My Friend Leonard

I am up early again. I have been waking up at 6AM most days. Probably because of the rooster outside my window that starts squawking as soon as the sun starts shining. Here’s a little update on the patients at the hospital… The girl with the burns is doing well. Haven’t seen her in a few days, but she smiles at us most times we see her. The boy who we gave the teddy bear to… he is so friggen cute! He is medically discharged, but can’t go home until his family can afford to pay the hospital bill. Hopefully he can go soon. We had a few other notable patients. The first one was a mother who had given birth through the night. We were working the next day and happened to go into her room- we can’t remember why we went in. She had been bleeding very heavily, several hours after giving birth, which is abnormal. It is called a post-partum hemorrhage, and it is usually considered an emergency. She had lost so much blood that she was weak and tired and hadn’t fed the baby. The baby was severely dehydrated. Both mom and babe were in pretty serious states. We were able to rehydrate the baby with IV fluids and we encouraged staff to re-assess the mom and help stop the bleeding. They are both doing well now, and I think have gone home. There was another very special mama who had some complications during her pregnancy. She had a scheduled cesarean last week. The baby had some respiratory difficulties and we were all very worried. We had been visiting every day. Yesterday, when we got there, the baby was no longer in the nursery- he was in his mom’s room, and doing much better. We were so relieved.
Last Thursday evening, we baked chocolate chip cookies to bring to the kids in the feeding program at the children’s home. We don’t think that they have ever had anything like them before, so we were pretty excited. On Friday, we helped serve their lunch, and then we passed out the cookies. Before we left for Kenya, my Grampy, Stewart, gave me a bunch of Canadian flags to bring. After we passed out the cookies, we handed out the flags to each child. Then it was time for the kids to go home. Watching them all in their adorable little outfits walking down the road and waving their flags was one of the proudest moments of my life. Thanks for all the flags, Gramper! The kids loved them!!
I think it is about time I talk about my new friend, Leonard. He is a pretty funny guy. He is probably reading this right now and will quote it back to me word-for-word the next time I see him. We’re not really sure what he does. First, we understood that he was a nurse and had been trained in Italy. However, apparently we misunderstood him (he would never lie!!) and the real story is that he went to Italy before and he WANTS to be a nurse. So his job at the hospital is an “assistant,” I guess. He also helps people move. We saw him the other day outside of the neighbor’s house, standing on top of a truck with a bunch of furniture. He threw his arms up into the air and yelled: “I am the tallest!” The other day, Amy, Allison and I set out to go for a walk, and we ran into Leonard, who looked very smart in his little red vest. We asked him to join us on our walk. Because he is a bit slim, he had to go in and put on something for warmth. He took us on this road that we had never been on before. We were a little worried because it was getting late and we had to be home before dark. And sure enough, we arrived home at 6:05PM. Just like he said. Later that evening, he came over to our disco party, which consisted of Allison, Amy, Stephanie and I drinking wine and beer, and Leonard drinking mango juice. The girls played a game of Sociable. For those of you who don’t know what that is, it is a drinking game played with a deck of cards. Each card has a task. For example, the Ace is the “sociable” card, and everyone drinks. There is a rule card, where someone makes up a rule (like you can’t say anyone’s name) and every time someone breaks the rule, they have to take a drink. One of the cards is the “category” card. Someone picks a category and everyone has to say something that belongs in that category. The first person that can’t think of something has to drink. One of our categories was “Funny things that Leonard said.” It included these gems:
-“Oh, please no.”
-“I am the tallest!”
-“Please apply to be my friend.”
-“Ouch.” (as he ran into a branch).
-“You are all invited to the funeral of my cell phone. Please bring airtime and extra chargers. Don’t forget your manners. Amy Somersault will read the eulegy. It was a good phone.”
These may all be you-had-to-be-there moments, but we think they’re funny. Leonard provides us with non-stop entertainment. We won’t be giving him the red card anytime soon- that is, unless he ditches us to clean his shoes again.

St. Theresa's Mission Hospital

I have been having a difficult time deciding whether I should blog about patients at the hospital or not. Being a nurse, I am supposed to respect the privacy and confidentiality of my patients, whether they are in Canada or Kenya. I do not want to disrespect them by publishing their stories without their permission or knowledge. Another reason is that we were told before we came that Kenyans do not want to be pitied: they are proud and happy people, and want to show their best face, always. But on the other hand, I am meeting so many special people and I want to share their stories- or at least what I know of their stories. Part of our role here in Kenya is to share our experiences with the people at home.
