Let’s make this clear – I came to Eldoret ready to work -if David could return to work, so could I! I had brought only the pair of pants and shirt I wore on the flight... and 5 pairs of scrubs! It never occurred to me that I wouldn’t be needed somewhere to do something, but it didn’t work out as I thought...it worked out even better. Instead of sentencing me to 2 weeks of hard labor on the wards, the personnel dept. at the hospital gave me free rein to go, see, do, (even photograph) whatever I chose. It didn’t take long for me to realize that the learning experience I would gain from “free time” was immeasurably productive. In retrospect, the British/African system of nursing was not just foreign, it seemed almost from another planet for me, an American trained RN.
I got a map of the hospital and was given a contact person in any dept. I wished to visit, who would explain to me the machinations of the 2nd largest hospital in Kenya. MTRH (Moi Teaching and Referral Hospital) is run more as a mini-macrocosm of life outside the hospital, than as the institution of health care we know in America. Families gather and usually stay all day, sometimes even sleeping at night on the floor next to the patient. They bring in food, bathe and care for the patient and wash/dry the patient’s laundry, since frquently the hospital runs out of patient’s gowns. Nurses work all shifts rotating thru this schedule: Day #1: 7:30AM – 1:30PM, Day #2: 12:30PM – 6:30PM, Day #3 and #4: 6PM to 8AM, and then they have 4 days off (the overlap 30-60 min. is allotted for report).Then the cycle is repeated. The RN I spoke to on the orthopedic ward carries a typical load of 18 patients on day shift but does have assistance from 2 or 3 nursing aides. If patients are ready for discharge but perhaps live in the countryside or have no one to take care of them, they stay at the hosp. as long as needed, and that may be for many months (a patient was recently sent home after 3 years). Those awaiting surgery also just “reside” until they get their operations. This may take a while since there is only 1 neurosurgeon, 1 ENT, 2 opthamologists, 1 cardio-thoracic surgeon and 2 orthopedic surgeons and 10 general surgeons.There are no extended care facilities or nursing homes in Kenya. Basic hosp. cost is KSc 2,000 a night ($24.). Approx. 20% of patients are able to buy insurance for the private hospital close by; those without insurance are not charged for care or surgery.
My first day at MTRH, I felt like I was in a busy American mall on a rainy Saturday – it was a constant hub-bub of people everywhere, so crowded that it was often difficult to walk. Patients were admitted in a public area, and since medical records are not computerized all paperwork was stacked higher and higher up the walls in those ubiquitous manila folders in a small office. It was noisy, hectic yet cheerfully boisterous. Due to the temperate climate, most wards and buildings are open to fresh air and connected to other parts of the hospital by breezeways. The hospital has 800 beds but usually has 1200-1600 patients. How do they do this? Simple...2 and sometimes even 3 patients per bed (you can see this in the two photos showing patients: one picture of 2 moms holding their newborns, all sleeping in one bed, and the other picture showing one male patient with his head at the head of the bed, the other with his head at the foot of the bed). The catchment (service) area includes over 20 MILLION people, many from south Sudan, Uganda and Ethiopia; and an average of 1,000 patients come in daily for care. MTRH births approx. 10,000 babies a year, many high risk due to poor pre-natal care. Home deliveries, without trained mid-wives, are very, very common and add to a high infant mortality rate. Only 1 kidney transplant was done in 2004-5. It cost 1.2 million KSc (US$13,480) and was deemed too expensive so it’s no longer avbl. For this entire catchment area there are only 13 dialysis machines and the charge is US$400. cash per session, clearly only for those who can afford it.
The average monthly wage for a prof. driver, such as our Kirui, is KSc 18,000 (US$216.). A young everyday Kenyan professional earns a monthly salary of approx. KSc 25,000 (US$300.) and a physician approx. KSc 100,000 (US$1200). Doctors receive a monthly housing allowance of KSc 30,000 (US$385.) and nursing and administrative staff KSc 5,000 – 13,000 (US$62. – $184.) Doctors frequently live in the “Doctors Village” adjacent to the hospital, which charges nominal rent. Small building lots outside of the central area are for sale and cost US$3,400 –$3,800, sometimes without electricity and usually without water. Banks offer loans to the brave souls who choose to build and dig wells at 15% with a 3 -4 year payback, which is automatically deducted from your paycheck. OUCH!
The hospital even had its own choir! Its members would dress in lovely African regalia and sing at important functions, on holidays, or just do “cheer-up” rounds at the hospital. Their voices were beautiful, and I was lucky enough to hear their singing at 3 events.
Medical Records - not yet computerized
There's my David, ready to go to work!
