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.

David Nawrocki at Maseno, Kenya - Chapter 5

Chapter 5   Community Health Outreach Work in Maseno and Luanda: HIV, ARVs and AIDS   There continues to be a tremendous stigma associated with HIV in Kenya therefore many people in Maseno and neighboring Luanda do not pursue the healthcare they need to treat the disease.  Family members in some cases abandon children with HIV.  Life is very hard in Kenya with very limited money and a very high unemployment rate.  People make tough choices every day about the little money they have and how to spend it.  Healthcare still costs money in Kenya although it is pennies compared to what we spend in the U.S.  Community Health Outreach Workers from Maseno Mission Hospital travel by foot to the neighboring villages in Maseno and Luanda encouraging people in the community to seek the healthcare they need rather than face the inevitable death sentence that HIV places on them without immediate healthcare.  Many of the Community Health Outreach Workers have HIV themselves; therefore, they can relate to their clients the importance of getting treatment for the virus before it turns into AIDS.  HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Autoimmune Immunodeficiency Disease).  Antiretrovirals (ARVs) are medicines that help lower the amount of virus carried in your body when you are first diagnosed with HIV.   The Walk Through Luanda   Paroxetes Agara is one of Community Outreach Workers who was recently diagnosed with HIV as well as tuberculosis.  Most of the patients we see at the hospital have complications associated with HIV, malaria and tuberculosis.  She had taken a break from her daily community visits where she walks several kilometers while she was being treated for her tuberculosis with regular injections of streptomycin and working from the outpatient clinic.  She agreed to make an exception and take Helen and me out for a day of home visits since she knew the outlying villages so well.    Helen, Paroxetes and I left Maseno Mission Hospital early in the morning. and walked for several kilometers through the jungle back trails of first Maseno and then Luanda.  We left the backroad trails at one point and came back up on the highway just in time to pass through Luanda center.  Luanda center is filled with outdoor merchants, bicycles, trucks, small fires with pots of oil cooking fish and samosas (fried dough with lentils).  All along the shops there are small children barely clothed playing amongst the abandoned skeletons of cars that once traveled the roads.  The children make up games from anything they find along the roadside.  Shingles, tin cans, plastic cups, automobile tires all become the objects of a game to be played in the hot late morning sun.  There is no trash pick-up or recycling in Maseno or Luanda.  Everyone burns their trash including plastics.  On many days there are several fires producing their acrid smoke that fills the air as you walk the dirt roads.  Most of the cars and trucks operate with diesel fuel.  The exhaust they produce is dark, black and suffocating especially after the third or fourth truck passes by in tandem.  Walking through the township with dozens of Trans African tractor trailor trucks idling in the town square made the walk almost impossible if you wanted to breathe. There was a sigh of relief as we made it to the outer limits of Luanda township. I stopped for a minute, took a deep breath and renewed myself for the journey into the local villages  As we walked through town, Paroxetes continually met clients she knew who were HIV positive and were continually monitored for consistently taking their ARVs so that the medication would keep the HIV virus in check.  We would stop so she could shake hands with her clients, reaffirm their commitment to their medication regimen and more importantly their commitment to life itself.  "Asante-san" as we continued walking.   The Kisumu to Mombassa Highway & the Kenyan Railway   As we left the town center on the main highway that passes from Kisumu to Mombassa, we passed another one of Paroxetes' clients, a middle aged woman who was HIV positive with her eight year old son in one hand and a live chicken with its legs tied in the other hand.  She said that she was on her way to Luanda township to sell her chicken for 380 Kenyan Schillings.  She would use the money to pay for her son's circumcision at the Maseno Hospital circumcision clinic that morning.  (Maseno Mission Hospital sponsors a circumcision clinic once a week and performs the surgery on eighteen to twenty-two boys per week).  She said that the rest of her money after the surgery would be used to buy food for her son and a ride home in a "mutata" (Kenyan minibus that functions like a local cab/bus service).  We said "Asante-san" after talking for a few minutes and continued on our journey down the long steep hill and back up the crest of the next hill.  All along the highway, people walked with jugs of water balanced on their heads.  Farmers tended their cattle with ropes tied to one of their legs.  Little children played in the fields along the roadside smiling as they hid behind the corn crops atop the many hillsides on the other side of the highway wondering why there were "mzungu" walking along the road.  As we reached the crest of the second hill, we turned left off the main highway and walked behind a closed store front until we came to railway tracks that had been laid down during the occupation of Kenya by the British.  The railroad bed was poorly maintained but still functional.  I am told there is a train that passes on the track three times a week from Nairobi to Mombassa and is extremely unreliable and dangerous to travel on.  The tour guide books tell you it is a safe and romantic ride through the Kenyan country side.  The local people tell us that the train ride is anything but romantic.  The train frequently breaks down in the middle of the country and can take hours or days to be repaired.    The First Home Visit and President Barack Obama   Once we walked over the ancient railway, we were on clay path that meandered into crop fields, lush tropical vegetation and dozens of homes that were dispersed deep amongst the tropical foliage.  After three turns in the path with multiple intersections, I became completely lost and totally dependent on our guide.  There were labyrinths of homes and trails that went deep into the countryside of Kenya.  I had no idea how Paroxetes knew which house to go to.  We would simply leave the path and begin walking down someone's dirt path to their home when we were directed by Paroxetes.   Our first client, Evelyn, was a woman who had just given birth.  Evelyn's mother graciously invited us into their home.  Kenyan rural village homes typically have a few chairs, a table and a couch.  If a house has more than one couch, it is a sign of wealth.  Roofs are made of tin.  Pictures of family members can be seen lining the walls along the inside of the home with a Kenyan calendar, and sometimes a poster that reflects the recent election violence in Kenya.  There is also usually some type of poster that describes the election of President Barack Obama in the U.S.  Everyone asks us during our visits about the work President Obama is doing in the U.S.  We have even heard children quote Obama as their president in Kenya out of frustration with their current political leaders.   Evelyn' son was two weeks old.  The mother was religiously taking her HIV medication and her son had already started his medication from the time of birth.  Both mother and son were doing well as long s they took their medication.  The HIV medications will keep the level of virus in their blood at a low level as long as they continue their ARV medications.   Sounds of Life in the Chair   Our second client was an elderly woman named Florence.  She lived in a dirt floor home that had minimal furniture, tin signs, and dusty pictures of family members along the wall who had long since left home or passed away.  The house was dark, cool and musty with dust many layers thick on the wall. Chickens walked in and out of the house at will as we spoke about the status of her daughter.  The house was not unlike the home of someone in America who had aged to the point that they had difficulty taking care of themselves as well as the house they lived in.  Florence's daughter had missed several appointments at the HIV clinic.  As we spoke with Florence, we noticed the quiet sounds of another two week child wrapped in a blanket sleeping in a chair near the end of the table where we all sat.  It was Florence's granddaughter, Marilyn.  Florence reassured Paroxetes that the child was fine and taking her HIV medication.  