Somedays you feel like a NUT!

And by nut, I mean Nutritionist..... The saying goes "good things come to those who wait," and its true in Africa. I must admit, I was starting to feel anxious after the first 2-3 weeks of volunteering between two clinics, and trying to develop a project for myself. I think it was in part, the language barrier, perhaps I had ambitious expectations, and I also think that in any workplace or new endeavour, you first have to learn about how the system works, assess how you will fit into the system and earn trust and respect in order to fit into the system. Anyone who has recently started a new job, will understand exactly what I am talking about. I guess I was anxious to jump right in and start being a Nutritionist as I am back in Canada. Now, after being here for almost 6 weeks, I have deeper insight into the complexities of the way health care is delivered in Kenya, how office dyamics play a big part in the workplace, and most importantly what are the key nutrition issues that I can have an affect on during my short time here. I am feeling like one of the team at the Majengo Clinic, thanks to time, humor and the staff finally having a general understanding of what I can offer. As I mentioned earlier in my blogs, I was invited to present on nutrition to the AntiRetro Viral patient's Get-together (called Baraza) which happened last Saturday, Valentine's Day. It was an incredible day, where I not only got tonnes more exposure at the clinic, but also earned the respect of the patients and I think the staff. It was a fun presentation, that in my style was supposed to be 20 mins, turned into 45 mins, because everyone wanted to ask questions and partake. I asked for volunteers to demonstrate nutrients in Kenyan traditional foods, sugar content of common sodas consumed here, and alternatives to junky convenience food sold by street vendors. It was a hit. There were patients at the back of the tent standing to see what I was doing, and I even had a patient call me on Sunday to thank me for the presentation. What a difference it has made in the clinic also, now there are patients who not only recognize me, but know my name, and have come up for individual counseling on certain nutrition issues. I've been seeing patients individually this week because of this, and the staff are also referring patients they screen with nutrition issues. Its hard for me to fully explain how drastically different this is from the first few weeks that I was here, but just imagine me, listening to hours of untranslated Swahili and counting pills in the pharmacy to feel like I was helping in some way. Also, I've realized that there are always a few in a crowd who know enough english to translate for the others, and with the few words I know in Swahili, and the art of miming, I can get nutrition information across. So every morning I've been picking a topic and sitting in the waiting room with the woman to try to do a facilitated discussion. Its been going really well. Today I even had a woman basically 2 way interpret the whole discussion for her friends without being asked. On a separate but also fulfilling note, I had a chance encounter with an endearing Kenyan man today, where I basically counseled him to get HIV testing done, information regarding HIV transmission and treatment options. It was at my new tailor actually. So, the other day I went out into the overwhelming and intimidating market to buy a pair of jeans. I did not bring any jeans with me and very little long pants, and the nights are cold here, so I was on a mission to get some. I ended up bartering the guy down to about $13 Canadian for what I found out later was actually new, factory defect H & M brand jeans. They were a bit too long, so I stopped off in the small shack kiosk just on the same road as my flats to talk to the guy with the sewing machine. I discovered that we in Canada are fools for paying and waiting for a simple hem job. I paid the equivalent of $1 for an on the spot hem that looks better than any Stitch It could have ever done. On the SPOT! It was done in less than 5 mins. I actually asked the guy when I should pick it up, I suggested the next day?? and he had a funny look on his face, so I said, next week? and he said, sit down and I'll do it now for you while you wait. While I waited, I think I convinced his friend in the shop to go get tested and learn more about his status. All in all, I feel like I've begun makin a difference, even if its just in a small way.

Lions and hippos and elephants oh my!

