Saturday, 29 June 2013

Quilting in Nairobi

This post is dedicated to my quilting friends. To my midwife friends, hang in there! More for you soon.

As some of you know I've been a quilter for a very long time, and when something is an intrinsic part of you, it is always with you. It’s like being a midwife, you always notice the baby that is breastfed, you see the mother walking at the shops with the symphasis pubis dysfunction or the OP position. It’s just something that IS. So it is the same with quilt makers, we see patterns and designs where you might not notice anything. We are always on the lookout for the next idea, pattern, thread or fabric.

So it is no surprise that quilt making has been part of this adventure. Read right to the start of this blog and you see the quilt that was raffled as a fund raiser for FreMo. You’ll also notice the occasional post about the project I am working on here, in my spare time. I will never be bored if I have some stitching to do.

all the centre blocks finished and laid out
started the yellow border
just need to sew them together in this order

Before I left Australia, I made contact with the Nairobi Quilters Guild, and a lovely lady named Gretchen. Once I was here we planned to get together for the NQG meeting in June. They meet once per month and I missed the May meeting by the skin of my teeth, and I will miss the July meeting because I am attending the ICM East African Conference. Love those tax deductable CPD points.

So Gretchen and I agreed to meet early on Thursday morning so she could take me to the meeting. But I have to move back a step. The story starts on Wednesday as the two days melted into one.

Molly arrived with Flora in early stages of labour late in the afternoon. (names have been changed) This was her second baby, so we didn’t expect too much trouble. Good on Molly, we didn’t get too much trouble and the labour was text book. She worked hard, she moved, she swayed and she took on the suggested movements to help that baby out. She was the model patient. The only issue was Molly has HIV. At least we knew that this mother was positive. Some mothers come in, without any antenatal care and we don’t know. We have the facilities to perform the tests, but not in the middle of the night.

Molly had done the best she knew how and was taking her medications to decrease the viral load in her system so that it reduced the chances of transmitting it to the baby, and she had already procured the medicines for her baby. She was prepared. One thing we had to be careful of was that Flora didn’t know of her friends HIV status. So we were silent on the topic. I was glad of my own supply of personal protective equipment, which I used to ensure universal precautions against accidental transmission to me were maintained.  The hospital doesn’t always have everything WE would consider necessary.

The beautiful Charlene Michelle was born at 0240hrs in the morning. Isn’t she just lovely??

Sometimes my camera won't focus!
Now my problem was I had to meet with Gretchen in just over five hours. We waited for the placenta, no active management here. We started to tidy up. But by 0300, I suggested to Phillip that he take over, and I headed off to bed. He was happy for that so by the time I hit the sack it was 0330. I set my alarm for 0700 but my body clock wasn’t going to let that happen. I was awake by 0600. I figured if I went back to sleep I would probably sleep all day. If I did wake at 0700, I would probably feel worse, so I got up.

Molly and Charlene were sleeping comfortably when I went round to the hospital. I greeted them and Molly was just so thrilled with herself. I had a quick breakfast and scooted off to find a matatu to take me to the meeting point. It wasn’t hard and I was early so ordered a double cappuccino in an attempt to arm me for the day.

Gretchen arrived and we did the trip the long way round because it was quicker. Nairobi traffic is just shocking. I got a good look at parts of Nairobi that were new to me, and I’ve decided that I would never be able to drive in that traffic. The quilters were very hospitable and made me feel welcome and at home. There was a sales table to enjoy, but I didn’t buy anything. Some ladies were leaving the country and were selling parts of their fabric stash. But from the prices on the fabrics, I gather that the American prints are very expensive here, because their ‘bits’ were still fairly expensive. The library was well stocked and I even saw some Australian Patchwork and Quilting magazines ( none that I was in tho!!!).  The tea and coffee was already set up so I grabbed another, and the first biscuit I’ve had in over a month and settled in with my Apple Core quilt.

The meeting was typical and I sat patiently waiting for show and tell. The ladies all brought something and I was surprised to find that there wasn’t a lot of what might be interpreted as African influence… but there was some. At the end of show and tell I found out that they had just staged a large exhibition somewhere in Canada, so there were a lot of the African design quilts over there. The slide show of the exhibition was fabulous.

