Categories
Kenya

Sunday Walk in Embu (part 1)

The clear, bright, blue sky was a welcome change to the ominous, dark, cloud-filled skies of the past few weeks. The rainy season has been unusually prolonged. Some say el nino, some say la nina. I was just glad to be able to go on a long walk without being drenched.

I packed my rucksack with apples, a litre plastic bottle of boiled and filtered water, my sunglasses and the brilliant Canon EF 100-400mm f/4.5-5.6L IS II USM lens fitted to my 6D camera body. This would be ideal for capturing photographs of birds. For close up and “street photography” I would rely on my OnePlus3 smartphone.

The first church services of the day were ending when I tramped up the muddy road from our house to the main highway. Families dressed in their Sunday best and clutching their Bibles were walking home. I crossed the highway by the Anglican Cathedral and headed north down into the valley.

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Boda-boda motorcycle taxis swished past me when their riders had cut the engine and were freewheeling down the slope. Those with empty pillions beckoned me to come aboard. Those already loaded with passengers would wave and shout greetings, lost on the slipstream. I discovered recently that there was no import tax on motorcycles of less than 250cc, so they were popular and more affordable.

Motorbikes coming towards me would have coasted down the opposing slope of the valley. As they bled off speed, their drivers would press the electric starter, but sometimes this didn’t work, and they would stop and have to kick start the motor. Going over speed bumps can be tricky while you are messing about with the starter.

Everyone at the side of the road, gardeners, motorcycle washers, people coming and going to church, would all catch my eye and greet me.

“Where are you going?”

“To the forest,” I would reply.

“Oooooh. Why?”

“Because I want to walk.”

Some of them expressed surprise that a muzungu (white man) would be walking at all. They think we are all from the WaBenzi tribe (the people who are driven around in Mercedes Benzes).

Up ahead was the Sunmoon Lodge, a local hotel. There was a half moon in the sky, but I couldn’t frame a photograph to show both. I walked up the hill and past a few dilapidated dukas (shops). The Njukiri Forest was to my left, but there were no clearly marked paths in that direction according to Google Maps. (I have a love/hate relationship with this app. It can be lifesaving at times and infuriatingly wrong at others.)

There was a sign pointing to the County Show Grounds, laid out on the fringes of the forest. I can just imagine the scene 70 years ago, with the white farmers proudly displaying their produce, their wives entering bakery and flower arranging competitions, with prize beasts being judged by men in white lab coats. It looked sad and dejected now.

At Njukiri Shopping Centre, a vivacious middle-aged lady wanted to walk with me. She hooked her arm through my elbow but I declined. I didn’t want to spend the next mile explaining to her why I didn’t want an African wife. She laughed and went back to her crowd of friends. I wondered what on earth had been in the priest’s sermon.

The prolonged rainy season had painted the countryside bright green. It is very fertile, with people planting stands of maize, interlaced with beans, sugar cane, potatoes (English and sweet) and arrowroot everywhere. The lakes and dams were full. I took a long look at one stretch of water to see if there was any birdlife. Two lads in fashionable Western clothes and American baseball caps asked me if I wanted to swim. I told them that I’d left my swimming trunks behind, unfortunately, and they laughed.

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On the other side of the road, there was a ruckus. A man was trying to control a massive bull as it rumbled through the undergrowth onto the tarmac road. The bull continued to be rather frisky on the road, and motorbikes had to swerve to avoid it. I greeted the man and asked him what he was doing. Surely they would not be slaughtering on the Sabbath? No, he was taking the bull to cover some cows. “He knows, that’s why he’s impatient,” said the cowherd.

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From one of the many churches at the side of the road, I saw a man with a massive box on a wheelbarrow. We chatted and he told me he had to move the loudspeaker from one church to another for the next service.

A boda-boda driver stalled his engine going over a speed bump and couldn’t get it restarted. I offered to help but he didn’t think much of my expertise. He pushed the bike up the hill, where there was a shack offering boda-boda repairs.

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I’d been walking for two hours now and the sun was beating down. I stopped to rest and look down at a garden in a flooded valley. It looked charming, so I got out my camera. Out of nowhere, two men came to ask me what I was doing. “I am photographing this attractive scene. Your country is very beautiful.” They seemed unconvinced. “Why is this beautiful?” I rambled on about the verdant pasture, the different crops, the flooded stream, the people working in the distance. They were still suspicious. “What are you doing here?” I told them I just wanted a pleasant walk to see the countryside. “Why are you in Kenya?” When I said I was Daktari, their manner completely changed. From being a suspected spy, I had become a most welcome guest.

