"Life is a Bold and Exciting Adventure"

         “Life is a Bold and Daring Adventure!”

    25 years ago David and I got this very fortune in our fortune cookie after finishing a dinner of Chinese take-out... and that’s the way it’s been ever since, but Kenya was the epitome! Whodathunk two semi-young oldsters like us could go and be and do all that we went and gone and done! It still gives me goosies.

Dr. Komar Koech, the one and only neurosurgeon in Eldoret now has attachments for his cranial drill, a plethora of drill bits, ventricular and lumbar drains, instrumentation for repair of skull and dura defects, assorted forceps, aneurysm clips and appliers. He and David became good friends, sharing ideas, experiences, concerns and anecdotes. Congeniality flows easily when standing side by side with a colleague, muckin’ in a brain. There is no question MTRH and Dr. Koech were very grateful (see attachment) for our visit.

      I gained a new understand about third world medicine and its challenges, and how phenomenally privileged we are to have clean water, fresh food, a warm and dry shelter to keep us safe, and electricity to light our way. Kenyans are industrious people but how can they support their families when jobs are so scare and education so minimal? How can their children be healthy when there is not enough money for food or shoes?

    I have reassessed my thoughts about charitable giving. David and I have always been generous contributors to educational institutions, cultural events and foundations for public good. However, I have never been a believer that a whole lot of money necessarily makes things better. It certainly makes things different, but often new problems emerge. I’m not interested in helping mega-coffers get fatter and letting the largesse accumulate until a miniscule portion is siphoned off at a set time, supposedly to benefit some unknown entity. I want to feel that human-to-human touch, and know that my contribution can actually change a life. I felt that at The Patrician School and at the Fistula Clinic. Imagine, one year of fine education for one young boy or girl for $100! (Isn’t that about a month’s worth of lattes?) Or a young woman given a whole new life to look forward to, thanks to a $500 surgery! Has there EVER been such a bang for a buck? If you have an extra $10 or $20 or $50 in your wallet, consider donating to: www.alittle4alot.com ( check out their website to learn how they are sending young fistula survivors back to school, then helping them find a career to gain their independence). If you wish to express your generosity thru scholastic endeavors, then consider a small donation to the Brothers of St. Patrick and ask that it be sent directly to The Patrician School in Kabongo (www.patricianbrothers.org).  Donations to any of these 3 is fully tax-deductible. Then give yourself a hug...a really, really BIG one! (and you’ll get a BIG one from me too!)

     I am grateful for the beautiful zoos we have in America. All these years I had viewed them with a modicum of distaste, believing that animals deserve to live their lives in the wild. I have come to learn that the wild is, in truth, often too wild and these magnificent and exotic creatures have their life span shortened by half when not protected from predators. I also realized that without zoos, children would never see the majestic grace of a cheetah in a tree, or the lumbering gait of a giraffe, or the gray crinkly folds in an elephant’s ears. To spend one’s entire life and only see the tantalizing stripes of a zebra in a picture book? No, I’m glad we have zoos.

And then, there’s Veronicah. I don’t know what she will become, or what will become of her. Will she be strong enough to stand alone and rise above her generations of poverty? Will her determination of getting an education be stronger than the primal and cultural pull of early marriage and endless babies? I sent her a picture of our first day when we were registering at the school together. She was barefoot and small and I tucked her in close beside me, in some vague and futile maternal hope that I might somehow leave a protective aura around her, even when I am half a world away. I want her to remember that picture and know that on that day someone looked beyond the dusty and dirty old dress and saw a precious jewel, a beautiful and intelligent young girl, a tender being with a beating heart who deserved every chance in the world to shed her rags and fly to freedom. I want her to look in the mirror and know she is worth it. I knew it then and I know it now. I want her to hear her once stifled voice, as it says to her: “Veronicah! You are worth it! You are worth it!”

I’ll keep my fingers crossed.

I can’t say goodbye to Kenya without revealing what I will miss most. It will be the graciousness of the people; their smiles, their kindness, their gentle humor and endless cheerfulness. For all the extreme poverty, the abysmal progress of government to ameliorate basic services, the high prices that rob these dear people of basic food and needs, they are HAPPY! They are joyous to be alive, grateful for another day and delighted to share that with everyone. They don’t have “issues”, they don’t wake up on the wrong side of the bed, and they don’t ever think they got the short end of the stick. By having nothing, they got it all!

Figure that one out-

Harambee! (“Let’s all pull together”)

1. You have let me walk a mile in your shoes, as I was walking in mine. Thank you for the honor.

2. Quiet moments at the Club in Eldoret.

3. A few of my favorite souvenirs: Hand woven and beaded basket from Imani Workshop, with 2 Kenyan pencils and a soapstone heart I found in a

shop next to the Uniform Store in Eldoret. Two hand carved wooden masks, an eland and a cheetah and between them a small tasting spoon with a horn handle. A charming little round beaded box made by the Nalutuechas, a necklace from Imani workshop (round beads hand rolled from clay then baked and glazed; long beads made from glossy pages of old magazines, rolled and shellacked). Assorted earrings and key fob and coaster made by Alice, the lovely Maasai lady. A small and oh- so-charming handmade polka-dot giraffe from “Mothers with HIV” group home.
4.  What a delight for us! We hold a small fund-raiser/reception at our home for Hillary and Carolyne Mabeya (and the One-by-One Foundation) when they come to Seattle for a visit!
                                                            

                                                            

 

 

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US-based Neurosurgeon Donates 8M Equipment to Hospital

Tuesday, 27 March 2012 11:43 | Written by Public Relations

A US-based Neurosurgeon has donated neurosurgical supplies and equipment to the Moi Teaching and Referral Hospital’s Neurosurgery Department worth US$100,000 (Kshs. 8M).

