Faces

I ran away from home on Wednesday -- at my own, not our donors', expense. Actually, I convinced myself that I really wanted to take the "Lunatic Express" (the old British night train from Nairobi to the coast, replete with sleeping berths and dining cars) before returning to the Vineyard at the end of my first mission year in October. My beloved grandmother took me via train across the U.S. fifty years ago, and I've never forgotten the experience. Nor will I forget this one.

The truth is, I am tired. I needed to take a break for a few days from the frustrations of a hospital with no water and little electricity and minimal medications and late employee paychecks. Again.I needed to take a break from the faces of the Pamelas and the Susans who separately looked into my eyes on Monday and asked me to let them die. "We're not giving up on you. Don't you give up on you, either," I responded, with a squeeze. (They both have TB and can survive, with time and food and medication. And they're getting all of the above at Maseno Mission Hospital, TG.)

So when a neighbor told me she'd soon be taking the bus to visit her daughter in Mombasa, my heart skipped a beat. I asked Judy, "Would you consider traveling by bus to Nairobi with me, and then going by train, as my guest, to the coast?" (It's not safe to travel alone at night in Kenya.) She was delighted, and so was I. We made our plans quickly, secure in the knowledge that a Boston medical resident would accompany Dr. Hardison on rounds in my absence.

In all candor, we were probably the only "lunatics" around on Wednesday, and there was nothing "express" about that train. But Judy and I shared an amazing experience, and I am grateful for her companionship. We took the morning Easy Coach bus from Maseno to Nairobi, and it was a thrill to see the sights, en route -- all eight hours of them. Sugar cane fields in the rolling dark earth of Nyanza Province merged into tea plantations in the lush green hills of Kericho, where we saw the tenderest tea leaves being harvested by hand. But that lovely land gave way to increasingly parched tan earth as we approached Molo in the Rift Valley. Familiar acacia trees dotting the countryside of the west were replaced by desperate cacti, reaching their withered arms to a merciless sky.

And there, in Molo, the faces appeared again... Faces of illness and hunger and despair and poverty. Mostly the faces of children this time. Children who were too tired to play and who simply stood at the station on spindly legs, arms out, eyes wide and sunken with hunger. Beginning in Molo, in fact, children began to routinely line our route. At the Nakuru stop, we saw the menacing sight of older kids, armed with hand-hewn clubs, stealthily approaching a private vehicle. We soon realized, with great relief, that they were unleashing their own venom onto a black mamba that had wrapped itself around the car's axle.

Our bus made its way through the more prosperous town of Nakuru, where we saw the pink sands of the lake in the distance. The sand wasn't really pink, of course: it was chockablock full of flamingos! Further along, at Gilgil, we narrowly averted a collision with a zebra. Children's faces temporarily faded in the dust of the Kiligo Wildlife Conservancy, as ill-advised baboons bounced in the roadside ditches, while warthogs and oribi antelope played chicken with the bus. Shortly thereafter, we encountered a vast eucalyptus forest ("Emmah's trees," as Judy called them) being laboriously logged by donkey carts.

Approaching Nakuru, goats and sheep grazed the meager fields and rocky roadsides. Then we saw the faces again. This time the smallest of the faces were bundled in the hoods of mission-box snowsuits. It was cool (70 degrees F) and rainy near the lake. Nearing Nairobi, the scene changed as buildings began to dot the skyline. A large sign posted at the entrance of the parking lot for the Communication Commission of Kenya announced, "You are now entering a corruption-free area." The lot was filled with gleaming new black and silver BMWs.

We arrived in bustling downtown Nairobi and walked quickly from the bus to the train depot, where we awaited the arrival of our assigned "Coach Number 1223, Chumba/Compartment C." The history of the British Railway/Kenya Railway/now Rift Valley Railway is the history of colonial East Africa. As Judy kept remarking during our trip, "Those men who built it, they were strong." They were also essentially slaves, brought from India, and many died on the job -- of heat, hunger and lions even hungrier than they.

After a series of zany misadventures (who knew that a receipt was not a ticket, that a ticket was not a boarding pass, and that askari/guards would challenge our anxious comings and goings?), we boarded at 6 PM for our 7 PM departure. Miracle of miracles, the train actually departed on time. We settled in to enjoy the ride -- and soon the dining car, where the starched white tablecloths and mismatched silver and stainless tableware provided an elegant counterpoint to the hot and rumpled passengers (just like us).

But then the faces returned in earnest. Faces of every age, lining the tracks, vying for slices of bread from the kitchen crew tossed out railroad car doorways, and coins from the passengers tossed out dining car windows. The scene bore no resemblance to Oak Bluffs harbor, where kids dive for coins tossed off the ferry for fun.

After a decent, but disconcerting, meal, we "retired to our cabin," which had been neatly made up in our abseAfter a decent, but disconcerting, meal, we "retired to our cabin," which had been neatly made up in our absence into very comfortable bunk beds. (Yes, I got the top, Maisie and Nico and Nell and Nadia!) Although I was up once -- n.b., a stationary long drop is nothing compared to a rolling choo -- I saw no sign of the infamous Tsavo lions during the night. And when we stopped at various stations along the way, it was blissfully dark. No faces could be seen, just scattered cooking fires in the distant bomas/settlements.

