March 2nd, 2011 by INMED
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I’m back in the US! It only took about 45 hours to travel between Kapsowar and Memphis, but I made it!! The morning of the 28th began bright and early, as we left Kapsowar for Eldoret about 5 am. I had about 12 hours in Nairobi from the time I flew in that morning from Eldoret and the time I flew out that night to Amsterdam. To keep myself occupied (and safe), I hired a driver for the day. This gave me the opportunity to have a little tour of the city, go to a mall/market for last minute souvenirs, and see the National Park. Nairobi National Park was awesome. I’m told it’s nowhere near as nice as some of the other parks in Kenya, but for an afternoon safari it was perfect. We entered the park just before 3, and we left right after closing around 6. During that brief time I had the opportunity to see so many of the different animals for which Kenya is famous. The first ones we found were giraffes—about 10 of them—just hanging out along the road, as though they were waiting for me. Then we saw even more giraffes, with zebras mixed in, just around the corner. I ultimately saw about 3 herds of zebras (very large groups, not just a couple), and lots of giraffes. In addition, the park has several herds of water buffalo (some with babies!), and several rhino. I wasn’t able to get very close to the rhino, but I was close enough to get good pictures of everything else.

We also saw some ostrich (with babies), impalas (antelope looking things), other antelope that I couldn’t understand the name of, and several different types of birds. The final excitement came when we spotted a lioness sleeping in the grass. She never really woke up and moved around, but I was able to see at least the one lion, and she would occasionally lift her head. The only thing that we missed was an elephant, and apparently the park doesn’t have very many of them. It was so cool to see all these different animals so close to the city; while the park does have a fence around most of it, it’s open on one side for migration paths of the animals. I was amazed at how close we could get in many cases before the animals got spooked and ran. I had a great time seeing all the different animals; it was a wonderful way to end the trip!

This whole experience has been amazing. The month flew by—I have no idea where the time went, and next time I’ll have to go for longer. I learned a lot medically about how to function in a hospital without what we would consider the most basic tests and supplies (most of the time we couldn’t check electrolytes or blood cultures, for example). In Kapsowar, I was able to see a variety of medical conditions we don’t have in the US, from malaria or typhoid to rheumatic heart disease to arrows perforating the bowel. I also had the opportunity to grow in my faith and see a different—more enthusiastic—side of Christianity than I’m used to here.

The Christians in Kapsowar are so excited about God and their faith; I think in many ways we often take it for granted. When we’ve never been oppressed, or in the minority, it’s easy for faith to just become a part of us—not something we talk about as much, or something new or amazing or that could become a problem for us in the community (the Pokot Christians, for example, are ostracized from their families and the community). The Christians I met were much more vocal about putting their trust in God and believing that God is good, all the time. I’m not saying we aren’t, I’m just saying that they were more apt to talk about it than I think we are in this day and age. I don’t really talk about my faith all that much back home (especially with strangers); in Kapsowar, as a visitor to a church, you were expected to stand up and introduce yourself, including a statement of belief or a statement that you’re saved. It’s a bit different from how we worship in the Presbyterian church! In less exciting ways, I’ve gotten great at improvising for meals and cooking with the same few ingredients over and over. I’m definitely going to miss Kapsowar, but it is nice to be home.

February 26th, 2011 by INMED
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Today was my second to last day in Kapsowar, and it was a busy one. We were invited to lunch at one of the Kenyan women’s homes, and she told us about her life as a Kenyan missionary. She actually lived among the Pokot for 8 years (back when they were at war with the local tribe here), trying to spread the Gospel. She lives on donations from others as a missionary—about $60 a month! Lunch was delicious, as usual, and we really enjoyed our conversation. She asks for prayers of support and that the local people here may open their hearts to God. I spent a lot of time trying to organize all the pictures I’ve taken, in between running out to see how two of the girls hair was going in the braiding process.