Prof. David Pitkethly, M.D. Professor Emeritus at the University of Washington’s Department of Neurosurgery and his wife, Mara, a Registered Nurse, visited Hospital under the auspices of the Foundation for International Education in Neurological Surgery (FIENS).

Prof. Pitkethly worked with the Hospital’s Neurosurgeon, Dr. Florentius Koech in the theatre and at Neurosurgery Clinic for two weeks. He was also involved in the Medical Students’ Instruction Program.

“I had occasion to work with Dr. Koech and I must say the cases in the United States are quite different from the ones in Africa in a number of ways, but all the same it was an excellent experience,” he said.

The donation, said Prof. Pitkethly, was made possible through the efforts of American companies led by Styker, Medtronic, Aesculap and Integra.

While receiving the donation, Dr. Koech-Head of Neurosurgery Department, expressed gratitude saying most of the neurosurgery equipment and supplies are hard to find locally. He added that the donation will be of assistance to persons living within the Hospital’s catchment area.

“This donation will sure go a long way in helping people residing in Western Kenya, parts of Eastern Uganda and the Southern Sudan with a population of close to 20 million. We treasure the collaborations and partnerships entered between the Hospital and medical and teaching institutions in Kenya and the world over. We look forward and remain indebted to their continued support,” said Dr. Koech, the only practicing Neurosurgeon outside Nairobi.

His wife Mara, who was attached to the Academic Model Providing Access to Healthcare (AMPATH) outreach services, had occasion to be at the Hospital’s Riley Mother and Baby Hospital (RMBH), Reproductive Health Division (Fistula Clinic) and the Patrician Primary School in Kabongo.

“Our two weeks at the Hospital has been most delightful. We enjoyed working there just like we did the excursions. Kenyans are the kindest and most friendly people we have ever come across,” Prof. Pitkethly and Mara said on their last day at the Hospital.

 

All Good Things Must End

We had originally planned to stay 2 full weeks in Eldoret, departing for home on Tuesday. However, after talking with Dr. Koech and learning there was no surgery scheduled for the weekend, he encouraged us to spend the last 2 days of our trip in Nairobi. We had bought one-way plane tickets from Nairobi to Eldoret, leaving open the possibility of driving back at the end of our stay. I had longed to see more of the countryside, but David was not too eager to suffer through the endless bumps, potholes and areas where the road was simply gone. When the hospital offered to arrange a driver and a relatively new SUV Suzuki to deliver us, David happily settled into the front seat for the next 5 hours and we gazed endlessly at the wondrous countryside.

The scenery was delightful. As in Eldoret, there were cows and goats and donkeys grazing along the roadside. Of interest, is that the majority of cattle in Kenya are sold and shipped live to Saudi Arabia, where they thrive in the similar climate, and are resistant to most diseases. We passed truck after truck, yet there were always many more ahead of us. This was the main east/west route between Mombasa and neighboring African countries (Sudan, Uganda, Rwanda, Burundi and the Congo). The faster the truckers are able to drive, the sooner they can deliver their goods, get paid, and head out again. Gas is the same price as here ($4 a gallon) so they rely on their speed and daring to cross the finish line in record time and start the clock again.

Nairobi! Here we come!

Nairobi National Park: What an unimaginable place! This 30,000 acre reserve is just 4 miles out of town and what separates the wild animals from the booming downtown metropolis is just one fence. Suddenly we were on a mini-safari! Lions and tigers and bears... oh my! Well, lions yes, but not for our eyes, they stayed tucked away and felt no need to impress us “mzungus”. Same for the tigers. and no bears there, never were, nor elephants. But we tooled around in a big desert buggy and had some up-close and personal moments with giraffes, zebras, gazelles, wildebeesties, impalas, buffalo and even a white rhino! The park is a self-sustaining ecosystem, meaning animals are not fed, they must hunt (each other) for all their food.There is no breeding program and every animal fights for its own survival.

David Sheldrick Baby Elephant Sanctuary: Located near the park’s entrance, and open one hour daily, from 11-12, this place is the ultimate definition of CUTE! Only baby orphaned elephants up to 2 years may reside here, then they are transported to a national park in the south. At the sound of a gong, they come ambling from the upper meadow toward the crowds of gaga-eyed tourists and clicks of cameras, heading straight toward their trainers and that BIG baby bottle of fresh milk! I couldn’t help but start humminng the “Baby Elephant Walk” song of the ‘60’s by Henry Mancini.

