Days always seem to start out so peaceful here in Kenya. I really enjoy the bus ride to Botoro because all along the way you see people just beginning their days as the first rays of sun come over the hills and light up the land in such a way that it is almost breathtaking to behold. The roads are always busy with foot traffic in the mornings as people are walking to work, market and school. Women are out watering their gardens, and the cows and goats are just grazing along. A new beginning each day.

Prior to the bus ride, we had our normal breakfast at the hotel of eggs, sausage, bread, pineapple and juice. This morning we were joined by the LCMS mission pastor, Pastor Shauen, who is living in Nairobi. He serves East Africa, which includes Kenya, Tanzania and Uganda. He was just traveling back from Uganda, so he spent the night at our hotel to visit with us and check in on this new clinic site in Botoro. He mentioned that his hotel in Uganda did not have any running water, just a jug of water outside his room that he could use. He was grateful for the amenities at this Bluu Nile hotel in Kisii. That really puts things into perspective!

Clinic day begins with a devotion, and today it was spoken by the LCMS mission pastor. What a great way to begin the day. I spent today in the triage room. Here I worked with an interpreter, and we asked each one of the people being seen at the clinic what his/her chief complaints are. We only allow each person to list up to three chief complaints so that the providers have a chance of keeping up. I am discovering that these people have long lists of ailments. Many of the same complaints come from the majority of the people, and these include joint pain, back pain, stomach ache and headache. I think my joints would hurt a lot more if I walked multitudes of miles each day and carried all of my supplies on my head! The children usually report fevers, headaches and stomach pains. We have many people who report eyesight problems. However, we do not have anyone here who can perform ophthalmologist duties. Once we tell them this, they just proceed onto the next ailment that is bothering them. Eye clinics would serve thousands here, I have no doubt!

In addition to inquiring about the patient’s chief complaint, I ask about the person’s occupation and then check their blood pressure, heart rate, temperature and oxygen level, if indicated. I have discovered that the primary occupation in and near Botoro is farming, and most people farm maze, beans and wheat. Ironically, we did not come across any coffee or tea farmers. There are some younger people, as well as the educated adults, who speak English. Many others speak Swahili, but there are those who speak the native village language of Kisii. And the translator I am working with speaks all three!

Triage is an interesting job because you get to see all of the people that come through. There are two of us in the triage room checking the people in. However, you rarely get to see what the people are diagnosed with, which just keeps your interest piqued. We saw many more families today, and they check in as whole units. So, for example, a father and five children checked in with me at one point. The really young children do not love being seen at the clinic. I would merely put my stethoscope in my ears to listen to the child's heart, and he/she would just start screaming with real tears falling down the cheeks. I am not sure if they are scared of us as white people or just scared because they do not know what we are doing. Perhaps it is a combination of the two.

Today we did see some more interesting diseases that are not as common in the United States, including sickle cell anemia in a young child, aplastic anemia in a young child, scabies in children, HIV patients with opportunistic infections and very high blood sugars (650 in one man!). We did have a very touching case. A mother brought her two children in to be seen. One was two years old, and the mother handed me the CT results and the discharge papers from the hospital several months ago. The young boy had a brain infarct (stroke), and his brain was slowly atrophying (shrinking and dying). The boy was very malnourished, and the mother was concerned that her son was unable to suck and swallow. The doctor confirmed that there is nothing that can be done for her child and that he is dying. At this point, medicine failed. However, Pastor Bill in our team prayed with the mother, and the child had been baptized. It was neat to have the ability to offer spiritual help when modern medicine failed.

Overall, our little medical clinic and team saw 230 people today. We worked from 8:30 AM until 5:30 PM, and we still turned away large quantities of people. Despite not being able to see everyone, I do feel that there are patients who are super grateful for the care, especially the elderly patients. At the end of the day, the children from the neighboring school yard come over the fence to play and say hello. They seem utterly amazed by us wazungu (white people).

In the middle of the day we did take a break for lunch, which still feels very inappropriate and inconsiderate as all of the Kenyans wait to be seen. The women at the church and school made us ugali (which is growing on me), chicken, rice, potatoes, stewed veggies and mini bananas, and they offered us soda in a glass container (Coke, Sprite, or Fanta).

By the end of the day we were all pretty exhausted. The drive home is always very quiet as we watch all of the Kenyans gather wood or cook dinner, walk home and prepare for the night. The hotel each night has cold juice waiting for us on the patio, which is quite nice. Tonight the hotel staff tried to cook us something that we are more used to I think. They made spaghetti with meat sauce, chapati (the tortilla-like items) and mixed vegetables. Catherine, the LCMS office manager who is a Kenyan, told us that spaghetti is not "real food." She said they only feed pasta to children here. Catherine said she has been to America a couple of times, and the only "American" food she enjoys is potato salad. Catherine did say that if someone is truly welcoming you into their home, they will fix you chicken and chapati. Based on the quantities of these two items we have consumed, I think the Kenyan people are happy to have us here! I inquired about foods that are prepared for special occasions, such as weddings and graduations, and Catherine said that pilau (spicy rice) and chapati are prepared and eaten for special occasions.

The dinner conversation became quite interesting as Catherine explained other Kenyan cultural differences. For instance, dowries are paid in Kenya for marriages. Kenyans do date, and there are not arranged marriages. However, a dowry must be paid by the soon-to-be husband to the bride's parents. The value of the dowry is set by the community the bride resides in. For example, in Catherine's community, her dowry is 100 goats (or the money to be able to purchase 100 goats). If a marriage ends in divorce, the bride's parents must pay the dowry back. Can you imagine this in the U.S.? So I inquired how people save enough money in order to be able to pay the dowries. Catherine explained that Kenyans do not plan ahead, so they most definitely do not save money. When the time comes, the community comes together and figures out how to pay the dowry. What an interesting concept—no worrying and everyone works together to make sure the payment is raised and paid. The same occurs when it is time for a child to go to school. Even though the family knew this would be happening, they do not save money. Instead the community helps raise the money when the time comes. Now is now in Kenya, and the people just deal with the situation when the time comes.

Children are raised by the community here in Kenya. The children run all around their village. Any community member can discipline a misbehaving child. The parents are told what happened and what the discipline was, and then the parents can choose to provide additional discipline if needed. The school system is also slightly different here in Africa. A child begins with nursery school at the age of four or five. This is followed by primary school and then secondary school. School is compulsory and is focused more on passing the required exams than on actual learning. A child can repeat a grade as many times as necessary until they pass an exam with a certain score. If a person chooses, they can pursue higher education. Colleges here are two year programs and universities are four year programs. The cultural differences are pretty amazing!

Overall, we survived a very busy day at the clinic. We are brainstorming how to keep order and still see as many people as possible. I think the villagers are spreading word about our clinic … hopefully we can meet the demand and their expectations!

Saint John's member Kimberly Pepmiller is in Africa through July 25 with ten other doctors and nurses, lending her medical skills at clinics in Kisii, Kenya, operated by the Lutheran Church—Missouri Synod's Mercy Medical Team.