Expand your mind

Well, sorry for the delay in posting, but I've been at a HIV conference all week, and haven't had much internet time or really, much interesting things to say. The conference has been mind expanding in general, much of the information is not related to nutrition, and some of it is way over my head. But, it was a good experience nonetheless. There are lots of people intown from Winnipeg right now, and I have been the tour guide for everyone, which I find hilarious because its sorta like the blind leading the blind! They are appreciative of the lessons I have learned and its been fun for me to have company in the flat and around Nairobi. I was planning on a safari this weekend with two of the girls here, but they've chosen one of the most expensive and fancy 5 star lodges to spend 3 days at, and I can't afford the luxury. So I am trying to see if I can find anyone else who might want to join me for a safari in the next few weeks. Tomorrow I'm planning on trying to get to the Nairobi National Park, which is only 30 min or so outside of Nairobi and you can see all the big 5 animals except Rhinos. How amazing that such excitement is so close, I'm looking forward to seeing some animals, as I haven't left Nairobi since I've been here. Yesterday, we walked to a marketplace during the lunch hour of the conference and bought some souvenir items. The market was called the Triangle Market, and its literally ontop of a triangle shaped median between two busy roads. There is a small doorway and very narrow walkways between about 200+ shops/stalls. I found it much calmer than the Masai Market, and was only called sister a few times, and no one yelled, which was a nice change! Its funny being her for a while, I now have a good understanding of how much things should cost, and a friend who's an old veteran here told me that you should first offer 1/5 of the price, because they up the price by 5X for muzungus (white people). The act of bartering is exhausting, especially when you realize you're fighting with them over a few dollars, and really they need those dollars, but at the same time its discriminating to know that you are paying 5X the regular price. I think I have managed to get some pretty good deals, its easy when you honestly don't need to purchase that item from that person at that moment and you can genuinely walk away, they almost always CHASE you to give you your price. A demeaning experience for both parties, in my mind. This week I've met all sorts of interesting people, and have been spending a lot of my free time with Doctors and med students from all over the world, its really interesting hearing about their experiences and learning things from hearing them talk medical talk amongst themselves. I was very interested in the sessions on infant feeding, especially the study that was presented that showed increased morbidity and severe malnutrition after they recommended abrupt weaning from breastfeeding at 6 month in HIV infected mothers. They were trying to reduce vertical transmission by putting the mothers on ARV's for 6 months despite their CD4 count and breatfeeding the babies for only 6 months, then telling them to wean within 2 weeks to food and cow's milk. No surprise to me, many of the babies died, had anemia or other growth complications as the families are too food insecure to make up for the increase iron needs a baby needs at 6 months. Its sad to see how standards of care we use in Canada are not feasible here, and how different research recommendations can prove to be horribly wrong at the expense of a human life, especially a baby. To say the least I've learned a lot this week, both professionally and personally. I'm glad to have a quiet day to myself in the flat today, enjoying the sun outside, the birds chirping/or squaking, and the knowledge that although I miss home and Morgan and all thats familiar, I'm glad I am here. I think I'm learning things about myself too. Hope all is well in the freezer! Norah

Walk the walk, talk the talk.

I seem to always be the bearer of bad nutrition news where ever I go, to those who think its simple to feed a crowd with chips and soda, well not while I'm around. Like I mentioned before, the staff at Majengo have really welcomed me in and are making me feel like part of the team. They are planning a "Mini Baraza" which I gather means a meeting for 200 patients at their clinic that are on ARV's. Its supposed to be a chance for the patients to learn about ARVs and discuss their personal issues with adherence to the drugs. The staff has invited me to present on nutrition for 20 min and answer questions with one nurse interpreting for me. Finally, and interpreter!! What a novelty. Actually the Majengo staff have not only been speaking lots of english to me, but they have also taken to helping me learn Kiswahili, which is fun and useful. They all say I have a natural ear for it, but really I have a book I bought at Chapters and the language appears to be prounced just as its read, I like learning languages, maybe I'll give up on french and go head on for Kiswahili. Anyways, they had submitted a budget to the office for providing food and refreshments for the 200 patients that included only soda and pastries, after I was through explaining that they couldn't possible ask me to speak on nutrition and then feed people junk, they all overwhelming agreed, like they had never thought of it. The whole staff group brainstormed excitedly and we came up with serving boiled eggs, porridge and banana with Kenyan tea, and it ended up being cheaper than the junk! A real success in my eyes. They all laughed so hard and seemed so excited that I was promoting nutrition, it was fun to be a part of. I also met the district manager of the Nutritionists in Nairobi, who was also very interested in meeting with me soon to talk about dietetics and projects they are working on. Its amazing after only 2 weeks to be making connections both personally and professionally, the two weeks has really flown by. The other funny thing that has happened at the clinic this week is I gave 2 community leaders from the surrounding area a small change purse with the Canada flag on it that I bought at the dollar store back home. When the head nurse at the clinic saw what I gave she made a huge fuss, and soon everyone in the office was badgering me for a Canada item. I brought some bracelets, beach balls, pencils and cloth bags with me, and they attacked me today and it was all gone in minutes when I opened my bag today. I never in a million years thought grown woman would be so excited about dollar store items, but they were elated. I had initally brought that stuff to give out to children I met along the way, maybe Morgan will have to stock me up again when he come in March. It was fun to see their excitement, which was the point of the Canada paraphanilia. They more than payed me back when they took me out for lunch today and I ate all sorts of different traditional Kenyan foods today, like Ugali, Kengeki, and Nyama Choma. Again, lots and lots of meat, I sure will have rich blood by the time I get home and a full heart.