In the afternoon we went for a final long walk, this time not nearly so long or so steep as previous Saturday walks. We just didn’t have time! One of the other students and I are both leaving Monday, so we walked into the forest along the road to Eldoret. Along the way we met 2 sisters, one 12 years old and the other looked about 10, who were fetching large loads of wood for their families. Besides the fact that they kept laughing at us, they were interesting to talk to. We also were followed by large crowds of children—mzungu always have a following. After the walk we had chai with one of the pastors, then said goodbye to other Kenyan friends. It’s been a busy day of visiting, and tomorrow looks to be pretty similar! At this point, all four of us girls have our hair braided Kenyan style, which seems to make the locals happy. J I can’t believe tomorrow is my last full day in Kapsowar!

February 25th, 2011 by INMED
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As I write, I have Oscar Kiproteich the chameleon on my shoulder.  The name is fairly typical for Kenyan names.  Most Christians have some sort of English first name, usually from the Bible (twins Shadrach and Meshach were in the hospital today visiting their mama).  The second name usually refers to the time or occasion of birth.  Kiproteich means born at 4pm, Kibet is born 12-1, and many others indicate time of day.  Some mean things like “should have been born yesterday”.  Names starting with “K” are for boys; girl names start with “Ch”.  It’s quite interesting, but I have a hard time remembering the meanings of all the names.

In case anyone was interested, I received more comments about my hair today than “habari”.  Everyone greeted me with “oh your hair, it looks so smart” (or in one case, “lovely” and “fly”—still trying to figure that one out).  It was rather interesting to walk around the hospital with my hair all braided.   It was also my last day at the hospital (time has just flown by), and I had a good morning on OB, just nothing too exciting.  I walked up to the local Children’s Home  during the middle of the day, which was interesting to see.  The kids don’t have much, and there isn’t a lot of money in the local churches to take care of the orphans properly.  They’re fairly self-sufficient, growing their own maize and beans and vegetables, but they lack things like flour.  As a result, the Christmas treat every year is a chapatti and a soda…it makes me realize (yet again) how great I have it back in the US.  In the afternoon, we finished off seeing OB clinic patients, including one with rheumatic heart disease (not something we’d see in a pregnant lady back home).

Tonight I assisted with a c-section of a lady who had been in labor for over a day.  (Probably TMI ahead, skip to the end if you don’t want medical talk).  The c-section was held up by the placement of the Foley catheter (goes into the bladder), because we had a really hard time finding her urethra.  She had been circumcised; about 80% of the women here are.  It’s horrible, as it completely screws up the normal anatomy, makes everything more painful, and makes childbirth much more difficult.  Episiotomies are so common here that it’s almost rare to have a delivery without one.  Circumcision for girls and boys happens at about age 15-16, and it’s basically an initiation rite into adulthood.  Even though it causes a whole lot of problems for the women, it’s still a part of the tradition and culture, and that’s really hard to fight against.  I think slowly but surely the strong Christians are trying to make an impact, and change is happening, albeit much more slowly than we would like.  Ok, I’ll step off my female circumcision soapbox now

It has been a good week on OB, but it’s also reinforced that I really want to go into Pediatrics. I still easily like the babies and the kids the best.

February 23rd, 2011 by INMED
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Today has been a great day. I got up way too early in the morning because another one of the med students and I were going into Eldoret to pick up the long-time surgeon and his wife, who have been home in the States for the past 3 weeks (they’ve otherwise lived here 12 years now). We made it to Eldoret (2 hours away) shortly after 8:30, which gave us almost 3 hours to do our shopping. I had no idea how much I’d adjusted to Kapsowar and Kenya. First off, the bumpy roads from my drive in to Kapsowar were so much better; they seemed great. I still got really excited to see a monkey (colobus is apparently the name of the type of monkey) running across the road, then hanging out in the trees. Then, Eldoret felt like a city, and I’m sure it’s much smaller than anything I would have called a city back home. But there were so many people, and I didn’t know any of them, and so many streets and cars and pedestrians. There were also a lot (ok maybe I saw 8 or so) mzungu around, none of which I knew…I hadn’t realized how used I was to not seeing any mzungu I didn’t know around town. I also really wondered what they were doing in Eldoret, as it’s really not on the tourist trail of Kenya.

