Kenya

Kenya
one of our favorite sights

Sunday, April 26, 2015

Pamoja


The doors are soon to open on the new Chandaria Cancer and Chronic Care Center in Eldoret.  27 months after we actually broke ground on the 100,000 sf facility it will open to begin serving those in need.    The new facility will open in phases with the research floor being occupied first, then the oncology and chronic disease care areas on the ground floor, then the administrative areas on the 3rd floor and radiation oncology wing.  Hopefully in the not too distant future the radiation oncology wing will also be equipped so that it too can be put to use.   The first floor (2nd in U.S) is set to accommodate future expansion of services and treatment. Discussions are already underway as to what types of clinics will be there.
27 months to construct a facility of this nature is no mean accomplishment regardless of the measuring stick used.  The site has regularly employed in excess of 100 men and women directly and countless others in the supply chain.  We have focused very hard on sourcing from Kenya and East Africa to the greatest extent possible.  Our power tools consisted of concrete mixers, a concrete pump, a couple of power drills and power saws and welding equipment.  All other tools were powered by hands, legs and strong backs! For the most part we have very good tradesmen, supervisors and design team. With very few exceptions they have been a pleasure to work with.  That is not to say that there weren’t frustrations….there were….but those are eclipsed by the success of the efforts.   The story of constructing the building is interesting in its own way but by far the more interesting and powerful aspect of this project is the strong sense of collaboration, commitment and determination on the parts of Kenyans and their American and Canadian counterparts.  Their dream is to provide better care delivery and medical care for those of lesser means.  The building and the programs it will house are a culmination of one part of the dream.
Beginning in late April researchers will have a common facility to work in where they can undertake critical clinical research as well as general research.  At present these researchers from Kenya and around the world are spread throughout Eldoret in a variety of locations.  The new building provides them with clinical treatment rooms, a clinical pharmacy, meeting rooms, team work rooms, a library, and data manager facilities.  Perhaps some of the research here will help solve some of the medical problems challenging people in Kenya and throughout the world.  Beginning early May the ground floor will be opened and patients will have the opportunity to see doctors for many chronic diseases…..all in one facility!    There is a beautiful new open space for infusion of chemo drugs used in oncology in lieu of the tent in which the drugs are currently administered.    There are waiting areas, staff rooms, a pharmacy, cash offices, nurses stations all designed with the intent of providing top quality medical care in a dignified manner for the patients.
Later in the year the radiation oncology wing will be opened post receipt of the radiation oncology equipment.  Our work as builders and tradesmen will be finished by the end of May and a facility will then be in place that can house the latest in bracheatherapy equipment, CT Simulators and radiation oncology equipment.  This is big news in a country and region where there are very limited options for those of lesser means who are also stricken with cancer.  Final sourcing of this exceptionally expensive equipment remains pending however the Government of Kenya is working diligently to identify sources.  Simultaneously there is the possibility of donors assisting.  Pricing for the equipment can be as much as $3.5million depending upon what is purchased……big numbers but the funds must be found.   Cancer has recently overtaken malaria as the number 1 killer in Kenya……that is really hard to imagine.  The most recently reported numbers indicated approximately 27,000 deaths due to cancer.
By August the 3rd floor (U.S 4th) will be ready to house the administrative wings of Moi University Medical School, the Director and his staff from Moi Teaching and Referral Hospital as well as offices for the Ampath Consortium partners.  This proximity will give the leaders of each group the opportunity to interact more readily and continue to build on the successes they have enjoyed together.
Working “Together”…..or …..“PAMOJA” is what has made this project possible.  From the dreamers to the donors to the doctors to the designers to the tradesmen, and the myriad of supporting people in between a dream is being realized.  Regrettably resting at this juncture is not an option!
Cancer and other chronic diseases are brutal.  They inflict great pain and suffering on those being treated as well as their families.  These diseases are not easy to treat and the treatment is often very expensive….and beyond the means of many to afford.  There is much, much work to be done to find the cures for these diseases.  In the meantime there is significant expense to be incurred to train the doctors and technicians, fund the construction and maintenance of the facilities as well as purchase the medicines and equipment.  ”Pamoja” we will need to continue to work hard, each in his /her capacity to make a contribution to meeting this challenge.
As we near the end of this chapter in the dream for us, I can say without reservation that the past 33 months have been very special for my family and me.  We have met many truly wonderful and inspiring people from both Kenya and other parts of the world.  We have enjoyed some of the most spectacular sights one can have the opportunity to behold on Mother Earth and we have grown and learned to appreciate more readily.  We have had to confront some of our own weaknesses and to reflect on our priorities.  I can hardly imagine a richer experience.

