Return to Mara

The week before leaving Tenwek, I took the opportunity to return to Maasi Mara and the Safari Club, which my wife Cheryl and I had visited on our 25^th wedding anniversary in 2002. Maasi Mara is a game preserve, which is however owned by the Maasi who still live here in small villages, still keep their cattle (sometimes mixed in with the game) and still hunt lions that endanger the aforementioned cattle. The Mara means the “spotted land” and indeed from the slopes of the escarpment, which commands the landscape, the wide expanse seems strangely dotted with solitary trees at orderly intervals as far as the horizon. This is in contrast to the area further south, the Serengeti in Tanzania, which is essentially treeless.

The Safari Club is situated in an oxbow of the Mara River, a reliable watercourse except in a drought year. The river protects the thatch-roofed lodge and canvas tents on three sides and an electrified fence on the North side. Nevertheless, evening strolls without a guard are rigorously discouraged. The Safari Club is that odd mixture of opulence and exigency which means to me “This is Africa” although in a larger sense I think any sentence that begins with “Africa is…” is immediately suspect of over simplification. The entire African continent and its many diverse peoples are immune from any easy summation of its essence.

On our arrival in 2002, we settled into a large and well-appointed, if rustic tent, with two single beds, modern plumbing and solar heated water. Looking out the front porch however was the curve of the river and the red wall of the fine-grained silt, which makes up the banks, falling 30-40 feet to the river below. In the curve, parked it would seem by a careless attendant, were about a dozen dark grey to startlingly pink hippopotami. Supposedly, the hippos had chosen this site as it was free of crocodiles due to rapids above and below this stretch of the river. They are accustomed to laze away the hot afternoons in the Mara River, with occasional sallies-forth into deeper water after some hippo domestic quarrel with loud grunts and mouths agape. After dark, however, they emerge, climb the steep bank and walk single file to browsing areas, returning in the wee hours of the morning, accompanied , like a drunken sailor coming to port, by hubbub, loud halloos, grunting, fussing and fracases. For those who sleep lightly, hippopotami are not good neighbors. In the morning, deep but surprisingly narrow furrows in the landscape show where the hippos have slunk out and back to the river.

Cheryl and I spent the time at Mara doing game drives interspersed with leisurely meals, and conversations with the many other guests and staff. Once while we were eating a late breakfast in the high-ceilinged dinner room, we were assaulted by a blood-curdling growl, morphing into the squeal of a pig-sticking ending in the heart-rending cry of an injured child. It seemed to emanate from the very air around us, lasting for about 10-15 seconds. On catching our breath and looking around, none of the several waiters in attendance seem to have heard a thing. What we finally discovered was that the thatching of the lodge was inhabited by tree hyraxes. Hyraxes http://en.wikipedia.org/wiki/Hyrax are small critters (the “coneys” of the KJV of the Bible) who oddly enough are most closely related to elephants. Now that we were in on the secret, we waited for another outburst and ourselves pretended to be stone deaf.

The game drives typically start shortly after sunrise and our 6AM wake up call, by the tent attendant, was ameliorated by his leaving a pot of cocoa and a plate of several excellent almond macaroons. Over time, this procedure, however, had not gone unnoticed by the local troupe of Verbit monkeys who had learned to reap this harvest. By following the attendants at a casual distance, they could whisk away the food before a groggy guest could retrieve it. Being duly warned we made a point of arising in a punctilious fashion at the first call.

One of our cherished memories is that of the naturalist, an authentic old East Africa hand were there ever such a one. He was tall, and thin wearing his grizzled beard, a slouch hat, khaki hunting shirt, shorts and knee socks with aplomb. While normally in Land Rovers, we scheduled a walking tour with him early on our final day.

Cheryl and I were the only ones who arose in time and thus had an entourage of our own. On the walk but we had security in abundance; a uniformed guard with a shotgun and two Maasi warriors in leather kilts, red plaid, spears and dangling pierced ears. The walk took us around to a number of sites just outside “the wire” but it was not without drama. As we rounded a curve, we saw about 40 yards off, a spotted hyena, acting strangely stiff-legged.

“What’s he doing?” I asked.

“Hunting you, I would imagine,” was the naturalist’s immediate response.

He turned out to be a regular gossip about the political life of Kenya since its independence. He had marked and ardent views on the character of the personages of the day, especially in regards to the Leakey’s, that family of fossil-hunters and scholars cum politicians who successfully bridged the era from British East Africa, the colony, to The Republic of Kenya.

