David Nawrocki at Maseno, Kenya - Chapter 6, Final Chapter

Chapter 6   As you read this final chapter, you may continue to find errors in the typing of these journal entries.  The entire three weeks here have been a struggle to access both water and electricity for daily life.  We live each day with the uncertainty of not knowing whether we will have electricity or water and for how long.  Many of the journal entries have been done under a mosquito net at 2:00 am because that seems to be one of the times where the electrical power remains on.  Loss of power makes caring for the patients difficult because we cannot take x-rays and evening treatments in the wards at night must be done by railroad lanterns.  We have collected water in buckets this week along with everyone else with each rain to flush toilets and take bucket showers.    As I write this chapter I find I am already missing the staff, the patients, the laughter and innocence of the children of Maseno, Kenya.  I will miss my daily Swahili lessons with the Reverend James Obura, the hospital chaplain as I have attempted to learn the Lord's Prayer, the 23dr Psalm and the Apostles Creed in Swahili.  I will miss the impact that everyone here has had on my life.  I am asked daily when I will return and why I cannot stay for another few weeks.   This final chapter and this journal would be incomplete without sharing some final experiences of the last three weeks.   The Orphan's Programs   There are two Orphan's Programs that Drs. Nan and Gerry Hardison have helped develop in Maseno since they have been here.  The first program involves free medical care if you are an orphan and have lost both blood parents.  You are eligible to be seen at the Maseno Mission Hospital and Dr. Gerry Hardison will care for you, no questions asked.  Your medical record flags you as an Orphan's Program patient and care is provided.  The Hardisons cover the cost.   The second program involves the 43 parishes in the northern region of the Anglican Church of Kenya.  Thirty-eight of the 43 parishes have approximately 250 to 600 orphans per parish.  These are children spread throughout miles of country side that have lost both parents to HIV, other illnesses or tragedies and are monitored by church elders, extended family members, or the children themselves.  It is not uncommon to have children ages 7, 8, 9, or 10 become heads of households.  The children from each of the parishes walk for miles each Saturday to come to their respective parish for a day of gathering which includes one cup of tea and a meal of beans and corn which is a staple meal in this part of the world.  Education is also provided during the morning for these children by grade levels under the shade of the nearby trees.  The cooking of the tea and food on open campfires begins at 5:30 am – 6:00 am every Saturday by volunteers in the community from each parish.  Education, games, dancing is all provided by the same volunteers for the morning.   The children come in from the surrounding villages between 7am and 8am in the morning.  Many of these children are as young as 3, 4, and 5 years of age.  They walk several kilometers by themselves in some cases to attend the Saturday morning gathering at the church and hopefully have the one major meal they will eat all week.  There are games, singing and dancing for the couple of hours as the children arrive.  When it is time for tea mid morning, the children line up in long lines in front of a make shift table which is really a fallen tree trunk.  Each child carries a small plastic trash bag where they keep their tin cup or plastic cup (recycled margarine containers) that they use to drink their tea from.  Children as young as three stand in line with their cup waiting for their cup of tea which is comprised of tea, milk and lots of sugar.  Once the children finish their tea they sit in small groups under the trees for education by grade level.  Classroom education may include Math, Swahili, English, or basic games for the 3 and 4 year olds.   Dan and I used the opportunity to visit the eighth grade class, to meet the students and to provide a guest lecture with the permission of the instructor.  As we met with 8th grade students, classrooms with the 7th and 9th grade students emptied out to join us.  Dan and I began asking the students about what they wanted for their own country based on the violence of the recent Kenyan elections.  The students were filled instead with questions about America and President Obama.  They were curious about poverty and homelessness in America.  One student asked about nuclear disarmament and asked if President Obama's efforts to reduce the number of nuclear weapons in the world would make Kenya and countries in Africa a safer place.  The students briefly talked about their own country after a lot of prodding and agreed that one of their greatest assets in Kenya was their natural wildlife and the importance of taking care of it.   Dan then opened the door to questions about HIV.  As visiting clinicians to the country, the teachers in the classroom gave us permission to pursue this line of dialogue.  Dan and I were amazed at the number of questions students had about HIV, vectors of transmission associated with HIV, and the possibility of survival once the virus was contracted.  Many students still thought that a HIV diagnosis was an automatic death sentence if you were diagnosed with the illness.  Many students did not realize that there were medications available that could treat the disease free of charge available in the community.  Our discussion lead into many questions related to sexuality and its implications for HIV transmission.  