Day 13 - Malindi and the Marafa Depression for the Easter Weekend

For Easter weekend, we decided to drive up the coast to Malindi. It is a city about 1.5 hours up the coast of Kenya that is somewhat known for being a place where old Mafia bosses move to to escape persecution… AKA the Italian food in Malindi is supposed to be phenomenal!

The boys (Sid and Gaurav) were supposed to go with us and actually drive us up to Malindi, but they had a long night the night before (AKA drank like fishes and were hungover) and weren’t responding to our texts well past the time when we had slated to leave. Groan! Thank goodness the girls were equally willing to work around this matter and go up to Malindi with or without the boys. So, we headed to the center of Mombasa to catch a bus/shuttle up to Malindi.

Example of a matatu (white car with yellow stripe)

Getting a bus apparently comes with a bit of a learning curve because in retrospect we got totally hosed. We paid waaayy too much (it didn’t seem like too much to us at the time) and bought seats on a “shuttle” that wasn’t any different than a matatu (the public cars that run throughout Kenya). We were cramped on 3 hour drive up to Malindi. It took soooo long to get there because the matatu stopped every so often to drop off and pick up more passengers. The music was good though, and Charley and I sang out loud for at least an hour or so. It was a good learning experience, and we had a blast. I think we really ended up paying extra simply for the experience and a story that we will tell many times over and remember fondly.

Tuk-tuks

 

Once in Malindi, we caught a tuk-tuk to the hotel we had booked for the night, Ozi’s. Ozi’s was perfect and mad props to Laurence, the hotel manager, who organized a great weekend on the spur of the moment. 

Charley, Caroline, and I with the Marafa Depression in the background

That same evening, after grabbing a quick bite for lunch, we took a taxi to the Marafa depression (AKA Hell’s Kitchen). It was an hour worth of rough roads in a good car way, but most definitely worth it. This is a natural sandstone gorge that had formed over hundreds of years due to erosion. A member of a travel website that I am a member of had suggested going for sunset, and I can say that we weren’t disappointed at all by this advice. For one, the colors of the gorge seemed intensified as the sun set, and then the temperature in the gorge itself during the day soars into the 120’s. (Hence the name Hell’s Kitchen.) We went on a walk around and through the gorge, and it was stunning. Highly recommended if you are ever in Kenya.

More Marafa Depression

Walking through the gorge

Charley climbing up to a cool formation for a picture

Sooo pretty!

After we got back to the hotel, we had a quick dinner of snacks because no one was all too hungry after having a late lunch and went to bed because we had a long day planned for tomorrow.

Ozi's Hotel for the night - pretty nice actually

Day 12 - A Good Friday

I asked Dr. Abdul (the attending I have been working with on OB/GYN) yesterday and was encouraged to not come to the hospital as it was Good Friday. He said it would be chaotic (I’m assuming he meant more chaotic than usual), the regular schedule would go out the window because of the holiday, and there would likely be nothing to do. He said that patients try to take the holiday, too and will elect to stay home with family rather than come into the hospital.   Therefore, Caroline, Charley and I decided to spend the day becoming more familiar with Mombasa.

We started the day by going to Bombolulu Cultural Center. This is somewhat of a tourist trap, but in a good way. This is an organization that employs people with physical disabilities (often polio) and teaches them a way of life such as making a handicraft. They also have a school within their premises for the families of those with disabilities. They have a tour set up that walks us through several of the native homes throughout Kenya. It is totally staged somewhat like a living museum, but it was a really nice way to learn about the different native people of Kenya and the outside influences that changed the way in which they lived. They also shared a number of native songs and dances complete with the area and people to which they belonged.

Trying my hand at grinding grain the old fashioned way... I would have starved back in the day.

Caroline trying to learn to play a native musical instrument.

Our tour also included a choice of meals, and we made a point to get Kenyan food. We each got a dish that appealed to all of us, and kept passing the plates along as we got a taste of the food.  I am including some pictures of the half eaten plates… I forgot to take pictures before we dug in. One of them was a coconut chicken dish with chips (not sure how Kenyan that part was but oh well that is what it came with) , the next was a vegetable curry with chapatti, and we also had a beef stew with ugali (a mixture of maize flour and water).

Caroline eating the coconut chicken with chips

Vegetable curry with chapatti

Beef stew with ugali

After that, we headed to the center of Mombasa to walk around Old Town. We just wandered around seeing the sights, checking out the market and trying not to get conned by the “Mzungu tax” (the extra price the locals tack onto their goods simply because we are white), and walking along the entrance to Mombasa port. We had every intention of going to Fort Jesus but learned that if we took the letter issued to us by the hospital as proof that we were working there, we could get in for local resident prices. 800 Ksh or come back with a letter and get in for only 100 Ksh… no brainer. We decided to wait on this one and just took some pictures of the outside of the fort.