So, its a bit, late, but I guess I didn't say much about the animals and sights I saw on safari last week. I really enjoyed the short 3 day trip, and yet was definitely ready to get off the bumpy ride at the end. We drove out in a gigantic land cruiser with our guide named Opany (pronounced like Opine), the trip was 5.5 hours of beautiful scenery and absolutely terrible roads. We first entered the rift valley, and then traveled through Maasai country. There were many times when Opany would drive in the ditch to avoid the huge, and I mean huge potholes in the highway, ones that make Regina's potholes look like tiny cracks. There was a small portion of the highway right before we arrived at our lodge that was nicely paved, apparently they're working on paving the whole stretch soon. This we observed through dusty, polluted highway construction zones on our drive back to Nairobi, which made for even more swerving and ditch driving to avoid the construction workers. Its interesting to see construction sites actually, because I guess labour is cheap here, and technology/machinery is sparse, so they have incredible numbers of workers working on each task. Like last week when I saw at least 150 workers digging a trench alongside a building in town. They seem to take shifts and rest in the shade from what looked like extremely manual digging with a hoe like tool. Anyways, then we arrived at our beautiful Mara Hippo Lodge, where we had a quick break (for half and hour) before we piled back in the land cruiser for our first evening game drive. Over the following 3 game drives we were able to see many of the migrating animals, despite July being the best season for migration. What amazed me the most was the size of the herds of animals, especially the elephants. I think we saw one herd of elephants that had about 200 elephants (including baby elephants) grazing near a river bed. They are amazing to watch, but don't get too close. We did sneak up on one lonely male elephant as we drove around a tree brush. It didn't take long for him to get uncomfortable with how close we were to him, and he began to charge our vehicle. Our guide recognized the charging right away and made a very stealth escape, before we even knew what was going on. Its great to have a knowledgeable guide to explain what all is going on. For example, we also saw many prides of lions. In one pride there were 2 female lionesses and 3 young lions. Opany let us observe their behaviour for a short while before he pointed out how uncomfortable and panty one of the lionesses was. She was in heat. Then as you watched longer you could see her approach the strongest lion in the pride and rub her tail on him. Unfortunately for her, he was not having anything to do with her, and she continued to get more frustrated and comfortable. An interesting site to watch, sort of like a bad bar pick up scene...haha. I especially loved the giraffes, much to my surprise. Its so spectacular how you can spot them from such a distance moving almost in slow motion across a huge plain. Their shape is so distinctive and their movement so fluid. I like to think I caught 2 lovebird giraffes embracing, but not sure if that is the case or not. I should have asked Opany. In addition to those animals, we also saw hippos, cheetahs, crocodiles, ostrich, impala, waterbuck, baboons, monkeys, hartebeests, wildebeests, hyenas, jackals, a wide variety of beautiful birds and butterflies. I was enamoured with the beautiful trees and vegetation actually. There is of course the typical acacia tree, there is a yellow backed acacia tree also, which is so stunning and my personal favorite, the sausage tree. The sausage tree has huge "fruit" hanging down from its branches that look like sausages. Apparently the elephants and ostrich eat the sausages and if they eat to many will become drunk. In fact, the Maasai people actually make a local beer from the sausages. No, I wasn't able to sample any of said beer, but sounds interestingly tasty. We enjoyed the