Catching Up With a Friend

Yesterday I was blessed with a surprise visit from my friend Rose. Although we had traded text messages, I hadn't had a chance to meet up with her and get caught up on news. And, believe me, she had a fair amount of news. I first met Rose at the Webuye AMPATH Clinic where I go for my checkups while here in Kenya. She was working there as a peer counselor when I first went in for my initial vist a year and a half ago. She's someone that I've come to respect for many reasons, but the main one being that she is open about her status as an HIV Positive woman here in Kenya. That's not a common trait.

But first, let's talk a little bit about what AMPATH is. The following is taken from their website.
"The Academic Model Providing Access to Healthcare (AMPATH) is Kenya's most comprehensive initiative to combat HIV. AMPATH is a working model of urban and rural HIV preventive and treatment services in the public sector. AMPATH cares for more than 55,000 HIV infected adults and children, with nearly one-half of all patients on anti-retroviral drugs, and enrollment into the program rising by 2,000 patients per month.

A robust program to prevent mother to child transmission of HIV has been initiated including an opt-out testing policy and programs fostering triple anti-retroviral therapy of pregnant woman and formula feeding of newborns. AMPATH has implemented programs that foster food and economic security for HIV infected persons and their families. AMPATH demonstrates the power of US and African academic medical centers united by common vision. (http://www.medicine.iupui.edu/kenya/hiv.aids.html)"

It's a partnership between the Indiana University School of Medicine and the Moi University School of Medicine here in Eldoret Kenya. There are 19 locations throughout Western Kenya. I visit the Webuye location which is about 30 minutes away by matatu. Although I only go for lab work and medication refills, the clinic does much more than that for Kenyans living with HIV. They help to insure that patients are receiving enough food to maintain their health and provide it when necessary. In addition, they do a lot in the way of Mother-To-Child-Transmission Education, family counseling and so forth.

I think what first struck me when I met Rose was the fact that she did not appear outwardly shocked to learn that an 'mzungu' was in the clinic receiving care for HIV. Trust me, I'm a surprise to many people here. It is not something that is really considered. I'm the anomaly when I walk into a large, crowded waiting room full of black faces. My pale skin is in stark contrast. I like to think that it helps to show that HIV/AIDS is a disease of the world and not the burden of just one country.

But, let's get back to Rose and what she does. She is a peer outreach worker for the clinic. Part of her job is to follow up with patients that don't come in for their regular checkups. She calls or visits them to see what issues and problems they are encountering. Did they simply forget or are they 'falling out of care." But, Rose is also active as a volunteer within the positive community. She helps to lead a youth support and discussion group to help reduce the spread of HIV. It is a group that is open to all youth regardless of their HIV status. They hold meetings to discuss prevention, have testing days, promote safer sex, and have support meetings for those infected. She is no different than the many activists I know back in the US.

When I left Kenya in October 2008, Rose was several months pregnant with her fourth child. This was her first child conceived as an HIV Positive woman. My parting visit with her was at the Webuye District Hospital where she had been put on bed rest. She was hopefully that she would be able to carry to term as was I. The great news is that she is now the mother to a healthy four month old boy named Joseph. This is the first son. To date, he has continued to test HIV negative.

So, with that being said, it's on to the primer about Positive mothers giving birth to babies. I have thought about it and won't go into a huge educational lecture on MTCT. If you want to learn a lot, just do a Google search. However, many babies are not born HIV+. Other babies are born and test positive only because they are still carrying the antibodies (which is what the tests look for) of the mother. Rose's son was born and tested negative. He went on a short dose of antiretrovirals immediately after birth to help protect him. There is still a risk of transmission through breastfeeding, but breast feeding is the best option for babies here in Africa. This is because the mother's milk helps to provide some natural immunity to the diseases natural to the area. In addition, a baby is more likely to die from malnutrition than become positive. Also, parents can not afford formula and have difficulty insuring that there is sanitary water and bottles. And, finally, there is still a huge stigma for not breastfeeding a child here. So, the recommendation is that a mother exclusively breastfeed for 6 months and then begin to wean as food is introduced.