Concerns were raised for Evelyn's daughter regarding her possible current level of HIV infection since she had not been seen at the HIV clinic for several weeks. The grandmother promised she would speak to her daughter and reinforce the importance of returning to the HIV clinic for medication monitoring and follow-up.   Sounds of Chickens By Our Feet   As we left Florence's house we passed several men herding their cattle and goats down the dirt path we were walking on.  Most livestock interactions were without incident.  Cattle were usually more interested in the grass they grazed on then the "mzungu" walking by.  Kenyans are very proud of their cattle and goats both for their monetary value and visible sense of pride.  We often waited for them to pass before we continued on our journey.  We made several more turns in the red clay covered paths until we walked along a line of corn fields to the entrance of a home where Michael lived with his two sons.  He was HIV positive and had started his ARV medication until he was attacked one night by a gang of youths, brutally beaten, and had his right leg broken.  He showed us his leg cast and stated that he had become more focused on his pain medications and forgotten about his HIV medications.  Our counselor reviewed with him his HIV status and arranged a time that he could come back to the clinic to restart his HIV medication regimen.  The entire time we were sitting in his home, Helen constantly heard the sound of chickens under a basket by her feet in the chair she was sitting in.  After the HIV counseling was completed, I asked Michael why he had chickens under a basket in his house.  He explained that his bean crops were at a critical stage and that chickens eat the leaves of the immature plants stunting the growth of the mature plant.  I asked if we could see the chickens.  Once he lifted up the edge of the basket, chickens went running everywhere and the chase began for the birds through the front door and out into the fields.  I apologized for creating more work for Michael and his sons.  He graciously said no problem, have a safe journey as he reached and picked up one of his chickens by the tail feathers and feet.   Death of a Brother   As we left Michael's house, we met a local community aid worker who joined us for our continued walk.  Her name was Linda.  She was responsible for supporting HIV infected people in her immediate neighborhood.  She led us down paths that even Paroxetes was not able to find.  The paths we walked on were typically at an angle since the land we walked was always on the side of a hill.  Our walking paths were also the drainage paths for the water running down the hillside when the heavy rains came.  I often imagined being lost on one of the many paths and watching the running flood waters coming at me as I scrambled to find my way out of the fields and onto the highway.  Fortunately the weather was in my favor, lots of sunshine and little rain for the day.   As we turned left onto another red clay path we saw a family sitting on a couch outside in front of their house about 25 yards down the path.  The couch was positioned between two homes on the path.  In front of the couch there was a campfire with the evening meal cooking and the freshly covered grave just past the fire in front of the couch.  As we approached children ran to meet us with their father directly behind them.  His name was Lawrence Mongata.  Lawrence invited us into his house and introduced his wife and six children to us.  He commented on how he had just buried his brother outside his house and was blessed that he had "mzungu" visiting in his home.  He said that this was a positive sign celebrating the memory of his brother.  He said a prayer for all of us and then wished safe passage for the white clinicians back to America when they finished their work in Kenya.  He had one daughter who was HIV positive.   He promised her continued compliance with her HIV medications and shared one last prayer with us before we left.  Before we left his property we walked out to his brother's grave site and said prayers and expressed condolences once again for his loss.   The Value of a Life   We continued our journey into the endless clay paths until we came upon a house set deep into the property with multiple cattle tied on the lawn.  There were several buildings on the property used as shelter for the animals as well as other members of the extended family.  There were children three and four years' old gathering firewood, then carrying it under their arms to the building where the family cooking was done.  We were once again welcomed into someone's home to discuss the health of one their children.  They explained that one of their daughters, Ann, who was HIV positive, had been sick for several weeks, had stopped eating, and could no longer swallow.  Helen and I were allowed to see Ann where she slept and evaluate her condition.  Ann was severely dehydrated, mal-nourished and required immediate medical attention in a hospital.  The family was reluctant to go forward with hospitalization due to their financial condition and concern that Ann was HIV positive and had little chance of surviving as it was.  Community Health Outreach Workers spent most of the day convincing the family to bring Ann to Maseno Mission Hospital.  Ann arrived at the hospital the following morning.               Jiggers and the Bishop's Message on St. Luke's Day   Many of the rural homes in western Kenya have dirt floors where children sleep at night.  There are no beds or mattresses in many cases.  The children often become infected with insects from the dirt and develop a disease called "jiggers".  The insects enter their skin while they sleep on the dirt floors during the night and infect them gradually from head to toe.  The disease is often fatal if not treated in time.  Children are washed in insecticidal soap and treated for chronic skin infection if caught soon enough. The home remedy also involves taking cow manure and covering the floor of the house with it.  The cow manure kills the infective insects and makes sleeping on the dirt floor safe again The Rotary Club International of Maseno is currently sponsoring a community awareness campaign to teach parents how to cover their dirt floors with cow manure to prevent their children from getting "jiggers".  Bishop Orchect's annual message which was given on St. Luke's Day (October 19th) also had references to the tragedy of children dying as a result of "jiggers" in Kenya.  He emphasized the importance of better educating parents regarding the disease as he spoke to a packed audience at Maseno Mission Hospital.   Our Final Visit   Our final home visit was with a young woman named Judith who recently found out she was HIV positive and was reluctant to seek medical care due to the stigma of the disease in her community.  She was a beautiful thin woman with a quiet demeanor and a resigned attitude that her life was over.  Paroxetes shared her life story and the importance of not giving up hope and that life was still possible with proper medication and treatment.   As we sat in Judith's living room children playing outside continually poked their heads just inside the doorway to see who the white strangers were.  They laughed and ran back in forth in the afternoon sun giggling in Swahili.  One two year old boy looked inside the doorway with a beautiful engaging smile over his dirt covered face that made you disregard the fact that he was dressed only in a shirt and no pants.  He did not seem to care nor did his friends.  He was proud and happy.  His smile conveyed his sense of confidence as he ran back out amongst the cattle, goats, chickens and cats roaming the yard.   Judith eventually agreed to come by Maseno Mission Hospital and be treated with ARVs to lower the level of virus in her body and hopefully have a second chance at living once again.  As we walked out the front door, the children were waiting for us.  "Hello mzungu, how are you?" The appropriate response was always the same. "I am fine, how are you?" Most children in Kenya only know the English words "Hello, how are you, I am fine."  You hear these words from children in the country side, along the roads, and along the red clay paths that crisscross the sides of the fields and hills.   The children playing in the yard posed for a few last pictures.  Paroxetes, Helen and I then began our two hour walk home back to Maseno Mission Hospital. Paroxetes said hello to a few more clients as we passed through Luanda center.  The late afternoon sun bore down on us as we passed through Luanda and then turned back into the countryside red clay paths to avoid the exhaust fumes of the passing trucks on the highway.

