Hi Everyone So it’s been two weeks since I’ve last updated the blog. Things have been going well. I have one more week left of my placement and then I’ll be traveling around Kenya and Tanzania for 2 weeks. During the past week we held another Training week at the Opaopo clinic. I had 4 clients that I worked with everyday. All four were children. I had two clients that actually had hydrocephalus and the circumference for both of the young boy’s heads was pretty large. If they were in Canada they would have received a shunt, but here in Kenya, the surgery is expensive and parents sometimes wait too late before taking their child to the hospital. One of these boys was a year and 2 months and the other was 7 years old. The 1 year old still was unable to hold up his head because it as so heavy. Luckily the circumference is no longer growing and is actually decreasing. So hopefully with time and proper positioning the young boy will be able to hold his head up and make other gross motor mile stones. The 7 year old boy started experiencing the growth of his head at the age of 2. When this started happening he lost the ability to walk. Since then, he’s been crawling on the ground or is carried by his father. The reason he couldn’t walk was due mostly to increase tone in both lower limbs. When he came to Training Week, we realized that he had enough leg strength to support his weight. So we made him a pair of crutches from rod iron. From all the clients I’ve seen this far, I feel like I made the most gains with this little guy. Who knows if he’d ever get the chance to walk if he hadn’t come to Training Week? We initially found him in a rural community in Rongo district when we went for our community outreach visits and referred him to Opaopo. I always forget that things that we would do at home (like go and get a wheel chair or another mobility aid) people here don’t have access too or do not have the funds. In other news: I got my first African dress and I was having a real lucky streak with the Matatus until today. Before today I was able to get the front seat on the Matatu (which is not at all squishy) 4 out of the 5 times and I got two free rides this week because my preceptors offered to pay and are refusing for me to return the offer. But my luck ran out today. Today the Matatu ride into Kisii from Rongo was one of the most challenging and I paid double the price. The conductor demanded 70 shillings a person rather than the 50 shillings that we normally pay. Everyone on the Matatu got really mad at him and were demanding that he charge us the usual price. They almost turned the matatu around to send us all back to Rongo. One lady actually got kicked out of the matatu because she as yelling at the conductor and the driver. We continued to travel towards Kisii and the man in front of me continued to argue with the conductor and then we got stopped by the police (there’s always police checks). This time however they were taking people out of the matatu if they didn’t have a proper seat (remember, people seat in between seats with their bottoms hanging and stand too). Luckily Steph and I both had seats at the back. But then, even though these people were kicked out of the matatu by the police, these people started to walk and jumped back into the matatu 5 feet away from the police. What was the point of that?? Anyways… it’s all in the experience I guess. Well, this might be my last real blog until I return to Canada. I miss you all very much. I’m returning on Sept 27th with Khadir. I do have access to facebook on my cell, so I’ve been keeping updated on that. So if you want to say hi before then, send my a facebook message. Otherwise, I will see everyone (InshaAllah) in 3 weeks. Love you all noreen xoxo strong>

Hi everyone So this weekend marks the mid-way point in my placement. It also may be my last official visit to Kisii (which means I might not be giving formal blog entries). I will try to access the internet from my cell phone and attempt to give you guys regular updates; but no promises. This week was pretty good. We did two days in the community and two days at the Opapo clinic. We went to a community that was close to Rongo (unfortunately I didn’t get the name but it was still in Rongo district). We saw approximately 40 to 50 different cases with my self seeing 19 individuals. Unfortunately, many if these people required medical attention and needed to be referred to the hospital. There were a couple of cases that I could help with direct (such as those who needed some assistance with equipment;mainly calipers which are braces used over here). The second community we visited was on the coast of Lake Victoria. It was called Sindo which was approximately a 2 hour drive from Rongo. We were able to identify 3 children that would benefit from intense therapy sessions so hopefully we’ll see them next week during our Training Week (where the clients will stay over night and have treatment everyday for a week). We also saw dislocated hips (which I’ve become an expert in identifying) and a possible case of sickle cell. During this last week I’ve also realized (or has come to a greater understanding) of the hardships that people here have to face; specifically those who have a disability or have been orphaned at a young age. I have come face to face with two young women who were in this situation. One I have already commented on. As an orphan she had a child at 13 and now at 18 has another baby. The second situation that I’ve come across is even worse. I met a 24 year old who suffered from polio as a young child and was left with permanent disfigurement of her legs (she walks on the lateral side of her feet). Because of this, she was coxed into marrying her older sister’s husband (culturally, if there is a disabled sister, the older sister’s husband is suppose to give support .. which can be seen as a form of marriage). With this man, this young girl has already given birth to 4 children. She came to the clinic asking for assistance because she has now left that house (which had her older sister, their husband and her sister’s 6 kids) because she was being physically abused by her sister. The worst part of this story is that she had just given birth a week before coming to us. My preceptor told her to come back to the clinic this week and we’re going to help her set up a business so she has a means to support her family….hopefully we can help her and she doesn’t have to go back to that home. The next 3 weeks I expect to go quickly. I will try to jump on here again with shorter entries. Take care everyone and Ramadan Mubarak Love Noreen

