Home at Last

Rich writes about getting home -

Under an Acacia tree on our last Safari. From left to right: Dick, Jonathon, Kathy, Brad, Gretchen, Moses, Kendra, Joyce, Mary, Tina, Chuck, Eleanor, John, Sarah

It has been a very long "day" of travelling. It started Tuesday morning at the Leisure Lodge in the Mara at 7:30am with seven hours of driving over typical Kenyan Roads (very bumpy or washed out). We stopped for several hours at the Ewaso Ngiro clinic where John Sankok lives to visit with him and his wife Grace. We then continued on to Nairobi for an 11:30pm eight hour flight from the Jomo Kenyatta airport to London. In London the team got separated while leaving the plane and eight of us left on the scheduled flight and the last four had to be rebooked on a later flight. Another eight hour flight to Chicago and finally a one and a half hour flight to Rochester. It is good to be home!

The following photo albums have been updated with more pictures:
Monday at the Talek Clinic
The Incinerator
Talek 911
Painting and Interior Maintenance

Two new videos have been posted including: a video of the Talek Community Health Centre on YouTube. Also, young men in the Maasai tribe compete in jumping dances to see who can jump the highest with the best form; some male members of the team participated in an impromptu jumping session with our guides Jonathon and Moses on the last day of the trip. This is must see!

Lastly we met some great people on the trip.

Carly has to decide

One of them, Carly, kept a blog about her time in Africa.
We had a great time in Kenya!

Rich and Mandela struggle with the internet

Last Post From Africa?

Rich writes about our last day of work at Talek Clinic -

This probably the last post from Africa. Access to the internet here in Talek is very limited and slow. No one has had access to email. Because of the slow connection (we are grateful just to have a connection), it wasn't possible to upload all of the pictures that were taken; however once we get home, more pictures from our time in Talek will be uploaded and a notice with the locations of the pictures will be posted. Thanks for all of your emails and comments, and we've tried to share them with the team as we've received them. See you all in a few days!

Work Hard, Play Hard, Sleep Hard

Sarah writes about our game drives -

Our drivers, Young Moses and Jonathan, have seen us safely through the dirt paths that pass for roads in the Mara. Both are Maasai, both have an endless supply of goodwill, and both are friends of John Sankok. They are also very supportive of our work at the clinic, and try make our days more enjoyable. After taking us back to the Mara camp one day this week, when we were all very tired from a full day of work, Jonathan told us to sleep hard. If you work hard, it would stand to reason that you should sleep hard, too.

This week hasn't been all work and sleep, though. We have had the chance to play hard and go on what you'd call a safari, but are known here as "game drives." They have nothing in common with a cattle drive, but you do drive out to see the game.

Giraffe herd with distant rain

Sunday afternoon we drove out, passing herds of Thomson gazelles, zebras, and wildebeests before finding a group of giraffes. After that, we were lucky to see several lions, a large group of hippos in some foul-looking water, and many beautiful birds.

The other drive was early Wednesday morning when we woke before the dawn, driving out for a short trip as the sun rose over the Mara and the animals were busy getting breakfast before the heat of the day. The team saw all but one of the "big five" animals -- elephant, lion, cape buffalo, leopard, and rhino -- with rhino being the lone hold-out.

The circle of life

We have one more day of game drive on Monday, when we'll be out all day, and John assures us we'll be in an area where we should see rhino, in addition to the massive wildebeest crossing of the Mara river, known as the migration.

With just two days left on the trip before we head to the airport on Tuesday, I find it hard to believe how quickly the time has flown by. When people we've met have asked when we'll be back, I don't know exactly what to say. I've blown through most of my vacation days with this trip, but I'd happily do it again next year if we could make it work. There's so much to be done, and so much more to see. And Rich has a never-ending supply of ideas for the Kenyans: new things the women at the craft and textile workshop of Amani ya Juu could make to sell, a new factory for standardized hammers and long-handled shovels, or star tours of the Mara where we can see millions of stars and the Milky Way far more clearly than we ever can in the light-polluted US. We're still trying to figure out if we can make it to the Kenya Museum and their exhibit of the Leakey's amazing discoveries of early-humans. Maybe on the way to the airport. Or maybe on the next trip.

I said before that I'm bringing home the red dirt of Kenya in my shoes. But I also have the black dirt of the Rift Valley that we dug through to build the waste incinerator. And the memories of all those we have met. We may not see the fossilized footprints of early humans, but I have the imprints of many new friends in me.

