Gluttony back in civilization

Being back in Western style accomodations has been really nice in some ways, especially with regard to the bed, which is a real bed (i.e., rather than a foam mattress – Diane thinks they use the latter in the bush to discourage infestation with bed bugs – nice, huh?) with a very, very nice soft, fluffy duvet. The first night back was the first night in a long time that I slept the entire night through without waking up once until the morning. So nice. Unfortunately, I haven’t been taking as much advantage of this wonderful bed as I would like or probably should.

Why? Well, a couple of reasons. One is that I because of my battles in the field with computer viruses (which I won, I think/hope, since my computer’s working much, much better now), I wasn’t able to get as much work done entering and analyzing data, documenting findings, and putting together my field report while I was out in the field. That meant that once I got back to Nairobi, I’ve had to do all of it here. A big pain as it would be nice to just relax when I’m here. Given there are necessary post-field debriefings and post-polio immunization campaign partner meetings, and, of course, most people work according to African time (i.e., start later than agreed – see the last paragraph of this post for more on that) which means a bit of waiting time as well, I’ve been working in my hotel room in the evenings. Actually, I like working in my hotel room. It’s quiet and very comfortable, so I can get a lot more done there than in the WHO office where people are constantly around and chatting. It’s similar to how I feel sometimes back home in Hawaii. At work, there are always meetings, phone calls, people who “need to talk to you right now,” a gazillion “critical” emails, etc. The one time I’ve been sick and had to stay home, I got so much work done on my laptop because no one was interrupting me.

Anyway, the other reason I’ve not been sleeping in much is that I’m back to getting up early to run again. Yes, sleeping in a comfortable bed is really nice, but I’ve really missed my morning runs. The first morning I went running again here, I could feel it – i.e., being out of aerobic shape and also the altitude here, but I’m quickly falling back into the routine. It’s great. All the hotel grounds staff know me now, too, since I run within the grounds of the Fairview; I think they find my daily running rather interesting. The gym guy asked me if I was afraid to go running out on the streets. I’m not, as Diane and I usually will opt to walk (e.g., to the WHO office which is just around the corner and across the street from our hotel) when possible. In daytime, it’s pretty safe, but despite that running within the hotel grounds means creatively using the limited space and running back and forth in an area (actually, the Fairview grounds are fairly large and with tranquil landscaping including a plethora of green vegetation and colorful flowers), I prefer not to have to deal with the cars on the streets here and directly breathe more of the smog from vehicle exhausts than I have to. By the way, in Nairobi, cars have the right of way, not pedestrians, so I’m more worried about being run over than of someone trying to mug me. Running in the hotel grounds means I can run pretty continuously, unbothered and in exhaust-free air.

Although I enjoyed the homey meals and basic comforts in Wajir, I’ve been looking forward to the easy access and variety of fresh produce in Nairobi as well as the wealth and variety of cuisines. It’s been wonderful for my palate to enjoy the great variety of tastes. The funny thing is that after so long in the field and adjusting to often only two meals a day, my stomach has also adjusted, so that it’s having to adjust to the sudden abundance and variety I’m feeding it. What does that mean? Well, I’m finding that I’m often not very hungry for dinner or, rather, a third full meal. Kind of funny. But since I’m running again, my body’s quickly adjusting back. It's probably just as well that I'm taking a little time to adjust back to the meals. My wallet is having to adjust, too. A bit of a shock to go from paying maybe even barely $3 for a plentiful and homecooked meal in a Wajir guesthouse to anywhere from $20 to $100 in a Nairobi restaurant.

The other thing to which my body has to adjust is the temperature. When I first arrived in Kenya, it was still the start of the dry, hot season. When I got to Wajir, they told me that January and February are their hottest and driest months – lucky me. Now the country has entered into the “long rains” season, when the temps start to cool. Although I’m told that the coolest months aren’t until June-August, it’s cool enough for me here in Nairobi right now. Even if I’d just arrived from Hawaii, I think I’d find it a little bit on the cool side for me, but after 3 weeks in Wajir where temps were regularly up in the 40+°C and even 45+°C, my body’s thermostat is definitely set higher. Diane thinks it’s funny because she thinks the temps here now (18°C, range 15-23°C or 64°F, range 60-75°F) are just perfect and sleeps even with her windows open and fan blowing, while I’m buried deep under that wonderful duvet. Hm, it’s about time to call it a night now anyway.

Just a quick comment about African time. Not sure if I mentioned it in a previous blog. Anyway, everyone (the Kenyans themselves especially) here jokes about African time – the fact that when Kenyans/Africans agree on a particular time to meet, you should commonly add at least a half hour and even sometimes an hour or more to that time. The problem is that very occasionally they do meet at the time they say, mostly because they realize that Westerners don’t operate that way. Still, many tend to operate according to African time. The funny thing is that some Africans really want to break others of that habit, and so they’ll make a distinction and specifically say that the meeting time is at the time appointed and not according to African time. Ah well. Back home in Hawaii, meetings may start on time, but, not uncommonly, unless you make people stick to the agenda at hand, meetings can drag on for awhile because of the local tendency to “talk story,” i.e., go off subject on tangents. So, it seems, every culture has some quirk with time.

See what I saw

A picture is worth a thousand words as the saying goes. Right? Well, you can't experience what I did in the past few weeks, but you can at least see some of the things that I saw...
Camels were just about everywhere in Northeastern province. Interesting creatures, the way they kind of lope along. And the way they run when they're spooked by coming cars looks so awkward...like a gangly teenager.

It's funny how the birds build their nests in the thorny bare branches of what seem more like desert bush than trees in some areas here. There would be stretches of road with all these bush-trees as far as you could see on either side, and there would be nests in all of them. They remind me of ornament on Christmas trees...African Christmas trees.






