After a hearty breakfast (a "Spanish" omelette, toast, a little bacon and sausage, the latter tastes more like a hot dog, fresh fruit, cereal, and tea – OK, that’s not the part that leads to the weightloss), Chesang (my WHO-Kenya counterpart) and I started our day together, but then soon had to split up to cover all the health facilities we intended to visit to assess their disease surveillance activities and offer recommendations to improve those activies. I’m sure Chesang’s day ran pretty much the same as mine.
The distances and poor-fair road conditions between facilities demanded that we not stop and travel from one to the next, so my day stretched over lunch and into the evening – i.e., no lunch and no chance to pick up something to drink. Obviously, finding a bathroom never came up because I was too dehydrated to need one – just as well, we didn’t have the time. Anyway, next time, I really should have some water – imagine me overheating, dehydrating, and fainting. It’s enough that I constantly draw curious stares – well, I am a lone Asian among all these Africans, and I’m hanging out in the countryside where these people would be even less likely to come across someone like me. It’s actually not any hotter here than it might be in Hawaii on a hot day, but picture dry heat and no air conditioning and sitting in enclosed areas with little wind or ventilation. Definitely have to remember some water next time.
Visiting these health facilities was really as much of a learning experience for me as it was (I hope) for them. Based on my own knowledge and experience and the recent training in Atlanta, I tried to help them examine their surveillance activites from a different point of view and hopefully offered some new or different ideas that they could implement or could use to stimulate their own ideas so that vaccine preventable diseases can be better detected, prevented, and controlled here. For my part, I reflected that the people and the relationships here really are not that different from those in Hawaii. As I assist in the public health activities here and in the upcoming mass polio immunization campaign here in Kenya, I find myself thinking occasionally about how some of the things I learn and observe here might be useful in Hawaii, especially as we are also planning a targeted mass vaccination there (albeit against flu rather than polio)…
Aside from public health, as a clinician, I find myself also interested in the clinical capacities of the health facilities here and the marked difference in healthcare delivery here compared with the U.S. or any western or industrialized country.
How lucky are we to have the high level of care that we do? The facilities here are often lucky if they even have one doctor but usually depend on clinical officers (kind of like physician assistants) and nurses; and the wards are strictly bare minimum with no ventilators, imaging capability, or any sophisticated monitors. If anyone required anything of that standard, they would have to be transported (if they were lucky) to Nairobi. People in the U.S. may complain about busy waiting rooms and U.S. doctors may complain about being overworked, but they should see the mass of people here waiting for hours on benches and wherever there’s room out in the heat. 
I’m told that market days (usually Tuesdays and/or Fridays) are the busiest since that’s when many can catch a ride in from the surrounding countryside or need to make the long walk to come to market. It’s amazing given the great difficulties with healthcare access here that as many children receive immunizations as they do. Kudos to the Kenyans.
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