Churches and Haircuts and Childbirth...Oh, My!!!

In my volunteer pre-arrival packet, we were told to bring one set of “nice clothes for church and official functions. Kenyan church service is not something to be missed and is unlike anything else in the world.” Waking up groggy after a crazy and memorable night of drinking in a hole-in-the-wall bar in a nearby village, I dragged myself out of bed, splashed some cold water on myself as my bath, and put on my “nice clothes” for church service.

The church was in a village maybe 20 minutes away by foot down dusty paths and meandering streets. The place was called the Solid Rock Worship Center and was run by a man named Pastor Bill. I went with Martin, Erin, and one of Erin’s students, Lucky. I was the only one out of the four of us wearing a shirt and tie, so when people saw us walking through their village, they must have thought I was a visiting dignitary and the other Mazungus trailing me were my entourage. I was worried that being an atheist, I would be forced into an awkward position and be asked if I had accepted Jesus Christ as my personal Lord and savior or if I had been saved.

The church was fairly sizable, with bare wooden rafters and corrugated steel walls. It was stifling inside and the benches were straight and hard. I thought of that episode of The Simpsons where Bart’s class gets new chairs to improve their posture that were hard and straight like the benches we were sitting on and Milhouse complains that he couldn’t feel the left side of his body anymore. I began to pray to my non-existent God that services would be over soon and I could get back to my semi-comfortable bed and read or listen to my iPod. Why would people voluntarily subject themselves to such torture every Sunday morning?!

I soon got my answer: Kenyans seem to worship the Old Testament fire-and-brimstone sort of God, the kind who probably doesn’t look down too fondly upon skipping church on Sundays. Everything was a sin, apparently, and I figured Gary the Pit Preacher would have felt right at home. The first few hours were a mix of sermons and songs, and everyone got very, very into it. Witnessing the craziness of the sights and sounds around me, I realized that it was a good thing I came and that, in fact, I hadn’t seen anything like it before in my life.

People were making animalistic sounds and shouting and screaming. Worshipers were getting on their hands and knees and prostrating themselves before God. Think of what you imagine the wildest Baptist or Pentecostal church services to be like and multiply that by five. I felt like I stood up and sat down over two dozen times throughout the course of the four hour service. I thought of it like a big game of Holy Simon Says: Stand up. Sit down. Bow your head. Put your hands in the air. Wave them around like you just don’t care (Seriously, although different words were used). I’m not going to lie, even I was getting a little into the music and commotion. The services were given in a mix of English and Swahili, with a Swahili interpreter for the English bits. We were the only Mazungu there and we must have stuck out like a sore thumb. We tried to keep as low of a profile as we could.

One especially zealous preacher took the stage, one of those born-again types, and said something about waging a personal battle with the Devil himself on Thursday night in the church courtyard, mentioned some things that would have freaked me out had I believed in a higher power, and then said something that did actually freak me out. He wanted all the visitors to come up to the front of the stage, take the microphone, and introduce themselves; so much for keeping a low profile. He wanted to know who we were, where we were from, where we were going, and whether or not we had been saved.

Crap. How was I supposed to answer that last part? I told my name, said I was American, that I was doing medical volunteer work for a month, and that I would be heading to Mombasa in a couple of weeks. The Swahili translator must have said something in addition to the “I’m an American” part, because people laughed a lot after I mentioned where I was from. No problem, there are many things to make fun of Americans about. I totally skipped over the “Are you saved?” bit and he didn’t call me out on it, which gave me a nice sigh of relief. After that all the visitors bowed their heads in prayer and the preacher called out members of the church to greet us individually and escort us to our seats. Each of the other eight or so visitors to the church had members of the congregation come up and greet them. But I had the honor of getting Pastor Bill, to much applause. I even got to sit with him in a special seat up in the front near the pulpit. He was a very nice man and looked kind of like Forrest Whitaker. He even behaved the way I imagine Forrest Whitaker would behave in real life, if that makes any sense.

Soon after I sat down with Pastor Bill and his wife Jemima (who, coincidentally, looked like Aunt Jemima, but I didn’t want to get into that with her), he gets up to give his sermon. The theme of the sermon was basically about saving those who needed saving, how Jesus is the only way to salvation, and no matter how many good deeds you perform on this Mortal Coil, it doesn’t matter one lick unless you’ve been saved. I felt like he had tailor-made the speech just for me, his special guest of honor. After his sermon – which seemed to go on forever and ever – we left and went back home.