Nairobi Giraffe Center: A non-profit park founded in 1979 in hopes of saving the endangered Rothschild giraffe from extinction. There were only 130 left in the wild at that time, having lost their natural habitat to the expansion of agriculture. Today there are over 500 in Kenya and they are magnificent!!!

Nairobi National Museum: Opened in 1930 and called the Coryndon Museum. After Kenya received its independence in 1963 it was renamed The National Museum of Kenya. This large and spacious museum is set on stunning grounds and features artwork, sculpture and botanical gardens. It is an educational experience and reflects Kenya’s national heritage and culture. We enjoyed a delightful lunch on the patio but passed on a visit to the snake house.

Maasi at the open market: Certainly the best place for souvenir shopping in Nairobi! Maasi ladies bedecked and bedazzled in their finest head/ear/chest gear are happy to bargain. You’ll always get a really good deal...at least the ladies will charm you into THINKING you did!

...and all too soon – we’re flying home to Seattle.

Kwaheri! (Goodbye)

Mimi itabidi! (I’ll miss you-)
                                      

Feeding time for the baby elephants and moms

A beautiful Masaii lady selling her jewelry at the market in Nairobi

Off on our mini-safari

Upstairs/Downstairs - A Neurosurgeon Turns Gynecologist

It had been quite an exhausting day at the Fistula Clinic and I was eager to tell David all about it. I shared with him some amazing (and heart-breaking) facts I had learned:

There are only 5 or 6 fistula surgeons in all of Kenya. Even though there are 20 gynecologists for the entire catchment area of western Kenya, only one, our Dr. Hillary Mabeya, does fistula repair. His clinic in Eldoret was the first dedicated center for this major health problem.

There are 3,000 new fistula cases in Kenya alone every year (50,000-100,000 in all of sub-Saharan Africa) and many thousands of women are suffering without even knowing treatment is possible treatment. 2/3 of the births in Kenya among rural women occur without pre-natal care or a skilled attendant at delivery. 1 in every 26 African women will die in childbirth...1 in 26!!! Compare that with 1 in 8,000 in developed countries.

The Fistula Clinic has done 100 surgeries since June 2011 and is on track to do 150 more before the end of 2012.

Total cost is US$450 - $500 and this includes surgery, anesthesia, medicines, supplies and total care for one woman thru the necessary one month of recuperation as she resides at the clinic.

The Fistula Clinic receives no federal money from the Kenyan government. Even though they receive a small amount from AMREF (African Medical and Research Foundation) the great majority of the clinic’s financing is obtained thru private donations and their yearly fund-raiser/gala in SEATTLE. They have contacted “Heifer International”, a very fine and trustworthy charity, for possible financial assistance and recently had an appt. with the Bill and Melinda Gates Foundation.

The clinic has a very long waiting list for surgery. They work as long as they have financing and sometimes must wait for additional funding to come in.

The key to eradicating fistula is education about family planning, providing timely access to healthcare, teaching respect for women and their role in society, proper nutrition and alleviation of such profound poverty.

With regard to female circumcision, many groups are attacking this ritual with a new perspective. Well known in Kenya is the national health program called SETAT which encourages a “Cutting of words, not skin” campaign. There is also male circumcision that boys undergo as a rite of passage to adulthood when they are 10-12 years old. The complication rate for this is miniscule compared to that of the girls.

It was Saturday and our last day in Eldoret before heading to Nairobi. We had been invited to an out-of-town party but would not have returned in time to pack, so we declined. That left the day open and Dr. Mabeya was delighted to see me again, and in particular, the new recruit I brought for his operating room! Dr. Mabeya works with a nurse and an anesthesia tech, who administers a spinal and helps out the nurse as needed. David and I both gowned up and scrubbed, and I assisted the surgical nurse while David assisted Dr. Mabeya. The basic role of a surgical assistant is to assist the surgeon thru retraction and suction, and David readily acknowledged that it made no difference what end of the body he was working on – the basic principles were the same (Yes, that’s him in the picture!). I assisted the nurse with sterile transfers; it had been a long time since I had been in the OR and I was delighted to reacquaint myself with the procedures.

Our patient was a 15 year old married girl who had recently birthed a 13 pound baby and suffered a protracted labor before she was finally taken to a hospital for a C-section. The fistula became apparent immediately after childbirth and she was in despair. She returned to her village and awaited her turn for surgery. She was lucky, her husband had not left her so she had a home to return to after her stay at the clinic.

Most of the women are from small remote areas and come a great distance. They stay at the clinic 4 weeks, keeping a catheter in their bladder to avoid any pressure on the repair site.The urinary drainage goes from red to pink and soon back to yellow. They need a healthy diet, strong antibiotics and quiet time for the body to rebuild tissue and heal. For this reason they are not sent home prior to one month; it is too likely they would have poor nutrition, be expected to work in the fields and have intercourse.

There is an excellent short film “The Walk to Beautiful” produced by PBS for the NOVA series, you can find it on the web. It follows an Ethiopian woman from her small village to Addis Ababa for fistula surgery. I have embedded a link to a preview. Click below on the photo.

                                      

 

                                                                                  

Dr Hillary Mabeya, a true HERO

David assists with retracting while Hillary operates.

