Giving Hearts, Part II

If you are interested in the coffee initiative where I purchased Geoffrey's plants, you can find them on the web, search for Rwanchege Farmers Co-operative Society.  Contact is Jane Muthoni.

Also, if anyone would like to further help the Mjagi family, please feel free to send new/used toddler clothing, girls age 6 clothing, or school supplies to the following address:
Geoffrey Kariuki Mjagi
Mwimbi Boarding School
PO BOX 404
Chogoria, Kenya

Lastly, is the great John, our pleasant 13-year old tour guide from the Mara Falls hike.  John offered his time and knowledge of the local terrain to us without asking for anything.  A little tip at the end of our adventure, equivalent to a little over 2 dollars, came to him as a sweet surprise.  During our walk we talked a lot about his school.  He was proud to have just joined the Gitare Primary School, a step up from his public school.  He was excited to have access to more books and asked me many times if I had any from America I could give him.  So on behalf of Chloe and Jenny Hall especially, I donated all the school supplies I had to his school.  I also bought classroom posters and books appropriate for their curriculum from the local paper supply store.  The 7 pairs of soccer shoes I brought from Marcilio's Soccer Shoes Project, also went to this school (and a pair already went to John himself).  Now, I had to find this school still.  My directions were an outstretched arm pointing west from the Mara Falls, "over there, right over that mountain" John said.  We grabbed a taxi and gave him the name of the school also, still not much help.  Up and down a few ridges outside of Chogoria, we came to the compound after about 30 minutes.  They had many acres of flora study  plots, a river snaked around the base of the compound.  The taxi climbed up the steep driveway, you would have to slide down on your rear if descending by foot.

Gitare Primary School, welcoming students in forefront, latrines behind the school

As soon as the mzungu strolled onto the school yard, faces peered through the open windows and the administrators chatting outside greeted us.  They weren't sure who this John was that had advocated for their school, so I had to pull out my camera and show a photo of him..."Oh! the one that lives down by the waterfalls!"  And a few moments later, John himself slowly approached us, obviously surprised we actually came.  He showed us his new classroom and schoolmates.

8th grade class: the big year for test-taking for high-school entrance

John and the school director, Justus

The school seems to have a link with Alderly Edge School for Girls, in Cheshire England, and projects are planned for remodeling.  You can see the project if you search for The Juniper Trust.  The administration didn't seem very convinced by the plans, maybe they haven't met them personally or it has been years since the project was initiated.  Either way, they have needs now and are trying their best to prepare their pupils for entrance into high school, the first step towards a career other than farming.  So if anyone would like to send more school supplies, especially classic novels, you may use the address below!

Justus Murutani

Gitare Primary School

PO Box 338

Chogoria, Kenya   60401

justusmurutani@yahoo.com

Another quick note, the Hall family had donated several dental instruments.  The dental clinic at the hospital, run by Dr. Odonde, was very appreciative and explained that almost everything in the exam room was donated.  A warm thank you from their staff.

ASANTE SANA FOR YOUR LOVING DONATIONS! 

Stay tuned for the next blog entry on African food... 

Giving Hearts, Part I

First of all, thank you on behalf of the Kenyan people, to everyone who made a donation!  The medical supplies will help hundreds of patients at PCEA Chogoria Hospital and the baby clothes are already being soiled, washed, and baked under the sun repeatedly.  I tried to allocate the monies to different sectors of the local society, so there are a variety of stories here and even some opportunities for further assistance.  I will mention one thing, it was difficult for some people to appreciate that the donations were not coming from me, but instead a stranger back in the US...so most will identify me as the donor, I tried!
First up, the Comprehensive Care Clinic (HIV clinic), very efficient and long-standing, just suffered the loss of a major donor.  A small portion of their funding comes from the hospital, but their budget is covered mostly by NGO donors.  All medications for HIV and related issues are free because of these donors and office visits are affordable.  In addition, the remaining donor (AIDSRelief) is no longer able to provide multivitamins to the clinic- a once daily is recommended for all HIV+ patients in their protocol.  I was able to donate a supply of liquid vitamins for children and tablets for the sickest adults.  100 bottles of liquid and 4,000 tablets.  There are 2,904 patients in the HIV clinic.  The supply was gone before I left Chogoria.

