Of Concrete, Radiation Oncology Bunkers and heading into the Holidays!

November 27, 2014

It is shortly before Thanksgiving as I write this blog.  Without a doubt thoughts stray to family and friends back home this time of year but we are very fortunate to have a fine community to enjoy Thanksgiving with this year.

Work on the new Cancer and Chronic Disease Center is moving along very well and we still plan on turning over the main building on February 1, 2015 and our initial tenants are planning on occupying on February 15 , 2015.  Right now our major focus is on the interior finishing and civil works at the main building and the construction of the radiation oncology bunkers in the radiation oncology wing.

Constructing the radiation oncology bunkers is the most significant challenge associated with this new facility.  This is the first set of radiation oncology bunkers in western Kenya and only the 4^th set of bunkers in Kenya.  The need cannot be overstated.  Due to a lack of adequate radiation oncology and oncology care opportunities over 65% of treatments currently being provided are palliative.  Bringing this new facility on line will most assuredly provide greater hope to cancer patients.

The “bunkers” are really rather daunting constructs.  The ADR/HDR bunker which will be utilized primarily for the treatment of gynecological cancers has walls that are constructed of 42”  solid concrete and steel.  The roof is also 42” of solid concrete and steel.  That devil cancer has got to be very, very strong to require us to build a bunker with those characteristics to protect the people on the outside.

Our “universal bunker” is being built to house either the initial Cobalt 60 unit or a Linac unit in the future. .....what that basically means is that we are building a bunker that will stop unsafe energy emissions from a Cobalt 60 which emits lower doses of radiation and it will also stop unsafe energy emissions from getting out when a more powerful Linac unit is installed in the future.  The walls on this portion of the facility range from 5’3” thick to 7’3” of solid concrete and steel.   Those are some mighty thick and heavy walls and casting this much concrete at a time takes special precautions.  The form works are powerfully built and supported.  Additionally the cast concrete needs to be kept at a reasonably constant temperature both at the center of the wall and at the outside while curing, otherwise you risk cracking during curing which would be very bad.  In order to achieve these critical goals,  care is taken to select cements, mix design, steel reinforcement,  form works, placement of concrete,  insulation of form works, temperature monitoring with thermocouples and curing times.  Our team has proven to be up to the task in the first set of pours.

As I have noted in the past we do not enjoy the luxury of calling the local Redi Mix company…..but we do have a solid crew of very capable and strong men and women.    We can cast up to 70 cubic meters  in one day (about 8 full ready mix trucks) with the crew running full tilt from shortly after sunrise to early evening.  The batching of sand and gravel are done by hand with measured cubes and the cement comes in bags.  Our casting of the ADR/HDR walls went very well with our temperature differentials being well within the norm and the walls came out looking excellent.

We continue to strive for energy efficiency and reduced operating costs for the facility.  To that end, Frik Lange at Osmond Lange in South Africa and Geoffrey Njihia, our project architect have  been working on a natural  ventilation program for the bunkers.  Frankly,  Eldoret has damn near a perfect climate.  If we are successful in accomplishing this goal these will be the first naturally ventilated radiation bunkers in the world that Frik knows about.  Frik is our IAEA (International Atomic Energy Agency) consulting architect and a big fan of folk music.  Frik advises that the math is promising….soon to know the final direction!    I turned Frik on to Tim Grimm, Carrie Newcomer and a few others….who knows….perhaps we can one day see Tim, Jan and the band in Cape Town.   

 We were able to work through a natural ventilation scenario with Hewlett Packard for the main data center as well.  We will be ventilating continuously but will not need to condition the air which will help reduce potential operating costs.

Inevitably with construction work there are some headaches.  Our solar program has hit a bump…a pretty big one….but we feel that we have secured an alternate partner in Solar4Africa.  Excellent program where they will actually recoup their investment through energy produced over time.  Our goal remains the 405 kw on the roofs of the building which will generate as much power as the building will need.  I will have to admit pretty big disappointment when it looked like we were going to have to pull the plug on the solar portion of the project.

As we get closer to finishing the building there has been focus put on making the facility as welcoming as possible.  Imani Workshops has created some stunning art pieces based upon the theme of “bringing the beauty of Kenya’s natural environment inside.”   The facility will also be graced by a beautiful sculpture done by Edward Romano that was a gift to the program by Cindy and Steve Chapman.  Many of you may remember that Edward was in Columbus last year for the Arts4AIDS event and then spent time working with Bob Pulley and local Hoosier limestone sculptors and artisans.