We went souvenir shopping at a cultural shop, then at some market stalls. Again, everything’s so cheap, and bargaining’s a big part of buying, but it’s easy to get caught up in the Kenyan mindset of “no, that’s more than the really really cheap price we want to pay”. Still, I was able to actually obtain some souvenirs of my trip–something that’s impossible to do in kapsowar. Still no postcards…I’m not sure the Northern Rift Valley has gotten that far yet in terms of tourist items. They should—the scenery around here would make beautiful postcards. We picked up the surgeon and his wife (who had met me a bit over 3 weeks ago when I arrived in Eldoret) and had initially planned to leave right after they got in from Nairobi. True to Kenyan style, 2 hours later we were on the way back to Kapsowar.

I got back and instead of going into work, I baked Tollhouse chocolate chip cookies, Kapsowar style, which means raw and unrefined sugar was used in place of the white and brown sugar and the amount of butter (and salt and baking soda) was guestimated. The dough was pretty sweet, but the cookies baked up ok. Remember that the oven has no thermometer, and we’re at very high altitude, so I’m pretty pleased they turned out, when it’s all said and done. Tonight we had a going away dinner for a resident who’s been visiting—I’m really sad to think I’ll be leaving as well in only 5 days. The dinner was a lot of fun—we made homemade pizzas (the only way you can find pizza anywhere near here) and had cake and the cookies I had baked. We also had a great time playing the game Settlers of Catan, which I had never heard of or played before. It’s normally a 6 player game, but we created teams so all of us could play. My partner and I were losing pretty badly at first, but we jumped in the lead to win unexpectedly. I’m really happy that I’ve had such a great group of people to work with so far away from home!

February 22nd, 2011 by INMED
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Today was one of those days when we were pretty much busy all day, but we didn’t really do much.  It started out with no water again, but we were expecting it when last night the water began to only trickle out.  I’m on OB this week, which really just means c-sections and anything gynecological.  The women who deliver vaginally are usually taken care of by the nurses, unless there is some complication.  We rounded, checked on the labor ward, got our morning chai from the kitchens, checked on the labor ward, saw OB clinic patients, checked on the labor ward (we had one patient that really wasn’t progressing; we finally broke her water just before lunch).  After lunch (during which time the water came back), we had 2 deliveries back to back, and I played pediatrician again to take care of the babies.  Both did very well, so there wasn’t much to do except examine them, then wrap them up.

The nurses all started laughing at me when I talked to the newborns.  I know they can’t understand me, but the tone of voice can be heard and soothing in this scary new world, right?  Oh well, I liked talking to them, and they didn’t cry at the sound of my voice so that’s all that matters.  After some more clinic patients (and a failed attempt to make a breech baby go the right way), it was time to go home.  I had ample free time today to take lots of pictures in the hospital and listen to the service given by the hospital chaplains on the female surgical ward.  It was another intro to Christianity kind of talk, and most of the women on the ward raised their hands to pray to accept Jesus into their hearts.  It was a pretty interesting thing to see, not having been raised in the tradition of altar calls; I’m not used to witnessing that particular type of service.  The hospital chaplains here take their jobs very seriously, and they do their best to reach all the patients.

Tonight we hosted dinner for some of the Kenyans who have had us over for meals.  I’ll think there were 12 people altogether…I’m not sure how we all fit inside!  No goat for dinner tonight, but I don’t think anyone was disappointed.  Hosting dinner is a big affair, as we have to have rice and cabbage (or some other vegetable), meat of some sort (we made a sausage, potato, and bean stew), and chai to follow.  I also made pumpkin bread to use up the last of the big pumpkin we were given a while ago, and it was a big hit.  Thankfully all the food turned out well, even though I don’t think any of us have ever cooked for that many people!  The power started to flicker right after everyone left, and due to peculiarities in the wiring system (or something, we’re not exactly sure why) every time the power went out the tap on the sink gave off really bad electrical shocks if touched.  It made doing dishes pretty interesting, but we’re told that it won’t cause bad power problems and that we don’t have to worry about the house burning down or anything.  There is always something going on here!