pool at the lodges in the evening, and the nearly empty restaurant and lounge. Our "lodge" was actually canvas tents, with king size beds, full washrooms and banana leaf roofs. I can't be sure but I think the cleaning staff washed and ironed the two clothing items I left out unintentionally on the 2nd day. Service really does take on a new meaning here. On the third morning, after our early game drive, where we saw a mother cheetah feeding her cubs her recent kill (Impala) we visited a Maasai village. There are 42 tribes in Kenya, but of the three largest ones, the Maasai people are the most distinctive. With the bright RED kikoys as there distinguishing "uniform" and rich culture with traditional customs still in tact, they made for my highlight of the trip. The Maasai tribe is most known for its startling traditions such as polygamy and female circumcision. Males are sent on a "vision quest" at age 17 or so before also being circumcised (with no anesthesia). Each young man has to prove his manhood by killing a single lion and bringing the carcass back to the village as proof. At the village, which I don't think even had a name, we were greeted by a representative from their community, a young, 18 year old male named John, with impeccable english, the skinniest/most muscular calves I've ever seen and an adorable smile. After paying about $16 Canadian, we were allowed to enter their village site, which consisted of very small huts formed into a large circle. The huts are very short, likely 5 feet tall only, with sunken in floors to allow for the height of the taller men of the tribe. They make these houses out of cow dung walls and slated roofs from the local forest. Their community depends on and revolves around cattle herding, which is why their houses are shaped in a circle, to enclose the sleeping cattle at night, their homes have a small room for a cow to sleep in if needed, and their diet consists entirely on cow meat, milk and blood. In fact, much to my dismay they explained that eating vegetables was "not allowed" in their culture. I wouldn't last a day there, haha, when in reality I would have loved to stay longer and learn more about their way of life. They had a traditional dance/song ceremony for us, where the young men of the tribe proudly showed off their incredible vertical jumping. Thomas tried to see how high he could jump, and I love this photo of him mirroring a Maasai boy, except for the hilarious facial expression of Thomas. After their dancing, I asked our guide if I could learn how they carry babies on the backs of the woman, but using a kanga (shawl). A Maasai woman generously lent me her beautiful daughter, who despite her fearful expression, sat quietly on my back for the demonstration. The baby's name was Didula, and was only 6 months old, as explained by her endearing mother, from whom I bought a few extremely overpriced beaded jewelry items. I wanted to show her my appreciation for her willingness to help with my weird request, and she ended up giving me an extra bracelet as a gift, "in friendship" she explained in her language. I think I'll always remember her giving smile and beautifully innocent looking daughter. I also had brought an old frisbee found in the flat to give to the local children. It appeared that most of the school-aged children were not at the village when we arrived, but I managed to find one interested boy who was very appreciative and quick to learn the skill of the frisbee flick. When we looked through the handi-crafts at the end of our visit, I noticed round disc looking beaded items, which John then explained to me were in fact Maasia frisbees. Skeptical that such a heavy and seemingly unaerodynamic item would actually fly, and the outrageous price they were asking for it, I figured I'll just remember the interesting artifact in my mind instead of buying it. We were all ready for a nice hot shower and calm evening after the long bumpy ride home, but it was an experience of a lifetime that I will never forget.

