(JOURNAL DATE 3/17/2010)
Above are pictures of the bridges over the safari land we ran on when I went back - trouble is, during the afternoon the animals were sparse. I did catch another rhino!
Spent the rest of my day in the surgical theater today and it was "prostate" day. They reserve Wednesday to do most of their open prostate surgery. Basically, make a small incision in the lower abdomen, open the bladder and use their finger to remove the prostate. These surgeries are almost extint in the US as we are capable of the exact same operation with a scope which requires no surgical incisions. Additionally, our patients generally go home the same day or the next. These poor men are in the hospital for 5-7 days. We did 7 prostate surgeries today and they let me do them all after I assisted the first two. It's a simple operation really and nothing compared to the complexity of radical prostate surgery or transurethral prostate surgery (something I am much more accustomed to). By the end of the day, I was completing these in 25-30 minutes skin-to-skin. I really enjoyed it.
Above is Dr. Nyagah and Lydia (scrub RN) completing an appendectomy in a 12-year-old boy.
But that was only part of the day: finished up the day with a couple c.sections, ruptured ectopic pregnancy, torsed ovary, appendix and I was provided the opportunity to teach them an alternative way to divert urine following bladder removal. This was largely successful and the surgeons felt this is something that they could add to their treatment options. However, some of them (there are 3 surgeons here) showed more interest than others. I've already been placed in a box by one of them, who sees my time here as nothing more than lightening the workload. He really isn't interested in practice change, even if it is teachable and applicable. The thing is, as a urologist, I have a very specific area in which I study and can provide them with more insight than their general surgery training. I guess I shouldn't worry about it. I'll let everyone get what they want out of my time here.
As if this wasn't enough for one day, that evening Karanu and I went to Kibera. I had been near it but this was the first time I would travel into the famous "shantytown." My view of life would never be the same. As we entered via a side alley, we were surrounded by children chanting "mazungu! mazungu!" As a mazungu in the slums, I represent many things, but to the children I represent hope. They see white people and foreigners as evidence that their is life outside their sad existence. That people outside of Kibera care and are willing to help. Most of all though, the kids see me as a zoo animal - we are more rare than elephants in these parts and the kids love catching a glimpse. They all know one phase in English - How are you? - and they repeat it over and over no matter where you walk. This is a very unsafe place to be as a foreigner and even for a Kenyan not living in the slums, so Karanu and I walked briskly and I did not bring a camera (this time - I did later). On this trip, I did not speak much to the residents (although I did the next time) but I did meet an artist named Joseph, who was quite amazing. I told him how good he was and that he should paint more of his tribe, the Maasai people, to sell to tourist. (Remember this part because I will see him again in a few days).
The location at which we entered Kibera.
Let me orient you to Kibera. This place is no stranger to tribal/gang violence, riots, drugs, alcohol, sexual immorality, disease and a lot of petty crime. The conditions, in short, were atrocious. Two million people packed into 2 square km with no electricity, no plumbing, no city resources. The residents of Kibera are written off by the country of Kenya and the city of Nairobi. They have nobody to defend them, nobody to stand up for them and absolutely nobody of power that cares about them enough to claim them. So how did it all begin? Well, we can thank the British for that. The British colonized much of the world, including Kenya and the more centrally located Uganda. In an effort to "open up" the interior of Africa in the late 19th century, the redcoats started building a railroad from Mombasa (the coast of Kenya and previous capital) toward Kampala, Uganda (the present capital of Uganda). In the interim, the city of Nairobi was created out of thin air to support this effort and people were "transferred" from northern Kenya and Sudan to build the railroad. When the efforts were completed the Sudanese and displaced Kenyan were given land outside of Niarobi. These individuals have been called nubians and, under the British colony rule, were the rightful owners of the land - their reward for a life of slavery and displacement. As Nairobi industrialized and grew, it became obvious that more and more rural Kenyans would move to the city and the nubians started to offer their land for rent. Many poor rural Kenyans started moving in and building "structures" to live in. The city never brought power, plumbing or amenities and drew the area on the map as a green blob outside the city - funny thing is, the slums are still a green blob on the map today, except the blob is now inside the city. As the structures grew and more people moved in, the Nubins continued to divide the land up, affording each member of the slum less and less space to live in. Today, the average family of 4 sleeps in a 6 x 6 foot room, which may be built from mud, sticks, aluminum or a combination of and the floor is dirt/garbage or concrete (for the lucky ones). And, yes, they sleep on the floor. The British treated this area like Americans treat Native American reservations - do what you want with the land, but we don't feel like providing anything. This worked okay because the Nubins were the rightful owners and even had paperwork to prove it. Eventually, the slum was so large, that it was divided into villages, each with its own "governments" of nubians and many times governed by tribal law (still the case today).
A known orphan in the Kianda village of Kibera. He is taken care of by multiple "mamas" in the nearby housing.
When Kenya gained its independence in 1963, the new government stripped the nubians of their claim on the land but did not really do anything. In fact, the nubians still claim the land, still claim rent from the inhabitants (about Ksh300-700 per month for above described "complex" - $4-7 USD), still govern amongst themselves within the villages and still lobby for the city to acknowledge the area. They want acknowledgement because the fact now is this land is valuable. They can build 5 story apartment buildings here and make a lot more money - of course this would displace millions of people as well. So, why hasn't this happened? Funny thing, because of the years of living here with no city amenities, the people of Kibera merely throw their garbage on the ground. Over time this has led to incredible instability of the hills and ground onto which the buildings would be placed. In fact, Kibera is literally built on a landfill now. Wherever you walk, you are literally standing on garbage and the smell doesn't lie. It is so bad, that during raining season landslides will literally bring down 25 houses at a time and kill hundreds.
It's "cute", but this is the railroad the original nubians help build and it goes right through Kibera and is still active today. Notice the garbage, structures and 13 or 14 year old girl with an infant of her back.
Well, where do you stop...I could go on for days about the place and people I served, but the reality is this, the conditions are worse than you can probably imagine, 50% of 16-25 year-old girls are pregnant, 40% HIV rate, 60% of the children you see are orphaned and rely on a kind stranger or older sibling, the avg resident lives on 45 cents per day, 60% of Nairobi's population lives here and they occupy a mere 6% of the city's land... without clean water...without electricity...without plumbing... and many without hope, vulnerable, becoming prey of radical Islam and sitting on the frontlines of a spiritual battlefield they I didn't know existed before today...
Me in Kibera.
HAPPY EASTER
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