Matatus'R'Us

Matatus are an essential component of the transportation grid in Kenya. By definition, a matatu is a 15-passenger van, with three bench seats and 2 rows of 3 seats each. The seats in rows 3 and 4 are very narrow, with a very narrow space between the folding seat next to the sliding door and the 2 seats. It's by far the cheapest - and least comfortable - way to get from point A to point B

A moving matatu with 15 or fewer passengers is a rare sight, however. I don't know if I've ever seen a matatu tout turn any potential passenger away. There's always room for one (or two or three) more.; after all, the tout's cut for each trip is based on the number of passengers he can cram in.  25 adults is not uncommon. Adults who are sometimes accompanied by children, live chickens, goats, potted trees, sacks of potatoes, and baskets of greens.

Here's how they do it. 

 a) at least 4 people (sometimes 5) are expected to fit on each bench seat;
 b) children are expected to sit on laps or stand;
 c) rows 3 and 4, the ones with 3 seats, including the folding one - are expected to hold 4 passengers each;
 d) the narrow space between the folding seats and the rest of the seats in those rows is sometimes considered a seat as well.

It's essential to have small money on you for a matatu trip. That's because the tout often "forgets" to give you change, or the correct change, and, particularly with westerners, will hope that you won't remember the rate you were promised or will be too well-bred to keep pestering them.

It's also essential to keep your wits about you and keep your hands and eyes on your belongings, particularly in the city. Enough said.

While the ride in an inter-city matatu may be uncomfortable, it's much less frightening than riding in an urban matatu. Urban drivers have no fear, and urban matatu drivers take pride in their recklessness, their willingness to . They speed, they create lanes where none exist, they race to get their vehicles into awkward spots first, then become enraged with their competitors when "someone" has to back up to avoid losing a mirror. Drivers are often egged on by their passengers, and particularly egregious maneuvers are loudly cheered.

Trainings in Mumias

The highlight of my week in Mumias was the series of communication trainings I did with Rachel and David. The first was set aside for teachers from surrounding communities, and focused on the use of pictures and picture boards for children with communication difficulties to use.

Two days later came a session aimed at parents of special needs children. We covered all different types of communication and shared strategies for incorporating language into their children's daily routines.

The third training, for community health workers, was the most satisfying - and not just because of the rapport David and I were able to establish with the participants - who, by the way, are all volunteers. The focus was on techniques for teaching parents how to infuse language enrichment into multiple daily activities with their children.  Group members spoke at length about the poverty in their districts, and we were able to adapt the discussions to take that into account. Most of them really "got" the message, appreciated the information, and seemed confident that they would use it. Their enthusiasm was truly palpable.

The community health workers learned so much from each other
that it seemed only fitting that they recognize each other and
pass out their certificates for the day's training.

I hope to take part in more of this kind of training in the future. The information is relevant to all parents, not just parents of children with special needs; special materials, toys or books aren't necessary for family success; there is such a wealth of knowledge the outreach workers have to share; and, getting this information out through community members the families already trust has a much greater impact than having parents hear it from outside "experts."

Of Locks and lights

Our hotel room in Mumias had such a unique system of locks - I just have to share it.

Outside view	Inside view

The door is padlocked and bolted from the inside at night, but locking the door from the outside when we leave in the morning is a very tight, two-handed process. It goes something like this:

- left arm goes through the little, square "window" you see in the picture on the left, and reaches up toward the sliding bolt (top of the left and right pictures).

 - left hand pushes the sliding bolt to the right and through the latch, and places the locking arm squarely over the eye hook. 

- right arm squeezes through the remaining space in the window, holding the padlock.

 - left hand slides the padlock through the eye hook (and thus also over the locking arm).

 - right hand clamps the lock shut.  

 - both arms withdraw and right hand tries to pull the little door closed (that door doesn't lock from the outside).  

Unlocking the door from the outside reverses the procedure, but adds the necessity of reaching up to the padlock and blindly unlocking it, removing the padlock, and trying to slide the bolt far enough to the left to open the door.

We just used the one lock to lock the door when we left for the day. There were 3 sliding bolts on the door to close when we were ready to shut down for the night, including one on the back of the little square door.

Because of  frequent power outages - and infrequent use of the hotel's generator - there was often a ghostly glow emanating from our room. Alicia and I would hunker down with our electronics under our mosquito nets (malaria is a serious problem in Western Kenya) for an hour or two of computer time, phone time, reading and conversing, booklights ever by our sides. Those booklights were lifesavers. We used them to help us see our computer/iPad keyboards, take our cold showers by, and even do our laundry.

