Team spirit

There are so many data issues with the questionnaires that i'm working on, and it's frustrating because the sites are either taking a long time to reply, or don't reply at all. Now I can sympathise with the data-managers back home. I'm sorry for all the times that I've chased them for data, I take it all back now! 

 

Feeling a little frustrated too, as I analysed the data using absolute differences, later to be told that the results were different from the national results. When we looked further into it, it turned out the populations were different pre- and post- training, and so I should have been looking at percentages. Ergh!

My colleague had a call from the college administration office to say that her brother had been arrested with no reason why. She was upset he'd been arrested, but so relieved that he was alive. She was to travel over to the borders to help get him out of jail. Families really pull together here, there's such a sense of team spirit when family members are in need of help, the other members don't even hesitate to help out. My other colleague was back in the office, feeling much better. Her blood-slide had come back negative for malaria, so that's good news. She thought perhaps she was suffering with exhaustion. The reasons for time off work here are a little different to our reasons back home.

More on the African culture...

I thought the training went really well this morning. There were some really good questions asked; Can you write a paper with descriptive statistics only or do you need inferential statistics also. Also, if my sample size should be 342, but 1000 patients were screened and participated, should I only use 342 in the analysis? So the class had a really good discussion around these two points.

Here I am teaching

I finally spoke to the Prof today about the Run for Good in Eldoret. He's not keen on raising money for Vitamin Angels, and wants to have the discussion with the Global Network team about who we raise money for. He felt we should focus on the community needs; for example, buying bicycles, or an ambulance.

One of my colleagues went home with suspected malaria. Another colleague's brother has gone missing. He had gone to take an exam in Uganda at the weekend, and was due back on Sunday evening, however, there was no sign of him. My colleague spent most of her day trying to find out what had happened. She called the university, but couldn't get through.

One of the Professors had come into our office and was talking about Politics as Ruto heads to the Hague to attend the confirmation of charges hearing at the International Criminal Court. He is defending himself, along with 6 others implicated as key perpetrators of the 2007/2008 post-election violence in Kenya. I was finding it hard to follow the discussions as they kept switching between Swahili and English. The conversation changed direction, and they started discussing family planning in Kenya, and I was able to pick up on some of the discussion; which went something like this:.

The Professor explained that “..people were told you use contraceptives because you didn’t want children. In Africa, everyone wants children – it’s the culture here. If a woman doesn’t want children, she is considered a witch.” Families tend to be large, because it’s a sign of the families prosperity and also, the parents know they will loose some of the children due to disease. I’m wondering if these opinions will ever change in terms of the size of the family reflecting prosperity? I’ve discovered that if a community/tribe have a particular belief, then it is difficult to change this. For example, FGM (Female Genital Mutilation) still goes on in many of the villages in Kenya. Despite efforts from International and local human rights groups, the women in the tribal communities protest against these groups, because they believe that the men won’t want them unless they are circumcised. I have to admit, this shocked me, but then I can understand that if it's been part of the culture and is a long, old tradition here, then it’s hard to change a mindset. Although, it might be an old tradition, but if it leaves the women with chronic infections, infertility, the spread of HIV and severe bleeding being just some of the side effects, I struggle to see the arguments for it. In the Masai community, female and male circumcision occurs when they reach adulthood. It is a sign of the change in their status’. It seems this is changing however, as the communities learn the risks and the side effects of such practices on women.

Things are so different to back home, it made me realise how we are two worlds apart in terms of culture and beliefs.

I'm getting messages from back home, as people are worried about me. They've heard on the news about the British man murdered and his wife kidnapped on 11^th September. It's sad and devastating news.