Grace

God's grace is an incredible thing, and they say God works in mysterious ways, I feel that is true this week. How can I feel comforted during a time of loss, when I'm with strangers in a foreign land? The answer is Grace........seen this week through the beauty of nature! I felt comforted in my surroundings on safari this week, despite hearing news that my Grandmother has passed away in Canada. Maybe it was the outstanding beauty, maybe it was the incredible quiet, maybe it was the way every plant and animal seemed to live in harmony or for a purpose, but I found clarity in the complexity of nature in the Mara. I've posted new photos in my picasa web album of the amazing animals and scenery we were blessed to see, and the wonderful family from New Zealand I was adopted into this week. I'm grateful for so much, mostly that my Grandma is in a better place, with my Grandpa and with the creator, the creator of all the beauty I enjoyed this week. I feel like God was comforting me by showing me a small portion of the beauty that Grandma is seeing now in heaven.....

Faces and places...they all have a story.

Faces and Places......they all have a story! I've been feeling bad about my blog entry marking 1 month in Africa, it seems most of my comments were negative, or redundant facts about life here, when really thats not what stands out most to me. I think I was tired from feeling sick when I wrote the blog entry. Today I was reminded of the reason I came and the reason I am staying in Africa. The reason is to learn from the richness of Kenyans, and tell their story, in whatever way I can. Today the story is about perseverance, dedication, vision, and simplicity that when you look deeper is actually complex. I think grassroots is a vast overstatement when you look at a NGO such as MOCASO. I visited MOCASO today, which stands for Mother/Child with Aids Support Organization It was started by a woman named Joyce Kamondo, pictured here, who has a heart for helping others, and who has not given up in 22 years, on herself, her HIV status, has not given up helping others deal with living with HIV, and also humbling herself to accept help too. I think I can honestly say she may become a hero of mine, and I've only known her 1 day, but she said we are now friends, and has invited me to return. I spent time today learning about what her organization is about, and how they help people, in what appears to be a small way, but in reality is a world of difference made for each family. She started 22 years ago when she was diagnosed with a death sentence, a shameful one at that. Today she explained to me that she and others would cover their faces/heads with scarfs to enter the gates where the Pumwani clinic was, in order to get tested/treatment. They did not want anyone to see them entering as they would surely be known then to have HIV, and that had such stigma, they would be cast out of their families and communities. She said, she realized she needed to change that stigma, and was the first of her community to "come out with HIV" and speak about her illness, and although her community shunned her, slowly other infected women came to her and asked her, "I'm the same, now what do we do?" They began support groups at the clinic, and in 2004, her cause was so successful she started renting out office space and growing her staff. I saw the office space today, its as I said, "grassroots" but the world to Joyce, you can see that in her eyes. She helps women to support their families by teaching them and providing materials Income Generating Activities including making bead necklaces, beaded red HIV ribbon pins, powdered and liquid soap and tie-dying material all for sale in the market outside. They get piecemeal funding from the Kenya Government, USAID, and World Food Program., however they do not always have funding for IGA supplies, or food to hand out to those in need. They've made orphans of HIV and vulnerable children a priority for food, and provide them a kit as seen here, a simple kit with donated clothing, water purification drops, a toothbrush, 1 kg of maize flour, sometimes beans, maize and porridge. They understand this is not often enough to feed a whole family, but they can only give what they are donated. When donations are plenty, the provide food to HIV infected women also. They currently have a wait-list, or pending names as she explained it, of 300 people. Her dream is to start a food bank, but find funding is an issue. After seeing her office and their situation, it was clear to me how they can make so much from so little. Its truly an amazing feat that she can make a family able to sustain themselves on a few simple bead necklaces. When I was leaving, I asked her if she had any questions for me, In her simplicity she replied that she would like me to find someone in Canada to partner with her organization to help with funding her Income Generating Activities and her work. Wouldn't I love to magically provide her with a funder, I did promise her I would market her products, shown here in the photos.

Cradle of mankind

Despite being rather ill, we ventured out today to the National Museum here in Nairobi. It was a very interesting day, and we ended up spending 4 hours there, without realizing. The truth is I realized, I was pretty tired and sore at the end. I posted another album on my blog showing the beauty of the museum grounds, and the interesting fossils and history and artwork they feature there. It was very interesting learning and seeing early man's fossils, replicas of African animals and learning about traditional Kenyan customs/paraphernalia. When we got home, Barclay, the med student from upstairs, who has been checking in on me and my annoying illness, said he and 2 other doctors yesterday were discussing my symptoms and have narrowed my diagnosis to three possibilities, all of which are viral and untreatable, except rest and fluids. 1. Aseptic meningitis (not the fatal kind of meningitis - apparently not a scary diagnosis, but it sounds scary to me), 2. encephalitis (again, apparently not the scary kind) or 3. viral chikungunya (from mosquitos). Either way, I should be feeling better in a few days, and its not a big concern, and does not require medical attention. I should have know he thought it was something more than the flu when he was checking in on me a few times a day, and giving me lots of attention. How convenient to have free diagnosis by tropical disease doctors! I feel lucky, and blessed that this is what i'm ill with, and not malaria, or something serious. Pray for me if you wouldn't mind. My thoughts and prayers are with you each of you also. Later.....