Liz and I are empty nesters…..of sorts.  Rather than move when Liam left we opted to stay in this larger house and have had young medical or pharmacy students/Doctors/Residents  staying here as well as Dennis from time to time.  One of the medical students, Nathanael, was from Burkino Faso and is a medical student in France…..he lived with me for 6 months and suffice it to say that we often had a good laugh….all too frequently associated with a sub par meal that one or the other of us prepared.  Before he left Kenya he had gained a wealth of experience and also fallen in love with a young Kenyan woman, Chico.   Liz, a Pharmacy Phd  is living here now and we enjoy her company….and her cooking!  Dennis had a much better last term at school pulling a 375 grade…. a dramatic improvement for him of nearly 50 points, so we are looking forward to a good year to come for him.  He will soon be 14 and is growing to be a fine young man.   We continue to enjoy going to LEWA to see the kids, particularly Julius and Nyaya.  Always a good time playing a few games or going for a long walk to check out the cows, sheep and gardens at the orphanage.  The energy of little kids is simply magical!

 Liz spends her days working with kids and she has also worked diligently to get our new 501C3 organized and on line.  The new firm is called EcoSource Sustainable Initiatives and I invite you to check it out on FaceBook.   We have come to the conclusion that Kenya, and particularly the folks in this part of Kenya, will be a part of our lives even when we are not here. We feel that EcoSource Sustainable Initiatives  will be a means for others to help make a difference in the lives of those seeking a better future.

The holidays will find us traveling a bit more in this beautiful country  and meeting more Kenyans in our 1997 RAV 4.  Packing up the camping gear including a nice blow up mattress that we brought back with us, and our little stove and off we go.  We won’t be roughing it entirely…….we will be on an island off of the coast of Kenya for a few days where we look forward to fulfilling a life’s dream of swimming with dolphins……..some of you may remember  “Flipper”………well, I have never forgotten!

On that note, wishing all of you a wonderful holiday time and know that we will be thinking of you!

Asante sana, Michael

                                              

Maiyo checking temperatures on concrete

preparing steel for bunker

shooting grades for civil works

after unpacking sculptures donated by Chapmans

rebar rebar and more rebar

Heavy Loads

 The people of Kenya, seem to be inherently tough.  After spending 4 months in the US where everything is automated or mechanized, it’s easy to be impressed by physical labor, which is very commonly done here.  The contrast to how things are done at home is remarkable. Physical strength doesn't

digging drainage ditches by hand

a bicycle taxi with his load

the dolly station

milk delivery

working on the railroad

yep, those are chickens!

children with grain sacks

charcoal

child with grain

"mopping"

roadbed near our house

on a construction site

just manifest itself in the act of labor, though. It is also a part of  everyday life for most of the  people here.

Considering that children start carrying things, like jugs, buckets, loads of wood, and each other, from an early age, it makes sense that they grow into strong adults. They definitely don’t have to go to the gym to get fit!  I find that the strength of people’s arms, legs, ankles, shoulders, necks and backs is quite incredible and admirable. Because I walk a lot,  it makes me feel  old and frail, as I pick my way slowly around the debris that is found on the sides of some of the roads.  There is plenty to be conscious of, like broken metal sticking out of the ground, uneven ground, concrete pieces, stones, and large ruts in the side of the road. Not to mention trash and standing water sometimes, which it seems wise to avoid.

So, as I walk, head down, picking my way along, I am usually being passed by old women, older men, young children and young men and women, all dressed in their fancy clothes all with the most beautiful posture, everyone walking upright. I am most amazed by the young women, because believe you me, they do not allow an uneven road bed or garbage strewn route to deter them from dressing up and wearing what I consider to be not very sensible shoes. I am always stunned at some of the shoes women are wearing…I know for sure I’d break an ankle even on smooth roadsides, or good sidewalks, not to mention these roadbeds. I have to attribute it to the fact that many of these people grew up in the country side not wearing shoes and were trained at a young age to carry many kinds of objects along all sorts of pathways.  Their ankles just seem to be incredibly strong. I have actually watched women in high heels maneuver down a steep incline strewn with broken stones, with nothing to hold onto, carrying stuff in their hands, and  descending safely, without missing a beat, much less falling. 

It’s not just their ability to walk, talk, carry things on their backs and heads all at the same time , that is astounding….it’s also all the loads that are being carried otherwise, to or from a work place. There are certain people that carry certain things in a certain way, determined by custom and/or gender roles, and I am not 100% sure that I understand it completely. On our travels, we have seen any number of seemingly crazy loads on people and bicycles . The bearers of these burdens typically are maneuvering through packed roads with many people and other vehicles in the way! Sometimes even in the dark!

