Visitor - O- Rama!!

Our friends Chris and Rachel arrived in Kapsowar last Monday evening in the middle of one of the worst rain storms we have seen (heard? felt?) since we have arrived in Kapsowar. We received an e-mail from Chris at 4pm saying they were in Eldoret. At around 4pm an absolute DOWNPOUR started in Kapsowar and did not let up at all for the next three hours. We decided there was no way that the matatu could make it to Kapsowar on the mud roads so they would be spending the night elsewhere. To our great surprise we received a phone call at about 9:30 saying our visitors were waiting for us in the Outpatient department.

I have become a "hand quoting" machine since Chris and Rachel got here, not sure why but they bring on the annoying hand quotes in me.

We have had a great week so far, visiting with Rachel and Chris, eating A LOT, and doing a few little walks. (Mainly Chris, Rachel and Marc, I have been a bit sick this week. Today they are going up Kipkener and after the last slog I decided that maybe it wasn’t the best thing to do with a sore throat. I’m sure Marc is happy that no evil eyes are boring into his back.)

Chris by the river on the walk he and Marc did yesterday.

Rachel has also been busy this week working in the maternity ward as a mid-wife, she has been thrown right in and is quite enjoying herself. Chris has been busy eating mendazi’s and chai at the local restaurant, going for walks and bike rides, practicing his Swahili and fixing things for me like my watch.
Rachel also got her hair braided by Risper yesterday and after a 7 hour marathon yesterday I must say it looks amazing! We had many visitors yesterday (hence one reason for the title) as she was braiding. Juliana and Chara came over to check out the process, Benjamin and Abraham came over to discuss the logistics of climbing Kipkener and to check out our sunflowers. Later in the evening we had a Canadian party (not too much Canadiana was in sight, just all the Canadians on station minus Daniel and Deng.)
This week we also celebrated Marc’s 29th birthday!! Can you believe that? I certaintly can’t, lucky for me I’m a young buck and mine doesn’t come for another six months. ;) While there aren’t too many special things to do in Kapsowar (last year we went to Cirque du Soliel) but I did make a special dinner of homemade hamburger buns (yes you read that correctly, it says homemade) with of course hamburgers and bacon and potato salad. We had nummy cake for dessert. We finished the cake off the next night at the Larson’s where Marc was showered with cards, presents and balloons by Chara and Juliana.

Marc and I were both commenting last night that he looks a little emaciated in this photo. Don't worry you at home! It is just the angle, besides who could be emaciated after a dinner of hamburgers, bacon and potato salad!!

Marc and "my" buns! (Lucky for you, you didn't have to see the hand quote!)

We are off to Uganada with our visitors and then we will be back here for about 10 days and then my dad arrives. We will be going on safari for a week and then in another three Marc’s sister and parents arrive. The lovely Joshua (do you mind that adjective Josh?) says he also might come by for a visit mid August. WHOA! Now do you fully understand my title? ☺

nutritional deficiencies

we have had a few interesting examples of severe nutritional deficiencies with happy endings here in kapsowar recently.

one is a patient who is now well known to everyone in the hospital. when gideon arrived he was close to death. his mother had left the home and he had spent much of the previous year neglected in the corner of the family hut. when he was finally brought to the hospital his heart, lungs and kidneys were all failing, his entire body was swollen, he was partially paralyzed and he spent most of the energy he had screaming whenever anyone came near him.

after treating multiple problems, we realized that his main problem was something called beri beri, caused by a lack of thiamine in the diet. his therapy had 2 major thrusts: the first was medical and involved supporting various systems while supplementing him with thiamine, the second involved the commitment of 2 volunteers from the US, alice and natalie, who spent a good part of every day playing with gideon and mobilizing his contracted joints. in addition to their efforts, most of the staff in the peds ward payed this little boy a little extra attention.

gideon was admitted for almost 3 months, and because his family could not pay the montrous bill, he was kept for a further 2 months. during that time he experienced a miraculous transformation. he went from a huddled weeping wailing invalid to a little 4 year old ball of social energy! anyone who walked by the pediatric ward was gideon's friend. if he saw kylie or myself walking up the path he would stand up and begin to wave frantically, then at a certain distance he would lean forward and just as he was about to fall on his face he would propel himself at top speed towards you like a miniature linebacker.