So, where does Joseph stand now (or lay, since a 4 month old doesn't walk). He continues to test negative. He'll have another test at 6 months, then 1 year, and a final one at 18 months. But, all things right now look very promising that he'll remain HIV negative.

Living in 208 Square Feet

Yep, that's the size of my apartment... a whopping 208 square feet. Think of it as a large master bedroom suite in the United States. The total dimension is 13 ' by 16'. It consists of my bedroom which also serves as the living room. The kitchen area doubles as my closet. And then there is a room with a toilet and another with a shower. It's a little shabby by most standards I suppose, but it's home and I really enjoy it.

My bedroom is the largest of the rooms being 7' by 10.5'. I am a little spoiled so I have what is called a 5x6 bed. Simply put, it means it is 5 feet by 6 feet, which is near to a queen size back home. I have an ample supply of pillows because it serves as a couch for other MALE guests. Females must sit in either the desk chair, or a simple arm chair such as what we would call the captain's chair at a dining room table. Usually, a woman would never enter the bedroom of a male but it's permissible as long as they can sit in one of the chairs, and preferably if there is another person present. I also have a desk with space for my laptop and TV. Storage is at a premium so there are shelves tucked up around the room.

As I said, the kitchen is also my closet. It's only 7'x7' and has a set of shelves for clothes, a set of shelves for dishes and food, and a stand for my cooktop. I don't own a refrigerator so perishables such as meat need to be bought at the time I will be cooking them. Other items, such as githeri (beans and maize) can be cooked and kept overnight as long as they are heated in the morning. I cook on a little two burner propane stove.

The bathroom... Well let's just say that you need to be good at squatting. I moved up in the ranks of luxury when I moved into town. Prior to this apartment I used a "long drop" which is basically a a whole in the floor of an outhouse. My toilet here is a flushing long drop. It's not a regular toilet that you sit down upon. It looks like a urinal put into the floor and so you squat down on your haunches and do your business.

My shower room is truly multipurpose. I do use it as a shower. There is an electrified shower head that serves as an instant hot water heater so that I do get a hot shower. Again this is a luxury in these parts. Many people in town have showers but the water is not heated. In other more rural areas, a shower is bathing from a bucket. This room is also where I do my dishes and do my laundry. I have several sets of buckets for different purposes. Two basins serve as my "double sink." One is for washing and the other rinsing. Dishes go into a drainer and then sit on a shelf in my kitchen area. Two 5 gallon buckets are for doing small loads of wash. And, then I have two huge basins that I use when doing larger amounts of wash.

Everything has to have it's place in such a small area. This is good since it helps to satisfy my burgeoning obsessive/compulsive disorder. I can spend time rearranging to get the perfect fit of things. I think most followers of my blog are also Facebook friends. There are pictures of my apartment there although I should take some new ones as I've made some changes.

Counting Your Blessings

All right, let me preface this entry by saying that I recognize some people may take offense. They may say that I’m being unfair or overly critical. To that, I might concede on a case by case basis. This post is not really meant to shame anyone into thinking they don’t deserve the luxuries they’ve acquired. Nor, does it mean that they don’t have legitimate complaints about being overworked, underpaid, underappreciated and so forth. It just means, that if you find yourself feeling stressed or sorry for yourself, then take a few minutes to put it in perspective.

The idea for this post came from the Facebook page of a friend of mine who is in the Peace Corps in Senegal. I first met her while she was student teaching here in Bungoma. The post is a little back and forth from her Status Update.

Peace Corps Volunteer “is wondering why some (not all :)) people at home find it so difficult to keep in touch!”

Friend back in the US… “Because we have kids! That keep us busy cooking and cleaning up after them all the time. Laundry...it's never ending! And my computer is slower than dirt and I don't have the $$ to buy a new one because we spend it on our kids. How are you?”