David Nawrocki at Maseno, Kenya - Chapter 4

Chapter 4   My Fellow Medical Volunteers   During my short time here, I spend each day with two other health care volunteers, Dan and Helen. Together, the three of us work with Dr. Hardison caring daily for the patients seven days a week at Maseno Mission Hospital .  We also sing together (off key albeit), pray together, hike together, and take our meals together.   Dan is a resident physician at University of Tennessee in Memphis , TN.  He is 28 years old.  We celebrated his birthday this past Wednesday.  Dan was born in Chicago , Illinois .  He lived in Chicago for 16years then moved to Georgia and now Tennessee where he currently resides.  Dan is a skilled clinician as well as a brilliant computer software/hardware guru.  He loves technology and has helped remove viruses from our laptop computers for the three of us as we have attempted to journal each day.  He has a dry sense of humor and loves to make people laugh.  His body mass index is slightly elevated.  He announced the first day here he was here the he was probably the fattest white person in Maseno.  Once he had established himself, he was able to get down to work as a volunteer.   Helen is a fourth year medical student who is completing a medical rotation here at Maseno in community health.  Her full name is Helen Shi Stafford.  Helen was born in mainland China and moved to the U.S. when she was two years old.  Her parents are both medical physicists who came to the U.S. to further their education.  Helen lived much of her life in Oklahoma before moving to San Diego , California to attend medical school.  She is married to Chase Stafford who works for an organization called "Worldvision".  Chase travels to underdeveloped countries where he establishes organizations that can design and build infrastructure projects for developing countries.  Helen and Chase have been married for approximately two years.  Helen is a boundless bundle of energy that engages with everyone that crosses her path.  She is also the volunteer who has been here the longest (by one week) and has been the orientation guide for both Dan and myself.   Cycles   The are many cycles that play themselves out every day at Maseno.  We have had four pediatric admissions this past week to the hospital.  Two were for malaria and two for malnutrition and possible pneumonia.  Malaria is endemic in this part of Africa .  People of all ages come to be treated for signs of symptoms of malaria.  The government provides chemically treated mosquito nets for its population however they do not provide or help pay for the malaria medication that is required to manage the disease.   Francis, one of the clinical officers here at the hospital explained that as the rainy seasons change in Kenya with the time of the year, so do the increases in malaria rates change.  The incidence of malaria is directly related to the presence of standing water on the land.  Malaria rates go down during the dry season because there is no standing water for mosquitoes to breed in.   As the land becomes parched with the advent of the dry season, water can only be found near the riverbeds.  As the animals migrate towards the last evidence of water and the riverbeds, the footprints they leave in the earth create small pools of water that breed mosquitoes before the water eventually dries up.  The health ministry has demonstrated through studies that they can predict the increased levels of malaria in nomadic populations according to the migration of animals they follow with the gradual disappearance of water on the land.  Eventually the water dries up and rates of malaria temporarily drop until the next rainy season.   As the sun dictates the cycles of life in Kenya , it rises and falls every day at the same time since we live at the equator.  The sun rises at 6:00 AM every day and sets at 6:30 PM every day.  The sunrise and sunset occurs very rapidly given our geographic location.  One evening we had hiked four kilometers from the hospital compound.  We began to make our return journey after sunset thinking we still had enough time before darkness fell.  We found ourselves racing back to the hospital compound to reach the safety of its gates.    The temperature rises and falls consistently every day.  It is cool in the morning and then becomes oppressively hot by 12:00 PM .  The temperature then begins to cool off in the afternoon.  There is a wonderful tropical breeze that returns every evening that blows across the land.  Then of course, there are the evening rains that bring the life giving water back to the land.   My favorite cycle is the afternoon return of the juvenile monkeys near the outpatient clinic.  They appear each day in the afternoon to entertain and joyfully play in the trees between the hospital wards and the outdoor clinic area.  We have a mother/infant pair that travel amongst the mayhem of the juvenile playtime.  She lets her infant play with the older juveniles, always with arms length of pulling him/her back.  One evening I sat on a bench under a tree outside the hospital ward with a 12 year old boy named Thomas who was hospitalized for an acute attack of juvenile arthritis.  We talked about his aspirations to become an engineer as the monkeys came cautiously towards us while we fed them coconut cookies.  Thomas and I eventually went out separate ways for dinner.  The monkeys remained on the roof of the clinic quietly contemplating the sunset and their choice for a resting place for their sleep in the trees that night.   There is a cycle of patients that come to the Maseno Mission Hospital according to the visitation of health care professionals.  One patient told me that she walked several miles to come to Maseno because she heard that there were "mzungu" white people here.  When the mzungu people leave, patient counts drop slightly until the next "mzungu" visitors arrive.   Monday through Friday we begin the day with our Spiritual Devotional Service.  There is an assistant pastor that always goes through the hospital wards first thing in the morning praying for the patients that are hospitalized.  This week, one sermon referenced the writings from the Book of Revelation.  One of our nursing students gave the sermon.  She asked us if we would recognize the face of God if God knocked at our door?  Would we recognize the face of God in the faces of our patients if God knocked at our door?   Once the service ended, we left the chapel and began our morning rounds.  The night before a patient had been admitted to the hospital with complications from HIV/AIDS.  As we approached his bed we realized that he had passed away shortly after the end of our morning Spiritual Devotional Service.  