Here's a typical bush bula (village) scene.





And here's a luxurious toilet in the bush...with a public health message. Actually, this is the typical pit latrine "house" for the health facilities in the bush, and they were pretty clean compared to other places I've been and seen.




Here's another public health message on the water catchment tank for the health facility. It's really interesting to see the influence of all the NGOs in this province and some of the benefits and support they bring, although that very support can produce a dependence that becomes problematic when they leave the area.




Kids were always curious whenever I came to their bula. The boys, especially, would follow me around, at a safe distance, of course.




Finally. I got a picture of a dikdik. They're so fast. Like jack rabbits. And they're so miniature and cute.








This jackal was just a bit too fast.

Here's a poster in one of the many health facilities I visited. It's advertizing the last national polio immunization campaign in Kenya. Catchy slogan.





Early morning on one of the campaign days. All the vaccinating teams mobilized to get out to the field.

And this is one of the places where they're headed. Not an easy job to find all those kids in the bush.

One of my responsibilities during the campaign was to monitor the process, meaning, among other things, visiting bulas, talking to mothers, checking kids for the marks on their fingers to indicate they'd been vaccinated, and checking the "houses" to see if they'd been marked to indicate teams had come by there. Can you imagine trying to find someplace to mark this house?

Occasionally, I'd be asked to help assess a potential measles case. The child in the picture was one such case (measles looks very different in Africans, by the way). Unfortunately, she passed a few days later, and her mother had refused for blood to be drawn, so we'll never know for certain what caused her illness, although there are others in the community with similar presentations...



I have to thank my security guards, pictured here sitting behind me in our Land Cruiser, Mohamed on the left and Billow on the right. They took good care of me and were fun to hang out with, too.


Some last few images from all the road trips to bulas and health facilities around this huge district known as Wajir. (No, we didn't purposely look for the animals. They were just all there. Pretty cool.)




Lots of odd looking things like this...gigantic termite hills.

More ostriches.

Maribou storks in Garissa.

Contrast to a flock of Ibis we saw and inadvertantly disturbed on the road.

Finally! A good picture of a gerenuk. See how it feeds by standing on its hind feet and stretching out its long neck? Pretty cool. They look very graceful, too, when they run.

Just a taste of the things I experienced.

Farewell to Northeastern - bush survivor

Tonight, I’m in an air conditioned room in Garissa at the Nomad Palace Hotel. Ah. I’d forgotten what it’s like to be cool and dry. Actually, I seem to have acclimated to the Wajir temps as I’ve set the thermostat for about 28-30 degrees C, which feels really nice and comfortable to me. Can’t quite believe that I’ve finished my second field assignment and am heading back to enjoy a respite and the creature comforts of the Fairview in Nairobi.

Last night, I enjoyed an amazing experience with some of my new friends and a memorable way to end my time here. I decided that I wanted to revisit Lake Yahoud except a little later in the evening so we could try to catch the animals, namely, the giraffes that are known to come to the water in the evening to drink. Danielle, a young Dutch nurse who is spending 3 months in Wajir for a small NGO working on improving community health and who has been staying at the same guesthouse as me; Mohamed, one of security guards now off duty; my driver; and I drove down to the lake around 6:15pm and settled ourselves to wait for the giraffes. We weren’t disappointed. The giraffes, however, seeming to sense some extra guests at their watering hole, decided to turn around and approach the area the long way around, so unfortunately, I couldn’t take pictures of the amazing gathering that followed later, although I did capture some of their silhouettes against the sunset across the lake as they made the trek around. Talk about amazing. As dusk began to settle, giraffes started appearing from all directions it seemed. The original four came around the lake, then came five more from another direction, and then four from another direction, then another three…..Soon, there were around 20 giraffe gathered, a veritable giraffe enclave communing with each other, and taking water from the lake. We could see three of them entwining their necks and others huddling together. We even saw a lone small jackal scoot past and amongst them. Although these giraffe all seemed to be groups of different families, it was as if they all knew each other and were socializing with each other as they drank occasionally from the water. By the way, although by now it was getting dark (just after 7pm), we could still see the giraffes, especially their reflection in the water as they drank. Have you ever seen a giraffe drink? It’s kind of funny, really. They have to spread their front legs to the sides so they can then bend their long necks down to the water and drink. Interesting sight, really. Since it was getting dark, we decided that we’d had enough of the wonderful experience to keep in our memories and got in the Land Cruiser to return to our guesthouse.

To top it all off, my colleague Abdikadir had arranged for my guesthouse to provide me with camel meat for my last dinner. He had really wanted me to try camel milk, but the infectious disease expert in me just can’t quite bring myself to try that. There are a lot of TB and other diseases running through the communities here (I wonder if camels can carry Brucella?…), and the milk often has some blood in it, too, I’m told - don't know why that is. Anyway, unless it was boiled very well, I really didn’t want to try it, but I had told him that I was curious to try the meat, so they fried some up for me to have as part of my dinner. It was pretty good, better than the usual dinner fare of goat meat. It had the same gamey taste although not quite as gamey and was pretty tender. The meat is also a little lighter in color (although not quite as light as pork) compared to goat meat, which is dark like beef. Wouldn’t mind trying it again.

