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.

Fistula Camp - Day Two

We all tumbled out of bed and met at 7am in the dining hall for breakfast. Loud poorly sung church music was playing on the radio. There was some kind of tour group leaving that morning sitting at one end of a long dining table – obviously unsure abou this group of loud, boisterous and obviously educated group of Kenyans with one seemingly out-of-place mzungu in their midst.
We got to Kisii hospital and there was a crowd of people at the gate – it was unclear why they were being held outside but it seems they were merely awaiting visiting hour and not urgent treatment like I initially worried.
We went straight to Ward 7 where the fistula patients were – all in one room, lying row on row some with catheters and obviously post-op and others awaiting their turn. We did the fastest ward round I think I have ever seen – 40 patients in approximately half an hour – this was facilitated by the fact that there was NO privacy when being examined in this room other than the assistance the patient’s own skirt might give her. We then went to the operating theatre where we remained for the next 12 consecutive hours. The “scrub” station in Kisii is a faucet with a bar of black soap – that was it. In our first case they tried to put a fan on beside us to keep us from overheating but unfortunately the fan succumbed to that fate, catching on fire itself which was quickly extinguished. We did only four cases that day due to the complicated nature of each case. Some of these girls believe they will stop leaking if they don’t drink anything so their urine becomes so concentrated they get bladder stones. A lot of people know about kidney stones but these are a bit different and I examined a patient that day that had a bladder stone the size of a small chicken egg which we removed but I could not contain my disbelief which splashed all over my face as I examined her making Dr. Khisa laugh and say “You have learned a lot of things in Kenya” – a very true fact indeed. When we start some of these cases I have so little faith that we will even be able to do anything but I am always amazed at what he can do for these women. That day we had a fifteen year old girl who three months ago endured a stillbirth, a Caeserean section to remove said stillbirth, a hysterectomy for a gangrenous uterus after labouring at home for days and getting so badly infected AND a fistula from the same causes. She had sepsis so bad that she nearly died and what we were seeing was the aftermath and it was unidentifiable. I would have abandoned that case so fast your head would spin needing multiple other specialties to assist me but Dr. Khisa actually restored function for this girl – a small but welcome relief for a girl who’s life is now over by rural African standards – barren at 15 with no hope of future children.
We left the operating theatre into the darkness of the night. During the day Kisii hospital is warm and inviting with manicured lawn and beautiful trees (they laughed a lot at me when I couldn’t identify an avocado tree seeing as how I have a great love for avocados but when would I have seen an avocado tree!) but at night all the harsh realities that are covered by the brightness of the midday sun become glaringly obvious. The flood lights exentuating the corridors lined with chicken-wire and the large, metal gates at every entrance – it feels like a penitentiary rather than a hospital. And there is no relief once you leave the walls of the hospital compound as there are no street lights in Kisii – the only lights pouring out from the local shops or the headlamps of the workers - it looks like a scene out of a science-fiction novel. We went to Nakumatt (supermarket) that night and I picked up two bottles of red wine for us to share for working so hard and that night they toasted “To Canadians in Kisii”. For those of you keeping track the fact that we did four cases that first day meant we had 14 left to go. We all settled into bed that night, exhausted and a little tipsy from the wine and good company, knowing there was a lot more work ahead.

Fistula Camp - Day One

We finally left around noon – off on the adventure of “restoring women’s dignity” (AMREF’s slogan for fistula camps) and I couldn’t have had a better tour guides for our trip across the country than Dr. Khisa and Richard. It was so nice to see people so proud of their country. We stopped at the lookout point over the Rift Valley, they pointed out every town and every different type of tree. It was a beautiful day for a Sunday afternoon drive. And then we got stopped by the police. They said that Richard was going 112 kph which was “over the spped limit” (there were no speed limits posted on the highway). He talked the ticket/bribe down from KSh 5000 to 200 so it ended up being okay but it was a bit disconcerting to be stopped in the middle of nowhere by “police” that were not above board. We had to buy sugar cane and sweet bananas (plantains) once we got to the Western part of Kenya – the “land of bananas” and very green. The lushness of this area was pointed out to me several times (can you tell my tour guides were biased to their hometowns?) until I said “God must only rain on the Western part of Kenya.” – this amused them immensely.
We got to Kisii around 5pm and the Lonely Planet description did not disappoint:

“Kisii is a noisy, polluted, congested mess and most people quite sensibly roll right on through without even stopping”.
-Lonely Planet, 2008