The CCC is also in dire need of a Viral Load machine and the clinic director has supplied me with a formal letter in case I am able to locate a donor.  This machine would assist the team greatly in determining whether or not a particular drug regimen is being effective for the patient, instead of just waiting to see if their immune system cells decrease again.  There are currently only 5 of these machines in Kenya and one at CCC would operate for the whole eastern region.

Second, a patient I saw, an HIV+ man in his late 30's who had painful lumps under his right armpit and a red, swollen bicep muscle.  He had pyomyositis, an abscess within the muscle and it had already spread to the lymph nodes in the armpit.  He was a single man, no children, and lived in his family's compound.  He's been a tea leaf picker for as long as he can remember and just wants to be as productive as he was a couple months ago.  Spending every last earning for transportation to the clinic and the appointment fee, he had nothing left for an Incision&Drainage and antibiotics.  The danger was waiting to long and the infection becoming septic- throughout his bloodstream.  More at stake than just losing an arm.  I decided to cover his expenses as the whole package (surgical consult, minor surgery, medications) only cost about $35 dollars.

Third, Mr. Geoffrey Kariuki Mjagi, a tea farmer and father suffering from Lupus (SLE) and Rheumatoid Arthritis (RA).  Christine, another American medical student, and I met him while taking a walk on the dusty rural roads outside of Chogoria.  He was pushing himself in a wheelchair to the evening mass when he felt urged to stop us and tell us his story.  He had had a good business in planting tea and tilling others' land, until five years ago when both knees were destroyed by the autoimmune arthritis and secondary bacterial infections.  He spent 3 years in and out of the hospital in Chogoria and also in the capital of Kenya.  Now his knees are unable to extend, limiting him to a crouched position, unable to stand.  Since then he has been without any major flare-ups and still manages to till some land while working from his wheelchair.  A double-knee replacement costs at least 750,000 shillings, only a dream to Geoffrey.  But this is what he was hoping we could provide for him.  I suggested he come find us the following week at the hospital to discuss what he really needed.  Just then a motorcycle passed and he waved it down.  Within 2 minutes he had the wheelchair collapsed and secured on the back on the bike with him in the middle.
Sure enough he found me at the CCC a week later.  I explained that the best I could do was look for orthopedic surgeons doing mission work in Kenya.  But I wanted to know how I could help in the interim.  He gave a hesitant smile and went on to tell about his wife, Veronica, four months pregnant, and his daughter, Wendy, who is excelling in the 1st grade.  A week later a letter came for me describing all his needs he was unable to express on the spot.  What would be most helpful to his family would be tea plants.  There was family land ready to be sowed, and they could harvest three times a year.  The tea distributor was over an hour away and that transportation would have cut into donated plants.  So we decided to go with coffee plants!  So much tastier anyway ;)  The coffee plant factory was just a few hills from his house and he had already completed the free coffee-growing educational courses provided by the factory.  I was able to provide 120 seedlings and enough fertilizer.  Harvest will only take place once a year, starting in two years so this was a different type of investment but he was grateful all the same.  I was invited to come meet the family (very EXTENDED family..and pets...and livestock) and had the pleasure of presenting Veronica with many baby outfits.  We shared stories while eating tree tomatoes- if you bite into them you can squeeze out dark red bloody seeds.

 Geoffrey in his fields, the land for coffee planting is on the left.