“Humph, now Richard (Leakey) has been made the curator of the National Museum, very improper. He hasn’t got the education, too political, much the wrong sort of precedent, doncha know. His daughter, Louise now, London educated, you see, good lass, should see the family name right, I should think. Married some Belgian chappy though….”

Observations on nature, Maasai marriage customs and drinking habits were interspersed with the experimental reaction of the Tsetse fly to zebra herds (confusion and apparent nausea ), the nature of butchering hippos and his preferences in game meat (Eland and an opinion in which I concur).

It is now eight years later and I returned to Mara not only to take a break but also to revisit this wonderful place since I was a mere two hours drive away. I was scheduled to leave in the early morning but could not go until noon, as the ward and nursery were so busy. Collins, my driver, gave me a running commentary of the trip; pointing out the sights including his hometown and stopping in a cloud of red dust when he saw his father walking home from the elementary school he runs. “Habari gani’'s” and welcomes exchanged we were on our way again shortly arriving mid-afternoon in time for a late game ride with Leo who would be my guide and driver for the next two days. Where Collins was spare and lively, Leo was quiet, large and capable, seemingly able to drive the deeply-rutted game trails, talk non-stop (via radio) with the other drivers as they compared notes as to where the game might be found, point out the open side of the Land Rover at a distant gray blotch and call “Tembe! (elephant)” simultaneously.

The Safari Club has much changed, having been renovated after being sold to the Fairmont chain. The tents are now on smooth stone platforms, the beds replaced by a queen size four poster, the plumbing and lighting ungraded to reliable (i.e. between 6AM and 11PM). The shower especially is a wonder, as it supplied authentically hot water and in adequate volume to justify the name. I muchly appreciated this as the first night we finished the game drive after 6PM (ie in the dark) during a driving rain storm we had watched sweep in from the east. I walked to my tent in the deluge and arrived wet and cold. A hot shower and a pre-dinner pot of tea was a welcome restorative.

With the change in ownership, the lodge has been roofed in tin and the thatching and Hyraxes removed in consequence. The waitress was obviously just new, very earnest, very nervous and quite proper to the mzungu mzee (old white man). No amount of banter made her relax or stop fussing with me while I contented myself with looking about at the new décor in the nearly empty dining room and reading my book on Swahili. In the past, on a Friday evening there would have been several presentations regarding the game in the area and even a dance demonstration by the local Maasai.

Hyraxes, thatching, naturalist and dancing were gone, leaving the evening strangely quiet in the rain.

The following day, Saturday, I went on two game drives morning and evening, the landscape again threatening with dark clouds welling up in the afternoon behind the escarpment. This time we ventured up the slope in search of rhinoceroses. Rhinos, I was told, favor a higher, cooler and more shaded environment in the wet season Moreover, these came with their own posse, an army detachment, stationed there to discourage poaching which has reemerged after the political turmoil of 2007-2009. Leo pulled up and motioned us to get out when he sighted a large bull “White” Rhino (properly “Wide Rhino”, for the shape of the mouth). We happily followed snapping pictures as the animal stalked off uphill until one of the guards urgently called something in rapid Swahili. Leo immediately herded the Belgian family I was riding with and myself back into the Land Rover saying “That is not the right rhino, the zamu (guard) says he is too arrogant.” While I was trying to picture a humble rhino, we moved about a hundred yards uphill and found two young males grazing. This time we were able to get within about 20 feet of one of them as he methodically grazed on the short grass and young shoots. We took turns taking “bragging rights” pictures of each other with a rhino in the background. On coming back to the Land Rover, a cartridge box labeled “TIPS” was prominently placed in the middle of the trail. We all left a contribution.

Coming back to the Mara, we spotted a walk of giraffes. A group of giraffes is a “walk” as they will move from place to place single file at regular intervals using their seemingly sedate stride, covering 8 feet at a time.

We arrived as a group was leaving a browsing area, walking by the vehicle about 6 feet away. One giraffe remained, apparently scratching an itch in his right ear using a tree branch (some 18 feet above us) for the purpose.

Over the three days I went on four game drives, each time seeing much that I had seen before and yet always something new I had never seen: a family of mongooses getting up to sunbath after the cool of the night; a young lion apparently oblivious to a snout covered in about a few dozen black flies, a secretary bird laboriously taking flight, a troupe of baboons racing the vehicle and pouring over the trail in front of us.