 

Categories
Bangladesh Thursday Doors

Thursday Doors in the clinic

This is from my journal, five months ago in Kutupalong Hospital, Bangladesh. There are some photographs of a few doors in this piece, but it is worth reading if you are interested in what it can be like working in a refugee camp.

 

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Rohingya refugees queueing up by the door of the health post.

 

The young man looked ill. His hair was plastered onto his forehead with sweat. The medical assistant asked him to leave so I could see a different patient. I said, “Wait a bit. He’s unwell. Let’s sort him out first. What’s his story?” Just fever.

Fever for ten days. Ten? Getting steadily worse.

What else? Nothing much. “Bish (pain)?” I asked him.

A headache, bellyache, a bit of diarrhoea, not severe, no blood.

Anything else?

Feels tired, not sleeping, poor appetite.

Helal, the medical assistant, and I looked at each other warily. I said, “Could be typhoid. All he needs to have is a slow pulse and it would clinch the diagnosis.”

Helal took the right wrist, I took the left. The pulse was far too slow for the height of his fever, a characteristic sign of typhoid. We nodded at each other. I remarked that it was a good catch and he prescribed the ciprofloxacin.

 

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There is a door behind the blind man sitting on a green plastic stool. It is made of plastic sheeting stretched over a framework of strips of bamboo

 

The patient he wanted me to see was a little boy with a painful, irreducible hernia. The last child with a painful hernia I sent to the surgeons actually had an inflamed appendix in the sac. He ended up having two operations for the price of one. So I have a low threshold for referring hernias in children. This little chap had so much intestine in his scrotum that you could see the peristalsis, visible movement of the bowel. It was so big that it was a struggle to fit it into his shorts. There was no clearance for him to pass urine properly. I made a clinical decision to refer him, even though it is stretching our guidelines to refer only urgent cases.

 

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This man is standing in the doorway of the health post. He reminds me of a crazy nun wearing an outrageous wimple, but it is just a split plastic sack, tied around his head to give some relief from the hot sun. He has been bringing supplies up from the road into the heart of the camp, carrying the load on his head.

 

I see the most horrendous eye conditions. Every day, three or four people come to the hospital with incurable eye problems – penetrating injury by splinters of bamboo, blunt trauma, corneal ulcers and cancer. My last teaching session to the staff was on the subject of eye disease. I have a complete set of illustrations of the common eye conditions the doctors are likely to see, all photographed here in the hospital. I would like to say a word of thanks here to HughdeBurg, for his swift replies to my requests for ophthalmological advice. I hope that this will help to reduce unnecessary referrals to Chittagong Eye Department, six hours away by road. I have donated my personal ophthalmoscope to the clinic so the doctors can examine patients properly.

My day is often like this. I hardly ever see anyone who is not sick. Quite often, the doctors call me in to confirm that there is nothing more we can do for patients. They want me to be the one to deliver the bad news. The disease is too advanced or too difficult to treat in this setting. Patients suffering from end-stage kidney disease, a cirrhotic liver which is decompensating, cancers, heart failure, or ruined lungs from a lifetime of cooking with biofuel in a confined space. I feel I am a harbinger of doom.

Every now and then I see patients who have scraped together enough cash to pay for the opinion of a local specialist. Even when the evidence is incontrovertible, the specialist will never tell them they are dying or that they have incurable cancer. Perhaps it is traditional to do this, not to take away any slim hope of recovery. Maybe I am more cynical, thinking that a desperate patient will pay for more consultations and treatments as long as the stark truth is withheld from them.

 

Categories
Kenya Medical

Accident

I caused an accident last week.

A saloon car driving up Embu’s Main Street (Nairobi – Meru Highway) decided to turn right into a side street. Coming down the hill, a motorcycle taxi (“boda-boda“) driver spotted me walking on the opposite side of the road and was distracted. Even though I’m not the only muzungu in the village (there is a blond, young, Danish man working with us), I still can attract rapt attention. The car driver cut the corner, probably expecting the motorcyclist to slow down or take evasive action, as they usually do.

It’s live and let live here, rather than obsessively obeying the Highway Code.

It was too late for the motorcyclist to react, so he laid the bike down and slid into the front of the car. The pillion passenger and the driver of the boda-boda were not injured. The bike sustained some damage from scraping down the tarmac. There was also some minor damage to the radiator grille, front bumper and number plate of the car.

I didn’t need to intervene medically, though I do have access to a magnificent emergency backpack at the office. It is huge, bright red with yellow reflectors and two extra panniers on each side. It weighs about 25kg so I don’t relish having to yomp a long distance to attend an incident. There is so much equipment inside that I could probably perform major surgery.

