It’s hard to believe that our time in Kenya is coming to a close. Three weeks went too fast. My mind is full of images of smiling children, crying babies, handshakes, warm welcomes, dust, and sunshine. With so many memories and experiences it’s difficult to chose which ones to share. Looking back I do have a best day in mind as well as a worst day and many experiences in between.
Angie and I started out at the Mikinduri hospital working with a C.O. (Clinical Officer, similar to a NP at home) and a few different nurses. This hospital is primarily maternal-child oriented with maternity being it’s only currently operational inpatient unit. The hospital programs place focus on children in the first 5 years of life; running immunization and nutrition clinics daily, providing antenatal care, maternal care and education, following children in appointments to assess development and milestones.
The immunization clinics are very busy. Mothers and babies fill the waiting room. There is a steady stream of women squishing into the clinic room 7 or 8 at a time with their little ones bundled up on their laps. Keeping the babies warm is a sign of their care, the warmer the better. These little ones are literally wearing snowsuits, hats and mittens then wrapped in blankets in 30-some degree weather. Meanwhile Angie and I were on the verge of heat stroke. It was at the immunization clinic that we met a young nurse named Olympia. She was sweet, helpful, and very knowledgeable and ran the clinic with efficiency and ease. Working with her, Angie and I saw and immunized more than twice as many babies before lunch as we had the entire previous day. Luckily she agreed to work with us for the remainder of our time doing our community assessments.
There is a large rehabilitation center for persons with disabilities located next to the Mikinduri hospital. We had the opportunity to spend some time here and take part in therapy for a 4 year old with Cerebral Palsy. There is a large population of children with physical and mental disabilities in the area. A very high percentage of home births is believed to be factor as delivery complications such as anoxic injury occur. In many communities here, having a child with special needs is believed to bring shame on the family so they will often hide these children in their homes. This means that they don’t get the socialization they need, most do not go to school and are deprived of an education and of interaction with other children. At the rehab center we met Nelly, who is a rehabilitation coordinator for persons with disabilities and is also a member of the MCOH team on the Mikinduri side. She is passionate, knowledgeable and caring. Exactly the kind of person you want working with your family member with special needs. We were lucky enough to have her agree to working with us in the communities as well.
Mikinduri Hospital and Rehabilitation Center services the people of Mikinduri and surrounding areas. Some communities are so remote that accessing a hospital is nearly impossible. Imagine being sick and having to walk hours to get help at a hospital. It would be a difficult journey on the dusty roads in the sweltering heat for a well person, let alone for an entire family suffering malaria. We spoke to families who had their young children die while walking to the hospital trying to get help, sometimes a 4 or 5 hour journey on foot. The MCOH program has done so much in the Mikinduri area, they wanted to know if there is something we can do to help in the nearby areas. 5 surrounding communities were identified as being the poorest and thus likely to have the highest needs. Our job while we were there was to assess these communities and see what these needs are. These areas were remote, requiring long drives on dusty bumpy dirt “roads” followed by hikes up and down hills and mountains. My faith in Paul (our driver) was quickly earned. He got us to places no one should be able to go. Up mountain sides, over riverbeds, through valleys. There were times the combi was a few degrees from vertical and others where we were on only two of four wheels. As some of these villages are time consuming and difficult to get to, most members of MCOH had never been to them and were eager to learn what we’d find there.
Once we had our team together, Angie, Nelly, Olympia, and I met to finalize our assessment survey with Libby and Mikinduri program members. Starting out, we didn’t know exactly what we were looking for. We started with the idea of collecting information to build a base for community health care workers (CHWs). With the nearest hospital often several hours away and walking being the most common means of transportation, assistance is needed. The responsibility of the CHWs would be to be the health spokesperson for their community, someone to go to when they’re sick who can provide basic medical attention and assist them to get to hospital when needed. The intention is to produce communities that are more self sustainable and involved in their health care by training community members as CHWs as well as to decrease the number of preventable deaths and suffering of illness by having a local connection to health care.
We were told that the government had taken on the CHW initiative, reportedly placing 10 trained individuals in each community to serve as a health resource. We quickly discovered during our time in these villages that unfortunately there are no CHWs in any of the 5 areas we went to and that they are badly needed. This has been a finding we’ve highlighted with our assessments to be addressed.
