November 14-17, 2010. Africa Journey Coming to an End

Sunday was  a relaxing day.  I caught up on some things, like organizing photos!  Chhani and Varinder took me out for Chinese food.  They frequent this restaurant, and it is the place where they held Varinder’s 60^th. 

Monday morning I was dropped off at Tumaini so I could visit the school.  I was walking around and was invited into a classroom.  It turns out the Head Master was the teacher in this class.  All the students stood up and said Jambo to me.  This was a class of 4^th graders and they were learning Swahili.  Then they sang for me and the teacher asked if any of them had questions for me.  He told them I was a very important person and had done so much for their facility.  So, these kids asked me unbelievable questions.  They asked about weather in different parts of the US, they asked how long it took me to fly to Africa, then one girl asked me who was the 5^th president of the United States.  Much to my chagrin, I could not answer that off the top of my head.  I could tell them that Obama is the 44^th president, and I could count back from a number of years before I was born, but I had to look it up to know that James Monroe was the 5^th president!  Then one student asked me what kind of weather instruments we use.  I had to explain that our equipment is mostly computerized and digital.  They had just studied weather instruments.  At break, the teacher asked me to come into his office for tea.  He is a young man about 34 years old.  He told me his life/family story, and it really was interesting to see how his life has led him to where he is. 

Mwachiro picked me up at Tumaini and took me to Bambalulu workshop.  This is a facility that employs all disabled adults who create all kinds of things to sell.  They have jewelry, wood carvings, table ware, some clothing and they even have a garden where they grow fruits and vegetables.  I really like being able to support causes like this, so it was a good place to buy gifts.  Like Nyumbani, I knew the money was going to a good cause.  From there I went to the tailor’s to pick up my salwar and tunic.  She charged me 1000 KSH which is equal to $12.50!!!!  She did an outstanding job. 

I went back to the house for lunch.  I now know how to make home made yogurt.  It is so good!  Yogurt and fruit has been my daily lunch in Mombasa, and it is perfect.  At 3:00 I was picked up by Musti and Shakila Mamujee’s driver.  I was taken to their house in the city, and from there Shakila took me to the school where my granddaughter Lauren’s class donated some school supplies they had collected.  From there, Shakila and I went to meet Musti and we went from there to their second home which is right on the Indian Ocean.  We put on walking shoes and went to a forest trail where they walk every day.  We walked 4 ½ miles and it was definitely the best exercise I have had in three weeks!  We saw some wild animals along the trail and it was wonderful.  We went back to their home and showered and sat in the yard looking at the ocean.  Musti made his famous Dawas (Swahili for medicine, but a wonderful drink!)  I have made them at home, and will be sure to do so again!  We then walked to a restaurant down the beach and shared a pizza and a hamburger!  This is the first American food I have had since being gone, and I must say, it was an excellent hamburger and a great thin crust pizza! Musti and Shakila have a son in San Francisco, working for an IT company, and a daughter that just got married in the UK.  She and her husband are both attorneys.  Musti had an interesting perspective.  He said he doesn’t care if his kids don’t come back to Kenya, though he would love it if they would.  However, he said he thinks they will have a much better life in a developing country than in the UK or the US.  I totally see what he means.  The life style in Kenya affords people some luxuries that we don’t have.  They all have drivers, maids, house boys, live in gardeners, etc.  Certainly they have some other hardships there, but the life style is one in which they are waited on and taken care of.  Laundry is done for them daily, their cars are washed daily, dinner is prepared or in the oven when they get home from work.  Mwachiro asked me if I had a driver at home!

I got home about 10:00 and Varinder was still at the hospital.  As Chhani and I were talking, the lights went out as it started to rain very hard.  This is not as typical of Kenya as it is of Uganda, but Chhani was prepared with candles.

Tuesday morning I went to see a clinic for disabled children that Shakila has been very involved in.  It was a wonderful place and I would love to spend more time there on my next visit.  There are physical therapists and occupational therapists there as well as a resident orthopedic surgeon.  They have one department that makes artificial limbs, and a casting room for the kids that have a club foot (or feet) and need to be re-casted every two weeks.  Some of the children are there for a few months, so there are classrooms and teachers so they can keep up with their studies.  There is also a full time school across the street. 

After visiting the clinic I was taken to meet Varinder at a local Rotary Club meeting.  The speaker was the US Ambassador to Kenya, Michael Rannenberger.  He spoke about the drug trafficking in Kenya and how the government officials that are involved for their own benefit will have their visas taken away so they can’t travel to the US and how the Kenyan people also have to speak up.  He really had a great presentation.  I spoke to him afterwards for a few minutes.  He knows Barbro Kirkpatrick from my Rotary club.  Barbro was the US Ambassador to Niger a number of years back. After the Rotary meeting I went with Varinder to see Mombasa Hospital.  It is a private hospital and quite well equipped.  The private rooms are beautiful with all ocean views and balconies.  There were many wings that noted they were donated by the Mamujee Brother Foundation.  That is Musti’s family business and he has been very active in helping to upgrade this facility.  From there I went to see the pharmaceutical company where Chhani is the manager.  The company is Surgipharm and it is an Indian company.  She is a pharmacist and has been there many years.  They get their supplies and drugs from the Nairobi office and then sell locally to chemists, hospitals and clinics.  We actually bought some of the lab equipment for Tumaini from Surgipharm, and they donated some equipment as well. I then went to pick up my second salwar and tunic from Heena’s mom, and she would not take any money from me.  That was one of the reasons I did not want to give her both of them to make, as Chhani told me she was sure she would not charge me.  She hugged me and thanked me for taking care of Heena in the US.  Heena was at the opening for Tumaini and volunteered to go there once a month to donate her time providing dental care for the kids.  That was really a much appreciated gesture.

