Dirt, Bugs, Bites and Beads

            Several people have told me the formatting of the blog made it hard to read so, after literally  hours of trying to fix it from my end I ended up with this new, and really simple template. Hope this is easier on the eyes...
                                      Here’s a random cute pic to start off the entry…



Boo helping me study



And this is what the doctors do in the reception area of the clinic when there aren't a lot of patients...

 

The clinic staff shelling peanuts in the reception area of my clinic

 

                 So I made a list of New Year’s resolutions the first week of January and I’ve been trying to at least attempt to follow through on them. Mostly they’re the same ones I’ve been making for years; get in shape, eat better, study, make better relationship decisions (ie stay away from boys), be less dramatic. There were a couple more specific goals though. I want to get a 37 or better on my MCATs in May, which means my nose needs to spend a lot of time in a book over the next few months (for those of you not up on your MCAT scoring grid, a 37 would put me around the top 1% of testers which makes it a really lofty goal). I also want to get the “read” folder on my Kindle to over a hundred books by the end of this year (currently at 59 so I’m thinking this one is in the bag). “Be happy for ____’s happiness” is another one. If you know me well enough (ie have heard me bitch about my previous relationship enough) you know who’s name goes in the blank. If not, let’s just say I’d like to be happy for an ex of mine who happens to now be shacking up with my arch-nemesis. I’m not yet “zen” or a big enough person to give a shit about her happiness- maybe in 2013.

Another resolution; finish writing a book by the end of this year. I’ve started writing a couple since I’ve gotten here. One is around 18,000 words and the other, newer one is around 12,000. Both have promising beginnings but my downfall has always been in the follow through. This resolution is probably the goal least likely to get completed. Admittedly, it’s a repeat offender having made numerous appearances on lists of ‘things to do’ over the years. I’ll try to keep you all updated on how the resolutions are coming…

In January I spent some time in the shamba (field) planting vegetables for the clinic. When the new addition to the clinic opens we will have in-patient care and would like to use the crops from the shamba to feed the in-patients and the staff. They also gave me a little plot of my own to try and grow some other vegetables. Right now I’m trying my hand at cucumber, carrots and pumpkin but I’m hoping to add more variety as time, space and motivation allows. The garden has a two-fold purpose. On one hand, I need stuff to do until the new addition opens. I have some other stuff going but a lot of it involves sitting in my house, which gets depressing after a while. So, the garden will get me outside, get my hands dirty and also cut down on my food costs since I’ll be growing some of my own veggies instead of buying them. Plus, I’ve always wanted to grow stuff. Mom and Dad (and the 30 x 6 ft strip of dirt in the backyard where grass used to be) can attest to my previously failed attempts at gardening.

The other goal of the garden is to try and get people to grow other kinds of vegetables. Even though there are a wide variety of crops that could be grown here, the Kenyans tend to eat the same five things over and over again. As a consequence they tend to grow those same few crops. This wouldn’t be a problem if they were getting sufficient nutrition from what they were eating. Unfortunately they aren’t and considering the fertility of the land here, that’s a real shame.

 Vitamin A deficiency is the number one cause of preventable blindness in Kenya, especially for children. This is the case in many other developing countries as well. In addition to causing blindness (especially loss of night vision) Vitamin A is important for boosting immune function and, as an added bonus, keeps your skin nice and healthy.   Due to wide-spread deficiency, Vitamin A is supplemented for all children under 5 (every 6 months) and pregnant women. However, since there aren’t magic supplement fairies that go to people’s houses to make sure they’re getting proper nutrition , this requires that the kids be brought to a health center at regular intervals which is hardly the case (even for people who live within a few kilometers of our clinic) and many kids don’t get these supplements. I have, on several occasions, met children in the village who were 2, 3, 4 or more years old and had never been to a health facility, didn’t have a single immunization and no birth certificate.

Really though, the supplementation shouldn’t even be necessary. Vegetables like sweet potatoes, carrots and pumpkin have lots of vitamin A and are easy to grow and prepare. And when I say “lots” of Vitamin A, I mean 1 cup of mashed sweet potatoes has 769% of your RDA (recommended daily allowance), 100 g of raw carrots have 334% and 1 cup of boiled pumpkin has 245%, making all three of them great sources of Vitamin A. So, what’s the problem?