gideon finally went home 2 weeks ago. his physical transformation was interesting to see, but the psychological one was miraculous. from his initial reclusive angry state, through the love of many different people, he became the most gregarious precocious kid on the ward. his lopsided smile (a reminder of his previous hemiparalysis) will be missed throughout the hospital.


the second patient, jebet, came to the peds ward in a similarly critical condition. one week previously she had been alright aside from a case of epilepsy and a slight scaly rash. over 5 or 6 days the skin on her hands, feet, shins, arms and neck just peeled off, leaving a shiny pink and white area of "burn" in its place.
after initally treating her for several things at once we centered on pellagra, a deficiency of vitamin B3 (aka nicotinamide, aka niacin, aka nicotinic acid) common to people who eat primarily maize. in all our pharmacy's supply of dietary supplements, both oral and intravenous, none could be found which contained vit B3. finally, the medication i ordered for her, and the one that solved her problem, was a simple Centrum multivitamin that someone (perhaps myself) had brought from north america.

unfortunately, her right wrist was so far gone that her hand was amputated, but 1 month after coming to our hospital and being near death, jebet is smiling and happy and almost ready to go home. she used to hate me for torturing her with debridements and dressing changes and serial examinations but now she will even smile for a picture!

a third example of nutritional deficiencies hits a little closer to home. our diet here in kapsowar is radically different, but i didnt realize how much it was lacking in essential brain nutrients until kylie devised this helmet to ward off the antagonistic aqueous animae.
luckily cherri brought us our own bottle of centrum multivits, so kylie is back to her normal entirely rational completely serious self.

*****NB*****

those of you who apprecıated thıs medıcal post may also enjoy
thıs post about worms, leukemıa and lıghtenıng...
or thıs post about crazy afrıcan call replete wıth trauma and sıck babıes.

Nairobi baby!

Marc and I just got back from a whirlwind trip to Nairobi. We found out a couple of weeks ago that we would have to head to Kenya's capital because Marc's work permit had not come through and if we wanted to continue to stay in the country we would have to go and re-new our Visa's in person and get fingerprinted. (I was not very good at the finger printing, the lady had to keep telling me to relax and then she told me it was a good thing I wasn't a carpenter, not sure what she meant by that, maybe she thought I would be the tense carpenter who always hit my thumb with the hammer.)

Luckily this trip also coincided with my mom's departure from Kenya so we were able to see her off. Before she left we visited the baby elephant orphanage. awwww
Everyone here who talks about Nairobi talks about it as the awful dangerous, crime filled place and while I know that Nairobi is not the safest place in the world and that you should not go out at night, I was pleasantly surprised by the infrastructure downtown, all the parks and how clean it was!! Kapsowar is definitely not the cleanest city around with no system of garbage pickup there is garbage all over the town centre that occasionally gets burned. (Which tends to give off the most appealing smells! Last week I also saw some chickens eating some burning garbage, they didn't seem to notice it was hot. hmmmm) Anyways, that long run on sentence was there to inform you that Nairobi (at least downtown) is an extremely clean city. (Even cleaner that Paris!) There are garbage cans everywhere and absolutely no garbage on the street. In the parks there are many LARGE signs saying that if you litter you will immediately be arrested and prosecuted by the town officer. There's some motivation! Here are some pictures of our trip:

I have been craving sandwiches ever since we came to Kenya. We stopped at this cafe in Nairobi and had great sandwiches and some amazing drinks. Marc had mango juice, note his straw sticking straight up in his juice (it was so thick!) and I had a strawberry milkshake. mmmm

A flower in a lily pad pond in a park. There was a pond absolutely FULL of these flowers and there bees in a lot of them.

It's Marc's Driving School! I don't think Marc could teach anyone to drive in downtown Nairobi, it was so crazy! There are traffic lights but no one follows them. On a side note, recently a traffic light was put up in Eldoret (the nearest city to Kapsowar) but it lasted all of one day. Instead of creating order it created absolute havoc because no one knew what to do so now it just hangs lifeless on the main road.