We had dinner at home and Chhani showed me how to make this easy and delicious Indian chicken dish.  I showed Varinder how to make Dawas.  He’s hooked!

Wednesday morning I was dropped off at a school for the deaf that Varinder’s club has provided some support.  Due to the Muslim holiday, the kids did not have class, but since it is a boarding school, they were around.  I talked to the head teacher for an hour and he showed me around.  I also gave him the website for Cochlear so he can see if anything can be done for any of their kids needing hearing aids or cochlear implants.  From there Mwachiro took me to Varinder’s office to say goodbye.  Then Mwachiro and I went to Haller Park, a wild animal preserve.  I got pretty close to some giraffes, huge tortoises and some monkeys.  I saw some elants in the distance, but 4:00 is feeding time, and therefore a much better time to see all the animals.  We stayed an hour.  I went home and Bahita had fruit and home made yogurt for me.  By the time I took a shower and finished packing, it was time to head to the airport.

I am now sitting in the Amsterdam airport reflecting on the past few weeks.  I was definitely not ready to come home.  This was a magical three weeks, and very different than my GSE month.  I had my own agenda this time and was not being hauled around on someone else’s schedule or to see what someone else thought was important.  I was not being looked at as if I came with Rotary money and looking for projects.  So I found that there were a lot less hands out to me and everyone was just so grateful that I was there doing the things I came to do.  And there is so much more I want to do….and I will.  So for now, I bid my friends farewell, but knowing I will be back.  Photos to follow.

November 11-13, 2010

As much as I loved being at Mildmay and seeing good friends and a wonderful project in Kampala, I am very happy to be in Mombasa.  This feels like coming home.  When I got my luggage at the airport and walked outside, Janice and Matt were there to greet me!  Our time together in Mombasa, would only overlap for one evening.  They were leaving for India the next morning.  I was greeted warmly by Varinder and Chhani, and we just picked up where we left off.

Channi had a dinner party that evening.  Her inlaws and Varinder’s brother and sister in law came, as well as Heena Vaghela and her mother.  Heena stayed with me when she was on her GSE trip to San Diego with Kenneth.  Channi made a wonderful Indian dinner wFith delicious barbecued chicken.  I don’t think I could duplicate the marinade and spices, though I would love to!

Friday morning I went to Varinder’s clinic with him.  He wanted to finalize the wording for the plaque that was being made for the Tumaini Children’s Home lab.  He kept asking me to pronounce La Jolla for him because the spelling and pronunciation don’t match!  Then Varinder’s driver, Mwechairo, picked me up and we went to get Chhani at her office.  She took me to a fabric store that has pre-packed material for salwars and tunics!  We went to her tailor who took my measurements and we gave her the dressier one to make.  The other one I took over to Heena’s mother later, as she does the same thing.  My new attire will fit right in with San Diego fashion!

I then went to Tuimaini with Varinder.  We arranged the lab equipment, treatment rooms and consultation room.  It was such a thrill to see all the equipment in place and know that our club and our district played such a big role in making this happen.  I met the lab technician and staff.  I walked around the facility and gathered children along the way.  They were all trying to hold my hand, and I had kids clinging to every part of me!  The youngest is 1 ½ and the oldest is 18.  They are not all HIV+, but most are.  The dorms are very nice and the kitchen and dining room are spacious.  The school is right across the street.  The kids were all neat and clean and well cared for. 

Saturday I went to Varinder’s clinic and provided him with my resume to which I added all my Rotary activities.  I was to be considered the guest of honor at Tumaini for the opening, and Varinder wanted to make sure he introduced me properly.  Yasmin, Varinder’s secretary, took me on a walking tour of Old Town.  She lives in that area, so I saw things that I never would have seen otherwise.  We wound through all the dirt roads and alleys through ancient buildings.  We stopped to meet her father, and then two of her sisters.  They were all very welcoming.  Old Town is mostly Arab, but those Arabs are really Swahilis.  That means they are Arabs who married those who were indigenous to the area.  Mostly Muslim, there are many women who are covered head to toe in black with only their eyes uncovered.  Others are more modern and do not cover their whole face.  Yasmin wears Indian attire, but she is also part of the Muslim culture. Walking those streets and visiting the shops was a wonderful experience.  It is not something   tourists would normally do.  They would get lost in the maze of the dirt roads and alleys!  There is also a main street with larger shops, such as the one Chhani took me to the day before.

Two more house guests arrived.  Two young men, one from New Jersey and one from the Netherlands.  Chris, from New Jersey, is working in Kalifi as an intern.  He wants to go into epidemiology, and his friend, Tommy, is there working with him.  Nice young men, and they were invited for the opening of the lab at Tumaini.  They are not connected to Rotary.  We all went over to Tumaini at 3:30.  Heena was with us as well.  The children welcomed us with songs which I hope recorded on my video camera.  Since I was so involved in all the processes, one of the boys had my camera, and Heena had my video camera.  We all gathered together and Varinder gave a long introduction.  He talked about my previous trip to Mombasa and some of the experiences we shared together.  He talked about my professional accomplishments and my Rotary involvement.  He introduced Joanne, a woman from the UK who founded Tumaini.  She has been living in Kenya for some time and is a remarkable woman, close to 80.  I was asked to say a few words as well.  Varinder had already said so much, so I kept it brief and sent greetings from our district and our club.  I told them how this project came to me through Varinder, and how thrilled we all are to see it come to completion.  We then went down to the lab, where there was a big ribbon on the door.  I officially cut the ribbon to open the lab.  We then went in and Varinder and I unveiled the plaque (covered in Chhani’s Rotary scarf).  The plaque has our district, our club and my name and Varinder’s, along with his district and club information.  What a thrill to see that! A couple of hours later, there was a Foundation dinner in an outdoor area with all kinds of barbecue, samosas and some other Indian food.  Varinder made some presentations.  He had me come up and again pronounce “La Jolla”!  Of course, Steve Brown’s name was mentioned, as being responsible for connecting our two districts.  A certificate was presented to me, as well as one for our club and another for our district.  I was also given one for Janice who allocated $1000.00 of  District Simplified Grant money to Tumaini when she was here on her GSE trip.  It was a wonderful evening.  I felt very fulfilled, proud of our club and our district.  We are really providing a wonderful service.  Not only will this lab serve the children at Tumaini, but also the larger community.

