Cian's Tree

At Mara Timbo they provide an opportunity for reforestation of the Masai Mara reserve. You can buy a tree and the money goes to the Masai people and they send you pictures of your tree. The program is called "I have a tree in Africa" after the line from "Out of Africa" that starts with "I have a farm in Africa". Anyway, Keith and I decided to get a tree for Cian for him to remember the trip and to be able to watch his tree grow.

On our way out of the camp there was a small patch of land where they plant the trees and the guys were there waiting for us with Cian's tree. They didn't know the English word for the type of tree but the Masai people use it to brush their teeth they said smiling. They had dug a hole and Cian, slung on my hip, and I put the tree in the hole and covered it with earth and the guys helped us plant his tree. He had a little placard that has his name on it and for some reason the whole experience was really moving.

I know I have a love of trees and Africa and my kid so it sort of makes sense that it would mean a lot to me but it felt like a sacred act to plant this tree. It reminded me of my "African mom" Catherine Phiri (from Malawi) and a scene from my life that I have thought of often since I have been here. One day when we were out having dinner someone said something to her about her HIV/AIDS and her not-so-distant mortality. This was a woman that lived life out to every little corner and was healthy and strong but HIV/AIDS is a death sentence in Malawi so he wasn't entirely wrong just entirely rude. Anyway, she stretched up to her full height and held her head up high and said "I am not dying - I will live long enough to see Amanda bring my grandbabies home to Africa". She died in May 2003 from AIDS. Keith and I traveled to Malawi a few months later to see our friends there and I missed her presence greatly and I never forgot what she said. I always knew that I would bring my babies to Africa even though she wasn't there to see them - to honor her memory and her impact on my life. And having something permanent, growing roots into the ground on the continent I love so much with the name of my son beside it, proof that he was here, was such a beautiful sight. I will always carry it in my heart.