What a difference from the way I’m spending tonight. Here in my air conditioned room, I have a TV with cable. In Wajir, in the guesthouse common room, there had been a TV hooked up to a satellite, but it still had only one channel, so not many options, but then, I wasn’t really motivated to watch TV there. Here in Garissa, out of curiosity about what is happening in the world these days, I turned on the TV…..and promptly shook my head and had to laugh. Why? The channel that came up was getting a feed of the so-called “reality” show Survivor. On principle, I normally refuse to watch that and any other “reality” show, but especially that one. Especially now, as I return to civilization from the bush and have witnessed how people must really survive in often extremely harsh conditions of severe heat, rough terrain, and little water, and have myself almost been forced to spend a night out but also to live in basic conditions well below usual Western standards, this show is laughable. Still, I admit that this time I watched out of some weird fascination. I think I’ve been so long away from home and hearing American English (by the way, the people here sometimes have some difficulty understanding my "accented"English - funny that my English is accented and not theirs, so I've subconsciously slowed down my speech and have taken to speaking more exact English) and seeing people of different races speaking American English and interacting, that I was thirsty for that, if that makes sense. A couple of the guys are hot, too, especially one of the Asian guys – hm…guess I’ve been out in the bush a bit long... Well, just a bit over a month and I’ll be heading back home. At times, it seems such a long time from now, and at other times, it seems much too soon. The experience I have gained and am gaining here is just so amazing in so many ways.

Adventures in the bush

The last few days have been rather…um…interesting. I decided that I really should make another visit up north to monitor the bulas during this round of the polio immunization campaign. That meant, of course, that we would have to spend the night again in Moyale. However, this time, I decided that we’d try sleeping on the Ethiopian side, which happens to also be called Moyale. Actually, the two are adjacent with a simple border that people on both sides cross freely between 6am and 6pm. Anyway, after a long, bumpy ride but productive day, we arrived in Moyale, Kenya by about 2:30-3pm. My security guards dropped their guns at the local police armory and changed into civilian clothes (they’d be shot or at least detained if they went over the border otherwise). Then, we drove across the border, which was completely open, into Ethiopia where everyone drives on the right like the U.S. – somehow nice and familiar. Unfortunately, that was when the downpour started. That didn’t make for much fun while looking for a place to stay. Unfortunately, we found that every guest lodge was completely booked, so with a sigh and grim resolution we quickly hopped back to the Kenya side. Oh well…only to find that every place on that side was booked as well! What was going on? It seemed that everyone had decided that they were staying in Moyale that night, perhaps because it was a Monday (market day??) and/or perhaps because the polio campaign was occurring at the time. Who knows? After asking advice from various locals, we finally threw ourselves on the mercy of the man in charge of the Kenyan government guesthouse. One “minor” problem, the government guesthouse is still very much under construction. Still, it was a dry place to stay with beds. The man in charge, I think, took pity on me. He was extremely apologetic about the unfinished state of the guesthouse – that there was no running water or working toilets, but I thanked him for even providing us with beds and assured him the basin of “clean” water (from catchment) and the outdoor pit latrine would be OK for the one night we had to spend there. After all, beggars can’t be choosers, as the saying goes.

If I had a choice, I’d be back in Wajir at my Neyrus Guesthouse, but since I didn’t… The bed was at least comfortable enough, and no worries about what bugs might be in the sheets since I slept on top of them, rather than in them, in my sleep sack. There was even a new bednet (i.e., no holes), so I wouldn’t have to worry about some random spider, cricket, or other bug crawling on me at night. It was good to have at least the basin of water to clean off all the dust from my face and as much of my body as I could rinse. Although there was no running water, we could still use the shower drain to dump water. Unfortunately, it seems that drains are always, as seems to be the usual thing here, a good source of insects. I think I killed about 7 crickets and a spider, and I don’t want to think about the dead centipede I saw in the corner.

After cleaning up, my security guards, driver, and I all enjoyed some decent chai and made some small interesting conversation while sitting on a big mat in the large hallway between our rooms. After finishing their chai, my security guards, who were Somali and Muslim, performed their evening prayers, while I quietly finished my chai. They reassured me that I wasn’t in the way, so I sat and listened to the calm sing-chanting of their prayers in the dark by candlelight (oh, I don’t know why, but there’s no power until 10pm – like the last time we were in Moyale, so must be a routine thing here). We chatted some more after their prayers – they asking me about my life in the U.S. and I asking them about their families and about Islam – then it was time to call it an early night (it was about 7:30pm). One of them lent me his flashlight (he said he’d rather I used his brighter light than my small one) so I could make a trip to the latrine before going to bed.

Hm. That was an experience. A small trek outside to the enclosed latrine, which actually wasn’t too bad – actually fairly clean as far as pit latrines go – except that when I shined my torch on them (there were two individually enclosed latrines), large cockroaches were crawling all over them. Eek! Well, one had only a couple, while the other had at least 10, so I kept the bright light on the first so the roaches quickly scuttled down the pit into the dark. I tried not to think about the large spiders up on the ceiling that I’d seen earlier and kept the torch down on the pit while I quickly did my business and really tried not to think about all this. Let’s just say that I will really appreciate my nice clean bathroom when I get home.

The night was fitful given all the noise and ruckus from the crickets as well occasionally donkeys and whatever other animals and insects, but at least I had someplace to rest and the morning view from the front steps of the guesthouse was a nice thing to see as we started our day at around 6am. After packing up, we went to the hotel in town where we’d eaten breakfast last time to enjoy some decent chai, good samosas, mandazi and even injara (Ethiopian style sweet flat pancake-like fried dough), ready to face the day.

Skip ahead now to later that day, as I finished my work in Eldas. We were now maybe 2 hours from Wajir and had made good time, so we expected to be back by about 4pm. As it turned out, it had rained quite a bit, not just in Moyale, but all the way down to Wajir town, so the roads were pretty wet and muddy, with the occasionally dry areas of sand. Well, the first thing that happened was that not too long down the road from Eldas, we hit a long patch of sand. My driver had already been cautioned by my security guards “pole pole” – go slowly. He hit the patch a bit too fast, and, as we found soon enough, we happened to blow a tire at the same time. My heart skipped a few beats as the Land Cruiser proceeded to hydroplane on the sand, and we first tipped one way and nearly tilted to my left and then our rear swung left and the car swerved as the driver tried to compensate. We finally came to a stop, and my security guards and I all looked at each other and then at the driver, who got out of the car mumbling that the car had been pulling left. Sure enough, the left rear tire was flat. After a relatively quick change, we were on our way again. No problem. Hakuna matata. Just another flat in the bush.