Dawn over Tsavo brought a startlingly different landscape. Ubiquitous plastic bags and the skeletal remains of a variety of livestock littered the arid pasture land between us and parallel MacKinnon Road. The drought in Kenya is real. A pungent stench, that of not-quite-rotted flesh, made breakfast unappetizing enough. But hungry faces peering in the dining car while we were sidelined at Taru Station made it impossible. The flat red earth of Taru was criss-crossed by narrow trails, down which children in oversized shirts (and nothing else) came running. Gesticulating hand-to-mouth, their needs were all too apparent. Judy and I waved and retreated. There was, sadly, no way to give anything to anyone without starting a stampede of children.

The train moved on. As we passed Samburu Station, we saw toddlers and mamas fetching firewood, with babies tied on their respective backs. Then came a surprising stretch of stately green sisal, as far as the eye could see -- a blessed relief from the haunting realities reflected in the faces of poverty. Clusters of coconut palms began to dot the horizon as we approached Mombasa. Clusters of kids again began to dot the tracks. More faces.

The train arrived two hours late, right on schedule (TIA). Judy's beautiful daughter, her husband and two-year-old Deborah met us at the station and led us through Biashara Street, Old Town, and stalls of sticky dates -- a great delicacy imported especially during Ramadan. They then kindly delivered me, via tuk-tuk, matatu and ferry, to the ACK Guest House in Likoni, just south of Mombasa. I can personally attest to the fact that there is something wilder than Vineyard Haven's Steamship Authority dock in August. That pales by comparison to Likoni's ferry terminal! On the other hand, the Mombasa-Likoni ferry is, ahem, FREE.

It is now a quiet evening in a quiet place. The calls to prayer from the mosques of Mombasa are somehow soothing. They remind me to pray, too. Even as I remember the faces that I so foolishly tried to forget in Maseno (and all along the Way), I am remembering again to breathe and to pray. Thank you, dear friends, for the reminders! I'll be homeward bound tomorrow -- by plane to Kisumu, then car to Maseno this time. And I will be ready, once again, to see the face of God, as well as the faces of pain, in Pamela and Susan. Please pray for us all at Maseno Mission Hospital?

Market Day

Monday is market day in nearby Luanda. We went shopping for papayas/popos and pineapple and came back with a broom, a goat rope and kitenge/fabric, as well. (The ladies in our HIV/AIDS crafts group want to sew "a smart Kenyan dress" for me.) I'm just sorry I can't bring any fresh fruits home in October to share!

Market day always leaves me on overload. There are so many amazing things to see, hear, taste, smell and do -- including, today, diving into a crowd of shoppers to avoid being trampled by bulls. Six of them, in fact. The critters had been startled by a passing lorry, broke loose from their tether, and thundered in a red cloud of dust straight for Emmah and me.

Upon our escape, amidst much relieved laughter ("Aiyeee, Mzungu!"), we resumed shopping. Actually, Emmah resumed shopping. I was too distracted by the myriad of stalls selling everything from beautiful beans and millet, to fresh fruits and aromatic spices, to mahindi/grilled corn, to pilipili-hoho (green peppers-haha/no heat), to used Goodyear tires, to cheap Chinese hardware, to kukus/chickens and wabuzi/goats -- both "before" and "after" (edible) varieties -- to be of any help to her.

Carlos, a visiting physician from Peru, via the University of Tennessee, is now busy making guacamole with the fresh avocados (7 cents each) and tomatoes (half of that) he bought this morning. His recipe rivals even the Hardisons'. A mission hospital in rural Kenya can be a very cosmopolitan place! Soon it will be back to our simple, but no less stimulating, world of afternoon rounds. If this is Monday, it must be Maseno...

Someone's Son

Dickson was a private man. He died yesterday, an hour after I had quietly reassured him, "You're safe here. We'll take care of you." His core body temperature was 33 degrees Celsius (91.4 Fahrenheit). Dickson looked at me and smiled as I covered him with another blanket. We both knew he would die soon.

He came to us too late, suffering from end-stage AIDS. A kindly outreach worker in Homa Bay, two hours away, had brought Dickson to Maseno because he felt we would give him better care than the several district hospitals in between. But we couldn't do very much.

"Dickson has no one," Desmond told us. "We're his family. He's from the 'interior' -- a region with few roads, isolated from other villages. We know he's in bad shape, but we couldn't leave him there. He's only 28. He says he's been sick for a long time."

Wasted, weak, gaunt and cold, Dickson spent only four days on Ward I before he died. We fed him, bathed him, changed him, talked and prayed with him. It was too late for anything else -- ARV's, anti-TB's, even steroids. He never complained, and he always smiled.

"Whose son, whose friend, whose lover, whose brother was Dickson?" I wondered, as "Sister Helen" and I closed his eyes and wrote his name on the "strapping" (adhesive tape) that would bind his limbs together. "And how could he die alone?"