The poor get poorer!

Yesterday was a surprising sight for me. I spent the day at the other clinic, called Majengo and we returned to Pumwani at the end of the day to pick up blood samples and staff, there I saw a confusing and shocking sight. Where there was once small independent kiosks selling food, services, etc, there was now rubble. I learned from the local staff that occasionally they City Council or Government will manually demolish such businesses, especially in the poor areas or slums to make sure the poor are not able to make money. How awful? These pictures show the people only hours after it happened, scavenging the rubble for their personal items and sorting the materials. I can't even wrap my head around such injustice a day later when I saw it again in the van. I am once again reminded of the differences in 1st and 3rd world countries.

Survival!

Last night was a fun night, I went to a world famous restaurant called "Carnivore" for dinner with some friends that are leaving and some friends that are new. http://www.tamarind.co.ke/carnivore/ The restaurant was like nothing else I've ever tried, and I ate more meat than I'd need in a whole month. I even ate ostrich meat balls and crocodile, which were very tender and delicious. This place was made famous not only for its atmosphere but also for the exotic meats they served like hippo, zebra, gazelle etc, but are no longer able to serve due to endangerment issues. Too bad, would have been neat to try that, but crocodile was very tasty! The way it works is you leave the flag on your table up as long as you want food to continue coming, and they come around with the meat on a huge sword looking thing, and carve it off with a huge masheti knife. Wow. It was especially fun because it was the inauguration of Obama last night, and the Kenyan people were so excited for this event, the thought Kibaki their President might even announce a national holiday today, but alas, we all had to work. Apparantly there was 1-3 day holidays all over Africa when Obama was elected. The excitement was really fun to watch. There is so much paraphanilia around for Obama, I think every Matatu (bus) has a sticker or sign or something. Its been 24 hours of interesting local food, because today I was at a different clinic, one called Majengo, which researches sex trade workers who appear to be immune from HIV infection despite continued exposure. At the clinic the staff were SO welcoming and spent the day touring me around the open air market just outside the clinic and feeding me local traditional foods from their tribes.I learned very quickly that pilli pilli means chilies and wow were they hot. The market is known as the clothing market and like mentioned previously, I saw piles and piles of shoes. All the shoes are perfectly clean, despite being used and donated from 1st world countries. The stall owners spend lots of time cleaning them spotless and hanging them in lines or stackign them up to sell them for a higher price. Or you can dig around in a huge bin and find a pair for significantly cheaper. I even got escorted by a staff member's brother to a "boutique" or clothing stall in the market to look for a shirt or two. After trying on many shirts with the help of like 6 Kenyans who even tried to do the buttons up for me on the shirts I tried on over my own shirt, I found two shirts, and purchased them for the equivalent of $8 a shirt, apparantly I got ripped off for being a Muzungu (white person) despite my bargaining for over 500 Kshillings off. These clearly used shirts, some even with the tag from Value Village, I guess I'll just consider it my donation to the biggest open air clothing market in the Nairobi slum. Next time I'll take a woman with me, who knows what the price should be. They laughed at me lots trying to practice my Swahili but they were so impressed with my efforts to know their culture. I felt so welcomed there, maybe because they are not as busy as the other clinic I was at last week, they had more time to talk with me. Despite what you might imagine to be a harder, crazier and sadder clinic when dealing with sex trade workers, I was surprised to see that the woman were of all ages, sizes and definitely did not look like typical sex trade workers at all. The sad truth is, prostitution is a very real economic trade here for women, because they are so desperate for money to feed their families, they'll use what they've got to survive. One patient even told me that she loved coming to the clinic because she recieved free health care, friendly caring support and was feeling healthier than ever. I was struck by this poster I saw hanging on the door, as it is so true and yet very underfunded. Nutrition is not a focus for funding the care of HIV patients, and it is such a complex problem, I don't even know where public health officials would start. Currently there is a huge shortage of maize, which is the most common staple food in Kenya. The shortage comes from two reasons, a drought this year which is affecting crops, and then a huge scandal where the corrupt government has stolen maize from the people and has been selling what maize there is to Sudan and keeping the profits from the people. Its all over the media here as certain officials are now being named and I assume prosecuted. The picture above actually features maize (corn) making up the HIV/AIDS ribbon. A poignant poster indeed. I also got lots of food resource suggestions from the staff today, and I seem to be making lots of progress on my project. Its suprising how when I explain my project to them, they all seem so amazed by the idea, and supportive, but how could no one have thought of this before. It will be interesting to see how this project unfolds, and how much the staff utilize the resource when helping clients. I even got to meet two "community leaders" (featured in photo left) from the local slum who offered to take me to their house and feed me and tour me around. It would be an amazing experience to have a guided tour, but not sure if I'm brave enough for that one just yet. Everyone was so pumped to have me take their picture, and they all want copies, I just need to figure out how to print them off. I guess we take for granted having a camera, I assume they don't have a camera or means to print pictures. These truly are the faces of the heroes of the community, who spend their lives trying to make a difference and improve the quality of their people. I'm hopeful and can only trust that my little bit of effort can help in the grand scheme of HIV and the lives of the beautiful women I see everyday at the clinics. It sure is changing me, in a positive way and affecting how I veiw myself, my life and my blessings. Now I'm heading home, and hoping that food I ate today and yesterday doesn't come back to bite me...hehe. Later....