When we were about 15km from Wajir, we experienced our second and more significant event. As I said, the roads were pretty wet and muddy with plenty of “lakes” in the road. Actually, the lakes, or rather more than usual water, drew a lot of other creatures that we hadn't yet seen, like a large tortoise, a huge monitor lizard, and some fishing eagles. My driver preferred to try to circumvent these “lakes” and take the car up on the side of the road despite the advice of my local security guards who kept telling him to just follow the track through the water. Sure enough, this last time, they were warning him again as he took the car off the track and up the side, when we got stuck in the mud. No problem, we’ve got 4WD, right? Just engage and go. Not. Long story short, after a couple of long, hot hours trying to get enough rocks and brush to put under the tires for traction and despite the assistance of a few passing groups of men in trucks (unfortunately all smaller than the Land Cruiser), the car had not just one originally sunk tire, but three tires completely sunk in the mud. We were not in a cell coverage area, the closest being at least 7km away in Wagalla, and our UN required VHF radio was useless (couldn’t raise anyone on it). After I learned how close we were to Wagalla and Wajir, I suggested a few times that we just leave the car and walk to get assistance. I think they didn’t think I’d be able to walk those distances – much too far, especially for a woman. Men. They were finally reassured when I told them that in the U.S. I normally run 10-15km every morning and even farther on weekends. So, one of my security guards and I started walking while the other guard and the driver stayed behind to keep trying to get the car out. They were surprised that I put on my backpack and wanted to haul all my stuff with me. I wasn’t about to leave anything behind that I didn’t have to, and my pack and carry bag weren’t really too heavy, especially since I’d left my laptop in Wajir. No big deal – just like a hike. Anyway, the walk turned out to be pretty enjoyable, although hot – I went through the liter bottle of water I had pretty quickly. It gave me the opportunity to see a bit of Kenya the way most rural Kenyans do: by foot. We even saw giraffes feeding just by us on the road as we walked, and eventually the late afternoon/evening temperatures cooled enough to become more bearable. When we got to Wagalla, we arranged for a passing lorry to stop and help my driver and other guard, and I called one of my Wajir contacts to ask for the short lift back to town.

Talk about a story to tell. There’s more to the story, but my driver, the other guard, and the car finally got to Wajir some hours later after two lorries and a truck tried to pull them out and failed and only after a large passing bus stopped and managed to yank the Land Cruiser out. All’s well that ends well.

Cultural differences

As I live, work, and travel through Kenya, I’ve noted some interesting, some odd (at least odd by my Western standards although not necessarily by Kenyan standards, and some quaint things here. I’ve mentioned some in previous blogs, but I thought I’d mention or further explain some here in no particular order or importance.

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I think I mentioned before how Kenyans like to vigorously shake hands in greeting. Interestingly, if their right hand is dirty or holding something, they’ll extend their wrist for you to shake instead. Sometimes, old friends will greet by slapping their right palms together, and sometimes, some will even give you a “soul-style” handshake (hard to explain that one – but think of the old African-American TV show “Good Times”).

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Eating with one’s hands is very expected and normal here. In fact, Kenyans (in rural areas) find using forks, knives, and spoons interesting and will even watch to see how you use them. Anyway, it’s common to wash your hands before the meal, because your hands are your “utensils” and using dirty hands is considered a social faux pas. In Wajir, spaghetti or pasta is quite commonly served along with rice and occasionally, but not as often, ugale (the cornmeal type starch). It’s kind of grossly fascinating to watch people (usually men as Somali women usually don’t eat out in the very few eating establishments, or hotels) use their hands to mash the spaghetti with sauce, meat, rice, chipati, or whatever thrown together on a big platter, pick it all up in a very large bunch, and stuff it in their mouths to eat. As you might imagine, it’s an interesting mess that brings to mind small children eating their meals. I think I’ll stick to my standard utensils…actually, I’m missing using chopsticks…After the meal, everyone reaches for toothpicks…

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Bodily functions and picking one’s nose…Actually, this isn’t the only culture (normal for plenty of Asian cultures) where letting rip a burp in mid-conversation or out of nowhere doesn’t raise any eyebrows. What is odd (to my Western and Asian sensibilities) is the fact that no one thinks it odd or gross to very obviously pick one’s nose in public, even as one is talking to others. What do they do after they pick their nose? They might wipe their finger on their clothing, but more often they just flick their finger or rub their fingers together to remove whatever they picked…..Let’s just say that I am trying to always remember not to touch my face or eat before I’ve washed my hands or used my hand sanitizer given how many hands I shake in greeting.

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If you think someone is hissing at you, they may be just trying to get your attention. It might be a bit disconcerting at first, but Kenyans will hiss in the direction of a person whose attention they’re seeking. Interesting actually.

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Garbage or the disposal of it is an interesting issue. While in most industrialized nations we’ve become sensitized to trying to keep our environment clean, recycling, not littering, and not contributing to unnecessary waste, those notions seem to have yet to catch on here. There are signs that some are trying to introduce these ideas here, but they seem to be fighting an uphill battle. Many here seem to think nothing of just rolling down the car window and tossing an empty bottle or other litter out onto the road, as, much to my chagrin, I’ve found when carrying some of the local public health officials in my car. One time, I had stuffed a used handwipe into the empty plastic packet and had handed it to one of my security guards for him to do the same with the handwipe I’d given him for use. After he put his in the plastic packet and before I knew what he was about, he had rolled down his window and thrown the whole lot out the window and contributed to the accumulating litter that I’ve seen out in the bush. It’s really kind of sad.