 Geoffrey, Wendy, Veronica, and I

Mount Kenya

12,467 feet above sea level and this was just the beginning.  Onwards to waterfalls and caves, but Mugi Hill already gave me my daily calorie expenditure and then some.  We left Chogoria the night before and stayed at the Meru Mt Kenya Lodge on the Chogoria Route of Mount Kenya.  This was one of those trips that attitude made all the difference...Only a couple hours out of town our Land Rover came to a thrusting halt.  Engine turned over, transmission is grinding, and the gear shift lever breaks off! All we could do was laugh and jump out into the blistering sunshine.  Time for a nature moment in the Mt Kenya National Park and our first visitor dropped from a branch above.

One side of the dusty two-track was a quasi-impassible bamboo forest that called my name.  I've seen bamboo growing but this was a symphony of plants living under protection of the park, so there were no more vertical shoots than there were horizontal and diagonal.  Their music was magical, each clap of one bamboo shoot on another in the wind created a different tone based on the plants' age- the older, the hollower. 

In the bamboo forest; my new African do

Our guides figured out a way to set the transmission selector in 1st gear and that would get us all the way to the lodge.  Still one more stop en route though, for a quick sandwich and mango juice box.  A couple truacol's were communicating our presence to the rest of the forest.  The small red bird was native to the higher altitude.  As we ate, our guides laid in the shade, one of them was picking mihai, a medicinal berry fallen from the towering tree above us- good for the common cold when made into a tea. 

Camp, or bandas, was a cozy wooden cabin with a bedroom, living room with a fire place, bathroom, and kitchen.  Our shower was supplied by a tank behind the cabin being heated by firewood!  Quite luxurious for some.  A quick swim was in order at the nearest "river".  Quotation marks because we had to help our guides learn the difference between that and a creek.  Bathing wasn't really possible in 2-inch water, but wait, we can forge through animal dung and clay up the creek to the "Fishery Falls."  Here the water had dug out a 4-ft wide, 3-ft deep swimming hole we just couldn't resist after such a journey!  And there were leeches, yea.  Dinner on the fire consisted of roasted chicken, cooked cabbage, and white rice.  Before retiring, we sat under the stars and listened to the nocturnal creatures awake.  Most notable was the marmot-like tree hyrax that first made an obnoxious clucking call then a eerie, high-pitched screaming.  A fellow student stayed up later and had the opportunity to hear the hyena's whooping in the distance. 

Frozen toes woke me at 4am, so 7am breakfast and 8am departure couldn't come soon enough.  Ascending Mugi Hill seemed impossible to us amateurs as we packed our bags and slopped on the sunscreen.

We did it in about 4 hours but that included a stop at Lake Alice, behind the mountain to the west, the drinking water source for camp and beyond.  I'm proud to say, me, da only Yooper, was the only one able to swim in the frigid mountain lake...coming out after numbing my entire sunburned-speckled body was just shy of excruciating against the brisk gusts.  A quick nap in the sun and we were off to the peak of 3,800 meters.

Christine, Jen, Aimee, Dave

Little did we know how much hiking we still had ahead of us...our guide said the nursing students he brings every February do this itinerary in two days.  So over the foothills, bushwhacking through a shortcut, and another liter of water later, we've almost made it to Nithi Falls.  You hear the cracking of branches- those same black sooty branches that loved to tear across our thighs- as the only indicator of animals in the distance.  A buffalo ran just over a ridge out of sight and moments later a small herd of waterbuck clear way for us.  Swimming in the lake was a little crazy, but swimming in the falls would have been insane.  Just sitting at the base of it you felt an arctic blast of mist that would quench any one's thirst for water or adventure. 

Nithi Falls

 

Making the way back to the bandas was all downhill and dusty, time to let gravity take over and get us home!  My leg muscles were jelly by this point and picking flora was a great escape from the pace.  Flowers for pressing, lemongrass for cooking, and mihai for my next cold.  Just a few minutes from home I heard the crashing of branches again and knew we were close to the resident elephant's range.  An old, male named Mitwa Kinyori, was up on the hillside opposite the road from where he had been in the morning.  I'll end on his note, an amazing animal, solid and smooth moving.