Some very strange orbs on the main floor of our hotel. They look like they used to be lights but now they are there for crazy tourists like Marc to ride.

Oh the joy. Ice cream for the first time in many months, eaten at the Creamy Inn, located next to the Pizza Inn and the Chicken Inn.

On the grounds of the Kenyatta Conference Centre.
Civic Square.

We also tried to get in to watch a session of Parliament but unfortunately the men needed to wear a collared shirt and tie and since Marc does not have any ties we were not allowed. Maybe next time. We did see a man wearing a very cute tie of Santa golfing on the North pole so maybe we can find a quirky one to go watch the MP's debate next time. (But no clapping!)
So that's it that's all folks. Have a good day!

lake nakuru... eventually

we are falling a bit behind in our blogging due to both a decrease in the reliability of our internet connections and an increase in our activities and photography. after returning from kakamega and lake nakuru myself, kylie and her mother all promptly got sick. it was a weird sort of illness in that it seemed to affect all systems (yes, even that one) but it would somewhat retreat into the background during my workday, only to reappear with added vigour every evening. after a week of working through it i really thought i had it beat, but saturday morning it hit worse than ever! weird shift related fluctuating course. anyways, this blog post is not supposed to be about african viral patterns; suffice it to say that we were sick but not debilitated, and i seemed to get it the worst. we are mostly recovered now but still tired.

so, due to predictable kenyan bureaucratic slowdowns, my work permit did not come through, which meant that my extended work visa could not be processed, which meant that kylie and i had to make an appearance in nairobi to renew our visas and apply for permanent resident status. sounds sad except that it meant that we HAD to accompany cherri to nairobi to see her off and i HAD to take 4 days off work to allow for the aforementioned bureaucracy to grind along. aaaanyways, this blog post is not supposed to be about our trip to nairobi either, it is supposed to be about our time in lake nakuru (not actually in the lake mind you - schistosomiasis is NASTY). suffice it to say that despite all the awful stories we heard about the most dangerous city in africa, we actually quite enjoyed downtown nairobi. it is very clean and the people are incredibly diverse and quite friendly (some follow you for blocks in an effort to convince you how friendly they are)... man! here i go again; see what i mean about too much stuff happening?

soooo... lake nakuru was pretty amazing. the first night we arrived we were a bit put off by the amount of people and the buffet food and the slightly tawdry false adventure atmosphere of the lion hill sarova safari lodge where we chose to stay with kylie's mom. after a good night's sleep however we were able to put it in perspective and realize that not every place can be rondo retreat with virtual solitude in the jungle and gourmet food for every meal.

then we were further convinced that lake nakuru wasnt actually all that bad by hopping in an open topped minibus with our friendly and surprisingly humourous guide patrick. not only only did we see an incredible diversity of african wildlife but we saw it in enormous volume! i'm talking about the costco of wildlife parks. kylie and i had been on safari in uganda and seen a lot of cool things (and got invaded by army ants) but it was nothing like this! i'm talking about a MILLION flamingoes, hundreds of zebras and gazelles and impalas and water buffaloes, hundreds of baboons, twenty rhinos, fifteen giraffes etc. etc. seriously crazy.

this is me standing on the beach with the flamingoes (this blog is close captioned for the blind who have someone else reading the captions to them)
this is me wondering how on earth one lake could breed this many flamingoes. i know there have already been 3 flamingo pictures, but these guys were seriously crazy. lake nakuru is famous for its huge bird populations and on the beach you could actually feel the sussurations of hundreds of thousands of flamingoes making the odd cooing noise, stepping, feeding, flying etc. it filled the air with a soft throb of audible avian amplitude.

we saw a lot of ostriches up close and they looked grumpy. we decided that they must be pretty jealous of all the other birds that can fly. ostriches just get these useless wings that they cant even pick things up or defend themselves with.

like i said, a huge diversity of wild animals... this one was the one that put a chill in my spine. you wouldnt want to cross her by say, drinking too much of her milkshake, or insinuating that she consistently eats the best bites of your sandwiches.

here is a picture that proves beyond a doubt that baboons are truly evil. these little monsters eat calves and baby impalas! plus they moon unsuspecting bystanders whenever possible.

we saw a herd of giraffes that complacently grazed right beside the vehicle.