As well as doing the “day job” supporting Kenyan health workers in providing high-quality care to people in rural areas suffering from chronic diseases (such as asthma, chronic obstructive pulmonary disease, diabetes, epilepsy, and hypertension), we have to be on the alert for other medical calamities which could occur in our locality. My predecessor picked two of the most likely outbreaks (cholera and methanol poisoning) to prepare for and stocked up on specific equipment and appropriate medication. But even if we are called upon to help in these situations, I don’t think I will be lugging the massive red rucksack.

Post Script: Methanol poisoning is caused by drinking illicitly distilled liquor. Ethanol – ethyl alcohol – in beer, wines, and spirits, is metabolised in the liver to acetaldehyde (which wakes up you a few hours after overindulging, making you feel unwell) and finally acetate. But methanol – methyl alcohol – is metabolised to formaldehyde and formic acid, which can be fatal. It might seem odd to non-medics, but the treatment for methanol poisoning is to give the patient ethanol.

So perhaps I ought to have a wee dram in a hip flask attached to the emergency backpack?

 

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This man is at risk of methanol poisoning

 

 

Categories
Thursday Doors

Thursday Doors Palma 3

Categories
Kenya

International Labour Day

The office was closed today, 1st May, in commemoration of Workers’ Day in Kenya. I decided to go to the Sports Ground in Embu to witness the celebrations. The show was supposed to start at 10am, but in my experience, time is more flexible in Africa. I lay in bed listening to the birds tweeting outside my window and didn’t get up till 9:30.

I walked up the muddy path towards the main Nairobi – Meru Highway and encountered the coffin makers. The headquarters of Golden Funeral is conveniently close to the Hospital Morgue. Two joiners were constructing caskets outside a tin shack. I asked them why they were working on Workers’ Day and one replied that death doesn’t stop for public holidays. True.

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From a distance, the wood of the coffin had a look of quality, but when I got closer, the “grain” of the wood was fake. The appearance was produced by wood stain painted on and fashioned to look more expensive than pallet wood. There were some gaps in the planks in the floor of the coffin, which could be embarrassing. The cheap tin alloy handles looked so fragile that I thought they must be for show only; if you tried lifting a loaded coffin using the handles, they would snap off.

The chief coffin maker insisted I take his photograph and to include a shot of his new hearse/van. “I need all the publicity I can get,” he said.

 

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Yellow-bellied sunbird

 

I used my phone to take the pictures as using my Canon 6D fitted with a zoom 100-400 lens seemed like overkill (sorry). Anyway, it was packed away in my rucksack. I intended to photograph some birds on the way to the Sports Ground. I took several shots of a sunbird and was surrounded by a group of children, wondering what I was doing. I had to take their photograph of course. A middle-aged lady joined me on the path and we chatted as we walked down the hill to the town centre.

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People want to know your marital status in Africa. It helps them place you. This lady said she was a widow. Her elderly husband died in 2012. “I married young, at 18, so I was never able to complete my education. My parents didn’t think it was important.” I asked her if the marriage was arranged or whether it was a love match. “I picked an older man because he was grown up, not like the boys my age I knew. He was less likely to go off with other women.”

She told me that she had four children, three grown up and one at school. The salary of a civil servant was enough to pay for living expenses and boarding school fees

“Do you want to marry again?” I asked her.

“No! African men are bad. They just want to use you as a servant. And a man will not accept another man’s son as his own.”

When I told her my age, she complimented me. “In Africa, you would be retired for a long time now. But it is good that you are still working, helping people. Here, when men retire, they take to drinking beer and then they die soon.”

I asked her about the best places to eat in town but she said that she always cooked her own food and avoided restaurants. She went into the butchers and I walked down the road to the Sports Ground.

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The event had finished. There were no bands, no speeches, no cheering crowds, no music. Just overgrown grass and patches of mud. There was no evidence that it actually happened.

I walked back up the hill and called in on N. We sat on the veranda and I took some photographs to show off my camera equipment.

 

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Red-winged Starling

 

On the way back to my house in Spring Valley Road, I saw a knife grinder called Henry. He was using a Heath-Robinson apparatus to sharpen knives. I chatted with him for a few moments before he made a sales pitch. “Do you have any knives I can sharpen? Good price.” I declined, but he persisted.

 

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Henry

 

“Do you have any work tools, machetes, pangas, axes which are blunt?”

“I am a Daktari. I don’t need my stethoscope sharpening.” He laughed.

But actually, I think my hearing could be a bit sharper. My ears need syringing.