Hiking

As during our morning jogs, setting out for a hike draws quite a bit of attention.  Equipped with water bottles, backpacks and wearing tennis shoes instead of flip-flops, we must look like a bunch of clowns going out to look at nature as if we'd never left our American suburbs.  But just like in any place, you get accustomed to the views and extraordinary features of your landscape, until someone shares their amazement with you.  As soon as we got off the main roads and into the countryside, we acquired children who knew we were out to explore.  It's a good thing John had nothing better to do this Sunday afternoon, without him my friend from the clinic, Caroline, would have taken a few wrong turns.  Although I think we got the most direct route possible to the falls and that meant descending trails with much more caution than the kids floating ahead of us.  We were headed to the waterfalls of the Mara River and caves in the vicinity.

 John was 13 years old but much smaller for his age in American standards. He was in the 8th grade and could tell us the species of every tree or bush we passed, in English and kimeru- the local dialect, still similar to Swahili.  He told us stories about seeing "indians" kill a lion years ago in a neighbor village and about how he has seen elephants near his house and maybe he could take us their one day!

John

From here we make our way back up the hillside and further down the river to where he remembers the caves being.  The trail is about 6 inches wide as we clumsily descend to the river again.  Only once we were down there did John tell us we just walked across the river on a huge land bridge.  I can't imagine the size and speed of the rapids that once carved out this passageway (shown below).

Caroline, Timo (med student from Germany), Christine, Dave

This was the caves right? Of course not, we had to cross the rapids to get there! John tears off his shoes and wades over with ease, expecting his little ducklings to follow without pause. We scrambled up and down the riverside looking for the most comfortable route to take across the slippery, hidden boulders beneath the water's surface. There was a huge vine extending from the top of the land bridge down to the river and trailed off in it for several meters, now there's a tempting way to cross! Water up to our thighs, we made it safely, and didn't even consider if aquatic predators were near. Under another section of the land bridge was the entrance to the caves. Water dripping from the black roof a foot above our heads was so refreshing on our necks. John crouched as he neared the entrance and said the water had risen too high, it had obstructed the narrow passage. No caves today, but I ventured around the edges of this cavern and before I noticed the other entrance a swarm of black butterflies zipped past my head from their secret crevasse. This too was another dead end, so we called it a day and prepared ourselves for the treacherous climb up.