The goal of our assessments became to find out how these people are living, identify what they need, then to share this information with the people who can make a difference. I’ll admit that starting out, doing surveys in poor communities was not my ideal situation. When I joined this team, I had doing medical clinics in mind, working in an environment where my role was clear and I could use my skills. I was fearful that doing community assessments would be unfulfilling and overwhelming, that I would see sick people and be unable to help them. However, I recognized that the intent was to help these people not just in the now but in the long term. We were trying to do something different, to empower the people to take part in their health care and to discover what their needs really are which is more important than what we may assume them to be. I appreciated the CHW initiative and that it had to start somewhere so Angie, Nelly, Olympia and I set out with our surveys and an open mind.
Still, I wanted to be able to do something more for the people while we were there. We hoped that the assessments would lead to a long term pay off but in the short term Angie and I wanted to do something small if we could. We talked with Nelly and Olympia to identify common healthcare needs we could address while we visited families. Intestinal worms are a major problem with children and adults here, they are caused from poor sanitation and contaminated drinking water. The worms cause abdominal pain, distended bellies and weight loss. These worms cause diarrhea and dehydration and can progress to be fatal. Many children suffer without treatment. Ringworm, a highly contagious skin fungus is also a major issue for children. Many children have scars on their heads and faces from scratching untreated areas. Two very treatable conditions that cause a lot of unnecessary suffering. We were able to get access to a supply of oral deworming medications as well as ringworm ointment. Libby was teasing me because I was really wanting to do the deworming on our visits and kept talking about it while in Canada. When we got the medications I was very excited were able to it! Every child Angie and came across got dewormed. It was great.
*Shout out to Libby here for organizing all of our different directions for our 4 different groups, listening to our concerns and just generally being awesome at getting things done. She listened to our concerns, helped us to get supplies we needed, to be the places we needed to be and somehow managed to sneak some surprises in for us too!
The first day of our assessments we went to a community called Giithu, where the boys met Catherine, a girl with debilitating arthritis who’s wheelchair they modified to suit the mountainous roads by her home. We met Joseph, a disability mobilizer whose role is to be the spokesperson for persons with disabilities in his community. Although the areas we visited lacked CHWs, they have excellent resources with their disability mobilizers. Each community had 2 mobilizers, they were well known and well accessed assets to their communities. A promising sign for a future with CHWs. Joseph lead us around his village introducing me to the many families.
Here I met Grace, a grandmother who was in her 60s, (she thought) most elders do not know their age or the ages of their family members and they laugh when you ask like it’s a crazy question. Grace has 7 people living in her home which is smaller than my bedroom. Her husband has died and she takes care of their children as well as her two young grandsons, Loyd (they spell with one L) who’s 4, and Duncan who’s 6. Loyd’s mother abandoned him at birth and his father is in jail for rape.
Loyd is HIV positive and must travel to the hospital in Mikinduri once a month for treatment. Grace takes him by boda boda (motorcycle), a common mode of transport here, they are the local taxis. The cost is 800ksh or about $11 CDN but the drivers have started increasing it to 1000ksh to take young children because they fuss or cry or want to stop to use the bathroom.
Grace works in the community gardening and doing chores to try to raise the money each month. She has 6 children to feed and send to school and walks an hour each way to fetch their water. She looked down as she told us apologetically that she knows it’s bad for Loyd but that she sometimes doesn’t have enough money to take him to Mikinduri so he has to go without treatment.
Loyd sat on her lap looking up at me smiling shyly as we talked. Many small children have never seen a muzungo (white person) before and are afraid. The older children tend to run up to you waving and smiling and the younger ones tend to cry. Loyd warmed up to me quickly, coming right over to touch the skin of my arms and face, pointing at my freckles and touching my hair. When I leaned down to check Grace’s blood pressure he moved over from her lap to mine and my heart melted.
I knew I wanted to sponsor a child while I’m here and I wanted it to be him right away. However this was only the first day, I had no idea what was ahead of me and how many children I would be in need or how many I would want to pack up in my suitcase and take home with me. I made the decision before we left to wait until the end of the assessments to sponsor, that way I could choose the one who would be helped the most. So I wrote down Loyd’s information and hoped I wouldn’t find a child in more need.