this young male lion was only mildly perturbed by our presence and after a while got up, stretched and ambled slowly through the underbrush alongside our vehicle. this is the only good picture i got of him, but i took some nice video as well.

as i mentioned, rhinos all over the place... these guys are huge!

i already put up a picture of this lizard ( i dont remember the name - red headed something) but he was just begging for more. he was totally working the camera, flitting from rock to rock, stopping to stretch his neck against the backdrop of the lake in several different poses.
after our exciting day we cooled down in the hotel pool and had a great talk with the pool attendant michael, a masaii man who can support his entire extended family back in transmara on his salary from sarova. after this picture was taken i took great pleasure in throwing cherri in the pool. michael informed us that in african culture i would be terribly cursed for showing this level of disrespect to my mother in law. cherri was elated. michael was also aghast that i had "acquired" kylie for free. if i was not able to provide her family with 20 cattle then i should have at least bought her a home. note the massage tent in the back left where kylie and i both had the massage of a lifetime in the evening to an aural backdrop of croaking frogs and twirping crickets.


finally, on day 3 in nakuru we left the sarova and moved to a much cheaper hotel in nakuru proper. we spent the afternoon on top of an incredible crater. i am really tired of typing now so i will let this picture say its 1000 words. hopefully we will post about our time in nairobi in the next couple days... we dont have much time, b/c our friend chris is coming in less than a week and after hanging out in kapsowar for a while, we will be off to explore uganda for a few weeks with him! dont worry, i will still be working at the hospital in between all these adventures, so there will still be adequate opportunity for more lovely medical stories.

Rondo Rondo

As mentioned in our last post, Marc, my mom and I are back from our week of vacation. We had a wonderful time and did not want to come back. (Even though Kapsowar is very beautiful, it sure is nice having gourmet meals made for you every day and laying around reading and walking in the jungle for a while.)

We went to two places on our vacation. The first destination was the Kakamega Rainforest. Here we stayed at a place called the Rondo retreat centre and I must say that it is one of the most beautiful places I have ever been. We also went to Lake Nakuru to go on safari but Marc will do a post about this after.

In the matatu on the way there.

The centre is set up with a main house and several cottages around the grounds. We stayed in the main house and had the veranda and BOTH living rooms all to ourselves the whole time.

A crazy flower on the grounds. It was a type of banana plant!!!

Here is a typical day at Rondo:
Rise at about 7:45 and leisurely head down to breakfast. Breakfast was a piece of fruit (mango, passion fruit etc..) with cereal, followed by eggs made any way you like and bacon and toast.

My mom enjoying the fruits of her breakfast.

After breakfast we went for a jungle hike. The first day we walked through the rainforest and saw hundred of butterflies. Monkeys were also seen in abundance both days. We climbed up a lookout point and had a great view of the forest as well as some areas where some nursery trees are growing.

A blue monkey

A colobus monkey

A binoculus monkey

This is a parasitic fig tree that starts out as small roots and slowly wraps itself around an existing tree and strangles it to death. The tree then dies and all that is left is the fig tree and you can't even eat the figs!!
Inside the evil fig tree
On the trail

The second day we did the hill walk where we walked to to top of a hill (imagine that!) ;) and had a great view of the Kakamega Forest. We also went into a bat cave. We had decided the day before that the hill walk and bat cave would be a great idea and when I was imagining a bat cave, I was imagining a tall cave (at least 10 feet) and if the bats flew over my head it wouldn't be a problem because they would stay close to the top of the cave. However, the cave we went into was barely six feet high and in some places was about 5 feet high. This made from some very loud screams emanating involuntarily from my mother and I and looks of annoyance from Eunice (our guide) and Marc.

Eunice and the bats.

Crouching to get away from the bats. My mom is only smiling because she knew Marc was taking a picture.

Our afternoons were usually spent reading on the veranda. Here is the view we saw when we looked up from our books.

Sometimes we went for a walk to look at the beautiful flowers on the grounds!

At 4:30 high tea was served on the veranda with a very large piece of cake. We did A LOT of eating on this trip!

The view from inside our bed. After an amazing full course dinner we headed to bed to start another day of relaxing.