My Week in Mumias - Parental Expectations

Parents everywhere want the best for their children. Above all, they want to know that their kids are "OK," that they're developing on schedule physically and mentally. That their bodies, minds and speech are all developing on schedule.

Parents in Kenya are no different. Inability to communicate through speech is one huge concern for most parents there. If their child could just speak, everything else would fall into place. Serious educational challenges, severe behavior problems -- these are not things they ask anyone for help with. But speaking? Now that is a problem! And of course the "solution" is to find an "expert" who will "fix" the problem.

In the week I spent in Mumias we saw numerous children whose primary parental complaint was "he (she) doesn't speak." Even parents of toddlers had such concerns. We saw two adorable little boys - one 14 months old, the other 17 months old - whose mothers were worried because they were not yet speaking. Both boys showed normal development in non-speech areas - locomotion, fine motor skills, attention, turn-taking, appropriate manipulation and play with toys - and both vocalized an assortment of sounds. Rachael assured both mothers their sons were functioning within normal limits, and showing all of the precursors to the development of speech. We gave each mother strategies for creating a language-rich environment during play and daily activities.

Other cases in point:
 - 6 year old Delores - hyperactive, distractible, screams when she can't have what she wants or when someone attempts to take something away. Her mother accepted her behavior with a shrug, but wanted to know why she didn't talk.
 - 10 year old Alfred - mild hearing loss, enrolled in a primary class (5-6 year olds) this year but lagging far behind the younger children, follows instructions when accompanied by gestures, can't group items by categories. Here again, his father was happy he was in school, but wanted him to "talk more."

My Week in Mumias - Meet and Greet

I had wanted to come to Western Kenya because of the Mumias Educational Assessment Resource Center, which has the reputation of  being the best EARC in the country. Two Mumias EARC staff members - Martin (occupational therapist) and Simon (assessment teacher) - had attended the 4-day AAC/Assistive Technology workshop I had presented in Mombasa last year. I was so impressed with the questions and perceptive comments Martin asked, the obvious concern and affection both men had for the people they served, and their sense of dedication to their work; I knew I wanted to work with them if I returned to Kenya.

My roommate (more about her later) and I took a tuk-tuk to the EARC Monday morning with 3 heavy suitcases of donations we had brought. Everyone ooh-ed and ah-ed when the stacks of shoes, pants, shirts, splinting materials, OT, AAC and school supplies were spread across their conference table. Martin and Lillian, the orthopedic technician, were particularly appreciative of the 6" x 9" samples of splinting materials. I understood why when Martin showed me the bits and pieces of material they were currently relying on - many in the 3 to 5 inch range. A big thank you to Bill Schuhle of Patterson Medical, who donated the set of samples.

As I was introduced to the rest of the EARC staff, the reason for their exceptional reputation became clear. There is a culture of dedication and commitment that is supported and nurtured by director Martha Odhiambo. Team members are proactive in finding and serving children with disabilities and their families. They are supportive of each other and seamlessly filled in when one or more of their co-workers was out of the building. And all willingly step in to translate when needed.

I also finally got to meet speech and language therapists Rachael Gibson and David Rochus, who were going to be spending a few days with me in Mumias. Rachael is a volunteer therapist through VSO, which helps place and coordinate therapists in developing countries. She has been working at the EARC in Vihiga since last summer and coming to Mumias a few days a month (about 65 km away, but a 3-5 hour matatu ride). She's nearly done with her 1-year term and is planning a return to Kenya after a few months of travel in southern Africa and a 4-month return to the UK to raise funds for her second tour.

Also at the Vihiga EARC this past year has been David Rochus, a member of the first graduating class of the Speech and Language Therapy program at Makerere University in Kampala, Uganda. Growing up in neighboring Uganda has provided David with invaluable insights into cultural norms and expectations in East Africa. David has applied to graduate programs in Speech-Language Pathology in the UK and is waiting to hear about financial aid.

Photos Not Included

(sigh) I had been waiting and waiting to borrow a laptop so I could get web access and so I could insert photos in these blog posts, since it's not possible to use pictures when blogging on an iPad.