The different areas of the countryside here are really quite beautiful, but they are gradually becoming marred by litter. Along roads, you can count on seeing the occasional black plastic bag or water bottle container. In towns, garbage has accumulated on the “streets” and roads. Moyale was especially filthy with trash in the streets. I inquired whether there was any regular garbage pickup or a common garbage dump or any type of recycling. The concepts are beyond what seems possible for them. Most people either burn their garbage (yes, even the plastics – don’t want to consider the amount of toxins contributing to the overall pollution) or just dump them wherever. Many don’t seem to mind living amongst the garbage – bizarre. I suppose some recycling occurs inadvertently. The large yellow plastic containers in which vegetable oil (a very common cooking staple here) is packaged are often kept to later serve as water carriers. Any metal goods like large metal cans containing food stuffs commonly from the U.S. and other sources of relief aid are often opened up and flattened and used as building material on houses (e.g., doors). Even the cloth of old clothes or the cardboard from boxes or the paper from newspapers may be used as part of the building materials for houses and other buildings.


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Trying to hitch a ride is very common on the rural roads here, but whereas in the U.S. and other Western countries, it’s not advisable with regard to safety for either the hitcher or the driver, here, it’s generally safe for the hitcher and common practice. The driver, however, is the one taking the risk of picking up someone who might be out to either rob you or swindle you out of your money or worse. Anyway, you’ll often see people trying to flag down a car by waving, or rather, flapping, their outstretched hand up and down, usually palm down. I’m sure the many rural people we pass think I must be some rich stuck-up foreigner who won’t even stop to give them a lift. Oh, and the hitching isn’t limited to trying to flag a car down. Whenever we stop anywhere, someone is always asking whether we can just take them here or there. Sorry. UN rules – no extra riders, but even without those rules, I wouldn’t pick up someone I don’t know, especially in a foreign country. There are stories about what can happen if you do…

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Holding hands among males is a common sight. Unlike in the West where homophobia seems to abound. Here in Kenya and elsewhere in Africa, it’s accepted as a show of close friendship among males. Reminds me of the innocence and openness of children.

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Computer viruses unfortunately seem to be commonplace on many systems here. Interestingly, I’ve noticed that many have appropriate antivirus software on their computers. However, it seems that they don’t realize that the software needs to be periodically updated and that the computers should be scanned regularly. So viruses run amuck unchecked. A big problem. I had a horrible time the last few weeks with a couple of viruses I picked up from the national public health headquarters and then from the Wajir district health computers. Being out in the field and having computer issues can be a real challenge, but often, the situation forces you to be resourceful and creative to deal with the problems; otherwise, you’re paralyzed or your work is. Well, these viruses definitely mucked up my computer to the point where programs would barely run and files wouldn’t open. I finally figured out that whatever they were, the viruses were directly affecting and tying up my antivirus software. Then, I figured out how to expunge them from my computer. What a relief. Having a functioning computer in the field is a must – not to mention that it also allows me to write these blogs so I can upload them later to the website. Anyway, I’ve learned my lesson. Just as one should always be careful who one takes up with (i.e., has sex with, to be more blunt), with computers in a foreign country, better to not share files unless one really has no other choice. Then, one should always have protections in place.

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Cell phones have really taken off here. Makes sense in a weird way. Laying down phone lines in the bush or unstable areas can be a real challenge. Add to that the maintenance issues. On the other hand, establishing and erecting some well-placed cell towers is a much more tenable option in a country such as this. Interestingly, most people here just buy a certain amount of credits for their cell phone and replenish credits as needed rather than signing up for a long term contract with set minutes like we tend to do in the U.S. Texting, as elsewhere, is a cheap and affordable option compared to voice, so many send text messages. They even have the option to send a free text message to someone to ask that person to call them in case the first person has no or limited credits to call the other. Of course, some abuse that option to get the person with whom they want to talk to pay for the phone call rather than using their own credits to call.

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Many Kenyan women, especially in rural areas, will carry their infants by slinging them in a large cloth that they wrap around one shoulder and back. Kind of reminds me of how Asians also carry their infants. My mother used to do the same when I when I was a child. It’s funny how in the U.S. and other Western cultures the “Baby Bjorn” and other fancy baby slings are popular now when many other societies and cultures have always used a cheaper and easier option. Interestingly, I didn’t Somali women carrying their infants in this way, but then that may have something to do with the fact that their style of dress (i.e., Muslim covering) is not exactly conducive to such a sling.

Life in Wajir...mzuri

I still think it’s much too hot here, but I must be getting used to it. I’m not waking up nearly as often during the night from feeling too prickly and parched from the heat (i.e., less interrupted sleeps), and I’m not sweating quite as much at night. As you might imagine, given the heat and that it’s predominantly Muslim here, I’ve stopped running in the mornings, even within the area of the guesthouse. I suppose I could just don my quickdry REI pants rather than my shorts, but I don’t really feel like sweating through more clothes in a day than I have to. Instead, I do exercises in my room most mornings and then try to take brisk walks in the evening after I’ve finished for the day if time allows before my evening shower and dinner.