Sunday, Collins was there to see that I packed up and got off on time despite the wet roads. As I was leaving, I surveyed the river from the veranda behind the lodge, spotting the sinister shape of a crocodile a hundred yards downstream from the gray-and pink hippos grunting in the shallows of the oxbow of the River Mara.

Birds and Blankets

Swallows nest under the eaves of the new surgical theatre as well as the OB ward. In the afternoons they come out to swoop around in intricate aerial dogfights with adversaries I cannot see. While they swoop, some so close as to make me believe I can feel the breeze of their passing, they make this incessant chatter; as if congratulating each other on their expertise.

There are numerous birds at Tenwek; African Robin, Crested Bulbul, Superb Starlings (no, I am not kidding), Weavers, Sunbirds, as well as a bird who serenades me at breakfast with a one note song which seems to repeat every one second, like a metronome.

The most sinister of these birds is the Black Kite, usually a scavenger. However, I have noticed that when the long sharp-winged shadow of the Kite drifts silently over the grounds, all the small birds seek shelter. The Kite, a trim small raptor, sails silently in the blue skies, barely ruffling a feather, solitary stolid and deadly., reminding those who are able to hear, that sudden death is always at hand.

It has been a difficult week. The rains and the fear of famine continue. One of the patients on the ward has been abandoned by her family after she was admitted for a serious fracture. The father apparently has a drinking problem, the girl’s mother has run off; he is subsistence farming while squatting on a Maasi preserve and it appears has no intention of retrieving his 9 year old daughter, now completely healed. The nurses have set her to work distributing meals but she may be found almost anywhere on the grounds in her cast-off green skirt and Manchester United rugby jacket. Last night we admitted a girl in congestive heart failure, unable to breathe, wasted, and cold to the touch. She is better this morning after restarting the medications her family had stopped due to cost. An infant was sent in with three contradictory diagnoses; unfortunately missing the major heart defect which would kill him two days after he arrived here. “In many words, there is little wisdom"

Another girl came in with a bloody nose...which refused to stop even after we gave her blood. Her platelets, the small particles which provide the "thumb in the dike" when bleeding occurs, are dangerously low. I did a bone marrow for the first time in 30 years and was walked through doing a biopsy as well. The results suggest she has a chronic viral infection destroying he platelet-making cells in her bone marrow. We have no treatment.

A two year-old with a large heart on Xray was admitted for congestive heart failure on treatment from a district health center; she responded to none of the usual treatments and her physical was wonky, none of the expected heart murmurs. I was able to abduct the OB ultrasound machine under cover of darkness and do an exam showing her heart is not floppy and dilated as expected but rather thickened and "muscle-bound." We stopped the meds she had been on two days ago; she is now able to breathe better and is in room air. We returned the machine before it was missed.

The nursery staggers on. Of the 9 deaths we have had since I came, all but two have been associated with major failures of temperature control. This seems too trivial to most people but careful control of the temperature of the environment for premature infants was the first intervention to show that mortality can be decreased by medical care. That study was done in the early part of the 19th Century with the (then) new technology, the mercury-glass thermometer. It is difficult to convince people that the mundane business of newborn care, what I call the “housekeeping” functions are the things that make the difference in survival.

A high school acquaintance who I have not talked to in 44 years started writing me in Facebook (yes, I confess, I Facebook). I was describing the mission and he asked if he could donate something and while I was hemming and hawing about what little space I had, he suggested “Space Blankets,” the thin silvered Mylar sheets used in emergencies to reduce heat loss. I think it was a brilliant suggestion. The day before I left the package arrived and I used the 250 little packets for padding. Each sheet can be cut up into individual 24 x 13 inch sheets which can be used to swaddle small infants in the largely unheated highland homes at night. The man is a genius. Who woulda thought Timmy Cahill would turn out so well?

I was called to a delivery last night. A mother had been laboring at home for two days and came in exhausted from the effort. She eventually delivered this limp, blue, non-breathing infant with a scant slow heart rate. The mechanics of resuscitation are pretty routine and I started to breathe for him after clearing his airway. He responded very well, his heart rate jumped up, he turned pink, his pulses became strong and his tone improved somewhat. He would not breathe on his own, however. Each time I tried to “let him solo” his chest showed no sign of movement. His legs remained floppy and his eyes seemed to stare fixedly from his head without moving. After 50 minutes of hand-bagging the baby, I called the code and pronounced him dead. The sun was just coming up as I left the OB ward and heard the start of the high-pitched wavering ululations of the mother’s sisters and aunts as they learned of the son’s death.