Peace Corps Volunteer… “I’m busy in a village in the middle of nowhere with no electricity or running water. eating out of a bowl with a million dirty hands and doing laundry by hand, also pulling the water out of the well by hand...email is often a two hour bike ride away and I have to pay for it by the minute after I finally get to it... but I still find time to email and write on my blog.. Excuses, excuses... but I am doing just fine!!”

My apartment building is two stories with an inner courtyard. My apartment is on the second floor and my bedroom/living room/office window looks out onto the area where people do their laundry and hang it out to dry. Laundry is typically done by the women but there are a number of single men or men whose families are “upcountry.” Despite the amount of dust and dirt that one accumulates from the unpaved roads, clothes are kept surprisingly clean and pressed.

I’ll be doing laundry in a little while today. It involves 2 large buckets of water. I have the luxury of a 2 burner propane cook top so I heat some water so that it’s at least warm when I do my wash. I use a powdered detergent whereas many people use laundry bars of soap. It takes a little soak, a lot of scrubbing, wringing out, and then rinsing. It’s not like doing a few delicates by hand in your kitchen sink. It’s doing everything from jeans to sheets while bending over a bucket. I’ve only done one round of wash since I’ve been back so my calluses aren’t quite developed yet. The nice thing is that everything is dried in the sun so it does have a nice fresh smell.

Some of you know that I love to iron and that’s a good thing here in Kenya. People dress surprisingly formal and pressing clothes is commonplace. Again, I have the luxury of a nice steam “ironbox.” Others, if they have electricity, use a less expensive ironbox which may or may not be steam. For those of you old enough to remember, think back to the days when you had the “sprinkler” cap that you put on top of a Pepsi bottle full of water so that you could dampen your clothes before ironing them. If a person doesn’t have electricity, then they use an iron that has hot coals put inside it to provide the heat. I will say that many people have some sort of synthetic blend so it’s not quite as difficult as ironing pure cotton.

Now, it’s on to the computer situation. The average Kenyan does not own a computer. On this return, I was happily surprised to find out I could buy a USB modem so that I can access the internet from home. In the past, I’ve always had to go to an internet café to either use their computers or access using my laptop. Most café’s charge 1 shilling per minute which works out to be $1 a day. In a rural area where the average daily income is $1-3 a day, internet is a luxury. Computers tend to be older and connections slow. The rooms are hot and crowded. But, the bright side is that you get to visit with people while you are there. Getting a “good” connection means that you fall somewhere between dial-up and DSL in terms of speed of upload. Printing something usually costs 10 shillings a page or about 15 cents. Photocopying is cheaper at about 3 cents per page.

So, keep in mind that what you perceive as hassles in the United States might be exorbitant luxuries in other parts of the world. Don’t take things for granted and when you do, try to recognize it and put them back into perspective.

Modes of Transportation

I thought it might be worthwhile to take the time to write about the different modes of transportation available to the average person in Kenya. Many of my posts reference transportation but people may not understand what I’m discussing. So, here’s your primer.

Walking is probably, by far, the most popular way at get from A to B. There always seems to be a steady stream of people along every road or pathway. From a plane it would look like an army of ants marching to and fro. It’s not uncommon for people to walk several miles to reach their destination.

It’s also important to understand that a human serves as a popular means for transporting goods. The head and back are indispensible. In rural areas, one will see people balancing large packages, jerry cans of water, or burlap bags full of produce on their head. This includes children of a very young age. And, by jerry cans, I’m not referring to small containers, but talking about 5 gallon containers. A common site is a family with jugs appropriate to the age and size of the child gathered around a well filling up there containers. Also, one will see women carrying bundles of firewood strapped to their back. The wood is about the size of a 55 gallon oil drum. The bundle is tied and then often strapped with a “handle” that they support either across the forehead or over the neck and shoulders and resting across the front of the chest.

Boda-boda is the local name for a bicycle taxi. They originated near the borders and were a way for people to carry their belongings across the “no man’s land” between the border posts of the two countries. The bicyclist would call out “boda boda” as a way to get customers. This transportation mode is not as popular in Nairobi. The bicycle is equipped with a padded seat that rest above the rear tire. The pad can be easily removed so that goods can be strapped on instead of a passenger. It’s not uncommon to see a mother and child or several small children sharing a bike.