I found the words of our morning service present in my mind as I helped carry his body from the hospital ward to the morgue where the family would comes to claim his body and take it home to bury with his relatives on their family plot.  We carried the body pass an outdoor area where HIV positive patients were awaiting counseling and access to their medications.  Patients sitting in the outdoor waiting area knew that we were carrying the body of someone who lost their battle with HIV/AIDS.  We all found ourselves asking if we would know the face of God if He knocked at our door.   The cycle of life plays itself out in many ways at Maseno every day.  Faith plays a pivotal role in the lives of people here where medicine can no longer fulfill the need.  Many of the staff at Maseno Mission Hospital are HIV positive yet they live in fellowship to serve the needs of people who attempt to survive the disease.  I cannot tell you the number of people that have asked us to pray for them as we return to America .   The Reverend James Obura   The Reverend James Obura is the chaplain for Maseno Mission Hospital .  He is a rugged glowing man with curly silver/gray hair who dresses in an unpretentious green tattered robe and leads us in spiritual worship at the devotional service every morning.  James (as he likes to be called) is in his 80's and can probably still run a full marathon.  He leads us in worship, song, and praise.  He teaches us Swahili each day.  We say the Apostles Creed, the 23rd Psalm and the Lord's Prayer each morning in Swahili with his guidance, patience, and prayer.  He always prays for us each morning before we leave for the hospital; wards and prays that the patients we touch are filled with faith and hope.    James lives on top of a mountain behind Maseno Mission Hospital that has been in his family for generations.  Standing in his front yard you have a commanding view of Lake Victoria that fills the entire horizon as if you were looking out over an ocean.  James told us that when he was a boy, his land was home to dozens of wild leopards that roamed the countryside and the hilltops.  He was taught as a boy never to run from a leopard if you were approached.  He was told to pick up a rock and throw it in the direction of the leopard.  The leopards would realize that you were not afraid of them and would give you quarter so that each of you might go your separate way.  Kenyans who are diagnosed with HIV make a decision each day whether they are going to fight the disease or give up and die.  Kenyans face their leopards each day with their disease.  Their faith is their rock which helps them move forward out of fear and back into life.   Times have now changed.  The leopards are gone but the land still provides for James and his extended family.  It is a refuge for prayer, meditation, solitude and the home of his family burial plot.   James recently lost a daughter named Helen.  James and his wife now take care of Helen's children since her death.  Helen is also the name of the fourth year medical student who is volunteering here with us.  James fell in love with Helen when he first met her because she reminded him of his lost daughter with the same name.  He recently invited Helen to his home for dinner with the opportunity to meet the rest of his family.  James and his wife had seven children.  Six currently survive.  During the family dinner, Helen had the chance to meet all of them.   After dinner, Helen walked the land of James ' ancestors with him.  They sat in the late afternoon shade and discussed Helen's aspirations to work as a physician in developing countries as well as James' aspirations for never leaving his ancestor's mountaintop land in Maseno.  At the end of the day, two of James' sons gave a had written note to Helen when she was leaving which read as follows:   To Our Guest   First Born: Dishon Mahoma Obura Second Born: Patric Lumumba Obura Box 116 Maseno , Kenya   Madam:             We kindly request you when you go home, please remember us. We have HIV and we are on drugs therefore, we humbly request you to support us in prayer that we are able to start our project (crops while we are still alive to feed our families).   Yours faithfully, Dishon and Patric, Sons to Mr. James Obura   Christ's Hope   There is a man named Desmond from Northern Ireland who lives in Kisumu (2nd largest city in Kenya bordering Maseno). He works for an organization called Christ's Hope.  Desmond is one of several people who scour the townships of Maseno and Luanda looking for HIV positive people who have been abandoned by their families and require health care.  He brings them to Maseno Mission Hospital where they are cared for and nursed back to health. Desmond recently brought us a man named Jerrod who was wandering in the streets with shortness of breath, malnutrition and fever.  When Jerrod arrived at the hospital, he was listless and struggling to breathe with pain in his chest.  He was diagnosed with tuberculosis and placed on medication, fluids and food.  His ability to breathe without pain gradually came back, his smile returned and he left the clinic with Desmond to return to his community.    Prayers for the People of Maseno   As Helen, Dan and myself prepare to leave Maseno Mission Hospital this week, we are continually asked by patients, family members and hospital staff to keep them in our prayers as we prepare to return home to America .  I ask you to keep them in your prayers this Sunday and in the weeks to come.

Random notes from the Rector

David's messages from Kenya are amazing - I hope he knows we are all praying for him and wishing him well and cannot wait to hear his story when he returns. The differences are astounding and make you realize how much we take for granted with all we have in this country. Thank you, David for sharing your story.

Will and I took two days last week and journeyed to Eastham where we attended the mycological foray - over 200 mushroom nuts from all over the Northeast gathered from Thursday to Sunday to collect and study mushrooms. We hunted in some beautiful areas - one in the beech forest in Provincelands and another on Griffin Island in Wellfleet. After walking over two hours in wet woods we came back with baskets of all sorts of fungi - these were put on identification tables and were labelled by the experts. It's amazing really - to see what grows under our feet! All of us there are kind of odd I think - and I am right in there with them - but we are friendly and curious so it is easy to get to know people. We stayed for the evening lectures too and though some were a bit too scientific for me I learned a lot. The colors of the woods are still with me. We missed Saturday walks as we got back early to check on the church - and more important - to check on the people in our church family.