Very crowded wards, notice 2 patients sharing the same bed in the back.
Lunch time for the patients, who must bring their own plate and silverware in order to receive a portion.
Two new moms and their babies, also sharing a bed for several days until dischar
After spending a day with Nurse Josephine at the Patrician School Clinic, I became quite curious about the Patrician Primary School itself and asked Brother Paul if I could plan a visit there. He happily agreed to take me there the following morning.
Brother Paul built the school in 2003 with funding from the Brothers of St. Patrick’s as well as his little home town in Ireland, and some help from the Lions Club. He bought a tract of land in Kabongo, 10 km. east of Eldoret, adjacent to the site of the violent post-election riots and “ethnic-cleansing” of Jan 2008, and what an impossible! impassable! dust-laden! spine-manipulating! and pot-holed! road we took to get there!!! Brother Paul hired local contractors to built the 2 long classroom wings, enough room for 8 grades plus a pre-school...as well as the “long drop” toilets (of which he is very proud...no explanation needed). Then he invited the poor to fill the classrooms; any child who could get there daily was welcome to be a student and for those unable to pay, some scholarship was awarded. Private schools abound in Kenya, they are everywhere; built and sponsored by companies, countries, service clubs, religious groups and even private individuals who feel the call to help. Public schools are just not quality schools, and Kenyans realize that the key to raising standards in their country is thru education of their youth. Those who can possibly afford it, send there children to private schools.
Patrician Primary School now has almost 500 students. Children in Kenya speak Swahili at home (given there are 42 tribes, that means there could be up to 42 different dialects spoken in every classroom) but starting on the first day of pre-school, only English is allowed. Reading and writing of Swahili is taught as a “class” for one period daily. I visited every classroom, listened to the recitations, watched the board work and scratched my head as I audited the decimal and algebra equations of the upper classes. From 4th grade on, each student attends a computer class with Mr. Sammy, where he teaches them hi-tech skills on 15 donated computers. All the teachers are young, inspired and clearly love their students and are loved in return. Through their energy and vision they inspire a thirst for knowledge.
This spring marks the completion of the last building phase. Last year, after giving a speech at a fund-raiser, Brother Paul was told that a “Mr. Hilton” had arranged a meeting. When asked what needs remained for his school, Brother Paul said he wished to build faculty housing so that teachers would have a clean and safe place to live and not have to leave the campus after classes, thereby being more available to the students. As for the costs, Brother Paul said he needed living quarters for 18 teachers at US$10,000 a unit. Mr. Hilton (yes, THE Mr. Hilton of the hotel chain!) took a blank check from his pocket and filled it out for $180,000. The rest of the donations have been small but adequate for the school to function.
Teachers at the Patrician School are paid US$125. a month, compared to the Kenyan public school wages of US$160. monthly. However, they receive new housing with private bathroom and flushing toilets (!!) and may move their entire family in with them, and everyone may use the on-site Health Clinic. This school also bought the neighboring 40 acres on which they plant maize and kale and tomatoes for the student meals. Since so few homes in this poor neighborhood have electricity, they have a boys and girls dorm for a small number of older boarding students who need light so they can study late into the night, or have come from a distance to attend.
The children are amazingly very well-behaved. One class was taking an exam and as I peered in the doorway, every head was buried in deep concentration and there was absolute silence...all this while the teacher was in another classroom, teaching another class! The children are honest, exuberant and polite. “Sassiness” is just not part of their culture. Hands shoot up when the teacher asks a question but no one speaks until called upon, then the child stands and replies. If the answer is incorrect, all those little hands silently shoot up again. It’s all so REFRESHING!
My time there seemed as if it were straight out of a late-night “SEND IN MONEY RIGHT NOW!!!” infomercial except this was the REAL deal; these kids truly are abysmally poor and Brother Paul honestly spends every donated dollar trying to improve their lives. It is mandatory in all of Kenya that students wear school uniforms, and I noticed so many children with tattered and torn sweaters and ripped shirts/skirts that clearly had been handed down a few too many times and/or were just not the right size. The children are required to wear black shoes and to keep them polished but for most, this is the only pair they own and there is no money for shoe polish. Brother Paul started a meal program, serving 2 meals a day (and a 3rd for boarders) when he realized they didn’t have food at home and had trouble concentrating due to constant hunger. Few of these kids have clean water for bathing.
As I made my way thru the classrooms, I was overwhelmed at how absolutely delighted the children were to see me, a “Munzungu” (white person) and they rushed toward me. Each wanted so badly to shake my hand, repeating over and over “How are you? How are you? How are you?”. I had a good laugh when they quickly added “Fine, fine, thank you very much” before I had a chance to reply. I have little doubt that the Patrician School brought them the first joy they’d ever had in their young lives, thanks to Brother Paul.