I’ve fallen into a sort of routine here, which is actually kind of nice. I wake in the mornings, do some exercises for about 45 minutes, take a quick shower to rinse off (and cool down), dress and grab breakfast (milk tea, bread or mandazi [kind of like puffed fried dough], or some waffle-like things, and sometimes a hard-boiled egg), then start my day, which can be anything from meetings with district Ministry of Health staff to usually driving around the district (or, more like, bumping along) to visit health care facilities. Sometimes, I get a real lunch (usually spaghetti with some sort of tomato? and potato based sauce and some beans); sometimes, it’s just a Power bar; and sometimes, nothing but my water – or, if I’m lucky, some milk tea, chipati, and sometimes even some goat meat to accompany the chipati, at some very modest hotel in some bush bula. (I'm probably taking some risks eating/drinking in the bush, but I'm careful to drink only tea, which is always boiling hot, and avoid any water or other nonboiled liquid - funny that I've grown accustomed and even look forward to hot tea even in the scorching 40+ degree C heat.)


In the afternoon/evenings, if there’s time, I take that walk I mentioned down the road away from town. It’s pretty safe. The few people I run into are friendly, although they probably think I’m an odd “white woman” to be walking and walking so quickly compared to them; my pace isn’t particularly fast, but a normal Western pace is practically cruising compared to their walking pace. (Oddly, they don’t have a word or distinction for Asians from Caucasians here, and in their minds, I’m just as white as any Caucasian. Very funny – although most still tend to think I must be Chinese or Japanese and are very confused when I tell them I’m American. They insist I can’t be from the U.S. Bizarre, since Kenyans have migrated to the U.S. just like every other ethnic group.)

Walking has allowed me to see some of the interesting wildlife in the area – especially, the giraffes that amble down the road almost all the way to town every morning and evening as they feed on the trees in the area – very cool. One evening, my driver, one of the guesthouse staff with whom I’ve become friendly, and I drove the 6km or so down the road to “Lake Wajir,” actually it’s called Lake Yahoud. OK. It’s not a lake. It’s an old quarry that’s been drilled down to the water table to allow it to fill. Although when we visited, only birds, especially the large, scavenging, and peculiar Maribou storks, abounded, there was plenty of evidence of other animals. Seeing the water was really comforting (I really miss the water – especially the clear blue waters of home); and it was very peaceful to stand in the shade of a tree and watch the birds.

Just before dinner, which is usually at, 7pm, I take a shower to clean off everything, and I mean, everything. Since the sink isn’t conducive to washing clothes (small, kind of dingy, and no plug), and since the water is pretty hard here (so soap doesn’t lather at all), I walk straight into the shower with all my clothes and even my shoes (I’ve got a pair of Keen sandals) on and use a lot of shampoo to clean everything. Works OK, and my clothes and shoes all dry, for the most part, within a matter of an hour or two.

So that’s pretty much my routine here in Wajir. The next week will get a bit busier as we start the second round of the sub-national polio immunization campaign, but at least I have a relatively comfortable home base.

Dust everywhere

I’ve spent the last several days traveling and tromping throughout the vast (56,501km2) district of Wajir in Northeastern Province – or NEP aka “nothing except problems” or “nothing except pleasure” depending on your point of view according to my security guards (UN requirement for phase III areas – I had two military style police escorts) and the district disease surveillance coordinator (Abdikadir) with whom I’m visitng various health facilities. The first day was the easiest since we just visited facilities in and around the town, so no need even for a security detail. Our primary objective is furthering public health through assessing surveillance for acute flaccid paralysis, measles, and neonatal tetanus; assessing immunization activities; teaching (or as it’s known in the field, sensitizing) health care workers about basic concepts of surveillance, immunization, and diseases; and increasing awareness (or social mobilization) regarding the upcoming 2nd round polio immunization campaign. However, on occasion, given that I’m a doctor, I’m asked to help assess a patient or two. For instance, a local private health care worker reported a potential measles outbreak in one of the Somali villages around town, so Abdikadir and I went to investigate. The presentation of the supposed cases overall weren’t consistent with measles (i.e., rash history and presentation not consistent, etc.) – I hate to admit it, but I was a little disappointed. It would have been really interesting to see real measles – it’s unfortunate that pathology or ill patients make for more “fun” intellectually for infectious disease docs. Anyway, I suspect some other viral or possibly bacterial infection was making the rounds in this village…

Following the first day around town, the next several days were real safaris out to the bush. Long, hot days and very bumpy, crazy drives over very, very bad, unpaved roads, sometimes rocky, sometimes packed dirt with unexpected little ditches or potholes of all sizes, and most times plenty of sand or very fine, loose red dirt. Sometimes, I wondered if parts of the road were even passable, but somehow we always managed to either get through or find a detour or “diversion,” as they say here. By the end of our series of sojourns, we were all covered head to toe in fine red dust, as was the car, inside and out, and everything else that was exposed during our drives. I even taste dust and blow out red dust. Blegh. But despite that and having to get used to constantly feeling hot, dehydrated, and intermittently wet from sweat and/or sticky, the last several days were really great. We started early every morning, which meant that often we’d see plenty of the wild animals that were up and taking advantage of the cooler morning temps to feed. Lots of dikdik, giraffes, gerenuks, and even a few jackals and servals. Unfortunately, they’re all much too fast for my camera, but I have the memory of them in my mind. Pretty cool. Although most of the time, we barely ran into anyone or anything out there between bulas, or villages, we occasionally ran into a bit of a traffic jam – camels, donkeys, and/or goats with their herders. We certainly saw plenty of them at various watering holes, too. Funny thing just to mention, according to Abdikadir and my security detail, the people here don’t ride the camels. They use them as beasts of burden like the donkeys they also have, or for milk and meat, but they would never think to try to ride them. In their minds, that would be abuse – don’t ask me about that logic.