At around that time my stomach started cramping up like crazy and I laid down for the rest of the day. I knew eating that sketchy meat in the little shack with all the flies buzzing around was a bad idea. At that time, the visitor in me was saying “If you don’t eat it, they’ll get insulted. Just do it!” The microbiologist in me was shouting “Don’t do it!! Are you out of your mind?! Clostridium perfringes! Intestinal worms! Salmonella!” Curled up and clutching my stomach, I cursed myself for letting the visitor in my conscious win out. But diarrhea is just another price to pay when visiting a foreign country that can’t be avoided, like the $50 Visa fee. One of the worst things about having medical knowledge is that you start to think of all the worst case scenarios when you get sick. Even if the odds of the disease occurring are literally one-in-a-million, something that they could make an episode of House, M.D. about, if it’s horrific enough and you’ve read about it, you’re totally convinced you have it. I think they even have a name for it: Medical Student Syndrome. It’s a very real syndrome, and anyone who knows me knows that I suffer from it.

Damn, I remembered that I promised Rachel that I would be cooking that night! I guess that’ll have to wait till tomorrow, after my orientation. The orientation the next day was much more painless than I imagined it would be. It was run primarily by Joe, with Mike, Cleo, and Bonface helping out. I sat around a large table with the other dozen or so new volunteers. I was the only guy over there that didn’t come with his girlfriend (there were two other guys), and I started to wonder if men are just less altruistic than women or if there was some other reason for the skewed male: female ratio. In the orientation we went over our room assignments (I would stay with Rachel, which I was happy about), tips on health and safety (“If you drink the water in Kenya, you’re going to die.”), Kenyan culture and customs, and what everyone was waiting for, our work assignment.

I was assigned to a Catholic hospital named Mama Mumbi with a Norwegian nurse named Hannah, who would also be my roommate. She seemed like a nice girl and I’m sure we’ll get along just fine. After the orientation, we all ate some Kenyan food together in an adjoining guest house and then most of the volunteers went to Nakumaat for shopping. Since Sara and I had already done our shopping, we decided to head back to Rachel’s, hang out for a bit, and then go to Nakumaat later on in the day. When we arrived there later in the afternoon, we checked out what movies were playing in the cinema there since Mondays were Monday Movie Madness, where you could get a ticket to a movie, a drink, popcorn, and a candy bar for around $5.

Unfortunately, the only movies playing were one of those computer animated movies with the talking animals with celebrity voices. There must be like 20 of those by now. At least Pixar realizes that computer animation is a medium with potential and not just a lazy way to make money with abominations like Ice Age 7: The Start of Global Warming. They also had The Curious Case of Benjamin Button, but Sara and I had already seen that. We got some groceries and headed back home. I helped her pack her stuff up and load the Mutatu to go to her new place. I’ll miss having her around by I’m sure we’ll see each other again soon.

Later that night I cooked some food for my new roommate and Rachel’s family. It was a huge success! I felt like I was on Iron Chef since I had a limited number of ingredients to work with and a theme ingredient, which for that evening would be some sort of white fish fillet. To cook it, I decided to beat some eggs with milk, dip the fillets in that, and then dredge the fish in a mixture of Ugali flour (which is more or less cornmeal), regular flour, salt, pepper, and some African spices. I then fried it in a pan with some sunflower oil. I forgot how much I loved cooking with sunflower oil since it has such a high smoke point, and reminded myself to start using it more often when I get back home.

I cooked on what was basically a larger version of a camping stove, and there were a few times the pan almost fell off its unstable base and onto my foot. I thought about the little girl I saw in the ER shortly before I left that had oil burns over much of her body from grabbing and spilling a pan full of hot oil. That’s the last thing I wanted over here in Kenya, so I was super careful to balance out the fish on the pan. For the sides I made some rice and mixed vegetables that I just sautéed with salt, pepper, and garlic. I love cooking for other people and I was especially happy to share an American method of cooking fish with my new Norwegian and Kenyan friends. After stuffing myself, I collapsed into bed, excited about the prospect of getting to start work tomorrow.

The next day, I went with Bonface and Rachel to my new placement, which was a 15 minute Mutatu ride away from the house. Hannah’s Scandinavian body wasn’t prepared for the heat and dust of Nairobi, so she decided to stay in bed and recover while I went out to see the clinic. Bonface said that Hannah and I would be the first people they’ve placed there. When we got to the clinic, which was part of a large complex which also containing an orphanage, a monastery, and a social work center, we were told that the head nurse had just been admitted to Nairobi’s central hospital with malaria.

So people actually did get malaria around here. I had read somewhere that malaria wasn’t much of a problem around Nairobi, so I had just been taking my Doxycycline tablets and not bothering with a mosquito net since it always collapsed on me. It hit me right then that what I had been doing all along was not much different then going to a Nairobi whorehouse, screwing a bunch of prostitutes, and hoping that I wouldn’t get AIDS because I was using a condom. So don’t worry Mom, I’m going to use a mosquito net from now on.

