Kenya!

Following my five weeks in South Sudan, I headed to Nairobi for the East Africa Regional Conference.  I don’t have much to report on the conference (really important professionally, but really not terribly interesting otherwise), other than that it gave me a chance to stay at my friend Dina’s lovely cottage in Nairobi, with it’s lovely garden…

And it’s adorable kitten, Crumble, my new BFF.  I don’t even like cats, but Crumble is awesome.  Let’s just say, a special request for a sparkly kitten collar will be granted upon my return to the US (strangely, sparkly kitten collars are not something that appears to be available in Nairobi.)

Following the conference, two of my colleagues and I headed to the east cost of Kenya to do some site visits.  Conveniently, the conference ended on a Friday and no site visits could be done until Monday.  What to do with a weekend, what to do with a weekend.  How about the White Sands Resort just north of Mombasa?  Yes, please!  

It was lovely, and after weeks of working basically non-stop, a nice break.  

I rode a camel.

The world looks different from the back of a camel.

I hung out with a sand sculptor on the beach.

 Listened to some of the most awesome karyoke (um, not) I’ve ever heard.  I was laughing so hard I cried at one point.  I also met two people NAMED Karyoke while I was in Kenya.

I went to see Owen, a pygmy hippopotamus who was orphaned in the tsunami in 2004 (though less remembered and less substantial, it did damage on Africa’s east cost).  He was taken to the Haller Animal Reserve, but no one knew if he would be able to connect with the hippos already living there and survive.  Fortunately, 100+ year old notoriously grumpy giant tortoise named Mzee took Owen under his wing and taught him the skills he needed to survive.  It’s a great story.

We also saw a lot of monkeys…

And a giant tortoise (maybe Mzee, maybe not).

Oh, and the crocodiles.  Having dinner.  Crocodiles scare me, FYI.

The crocodiles ended up being good practice for one of the field visits later in the week to the Tana River District.  The Tana River has a reputation as absolutely swarming with crocodiles, which my casual viewing from the bridge as we drove over it (me silently praying, please don’t let us fall through, please don’t let us drive off, please don’t let us fall through, and so on), where I got a visual on at least 5 crocodiles, doubtless hungry.  Probably for human.

 Got up early the last morning in Mombasa to see the sunrise.  The monkeys ended up taking center stage, though.

Anyway, in Mombasa, we visited one of Kenya’s largest and highest-security prisons.  Interestingly, this is the prison where the most notorious of the Somali pirates are being held.  We run a tuberculosis outreach program in prisons all through the coastal region, as prisons are notorious for high rates of TB.  The prison was very crowded and basic, but better than I had been expecting.  The prisoners have chances to go to school, sing in choirs or work in one of several workshops and community gardens.  I don’t have any pictures of inside because we weren’t allowed to take anything valuable in, since we were going into the cells to speak with prisoners, but this is the outside.

After the prison, we headed to a health facility that serves the prison and the community, especially through a community health worker outreach program we support.  We gave a group of newly-trained TB-focused CHWs messenger bags to carry their stuff around it, which they were pretty excited to receive.

...and then out to a rural outpost to meet one of the community sputum collectors who help refer potential TB patients to us for treatment.

Then we headed north to Malindi for the night, where we stayed at the gorgeous Eden Roc Hotel.  I’m just going to say that floating in a warm pool surrounded by lights on a string, staring up at the moon and the stars spread across the giant African sky must be one of the greatest pleasures in life.  Even if it is a bit difficult to wrap your head around, given that you spent the better part of your day in a prison.

We were up early the next morning to head further north and inland to the Tana River (aka Crocodile) District.  This is a remote and extremely dry region, dramatically different than the lush coastal region.  Many of its residents are nomadic herders, who are extremely susceptible to drought conditions since they have to go further and further to find less and less water, which sparks tribal conflicts and takes animal protein and milk away from the women and children (who traditionally stay put while the men herd the animals to water), leading to severe malnutrition.  We run a number of nutrition programs in the district, intended to identify malnutrition early on and treat it before a child or a pregnant or lactating woman becomes extremely ill.   Looking out across the landscape, it’s not hard to see how easily malnutrition can occur, what even slight imbalances in the rains can have.