First, I will tell you a bit about the hospital. We live directly behind the hospital. It takes about 45 seconds to walk from our gate to the back door of the hospital. There are several buildings that make up the hospital, and everything is very open. The newest building houses the maternity and surgical units, and the surgical theater. There is a courtyard between the maternity and surgical units and we often see many of the patients sitting outside on plastic lawn chairs, or even laying on the grass. There is a television mounted on the wall in the hall of the maternity unit (which is open to the courtyard) and the men (the ones who can get out of bed) from the surgical unit are usually seated in front of it, watching the news.
The patients roam around freely. I will often see maternity patients walking around the medical unit, and every so often, we see patients standing outside the backdoor of the hospital, facing our home. I really like the openness of the hospital and find it comforting that the patients can sit outside in the sun. There is nothing more depressing than being stuck in a hospital room with a bunch of other sick people, and not having anywhere to go. The patients here have fresh air and sunshine all day. I think that is almost as important a treatment as medications.
For my first day on the job, I was on the maternity unit. The labour room has three beds: there can be three women giving birth at the same time, within feet from each other. I was there for about five minutes when I saw my first Kenyan baby being born, and a few minutes later, mom and babe were ushered off to their room. There was a woman in the next bed. I stayed with her and rubbed her back. Women in Kenya do not receive pain medication while in labour. While experiencing contractions, she prayed that God would release her, but between contractions, she spoke pleasantly. It is traditional in Kenya for women to labour alone: no husband, mother, friend, or nurse support the woman while her body painfully prepares present a new life to the world. You may think these practices are cruel, but we are learning quickly that culture is culture: this is the way that it has always been done here, and for these people, it works. The mothers do, however, express appreciation to us when we stay with them throughout their labouring process. Because we are used to providing labour support, it is difficult for us to leave the room when the other nurses do. I have a lot of mixed up memories about the births that I experienced, and I cannot remember if this mama had a boy or a girl. I do remember, however, that she was happy to have a mzungo present for the birth of her child.
I spent the next few days with Pasqualina. She is a nurse that kind of floats around from unit to unit. Officially, she is a maternity nurse, but when she is not busy, she will help out on surgery, or wherever. So, I think it was Tuesday; I helped her check the vitals of the patients on the surgical unit. I wandered into one room by myself and saw the most horrendous thing that I have ever seen in my entire life- or so I thought. There was a little 10-year-old girl, naked from the waist up, sitting on her bed, with her back to me. Her back was covered in burns. They looked fresh, but then I saw that her arms had also been burnt but looked like they were healing well, so I could only assume that the burns were not fresh. I hardly even responded, because I knew that if I did, I would start crying and would not be able to stop. So I smiled at her, took her roommates blood pressure and left the room, and tried not to think of it again- which proved to be a difficult task. We asked about her and were told that she is had been playing with friends around the fire and her shawl caught fire. She ran, which only made it worse. She had been in the hospital for about 3 or 4 months. Over the next few days, I saw her around the hospital, and each time, I smiled and waved. Sometimes she would smile back shyly, and other times she would look away. A few days later, I saw the most horrendous thing that I have ever seen- for real, this time.
Allison and I had just returned from lunch and were walking through the hall with Josephine. We heard blood curdling screaming coming from the little girl’s room. We went to her see what was happening. She was sitting on a chair, rocking back and forth and screaming like I have never heard anyone scream before. She had just received treatment for her burns. A topical antibiotic was applied, and as Josephine explained, with burns, the nerve endings are exposed, the treatment causes a lot of pain. I asked if she had been given anything for pain- she hadn’t. I asked if someone would please give her something now. I had been accepting and understanding of the cultural differences up until that point, but this was something that I could not watch without doing something. One of the nurses prepared an injection and administered it. Allison and I stayed and held the girl’s hands until she stopped crying. When I left the room, I cried for the first time since starting to work at the hospital.
Since coming to Kenya, we have been trying to think of things to do for people. One of our classmates, Emily, gave us packages to give to new mothers. Each package has a receiving blanket, teddy bear, sleeper and soother. We decided to make a little gift bag for the girl with the burns and her young roommate. We took two of the teddy bears, Canadian flags, and a whole bunch of candy and put them in little bags. We went over to the hospital to give the gifts. They were not in the room. We went looking for the girl and found her sitting outside. We handed her the bag but she would not take it. We asked her to come with us, but she didn’t understand us. So we went back to her room and set the bag on her bed. The older lady that shared the room with them told us that the other girl had been discharged. We decided to give the second bag to very cute young boy who had his appendix out the week before. We handed him the bag. As we walked away, we turned and saw him looking to see what was in the bag- and he had the hugest smile on his face.
