Challenges of Poverty

This week has continued to challenge my thinking about how to best care for the people of Kenya.  It all stemmed from a difficult day at work.  While collecting data for an ongoing research project of mine, I was called to help out in Casualty.  We had a mass casualty from another matatu accident.  Unlike the usual three or four patients received from motor vehicle collisions at home, we were presented with thirty-three patients at once, twenty-two of whom died.  How can such tragedies be prevented?  In high-income countries, increased road safety legislation, education, and enforcement have led to a reduction in motor vehicle collisions and fatalities.  So why haven’t the few attempts at injury prevention worked here?

Legislation in Kenya mandates matatu drivers/owners to only carry one passenger per seat and to ensure each seat has a safety belt; however, the country has yet to see any change from this law.  The issue boils down to poverty.  On one of my recent matatu adventures, twenty-three of us rode snuggly in the fourteen-seat vehicle.  Despite the legislation, matatu drivers can’t afford to travel with fewer passengers unless raising prices and Kenyans can’t afford to pay more for transportation.  On our journey, we were pulled over at a police check, but a small fee for the policeman’s pocket put us back on the road without any further penalty for breaking the law.  This is just a small example of the corruption that is entrenched throughout the Kenyan law enforcement and government.  Why have laws if they're not enforced?  It is even the issue of poverty that has led to increasing corruption as people become greedy for power and money, feeling entitled after years of struggling.

Many of the issues faced every day at the hospital stem from poverty.  In addition to preventable injuries, patients present in late stages of their illness as they have delayed their care due to concerns over ability to pay.  Illnesses related to malnutrition and poor sanitation are overwhelming.  According to the World Bank, more than one billion people today live on less than $1 per day. About 70% of those people are women, and almost half of the population of sub-Saharan Africa survives at that income level. We know that every 3.5 seconds, a child dies in the developing world from poverty-related circumstances. 

Map of world poverty - Sub-Saharan Africa is the worst

While on the surface poverty is often defined as a lack of income or assets, in the lives of the very poor, poverty becomes a network of disadvantages, each one exacerbating the others. The result is generation after generation of people who lack access to education, health care, adequate housing, proper sanitation and good nutrition. They are the most vulnerable to disasters, armed conflict, and systems of political and economic oppression.  The poor are often powerless to improve their circumstances, leading to a sense of hopelessness.

So, what can we do to help?  The problem seems so overwhelming to me without really any idea of where to begin.  It is clear that handouts and traditional aid are not enough to solve the problem of poverty.  Handouts typically just create dependency without empowering the poor to remove themselves from their current situation.  Finding solutions that help build infrastructure, organization, and education within resource-limited countries is critical.  We need to find ways to invest in the poor, to enable them to improve their situation in a way that is sustainable for themselves and their families.  Maybe then we can make greater strides on global health issues like malnutrition, death from preventable diseases, and child sex tourism.  May we develop a greater awareness and wisdom to know how to best serve the poor and needy with the love of Christ.

"If anyone has material possessions and sees his brother in need but has no pity on him, how can the love of God be in him? Dear children, let us not love with words or tongue but with actions and in truth." 1 John 3:17-18

What can you carry on your bike?

The better question in Kenya is "What can't you carry on your bike?"  The bicycle is one of the main ways of transportation, also called a boda boda.  Not only do Kenyan's transport each other around on their bikes, but many other things as well.  They are very creative in finding ways to strap various objects of any size onto the bike, front or back.  Here are a few pictures demonstrating some of the endless possibilities.



Bike carrying another bike



Need to transport your lawnmower?  Easy, strap it to your bike.

Grass for thatching the roof.

Furniture and miscellaneous objects easily fit



Stacks of wood are often seen on the back

Other objects I've seen on the back of bikes:  several large bags of charcoal, a bed, and the best ever bike cargo...a pig.  I am still disappointed that I missed out on that picture.  It was during one of my runs that I was passed by a bike with a live pig strapped to the back, squealing the entire time.  Needless to say, I now take my phone with me for such priceless photo opportunities.