Pole Pole (slowly slowly)

Slowly slowly things are coming together and I am starting to feel comfortable here. I have new insight into how new immigrants feel in our strange country as it is tiring to hear a new language all the time, the public transportation is very confusing and intimidating, and I am overwhelmed with how to find the things I need in the grocery stores. Just as I wanted to feel actually, its a good experience. I'v noticed a big difference in teh warmth of the clinic staff also over just one week with them. I may have too quickly judged their hospitality and engagement with patients, I think that their way is just more relaxed and their resources are so limited, what can they do in a hurry really. Many of the clinical officers (sort of like Nurse Practitioners I would say) are very skilled, I think what really surprises me is how short and fast assessments are here in all fields, compared to back home where we badger people for all details to fully understand their situation. The Doctors here are good at diagnosing in the field with little diagnostic help from labwork or test results, as they cost money to get and they are often not done. I spent the day today discussing my project idea for a food security resource with the Dr at the clinic who fully supports the idea, even had suggestions and said he'd back me with a staff to accompany me to visit the sites and a driver. It feels great to feel supported and on the right track. Every staff I've interviewed so far has come up with at least one community resource they can think of, and its my job now to visit these places and catalogue their services and provisions into a useable directory for our clinic staff to use. As I sat in the van today waiting for everyone to finish their work and pile in for the drive home, I starred at an empty space of grass across from the clinic that would make a great community garden plot for patients....a dream I guess, I know for certain that things here move way too slowly for me to do that in the 2 short months I'm here. Perhaps I will put a bug in Judith's ear, the counsellor who is interested in helping me with the project as she has already expressed interest in nutrition and said she wants to take a correspondence diploma in nutrition at Kenyatta University. The weekend was relaxing and entertaining. Lisa and I had dinner together 2 nights, went to a local art gallery for a new exhibition and sat by the pool in her apartment compound under the hot African sun. I also met her friend Philamina, and her two beautiful children Ian (10 yrs and Abigail 6 mos) who came swimming also. Philamina is a Kenyan Obstetrician who Lisa knew from 5 years ago when she was a resident here in Kenya. Her family was so nice, I even taught Ian how to play Coloretto a card game of Morgan's I brought with me and he caught on right away and even figured out the strategy. I was impressed by his counting and math at 10 years old, it was fun to play with him. The night before i tried to teach the Newfoundland Medical students who live above me, and lets just say I think Ian got the strategy for winning quicker than them. haha! Lisa and I also spent time with two other medical students here from USA, Adam and Barkley. They are both extremely interesting people, who have travelled lots and understand the culture and politics of Africa well. Adam spent 2 years on the coast of Kenya with the American Peace Corps where he learned fluent Kiswahili, and Barkley appears to me to know it well also. They are all very down to earth people here to make a real difference in the lives of those in need. Barkley is committed to being a trauma surgeon in conflict areas when he is done med school and has lots of ideas for researching TB and HIV co-infection and treatments. I learn so much listening to them talk about their experiences and their insights into African health care, I feel so fortunate that they have adopted me as new friends. Lisa is so generous she has made me dinner twice now and invites me to all of her plans around the city, she's like my personal tour guide so far, which is very much so necessary in this maze of a city that you don't want to appear lost in or you'll surely get attention. She keeps saying its her pleasure to hang out with me, I guess everyone needs friends really. She has rented a house on a costal island called Lamu in February for 1 week and wants me to come out to stay with her for a weekend, sounds very tempting, I have to look into cost of flights. Lisa is 35 years old, and has been a practicing Obstetrician for only a few years but has already worked in Winnipeg, Liberia, Kenya, Uganda, and Denmark... you can imagine the stories she has. It rained all weekend, and not the kind of rains we see in Canada, they were soaking tropical down pours Thur-Sat, but now it is hot again, and I feel a bit dehydrated today! There are lots of structures which flood when the rains come, like Adam and Barkley's kitchen..hehe. So far my flat is dry, but I've noticed lots of small gekos are coming inside from the rain. I unintentionally killed one the other day by suffocating it under a glass, oops. Oh, and I found a catholic church 3 blocks from my house, and went to mass yesterday for a profound message directed at me (I believe). It was about God calling Samuel's name, and he saying "Here I am Lord, your servant, I come to do your will." The priest did a whole sermon on us helping others as Christ did and being the best we can be for each other. I felt inspired. The african drums and awesome music helped too. Anyways, here's hoping week 2 proves to be as fruitful as last week. Cheers!

