Kericho

This last week I traveled to Kericho (about an hour away) each day for a conference on "Integrated Management of Severe Acute Malnutrition". The conference was fascinating both from a medical standpoint and a cultural standpoint. As you can imagine, I did not learn much during residency in the States about malnutrition except as it related to anorexia or obesity. I have cared for many children here in Kenya with severe malnutrition, however, whether from lack of food supply, HIV/AIDS, or difficult social situations. Refeeding these children can be tricky as the body reacts to undernutrition by slowing down in many ways (to allow survival despite limited caloric intake) and then resists when increased calories are given. I appreciated the chance to learn more about initiating feeds, repleting vitamin deficiencies, and treating hidden infections in this unique patient population as well as preparing them for discharge and preventing the same problem from happening again.

I traveled with Mercy, the nutritionist from Tenwek, and enjoyed getting to know her as well through this shared experience. As you can see from the group photo, I was the only non-Kenyan at the conference. This provided the opportunity for many interesting cultural observations:
1) There is very little variety in the Kenyan diet. The staples are ugali (like corn meal mush), rice, potatoes, chapatis (like tortillas) - lots of carbs! - sukumawiki (greens), cabbage, and maybe some broth with small pieces of beef or chicken. We were served 3-4 of these items each day for lunch - and that seems to be what people eat every day for two meals a day without complaint (even nutritionists!). Notice there is very little protein - probably contributes to the malnutrition. But it also highlights that variety in diet is a luxury that most people in developing countries do not enjoy. I did look forward to chai twice a day, though!
2) Kenyans prefer speaking Swahili to English. The first language here is either Swahili or a tribal language and then people learn English in school - professionals speak English well (although it's more British English and thus my American accent is hard to understand.) But, although the handouts and power point slides were in English, the instructors and fellow conference attendees frequently slipped into Swahili - especially when sharing an anecdote or conversing casually. The result - I missed pretty much every joke all week! It was very good practice, though, and I noticed I understood a lot more of the Swahili by the end of the week. I even spoke in Swahili for a couple sentences Friday when it was my turn to recap the previous day's learnings. Good motivation for continuing my Swahili study!
3) Recognition/appreciation of the speaker is very important - and brief uncoordinated applause as we're used to in the States is not sufficient. So after each session we all stood up and either clapped a pattern in unison or picked imaginary flowers from the sky and "gave" them to the speaker in unison.
4) During introductions, rather than just saying "married", people said "married with one wife". One of the instructors also told an amusing story about her "co-wife" at one point (meaning her husband has more than one wife). Polygamy is pretty common here - evidently even in professional circles.
5) Audience engagement and participation were very important. Speakers frequently asked, "Si ndiyo?" (Is it not so?), "Tuko pa moja?" (are we together), "Isn't it?", or "Do you agree?" and expected responses. They also frequently left sentences what? Left sentences hanging and waited for the audience to fill in the last what? The last word.

As you can see from the below pictures, I also enjoyed beautiful and interesting scenery en route to Kericho and back each day. Some of the tea you drink probably comes from the Kericho area (tea is one of Kenya's main exports). The tea fields are very green and beautiful - and the leaves are all picked by hand! We also saw monkeys daily as we ate lunch and even visited the Kericho District Hospital. Thanks for reading to the end of this long blog!