So, why do we even need trucks?  Whatever it is, strap it to your bike. 

Kenya's Coast

I returned from vacation on Monday and found myself swamped with work again.  The past two days have been filled with several research hurdles, training medical students, and teaching basic life support.  While I should be preparing for another lecture, I find myself looking through my pictures and wanting another day on the coast of Kenya.

Kenya is a beautiful country with a wide range of terrains from the low coastal plains to the central highlands bisected by the Great Rift Valley and climates that range from Kakamega's rainforest to the desert of Turkana   Over the past six years, I have been able to see much of Kenya.  However, until this vacation I had never made it to the coast of Kenya and the Indian Ocean.  As the warmest ocean, you can't help but want to jump in as soon as the water rushes over your feet.  I love it!

During our stay on the coast, one of my biggest goals was to take a camel ride on the beach.  As someone interested in participating in Kenya's annual Malaral Camel Derby this August, I needed to get some experience.  I attempted to get some pointers from the camel owners but with little success - I think they may be my competition.  Nevertheless, I did enjoy some riding time on the beach and learned a few things.  Camels are really tall, much taller than I imagined.  So for the race, I need to make sure the saddle's on tight and I hold on tight; otherwise, that could be quite a fall.  Also, I was taken by surprise when the camel stood up and sat down. When standing, he quickly put his butt up in the air, launching me forward and nearly over the camel's head.  The same occurred when he sat down with his front legs first...it was quite a drop.  Thankful for my few valuable lessons learned on the beach, I am now ready for the races. 

Getting a kiss from George...only a little slober

Wow...taller than I imagined

My other favorite activity on the coast was snorkeling in the beautiful Indian Ocean.  We ventured out to the coral reef in a glass bottom boat where we jumped off the side and swam with an incredible amount of tropical fish.  The bread many of us held in our hands to feed them helped attract a large number and wide array of fish.  It was by far the best snorkeling I've done to date. 

Looking good girls!

There is so much to be thankful for every day...this trip was filled with beautiful weather, relaxing time by the pool, and good friends.  I can't help but be overwhelmed and challenged by the opportunities God has given my to travel and enjoy His creation, something that most Kenyan's will never experience or enjoy even in their own beautiful country.  Another reminder of the many undeserved blessings God has given me and my responsibility to be a good steward of these gifts.  May all of this be a source of continued encouragement and reminder of my purpose as I come back to busy and often difficult work days. 

Masai Mara

Our time at Masai Mara was unbelievable.  Masai Mara is a large game reserve in southwestern Kenya that also expands into Tanzania, known as the Serengeti.  It is one of the best places to go on safari and unlike Hell's Gate, did not prove me wrong.  In the course of 2 days, we were able to see the “Big Five” (elephant, rhino, cape buffalo, lion, and leopard) and so much more.  Our driver was fabulous, blazing trails through the Mara getting us to the best spots for photos and competing with other drivers to get to the animals first.  Here are some of the highlights and photos from the trip.

Highlights:

• Watching lions chase a leopard into a tree.
• Lion cubs playing together
• Elephants coming after us in the van.
• Lions feasting on a zebra
• Being attacked by a monkey  and having him grab my leg as I tried to get away
• Driving past a cheetah relaxing on the side of the road
• Finding a black rhino in the bushes

Enjoying our safari

THE BIG FIVE



Some other pics from Masai Mara:



The leopard safe in the tree watching the lions

Lion cubs having fun - don't you just want to take one home?

Feasting on zebra

Zebra ribs - Yum!

Cheetah looking his best

I look forward to sharing more photos when I get home.  If anyone else is feeling compelled to come to Africa and join in the fun, let me know. 

Safari Salama

“I like that you went to hell and back and are still laughing,” our driver commented as we left Hell’s Gate National Park.  It pretty much summarized our stay there.  When I planned the safari and vacation with my friends, I made sure to include a day at Hell’s Gate, one of my favorite parks in Kenya.  One activity unique to Hell’s Gate is biking through the park amongst the animals.  The only animal in the park you have to beware of is the cape buffalo; otherwise, you can get close to the zebra and giraffe without much worry. 