All you need is love

I spent over 2 hours last night, taking the local Matatu to the grocery market and back in rush hour, lesson learned. With lots buzzing in my head from the day at the Maternity Hospital, no sooner did I sit down to eat my prepared dinner, than a friendly face pulled up in a taxi and popped right into my ground floor flat as the door was open. It was Lisa, an Obstetrician from Manitoba I had met on the first day. It was so nice to see someone friendly and interested in talking to me, she came right in and told me about her day. I've been finding the other girls on the compound very distant and they keep to themselves completely, and thought it was maybe something about me. Lisa explained it was her birthday and her and 2 Doctors from U of Washington who also live in my compound were going out for supper. They all arrived in my apartment and insisted I pack up the taco dinner I had prepared and come out with them, after we toasted her birthday with a bottle of wine I had bought at the Nakumat of course. I had a great evening with them, finally some genuinely friendly and inviting people. They said the same of me that finally I proved that not all Canadian girls are unfriendly, like the other girls in the compound. We had excellent discussion about health care in Kenya and current iniatives and their observations of the medical care. They planted a seed for an idea that sprouted into nutrition project for me to work on, I may it pitch to Joshua, the program head next week. Its amazing how renewed I feel after feeling that someone reached out to me in friendship. I woke up this morning with extra ambition, and spent the morning groundtesting my idea with the counselling staff at the clinic. They were so open to my nutrition project idea and had great input and ideas to share. I plan to attempt to create a directory of food resources in Nairobi, as I've noticed a big issue for the HIV patients is that they have severe food insecurity. Since you need to take your ARV's with food for them to be absorbed properly, it becomes an issue of medication compliance and can gravely affect their treatment. The counsellors each have a few resources they may suggest to a client, but like everything in Kenya, the resources are not catalogued or organized or utilized effectively. I figure I can do the foot work of researching local organizations and staff and patients and try to start a directory for use by the staff in the clinic. I've been thinking this week that I need to create a project for myself as the patient counselling seems to be impossible due to language barriers and lack of translators. I want to finish something during my 2 months here that will help the clinic far after I'm gone. The staff felt this was the biggest nutritional concern and the biggest gap for them as counsellors. So I've got a plan. I feel different today like I have a purpose and I've noticed changes in the staff at the clinic. I feel much more included and welcomed by their warmth and they are stopping to interpreter slowly for me. Its slowly coming together, and really, I've only been here a week! God truly has a plan, and I have to keep remembering that I am not in control anyways, so patience is the key! I hoping to do some touristy things this weekend, maybe with the two Newfoundland Med students who are leaving next week. Thanks for listening today...I feel like I'm having coffee with each of you when I sit to journal. What an experience so far.......we're not in Kansas anymore Totto!