The next day, yesterday, I had to stop by the hospital to pick something up to bring to Denis, our good friend that calls us fat. First, I saw the boy. He was still smiling. I asked him how he was feeling and he said: “Well. Very well.” He was beaming. What a sweet little child he is! Then I saw the little girl, sitting on a bench a little ways away. I waved to her and she waved back. I picked up the package and quickly returned home, as the driver was waiting for me. When I got to the vehicle, the other girls saw that the little girl had followed me to the back door of the hospital. We drove away and went to the children’s home. When we returned, about 5 hours later, she was still standing there. She walked up the driveway towards us and stood there, holding her shawl. We approached her smiling, and she kind of smiled back. We tried saying some Swahili words that we know, but she didn’t respond. I reached out my hand to shake hers. She shook hands with all of us- the traditional Kenyan greeting. We continued to say some words in Swahili and managed to get a little smile out of her before we returned home.
A week later, she is still shy, and will only sometimes wave or smile- not usually both. Yesterday, I was with her while a nurse applied the cream to her back. I asked about pain medication and the nurse said that they only administer analgesia when the girl begins to feel pain. I told her that in Canada, we usually provide analgesia before a painful procedure so that the patient does not feel pain in the first place (or at least they feel less pain than they would without analgesia). She disagreed with my method, so I promised myself (because I can’t communicate with the patient to make the promise to her) that I would return to check on her soon. Soon after, Allison, the head nurse and I joined Dr. Kiiura on his rounds. When we got to the girls room, we saw that she was definitely experiencing pain. I asked if I could prepare an injection for her then and the doctor agreed. While the medication they use is an anti-inflammatory used for mild pain, it seemed to help. She did smile at me when I left that time.
Everything is so different here. Sometimes it is difficult to appreciate the cultural differences, but we have to. Pain management is not a top priority here like it is in Canada. I think that is one of the most difficult things to deal with. In Canada, we are very nurturing and compassionate towards our patients, and it is not quite the same here. Of course, staff cares for their patients, but just not in the way that we are used to. The hospital motto, in fact, is “To Love and Serve” which amazing. That, I think, should be the motto of nurses everywhere.

My new friends

We are starting to make friends in Kenya. I’ll tell you about them. I will try to get pictures of them and will update this post as I get them.
Pasqualina
She is a nurse that works at St. Theresa’s. She worked here last year when the other students were here, but has been away for a while and she just returned on Monday. I spent a bit of time with her on Monday, more time with her on Tuesday, and most of my time with her on Wednesday. I told Allison that I was having a great time on the maternity and surgical units with Pasqualina so she joined us and also had a great time! Pasqualina seems to have high standards for her nursing practice and has shown us some very clever tips and tricks- skills, she ensures us, we would never learn in school! She is incredibly sweet and very smart. I have heard her speaking several languages (English, Swahili, Kimeru, Spanish…) and I hear from one of her friends that she knows many more. After work on Wednesday, she led us around the hospital and kept saying: “We will go here and do this, and then we can go.” We did a few things, and when it was finally time to go, she led us between buildings, introducing us to hospital staff and pointing things out. She said that she wanted to take us to her home- her castle- a place called “Number 5.” We saw a row of apartments, and she led us to the door marked “Number 5!” It was a small room with very few things. But she just moved in a few days before. She had two chairs and offered them to Allison and I. She showed us two photo albums: one that Cheryl (one of the UPEI students that was here before) had sent her, and another of her own. She told us stories that went with the pictures, and when she finished showing them, she told us that we are welcome to visit any time. I am sure we will be visiting often. Today, we opened the fridge and realized that we had a ton of left-overs. We heated them up and brought them over. She wasn’t home, so we figured that she was at the hospital. We found her and another nurse, Carole, on the maternity unit and handed them the leftovers. I hope they enjoyed the meal.