Tomorrow will find me working on worklists and details with men I have grown to enjoy and respect.  I will fumble along in my pseudo Swahili and they will humor the mzee as he mixes up pronouns……but somehow….”pamoja” we got a building built. Work remains and we plan to be part of it!












Sunday, April 5, 2015

Heartbreak in Paradise

 All of East Africa including Kenya is geographically unusual and stunningly beautiful in many ways. With white sand beaches and turquoise water at its coastline, volcanic mountains dotted with plants and animals unseen in other parts of the world, iconic plains with their large mammals and trees, and the Great Rift Valley surrounded by dramatic escarpments, inhabited by interestingly garbed people and birds, it is  a sensually stimulating and endless palate of options for people who like adventure. It is paradisiacal in many ways. 
Due to its incredible natural beauty and well-advertised and appointed tourist industry, if one comes here as a tourist, it’s quite easy to avoid the disturbing reality underneath. One can ride around with a driver in a nice vehicle and go to the many national parks on safari and be taken care of by ingratiating and lovely people, lounge by pools at lodges drinking delightful cocktails served by charming Kenyans. You can shop in the malls in Nairobi which could be in Boca Raton, and pretty well avoid the poverty, and distress of a country in which many of the children are undernourished and unable to go to school because their families cannot afford it. A country where most everyone has been touched by the tragedy of the AIDS crisis; families have been torn apart and are healing still today after over 20 years of working towards normalcy and better health.
Since we were not tourists and we were actually here for a relatively long time, we did get involved with many people and organizations and we learned an incredible amount about the real lives of Kenyans. We also became quite attached and involved in the lives of 3 boys: Julius, his brother, Ngang’a, and Dennis.
We were never uncertain what our relationship with Dennis was going to be, but as it turns out, when in Kenya, you can’t draw boundaries easily and everything is more complicated than it seems or should be. Dennis  is now 14.   We are sponsoring him so that he can go to school and hopefully go on to HS, and he is doing well, so our concerns about him have reduced because he is older, getting enough food, in good health, and a motivated student. Like a good Kenyan boy, he has become quite self-sufficient, although he has no other support besides us. When we met, he was alone, sad and hungry, and struggling to be in school. His life has turned around. He now has our care, he knows we attend to him and plan to continue that support, but also he is much more self-confident and has a good head on his shoulders and his English has grown quite good. As we had hoped, the adults at the school are looking out for him and paying attention to him. These are all huge steps in the right direction, although his life is far from perfect and far from what I would hope for any 14 yr. old.  We are committed to continuing to back Dennis through school and hope one day to see him succeed academically enough that he will be able to get a higher education and a good job. We will be checking in on him and hopefully at this point he feels our support enough that he won’t falter.
Not an ideal situation, but one that we all feel varying degrees of comfort with. One thing I’ve learned is that my standards of what is ok for children are completely different than most Kenyans, and the fact that he has a roof over his head and is in school seems “all good” to them. Emotional, psychological and developmental support are not priorities and seem to be the realm of the privileged. When I complained to a neighbor who is a high level U.S educated  neonatal doctor  about the fact that the children at the children’s home did not get, what I consider to be enough stimulation, she said, “oh yes, Liz, we are not yet good at this. We feel that if the baby is full, the baby is fine.” In other words, the fact that their children are not dying at the rate they were before,  is progress.  Medical advances have also made a huge impact here for children’s lives. This was revelatory to me, and made me realize that from my perspective as a privileged American, my sense of what makes a child “happy” or well-rounded is far from many Kenyans’ idea of the same. A brilliant and important epiphany which has also helped me to process the circumstances of our relationship with the other two boys.
Our relationship with Julius and N’ganga’ is, in a lot of ways, more complicated, because they are younger and they do not have family members  who have shown any interest in their well-being for the last 3 years. In fact, that might seem like it should make things less complicated, but because of the peculiarities of the Kenyan system and our being “guests” here, it actually is more difficult. Our relationship with Julius and N’gang’a , because of their ages, and who we are, is also more “parental” emotionally. As a family, we consider them “ours” because we are devoted to them, despite the fact that our devotion is not eliciting what we had hoped in terms of results.
The notion of becoming so attached to and really falling in love with a baby while here had not occurred to me, surely partly because of my age. I didn’t quite “get” that one can be totally overwhelmed with and focused on the craziness of orphans and vulnerable children here, even though of course it’s something we have all read about. Reading about and knowing about situations is quite different than actually being in them and dealing with the associated emotions.  I guess I’m what one would call a “kid person” in that I am actually attracted to small children. I knew this about myself as well, but again, pretty much all of the children I’ve ever been around have been the children of friends, happy, healthy and in good family situations. I had worked in some poverty situations, as a volunteer, and had tried to help a family with which I was working, overcome some of its issues, but that was not long lived and they were not babies. The children that I started meeting here in Kenya who were in the center that takes care of abandoned babies at the hospital and then at the orphanages, were in fact the neediest people I had ever met. For one, they were babies or toddlers, who had been left behind by their families, and most had been neglected, malnourished and also abused. Just knowing this is enough to break one’s heart; and they were actually the lucky ones, because they had been found, by neighbors or the police and brought in.  There are others who are not. The idea of abandoning children is a concept that is terribly hard to get one’s head around, but after being here awhile I recognize the desperation that pushes people to that terrible act. Then the orphans, are simply that. They’ve lost everyone in their family, either to the horrors of extreme poverty or to disease, or both. 