Over the next days Angie, Nelly, Olympia and I trekked through the 5 communities. Meeting numerous families, who welcomed us warmly into their homes. We often gathered large crowds of children (and adults) that followed us from place to place, entertained by our presence. In one community a group of children laughed and giggled so hard that one them actually dropped to the ground in a fit of laughter, unable to catch his breath. I asked Olympia what they were saying and she said “they think it’s hilarious that you are walking the village”. The feeling of being followed, stared and pointed at was a weird combination of feeling like a celebrity and feeling like a parade clown. My favorite time was sitting and talking with the people, the interviews gave me that opportunity to go from “white person walking the village” to just a person talking with other people. It helped to make things less foreign, at least for me but I like to think that both of us realized that the other isn’t all that different.
I went in with a preconceived notion of what their poverty was and what it looked like. The first day looking out the window on the drive up to Giithu all I saw was sadness and poverty. No one worked outside the home, their homes were small- one room often made from mud and sticks, they had nothing but the bare necessities and many lacked even that. My outlook changed pretty quickly after meeting these people. I went from seeing a poor person to seeing a farmer. They were all farmers of crops, fruit, khat (a local drug, legal only in Africa) and some animals. After the first day I remember watching out the window of the combi on the way back to the compound at the men and boys plowing the fields with oxen and hand made wooden carts. My view changed from seeing poverty to feeling like I’d somehow gone back in time, when people did everything by hand and lived off of what they had. Sure, they were poor but the people in this first community were happy, not all sad and in despair. They were well for the most part and had enough to eat. They worked very hard for everything they had but they were making it work for them. In just a few hours my perspective had changed.
Angie and I are both glad we started in that community because things seemed to get progressively worse from there. Most communities were in similar standing to the one above, poor but getting by and happy. All were suffering the effects of the current draught, with a lot of crop failure, less income and less to eat. Some areas had nearby access to water, at the first one many homes actually had the water piped in from streams and rivers. Another community had a solar powered well and several drilled wells that were dug by the organization Plan and some had access to nearby streams. Others were not so lucky, having to walk hours to get water from the river multiple times per day.
All communities had schools, a primary and secondary and most parents recognized the importance of education for their children. The poorer areas obviously had more difficulties paying school fees and therefore had more children at home, unable to get an education and perpetuating the poverty cycle. Many said that schooling their children was the top priority, next to having enough food. Some explained that they will do their best to educate the oldest child and if successful it’s then that child’s responsibility to cover the expense of the next sibling and so on. This has been successful for some families but their system is different than ours. Class 8 exams are a determinate for who goes on to secondary school (like our highschool) so if you do poorly, you don’t go on. The kids work hard and study hard but there are many barriers. It’s hard to learn on an empty stomach, if they don’t have enough to eat, or the money to buy uniforms, or school supplies, or if they have farming or siblings to tend to at home, or if they are sick their schooling suffers and ultimately they suffer. This is a reality for most of the children we met.
There were positive stories too, for example in the first community of Giithu, Joseph’s 15 year old daughter is the only one of 8 children to attend secondary school. He said they decided to invest in her because she’s the brightest. She wants to become a doctor. Unfortunately she has asthma and her medication is quite expensive. The neighbours in her community contribute to the cost of her puffers and to her school fees because they know that if they support her she will in turn help them when she’s successful.
Their sense of family is very strong. Many of the children are older than they should be. We’d often see kids not much bigger than toddlers carrying babies on their backs. At one home I gave a candy to a little girl who looked to be about 3 years old. She opened it, put it in her mouth then closed her eyes with a look of sheer pleasure on her face, it was probably the first time she’d ever tasted a candy. Her 1 year old brother sat on their mother’s lap beside her, looking around. The little girl kept the candy in her mouth for all of two seconds, then took it out and rubbed it on the lips of her baby brother so he could enjoy it too. He never would’ve known he was missing out on anything, she could of kept it all to herself but she continued that way, sharing it with him until it was gone.
We saw a lot. Good and bad and too much to describe in words but there was one community in particular that stood out to have overwhelming need, Igurune. Families here were eating at most 2 meals per day, some only one. Many of the children were malnourished and not in school. A few families in particular were very bad. Angie and Nelly met a young woman who was very poor, a single mother and pregnant with another child and no one to help her take care of the children. She cares for her 90 year old father as well who has been unable to walk for 3 years but has not been seen by anyone because they have no way to get him to a doctor. Their house was the worst we’d seen, made of grass and sticks.