February 5th, 2011 by INMED
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We’re back in Kapsowar after the weekend away, and it’s strange how much it felt like coming back home (don’t worry, it’s still not home home).  If I didn’t already know I was in Africa, the weekend in Pokot confirmed it.  East Pokot (Lodengo is the name of the village) is pretty much how I pictured Africa before I came here.  It’s very very dry (the fact that we’re toward the end of dry season doesn’t help), with scraggly thorn trees and acacias and low level brush (also thorny).  We decided while down in the valley that Africa’s just a dangerous place—dangerous animals, insects that carry dangerous diseases, dangerous plants that like to stick you, and probably dangerous people.  The Pokot people are very traditional, and still lead fairly traditional lifestyles.

One of my favorite sights on the trip (which unfortunately I couldn’t get a picture of) was a man dressed all up in tribal garb: bright colorful cloth worn rather like a toga, beads at the neck and wrist, big earrings, sharp spear-looking stick.  The rather random additions to his wardrobe were a camouflage baseball hat and a cell phone.  Quite the 21st century African warrior!  Many of the women in Pokot wore the usual skirt, but with bright fabric capes worn over one shoulder and big earrings in huge holes in the ears (some of the older women had ear lobes down to their shoulders, no joke).  One of them wore a goat skin, which she graciously allowed me to try on and take a photo with.  She didn’t want her picture taken because she thought the camera would bewitch her…apparently a pretty common view among the older crowd.  A lot of the men also wore skirts and carried big sticks (apparently a man should not be without a big stick—what would happen if they came across a snake in the bush and didn’t have a stick with them?).  They also carried little seats with them: basically a flat bottom, short stick connected, with a cradle like seat.  Very small, compact, and ideal for the thorny ground.  The main industry of the Pokot of Lodengo is goat herding, and goats are everywhere.  From what I can tell, they’re mainly looked after by the children, who also carry sticks to herd them.  There was one adorable little girl (maybe 4?) who was carrying a stick twice her height and “helping” with the goats.  We had a goat spraying party this morning, and I took way too many pictures of all the kids.

So that’s a bit of the Pokot culture/background.  On Saturday we drove the four hours down into the valley from Kapsowar.  I have a feeling it wouldn’t have taken as long, but just about all the roads are unpaved, steep, rocky, and generally pretty poor driving conditions.  I was told over and over that the roads were greatly improved, so I don’t want to think about what they used to be like.  It still wasn’t too bad of a trip.  We were fed almost immediately (by Kenyan standards, which means within the hour) on what was the staple meal over the weekend: ugali, cabbage (a treat), and goat stew.  The goat was actually delicious—it’s probably the best meat I’ve had since I’ve been here.  They apparently slaughtered a goat in our honor.  At lunch we had delicious chapattis; at dinner the menu was altered to include rice (which oddly enough tasted buttery; as they don’t use butter, I have no idea what the flavoring actually came from.  It was delicious, so I’m asking no questions).

After lunch we went over to the church (nursery school during the week) so have an initial Come to Jesus talk (sorry, there’s just no better way to describe it).  I think many of the clinic patrons were already church members, so there was some really enthusiastic singing and prayers.  We all had to stand up and introduce ourselves (I managed to get my introduction done in Swahili—I’m learning!).  After the 4 female med students were introduced, there was apparently some debate in Pokot about how many camels our parents would want to marry us off.  I’m glad whoever was speaking on our behalf managed to dissuade anyone of that notion.  Once the service was done, we moved on to the clinic.  The one of the other med students, a translator, and I ran the prenatal clinic over in the corner of the church behind a pair of sheets for privacy.  We had 11 expectant mothers, about half with urinary tract infections and/or yeast infections, one with malaria, and one with pica (where you crave and eat dirt, usually due to iron deficiency).  I can safely say I never saw malaria or pica on my OB/GYN rotation back home!

What was also different was that most of our patients didn’t know their ages.  We saw a few who looked young—maybe 16 or 17—who were pregnant with their first, and several who were on baby #7.  We saw our patients, consulted the actual physicians as needed, and prescribed a lot of multivitamins and iron.  The afternoon moved pretty quickly, and I had a lot of fun.  We had a walk to a “spring” after clinic ended—basically a hole in the ground with a bit of very dirty water.  That’s apparently the closest water source the people have…not good.  We had dinner (same as lunch, plus rice), then there was a service of encouragement for the budding Pokot church.  The sleeping arrangements were pretty interesting.  We had 3 twin mattresses and a row of couch cushions for 7 women, so we were all sleeping pretty close in the pastor’s house.  I had mentioned last week that we take running water for granted; well, I also take flush toilets for granted.  We had no running water (they pour water from a jug over hands to wash them) and only an outdoor pit toilet.  Definitely my first experience with a pit toilet, and I like our Western flush toilets much better, thank you very much!  Today we had the aforementioned goat spraying party in the morning—apparently they sprayed over 500 goats with tick spray.  I kept myself entertained taking pictures and chasing the camels—they have camels in the area!  Apparently the women aren’t allowed to help with goat spraying, so we just had to watch.