We’ve traveled in every direction from Wajir town, which is somewhat central in the district: east almost to the Somali border, south as well to the border, west to the neighboring Kenya district, and finally north, just a kilometer from the Kenya-Ethiopian border. The last was quite the experience. Up until then, we were making long days so that we could always return to Wajir to sleep with the longest trip being a 500km circuit around the South. However, the North circuit required traveling at least 600km. Given the poor condition of the roads and harsh climate as well as the number of facilities we needed to visit, it would have been crazy to try to do all of that in one day. So, we had no choice but to overnight in Moyale, a town just a kilometer from the Ethiopian border and just in the neighboring Eastern province. That was an experience I wouldn’t care to repeat. I think I would rather have gone camping. One guesthouse we looked at had showers and Western style toilets, but you wouldn’t want to use them given their condition and odor – definitely disgusting. The guesthouse we ended up in had no running water (they have a bore-hole well and you take basin-type baths), and yep, the “toilet” was pit latrine style. Well, it was only for one night. I was glad that Abdikadir, my driver, and the two security guys were all going to stay there, too, in rooms around mine because there were no other females staying there, and security seemed a little questionable. Given that there were no other females and limited privacy, I opted to forego a “bath” and instead used copious handwipes to clean up – almost like camping. Plenty of insects abounding around the place and even in bed with me despite my using my bed net. I woke up twice to feel something crawling on me (definitely good size, not some small bug or mosquito), reflexively wiped or swiped them off, and heard them smack the wall and fall to the ground – I don’t want to think about what they could have been. Oh well, things could be much worse, and at least dinner at one of the nearby hotels (did I mention how “hotels” here don’t usually mean lodging; they mean restaurants or food stops) was decent (and hygienic, I hope) – plenty of goat meat, which is pretty tasty, and spaghetti with kale. I’m laughing at myself now for thinking that the lodging at Mwingi had been bad. Still, despite the minimal lodging accomodations, it’s been a really interesting and rewarding experience overall to work with health care and public health workers here in Northeastern province.

Acclimating

Oh my God, it’s hot here. I like warm, but this is really crazy. You sweat through anything you’re wearing within seconds. How do they function? I’m truly amazed that people survive, live, and work out here. The early to middle of the afternoon is the worst time of day. There’s no breeze, and the sun just beats down. Fortunately, we try to go visit facilities and have meetings early in the morning and get done by lunch, which, by the way, in Kenya is routinely from 1pm to about 2 or 2:30pm. Here, many places actually close for a couple hours in the afternoon, and many people rest in the shade or indoors and even take a nap. Not a bad idea if you can manage. Trouble is that sleeping can be difficult when there’s no real breeze to cool you off, definitely no air con, and sometimes, no fan even to move the warm air around.

The latter is because of the occasional “power rationing”. Apparently, this is a recent thing due to “improvements” being made to the nearby airstrip – yeah, there’s actually one nearby; it used to belong to the military and only recently opened up to private charters. Wajir is also not on the usual hydro power grid that is common to most of Kenya. Instead, they depend upon generators powered by diesel – pretty expensive option. So, anyway, that means, every other day, the power is nonexistent. This is where I’m glad to have brought along my Xantrex power source to power my computer and my Solio power charger to charge all the little things I can’t seem to do without (i.e., Ipod, cell phone).

Can I just say too how much I appreciate and am so glad that I bought and brought along clothes made of quick-dry materials? Sweating through ones clothes is not really all that comfortable or odor friendly, but with the modern materials used for many trekking clothes nowadays, it’s a lot more comfortable as well as conducive to quick washing and drying. I only wish bras were also made of these materials. Oh well. Except for that, I’ve packed away all my non-synthetic (i.e., cotton) clothing, which is probably just as well. Remember how I spent that first night in that Catholic mission and I saw a few bugs on the sheets? Well, it turned out the bugs didn’t eat me, but they sure liked my cotton T-shirt. I found in the morning that they’d managed to eat a number of holes in my “new” STOP program T-shirt that I’d got in Atlanta during training. Another oh well. The guest house I’m staying in now, Neyrus, although pretty basic, is comfortable and relatively clean (just ignore all the spiders, some live and some dead, hanging in the corners and other parts of the ceiling, and all the other common insects); actually, it’s a converted Somali family house, and the meals they serve are home-cooked and pretty tasty. All in all, not a bad place to call “home” for the next few weeks.

Tomorrow, we leave at 6am to travel far out in the district to assess some facilities. Why so early? So that we can make it there and back before dark and not get stuck having to stay out there where I would really be stuck in the bush with just the basics and nothing else. Just another adventure.

Roughing it

After a long, hot, bumpy journey, we finally made it to Wajir, about 300 km or so from the Kenya-Somalia border. The next 3 weeks may be a bit of a challenge in many ways, not the least of which is the climate. I only hope my stomach situation improves and stays stable. The day before leaving Nairobi, I suffered a relapse (I think) of my previous ailment. This time around wasn’t as bad as the first time, but it hasn’t been fun either. I’m medicating again with metronidazole, but this time with the “regular” 5 day course rather than the whopping dose all at once. Hopefully, I’ll kick it this time. I’ve met some folks from various NGOs in Garissa who’ve recommended trying tinidazole if this round of meds doesn’t work. Hopefully, I’ll be able to find some here in Wajir if I need it; had meant to pick some up in Garissa…

I arrived in Garissa on Sunday evening after a long hot drive (remember, no air conditioning in my car – of all the luck, I’m the only one without it this time around). Along the way, I saw plenty or camel herds, which the Kenyan Somalis keep rather than cows as they’re more suited to the harsh climate here. I arrived in Garissa to find that the one really decent hotel was fully booked. They did manage to find me a room in a “new” hotel down the road. The Halgen, where I stayed the last two nights, was at least clean, and yes, at least had air con, but the power would cut in and out and then they shut the power off from 6am. Water supply was OK and the usual low pressure I’m getting used to, until this morning, when I found at 7am that there was no water at all. Oops. Oh well, so much for a morning shower – thank goodness for my supply of hand wipes. It’s supposed to be relatively safe in Garissa (the majority of Northeastern Province is Muslim), but still, it’s weird having a room with two doors, one on either side of the room, leading into it. Should I mention, too, the endless crickets? I found 7 hopping around in the bathroom the first night, and then there was always at least one in there chirping away from 5am every morning. [sigh] Here's the charming view from the balcony outside my room.

