A tale of twins

I have two West African friends, they are sisters. Twins. The first born’s name literally translated means “the first to taste and see the world” while the second born’s name is “the other.”

Yesterday we delivered four sets of twins in four hours. The first were vertex / vertex and delivered vaginally in a multip. Such a common event that nobody thought it was worth my while to attend the delivery.

The second set was a precipitous pre-term breech / breech vaginal delivery in triage in a primip. Neither the woman nor I was aware that she was having twins and the breech was diagnosed as she got on table and the bum was crowning. My internal voice was screaming “God help me I have never done a vaginal breech delivery,” and my outside voice was calling for help, and a line, and oxytocin, and someone to hold the legs, and to push, and to stop pushing, and the head, can I get the head . . . Then all I could hear is mother screaming “Thank you sweet Jesus” when the baby was born. And “Sweet Jesus” again when I told her “watoto mbili.” There are two babies. And help has come. And the babies are rushed to the nursery.

After that there were two more twin breech / breech deliveries. Both C-sections: one in a labouring multip and the other in a pre-eclamptic, anemic primip with O negative blood. Enough to cause palpitations on a regular day but yesterday they seemed like ‘the other.’ I felt traumatized and exhilarated and terrified by the twin breech vaginal delivery. Perhaps the way first twin feels being the first to taste and see the world.

The lifecycle of a Kenyan woman . . . through the headlines

If the newspapers are a reflection of the views of a community, what do the headlines say about the value of the Kenyan woman in society?


"Three in every 10 teachers think it is wrong to dismiss teachers who have sexual relations with students. At least two in every ten teachers think pupils who are sexually harassed by their teachers or fellow pupil are to blame for the incidents."

"Inspired by an ongoing national campaign against violence targeting girls in primary schools across the country, the study painted a grim picture of schools that still perceive girls as the weaker sex. For example, nearly half of the boys in these primary schools believe it is alright to beat up girls in their class, if only to prove that they 'love' them."


"Today, the world marks the International Day of Zero Tolerance to FGM (female genital mutilation) to highlight the dangers this traditional rite is causing to millions of girls worldwide. But do we really care? Should the welfare of Kenya's girls and women be our collective responsibility?"


"It is expected that as head of family, the man should shoulder the bigger financial burden. But over the last few decades, women have become increasingly empowered economically. Plum jobs with the attendant high perks are going to women because they are deemed to be more efficient as managers. An iron lady who manages 300 people and is used to getting things done her way is a man’s worst nightmare. His pride will force men to avoid this variety because he fears he may be forced to surrender his authority as a man. And, of course, his ego will also not allow him to play second fiddle."

"Women peak at between 21 and 25 years. After that, it’s injury time physically and emotionally as far as romance is concerned. This is the window that make or break women’s entire lives. . . . After 28, suitors disappear and the girl enters the next phase of her life. . . . After 30 years, fear sinks in and with pressure coming from family and friends to settle down, the standards are lowered even further. She starts casting an eye on married men and eventually resigns to being merely ‘the other woman’."



"Dear Fida-Kenya, I voted against the new Constitution during the last referendum because of issues relating to the abortion clause and termination of pregnancy. What does the law really say about it? -Kamau, Nairobi"

"Dear Kamau, . . . What is provided in the article [of the new Constitution] is that everyone has the right to life. . . . However there are instances where abortion may be permitted under the law - when in the opinion of a trained health professional, there is need for emergency treatment of where the life or heath of the mother is in danger. . ."


"After repeated childbirths the pelvic floor muscles tend to slacken. . . . Every woman should know how to do the Kegel exercises, the ones that tone up the pelvic floor by controlled contraction release of the pelvic muscles. . . . An electronic pelvic floor exerciser tones up the pelvic floor muscles without much effort on the woman's part."

Every cloud has a silver lining . . .

And every lake should have a pink lining, like Lake Bogoria. It's a small body of water in the Rift Valley that is salty and hot. Honestly, it's hooooot. The temperature reached 39C in the shade and was unchartable in the steam of the hot springs. You can boil an egg in 5 minutes flat on the edge of the lake.


Given that description, one would think the lake would be a barren wasteland. But it's not. It's filled with pink flamingos. Millions of them. Apparently they enjoy a slow roast. It was a truely incredible sight.