Shock and awe

Yesterday I spent the day with the nutriitonists at the mother to baby transmission clinic next door to the University Clinic I'm usually at. I found everything they say and do very vague to say the least, and very casual or laid back. The morning was spent weighing babies. Mother's came into the room 2 or 3 at a time, and undressed their babies and laid them on the scale. The nutritionists wrote down their weight and checked for doubled birth weight at 3 months and tripled birth weight at 6 months. This is the only assessment tool or strategy they use. If there is a discrepancy and a baby is lower than these expectations they casually ask how the baby is fed. Their method of nutrition assessment and counselling is drastically different than I'm used to. They were very comfortable throwing me into the mix and stuck me in a room with one mom who's child was underweight. I spent 20 min showing her how to have a proper latch and discussing breastfeeding. This was significantly more time than the other nutritionists would spend, as they mostly were distracted with other tasks and merely stated tips casually to the mother waiting in the doorway. It felt good for me to finally help someone, and the woman seemed really appreciative of the help and said she noticed a difference in how it felt immediately, no more pain. Then a woman was forced on me by the nutritionist after they spoke with her for 5 min in Swahili she turned to me and said, "now you talk to her about weaning, over there." Through a painfully mixed up assessment I discovered that the clinic provides formula to babies under 6 months only and this mom, with a 6 month old baby was being discharged and was now told to wean to food to make up for the loss of sustenance for her child. She explained to me that she was kicked out of her house last year, has no work, no money and no way to get food or milk for her baby. After consulting with the Nutritionists again, I discovered they advise women to start cow's or goat's milk at 6 months and foods, whatever they have to give. I was shocked as this is a very different recommendation than in Canada, how was I supposed to come up with that on my own. I also learned some other shocking nutrition advice given here...like put a rusty nail in an orange and let it sit, then make juice from that orange for an iron supplement, also they do not provide prenatal vitamins or multivitamins post partum, instead they provide 200,000 IU of Vit A once post partum in the hospital and then to the child at 6 months 100,000 IU Vit A. This is very confusing for me, and I need to look up the reason for such a mega dose of a vitamin we do not supplement routinely in Canada. Next I joined the Nutrition intern on the post partum unit of the Maternity Hospital and we proceeded to hang out the Vitamin A pills like candy to the woman who had just given birth that day. I was exhausted from the afternoon as it was sensory overload, the wards were so overloaded they made Canadian hospitals look like the Holiday Inn. I could not take many pics but there were at least 2 and sometimes 3 woman/baby couples to each BED! Yes bed not room, and tonnes of visitors roaming around, questionable stains and sticky spots on the floor and very questionable smells. I learned that there is no laundry service while in the pay for fee hospital, and woman hand wash their own clothes and blankets in the courtyard and wait for them to dry because they are often stolen by other patients if you don't guard them. I was getting frustrated with Lydia, the Nutrition intern as she did not fully understand my challenge with the language barrier. She'd greet a woman, and talk with her in Swahili and then turn to me and say, now counsel her for breastfeeding. Excuse me?? The concept of assessment and care plans are completely unknown here, and basically she just blurted out a few memorized details and walked on to the next client. How do I even make sense of this in my mind?? I was overloaded...thinking about Dietetic standards, and standards of care etc. I later learned that there is no registration for Nutritionists in Kenya, no college, no regulations. They are hoping to start some this year, which in Africa time likely means 5 years. The other shocking thing was the charting and resources they have to work with. Most are from NGO's or foreign aid organizations and I never saw anything dated more recent than 2006. There have been many times in the last week I have stopped to think about how grateful I am. Grateful that I don't have to worry about how to feed my sick baby, grateful that I have a safe place to live, grateful that I have an education, that our hospitals are sterile, that our food is clean, that our government is not corrupt and much more. I am grateful that our hospital food services is not the fly infested basement room that I saw yesterday, with whole sides of beef hanging from hooks and dirty counters and utensils. How does one make sense of all this???

Becareful what you wish for....