As I said before, people here tend to eat the same five things every day. Here’s what a typical diet for a villager around me might look like:

Staple Foods (i.e. consumed on a daily basis)  

·         White bread or Mandazi (maa- n- da-zee) – fried doughnut like things only with less sugar

·         Chai – black tea, milk and sugar

·         Maize flour – very similar to corn flour. They use it to make ugali (oo-ga-lee) which is eaten at least once a day if not twice. If you want to know what ugali is like, take malt-o-meal and add about a third of the water you’re supposed to (no sugar) then heat and stir…

·         Sweet bananas – tiny little things I never believed would taste different than normal sized bananas but actually do…

·         Kale – they call it skuma wiki (skoo-ma week-ee) and they prepare by finely chopping the leaves, boiling, draining, and frying with a small amount of onion and tomato.

·         Other native green leafy vegetables – some of these are actually my favorites both taste wise and from a nutritional standpoint. They tend to be high in calcium, iron and folic acid (like green leafies back home) and their biggest downfall is that they are traditionally prepared in the same way as skuma wiki, so some of their nutritional value is lost through boiling and the frying adds unnecessary fats.

Semi-Staple Foods (consumed once, twice, possibly three times per week):

·         Black beans

·         Whole maize (similar to corn but tougher and (guessing based on texture here) with a higher starch content)

·         Potatoes, sweet or regular

·         Eggs – may be eaten more often if they own chickens or have easy access and moderate income

·         Milk – may be drunk more often if they have easy access and moderate income

·         Other tropical fruits (oranges, mangoes, papaya, very rarely pineapple (they are expensive))

·         Sugar cane

·         Porridge (usually exclusively fed to small children)

·         Green bananas – peeled, boiled and fried with onion and tomato (seeing a pattern here…?)

Rarely Eaten Foods (A few times a month and/or at special occasions)

·         Meat – usually goat, chicken or beef. People raise livestock here but it is the “middle-class” villagers who can afford to eat their animals. I would say most families in the village, especially very poor families, have meat only a few times a month.

·         Dried fish – either tilapia or omena (o-men-ah, small minnow-looking fish) that are sun dried and transported from Lake Victoria. Omena are reasonably cheap and eaten more often than other meats.

·         Sweets – suckers and bubble gum are available at most little shops and given to kids as a reward or on special occasions

So, the goal of my garden is to introduce the community to different vegetables and subsequently show them ways to prepare them. To do that second part I want to get a community resource center started. It would be a space for educational materials (textbooks, etcetera) that everyone could benefit from, plus a place where we can hold meetings for youth groups, cooking classes, etcetera.

Here’s a few pictures of the shamba around the clinic and some of my own little plot that they gave me to grow my “other” vegetables. Since writing the first part of this post I’ve found seeds for watermelon, cantaloupe, baby spinach, mixed baby greens and broccoli.  The carrots, cucumber and pumpkin have also started to sprout and it’s a little ridiculous how excited I am about that fact. At least for now, I’m loving being a farmer.



The field behind the clinic where we planted a TON of kale and I got more dirt under my finger nails than I was aware they could hold,



My little shamba. It's about half way dug out, the far end will be a melon patch when I find the time and energy to hoe-out the rest of the space!



The only downside to the location of my shamba is its proximity to that fence you see in the picture. There’s a path on the other side of that fence which a lot of people walk down and, even though I’ve been out there for over 2 weeks straight now, every single day, people still stop and stare at the white woman working in the field. Some people applaud me (literally) and think its really cool that I’m doing the same things they do, that I’m making an effort to really experience their life. Others ask me why I don’t find a boyfriend to do the digging for me. The people in this second group are all men and they all annoy the hell out of me. One guy (who has defended himself as a proponent of gender equality on numerous occasions) went so far as to tell me that my body is going to get “hard” if I keep working and a young women like me should have a soft body and should do work in the home to keep it that way. I am getting extremely good at smiling and nodding cordially while secretly wanting to punch someone in the face. Perhaps I should consider a career in politics.

The fact of the matter is I enjoy the work. I like getting all dirty and sweaty. I love falling into bed at the end of the day and sleeping like a log. Plus, having a Kenyan do it for me would I mean I would have to pay them money I really don’t have or I would have to date them, something I am wholeheartedly uninterested in. The reasoning there is a whole other issue I might get into at a later date.