Today we are lying low, and I may go to the beach later with Heena.  More soon. Link to photos sent in seperate email.

November 6-10, 2010

The days since I left for Kampala have been  jam packed, often 14 hour days.  I feel like I am back on a GSE trip!  There was a lot of confusion and miscommunication on many levels about my travel back to Kampala.  I thought William and Beth were picking me up late Saturday after the wedding they had to attend  in Mbarara, but then Kenneth  told me they thought I was going to the wedding with them and spending the night in the village where William’s mother lives.  I had no clothes for an African wedding.  It’s an all day event and the attendees dress in very dressy formal  and  traditional African attire.  I had only enough clothes for two days with me and they were very casual.  And, as much as I would have loved the experience of sleeping in a village, the village was further from Kampala than Mbarara.  I did not think I would be back in time Sunday to meet the Rotarians from Kampala Sunrise for a visit to a project.  Without going into all the details of  what we went through to resolve all this, the end result was that Kenneth drove to me Kampala.  We met up with three of the members of his GSE team and it was wonderful to see them all again.  One member was not there, because she lives in Mombasa and I will see her there.  William and Beth arranged for their driver to pick me up and take me back to their house.  My suitcase was there anyway.  The kids were all home with the housekeeper. 

Sunday morning the driver picked me up to go to the Kampala club where I was to meet Dorcas Tusubira and several members of her Rotary Club.  La Jolla Golden Triangle had provided funds for a water project in a village (Bulindo) and we were going to visit.  The drive was about 40 minutes from the city.  When we got there, we met in a central outdoor meeting area at the local school.  Women came bearing fruits, vegetables, sugar cane and chickens….live chickens!  The Rotarians told me they were bringing all these things for me as a show of appreciation.  One of the Rotarians acted as an interpreter, as the villagers spoke Luganda.  They asked me to say a few words, and I told them that I was thrilled  to be there representing La Jolla Golden Triangle Rotary Club and we were so glad to be able to provide them with these water tanks.  I originally thought our money would buy 5 tanks, but it actually bought 8 tanks.  The rain water is harvested through gutters into the tank.  Each tank is 100.5 liters.  The village council made the decision as to which residents would receive the tanks.  Since the receivers had to agree to pay for and install the rain gutters as well as the pedestal for the tank, I think it was partially decided based on who could afford it and who would maintain it.  It was quite a thrill to see our club name on these tanks.  We visited about 5 of them.  There were many photo ops (to be posted soon) and there was also a TV news channel filming.  I have been promised a CD of the event.  One man, who was a Muslim, asked to go change his clothes before being filmed.  He got into his long white ethnic attire.  He was one of the few who spoke a few words of English.  What made me cry was when the ladies got down on their knees to thank me,  I kept trying to explain it was a group effort, and they probably understood that, but since I was the one there, they were on their knees.  Dorcas had prepared a very big meal at her home for all of us that had gone to Bulindo.  Tusu greeted us there, of course.  They have a lovely home and the feast was incredible.  Tusu drove me back to William and Beth’s.

Monday I went to Mildmay.  This facility was the first facility for HIV patients in Uganda.  They have an outpatient clinic for adults and for children.  They also have an inpatient facility for very sick children.  The inpatient facility was where I was assigned.  I have spent three days there.  The things I have learned have been incredible.  All care is free and the organization is non-profit.  They are running short of funds for the inpatient facility.  The children range in age from a few weeks old to children about 18.  There is one head nurse and another staff nurse no matter what the census.  Therefore, the mothers are asked to stay there with the kids to help feed them and give them medication (except for IVs).  The cultural issues are almost beyond description.  There was one young mother there with her 11 month old son.  The woman stopped breast feeding at 7 months when she found out she was HIV+.  The baby at this point is negative, which they said is fortunate and the baby should remain negative.  The mother asked me how all this could happen.  Her husband died in an accident while she was delivering the baby….except none of the staff believe that story.  I asked this woman if her husband was sick.  First she said no, and then as we talked further, she told me he had a chronic cough that would not go away.  He most likely had either TB or pneumocystis pneumonia as an opportunistic infection  related to HIV.  Another child there was 17.  She had just been diagnosed.  Her mother acted surprised, but the mother was HIV+, but was not talking about it.  So, there are mothers who would rather wait until their children are older and very sick before seeking treatment, because they don’t want anyone to know they are positive and they refuse to discuss these matters with their husbands….in most of the cases, the husbands are the ones that infected their wives.    There are many more stories and I will discuss more of those with any of you that want to hear once I am home.  I would be writing a novel if I put it all here.  I participated in rounds with the doctors (all female, by the way, and one was a Rotarian!), I helped feed babies, play with them to give the mothers a rest, got information from charts, reviewed lab work and felt very much a part of the staff.  The only thing I declined to do was start an IV.  The reason is probably not what you are thinking.  The reason is because these kids were all so wasted, small for their ages and were basically skin and bones.  I’m not a pediatric nurse, and don’t like making kids cry!  Some of them had arms the size of toothpicks.  The babies got IVs in their feet (as we also do for small babies), but their feet were the size of a quarter.  So, I watched instead.  The nurses are very skilled, though their equipment is pretty basic.  They had never heard of a PICC line.  The kids all get peripheral  IVs, even if they are getting transfusions.  And no such thing as an IV start kit!

