Getting Oriented in Kehancha

(This is gonna be a long one…)

Today was my first day in Kuria and it was amazing. I arrived yesterday to the town of Kehancha which is sort of the municipal center of the District of Kuria, the USA equivalent of a county or township (and actually, “district” here also refers to the area represented by one member of parliament). It took me about 12 hours of taxi, plane, matatu (large van fitted with 12-18 seats), and Nissan station wagon crammed with 8 people, bouncing over rocky dirt roads to actually get here. I was introduced to my host family which consists of Pauline (mother), Bhoke (daughter, age 20), Wingira (son, age 15), and Shirley (daughter, age 6 months). Two doctors from Cincinnati, Mara and Laurie, have been volunteering for the last month through SOTENI and it has been nice to have them around to ease the transition into my life here.

I love Kuria. It is very rural, which I welcome after the hectic pace of Nairobi. It is very dusty but rains about once a day and is lush and green, with gentle rolling hills. We’ve been eating delicious meals including things like skuma (a leafy green in the kale family), mixed beans, rice, ugali (a thick and sticky mash made of maize), eggs cooked with tomatoes and other vegetables, and chipati (delicious flaky flatbread, kind of like Indian naan). We’ve also been enjoying watching little Shirley have her bath twice daily which consists of filling a plastic bucket with a few inches of water, throwing in a bar of soap, and plopping her in it to splash around till she’s fresh and clean. Witnessing this is positively heart-warming, and all the more precious because it takes place on the floor of the hallway so you have the pleasure of stepping over it on your way outside, or to the living room, etc. The non-babies of the family are also wonderful people, warm and sweet and spoiling us completely.


For me, today was life-changing. I went with the doctors to the hospital, walking through fields of tobacco and skuma, cassava and sweet potatoes, past cement structures housing the court, the police station and the Department of Children. The hospital is also cement, painted white and navy blue, and consists of about 10 small structures with sporadic electricity. We ran into a friend of the doctors’ named Nyamohonga who is a Clinical Officer, which is similar to a physician’s assistant. He informed us that he was about to perform an HIV test and invited us to observe, as the doctors had not yet had the opportunity to do so.

It was amazing.

The woman who came in first was probably in her 20’s and had been tested three times before, the last time in July of 2008. Evidently she is now in a relationship so she wanted to be retested, and also indicated that she worked in a guesthouse and felt this exposed her to HIV. Nyamohonga didn’t say specifically, but I took this to mean she was either prayed upon by men staying there or she was required to provide sexual services as part of her employment. She didn’t speak English but watching Nyamohonga with her was incredible; I have never seen a doctor create such a rapport with his patient; from his calm and deliberate way of speaking, to the constant eye contact, he handled the consult beautifully and appeared to care for her in the truest sense of the word. The testing consisted of three separate instant tests in case two of them showed disparate results and a tiebreaker was needed. A few drops of blood were taken and mixed with different chemicals and then after 7-15 minutes a single line appeared on all three, indicating the woman was negative. This was a great relief to me, although probably did not faze any of the doctors in the room.



After this, he asked an HIV-positive woman to come in so we could see the tests performed with a positive outcome. In both cases I was amazed at the bravery of the young women, first to come to the hospital at all, then to share intimate details of their lives with a man who was a stranger to them, and finally to do all this in the presence of three mazungas (white people). The entire situation was very moving, and clarified for me the complexity of the healthcare system, and specifically the AIDS crisis in Africa. As much as Americans are part of the social, economic, and political structure that has wreaked havoc in this part of the world, and created the ideal conditions for disease and poverty, I think we find a certain satisfaction in pitying these people. I have heard many recite, almost with pride, the desperation they have witnessed in the non-industrialized world, and describe in self-congratulatory tones what they have done to rescue those less fortunate than them. Yet, what happened today demonstrated that the reality is far from being that simple. In fact, Kenyan doctors were caring for their patients with respect and compassion, long before any Americans came to help, and they will continue long after we grow bored with this mission and move on to a new cause. The fact that they are doing this in Kenya with fewer resources than we have ever been asked to, should not shock us so much as remind us that access to healthcare is a fundamental right of all people, and the desire to deliver it is part of being a good doctor in any part of the world.

At the same time, goodwill, and strong doctors can only do so much if they have primitive equipment to work with. Mara has been telling me about some deliveries she and Laurie have participated in and in both cases, they were appalled by the lack of basic equipment. In the first instance, the newborn child did not survive and Mara explained to me with some basic manual suction devices (i.e. the type you buy at CVS to suck snot out of babies’ noses) the child could have been saved. Another time, a child was delivered via C-Section and had no pulse. Evidently the doctors in the room were admitting defeat when Laurie initiated CPR and actually saved the child’s life. There seemed to be a sense that in so many cases, the doctors do not have the right expertise (for example the nurse attending the C-Section had probably never seen one before) and without equipment there is nothing to be done when things go bad.

I am hoping to attend a home birth along with a midwife who lives here in Kehancha and I am told those are the best births available here, barring complications.

Kwaheri for now….