Boda bodas are a popular way to transport goods. I’ve seen them loaded down with large bags of coal, corn, doors, upholstered chairs, and even coffins. If the load is too heavy or the hill becomes too steep then the pedaler simply gets off and pushes, sometimes with the help of another person.

Boda boda’s are relatively inexpensive. It costs 10ksh or about 13 cents to go from one end of town to the other which would be about a 10-15 minute walk. Going longer distances of about 3 miles would run you about 45 cents.

Moto Bodas are becoming much more popular throughout Kenya, but especially in the rural areas. It’s a much faster way to get from a village in the interior out to a main road where one can catch a matatu (explained next). For the most part, these are 125cc motorcycles that serve the same purpose as a boda boda. You do pay a small premium over the boda boda price but it’s not exorbitant. The only real problem is that not all drivers are equal in terms of skill in handling the bike so it is passenger beware.

Matatus are probably the backbone of transportation options. They are Nissan Minivan with a legal capacity of 14 and an average capacity of 20 plus. In addition to people, a matatu usually has some cargo of items such as produce headed to market or chickens. More than once I’ve had a chicken pecking at my ankles from under the seat. In Nairobi matatus are often pimped out with elaborate paint jobs of rappers and the music is blaring. In the rural areas, the outside is usually white and the music not quite so loud.

There are set prices for trips but if the conductor thinks he can charge you more then he will. Several times I’ve almost come to fisticuffs with a conductor trying to rip me off. Fortunately, most of the ones in Bungoma now know me and tend to be reasonable. I’m sure they think I’m a truly crazy mzungu (foreigner) and that it’s best to let me be.

It’s truly an experience to take a ride in a matatu. As stated earlier, the vans are always overflowing. People tend to sit about halfway on the lap of the person next to them. Children kind of get stacked or handed back over seats like a package. But, it’s always interesting to see how many they can get into the van. My record was 25 although I’m jealous of a friend who was in with 27.

Buses are popular for longer distances. If I am traveling to Nairobi I take the Easy Coach. Other buses are more popular with the locals as they can be a little cheaper (but a lot more crowded). Easy Coach costs me about $13 for the trip and a bus such as the Eldoret Express or Akamba would be closer to $9 or $10. I opt for the assigned seat and not overcrowded.

So, there you have it. How I get around Kenya. I guess I could have mentioned a car, but that's not something I use to often. They do have taxis but it's easier to use the other means of transportation unless I'm in a hurry or need to get a lot of luggage from to the bus station or airport.

Traveling from Nairobi to Bungoma

Well, after four days in Nairobi, it was time to head west to Bungoma. It's only a distance of 200 miles (325km) but takes between 8 and 10 hours by bus. If only they had an Interstate system the way they do in the US. The route is directly along the A104 which is the main highway running from the port city of Mombassa, across Kenya, and then on through Uganda. It is the main transportation route for all cargo going anywhere west. Read that to mean a lot of trucks on a road that, for the most part, is two lanes. One is lucky to reach a sustained speed of 35 miles an hour.

Easy Coach bus company is probably the most comfortable way to travel. There buses are modern 'Greyhound' type buses with assigned seating. The assigned seating comes in very handy as long as you are accustomed to riding them. A veteran traveler knows that you need to be towards the front of the bus so as to avoid being bounced for the duration of the trip. James Bond would want his martini to ride at the back of the bus. Also, it always helps to be on the side opposite the driver so as to avoid being baked in the sun.

The drive is actually a beautiful one. The A104 traverses the Great Rift Valley. The valley runs from the Dead Sea in Jordan south to Mozambique. The drive provides wonderful views down into the valley. Then, in Nakuru, you can look off into the distant and see a mass of pink out on the lake. Were you a bit closer, you would know that the pink was made up of the thousands of flamingos that make it their home. Once you are past Nakuru, you begin the gentle climb back up off the valley floor.