If you wish to donate to The Patrician School ($20 will buy school supplies for the whole year; $100 is a full year’s tuition), the address is:
Brothers of St. Patrick, c/o Brother Aquinas Cassin, PO Box 116, Midway City, CA 92655
Click on the arrow in the picture above, I have embedded a short video about Brother Paul and his school.
Little kids rush to the door, they are very excited to meet me.
Pre-school, mandatory in Kenya. In consists of 3 years:
Baby class, Middle class and Top class.
Brother Paul helping stir the pot for hot lunch. It alternates from rice and greens to rice and beans. Often this is the only meal some of the poorest students get in their day.
Changing classes
I saw this on the chalkboard of the 6th grade class. I have no idea what it is.
Education is taken very seriously, all students have exams every 3 months and must attain a certain
grade level to move.
Teacher Sammy and his donated computers. From 4th grade on, all the students take computer class 2x week and are thrilled.
I help out in the kitchen. Looks like lentils today - fine with me!
David operated 2 times a week with Dr. Kamar Koech, the only neurosurgeon in all of west Kenya, and they shared the clinic load during the week. That left me with time to explore. Our first chance meeting with Brother Paul was invaluable; we would see him at the Eldoret Club almost daily, where he regularly schmoozed with old buddies. One evening he introduced us to Chris Strong, an Irish fellow who managed the large dairy “Doinyo Lessos”, named after a Masai chief. Being a Vermont girl and an old-time “bovine-o-phile”, I eagerly asked for a tour of the facilities which were smack in downtown Eldoret, just a short walk from the hospital.
The dairy was built in 1935 and very little of the equipment has been updated since then. Chris explained that the farmers work under a “co-op” system. Raw milk is trucked in every AM in large metal milk cans from many outlying farms, marked with an ID number. The containers are weighed and payment per liter tallied up for each farmer. After pasteurization, some is siphoned off for cheese, yogurt, and ice cream. This is the biggest cheese factory in Kenya and it makes some 30 different kinds including the popular “paneer”, favorite of the large Indian population. Tinned (canned) milk and cream is also very popular as it has a long shelf life and does not require refrigeration. Cream cheese is also well-liked but an 8 oz.container is almost US$3. which is more than we pay here. There are no refrigerated trucks, so products are shipped out quickly, before the ice cream can melt! There was a milk program for school children from 1979 –1992 but it has not been reinstated, and milk is too expensive for most poor families to afford. I spotted goats grazing by the roadside but unfortunately Kenyans do not drink goat’s milk, nor make goat cheese. Goats are raised for meat.
Once a week an enormous farmers market is held. Streets on the edge of town are lined with vendors, often 3-4 deep, selling everything imaginable: plastic house wears, T-shirts from American sports teams, toiletries, vitamin potions, mountains of shoes, wilting vegetables and squawking chickens etc. It goes on and on, street after street for at least a couple miles. Colorful, wild, outrageous but also rife with pick-pockets. I kept my distance.
Every year in March the Agricultural Fair is held for 5 days, a very popular event for all of western Kenya, and it has up to 40,000 visitors DAILY! It covers 50 acres and students have the day off to attend. It reminded me of the World’s Fair of 1964 in New York where you enter inside a building or large tent along a cordoned walkway as various posters/videos/demonstrations are shown, and emerge on the other side, flush with new information. There is something for everyone here: amusement park rides, pin wheels and balloon animals for the kids, importers show off shiny new Korean farm tractors, and seed manufacturers exhibit their “test” gardens with buoyant emerald cornstalks and juicy tomatoes. Everywhere there are happy faces enjoying this delightful event. Even MTRH had a pavilion where they fearlessly handed out condoms while soliciting volunteers for on-the-spot blood bank donation, as well as breast exams, blood sugar, cholesterol and HIV testing. Young pre-school children, attending with their teachers, were encouraged to come in and learn.The hospital proudly showed off it’s ambulance. The noise of the crowds was deafening. The hospital had even brought in a DJ for entertainment. I found myself grooving to the beat of some African reggae band being piped out on loudspeakers and I learned it was music from the “Kanungo”, the tribe of Obama! The following day I purchased the CD at a record store for US$2.50. Why so cheap? You make your request to the shop-keeper, he slips both an empty disc and the original disc in a computer, pushes a few buttons and moments later hands you the finished product with a Xerox copy of the original cover. Voila! ....Hakuna-matata!! (no problem!)