Alas, this Windows 7 laptop the EARC is letting me borrow can't read my camera card ( wrong type - SDHC; wrong size 4G). So, no gorgeous shots of the Indian Ocean; no photo guide to baking a cake in an outdoor cookstove, and no intriguing pictures of our medieval door lock. Those will have to wait until I return to my trusty Mac at home.
.
And yes, I do intend to fill in the nearly two weeks of missing posts.

The Road to Mumias

No water since last night. Not from the shower or sink. I had to use my drinking water to wash up in the morning.

Nairobi is in the midst of a water shortage. In the best of times the municipal water authority has never been particularly reliable. With the recent bursting of several large water mains, nightly news reports show long lines of people waiting their turns to fill large jugs with water to use for cleaning, bathing, washing clothes, and, after boiling, for drinking.

Mumias is a small town in Western Kenya, north of Lake Victoria. The scenery en route is beautiful. Most of the road is lined with trees. Part of the "highway" (one lane each way) overlooks Kenya's famous Rift Valley, and the vistas are breathtaking - gently rolling hills, small farms, a patchwork of lush green fields - thanks to recent rains - as far as the eye can see.

The condition of the highway varies. The first 150 kilometers or so is smoothly paved, with each lane clearly marked. Kenyans drive on the left side of the road, so passing is on the right. While our driver was by no means reckless, it's always a bit unnerving watching your vehicle heading straight toward an oncoming van or truck. One of the "perks" of sitting close enough to have a nearly unobstructed view of oncoming traffic.

The next stretch of road is . . . challenging. Potholes of every size, shape and depth cover the road, many courtesy of recent heavy rains. Our driver was determined to avoid these at a ll cost - more out of concern for his vehicle's suspension than for our comfort, I'm sure. It took every ounce of skill he had to manuever the bus around these obstacles, as well as to avoid the cows goats and sheep grazing along the berm who decided to cross the road to visit friends on the other side, AND the occasional large boulders that had not yet been removed following a recent landslide.

Kenyan Inventiveness

The old adage "Necessity is the mother of invention" may be more true in Kenya than anywhere else in the world.

Proof? Here are just a few examples of Kenyan ingenuity I saw at the Science and Innovation Week Expo at the Kenyatta International Conference Center in Nairobi today:

 -  a procedure that allows you to charge your cell phone while you walk, as well as to charge multiple cell phones. The inventor embeds an ultra-thin crystal into the sole of your shoe. The chip generates electricity when put under pressure. It's wired to a port you plug the phone charger into, and there is also an attachment with multiple ports for charging several phones at a time. This is a boon in a country with unreliable power, and particularly in areas that have no electricity. People in remote villages often have to travel by foot or hitch a ride to find a place to charge their phones - for a fee, of course.

 -  a crank-operated apparatus to create briquettes for cook stoves by mashing together sawdust and other discarded materials - newspapers, coffee husks, large seed pods, etc. The briquettes are ready to use after drying in the sun for 5-7 days. The inventor also reported the machine could be used as a juicer ("you clean it first," he informed his audience solemnly.)

 - a seed based absorbent derived from a common plant (the inventor would not divulge the name of the plant, and used for: quickly creating Braille copies of drawings and diagrams; a soil conditioner; an absorbent component in sanitary napkins. Still in the testing phase is an anti-diarrheal medication.

 -  remote control via cell phone to unlock a door..

 -  a microscope that can measure the size of stomata (pore openings) on live plant leaves in 30 seconds, plus a procedure to apply a mix of chemicals to shrink the stomata, allowing the plant to retain more water - a critical need in areas with limited rainfall. The procedure is being used on lisianthus, a major flower export.

 -  biometric ATM to deposit and send money. The ATM does a vein scan of your finger for ID, scans any bills you insert, then deposits the amount in a bank account, pays your bills, etc.
The vein scan is considered more secure than a fingerprint scan, which can be lifted and copied.

 - a simple process that can boost eucalyptus seed germination from 20% to 100% and speed up the growth cycle as well. Seeds are removed from the seed pods and soaked in water. They begin germinating in 2 days. Eucalyptus trees are an important source of lumber, firewood, animal feed, biodiesel, and pesticides in Kenya.

The granddaddy, the most far-reaching example of Kenyan ingenuity, is M-Pesa ("mobile money").
M-Pesa, which was launched in 2007 and now has over 6,000 users, is a cell phone based money transfer system. Users go to a local M-Pesa agent - there are thousands are all over the country - and pay to have M-Pesa credit put on the cell phones. They can send some of that credit to any M-Pesa user anywhere in the country. The recipient goes to their M-Pesa agent with their phone and is given that amount of money - to buy a bus ticket, pay a bill, stock up on seeds for the next planting.