Monday night I went to a Rotary meeting, Kampala North Club.  This club is Tusu’s club and he was the program.  The program was about Future Visions and Global Grants.  It was essentially a Rotary Foundation presentation.  District 9200 has implemented Rotarians at Work Day!  This was great to hear.  I told them this had originated in our district with DG Bob Watson.  They also kept referring to New Generations.  When I asked about it, it’s quite different.  For them, it just refers to Rotaract and Interact.  I told them about our New Generations and they were quite interested.

Tuesday morning, I was the program at the Kampala Sunrise club.  Dorcas officiated, as the president was not present.  The structure of their meetings is quite different from ours, but it is quite efficient.  The members of this club thought our club was HUGE when I told them how many members we have!  There are not many clubs in East Africa that are more than 30-40 members.  The largest I have been told about is 60.  They thanked  me again for our club’s participation in the Bulindo water project.  Then they sang, “For She’s a Jolly Good Fellow”.  It was very touching.

Tuesday night I went to William’s Rotary meeting.  I saw some familiar faces.  They did a presentation for Vocational Service Month.  Their Vocational service is different than ours.  It is truly about vocations and business practices, not like ours which focuses on kids and schools.

Three Rotary meetings in two days was enough!  Last night Beth’s sister came over to talk to me.  She has been HIV+ for 17 years.  She has become an advocate and counselor for an HIV program.  She got her master’s degree and has become quite vocal for women.  She advises them how to have a discussion with their husbands.  She teaches the women to be creative so the doctor can inform them at the same time.  She is healthy and active, but wanted me to see her thighs which are pretty wasted, most likely from AZT.  You can feel the bone.  The rest of her looks fairly good with the exception of a small hump below her neck on her back.  She asked me what we would do for that in the US.  Especially do to the decrease in muscle mass, I told her the simplest thing she could do would be to get physical therapy.  She said it was too expensive.  When I was at Mildmay today, I spoke to the physical therapist.  She said I was right, they would definitely try to help with Physical Therapy, and it would most likely be effective.  She said it is free of charge at Mildmay if that is where you are receiving your care.  When I told her where Molly received her care, she told me which hospital she could go to for treatment at no charge.  I felt really great about being able to get that information for her.  On the way back today, I met up with another one of Beth’s sisters who is a nurse.  She works for the health ministry here.  She said the next time I come back she would like to set me up to give some lectures at the nursing schools at three different universities here.  She was fascinated by my work as a legal nurse consultant and said that law suits are definitely becoming more prevalent here and that the nurses could benefit from learning how to protect themselves, as well as learning how to work with attorneys.

Tomorrow I leave for Mombasa.  I am looking forward to it, as the pace here has been very hectic and it’s been difficult to sleep due to the commotion of the dogs barking in the yard (not pets here, but guard dogs) and the chickens and roosters cackling!  Plus, it has stormed every night, but stopped by morning.

November 2-November 5th, 2010

Sorry for the lengthy entry, but need to cover 4 days!

Tuesday, I was helping Nurses Phrelym and Marcy prepare the medications for the children.  Shortly thereafter, Janice, Matt and Kourtney arrived, as did our driver.  Unfortunately, Kourtney was feeling pretty sick, so I don’t think it was a very good day for her.  I had some medication for her and both Janice and Matt are doctors, so between us, we did the best we could to keep her comfortable. 

We picked up Sumant Desai, his wife Jyoti, and a couple of other Rotarians.  We then  headed for Makuru.  At the school we met with the principal for a few minutes for Janice and Kourtney to present their proposed curriculum.  The principal seemed to have a positive response.  We visited a couple of classrooms.  We then walked around the very muddy property.  I was most interested in seeing the completed project I began almost two years ago.  When I last visited we saw  the dorms.  About 100 children live there, either because they are orphaned  or because it is better than living at home in the slums.  There were two water tanks on the premises, but no toilets, sinks or showers.  What they had  was a rock floor behind some sheet metal with a broken bucket.  I had been  given the authority by our district to use some District Simplified Grant money for any worthy  projects I found while traveling with the GSE team.  This was one of the projects I chose.  I worked with the Rotary club in Nairobi that had taken us to see the school.  It took over a year with some help from a past district governor in Uganda.  We finally got the paper work telling us the project was complete.  Well, I was in for a big disappointment.  The toilet block building and shower structure were there and complete.  However, the doors to the toilet areas were padlocked.  Matt stood  up on a rock and  put his camera through the window.  No toilets or latrines.  There was no sink and no shower heads.  I asked the principal and he told me that they were waiting for the sewer line to be connected and  it might be another month.  Obviously, the follow up on this is something I am going to have to handle while I am here.  I will be seeing the past district governor who previously helped me this coming Sunday.  I will certainly ask for his assistance in getting this handled. 

We were taken by the Rotarians to a part of the Mukuru slums where we walked around and saw a couple of Rotary projects and a microcredit project.  Kourtney did not get out of the van and decided to go back to where she was staying instead of joining us for lunch.  I felt so badly for her.