                                                                             

A Most Indelicate Situation - The Shame and Disgrace of Sub-Saharan Africa

My days were so full, it left my head spinning. I felt like a kid in a candy store and there was still so much I wanted to see and do during our time at the Moi Teaching and Referral Hospital (MTRH).The past several days had been fun and upbeat ; our weekend trip to the country, Veronicah’s very first shopping spree, and spending time with the HIV kids in the Sally Test Playroom. Of the many learning opportunities that abound at MTRH, there was one that was emblematic of the African woman’s degradation and heartbreak: Fistula. This was my chance to learn more about it.

I asked the PR Dept. to make a contact for me and 20 min. later Jared Momanyi was greeting me outside the door of the Fistula Centre, just a short walk from the hospital. He handed me a business card and explained that the foundation “One by One” raises money for these surgeries and almost 80% is thru individual donations. I glanced at the card and did a double-take; written on the card was 2622 NW Market St., Seattle, WA. He explained that 2 women, Heidi Breeze-Harris and Katya Matanovic, had heard about fistula on the Oprah show and wanted to do something to help, so they started this wonderful foundation and now support similar fistula repair efforts in Tanzania, Niger and Ethiopia.

Fistula: a narrow passage or duct formed by disease or injury; an abnormal opening between one hollow organ or cavity to another.

Fistulas can occur in many places in the body, but now I am referring to obstetrical fistula, which is quite prevalent in third world countries, and very, very rare in America. For the 3 million sub-Saharan African women with inadequate medical care, obstetric fistula is a life-changing situation. It is estimated there are between 50,000 to 100,000 new cases every year and pitifully few doctors willing or trained to treat it. It is the “by-product” of an uneducated culture firmly rooted in its traditions which are maintained thru relentless poverty. Young girls are married off early, often by 12 or 14, so as to assure their virginity for a suitable marriage partner. It is not unusual for them to be treated as second class citizens (domestic violence is not uncommon) and they are prized for their ability to procreate. Frequently they are taken to live in remote abysmal bush areas, far removed from medical facilities. With no prenatal care, it is not unusual for these young girls to be in labor for up to several days, resulting in death for over 50% of the newborns. The prolonged and unrelenting pressure of the infant’s head in the birth canal cuts off blood flow to the wall between the bladder and the vagina (or rectum, or both, in some cases), leading to tissue death. This tissue death leads to erosion with “holes” (fistulas) to the neighboring organs. Vesicovaginal fistula is an abnormal opening between the vagina and the bladder that allows the continuous and involuntary discharge of urine into the vagina, from where it flows freely out of the body. Rectovaginal fistula, occurring in 20% of the cases, is bowel incontinence thru the vagina. With subsequent childbirth, these fistulas often enlarge and get infected, and without treatment, this leads to weakness, cachexia and possible death.

The psychological toll almost defies description. Imagine being an adolescent girl who suddenly finds herself without bladder (or bowel) control. What an appalling situation! They often restrict liquids and food to decrease the leaking or seepage, resulting in marked malnourishment and kidney disease. They are shunned by their husbands who frequently leave them, and family members who view them as offensive. It is not unusual for them to be sequestered in small huts on the outskirts of their villages with limited personal contact. They are so poor that they use whatever rags they can find to absorb the soiling, then wash, reuse, wash, reuse.

Another cause of fistula in young women is secondary to infibulation, or ”female circumcision” (also called female genital mutilation: FGM) still practiced routinely by certain African Tribes. Even though it was finally banned by the Kenyan legislature in 2010 (barely 2 years ago!), the law is practically impossible to enforce. In this horrendously archaic and barbaric ritual, a pre-pubescent girl’s clitoris and most times, the labia as well are cut off (without anesthesia or sterile equipment, perhaps with just old knives or sharp rocks) and her vagina stitched tightly closed leaving a miniscule opening for urine and menstrual flow. She is then “unstitched” a short time later when a husband is found. Unfortunately, the damage is already done. These young girls suffer chronic pelvic infections which lead to anemia, dysmenorrhea, compromised fertility, life-long discomfort, and often times, fistula. It is not uncommon for them to be HIV positive.

Jared gave me a tour of the clinic, which had been an old condemned house. A small outside shed was the new kitchen where 3 young cheerful cooks prepared greens and rice for lunch.The original living room was now the patient waiting area, 2 bedrooms were made into exam rooms and the original kitchen with its kitchen sink became the scrub area and surgery suite. I was given permission to observe 4 women who were scheduled for surgery the following day and were receiving their pre-surgical exam. Two of them (one was very young, the other 67 years old) had been circumcised. The doctor spoke to the older woman in Swahili and learned that this was her first gynecological exam. He carefully explained that he would insert a catheter into her urethra and then fill the bladder with sterile saline solution colored with a blue dye (gentian violet). By observing thru a vaginal speculum, he could watch the stream of leakage and assess the size and location of the fistula. Almost immediately as he filled the bladder, the blue liquid flowed freely out thru her vagina and into the basin beneath her. She said she had been incontinent of urine since 1985 and only recently heard that this operation is available. It has a 90% success rate for simple cases and 60% in complicated ones. Three more patients were examined, one with a rectovaginal fistula. After the exams, the ladies went outside and chatted with the dozen or so other patients who were staying in the clinic wards, recuperating (seen in the photo outside the clinic).