Stepping out into concrete grey walkway in the soft light of dawn, I glanced up to see the Kite drift silently on the morning updrafts; his shape a featureless black against the morning sky.

As I walked back to my quarters, I also heard the swallows in their nests making the noisy chatter of their small lives, tucked into the eaves of the hospital ward; calling out rebellion to the silence of the grave

Kenya by Shanks’ Mare

It was “lights out” for Tenwek yesterday. The electrical power was off for forty minutes. This compares favorably to our home in rural Alabama in my estimation but it brought home to me some truths. Moreover, as yesterday (January 30) was the first day I had off since the 17^th, I took the opportunity to walk to town (Bomet) and back, about 10 miles.

The day was clear, bright, warm and the road was macadamed wide and welcoming. At the gate to the hospital however it was a major traffic jam. Motorcycles, maduka (meaning shops, kiosks, patches of ground where a blanket may be spread to display the wares, duka is the singular) and matatus all crowd the roadway making even pedestrian traffic come to a halt.

The matatu is an interesting vehicle. It was originally an unlicensed private vehicle whose driver would promise to get you someplace, sometime, for a fee (typically very cheap). It is now a bit more regularized, going from set place to place. The name derives from the Swahili for three, “tatu.” The average matatu is seen sitting by the roadway, while the driver shills for more passengers; “Just three more, just three more and we leave!” They are indispensible, ubiquitous, gaudy, idiosyncratic and many unsafe at any speed. As it was, I had to deny I was walking to Bomet in order to get through the scrimmage line.

Once free of the “matata ya matatu; the tangle of matatus” I stepped out with vigor, the road rising slowly over the next two miles to the junction for Silebwet. The country side, opened up in the slow revelatory way it does when one is moving on foot. Green hills checker-boarded with chocolate-colored cultivation, drying the soil before a second harrowing before planting. The homesteads remind me of Appalachia in the 50’s but without the washing machines on the front porch: unpainted clapboard, split rail or barbed-wire fences with withies of branches woven through the strands, goats, dogs and cattle wandering about, tended by small boys.

Walking anywhere leaves you open to the drama that is happening “beneath” your notice in a speeding car. As a major distraction, this “mzungu mzee” (old European) probably created at least as much additional drama. A heifer, momentarily untended as her keeper was marveling at me, took the chance to start grazing on a young banana plant she spied through the fence. Loud recriminations in Kulani (which I do not understand) were visited upon the young boy as I rounded a bend.

I made a point of walking on the right (against traffic) as the motorcycles routinely cut their engines and hurtle down the grade at speed in order to save gas. The approach is almost silent so I wanted the hazard to my front. The number of RTA (road traffic accidents) from ‘cycles is daunting. Since they a usually carrying at least three people, the carnage is impressive. Most of the foot traffic was coming back from Bomet, as I left after 2PM and smart shoppers hit the shops on market day as early as possible. Saturday is also a school day and the crowds of students in their distinctive uniforms (a different striking color for each school) made a palette of primary hues along the long steady slope.

I am yelled to from time to time usually by small boys asking “How are you?;” but have no clue as to what I say when I answer. There are a large but yet limited number of ways to respond to the question (Swahili is taught in secondary school so many of this age speak only Kulani; English is the language of instruction in elementary school). I am not infrequently approached by young men who make a point of welcoming me to Kenya and asking me the “who what when where” they have undoubtedly learned in class. Frequently there seems to be a shy smiling young lass about with looks of admiration for this evidence of sophistication. Of course, this just might be my imagination.