Excited for this adventure, we rented bikes and rode into the park, admiring the beautiful landscape.  The goal was to bike to the middle of the park, hike through the gorge for a couple hours and then ride back.  On the ride into the park we were able to enjoy seeing some of the animals before getting wet with a short downpour of rain.  The rain was short-lived so we kept pressing on to the ranger station at the gorge.  About a kilometer away from the station, we ran into a road block – cape buffalo standing in the path.  Stink, we were stuck.  We could see a couple on the other side admiring them as well, knowing that it would be too dangerous to get any closer.  We tried to wait them out, but they kept their position just staring back at us.  While waiting, the rains slowly began again.  We turned around toward the entrance of the park, at least an hour ride back.  Loud thunder announced the downpour of rain.  We were quickly soaked but continued to try to ride to shelter.  This effort quickly faded when the hail began.  We laid down our bikes and ran to a nearby tree to try to take shelter (although if you have seen the trees here, there’s not many leaves to give any protection).  A small improvement as we cowered together for warmth as the wind, rain, and hail continued to overwhelm us.  More than 45 minutes had passed, no relief in the weather or rescue van to take us to safety.  It was getting dark.   We had to start biking again if we were going to get out of the park by sunset.  We pushed through and painfully made our way back, soaked and tired.  Riding in front, Charity at one point stopped, put down her bike and turned around to face us.  I was sure something was wrong with her bike (ex. flat tire, broken chain) which would be disastrous given the weather conditions and our distance from the park gates.   Thankfully, it wasn’t the bike.  Instead, pained by the hail pelting her in the face, she just needed a break.  We finally made it to the gate with dripping wet hair and soaked clothes.

Enjoying the ride...little did I know what the rest of the day would hold. 

I was sad that they didn’t get to enjoy the park, ride next to the animals, or hike through the beautiful gorge.  Not exactly what I had in mind for their Hell’s Gate experience.  Despite that, we all laughed the entire way home recounting our experience.  I was thankful that we had at least had a successful morning earlier with our boat ride on Lake Navaisha and visit to the island where “Out of Africa” was filmed, walking amongst the giraffe, zebra, and wildabeasts.

View of Mt Longonot from Lake Navaisha

Lots of hungry hippos in Lake Navaisha

Amie, Charity, Katie, and I enjoying our walk with the animals

God's creation is amazingly beautiful

Off to the Masai Mara for another safari followed by a trip to the coast to enjoy the beach and Indian Ocean.  Yay!

Asante Sana!

I am sending a big thanks to my friends and family at home as well as my wonderful visitors (Katie, Charity, and Amie).  They arrived on Friday with much needed smiles, hugs, and gifts from home.  I have enjoyed spending the weekend in Eldoret with them, showing them a little bit of life here in Kenya. 

We went to the Tumaini outreach on Saturday morning with a supply of jump ropes and candy for the children.  They loved it!  I had a great time with the jump rope activities, especially since I don't think I have jumped rope since grade school.  Who knew there were an endless number of jump rope activites:  seeing how long we could jump, how many people could jump the same rope at one time, races jumping rope up and down the field, etc. 

Elizabeth showing her skills and Junior trying to join the action

Me and 2 jump rope all-stars (Cecelia and Elizabeth)

The children of Tumaini and I say thank you for the gifts.  We look forward to many more fun-filled outreach days.  I am also excited to share some of the gifts with the children in sick-child clinic. 

Thanks also for the other wonderful treats and words of encouragement.  What do you think about this gift?  The great thing is that I didn't get just one, but two - Thanks Dad and Lacy!

Much needed Green Bay apparel - Love it!

After a full weekend enjoying Eldoret, we are headed on safari tomorrow.  The adventure includes Hell's Gate National Park, Masai Mara, and a few days on the coast in Mombasa.  Can't wait!  For more details on all of our adventures, check out Katie's blog. 