Luckily, the meeting finished at lunch time, and I was taken home again where I promptly went to bed! Thanks to the Nairobi Quilters Guild for your hospitality and to Gretchen for the lift. But don’t worry girls, there is definitely fabric shopping going on, and you’ll have an opportunity to see it when I get back.

And here are some pictures of quilts!!!

Saturday, 15 June 2013

These Shoes Were Made For Walking

This post is dedicated to my friends who work in the homecare department in the hospital I work at. I hope you enjoy!!

There are two main reasons why we get out and pound the pavements. One is marketing and the other is homecare. But first a little background.
Pounding the pavement.... the view back over Kangwangware
from the railway line... on our way to Ngong.... yes we walked
 the line!

FreMo is basically a private hospital. It has the facility to provide most care including antenatal, birth (normal), postnatal and now, thanks to our fundraising, immunisation. The local public hospital just down the road provides antenatal care, but not birth. So when the women get to 36 weeks of pregnancy they are told to go find somewhere to deliver. That’s why we do marketing. We hang around town on the busy days handing out leaflets and inviting women to come and check us out. They come and birth without too much antenatal input from us, and their hand held records usually have the basic information required, and I mean basic. Once they have delivered, they might spend 12 hours or so in with us then we start what we call ‘outreach’, but you know it as homecare.
Magdalene and myself at a home visit.
Of course, I get to cuddle the babies...
But this IS Kendall whom I helped her mum  with!
We do outreach every week day, and we usually see the mumma and baby at home within the first 3 days. Then they are invited to come for a check-up at the hospital and then we usually determine when we need to see them again. If there are no problems, we continue to visit every fortnight for two months.
Eunice Popped back in for a check up!
Mercy and Magdalene navigate a rather
rickety bridge .... and then turn to check on me
and make sure that I make it over...

The postnatal check on the baby is extensive. At each baby check we weigh the baby, measure the heart rate, respiratory rate, temperature as well as the additional details that we know so well. We check the umbi and clean it with spirits and advise the mums to do the same. They don’t. Some mums prefer to use charcoal to dry it out. All the mothers have their blood pressure checked as well as the usual checks and balances. When we return to the hospital the information is transcribed into a postnatal register that the government keeps (we have one for antenatal as well as birth!!).

What we don’t do.

We don’t talk about SIDS and safe sleeping. We don’t talk about how to make up the cot linen for the baby to sleep safely. We don’t discourage co-sleeping and we don’t discuss overheating. Most all of the women live in corrugated iron shacks, one family to a room which is usually 3-4m square. Sometimes the walls are brick but the roof is still iron. A curtain will separate the sleeping section from the living section. There are always lace curtains. The sleeping section usually has one single bed for everyone, and the living section will have a sofa crammed in with everything else. The ‘kitchen’ is any accumulation of surfaces that might hold utensils with a cooker of some sort (gas, charcoal or electric) featured somewhere, usually on the floor. Food is not stored, it is bought every day. Babies sleep in the bed next to mumma with everyone else, and are usually wrapped in several layers. I counted 8 layers on one baby. 

Mary at home with her twins. Her's is another whole story on it's
own. Here you can see the sleeping side of her home.
Breastfeeding rates are 100% and there is a new definition to on demand… read all the time. Physiological jaundice hardly gets a mention, and when it does, mums are encouraged to feed the baby outside occasionally. There is usually only one window (and door) per room and they are usually very dark.

Kids filing our of school.... a photo because I liked it!

Now here is the thing, girls. We walk. We walk all over the slums, everywhere, over drains and rubbish piles, past the pigs and goats shuffling through the rubbish looking for something to eat. We walk through the markets and through compounds taking short cuts. We walk sometimes for 4 hours with our equipment in packs on our backs. As we walk we constantly hear the work ‘Mzungu’. Yes that’s me. Crazy drunk men want to shake my hand, children want to touch me, and mothers just look as I pass by. Often I say ‘Habari’ and in return they chorus ‘Muzuri Sana’ – good thanks. We travel in three’s with Magdalene the midwife, myself (I get to do the baby checks and have nice cuddles too!!) and Mercy. We are known as 3M!!
Rubbish and Dust!!