Josephine
Josephine was one of the first people that we met. She is also a nurse on the maternity unit at St. Theresa’s. She also does HIV and AIDS outreach on Thursdays. We accompanied her last week and yesterday. In Kenya, most people do not own cars, and they travel by taxi, or matatu. So last Thursday, we (me, Allison, Stephanie, Amy, Kim, and Josephine) walked up to the Kiirua market and stood at the corner waiting for a matatu. We didn’t wait long. We were soon swarmed by men offering to drive us wherever we needed to go. Josephine brushed them all off until she found a car that she thought we could all fit in- which was difficult, because they are all small cars, and we are not the slimmest folks around (which the Kenyan people never fail to remind us about!) So, 6 of us, plus the driver piled into the car and headed up the hill. It was quite uncomfortable, but a lot of fun. The drive home was much the same, as was the drive yesterday when Allison and I went with her to another place called Ntemburi. Josephine asked us, on the first day how old each of us are. She told the other girls that she would be there mother while we stayed in Kenya, but said to me that I was old enough so didn’t need her- I assured her that I do, in fact, need a mother, and she is more than welcome to be my Kenyan mother while I am here! Yesterday, we went to a school to meet some kids. One of the teachers is Josephine’s sister. We talked about siblings. She told me she has 6 sisters and brothers. She asked how many girls are in my family. I misunderstood. I thought she said “How many cows?” I responded: “HOW MANY COWS??” and she laughed her head off. For the rest of the day, she’s spontaneously break into laughter and say “Ha ha ha, how many cows!” Pretty funny. We went to a restaurant that butchered and cooked goat. Yes. I ate goat. While we waited 3 hours for our food, we talked about the differences between Kenya and Canada. I told her that I have 2 dogs. She asked if they are allowed to enter the house. I said yes, of course they are. She asked if they have names. Again, yes. She asked if they are disciplined. I said… well, kind of… She laughed really hard and said that if I lived in Kenya and had dogs that slept in my house (and sometimes my bed) and I named them and talked to them, I would most definitely be sent for psychiatric treatment. She laughed some more.
Denis

Denis is a lab technician that works at St. Theresa’s and at the Machaka dispensary. Machaka, as you may remember, is where the children’s home is that we have been visiting. The dispensary is kind of like a public health office. People come for immunizations, child health clinics, etc. He comes with us and Josephine when we do outreach. The program has just recently been approved for doing HIV testing door-to-door. Previously, the outreach workers would go door-to-door and encourage people to go to the hospital to be tested. This hardly ever happened, because people do not have money for transportation to the hospital. So this new development is great progress. Denis does the testing and it takes about 10 minutes. It is amazing. If people test positive, they are counseled and advised that they can go to the hospital for free treatment. If they test negative, they are encouraged to be tested again in three months. So, Denis… He is very funny. He is not a tall man, and not an incredibly thin man, but he is a man that insists on commenting on how we Canadian nurses are rather large. The first time we met him, he looked at us and didn’t say anything, but made a hand gesture that outlined the roundness of our figures. Awesome. Yesterday, me, Allison, Josephine, Denis and another lady were in a car with Father Joseph, on our way to Ntemburi. At our first stop, he got out of the front seat and told me to get in the front because I was the fattest. Also awesome. Later, he asked Allison how many kilograms she weighs. We told him that we don’t really know- we use pounds. He told her to convert it. I told him that in Canada, it is rude to ask a woman how much she weighs. He didn’t catch on. So at the goat restaurant, Denis walked around the grounds and picked an orange from a tree. He went to the outdoor sink to wash it and got bit by a duck. We ate the orange while we waited for the goat that took 3 hours. We met up with him again today at Machaka. We were going to visit the kids and he wanted to do more outreach because we didn’t really get anything done yesterday. So we, along with two vet students, walked around Machaka handing out de-worming medicine to the folks we met and we tested one person for HIV. By the way, everyone that we have tested so far has been negative. He taught us some works in Kimeru. Kimeru, by the way, is a local language. The official languages in Kenya are English and Swahili, but there are many local languages, and the one most common in the area we are in is Kimeru. So he taught us some words, but I forget most of them now. He took us to meet some older women. We went into one house where there was an open fire and two women who looked to be about 95. It was incredibly smoky in the room (house). I took some pictures of the women but unfortunately can’t post them because I don’t have the software for the camera. Anyway, Denis is a very kind man who obviously cares for the people in the communities he visits. He is hilarious- despite the fact that he keeps telling us that we are fat. He told us that we can’t leave Kenya without eating a chicken that wanders around…. He said that they are much sweeter than chickens that are raised for grocery stores. He’s looking for one for us. I’m excited, as long as I don’t have to slaughter and pluck it.
Well, the power just went out and I am running on battery power, so I better publish this before the battery runs out. I will post pictures of my friends as soon as I get them. And there are many more people that we have met that I will write about soon.

Update from Kenya!

Blogging every day is proving to be a difficult task. We have been very busy since we arrived. I have the rest of the day off today, though, so I should be able to accomplish a blog post.