 Wood and charcoal are the two most commonly seen items, as they are both either cut and/or made for sale as everyone,  who doesn’t use gas, must have  fuel for cooking and heating water. So, there is an abundance of fuel being toted from the countryside into towns to markets or specific places for sale. Of course, the more you can carry in one load, the better off you are because if you can carry several loads in one day and sell them, then you are making some relatively good money! Then there is the grass that the cows are fed when they don’t have enough pasture. Grass might not seem like such a heavy load, but when we see it on the back of a small motorbike or bicycle it seems quite an impressive balancing act!  It’s awkward too, as it is not baled, per se, but rather stuffed into big plastic grain bags. People also carry food stuff on their heads, vehicles, backs and bikes. Bananas, corn, potatoes, onions, and any number of other heavy and awkward items can be seen on the backs or heads of women.

 There are other ways to cart things around as well, and they are all physically exhausting, even from a spectator’s viewpoint! Many young men are employed pushing large dollies of whatever needs to be pushed. Men also seem to be who push carts loaded with all sorts of large and small items, including tires, grain sacks and other goods.

Although I think of myself as a relatively strong person for my age, carrying heavy things is one of my least favorite things to do. I prefer to wear a backpack with a load than carry things in my arms, but I am fortunate not to have to carry heavy items for my work. I do sometimes carry children in my arms and can see how carrying them  on one’s back is less straining but also frees your arms up. For more carrying, of course.

In any case, I would never ever challenge a Kenyan women to a carrying contest or a leg wrestling match! Or a posture competition, for that matter.  I have seen 5 gallon jugs carried on a head while the carrier is walking and holding the hands of children. One often sees a LARGE amount of sticks being carried on a back with the strap of the carrying bag wrapped around the head in order to stabilize it, or the ubiquitous children on the back and foodstuff on the head.  You also see children who cannot be more than 9, carrying large loads of sticks and corn in bags in the countryside. Early training is the key to super human strength as an adult, right?

Another part of the physical labor that always amazes, is the way that the women clean house. There is the ongoing task of laundry, which is mostly done by hand, scrubbing it and hanging it to dry.  That is done standing, bent over a large bowl. The other constant task of cleaning floors, is done by sweeping them clean, with a very short broom, or by “mopping” with a cloth, not a true mop. This means, if you are sweeping with a short broom, or mopping with a cloth, that you are completely bent at a 90% angle, from the waist, doing it by hand, again. It’s pretty amazing to watch. During the rainy season in particular, “mopping” of floors is a necessary and endless tasks. In most public facilities as well as homes with concrete floors, people going in and out of these buildings drag dirt or mud through them all the time so the floors are incessantly cleaned.  They don’t tend to have mats at the entrances for people to wipe their feet on although mud is omnipresent. Children are trained at a young age to help out and do their own laundry, as well as sweep and “mop” with a rag. If they live in a hut that does not have a concrete floor, which many people still do, there is the task of sweeping the dirt floor so that it is tidy as well.

So, it’s impressive and really a wonder. I think about how tired I am at the end of the day in Indiana after I’ve worked in the garden for several hours. I multiply that by 10 for the amount of physical work an average Kenyan does on any day and it makes me want to go straight to bed! Mostly, though, it makes me feel embarrassed by my inability to get around without being completely obsessed about breaking an ankle or otherwise hurting myself. I don’t know a single Kenyan woman who complains about her burdens during the day or how she might get hurt walking around in town, or that she might not have the exact right shoes for the job! I don’t think I’m at a point in my life when I can start taking on more loads but I do admire these people for their ability to do such incredible physical labor. 

Safari Njema (Safe Travels)

This past summer I had to take many driving trips in the US and it highlighted for me how I feel about driving in Kenya vs. the States. Driving in the States is so easy and enjoyable compared to driving in Kenya.  As someone who doesn’t really love being in cars, has no appreciation for the machine itself, and has some driving anxiety, I don’t really appreciate the driving experience at home or in Kenya. I do like to travel and enjoy being able to see the scenery wherever I am, so it is a bit of a conflict. In Kenya,  the conflict persists because not only does driving into the unknown often cause a sense of unease,  there’s also sometimes  the physical discomfort of having your teeth practically bounced out of your head or your head racked on the ceiling of the car. Yes,  driving on some of the unpaved  roads here is both good and bad because there are so many opportunities to experience Kenya in a way one normally would not.

