Friday, August 31, 2012

Dr. Quack, banks, driving in Nairobi, and Dr. Quality

Arriving in Nairobi 6 months pregnant, I really felt the pressure to set up quality prenatal (antenatal) care for myself and our unborn child. I read many expat blogs and came across one which recommended a doctor that has a private practice very close to our home. Walking distance is very good when we don't have a car and public transportation is effective but scary. I may start taking pictures every time I see a mutatu or city bus in an accident to emphasize how often they occur...I've been here 3 weeks and seen at least 5 of them involved in crashes, 6 if you count the two that got is a crash with each other.

So, I called the provider that is so close to our home and was informed that I could come into the office any day for walk in hours, which are after 2 pm. On Friday, 8/24 Jason left work early (though everyone leaves work early on Fridays) and we walked over to the clinic. Upon arrival I filled out my personal information and then we sat in the waiting room. We arrived 10 minutes prior to the start of walk in hours, and there were only a couple women in front of me. There were no other men in the waiting room..perhaps women here don't bring their partners to antenatal appointments?

This is the view from the stairwell of the office tower, looking South across Upper Hill, Nairobi.

The waiting room was both comedic and slightly uncomfortable. It was very small and the only seats available were under a flat screen tv mounted on the wall. Across the room was a mirrored wall so we could still see the tv and hear it. What was both uncomfortable and comedic about the scenario was that the cable channel that was being watched was all American broadcasting of the sort you might find on Spike TV in the States. Commercials blaring out "the dumbest..Americans, the craziest...Americans, the WILDEST..AMERICANS!" with images of people jumping off roofs, running through fire (and catching themselves on fire), fist fights breaking out at weddings, backflips with people landing on their head, testicles getting smashed, etc. Having also been the only white people (and coincidentally the only American people) in the waiting room, many eyes were shifting from the television directly above our heads to our faces directly below the screen. Fortunately, the hilarity of dumb people seems to be a comedic phenomenon cross culturally, as we all wound up laughing together during our wait to see the doctor.

About an hour after arriving at the clinic I was seen by a nurse who took my blood pressure and sent me across the hall for a urinalysis. Across the hall was yet another waiting room, where we waited for another hour before being given a specimen cup. When I say "cup," I actually mean a vial, as the opening was about the size of a nickel in the States. I bow down the talent of the women here that are able to make it into that opening. Another feature of my "cup" was that it was clearly being reused. There was sticky residue where a previous patient label had been attached and removed so that my label could be added. I told myself that it had been sterilized somehow and went an my business. Another feature of the cup became apparent when I tried to place the lid on it and found that the lid was mismatched and would only screw on in a cross-threaded fashion that left it susceptible to leaks. Oh well. :) I turned in my sample and went back to the main clinic where we were advised to have a seat and wait. Another 2 hours passed! I was starving, approaching a cranky mood, and very uncomfortable from the heat of the room and the long period of sitting.

I approached the receptionist, who informed me that next time I can make an appointment and be seen in a more timely way. I informed her that I had requested an appointment and she told me they only do appointments in the afternoons on Wednesday's. "Okay, so can I come back next Wednesday with an appointment" I asked. I explained that I had not eaten for too many hours and that I needed to leave for food. She explained that the doctor would see me very soon, and would I like some fruit ordered? She promptly called a food delivery service which brought Jason and me two large servings of fresh fruit salad. Bananas, avocado, papaya, and pineapple were my salvation while I continued to wait.

About 5 hours after arriving I saw the doctor finally. He informed me right away that because of my gestational diabetes, no doctor would allow me to go to full term and therefore, he anticipates inducing my labor several weeks ahead of my due date. I politely informed him that we plan on having as natural a birth as safely possible. He attempted to convince us that because our baby was conceived with IVF, it is a higher risk pregnancy and more precious and therefore we should not take risks with natural birth. All the empirical, evidenced-based research I have read indicated that conceiving via IVF does not indicate a higher risk pregnancy than a naturally conceived pregnancy. So, Jason asked why he felt that I would need to be induced, and he did not answer this question. He then went on to say that my blood pressure reading was very high and that he would like me to take blood pressure medication. My blood pressure is normally very good, but during this appointment was around 150/90. Perhaps it has something to do with moving from sea level to nearly 6000 ft elevation, traveling half way around the world, the stressful clinic environment, the treat of inducing my labor, or the fact that I walked to the clinic? He further stated that we should have an ultrasound to check on the baby as well as blood work.

We again went across the hall, this time for an ultrasound and blood work. Blood was drawn (with a new needle I made sure) and the we went on to the ultrasound. The ultrasound was great! Baby was facing head down and is measuring right on track. We observed our baby sucking it's thumb and having an enormous yawn. SO cute!