My 2nd week of placement in Kenya

Hi Everyone I’m officially finished 1/3rd of my placement. Things have been going great. This week we had training week in the clinic where the clients come to the clinic for the entire week and stay over night. The reason for this is because they have training everyday of the week and some can not afford to travel back and forth from home. We still stay with Mr. Okidi in his home and return every morning. The clients I saw this week were similar to the ones that would be at home with one exception. There was this young boy who was no bigger than 10lbs and his mother said he was the age of 2. He was severely under nourished and it was very hard to believe that he was any older than 6months old. I looked at his teeth to really confirm his age (to the best of my ability that is..). The best thing we could do for the mother was continually remind her that she needed to feed her child every 2 hours even if he wasn’t crying. My preceptor was determined to make the mother understand the efforts she needed to take to feed her child, even if he wasn’t awake. We’re expecting this client back at the hospital so we can get more medical interventions underway. The 2nd child I saw was similar to one I have seen in the past at home. He had CP and was having difficulty with increase tone in his legs. I really hope that he comes back and we can achieve some more goals with him. I’d like to see him walk, however a walker for a child is unheard of here. Even for an elderly person, walkers are too “cumbersome” when there’s no pavement but just gravel roads. I also saw adults during the week. I saw a women who had suffered from severe rheumatoid arthritis and she had lost her ability to walk. We are planning on visiting this lady in her home and see if we can find alternative ways for her locomotion. Currently, she is being carried by her daughter and son (who could be as young as 12 years). In other news…I’m having a great time… next week we may go to Roma which is a national park in West Kenya.. Miss everyone very much Take care Noreen

My 1st Week of Placement in Kenya

Hi everyone

So I completed my first week on placement in Rongo, Homa Bay and surrounding areas. It was a week full of eye opening experiences. On the 1^st day of placement, I was able to use my skills from ErinOaks Children’s Centre to diagnosis a dislocated hip for a 15year old boy. Over in Kenya, physiotherapist are allowed to give their clinical impression (diagnosis) to clients/patients. In Canada, we can’t really give a true diagnosis. Also, Kenyan PT’s can cast fractures and club foot (a common foot deformity seen in infants). When I was in Homa Bay (2^nd day), I assisted in casting for club foot. Unfortunately, surgery is very expensive for many people over here, where as in Canada, many people would just have a surgery to correct the club foot.

It can be very frustrating, unfortunately, when we come across people who can’t afford simple things like an operation to fix a fracture. Since this is a common problem, they use a device here that will pull the legs (or arm) apart while the fracture is new until the bones meet. We came a cross a man who was walking on a one year old compound fracture of a femur. When he brought us his recent x-ray (2 weeks old), this fracture was still separated.

Another issue that we’ve been running into is individuals coming to the clinic asking for money, rather than help for their disability. Over here, the white man is called “Muzungo”. We commonly hear people yelling this while we walk down the street or when we’re in the Matatus. Anyways, people in the towns have been hearing that the “Muzungos” have come and this has brought many to the clinic with the hopes to get some financial assistance.

We have also come across spina bifida (another very common problem). In Homa Bay hospital there as a 6 day old infant that was waiting sponsoring so he could be taken to Nairobi or Kisumu for surgery. The protrusion of the dura (the area around the spinal cord) was fully exposed.. which is scary since this child was at a crazy high risk for meningitis.

On a happier note, the food here is great. I also got a chance to visit another city/town/district called Magori. Over there they had a hospital as well and we stayed in the hospital guest house (which had running water and flushing toilets .. very exciting).

I was also going to post pictures today, but I changed my memory card and completely forgot to bring the full card.. so…I will try again in 2 weeks. I might not jump onto the internet next weekend. Getting to Kisii (the city).. can be difficult on the Matatus.

Miss you guys a lot..

Love

noreen

Way of life and the Matatus

Yesterday night Deb arrived (another PT student from Mac) and the rest of the group also returned from their weekend trip to a rainforest (Kakameca…north of Kisumu). So yesterday night was pretty fun having a large group of people in the home. All together, there is 3 OT students from Mac, 2 PT students from U of T and 4 PT students from Mac (including myself). Today we decided to come back to Kisii to check emails and look around some more. I decided it would be a good time to tell you guys a little more about how Kenya is like India and about the Matatus.. Well.. Kenyans love to sell stuff to you in the same manner as an Indian would. My mom would love it actually because she could use her bartering skills to the max. Also, showering is the same with the bucket over the head and they also eat chapathi.. which is sooooooo good! The toilets are also the same which I talked about already. There is also a lot of Indians in the area.. so it’s very interesting to see a lady wearing outfits shopping at the local Nakumatt.. which is a large superstore of East Africa.. also owned by Indians.. it reminds me of Walmart.. seriously…. They sell everything.. The matatus are also very interesting and fun to ride.. sometimes. They are small mini buses that they pack full of people. They will literally try to fit 14 people plus a driver and a man that collects money in a car that should only hold 10. They also drive pretty fast and pay some local music .. which is fun. That’s the way we’ve been traveling to the city of Kisii.. a 20 to 30 min. drive from Rongo on a matatu. Tomorrow I will be starting my placement at the Opapo clinic. Hopefully I’ll be able to jump onto the internet again next week (Saturday or Sunday) and fill you guys in on how the week went “at work”. Bye for now! And Miss you all!

Living in Rongo

Well, I’ve made it to Rongo, Kenya and I’m having a great time. I am a little home sick but I think that was to be expected. Everyone is very nice! Food is also very good. Yesterday I was able to see many areas around Rongo. I went to Homa Bay and Kisumu. Kisumu is larger than I expected and there are a lot of Indians.. :) I also so a little or Rongo which reminded me of Milton; but mainly because it has the same population . Kenya reminds me a lot of India. In India .. we did have running water, but Mr. Okidi’s place doesn’t.. that’s the only difference this far. Everything else is the same. I take showers the same way (bucket over head.. after boiling the water). Thank goodness I cut my hair!! I will take pictures of my room etc, but I can’t promise I will be able to post many because the internet is pretty slow and I’m afraid it would take almost 30 minutes to load them. But I will try. My mosquito net is lovely.. it’s kinda funny how a princess net for decoration in my old room can actually be put to practical use over here. Currently, the only problem I am having is using my new international SIM card.. I was either very tired yesterday, or I was going crazy ( not sure yet). Either way, placing a call was a pain. I’m sure Roger’s is going to love me because I am expecting a large bill next month (yes.. My Roger’s number is still working.. but don’t even think of call me sidrah.. I’m still screening my calls :P.. j/k). I will get Khadir to try skyp and if that works, he can give the number and we can still chat. The issues with the “hole in the ground” isn’t that bad.. actually.. I was also surprised Amarah.. haha.. . Well that’s all for now. I’m sure I will have a lot more to add next week. I start placement on Tuesday and that’s when the excitement should begin. Miss everyone Love Noreen Xoxo p.s.. if my grammar is bad.. or there’s spelling issues.. get over it.. I don’t have time to proof read…time is money.. J

A YouTube Video about the Kenya Working Group

The Kenya Working Group has put together a great video that talks about the program and shows individuals being assisted by the program. The following link will take you to the video.

http://www.youtube.com/watch?v=0rkyxgWdPug

Why am I going to Kenya?

I'm going to Kenya through the Kenya Working Group (KWG) to complete my final placement in my physiotherapy program at McMaster University. KWG began in 2004 with the goal to provide health care to the disabled individuals throughout Kenya. More specifically I will be assisting with the "Disability Services Programme" that is in an outreach clinic in Rongo (on map) and Homo Bay. The purpose of these clinics is to not only assist those with disablities but link those with disabilities with vocational and educational opportunities. In the past, this program has also offered equipment and facilitated surgcial interventions.