Cheese, please! GottagettaGouda!
Fresh farmers cheese
David never turns down vanilla ice cream!
Giganormous shopping area, many football fields in size
A purely fortuitous situation occurred as we registered at the Eldoret Club upon our arrival. There was a gray wispy haired gentleman on his phone standing next to us at the desk and in a delightful Irish brogue was lamenting to someone on the other end that he couldn’t play golf for a month due to a recent surgery. The clerk had left the desk for a moment, so I made small chit-chat, sheepishly admitting that I couldn’t help but overhear his conversation. I told him my husband, David, was also on the “injured list” (broken clavicle with surgical pinning 4 weeks previously) and was also unable to golf. A small conversation ensued and our Irishman introduced himself as Paul, a Brother from the Order of St. Patrick’s, as well as a five-term Chairman of the Eldoret Club. When I told him of our medical mission and that I was an RN, he immediately invited me to his school in Kabongo, approx. 8 miles out-of-town, where he also had a medical clinic. I immediately accepted his offer, and he made arrangements to pick me up and drive me there so I could spend the day with Josephine, his on-site nurse at the clinic.
Lovely Josephine lived in faculty housing Brother Paul had built next to the school, and she did anything and everything in the health care field. Every week she held a mother/baby wellness clinic for moms in the area. At birth, every mother in Kenya receives a small paperback notebook for her baby, in which is recorded all important data, such as weight, length, immunizations, feeding issues etc. About 20 moms arrived early at the clinic, notebooks in hand and they sat on a long bench, happily waiting their turn. The babies were very quiet, I think only two cried during the entire time I was there, one when he received his latest round of immunizations and the other when he saw ME, his first “muzungu” (white-skinned person)!!!
Brother Paul had built his Patrician School in 2003 from private donations with the promise that he would find the poorest and most underserved area in Eldoret. It was on this site that a church and homes were burned and people were murdered in the post-election riots. Two years later he had enough money to add the clinic. True to his promise, no money is collected from the patients and all are welcome. Josephine handles everything from birthing babies to intestinal parasites.
It’s a very simple set-up; each mom signs in using her cell phone number as an identifier (EVERYONE has a cell-phone; there is no rural mail delivery because the poor have no address, they just live in small shacks on odd snippets of land. While post office boxes are available, the poor get no mail, nor could they afford the monthly fee). She brings a small cloth on which to lay her baby when ready for weight and examination. Forms are filled out by hand in triplicate, no, quadruplicate! All data is excessively recorded over and over; one large ledger for the government, then one for the city; another for the health dept., one for the clinic, and then again in the baby book.
One mosquito net is issued per child. If the baby was born in the country without medical assistance, then this is often the first time the baby is being seen by a health care practitioner and is given a net, which is dutifully recorded. Otherwise, netting is given at the hospital. Mosquito netting is quite a problem lately.The Gates foundation has funded an enormous quantity of a new kind impregnated with insect repellant, to be given out, but it has recently come to light that over 50% are being used inappropriately: to deter rodents from entering the food supply area at the shacks, to wrap around trees and keep small animals away, or...as wedding veils!!!! A massive educational program ensued and it suggests there is some improvement in appropriate usage. When I mentioned this to the moms, they tee-hee’d and glanced conspiratorially at each other but then instantly denied they would ever do such a thing...
We also counseled regarding “family planning” ( 60% of Kenyans are Christians, 30% are Muslims; the term “birth control” is rarely heard; it’s a little too direct). Unfortunately, the uneducated men are quite chauvinistic and enjoy the freedom to make as many babies as they wish; sons are certainly preferred and there’s no societal or financial disincentive for bad behavior. Men have perpetuated the myth that birth control pills make women “sick”, so women are reluctant to take them. In truth, however, men feel that the pill lessens a woman’s desire, and therefore they discourage its use. There has been more luck with the birth control shot that lasts for 3 months but follow-up for return injections remains a problem. in the urban areas, however, young families are having 2 or perhaps 3 children, rarely more, and men take responsibility and invest fully in their families.
Josephine R.N. in her office/exam room
After building the Patrician School, Brother Paul requested a nearby tract of land from the government on which to build a clinic for the poor in the area. He received some funding assistance.
Our BEST Bro, Brother Paul
Moms waiting happily with their babies for weight and vaccinations
Moi Teaching and Referral Hospital (MTRH) was most gracious in providing us with accommodations at the Eldoret Club, an old British golf club built in 1923. It has 18 duplex-style cabins bordering the fairways and greens, each complete with tub and shower...and mosquito netting!... which we found to be essential. They had an excellent restaurant with both Kenyan and continental meals, so we ate breakfast and dinner there daily. There was also a large state-of the-art work-out room with sauna as well as squash and tennis courts. Little had changed over the years; the old highly polished wooden floors creaked, and the waiters and and office staff wore starched white shirts and addressed us as Sir and Madam.