We met Sudesh Walia and Geeta Manek for lunch next to the market Geeta owns. Geeta has been wonderful in helping with so many details of my trip.   It was wonderful to see her again.  Sudesh had made all of my inter and intra country travel arrangements and gave me all the paper work.  I was then taken back to Nyumbani.

There was a woman at the House Tuesday night who has been staying at the village.  She sold her house, took her 3 kids (12,13,18) and a friend’s son who is also 18.  They are traveling around the world for a year and targeting projects they can work on.  From Africa they will head to China, Viet Nam and Cambodia.  What an incredible experience for her and the 4 kids.  They have learned to farm, assist with clean water projects and do with very basic needs.

Wednesday morning I again assisted Phrelym and Marcy prepare the medication trays.  Interesting how quickly I have learned where each med goes and how many times a day each child gets what med.  you note for helping them.  Phrelym  then took me over to the lab where I got a tour.  They have a CD4 machine  and a centrifuge and many other wonderful pieces of equipment.  Then Phrelym took me to see the new lab facility they are building.  It’s huge and still in early stages.  The equipment they will have at that facility will allow them to more closely monitor the children who are becoming  resistant to their ARV drugs.  Sister Mary has been fundraising for this all over the world.  I was very touched when Marcy and Phrelym presented me with a thank you note for all the wonderful things I am doing, especially for the children of Africa.  It is truly these two dedicated nurses who have given their careers to work at a place where they will make less money, all because they love the children and love what they are doing.  I went to the gift shop in the afternoon.  There were things made locally and things made by the children.  I would much rather buy things where I know the money is going to a wonderful cause.

In the evening, I went to the Rotary Club of Karen with Protus.  I had been to that club two years ago, and know some of the members, including Protus.  The country club where the meeting is held is beautiful.  Alex Nyaga is a member at the club and took me GSE team  there to swim and relax two years ago.  Karen is a very nice part of town, and certainly the most expensive.  It was really nice to see Kate Fletcher and some others. 

I told Protus on the way back to Nyumbani that I was very sad about leaving.  4 days was not enough.  I would love to go back for a month.  I could spend more time at the home, spend some time in the village and visit the Leatoto outreach  program.  The social worker told me that she also could have used my help.  The social workers interact with the schools and do home visits if needed.  They work as an integrated part of the team.  The social worker was aware of my background and said that next time I should spend some time with the nurses, some time with the social worker and certainly time visiting the other two programs.

I am now on my way to Mbarara by car on some paved roads and some very wet, unpaved and muddy roads.  It’s not a quick journey and certainly bumpy.

Arrived in Mbarara a bit late, but met Kenneth Kagame at his Rotary meeting.  Kenneth was the GSE team leader who came to San Diego last spring.  I was asked to speak at the Rotary meeting for a few minutes about my club, our district and projects we are involved in.  There were many questions; some about the size and management of our club, but even more about Obama, the tea parties and our recent elections.  Luckily, I had read all the news online!

I was welcomed to Kenneth’s home by his lovely wife, Hope.  We had a wonderful dinner, another typical African meal of rice, peanut sauce, beans and salad with avocados and tomatoes.  This morning, Kenneth and I took off early.  Hope is up at the crack of dawn, because she recently bought a fast food restaurant in town.  She does all of the cooking for the buffet at home, and takes it in with her.  She has also hired a chef.  The a la carte food she orders from local vendors.  Kenneth and I went to his clinic where he volunteers his time as an ophthalmologist.  I got a tour and then got to go into the operating “theater” to watch a few cataract surgeries.  I was given scrubs, a mask, and sandals…yes sandals that are meant only for the “theater”.  The cataracts in Africa are far different than in the USA.  They are much more extensive and most of the patients are totally blind in the effected eye.  Also, children get hat cataracts here, it’s not uncommon.  The cautery machine is not electric.  There is a small oil lamp with a flame, and a glass rod is heated and used to cauterize!  Sometime during the surgeries, the lights went out and someone had to go start the generator.  I am so glad that the surgeon’s knife was not in someone’s eye at the time!  The operating theater is one big room with two patients being operated on at the same time, but with two different teams.  One team consisted of a German doctor who was not wearing a mask!

From there, we went to pick up tow Rotarians and went to visit a school for handicapped children.  The handicaps ranged from  physical deformities to deafness.  The school was in a very poor area and in some ways, a similar environment to Mukuru in Nairobi.  They need a lot, but they do have water and sanitary facilities.

After dropping off the other Rotarians, Kenneth and I went to have lunch at his wife, Hope’s restaurant.  The buffet had matokeh (steamed bananas) taro, a white sweet potato, cabbage, peanut sauce, and a choice of fish, chicken, beef or goat.  I had the goat because I cannot get that at home.  It really tastes like lamb and is very tasty.

From there, I was off  to give a lecture at the University where Kenneth volunteers his time as a professor of ophthalmology.  I spoke to the nursing students, and a few doctors were in and out.  I talked for about 45 minutes about legal nurse consulting which is a totally alien concept here.  However, I was able to impart to them the importance of accurate and complete documentation and general information about the services I provide.  They were genuinely fascinated and had terrific questions.  Many of their questions were about ethical issues.  They were amazed that patients in the US actually have the right to refuse treatment and make advance directives.  They asked what we do if a patient refuses surgery that would save their life.  I told them as long as a health care provider has explained the consequences, then they are entitled to make a choice for no treatment.  The next question was about attempted suicide.  They wanted to know if that was also ok because it was a patient’s choice.  I explained the difference to them  between attempted suicide and choosing to stop treatment  or refuse treatment.  I put that also in the context of hospice patients not getting further treatment.  That they understood.  They wanted to know if they could be sued if a patient died on their shift because they were the only nurse present with a case load of 60 patients.  I told them that in the US, the hospital might be sued for not providing adequate staffing, but nurses can be named in any suit.  The next question was could the nurse turn around and sue the hospital if they failed to provide adequate staffing and there was an occurrence during that shift!  And so it went….I was with them for a total of about 90 minutes.  I left my brochures for information and business cards so they could contact me by email.