The impact on families of both disease and extreme poverty is not one that we in the States can even imagine. People continue to have babies though, people who don’t know any better, don’t have access to healthcare or family planning, or don’t understand it, or are certain that having babies is maybe going to somehow help them keep a man or family intact. Like in many poor places, there are lots of young mothers and there are certainly many who shouldn’t be having babies as they have no way to take care of them. My interest in these children was not even altruistic at first. I was sort of thrust among them because I was looking for something to do, when I arrived in Kenya in September 2012. Being someone who loves kids and likes to be around them, I was able to find a niche with them. I enjoyed holding them, making them comfortable, reading, playing and singing to them. Oddly, to me, I found it easy to love them.
Our relationship with Julius blossomed because he was sick, at the age of 6 months, when he was sent to the children’s home from the center for abandoned children at the hospital. Although the home he had been sent to was superior and the caregiving strong, there were also 9 other infants there at the time. Since he had a mysterious illness, that was hard to diagnose, he was a lot of work.  Because we had already bonded and he was niggling his way into my heart, I spent many hours with him at the hospital and finally, after 6 months of mystery, he was diagnosed with TB. We brought him home to help lighten the home’s load, and he grew and became strong….while we fell in love.  He went back to the home in August of 2013, to live, and that is when I started really feeling like that was all wrong.
 After about 1 ½ years  of knowing them, caring for Julius at our home, and having both boys stay with us, we began feeling  that adopting them was a reasonable option for us, despite our age and the potential complications involved. Although we had not spent nearly as much time with N’gang’a, we knew that the only way for an adoption to move forward was to keep them together. We were willing to go into this likely quagmire of bureaucracy here in order to take the boys home and give them what they need: a loving home in a family. Although at the time I could not think of any, there are reasons, I guess, not to adopt children from Kenya, reasons that some Africans think are clear. In fact, I’ve had conversations with several Kenyans, when I would mention that we were thinking about adopting the boys, who were very negative, saying things like, “well maybe it’s not necessary for a Kenyan child to grow up in the U.S.” or, “don’t you think it would be bad for an African child to be raised in a white household? He/she will lose his/her culture.” I set these comments aside, thinking it was an interesting, but  a sort of ignorant take on balance to what a child actually needs. I spoke rather frankly with an African friend who had lost both his parents as a young adolescent about this whole idea of orphans being adopted and losing their culture. His opinion was succinct, “you don’t have a culture if your family has gone and you are being raised in an orphanage.” Indeed.
 There are laws on the books in Kenya about adoption, but many of them are circumvented, we are told, or people don’t do their jobs or, because the system is so overburdened by children, things just don’t happen the way “they are supposed to.” We were hopeful at the beginning of our journey because we were getting a lot of support from family and people here. Of course there were Kenyans who looked at us askance when we said we’d like to adopt them, but honestly, very few Kenyans pay much attention to the situation of the orphans and abandoned children. It seems, from  our perspective that only people who work in the system or are social workers or directly involved with children, even realize they have a problem with number of kids being brought up in children’s homes. Most people think that they are being well cared for, these vulnerable children, and when life on the street is the alternative, I guess they are.
I was excited that Michael had come around and that we had a definitive plan, so I tried multiple times to sit down with Phyllis, the director of the home, whom by then I considered a friend . A stellar leader in her community, and maybe the busiest Kenyan I know, I was able to actually jump into her car as she was driving off and get a 5 minute conversation in about adopting the boys.  She  was rather encouraging….she didn’t say no way, or “I won’t help you” or anything negative at all, but she did say she would have to figure out their status because theirs was not a normal case. I only told her to please try to focus on it because I knew she was extremely busy and that getting another chance to discuss with her was rather difficult and that “none of us were getting any younger.” Well, October, November, December, January, February and March all went by with no movement in any direction. I began to realize that we had no control or power in the situation and perhaps neither did Phyllis.