Bomet is a town evidenced by radio towers, a prison, long blocks of maduka, highway construction, and banks as well as red dirt streets, feral dogs, sidewalk (I mean the entire verge of the road) vendors of shoe shines, roasted corn on the cob, cell phone charge-ups, nyama choma (grilled meat)shops, a ramshackle dark windowless corridor with “Mountaintop Resort Hotel” in hand-lettering over the door, a man inside a steel container (turned kiosk) banging on it loudly with a sledge. It is dirty dusty, smelly, gaudy, crowed industrious and noisy. I stopped and bought four pens, a handkerchief, some “Obama Chewing Gum,” and a Coca Cola. Kenyan sensitivities are different. The sidewalks are narrow, crowded and the locus of many heated debates. I paused to allow a procession of ladies to negotiate a particularly narrow slalom around some idlers only to have a young man walk around me and squeeze his way through the press. Not infrequently, I receive an elbow as I stop to decipher a sign. It is not Kenyan to say “excuse me” in these circumstances but should you drop something accidentally, anyone near murmurs “Polay Polay!” (excuse me excuse me” as if they were the cause.

The trip back is a long slow climb at a mile every 20 minutes. As I approach Tenwek, the quiet of the countryside is shattered by the hubbub of matatus.and motorcycles, maduka and mankind at the gates of Tenwek.

Building a hospital here was dictated 50 years ago; it was a demon-possessed site and considered useless otherwise by the Kipsigi elders. Three girls had died during initiation rituals on the same site, no doubt from malign spirits.

Building a hospital here is a bit more complicated than state-side. Consider: you have to secure a clean reliable water source and protect it from contamination, process it, filter it, settle and then pipe it into the hospital as well as your home, get a generator for electricity until they build the “grid” close enough to you, build housing for yourself as well as all your staff, provide security around the hospital compound (meaning a big high fence manned by mazamu (gueards)) for the hospital, your families as well as your people and their families, build a road, get the equipment that allows you to function, build a kitchen to feed the patients, plant gardens to give you and your staff fresh vegetables, and lastly build the hospital buildings themselves as well as the labs, X-ray, pharmacy and the surgical theatres. Then see if people will come.

I am reminded daily that God works his miracles not with the strong, confident, and forceful but the weak, flawed and hesitant stuff. We are not asked to be successful merely faithful.

The Countryside

Relayed by Dr Walt February 1, 2010 2:08:58 PM EST

Working at Tenwek

Tenwek is amazing. Where most mission hospitals have a handful of western-trained physicians, Tenwek has a dozen. Where other hospitals have a few visiting docs, Tenwek has a houseful of docs with specialties ranging from ENT (Ear-Nose Throat) to Urology. This last week, a team of cardiac surgeons, anesthetists and cardiac by-pass technicians replaced heart valves at an amazing rate, doing several in a day. They will be here for another week. They are training the Kenyan nurses in the techniques of open heart surgery, cardiac anesthesia as well as the pump routines. In consequence the wards are filled with children who have huge dilated hearts from the effects of Rheumatic Heart Disease and the scarring of the heart valves which frequently happens. I have never seen the concentration of this disease in my career; I have a half dozen at the moment and it allows me to get a great deal of experience in caring for this important condition.

In a lot of ways, however, Tenwek is a typical “mission hospital;” the wards are crowded with the diseases of the poor: tuberculosis, AIDS, trauma, massive burns, pneumonia, congenital defects, malnutrition and malaria. There is also the typical menagerie of medical rarities, human tragedies and colorful stories. The hours are long: 8AM to 7PM. The call schedule daunting. The usual actions of medical care are compounded by an overworked staff who do not speak (my) English. It takes several phone calls to get a whirlpool treatment for a girl with Stevens-Johnson syndrome, causing blisters over most of her body; that is, however, it takes several calls to get assent in principle for the treatment, the 5 year old girl has yet to actually get it. Labs are neglected or misplaced; unfamiliar treatments are merely ignored. On the upside, quinine is given on time and accurately, nurses make a point in the gentle accent which English takes in East Africa, to bring the over-looked needs of anxious parents to the attention of a passing, harried and distracted doctor.

The general chaos is multiplied by the fact that it is “logical July.” July, as many may know, is NOT the time to be sick in a teaching hospital in the USA; new residents and interns are just figuring out how to begin their training and much time and effort is expended in caring for their needs as well as the patients. In Kenya, this start of the academic year is in January. We are doing daily training rounds for all the Clinical Officers and Medical Officers in resuscitation and intubation; the deer-in –the –headlight look is epidemic in the ranks. Medical Officers, by the way, are interns and will be here for but one year. Clinical Officers, who operate rather like Physician Assistants” are not MD’s but for my purposes in the Pediatric Ward are much the same in function.

The hospital, like so many mission hospitals, is built going up and down a rather steep slope. Top floors of one building bridge over onto bottom floors of other buildings in the long low architecture of third world hospitals.