The one haven was the St. Vincent Catholic Guest House where we were staying. It was not posh but clean and the staff were very friendly. The dorm-type rooms feel like you are in seminary or a monastery with little red flip-flops beside the bed. We had brown ugali that night for diner which I am confident I never need to try again but did try that night for “record purposes” (I did a lot of things for Dr. Khisa for “record purposes”). Ugali is the the maize flour porridge that is the traditional staple food in a number of sub-Saharan African countries (It’s called nsima in Malawi) – it is usually white because all the nutrients have been boiled out of it – the Wonderbread of Africa. But brown ugali I learned was a delicacy that is rarely made correctly but the Catholics in Kisii supposedly have this as their specialty. It’s ugali + kassava + millet (?) and some other ingredients I can’t remember and instead of a thick porridge it has more of a “raw dough” consistency, like thick and sticky peanut butter. Because of this you need to mold it into a ball and swallow it whole (this is according to Dr. Khisa and it’s very difficult sometimes to tell if he is joking but it was what he was doing so I’m going to assume he was serious). After several tablet-sized swallows I honestly count not swallow my dinner any longer – that was the end of the love affair between me and brown ugali.
I met the rest of the fistula team that night – they were lovely and extremely gracious. There were two other gynecologists – the host from Kisii and one from Kisumu , an anesthetist Dr. Okumu, who I believe is the best anesthetist I’ve ever met and one of the nicest guys, Rachel and Kristin (two Nairobi nurses who had also been there the week before) and Agnes from Human Rights Watch who came to talk to the patients about their experiences.In total at the camp there were 42 patients that had been screened as good candidates and would be operated on in this two-week camp. The simple ones had been done the week before by the two other OB/GYNs and the 18 more difficult cases remaining were for us that week. To put this in perspective for those not usually finding themselves in an operating room, a typical OR slate in Canada usually has a maximum of 3 major case a day (usually) and we were going to double that. We enjoyed the luxury of a good night’s rest before what was to come.

Our Tanzanian (Mis)adventure

Subtitle: "I love you like Kilimanjaro"

This weekend (or what is technically my weekend as I worked last Saturday and this Sunday so I took an early weekend) the three of us packed up our stuff and backpacked it out to Moshi, Tanzania to see the famous Mt. Kilimanjaro.
I have had a fascination with this mountain since I was in Africa in 2002. I remember going to the fish farm in Senga Bay, Malawi (Malawi is pretty famous for its freshwater fish) and meeting the owner there on the beach - he was an older British gentleman with white hair, a crisp white shirt and khaki pants. The years had been good to this man here in Africa demonstrated by his waistline and his young nubian bride at his side but he was everso charming and as we sat at his private bar drinking rum and cokes watching the sunset over Senga Bay I remember him saying to me (and I believe it was my friend Erin that was with me) "I know women like you - "Kilimanjaro before breakfast" kind of women". Ever since then I have to say I always wanted to prove him right.
So the first step in this plan would actually be to physically lay eyes on this beautiful mountain. The problem is that Mt. Kilimanjaro is in Tanzania and after this weekend I am not Tanzania's biggest fan. In fact, I have to say that I am unlikely to go back to this country unless under some pretty strong compulsion. Here are the reasons why:

#1: The roads.

The three of us booked our shuttle from Nairobi to Moshi figuring that if Cian could handle a 24 hour plane trip he would do quite nicely on a 5 hour bus trip. Cian did great but this was no 5 hour leisure tour (it was actually an 8 hour trek) even though we booked a "luxury" bus. I think my idea of luxury and the shuttle services idea of luxury are two different things. My idea of luxury would include things like "air conditioning" or nice padded seats and their idea of luxury is to get us there alive and with all four wheels and axels of the bus - fair enough. Now as some of you know I consider myself a pretty avid traveler and I have traversed the highways and by-ways of China, Egypt, several sub-Saharan African countries and the Canadian North (if anyone reading this has been on a reserve road it's earned it's ranks as a 3rd world passage) but I have NEVER seen roads as bad as the road from Nairobi to Arusha. I don't think it would even fit into the classification of a road if there is such a classification system. It was mostly dirt that we drove on beside the actual road that was currently under construction with several potholes and speedbumps and sometimes actual moguls. On top of this you then layer Nairobi traffic, impatient matatus and giant hauling trucks and you've got yourself quite the roadside safari. Oh and then sprinkle a fine layer of dust on everything as it hasn't rained in Tanzania in quite some time and even the trees were covered in dust that made them look older and more withered than they already were so even if this "luxury" bus had air-conditioning it couldn't be used as it would have just made all of us look like those poor trees. It was ridiculous and we did it twice. This is the thoroughfair between Nairobi and Arusha, which is a main city in Tanzania and the axis to the Serengeti and Mt. Kilimanjaro - how can the road possibly be this bad?

#2: The people.