We’ll see what tomorrow brings for them...hopefully, a new way of life, they have certainly suffered enough-

The Fistula Hospital in Eldoret



The cooks are in the kitchen...fresh greens for lunch!



Ladies lying down are post-surgical; those standing will have their operations tomorrow.

Clean, tidy dorms where the ladies live for one month post-op.

                                                                        

Time for a Road Trip -Our Weekend Away

David’s time on the neurosurgery service was primarily Monday to Friday which left us the weekends for visits to the countryside. Our driver, Kirui, offered suggestions and he happily drove us to several well-known sights.

We spent an afternoon in Kitali, a town NW of Eldoret, where they have a well-known nature conservancy dedicated to plants, trees and deformed animals. It reminded me of a “Ripleys Believe it or Not” but at least there was consolation in knowing, that the bull with 2 heads, the cow with 3 eyes and the goats without forelegs (not to mention countless hermaphrodites) were well-fed and grazing their lives away on the savanna. The gardens in this conservancy were picturesque, as were the old wooden bridges over streams, thatched roof meditation huts, and even a small boat begging for a quick paddle.

Kirui insisted we see a lush and green part of the Rift Valley so unlike Eldoret, which has a landscape of dust and red clay. He drove us to the Kerio Valley, about 30 miles east of Eldoret. The thin ribbon of water at the very bottom of the valley is the Kerio river, where we saw crocodiles sunning themselves on the hot sandy banks. Steep rocky cliffs line the sinuous route of the canyon, carved out over millions of years by the river. We planned this volunteer medical trip to avoid the rainy season: Kenya has 2 a year, April to May and October to December. During that time, the canyon is flooded to the very top, roads turn to mud and pot-holes become small ponds. A delightful restaurant at the summit, Hotel Kerio Vista, lived up to its “Vista” name and also offered grilled cheese sandwiches, a welcome alternative to the typical Kenyan fare of rice / beans / kelp.

Kenyans are well-known for long distance running, having dominated both the Olympics and the NYC Marathon for decades. The high altitude of Eten, 34 km. east of Eldoret, at 7,500 ft. makes it a perfect place for training. Located at the crest of the Kerio Valley and far removed from the lumbering camions in Eldoret, it guarantees quiet roads and challenging hills. We visited a high-altitude training camp run by Lornah Kiplagat, one of the most successful Kenyan women runners of all time. Foreign athletes often stay for long periods of time, but it is also open to tourists for $33 per person a night, which includes 3 organic meals daily, personal coaching, 5-lane lap pool, physical therapy and massage. The atmosphere is unpretentious and jocular, as winners and wannabees mingle and watch track and field meets on a large screen TV in the clubhouse.

Who could resist a visit to the equator... a chance to be on the opposite side of the hemisphere and still hold hands with your loved one? A photo-op, for sure, as well as an opportunity for entrepreneurship, as locals ply their way along Latitude 0, selling “Certificates of Authenticity”. So, who needs a piece of paper? We knew where we were - I was here...and David was... a hemisphere away!
                                         

My lovely Veronicah

I am on the road with AMPATH as Emily tries to “capture” those who have not maintained recent contact with the clinic. Have they moved? are they non-compliant? did they die? A young girl has pointed us to a woman washing clothes. I stay with the girl as Emily speaks to the washer-lady who shakes her head: No, she doesn’t know where we can find our lost patient, she moved away and is gone. I look at this little girl and think: one is gone, and from the looks of things, this one next to me is going, going...going nowhere. I gently question her. She says her name is Veronicah and she doesn’t go to school, and no, she’s not sick. I ask Emily to speak to her in Swahili so I can know more about her. The girl is shy and speaks very quietly, as do most young Kenyans, often inaudibly. She says her mother and father died and she was sent to live with a grandmother in another region but when that grandmother couldn’t care for her, they sent her to the grandmother she is living with now, named Jane. But why isn’t she in school today? I ask again. More Swahili chatter. Emily looks confused with her response so she returns to the lady washing clothes, Veronicah and I follow. More Swahili. The lady washing clothes shrugs a lot, seems to answer Emily as best she can but finally just puts her hands on her hips with a: ”That’s just the way it is” finale . Veronica’s hands are back in the murky suds, scrunching and wringing and I ponder if the clothes are looking one bit cleaner coming out of the water than they were going in.

In 2003 the Kenyan government announced this as truth: “Public education is free to all Kenyan children”. Well, that’s probably no more than a HALF-truth...Education is free to all Kenyan children... Yes, to those Kenyan children who can afford to buy the full uniform of their school (US$45), own clean black shoes (US$22), buy a wooden DESK (YES! it’s BYOD! price variable), get a “gym set” uniform (US$10) and a “math kit” (US$4) and notebooks and text books and other supplies (US$15) and, in the case of Veronicah, also pay a “transfer” fee of US$10 to change schools. Schools in Kenya receive only US$130 per student per year from the federal government and will often add illegal “fees” to bring in more revenue. For grandmother Jane, that would be more money than she could ever put together. So while Jane is hoping to find day labor in the fields (almost 25% of Kenyans earn less than US$1 a day), Veronicah idles away her time, thinking she may earn a few schillings by helping a neighbor wash clothes. Food isn’t cheap in Kenya: loaf of bread $1, apples, fruit, sugar and dairy are about the same as here.