We are so blessed - and now we look forward to our parish dinners on Friday night - hope to see you there.

David Nawrocki at Maseno, Kenya - Chapter 3

Chapter 3   Health Care in Kenya and the Role of Maseno Mission Hospital   Optimal health care is provided to those who can pay for it in Kenya .  If a resident cannot pay for their healthcare, then they will not typically receive it.  If a patient requires surgery or care for a catastrophic illness, they may be sent to a government hospital in Kisumu or Nairobi where they are asked if they can pay for the care they require.  If they cannot pay for the care, then they are held captive in the hospital until they can pay.  Healthcare can be withheld until a form of payment is provided.  If payment is not found by the family, the patient may become terminally ill while waiting for their necessary care in the hospital, or they may be eventually sent home with their family with their terminal illness.  Kenyans in the lower socio economic level of society (50%+) do not seek the care they need in many cases due to the cost.  Kenyans in Maseno and surrounding Luanda come to the Maseno Mission Hospital because they know they will be cared for here.  Patients receive nominal bills.  They are lucky to pay 25-30 percent of their bills in many cases.  Some of the patients leave before it is medically advisable in order to honor the portion of the medical bill they can pay.  Many are without food and without means to buy seeds, supplies and fertilizer for their crops.  Many cannot afford the cost of the medicine they need.  One gentleman left the hospital prematurely this afternoon because he was the sole caregiver for six children and stated that there would be no one to feed the children and care for them at home if he did not leave.  He was still recovering from his anesthesia. Despite the challenges of financially supporting the Maseno Mission Hospital , anyone who walks through the gates to the Maseno Mission Hospital compound is treated and care is given despite the realities of the healthcare system in western Kenya .  Maseno Mission hospital mission is a respite for the poor, the needy, and the sick that walk for miles in hope that someone will care for them or their children.  I have seen children brought to the hospital semi-conscious in the arms of their parents and go home a few days later with food and the appropriate health care.   Maseno Mission Hospital   Maseno Mission Hospital began as a small Anglican mission in 1906 under a fig tree.  The Luhya word for fig tree is "omasena" which was westernized by the early missionaries to Maseno.  Over time with the help of the Anglican Church, buildings for the clinic, outpatient department, wards, mortuary, operating theatre and x-ray department became established.  Maseno hospital mission grew from the 1930's to the 1990's with the help of Swedish Rotary.  Their support ended in 1999.  In 2001 Nan and Gerry Hardison arrived from San Diego under the auspices of the Episcopal Church of USA Volunteers for Mission for Services in the Anglican Church of Kenya to continue the work here.   Dr. Nan Hardison was professor of business administration at Pt. Loma University in San Diego , CA .  Dr. Gerry Hardison was a physician at the Veteran's Hospital in San Diego and a Professor of Medicine at the University of San Diego , CA. prior to retirement.  Nan and Gerry Hardison traveled to Nairobi , Kenya after retirement where Nan Hardison became vice chancellor of academic affairs at Africa Nazarene University while Gerry Hardison practiced and taught medicine at the University of Nairobi and Kenyatta National Hospital .  They were both asked by the Bishop Simon Oketch of the Diocese of Maseno North in the Anglican Church of Kenya to provide the necessary leadership at the St. Philips Theological Academy and the Maseno Mission Hospital , where they now reside.   The Basics of Life   Sunshine and moonlight dictate the cycles of life in Maseno.  We get up with the morning sun and retire with the setting sun and the rise of the moon.  The sky is flawlessly clear here at night at the equator.  The streams of clouds against the dimly lit blue evening sky gives reverence to another day's work and the many lives we have been touched by.  People here in Maseno rise early to gather their firewood, begin their daily chores by collecting and carrying water for their morning bath and meal preparation.  Washing clothes by hand is also done early in the morning to optimize the use of the community clotheslines and morning/noon day sun before the afternoon rains come.   I was washing my clothes this morning in a bucket on the grass behind our cottage.  As I was scrubbing my clothes in the water, I saw two little feet in front of me.  I glanced up.  It was one of neighborhood children. "Habari"  I said.  Good morning he said in English.  He asked, "Why are you washing your clothes with your hands?"  I told him that I needed clean clothes so I had to wash them before the week started.  He then looked at me and said,"Do you wash your clothes with your hands in America ?"  I replied, "No, we use machines to wash our clothes in America ".  He said, "oh, ok, kwaheri, kuonan."   We have been without electrical power for three days.  We rely on the sunlight and candles for our existence inside the cottage we live in when we are not in the clinic or at the hospital.  Showers in the morning are cold water with the use of a small bucket to pour water ceremoniously over one's head.  The water comes once again from what has been collected from the roof from the previous night's storm and the local water department (when it is working) so your mind is always thinking conservation.  Our housekeeper Emma boiled some water for us this morning so it temporarily muffled the shrieks and yells of the three of us pouring the cold water over our heads as we prepared for the start of another day.  Cold is relative here in Kenya .  If the temperature drops below sixty degrees Fahrenheit, people put on heavy winter jackets, ski caps if they have them and gloves.   Another Day   Each day begins with Helen (4th year medical student, University of California , San Diego ), Dan (2nd year physician resident, University of Tennessee ) and me having our communal breakfast at 6:30 am .  We walk down to the hospital at 7:15 am to see the patients in the hospital wards before we attend the 8:00 spiritual devotional church service which is in the open air chapel connected to the HIV/AIDS hospital clinic. We say good morning "habari za asubuhi" to the school children walking with us.  