Now I don't want to color all the Tanzanian people with the same brush as I would not want Canadian people to be judged by Stockwell Day for example but there were a fair number of Tanzanian people that were not very nice and for a continent where I have received nothing but hospitality this was kind of shocking. It started with the bus driver who yelled (I'm serious, YELLED) at us for holding up the bus at the border when he did not give any explanations on how it would cost $50 US PER PERSON INCLUDING THE BABY to get into Tanzania (this was explained to us by the exceptionally rude passport officer at the border). And he kept yelling and dragging us in all sorts of different directions until finally we got our passports BEFORE the rest of the group (jerk!) The entire border experience in Tanzania was so bad that if I had transport back to Nairobi I probably would have scrapped the trip right there and then. There were no other downright rude people that we had bad encounters with but there's a general depression that seems to settle over a lot of the people that we met and I have to say I was surprised considering the amount of tourism that Tanzania must welcome - how poor the country seems to be. It was quite a contrast from Kenya, a country that doesn't have the famous Serengeti or Kilimanjaro or Zanzibar. I was really expecting things to be more developed and the exact opposite was true. To be fair our waitress at the hotel loved Cian and would carry him around the restaurant and pinch his cheeks every time she walked by (thank God he's so good-natured) and a lovely woman said "Welcome to Africa" to him and to "say hello to everyone" so Hello Everyone! on behalf of Cian and this lovely African lady.

#3: The power.

I love electricity. I love it and it's reliability. I like when you flick a switch the light turns on or off and I really do not like when the absence of that exists. As it did in ... Tanzania. As the dusty drive demonstrated there has not been a lot of rain in Tanzania and because of this the power is unreliable at best; however, it did seem that the power seemed to take a great disliking to us. We stayed at Keys Hotel in Moshi in a little rondavel (circular hut) that had a bathroom and 3 beds with mosquito nets. I'm really glad that we decided to bring a net though because the nets provided barely reached the beds. This is somewhat ridiculous as a mosquito net is totally useless if it touches you. Keith solved this problem by spreading his out with his body as far as he could stretch and then curling up in the fetal position in the middle of the bed so none of the net touched him. His alternative position, if he wished to stretch out was to lie in the middle of the bed with his pillow on top of his head so that it would act as a mosquito barrier/buttress for the net. These are all the maneouvers he figured out in the dark as we had no power from about 7pm until 9am the next morning in our tiny, dark, non-air-conditioned rondaval. What was I doing while Keith was practing these mosquito-diverting yoga positions? I was enjoying the combination heat stroke/sun stroke/dehydration experience that I had received as a parting gift from the bus trip. Cian, always the best of us, was sleeping peacefully under his luxuriously large mosquito net that his parents had so lovingly brought for him. After about an hour of lying face-first on my single dorm-like mattress praying for the nausea and the pounding headache to stop and for the fan to stop its teasing with 5 minute intervals of power and breeze before long periods of silent darkness I decided that I was not up for being vacuum-sealed into my bed by this suffocating miniature mosquito net and instead would get into bed with Cian. This was actually a good idea because the mosquito net didn't touch me and it was cooler on Cian's side of the rondavel. The only problem was because it was so hot and babies are tiny little furnaces we were a bit hotter but all in all I think it was a better option. Cian woke several times in the night as it was so hot and so Keith and I made a good team of one parent inside the net and one outside - like a scrub and circulating nurse for those in the medical profession. Then at one point he wasn't really drinking his bottle and he seemed a bit fussy and when I turned to him I felt something wet under my hand - he hasn't had a leaky diaper in so long this seemed strange but new country, new rules and as I turned on the flashlight it revealed what my nose had suspected - this was not a simple leaky diaper this was a "Code Brown" that with the heat and the drive caused some major bowel upset. So there we are at 4 am trying to clean up a gross baby in the dark with no power, sweating buckets as the fan doesn't work with all sorts of strange animal (ie dogs and birds) noises outside and we get him all squared away with a new diaper and a new bottle and then the power comes back on as if to celebrate our momentous achievement...for about 1 minute and then it shut off again. Now it was about 5 am and I had slept for approximately an hour and 45 minutes and had been sweating in complete darkness (which is worse somehow) and at this point we had just arrived in Kilimanjaro and I was feeling that surviving this night would be a bigger achievement than actually attaining the ascent. In fact, at this point I told Keith that our previous statement to denote real love to each other which was "I love you like a Star Trek line-up" (for when Keith took me to Vegas when I was pregnant and we stood in massive lines to partake in the "Borg Encounter" and the "Klingon Experience" the month before they closed the entire "experience") would now be replaced with "I love you like Kilimanjaro". I like when things become so ridiculous that you just have to laugh.

