As I write this blog, I realize that it will be sometime before I can post. Our internet is down, hours of tending to degrees and positions of spacial satellites, we abide now in electronic quiet. No email, no Facebook, no Google, no contact it seems with the outside world.
We have a new family member (sort of), in addition to sheldon our leopard tortoise, Lucy the dog, Buster the cat, we now seem to have adopted (or rather he has claimed our tire swing) a hawk. Jay, the physics novice has named him “Steven”. He comes in the morning and the afternoon to perch on the swing and survey the yard, looking for mice or moles or whatever it is hawks eat, hopefully not Buster the cat.
On Tuesday I ventured out with my faithful and brilliant community health helper, Amin, to a village called Ketepes. It is about a 25 minute walk, upon sandy soil, thorn bush and rocks, as I climb towards the base of Mt. Nyiro. Ketepes is the closest village to us, and the first village which the TB screening and testing will begin. It took about 30 minutes for community members to collect under two separate acacia trees, one for the old men (wazee) who lied down, heads upon rocks, or squatting with a staff in hand, waiting for the event to start, the second for the mamas gathered in a group spotted with toddlers and babies crawling and or sleeping in the sand in front of us. With difficulty getting water these last number of weeks, most of the clothes of the children were absent or terribly soiled. Happy faces though, seeming oblivious to their relative poverty clamoured onto their mother’s laps. In hope to provide some health teaching and standardization of teaching in all the villages, I came up with a TB Community Education Booklet, which looks to be a little like a grade 6 science project. With few supplies, I took to drawing pictures (yes some with crayons!) illustrating how TB can cause problems, the symptoms and treatment options of TB. It took a role of packing tape, used as lamination, and an afternoon to “water proof” the bristol board sized booklet. After some teaching, and translating, we went about the work of screening the 70 or so people who gathered.
Of all the adults screened, about 20 have at least 3 major symptoms of TB. Of course not all 20 will opt for testing, but it is a start. I wait for Monday to see how many of the 20 will provide a sample for testing, and then the work of testing each sample using the nucleic acid assay (Genexpert) which takes about 2 hours per test. At times, I am overwhelmed with so many of the barriers and astounded with so many differences here with trying to implement a community health program. Going to villages, the morani are always in the ‘fora’ (mountain) with the animals, thereby a large group is left out of education and screening, the lack of confidentiality (I tried in my Western approach to uphold some sort of one to one screening, however the women far preferred to share their health symptoms with the entire group) It felt like more of a support circle than a individual health screening session. There is such variation in heath illness, and interpretation of symptoms. When I say “fever” what does this mean for a Samburu? When I ask about “night sweats” is it possible to NOT sweat at night in a small hut with a fire roaring? The questions plague me, but I also realize that must be able to identify the barriers and also be willing to continue on despite of them.
On my return trip home, I came across three patients. Often in any gathering there will be one or two mama’s who request for a home visit due to a sick family member too weak to walk or move. So, I visited a young girl with epilepsy, whose seizures are worsening. This young lady, about 15 years has permanent brain injury likely due to the many years without seizure medications. Her little baby brother (named “nathan’ after our Nathan) also presented with a mass on the side of his neck. This could very likely be TB to the glands, but we will treat first with some antibiotics to see if there is perhaps another cause. The last patient was a newborn baby. She was born early that morning, and came into the world only at 8 months gestation. Weighing less than 3lbs, her pink skin and tiny fingers were swallowed up in the cloth in which she was nestled. Unable to suck due to weakness we are trying a medicine dropper to promote feeding. A miracle to see a baby so small survive here, and I caught myself thinking of the little one I am carrying, given that we are at the same weeks (32 weeks) of pregnancy.
By the time I arrived home, I was slightly sun burned and adequately exhausted. I realize more now than ever (as I waddle through the bush) that I have some limits I must abide within.