Other objectives of the Disability Services Programme include:

• Develop a community structure for delivering efficient and effective services to disabled persons
• Educate and sensitize the community on the abilities as well as the needs of disabled persons
• Equip people living with disabilities with the skills that are relevant to their unique challenges
• Provide “training of trainers” to enable the community to effectively serve the needs of people living with disabilities in their community
• To educate and reduce stigma associated with HIV/AIDS
• Give support to HIV/AIDS orphans
• Promote and advocate for positive behavioural change among the youth
• Improve accessibility to the basic health care amenities, education, and community resources for people living with disabilities
• Strengthen collaboration among other local and international service organizations/agencies focusing on children and disabilities including HIV

To learn more about the Kenya Working Group, please visit their website at: http://www.kenyaworkinggroup.org

Countdown: within the last month before departure

My Journey to Kenya

Wow, my time to departure is quickly approaching and I've been slowly preparing. I finalized my KLM flight (back in May) from Toronto to Nariobi with a stop over in Amsterdam. From Nairobi I will need to get to Kisumu (a large city west of Nairobi). I decided that I would avoid a long bumpy 8 to 10 hour bus ride from Nairobi to Kisumu and take a local plane. Originally, there was a little problem. The flights from Nairobi to Kisumu, offered by Kenya Airways were not available due to construction at Kisumu's airport. I did some hunting and found another airline called Fly540 that allowed me to book local flights from Nairobi to Kisumu through the internet (which is great). When I arrive in Kisumu, I will meet my preceptor at the airport. From there I'll go to Rongo (approximately 2hour car ride from Kisumu). In my next blog I'll tell you exactly why I'm going to Rongo and Homo Bay (another town in Kenya) and how the Kenya Working Group offers assistance to locals within these towns.

Last Minute Details

I started to take my anti-malaria medication a week ago. It's recommended that you start taking one prophylactic anti-malaria pill a week before departure and continue throughout your trip. You continue to take anti-malaria for four weeks after your return as well. The first time I took this medication I required A LOT of water, which is also recommended (as stated on the box). The second pill wasn't so bad. During the last month I've also started packing my "backpack" very very slowly. I took my "princesses" canopy and decided to use that as a mosquito net rather than paying an additional sixty dollars. I sprayed the net with some Double Action Raid that contained Permethrine and Tetramethrin. This is suppose to help keep both flys and mosquitos away (which is perfect). I also started to roll all my clothes to save space in my bag. I only want to pack within 44lb so that I can avoid any problems with the local flights within Kenya.

Toilets??

Why do I have a topic on toilets? Well, from my understanding it is difficult to find a toilet in public areas in Kenya that will be equipped with the essentials (ie. toliet paper). As a result, I've managed to stick 8 rolls into my bag. Also, I've been informed that the common type of toilet is a latrine (aka hole-in-the-ground). I've included some advise that I have received from others below. a) Even if you are in a place where they go to great trouble to get you the key for the "choo" (toilet) out the back, don't expect the area to be clean or maintained at all b) Roll up your trouser legs as these will get soaked with the urine of others spilled all over the floor c) Wipe your shoes on the grass after d) If possible, go in the open air as the risk of other people's waste on your clothes is less e) CARRY A TOILET ROLL in your bag at all times. Even hotels outside Nairobi don't stock any; when I asked why I was informed "because people steal it"! f) Purell or other sanitizers are good idea to carry g) Use the latrine at our preceptors home before leaving for the day.

My reaction

Well, what can I say. I talked to some friends about the toilet issue and they became more interested in my placement (ironic). For those individuals who wanted to hear more about squatting for 6 weeks (and you know who you are), I may mention this topic again (maybe).

For the rest of you who would like to know what I'm planning on doing during my 6 weeks in Rongo and Homo Bay and the objectives of the Kenya Working Group,....stay tuned for the next blog!!

Plan ahead: Safaris and other adventures after placement

3 Types of Safaris

Usually most tours and accommodations are all inclusive (including meals and drinks) with transportation, regardless of the type.

1.Budget Safari

This type is very similar to camping in a park. These tours will provide a standard tent and a guide with meals. Washroom facilities may or not may not on site and showering may not be provided on daily basis. Usually with these safaris the tour guide will take you on the game drive and transportation between sites. This type of safari is good for those who do not mind "roughing it". For those who wish a shower and bed daily, this would not be the best options. This would be a great option for those who love to camp and be "one with nature". Another advantages is that in some cases you can camp right in the park and be closer to the animals.

2. Lodges

These type of accommodations are for those who are not used to "roughing it" and never have camped before. Lodges are similar to hotels as they have restaurants and swimming pools and spas. These are typically not in the park but located just outside the park and some will highlight views of animals in the park or scenery. In all cases, the lodges are going to be priced higher than standard budge safaris and in some cases, lodges are more expensive than luxury tents. For these accommodations, each lodge will provide a separate game drives at scheduled times.