Still, Garissa was interesting. Carry (remember she’s one of the WHO short term consultants recruited for the two months of the polio immunization campaign) and I went for a walk around town one evening before it got dark. I’m sure the locals weren’t sure what to make of us. Garissa, however, seems to abound with plenty of NGOs. It’s kind of weird actually to see so many foreigners out here. Some of them from an organization called Mentors’ Initiative, an organization that promotes and assists with malaria prevention, had a house near town and invited a bunch of us to dinner one night. It was a haphazard and fun experience. Imagine a big relatively empty Somali style house (flat, kind of high ceilings, large square/rectangular windows, large rooms, Muslim influenced style doors – this one probably was built for a wealthy family) with barely adequate lighting powered by a small generator and then a whole lot of mostly Caucasians, a couple Africans, and me, the lone Asian. We enjoyed a very simple but very “hit-it-on-the-spot” dinner of spaghetti marinara. It was really wonderful.

So that was Garissa. Seems ages ago. The drive to Wajir was a bit hot (up to 43 degrees C and probably hotter if I put my pocket thermostat in direct sunlight) and rough – no tarmack and plenty of dirt, sometimes packed and treaded like a washboard, and/or sand and occasionally ditches and deep divets – but there were some interesting wildlife along the way. We saw Gerenuks – guess it’s in the deer or gazelle family. The name comes from the Somali word for giraffe-necked because of their long necks relative to their bodies and the way they seem to move like giraffes. Usually, they were trying to seek shade from the scorching sun or running away from us. Interestingly, they tend to feed standing up on their hind legs. We also saw plenty of other gazelles and a small version called dikdik; they mate for life and are so committed to each other that if one dies, the other will starve itself to death. We also saw ostriches – talk about some powerful and very imposing birds. Pretty cool. Fortunately, we only saw animal wildlife and the occasional bus or lorry rumbling along and kicking up plenty of dust, and not other kind of trouble, so my three security escorts had an easy ride and snooze in the back of the Land Cruiser. I think they even enjoyed seeing the wildlife, too.

Tonight, I’m staying in a Catholic mission guest house just a little outside of the center of town in Wajir. It’s not too bad compared to all the other places I’ve been. Just very meager, although I see a few small bugs on the sheets – seems to be a part of life in the bush. Thank goodness for the fan in my room, although it tends to blow around the warm air rather than send around cool air. Still, it’s good to have been able to take a shower, which I kind of shared with a little frog who appeared to usually inhabit it but hopped out the side hole that was the drain when I started the water and returned when all the water had drained out at the end of my shower. So, now, clean again, and ready to get some sleep, although I could wish to be back in the Fairview in Nairobi, I’m glad to be out in the field where it’s more fun and I can really help out.

Heading out again

Well, we're set to head out to the field again. It's been a nice break here in Nairobi, both because of the wonderful accommodations and amenities at the Fairview and because I'm fortunate to have a few friends from CDC who happen to be living and working here. They've enabled me to see more of Nairobi and the surrounding areas than I otherwise might have had I been on my own.

Yesterday, Diane and I got to join my friend Pauli, who is working here for the International Aids Vaccine Initiative (very cool work), on her "errands" in Karen, a suburb of Nairobi where many of the white Kenyans live and also where there are many craft shops that sell real quality artwork made by Kenyans. It's also the suburb where Karen Blixen (remember "Out of Africa" lived, although it's named after her cousin not her). You would never know these craft shops are there unless you knew where to look. It's not like they're in one area and have obvious store fronts. Instead, each one is located on an estate in the area, and unless you knew where they were, you might have trouble finding them. The restaurants in the area are the same way. One of the places we visited was a bronzeworks shop called Matbronze, where we could watch Kenyans preparing the wax molds. They turn out some really beautiful pieces, some of which are on display along the walkway up to the shop.

Pauli also took us to the Sheldrick baby elephant orphanage, where baby elephants who have been orphaned by poachers in Kenya and surrounding countries are taken in and cared for until they are about 2-3 years old and able to fend for themselves. Then they are released back into the wild. Elephants really are amazing in how “human-like” they are. The mothers are very nurturing and devoted, so when the babies are orphaned, the experience can be very traumatic. At the orphanage, each elephant has 2 devoted attendants who take turns sleeping with and caring for each elephant. It’s obvious how attached these elephants become to their attendants as they follow them around and even run after them if they see them walking away.

So now, after enjoying our time here and making our first reports, we head out again. This time, I'll be heading to Garissa and Wajir in the Northeastern Province, where it's supposed to be pretty hot, dry, and dusty, and there will be more than enough bad roads - another adventure. I'll be traveling in a huge Landrover with no air-conditioning - that could get interesting - and as the area is considered phase 3 (given the proximity to the border and influx of refugees), we'll have a security escort. Diane is heading to the Western Province initially, and then will head again up north in the Rift Valley, familiar territory now for her. Not sure whether I’ll have internet access; and who knows what cell coverage will be like, but we’ll all try to stay in touch with each other at least. It’s good to hear a familiar voice from time to time in the field. We’re all scheduled to return again around the 25th, so till then…