Walking around Fort Jesus with a view of Mombasa Port

Map we kind of followed for our walking tour of Old Town

Stunning carved door in Old Town (The carvings tell the city's history in the intricate carvings, and no 2 doors are alike.)

Day 11 - Doing a C-section

After another pretty unproductive ward round (there are just so many people, usually 20 or so on rounds so it is hard to get much done), I actually got to be 1^st assist on a c-section today! I helped a doctor who is actually specializing in OB/GYN. He called himself a resident but the system is structured differently here. In asking questions, it is my understanding that after you become a medical officer (the equivalent of doctor) you go and practice for a few years without a specialization. The hospital can just assign you to any ward and you have to be able to handle it. After a few years in practice, you can go on to get additional training to become a consultant is a particular field. This doctor I worked with is in the process of becoming a consultant so he is pretty high up the food chain. Anyway, it was cool to actually do something.

I have asked about low transverse incisions and why they swear that it is everyone’s preference and a standard practice here yet, every c-section and c-section scar I have seen thus far is vertical. (I do understand that if a woman comes in for a repeat c-section with a vertical scar you wouldn’t want to give her a new one… but other than that, still all vertical incisions.) This is still a mystery to me since I’ve been doing some reading and the complication rate (the only saving grace that I could have imagined for the vertical incision) is actually lower for transverse cuts. Maybe it has to do with the medical officer performing the surgery and his/her comfort with trying something they haven't seen before or have only seen a few times, despite the evidence?

Then after rounds today, we (Charley, Caroline, and I) were thinking about going to a craft workshop but decided against it because we got out considerably later than usual and didn’t think we would have time before it got dark. So, we just checked out the local market, got in a couple of errands (I had to get out more money in Kenyan shillings and buy a few items), and then plan for the extended Easter weekend. We are planning to go to Malindi, a city about 1.5 hours up the coast of Kenya. There is supposed to be spectacular reefs there and this really cool natural sandstone gorge that I’m excited to see.

Day 10 - Clicking on all cylinders... or well more anyway

I think I am finally understanding that my role within the health system here is more of an observer of a different system and to learn the different way in which things are done here. I had expectation that I would be able to do a lot because the area was so resource poor. I mistakenly understood resource poor to also imply workforce poor, which isn’t the case. Certainly, the training to become a medical professional isn’t as extensive in Kenya as it is in the US, but it doesn’t mean that they are lacking health care professionals (at least not in the hospital system). So, I have become more content to watch the goings-on of the hospital and do a comparison of how things would be back home.

Today, I got to participate in 2 SVDs after rounds in the maternity ward when we got to see a cervical tear. The cervical tear was a bloody mess and something that I hadn't see yet. Of the deliveries, the first woman was a primagravida. Undoubtedly even primas take shorter to deliver here than in the US. I also think great lengths are taken to ensure that the woman delivering is as comfortable and calm as possible in the US. Here, they are pretty much left in a room (these actually have walls between them with a curtain for a door) to get through the 1^st stage of labor alone. No pain meds. No real explanation of what is going on (even for the primagravida). Undisturbed save for a vaginal exam or 2 to monitor their progress. C-sections are similar save for a few key differences. However, vaginal deliveries seem to be a whole different cup of tea and are very different than the process I am used to in the US.

For a country and culture that prizes modesty so much, I am still surprised despite several days of maternity wards that Caroline and I are the only ones who seem to make much of an effort to close the curtains when we enter a leave a room. The woman sits on the bed mostly or completely naked and has strangers parade in, the least I can do is make sure the curtain is closed after I enter and exit.

After we left the hospital, all of us (Sid, Gaurav, Caroline, Charley and I) ate at one of Sid's favorite Chinese food places - Kenyan style, of course. We just let him order a bunch of food for the table and then ate family style so we could try a little bit of everything. It was AMAZING! (No pictures of the food, sorry! I am trying to get better at taking pictures of the food I'm eating but usually by the time the food hits the table my first thought is "eat," not "picture time.")

After Chinese food, I had a lazy evening where the girls (Caroline and Charley) came over to the house I’m staying in and we read by the pool since we had had a whirlwind kind of evening the night before. The beach in Nyali (very close to the house here) has incredibly fine sand so even a little bit of wind is enough to start turning us into a little sand dune as the sand starts to build up around you. So, we decided to take a break from the sand and give the pool a shot today. It was a nice change to not leave the beach covered in a fine dusting of sand.