Four new friends and Kakamega Forest

Arrived at the matatu station this morning. I asked the men there how to get to Khayega, which was a mistake, because of course everyone wants the business. The man I asked said I could take his friends' matatu and change at Kapsabet for another matatu going to Chaveli, and then Khayega, which is where I'd arranged to meet Michael (the other PULSE volunteer from Kisumu working for the OGRA foundation.) He was driving, and the plan was to meet in Khayega, and travel to the forest from there. Anyway, the man at the matatu station gave me his number and said to call if I had any problems. I call Michael from inside the matatu, and we agree to meet in Chaveli instead. The matatu takes some time to fill up, but once full, we’re off. Peter (the missionary sat next to me) overhears my conversation and starts chatting to me. I'm skeptical at first, and weary of how much I tell him, but he seems quite genuine, and i'm enjoying the chat. He's going to preach at a boys school on excellence this morning. Just before getting off, he says if I need help at anytime, here's his number. 

We pass the 5km sign for Kapsabet, and the matatu stops. The locals are talking anxiously in Swahili, and i'm not understanding a word. Suddenly everyone starts putting on their seat belts, so I do the same. We continue a bit further down the road, and the conductor dismounts. He runs up the road, and then back, and says something in Swahili, and everyone gets off the matatu. It seems that the traffic police are there, and the matatu doesn't have the appropriate license for which they could go to jail. The conductor tells me to follow everyone else. So I do as i'm told. It's here that I meet my new friend Robert. He's from the Kalenjin tribe, and an athlete, studying car mechanics at the University in Kapsebet, wanting to get a scholarship for his running to study in France. Robert showed me the way to Kapsebet. He explained he was an orphan. I was expecting that I'd have to give him some money for showing me the way, but at no point on the journey did he ask for or expect me to give him money. I wish I wasn’t always so skeptical, I just can't help it. Instead, Robert gave me his number, and said to call him anytime, and gave me God's blessing. What a nice guy. I called Michael en-route to explain what had happened, and he said he'd drive to Kapsabet instead.

I found a hotel called Elten. Apparently, this is the tallest building in Kapsabet, so Michael should find me easily! Here, I met Dan, who seemed anxious to talk to me. I thought he was a worker at the hotel, as he was lingering in the hotel entrance, but later turns out he is friends with the owner. Michael turns up about 15minutes later in a four-wheel drive.

It was great comparing stories and experiences, it sounds like he’s having a completely different experience to me! I guess one of the reasons being he is one of 6 PULSE volunteers in Kisumu, and I am on my own.

We got a guide at the forest for 500KS (~3.50 GBP) each, and then 600KS (~4.00 GBP) for entry into the forest. We went via the Southern part (the Isecheno area). Kakamega forest is amazingly beautiful. 

Saw lots of butterflies, monkey's, and safari ants! There were also medicinal plants there for various ailments, including healing colds. We ended in the butterfly house. On the way home, we saw baboons on the road, which was pretty cool. I wound up the window to stop them stealing our food!

Can you spot the black & white tailed monkey?

 I caught a matatu from Kapsabet. It took some time for it to fill up though. Street sellers were trying to sell me nuts, fruits, maps, posters and various other paraphernalia. Grace made a fruit salad with the avocados that Evelyn had given me on Friday, which we shared. The fruits are so juicy and tasty here compared to back home. I worked on statistics lesson for tomorrow, then skyped home. Was nice to see and chat to everyone. I feel so distant from them all.

A day in the life of…..a Kenyan family

This weekend was probably one of the best I've had so far in Kenya- it's really given me the chance to see how Kenyan families live, and it's something that I don't think a tourist would be able to do easily.

From left to right: Kennedy (holding Dotty), Cecile, Judy, and Josephine holding Cos

I went with Judy and her family to church this morning. Judy was keen I went to the study work group, so I attended with her husband whilst she took her youngest children (aged just 5months (Cos), and 1yr 5months (Dotty)) to the creche. Feeling a little awkward, I listened to the discussions, about believing truthfully and spiritually. At the end, the group leader said; none of our sisters have said anything (there were only 2 “sisters” in the group, including myself) and he wanted one of us to end with a prayer....ahhhh! I hadn't expected that! Praying that the other “sister” would pray, as I had no idea what to say, luckily, for me (and everyone else there) my prayers were answered, and she said a few words...phew! Wow – all this praying seemed to pay off. The church service was about family life, held under a canvas outside. Dotty has a crazy amount of energy, and it was difficult to keep track of where she was! Josephine, the house-girl, came along too. Judy's brother, Henry, is over from Busia, staying with them at the the moment, as he is doing an undergraduate degree in social work.

