Notes from the Edge Day One

4:30 a.m. we squeeze into a taxi, the escarpment is dark and cool and quiet at this hour, and I am wedged in the back seat between a paeds surgery fellow who was once a national rugby player for Kenya, and my own 19 year old whose 6 foot 2-and-a-half inch frame is more muscular and substantive after two years of collegiate club football.  Consolation:  if we get into trouble here, these are two of the kind of guys you want to have your back.  We squint at oncoming headlights, pass trucks, weave in and out of matatus and buses even at this predawn hour, all the way to Wilson Airport.  The UN has people flying to K-a on the Sudan border and D-b on the S0mali border, with their coolers of vaccines and blue diplomatic passports, their jeans and scarves and NGO-casual wear, their newspapers and glasses.  Perk of the international aid scene:  there is a coffee bar which opens before our plane boards, with legitimate lattes.  Hooray.  

We doze at the 19,000 foot cruising altitude and descend through thick clouds towards the srub-land of NE Kenya.  Thorn kraals and tiny white goats and cows are visible against the dusty red earth; the slight green of acacia trees and no buildings or tarmac for miles in any direction.  Then out of the desert there is a camp, strictly straight lines of roads with an impossible conglomeration of dwellings crammed into every millimeter of the grid they form.  Homes made from sticks covered by bits of plastic.  Then the airfield, and we touch down.  Into a world that is uniquely its own.  We're in Kenya, so there are Kenyan police in camo with guns.  But the airstrip is tarmac, and neatly apportioned, and everything here is clearly controlled by the UN.  A veritable fleet of white landcruisers awaits the plane.  Each says "Owned by UNHCR for use by ______", fill in the alphabet of organizations.  Each driver searches for his particular people, until they are all sorted into the proper nearly identical white 4WD for the five minute trip to UN central.

D-b used to be a sleepy crossroad with a few dukas.  Now it is the epicenter of aid.  The roads are wide and graded.  Containers and mbati have been transformed into a thriving market.  We pass through a security checkpoint into the home base area for all the organizations which support this massive community.  Behind sandbags and barbed wire, apportioned areas are given to each NGO.  There are guest houses, open areas for eating, offices, computers, dusty paths.  I am escorted to my room-a couch on a screened porch, my own bathroom and simple bed and mosquito net--to drop off my things and head out to the first camp.

Back into the ubiquitous white landcruiser, and out of the maze of the secure compound, we pick up our required police escort vehicle and follow it out of town.  Through the final checkpoint, and then out into the wasteland, roaring along in a cloud of dust.  We are in the middle of nowhere when our lead vehicle stops.  The armed policeman and the driver get out.  No, not s security risk, just a flat tire.  A totally blown out tire, and as the driver explains, "hakuna spare".  So we wonder which is riskier, sitting like a duck out on the road or continuing on unescorted.  Before long other vehicles come, the policeman switches to a new lead car, and we continue while the first car waits for a spare tire.  (On the way back, the police escort vehicle was stalled and had to be pushed and coaxed to life by the crowd getting rides in the back.  There is considerable debate about whether the presence of security makes one more or less secure).

Our first camp is a handful of kilometers southeast of D-b.  The geography is this:  the foreigners and most of the Kenyan staff (the vast majority of aid workers here are Kenyan) stay in makeshift compounds which have grown into the sprawling UN village in D-b, and make forays by armed convoy out to the camps, which are tightly clustered masses of humanity surrounding schools and hospitals.  It feels surreal and controlled.  We are delivered through another guarded gate into the small universe of the International Rescue Committee, the organization that basically runs this particular camp of 132,000 people, and also serves a newer camp of about 10,000.  Each camp is the kingdom of a different NGO.  The IRC has just poured a boatload of money into this hospital.  New facilities, cleanly painted, sport plaques saying they were dedicated four days ago.  Incongruously, the place feels fresh and clean, a hot wind blows through, patients cluster and squat in the shade, until they see the Kijabe team then they push forward to muscle their way into line.  While the surgeons examine a smaller-than-expected number of referrals and follow-up patients, Luke and I spend the morning in the maternity ward and nursery.  We talk to nurses, midwives, and doctors, thumb through records, make notes on facilities, ask questions. 

I teach an abbreviated version of Helping Babies Breathe.  I've traveled with the resucitatable model babies, twin "NeoNatalies".  We discuss the golden minute, the crucial assistance a trained birth attendant can give to make the baby's transition from fetal to extra-uterine life successful, the heavy burden of neonatal mortality.   The small class of six medical personnel practices suctioning and then bagging the babies, awkwardly learning to handle the ambu bag, to see the chest rise, to feel the cord pulsate.  They are bright and interested and game.  I thoroughly enjoy them and feel like we could spend the whole day, but before too long the surgeons are done and we are called away.

Then we embark upon a tour of the entire facility, noting the presence or absence of microscopes and oxygen, antibiotic choices, malnutrition programs.  A goal of this trip is to assess opportunities for Kijabe Hospital to assist and improve Paediatric care in these camps.  We find excellently equipped facilities but some gaps in knowledge and practice, and an eager openness to further training.  We make a list of topics that the staff would like to be taught, dreaming of the next trips.  Luke ruminates and I agree, the facilities and staff we see here are far superior to most rural African hospitals.  The refugees suffer loss of land and identity and livelihood and dignity and a thousand other things tangible and intangible.  But their access to health care is probably better than most.  Another paradox.

Now it is evening, the hot wind has cooled, a cold shower has removed the dust, and darkness falls early and fast in this eastern province.  Thankful to be here.