I had told Michael back in December, because of the lack of progress and because I felt so destroyed about it all the time,  that I thought the only way I could deal and process the whole thing was to write about it. For me, writing is a good way to process my innermost feelings and insights, so I decided then and there to actually pursue this as a task.  I also had people tell me that it might be a good thing to expose. The lack of movement, kids languishing in children’s homes, people in child welfare not doing their jobs, etc. It seemed sort of arrogant and judgmental of me to take the tact that things were going wrong. They were certainly not going our way, but I was bound and determined to figure out what was happening and why things were not moving forward or changing or why there was never any change. It kind of was driving me crazy and it made me feel very insecure about my role in the boys’ lives and how we were to proceed with these relationships. Our visitations to the home continued during all those months, to play with the boys and all of the other children. We also began to hear stories from other Americans about their own experiences trying to adopt, none of which were easy and positive, but it became clear that with a lot of fortitude, it might happen.
One thing that stands in the way of international adoptions in Kenya are the Hague Conventions. These were laws that were written back in the 90’s that are designed to prevent or stem the tide of child trafficking. The whole idea of child trafficking boggles the mind seriously but apparently East Africa is a hotbed for it. I also had someone tell me that the whole issue of child trafficking became more of an international hot topic because “Madonna stole a child from here” One of the many absurd and vague pieces of information floating around. The morass of absurdity is deep and broad and it would be almost funny if it didn’t involve the lives of children!
The one law that would affect us was that you are not allowed “prior knowledge of the child.” Although of course we had prior knowledge of the boys and in fact, it’s clear we are bonded, we were also told that our situation was different because we had fostered Julius while he was ill and we had lived here a long time. So there are little ways to get around this particular law. We decided to persevere and really push the long term residency envelope, in hopes that whomever we were dealing with ultimately would see us for what we are: nice people who want to help these kids. Over the summer 2014 months, Michael was here alone and continued to visit the boys and he began making more aggressive moves with the children’s welfare department to get information and figure out what we needed to do to make this adoption happen. We had been told by friends to “not show our white faces” at the doors of these offices because once people see westerners they see cash and that would mess up the whole path by our being construed as people that had money to offer in payment. This was a difficult piece of information for us to digest and Michael decided not to take it too seriously. We agreed, after many discussions over email, as I was out of the country, to pursue the adoption through the “legal path, “ so he went to the offices of the Children’s Welfare Society and I talked to an international adoption lawyer in the US. The news was never good. The guy in Eldoret, who was running this office alone, basically and dealing with the abandonment of 25-30 children a week, was overwhelmed and claimed to “not be able to do anything to help.” He told Michael the boys’ case was complicated because “the father was around” and he told Michael to go to Nairobi to have an official meeting there. The lawyer in the States was not optimistic either and told me that the only possibility was to stay another few years and then get them out. Tears were flowing and hair was being pulled out at this point. Michael and I agreed that we could not put our health and marriage at risk due to this stress. We had to be a united front and totally on the same page at all times.