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On to a more depressing story… I think I might have talked about jiggers before, so if you’re a frequent viewer and you know about them, skip the rest of this paragraph… Jiggers are tiny little bugs that are related to fleas. They live in the dirt and when you walk barefoot they can ‘jump’ onto your feet, burrow under your skin (they especially like the nail beds) and lay their eggs. The jigger stays burrowed and grows as they produce more and more eggs and eventually the sack bursts and the eggs are released into the dirt where the cycle can start over. This process leaves open wounds all over the feet of an effected individual. In severe cases the jiggers can infest the hands, knees and even genitals. If they are not treated the person will become disabled as their toe nails fall off and the toes eventually atrophy and fall off. Painful sores on the feet keep the person from walking so they end up crawling around the house, which is how the jiggers end up on the knees, elbows, genitals (from sitting on the floor with inadequate clothing). The saddest part of the whole thing is that the treatment is cheap and easy; you dunk your feet (or whatever other part is affected) into a bucket of water mixed with about 15 cents worth of liquid medicine (a cleanser very similar to bleach). In 20 minutes the jiggers are killed and after a few days they fall out of the skin. The wounds begin to heal like any other and in a couple weeks the wounds are healed.

So, this brings me to my story… a couple weeks ago I went on an “outreach” day into the village to treat jiggers. We’d done a similar trip the week before waaaaay in the interior (well over an hour of walking away from town) and treated twenty or so people over the course of an entire day. Here are pictures of the first family of kids we treated. We found the 3 sisters home alone in the middle of the day; their parents had gone off to try and find or beg for food.

It's not at all unusual to find a 9 or 10 year old taking care of their younger siblings.



My friend Ignatius washing the feet of the girls in a basin of medicine.



One of my favorite pictures from my time in Kenya so far.



We also sprayed the houses of the people with moderate cases to try and stop the buggers from re-infesting. This day, however, we made the short trip to the school I taught at and treated over 60 kids in a couple hours.



A bunch of the school kids waiting or being treated in the front yard of the school.



Most of the cases were pretty mild, a few on the toes, maybe one on the heel or the ball of the foot, but nothing we hadn’t seen before. Then the teacher’s showed me the feet and hands of a pair of brothers. The pictures are below.

You can see the sores where the jiggers burrow in, lay their eggs and then eventually burst out of, leaving a painful open sore.

This picture does a good job showing how the toenails in particular are a favorite area for the jiggers and how their infestation can disfigure the toes.

These were the only kids who had jiggers on their hands and it wasn’t just one or two, it was enough that it was probably affecting their ability to write and do other activities requiring fine-motor skills. We treated the boys' feet like all the others and I had the idea to treat their hands by putting them in gloves and filling the gloves with medication. They looked a little goofy but it got the job done.

So, we treated these two boys and the rest of the kids at the school and then we went to the house where the brother’s lived so we could spray since they obviously had a bad infestation.

The house, a four walled mud hut with a roof of dried banana leaves and maize stalks, was on the way back to the clinic, a house I’d actually been to before. We called “hodi” as we walked up, which  is basically like “anybody home?” and an obviously old voice cracked “karibu” from inside, which means welcome. The five of us piled into this tiny room, maybe 13 x 15 feet and exchanged the necessary greetings with the old woman who turned out to be the grandmother of the boys.  We told her that we’d seen the two boys at the school and asked if we could spray around the inside and outside of the house. As this conversation was going on I was looking around the tiny house wondering if one could inherently ‘know’ there were a shit-ton of bugs here just by looking. Really, you can’t; the house looked like any other mud-walled-hut I’ve seen a hundred times in the village. However, as I was eyeing the cracks and crevices of the floor from afar, I noticed a little kid sitting in the bedroom. The ill-fitting wooden door was barely half open but I could see the little boy sitting on the floor through the space where the door ‘hinged’ with the wall.

He was cross-legged on the floor, picking absently at his bare feet. I nudged Jen (one of the community health workers for the area) and pointed to the kid in the room. She peered in at him for a moment before going into the room and scooping him up off the floor. She lifted him easily, carrying him away from her body with outstretched arms like you would a filthy animal.  She crossed the living room and brought him outside. She tried to get him to stand but he refused to put his weight on his feet and let his legs buckle and his butt fall to the grass when she finally let him go. He tucked his legs up again and slumped forward, his head hanging droopily over his feet. If he had been a depressing sight inside, seeing him in the harsh light of the day was enough to bring tears to your eyes. The pictures below are of this little boy and they are disturbing.