A Positive Paradise

Again, the HIV mobile clinic this week was a memorable one, and overwhelming to say the least.  I knew the village was called Nchiru and we'd be seeing lots of children, so I imagined something similar to last weeks clinic in a rented cabin.  Ai ai ai, after an hour and a half drive in the loaded up SUV, the road finally narrows to two, packed dirt peaks the tires try to stay on.  After riding through a lush, green tunnel it came as a surprise to pass through the compound gate into an expansive view of mountains, near and far.  We had just arrived at the "New Hope HIV Orphanage," founded by AINA onlus of Italy- "Italian Association of Nomads of Love."  The Polish director came to greet us and invite us for tea and bread.  Recognizing the new member of the team, he gave me an introduction to the project.  After he said that 84 children live at this site and are all HIV positive, my heart sank into this reality and my attention was gone.  Eight-four.  It was too much, yet a small portion of the country's orphaned children.  From the gates, the orphanage spread down a soft hillside, with their livestock down at the bottom.  Three different sleeping quarters and the dining hall created a "U" shape, hugging the central play area.  A jungle-gym, flowering bushes, and green grass gave the children their own safe and loving space.  Some were being wild and crazy, digging holes and riding the swings and others were laying in the grass in total peace.  So much to see but strangely it all started to blur together like a Monet painting.  The beautiful faces and flowers swirled together and I closed my eyes.  I didn't need them to feel the grace here. 
After tea we set up clinic in a room dedicated for us and the children's medication cubby holes.  Over half of the children were due to be seen so we had our work cut out!  Youngest to oldest.  The three-year-olds fluttered in and each sat neatly on a tiny wooden seat, waiting to be seen.  With no parents' hands to hold, they look wide-eyed at the buzzing line-up ahead of them, first height and weight, then another nurse to take their vitals, next the waiting chair in the corner, then on to see Caroline and I, then either out the door or on to the lab tech in another corner for a CD4 count blood draw.  Not a single child complained except when asked to describe their complaint...a rash, bumps, belly ache, etc.  Any serious complaints were brought forward by one of the seven "house mothers."  This newer generation had very different names compared to what I have noticed so far: lots of Ann's, Mercy's and Agnes, Beatrice, Glory, Valentine, Purity, Nimrod, Fridah, Moses, and my favorite, Perpetual.  Moses is one of the two HIV-negative children here.  Usually they would be taken from the home and placed in a foster home, but they are trying to construct a separate sleeping quarter for them.  Moses is only 7 months old.  He was rescued from a car accident here in Chogoria a few months ago in which the car had ended up in a river, he was the sole survivor of a matatu-full of people.  I think he was accepted because his mother was HIV+ and his status was unknown at the time.  Definitely a cutie and pretty chubby, it showed how much this disease can affect growth. 
Only a few had to get their blood drawn, at least that I noticed, none of them cried so I practically forgot it was going on beside us.  Until it was Erick's turn.  HIV+ but healthy in all other respects, his immune system was doing well with the help of antiretroviral meds.  I think they called him back after we were finished with the rest of the kids for a reason.  Four years old, gabbing away, he acted like he was the boss of this clinic and if he wasn't examining something, he was asking questions or showing you his stuffed Tiger.  The first attempt at drawing his blood was unsuccessful, the holding team was upped from 2 to 3.  He wasn't crying, he was screaming and as soon as he saw the second needle and syringe it was no longer pain that fueled his lungs, but anger.  He pleaded for them to stop, kicked, pushed the syringe away after it was already in his skin.  A third time and we were all as desperate and anxious as he.  Then he let out one last plea and I had to leave the clinic in tears.  He screamed "But I'm not sick!  Please don't subject me to another injection!  I'm not sick!"

HIV Bush Clinic & Khat

Part of the battle against any treatment for illness is compliance.  And that can include issues of finances, belief systems, transportation, etc.  The HIV clinic in Chogoria (and anywhere in Kenya for that matter) is given the name "Comprehensive Care Clinic", or CCC, I think to decrease opportunities for stigmas.  The CCC has a mobile clinic that goes to four different villages, each once monthly.  Medications, records, our tea & bread are all loaded into a hospital 4x4; as well as two nurses, the PA, and a tech from the pharmacy and laboratory.
It was about a 45 minute drive, first on the highway then a dwindling dirt road through encroaching banana plantations.  The countryside looked a bit familiar since this was the way to Meru, the city we traveled to last weekend.  Despite this familiarity, something was different and it squeezed my chest.  Soon, Marcilio was there.  His presence was not joyful, but worrisome and it made me breath faster and tears started falling.  Against my good judgement I tried to fall asleep and was out.  I woke up during the steep climb up the clinic's driveway.