In contrast, the new surgical theatre building is tall, with clean lines, tile roofs and marble floors. As in most busy mission hospitals, Surgery casts a large shadow over other specialties. The thinking being (and accurately I have to admit), that surgery requires no ongoing expense and compliance from a population which is cash-strapped and uneducated in the need for long term medical management. We have just gotten a girl successfully out of ICU after coming in with diabetic coma, after the family failed to buy more insulin due to its cost, about $4 for the month.

I have been given a room at the guest house; think of it as your freshman dorm room without the acne and posters. It is spare, cinderblock, chintz curtains covering large unscreened (“Keep them closed at night and take your anti-malaria treatments!”) windows with a small bathroom with drizzle (calling this a shower is inappropriate) and an efficiency kitchen. The bed is lumpy and with the mosquito net, claustrophobic, the furniture is limited and of local (approximate) manufacture; the food is plentiful but bland (working on finishing off a bottle of Kenyan Tabasco sauce in consequence); and then there is a Kenyan Canary (donkey) who has insomnia, judging by his singing all night. I am where I should be.

One sad story: a baby a few days old was treated with traditional medicine. This meant that the infants was treated by passing her repeatedly over a steam bath filled with the “herbal medicine.” She suffered 85% second degree burns. She was repeatedly treated in this fashion for two more days before coming to the hospital. She survived for a scant two days more.

The mortality rate among young infants is daunting, but even those who survive infancy are not proof from disease. A 10 year old girl who was brought in due to confusion rapidly slipped into a coma and after ten days on a ventilator without any improvement was taken off life-support at the parents’ request and my agreement. We have no idea what poisoned/ infected her. Diagnoses ranged from insecticide to rabies. I pronounced her and, as I was filling out the paperwork, her father carried the shrouded body of his eldest child home to bury.

I went walking last weekend (as I was on call-this last weekend, I had precious little time to sleep). A wazungu (Westerner) and a camera was too much of a temptation for two school-girls I met. They demanded that I take their pictures and then one of them wanted to see my (very odd) glasses. The photos speak for themselves.

What they do not show was that I had to bargain for my glasses back again, much to the hilarity of the assembled kids. Children are the most seductive of humans; how else would we choose to feed, cloth and house them for so long.

The Kipsigi children of Kenya, are bright, smiling and engaging with none of the stern reserve that is shown by their parents at first meeting. I have found that parents hearts are softened and sensitized by the plights and pleasures of their children. Bringing a smile to a young patient by making faces at them during rounds is frequently followed by giggles and embarrassed smiles from behind the hands of a seemingly dour mother . My attempts at Swahili are guaranteed to bring laughter even as the pronunciation and grammar are corrected with a “polae polae, sawa sawa” (excuse me! Perfect!).

Jesus Heals at Tenwek as in the whole of Creation. The missionary doctors’ prayer which I find I recite daily:

“Lord, my Creator, You have made us and you know us from the smallest part even before we ourselves were born. You have made and sustain us minute by minute. Lord, my Master, I do not know why this child has been sickened so terribly. His pain is beyond what I can do to help him. You have allowed me to ask for what I want and it is for his complete healing I ask. That is what I want; but I want more to be your creature and servant. I pray that your will be done on this earth. Lord, we praise you for your sending out savior Jesus, who was wounded for our healing. Bring Your peace to this family in whatever happens. It is in your Son’s name, my savior I ask this.”

Relayed by Dr Walt January 27, 2010 2:14:33 PM EST

Road Trip to Tenwek Hospital

On schedule I left Atlanta International at 5:40 PM on 14 January. Each bag had been carefully weighed and came in scant ounces under the dreaded 50 pound limit that triggers outrageous fees. I was able to stagger under my two carry on bags weighing together an additional 50 pounds. I may be slope-shouldered for a month.

The nature of air travel, of which I have done a surprising amount in the last ten years, is that of a tube. One enters the tube immediately after watching your bags disappear into the infernal regions of the airport check-in. You then negotiate one long corridor-tube after another before being inspected to be allowed permission to continue your sun-less journey to wherever. The tubes in which one is slowly processed, as if by a large multi-headed snake, are of only two types: those that vibrate (in which you and your fellow travelers are required to face in one direction) and those that don’t vibrate (and you are free to sit in any orientation).