Deep Thoughts

I can't believe I have been here for one month already, one month today actually. In one sense its gone by in a blink, and yet, it seems like its been forever since I was home and in the familiar. I'm really starting to get used to life here, and things aren't nearly as shocking on a daily basis as they were at the beginning. Impressions after 1 month in Nairobi: #1 I am starting to be able to understand Swahili a bit, even speaking a fair number of phrases, and be able to carry on short conversations in Swahili, or interject into someone's conversation with an appropriate Swahili response, the clinic staff are impressed with my progress, and try to teach me new things every day. Its fun actually. #2 Nothing is as it seems here, in terms of prices, there is basically one place you can't barter for prices and that's the Nakumatt, the supermarket, but anywhere else, if you argue enough, or threaten to walk away, you can bring down the price. Adam actually taught me that at the market, you should counter offer with 1/5 the price they quote you on anything, 1/5 is shocking to me, but he figures that's the mark up for Muzungu's, then he says you should settle at 1/4 the original quote, or 1/3 if you really want it. This is harder said than done. I find it hard to keep a straight face and offer 200 Kenyan shillings when they quoted 1000 Kshilling, I usually do half, but I'm sure I've gotten ripped off more often than not. #3 I even think I'm used to the traffic, which is hard to believe, since they not only drive on the other side of the road, but its much faster paced, no lanes, lots of jams, and there are no crosswalks in the whole of Nairobi. I'm much better at timing the traffic to get across the street when I need to, and I've become old hat at riding the matatus where I need to go, which is much more affordable. The same distance you take a 20 Kshilling matatu would be a 400 Kshilling cab ride each way, that adds up. Matatu's are fun actually, once you get over the speed and claustrophobia of 10-14 people jammed in very narrow seats, they blast african music, or sometimes reggae, and when you want to stop, you tell the money collector, who taps on the window, sometimes with a coin so the driver can hear over the blaring music #4 Kenyans have a great sense of humour and they love Obama: Last week at the conference, the mixed up my name tag and it appeared as "Norah Heroxick Oloo" which made me laugh a lot. One friend even said that it sounded like my Dr. Suess name, Norah Heroxick oloo didn't know what to do.... So, my latest ice breaker is to introduce myself as Norah Kathleen Oloo. Kenyans all have 2 first names, a "english" one and a "kenyan" one, for example Jane Kamane, so they always ask me what my second name is, I've started saying my middle name as well. I tried it on a matatu the other day, and it generates good conversation. A kenyan had told me that Oloo was the family name of Barack Obama, and so it makes people laugh that a "muzungu" (foreigner) would claim to be in Obama's family. Then they start talking about their tribe, or politics, or Kenya or making jokes, etc. Its fun to be able to strike up conversation that doesn't start with "Muzungu, take me to Canada." #5 One thing I've yet to understand, is why everyone feels the need to point out how white I am, wherever I go. Sort of a funny, sometimes annoying phenomenon, do they really think I don't know I'm clearly different than them? At any given location, or time, people just blurt, or yell out "Muzungu" as I pass in a car, as I walk on the street, as I ride the matatus. Especially when we come to and from the clinic daily, we drive through the Majengo clothing market, and yesterday I counted, 8 different people yelled out, as they saw me in the van full of clinic staff in what was probably a 2 minute stretch. I wonder if that will change, as they recognize me, or maybe I'll stop noticing it. As for my work here, I'm slowing molding myself a role as the a nutritionists is a new and foreign addition to their team. I've noticed the clinics are very focused on research, completing forms and collecting samples, and less on actual health care counseling and assessment, or health promotion. I've now devised a plan with the clinic manager, on which clients I will be referred. So now I wait for them to send those people my way. I am presenting at the Baraza (meeting) for 200 patients next Saturday, so I'm hoping that ups my profile in the clinic a bit. I've been spending this time observing lots, and learning about nutrition for HIV on my own. I plan to make some nutrition poster boards for the waiting rooms, some fact sheets for the clinical officers, offer a nutrition seminar for the staff and hope to do some one to one counseling with high risk patients when possible. Things move slowly in Africa, so I'm trying to remain open to experiences daily, learn all that I can about not only nutrition, but the patients, the health care situation, the customs of Kenyans, how research is done, what motivates people to change and how the determinants of health effect how things are handled here. It seems there is a general acceptance of death, of sickness, of poverty and little motivation to try to make large scale changes. I've also noticed that people are dependent on pharmaceuticals to fix or ease whatever ails them, its the first line defense, I think because most have trouble affording them, they hold drugs up on a pedestal almost like a status symbol, if you can afford drugs, or get them from a clinic for free (by being a research subject usually) then you are better off than those who can't. Oh and I also discovered that only poor people eat vegetables, and its also a status symbol to eat junk food like pop, fries, bread etc. If you are financially comfortable you don't eat vegetables, come on, you're way better than that.......obesity is actually an issue here, so is heart disease and diabetes, with higher rates than even North America, its just overshadowed in by more imminent diseases like HIV. With lots to learn here, and lots of differences, Africa will never get boring... I'm off to a safari on Tues, in the Masaai Mara, more to come...