George S. Osborne College of Audiology

Doctor of Audiology Program (Residential)

2010 Mission to Kenya

Welcome Note

February 21, 2010 - 1:15 a.m. (Kenya time)

Jambo

I apologize that this might be a short entry, I am needing to head to the first of two opportunities to see the children's mass here at Nyumbani. When we arrived at the airport last night we were greeted by Sister Julie a driver, as well as four of the boys from Nyumbani to help us with our bags. Arriving at the airport is a very interesting experience, as there are porters who say they work for the airport who always try to take your bags to the car for you. They will just grab them and no matter how many times you say “no thank you,” they just say that it is their job etc. Then, after they push the bag only for a minute to two, they say you must give them a good tip! This is the only bad experience that I can recall having in Africa ever. The ride to Nyumbani was short but bumpy! We had a great time catching up with our old friends!

I have a nice room, I am very comfortable and I am looking forward to more reunions! I think that the first time students, Nicole and Theresa, are adjusting well. It is interesting to see them experience this all for the first time.

It rained last night so there are more bugs today than I remember from last year; we are all prepared though - with lots of bug repellent! Nyumbani is just as magical as I remember, and I am in awe of the children who remembered me instantly! It defines the "warm and fuzzy" feeling! We arrived to smiling faces and very sweet signs on our doors. They all say the same thing and I have included a photo of one: "Welcome Tomi and Dr. Yell, We missed you, our friends. We love you." That pretty much sums up our first night!

I will write more later or tomorrow!

All of our love:)
Dr. Yell:)

Children welcome us.

February 21, 2010 - 3:03p.m. (Kenya time)

Hello- or should I say "AHH-Lo?"  That is how Mungai says hello. It sounds like "Ahh-Lo" and is really cute.

I am extremely tired, so this again will be short entry. I was so excited this morning. I was awakened at around 6 a.m. (Sunday morning, Kenya time;10 p.m. Saturday night, Philadelphia time), by two sounds: the rooster that lives close to the guesthouse and the laughter of the children! The latter made me too excited to fall back to sleep. I was so eager to start my day and reunite with the children I had not seen last night when we arrived.

This morning was Mass with all of the children, staff, and volunteers here at Nyumbani. The service was very nice (I have to admit though that the pile – literally - of children that were on my lap was my favorite part!).

After Mass, we met as a group to scout out the perfect location to do the in-service training that we have planned for this week, then we had tea with Sister Mary, the director of all things Nyumbani*. After tea we piled into Sister Julie's car and went to the Nakumatt (the Kenyan grocery store). I bought my SIM card and a phone card - just in case of an emergency- and we each bought some food and items we needed for our time here.

Upon returning home from the store, we got changed and immediately began setting up the clinic, unpacking supplies, and discussing and deciding as a group how we want to organize tomorrow's patients. We have 75 children as well as approximately 30 caregivers, medical officers, nurses, and clinic managers coming from two of the Leo Toto programs. As of now the plan is that three of the students and myself will greet the children and their caregivers, and get the testing started. During this time Dr. Tomi will bring the in-service participants over to the classroom and welcome them. After Dr. Tomi welcomes the group, she and I will switch; she will precept the students in the clinic, while I teach and lead the in-service training with the aid of Theresa Mamah, one of our second year students on the trip.

Working with the children of the Leo Toto program, who are from the Nairobi slums, is a different type of experience than testing and working with the children from the Nyumbani Children's Home. The children from Kibera for example, who are coming tomorrow, are much more shy and quiet than those from the Children's Home. I am looking forward to teaching the in-service training, and of course experiencing the screenings with the students. I can't express how much I am enjoying seeing this opportunity through their eyes as well as my own. The beauty of working with students, and bringing new students here each year, is that I get to never become jaded by this experience. I have the distinct  pleasure of witnessing this experience envelope a new set of students each year, and for this I am very grateful.

I am also very grateful to all of those who donated funds, supplies, and DVDs for the children. This trip would not be possible if it were not for the generosity of others. I will keep everyone posted as things progress. Please enjoy today's pictures:)

Warmest regards from a fuzzy heart!
Dr. Yell:)

(* For an explanation of Nyumbani Children’s Village and their programs go to http://www.nyumbani.org.)