The elephant herd made us late for breakfast

Spring Cleaning Comes Early to Talek

The team writes about painting and interior maintenance -

Brad and Maurice

After spending most of Monday removing the posters that were plastered to the walls throughout the clinic, Brad, Tina, Joyce, Mary, Gretchen, Kathy, and Chuck (who joined the painting as work on the incinerator progressed) were eager to get back to actual painting on Tuesday. Of course, with twelve rooms, three hallways, and a large open porch in the clinic, not everything was quite paint-ready yet, but Maurice and his professional painters were already hard at work.

Hanging the curtains to dry attracts some attention

Gretchen and Kathy took down all of the curtains to wash them and keep them out of the paint until everything was dry. In true Maasai style, they washed them in two buckets with cold water that turned chocolate-brown in no time, and then hung them on the fence to dry, which took less than an hour in the dry breeze.

Maurice and his painters were thrilled with the rollers we had brought, as they had never used anything but brushes, and the team wished they'd brought even more tools and supplies to help with the task.

How to paint high places in Kenya

This was particularly true of ladders, which don't seem to be very common in Kenya, leading the team to stand on paint cans, desks, bedside tables, and wooden benches from the hallway patient waiting area to reach the top of the ten-foot walls.

As the painting progressed in earnest, a disagreement about best practices arose between the Webster painters and Maurice and his team. The professional painters were used to thinning the oil-based paint with large amounts of turpentine, making the paint nearly as transparent as water, which didn't cover newly primed sections of the wall. It also released huge amounts of noxious fumes that were almost unbearable. At the end of Tuesday, the Webster team reached an agreement with the painters: Because the team had purchased plenty of paint, everyone would use it unthinned, which is generally unheard of in Kenya where almost everything is stretched as thin as possible to maximize resources.

Once that was resolved, the remainder of the week progressed without incident with more cleaning and painting, plus repainting of many areas.

Joyce and Tall Moses

Even with unthinned paint, some areas had to be repainted three or four times to have complete coverage. William, Moses, and others from the clinic staff contributed significantly to the effort, with the very tall Moses washing the highest spots and everyone pitching in on any task at hand. Jill and David, a couple from Hoboken staying at the Mara Leisure Camp with us, also lent a hand on Friday after hearing about our project during mealtimes.

Replacing window hardware with the only tool available

Dick spent most of Friday and Saturday installing notice boards, including hand-sawing miter joints, and repairing and installing new window hardware, with little more than a Swiss Army Knife.

Everyone at the clinic was thrilled with the brightness from the fresh paint, and several remarked that they were looking forward to continuing our efforts with regular maintenance in the future.

New friends Jill and David probably never expected to be painting in Kenya during their vacation

Talek 911

The team writes about seeing patients -

Both Kendra and Eleanor spent all week seeing patients in the clinic, which was a little unexpected. They had anticipated a day or two of observing how the clinic functioned, but Juma, a nurse and clinic manager, put them to work seeing patients. Luckily the team had brought some lab coats to be donated, so Kendra and Eleanor could be properly attired for the work.

Kendra, Eleanor, and Juma discuss a diagnosis

Juma served as interpreter for the first several patients before Kendra and Eleanor started working on their own and they saw patients ranging in age from newborns to the elderly with ailments that included malaria, brucellosis, typhoid, TB, fungal infections, and burns.

The clinic has a well-ordered intake process to see a medical professional (known as a "clinician") that starts when the patient arrives and registers with the social worker at reception. If the patient has been to the clinic before, the social worker gets their history file (written on a 5-by-8 index card), then the patient waits his or her turn to see the clincian who will interview the patient for symptoms and arrange for treatment. An on-site lab can complete tests to confirm diagnoses, including serious illnesses such as TB, typhoid, malaria, and venereal diseases, and the pharmacy in the next room can dispense most needed medications.

Alex, Kendra, and Eleanor

Just as doctors in the US are extra busy on Mondays, that was a busy day at the Talek clinic, full of patients who became ill over the weekend. Soon Kendra and Eleanor found that the most common issues, malaria and fungal and respiratory infections, were easily diagnosed and treated, even with the difficulty of working through a language barrier. The adjustment to practicing international medicine was fairly quick, even though it included illnesses rarely seen in the US.

After a lighter patient load on Tuesday, Kendra and Eleanor arrived to a full waiting area on Wednesday which is the immunization and obstetrics day of the week. The clinic and the community health workers have had great success with communicating the benefits of immunizations to the Maasai, and now most children in the area receive their routine immunizations on schedule.

Eleanor and friend

Thursday included two unusual cases: one was a boy who had been kicked in the chest by one of his family's cows and another was a follow-up visit by a man who had been attacked by a lion while herding cows and was saved by friends who came to his rescue.