Just another day at the office....sort of. Today I woke up with renewed energy after almost 10 hours of sleep, I guess all this change tires a girl out. I struck up conversation with the nursing staff on the drive to the clinic this am, and got one girl talking about the political tension in Kenya and how it affected her and the city. It was interesting hearing her views as they seemed to be raw and uncensored. She believes its a tribal war, satisfied by the current President making the leader of the opposing tribe a Prime Minister so they believe he has some power. He says when your tribe is in power than your roads get paved, your houses get built etc, so thats why they fight, to get their own tribe some power and ahead a bit. She said until Jan 2008 most Kenyans were afraid to leave their homes even to buy food and over 1200 people died. This was expecially interesting while we drove through the slums again, and I saw what real poverty is for the second time. I think today I was less shocked and more sad, as the people look so powerless. One thing I've noticed about the local people that come to the clinic and even the staff is that no one gets excited or animated about anything. I rarely see anyone very happy to see anyone else, but laughter is a commonplace thing, it seems things I say are particularly funny. Today I was told the following: 'Your so blond, my child is frightened of you' and 'Look at her, her father ran out of black paint that is why she is so white' the latter was by a Doctor at the clinic, as he told this to a 1 year old child who was staring at me, he was joking...I think. I'm not offended at all, and I've learned the word for white people in Swahili is Mazunga, I know I'm different its ok. Today I also discovered that Hakuna Matata from the Lion King is actually Swahili, not sure if anyone else knew that, but it made me smile a bit. Its become my new motto, for in my head, when things are overwhelming. So, back to the clinic....becareful what you wish for indeed. Today I tried very hard to ask if I could observe the several points of patient contact to better understand where I might fit in. Still no one bothered to translate, except until after the visit was done, and then it was very abbreviated. Its difficult to understand the gravity of each woman's situation in such short time, but needlesstosay each woman has a long and sad story. Today I met a 17 year old girl that has been on the program since its beginning as she was infected when she was born by her mother during the labour. All the nursing staff knew her well, and despite her spending lots of time at the clinic, their affection for her was significantly more laid back and calm than I would expect, or that I would see in our Best Beginning Program. Everything is done very slowly and calmly in the clinic, and no one is in a hurry. Except for me.....out of the Doctor's room, where I was observing the Pediatrician attempt to take a blood sample from a 1 year old HIV infected and TB infected child. I was curious when he began examining the child with no gloves on, and when the needles came out, I was fine, blood doesn't bother me. But, after the Dr poking him in 4 different places on the tops of his palm and the baby screaming with fear and ? pain, I began to feel very weak, very hot, my hearing started to muffle and I ran quickly to the door to sit down. I sat beside the nurse I had spent the morning with, who asked me in Swahili first, then in English, are you in pain? I said I felt dizzy and sat with my head down for a couple minutes, no one seemed to care really. I felt better once I bought a gingerale from the canteen beside. Thats a first for me, I'll blame it on the heat, or the inadequacy of my lunch, guess I'll need more than PB and J tomorrow. The nurses stop for "tea" at about 2 pm where they stack 3 or 4 pieces of white bread and spread Blue Brand (margarine like substance) in between and eat them like a tall sandwich. The med student, I can't remember her name, said she was at the Maternity Hospital this morning and broke 3 women's water with the back of a syringe case. We laughed a bit about how different the sterility is from Canadian hospitals, lets just leave it at that, I don't think you want to know the gory details, I didn't. Oh, the charting here is quite different also. Lets just say "sticky notes" and hopefully the papers get into the right chart, but if not, Hakuna Matata, they even write notes on full scab, and rarely is the date complete on it. Joshua, the program director keeps introducing me to people as the nutritionist who will fix their BMI, and yet I am still waiting to see a BMI completed on a chart despite the blank for it. I took lots of pictures of the slums from out the cargo van window on the drive home today, but can't load them here, I'll try tomorrow. Mind the blurriness and reflection of some, you'll get the idea, it was a bumpy road and i couldn't open the window of the van. I hope all is well in Canada, I hear its blizzarding in SK. Thinking of you all. Thanks for the emails, keep them coming. Later.....

Burnt Garbage!