Now what can I tell you about Mercy. She is one of the hard workers here. Her job is multi pronged but titled ‘Midwifery Assistant’. She does everything from feed the women, clean the floors, hang and fold washing and put it away, wash the dishes, fetch and carry and most importantly, she is our GPS. She knows these slums back to front and upside down. Considering there are no real street addresses, she manages to find everyone. She phones and lets the mothers know we are coming, and if it is difficult to find, she arranges to meet a relative somewhere close by. She translates for me, laughs at my attempts at Kiswahili, explains things as we go and best of all she documents our findings for us. Sometimes she’ll even buy something in the markets on my behalf if I don’t want to pay white woman’s prices!! And not because she asked me to, but I will leave Mercy my shoes when I leave, seriously, these shoes stand up to everything. That must be a recommendation to nurses and midwives everywhere!!! 
The dirty dusty hard working feet!

Could these shoes look any worse for wear???

The shoe shine boy in progress and
below... after... good as new!!!

By the way, did I mention we walk? Everywhere? Seriously, If I don’t lose weight doing this there is something seriously wrong with me!

Wednesday, 12 June 2013


As I sit writing this there is a 12 year old boy in an intensive care unit in New Zealand suffering from Tetanus. The article said that his parents thought they were doing the right thing by withholding immunizations. Five years ago, we had an outbreak of whooping cough in Australia. One of my friends contracted it and he very nearly ended up in intensive care himself. As it was he spent some time in hospital and was very sick for a long time.

Debate will always rage in the western context regarding the appropriateness of immunizations. And honestly, I’m not sure of all the reasons people use to withhold them from their children. But this blog post is not to incite argument or rhetoric; it is simply to document my experiences here in Kenya.

Magdalene with the cool carrier
 getting ready for our first day.
In Kenya, it is a legal obligation of all parents to immunize their children. The parents don’t actually have a right to consent or withdraw from the system of immunization as the government will mass immunize in the field, ie at school or elsewhere irrespective of the parents views.

Preparing the first jab. See the one and only kidney dish?
No it was in use elsewhere. And we went through many
syringes due to their poor quality.

So given that here in Kangwangware and more than likely many other places, the levels of hygiene that the western world might be accustomed to are difficult to achieve let alone maintain, the risks of disease are much higher. There is no running water, sewerage systems or garbage disposal. Good health means that you aren't sick and that you have something to eat. Protecting children from disease is an essential. Parents understand what it is like to lose a child to disease or malnutrition. So they agree to immunize.

Noel of 'Baptism of Fire' fame was
the first to line up with the
Beautiful Trisha.
Open wide.... it's only Polio Vax!!

Achieving immunization capabilities for FreMo hasn’t been easy. In the three weeks that I’ve been here, I’ve seen the frustrations that Magdalene and Moffat have been up against in what should be a simple effort to set up the service. Moffat has more stories of the 3 year journey it has been for FreMo, but they are not mine to share here.

A beautiful bubba getting naked
ready to be weighed

Below are excerpts from my diary documenting their progress.

“Magdalene and Moffat were discussing the adventure Magdalene is having trying to obtain immunizations for the clinic. If it’s not a wrong fridge thermometer, it’s incomplete paperwork from officialdom or other such issues. I find it frustrating and I’m not really involved. Magdalene went all the way to Bagathi Hospital today by matatu to pick up the immunizations. Everything was in place and we’ve been telling women to come to have their children immunized. They are coming and we are turning them away. Today is the day. But no, the cold carrier (I think she means esky) wasn’t available. They are locked away in the store room, waiting to be used. The man with the store room key is nowhere to be found. There was nothing to be done but come home without them. Of course this latest turn of events caused us to discuss their inefficiencies again. 

Nothing like a bit of boobie to sooth
after an immunization!!
And again…..

“Magdalene returns in triumph. We have immunizations as well as cold boxes. And yes, they are small esky’s. She calls a meeting and tells us of her adventures. Apparently they didn’t want to give her much stock, but she talks them around as it is our first order. Moffat immediately goes into marketing mode and decides the best way to do it is to turn FreMo into a telemarketing center. Off they go and pull all the charts of birthed women since September 2012 and start cold calling. It takes all afternoon.”

And of course, more photos of beautiful babies.

Thursday, 6 June 2013

The Secret Life of Tee Shirts

AKA Where all unloved Tee Shirts end up!