Kenneth said next time I am here, he will arrange for me to be the presenter at grand rounds with the physicians.  After the university, he dropped me off at the local hospice.  I met with them there for about 45 minutes.  They provide hospice and  palliative care to about 450 patients at any one given time.  The nurses can write prescriptions that do not need to be counter signed my a physician.  Patients who are still reasonably well, come into their facility to be checked.  When they are too sick, nurses are sent out to the homes that are within a reasonable distance.  Some are just too far and the roads are terrible.  They try to teach family members how to keep the patients comfortable, not much different from what we do.  This hospice is the Hospice of Uganda and has several locations within the country.  It was started by a woman from England in the 90’s.  I was told that their primary focus is cancer patients, not AIDS patients, unless there is associated pain.  However, in looking at the list of cancers, Kaposis Sarcoma and Burkitt’s Lymphoma are a large percentage.  So.;.;..of course they are treating AIDS patients, but they are not treating them because they have AIDS, it is for their cancer diagnosis. They have the same problem we do with patients being referred to hospice far too late.  They are getting patients that die a couple of days later, though many patients are on service months before dying.  As in the US, early referral, when patients are still well enough to get around, is a far better choice for the patient as well as the families.  It gives hospice a chance to really do what they are there to do.

Tonight we went out to dinner at the Acacia Hotel.  Turns out that Kenneth and Hope own this hotel!  They also own some other commercial property in town.  Benon Mwegera met us for dinner there.  I stayed with him and his wife when I was here last time with my GSE team.  It was wonderful to see him again as well.  He also talked to me about some possible projects!  He is a physician and built and owns the hospital where he works.  Two days was not enough in Mbarara, but I packed a lot into these two days….actually, only a day and a half!

Off to Kampala tomorrow.

October 31-November 1, 2010

This has been a very interesting two days.  Yesterday morning I went to Mass.  What a moving experience.  The children choreographed much of the service; there was dancing and singing and the children did much of the reading.  There were drums accompanying the singing and dancing.  Just prior to the service I was standing outside, and a small boy came up and hugged me.  I noticed he had a Cochlear implant.  I told him I knew what it was and hoped it helped him.  He asked me how I knew and I told him I also had a device, though totally external.  I showed him my BAHA.  He was amazed.  I snapped it off and he looked at my head and looked at the processor.  He walked away and came back a few minutes later with another boy and told me he wanted me to show his friend also.  Many of these kids with HIV develop hearing problems because they get ear infections that go undetected.  They are so used to pain that they do not complain and by the time someone discovers it, damage has been done.  Many of them suffer permanent hearing loss.  Sister Julie knew all about BAHAs, but told me they are far from having the technology here.  The boys and girls that have had Cochlear implants were sponsored to go to the US and the Cochlear company donated the devices and the doctors donated their services. 

Lunch was rice and meat chunks again.  Not too imaginative!  I then met with the nurse, Phrelym who showed mne the medication system.  Not too high tech, but very practical.  They have plastic containers with dividers that go to each house containing morning and evening doses of medications for the younger children. The moms give the meds. The middle level children have the same system, but they take their own meds, supervised by the moms.  The oldest children just get the bottles of pills delivered to the house they are in and they are totally responsible for knowing what meds to take and when.  The nurse does surprise spot checks when he counts the pills left in the bottle.  That way he knows if the kids are being compliant.  Phrelym also took me over to see the respite house.  This is where children from the outside Nyumbani Village come when they are sick or when family members just can't take care of them for a week or two.  The village is an orphanage also, but not for kids infected with HIV.  In East Africa, the word orphan is used looesly.  It does not necessarily mean the kids have no parents.  It may mean that they have been rejected by their parents or that their parents just cannot take care of them.  The mom in the respite center was wonderful.  Most of the kids are malnourished and/or dehydrated.  They all looked far younger than their actual age.  Since they are sick, this is the only place I have not seen smiling faces. 

Sunday is a free day for the kids and I wandered around talking to them and taking photos and movies.  They were playing basketball, riding scooters and bikes, many still wearing their Halloween masks. 

There were some unannounced visitors today.  Some Medical Students/Interns showed up unannounced this afternoon.  In addition, some administrators from the Deaf School down the road.  I had visited that school two years ago with the GSE team.  I was talking to one man named Fred.  The conversation led to my BAHA.  He asked if I would come over and speak to their students the next day.  Protus was standing there and thought it would be a good idea for me to do that. 

Sister Julie took me into Karen, which is the town we are adjacent to, and only about a mile and a quarter away.  We went to Nakumat which is their big store with everything...similar to WalMart, food and all.  Many of the locals think it is too expensive, but by our standards, it is quite inexpensive.  I bought water and some yogurt and things to have in my room.

Dinner was rice and green grams (similar to lentils).  Certainly healthy! 

This morning, I met Phrelym after the staff morning meeting.  I helped him set up the medication containers and deliver to the houses.  We then stayed in the nursing office to see if anyone came or needed anything.  Only the preschoolers were on campus.  The older children either went off to primary school or to boarding school (high school kids).  The only people that came into the nursing office were staff members needing one thing or another.  Most medication here does not require a prescription.  It is similar to the system in Mexico.  After a while I went over to the preschool and helped the kids with some of their school work.  I then played with them at recess.  The preschool kids are 2-6.  The babies, younger than 2 are in a situation more like a daycare with a staff member.  We had ugali for lunch....an East African staple.