I met 3 families in the same community living side by side, they were all desperately poor infested with jiggers (or chiggers). Jiggers are small insects that live in soil or on animals and in houses. They bite the hands and feet entering the skin and depositing eggs and larvae that multiply causing painful inflammation. From the outside they look somewhat similar to plantars warts that are heavily calloused. These families were infested with them, covering their hands and feet. The children were especially bad, a baby as young as 1 and a half years had them on her hands and feet so badly that the parents were worried she’d be unable to learn to walk. One of the families had 14 people. The children were very unkept and the father was their sole provider. He is HIV positive and has pancreatic problems and large debt from hospital bills. Their mother suffers a physical and cognitive impairment to the point that she is non verbal and needs assistance with walking and full cares. She had attempted suicide 3 years prior. This family was desperate, even the locals described them as hopeless. It was really difficult and overwhelming to see, I felt like there was nothing we could do to really help them. Some families in Igurune ate only one meal a day. Children were not going to school and there was a lot of sickness. Their needs went far beyond any of the supplies I was carrying in my backpack.
The drive back to Mikinduri was especially long that day. I felt completely helpless and was just trying my best (unsuccessfully) to fight back tears for those children and those families. On the way home we were to stop at the Chalice sponsorship program office so if we’d met a child we wanted to sponsor we could set it up. I wanted to sponsor all 12 of those children in the family I’d just met. Plus the 7 next door. And the 5 that were the neighbors children. It was overwhelming. There are certain requirements for sponsorship to make sure that it’s successful on both ends. Parents or guardians must be able and willing to attend classes and must be able to be trusted to use the money for the benefit of the child. The ones that are successful are those whose caregivers have the child’s best interest as priority.
After some discussion I came to the conclusion that sponsoring Loyd, (the little boy I met that first day) would be the best decision for sponsorship. His grandmother is already working so hard to do what’s best for him. I can’t say that the other father wasn’t, but when I asked about the families needs Grace talked only about Loyd and the children, where the other father talked about himself when it was obvious that his children were not well. I met only the young ones, he had some teenagers and 2 in their 20′s who were at school and work. I didn’t know who of the 12 I would even choose to sponsor, or if sponsoring one would even help. Their problems went so far beyond what I could even think of covering. I feel sick to my stomach just writing this because making the decision to choose one child felt like I was leaving those other 12 behind. I felt defeated. We still had one more community to assess and they seemed to be getting worse each day. We were both overwhelmed and dreading the idea of going back out and seeing the same or worse and feeling this hopeless feeling all over again.
That was the worst day.
I managed to get myself together that evening enough to go out the next day. The whole point was to find out where the need was and if we don’t see it they may not get help. Thankfully things were not worse and we were able to end out assessments on a positive note. That evening we were motivated to do something for those families in Igurune. We had to do something. We saw a lot of problems with those families but what they identified as a big issue for themselves were the jiggers. We decided we could at least see if we could help with that. We looked up how to get rid of them as neither of us had ever had experience with them before. Libby came down to the market with us and we bought shoes for the children and adults as well as materials from the chemist to treat the jiggers. Angie and I were going to see about going to Chaaria on Thursday to see the hospital where Dr. Fleming was helping and to help out where we could but we decided to use this day instead to go back to Igurune and try to do as much as we could there. We knew we couldn’t fix everything but felt that something was better than nothing.
On Wednesday we went with the boys back to Giithu to fit Catherine’s wheelchair. I was excited for Wednesday because it meant going back to Grace and Loyd’s house to tell them I wanted to sponsor him. They would have some paperwork to fill out in town and the process tends to go smoother if we can make that contact before I leave. I was antsy to get there to see them. Joseph showed us the way back to Loyd’s house. No one was home when we arrived, we waited a bit but they didn’t come back. I was disappointed to say the least, I was worried that I wouldn’t be able to make contact with them, after all they have no phone and I don’t even know their last name. Giithu is also quite out of the way but the boys were going back to deliver Catherine’s finished wheelchair on Friday.I asked their neighbour Joseph to let Grace know that I would come back on Friday to see her and Loyd but I didn’t know if Joseph would see them in the meantime or not. I’d have one more opportunity to make contact with them but I was cutting it close since we were leaving on Saturday morning. They’d have to go into Mikinduri to do the paperwork and I knew that transportation costs were an issue already.. I wished I had of just sponsored him on the spot that first day when I had the chance.
