April was supposed to be a really exciting month for me ... I had plans to visit the coast over Easter weekend and had also volunteered to be part of the team for Ambassadors In Sports camps running in Nairobi (the international equivalent to Christians In Sport in the U.K.). Unfortunately, on the last Friday of March, the government announced a lockdown due to rising Covid cases, so my exciting plans were thwarted. 

The lockdown announcement here was almost identical to lockdown announcements back home - the prime minister appeared on TV screens dressed in a suit and tie, and proceeded to address the nation. There is an old TV hanging from the waiting area outside the Emergency Department and a large group of people crowded round when the announcement was made at 3pm. There was a collective groan as lockdown was confirmed. Walking back to the hostel that afternoon, there were multiple smaller crowds of people gathered around radios by the side of the roads. Lockdown here is very different from British lockdown. Only 5 counties are affected - essentially Nairobi plus the 4 surrounding counties, one of which is Kiambu where Kikuyu is. There are two main restrictions - a curfew of 8pm - 4am, which doesn’t affect me too much, and a travel ban from the 5 ‘red counties’ (I was relieved to hear that travel between red counties is still allowed.) All shops and markets have remained open; restaurants are still open but only for take-away. However churches and schools have closed, which is a shame. The consequences for breaking Curfew vary depending upon where you are. In Kikuyu, the police are known to ‘rough up’ anyone found wandering the streets after 8pm (the first night shift after lockdown was apparently full of people having been ‘roughed up’ by the police). However, in the wealthier areas of Nairobi, the police arrest you until they are given money. 

When I first arrived in Kenya, there was very little talk of Covid compared to that at home. Everyone was told to wear a mask at all times (even outside) but adherence to this rule was poor with most people wearing their mask as a kind of fashion accessory, dangling off one ear or tucked under their chin. In the two weeks leading up to the lockdown, there was definitely more of an awareness of Covid in Kikuyu, as close relatives or friends within the community became infected.

We also started seeing more and more cases in the Casualty dept of the hospital. Initially there would only be a couple of cases per week. By the end of March, there was on average about 5 cases per shift. Kikuyu hospital is shielded from Covid to some degree because of the lack of resources. There are only 4 beds for Covid patients, so the ‘isolation unit’ is almost always full. Plus, there is no High Dependancy or Intensive Care Unit in Kikuyu. For this reason, the majority of unwell patients with suspected or confirmed Covid are usually directed to a larger hospital in Nairobi. However, often it is really difficult to persuade the relatives of the patient to do this - we have often been accused of not caring or not willing to help very unwell, hypoxic patients who require critical care. It’s quite a difficult situation. To help with this problem, the nurses decided that for any possible Covid patient, the doctor should ideally assess the patient in the back of the car, before they step foot in the hospital. Although it sounds ridiculous, this is definitely the most efficient and straightforward way of caring for these patients - by directing them to another hospital immediately, before there is any record of their attendance in Kikuyu hospital, and most importantly, before any payment is made. 

A daily update on Covid cases, deaths etc is published by the Ministry of Health on social media; the data is also published on the national news website. It’s impossible to know the accuracy of these numbers because testing is not done as widely as it ideally should be. The test is expensive (about 70-75USD in most places; in KIkuyu hospital it is 140USD) and, from my experience, it is not uncommon for patients to refuse testing. From the published data, the infectivity rate has fallen from 51% at the end of March, to 10.5%, which is promising. There are rumours that the lockdown will continue until May 29th ... I hope and pray it will not be as long as that! There are two types of vaccines available in Kenya - one of which is the AstraZeneca. Healthcare workers were prioritised in the vaccine rollout, after which anyone could request a vaccine, with no particular priority given to any groups of people. I find the attitude of Kenyans towards the vaccine really quite frustrating ... several of the nice, sensible people I work with have refused to take it due to fear of side effects. There is an attitude of skepticism and suspicion, and even a belief that the vaccine is poisonous in an attempt to kill off the African population. Moreover, it is quite possible to get a ‘fake’ vaccine (a vial of water injected) for people who may require proof of the vaccine but are reluctant to get it. I’ve found it easier to stay out of any discussions regarding the vaccine. 

Hospital News

Anyway, enough chat about Covid. Things at the hospital are going well. One fairly common presentation we see in the ED is complications from childbirth. Home births are very common here, without a midwife of course, and can lead to devastating effects for both the mother and baby. In the past 6 weeks I’ve seen two cases of post-partum cardiomyopathy - both patients were young mothers, in severe heart failure as a result of childbirth. This is something I had never seen before in the UK. The baby in the picture is a patient I treated last week - his parents brought him into hospital at 36 hours old due to inability to feed. The mother had had a difficult home delivery - she was concerned about the baby immediately and attended a local health clinic within hours. The physician or nurse at the health clinic recognised that this baby was very unwell but did not know how best to treat him, so sent the mother and baby home. The following morning the baby presented to Kikuyu in multi-organ failure due to neonatal sepsis. The family were unable to afford the treatment they required at Kikuyu, so left the hospital with no treatment for the baby and promised to drive straight to a government hospital in Nairobi. However, even at a government hospital, I doubt the family will be able to afford the intensive care therapy their baby requires. 

And a slightly more light-hearted (borderline inappropriate) case: A young man came into hospital having been head butted by a donkey and subsequently breaking his ...well, let's just say, for a guy it wasn't good news. It looked so sore!!  (A reminder that I did come to Kenya imagining that I might deal with things slightly different from your usual Edinburgh Royal intakes). 

The 11th plague of Egypt/Kenya?

The rain has started here in Kikuyu - it tends to really pour from about 7pm into early morning and then the clouds clear and it’s nice and sunny from about about 9am. The sun is so hot that the ground is usually completely dry by late morning. I have learnt an important lesson about rain in Kenya in the past week ... there’s a particular type of ant you get here, which has a large ant-like body but with 4 huge wings attached. When the rain starts at night, the ant holes where these insects live are disrupted so the ants fly up in massive swarms and make a beeline for the nearest light. One evening I was reading a book in my bedroom when suddenly 4 of these flying ant things came in. I thought it was very unfortunate for 4 to have all flown in to my room at the same time, and quickly set about slapping them with my flip-flop. By the time I had finished with those four, I was horrified to see about 20 more had come in behind them! That’s when I realised the swarm of hundreds of these insects battering against my window which was open just a crack. I slammed the window shut and proceeded to attempt to slap each of these nasty insects with my flip-flops. Just as I thought I’d completed my work, I looked around and saw there were several more crawling in under the door frame! I was absolutely horrified. I taped the door shut to close any cracks and once my room was completely secure I was able to kill all the flying ant things in my room. It was horrible! Of course all the Kenyans found my retelling of the nightmare hilarious at work that week!

Bit of a different newsletter this month ... less exciting (although the picture below is a highlight!) and more Covid-esque. Hoping and praying that lockdown will be lifted in the next few months so I can get a bit more of normal Kikuyu life, eg, the church opening again with its attached groups and the school opportunities which were just starting when lockdown kicked in.


Nice to get a parcel from home - had given up on it reaching me. Don't look too closely at details of contents!


Thank you for your continuing interest and support.

Asante Sana!

Rebecca