They respond in kind as they leave the hospital compound for school "kwaheri ya kuonana" until we meet again.  The spiritual devotional church service always begins with hymns sung in Swahili, the lesson for the day, the Apostle's Creed and the day's New Testament lesson spoken in Swahili.  Sometimes the sermon is presented by one of the resident nursing students studying at the local nursing school.  Portions of the service are translated sometimes in English for the white "mzungu" (non-African) visitors.  The day's lesson is always related to the importance of the care we will all provide to the patients of Maseno Mission Hospital that day.  The resident minister always asks Helen, Dan or me as visiting health care providers to give the parting blessing of the day before we enter the patient wards for another day of patient care.   Making the Patient Rounds   We meet Dr. Gerry Hardison the medical director (also known by the staff as" The Professor") and begin rounding (visiting) the patients in the wards at 8:30 am.  The wards all have open windows (no screens or windows) and of course everyone including the patients sleeps under mosquito nets.  Patients are attended by nurses from the resident nursing school and clinical officers that provide clinical coverage seven days a week.  The out patient clinic opens at 9:00 am.  Patients begin to come in from the countryside.  Surgeries begin in the operating theater mid morning, and minor procedures (putting casts on broken bones, wound care) begins in the treatment room adjacent to the operating theater later in the morning.  Helen, Dan and I see patients in the medical wards at the beginning of the day and then we go to wherever we are needed.  I have spent most days so far in the out-patient area of the hospital running an Ear, Nose and Throat clinic, starting IV's, assisting with endoscopies, explaining to families the nature of their loved one's illnesses, working with my 4th year medical student and first year resident colleagues setting broken bones and applying casts, visiting with patients and family members in the evening when the family member will probably pass away during the night due to terminal illness.    We stop sometimes for lunch at 12:00 pm and then continue seeing patients into the early evening.  Our days end around 5:30 unless there is an emergency case that arrives through our gates.  Earlier this week we had a young man who was admitted to the hospital with pneumonia, tuberculosis, and seizures.  That same day, a young man who had been hit by a truck after drinking the local "chunga" came in with a skull fracture.  Sixty minutes after he was hospitalized he became paralyzed on the left side due to internal intracranial bleeding.    There are no MRI's, CAT (Computer Aided Tomography) Scan's for immediate clinical diagnosis or trauma centers to send people to here.  There is no Cardiopulmonary Resuscitation (CPR) administered because there are no ventilators to help people breath after CPR, nor are there any intensive care units.  There is no physical therapy, occupational therapy, speech pathology or long term care facilities in Maseno.  Families care for their loved ones both inside and outside the hospital.  There is an x-ray machine in the hospital with limited x-ray capability, and a laboratory.  Endoscopies are done by Dr Hardison (he is the only physician in western Kenya who does them) which is interspersed between the other patients throughout the day and on the weekends.  Medical care is given based on the time honored discipline of a good physical examination and the knowledge of tropical medicine, HIV/AIDS and internal medicine.  The rest is made up as you go.  Splints for IV's are made of cardboard found in boxes.  Some medicines such as amoxicillin and cephalosporins are readily available.  Antibiotics such as fluoroquinolones and clindamycin are not.  You treat your patients with the medications you have and hope for the best.    Maseno Mission Hospital came into existence in response to a need to provide healthcare for rural Kenyans in western Kenya who had no other alternative.  People of Maseno, Luanda and neighboring towns come to the Maseno Mission hospital to be seen by medical officers, physicians, visiting medical student and nurses and anyone else who is willing to take the time to travel to Maseno to provide free health care.  It is not uncommon to have patients tell us that their home is several kilometers away or a 3-4 hour walk one way.  The people of Kenya are warm, and gracious with smiles that beg introspection into what is really important in one's life.  Once the patients are seen, they are prescribed medicine or they may be admitted to the hospital ward if they are critically ill.  Many of the patients we see have tuberculosis, HIV/AIDS, and malaria.  Little children in most cases come to the clinic with malaria with other illnesses added on top of it.  Children are often seen with malnutrition because the parents cannot afford to feed their child or themselves.  Patients that come to the clinic will tell you their symptoms have been present approximately two weeks.  Their physical presentation often betrays their self report of a two week illness.  Malnutrition and disease processes that have lasted for several years are often the clinical presentation that we see.  Patients come to us in many cases in the last stage of their illness when it is too late to do anything.  Many remain alive for a few days in the hospital wards and then succumb to their illness.  Family members are usually present providing care for their loved ones throughout their hospital stay.    Death occurs every day at some level here in Maseno.  In my first week here I have seen the death of several patients and the emotions of the grief-stricken families as they attempt to cope with their loss.  This week we saw one family who lost two children in one week.  I am constantly reminded by my colleagues that death is part of the circle of life and that the circle of life is also seen in the beautiful faces of the children of Maseno.  The children here in Kenya are gorgeous, radiant, innocent, and filled with the spirit of life itself.  They remind us that life is very brief and should be enjoyed for every moment it offers.  Faith in God and the Lord Jesus Christ plays a pivotal role in the lives of so many of the people we care for here in Maseno as well as the staff.  Our daily morning spiritual devotional service reminds us that God is present in the lives of everyone who comes through the gates of Maseno Mission Hospital and that we should always be thankful for what we have.