February 24, 2010    3:19 p.m. (Kenya time)

Hello everyone!

Dr. Yell and friend.Seeing patients.

Sasa? “Sasa” means several things in Kiswahili, including a "what's up" type of greeting. I find myself saying “sasa” a lot. I have been using other words a lot here (excuse my spelling if it is incorrect): “sawa,” which means good, fine or alright. I use sawa when I am telling the child that things are alright. “Pouwa,” which means cool; “asanti sana,” which means thank you very much, and “karibu sana,” which is you’re very welcome.

I learned many more words; however, as of 6 a.m. tomorrow morning they will mean very little and do me very little good, as myself and the students, Siwe Merritt, Kim Basilio, Nicole Deweese and Theresa Mamah, are heading out to Kitui in a van to see patients and set up shop at the Nyumbani Village. For those of you who are not familiar, the Village was created on 1,000 acres of dry and barren land in a rural area of Kenya. The people who helped to set it up made the bricks for the structures out of the soil on which they stood.

It is an amazing place where children who have lost their parents and families to HIV/AIDS live in these small brick structures with approximately 14 other children of different ages and one “Shou Shou,” a grandparent. Interestingly, the parental generation in Kenya has been severely depleted by HIV; therefore, the children are left to fend for themselves AND the elderly are left without adult children to help them. This realization lead Nyumbani to put the saying "It takes a village to raise a child" to the extreme, and they made these new "families" from 14 children and one grandparent.

Today was the final day that I gave the in-service course on ear health, hearing, and the diagnosis and treatment of middle ear infections to the healthcare workers from the Nairobi slums. It was a very interesting experience to teach here. I LOVED it! I was able to see very quickly the impact that the course had on these individuals. They are eager and interested in learning and applying the new information. I am going to get to work soon on the next level of education that I hope to provide the next time I am here!

The students seem to be enjoying themselves. The two new students (Theresa and Nicole, who did not come last year) are glowing. It is so wonderful to re-experience, through them, the shock of how wonderful these children truly are. I have been working to get some great video footage. The kids LOVE to see themselves on camera and video camera!

I am falling asleep from an exhaustion that can only come from a blissfully busy day working at Nyumbani here in Kenya.

All of my love to everyone stateside!
Dr. Yell:)


February 27  (1:05 p.m. Kenya time; 12:05 a.m. EST)

Watindata! That is Kikamba (pronounced key kam ba) for a greeting. Kikamba is the language that we were thrust into when we were at the Nyumbani Village in Kitui, Kenya, approximately a five hour drive east of Nairobi.

Kim Basilio enjoys the view.

The ride there was not so bad. I actually remembered it being a bit harder than it actually was. Perhaps that had something to do with being squished between two large bags of equipment last year (bychoice; I thought that it would let me stretch out better than a regular seat - not one of my brightest ideas!). Anyway, we left Nyumbani at 6 a.m. and arrived in Kitui at the Village in time for 10:00 a.m. (well 10:30) tea time.

[Side bar: I love the tradition of tea here. I believe we should institute it in the States - or at least at Salus University...I know that I am not the best at stopping work for lunch most days; however, I am learning to love the tradition of everyone stopping work - stopping everything - to sit, chat and have a cup of tea at 10:00 a.m. and 4:00 p.m. Even the children have teatime. It is actually an odd sight to this America - seeing a three year old child drinking tea! Today we worked straight through 10 a.m. tea, and I was really missing it by 4 p.m.]

Back to the point...We were a half hour late for tea because we stopped on the way to Kitui for a fuel, food and potty break (oh, and tea, of course!). We stopped in the town of Machakos. It is interesting how some things are more pricey here in Kenya, whereas others are ridiculously inexpensive. Six of us had breakfast for less than 100 Kenyan shillings (KES) - that is less than $13.00! My breakfast - one of the lighter ones of our group - consisted of a cup of chai (tea), an andazi (yummy dough deliciousness), and a meat samosa. It came to less than a total of $1.00. That would have cost at least $5 - $7 in the states!