There were lots of excellent things about our trip though - the most important being Mt. Kilimanjaro itself. After the long and awful ride to Arusha we took a smaller Land Cruiser-type shuttle to Moshi and when we turned around Mt. Meru there she was - this beautiful snow-capped peak in the middle of the flatest savannah landscape - the clouds surrounding the summit making it look even more other-worldly. That moment of seeing Kili in all its greatness as the sun had started to turn back towards the earth - that was breathtaking. And then the next day when we got to go up to the gate and physically walk on the mountain - that was pretty incredible as well. That day we also saw Kinukamori falls and got to stand in the bottom pool looking up at it cascading over the rocks. Cian also had his first swim in Moshi which went very well, he's a lot braver than his dad when it comes to getting in the water and he enjoyed splashing around. All in all, even with the unexpected visa expenses and the dusty road and the crazy power outages we had a pretty wonderful trip and although I didn't do "Kilimanjaro before breakfast" I did walk up to the gate before lunch with a baby in tow so I think it's equivalent :).

Survivors

**This post will have medical terms and opinions about sensitive topics so if you are squeamish about medical things or strong opinions maybe you want to sit this one out**

They call the fistula patients the survivors because anyone who has endured more than they have found death in relief. Today I sat in awe of an 18 year old girl who spoke no word of English or Swahili but had more courage and strength than any girl of that age should be asked to have.

She was probably ten years old when the women she trusted in her community took her to a hut somewhere where they held her down most likely screaming and afraid with no anesthetic in dirty conditions. Here some half-blind elderly woman cut off the "offensive" clitoris and inner labia and sewed her shut. There would be no doubt when she was sold off to her husband, probably far older than her, that she was virginal when the whole village heard her screaming night after night as he ripped her open. Out of that trauma came the blessing of a pregnancy. Just a baby herself but finally her womanhood had given her something to smile about.

This smile would not last long as she would be forced to labour at home. The village she lived in too remote to easily get to a hospital and deeply rooted fear that doctors would cut her open and her relatives would not be able to pay for even in the public hospitals medical services cost more than most people can afford. Finally after labouring and convulsing for more than three days the people of her village take pity on her as she looks so unwell. The girl was taken to the nearest hospital where her blood pressure was 220/110, she was unresponsive with a GCS of 5/15, a temperature of 39.5 and purulent drainage from where the baby would not come out. The baby would not come because the baby had already died long ago from any one of the complications this poor girl had endured: obstructed labour, eclampsia and sepsis. For some reason in East Africa most places will do an emergency Caeserean section for obstructed labour, probably because they cannot stomach the other option. After all that this poor girl endured the Caeserean complicated the fistula she was probably already developing from obstructed labour and as she left the operating theatre urine wept through the cervix that wouldn't allow her baby to come out.

I met this beautiful girl in VVF (vesicovaginal fistula) clinic where she stated that she wasn't leaking but that she had trouble holding her urine if she needed to go to the bathroom. When she had been seen immediately after delivery, after she recovered from the brink of death from all the other things trying to take her into their fatal embrace, she was told that she was to wait for 2-3 months to see if maybe it would heal on its own. This is a survivor, a champion, told to try to do something on her own. Well she has already proven that she can do anything. She tries the local herbs the traditional healer tells her to use causing inflammation in a place that has already endured too much and she begins to be able to hold her water in a place it just shouldn't be. Finally we press to examine her to make sure everything is as good as she claims. When she gets on the examing table the urine pours out of her in betrayal. We tell her and her uncle that we can fix her the next day and they smile gratefully.

We came to the hospital in the evening today because that was the earliest we could get time and people will come in the dark of night to help these brave women. The sky was a dark grey and the skyline looked like a charcoal painting as we took our instruments out of the car to the awaiting nurses in the theatre. I saw her there without her hajab and she looked even younger than she had the day before. I asked her "Habari?" ("How are you?") and she answered with the only Swahili word she has learned "Msuri" ("Good") with a smile. She sits there on the operating table, her small 5'2'' frame bent in half as she receives a spinal anesthetic not able to communicate with any of the doctors or nurses in the room. She just boldly enters this world hoping to be rid of this constant reminder of that agony. As we put her in position we see her mutilated vulva, a perfect line where her clitoris should have been, intact and pristine and almost mocking all the disasterous consequences that followed. The skilled hands of surgeons who have married their work seperate the post-traumatic embrace of this girl's bladder and cervix allowing her to have some quality of life in her village - not reaking of her shame. Her surgery went well - in fact when asked to cough to test the bladder repair she did it with gusto! Hopefully she will come to hospital when she gets pregnant again as she will have to have another Caeserean section - this her village will blame on the doctors instead of on the mutilation done in the name of chastity. I know she will do well but I also have to think - how did it get to this point? How are women having to endure so much pain and suffering? We have to do better.