kenya – ToewsTravels

lamu!

for as long as i can remember, i’ve wanted to visit the idyllic swahili town of lamu, and it didn’t disappoint! lamu is located on an island on the indian ocean, in the far northeast corner of kenya, just miles from the border with somalia. it is one of the last bastions of swahili culture – a unique blend of arab and east african influences, where life has revolved around around islam and the ocean for hundreds of years, and has changed relatively little even in the modern era. the town is composed of countless narrow alleys, which are always busy with donkeys and commerce.

the area is known in security circles due to its proximity to somalia. united states special forces maintain a heavily insulated base called camp simba a few miles outside of town, which was infamously briefly overrun by al-shabaab militants in 2020, the first such direct attack on us forces in kenya. we chatted about this and other current events over drinks with a couple british military contractors and – you can’t make this stuff up -a local named satan (who was actually a nice guy), and an aspiring nomadic kenyan poet. lamu’s manda airport, across the water on another island, has been intermittently shut down for security reasons. but as expected, all was good during our visit. definitely recommend visiting this paradise while it remains an idyllic backwater!

disaster response headquarters, lamu, kenya

lamu house hotel

in lamu, kenya we stayed at the lamu house hotel. this is the only place you want to stay or eat in lamu town. that is partly due to lack of any other options, but it really is one of the best places we’ve ever stayed, anywhere. very kindly, they upgraded us to a rooftop suite with amazing views over the town.

2 rainfall shower heads beside each other? alright! lamu house hotel, lamu, kenya

doors of lamu

many of these intricate doors in lamu, kenya have seen hundreds of years of history.

shela

about a 15 minute boat ride south of lamu town is the village of shela. it has a totally different vibe than lamu, as many of the homes are owned by wealthy elites from outside kenya. mick jagger owns a home here, which prompted other ultra-rich to do the same. the narrow alleys, in contrast to lamu town, are empty and clean. across the straight is an opulent resort called the majlis, which we also walked around for a bit while our boat driver took care of some business. shela is nice to walk around for a few hours, but i’d say lamu is the place to be.

the “taylor swift,” shela village, lamu island, kenya

the only donkey drinking station in kenya, shela village, lamu island, kenya

coral wallwork, shela village, lamu island, kenya

ann <3, shela village, lamu island, kenya

lazy days, shela village, lamu island, kenya

2 weeks of pediatric emergency medicine and critical care at kijabe hospital, kenya

kijabe hospital emergency department, kijabe, kenya

i was able to do the final global health rotation of my medical education at kijabe hospital in kenya for 2 weeks of volunteering and teaching! kijabe hospital is growing, medium-sized rural mission hospital on the edge of the great rift valley about 1 hour north of nairobi, and has developed a reputation as one of kenya’s best hospitals. i spent 3 months volunteering at this hospital back in college, so it was a special experience to be able to return now, 10 years later, as a pediatric emergency medicine fellow. there have been amazing strides made in the medical education offerings at the hospital, and it is now has numerous training programs, including a surgery residency, nursing program, clinical officer (kenyan equivalent of physician assistant) and medical officer (kenyan equivalent of medical internship) programs, and more! impressively, it is also one of a few teaching sites for a new pediatric emergency medicine (pem) and critical care fellowship program, which is the first and only program of its type in africa!

i spent some time with the kenyan pem/critical care fellow rotating at the hospital that month, as well as a lot of time supervising and teaching the clinical officers and medical officers in the emergency department and the 10-bed pediatric intensive care unit. they loved learning and loved my lectures, which was great! i was able to give a number of lectures on burn management, pediatric advanced life support, pediatric abdominal emergencies, seizure management and more. and i was able to lead rounds in the intensive care unit, and did a number of nights as the pediatric attending on call.

as one might expect, rural kenya remains a very resource limited setting, though kijabe hospital has many more resources than almost anywhere else in sub-saharan africa. their 3 pediatric ventilators provide an almost unheard-of abundance for a hospital in the region, yet they are still not enough for the number of patients who need a ventilator, which is always tough. through donations, the hospital is able to cover inpatient medical costs for many families who cannot afford care, which most hospitals do not do. the pathology in rural kenya is much more advanced than in the west, and patients often present very late in the disease course.

pediatric emergency department, kijabe hospital

pediatric intensive care unit, kijabe hospital

it was also fascinating to learn about differences in medical management in africa compared to the west, and not just those one might expect due to resource limitations. for example, a mainstay of treatment in the west for sepsis, an overwhelming blood infection, is aggressive resuscitation with fluids. however, a landmark, large, blinded randomized controlled study in east africa (the feast trial) revealed that aggressive fluid resuscitation is associated with worse outcomes in this setting, so fluid resuscitation is used very judiciously throughout africa, which is a complete paradigm shift from what had been considered sacrosanct in sepsis treatment for decades. the evidence-based treatment for severe acute malnutrition is also notably different in africa than in the west (where admittedly it is very rarely seen). in any case, for my pem fellowship senior lecture after i got home i talked about these differences for 1 hour as i think they are very fascinating!