After the ultrasound we were told to wait again. After another hour the doctor saw us again. He reported that the ultrasound looks good, but that he still wants me to take blood pressure medication and...ASPIRIN! Seriously...he wrote a prescription for aspirin. Contraindicated for pregnancy as a Class D drug during pregnancy due to evidence of fetal harm, and yet..there he wrote it on my prescription. At that point we left.

I was not feeling very confident in the medical care here when we left. Home birth was starting to look more attractive, even in a place with reduced infrastructure. I know my body is able to give birth and I know my baby is healthy. I refuse to let Dr. Quack-O derail me from my holistic approach to a gentle birth.

One outcome of the very bad medical visit is that Jason and I decided that if we were not going to rely on the medical care within walking distance, we are in need of a reliable mode of transportation to care that we deem quality. So, we decided to buy a car. We found a very great 1999 Suzuki Jimny (aka Samarai in the States) with 4WD and great economy. 4wd is a necessity here. There are incredible pot holes, and the roads are often unfinished or in disrepair. Additionally, flash flooding can occur and cars without 4WD may not be so safe. Also, we wanted a car that could get us out to see the great rift valley and Masai Mara among other things. So we found the perfect little jeep-like vehicle. It's in great mechanical condition, and in typical Nairobi condition for the body..meaning plenty of cosmetic dings and repairs.

In order to buy the car we needed to withdraw 300,000 KES, or about 3,500 USD. This required us to go to several banks, western union, etc to try to sort out how to get this money from our account back home. Eventually we founda. Bank that would do a credit card money order, up to 50,000 KES per card per day. So for several days we went to the bank slowly accruing the money for the car. We then contacted the sellers of the car and they agreed to meet us at a mall. The mall is about 4 miles away, and due to rush hour the taxi took over 2 hours to get there. Worst traffic I have ever seen...ever...and it's par for the course during rush hour here. I sure hope my labor stays far away from rush hour or we may have a backseat baby.

We bought the car, obtained insurance, and are working on getting the title transferred. This requires us to get a Kenya PIN (personal identification number). All in due time!

With our new car and insurance in place, we drove to Aga Khan University Hospital Antenatal Clinic for another attempt at antenatal care. We met with a very good OBGYN. Our confidence in the available medical care is much renewed with the visit we had yesterday. My blood pressure was very good at 130/80 (still higher than prepregnancy, but good nonetheless) and the doctor was very pleased with my diabetes management. The doctor is part of a obstetric team, and for our next appointment we will be paired up with a primary care doctor as well as an obstetrician for a team approach to the pregnancy through the hospital. It was a huge relief to have quality healthcare. Seeing the OBGYN, and providing a UA cost about $13. Fabulous!

The baby is moving around a lot, especially when Jason plays music for it. It seemed to really like Pacabel's Cannon...perhaps that's genetic? These days the movement is significant enough that we can see my entire stomach heave in different directions or just pop out in places when the baby shifts positions. Another piece of good news is that the baby has remained in a head down position for the past week, per our ultrasound last week and the doctor yesterday. :)

Hard to believe there's only 9 weeks left. Now that we have a car, Jason and I will be going to look at bassinets this weekend.

Saturday, August 18, 2012

12 days and going...

I have now been in Nairobi for 12 days and I am really starting to feel adjusted to the time zone, the climate, and the culture. When I say that I am adjusted to the climate, this does not imply that like the locals I am sporting a fleece and long pants in 70 degree weather...this simply means that I am not sweating quite as much in my shorts and short sleeved shirts.

Jason and I have been spending much of our free time out walking and exploring the area around us. One would think that moving the the other side of the earth would make one feel as though their world has expanded, and yet upon arrival I felt very much like the world had shrunk around me. This was largely due to moving to a place where I know nothing about the street names (if they have names), where to go for basic things, how to get around, or which direction is which way. I felt a bit like this when I moved to Oakland California for college, however, I had a car and all the normal way of finding things applied. I could find any store on the Internet, print out directions and off I went. Another bonus about Oakland was that it had the ocean/bay in one direction and the largely visible Oakland Hills to the other direction. This made knowing north very easy. The same type of geographic identifiers have been present all my life in Seattle. Having always lived in a place with mountains and water, I find that I continually try to orient myself here in Nairobi based on the direction to the mountains or the water...but there is neither here in Nairobi.

Fortunately, I married a man who has as strong a desire for adventure as I have, and we have been slowly expanding our new world here. A couple days after arriving, Jason and walked about 45 minutes to a very large Nakumatt grocery/department store. Yes, we do have a Nakumatt that is closer, but we wanted to venture further and see a larger store. After walking to the Nakumatt Mega, we walked along Uhuro Hwy until we got back to the main bus/matatu route, where we hopped a city bus back to a stop near our apartment.