Once we arrived to the Village, we had tea with Nicholas and Stacey. Nicholas is the manager of the Village; he is a wonderful guy, so welcoming. Stacey is the person who arranged our time there. She is very talented and it is amazing to consider that she went from working for pay in luxury hotel hospitality services in Palm Springs CA to volunteering at the Village, where there is no working plumbing!

Kim Basilio checking hearing.Taken from ears!

After tea we got right to work setting up the makeshift audiologic clinic in the Village’s clinical building. We were able to see over 150 children and some grandmothers in a day and a half, even with the fact that the power was out more than it was not! The students continue to amaze me, they are doing so well. They are getting such an amazing education here, as am I. The first day Theresa and Nicole were desperate foranswers, straight ones. They had to learn quickly that I could not tell them exactly what to do, as I had no idea what was going to walkthrough the door, or if the power would stay on, etc. Here the students really have to use otoscopy as a diagnostic tool so much more than they do currently at home. Additionally, they have to learn to think on their feet. I have been spending all of my time (now that the in-service trainings are over) doing cerumen management, both while in Kitui and now that we are back at Karen. This means that I cannot just drop what I am doing every time they have a question about how to handle something. Obviously, they always can come to me for help; however, the students are learning to ask themselves what they should do before coming to ask me. They are starting to know that I will be asking them "Well...what do you think you should do?" I am proud of each of them!

I realized that I said I have been doing a lot of cerumen management since I have been here. I have a slight correction to that. In Kitui, yes, I did remove many a wax plug; however, more common than even wax were the beans, and beads, and rocks and sticks that I had to get out of kids ears (without any specialized equipment like head lamps, or suction). I love it! I get frustrated when I cannot get something out; however, luckily that was not the majority of the time. I had one case in particular, I felt like I failed. A child had a bean stuck in her ear - a kidney bean (or it looked like a kidney bean). The biggest problem was that it was very hard in texture, had split apart in her ear and is now bigger in size than her ear canal. These are the types of things we are seeing here. I will send some pictures when I have them. It is nuts.

We left the Village around 4 p.m. yesterday and made our way back to the Children's Home. It felt like coming home after a long camping trip! You miss your room, your bed and most of all, your shower. I told Tomi (Dr. Tomi Browne, who did not go on this trip with us) about the testing, etc., and then took the best shower of my life and went to sleep. We woke up this morning, unpacked, and then we started working with the Nyumbani kids.

Kim with little patient

Above: Kim with little patient.

Yell with little patient.

Above: Yell with little patient.

Yell with high school volunteers.

Yell with high school volunteers.

Siwe Merritt with patients.

Siwe Merritt with patients.

Theresa Mamah and Dr. Inverso.

Theresa Mamah and Dr. Inverso.

I have tons of pictures and videos. Anyone who watches will have to excuse what I look like (I can only speak for myself), it is hard living in Kitui!

All the best
Dr. Yell:)

P.S. We finished up yesterday in Kitui, did a sustainability tour (which can and probably will be a blog entry of its own).


March 2, 2010    6;35 a.m. Kenya time (5:35 p.m. March 1 EST)

Sasa?
I hope everyone reading this is well. It is at this point in the trip that home starts to seem like here and the idea of leaving seems foreign. I wanted to write about something that I forgot to mention in an earlier entry. Audiology in Kenya is practically non-existent. We have learned that there are only four individuals in the whole of Kenya with the job title of Audiologist. They have a nine month post-high school course and then work usually in hospitals under the doctors, or ENT consultants. They are not responsible for balance, only hearing testing. We do believe however, that we may have converted a few of the high school aged girls here at Nyumbani into future Audiologists or Audiology assistants!

 We needed some help with KiSwahili interpretation/translation when we were working with the children from the Leo Toto Program, as English is less common with this population. We had four of the high school aged girls who were on break from school (high school here is boarding school) who wanted to help us. We gave them each a pair of red scrubs to wear so we could identify them easily. After the first hour, we didn’t even have to tell them what to say anymore; they would go right into instructions for how to participate in a hearing test, to sit still and quietly while we test the ear drum for tympanometry, etc. They were amazing. Two of them later came to me and told me they wanted to be Audiologists when they finished with school!

