12/17

Peter Gachanja picked me up this morning to head to the clinic. Since it is a Friday and Fridays are slow, we had time to visit Peter's dwelling within Kibera. I mention his last name because Peter is, in fact, a celebrity. He was featured in National Geographic's December 2005 issue about Africa. Peter remarked that this was the first time Nat Geo turned from discussion animals and their environment to people, and was highly impressed. Peter works as a film producer now. He had not received any formal training, but has learned to shoot films and take wonderful photographs. If you are in Nairobi, Peter would be glad to give you a tour of Kibera. Please email me for his mobile number.

Although I had walked into Kibera yesterday, this was my first time actually walking in between the houses and walking through the slums. There is a beautiful forest in the background, Ngong Forest. Once again, Kenya appears to be a land of stark contrasts. There is a busy market. Peter's house is very lavish inside, with leather couches, speakers, and a TV. I also met his wife.

I encountered my first "flying toilet." As I mentioned in an earlier post, people defecate into a plastic bag and fling it as far as they can. The government has installed 3 bathrooms in Kibera to decrease the occurrence of this, but 3 bathrooms are obviously insufficient for about a million people.

There are giant pockets of waste where people throw away large garbage. Much filth is intermixed between the homes and is on the road, but this was a full-fledged dumb. Ushirika burns its garbage to prevent the transmission of disease into the community, which will ultimately then find its way back to Ushirika.

I then worked with the CHOs. They oversee general patients (non VMC--voluntary male circumcision--and non CCC (HIV)). One woman had a spontaneous abortion within the last 24 hrs, and a speculum was inserted into her genitalia to take a blood sample from the walls. While everyone would leave the room as the patient undresses in the US, this was not the case here. This was also the first procedure of its kind that I witnessed here.

I then witnessed my first circumcision in the VCS. As a male, I can admit that it is a truly traumatizing experience. Patients receive counseling, and the procedure is free (it decreases HIV and STI transmission rates). Circumcision is a right of passage in some subcultures. The doctor informed me that one particular village he is familiar with has all 12 y.o. boys line up at the bank of a river every August, and a communal knife is used to circumcize everyone (with no anesthetic). I grimaced at the thought of this, but understood the cultural significance. My stomach was extremely squeamish after this procedure, and I become nauseous just thinking about it. I have seen baby circumcision videos on Youtube, but this did not come close to comparison.

Another patient had severe asthma. For one, there were no dosage cups available for cough suppressant. Secondly. she was given epi IV. This is done in the states only after someone has died, as it is an extreme measure. However, there are no resources such as albuterol or nebulizer, so drastic measures must be taken. Theopylline is also used, which has nasty side-effects and is therefore not used in the US.

The doctor trained at Nairobi medical school, and as part of his training he worked in the rural area for 3 months. He told us that although many people do not know their HIV status, there is NO stigma when it comes to getting checked and sharing the status. People are open about their status. It is, however, considered shameful to go buy contraceptive or things that allow one to practice safer intercourse. For this reason, even though there is lots of education and awareness surrounding HIV, people have the wrong attitude. They choose to engage in risky behavior even after understanding the risks either because they think they are immune to the problems, or because they feel that they have no other choice. This contrasts severely with the US, where HIV status is very hush-hush and obtaining contraceptives is very open,, especially at university health centers.


There is also a shortage of doctors in rural areas. Doctors that work for government hospitals have private practice in order to "keep up with the lifestyle that is expected of us," according to the doctor. People do not want to go to rural areas because they are unable to make much money, and "people start wondering what is going on." I saw many similarities between this overall thinking and the US; it allows me to appreciate the importance of rural education programs.