A lesson in improvisation: On the bank of the dry river bed babies get immunization shots.

I love the feeling of the small twin engine plane speeding up the airstrip at Nairobi Wilson airport, the noise that it makes when the engines are on full blast and the following lightness as the plane lifts off the runway. Inevitably a sense of excitement overtakes me.

It’s an old feeling: many years ago I remember taking off the same runway having just arrived from France and on way to Ol Pejeta, a ranch at the foot of Mount Kenya. I felt the same eagerness as the promise of the African bush lay ahead. Today I am on my way to the Milgis just south of the Ndoto Mountains where I am meeting Helen Douglas Dufresne for a three-day stay at Lkanto, her special sanctuary. I get such a thrill sleeping on top of that hill with no cover.

I have been helping fund the costs of the small clinic in Latakwen and I am here to spend some time with Nurse Rita. I have read her medical reports for the last three years and I know  good work is being done. But being a nurse in the bush deep in Samburu land is very different from being a nurse in an urban hospital and I want to see what it entails.

Rita has scheduled a mobile clinic day a good two-hour drive west of Latakwen.  I wake up at daybreak and meet up with her at the clinic. The land cruiser gets packed with all the medical supplies for a day of immunizations and off we go with Francis driving us through the hilly landscape of the Milgis.

It is dry and windy at this time of the year. While clouds hover over the horizon and rain has blessed many rolling hills further to the south, only scattered showers give a little respite.

On the way we stop at Masikita,a village that has grown quite a bit recently because of an influx of migrating herders escaping intertribal altercations in the north.  Villagers and in particular lots of small smiling and eager children gather around the car.  Rita steps out of the car and confers with the elders of the community. Composed and assured she exudes calm and competence; at times when she smiles her face becomes almost girlish.

I love that mixture of equanimity and playfulness. In the midst of daily challenges that dwarf many of my most serious concerns in my life in New York city  I am profoundly touched by her deep love of life and ability to laugh no matter what! I am soon approached by a group of young men, apparently young elders, who speak English. After introducing themselves they ask: “Can you help us find a nurse and pay for her? We have a dispensary but the nurse provided by the government is rarely there.” They have heard that I am the one paying Rita’s salary. They are amazed that someone living so far away from their world is concerned about their welfare while wealthy local Kenyans don’t feel compelled to help. Rita checks on a pregnant young woman who seems to not be feeling well. After checking her for malaria she examines her in her manyatta.

We climb back in the car and after an hour we are driving up a lugga -the local name for dry riverbed – where we encounter a group of women herding a few donkeys and a couple of men sitting under the shade of the acacia trees on the banks of the Masikita lugga at the foot of the Siambu mountains.   It seems that we have arrived at our destination, but where are the patients? I had imagined driving up to a large gathering of patients eagerly waiting for us. I soon learn  that it is not how it works.  Rita confers with the women and it is decided that we are going to set up the clinic on the bank of the lugga under a tree while the word goes out to the various manyattas – hut – in the area.

Rita, Mama Peters, and Esther set up the “clinic” which consists of a weighing contraption attached to a branch, a large container that serves as a desk, and the bend shape of a trunk that becomes a seat. The women then sit down and sip some tea and within a half an hour young women carrying their babies wrapped up in their colorful cloths stroll in with their children in toe. Adorned with multilayered red beaded necklaces their demeanor is strikingly majestic.

Lots of talking ensues, they eventually all sit down in groups and for the next two hours Rita and her team weigh the babies and children, lecture the mothers on health matters and record all findings in a large and unwieldy notebook.

Lots of laughing, talking, especially when the kids get weighed in that strange contraption and without fail scream their heads off. I don’t get a word of what is going on and feel uncomfortable in my outsider observer status. A look of worry does cross the mothers’ faces when it is time to give the shots.  They don’t like their children being hurt and yet they do know that these immunizations have saved many from the deadly effects of measles and whooping cough.  Patience and humor is of the essence.   Two hours of crying babies can drive anyone crazy.  Rita and her team stay focused, unperturbed, keeping their sense of humor while truth be told I do get a bit frazzled by the cries. Fortunately the older children are perfectly behaved and are keenly interested in Rita’s coming and goings.  The babies are given the polio, tetanus, whooping cough, pneumonia and TB vaccines and Vitamin A drops in the mouth.

The women eventually walk away just as casually as they arrived and return to their lives in the bush.  While their world is so far removed from my life in New York city, I can’t help thinking of the many times I sat at the pediatrician waiting for an hour in the waiting room for my babies’ turn to be immunized.

Rita then gives her attention to a group of three young warriors with their hair braided and covered with a reddish clay mixture who want to get tested for AIDS. She pulls out the testing kit, takes blood samples and to their great relief they all test negative! What a surprise when they allow me to take pictures of them. That is a first and I feel privileged. I don’t understand how AIDS can be an issue for these young men in the middle of the bush. Rita tells me AIDS is commonly passed on through open wounds. We pack up pretty satisfied. The day has been productive. Twenty children in total have been attended to.

We drive back stopping here and there to pick up and drop of people, and get back at dusk. The day has been very long and quite tiring for Rita and her team but hugely gratifying for me to see all the good work that is being done as a result of my contribution.

I join Helen and a couple of conservationists around the camp fire while Rita returns to her village where she will be on call and will have to attend to the needs of a young pregnant woman who is not doing well.

This teenager who looks totally dejected is seven months pregnant and it appears she is suffering from preeclampsia and I am concerned that she be taken care of sooner than later. I knew that this was very possibly what she was suffering from having just watched an episode of Downton Abbey where a woman dies of eclampsia after giving birth. (These TV shows can become useful!) Fortunately Rita knows what she is doing.But things are not easy in the bush.  To get good medical help the woman has to be taken to a hospital 5 hours away and her husband says that he has no money to take her there.  I keep bringing the subject up with Helen and Rita, Rita works her magic with the husband, and I find out the next day after landing at my next destination that she has been driven to the hospital in the MEAK land cruiser. I am relieved!

Two days ago I got an email from Helen telling me the woman is doing well and delivered a healthy baby! I was really happy. It is a wonderful feeling to feel like you have made a difference in someone’s life.

It never ends for Rita but she is hugely grateful for her work. Most of all she loves it and it provides for her family – she is the sole provider. She is a grandmother and takes care of her grand child and you can see him running to her at the clinic in the morning, full of excitement and smiles.

Mama Peters is also hugely grateful. She is the sole caregiver to her four nieces and nephews – her sister died and left her with the children.

I ask Rita what she would like to do going forward and what needs to be done. First and foremost the clinic needs electricity! It seems so basic for us but not an easy thing to achieve in the bush.

Rita would also like to develop her midwifery skills and encourage the women to deliver at the clinic instead of in their manyattas. I think it is a super idea and ask her about family planning. I have seen so many babies, small children and unwed mothers that my feeling is that family planning should be a total priority!  I later learn that the population in Kenya has exploded. Thirty years ago Kenya had a population of 6 million.  Today 46 million people live in Kenya!

She also wants to get a certificate to do TPR surgery. Trachoma, which is a potentially blinding and very painful eye condition, is prevalent in the area. Finally she thinks a mobile clinic could be very useful to reach out to the distant manyattas in Samburu territory. There are clearly lots of needs and worthy goals.

Now the challenge is to sort out which ones are the most needed and can be achieved. Funding is obviously the first issue but the follow through and support of the community is also something to take into account.

I think I will start with the most pressing:electricity. A simple scale could do wanders too!