Judy and Henry

He previously had a contract with AMPATH working to prevent HIV in commercial workers, prison workers and long distance truck drivers. He's passionate about his work, and it's great to see. He has the funding for the first year of his undergraduate course, but needs funding for the next couple of years. Judy had asked me previously if there was anyway I could find sponsorship for her brother. I'm struggling with these requests. I have no idea who to ask? Unless we can fund raise to get this money, but then you'd be forever fund raising. There must be other ways?!

After church, I went back to Judy's house in Kapsoya, which isn’t all that far away, but the roads are bad. We were lucky the rain stayed off. She cooked Githeri for lunch, which is a bean casserole. We also had cabbage stew and pumpkin, finished up with bananas. 

The girls played outside, whilst Cos slept, and I helped (or more like watched!) Judy make Chapati's. 

Dotty and her crazy amount of energy!

Judy making chapati's

They are growing sukuma wiki – it's amazingly tall. We had it fresh in the evening. I learnt about tribalism, and how prejudices exist against certain tribes, which can actually influence whether people are selected for jobs or not. Life is tough here, not only are they dealing with the corruption and poverty, but this just makes it even harder . We ate tilapia (stewed fish) from Lake Victoria, which was lovely and cooked soya meat.

We had a blessing, just like last night, and sang some hymns. Kennedy (Judy's husband ) drove me home with Cecile and Henry. Apparently, Cecile has since been asking that she wants “.. to be taken back to the house of the Mzungu!!”

An evening living Kenyan culture and a surprise visit

This morning, I got a fright going into the kitchen, as there were two cats fighting in there! I'm such a scaredy cat. I have no idea how they got there?!! I think they were just as scared as me as they ran into Mira’s old bedroom. Thinking about it, it might not be such a bad thing having the cats in the house, they might resolve my furry friend problem! I got a lift from my landlady into work and told her about the cats. She was on the phone immediately to the house-girls to get rid of them as they were strays...oh well, so much for the mouse trap idea.

At the training on Monday, one of the nurses asked if they could have my hand written notes from the classes, so I've spent the day writing them up. I went out for lunch to shop for presents as I’ve been invited round to Evelyn’s tonight, and then spending the day with Judy tomorrow. I’m wondering what I should take with me to say thank you?

My colleague got some exciting news this morning. I’d reviewed an abstract of hers last month, which she'd sent off for presentation at a conference over in Montreal, which had been accepted. The only problem is, she cannot fund herself to go over. She was asking me about sponsorship. I've got no idea how people go about getting sponsorship here? That said, back home either? I emailed GSK to see if they would be able to sponsor her, but unfortunately they only provide funding for organisations, rather than individuals. I’m not sure how I can help her?

My colleagues were discussing salaries in the office, and the poverty in Kenya. I discovered that one of the office girls pays 2000 KS per month (approx. 14 GBP) for her accommodation, (which includes an outside toilet and washing facilities). After she’s paid her rent money, she doesn’t have enough left from her wage to take transport into the university, and has to walk 1.5hrs to and from work each day. How is this fair? Ergh, I know we complain at home, but this really puts things into perspective.

I was invited back to Evelyn's compound tonight. She owns chickens, which were clucking around outside. 

We sat outside and watched the cooks and house-girls cooking on a jiko (a stove heated with charcoal.).

I still find the concept of cooks and house-girls difficult. I remember it was the same when I was in India. It was quite a natural thing to have a cleaner, and someone to iron for you. I felt guilty asking someone else to do it, but I guess at the same time, it creates employment. I also saw how the maize was ground in order to make ugali. We took the maize to a man, who first shakes it in a tray with netting to remove the husks:

  It is then passed through a machine with a huge funnel at the top to grind it down.

Evelyn taught me to make chapatis and ugali. 