Most little kids love having their pictures taken. This little boy would not look up from the ground and he wouldn't talk to me or any of the other community health workers, even to tell us his name and how old he was.





The worst case of jiggers I've ever seen in a small child.



There are no words that can describe the particular mix of emotions I felt sitting there with this child. The jiggers were so bad on his hands and feet that they were forcing some of his nails right out of their nail bad and they were in the process of falling off.  He wouldn’t stand because he couldn’t; he was in too much pain from the open sores all over the bottom of his feet. One of his fingers was shorter than the matching one on the other hand because the jiggers had literally eaten off the tip of his finger. I would have been surprised if this kid could hold a pencil or feed himself without considerable pain.

I was simultaneously heart-broken, angry and so, so frustrated. We sat him down on a tiny little bench and submerged his hands and feet in the water-medicine solution. I put gloves on and squatted down next to him, trying to pull off jiggers I could see and rub loose skin out of the way so the liquid could get better access at the bugs under the skin. The kid kept trying to yank his hands away because it hurt but it was important to make sure the medicine could work properly. I felt awful inflicting that pain on him and watching him squirm in pain made me even madder. I paced back and forth in the front yard fighting tears as his hands and feet continued to soak. Nothing is sadder than seeing a child in pain Nothing is more frustrating than knowing the prevention of that suffering is as easy as washing ones hands and feet. And, nothing is more maddening than hearing the caretaker of that child make excuses as to why he’s in that condition.

I have constant discussions here about family size, about why it’s important to reduce the average family size if Kenya ever wants to get itself out of “third-world” status. The Kenyans tell me that Americans don’t like children and that’s why we only average just over two per couple. They tell me that Kenyan people cherish and revere children, that they are a gift from God and that’s why they have so many. It’s really hard to see something like the boy with the debilitating jiggers and think that that qualifies as cherishing a child. Isn’t it better to have a few children and take care of them than have a baker’s dozen and leave them all suffering?

In that family’s case, the mother died about five years ago and the father abandoned the children (there are four of them). In fact, that father lives just down the street with a new family. For all intents and purposes his children died to him when their mother passed. Though I can understand a lot of things and my horizons have been broadened through my experiences, I will never understand how someone can walk away from their four small children and never look back. I cannot understand how he could live in the same village, undoubtedly knowing of their suffering and do nothing to help them.

The sad thing is this story is not a rare one. I am told that if a woman dies the chances that the father will stay with the children are slim to nil. In Kenyan society it is the man’s right to take a new wife and have a new family. If this sounds like I am laying blame solely on the men, I’m not. The women are just as much to blame for this practice as far as I am concerned. It is these new wives who, in many cases, insist that the man sever ties to the children he bore with his first wife. Instead, it seems to me that these women should insist that the man take care of all of his children. After all, isn’t that what she would want if she were to die?

                Alright, enough preaching on that depressing and oh-so-frustrating topic! Here are a couple pictures I have to share are of my own recent experience with bugs. After waking up with increasingly itchy for two weeks straight I finally took a picture (I don’t have anything bigger than a face mirror) of my back one night after getting out of the “shower” and this is what I saw…

First I laughed at the fact that I looked like I had chicken pox and then I promptly started researching how to kill bed bugs. I went to the chemist (drug store) and bought 75 cents worth of poison which I mixed with water (per instructions that were, thank God, in English) and proceeded to spray everything in my room that could have possibly come in contact with my bedding. There is nothing quite so depressing as having to de-bed-bug a Carebear and a stuffed lion. I lined them up against the side of the bed like a firing squad, apologized and doused them liberally with stinky poison. In fear of night time retaliation I have not yet invited them back to bed and they currently glare at me from their perches atop my still full suitcases.

Finally, I’ve told many of you that I’ve been making jewelry and I wanted to share with you a few pictures of some of the things I’ve made. Thanks to everyone who has sent me magazines, you’ve helped make some of these! If anyone is interested in purchasing anything, let me know :-)

These are the paper beads made from magazine!



A necklace (or wrap it on the wrist a few times for a bracelet) and earring set.

    

    This is just a few of the pieces I have made and if people are interested I can post more pictures in future entries. Alright, until next time, love you all!