We held a show of hands to see who knew what their HIV status was, instructors included. Our guest lecture ended with a wish for all of them to find peace and an end to their tribal warfare that plagued their last national election.  Young people in Kenya have told us that they are tired of watching their countrymen and women die of disease, violence and malnutrition.  They are tired of the blatant corruption in local government and they want peace, employment, access to medical care and the opportunity for a better life.   Our guest lecture ended with the shared hope that the students in the class would complete their education and become the future leaders of their country.  We thanked the teacher in charge for the privilege of speaking with his students and returned to the local parish where the children grades 1-6 were completing their class room time.  As 12:00 pm approached, large cooking vats of beans and corn were strategically arranged on the log and nearby table so that lunch could be served to the hundreds of children. They once again formed three very long lines so they could be given their free meal.  Plastic plates were used to serve the luncheon meal.  We served the children one by one.  Once the meal was completed the children quickly returned with their plates for the remaining food.  The plates were then returned for cleaning and use for the following weekend.  I was surprised how quickly the food was consumed and at the same time I was not surprised.  As the children completed their lunch, they played or rested for a brief moment before their journey began back to their homes.  Some children played soccer in the afternoon sun.  Many of the children looked for an adult who was willing to sit on the ground with them and put their arms around them as long as it was possible.  It was not uncommon to see 5 to6 children sitting next to one adult.  The children would just huddle next to you for the opportunity to be touched and sometimes held.  They would say very little.  There were several occasions where I would be taking pictures and felt the warmth of a child leaning up against my leg hoping that I would not move.  I have seen these same children in the pediatric wards of the Maseno Mission Hospital sometimes sitting by themselves when their parents are not there.  Their faces expressed a sense of experience that some Americans never achieve by the time they are in their older years.  Many children in Kenya experience the maturity of a lifetime before they reach the age of 10.  You see it in their eyes and the way they handle themselves when they are in the hospital for illnesses that you and I would simply give into.  They are brave beyond words and rarely let on to the suffering they have already experienced.   The children gradually left one by one.  They all said goodbye as the "mzungu" left for their return trip to the Maseno Mission Hospital.  The sight of 200+ orphan children standing with their tin cups in their hands was humbling and hard to describe.  It is an image I will never forget.  Some parishes have up to 600 children fed on Saturdays in a similar fashion.   Victories and Losses in the Hospital Wards   There have been many victories in the hospital wards as patients have been treated for malaria, tuberculosis, HIV/AIDs, meningitis, pneumonia, malnutrition, cancer, and many other illnesses. We had a child who fell from a tree and broke both arms.  His arms were set in casts and he was sent on his way.  We saw another child who was seen by a local healer for spirits (headache).  The local healer placed several cuts on his forehead with a non-sterile blade (to release the spirits) that resulted in a massive infection below the skin on the child's forehead.  The infection was surgically opened and the infection treated.  The child eventually went home with his parents days later.  Klein was a four year old boy with tuberculosis, malaria and HIV and infected ears.  He was treated for all four infections and finally smiled the day he was discharged to go home.  We have had a 12 month old infant and a teenager that accidentally consumed cattle pesticide.  Both children had their stomachs lavaged and eventually discharged to return to their homes.  We have had several children delivered by caesarian-section.  We have also had several children diagnosed with "jiggers".  They were all treated with medications that would draw the insects out from the skin on their feet and legs so that their skin could once again heal.  These children were the lucky ones who were treated in time for a complete recovery and the opportunity to continue life.   Some patients have been seen and then sent on to larger hospitals in Kisumu.  One 5 year old girl named Rebecca came into the hospital barely breathing with pneumonia.  Her lungs were drained of fluid for three consecutive days.  She was eventually transferred to Kisumu to be seen by a thoracic surgeon.  Two weekends ago on a Sunday we had several people brought to the hospital by ambulance from an auto accident that occurred in Luanda.  The father died instantly in the accident.  The mother suffered a fractured leg and pelvis.  The two boys in the car suffered multiple lacerations, broken bones and a fractured skull. The mother was in the operating theater while we were carrying the injured boys in our arms from the outpatient clinic to X-ray and then back to the medical wards for suturing.  The boys involved in the accident had their heads sutured and arms set in casts before they were transferred to Kisumu for further care.   Many other patients have been less fortunate.  