The next week, I spent testing, which involves samples, reagent, computer input and the like. It takes some juggling of time management as I can do two tests at a time, but have to run them during peak sunlight hours so that our solar batteries can recover. I must admit I am no lab technician. Sputum scares me, I gag, even fully armed with masks and gloves and if could have it my way full body gear, there is a certain disdain for the testing process. Each test takes about 2 hours. Of the 12 tests I did, 2 were positive. So referrals were made to the dispensary to start the drug protocol. I am still working on a contact tracing protocol….. It was interesting, those who received a positive result seemed much happier and relieved than those who tested negative. I felt in giving them the “TB not detected’ result, I was letting them down. People want to have medicine (the more the better!) In fact, the other day, I saw a young girl who had a mild urinary infection and had been treated with 3 oral antibiotics, 1 antibiotic injection, anti-worm medication and painkillers. People want to know why they feel sick, they are scared by the illness they see and death around them. The Samburu here continue to die of preventable illness, pneumonia, burns, diarrhea, TB, there are cases of tetanus and polio. Malnutrition is commonplace. Disease is continual, in part due to poverty, lack of food, lack of resources such as a toilet or latrine, soap, lack of education, literacy, and cultural practices (living in mynyattas with the animals means that the ground is a cesspool of animal feces which the children crawl or walk on or play beside. There is little or no ventilation in a Samburu home, which also includes the smoky cooking fire. This compromises breathing and creating exacerbations of asthma, bronchitis or pneumonia. In general there is a great fear of HIV. Part of the resistance to TB testing is that it is by government protocol combined with HIV testing. So, I can understand in part why, not having a diagnosis is a bit of a discouragement. At least they could fight something with a name, with a course of action, because simply having to endure more days of fighting poverty and the unpredictability of health crisis that arise, is an exhausting battle with no potential end in sight.
At times I am overwhelmed. Any number of ‘health deficits’ here could provide any number of benefits and work towards prevention of diseases and improvement of health outcomes. Providing toilets or soap or food or literacy as simple as these measures seem would likely save any numbers of lives. The ideas explode in my head, but my limitations to plan, fund, implement is frustrating indeed. So I focus on what I can do, for now it is TB. I journey on with efforts to battle what I can, taking the cultural complexities and complications as learning for a greater understanding of how to improve. It is a process. I am but one person, far away from (and quite lacking in) academic brilliance and specialty knowledge. But this is what I can do. This is what I am doing. I am hoping in the new year to be able to have funds enough to buy some MP3 “treasures”, which contains the Gospel in the Samburu languages. These I can leave for a few families to share in each of the villages I visit, leaving them with a different Hope for life and healing.
The great big Lion
The volunteers girls crept over Thursday evening. Flashlights in hands, whispers that there may have been a lion spotted on the threshold of their lodgings. Armed only with flashlights, they had the good sense to come and get Jay to investigate further. So the trio returned to the scene of the crime, with our guard Isaya and a few large pieces of iron rebar. There are lions which live about 30 minutes North of us, near the airstrip at Sedar. They are, we are told mane-less lions, due to adaptation to the extreme heat of the area, but to have one in the vicinity would be rare indeed. At Sedar we often see zebra and ostrich, but so far no actual lion sightings! Leopards are more common or cheetah. GIven the description of the size (about the size of large dog) we thought perhaps a leopard or baboon. The last thing we desired was to figure out a leopard was stocking Morgan and Liesl the night before we left for Nairobi. We do feel some responsibility that our volunteers do not get eaten while we are away! Well the culprit was still there, snooping around the rondavels, it sensed the presence of four investigators and fled leaving behind a few 12 inch quills. Ok, not a lion, and thankfully not a leopard, but a 40kg porcupine with hundreds of 12-18 inch spikes standing on edge is no small visitor. Jay left them with some pieces of rebar. I don’t think there will turn into porcupine slaying champs in the next few days, but hopefully no stories either about nocturnal punctures with flying quills.