Masai Mara Safari

A trip to Kenya would not be complete without a trip to Masai Mara - the Kenyan side of the famous “Serengeti”. Keith especially deserved a great safari as he has a) taken care of the kid the entire time we’ve been in Africa and b) did not get to go on an awesome safari last time we were in Africa because his future wife got malaria. So I was bound and determined to provide an excellent safari experience and figured the reserve where “The Lion King” was based upon would be the perfect spot. Kenya is also the home of the late Karen Blixen who’s life was the basis of the book and movie “Out of Africa” so a lot of the safari experiences in the country reflect the style of that time (circa 1920) large, luxurious canvas tents in the middle of the savannah – something we were also pretty keen to experience. So after heavily researching this topic I booked us on a 4 day / 3 night safari at Mara Timbo Camp (www.maratimbocamp.com).
We choose the fly-in option because it was easier and cheaper with an infant and actually turned out to be the best option for us by far. We flew out of Nairobi Wilson airport which is this small local airport for essentially safari holidays and fly-out medical personnel so I was very happy and we hadn’t even left the airport. We boarded a 12 seater Twin Otter plane (Keith pointed out that they likely make these somewhere else as Africa doesn’t have otters – coincidentally the Canadian North also flies the same small planes) with the mtoto in tow who promptly fell asleep as we flew into the air. I had never really thought about this but flying over the East African landscape in a small lightweight aircraft really makes you feel like you are going somewhere remote and exciting which we were. We made one stop at another small airstrip in the Mara before getting to our airstrip at Kechwa Tembo. There our bags were taken out of the nose of the plane and we were greeted by camp staff who took us on our first game drive. The Masai Mara is unlike any other park I have ever been to because it is SO green. This area of Kenya started receiving rain about 3 weeks ago and our naturalist Kinata said that after 3 days the entire 1,000 sq km turns green. And not a little bit green…bright green. It’s like someone took the Emerald Isle’s emeralds and planted them in Kenya and put some African animals on top. With how blue the sky is here it’s like someone took the colour contrast button and cranked it right to the max. It’s amazing. Quite literally from the air strip to Oloololo Gate of the Masai Mara game park we saw: zebra, water buffalo, warthogs, giraffe and impala and we weren’t even in the park yet. Cian’s response to all the animals (especially the zebras which we think are his favourites) is a very loud and excited “Aaaahhhoooooooo”. It’s adorable and makes everyone else smile too. I’m so glad that even though he’s so small he can still enjoy the safari.
Within the park we saw all sorts of animals including a pride of lionesses and a male lion with his leg up on a solitary tree relaxing in the shade. We had lunch with the hippos that day and that made our way to Mara Timbo camp. There we were greeted with hot towels and our personal butler Constelata immediately took the baby. All of the wait staff are women here to promote female employment and empowerment (which is of course another reason why I chose this camp). They gave us the family tent which has a huge luxurious bed, desk and trunk in the main area looking like something out of 1912. There is an adjoining bathroom with his and her glass sinks and a shower with a huge showerhead and a tree trunk post and then there was a little adjoining room for Cian with his own big boy bed and a mosquito net. Outside on the veranda was a big river-rock tub (a huge selling feature for all three of us bathlovers), a porch swing, a dining table and a small couch. From the porch you had a beautiful view of the trees and the Mara river with the sounds of the hippos and bright­-coloured birds flying by. We relaxed at our tent in the rain until supper and then headed off under the umbrella with our askari (security guard) to have a lamp-lit supper which was absolutely excellent. Cian was so exhausted he almost fell asleep sitting in his high chair drinking his bottle and promptly fell asleep when we got back to the tent to tuck him in.
The next day we woke up for a 630am breakfast – that’s right Keith woke up 600am on purpose and stayed awake, it’s shocking. They had arranged our dining tables out by the river and we had a beautiful breakfast while watching the hippos and the sun pop their heads up to greet the day. Conselata watched Cian while Keith and I went on a game drive and saw lots of animals including hyenas and cheetahs which I had never seen in the wild as well as two black rhinos. There are only five rhinos in the Masai Mara park due to previous problems with poaching as the rhino horn is used as an aphrodisiac – the thought is the rhino’s horn is always erect and therefore…you get the idea. Anyway, they are a very shy animal and extremely difficult to spot so we were very lucky to have seen them. We also saw about 100 hippos bathing and lounging in the mud along the river in the park – I don’t think I’ve ever seen that many hippos together at one time. That day we had a picnic lunch up on a hill overlooking the whole park with zebra grazing nearby. It was amazing. We came back from the drive and Conselata greeted us without Cian, after an awful story from our guide about a baby that had been taken from another camp by a hyena I was a little stressed. She laughed and said he was at the bar – if you’ve been reading the blog you’ll know that it seems our kid is often found in the bar, an experience I do not think will be limited to his first year of life. There he was sitting on the bench with the bartender watching the hippos – he greeted his parents with a smile. He had spent the whole day with all the camp staff. One of the security guards who had taken a real liking to him took him up to the staff housing and he taught him a Masai song and a Masai dance – they were very good friends. It’s so nice to see how wonderful people are with him here. That night we hung out at the bar with David and Linda, a lovely couple from the UK and the only other guests at the camp before another wonderful dinner, this time under the stars with a bonfire and lamps in the trees (gorgeous!) before settling in again for an early night.
We opted to leave even earlier the next day – leaving for safari by 6am. I’m a big fan of seeing the sunrise in a foreign country and this one surely did not disappoint. We brought Cian in his blue zebra-stripe pajamas and watched the sun rise over the hills of the Masai Mara – it was gorgeous. The sunrise made me completely forget about the hippo that had tried to charge the car only minutes before (never get between a hippo and its baby or the river and we had done the latter – the guide said it was fine that he was just trying to get us to move). We had breakfast on the hills watching the zebra and jackels and a family of elephants descend from the ridge. It’s amazing for such a big animal how they can just suddenly appear. Cian was a big fan of the elephants – letting out a resounding “Aaaahhoooooo”. We got to see some very close-up too which was great fun. We also saw some cheetahs playing and watched them run around and saw a lion hunt a warthog. They are very lazy creatures and gave up extremely easily and settled in for a long nap after its half-ass attempt but not before walking right in front of the car (Cian really liked the lions too).
After a wonderful lunch we had a relaxing afternoon and I went to the massage hut for a full-body massage up in the trees. It was the most relaxed I’ve been in a long time – it was incredible to watch the river and hear the sounds of hippos and birds and get pampered for an hour. It’s amazing how now that I’m a mom I’m so happy with even just an hour to myself to relax (my mom is probably laughing right now).
That night we had another lovely evening under the stars at a lantern-lit supper. Linda had mentioned Gin and Tonics and I had forgotten those were my favourite safari drink ever since my dad and I had them in Malawi on the sunset cruise on the river so it was really nice to relax in the evening and have a nice meal. We put Cian to bed and settled in for the night knowing that we didn’t have to wake up at a ridiculous hour the next morning.
It was so nice to wake up to the sunshine – we leisurely got ready and headed out to the riverbank breakfast awaiting us. The sun was warmer than usual (go figure since it was later than usual) and we had a lovely breakfast and Cian played with his staff friends. We chose to just relax at the camp that day which was brilliant because with all the windows open in the daytime having a nap in the luxury tent was a whole new experience. I’m so glad we got that day to ourselves, the only guests at Mara Timbo, relaxing like royalty.We returned to Nairobi boarding the lightweight plane right off the airstrip while zebras looked on. This trip required a few more stops before heading to the capital and was a bit bumpier so Keith, not well known for his iron-clad traveling stomach, had a bit of a rougher go of it. There were a couple of young girls (maybe 6 and 8) on the plane who were total princesses and cried uncontrollably after the descent. Their mother pointed out that Cian was perfectly fine and far younger than them – yay my little traveler – he just watches out the plane window now on take-off and landing he doesn’t even need a bottle. Keith did well and did not have to remove his air sickness bag from the aircraft so all in all it was a successful plane trip and a wonderful vacation.