Thursday morning we had a few more things to pick up at the chemist before heading to Igurune for the battle against jiggers. We walked over to the MCOH office first to pick up Nelly. Went I came around the corner, Loyd and Grace were sitting outside waiting for me. Best surprise ever! I was so happy. It turned out that Joseph gave them the message and also brought them into town to the office. They’d already been down and completed the paperwork. I ran back home to get the bag of a few things is picked up for them at the market: a pair of sandals for Loyd and leather sneakers for school, a scarf for Grace, and some blankets for the the two youngest. I have them some money to go to the market to get things they needed for their family. The Chalice staff are amazing. They sent someone up right away to help get supplies at the market. I was able to fill out my information and now we wait until the sponsorship goes through. I was able to spend some time with Loyd and Grace which meant a lot. I didn’t want to leave but we had to get going to Igurune I said my goodbyes, thanked Joseph and we headed out. Mary, Libby, and Francis (who is MCOH staff that works with agriculture) came along with Angie, Nelly and I. And Paul of course.
Angie and Nelly were motivated to help the family they saw and got a wheelchair set up for the 90 year old man who couldn’t walk. Paul got us up to his inaccessible house by driving the combi up what looked like a walking path. They delivered the wheelchair and Nelly did some teaching with how to use it. Next we went to the first family who had jiggers and started by treating the children. Angie and I brought our basins for washing clothes up to use to soak their hands and feet in the treatment solution. Once they saw that we came back to help the word spread quickly and parents were carrying their children from all over the village to us to get treated. We put as many little feet in as we could. They had to soak for 20 mins and all of the kids were patient, even helping the smaller ones to balance and keep their toes under. The little 1 and a half year old was not happy with me or the fact that I was holding her feet underwater. The poor thing bawled her eyes out for the whole twenty minutes while her older brother held her and I held her feet.
We went to the family of 14′s house next where there seemed to be even more children and a crowd of adults. This time we had the disability mobilizer do the treatments and the father of the family to help. The disability mobilizer jumped right into the role. We left supplies for future use as it takes multiple sessions and he has agreed to organize follow up treatments. We also brought what clothes, shoes, blankets and supplies we had left and gave them to the father along with moringa a super food gown in Kenya that is full of vitamins and aids in nutrition status.
Francis and Libby went up to the primary school to do an assessment for a feeding program. As this community was identified as having such high needs and low nutrition status we’re hoping to start a feeding program as early at May 1st! This would be fantastic for a number of reasons. It would mean a meal for children who sometimes eat only once per day, is an incentive for children to go to school and for parents to pay school fees. Attendance in the other schools we visited more than doubled after feeding programs were initiated. It creates jobs, encourages parents to be involved in the process of growing and preparing the food and builds community. After seeing MCOH feeding programs up and running in other schools and the impact it has Angie and I beyond pleased that this is being proposed. It would make such a difference for so many people.
That was the best day.
Today we head back to Nairobi to catch our flight to London. It’s hard to believe the weeks have passed by already.
It’s funny how much has changed in such a short amount of time. Starting out, I was worried about doing the community assessments because I felt that it wouldn’t be the “hands on” nursing skills experience I’d pictured myself doing. Now I am so glad that it worked out this way. I’m sure I would of enjoyed the clinic setting but for this trip I wouldn’t change a thing. We were able to see and experience the Mikinduri area, get to know the people and see how they really live. I feel like I have a greater understanding and appreciation for the people and their culture. We met families who would never of made it to the clinics and found out about needs I didn’t even know existed. I felt like we were able to give a voice to people who didn’t have one. We identified the community of Igurune to be in particular need and we are looking into what we can do to make it better, hopefully through starting a feeding program. I was worried about not being able to be a nurse here but I think I forgot why I became a nurse in the first place…not just to use skills but to help people.
I feel like Angie and I now have a great base for the next trip!