Last day in the field

Yea! It’s a little hard to believe that three months have gone by, and today is my last day out in the field – at least in Kenya. It was a great feeling to give my last talk on acute flaccid paralysis, measles, and neonatal tetanus to the last group of clinicians, get in the car, turn to my driver, and say, “George, let’s go home to Nairobi!” Of course, we won’t be in Nairobi until tomorrow afternoon. It was too late to reach there before dark, and neither George nor I really want to risk driving into the city at night, especially on a Friday night – notoriously the riskiest time for carjacking incidents, and there was another one just the past week. The drive, while doable, is pretty long anyway, so we opted to overnight in Nakuru, about three and a half hours from Kisii. (Nairobi would be another three to three and a half hours from Nakuru.) So I’m enjoying the relative comforts of the Midland Hotel (not too bad –the recently renovated annex is actually pretty modern although the key tends to turn round and round in the lock and the shower tends to run either hot or cold and has a hard time settling into something in between) here in Nakuru, where it’s a rainy afternoon and evening. It seems I’m leaving western Kenya none too soon – the rainy season has begun, which means flooding and impassable roads.
I still have a little over a week before I return home to Hawaii, and it will be a busy week. I have at least three reports to write: the field report for this latest assignment in Nyanza, the mission report for WHO headquarters, and the trip report for CDC (to justify the per diem funding), and of course, there’s the debriefing meeting. But before I go there, here are a few last images from Nyanza.

It never ceases to amaze me how the women in Nyanza walk around so easily with what sometimes look like precarious and heavy loads on their heads. I've even seen some carry long bundles of wood without even needing to use their hands and turning this way and that, seemingly without a thought or worry that whatever is on their head will tumble down. The funniest thing I've seen is someone carrying her umbrella (lengthwise, of course) on her head. It's just natural for them.

This is an example of medical records in one of the hospitals. We keep hard copy records in the States, too, but often, these days, there's electronic back-up or some other back-up (like microfiche) of records. Can you imagine trying to find a patient's records in these stacks? Then again, interestingly, every person keeps a notebook that contains the clinicians' notes from every outpatient visit. Hospitals and clinics apparently don't keep patient medical records (unless they're a private institution, and even not all of them do); people keep and carry their own medical records with them - except for inpatient records. Then, the hospital keeps those. Trying to review, or actually find, clinician notes for research or investigative purposes would be a challenge here.

The countryside here is such a stark contrast to Wajir. Many of the people here are farmers, so much of the land has been turned to agriculture. The result is that much of it has been developed and looks amazingly green.











Unfortunately, that also means that they seem to be indiscrimately destroying much of the natural forests and therefore endangering the natural wildlife, not to mention that one day they'll find that they don't have wood for burning. Sad. But it's hard to argue with them about environmentalism when these people are focused on survival...
On another note, it's a good thing I finished my mission before any serious rains began. The countryside may be beautiful, but I wouldn't want to get stuck someplace indefinitely.
Everywhere we went, markets were bustling. It was amazing to see the huge crowds and all the things being sold.
I just wonder, so many people selling the same things (every time you slow down or stop near where people are selling things, so many of them would come toward the car and hold up bags of carrots or bunches of pineapples or bags of beans) - with so much competition, are they really able to sell enough to live? Really, when you're bombarded with so many of them, how can you choose from whom to buy? (Funny and smart thing: some of them gathered by the side of the road near speed bumps, where people have to slow down - good place to try to sell your produce and wares.)

By the way, in case you're wondering, most of my pictures were taken through the car window. After all, I'm not here as a tourist, and I don't have the luxury to stroll the countryside or the "streets" and stop to take pictures anytime I'd like. Usually, we're trying to get from one facility to the next, and traveling over these roads and distances is definitely not like traveling back home.

Soon enough, I'll be home where I left behind concerns regarding avian and pandemic influenzae. Oh, those concerns are here, too, but they're not quite as prominent as other things like ethnic violence, HIV/AIDS, measles outbreaks, poverty, etc. Still, those in public health and health care are aware. My colleagues and I only half joked about the risk all the chickens running around the hospital grounds in Suba might pose if avian flu made its way to this country (unlike in Hawaii, people here do live among, catch, and eat the chickens running around here - weird to see farm animals like chickens and even pigs living on the grounds of a hospital...)

By the way, while I'm on the subject of birds, like Hawaii, or even more so, Kenya is full of amazing bird species. These are pictures of some on the grounds of the hotel where I stayed in Homa Bay. (Called the Tourist Hotel - nice exterior and seems clean initially, but I wouldn't necessarily recommend it. Or if you ever end up there, would only pay for the cheaper option as anything more than a single is not worth it - dead bugs all over my room, even in the sheets, and dead ants all over the breakfast bread just to start...)

Towards the end of my time in Nyanza province, there was an awful road accident just outside of Kisumu, a head on collision between a matatu (minivan taxi) and a semitrailer. Something like eight people including two children were killed; some were decapitated! Anyway, the accident resulted in a crackdown by police. Police checkpoints along the roads here are commonplace. Ostensibly, the police are supposed to check to make sure vehicles and drivers are roadworthy and fine people or pull vehicles off the road if they aren't. Unfortunately, most of the time, the police are just looking for a "small bribe." During the crackdown, they got pretty serious. It was interesting that road traffic the day after the accident was scarce in much of the province as buses, matatus, semitrailers, and any vehicle that might have any problems were not driven, and matatus and buses that were carrying passengers well over the legal limit tried to stop well short of the police checkpoints to let off passengers so they could pass through the checkpoints without being hassled. Kind of scary then to realize how many vehicles are not really roadworthy and how many are usually so jampacked with commercial goods or people as drivers are trying to make as much off the rides as possible. Sometimes, it's even comical, as you can see here. At first, I was puzzled why this car would have shoes dangling out the back...until I realized it was stuffed to the gills with people. I remember in college we used to all pile into someone's car to get someplace, but this is pretty ridiculous, not to mention dangerous, especially with the way most drive in this country.

It's been nice to be able to end my time in Kenya by Lake Victoria, near water. Although nothing like the Pacific Ocean, especially with all the hyacinth in so many areas (like by the dock here near Hippo Point), a sunset over water is still beautiful.