One Earth, Two Different Worlds

I have had the privilege of spending some time on the pediatric wards this past week.  I almost forgot how much I love it.  The peds wards are full of children with very interesting medical issues, especially when caring for them in a resource-limited setting.  One day on the wards presented complicated cases of pulmonary embolism, newly diagnosed congenital heart disease, malaria, rheumatic fever, meningitis, lymphoma, and the list continues.  With the acuity on the wards so striking, I found myself thinking about differences between here and the children's hospital at home.  I wonder what it would be like if a patient and family from both places were transported to the other hospital for care.  The vast difference between the two hospitals would make for a shocking experience for either patient.

On the wards here, there are no individual rooms.  Instead there is one large room divided into six pods, each with six beds.  There are two patients to each bed, which means two children with one parent each sharing the bed.  On the adult wards, there are usually two patients to the bed sleeping head to foot/foot to head, and occasionally three with one person in a chair next to the bed, all taking turns laying down.  Visitors are allowed at two one-hour periods over lunch and dinner.  Because the wards are so busy and understaffed, it may be up to the parents to give the medicines and therapies.  During their hospitalization, families are often not involved in their child's medical care; something that frustrates me most.  Involving families on rounds, updating them, or breaking bad news is a skill set not used much here, and probably arguably some places at home.  As can be anywhere, medical costs are hard for families; however, here patients can't leave the hospital until their bill is paid and continue to accrue costs until they leave.  Frequently, there will be other family members in the village and in town trying to raise money to pay the bill.  How would I do if I had to be admitted to the wards here? 


Adult female wards with two per bed



Peds wards...1 bed, 2 patients, 2 parents


How would one of our Riley families manage?  No video games.  No TV.  No McDonald's.  I couldn't help but think about the new Simon Family Tower.  While I am happy Riley Children's Hospital expanded, I was disappointed by the excess during my tour of the new facility.  Huge single-patient rooms with two beds and two flat-screen TVs (one for parents and one for child), an entertainment system (including a Wii), refrigerator, and wireless internet.  It was a similar feeling when I returned from Zambia and took a tour of the new Colts stadium.  Don't get me wrong, I'm not against nice things; I love football; and I want the children of Indiana to receive wonderful care in a comfortable environment; but when is it too much?  Is it the most responsible use of money?  I can't imagine what one of the Kenyan patients would do in such a room, bigger than their own home.  Typical toys for a Kenyan child include a stick and bicycle rim; maybe they can make a game to simulate it on the Wii.

During rounds, I couldn't help but wish things were different, more equal.  Wanting myself and the rest of the Western world to appreciate what we have without a sense of entitlement.  Maybe even give out of more than just our excess, not just when it's easy and safe to do so.  Certainly, no one is guiltier than me.  Wanting the Kenyans and others living in the developing world to have better health care, an abundance of food, and clean water.  A book I recently read, Outlive Your Life, makes a statement about bringing our world together:

"1.75 billion people are desperately poor, 1 billion are hungry, millions are trafficked in slavery, and pandemic diseases are gouging entire nations.  Each year nearly 2 million children are exploited in the global commercial sex trade.  And in the five minutes it took you to read these pages, almost ninety children died of preventable diseases.  More than half of all Africans do not have access to modern health facilities.  As a result, 10 million of them die each year from diarrhea, acute respiratory illness, malaria, and measles.  Many of these deaths could be prevented by one shot.  Yet in the midst of the wreckage, here we stand...you, me, and our one-of-a-kind lifetimes and once-in-history opportunity.  We can travel around the world in twenty-four hours or send a message in a millisecond.  We have the most sophisticated research and medicines at the tips of our fingers.  We have ample resources.  A mere 2 percent of the world's grain harvest would be enough, if shared, to erase the problems of hunger and malnutrition around the world.  There is enough food on the planet to offer every person twenty-five hundred calories of sustenance a day.  We have enough food to feed the hungry.  We have enough bedrooms to house the orphans..."  So, what are we doing?