the pediatric emergency medicine / critical care fellowship at kijabe is run by an inspirational american-trained pem named dr. ariana shirk, who has served at kijabe hospital for almost a decade. i truly appreciate her willingness to let me come out on short notice, and even provide me (and my wife ann for the second week) housing in a nice little guesthouse. i learned a lot from her. she is a true hero, and it is mindblowing to consider how many children’s lives have been saved either directly by her, or exponentially more-so by the countless providers she has trained over the years, who are now working throughout kenya and further afield in africa.

one funny story: we needed a portable xray on a patient. it was taking forever and we had called the xray tech multiple times, but they were saying the machine was too heavy for them to push it up some ramps to get to the icu. so i decided to go get it myself. it was a portable xray machine from about the 1950s, and did seem to weigh about 1 ton, and the wheels on it seemed very stiff. i struggled to push it up multiple ramps and down multiple hallways, finally arriving at the icu about 15 minutes later, sweating profusely. everyone started laughing, because apparently i had pushed this thing through the entire hospital without removing the brake. once that was off, it rolled easily!

medical education is definitely one of the best ways to go in terms of having a profound and sustainable impact in global health. i felt honored to have this opportunity to be involved at kijabe hospital and look forward to the next trip!

model of kijabe hospital. very impressive facility for rural sub-saharan africa

courtyard mid-day singing/worship, kijabe hospital

around kijabe

i was in kijabe kenya for 2 weeks, and ann came out for one week. she worked remotely in the evenings (work hours in north america) from a conference room in the hospital. kijabe is also home to the rift valley academy boarding school, where a number of my extended family whose families live in other parts of africa attend school. my cousin sonya and i got to meet up with them outside the school gates one day, which was really nice. i couldn’t enter the campus due to covid-19 restrictions.

kijabe hospital cafeteria food (which was a lifesaver because minimal other food around)

ann working remotely latenight from kijabe hospital conference room

nairobi giraffe center

the nairobi giraffe center is a great place where you can get very close to giraffes. these are rothchild’s giraffes, which are a very endangered species.

two rivers mall, nairobi

two rivers is a brand new shopping mall in the northern suburbs of nairobi. this is the largest mall in east africa, and y’all know i love shopping malls and superlatives, so here are some pictures. a great place to spend half a day in nairobi!

around nairobi

my cousin sonya was kind enough to let us stay with her in nairobi, and we had a lot of fun! the city has been changing a lot, with ever more restaurants and shopping malls, etc. we got some gourmet burgers in a repurposed shipping container, lots of good coffee at various nairobi java house locations, and i went on a few great runs in the city. we met up with another cousin and her family who were visiting. thank you for hosting us sonya!

nairobi from above, with nairobi national park in the foreground

the hub at karen, one of a plethora of newish shopping malls around nairobi

waiting for covid test to be able to leave kenya (wait was half the day)

dinner with my cousin sonya at nairobi’s most storied ethiopian restaurant

meeting up with another cousin and her family!

ol pejeta conservancy

we went on safari! ol pejeta is a private conservancy about 5 hours north of nairobi, in the shadow of mount kenya. it is a very new park, only established as such in 2004. we had a private minivan and driver named harrison and got a pretty amazing deal because there were almost no tourists in kenya at the time. ol pejeta is privately owned and maintained, in contrast to most of kenya’s other parks, which are run by the government. the private ownership allows ol pejeta to do things that aren’t possible in the other parks – like nighttime safaris! we saw some lions very close up, including 2 males facing off with each other, and then heard some other lions mating in the bushes – they are able to go at it every 15 minutes all night long when the season is right. the park has a unique model of raising cattle in the park to help supplement income, and presumably the diet of some of the predators. ol pejeta is also the only place in kenya where one can see chimpanzees. interestingly, they are not native to kenya – these chimps were all confiscated at the international airport in smuggler’s luggage. it is most famous for being one of the best place to see rhinos – it has the largest population of black rhinos in africa, with over 100.

in a special enclosure in ol pejeta live the last 2 northern white rhinos in the world. they are both female – unfortunately the last male of the species passed away, so the only hope for the species is artificial insemination, which is actively being pursued. being the last of the species, the last 2 northern white rhinos are heavily protected from poachers by security with guns and helicopters overhead.

probably the best experience in the park is seeing a black rhino named baraka. he is blind, and therefore won’t try to kill you. you can feed him and pet him – unbelievable!