Finally, when I returned in September, and fell back into my relationships with the boys, we had to come to some conclusion. Our time here was getting short.  I had hoped that Phyllis would advocate for us but it soon became clear that she was not comfortable in that role.  I know she trusts us and likes us. She made a comment one day, about the boys “being fine staying here” which made me realize that she did not feel any urgency to adopt them out and also that perhaps she was trying to protect us, or herself. I went to see the director of the Children’s Welfare Society in our county myself to better understand what was going on, and he “appreciated my passion” but couldn’t help me because of our prior contact, but also, it came out that day, the boys did not have a certain number, which the police give to abandoned children for their files. Apparently, the night that their father left them at the hospital, no one reported it to the police, so the boys never received the proper documentation. I have to say, I felt like screaming at him, “So, give them a number!”  Meanwhile, and most horrifyingly for us, he said they “were looking for the boys’ father.” Whether that is true or not is unclear, but what we finally decided was that they were safer at the children’s home than with anyone in this family that had shown no interest in them for over 2 years and had left them, malnourished and sick, in the hospital.
Suddenly, in November of this past year (2014) we were shocked to see an article in the national paper saying that all international adoptions had been made illegal. Apparently there had been some homes in Nairobi that were abusing the whole international adoption process, probably taking more money than they were supposed to and there was some male missionary arrested for sexually abusing children. We were saddened to know that our path had thoroughly been blocked then. There was a feeling of severe defeat and sadness, but it was the clearest statement on the topic that we had heard. Oddly, no one else seems aware of this new law, including the children’s home directors that we know or other childcare workers, but most of them don’t deal in international adoptions.
Our story is sad but not unusual. We have learned a lot and have seen that the boys are being well cared for at the children’s home and they are “happy” it seems. They are “loved” by the caretakers and family members who live there. It is a very personalized place and living as a family is what strive to do. Therefore, not without ambivalence, we have accepted the situation and know that we will be forever in the background.
 We feel sure that Julius and N’gang’a   know we love them. We want them to understand that, profoundly, yet we are uncertain how to make that happen, except to stay engaged.  We have committed to sponsoring them and keeping in touch with them, and making sure they know we are in the background as they grow up there. Phyllis has promised to keep them there and that she won’t allow a family member to come and take them away. I am not na├»ve anymore. I know this could happen. I know that the next email I get from the home could say that the boys have been moved to another home somewhere else or adopted to a Kenyan family (although they need that number!) or sent to a family member. I know that Phyllis is not completely in control, although if anyone has experience and sway in this world, it is she. My fantasy is that instead of one of the above emails the one we receive says we can bring them home.
 No one seems to be able to give us clear information on the family or if they are truly in the area because the police actually have never gone looking for them. We are deeply saddened to be leaving them and fully committed to coming back to see them and check on them. We plan to stay in close touch with the home. Both boys know, I think, that we come and go and that we do come back. They are so young, it is hard to know what they understand and I honestly don’t know what the childcare folks are telling them. Volunteers from the west come and go. Playful nice people who bring toys and candies. The kids love them too!  They are two of many small children out there and I don’t think they are seen as particularly special by anyone but us. Phyllis did tell me the other day, again, that it was up to her that they stay, and she planned to keep them, because of our caring for them. This made me breathe easier.
Our story is probably not all that uncommon in the world of child welfare in Kenya but it felt important to share. Despite all of our experiences in Kenya, many of which were positive and interesting, this is one of the deepest and most intense that we have had.  Although growing up in an institution seems   unideal, we are  thankful that they are in a home that is a very positive place, focuses on taking good care of them, they  spend a lot of time outdoors, and they will definitely get a good education. Things could be a lot worse, is what we’ve realized and seen. However, it is still heartbreaking.

Check out the home where the boys live at www.lewachildrenshome.com and the school they will go to is the Kipkeino School.