Trips and Travels
The days leading up to a trip ‘down country’ are always full and exhausting. We had been in Kurungu, for 7 months, save about 10 days in August where we got some supplies. It was time for a break. This has been the longest and busiest stretch so far in Kurungu. We can see so many wonderful things that have taken place (VBS, famine relief, construction, TB testing, Jesus Film Outreaches) yet by the end of the many weeks, the isolation, and especially in the last two weeks having no outside communication with our satellite down, the demands of village life of being on call for patients, church, school and community, as well as keeping station, car, 9 puppies (and our own children) alive has drained us considerably. So although tired we were quite happy in making preparations for a time away. It is funny the things that you have to plan for and bring for a car trip. Spare tires, air pump, patch kits, geri cans of fuel, extra shocks, water in case we are stuck for a few days, food for at least one or two days, medical kit including IV’s and epinephrine. This time, a midwifery kit was included, much to Jay’s shock and horror. (better be safe than sorry). He was quite frustrated that the delivery instructions only came in Swahili, and that the pictorial version looked like some kind of sequence game where all the pictures were out of order. We didn’t have a cord clamp, but figured one of those mini chip bag clamps would work. Thankfully, Jay did not have to crack open the kit. It is staying in the car though until we are living at the hospital in December. We made it down in 12 hours, very thankful that except for the roads being so bumpy my door and the snorkel bolts jostled out of the car frame, there were no incidents of insecurity or car breakdown.
Pray for Lesum, the boy with the foot injury. We (Amin and I) have been treating his foot since August, daily for many weeks, now every other day dressings. He was ‘taken’ back to his village by his father last week. Although the foot doing very well in it’s recovery, there is still the need for resting until the scar tissue has time to strengthen. We pray he will not be sent back out to the bush to tend the animals right away. Without knowing he would be taken, I did not have the chance to provide him shoes to wear, which might protect the foot a little. Pray there is some way I can find him to send some shoes to him.
Pray also for Mama Lareno and her 5 children. They are struggling for food. Mama Lareno works one day a week for us, but with us gone that income is not available. Instead, I have set aside some food for her she can pick up weekly to help her feed her children. In speaking with her, I was both happy and saddened to hear that in coming to live in Ketepes (a village across the airstrip from where we live) she feels her life has improved, ‘My life in Enderi, was much worse, I had nothing to feed the children and my husband would often beat me. I gave up that I would live long”. I am happy that things are better for her, but sad to hear that her ‘better’ still means relative starvation and daily hunger. Ntdallado’s knee injury is healing (he was ‘beaten’ up by primary school children). I am not sure what the reason is for the family being what seems to be ‘outcasts’. Her husband is from a different tribe, although he has abandoned the family now. I see her with her children and think of what a precious thing that is. What that has meant in terms of her will to survive. Mama Lareno recently had a TB test which was negative. She is wiling to have an HIV test as she continues to lose weight. It is hard to tell if tis is from poverty/starvation or some other disease process.
Pray for Peace- There has been no trouble in Kurungu or even in relative Samburu land. About 2- 3 weeks ago, on one of the main routes from the North to Nairobi, near to the Samburu town of Maralal, there was a disturbing incident of 24 soldiers sent to accompany the Kenyan Grade Eight exam, who were attacked and killed by members of the Pokot tribe for pillage of their weapons. It is always sad when there is pointless violence and loss of life. It is worrisome that the motivation is to steal guns. Worrisome also is the possible retaliation of the government towards the Pokot people. With rains and increase of animals often brings up old tribal rivalries and retribution for past animal raids.
And I finish this post realizing that it is mostly just a transcription of life events and days gone by, hardly interesting or inspiring I fear, but life just the same.
Piglet noticed that even though he had a Very Small Heart, it could hold a rather large amount of Gratitude.
– A.A. Milne, Winnie-the-Pooh.
Daily I am humbled by my smallness here, of life in the shadow of two huge mountains, of the smallness of efforts, of strength of impact, of my imitations of patience and love. My heart is indeed very small, but, as with piglet, I desire to stretch it with gratitude. For Him, for this work, for the Samburu, and for you…. how true are the words for us, – “I thank my God every time I remember you. In all my prayers for all of you, I always pray with joy because of your partnership” (Philippians 1:3-5).
Some more pictures to come…