On trips in the US, I always go prepared, which is essential for any trip, but frankly, the level of preparedness is all relative. In the states, for instance, you can have a roadside emergency card, like AAA and feel confident that that will work. Also you can get maps that are accurate, or mostly, and you now can, of course, use GPS if you are smart enough to have it (which I am not apparently!).  The nice thing also in the US is that there are roadside stops where you can take a break, stretch your legs, go to the bathroom, and look at a large wall  map (yes, I like maps). Of course, from my perspective, there is way too much garbage on the side of the road and very little variety; too many fast food joints, cheap hotels, lighted up byways, and big billboards, making the highway driving rather unappealing from an aesthetic perspective. But, honestly, the highway system in the US is a wonder and makes long drives so easy. The signage, the lane delineations, the shoulders,  the safety aspects, like guardrails and warning signs, the lighting,  the roadside stops, the convenient coffee and food, hotels and parks; all of these make for such simple driving, you can almost do it with your eyes closed !

I recently had  a hairraising trip home from Montreal by myself after dropping Jeannette there in August. It was not supposed to be a difficult drive because Windsor, Ontario, where the international bridge is, is a straight shot from Montreal on one road. However, I had a heck of a time finding a hotel and ended up driving sort of incessantly, getting more and more frantic and I felt I was in an Alfred Hitchcock movie as I couldn’t see anything except the car in front of me. Unlike in the US, not every town in Ontario has a selection of hotels off the highway, it turns out. And bless those Canadians, their exits are not even very well lit up. It’s actually really  dark in Ontario at night! And their signage is different too….since they are not promoting many businesses off the highway, there are not a million signs forewarning you when a hotel or restaurant is coming up. They do have these roadside “oasis” things, that have a coffee shop, a Tim Horton’s, and bathrooms (they are also LEED certified which is remarkable), but they are not that frequent and there are no hotels at those stops. So, needless to say, I ended up driving and driving and driving into the night, getting more and more tired, a little freaked out, and finally, when I got to Windsor, where the international bridge is, I stopped, thinking I would find a hotel. However, turns out there was a big baseball tournament and a lot of construction too, making access to the city a bit confusing, at 2 am.   After checking probably 6 more hotels, and finding no rooms available, I got directions to cross the bridge, got quite lost looking for it again, and then  I  ended up driving to Dearborn, MI and getting a hotel there. 13 hours later! Not my idea of a fun day or drive but I did learn a valuable lesson or two. I’m just glad I didn’t run into any moose on the road as the many  signs were forewarning me!

I recently returned to Kenya and was immediately immersed into the world of driving again because Michael picked me up in Nairobi and the following day we drove the 6 hours back to Eldoret. One never knows what one is going to find upon the roads here, but fortunately we had good luck and the highway which is in much better shape than it was 2 years ago, was actually somewhat clear.

Then, last weekend, Michael and I took a drive  to the Masai Mara, a large nature preserve in Kenya, bordering Tanzania. We have a small older Rav 4 with 4 wheel drive which we have fixed up and it runs pretty well. I call it the “blue bomb.” Michael has a penchant for taking the road less travelled, or the back way, partly because it’s “part of the adventure” but also because we  see and run into interesting things/people.  However, instinctively, by now, we should know that this is not always a great idea. We left Naivasha, where we had camped on Thursday night, and headed to Narok, which is sort of the gateway to the Masai Mara, by back road. We were told that the road was “ok” and that with our 4 wheel drive, there should be no worries (hakuna matata!). Well…suffice it to say it was not anything like driving on a back road at home. Not even in Brown Co, where the signage is not all that good. First of all, the road was really not built for cars and this we deduced after we noted that we were probably the only vehicle on the road…everyone else was on a small motorbike, much better able to maneuver on this very rutted, very bumpy track. There was no shoulder, and of course no signs or bathrooms or rest stops. We did have snacks with us, and plenty of water. Fortunately, we had 2 large bottles of water because the car began overheating as we climbed up and up into the hills. On the plus side, it was a beautiful region, covered in small farms and huge wheat fields, and something we would never have seen had we taken the main road. We stopped multiple times to let the radiator cool off so we drew a fair amount of attention from passersby and were continuously reassured by people on the road that where we were going was, in fact, quite far.