We had very hot water for bathing, and learned it was all due to Benton, who started work at 4 AM. After water collected in the large elevated cistern, it flowed thru pipes to two large drums over Benton’s fire that he stoked in the shorter smokestack and was then piped to our room when we turned on the faucet. Unfortunately, this causes much air pollution, as everyone burns wood for cooking also, often outside over a small open fire. At night, when guests returned to their rooms, he would heat more water for evening baths. Electricity is very expensive and there are very few gas lines, so most Kenyans heat water for all their needs the old-fashioned way: by fire. Finding/selling/buying/getting one’s hands on cheap wood is an essential part of ones daily rituals. Charcoal is also available (it is “home-made” by burning wood underground and the country people bring it into the city to sell), but not much cheaper and certainly more polluting. Interestingly, we once returned to our cabin late morning and found all our sheets and towels had been taken from the room for washing and would not be returned until around 5PM. My guess is that there weren’t any “spares”. As for personal laundry, we did our own and let in dry in our back window.
Our life was good, unlike many, many Kenyans, but in particular the 1.5 million poor Kenyans living in a 1 1/2 mile area outside of Nairobi called Kibera, Africa’s largest slum. Kibera is considered an illegal settlement, so the government does not acknowledge its existence and will not provide any services to it.
The Club had many amenities, including this beautiful clean pool
Club entrance, with an 18 hole superbly manintained golf course
We chose Kenya from a list of 22 countries with which FIENS (Foundation for International Education for Neurological Surgery) has a presence, and we chose the small city of Eldoret, so that we could make personal connections and feel at home. We made the right choice.
The weather was superb; always sunny, slightly cool to lower 60’s at night, and mid-70’s in the daytime. The roads were bumpy and the pot holes were bigger than bath-tubs (anyone who has traveled to Third World countries will know what I mean; they defy description). Eldoret ,a city of 250,000, did not have a single traffic light nor stop sign. It was always a wild ride. Luckily, the hospital gave us a wonderful driver, Kirui, who kept us safe while maneuvering thru the onslaught of “bike-taxi’s”, or “matatus”. These mini-vans have small seats and can hold 12 passengers for a nominal cost. They are run independently by a driver who buys the vehicle, then hires an “engineer” who collects the fare. They have no schedule, but the more frequent runs they make, the more fare is collected. So speed is essential. When they are full, which they always are, they will still pick up another passenger, and have the engineer step outside and ride on the running board. When even MORE passengers want to ride, they can also stand outside on the running board and hang on for dear life, as they zip along at 40-50 MPH. These matatus drive very fast and are known to be reckless. Most highway fatalities are due to them, and we vowed never to ride in them; thanks to Kirui, we didn’t need to.
The roads into town are generously dotted with street vendors and shops that sell everything from big yellow water jugs for water, to fresh fruit. Toilets are a true rarity, only those with a generous income have plumbing. But one little shop was happy to cater to those with substantial financial resources (mainly businessmen from India) who longed for the “boudoir” of their dreams.
Bycycle taxis for rent; you get the back seat and no helmet.
Very, very can afford this. Most don't even have running water or electricity.
Friendly fruit sellers, whenever our car stopped in traffic.
David and I are about to embark on a very exciting
adventure…to AFRICA! After 5 years of retirement, we are ready to get back to
work, but only for a couple weeks. We have volunteered our medical skills to a
hospital in Eldoret, Kenya, which is severely understaffed. Eldoret is about 150
miles NW of Nairobi. It is a small city of 250,000 inhabitants, with one lone,
overworked but greatly appreciated neurosurgeon. David will help him with his
clinic and operating room caseload, and I will do general nursing on the wards.
It should be quite an experience! We had requested donations of neurosurgical
instruments and supplies from several medical equipment companies, and the boxes
keep arriving at our door! We will have over $100,000 worth of essential
supplies to take with us - their generosity has been astounding. Even Costco
donated several hundred pens to the pediatric
unit!
We will do our best to stay in touch, but are not sure
about internet connectivity. We will be busy but you needn’t worry about us –
Eldoret is a very safe town.
The motto of Kenya is : “Harambee” in Swahili, meaning
“Let us all pull together”. What a fine and noble notion that
is-
Cheers and Harambee to you all!Mara
and David
PS/ We are volunteering under the auspices of
FIENS
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