I was appalled and couldn’t hide my astonishment. No problem, I said, I’ll pay the $10, let’s go to the school and get her enrolled. That won’t work, said Emily, children can’t be enrolled in school without the presence of a parent or guardian, and the grandmother is somewhere in the fields. She asks Veronicah if there are any other family members around. Yes, my uncle, says Veronicah but he’s not home either. Veronicah understood English quite well, but was shy about speaking. I told her to go to her house in case her uncle or grandmother had returned home while she was washing clothes. She ran off into the distance, but walked back slowly several minutes later. Clearly, no one was home and she understood what was happening: this “mzungu” (white tourist, but in a good sense) was trying to help her get into school and without her grandmother or uncle to sign the enrollment papers, nothing would happen! Emily and this American lady would drive away in their van and be gone forever! Veronicah looked at me, her eyes pleading with me to wait, to stay, to just make something GOOD happen for her, p-l-e-a-s-e. I asked Emily to check with the washer-lady if the family had a cellphone. Yes, they do but no one is answering it. My new friend Emily had 10 more AMPATH visits to make and it was almost noon, we’d already been here an hour. Thuo, the driver was thirsty, how long could I expect them to wait? Emily suggested I come back the next day but without an address, I knew I would never find this place or Veronicah again. We stood by the van, just waiting, waiting, waiting for something to happen...and it did! Across the field an old woman in a baggy skirt came running, waving her arms madly in the air and yelling : Ver-on-i-cah!!! Ver-on-i-cah!!!!

I felt like I was on a movie set and some insane script that I knew nothing about, was being rehearsed around me. Except this was real, and my life and Veronicah’s life were careening in a new direction that just an hour ago would have seemed preposterous. Emily explained again that I was willing to pay the $10. transfer fee. Grandmother shakes her head, no, that’s only part of it. There is no money for uniforms or the “desk”. I’ll take care of that too, I say, let’s just get her in school today! But then, there’s the problem that the public school is 3 km. from home and that’s too far to walk, especially in the rainy season. It’s all getting very complicated and I don’t know what to do. (I wished I could talk to David, but he’s doing surgery; he always helps me sort out dilemmas). How can I just leave this young girl here in the road, without a chance for an education for very possibly the rest of her life! But then I think: maybe all my talk is just making things worse; fate is fate, this is what real poverty is and this is what it does, so deal with it... not everyone can be helped. Suddenly I remember we’re in Kabongo and the Patrician School is only 1/2 km. away! I borrow Emily’s cell phone and call Brother Paul. He understands my plight but thinks the classes are already too full (45-50 students per class) and there is not room for even one more student. He suggests I call John, the handyman/financeman/enrollment officer. John and I had chatted when I was helping at the clinic, and then again when I toured the school. I call him up and he says he’s about 2 miles from the school and traveling on foot, but if we can come pick him up, we can all go to the school together and discuss it. We’re on our way! Emily and Thuo are in the front, Veronicah and Grandma are with me in the back, and minutes later we squish even closer as we pick up John. He talks to Veronicah to assess her grade level; he decides on 4th, with good reason. No one seems to know when she was last in school or what grade she completed, but she says she’s 10 years old, and 4th grade can make room for one more student... so 4th grade it is!!!! Grandma signs on the dotted line, grinning a half-toothless smile from ear to ear, and I am also a little giddy. Veronicah stays quiet, probably overwhelmed by the chaotic events that are suddenly unfolding a future that never seemed within reach. I write up a little “contract” for her on an index card, saying she “promises to study hard and be a good student”. She smiles and signs her name (Veronicah, yes, with an “h” at the end). I arrange to pay tuition to Brother Paul the next day at the Eldoret Club: $100 yearly.

But now it’s time for a shopping spree so Thuo and Emily drop us off downtown. My unlikely quartet includes John, Grandma Jane and Veronicah and we head into the Uniform Store. John says we need 2 blue school dresses, a red sweater, one gym set, black socks, a backpack (Veronicah likes the orange one), 10 spiral notebooks (5 subjects, 2 notebooks per subject), an English dictionary, 4 pens, 4 pencils and 2 erasers. I toss in some crayons and a coloring book...has she ever colored before? Then to the shoe store for those chunky black shoes and a BIG tin (per John’s insistence) of Kiwi shoe cleaning paste. The tab is now close to $70. Would Veronicah ever have had any chance to go to school? It’s clear that Jane could never have been able to afford this, and apparently the government isn’t too concerned about this outrageous injustice.

No doubt, it was Veronicah’s lucky day to be standing just where she was when our van came by. But it was mine as well. It’s the popcorn theory: there are kernels all over the place, popping here, popping there, but it’s the one that pops in your face that gets your attention. And that’s just where Veronicah popped...smack dab in front of my incredulous eyes! So this little darling treasure was the one who caught my attention...how lucky am I!