 

I can't wait to try this out myself :) I later learnt that her son, Emmanuel, has been bouncing the basketball ever since I left (my present to him), and takes it to bed with him...hmmm, I bet it drives his family up the wall though. I found it funny because Naiomi, Evelyn's daughter asked me if my hair was real??!! I guess because weaves are quite common here (where they sew human hair onto their original hair.)

All the food was amazing. We had sukuma wiki (kale), kunde (a green, leafy vegetable, a bit like spinach), yam (a root vegetable) and obviously chapati's and ugali (the staple Kenyan food).

 

We finished the evening with a blessing. I was feeling a little awkward during this devotion, as it was the first time I'd been to anything like this. The family prayed for me in Kenya. Then Evelyn asked the family to thank God for something during the week. I wasn't sure what was appropriate, but I thanked God for a lovely evening with them, and having the opportunity to meet them all.It was so nice (although a bit embarrassing) when Dotty (their house girl) thanked God for bringing me into their family.

 

Douglas, the taxi driver drove me home, and all the lights were on in my house...oh oh, perhaps there's a power cut at my land ladies house and her kids have come over again uninvited, but no, it turned out I have a new house mate, Grace, from Tanzania! I'm so happy to have some company in the house. She's a student doing a phD in business management. She’s a bit older than me, and has a family back in Tanzania.

The Importance of Titles...

I ran the third session on an introduction to medical statistics, including factorial, and fractional factorial designs, case-control studies, cohort, and cross sectional studies. A couple of my team came up to me after and asked for the slides, they also want my hand written notes (which I've made just for an aid to help me). It's great that they are so enthusiastic about the sessions. In fact, Betsy, explained that in her career as a nurse, no research went on amongst the nursing staff, and when she resumed her nursing role at the general hospital, she wanted to encourage the staff to come to my sessions. This was really positive feedback. At the end of the session, I asked the team what they thought about doing a "Run for Good" over in Eldoret. The response was fantastic. Everyone is so keen. The team think they can round up about 100 participants, including students, and raise money for charity. We thought perhaps we could raise money for Vitamin Angels (which provides the vitamins for the EmONC (Emergency Obstetric and Neonatal Care) project ongoing at the moment, but due to finish soon). This money could help with the distribution of the vitamins to the villages after the project finishes. The charities mission is 

"...to mobilize and deploy private sector resources to advance availability, access and use of micronutrients, especially vitamin A, among at-risk populations in need. Vitamin Angels reduces child mortality worldwide by connecting essential nutrients with infants and children under five. Essential nutrients enable young immune systems to fight infectious diseases, helping children attain good health and the opportunity to lead meaningful and productive lives."

We will need to think about logistics (people tell me here I will need to alert the police, which involves taking a letter from the professor), and also involve the Salvation Army nurses. The UK run is very soon (17^th Sept), so I will need to liaise with Shona (who is the senior brand manager at GSK for Lucozade Sport Lite) to see if we can have more time? This is exciting, but at the same time a little daunting! It seems like the event is going to be bigger than I expected. Everyone is being very supportive though. Allan has even mentioned that he thinks he can get 20 street children or orphaned children from the charitable children's institutions to participate!

Today, the data-manager asked me whether people in the UK consider their titles of great importance (for example Drs, Professors insist of being addressed by their title etc). It turns out that in Kenya, students have been known to fail courses for getting their lecturers title wrong. Also, if you ask a question to a professor, but by accident refer to him as a doctor, he is likely to ignore you. They explained that you're giving the impression of not respecting their knowledge, by addressing them incorrectly. I became aware of this hierarchy when at a meeting with the Professor and the Global Network team. When the tea was served, the professor had his own tea flask, and the Global Network members all had to share one. He also got served separate cakes to us. Also, the data-manager was telling me that people in authority don't like to admit that they don't know, even if it is not their area of expertise. They are happy to take advice from those specialist, but at the end of the day, they have the final decision.