When the team returned to the clinic after lunch on Friday, we noticed a long, pine box being constructed just outside the clinic grounds, and we soon learned what it was for. A woman from another village had died in Talek, and they needed to preserve her body for transport back home. Eleanor was asked to help with the embalming, but she declined, so the other clinic workers set about filling syringes with formaldahyde for the procedure. You just never know what international medicine will bring.

In addition to the medical supplies brought from the US and donated to Community Health Partner clinics, on our last day at the Talek clinic the team donated our unused Cipro, an antibiotic, which was timely because one case involved a boy with an abcess on the top of his head which was lanced and he was able to be given some of the donated medication.

Kendra sorting medical instruments

The usual maladies of malaria and typhoid rounded out the morning's cases. Kendra noticed that the surgical instruments could use some organization so she set about sorting and ordering them to make it easier to find the correct implement.

Working with patients in Kenya has been a great experience. It was a chance to see how the people in the Mara are treated, or not treated, particularly in comparison to what we experience in the US. The diseases treated here, which would be minor at home, would be painful or even fatal here without the intervention of the clinic medical professionals who do a great job, even under challenging circumstances.

"There ain't no short-handled shovels, no axes, saws nor picks. . ."

Rich writes about building an incinerator -

Tuesday morning I awoke to the sound of birds calling and cattle lowing. The cattle are grazed by Maasai herders across the stream that is in front of our tent. This is a very pleasant way to wake up, especially if the rest of the day will involve hard manual labor.

Clinic trash is burned in a pit

One of the tasks John Sankok felt our team could complete at the Talek clinic was to construct an incinerator to burn the clinic's medical waste. Before I write about building the incinerator, I should educate you about trash pick-up in Kenya: there isn't any, at least for most people. Having your trash hauled away is more expensive than most Kenyans can afford, so they either throw it over the edge of a ravine or burn it. All types of trash is burned, including plastic and glass, usually in a cool, smoldering fire. There is acrid smoke from the burning plastic, and shards of broken glass fill the ashes when they are raked out. The only recycling is in Nairobi, and since most people can't afford trash service, almost nothing is recycled. If you can afford to have your trash hauled away, that just means it is burned in a fire in a poorer part of the city.

There is no trash service in the town of Talek. Trash litters the ground or is burned in one of the two incinerators in town. At the clinic, all of the trash is burned in a pit in the ground at the back of the clinic grounds. Our task was to improve the process somewhat by building a brick incinerator where the trash could be burned.

On our first day of work, not all of the necessary materials had been delivered and the plans were not available. Tuesday morning the fire bricks had arrived overnight and were in a jumbled pile in back of the clinic where the new incinerator was to be built. However, before building up, the first step was to dig down and pour a slab foundation.

Digging the foundation

In Webster this would involve excavating with a power shovel to create a foundation below the frost line, then forms would be set up for the slab and cement would be ordered and delivered and poured by a cement truck. That isn't how it's done in Kenya. Mechanization is almost unknown in Kenya. There is a labor surplus, so most people will work for very low wages, which is cheaper than machines to do the work.

The first step for Chuck, Dick, Sarah, and me was to break the sod in an eight-by-eight-foot square using extremely short-handled shovels and pick-axes. After the sod was removed, a hole had to be excavated to a depth of one foot. I now know that the soil of the Maasai Mara is dark, damp, and sticky; we all took turns breaking the soil with the pick-axe and mattock, then shoveling the clumps out of the hole. After the excavation was done, we scoured the clinic plot for Tufa stones, the volcanic rock that is cut and finished to to build almost every building in Kenya is built from, that were leftover from other building projects. These rectangular stones were placed into the hole to make a "rubble foundation."

Chuck mixing concrete

In the afternoon Kuria the mason and Josephat the engineer constructed a form around the hole for the slab. Kuria instructed us in the proper technique to mix concrete in a pile of sand and cement on the ground. This involved shoveling and moving large amounts of sand, then mixing in water and cement using the very short-handled shovels.

I asked Kuria if a manual concrete mixer was ever used, and he said it was too expensive; it was cheaper to hire 50 men who could build a house in one day. There is a small building boom in Talek right now, which makes it shockingly apparent how much labor is expended to build anything. The mixed concrete was then shoveled over the rocks and tamped down. Josephat and Kuria screeded the slab smooth to end the day on Tuesday.

We resumed construction the next morning by laying out the locations of the walls and mixing the mortar (more hard labor) that would be used for the walls. Kuria asked Sarah, "Do you want to work?" and started instructing her in how to place bricks and fill the spaces.

Sarah building the walls

A woman doing masonry work attracted a large amount of interest in the following days. Over the course of the day on Wednesday, six of the eight courses of bricks for the walls were finished.