"But he didn't die alone," Desmond reminded me today. "You were with him, Dianne. "

God's peace, Dickson.

Uniforms?

Yes, uniforms. They're important symbols of community belonging and pride. They're undoubtedly a vestige of colonial order, as well. School children of all ages are required to wear uniforms, making Kenya's "free" public schools even more expensive. (It's not just the desk fee, the blackboard fee, and the hockey stick fee...) Years ago, at the inception of the Mothers' Union Orphan Program, one of Nan's earliest orders of business was prioritizing children's needs. "Uniforms" ranked right up there with food and potable water, according to the local church women. Thanks to California and Wisconsin donors, sewing machines were purchased, and volunteer "mamas" went to work making hundreds of uniforms so kids could go to school.

Uniforms became a hot topic at the hospital last month,when two staff nurses asked me, "Could you help us, Sister, with our leadership project?" As an outgrowth of their continuing education course, Salunia and Dinah had already carefully created, laminated and posted "mission" and "vision" statements on each ward. Now they needed to implement a project "to improve the standards of the hospital." The concept of uniforms as a project initially mystified me, since our nurses already wear uniforms. But they laughed and explained they meant "patient uniforms" -- a/k/a hospital johnnies.

Salunia and Dinah had done their homework and knew how much fabric would be required for 90 wraparound gowns, 30 per adult ward. They produced completed samples and then asked for "sponsorship," since the shamba they had planted on the hospital grounds, in the hope of selling sukuma wiki/greens to help purchase the material, was not yet ready for harvest. Dr. Hardison, grateful for an opportunity to more efficiently examine patients on daily rounds, generously donated 46,500 shillings (about $6.50/gown) for the project. Patients routinely wear several layers of their own clothing to bed at Maseno Hospital, creating unnecessary delays in administering care. The clothes might otherwise be stolen, however, if left at home.

Within a remarkably short time (TIA, remember), the ladies of our HIV/AIDS support group had sewn the gowns and earned a few shillings in the process.The seamstresses were pleased. Our nurses were pleased. Dr. Hardison was pleased. Now we just need to coax our patients into being pleased. The current promotion for compliance is, "Everyone at Aga Khan -- a private, exclusive hospital in Kisumu and Nairobi -- wears them." It remains to be seen how effective our "patient education" efforts will be. Meanwhile, though, the project earned Salunia and Dinah kudos in their leadership class. As Nan would say, "You go, Girls!"

Frangipani

Bad stuff happens. When I was a child, I would turn, in tears, to my parents for explanations. Life isn't fair, Dad would snap -- then bow his head to hide his emotions. Mom would simply purse her lips. Even they couldn't protect us from harsh realities, but they kept on keeping on. Together. Years later, I learned they would sometimes hold one another and cry themselves to sleep. In private. But in public -- even in family -- they seemed indomitable. They were our own personal blend of regional art and literature: "American Gothic" and "Portraits (sic) in Courage." Our parents.

Bad stuff still happens. Mom and Dad are gone now, so I am even more grateful for faith, family and friends. I am grateful, too, for the prayer and cyberspace that connect us. (Yes, it's a frustrating connection, but dial-up from Kenya is better than none!) I remember an old friend's remark, "Life works, if we just remember to take turns needing." It is hard to take turns in the midst of poverty, but I witness it every day. And I give thanks for new friends who, by example, ever-so-kindly remind me to notice. To -- as Dad would have said and Mom would have nodded -- "wake up and smell the roses."

Or, more accurately, the frangipani. It is heavenly here. So are you, Robin and Zach, Finley and Elizabeth. Asante sana for "frangipana." (Pole/Sorry. I'm ever the corny Midwesterner.)

Smiling from the Inside, Out

"Inside jokes" and funny familiarities are too good to keep inside. We have to laugh (or at least exchange smiles) -- sometimes at our patient files, often at our idealism and always at ourselves. A few recent file entries:

"Patient reports being bitten by a snake. The assailant was brown in color."

"Patient absconded when his pants were returned." (A drunk piki-piki driver sneaked out without paying after we stitched him up. It would be funnier if he hadn't also left two unrelated 15-year-old passengers -- with related wounds -- on Ward II.)

"Oxygen administered when meter read '0.'" (For all of our non-clinical friends, a pulse oximeter measures oxygen saturation in the bloodstream via clamp-on finger probe. We get pretty worried when the meter goes below 90%. At 0, a patient would be long-since dead. Fortunately, ours was alive; only the oximeter's battery was dead. And a little extra O2 probably gave 85-year-old Tom a temporary lift.)

My personal favorite, however, is a photocopied sketch of "The Ideal Nurse" that is posted on Ward II's bulletin board. In case this picture is too blurry, the labels read: "Head: full of knowledge of nursing and the Bible. Eyes: to say 'I care.' Ears: alert and listening. Mouth: to smile for Jesus. Heart: warm with love... for others. Hands: gentle to soothe and comfort patients. Feet: quick to respond to calls."

Smile, everyone!