Dinner in a Cave

Our last night in Diani Beach we decided to go out and give our wonderful chef Ali a much needed night off. We went to Ali Barbour’s Cave Restaurant (http://www.dianibeachkenya.com/cave_restaurant.html) . That’s right – you get to eat dinner in a cave. It was beautiful with lanterns hanging everywhere and open to the night sky. We had fantastic food and Cian fell asleep on the floor which is where we put him after he kept falling out of the Sultan high chair. With great food and fantastic ambience it was the perfect way to end off our trip to the Coast.

Our trip back from Mombasa was uneventful which was a pleasant change and when we got home the staff at Samra Apartments had missed Cian a lot. Cian had gotten a bit too much sun the day we spent on the dhow boat and one of the girls said “Baby – Mombasa has changed your face!” which Keith and I love and say to him all the time.

Sacred Forest

The next day Keith and I went to Kaya Kinondo which is a sacred forest for the Digo people of the Kenyan coast. I have always had a fascination with trees so a place dedicated to their spirituality was definitely a place I wanted to be. Granny and Cian stayed home having had a little too much sun the day before and giving Keith and I the chance to just relax and enjoy how peaceful a place can be where people understand the inherent nature of wise old trees.
Kaya Kinondo was the home of the Mijikenda which means “Nine Homesteads”. These nine tribes lived in this forest and cared for the trees here. Juma Harry, our guide and caretaker of this kaya, described the trees like they were his oldest and dearest friends. Inside the kaya all had to wear a kaniki (sarong), no headgear of any kind was allowed, you could not make loud noise or show affection to anyone…expect the trees. He told us that the Mijikenda believed that hugging an old tree would add years to your life and so he encouraged us to hug one of his old friends square around the middle – and it was so big you couldn’t fit your arms around it. He showed us the “strangling tree” that takes the life of it’s host over several hundred years. He showed us the Tamarind tree (like the spice) that signified the old Mijikenda village because it was not native to the area but would have been brought here almost 900 years ago and signified “home”. He showed us the Lianna tree that was used medicinally for pregnant women who had stiff backs or for men that could not get stiff :P and in one area of the forest a Lianna tree had grown with a swooping branch between two other trees so strong that a grown person could swing. As we were shaded from the hot midday sun by the protective branches of this lush, ancient forest we walked the footsteps of this askari’s (soldier) ancestors and it was so incredible to be with a person so proud of where he came from and what his people had loved – that he continued to love and dedicated his life to safeguard.