Since arriving in Nairobi, I've been almost inundated with news stories about the water shortage and drought conditions. This became quite apparent as I looked out the window at the withering maize (corn) fields. The long rains of March and April never really materialized. In many places the maize was not more than 2 feet tall and had not developed. Those that will be able to harvest a crop are expecting a yield of 33-50% of normal. I hate to think of the effect this will have on the Kenyan people. Obviously, hunger will be a greater issue. But, secondly, Kenya is very much an agrarian country. Many people rely on their crops to provide an income. With farming losses, many people will not have the money to buy other staples, pay school fees, or purchase medicine. Already, the water shortage has meant the curtailment of power because the hydroelectric dams can not operate at capacity. This is effecting the ability of industry to produce materials.

Lest, I sound all doom and gloom, it was an enjoyable ride. The road, which has been under construction for as long as I've been coming to Kenya is greatly improved. There was one 10 mile stretch that was completely unpaved. Course, that means that the bus travels on a dirt/gravel road at about 10mph. I was able to spot the occasional herd of zebra. No trip would be complete without a little nap put in for good measure.

Bungoma remains unchanged. No sooner was I off the bus, than I ran into my favorite taxi driver Ken. However, my 'taxi' to the apartment was a boda boda. I need to do a separate blog on modes of transportation, but for now, a boda boda is simply a bike with a padded seat behind the pedaler. One person loaded up my 2 bags and the second loaded up me. The ride down through town costs 10 shillings or 13 cents.

It was nice to be back in my quaint abode. If you want to see what $35 a month gets you in Bungoma then you can check out my apartment pictures if you are on Facebook. It may not look like much but it is comfortable and serves its purpose. It's in a secure building with tenants that all look out for me. I was greeted with handshakes and hugs. I should note that handshakes in Kenya are extremely important and are a ritual in and of themselves. It was indeed a warm welcome back.

Reacclimating to Life in Kenya

Well, after a surprising 9 month absence, I am back on Kenyan soil. The trip here is never an easy one. I flew from Orlando to London Gatwick. Then, I had to transfer, along with my baggage, over to Heathrow for the flight on to Nairobi. That little trip consumed about 1 1/2 of the 12 hour layover. Fortunately, Heathrow has dayrooms in the terminal. The Yotel is based on the Japanese pod concept only slightly larger. It was a neat little room with a couch that slid out to a bed and a bathroom. After a few hours of sleep and a shower I was as good as an older model used car. Trust me, it helped but didn't do wonders.

I've now been in Nairobi for 4 days and will head west to Bungoma by bus in the morning. It's been an interesting stay so far. Hillary Clinton has been making the headlines since she was here as part of a African-US Trade Conference. I had to laugh while watching a story about the level of security surrounding her. She was giving a press conference from the edge of a maize (corn) field. Once she was done and leaving the podium, close to a dozen Secret Service agents came drifting out of the corn. It looked like it could have been from a Saturday Night Live skit.

Life in Kenya is a collection of ironies. For as modern as some things are, other items are quite antiquated. For instance, I was able to buy a USB modem for my laptop. Cell phones have been available for years now, but the 3G networks are new. It's wonderful to now be able to access the internet without going to a cafe. But, on the opposite end of the spectrum are the workers near the hotel. They are digging a trench for utilities by hand. I'm not talking about a small trench. It is about 1 foot wide and 3 feet deep and currently running a block and a half. It seems like a trench digger would be much easier but instead it's a team of men shoveling all day long. It's work that an American would certainly run away from.

I've been fortunate to be within the center city of Nairobi. Once I get to Bungoma I'll be dealing with electrical brown outs for the next 2 months. Deforestation has been a significant problem in Kenya. Most of the forests have been cut down to provide fuel for cooking. It's caused severe problems to the watersheds and so now there is a shortage of water to power the hydroelectric dams. There are efforts underway to clear the Mau Forest of inhabitants so that they can restore the forest. This is a job that is proving politically divisive and difficult to carry out.