School started at 8:30 the next morning and I woke up early back at our Eldoret Club, fretful that it would be too much pressure and Veronicah would want to stay home. I needn’t have worried. When I saw Brother Paul at the Club later that day he told me the good news: Veronicah and Grandma were waiting at the school gates at 7AM! Veronicah was all scrubbed up, in fresh uniform and ready to go. Her books were in her new backpack and she was eager to make new friends.

I visited the school 3 more times before David and I left Eldoret. The last day I saw Veronicah was when I stopped by the mud hut where she lives with her Grandmother.She wore the new Girl Guides uniform we had purchased several days before, with the beret, matching socks and a little change purse looped on a black leather belt. She grabbed my hand and led me into the small dark room where we sat on old car seats. As my eyes adjusted to the darkness, I noticed 3 other smiling faces with shiny white teeth grinning at me. Much to my great surprise,Veronicah had 3 siblings: Sharon, 12, Kelvin, 11 and Moses, 7. They scrunched up next to me, grabbed my hands and gently patted my skin. What to do??? I couldn’t just leave them behind! We were heading to Nairobi in another hour and then home. I called Brother Paul and told him to enroll them all in the Patrician School and buy them new uniforms, as well as books and pencils. The boys will be Scouts, the girls Guides and they will all assist with flag raising and singing the Kenyan National Anthem at school. They will have to study hard; their previous school attendance record is practically non-existent. When I called a couple of days later from Bellevue and spoke to Grandma, she just shouted into the receiver: “Children! School! Children! School!”. I repeated it back to her. Our conversation was certainly brief but I knew just what she meant. It was evening in Kenya and too dark to read, so the kids stayed late at school where there was electricity.

We have also set up a small fund for incidentals the kids will need every year. Top priorities are a solar lamp for reading at home after dark, daily vitamins and a second pair of shoes. And for the girls, new cotton panties, and for Grandma too, of course...every woman, young or old, can use those.
                                        

Veronicah tries on a school uniform

Shoes! Imagine, a pair of shoes!

First day at school. We were both very excited!

Sharon, Veronicah and Grandma Jane

Our new family

AMPATH - The Gateway to Life

If ever there were a “tour du force” word for Kenya, it has got to be the acronym AMPATH, which stands for “Academic Model Providing Access To Healthcare”. When it became apparent to all the world that HIV/AIDS was decimating Africa, various non-profit agencies established a presence on the continent in an effort to staunch this mortal wound. By far, the best known in Kenya is AMPATH, a partnership between Moi University, MTRH (Moi Teaching and Referral Hospital) and a consortium of American medical schools, led by the University of Indiana. It’s goal was to provide a vision for living with AIDS rather than dying from it – and they are persevering and succeeding. About 80% of all Kenyan adults who are infected do not know it, and 75% of those in partnerships do not know their partner’s status. Among married/cohabitating adults, 55% have a partner who is currently infected. And with a 40% unemployment rate, few people have money for basic needs. Read that again, these are shocking statistics.

Tucked in on the main hospital campus is a modern and architecturally-pleasing 3 story structure known as the Riley Mother-Baby Hospital. It was built with funding provided by James Lemons, a Univ. of Indiana neonatologist, who had visited Eldoret in 1994. At that time, newborns slept in small wire baskets and the neo-natal unit was heated by a charcoal fire. He named it in memory of the Indiana children’s poet James Whitcomb Riley. A short time later, Dr. Charles Test and his wife from Indiana established the Sally Test Pediatric Center for sick and HIV infected children, and orphans abandoned by their mothers. Thanks to its great success, it has also expanded its services to include parenting classes, outreach programs to rural health centers, library services and sewing lessons to provide money-earning skills to HIV patients (Imani workshops).

HIV/AIDS spread insidiously thru Africa due to the well-traveled “truck routes” (see attached map routes) as goods were distributed thru the large continent. Foreign imports arrived regularly by ship to major port cities and were then trucked to inner countries. In Kenya, goods arrived at Mombasa on the east coast and were loaded onto hundreds of semi’s that hogged the broken-down roads with their heavy loads, spewing stinky diesel as they headed inward thru Nairobi and Eldoret and on to Ethiopia, Sudan and Zaire and Nigeria. They return to the coast empty, refill with goods, then head out again. Since these trucks are not allowed to drive at night, they pull off the road at well-known spots and accept food etc. from prostitutes.

An intense educational program has helped change this behavior but more is needed.

What AMPATH has done for sub-Saharan Africa is to create a system for identifying and tracking infected individuals so they can receive treatment, education and follow-up care. They currently have over 150,000 registered patients and enroll approx. 2,000 new patients monthly in their 60 –plus satellite clinics throughout western Kenya. Anti-retroviral Therapy (ART) is available and free for Kenyans but unfortunately it functions poorly in the face of poor nutrition, and compromised immune system, common to so many.To counteract this dilemma, MTRH has dedicated 50 acres of farmland adjacent to the hospital for growing crops, which are distributed to malnourished patients. Besides staffing its large clinic site on campus, AMPATH also offers business consulting, agricultural training and handicraft groups (Imani Workshops) for those who have been shunned and in need of a livelihood. Social workers are included in the staff to help preserve family life in such adversity.