This afternoon I was picked up by Fred to go over to the school for the deaf. Here is an update.  I went to the school for the deaf this afternoon.  It is an adult vocational training school.  They teach woodworking, sewing, cooking, auto mechanics and hairstyling.  They gathered all their students in a big multi-purpose room and asked me to talk to them for a few minutes about my BAHA and also how proud I am to wear it and that I am not ashamed.  Many of them do not want to wear hearing aids because they thing it is a stigma.  Those that have hearing aids have all behind the ear devices.  The audiologist interpreted for me in sign language.  It kind of freaked them out that you had to have your skull drilled, but I told them it sounded worse than it was, and that there was no real pain.  They asked many questions.  Thehy wanted to know if they could die from having someone drill a hole in their head.  I explained that it did not go through to the brain.  They wanted to know if they could play sports with it.  They wanted to know if they were born with bilateral profound deafness if a BAHA would work.  I told them it would not.  I had so many people touching my head and touching my processor, I could not wait to get back and wash my hair and clean my processor!  I gave the administrator the website for Cochlear.  They of course wanted to know the cost of the procedure and the processor.  I did tell them that some facilities and doctors will give a discount for cash paying patients and that maybe Cochlear could point them in the right direction and help them out in some way.  They have no neurotolgists here and very few ENTs.  I was so glad to do this, but also sad, because it is doubtful that any of them will ever be able to get this technology.  In a way, it was unfair, but it also gives them hope that maybe someday in the future, there will be new technology for them.  Very interesting experience.

Tomorrow I am going to Mukuru in the slums with Janice, Matt and Kourtney.  One of the Rotarians is going with us and we have a driver arranged by Sudesh.  This is where one of my water projects is at the school, so I will be glad to see its completion.
More tomorrow

October 28-30, 2010

As expected, my flight was very long.  Layover in Atlanta was short, and a little longer in Paris.  In Atlanta, I was standing at the gate and heard someone call my name.  I looked up and saw Rachel Tarshis, one of the teachers that went to Ecuador last year on a GSE trip!  She was headed to Greece with a friend.

I arrived in Nairobi and was greeted at the gate by a Rotarian named Barnard.  Jay Manek had sent him to meet me.  He is a travel agent, so has an airport pass to get past security.  We waited for about 30 minutes for a British Airways flight to arrive with Janice and Matt Kurth and Kourtney Kennedy.  They are all here for a shorter period of time and have a totally different agenda from mine.  Though we will see each other once later this week to go to Mukuru, they are not here for Rotary related projects.  It was great to greet them at the gate.  When we got outside, there were several other Rotarians there to greet us.  Geeta Manek had sent her driver, Joseph to pick all of us up.  It was amazing that he got luggage for all four of us in the back of his car!  He dropped me off at Sudesh Walia's house where I was spending the night.  Sudesh had dinner for me (10:30 at night) and I was not at all hungry.  However, it would have been an insult to turn her down.  She had made some Indian food...a vegetable bryani and a wonderful soup.  Of course she made her own flat bread as well.  She insisted that I have two helpings of everything.  I swear  the Africans here are all like Jewish mothers when it comes to food and feeding their guests!  Her daughter had made some pasta in case I didn't want the Indian food, but I did decline that!

Sudesh still does some of her travel agent work, but mostly for tourists from out of the country.  In addition, she now has an Ayruvedic business.  Her home is large and she has treatment rooms and an office for the doctor.  She has it set up like a medical clinic, not a spa.  She is emphatic about that.  The doctor lives on the premises, as does Sudesh's daughter and 3 year old granddaughter.  Her daughter is one of the practitioners for the business.  Many Rotarians come for treatment. 

I had not slept much on the plane, so crashed as soon as my head hit the pillow.  However, I was up at 4 a.m. and did not go back to sleep.  Sudesh had morning tea waiting for me (this was not breakfast, that was to come later).  I saw Alex Nyaga.  He came for an appointment with the doctor.  He told me he had been diagnosed by his regular doctor with gall stones a month ago and was told to have surgery.  He came to the Ayruvedic clinic for treatment and his gall stones are gone.  I had a consultation with the doctor.  He gave me a complete assessment and too bad I can't be there long enough for any treatments. There are physical therapists and other treatment modality specialists.  He gave me a specific diet that I should follow.  It sounds reasonable EXCEPT for no fish or seafood. Of course, no red meat either.  I told him I didn't know if I could go without sushi!  8 treatments here cost $400 USD.  In the States it would be probably three times that much.

Sudesh made a breakfast for us that we ate on the patio.  She has a beautiful views of  of lush green trees and scenery.  With cereal we had warm milk and you could see the butter floating on top!  We then went out to the mall where I bought a local mobile phone so I can stay in touch with the Rotarians here and I also bought a modem for my computer.  That is a great thing, as it makes it possible for me to always get on line without having to find an Internet cafe.

