # 9 1/2 (A series of observations, and a recipe)


The US has a new ambassador to Kenya.  Ambassador Scott Gration says graft and lack of accountability remain major issues of concern to the US.   Gration promises to push the agenda of fighting corruption and improving the justice system during his tenure.  He also promised to maintain the development programs supported by his predecessor.  Ambassador Gration has a background in both security and diplomacy and is fluent in the Swahili language.


We haven’t had rain in more than a week and the weather is noticeably colder.  (no frost warnings though; we’re not in Idaho), so guess we have moved out of the rainy season.  It was shorter than usual.  Here in the Highlands, the crops are fine, but in lower areas, the crops are stunted and fear of a drought and hunger are increasing.  Earlier this week, President Kabaki declared the drought in parts of the country a national disaster and called for importation of maize to boost the countries grain reserves.  


Isabella’s recipe for kale and also for carrots. ( You can probably use Swiss Chard instead since it might be hard to find kale.  Here they cut up the kale into fine pieces before selling it.)
3 cups of kale or Swiss Chard,  or six carrots, sliced thin
2 tomatoes, cut up
2 small red, mild onions, cut up 
1 beef boullion cube
Fry cut-up onions in a small amount of oil. Add tomatoes, kale or carrots, and boullion cube and simmer for 10 minutes.  If cooking a smaller amount, adjust the boullion cube accordingly or it will be too salty.


People are very impressed to learn that I am a retired “MP” (member of parliament) I try to explain that I represented my district at the state, not the national level and some understand.  Others think that I was in Congress.  I’m not sure if the impression of my MP status is necessarily positive since there are so many articles in the paper about corrupt or ineffective MPs in Kenya.  


ATTENTION:HP COMPUTER USERS:  Beware of unsolicited, unapproved HP programs that  suddenly appear and download on your computer.  This was our experience and afterwards, our computer just wouldn’t turn on.  Roger wondered if he has lost all his photographs; I wondered if I’d still be able to write this blog.  Finally, our local computer genius, after several hours was able to restart our computer and we breathed a sigh of relief.  To be fair,  people in the Information Technology Dept. here at the hospital use a lot of Hewlet-Packard computers and say that they have never had this experience with their computers or any problems with HP software.


Guns are illegal in Kenya except for law enforcement.  So the guys high and aggressive on miraa cut each other with their pongas instead of shooting each other.  The hospital deals with a lot of “cuttings” patients, most of them non-paying and difficult to handle for the nurses.  The law enforcement people have rifles for their jobs.  I haven’t seen a hand gun since we arrived in Kenya.


Group behavior in Kenya is different.  We have observed that, at least at church services, people file in 30 minutes, 45 minutes, or even an hour after the service has started.  If a pew is occupied,  (and after 30 – 45 minutes all the pews are full) they simply sit down, place their butt firmly on the seat and expect everyone to move over – which they always do.  Chapel services are much shorter, but the same late attendance and expectation that people will make room for them exists.  Even on a matatu, there is an expectation that one more person will fit in if everyone will just squeeze together.

Mission to Maua # 7 - Independence Day

(The photos in today's blog are from celebrations of Independence Day in Kenya.)

Today, June 1^st, is Independence Day in Kenya.  Formerly a British colony, Kenya established its independence in 1963.  While the transition to democracy has not been as troubled as in some other African countries, Kenya’s democratic journey is far from over.  A NY professor described it well in saying that Kenya is a “hybrid” – a country that has established some measure of democracy but still exhibits significant degrees of authoritarian rule and/or impunity to the ending of corrupt rule. 

A special government team found that 30% of civil servants either accepted bribes or committed corruption-related offences. Last year, the people of Kenya approved a new constitution, but their parliament is still struggling to pass legislation to implement it.  For example:  The International Criminal Court will be trying the six people charged with responsibility for the riots following the 2007 election because the ICC has judged the Kenyan courts incapable of doing so.  

The appointment of the nominee for chief judge of the Supreme Court, a respected human rights advocate, has been challenged; both the president and vice president have agreed on his nomination, public hearings have been held, but he is opposed either because he wears an ear stud, because he is a muslim, or because the Catholic Church fears he might be sympathetic to abortion or homosexual rights. 

Still Kenyans have much to celebrate.  There were no civil wars following independence, and the government is making a real effort to provide education and health services for its rapidly growing population.  Roger and I walked over to the near by stadium to watch the marching of the security police and of the school children, and to watch the native dance groups.  We were amused when a cow wandered on to the field, but enjoyed watching the crowd, hearing the music, and joining in their celebration.  We left before the honored guest, the district commissioner, gave his speech.