David Nawrocki at Maseno, Kenya - Chapter 2

Chapter 2   A Night in Nairobi, the Dry Landscape and the Trip to the Airport   I spent the night at the Anglican Guest House (a boarding house for missionaries traveling through Africa from one mission to another).  John, my cab driver picked me up the following morning to take me back to Jomo Kenyatta international airport for the flight to Kisumu, the third largest city in Kenya.  The rainy season has been slow to come to the eastern part of Kenya where Nairobi is located.  The land in Nairobi is very dry and the drought is visible everywhere.  Buzzards by the hundreds are seen in Nairobi in the trees and on top of lamp posts waiting along the highway for their next meal.  There are huge gates that you travel under as you leave the highway from Nairobi to the airport with hands sculptured and clenched in partnership at the top of the archway.  The archway celebrates the building of the highway by the mainland Chinese government as a token of their friendship to Kenya.  Once we passed under the archway, we were stopped by Nairobi police and forced to get out of the car for security inspections.  At one point I thought my trip was over.  The police eventually allowed us to get back in the car to proceed to the airport.  Once at the airport I checked into African 540 Airways, my connection to Kisumu.  American Airlines had been very gracious allowing my overweight bags with medical supplies to fly from Boston to Nairobi at no extra charge.  African 540 Airways asked for my backpack and pants pocket contents along with my bags for a grand total weigh in to calculate my overweight allowance and extra charge.  I was allowed to keep my clothes on at the time of weigh in before flight.   The Flight to Kisumu   As you leave Nairobi and travel due west towards Kisumu, the color of the land turns from a dry parched brown to a lush green carpet of tropical foliage with small lakes, jungles and crops visible from above.  The Kenyan landscape is divided into two distinct halves; the eastern half which slopes gently to the coral-backed seashore, and the western portion which rises more abruptly through a series of hills and plateaus to the Eastern Rift Valley, known in Kenya as the Central Rift. Kisumu sits on the shores of Lake Victoria.  Approaching from the air, the lake's edge at Kisumu looks like the Mississippi River delta with its muddy water and brown river banks.  This is the beginning of the rainy season which starts on the western side of Kenya making its way across the countryside to the east explaining the muddy runoff in the lake.  There were numerous fishermen in wooden dug out boats visible from the air placing their nets over the water as we landed.   The intensity of the daily tropical rains make you pause and wonder if the building you are in can withstand the intensity of the rushing water.  Each day the skies turn from a bright blue around 4 pm to a dark grayish blue with the sound of rolling thunder and lighting in the distance.  The winds pick up as the sky becomes darker and the rain begins to fall.  The rain eventually becomes torrential similar to a category 5 hurricane for about 30 minutes.  The storm passes, the sky clears, and the sounds of crickets and night life return celebrating another contribution from the sky that is so desperately needed in this part of the world.  Rain in Kenya nourishes and nurtures the life that exists here.  The afternoon thunderstorms here in Kenya are part of their biannual rainy season and the lifeline of their existence.  Life as we know it in Kenya would not exist without the rains that perpetuate its existence.   The Ride to Maseno   The ride from Kisumu to Maseno by car leaves sea level at the airport and climbs 4,865 feet into the mountains of western Kenya. The main highway is filled with Trans African tractor trailers that crisscross the African countryside with goods and material of all kinds.  There are speed bumps on the highway when you approach small towns that require a 4x4 vehicle to get over them.  Local people are seen along both sides of the highway with their cattle which are highly valued in their society.  There is tremendous poverty visible in the country side balanced against the majestic beauty of the land.  The search for food and water is not reserved just for animals and is common for many families in some of the rural areas.  It is not uncommon for people in this part of Africa to go with one meal a day and maybe potable water.  The average life span of people in Kenya is about 48 years of age with 50% of the population living below the Kenyan poverty line.  The approach to Maseno and the Mission Hospital is a dirt road that meanders through the countryside.  It passes beautiful farms that lie below in the valley with rolling hills visible in the near distance.  As you approach the entrance to the gated Maseno Mission Hospital compound, you pass through a small area of street vendors, shacks, small entrepreneurs and a bar that caters to life outside the gated mission hospital compound and the local university which is down the road from the hospital.  The street is filled with chickens, dogs, cats, children and people carving a means of living that involves selling anything that a passerby might buy.  The bar sells a local brew called "chunga" that is intoxicating and as lethal as Kentucky moonshine.  There is no electricity in this area so movement and business transactions at night are conducted by candle or gas lit Coleman lamps.   As volunteers at the medical mission compound, we are not allowed to leave the safety of our cottage and the compound at night, let alone the area just outside the gate of the compound due to the crime and uncertainty of the area.  We are locked into our cottages at 6:30 pm at night and not allowed to venture out of the cottage and back into the compound until 6:30 am the following morning.  These precautions we are told are for our own safety.  Drunken men with machetes are the specific danger we are told.  It defines a very different way of life that makes you incredibly thankful for all that you have at home and how little we think about it sometime.  Despite the dangers there is an innocence of human frailty that plays in this part of Maseno every day.  Little children covered in dirt and tattered clothes with symbols from the US, travel in small groups asking you to take their picture when you walk by. "Picture, picture please mister!!"  You take their picture and then show it to them on a digital camera.  They dance in delight at their image and remember you the next time you see them.  "Asante sana", thank you very much, "kwaheri" good-bye.   Crossing the Equator   A little further down the dirt road from the gate to Maseno Mission Hospital is the gate to Maseno University which lies directly on the equatorial line.  Each time I post an email to everyone, I walk back and forth across the equatorial line.  The number one question everyone has asked me about the equatorial line is which way do toilets spin and flush on either side of the equatorial line?  I have not done the experiment yet so stay tuned.  I will find out the answer before I return home to Plymouth and Falmouth.  I do not feel any different when I walk across the line.  Maybe I am doing something wrong?   I still walk in a straight line.   The Maseno Mission Hospital   The Maseno Mission Hospital has several buildings that are located in a guarded and fenced in compound.  The buildings include an outpatient clinic, pharmacy, maternity ward, two clinical wards, a surgical ward, two operating theaters, X-ray facilities, administration buildings, an open air chapel, nursing school,and buildings in the back portion of the compound for the nurses, nursing students and people who work at the medical mission.  Many people here still gather firewood to cook their food on.  All water consumed on the compound comes from water that is collected from the roofs of the buildings which is why rain is so crucial. Large collecting tanks located at strategic points on the compound collect and store the water.  The underground water tanks have hand pumps locate above ground that 5 year old children can operate.  Late in the afternoon, children of all ages are seen traveling with large plastic containers to the storage wells to pump and carry the collected water back to their homes.  Some children carry the containers on their heads that would give most of us neck strain and probably a headache.  The children carry jugs and baskets of all types effortlessly along with the men and women in their communities.   