AIDS Hits Home

In most families, the ex-wife doesn’t come to live with her ex-husband and his new wife. In most families, the ex-wife isn’t HIV positive and in desperate need of the medical care available just a block from her ex-husband’s house. We’ve had some interesting changes lately at my house in Msambweni, and they’re teaching me so much about understanding, tolerance, and love.

Mama Abee, my baba’s previous wife, has five children with Baba (More kids just kept coming over the weeks, but I think it’s just 5!). Msambweni schools are on a break for a couple of weeks, so the four of these kids who normally live in various places and boarding schools in the area are in our house living with us, and recently their mom joined us. The whole blended family is now together under one roof. I was trying to figure out how this works—why my Mama welcomes in Baba’s ex-wife, how everyone is able to get along without conflict. Then I heard a song by Matisyahu, and one of the lines made it all make sense: “Death brings life into uncertain things.” Mama Abee has progressed to full-blown AIDS, and isn’t doing well. The notion that she wouldn’t make it much longer if she continued without medical treatment brought the life, the humanity, into this situation. It makes petty arguments not seem quite so important; it makes the love within this family thrive, even in an unconventional place. Mama Abee is now visiting the hospital daily, and she can be loved on by all 5 of her children (who she normally doesn’t live with) every day and receive the medicine she so desperately needs. After studying HIV in a conceptual way for so long back in Wisconsin and then getting a little closer to the disease while working in the CCC Clinic for HIV patients at the hospital, I’m learning so much by actually living with someone suffering from AIDS. I see her struggles, the pain she faces on a daily basis, the love her caregivers show her to give her strength.

The house is full of laughter and love with all of the extra people around, and I’m thrilled with the opportunity to get to know my host brothers and sister better and have four extra kids join me on my daily swim in the ocean. It’s an interesting situation, but my Msambweni family has embraced it and is making it work.

Mama Abee with her daughter Mariam

Extra people means extra chaos at dinner time!

Miracle of Life

This has been a week of ups and downs at the hospital. Things started out dark. I saw a baby almost die from anesthesia problems on the operating table. Struggling to get the intubation tube inserted in the tiny airway of the baby who’s already paralyzed by the anesthesia, the anesthesiologist called for help, “Haraka, Haraka!” (Hurry, Hurry). Monitors start to beep as the baby’s blood oxygen saturation drops from a healthy 98 down, down, down, until it’s struggling to stay at 5. Blue lips remain quiet instead of struggling for air. As the assistant, I held the button for the emergency oxygen pressed. The doctor massaged the baby’s chest, trying to push in some life. The room is silent for the beeping alerting us of the dire situation, as everyone waits for the baby to respond. Finally, there’s a gasp for air. The oxygen saturation rates start to climb. Relief floods the room. I look down and see that my thumb had turned white from pressing the oxygen button so hard.

The rest of the week was far brighter. I moved to the maternity ward and have gotten to see two babies be born so far! The first birth happened 15 minutes after I entered the ward on my first day—quite the welcoming experience. Seeing the new life emerge and hearing the little boy’s first cry I almost began to cry myself; this is what a miracle looks like. My third day on the ward, things got even more exciting… I delivered a baby! I applied counter pressure, gave an encouraging “Sukuma, Mami!” (Push!), grabbed that cute little head, pulled out each shoulder and caught the infant. It was a healthy baby boy, weighing in at just under 6 pounds. Taking part in this experience was easily one of the most gratifying and life-changing things I’ve ever done— I ushered a new soul into this world.

This week reaffirms my decision that I’m interested in being a NICU (Neonatal Intensive Care Unit) nurse after I graduate before I go get my Master’s in Public Health. Nothin’ like the miracle of life.

The baby I delivered

A preemie I've been taking care of

Arusi ya Tatu

Arusi ya Tatu means “Third Wedding” in Kiswahili, and that’s exactly what I did with my weekend—went to my third Msambweni wedding! My family is amazing at trying to plan fun things to include me in their culture, and weddings definitely fit the bill. This weekend Mama and Baba and I took a friend’s car through the city of Mombasa to the North Coast to the small village of Mazeras to see another one of Mama’s cousins get married. (Her grandfather had multiple wives, so she has lots of cousins…) The wedding was everything a wedding should be—joyous, exciting, and full of love. I got to be in the room for part of the actual ceremony this time, which was really interesting and fun. The bride sits in her room, beautifully done up and wearing a lime-green veil. A sheet surrounds her as she sits and waits for the groom. He is led into the room by his elders, and after he is seated across from her bed the sheet is lifted and they see each other and are ready to marry. There were literally hundreds of people trying to get into her room to watch so I left at this point to make room for people who had actually met either the bride or groom before, but it was a cool taste of a Swahili wedding. Mama dressed me to the nines again, and I later in the weekend I even bought a traditional Swahili dress like the ones in my pictures (be prepared, I’ll be wearing it around Madison this summer! Ha.)