It’s an understatement to say that life in Africa is different. Things just work differently. Don’t get me wrong. Lots of things are exactly the same…. It’s just different. For instance, let’s use shopping at the supermarket as an example. Each aisle has a worker in it, usually wearing a lab coat printed with the supermarkets name, and it is their job to keep that aisle stocked, clean and to provide customer assistance. So every time you enter a new aisle in the supermarket, you meet a new shop assistant – and they live up to the title – they assist you! Another example is Margaret at the fruit stall. She will sell me anything I want on her stand, one thing, multiple things, half a thing peeled nicely and in a plastic bag, or even fruit salad, and she will do it to order while I wait.
A little boy outside his family grocery store
 - not quite a supermarket!!

So sticking to the theme of shopping, the markets in Kawangware are pretty well insane. They are open everyday to varying degrees but Tuesday and Friday are market days. This is also the days that we go ‘marketing’ to promote FreMo to pregnant women. I’m really good at this because my whiteness is a beacon for attention, and I get it. Then I just leave my fellow Kenyans to actually do the talking! For my friends at work, just think Homeless Connect in the biggest possible way!

Every Tuesday and Friday the stall holders receive a new shipment of stock. It comes in great big bales that have things squashed into it much like wool is pressed into bales. To be there for the opening of the bales is something to see as all the treasures come tumbling out. It seems that the bales are all second hand clothing, and that most of it comes from the western world’s charity shops. There are all sorts of brand names to be discovered if you are willing to stand in the sun, flinging clothing around with gay abandon. Some of them still have the charity shops price tags on so you can see which country they come from. It seems to me, that Africa is the dumping ground for the charity shops who can’t sell all their stock. The clothing sellers are standing in the midst of it all calling out to would be customers, telling us that everything costs 50KSH. That’s about 62 cents AUD.

But let’s get back to tee shirts. I’m having the best time checking out the tee shirts. People are walking around wearing tee shirts that are completely, shall we say, inappropriate. The other midwives I walk around with are totally oblivious, and I think they think that I’m a little crazy. Well really, a grown woman giggling to herself in the open for no apparent reason?!?  I accosted Josephat, our pathology technician who was wearing this QR National tee shirt. This one comes from Queensland Rail when they were going public and selling off shares in the company. My partner works for QR so I thought this was a hoot.
Josephat sporting a QR National Tee

Walking around the slums I’ve seen a young gentleman squeezed into a tee shirt from the Springfield Baptist Preschool Choir. Is that Springfield in America or Australia – I’m not sure! Then there was the biggest guy wearing a purple Curves tee shirt. For those who don’t know, Curves is a women’s only gym in Australia. I don’t think he realises that! Then there was the woman wearing a tee shirt with a picture of a young girl on it. It was pink and had the script ‘For ever in our hearts’ with her name and breast cancer awareness ribbons printed on it. Actually quite bazaar when you think about it. It's no wonder some of these tee shirts end up at the opportunity shops.

So the uniform at FreMo is pink tee shirts for the girls and blue for the boys with a teddy bear on the left breast sitting next to children’s building blocks with ABC written on it. I asked where they came from and was told that they chose the design because of the babies and they get them from a lady they know. I thought they looked familiar but when a new member of staff received theirs; they left the tag hanging around. The tag reads ‘Corporate uniform of ABC Learning Centres, Australia’. And now we know what happens to unused uniforms of companies that go bankrupt. I hope he had to give them away and that someone here is making a living from selling them.
Boaz being cool and smiling!!!

There are also multiple sports club tee shirts to be seen, many many many tourist locality tee shirts, so many in fact that I seriously wonder why any of us buy those tee shirts from places we visit? Do we ever wear those tee shirts before we give them away? They seemed like a good idea at the time! And then there are the university tee shirts usually from America. Today I saw St Helens College, University of Minnesota, as well as others.

I’ll keep walking around, checking on peoples chests as now it's getting cooler, the sweatshirts are appearing and guess what? The same principles apply! And I’ll continue to scheme ways to recycle more shirts! BTW, not many photos in today’s blog as it is a tiny bit conspicuous carrying around a gigantic camera in a slum!

And a little PS for those keeping track. Here is a photo of the latest of my quilting efforts. The blocks haven't been sewn together yet, just spread out to see how they look. And I've just started on the purple round. Watch this space!