It made me think back to the first telephone conversation I had with the professor, where I addressed him by his first name. Mid-way through the conversation, I was reminded of my time in Bangalore, and how all my colleagues addressed the manager as “Sir”, I also remembered that the Professor signed all his emails as Professor. I asked him if I was addressing him correctly, and he said No, he'd like to be called Professor. I felt a bit stupid after that, but I'm certainly learning here. 

Oh, something that made me smile was the quote from the matatu today "If somebody is talking to you about somebody else, it is likely that they will be talking to somebody else about you"

Lake Baringo

I left with the IU (Indiana University) students for Lake Baringo in a four-wheel drive at 7am this morning. Lake Baringo, after Lake Turkana, is the most northern of the Great Rift Valley Lakes of Kenya, and it is one of the two freshwater lakes in the Rift Valley. I was travelling with a bunch of medical and pharmacy students. I began feeling queasy with the conversations that were going on behind me, as they started talking about a tissue box which had a 16 week old foetus cello-taped inside with it's name on the box, which had been sat in the ward for a week now. Last week they'd experienced a child born as a hermaphrodite, and the parents had to decide whether to bring it up as a girl or a boy. I tried to block my ears after that, as the road was getting increasingly bumpy, and I was worried I might get a bill for a car valet! At one point, I thought we might have to get out and push, as a river had flooded the road. Some boys guided through, I don't think we really needed guiding, I think it was more of an entrepreneurial exercise just so they could make a few bob at the end!
We stopped off at some beautiful viewpoints.

It transpired that we were staying on an island in the middle of the lake! How incredibly exciting. We took a boat over to the Island resort. Apparently, there are crocodiles and hippos in the lake. I think the Flamingos have migrated for the season unfortunately. We're staying in little tents overlooking the lake, it's really idyllic – and, we are pretty much the only people in the resort. After setting ourselves up, and having a feast for lunch, myself and Myna went out on a couple of log canoes. 

We were a little worried when we were handed a couple of hand paddles, and told to go. I was out first, and had some problems with the steering, but got there in the end. Myna followed, but unfortunately, her canoe was broken, and she capsized. I took mine out a little further, but a dark cloud started drifting over, and I thought I'd better paddle in before the weather turned, (or I got eaten by crocs) especially as I didn't feel so stable with the hand paddles!

We met up with the others, and went on a boat trip around the Island. Saw an Eagle, Kingfisher, and my first hippo! 
All I could see were its eyes just surfacing above the water, no crocodiles though. I'm not sure if you can make him out in the photo below:

We landed on a rock, and dismounted the boat, so we could photograph the setting sun. 

We disturbed a few scorpions who were resting under rocks, no serious damage luckily.

We had a Bar-B-Q in the evening, and then finished with the Lion King. Molly had brought her laptop and movie with her..so in Zazu's own words; Oh, my, my, my. Look at the sun. It's time to go!

The following morning, we were up to watch the sunrise, and they brought us tea and biscuits. Some of the group managed to spot a crocodile in the lake. I missed it – typical...I sat, for ages scanning the lake, but it just wasn't happening. I was mesmerised by the rising sun, and continued to sit for ages, reading.

After breakfast, myself and Myra went water-skiing. The others watched from the Platoon. Myra just took off – and only used one ski. She was amazing on the skis, was doing all sorts of tricks like holding the rope between her legs, and waving at us. I, however, was pretty hopeless, having only tried it once before, and retrospectively, it probably wasn't the best lake to learn in with crocodiles and hippos, but I was keen to try it, and after all Myra made it look so easy. It later emerged that she water skis for the university team. I fell in several times, and managed to swallow a lot of the lake – here's hoping it was a clean lake – I guess I will be due a schistosomiasis check up when I get home!

Here I am, attempting to ride the waves on my skis

Feeling a little demoralised after falling in..

 

Anyways – it was good fun, and I'm really glad I tried it.  I was sad when it was time to leave.

The rain just came on as we arrived in Eldoret, so spent the evening preparing for my training session tomorrow morning at 8am. I've discovered that texting everyone the night before increases attendance at the sessions, so I'm going to get in the habit of doing this!