The funny thing is you really have to be careful who you ask here for directions or travel  information. For one, many people don’t drive so they don’t really understand distances. In fact, most people will tell you that the road is good and that wherever you are headed is far. Very reassuring, except that usually the road is not good and where you are going is not very far, kilometers-wise, but seems far, because  with public transport, there is a lot of waiting around and the vehicles are not in good shape, and the roads are terribly bumpy so they take a long time to get through! So, it really does not pay to ask. It was a lovely dad, at first, but soon enough we could see large billowing rain clouds forming and feel that the light rains were about to begin. The road got a bit better and there was more truck and car traffic, as we got closer to Narok, and then it started raining.  Because of the rain, it became very  slick and sticky. A bit of a cross between peanut butter and molasses with a deep dark rich hue. Since I was wearing sandals and knew I would not be very helpful if we did get stuck,  I found myself “praying” that we wouldn’t.  Thankfully, my hubbie, Michael “let’s take the back way” Greven, is a great driver and was able to get us all the way to Narok safely. There,  we found a mechanic who happened to have the fan that we needed for our Toyota. Not only that, we were able to convince him to give us a good price rather than the price for “ wazungus” so we did not end up paying an arm and a leg for it. Soon, we were on our way to the Mara , happy in the knowledge that our vehicle would not overheat again.

We spent a lovely day in the Mara the next day, seeing lots of wild animals and enjoying what is simply one of the most beautiful places on earth. The Masai Mara Reserve is surrounded by conservancies and we continued our day long drive into the next conservancy, having decided to go out of the western side and drive again through the countryside towards Eldoret.  Instead of staying the night on the conservancy, we left around 5 pm, thinking we would find a place to camp or a small hotel nearby the gate. We also needed fuel at that point and we were told by the people at the gate that we could find fuel nearby. Not so. In fact, we drove on this dirt road for about 5 kilometers after exiting the gate only to be surrounded by small Maasai villages and the only other thing on the road were herds of cows and their shepherds. It was a nice enough road, aside from all the cows that we had to drive behind, but then, as it began climbing, it became more and more bumpy. Nightfall was approaching and there was nary a guest house or campsite in view. I was becoming a bit anxious but didn’t say anything because I knew my super driver would take offense and/or just reassure me that we would find something soon.

We began to wonder where we were and if we had missed a turn. We had a map but it was difficult to say if we were on the road to the big main road, which we were seeking. The map has different colored lines, like most road maps, but they don’t really seem to indicate anything specific. Finally, we started seeing a few signs for campgrounds and then a few safari vehicles, one of which we stopped. Noone seemed to have heard of the town that we were heading to in our search for fuel. It definitely could have been our pronunciation, or it could have been that these people were driving from Nairobi and weren’t that familiar with the small villages either. The safari vehicle driver got out, wearing a big friendly smile, happy to help us. His English was good and he indicated that we should take the next  left and continue straight on that  road as it was a short cut to the big road, in 35 kilometers, he reassured us.  He was very confident seeming,  especially when  he said it was a good road. So, we bombed on up the hill; the road was more stone than dirt and I personally was fearful for the underside of our vehicle. There were many holes, ditches, gulleys, and large puddles filled with black water,  which were a bit difficult to traverse, but MG did it. We commented a few times how pleased we were that we had gotten the car fixed in Narok, as this driving would have been killer on our radiator.

We got up onto a rise above the Masai Mara just as the sun was setting and we stopped to check the level of moisture in a particularly difficult passage. I was amazed by the surrounding beauty and at the same time wondering where in the heck we were gonna end up! We continued on driving driving driving, plunging over large pot holes, through mucky puddles and narrowing passageways, where there was no one around. I said to Michael, “ well, we could probably set up a tent around here and just sleep rather than driving at night. “ I’m not sure he heard me because he did not respond and then a couple of minutes later I saw an extremely large warthog by the side of the road and thought, “well, actually, camping out in the open maybe isn't such a great idea!”  So we kept on. And on. And on. It definitely was not 35 kms and even MG was exhausted and frazzled by the stress of driving in such conditions and with little fuel, not knowing where we were going to find any. 

Once we got a bit closer to the town where the big road supposedly was, there were people all over the place too…bicycles, children, people carrying stuff, motorbikes, etc. And it was pitch dark. Not even the little shops on the side of the road had any lighting.   We were startled several times by people hawking vegetables in the dark and found ourselves wishing the roadside was wider at each turn. We did finally find the main road, took it to the next small town and got some fuel, then on about 12 more kms on another pitch dark but fortunately paved road to a bigger town that actually had a real hotel and a cold beer for the driver! So, another lesson learned….driving at night here  is not easy nor is it safe especially when you don’t know where you are and you can’t be sure to get help! No AAA here for sure. We do have plans for many more driving trips over the next 8

in the hills above the Rift Valley

no getting around this guy as he was slippin' and slidin'

first down truck we saw

Masai village

sunset over the Mara

tea fields near Nandi Hills

months, so learning this lesson now is important and we definitely will be better at planning our overnight stays so we don’t have to sleep with the warthogs or in any other unsavory or unsafe situations.