We thanked them by having a pizza party for them on their last night before returning to school. We also had a short ceremony where I gave them each a Salus University pin and thanked them for their service. It was a very special day. I have attached a few pictures from the ceremony day. The girls really related well with our students, it was beautiful to watch them interested and asking questions about the education involved with being an Audiologist.

Yesterday and today were our "free days" here in Kenya. This year we decided not to do a full overnight safari for a few reasons; however, we hired a driver from the tour company that Nyumbani uses exclusively and we had a day trip. We woke up very early - 5 a.m. - and headed to the Nairobi National Park, where you can have a sort of mini-safari in the middle of the city. Well, normally I would rave about the weather here; however, it was COLD and we were soaking wet from rain. Yes, rain and cold in the Kenya dry season!

We did manage to see some giraffe, a male lion, lots of water buffalo, a warthog, and some zebra. Not too shabby! Then we headed to this amazing elephant orphanage, set up to rescue and rehabilitate baby elephants that are orphaned or injured. They were so cute, rolling in the mud. We got very muddy but could not help but take the opportunity to pet them and learn all of their stories. Did you know you can adopt a baby elephant by distance? They will actually send you pictures and status updates on their re-entry into the wild. All for $50 USD - not bad huh? They do amazing work there. It is so obvious that the workers love the elephants and vice versa.

We then went to lunch, which was an adventure to say the least. We ordered this roasted meat called (phonetic spelling: “yuma chama.” Three of us ordered beef, one person ordered lamb, and one ordered fried chicken. Well, they brought us one big hunk of goat. Yes, goat! They decided that the goat meat just looked better, but did not think to tell us. It was an interesting experience that none of us will soon forget. It is a good thing that Siwe really likes goat meat!

After our "meal" we went to what is called the giraffe park. I was hesitant at first, as I am not big on zoo type places or anywhere that animals are forced to live and get petted by humans. I soon learned however, that this is not your average park. There is a species of giraffe here called the Rothschild giraffe that lost much of their natural habitat in western Kenya and faced extinction. In 1974, two highly endangered Rothschild giraffes were moved onto the estate where generations have thrived and still live today. The giraffes here mate and then are released into the wild. When the group started, there were only about 130 of these giraffes left in the wild. Now there are over 500. We got to meet four of these giraffes, three females and one little baby male giraffe. I can't wait for you to see the photos. Giraffes (like elephants) choose whom they like and are smart enough to know what/who poses no danger to them, means them no harm, etc. Therefore, it’s alright for the giraffes that are set free later in national parks such as the Masai Mara (a very huge natural reserve in Kenya) to be comfortable around humans. I have never been that close to or felt such an intimate connection with a wild animal before! They are so magical.

Yell up close and personal with giraffe.

Yell up close and personal with giraffe.

Today, I am busy compiling paperwork, looking at audiograms (we have well over 300 to look at), and making recommendations as to what the next phase of the project should be. This morning I was able to spend some time volunteering in the kitchen, sorting rocks and twigs out of beans for our lunch. Also, I got to spend some time with the children in the respite care unit here. They are already looking stronger since we first got here. One of the children however, is not so lucky- he had to be moved out to the hospital. The staff here is amazing - you feel it more every day.

Since we have been here, a young, three-week old baby girl was dropped off by a police officer. She was found basically thrown away in a garden. You would have to hear the story of her arrival from Protus, the children's home manager, as I cannot do it justice. She is beautiful though, and the children named her Gift Natasha. They have fallen in love with her; however, we learned today that she was tested and came up HIV negative. This means that she will have to leave here for an orphanage for negative children. Nyumbani has funding only for HIV positive children. Luckily for little Gift, her chances of being adopted are much higher now. In the past 20 years, Nyumbani has seen only one HIV positive child fully adopted, whereas they have had 30+ children, who came here but ultimately tested as negative, be adopted.
OK, that is all for now. Asanti sana for reading this!
Dr. Yell:)

P.S. I am sending lots of pictures, some of myself and Theresa Mamah with the giraffes; one of Siwe Merritt testing; one with all of the high school students who volunteered as assistants for testing and translating, and one with Nicole Deweese distracting a child in Kitui while I was working to take stones out of her ears! Enjoy: