Recycling 101

Recycling in North America is undeniably an industry. We appreciate that so much of the packaging and products we consume can be repurposed and recycled just by dumping them in a can by the side of the road. It is certainly easy - sometimes so easy that we forget that the first two of the three R's are REDUCE and REUSE. 

Not so in Kenya. Every product we buy at a "western" style store has packaging, every product that breaks or wears out has to be disposed of somehow. And at our station, we spend a lot of time talking about the best method of disposal. Recycling is not an industry in rural Kenya - it is an art. An art that we are trying to become better at, when REDUCE and REUSE fail us. 

A comment on reduce and reuse: one reason recycling has not yet hit rural Kenya in a big way is that reduce and reuse are the way of life here. For subsistence farmers, "packaging" is a non-issue. You don't package the eggs that your chicken lays before you consume them, so you don't have to worry about plastic vs cardboard egg containers. You don't wrap your vegetables in plastic wrap before you cook them for lunch. The amount of waste in their lifestyle is minimal, and for those storebought items that do produce waste (a jar of cooking oil, for example) there is almost always a way to repurpose them. Plastic cooking oil containers are reused over and over to deliver milk or kerosene, for example. 

Waste disposal is a problem everywhere, of course. Here, people have traditionally burned waste. However, not everything burns, and not everyone wants to burn. Trash pits attract animals, and the trash gets scattered around the environment, not to mention the fumes and toxins and greenhouse gases created. The alternative is a "dump" - which in our region is just literally a spot someone picked in the forest to dump trash. Again, lots of wildlife are attracted to this, and unfortunately people may also try to find treasures in the trash, which can put them at risk of injury digging through potentially dangerous refuse. At this point, there isn't a great third option, although we continue to discuss and desire another way.

What follows are the ways that we have been learning to reduce, reuse, and recycle:

Buying locally: Our eggs and milk come from our neighbors and therefore don't require any packaging

Making smart choices at the grocery store: Looking for packaging that can be reused or that can break down naturally, which is often a better choice than traditionally "recyclable" materials in N America like aluminum cans.

Socks and underpants wear out and can't be repaired and passed on as hand-me-downs:

So, they find a new life as filling for a new stuffed monkey:

Our pop gets purchased in glass bottles that are reused over and over. We bring the crate of "empties" to a shop in town, where we trade it in for a crate filled with full bottles of whatever kind we choose (our favorite flavors here are Krest Bitter Lemon - Kim, Stoney - Kris, and Fanta Blackcurrent - Dominic)

Even medicines get recycled here! When I was struggling with a post-viral cough, my neighbor kindly gave me here barely-used inhaler :) Our hospital doesn't take previously distrubuted or expired medications, and thankfully we no longer have to re-use needles or normal suction tubing. But we do routinely reuse (after soaking in bacteriocidal solution) several medical supplies including those little blue bulbs used to suction out a baby's nose and mouth after delivery (for any OB/Gyns out there: also Kiwi vacuums, amniohooks, suction tubing and curettes for D&C)

Saving up our recyclables: We have a spot in our house for broken electronics that we take or send back with visitors to the states. Disposing of those electronics at the right place means that those rare metals can get reused instead of burning up in a pit fire; we save certain plastic containers to bring to Nairobi where we know they'll be accepted at the grocery store chain where we purchased them; we pass along our glass bottles to a shop in Eldoret that makes them into drinking glasses and storage containers.

If I had to guess, these containers may have previously held soy sauce or olives

Have other great recycling ideas? We would love to hear them! Better yet, come to rural Kenya and help us learn to be better stewards of the beautiful environment here!

An excuse, by way of an anecdote

The past week has been a lot. A lot of joys, a lot more sorrows. Feeling like life is a tight-rope act, and some days we're just not up to the challenge.

So yesterday, as I was running around the house trying to get baking and meal prep done, clean the house, and clean myself before an afternoon party (a baby shower for our neighbor), I realized I had only 5 minutes to spare, and I still wanted to shower and needed to pee. "Well, I guess I'll just have to pee in the shower," I thought. And then I stopped and thought about that thought. I realized that wasn't a choice I had to make. I didn't move to rural Kenya, away from the craziness of life in North America (sorry, everyone) just to reestablish myself in a self-inflicted rat race over here. So I showered. Later, I peed. I was a few minutes late for the baby shower (venue: my house) which was fine, because everyone else was late, too. 

Today, "Write Blog Post" is on my to-do list. I have some pictures I want to share on my phone. Others are on my computer. The cable that connects the two is at my office, and I'm at home. So today, I'm going to do the best with what I have, upload a few pictures, and call it good. It's today's version of not peeing in the shower. I hope you find a way to not pee in your proverbial shower today, too. Happy Father's Day, Dad, and Happy Birthday, Mom! Sorry for using the word "pee" on the internet - you definitely raised me better than that. 💖

Dominic, the reader

Long weekend at Naivasha

Horse riding at Naivasha

These giraffes came to say hello every evening while we were eating dinner at our cabin

Kris and Dominic ran a 2K together!

Waking up in the night to watch our new cousin's baptism!

Visiting friends at Kijabe

I ordered a mint limeade - I wasn't expecting it to be phosphorescing!

Father's Day breakfast on our new picnic table

Gathering to celebrate a new baby

On call

Early in 2023, I had the privilege of welcoming three OB/Gyn docs (one resident, one attending, and one retired) who helped me manage my work load at the hospital and (perhaps most significantly) shared night and weekend call. Since we live about a 5-minute walk from the hospital, being on call means taking phone calls during the night/weekend, coming to evaluate any complicated OB or Gyn patients, and performing emergency surgeries (for OB/Gyn call in Kapsowar, that's usually c-sections, sometime dilation and curettage for incomplete miscarriage/abortion, and occasionally ectopic pregnancy).

When I don't have short-term visiting docs, I am usually on call about 50-60% of nights and weekends (the other 40-50% of the calls are taken by our hospital's medical officer, who also takes medicine call). This usually works out okay - while it's a lot of nights "on," I don't usually go to the hospital every night. But being available for emergencies more nights and weekends than not requires some getting used to. Over the past three years, here are some of the things I've learned (I'm sure there are many rural docs and other "call" takers who could add pages of advice and lessons to this short list!):

Life can't stop just because I'm on call: When I first started my career as a rural doc, I would *not* schedule events (meetings, inviting people over for dinner, calls to people back in N America) while on call. I would go to bed early in case I would get called in during the night. Now I know - life can't wait for non-call nights. We still invite people for dinner, and I have a (very limited) number of dishes that I can prepare in advance and just pop in the oven or InstantPot with Kris or Gladys' help. (Of course add to that our unreliable power supply, and just getting dinner on the table can become one of the most exciting and uncertain parts of the day!) Usually, things work out fine-and when they don't, most people don't seem to offended when I have to run off to deliver a baby.

Being on call didn't keep us from hosting a Coronation viewing party and potluck at our house - with a lot of help from our neighbors! 

Keep the cell phone charged: There's nothing worse than going to bed during a power outage with a cell-phone battery at 20%, and waking up multiple times during the night just to make sure the phone is still on! It's a great way to ruin an otherwise peaceful night of sleep.

Hold your plans and expectations loosely: I quickly found that if I hold too tightly to a plan (things I want to accomplish during a weekend call, for example), I would begin questioning my judgement at the hospital. Did I do that c-section because it was in the best interest of the mom and her baby, or because I promised Dominic that I would make cookies with him? Going into the hospital with an open mind and no expectations helps me to be less frustrated when things don't go according to plan - and believe me, Labor and Delivery *rarely* goes according to plan.

Set small, achievable goals: Baking a loaf of bread from scratch during call is a recipe for failure. I'll get called to the hospital when the bread is halfway through it's second rise, or just as I put it in the oven. However, there are a LOT of small things around the house (or office) that can be accomplished in the quiet moments. For example, writing a blog post...

I occasionally bake while on call, but never anything as ambitious as this super yummy 6 layer rainbow cake that my neighbor/coworker/supermom baked last weekend while on call!

Mute non-essential notifications: you know those people who have to look at their phones with *every* notification? While on call, I'm one of those people. Which means I liberally mute all notifications from people or groups who I know won't be contacting me about an emergency. I feel less tethered to my phone that way...and being less tethered to my phone is a major goal for my life!

Rest: taking call every other weekend means that Sabbath rest isn't likely in the traditional sense. So, I try to create space for rest, relaxation, and worship when and where the opportunity presents itself. And I nap - or I should say *we* nap. If you find our house locked up on a Saturday or Sunday afternoon, odds are pretty good that we're actually at home, enjoying a quiet time or nap while we can. So please - come back another time :)

On call: not a great time to start a big project, long board game, or haircut. But a perfect time to cozy up with a book or knitting project by the fire!

And with that - I'm on call, and I have to get going! Thanks for reading!

Happy belated Mother's Day!

Going somewhere?

Over the last month we have been busy with travel *within* Kenya. Due to Google maps and the internet, we do have greater freedom and confidence to travel around the country. Here's a glimpse at the methods we have used to travel in Kenya over the last few years (and some options we have NOT opted for in our personal journeys). 

Planes:
Our preferred airline is JamboJet simply because they are the most consistent airline at Eldoret Airport. We can get direct flights to Kisumu, Mombasa, and of course Nairobi from Eldoret. As in North America, air travel is the safest and most expensive way to travel. The dangers of the road in Kenya make air travel MUCH more appealing here - and also too expensive for most of our neighbors.

Dominic was 4 years old the first time we flew to Eldoret

Nala arrived to Eldoret in this tiny private plane

Trains:
The SGR (Standard Gauge Railway) connects Mombasa and Nairobi, and passes straight through Tsavo National Park, which means you get a view of Mt. Kilimanjaro AND lots of animals as you travel.
The journey itself takes about 5.5 hours and since the train stations are a little far from the city on both sides, it's really a full day of traveling. It's fun, safe and very affordable as long as you have the time for it!

Capturing photos of the wildlife was difficult, so we just took pictures of each other

Automobiles:

Personal vehicles: Well beyond the resources most rural Kenyans is a private vehicle. Having a person vehicle gives us independence to get out of town when we're able on our own schedule, but also comes with some pitfalls, including run ins with law enforcement, high risk of accidents and getting lost in areas where Google maps is misleading.

Hitting the road for our first trip in our "new" car back in November 2020

We have to keep a keen eye out for wildlife on the road!

Taxi and Uber: most ex-patriates we know have phone numbers saved for local drivers who know the area well and are trusted.
Tuk tuks: we haven't personally used a tuktuk - they are more common in the flat lands like the coast. They look like a tricycle but enclosed.
Matatu (buses/commuter vans): These are a very common method of travel and are probably safer than motorbikes, but still have a LOT of accidents.
Motorbikes (piki piki or bota): This is the most affordable and flexible AND DANGEROUS mode of transportation that we encounter in Africa. It seems that nearly everyone who uses a motorbike has been in an accident (minor or major) at some point.

Boats: We've been on three boats in Kenya - a canoe at Crescent Island, a ferry in Mombasa, and a glass bottom boat in Diani.

Bikes: Kris and Dominic both have bikes that they ride around our station. Bikes are probably more common in other areas of Kenya, but due to the very hilly terrain around Kapsowar, they are not a common method of transportation here.

Kris bought Dominic's first bike at this used bike "shop" in Nairobi during language school

"God gave you two good legs..." As I commonly remind Dominic, we have a great method of transportation in our legs! Traveling around Kenya you will find that most people are outside most of the time, working in their fields or gardens, walking from one place to another, cooking or preparing food, getting water, conducting their business (taking advantage of the free lighting provided by the sun rather than putting their business inside and then artificially lighting it), or relaxing - watching their surroundings or socializing with neighbors rather than turning on a television, videogame, or computer. Many places are inaccessible by vehicle or bicycle.

Walking to see giraffes at Kruger farm

Not ready to move to the developing world? Consider a short-term trip.

I had a chance to write some reflections for an organization / website called MedicalMissions.com about a year ago. They were planning an online seminar and publishing a series of short reflections about short-term involvement in missions. This reflection is really geared toward people in medicine, but I think it can apply to ANYONE visiting ANYWHERE new for ANY purpose. If you want to read more from other long-term workers or other people who have participated in short-term trips, there are tons of resources on the MedicalMissions.com website. I have also attended their Global Missions Health Conference (once, a long time ago) which is a great conference to learn more about opportunities to serve (medical and otherwise) around the world! Before arriving in Kenya as a mid-term medical missionary myself, my experience with short-term medical missions (and missionaries) was limited. In one mission trip, I had been on a one-day pharmacy outreach to diagnose and treat acute and chronic illnesses with a “gift” of seven days’ worth of medication; I had also watched specialists performing life-changing surgeries during a one-week outreach to patients in an extremely rural setting where they would otherwise have never had access to those procedures. For better or worse, I had intentionally decided not to participate in short-term medical missions during my residency, so that I could focus on developing my knowledge and skills before entering long-term service. So, in my first three months in Kenya, as I struggled to get my bearings in a new country/culture/language/hospital, I viewed short-terms in a variety of ways: as important encouragers and sustainers, as liabilities, as time-givers and time-consumers, as free babysitters, as potential future partners or financial supporters, and as the important final link in the all- important Hot Wheels and chocolate chip supply chain. Then, abruptly, there were no more short-termers. In the initial phases of the COVID pandemic, as a new physician, I have to be totally honest – the break from short-termers gave me time to really establish my footing and get my focus within my practice. But after a few months, the path between my front door and the Maternity Ward started to lose its luster and became tiring. A few months later, our long-term colleagues began to leave, for a variety of primarily COVID-related reasons, and the incoming volunteers were minimal. Within 18 months of the start of the pandemic, I became the second-longest serving clinical physician (Kenyan or foreign) at our hospital. Being without short-term volunteers for so long served to highlight the importance, as well as some of the challenges, of integrating short-termers into a long-term medical missions strategy. Due to COVID, I can say that my experience with short-term medical missions remains limited. But thanks to some absolutely amazing short-term volunteers, I can tell you some characteristics that stood out and made for really positive experiences. - Come for as long as you can. Remember that you when you arrive you will be tackling jet-lag, absorbing a ton of new information, and that orienting you takes a large investment in time and energy. The longer you stay, the better the return on investment – for you and the hospital. - If you’ve been somewhere already, return to the same place. You’ll know the hospital, workflow, records system – and more importantly, the people and eventually even the patients. - If you’re coming to serve, make yourself a servant. You may be asked to perform ACLS and save someone’s life in the emergency department. More realistically, you may be asked to cover outpatient clinic for a couple of hours while I catch up on homeschool with my kid. Both of those scenarios are a huge help; only one makes a good story. So ask yourself, are you coming to serve, or to collect stories? - Be gracious with your host-physicians. When we moved to Kenya, we were told to resist the urge to suggest changes for 6 months. Instead, our sending agency advised us to observe, take note, and try to understand the rationale behind things that we didn’t like or understand. Well- meaning questions or off-handed suggestions from a short-termer can put a mid- or long-termer on the defensive, especially early in their career when they too are trying to figure out the system in which they work. If you have genuine concerns or recommendations, save the comments for a time when you can have a serious conversation – not between outpatient visits or on morning rounds. - Be honest with yourself and your host about your skills and comfort levels. We’ll find a way to use your talent, but knowing in advance helps us to put you in the right place to help our community.