The city busses cost 50 KSH, or about .70 USD. Very inexpensive option to get around. This was a pleasant experience, except that the drivers need some convincing to actually make a full stop when you try to exit the bus. Everyone on board found my frantic attempt to get off the bus, while pleading for the driver to wait, very funny.

Here is a picture of me on my first Nairobi public transportation experience:

Despite eating most of our meals at home, Jason and I enjoy eating out because it is both very good (and often reasonable healthy) and very inexpensive. Below is a picture of a cat at the "Steak and Ale," a restaurant on Ngong Rd, about a half a mile from out apartment. The food was very good, and this cat seemed to know we were suckers for a cute face. When no one was looking I slipped the kitty a bit of the skin and connective tissue from our mixed grill meat platter.

I expected that I would experience a lot of new and fascinating (perhaps terrifying) insects here in Kenya. Since I have arrived however, I have seen very few insects. so far on the list of bugs are mosquitos, fruit/black flies, moths, butterflies (which I will try to capture some images of), and an awful but tiny spider. The spider was most awful because it jumps. It is tiny and black with small white specks on it and it can leap ling distances. The only thing worse would be a spider that could fly...I'm pretty sure those don't exist though. and an incredibly enormously huge grasshopper. I'm not sure the difference between a grasshopper and a cricket, but this was giant and caught my attention when it flew past me and landed a few feet from my feet. It was about 2.5 inches long!

Here I am with my friend Jimminy:

Our apartment is equipped with some very basic kitchen supplies, however we have found ourself needing/wanting several cooking items that we took for granted at home. One of these is our cast iron pan. The only pans/pots here are either non-stick surface, very thin stainless, or aluminum. None of these are ideal for us. So, we went off looking for a cast iron pan and thought that surely we would find a used one at one of the outdoor markets. We walked about a mile and a half to the Adam's Plaza, and around back found an enormous outdoor market. This is the Woodward Market, and if you go far enough into the market until you lose all sight of the road, then you have likely arrived at the Toi Market. I cannot emphasize enough how huge this sprawling permanent market is. It has endless vendors of used merchandise, such as clothes, dishes, cloth, produce (not used), and everything else you could imagine. We had the fortune to meet the proprietor of the market, Benson, who promptly took us under wing to try to locate the cast iron pan. he had no idea what we meant by cast iron pan or "chuma pan" (Swahili for iron pan) but I'm pretty sure he walked us to every pan in the market, ending with a metalsmith at the back edge of Toi Market, where he tried to barter for a metal worker to make the pan for us out of a disk of iron. Hammering scrap iron into a curved disk is how many of the chapatti pans are made. The metal smith seemed tentative, but willing, for the low, low cost of 5000 KSH, or $50. We said no thank you with as much tact as possible, and hoped that Benson would be as willing to lead us out of the market as he was willing to lead us into it...which he did. By the time we got back to a starting point, Benson was back to being very friendly and we told him that at the end of our time in Nairobi we would give him our cast iron pan (if we could locate one or get one sent from home) so he could sell it at the market.

Here we are at the start of the market, prior to Benson finding us:


We are having so much fun here. Every day holds new challenges, adventures, and experiences. Over this last weekend Jason and I walked about 3 miles to The Junction, which is a huge western style mall, equipped with food court, another Nakumatt, and lots of shopping and nice restaurants. There is also a kitchen supply store, where we found...A CAST IRON PAN! Im fairly convinced this may be the only one in the county...and we bought it. It was expensive, but well worth it! at The Junction, we also found a soft serve frozen yogurt place where you serve yourself and then pile on your own toppings. Jason and I split one with pistachio, passion fruit, and vanilla flavored fro-yo. It was so delicious after such a long walk to the mall. I will be back for fro-yo, and not feel a bit guilty when the total trip requires 6 miles of walking!


Tuesday, August 14, 2012

Jet lagged = blog lagged

It has been almost a week since I arrived in Nairobi and I am just now feeling adjusted to the new time zone. I arrived at 2:30 am Nairobi time on the 9th of August. The flights were very long, and by the time the plane touched down in Nairobi, I was a firm believer that restless leg syndrome is in fact a real condition. Remaining in my seat by that time was physically painful.  