Brilliant . . .

Speech Therapy in Nairobi

After an all-too-short visit with my friend Nduta, who has been fighting to make sure that children with disabilities in the Kibera slums get help, I joined up with Emma Shah for a 2-day stay. Emma is a part-time SLP working out of Aga Khan Hospital, as well as a full-time Mom, and a host of other roles that add up to much more than 24 hours each day. Emma's three children, 6, 9 and 11, are delightful - bright, articulate, and excellent conversationalists.

Emma has a truly varied caseload, so different than mine. We saw two young "locked-in" patients (saw them twice); an older gentleman with aphasia, an attorney with spastic dysphonia, a 12-year old stutterer, and a young woman with word-finding problems related to a possible neurological insult in childhood. Emma has been exploring AAC supports for the two locked-in patients and for the older aphasic patient.

We saw Mr. G in his home, by far the most spectacular home I've visited, with lush, beautifully landscaped grounds to match. His family was hoping he might benefit from a recently-purchased iPad.
We tried a couple of communication apps, and Mr. G smiled broadly when he realized his touch of a picture elicited a verbal message. He continued to experiment with the boards we had created while we reviewed programming with his tech-savvy young daughter-in-law.

T is a 23-year-old young man who had managed his own business outside of Kenya before suffering a subarachnoid hemorrhage that left him with a few inconsistent, barely discernable movements.He had been marginally successful using eyeblinks to respond to questions or to select letters on an alphabet board. Eye gaze appeared to be a much more reliable mode. He consistently and correctly (we checked with his mother) responded to questions by looking at "Yes" and "No" signs we taped on the walls of his hospital room. We also found a barely perceptible but fairly reliable head nod, just enough to activate a computer mouse (we had no actual switches to try) placed just below his chin. Of course, this kind of consistent response creates the potential for switch control of all sorts of computer applications, including text to speech and email, as well as switch control of an iPad , which his family already owns. His mother was interested in exploring different apps for communication.

R is 12, and had suffered brain stem damage in December of 2011 related to a congenital malformation. He appears to have no consistently reliable movements. Our timing was unfortunate both times we visited - the first time he was dozing off after a particularly strenuous ocupational therapy session. The next day we caught him about 3/4 through his OT session - his nurse had decided to take him to therapy early. Emma was beginning to have some success getting eye blink responses using a talking mat (a picture and mat system that has been used extensively in the UK; particularly successful with adults with aphasia and dementia). We also noted a possible small movement switch site at his left temple.

These cases illustrate an essential and unfortunate truth about communication devices and supports in most of Africa. Only a tiny percentage of families can afford mid- or high-tech AAC solutions, but money can't overcome the lack of  high-tech expertise and infrastructure. All the speech therapists I met in Nairobi were very dedicated and extremely knowledgeable, but there are only 7 in a city of more than 3 million, and most work part time. The variety of communication issues is so great that specialization is an area that most people cannot afford would be impractical. Technology costs 2-5 times more than in the U.S., and there are no experts to help with programming or to troubleshoot device issues. Charging of any sort of electronics depends on the vagaries of the power grid, which is reliable in its unreliability - power outages are the daily norm rather than the exception. Batteries are expensive.

Baking a Cake - Jiko Style

One of the highlights of my Mombasa stay was helping bake a jiko cake. The jiko is an outside charcoal cooker used to prepare - - - everyhing. Pictures tell it best, so there's not going to be too much actual text in this post.

The charcoal - sometimes people use branches and small logs as well - is in the bottom of the jiko.

Atop the jiko goes a large pot (our "oven") filled with wet sand. Stones are set in the center to serve as a base for the cake pan.

The sand (and stones) are heated.

The pan with the cake batter is set into the oven.

A lid is placed atop the oven, and hot coals are heaped on the lid to provide an all-around heat environment for the cake.

30 minute test - not quite ready.

15 minutes later - oops - the cake rose to the level of the lid and the top is a bit burnt.

Our cake - so moist that most of the bottom fell off. But no worries . . .

Stephanie prepared her special secret sauce that makes the cake's looks irrelevant - water, two different flavored powders, and a melted candy bar for good measure.

The result - delicious!