Since I'm on the topic of animals, here are a few others that I've seen on my short sojurn. If you have delicate sensibilities you may want to avert your gaze. Unfortunately I don't have a super quick camera so there are a lot of animal derrieres as they turn to run from the girl trying to take their picture.

If you were a rock star, I would be a groupie

Naana to Hillary Mabaye, a gynaecologist who specializes in vesico vaginal fistula repairs. I had seen him do one VVF repair and was in total awe. Then, he came in to help us with a particularly difficult vaginal case and I was blown away. He was completely inspiring: humble, kind and with amazing skill. When I grow up, I want to be a surgeon like him.

Like a bird in the tree tops

I flew into Nairobi on one of the biggest birds the world has seen: a white breasted, blue backed Boeing 747 that nests in Amsterdam. The next day, I flew to Eldoret in Western Kenya. Upon landing, I discovered that I was higher in the sky than I had ever been. At 2000m above sea level, Eldoret is perched on the edge of the Rift Valley with a view of the history of humanity.

Indeed, humanity in all its depth resides here: from the gentle touch of a nursing sister to a patient dying of cancer in hospital to the torching of 50 people seeking refuge in a church during the 2008 election aftermath to the physicality of the long distance runner. This quiet dustbowl of a town betrays little of its stormy past on the faces of its people. Quiet and reserved unlike my kin the Ghanaians who are boisterous and bold.

One of the night watchmen said that Kenya is like the mother of East Africa who welcomes the children (the refugees, the displaced, the homeless) of her troubled relatives who surround her (Rwanda, Burundi, Uganda, Sudan, Ethiopia, and Somalia).

It’s hard to know what to expect when one travels somewhere new. Hopefully, I will be welcomed by mother Kenya too.

1/12 th to go

Today I am 29 and 11/12ths. Most people stop counting their age in months or fractions of years when they turn ten. But I have persisted. And today, I am twenty nine and eleven-twelfths. The significance is this: it is the deciding moment when your age either progresses or remains 29 until you are 92 and have wrinkles deep enough to hide your bubble-gum lip gloss.

Now, I would like to be one of those women who, like my oma at 98, looked in the mirror for the first time in a few years and said, "who is that old woman?" Her self perception of age being a stark contrast to the reality of her longevity. I unfortunately have the opposite problem, being introduced as "une petite fille" to my new patients who are often younger than me and who are referred to as "madame." While I wouldn't want my age to measured by the length of my crow's feet, I would like to at least progress into adolescence for the sake of my professional life.

Well, at least I have one month to decide what my next birthday will yield.

Ex-pats Cry Twice: The Dhaka Club Scene

Apparently the saying goes: Expats cry twice - once when they are told they have to go to Bangladesh and once when they have to leave. Why? Because Bangladesh is considered the bottom rung of locations to do development work in the world. Africa is at the top, BD at the bottom. This is what I've learned from all the yearning to go to Africa I've heard from the Aid workers here.

Now why do they hate to leave? Because of the clubbing, of course. These aren't clubs in the sense that you may be thinking, like say discotec. No, these are Clubs in the most neo-colonial sense of the word: Country Clubs. And you have to be a citizen of the aforementioned country working with purpose in Bangladesh to become a member. Some only allow membership from the diplomatic community, some based on language but all have restrictions on the number of Bangladeshi's that are allowed in at any given time. Heaven's no, they can't become members, they can only be signed in as guests and only a few at a time because one wouldn't want to sully one's reputation. Once you are a member of one club you have access to all the rest. Except, some clubs (read the American Club) think other clubs (read the BAGHA Club - British Aid Workers Guest House Association Club) are too lenient with the locals and have placed extra restrictions on other club's members.

What's so great about these clubs anyway that everyone is vying for a spot at the membership roster? Well the alcohol and the scantily clad women, of course. These are some of the few places that serve alcohol and where foreign women can wear whatever clothes they want. They hold parties with both of the above present as well as music and dancing. Essentially they are an oasis of the west in Bangladesh. This wouldn't be so bad . . . if it weren't for the racist restrictions. I'm told that everyone tries not to think about that part and just get on with life instead of actually doing something to change it.

On the other hand, maybe it is more representative of the West than I am comfortable to admit.