We were able to refill everyone's meds for a month, take CD4 cell counts via blood sample, and do immediate testing for HIV on the infants at least 6 weeks old.  Both children we tested were 18 months old and tested negative, thanks to the education by the CCC about the importance of taking antiretroviral meds during pregnancy and if breastfeeding, making sure the infant is taking a drug called nevirapine.  My joy was pretty obvious unlike the mothers', to some its just part of life and others there is a little expression of relief, but overall my perception of the Kenyan people is that they are more reserved with their emotions, especially around "mzungos" or white people.  Regardless of that, they are very welcoming and sincere about making your time here enjoyable, even too much at times.  Clinic is closed up and the spiders begin their reestablishment of webs. 
The trek home begins and I hope to nod off again.  It's hotter now and the window's breeze just cakes my face with dust.  But eventually I nod off, the pharmacy tech, a young guy named Kevin sitting in the back of the SUV on top of the medications, probably thinks I'm lazy or easily fatigued but oh well!  Who knows how much time goes by, and I'm awakened by the shouting of the driver of some profanity in Kiswahili.  There's burning branches and boulders forming a barricade across the main highway in front of us.  Only seconds have passed but in my waking I blurt out "what's going on?" and expect people to already know.  Everyone sits up straighter in their seats to peer out and the mob of people we are approaching.  I guess we have to investigate right?  Our driver pulls to the side of the road with all the other abandoned vehicles and leaves us to go find out what has happened.  I see two police officers with their rifles just standing amongst the crowd not showing their concern.  Word is a khat, or miraa, transporter came flying through this community and caused an accident, although their were no casualities.  But the civilians were outraged and determined to not let them continue on their way.  So of course, the guys in our car jump out to go observe the action and us three, sensible women stay in the car and watch from a deceiving safe 20 meters away.  We all know things like this can go bad very quickly.  The miraa driver runs out of the crowd, comes back with a machete, and starts slashing through the miraa bags piled on his pickup truck.  There are different stories going around, if they are trying to move it by hand into another vehicle or giving it to the village members as payment.  Here he is in action...

Thankfully, our driver hears about an alternate route on another little dirt road.  He manuvers the vehicle with urgency and too much confidence now, all fired up.  His muscular hands wrap around the steering wheel practically crushing it.  The alternate route eventually winds us back to the main road and what is that up ahead, a bridge.  Blockaded by motorcycles and men.   We have to wait for the others to come down the winding trail before we can head up it again.  Another ten minutes in the bush and we make it back to the highway probably only a 1/4 mile down it.  All is well and Mr. Macho doesn't hurry us home but takes his time at every speedbump to share the news.  Back in Chogoria the news really wasn't noteworthy, but mobile clinics might just be out of the question for the rest of the students!  My angel was there all along :)
Ok, I have to throw one more picture in, this was when I jumped out of the SUV before it made an insane decent.

 * A word about khat (miraa locally)- it's a plant that has been chewed by people in Africa and Asia for thousands of years, it contains an amphetamine-like substance that causes euphoria and is classified by WHO as somewhat addictive (less than tobacco) and is legal in Kenya. Thank you Wiki. 

Tuberculosis

Nearly on a daily basis, we have a patient with an entirely new presentation form of tuberculosis.  This is mostly due to the fact that patients with immunosuppression from HIV have a different set of characteristics of a TB infection- basically it can cause pathology anywhere in the body, not just caseating granulomas in the upper lobes of the lungs.  Yesterday a woman presented with left flank pain (HIV+).  Once a urinary tract infection was ruled out and physical exam showed hip flexor weakness, it was diagnosed as psoas abscess caused by TB and a four drug regimen was initiated of INH+ethambutol+PZA+rifampin.  Extrapulmonary lesions in HIV patients increase as their CD4+ cell counts drop below 50.  The xray below demonstrates miliary tuberculosis in the lungs- a peppering of the middle and lower lobes.  A third example: an HIV+ woman presented with persistant diarrhea, night sweats and anemia, her chest xray was normal.  Other causes of anemia were ruled out and thus "unexplained anemia in an HIV patient" was attributed to TB.  Unfortunately, HIV increases the risk of reactivation of tuberculosis by 100x, as illustrated repeatedly here.

Miliary Tuberculosis (sorry very poor detail)

Tuberous xanthomas: on elbows, knees and extensor surface of wrists...

caused by hypertriglyceridemia (lipids/fats), a side effect of one of his HIV medications.

A Kenyan clinical officer, or physician's assistant, performing a lumbar puncture on a patient with suspected cryptococcal meningitis.  After ten pokes we were still unable to get any cerebrospinal fluid and let the 26 yr old rest... maybe because it was a needle half the length we needed?