On Thursday we completed the remaining wall courses to a height of just under four feet. Kuria had decided that the roof should have a gable, so he and Josephat constructed a form to pour a concrete gabled roof. We mixed more concrete for the roof, lifted it in buckets, and poured it into the form.

By Friday morning, the roof had hardened enough to remove the forms. Kuria instructed Sarah and I in how to build a chimney that stepped in with each course, that we worked on while he "plastered" the roof with a neat edge. After that, our work on the incinerator was finished, because the concrete needs to set for several days before the front and top doors are put into place, and then they must wait 21 days for the concrete to completely cure before the incinerator can be first used.

Sarah and Kuria next to the new incinerator

Building the incinerator was very hard work, and it gave all of us a new appreciation for the life of most Kenyans. Most of them work very hard in adverse conditions. No one we worked with wore goggles or dust masks. Items required by law on job sites in the US, such as safety shoes or hard hats, are unknown. One of the most disheartening things I discovered is that tools we take for granted -- screws, power drills, and circular saws -- are not available. Many of the tools and supplies that are available to Kenyans are of very poor quality. One of the Kenyan people's largest impediments to improving their lives is simply that they can not get quality materials to work with. For someone like me with an office job, the blisters I have now will become calluses, and the calluses will soften and disappear, but for the people of Kenya, the hard work goes on.

Water, Water Everywhere

Sarah writes about Monday, Sept. 6-

Back at home, water flows freely from the tap, and one of the world's largest sources of freshwater is a few scant miles from my door. In Kenya, water is their most precious resource. At Kimuri School, they had two tanks for water collection, but it wasn't enough for them. When washing the windows, for instance, we waited until we had water the color of chocolate before changing it to conserve it.

Talek Clinic Welcoming committee

When we left Kikuyu on Saturday morning, we drove more than five hours to the Masai Mara, the region where John Sankok's clinics are, traveling through miles and miles of high desert in the great Rift Valley. Sunday we attended church in a Masai community in the morning before seeing John's first clinic. It is fairly small, with just a few rooms, but the time since my in-laws last visit has seen much improvement. The generosity of many groups has ensured that every one of John's clinics has a robust water-harvesting system, gathering every drop of water that falls on a clinic's roof and diverting it to one or more large collection tanks.

Clinic director Juma explains the Talek clinic water harvesting

These improvements have been a huge benefit for the clinics and the communities they serve, meaning they can start their day with clean floors and treatment rooms, and they even have gravity-fed sinks near the pit toilets.

Those pit toilets are a huge improvement over what they could have, but I wasn't anxious to use them, so after breakfast I'd avoid drinking, slowly dehydrating myself until lunch. Lunch would be limited water, too, and then at dinner I'd pound down at least a liter to try to rehydrate. Here I was in a land where we'd passed women and girls carrying cans of water for miles, and I was playing games to keep from having to use the facilities they find a huge improvement. Pretty embarrassing.

Monday we went to the Talek clinic, one of the oldest in John's system, where we saw many more improvements. The clinics were the beneficiaries of the first Gulf War, with 150 surplus solar power batteries that made their way from Iraq to the US and then to Kenya. As a result, every clinic has at least a small solar array with a few batteries that power everything from refrigeration for vaccines and other medicines to a water well to the computer in John's office. And the number of clinics has expanded, too, with the total now at nine, plus seven mobile units that we will see later in the week. In addition to expanding the reach of the community health clinics, John has been appointed the Director of Community Health Partners with more than 70 employees serving the communities around Kenya.

John at the Talek clinic

After a tour of the Talek clinic, the team set to work getting ready to paint the clinic. Talek is much larger than the one we visited Sunday, with separate four-bed wards for men and women, two treatment rooms, a lab and pharmacy, and a counseling room that is dedicated to working with those receiving AIDS tests and treatment. We had to remove many posters that had been pasted to the walls, and with limited water to do so -- even with a well and the water-harvesting system, we didn't want to waste any of John's precious water -- it was a project to remove them. Painting started later in the day, but building of the waste incinerators was delayed. The fire-bricks needed for construction, along with the plans, were "on their way coming," a Kenya phrase that means things are coming sometime, but don't hold your breath waiting.

By day's end, the women's ward was painted, most walls were cleaned and ready for paint, and four bulletin boards were installed so they could use them for posters, instead of gluing them to the walls again. The bricks were reportedly nearby, but John told us to go; his team would wait and unload them when they arrived.

We won't know until tomorrow when the bricks actually showed up (assuming they do), but we headed back to our safari camp for hot showers. As I waited for the shower to heat up, and water spiraled down the drain, I worried briefly about that water, wishing for a way to capture it. But then I stepped into the spray and stayed for what was no doubt too long.

Walls being cleaned, floors being repaired, and patients waiting to be seen. The clinic is a busy place.