I was finally allowed to emerge from the snake in Nairobi, purchased my visa, collected my bags and got a ride to the Mennonite Guest House, a typical “room (and “bathroom down the way”) and breakfast” arrangement for about $35 a night. Jeremiah, the driver, and I exchanged news of Kenya politics and who happened to be rioting where and why (Muslims, downtown, for deporting an imam, 2 dead). Despite all the difficulties I have trouble sleeping past 3am (8PM CST) being awakened sweating from a Lariam (my malaria prevention)-induced dream that I immediately forgot and start rearranging the luggage for transport to Bomet.

At breakfast I met my fellow travelers: the Tapley’s, (Dwight and Mary) and the Winfoy’s, (Winston and Sally). Winston is a Urologist from Macon, Ga and Dwight is a family practitioner from South Bend, IN. The Tapley’s are returning to Tenwek for another 2 month tour and the Wilfoy’s are here for two weeks for the first time.

Our driver was Patrick, a large affable Kikuyu, apparently an expert in the practice of three dimensional Tetris, perhaps better known a “luggage stowing”; that not withstanding, the six of us, 10 pieces of luggage, an ice cooler (of unexplained provenance) and collected groceries did not in fact leave room for my one remaining duffel containing mostly requested gear for Tenwek Hospital but not incidentally my remaining supply of clean clothes. This would arrive late Sunday.

The road to Bomet goes north out of Nairobi past a large open air market, turns off to take the “Italian Road” a two lane that loops around the draping folds of the “Escarpment,” the eastern edge of the Great Rift Valley, descending about 1000ft in several miles. It is named for the Prisoners of War from Italy who were interned in Kenya (then Br. East Africa ) after capture by the British during the Desert Campaigns during the early part of WWII. Near the bottom, tucked into a small defile, the prisoners built a small chapel looking much better now than in 2002 when last I visited it.

The land is verdant, much to my surprise as this is the “Dry Season” which has featured rain daily for the last four months. Patrick kept pointing out Zebra herds along the road and standing pools of rainwater with the same excitement and expectant wonder. Although one might consider this fortuitous, the Kenyan farmers are greatly distressed by this occurrence as they only plant AFTER the rains have stopped. The rains that should have come in Spring 2009 hardly showed and the crops planted then died. The two previous harvests were devastated by the political unrest occasioned by the last election.

The political situation is tense as the contested election which prompted the violence and displacement of people has only just been smoothed over with a power-sharing arrangement and a promised plebiscite on a new constitution. Violence at whatever the outcome of the plebiscite is widely expected. Kenya, the poster child for a stable multi-ethnic democracy of East Africa, has lost a lot of its self-confidence with this open slide into partisan violence.

We started west into the Great Rift Valley and reached Narok, a town I had visited previously (see my comments on that trip on a linked blog). From there we started climbing through rolling hills, becoming more verdant as each new vista unrolled itself. Bomet, a bustling town of wood smoke, open air markets, sand colored cinderblock buildings and crossroads graced by patriotic monuments in concrete and vivid color, was passed (with whole inches to spare) at speed.

Even after we turned at the sign for Tenwek, the road still climbed, turning ever more sharply on itself. Tenwek is at 6500 ft, about the same altitude as the Nairobi, so despite being “in The Valley” we wound up into terraced hills of maize, banana trees and potatoes on small plots. Once leaving the main road, the smooth macadam (quite the improvement over the collection of pot-holes which it replaced) was itself replaced by the rutted red-clay tracks familiar to all east Africa. Deep gullies line this highway so that “stopping on the shoulder” and “falling out of the road” are not easily distinguishable. Indeed, trauma from traffic accidents is a major contributor to business at Tenwek, I learned. After about another 20 minutes we turn off onto a road and pass the sign:

Tenwek Hospital

“We Treat, Jesus Heals”

Relayed by Dr. Walt January 19, 2010 3:45 PM EST

Making a List and Checking it Twice

It is D-day -4 and I am hip-deep in final computations, complications and corrections. This has been made most difficult. I had been planning to carefully organize my stuff with time to repack or replace if needed before leaving about noon on the 14th. Instead there has been a steady procession of unexpected but "essential" tasks to complete before lift off. I discovered that I needed to find, drive to, complete and obtain the card for a Basic Life Support (BLS) course before I leave (Tuesday afternoon and evening just evaporated); my cell phone which I was planning to use for global service is 'hors d'combat' and had to be replaced, resynced, learned and troubleshot (last Saturday vanished); my wife's car battery died (last Thursday went AWOL); my bags are too small to pack the promised microscope which I had to collect Tuesday (emergent purchase of the biggest duffels I can find, promised arrival in two days).