Due to concern that I would not be allowed into the country without a return flight, I had made changes to my flight itinerary and flew from Seattle to Chicago to Istanbul and then finally to Nairobi. The airport in Istanbul was swelteringly hot, with no air conditioning to speak of and no drinking fountains. By the time I got on the flight to Nairobi I was extremely thirsty. I had also stripped off my compression socks due to the sense of hyperthermia i was experiencing. I spent the rest of the flight to Nairobi with feet and legs appropriate to the state puff marshmallow man, and endlessly parched. Water was very minimally accommodated on the last flight due to a medical emergency perfectly timed with when the first round of refreshments might have been served, and then taking up 5 of the 6 and a half hours of the flight. I was the nagging woman on the flight who kept getting up while the seat belt sign was in place to feign bathroom and then beg "please, please may I have another thimble of water please?"


I arrived in Nairobi and stepping out of the plane, I was pleased to find the temperature to be comfortably cool. The airport in Nairobi has very low ceilings and none of the glamour or glitz of the Istanbul airport. There were no duty free shops, no designer clothes or perfume shops. It was dirty, narrow-halled, and absolutely wonderful. I couldn't stop smiling. Like all airports, it was easy to find my way to the visa counter, where a friendly lady promptly took my $50 and stuck a 90 day visa sticker into my passport. I then waited for my baggage to arrive, and to my pleasant surprise, it did!


I cannot begin to describe how wonderful it was to exit the baggage claim area and find Jason waiting for me. His amazing friend and colleague Mburu was there with him to transport us back to our new home at the Savannah Sands Apartments.


The apartment is very nice! I will do a post at some future time with pictures of the apartment here. For purpose of brief description, it is a two bedrooms, a bathroom, a large living room with huge daybeds for couches, and a kitchen. It has a small balcony with a faucet, and clotheslines for drying clothes.


This first week has promoted many adjustments in expectations. I feel completely safe during the day to be out and about walking around and carrying out my shopping for groceries. Jeffery, our daytime security guard has expressed also that it is quite fine to walk about during the day, however everyone tucks in after dark unless they are driving from one point to another. Our apartment compound is right on the border of the Upper Hills Estate and Kilimani neighborhoods. Both of these are very areas of Nairobi. Everyone's homes/apartments here are within compounds that are walled, with electric fence and/or razor wire along the top, and full time security personnel.


Oe of the things that struck me in the first day was how dirty the city is. There is trash debris littered everywhere, along with huge amounts of dust and diesel exhaust. Due to the congested roads (and Ngong Rd where we live is one of the most congested) most people do not walk directly next to the road on the side walks, and rather walk along dirt paths several yards from the road. We follow the dirt paths as well. A note about the trash, while there appears to be a trash service that picks up the trash from compounds and businesses, there are no trash cans that I have see for the public. There are, however, dug out holes in the ground where people stuff trash, and then eventually someone will light the hole on fire to dispose of the rubbish. For this reason, there are also small burned out fire piles all over the place with charred remains of garbage. Another thing that was different for me, was that the refrigerated items (such as milk, yogurt, cheese, butter) at the grocery store are kept barely cool. They are all in a refrigerated section, but they are minimally cooler that room temperature. Milk is available in a plastic jug or in sealed plastic bags. Like most places around the world, the eggs are not refrigerated at all. All the food from the grocery stores is fine to eat, and we have not had any problems with buying the warm milk, refrigerating it at home and consuming it. Perhaps we can be a bit uptight about our food in the U.S.?


While there is not much of a restaurant culture (so far that I have seem), the restaurants that are available are incredibly inexpensive. Jason and I ate at an Indian restaurant at Prestige Plaza (home of the Nakumatt grocery store), where we received naan and chicken palak for about $8. This was more than enough food for both of us, and perhaps some of the best Indian food I have ever eaten. We also went to a place called "Steak and Ale" which is butcher, BBQ, bar, restaurant, and perhaps dance club (if we stayed late enough) all in one. Jason and I ordered a mixed grill with lamb, chicken, and beef with marsala fries. This plus a Tusker beer for Jason and a bottled water for me cost us about $12.


I have seen only a few dogs since we arrived, and all strays which have made packs with homeless people. The dogs all look the same: long legged, lean, pointed ears, dark masking on their face and otherwise golden short fur. They look like at some point they were mixed with a shepherd. I have not seen any dogs that would fall into the pet category, though every grocery story has a small freezer with chubs of frozen meat specifically for dog consumption. I'd guess this meat is purchased by those who have estate protection canines.


There are a fair number of stray cats, which are social enough to approach strangers for food, and often hang out around our apartment building. Hearing them fight in the night is common sound.


After one week in Nairobi, I am thankful to be here and very excited for the next 9 months. There is so much to learn and experience, and I love all the new sights and perspectives on life.


I know that blog posts are most enjoyed when pictures are present to punctuate the narrative. I will make an effort to take more pictures and get them into my blog.