There's not much more to report at the moment. Really, I've been fairly lazy in an attempt to get rested up after the flights. I had a wonderful dinner with two friends, Lucy and Rosemary. They work for the safari company that helped me on my first trip to Kenya. They've become good friends. Tomorrow I have to be to the bus station by 7:30 so that I can catch an 8AM bus to Bungoma. After a wonderfully bumpy and jostling 9 hours I'll be back in my old territory.

Stay tune for updates.

Reconstituting My Blog

Man, it is unbelievable how time flies. My last entry to the blog came about the time I was making the decision to cut ties with the organization with which I was volunteering and go out on my own. The whole process was a little easier said than done. It involved getting my own place in town, figuring out the whole market place for buying food, the intricacies of daily living without help cooking for me or telling how to get things done. But, on the flip side, I've never been one to not take on a challenge.

The unfortunate thing is that I got out of the habit of updating my blog. Many times I thought about it but then I always got sidetracked. So, here's to the hope that I can get it going again and keep people updated on my travels and adventures.

What have you all missed in the last year? Well, my travels took me to Rwanda, Zimbabwe, a medical airlift back to the States, 6 months helping family in Florida, and most recently a 2 month cross-country drive with my mom. At some point, I'll try to come back and provide some details but the following is a quick (or not so quick) summary.

Rwanda... what can I say. At the beginning of June 2008, Mary, who volunteered with me, and I took a trip to Rwanda. We traveled overland by bus. Day one meant a matatu (minivan) to the Ugandan border and then a second matatu to Kampala, Uganda. We overnighted at the Red Chili hostel and then caught a bus westward the next morning. Another overnight near the Ugandan/Rwandan border. Once we arrived in Rwanda, with its modern roads, it was just a short trip to the Virunga area.

We spent a day trekking to see the silverback gorillas. It was one of the most difficult things I've done because of the steep hike up the mountains. It took about 3 hours to reach the 9,000 foot mark where the gorillas roam. You're only allowed one hour in proximity of the gorillas and the climb was well worth it. They are such large creatures with soulful eyes.

The rest of our week in Rwanda involved overexposure to genocide memorials. I need to post my journal from this time period because it was so thought provoking. Between 800,000 and 1,000,000 people were killed in a period of 100 days. The ability of the human mind to rationalize the killings of others is beyond me. I'm glad I spent the time there but sometimes wish that I could remain naive to what I saw.

Near the end of my trip, I had the opportunity to join a 19 person delegation to Portland's Sister-City of Mutare, Zimbabwe. I thought I would be prepared for the poverty because of my time spent in Kenya but I was wrong. The government, the economy, everything is is such total disarray. What struck me most though is the amount of faith that people still carry in their hearts. They believe that life will get better. It was an emotional journey for all of us.

With 2 days left in Zimbabwe, I got terribly sick and started going into uncontrollable epileptic seizures. I am not new to seizures but these got the best of me. With the medical system in disarray, treatment was difficult. Many thanks to Maria Kosmetatis and Mary O'Hearn who provided me medical care as best they could. It took the help of the mayor and his staff, other trip delegates, and Zimbabwean organizers to get at least some medication to stabilize me. After a night in the local hospital I was driven across the border to Mozambique and airlifted to Johannesburg, South Africa. I remained there for 3 1/2 days before being airlifted back to Portland and OHSU.

December saw me relocating to Florida so that I could help my mom and stepdad as he battled mesothelioma lung cancer. It was such a privilege to be able to help them in a time of great need. He lost the battle at the end of March.

As my Facebook followers know, I've been on a wonderful 2 month trip. To date, my mom and I have put on over 7,500 miles. We've been to brother's in Oregon, an uncle's in Montana, Yellowstone, Mt. Rushmore, stepsister's in Illinois and Indiana, and a niece in Illinois. In the next 2 weeks I will have attended my 30th High School reunion and visit my oldest brother in North Carolina.

On August 2nd, I'll be boarding a plane to return to Kenya. Stay posted for lots of news and fun.