Anyways, we asked if there was anyone else we could talk to. Long story short, we got the run-around and were basically told that we couldn’t work there. Great. In a way I was happy since the clinic mainly dealt with maternity issues and I wanted a diverse patient population, there weren’t many patients, and the nun/nurse whom I would be working under seemed like a bit of a bitch, so it was a blessing in disguise. We got the names of some other places we could try. We walked down the road to another clinic that was recommended to us by the nuns. The place was overflowing with patients and looked like it could have really used the help. We spoke to the charge nurse, I showed her my papers and what I was capable of doing, and she made it sound like I was the answer to her prayers. They would love to have me, she said, but I would first need to go to the Nairobi City Council Ministry of Health to get the needed paperwork. Realizing that would involve going from one office to another all day long and most likely paying a fair share of bribes, I asked Bonface if there was anywhere else I could work. Hannah and I were told during orientation that medical placements can be hard to secure sometimes because of paperwork problems, but I of course figured that problem wouldn’t apply to me.

Bonface called up a guy who he knew named Dr. George, who ran a small clinic in the Nairobi slums. He said he would be happy to have us and told us to drop by his office. Dr. George ran a small 10 bed clinic named the Wema Maternity Center and Nursing Home, which does everything from childbirth to minor surgery to treating multidrug-resistant TB. It was like an African Urgent Care. There was also a little laboratory no bigger than a bathroom that could perform a surprising number of lab tests using decades old equipment and a hand-cranked centrifuge. Everyone who worked there was very friendly, laid back, and good-humored, and I could see myself loving it over there. This is exactly the sort of place I had in mind when I signed up for this program. Its funny how things have a way of working themselves out, because I likely would have been miserable at my original placement.

I used the rest of the day to relax and get a haircut at Rachel’s salon. My hair was blowing all over the place and becoming a tangled mess, so I wanted to have something a little more low-maintenance. They weren’t used to cutting Indian hair at that place, and they only had electric clippers and afro picks. All things considered, the guy did a pretty good job on it, and it only cost me around $2. I’ve paid $16 for haircuts that made we want to hide in a cave until my hair grew back, so I was pretty happy.

Fast forward to tomorrow, my first day at the clinic. The clinic is a half hour walk from my place, through slums with roadside shacks selling scrap parts and open sewage ditches flanking the trash-filled dirt roads. Hannah and I arrived there, were given a quick tour by one of the sisters (what they call nurses over here), and got to work. I was given a lab coat, and it seems clear that Hannah will be working more with the sisters while Dr. George would take me under his wing. I learned about the symbolic power of the white coat in one of my medical anthropology courses in college, but I never really appreciated it until I was the one wearing it. People looked at me and treated me differently. I wanted my first time donning a white coat to be as a medical student, I wanted to really earn it, but this let me carry my penlight, guidebooks, pens, etc. and was also very useful in protecting me from splashing bodily fluids, so what the hell. I was basically treated like a doctor and could do more or less what I felt like doing. My clinical knowledge was valued and tested and Dr. George treated me like a colleague as well as a student. Within my first hour there, I had helped assess a suspected stroke patient, dressed a lovely penile ulceration on a patient with AIDS, and stuck my hand up a pregnant patient’s vagina and determined that she was having a limb presentation and would need a C-section.

Dr. George and I worked together to try to reposition the baby but were unsuccessful. Rupturing the amniotic membrane was quite a sight, since about a liter of fluid gushed out about three feet and almost hit Hannah head-on. I had seen about 5 or 6 births before as part of my training and I told her things would get wet since it was her first time seeing a live birth. I’m sure she believes me now. The C-section would need to be performed in the hospital downtown. I asked if an ambulance would pick her up. Dr. George laughed and said her husband was on his way to pick her up. So this poor young lady, who was having her first baby, would be going to the hospital through Nairobi traffic in her husband’s car with a baby’s fist sticking out of her. There must have been a better way, but apparently there wasn’t. We discontinued the Pitocin drip, which stimulates uterine contractions, and gave her a tocolytic, a drug which slows uterine contractions. This was done to buy the father a bit more time. We wished them good luck and then Dr. George told me if the baby’s head had presented, he would have let me deliver it myself with him standing by in case any complications occurred. So, I really will be treated like a doctor around here. And considering this place gets expectant mothers everyday, I’ll be delivering my fair share of babies over here. Time to brush up on my obstetrics.

The other cases in the clinic were your standard textbook tropical diseases. Malaria seemed to be the main course, with a side of tuberculosis and some HIV/AIDS thrown in for good measure. The new drugs and equipment took some getting used to, but I’m sure I’ll pick things up eventually. It’s also nice being able to follow up in the lab next door and actually look at my patient’s blood smear under the microscope for malaria. This should be an amazing experience, and if I get rejected from medical school in favor of someone who handed out condoms at Planned Parenthood as their “healthcare experience,” I’ll be wicked pissed. Alright, my fingers are starting to cramp up so I’ll end this blog post. Till next time…

One more thing: My friend Brian Hestetune got into a pretty bad accident while riding his bike. He had to undergo surgery and is recovering at UNC Hospital. If you're the religious type, please pray that he gets better soon and makes a full recovery. Hope you feel better, Brian. I'll be thinking of you over here.