I had a great time with Mama and Baba on our ‘road trip’. I explained the concept of American road trips to them and they thought it was hilarious and kept referring to it as our ‘big adventure’. When we drove past the airport in Mombasa, Mama told me that “when you return to visit us after you’re done with nursing school you can fly straight to this airport and we will pick you up right here”. Glad to know that’s settled! It hadn’t been discussed, but it’s good to see we’re on the same page that I won’t be able to stay away from Msambweni for long.

Mama and I with the bride and groom. I didn't get the memo that smiling wasn't cool...

Sulie Loves His Mama

I showed Suleiman a video I'd taken at the wedding this weekend of his Mama and Baba waving at the camera and saying 'hi'. He couldn't get enough! There were actually tears when I put away my laptop...

Pediatrics

I spent the week in the Peds Ward, and was brought to my knees so many times by what I saw there. As a frequent flyer at children’s hospitals due to my osteomyelitis in high school, I have a pretty good feel of what makes kids happy when they’re sick. Some things that I always loved in the hospital were having a private room, when the ‘play therapists’ would come visit with games, a well-stocked physical therapy gym with lots of fun things to do, constantly being with my family, and the love of my nurses and doctors. Unfortunately for the kids at Msambweni, the children’s ward here lacks in almost all of those things. Kids from over 100 kilometers away trek to Msambweni District Hospital when they’re seriously ill, and the hospital has about 20-30 kids in the peds ward at any given time. Most cases are malaria, fractures, pneumonia, diarrheal diseases, and high fevers. There are also patients admitted with complications from AIDS, malnutrition, and tropical diseases like lishmainiasis.

Two patients on the ward especially pulled at my heart. The first is Kelly, a one and a half year old with severe malnutrition and probably HIV. Her mother is “positive” (HIV+) and hasn’t consented to test Kelly yet. Weighing in at less than 10 pounds and frequently sick, Kelly certainly shows the signs of having the disease. Left alone for most of the day, Kelly cries whenever anyone (especially Ms. White Skin over here) would come near her, and my heart just ached for this little girl having her life compromised when she still has so much promi

The second buddy of mine is an 8 year old boy, Rumba, on the ward with osteomyelitis. He fell from a coconut tree and fractured his femur. After sitting in traction in the hospital for over a month (common treatment for fractures here) he developed many complications, and eventually got tuberculosis in his spine and became paralyzed. Near death, the nurses didn’t think Rumba was going to make it. Almost a year later, he’s still in the hospital but getting around with a walker and carrying a huge smile on his face. He has osteomyelitis, a bone infection, in his femur but is recovering from all of his ailments in such a brave, positive way. I was immediately drawn to him, and had one of the Swahili-speaking staff explain to him that I used to have osteomyelitis too. We compared scars, and I brought some pencils and paper for him to color with so he’d have something to keep him occupied other than listening to crying babies all day. His smile helped me see the silver lining in the dreary Pediatrics Ward, showing me the hope these patients have despite the conditions of the hospital.

My osteomyelitis buddy, Rumba

Kelly

The Peds Ward

Playing with Starfish

I went to Tiwi Beach, a South Coast tourist hot-spot, for the weekend. The whole idea of taking weekend vacations here blows my mind—even on work days I go swimming in the Indian Ocean every day, so it’s not exactly a hard earned break ;) I love that I get to explore places along the Kenyan coast and become more familiar with the country that has been my home this semester. It would be sweet if East Africa had airlines like Ryan Air in Europe where you could travel between countries easily, but I can’t say I can complain about the locations I can reach by matatu in an hour.