Breakfast was chai and mandaazi (the sugar-less beignets), followed about an hour later with lunch (same as dinner the night before).  I learned how to make ugali over the open fire; they let me stir it until I slopped a bit over the side—then the stick was taken from me.  We med students ran a little Sunday School for about 15 kids at the start of church this morning.  Singing is a huge part of the culture here, and most of the songs have one person leading while the rest follow.  The little girl leading the singing couldn’t have been more than 8, and she was absolutely adorable.  All the kids were!  Church was very interesting.  The church in Pokot is very new, and it seems to me rather like the early church.

Christians aren’t well accepted in their families, and they’re often kicked out for professing their faith.  The group this morning was very enthusiastic and excited about serving God.  They are definitely an example to believers everywhere, and they have a difficult job trying to spread the Gospel in a rather uninterested environment.  The pastor—an African missionary from a different part of Kenya—made a plea for more missionaries to spread the Word to parts of Pokot that have never heard of Christianity before.  It’s so hard to believe in this day and age that there are places in the world that haven’t heard of Jesus, but this district in Kenya is one of them.  They ask for prayers of support and encouragement as they continue their mission.

February 1st, 2011 by INMED
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I’ve been at Kapsowar Hospital for two weeks already. We leave early tomorrow morning for our Pokot trip.  It’s quite exciting—one of the other med students and I will be doing all the prenatal visits for the moms there, as well as any other OB/GYN related issues, since the resident gynecologist here isn’t going.  It’ll be a little taste of acting like a doctor. Prayers for the success of our trip would be wonderful—we hope to reach many of the people there, both medically and spiritually.  At least half the point of the trip (if not more) is to encourage the very small church in the area, and we hope to reach at least some of the community with the message of the Gospel.  I’m sure it’ll be a very different experience as a Christian in a very un-Christian area.

Today was a fairly laidback day.  Fridays usually are—no one wants to be in the hospital over the weekend.  My sick Pokot baby is still very sick, but he’s still alive, which is more than we expected a few days ago.  For those who know antibiotics, we started him on chloramphenicol today which is pretty much last resort since it has some pretty serious side effects (but it’s a great drug).  We sent several kids home, including the baby with heart failure from the beginning of the week and a child with malaria.  I had my first real experience on pediatric side of a c-section today; we had an emergency c-section since baby’s heart rate was not going well during labor, and I was one of the people resuscitating him.  He did fabulously, especially for coming out fairly limp and lifeless.  That was about the most excitement we had over the course of the day; everything else was pretty quiet.  I did see my first chameleon; that was fun.  For some reason Kenyans are terrified of them, so I heard the shrieks of the kids before I saw the tiny thing (maybe an inch long).  After work, we had a great walk a little ways toward the valley for the beautiful views and the exercise.  It still amazes me how excited the kids get when they see us, yelling out mzungu over and over.  It’s really cute when they tentatively come down to shake our hands, as though we’re a completely alien species.  Living in Kapsowar, where there are white people all the time, you’d think they’d get over the amazement.

I hope everyone back home is doing well.  Again, any prayers for the trip would be much appreciated.  I’m told it’s a very different area down in the valley, and the church down there is doing its best to stay alive and spread the Word.  Plus, the people have to walk for at least a day, if not more, to see a physician, so there is a lot of medical need as well.  I’ll be sure to share all about it when we get back!

January 30th, 2011 by INMED
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Hello! My name is Meghan Hofto. I am a medical student at the University of Tennessee, and I’m starting my INMED service-learning experience at Kapsowar Hospital in Kenya, beginning in February 2011.