Joseph, Geeta's driver, picked me up at 3:30 to bring me to Nyumbani.  I was greeted warmly by Protus who is the manager here.  I met with Sister Mary for a while as well.  She is the director.  She "warned" me that the accommodations were very basic here.  I think she thought I would be disappointed or surprised.  She obviously does not know about some of the places I stayed on my last trip!  My room is actually very nice.  It has two rooms and a bathroom.  One room has a bed and a kitchenette with a propane two burner unit and a small refrigerator and table.  The other room has two beds, though no one is staying here but me.  There is a shower with hot running water and it is actually quite comfortable.  Sister Julie, who is from Philadelphia, has been here for 7 years and filled me in on some more of the details.  Protus took me around to some of the houses as the kids were taking their medications and settling down to see a movie.  Saturday night is movie night here for the kids.  They all repeated my name and welcomed me.  The kids here are from a little over a year old through high school, with a few exceptions of some older ones in their 20's who are going to university.  The older ones go out to boarding school and come "home" for some weekends and on vacation.  The pre-schoolers have school on campus here, and the primary grade children are all in local schools.  They are bused there each day.  These children are happy, smiling and friendly.  They wanted to know where I came from and were happy to show me their houses.  There is a "mom" in each house.  They are well behaved, clean and polite.  They are so happy to see guests and welcome them warmly.

Sister Julie sat with me as I had dinner.  Many of the volunteers and staff here make their own dinners in their rooms.  Dinner for me was some rice, a few vegetables and chunks of meat....not sure what kind of meat.  Good flavor, but pretty chewy and tough.  I was told that the water here is filtered and the volunteers and employees and the kids all drink it.  However, I am sticking to my bottled water!

Today is Sunday.  I slept for 7 hours last night and that was pretty good for me.  Maybe I am through with the jet lag.  I went to breakfast, and I was the only one there.  The kitchen staff brought me a tray with tea, instant coffee and bread and butter.  The butter was actually a vegetable spread.  I thought that was it, but then she brought me a fried egg and a banana.  Mass is at 10:00 this morning.  That is a very important thing here.  I plan to go as well.  There is a priest who comes every Sunday for this purpose.  Sister Julie told me that all the kids here have been baptised Catholic.  However, though religion is very important here....or rather I should say "faith", they know when these kids go out into the world, they may choose another religion and that is ok with them.  They just believe that with all these kids have to live with and experience in life, they need a solid spiritual and religious foundation.  It makes perfect sense. 

Being here, I totally remember and feel the pull that I felt two years ago when I said, "I know I will be back here".

Several Rotarians have already approached me with  project proposals.  Of course, they see some Rotarian coming, especially from District 5340, and immediately there is a long list.  Of course, I also see so much need here at Nyumbani.  Everything here is donated.  Sister Mary just spent a couple of months in the States fundraising.  They are building a new diagnostic lab here.  One of the problems they have is that many of these children who have been on  ARVs for so many years are becoming resistant to the second line drugs.  They have not had a death here since 2008, but they are very concerned about this drug resistance.  It will be very important to them to be able to test the children for resistance and  be able to acquire a 3rd line of drugs.  This is the main purpose for their new diagnostic laboratory.  All clothes are donated here except the school uniforms.  Interestingly, there has been some volunteer help from local Rotarians, but of course the clubs here have no money.  Lion's club has provided some assistance, but none of their funds have come from Rotary.  I hope we can change that.

I will be posting pictures soon.  Varinder and Chhani Sur called me last night to say "welcome home".  I look forward to seeing them.  I have a great level of comfort being back here.  I know I can make a difference, and that is the best feeling in the world.

Getting Ready for Another Adventure

Dear Friends and Family,
Once again, I am about to embark on an African adventure.  Once was not enough.  I am very excited and have a very full itinerary for the three weeks I will be there.

I am leaving October 28th and flying to Nairobi.  Loooonnnngggg flight!  I arrive in Nairobi the night of Friday the 29th.  East Africa is 11 hours ahead of us here in the States.  The first night there I will be staying with a Rotarian friend who has graciously asked to host me.  Late in the day on Saturday I will be taken to Nyumbani which is an AIDS orphanage in an area not far but Southwest of  Nairobi proper.  I will stay at the facility for 5 days, volunteering as a nurse.  When I visited this facility on my last trip, I told everyone how Nyumbani pulled at my heartstrings and that I knew I would be back.

From Nairobi, I will fly to Kampala, but I won't stay there yet.  Some local Rotarians will meet me and take me 3 hours to Mbarera.  There I will stay with a doctor and his family.  He has me scheduled to speak at his Rotary club and to speak to a group of nurses and physicians the following day.  I will see a couple of different clinics.

From there, I go back to Kampala until November 11th.  In Kampala, I will spend a couple of days at Mildmay, a facility for adult and children affected with AIDS.  Then my friends William and Beth Kaguma will host me for a few days of reminiscing.  I will see two projects I have been involved in in Kenya and Uganda.  I will visit the Mukuru School in the Nairobi slums.  We have provided them with money for bathroom facilities.  The project has been completed.  The children at Makuru now have running water.  I will also visit a water project that we brought to fruition which involves provided plastic tanks for water to a neighborhood who will be helped by the sustainability.

On to Mombasa.  This will be very special.  I will stay with my very dear friends Varinder and Chhani.  I will get to see a new school project, and most excitingly, I will be at Tumaini Children's Center for the ribbon cutting ceremony.  This center was helped by a matching grant that Varinder and I worked on together, and we were able to provide lab equipment to this facility.  The lab will not only be used by the facility, but also the larger community.  There will also be a Rotary Foundation dinner the evening of the ribbon cutting ceremony.  I will volunteer for a few days at Tumaini.  I will get to visit many other friends who have been so wonderful.

I return home on November 18th.  Once again, I know the time will fly by and it will be only a dream.

I will keep you posted along my journey.  You can sign up to receive all updates to this blog right on this website.  Otherwise, you can check back periodically.  If you wish not to receive any mail or updates, either let me know or just opt out.

I will keep you all up to date as internet access permits.
~Dale