There is no vaccine yet for HIV/AIDS but infants born of infected mothers are frequently being “cured”. Mothers are encouraged to limit breastfeeding (due to transmission) and newborns who are treated immediately at birth have a 76% lower death rate than those who had treatment at a later date. If regular blood tests indicate the virus has been arrested, children by the age of 5 are considered to be clear and no further testing is needed. The Sally Test Pediatric Center, nestled in the central campus of MTRH, cares for babies and youth who have been dealing with AIDS or other cancers. There also is an on-site orphanage to facilitate placement for those who have been abandoned or lost their parents due to AIDS.

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Follow-up is extensive and relentless. I asked to spend a day with AMPATH in their “Outreach” program and was paired with a lovely young Kenyan woman named Emily. We left early in the morning, using one of the 20 service vans MTRH has available. Emily had a list of 12 patients who had either not kept a follow-up apptointment, moved or just “self-detached” from the clinic. Contact is always first attempted by cell phones, which are very cheap and can be readily loaded with a few minutes air-time for just a couple schillings. In the poverty areas where AMPATH visits there are no street names, just loosely defined landmarks of where these shacks and hovels were last located (ie, “next to the store with a Coca-cola sign” or “a short ways after a maize field”). Our driver, Thuo, stops at a distance so as not to “hinder” our search by revealing the AMPATH logo on our van and causing embarrassment to those we seek. Emily says we are east of Eldoret in a small township called Ndata and we now head out on foot. She stops and asks a man we meet if he knows where we can find a family named -----.

He points back the way we came, but says in Swahili that we should turn right then continue to the clearing. We return to the van and drive back the way we came. Then again we are on foot, we ask directions from a fellow on a bicycle, and now it seems more clear. Emily points out the miniscule shack in the field ahead of us and I see a toddler sitting in the dirt and a couple of chickens pecking by the dirty sheet that serves as a front door. We slowly approach. (Does somebody actually LIVE in this?? I think to myself. Isn’t this just a dung-walled toolshed?) A thin young woman and her husband emerge and we all shake hands. They invite us in. (In to where??) The “house” isn’t any bigger than 8’x10’, with a dirt floor, 3 dilapidated car seats for sitting and no electricity or windows. She holds the sheet open so our eyes have a moment to adjust to the darkness and the chickens scoot right in and peck around our legs, jumping on the seats. I laugh and bravely sit down, remembering that I still have several pairs of clean scrubs at the Club. As my eyes adapt, I am startled to see a wide-eyed baby next to me on the torn naugahyde car banquette. I assume this little one had never seen a white person before because he immediately started to wail. This “dirt cave” is divided by another dirty sheet that separates a tiny sleeping area, so the 6 of us (mom, dad, 2 babies, Emily, plus me and the chickens, yes it was their "coop", too) are actually sitting in an area no larger than 6’x8’. The woman reaches behind the curtain and shows Emily her AMPATH treatment book, confirming that yes, she was at her appt. last month. Emily apologizes for the clerk’s error to note it in her hospital file. Both husband and wife are HIV positive and Emily encourages them to bring the babies in for testing. Do they have food? No, not much food, that’s evident...and if they did, I wonder, how would they clean it? Where would they cook it?The land surrounding the shack is not part of the rental, it belongs to a farmer who raises these crops for his own livelihood so they must not pick the maize or vegetables. Emily makes a note to increase their allotment of fresh produce at their next visit. They comment that they have no money for transportation and the hospital is at least 10 miles away, but they will do their best. I ask if I can take their picture, they smile and agree. I think they had never had their picture taken before. We say goodbye and walk back to the van.

Next on the list, says Emily, is a woman we need to find who last lived in Kabongo. !Kabongo! I exclaim, that’s where my Patrician School is! Emily had seen the sign by the road on a previous site visit but knows nothing more, so I tell her about Brother Paul. The ride goes quickly. Again Thuo parks and we walk and walk, hoping to meet a passer-by who can help us find our next patient. We finally cross paths with a young barefoot girl in a torn and filthy brown dress. She doesn’t know the woman we are looking for but points to someone in the distance who is washing clothes in a big basin, perhaps she knows. Emily tells me to wait and she will try to get more information. I stand beside this forlorn little snippet of a girl and ask her her name. In a very tiny voice she replies “Veronicah”. I ask her age – she says 10, and then I ask the big question on my mind – “Why aren’t you in school today?” Her bare toes fidget in the dirt and she shrugs her shoulders. Are you going to school tomorrow? I ask. She shakes her head. Were you in school yesterday? She shakes her head again. Are you sick? No, she mouths and keeps staring at the ground. How strange, I thought. I wait for Emily to come back and explain this to me. I brace myself and my stomach turns. I have a feeling that I’m about to hear a sad story.

Sally Test Mother and Baby Center

The spread of AIDS along the trucking routes thru Africa.

Imani worshops. All hand-crafted items are sold at fair market value.