Thursday, we donned our sturdy sneakers and headed for the slums (the slums are no place for sandals- sturdy or not!). We met Josephine at the hospital and walked up to the Kiirua market to catch a mutatu (taxi) up the hill to Machaka. Josephine is a nurse at the hospital but also works doing HIV/AIDS outreach in various slum areas. We (all for students, Kim, and Josephine) piled into a little car and drove up the hill… an uncomfortable ride. Good thing we like each other! We weren’t sure what we were in for, but expected to see some desperate situations. First, we visited Agatha. She is HIV positive. She had a baby a few months ago, but the baby died of pneumonia in May. Her house was very small. There was a couch, table, and chair with barely enough room between to walk past. There was a curtain separating the sitting room from the sleeping area, and I can’t imagine that the sleeping area was very big. She had a thermos on the table and offered us tea. This was probably the tea that she had prepared for the day. It is difficult accepting things from people who have so little. Kim and Josephine both knew Agatha well, and they said that she looks much healthier now than the last time they saw her.
Next, we visited Doreen. She was born with HIV, and has been on medication her whole life. She is 18, and quite ill. She had a sore arm, and when Kim assessed it, she noticed a large lump. Doreen had been to the doctor who prescribed some antibiotics, but she couldn’t afford them. Because she is HIV positive and very sick, she cannot afford to miss taking medications. We gave her the money to go get the medication and to pay for transportation there and back. We made her promise that she would use the money for medication. I am sure it would be difficult for her to spend the money on medication when she could also use it to buy food.
After visiting Doreen, we headed to the Machaka Children’s Home area to pick up Denis, who is a lab tech that works at the dispensary there. He had a jar of de-worming pills to give out to everyone we saw along the way. They hand out the medication every three months. The outreach program was recently approved to do HIV testing door-to-door. Previously, people had to travel to the hospital to be tested, which they didn’t often do, because of the cost for transportation. So, we walked around the slums for 4 hours and handed out pills and tested people for HIV. It sounds depressing, but every that we tested was negative, which was wonderful. Also, we tested several men, which is wonderful. Often, from what I hear, men will not be tested and if their wives are tested and found to be positive, they will leave them. The outreach program is raising awareness and helping people receive treatment. We met one girl who was very scared to be tested, but did it anyway. She was so brave. Another girl walked by and said that she was too much of a coward to be tested. She said that if she tested positive, she knows that she would just die right away. We told her that treatment is free at the hospital if she is positive, and treatment will help her to live a healthier life. She still didn’t want to be tested. Maybe next time. Each Thursday, we will be joining Josephine and Denis to a different slum to do the same thing. Denis was happy that we are coming back. He said he wants to teach us how to cook Kenyan food. I think that both he and Josephine will be good friends. I think we’ll be making lots of good friends.
On Friday, we spent the morning at the hospital. I was on the maternity unit, Allison was in the CCC, and Amy and Steph were on the medical unit. I saw my first African baby being born. It was a boy. Maternity in Kenya is much different than maternity at the Prince County Hospital! The labour room has three beds- two for births, one for assessments. The two birthing beds were occupied and people mid-labour were walking in and out to be assessed in the third bed. I was in the room for about five or ten minutes and the mother in the first bed indicated that she needed to push. There was no doctor present- only the mother, the nurse (Pamela, pronounced pa-may-la), me, and another lady about to give birth. So… the baby came out and about 20 minutes later, the doctor came along. He asked me if I wanted to deliver the next baby. I am still sure whether or not he was joking. There were no more babies born while I was there, but, being that there are around 5 babies, born there each day, I will probably see lots! I stayed with the other patient until 11:30. Labour support is not a priority in Kenya, so women are often alone while they labour. I rubbed her back and tried to comfort her- a difficult task when you speak a different language. She spoke some English, so we were able to communicate a bit. She asked for an injection for some pain relief and the nurse kind of chuckled and commented that the patient feels sympathetic for herself. Very, very different from Canada. In Canada, it is often considered unacceptable to feel pain, however, here, pain is a part of life and people are expected to just deal with it. Everything is that way, here, I guess.
I felt the most homesick when I arrived at the hospital Friday morning. It was the first time we went anywhere without Kim, and it was the first time I was surrounded by people who were all speaking a different language. I was terrified for a few seconds and thought “What the hell am I doing here?” but then we started doing work and I felt a bit better. Once I get to know the staff a bit and learn a few more words in Kimeru and Swahili, I will be fine.
For the weekend, we went to Sweetwater Game Park. It was pretty amazing. I’m too tired now, though, to write about it, so maybe I will later. Or maybe I will just post pictures. Hope everyone at home is enjoying the nice weather that I hear you are having.