The following morning, we turned around and hightailed it back to Mombasa, as much as you can hightail it on narrow, bumpy dirt roads that don’t let you go more than 10 or 20 kilometers an hour on.  We also got stuck in a terrible traffic…er, cow…jam for half an hour.

We made it back to Mombasa in time to have dinner at a beautiful restaurant across an inlet from downtown Mombasa.  Again, a luxury a bit difficult to wrap your head around when you know that just a few hours north of you there is tremendous food insecurity.  The views were gorgeous.

 Then back to Nairobi for the night and then onward back to the good ole’ USA, just in time for me to take the NCLEX…

Kajo Keji

After a few rough days in Malakal, Africa, as it always does, got itself back into my good graces.  This time, it was a trip to Kajo Keji, where my organization runs a midwifery school. 

Kajo Keji is a 25 minute flight from Juba, but the better part of a day’s drive.  On the way out of Juba, I got some great views of Juba as we flew south down the Nile.   Actually, I’m pretty sure I could still see Juba when we started our descent into Kajo Keji.  

Kajo Keji is lovely—a small town on the Uganda-South Sudan border.  It’s on a plateau, so is substantially cooler and greener than Juba.

I went to Kajo Keji primarily to finish up a proposal to the US government for funding a new class of registered midwives (a 3-year program) at the school.  Though I look at the M&E sections of most proposals my organization submits, I don’t usually write them.  But I was there, and let’s be honest.  Midwhiffs are my thing, so I jumped at the chance to go see the school and finish up the proposal (or at least get us closer to finishing…)

The school is fabulous, clean, well-stocked and filled with a group of bright, ambitious student midwives. 

The hospital, which we support with our student  nurses and midwives and partner closely with, was also interesting to visit.  

Each midwife is required to do 30 deliveries as the primary attendant to graduate.  However, many women in the Kajo Keji area deliver at home and there aren’t enough deliveries for the midwives to get as many deliveries as they need.  While I was there, we actually crossed into Uganda for a few hours to the town of Moyo to see about having some of our students do a rotation at Moyo Hospital, where there are more deliveries.   The border is quite porous, and almost all of Kajo Keji’s goods come from Uganda (which was creating an issue with the staff at the school when I was there—the cost of living was increasing partly due to the fact that in order to buy anything they first had to convert their Sudanese pounds into Ugandan shillings, and they were requesting a substantial increase in salary.  Of course I, as the visiting HQ person, was CLEARLY the person who could FIX. THIS. PROBLEM.  I kept saying, no! no! I’m monitoring and evaluation! [imagine elaborate arm waving that goes along with this…] Please don’t make me do anything with finance!  Let’s talk about your logistical framework!  Your patient registries!  Anything but finance! Noooooooo….).  

Anyway, it was very interesting to cross the border—Uganda feels markedly more prosperous than South Sudan.  Among other things, all of the children wear school uniforms and were on their way home from school.  I’ve seen almost no children in South Sudan in school uniforms, and there are many fewer schools visible as you drive around.  Evidence of what decades of civil war will do to your country, no surprises there.

When we got back, we walked around the market so I could see for myself some of the prices and how much came from Uganda so that I could report to our finance department better about whether the Kajo Keji staff’s requests were accurate and reasonable.  I love village markets in Africa, and once again, the ever-photogenic South Sudanese didn’t fail me.

 Walked around Kajo Keji to see a bit of the town.

This school is so important—it is one of only three in the whole of South Sudan that is training midwives.  Since skilled birth attendants (aka, midwives and others with midwifery skills) are the people capable of reducing South Sudan’s astronomical maternal mortality rates (2,300 deaths per 100,000 live births), I think we really can’t spend enough money and energy training midwives and supporting this school.

On an entirely other note, I'm partial to Kajo Keji because it seems to played host to my favorite disease not so long ago.  I noticed these binders on a shelf in the office and took them off for a little light bedtime reading.

I'm not joking.

Bid farewell to Kajo Keji and the crowd that had gathered to see the airplane land...

Flew through a rainstorm to land in Juba...

Just in time to meet their newest resident, another (yet unnamed) dik-dik.  This one was much nicer.  And also, didn't have horns.