Most of the buildings on the compound were built in the early to mid 1900's with a few more recent.  They are the minimal requirements that sustain life in this harsh environment.  Some of the buildings are filled with well intended donations from foreign countries that were poorly thought out.  Sterilizer units from Switzerland that required electrical power that this part of Kenya cannot produce, Handicapped walkers that cannot function in this wilderness environment.  Medical supplies for health promotion programs that never materialized due to poor planning by donating countries.  The medical equipment, hospital beds, anesthesia equipment are severely dated.  Hospital and medical supplies are typically in short demand.  On two occasions, temperatures could not be taken with patients during the past three days because thermometers were not available.  Mercury thermometers are often used here because digital thermometers eventually require batteries that are not available here.  The little electricity that is here is unpredictable.  It is not uncommon for nurses to have to place an IV in someone's arm during the night by flashlight or candle light because they have no electricity.  Despite its antiquated equipment and lack of supplies, the Maseno Mission Hospital provides healthcare to hundreds of people every day that would otherwise have none.  People that cannot pay nor have no money are never turned away.   The Wildlife Reserve Experience at the Maseno Mission Hospital Compound   I was surprised when I first saw the cottage I would be living in for three weeks with a cow tied up just outside my window. There were other cattle tied up in the front yard so I realized that this was just the way of life here.  Okay, just watch where you walk before you go into the cottage.  As I was walking in I noticed a creature with a very long tail causally walking across the perimeter of the yard.  I looked into a nearby garden and noticed more tails and a few heads poking up between the leaves of the plants. MONKEYS!  Yes the Maseno Mission Hospital is home to a troop of Rhesus Macaque monkeys along with cats, dogs, chickens, roosters and cows.  The monkeys roam the compound like it is their home.  Females travel with their infants on their backs.  Juveniles chase each other from tree to tree.  They walk down the sidewalks and roads of the clinic compound like they are there for their annual examinations.  They climb up on the porch of your cottage and they sit in the windows.  If hand fed, they welcome themselves into your cottage and steal your food along other items that are not locked up.  One medical student who was visiting here recently here left his cell phone in his room unattended.  Later that day he came back to his room to make a phone call and found his cell phone missing.  He finally had someone else call his cell phone out of desperation in hopes of locating it.  Another medical student standing on the porch heard a cell phone ringing up in the nearby tree vigorously being shaken by a monkey wondering why it was ringing.  Cats walk through the clinical wards. Chickens scratch immediately outside most of the medical buildings.  Monkeys frolic in the trees and bushes around you.  Yesterday when we went to the outdoor chapel for morning service, we had to pay homage to the monkey hanging off the entrance to the chapel as we tried to enter the physical space.  The day before that, a rooster walked into the outdoor chapel during the middle of the church sermon between the church pews challenging the minister giving the sermon to see who speak the loudest.  It is not uncommon to have chickens, roosters, monkeys and cows in the choir as we sing our morning spiritual hymns in Swahili at our 8:00 am devotional service each morning.

David Nawrocki at Maseno, Kenya - Chapter 1

Day 1 Nairobi   This is the beginning of a three week journey to the Maseno Medical Mission in Maseno, Kenya, East Africa.  Arrival into Jomo Kenyatta airport in Nairobi was at approximately 9 PM on Sunday October 4th.  The flight from Boston to Nairobi ,Kenya is a 14 hour with a brief layover in London.  Boston to London is 6 hours.  London to Nairobi is 8+ hours.  The flight from London due south takes you past the coast of Sicily.  As you approach the continent of Africa, you fly parallel to Alexandria, Cairo and Luxor, Egypt and the Suez Canal  at an altitude of 33,000 feet at approximately 870 mph ground speed.  Continuing south the flight then takes you over the Sahara desert past Khartoum.  The Boeing 767 we were flying in dropped its altitude to around 12,000 feet.  You could look out through the cabin windows and see this vast white ocean of sand that reached into infinity in all directions.  Prior to passing over the desert we flew over mountain ranges in north Africa that looked like they were going to reach up and touch the plane at times.  The mountain peaks were gray, snow and ice covered reminding you that it was 50 degrees below zero outside the cockpit of the airliner we were flying in.    We landed in Nairobi at 9:00 PM Sunday October 4th.  The actual time in Nairobi, Kenya is GMT +2 hours or seven hours ahead of EST time in Boston.  On the London to Nairobi connection I met other physicians, public health workers and a film crew that were on their way to Mali for the building of a health clinic for women with HIV and a pediatric clinic.  I mentioned my concern for getting and avoiding the confiscation of the 60 lbs of medical supplies I had in my bags with local customs officials.  I asked for their advice since they had been to Nairobi several times before on medical mission work.  Brad, the medical director and lead physician for the group asked me to join their group as we made our way through the customs area.  They encouraged me to be firm, respectful but persistent if the customs officials attempted to impound the medical supplies.  I mentioned to my newly discovered Mali medical missionary contingency that there were many people at home praying that the medicine would make its way through customs inspection and eventually to where it was needed most.  The medicine made its way through customs uneventfully.  God and prayer have a way.  Proceeding through customs in numbers also helped.   My new found friends at the airport were traveling in a different direction so we went to say good bye.  One of them asked Brad, the medical director, why he continues to travel to Africa to work in a medical missionary capacity when he has a successful medical practice in Kansas City, Missouri.  He simply said,"it is in my heart.  I do not know why God put that feeling there, it just lives there so I keep coming back".  We all shook hands.  Brad gave me a big hug and wished me luck on my continued passage to Maseno the next day.   Kenya is still considered the Cradle of Mankind, the adopted home of seventy different groups of African migrants each with its own distinctive cultural identity.  In parts of Kenya, the searing wind still scours the waters of the Jade Sea of Lake Turkana, hippos wallow alongside crocodiles, and nomadic tribes people still live a life essentially unchanged from that of their ancestors fifty thousand years ago.  Kenya is a land of miraculously harmonious contrasts: tropical ice, teeming wilderness, vibrant culture, and gentle tolerance.  A place where despite the burdens of poverty, drought and famine, the phrase Hakuna matata  ("no problem") embodies the national attitude, and a smile is the most valuable currency.   I met my pre-arranged cab driver for the drive to the Anglican Guest House to spend my first night in Nairobi before making my connecting flight the following morning to Kisumu, and then Maseno.  The minute you walk into the night air in Kenya, the smell and crispness is unlike any place I have been before.  The sky was remarkably clear and so close it looked like you could reach up and touch the large moonlit cumulous clouds. We made our way along the main highway from the airport to downtown Nairobi.  In the shadows of the headlights of our cab on the side of the highway, I saw the unmistakable movement of giraffes and antelope (at 10:30 at night!).  John, my cab driver said that the animals come in off one of the  game preserves located near the airport looking for food since the short late summer rainy season does not provide enough in their local habitat.  I was speechless over the wildlife discovery while John referenced the sighting like I might describe seagulls along the beaches back home.