I met up with a friend who’s living on the North Coast and we lounged in our cottage on the oceanfront Friday evening and Saturday morning. Saturday afternoon I hopped back to Msambweni so I wouldn’t miss a celebration of the Prophet Mohammad’s birthday with my family. I wasn’t there for the actual ceremony, but the preparations beforehand were lots of fun; they reminded me of getting ready for the wedding. Everyone was in a good mood, in a Christmas sort of way. My 10 year old cousin Faiz even made a comment that “We have no Santa, this is our celebration of everybody’s birthday!”. I was mad impressed he even knew about Santa, seeing as I had no clue the Prophet’s birthday was a big deal for coastal Muslims. It was a really fun experience to have with my family.

After the celebration I headed back to Tiwi to have a few more adventures. We hung out on the beach Sunday morning and were the only ones there—it felt like I had my own private paradise. Then we went snorkeling out past the reef. The water was pretty rough and I didn’t want a repeat of my Jamaican scuba diving incident (yeah, I got motion sickness and puked underwater. So not something I want to repeat.) so I didn’t spend too long out in the water. We took a hollowed out tree canoe to a sandbar known for all of the starfish that live there and I got to add another animal to the list of African creatures I’ve frolicked with! We got to play with the starfish for an hour or so and had a blast. Then it was time to return to Msambweni, where I came home to find my cousins had picked flowers for me and put them in my room and my mama (aka my angel) had hand-washed my laundry for me (my least favorite rural chore, I’m just NOT good at it!). Such a fabulous welcome home to end a fabulous weekend.

The view from our cottage

Frolicking with the starfishies

Private beach!

Canoe ride to the reef

HIV Clinic

I spent the past week at work helping at the Comprehensive Care Clinic (CCC) for HIV positive patients at Msambweni District Hospital. The hospital has over 800 patients on anti-retroviral therapy and is quite busy testing new patients, counseling those taking drugs, and managing the overall health of the HIV positive population of the area. Nurse Theresa explained to me that stigma isn’t as bad as it was a few years ago, and real strides are being made, but that doesn’t mean it has disappeared completely. Patients who live an hour and a half away in Likoni sometimes get their care at Msambweni so that they won’t run into anyone they know. Some people even come all the way from the city of Mombasa, where there is a much higher availability of high-quality healthcare, to Msambweni so they can be seen in ‘privacy’. Msambweni is a very Muslim area, and it’s not uncommon to see women wearing a full burqa (my Mama even wears one when she goes to work!), but I noticed that there was a much higher proportion of women wearing their burqas at the CCC, and Theresa confirmed that many women seem to get ‘extra religious’ when it’s time to come to the HIV clinic and don the face-covering veil instead of their usual head covering so that they won’t be recognized.

One woman really caught my attention at clinic this week. An elderly woman weighing less than 70 pounds, she was bent over with the weight of the world on her back. Coughing and weak, she looked like the ‘before’ patient in documentaries about the miracle of ARV’s and AIDS therapy. I found out she wanted to switch to a different clinic, and the staff was perplexed. After finding out a little more, I learned that she thought she had tuberculosis, a common opportunistic infection that attacks AIDS patients. Judging by her cough I would assume that she was correct, but the hospital was telling her that she had had a negative TB test and would be sent away without treatment. After asking around a little more, I learned that the negative TB test had taken place last November. I flashed back to my days of leg infections and how it was often necessary to speak up to get the best care possible and was so amazed that this weak old woman at clinic all alone felt empowered enough to speak up. It worked; the staff couldn’t afford to test her again ‘so soon’ but agreed to start her on TB drugs based on her clinical diagnosis.

On Wednesdays and Fridays I’ve been going to the operating theatre to watch surgeries. My favorites have by far been the 2 C-sections I’ve witnessed—there’s just something about a new life being brought into the world that makes everything seem like it’s going to be okay. (This makes me really excited that I will be spending my last two weeks of the internship in the maternity ward!) One of the most interesting but also the hardest for me was watching an ORIF procedure—an Open Reduction with Internal Fixation of a broken leg, the same procedure I had done to put a rod and screws in my tibia after it shattered. I had to leave partway through the surgery when the doctor started cleaning up the fracture by pulling pieces of bone out with pliers… I’d just rather not know. There have also been gynecological surgeries to observe like cervical cancer stagings and tubal ligations, and plenty of general surgeries like hernias and abscesses. Overall I’m really enjoying my internship at the hospital and I’m being exposed to so many new and interesting things. I’m so glad it’s just barely halfway over now and I still have 3 more weeks of this!

My friend Emma and I before surgery