Well, after some pretty close calls these past 24 hours (engine failure in Amsterdam, KJIAirport closed to terrorist, 9 minutes to get through Detroit customs and make connecting flight to Denver), here I sit on a Delta flight 2 hours from Denver enjoying a Corona. Ahhh. It will be good to be home.
Gotta rest up for the big Project CURE annual golf tournament tomorrow! Yeh! My golf game will suck, but for a good reason, right?
Bottom Line - a very successful trip. Delivered one container and networked to get 4 more in the pipeline! Not too bad for an ol guy with a serious expiration date problem! :-)
By the way, mucho thx to Ben Pederson for sending me awesome pictures from my Mfangano Island visit, some of which I uploaded to this blog.
Wednesday, June 6, 2012
Monday, June 4, 2012
DAY 15 - Wednesday, June 6 - FINAL POSTING
HOT TIP - read these blogs from the bottom up (i.e start with Day 1 - May 23rd and work your way up). Otherwise the narrative and 'story-line' may not make sense.
Thank you for checking in! I appreciate it.
Thank you for checking in! I appreciate it.
DAY 14 - Tuesday June 5 - MY LAST DAY
I have two appointments today and then fly out tonight at 10:30pm. I did have an absolutely wonderful evening last night with my good friend Steve Ndungu and his family.
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| Massive Muscle Joe, Steve Ndungu and wife, Mary, little Daisy and Marcy Ndungu, their sister in law |
We had a wonderful dinner at a local amusement park. Visited for several hours. While Steve and the kids were off doing the ride thing, I spent some time to get to know Mercy a little. She's 21 years old and without any real plan (or hope). She's been unable to get a job and, because of lack of finances, is unable to consider college. She lives with her Mom. Her Dad has passed away. So, I couldn't help myself again. Just had to have the BIG talk. I asked her what her dream was. I was actually surprised she was so clear about it. She told me right out. Not the typical "I don't know grunt grunt" conversation I've had with my kids. She wants to study IT. She tells me that a 2 year IT college program will cost about 250,000 shillings ($3,000 USD). Take a wild guess who's going to be her sponsor. Whatever happened to "Just Say No". Geeze. ;-)
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| Massive Muscle Joe |
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| Adorable Daisy |
Anyway, I meet with my dear friend Agnes Musyoka, the nurse from Kilgoris, this morning. Kind of a follow up to my visit there a week ago.
Lastly, Bishop is popping into town and we plan to have a late lunch together. I gotta find out if he liked my gift, the 17 year old single malt scotch. Because of my lost luggage, I was unable to present it to him personally. It will be nice to end my trip with one last conversation with the Bishop.
DAY 13 - Monday, June 4 - KIJABE HOSPITAL
Off to Kijabe Hospital today. About one hour north of Nairobi. Kijabe has one of the best reputations in the country for surgery. In fact, the man I was introduced to, Dr. Eric Hansen, is an orthopedic surgeon from the US. I met him via emails about a month or so before loading our container. As a means of introducing him and Kijabe to Project CURE, I included about 13 boxes of orthopedic and ENT surgical equipment on our container for Kijabe. Big thanks to Barb back at the warehouse for helping me pick these items and a huge thank you to Bishop Muheria for transporting these items all the way from Kitui to Kijabe.
My goal today is to establish a Project CURE relationship with this facility, operated by the AIC (African International Church). George, at the warehouse, tells me that Project CURE actually shipped a container about 10 years ago to a US non profit who shares the Kijabe Hospital compound.
Anyway, upon site review, I found Kijabe to be everything I heard it to be. Quite amazing, it's surgical operations. Wall to wall people. Interestingly, they get a large number of refugees from Somalia. The first hospital I've been to with a significant Muslim population. The unique problem this presents for Eric is one of translation. My gosh. At times, he needs a translator fluent in 4 languages.
Bethany Kids is a separate US non-profit organization I think, providing specialized medical services to severally handicapped children. An extensive neuro-surgery department. I think this is actually the NGO that previously received a Project CURE container.
At the end of the day, I am sorry to say this was a disappointing visit. Given our generous donation of surgical equipment and gesture of good will, my hopes were high.
We started out with an unfortunate mix up in meeting time, so I awkwardly waited around Dr. Hansen's empty house for two hours until we started. When we did meet, the requisite hospital representatives were not in attendance and I found it strange that we were actually conducting this meeting at Dr. Hansen's very busy personal residence. This made it very difficult for serious conversation or a business like meeting.
The good news is that we did get a brief tour of the facilities though, which was nice and informative. See above photos. However, the tour was far short of what we would need to do for a detailed site visit (probably an 8 hour task), which is what I was foolishly hoping for.
I am proud to say that the 12 or 13 boxes of donated surgical equipment arrived safely last week. However, it was strange to find these boxes in Dr. Hansen's kitchen, unprocessed or inspected by any hospital personnel. I had really made extra effort to get these boxes to relevant hospital personnel in advance of our meeting with the hope that we would have a detailed discussion about them, my primary example and selling point of what Project CURE can provide. Ugh. So much for heroics!
Although I believe Dr. Hansen fully understood and appreciated the Project CURE model (he actually had gone to Project CURE's warehouse in Nashville), his function at the hospital really isn't management or administrative as I was told and I wasn't able to talk with anyone who was. In hind sight, I should have found out in advance the names of the pertinent management and specifically requested a meeting with them, even if that meant meeting without Dr. Hansen while he was still on personal holiday.
I was supposed to stay the night, anticipating a much more in-depth conversation and site review. However, Dr. Hansen was being called back to assist with patients and there was clearly nothing left for me to do, so we arranged for early transportation back to Nairobi. Dr. Hansen and I did exchange pleasantries and part cordially. I left Project CURE's literature with him with contact information, hoping he would advance this information to the appropriate hospital personnel. However, given the state of the hospital's disorganized finances (they are apparently missing significant funds and still working on cleaning up financials from two years ago) and that the Project CURE container decision is primarily a financial decision, I'm not very optimistic we'll hear back from them. I hope I'm wrong.
I got back to the hotel around 5pm. To add insult to injury, they tried to bill me for transportation, even after our generous gift and initially agreeing to pay for transport costs.
Oh well. Better luck next time. :-)
My goal today is to establish a Project CURE relationship with this facility, operated by the AIC (African International Church). George, at the warehouse, tells me that Project CURE actually shipped a container about 10 years ago to a US non profit who shares the Kijabe Hospital compound.
Anyway, upon site review, I found Kijabe to be everything I heard it to be. Quite amazing, it's surgical operations. Wall to wall people. Interestingly, they get a large number of refugees from Somalia. The first hospital I've been to with a significant Muslim population. The unique problem this presents for Eric is one of translation. My gosh. At times, he needs a translator fluent in 4 languages.
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This is the first hospital I've seen here that actually has a separate emergency department entrance |
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| Ultra-sound machine |
Again, very hospitals actually have an ICU.
The private patient ward is much nicer than the general wards. 1 to 8 nurse to patient ratio. It's 1 to 16 at best in the general ward. Rooms are single occupancy and with TV. Unheard of elsewhere. But, they actually make good money with this ward, which helps subsidize general operations.
Bethany Kids is a separate US non-profit organization I think, providing specialized medical services to severally handicapped children. An extensive neuro-surgery department. I think this is actually the NGO that previously received a Project CURE container.
At the end of the day, I am sorry to say this was a disappointing visit. Given our generous donation of surgical equipment and gesture of good will, my hopes were high.
We started out with an unfortunate mix up in meeting time, so I awkwardly waited around Dr. Hansen's empty house for two hours until we started. When we did meet, the requisite hospital representatives were not in attendance and I found it strange that we were actually conducting this meeting at Dr. Hansen's very busy personal residence. This made it very difficult for serious conversation or a business like meeting.
The good news is that we did get a brief tour of the facilities though, which was nice and informative. See above photos. However, the tour was far short of what we would need to do for a detailed site visit (probably an 8 hour task), which is what I was foolishly hoping for.
I am proud to say that the 12 or 13 boxes of donated surgical equipment arrived safely last week. However, it was strange to find these boxes in Dr. Hansen's kitchen, unprocessed or inspected by any hospital personnel. I had really made extra effort to get these boxes to relevant hospital personnel in advance of our meeting with the hope that we would have a detailed discussion about them, my primary example and selling point of what Project CURE can provide. Ugh. So much for heroics!
Although I believe Dr. Hansen fully understood and appreciated the Project CURE model (he actually had gone to Project CURE's warehouse in Nashville), his function at the hospital really isn't management or administrative as I was told and I wasn't able to talk with anyone who was. In hind sight, I should have found out in advance the names of the pertinent management and specifically requested a meeting with them, even if that meant meeting without Dr. Hansen while he was still on personal holiday.
I was supposed to stay the night, anticipating a much more in-depth conversation and site review. However, Dr. Hansen was being called back to assist with patients and there was clearly nothing left for me to do, so we arranged for early transportation back to Nairobi. Dr. Hansen and I did exchange pleasantries and part cordially. I left Project CURE's literature with him with contact information, hoping he would advance this information to the appropriate hospital personnel. However, given the state of the hospital's disorganized finances (they are apparently missing significant funds and still working on cleaning up financials from two years ago) and that the Project CURE container decision is primarily a financial decision, I'm not very optimistic we'll hear back from them. I hope I'm wrong.
I got back to the hotel around 5pm. To add insult to injury, they tried to bill me for transportation, even after our generous gift and initially agreeing to pay for transport costs.
Oh well. Better luck next time. :-)
DAY 12 - Sunday, June 3 - TRAVEL DAY
Guess what. Trains, planes and automobiles again today. Hope to arrive back in Nairobi around 5ish. I'm looking forward to a little down time. This leg of the trip was particularly tiring for some reason.
I did have a special treat for breakfast this morning. Lime marmalade. Interesting yet good. I also had an awesome dish at the Kisumu airport waiting for my flight. Minced "meat" on rice with, of course, a Tusker. Ahhh.
I did end up with a case of Montezuma's revenge while I was here. I thought that only occurred in Mexico, right?? Thankfully, I bring Cipro with me which really nukes the problem. Key because traveling with a bout of diarrhea here can be REALLY humbling! Whew. Especially when you never know where the nearest "cho" is (restroom in Swahili). Opps. TMI. Sorry.
Goal is to get caught up on blog stuff and Tuskers tonight.
I did have a special treat for breakfast this morning. Lime marmalade. Interesting yet good. I also had an awesome dish at the Kisumu airport waiting for my flight. Minced "meat" on rice with, of course, a Tusker. Ahhh.
I did end up with a case of Montezuma's revenge while I was here. I thought that only occurred in Mexico, right?? Thankfully, I bring Cipro with me which really nukes the problem. Key because traveling with a bout of diarrhea here can be REALLY humbling! Whew. Especially when you never know where the nearest "cho" is (restroom in Swahili). Opps. TMI. Sorry.
Goal is to get caught up on blog stuff and Tuskers tonight.
DAY 11 - Saturday, June 2 - SINDO DISTRICT HOSPITAL
I am happy to say that I was pleasantly surprised. The Sindo facilities are top notch, the best I've seen of level 4 government hospitals. Amazingly clean and organized. I was equally impressed with the managing doctor we met with.
Great conversation. It gave me hope for this project. There are certain, modest, requirements of the hospital to move this project forward and, unfortunately, the local people never have the requisite authority, but we'll see. Let's hope Chaz can work his magic before he returns to the US in August.
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| Surgical Theatre |
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| Maternity ward - Birthing table and infant warmer |
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| Maternity ward - incubator |
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| Typical ward patient bed with bug net |
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| Patient Ward |
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| Surgical Theatre |
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| Today's catch - about 80 kilo of Pike |
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| Ole Punda and the Dream Team |
A GREAT DAY IN SUBALAND!
DAY 10 - Friday, June 1 - TOUR OF OHR
Anyway, I'm spending the day with Chas and his team to get a tour of their operations on the island. They tell me they came here about 5 years ago and have been coming back for various lengths of time since then. In fact, they have purchased some land here and are constructing a small concrete residence with thatched roof. Quite charming.
So, their organization is a US non-profit called Organic Health Response (OHR). Their literature describes their mission as "we activate information technology, social solidarity, and environmental sustainability to turn the tide against HIV/AIDS among the indigenous island communities of Lake Victoria and beyond."
It's amazing how much they have been able to accomplish on such a shoe string budget and patch work of donors. The thing I was most impressed with was their ability to construct a tower to receive a wi-fi signal from Kisumu, 80 km away, and bring HIGH SPEED internet to the island! That just happened while I was there. With this technology, they have started a cyber cafe membership. Dues are free IF you can prove HIV status every 6 months. Great idea. It's a real problem to get people tested here and this is a great motivation to do so and without the negative image people otherwise get at normal testing facilities. They already have 1800 members and I'm sure that will grow quickly with the high speed internet. Congrats to them.
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| Walter, Tielen, Chas, Richard and Ole Punda |
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| OHR (EK) Center |
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| Cyber Cafe |
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| Low voltage computers |
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| Recycled Mountain Bikes for sale CHEAP |
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| "Conference Room" |
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| The OHR Team |
Great people. Gotta love their energy, passion and big hearts. I enjoyed our wide ranging conversations. My gosh, it would be great to be that young again. :-) They are living large. They are also hoping to start a radio station in the near future. From a Project CURE assessment point of view, however, the question is one of sustainability. I told Chas I think of organizations as a three legged stool and you need all three to survive:
Leg one - the right people. So I asked this question: "What does OHR look like when Chas and Marco have to return to the US (they both need to finish med school/internship)?
Leg Two - capital. I really couldn't identify any recurring and ongoing sources of operating revenue. Operations are principally funded by Marco and Chas, personally, which further begs the question: "What does OHR look like when the Salmen family can no longer personally fund the ever growing activities of OHR?"
Leg Three - systems. They have no operating budget, financials or functioning board of directors.
I'm uncertain at this juncture as to how a partnership with Project CURE would look like. BUT, I'm going to stick with this because I do feel they have some synergy going on. Let's see where it takes us. I talked with Chas about the 10 ten reasons why non-profits fail, which scared him, I think. Based upon this conversation, I suggested the following steps to improve their odds:
1. Stick to a well defined mission statement. Don't try and be all things to all people (which is really easy to do over here).
2. Get a skilled and diverse operating board of directors who will meet at least quarterly for governance
3. Get financial statements and a budget and manage by them.
4. Aggressively develop ongoing, sustainable sources of revenue as soon as possible.
Leg one - the right people. So I asked this question: "What does OHR look like when Chas and Marco have to return to the US (they both need to finish med school/internship)?
Leg Two - capital. I really couldn't identify any recurring and ongoing sources of operating revenue. Operations are principally funded by Marco and Chas, personally, which further begs the question: "What does OHR look like when the Salmen family can no longer personally fund the ever growing activities of OHR?"
Leg Three - systems. They have no operating budget, financials or functioning board of directors.
I'm uncertain at this juncture as to how a partnership with Project CURE would look like. BUT, I'm going to stick with this because I do feel they have some synergy going on. Let's see where it takes us. I talked with Chas about the 10 ten reasons why non-profits fail, which scared him, I think. Based upon this conversation, I suggested the following steps to improve their odds:
1. Stick to a well defined mission statement. Don't try and be all things to all people (which is really easy to do over here).
2. Get a skilled and diverse operating board of directors who will meet at least quarterly for governance
3. Get financial statements and a budget and manage by them.
4. Aggressively develop ongoing, sustainable sources of revenue as soon as possible.
It's just really sad for me to see a massive US aid footprint in Kenya, resulting in one failed project after another. We Americans are great at short term stuff but aren't very good at long term stuff or addressing sustainability. What good is it to win the battle, yet lose the war!
Anyway, I'm a big fan of Chas, Marco and the team and will be rooting for their long-term success.
Anyway, I'm a big fan of Chas, Marco and the team and will be rooting for their long-term success.
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| Chas Family Home |
DAY 9 - Thursday, May 31 - OFF TO MFANGANO ISLAND
Boy, talk about "trains, planes and automobiles". It's a real trek to get to this place, the most remote location I've traveled to in Kenya. One of the largest islands on Lake Victoria, about 80 km SW of Kisumu (the city of Obama). I took a small plane to Kisumu, was picked up by a driver and drove 2 hours or so to the Mbita Ferry dock. I hooked up with a med student from US, Ben Pederson, who helped me find my way. Nice guy, great conversation. See below photo:
Beautiful island. Although, I could have gone without the swarms of lake flies (smothering at times!). The island, I'm told, is about 54 km around and 26,000 people or so. Suba and Lua tribes mostly. Claire Cunningham with Project CURE introduced me to these guys and was inspired by their activities. Chas and brother Marco, founders of this project, are also both med students. Chas did a research project on the link between the local fishing industry and HIV. Very interesting. This island has THE highest incidence of HIV in Kenya, about 30%. Chas concluded it is mostly due to fishermen coming to these islands with lots of cash from recent harvests but nothing to spend it on besides prostitution. He points out, however, there may be a self-correcting mechanism in place. They have so grossly over-fished the lake, yield is a tenth of what it was 10 years ago. No fish, no cash, no crazy fishermen driven prostitution. Yet, no economy and the people suffer. Ugh. Complicated.
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| Ben P at Ferry dock |
We took a 1 hour ferry ride to what looked like some sort of peninsula. Next task was to schlep across this stretch of dusty land on foot (luggage and all) to reach the other shoreline and catch a motorized canoe to the island. Normally, they take the public boat. Large and slow. Today, however, my hosts were gracious enough to bring the "speed boat", a small motorized canoe they use for emergency transport, which takes about 45 minutes.
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| Photo thanks to Ben P |
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| Ben Pederson and Chas Salmen |
Beautiful island. Although, I could have gone without the swarms of lake flies (smothering at times!). The island, I'm told, is about 54 km around and 26,000 people or so. Suba and Lua tribes mostly. Claire Cunningham with Project CURE introduced me to these guys and was inspired by their activities. Chas and brother Marco, founders of this project, are also both med students. Chas did a research project on the link between the local fishing industry and HIV. Very interesting. This island has THE highest incidence of HIV in Kenya, about 30%. Chas concluded it is mostly due to fishermen coming to these islands with lots of cash from recent harvests but nothing to spend it on besides prostitution. He points out, however, there may be a self-correcting mechanism in place. They have so grossly over-fished the lake, yield is a tenth of what it was 10 years ago. No fish, no cash, no crazy fishermen driven prostitution. Yet, no economy and the people suffer. Ugh. Complicated.
Anyway, I took a tour of the island and the local medical facilities, which are the following photos.
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| Sena Level 3 Government Medical Clinic |
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| "Maternity ward" |
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| Typical patient ward |
This medical clinic is very typical. No doctor. Staffed and managed by a MO (medical officer - about on the level of a PA in the US). Very challenged facility both in terms of lack of resources and management skills. The only way Project CURE can help here is by entering into a partnership with the hospital on the mainland. Given my experiences in working with government facilities, this is a huge uncertainty. We'll see.
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| Richard, the E.D. and me at Governor's Camp |
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