3. Luxury camping

This is a combo of lodges and budget camping. This is great option because it provides the camping experience but the tents have washroom facilities and showers located within the park grounds. Also the beds are raised. This type of safari provides the hotel experience in the wild. Unfortunately these accommodations fill up quickly and are highly priced. Like the lodges, luxury camping will provide scheduled game drives with a guide from the camp grounds.

Our Selections

We decided to do a little of type 2 and 3, lodges and luxury camping, respectively. We didn't pick option 1 due to the sleeping arrangements (the lack of a bed) and daily shower and toileting facilities. We decided to splurge (after all, how many times will I visit Kenya), so we choose 2 days in luxury camping and 3 days in lodges. We tried to get a 3rd day in luxury camping, however it fills up very quickly. So my advice is that if you know you are traveling to Kenya and you know what you want, better to book far in advanced.

Count Down: 3 months

At 3 months

Check with the High Commission for the country that you will be visiting Do you need a visitors visa? What are the time lines for entry? Kenya's High Commission allows a 3 months window from the data that the visa is issued to entering the country. Tanzania's High Commission allows a 3 month window from the date the at the visa is issued to the date that you DEPART from the Tanzania. This means that you need to account for the time you will spend in Tanzania. Currently, both embassy's are very good in Canada. Both are located in Ottawa and passports can be sent in registered mail. Kenya states that it will take 7 days from the date the passports are received and Tanzania states that it will take 5 days. Currently, if you are planning on visiting both countries in your travels, you can send your applications to one High Commission and they will take it to the other country's High Commission if you indicate with a note. For example, I sent both my applications (Kenya's and Tanzania's visa applications) 1st to Tanzania's High Commission and left a note stating that I wanted them to take it over to Kenya's High Commission. From there, Kenya's High Commission sent it back to me with a self -addressed enveloped. For further details, check out the following links: http://www.kenyahighcommission.ca http://www.tzrepottawa.ca/home.htm In both cases, you need to apply for your visa at the 3 month mark; not before and not too soon to the date of departure.

Travel Doctor

When traveling to a developing country it is best to seek advice from a medical doctor about the vaccinations and medications that you will need to take while there or prior to your departure. For Kenya and Tanzania I was advised to take the following inoculations (vaccinations). I have included prices for those that I did need to purchase for my entire trip (8 weeks). Hepatitis A, Hepatitis B, Yellow Fever: $95.90, Typhoid (Typhim): 36.30, I was also asked to take the following pills/vaccinations orally. Cipro: $21.83 - take only if fever and diarrhea while on trip, Dukoral: $64.36- required for Cholera and travelers' diarrhea, Apo-MeFloquin (Larium): $66.89- once a week anti-malaria propholatic medication,

Travel doctor fee

You must also account for the fee for the travel doctor; I payed $50 and if you have another traveler with you they will cost an additional $25. The doctor will speak to you both at the same time for approximately 20 to 30 minutes.

Yellow Fever Confirmation and Wait time

When you receive your Yellow Fever vaccination, the doctor will ask you to wait for approximately 1 hour after the injection in the office to ensure that you do not have any adverse allergic reactions. To enter Kenya and Tanzania, you will require a yellow card from the Government of Canada (International Certificate of Vaccination or Prophylaxis) and signed by the doctor that you have received the Yellow fever vaccination before entering both countries.

Count Down: 6 months

Hi and Welcome

I have started this blog to share my travels and experiences while I am on my clinical placement in rural Kenya. I am starting to become very excited as I will be leaving in 2 weeks. To prepare for my travels I had to begin almost six months prior! I plan to share these tips with you now before I leave so they are fresh in my mind. I have made a list for things to consider at least 6 months in advance when traveling to a developing country.

At 6 months

Buy your plane ticket: It might sounds straight forward, but the longer you wait, the more expensive the ticket becomes. Usually, for large airlines, a certain number of seats are allocated to different price points. For example 100 seats will be given the price $1000, the next 100 seats will be sold at $1200 and the last 100 would be $1800. If you book early, you can get a seat that is $1000 rather than $1800. Where are you going to stay? It is never too early to seek your accomodations if you have not already. There are many hotals that are now on line that you can book through. Luckly, my accomodations were already set prior to my placement comfirmation with the Kenya Working Group (KWG). For more information about the KWG please check out the following link: http://www.kenyaworkinggroup.org/index.html