Yes, it is oversimplified, but it emphasizes that the problem is not the supply, but instead the distribution.  May we take the opportunity to make a difference in a hurting world, recognizing needs and giving in a way that is beyond our excess.

Rafting the Nile

This past weekend adventures took a group of 12 of us from the IU compound to Jinja, Uganda.  The goal - whitewater rafting on the Nile.

We drove to Uganda Friday night to begin our adventure early Saturday morning.  Nile River Explorers picked us up from the campsite in the morning and took us to where we would begin rafting.  We divided up into two groups, those that wanted to flip and my boat that didn't want to purposely flip.  Despite that, there was still a good chance that we would flip on the rapids so we began with some safety tips.  Our guide was Alex, a native of Uganda and excellent rafter/kayaker.  Our safety lesson consisted of Alex flipping our boat and dumping us in the water, trapping us under the raft.  We practiced flipping the raft over and getting back in the boat.  Once we were sufficiently freaked out, we were on our way to the first rapid, a class 5.  Way to start the day.  Of course, all the rapids except one were class 4's and 5's. 

Halfway down the river, we had to get out of the raft and carry it around one of the rapids, a class 6.  Recently, a group from another rafting company went down this rapid, tore up the boat on the rocks and injured the rafters badly.  Needless to say, I was happy to walk around to continue our adventure down the next class 5.

Itanda Falls - Grade 6

The Nile River Explorers were amazing with wonderful guides and safety kayakers.  It was a great day of rafting.  Only one injury for a girl who got hit in the mouth by an oar when flipping on the rapid.  Easily remedied with some ice and medicine.  No stitches needed.  With rafting checked off the list, we were able to relax and enjoy the rest of the weekend in Uganda, a beautiful country.  Winston Churchill called this green little country "the pearl of Africa."  Here are a few other pictures from the weekend.

The Nile from our campsite. Deceivingly peaceful.

10 yr old Brenda selling bananas at the Uganda border...who could say no?!

 

The countryside with typical African homes

 I definitely hope to make it back to Uganda sometime.  Maybe a gorilla tracking adventure or mountain biking around Jinja.  Anyone want to join me?

Language Barriers

Language barriers are often the most difficult and isolating barrier to overcome in a foreign country.  I have been taking Swahili lessons almost daily in hopes of becoming fluent.  In addition to my one hour lessons, many others try to give me mini-lessons forcing me to use their language as much as possible.  At the hospital, I can usually get an OK history and understand the gist of the patients' complaints.  I usually elicit plenty of laughs from the Casualty staff and even patients at my efforts.  Sometimes I say the right thing, but my BrAzil accent can make it difficult for some to understand.  As is with learning any language, I frequently mix up words that sound similar (example - the other day I asked someone if they were vomiting potatoes (unatapika) instead of if they were cooking potatoes (unapika)). 

Despite the busyness today, my communication attempts gave us all a good laugh.  Casualty was packed so I started seeing patients in the waiting area.  Because everyone was so busy, I had to rely on my own Swahili to get through patient interactions.  I was seeing a patient with back pain and lower extremity weakness that had been progressing over the past 2 months.  She was now unable to walk or even move her legs.  In addition, she had been having fevers during this time frame.  After being seen at several hospitals, she was referred to us.  I did my workup, reviewed her films, and started antibiotics and pain medications.  She had several compression fractures of her spine and impingement on her spinal cord.  With the fevers, I was worried about an infection.  I was having a hard time explaining this to her and the family.  I finally borrowed one of the clinical officers to help.  After he spoke with the family, he looked at me and said, "They are worried about the big sore on her butt."  It all came together for me..."Ahh, that explains why she keeps grabbing my butt."  The staff all started laughing.  During my history and physical, the patient's sister kept grabbing my butt while telling me something, but I obviously didn't understand and wasn't sure what to make of it...Is she just misplacing her hand?  Is this cultural?  No, they were just trying to communicate with their limited Swahili-speaking doctor.  Now time to learn what "butt" is in Swahili.