As it is, "packing" is represented by piles of clothes, boxes, camera bags, tools, and paraphenalia on our enclosed porch, awaiting the promised duffels for "Big Duff" (I don't make this stuff up).

This task, writing this blog entry, will mean one more check off the list though, so I am well pleased. Regardless, I am where I am supposed to be and Lord willing (and I can find a driver) I will be on the plane at 5:30 PM out of ATL, heading for Schipol for a few hours before flying to Nairobi, staying overnight there before going on to Bomet on Saturday.

Keep me in your prayers.

Mission Project

On confirming that I would be going to Tenwek Hospital in January; I contacted them to see if there were a project that friends and acquaintances might wish to fund.

Tenwek Internet Update Project

I have requested of them regarding a project for which we may provide support. Surprisingly, hospitals in even the most primitive locales, have rather sophisticated internet services. This is necessary for all the same reasons that occur in stateside hospitals but more so because of the remoteness of the facility. Not only is the internet service needed for the transfer of patient information, but also for logistics, managerial aspects as well as the provision of pastoral services, and information services for evangelism.

It is estimated that the completion of the conversion would cost about $5000 USD.. Should you feel led to give to this project please send your tax deductible check to:

Vaughn Forest Baptist Church-Kenya Project
c/0Vaughn Forest Baptist Church

8660 Vaughn Road

Montgomery

AL

USA

36117

or

Samaritan's Purse- FBO Walter Boutwell-Tenwek Internet Project
c/oSamaritan's Purse/ World Medical Mission
P.O. Box 3000
Boone, NC 28607
Phone (828) 262-1980
Fax (828) 266-1056

About Tenwek

Tenwek Hospital is one of the largest mission hospitals in Africa. It provides primary health care to 600,000 Kipsigis people within a 32 kilometer radius and serves a referral center for a much larger region. Surrounding Tenwek are several small government dispensaries and health centers; many patient referrals come from those facilities.
At Tenwek all types of medical and surgical conditions are treated. Tenwek hospital has 308 beds and includes large general wards for the surgery, medicine, pediatrics and obstetrical services. An ophthalmology ward, and an orthopedic ward were added in 1997.

The maternity unit contains 72 beds, three delivery tables, and an operating room.
Two neonatal nurseries care for infants who are sick or premature. These nurseries have an average daily census of about 40 babies and it is to these nurseries that I have been asked to provide services. Laboratory, X-ray, physiotherapy, and ultrasound provide diagnostic and rehabilitative services. Routine biochemistry, hematology, and bacteriology studies along with blood banking services are available. Two large X-ray units, two portable X-ray units and two ultrasound machines are operational. Centrally piped oxygen and suction are available to most departments and wards.
Tenwek Hospital in collaboration with two other mission hospitals in Kenya, ( Kijabe and Chogoria together with Moi University Medical School in Eldoret) are operating a Family Medicine Residency. The medical school’s Institute of Family Medicine is the sponsor of this program.
Tenwek began its general surgery residency program at the beginning of February 2008. The residency is affiliated with COSECSA (College of Surgery in East, Central and Southern Africa) and PAACS (Pan American Association of Christian Surgeons).
Although the focus of service at Tenwek is serving Africans, Tenwek Hospital has helped educate scores of volunteers from overseas. This includes an active program utilizing medical students, residents, and practicing physicians as short-term volunteers.

Starting a new trip

This week I confirmed with World Medical Missions (part of Samaritan's Purse) an assignment next January and February to go to Tenwek Hospital in southwest Kenya, a country I have visited several times and enjoyed immensely.

My first trip was in 2002 to Kijabe Hospital, an African Inland Mission (AIM) facility. Tenwek is further "up country" in the western part of the Great Rift Valley. It is near Bomet, the "county seat" of the district by that name (see map). Tenwek is the largest mission hospital in Africa. Kenya's current political unrest has grieved me as Kenya has been (until recently) able to avoid the partisan warfare that has devastated so much of the continent (Somalia, Nigeria, Congo, Liberia) of recent years. Things are much better but my friends there are still extremely cautious of the future.

I have included a few links to give you an idea of the scope of the mission.