After a short drive through the slums on the way to the clinic this morning, I finally figured out what the smell I had been noticing since I got here was coming from. The passenger beside me on the plane on the way here said she noticed the diesel smell in Nairobi because all the big trucks are diesel. Today, however, it became clear to me that that toxic smell is infact burning garbage. There is actually no formal dump here or waste disposal program, most people find a discreet or not so discreet place to burn it away. As I sat in the passenger van the staff from the clinic take from Kenyatta Hospital to the Pumwani clinic every day, I was constantly entertained by what I saw out the window. The industrial area of the slums has rows of tiny makeshift stalls where workers are crafting all sorts of items from plastic barrels to steel chests to planters and some unrecognizable items and scraps. I noticed a marketplace set up in the slum where there were heaps and heaps and heaps of used shoes. It seems bizarre to me that all that is sold there is second hand shoes, perhaps that is all I could see from the road. Tiny shops/stalls sell anything from clothing hung on hangers, fruit, food, miscellaneous medications and of course always cell phone top up scratch cards. In fact, there is a whole road of housing in the slum we drove through where bring homes are painted bright pink, green, yellow or orange and are an advertisement in itself for a cell phone company. At first I thought it was stores, as they are completely decorated, but I saw children playing on the steps and clothing hanging on lines behind. Then we arrived at the clinic, which is also in the same guarded compound as the Pumwani Maternity Hospital, offices are held inside a very small house like building with several large tents around it for counseling rooms and education rooms. Although everyone was friendly and introduced themselves to me, no one really seemed to know how I would fit in. I basically sat (in the way I may add) all morning and listened for the odd english word amongst a class taught completely in Swahili. Surprisingly I could follow the topics they were covering, especially when the nurse would write words in English on the flip chart. Then a nutritionist from the Prevention of Transmission of Mother to Baby Clinic next door came to teach a 1 hour portion of the education session. I did not have a formal introduction to her before she began and she did not include as much English in her class, and I felt more lost than found in a nutrition class. I was surprised by how much scientific jargon she used with such a low income and low literacy population, she spoke of specific details about every vitamin and mineral, but did not discuss how to get the foods or how much to eat daily, unless that was lost in translation. Afterward, I ran to introduce myself to her and she invited me to her office to see what she does. She has an intern with her for 3 months, who also started today, and welcomed me to come join them on a tour of the Maternity Hospital and sit in on her nutrition assessments. I'm thinking that offer is very attractive after spending the whole following afternoon doing absolutely nothing but standing in the way of the busy nurses and asking "can I help?" Don't get me wrong, I'm happy to be here, and am confident it will get better, I just need to find my niche and perhaps be more assertive in asking for a mentor or a interpreter. The med students from Newfoundland who live above me have befriended me and invited me to do some touristy things with them. They even plan to do some rock climbing this weekend if possible, and I'm hoping to join them. Too bad I didn't bring my gear. One of them was at the clinic with me today but doesn't seem as interested in working a full day or learning new things, and left early to go to the gym. I guess she came to Africa to have a vacation. Thats all for now, until next time.........

Hurry up and wait!

So far, life in Kenya is quiet and slow and hot, with a nice breeze. Yesterday, Laina and I walked 1 hour each way to the Massai Market where local Kenyans had spread out blankets on the ground to display their handicrafts. The items were like those you'd find at Ten Thousand Villages in Canada, but of course, much cheaper. It was a busy place, where if you stopped to gaze at an item, the proprietor would instantly attack (well not attack, but yell at you) "Sister, sister, you like that, I give you good price". I resisted many beautiful purchases, as I have lots of time to scope things out and make sure I really am getting a fair price. I found it funny how each Kenyan claimed they made each and every item on their mat, despite the obvious fact there were many copies or duplicates on several mats around the market. Curious??

When we arrived home, I looked at my legs and thought, wow, I have a tan! 1 shower later, and my tan was infact dusty red dirt, as the sidewalks here are not paved. It was funny at the market actually, I purposely did not bring any jewlery or fancy things to Africa to avoid being a target of thieft and yet, repeatedly I was asked to trade my shoes, my watch and my sunglasses (or wind shields as they called them) for goods. They just scan you up and down for items they can use or sell. One man asked me for a Canada pin as he collects them. I did bring some dollar store Canada paraphanilia so I'll have to bring that next time to trade. Laina is leaving me Canada maple syrup and maple butter to trade, as she forgot to use it yesterday.

Today I'm sitting in the computer lab at the Kenyatta National Hosptial waiting for Joshua the director of the clinics to arrive back from the bank. Nothing in Kenya is urgent and so I continue to wait for almost 2 hours. I'm not complaining though, this internet is way faster and smoother than the wireless internet at the cafe yesterday! Internet connections seem to be very inconsistent here, and I spent over 2 hours yesterday trying to post pictures and gmail chat which failed miserably.

I'm anxious to see what today holds for me, what the clinics are like and what work they have in mind for me here. I sit waiting....patiently...excited!