Mombasa visit

I'm so glad I decided to take the side trip to Mombasa.  I had a lovely, relaxing time with Stephanie and her family, got to observe at Stephanie's and Diane's schools, and collected memories that will remain with me for a long time. Even got an extra day there, courtesy of the Horizon Bus' "mechanical difficulties" on the return trip.

Some of the highlights:
 - walks along the beach during low and (nearly) high tide. I never tire of the incredible vistas, or the immediate sense of calm the sea brings. How can you beat this?

     

 - rousing games of Spot It! (seriously, this is the BEST game - fun, challenging, easy to learn and portable - it can't be beat.
 - cake baking on a jiko ( a small coal/wood burning hibachi-like stove). Sure, it was from a Betty Crocker mix, but only because that was cheaper than the combination of ingredients we would have had to buy. Think super-moist chocolate cake topped with Stephanie's special mocha sauce - heavenly.
 - our midnight encounter with the praying mantis atop the laundry basket of clean clothes;
 - delicious kachoris at a small Indian snack shop;
 - long discussion about Kenyan politics with Stephanie's dad.

I spent much of Thursday and Friday observing at Stephanie's and Diane's schools. Steph has a class of five special needs children at Mombasa Academy. They range in age from 5 to 17. Two have behavior issues, one significant. Two communicate appropriately, using full sentences. The 5 year old, who was totally non-verbal when  I saw him last year, had been started on a donated single-message device to request "toilet." He now initiates a few verbal requests, and has been naming pictures in books. He follows directives, and is able to stay seated when asked. Huge progress.

Few schools have workbooks for their students. Teachers hand write pages  of  exercises for their students each week. Here are two pages of exercises  Stephanie prepared for one of her students.

Diane runs Angels on Earth, a school for special needs children she opened in August of 2011. She began with 18 students and is now up to 31 ( 3 new students were enrolled during the three days I visited). The school offers services to students with a wide range of ages, needs and abilities. In addition to Diane, who works with each child individually at least once a week, there is a head teacher, several assistants, and in-house speech, occupational and physical therapists. Diane has a hard time turning away students who cannot afford the monthly fees, so it has been a struggle to continue to grow. She's a great woman with a great vision (www.angelsonearth.za.com).

Angels on Earth  - Diane's special needs school in Mombasa.

On to Mombasa

6:22 AM - Ring-ring, ring-ring . . . "this is Horizon Bus. Sorry, the bus is having mechanical difficulty. We cannot go to Mombasa today."

Now what?

Tom to the rescue. You can always rely on Tom, the proprietor of the guest house, to come up with a solution to any problem. Within 20 minutes, he had found 3 bus companies claiming to have open seats to Mombasa, all leaving within an 8 AM to 10 AM window. Breakfast would be at 7AM.

After a final pack of the two suitcases I was leaving behind and a quick scan of the room, I raced down to breakfast. Rush hour was surprisingly uncomplicated, and we were soon on a street filled with the booking offices for many of the bus companies serving Nairobi. Tom maneuvered his truck into a tight space between 2 busses that we're facing each other, argued with the bus drivers about his right to be there and the availability of seats (two of the busses were full and ready to leave).

10 minutes later I was settling into the seat across the aisle from the driver, with plenty of room to stretch and set my backpack and other carry-ons. I was delighted to have gotten a seat, but not sure I was ready for such a close view of city to city traffic. Kenyan bus drivers in general, and drivers for this line in particular, have a reputation for total disregard for safety or posted speed limits. Accidents are frequent and sometimes deadly.

Ou driver was the exception. He drove carefully, took no unnecessary chances, and was considerate of the other vehicles on the road. I'm not sure how fast he was driving, though - the speedometer needle never moved past zero.

The road to Mombasa is one lane in each direction, and drivers drive on the left side of the road. Pedestrians (and sometimes goats) are common along the highway, and rarely move over for traffic, although I did see one man throw himself onto the grass when he realized a truck trying to merge from the left was not going to make it off the berm in time. ).

It was so good to catch up with Stephanie and her close-knit family. Steph had attended the Mombasa training last year. She is in charge of a small special-needs classroom housed at Mombasa Academy. Her mom, Diane, opened her own special needs school last Fall. Rounding out the family are Dad, a project engineer for Bamburi Cement, and brothers George (nearly 18) and Bruce (15). Diane had gotten an iPad for her birthday in April, and she was eager to get her iTunes account set up and to start finding apps that might be helpful.