The Coast of Kenya

Granny Morris decided to come visit us here in Kenya and after weighing her vacation options decided that the beach might be a nice escape from the harsh realities of a fast-approaching Canadian winter. After my week in Kisii I was desperate for an escape of my own and the four of us packed up our things and headed to Mombasa, East Africa’s biggest port. After a plan, a taxi and a ferry we were in Diani Beach at Warandale Cottage (www.warandalecottage.com) – a gorgeous white-walled, thatch-roofed cottage that was footsteps from the Indian Ocean. Our cottage included a chef named Ali who pampered us without restraint cooking amazing seafood concoctions at night and creating beautiful fruit salads every morning so that our entire job was to sit out on the patio and watch the tide of the jewel-blue ocean come in and out with the warm, salty seabreeze on our faces. It was tough but we all managed to survive it.
The first day we just relaxed at the cottage – sitting on the patio, taking a dip in the pool and walking on the beach (although Cian was not a huge fan of the tide and we weren’t huge fans of the beach boys that harassed you for money smelling of marijuana). Mostly it was just a beautifully delicious day of nothingness garnished with fresh calamari and red wine.
The second day we decided on a little more adventure and booked a tour with Pilli-Pipa (www.pilipipa.com) to ride on a dhow boat and do some snorkelling on the coral reef. To be on a dhow boat is sort of what I imagine what it would be like to sail a small, old, pirate ship. We set sail for Kisite Marine Park – it was a gorgeous day with clear skies and impossibly blue water. On our way to the coral reef we followed a wild dolphin pod around the bay jumping and swimming under the boat. It’s difficult to get a 9 month old to focus on anything outside of his immediate environment (i.e. “Ooooh look at the rope”) so getting him to see the dolphins was a bit tricky. The shipmaster’s solution to that was to HOLD HIM OVER THE SIDE OF THE BOAT. Somehow in the immediate moment this didn’t seem that ludicrous – the shipmaster wanted Cian to see the dolphins, Cian needed to get closer to see the dolphins – but after the fact I’m thinking “that random guy I just met held my kid over the side of a moving boat in the Indian Ocean!” I try not to dwell on that fact – all was well and Cian saw the dolphins.
We got to the coral reef and Keith and I did the first of two dives that day. I wasn’t sure how this was going to go as I’ve been snorkelling in salt water in the past and not had a great time but that’s what going with a good outfitter will get you – amazing guides and excellent equipment. From the moment I put my face in the water it was like I was transported to the real-life location of “Finding Nemo”. It was other-worldly and the water was amazingly warm and we sailed along together pointing out different types of coral, crazy amazing schools of fish, squid and stingrays – the time flew by and all I could think of was how much Cian loves the aquarium and how I couldn’t wait to take him snorkelling when he was bigger. Meanwhile the same guy that held Cian out of the boat said he’d gone for a swim and saw the fishes that he wasn’t a particular fan of the swim. This seemed very odd because anyone who knows Cian knows how much he loves the water. When we got back to the boat I pushed Granny Morris into going on the next dive and I would watch Cian. She was hesitant to say the least but I was not taking no for an answer so she put on one of Keith’s math T-shirts so she wouldn’t burn in the water and one of the guides took her around to see the coral holding on to a life preserver. Yes I took pictures. During this time I decided to try out the whole swimming thing again with Cian and wouldn’t you know the reason he didn’t like it the first time was that the guy hadn’t put him in his life jacket and he’s only gone swimming in his life jacket so once I put his life jacket on he was happy as a clam. Especially because the captain attached a rope to the ladder of the boat and Cian and I could hold on to the rope and swim out. He learned how to sort-of paddle on his front and he had a great time splashing around in the Indian Ocean. Granny had a great time snorkelling too.
After that we went to Wasini Island to have a fantastically decadent seafood lunch and then back to the cottage. It was a terrifically beautiful day.

Fistula Camp - Day Four and Five

Eight patients remained and it was obviously wearing on the entire team. It was probably like when a marathon runner sees the finish line and all you can think about is finishing. The ward round again went well with all the patients doing well without complications and finally dry. I had to laugh at my post-op notes because the attending physicians back home would definitely be upset with their brevity. They looked something like this:

Post-op Day One
Pt doing well
Dry
No concerns
Plan: continue present management

It's not exactly the thorough note I would usually write but when you're seeing 40 patients before operating on 8 more - brevity is your friend.
As I was heading to the operating theatre - the OB/GYN from Kisii reminded me that sometime around hour 10 the previous day I had agreed to talk to "some OB/GYN people" in Kisii about "Women's health in Canada". Since there were only 2 obstetricians in Canada I didn't see this as a huge deal - maybe a cup of tea and a little chat.
I got to the LECTURE THEATRE and 150-200 people started pouring in to hear me talk about "Maternal and Child Health in Canada". Huh...I was not prepared for that. Well what can you do when caught in this situation where you're essentially doing Grand Rounds on a massively huge topic to a huge audience without preparation? Wing it. I talked for a little bit about how we manage labour and our wards and some basic population information that I had researched for an upcoming grand rounds that I am actually PREPARING for and then I took questions. And the questions were extremely intelligent and thoughtful about how we keep our maternal and child mortality rates down and mostly I was embarassed to live in Canada. Not embarrased of my country because I am an extremely proud Canadian but embarrased of the vast wealth of knowledge and resources and free health care that I found myself using the word "luxury" over and over again. I imagined how they cared for their patients as much as I did and they would have so much less to offer them in terms of resources and would watch complication after complication that would be easily fixed with textbook medicine that they just did not possess. There was such an eagerness to learn too I thought of how sparsely some of our rounds are attended in Winnipeg, even by excellent presenters and it further magnified the inequity - even the knowledge sharing wasn't equal. I'm hoping with some of the information that we shared that day we can incorporate educational topics in our Nairobi-Winnipeg partnership. After the meeting was finished and they laid out their additional education plans based on the Millenium Development Goals (if only we did that in Canada) they gave me an extra special thank you. There are lots of different types of clapping in Kenya and it's also well-known for its flower farms so they mimed picking me "flowers from Naivasha" and then gave me a big boisterous clap - it was wonderful.
When I finally got to the operating theatre at around 10am they were on their 2nd case and we were well under way. That day we operated on a seventeen year old girl who had twin stillbirths that would have been the same age as Cian. There was also a 73 year old woman who had been leaking for 40 years with the easiest fistula to repair of the entire group - finally dry after all this time. By the end of the night we had done seven cases with only one remaining for the following day. Then the nursing staff came to the theatre to tell me that our last patient had been crying all day because she was convinced we were going to leave and she wouldn't get her surgery because why would the doctors stay around for just one patient and after all, all she had seen in her life was disappointment. Everyone else on the ward was happy and smiling and she thought that she would be left behind - still plagued with her problem. She broke my heart and the nurses asked me to come talk to her. Dr. Khisa was exhausted but such a softie that he probably would have done her that night but we had time the next morning before we left and it's always better to do surgery when you aren't totally exhausted. Plus I had been pushing him so hard to finish because I missed my boys so terribly.
When I got to the ward she'd obviously been crying but I promised her that we would operate on her "kecho" (tomorrow) and that we would not leave without her getting her operation. She seemed to finally believe this - content to rest before her big day and our final one.
We went back to the guesthouse for supper and with our final two bottles bought by the woman from Human Rights Watch. That day we toasted "To the patients" - to the brave women who survive.
The final patient got her operation the next morning without complication and with a big post-op smile on her face. All the patients in Kisii were dry at the end of the week and doing well. We returned home exhausted but fulfilled by their smiling faces and how they had touched our hearts.

Fistula Camp - Day Three

Another early morning with a quick breakfast and we were off again to the hospital. We did another quick ward round and the patients from the previous day were doing very well which was encouraging for the next round. It was always easy to tell the patients for that day because suddenly the "chosen ones" were dressing in green-striped hospital gowns assisted by the patients who had gone before and the patients yet to come. Watching this reminded me of women helping beloved brides into their wedding gowns which I know sounds strange but in some ways the anticipation had the same mix of anxiety and excitement.
The first patient we had that day was a woman about my age who probably suffered her injury from an emergency C-section by inexperienced hands. Her ureters (the tubes connecting the kidneys to the bladder) were draining directly into her vagina and that usually is a surgical injury rather than an obstetrical injury. We had to do a laparotomy (open her abdomen) to repair her and take her ureter disconnect it and reconnect it in a different place through the broad ligament of her uterus (for the medical people :)) it was incredible and unbelievable surgery.
We lost one of our operating theatres that day because General Surgery needed it for their emergency cases. As we were operating on one of our patients one of the nurses came in to say that the patient in the next room had died. No code called, no additional hubbub, just died on the table. I had to go into that theatre a few minutes later (as it housed the only scrub station) and they were sewing this man back up and on the radio playing eerily in the background was Kenny Rogers' "You've Got to Know When to Hold 'Em". It was one of those experiences when you feel like looking around because it can't possibly be actually happening.
We did five other cases that day including a woman who had been leaking for twenty-five years and finally got her repair after so much damage had already been done to her body (it wasn't even that difficult a repair which was so sad).
We left under the blanket of night again getting another two bottles of red wine this time toasting "To Kenyans in Kisii" and I went to bed at 830pm exhausted from the day.