Things I've observed so far:

- kenyas are very friendly

- most people have only ever heard of Ontario in Canada

- converting shillings to Canadian dollars in your head is hard

- taxi's can be anything from a taxi marked car to a van used for safaris, to some guy who knows the bellboy at a hotel

- water service can turn off at any time, yes its not all maids and drivers spoiling me here, we had no water for over 12 hours this weekend,

- yogurt and malaria medication do not mix, and yogurt is a drink here definitely not spoon worthy

- there are no lanes for traffic, everyone drives weaving in and out of each other and there are lots of round abouts, huge ones

- if you say one word in Swahili, you now have a new friend

- water in your bag soon turns to tea, which makes me think of my cute little Grandma who always likes to drink hot water

-you can a huge chopped fruit salad (approximately 5 fruit servings) for 50 shillings ( less than $1) from a roadside stand, but do you really want to eat something flies and dirty knives have been all over, no i don't.

-the fruit is amazing here, mmmm mango and these little tiny lady finger bananas from Uganda

-there are not as many guns around as people said

-women here wear high heel or wedge shoes to walk long distances on uneven rocky dirty sidewalks...ouch?

I'm sure there will be more observations to come. I hope things are well in Canada. Until next time....

JAMBO! (Hi in Swahili)

Well, I've only been here 1 full day, but already I can tell this is going to be a great experience. Its a pretty nice place, a bit rustic, sorta like a cabin in southern SK lake or something. I arrived and no one was home, but in another flat was a Canadian named Catherine, who had the key to my flat. She let me in and showed me my room, and assured me I could eat/drink whatever of Janice's I wanted. Then she left, and I was alone to explore my surroundings, get my bearings and crash, as 26 hours was a long time to be either sitting or standing. When I woke up the first morning, after a great long uninterrupted sleep, I could hear Janice was home from her night of dancing. Catherine had warned me last night that she was out partying on her last night in Nairobi and wouldn't be home until breakfast. I got up to say hello, and a friendly smile greeted me. "Do you know where anything is around here, or do you need me to help you find a grocery store" she chimed....an answer to my prayer really. After a short nap, she was ready to take me out and show me the ropes. Her sister Laina is here as well, both from Winnipeg, and our first stop was a hostel that has internet for cheap. At the hostel we met a girl from New Zealand who had just arrived in Nairobi last night as well. Her name was Iona. She shyly asked us if we knew where any grocery stores were in the neighbourhood, and Janice invited her to join us, much like the wizard of oz, our group was growing by the minute, and we were off on an adventure. We walked a short bit to a Matatu stand (sort of like the local transit system of passenger vans, packed to the brim and blasting loud music). We caught the first one, and piled in quickly with other locals. It wasn't far to the Nakumat (grocery store) which was 3 stories high and very modern looking. I always say that you should never grocery shop when you are hungry, but I hadn't eaten in over 18 hours, except for a few granola bars, and so I was desperate for some sustenance. I stood at the counter for a ready to eat samosa, when Laina mentioned that sometimes the meat samosa's in the rural areas have mystery meat in them, sometimes dog even. Needless to say I got a veggie samosa and just about swallowed it whole I was so famished. The grocery store has every thing you could ever need, in fact, all the choices of any Canadian supermarket, and lots of local foods as well. I also got a SIM card for the cell phone I brought from Canada, although Janice warned me that it was likely locked, stupid Rogers. Indeed it was, when I got home to try it out. I guess I'll have to splurge the 2,400 shillings ($35) to get a cheap cell phone or mobile as they call them here, the airtime scratch cards you buy are pretty cheap and I know mom would be happy to have a number to contact me at. Everyone has mobiles here, even the poorest people, it seems to be the norm. The rest of the night was spent at the flat, making dinner, watching a movie on my laptop and drinking wine, yes I'm sure roughing it. Today we're sitting at a local cafe, a beautiful spot actually with rich vegetation and umbrella'd tables where the wireless is free if you buy a delicious coffee. Mmmm double esspresso milkshake, I sure like it here! We're off for an adventure to walk 30 mins to the Massai Market, where Laina hopes to get some local trinkets to take back to Canada for gifts. Janice flew out last night, and Laina leaves Monday night. Then I think I'll be joined by another Winnipeger Rhiane on Tues. The med students from flat #5 have already promised that I can tag along with them to the Hospital on Monday to meet up with the administrators of the clinics and start volunteeering. I have no idea what to expect, but after meeting all these gracious and generous people so far, I am not worried one bit. Until later........