We have seen many chronically ill patients with gastro-esophageal cancer, thyroid cancer, congestive heart failure, tuberculosis, leukemia, hemorrhagic fever that could not be saved.  Ann who was our teenage girl we found on our home visits lasted for four days in the hospital.  She had a form of tuberculosis that became fatal because treatment began too late.  In each case several family members would care for the patients each day, feed them, wash them, and eventually carry them home for burial.  In one case last rights were given to a woman who passed away from congestive heart failure three days later while she was in the hospital ward.   There are many other cases too numerous to mention where Dr. Hardison and the medical staff have been able to provide the life saving care that people in Maseno and Luanda would otherwise not see.  Despite everyone's efforts, there are many medical specialties required for critical care that do not exist in Kenya when compared to the United States.  If the medical specialty is present, it is limited to those who can afford the surgery and most people cannot afford it.   Symba and the Holy Eucharist   We have seen patients in the medical wards twice a day, seven days a week. Sunday evenings we have taken dinner with Drs. Nan and Gerry Hardison at their house approximately three kilometers from the hospital.  They have a dog named Symba who is part of the family.  Symba is a middle aged, slightly overweight, male golden brown German Shepherd mix with a gentle personality and eyes for the next free meal or handout.  He can be quite vocal if you have food and you are not sharing or paying attention.   Wednesday mornings, there is an 8:00 church service at St Philips Academy in a small chapel on the grounds where the Hardison's house is located.  This past Wednesday Helen and I made the three kilometer walk from Maseno Mission Hospital to St. Philips Academy to attend the service at the chapel.  The chapel is open to the morning air and the doors in the front are left open during the service.  As I approached the chapel I saw Symba sitting on the walkway just outside the front door of the chapel.  He barked once then recognized who I was, wagged his tail, let me pass, and then reassumed his position sitting by the door to the chapel.   The Holy Eucharist service went as planned until we got to the celebration of communion.  Parishioners lined up in the center aisle to receive communion.  As the last person made their way towards the minister giving communion at the altar, Symba's keen eye caught sight of the morsels of bread on the plate the minister was serving from.  Symba got up and got in line behind the last parishoner.  He patiently made his way to the minister at the alter rail, sat down, began to wag his tail and waited for his communion bread.  The minister ignored him and went to the side of the chapel to give communion to someone on the right who could not come up to the altar.  Symba walked over to that person, sat next to the celebrant and waited once again for his turn for his communion bread.  The chapel was silent but you could see the smiles, silent laughter and surprise on everyone's face.   Celebration of the Eucharist ended and we began to sing our final hymn.  Symba realizing that his serving of communion bread would have to wait until after the service walked back down the aisle and sat beside me in the church pew for a gentle rub on the head until the service was finally over.   God's Presence at Maseno Mission Hospital   God is present in the hospital wards of Maseno Mission Hospital every day.  I have had the privilege of caring for the sick, celebrating the healed and carrying the dead who transitioned to a better life.  The future of Maseno Mission Hospital is uncertain as it struggles to become financially viable amongst the corruption and uncertainty of Kenya's political future.  Volunteers of all kinds will continue to come to Maseno Mission Hospital to care for the sick and forgotten as well as its orphans.  Engineers Without Borders will come in November to attempt to improve the facilities infrastructure for the hospital compound.  Christ's Hope will continue to provide in-home care for people with HIV/AIDS and search for those who have been neglected or forgotten in the community.  Jerod, who is one of Christ's Hope's clients, is with us right now for blood transfusions associated with his HIV/AIDS.  He is a gentle man with a gentle smile who was neglected based on the stigma and isolation of his illness.     There are numerous pictures to share with everyone on my return trip.  Your presence and prayers as a parish have helped the passage and distribution of the many medicines that were donated and found their way through customs.  Fifty percent of the medicine brought was distributed in the last three weeks.  I have told patients and members of the medical staff at Maseno that there are many people in Falmouth at St. Barnabas who hold them in their prayers each week.  You are all in their prayers at Maseno at the 8:00 spiritual devotional service at the hospital each morning.  They are grateful that people half way around the world would want to come to the northwestern province of Kenya to serve and care for the people of Maseno.  They do not know your face but they know your presence.   There is no way to easily end this journal entry except to say that there is much more work to be done here.  There are many untold stories.  There is tremendous need and tremendous opportunity for those of us that have so much to share with those that have so little.  I ask you to keep the people of Maseno in your prayers in the weeks and months to come.