ASANTE - The Kenyan Eye Charity

Eye Testing In Rural Kenya

From the Carlow Nationalist May/July 2007 ©

by Brendan Harding

We left Kenya’s capital Nairobi behind us before the sun had fully risen. That morning the sun rose at 6am just like it would the next day and the day after, and every other day of the year so close to the equator.S

Already, outside the air-conditioned jeep the temperature had reached the mid twenties and would continue to rise to a point we couldn’t imagine. The streets were filling with commuters, the lucky ones, the ones on their way to work and the promise of a wage packet at the end of the week - however little it may be. Despite Kenya’s status as a third world/emerging nation the people crowding the roadsides waiting for their morning busses were dressed impeccably in business suits and crisply ironed white shirts and blouses. They greeted each other and the new day with complex handshakes and wide smiles, ready to take on what was thrown at them.

The slightly faded but still traceable Cork accent of Sister Goretti offered Bernard - his first time driving on the African continent - directions and advice from the front passenger seat. “Mind that bus, they’re divils, he’ll run straight into you if you don’t blow the horn.” She waved the driver of the bus away and blessed herself. “Keep in the outside lane but look out for that pothole.” Bernard skilfully avoided the pothole, a pothole that was so deep, I imagined, in anther country it would have been fenced off and turned into a tourist attraction.

The inbound lanes to the city were bumper-to-bumper as far as the eye could see, making Dublin’s Red Cow roundabout seem like a fairground ride. Our side of the highway was relatively quiet, thankfully, which allowed Betty and myself in the backseat a chance to release our white-knuckle grips on the door handles and enjoy the changing scenery. The sight of hundreds of tiny corrugated iron shops and stalls, painted in startling colours of greens, reds and yellows that lined the road, advertising everything from grilled meat to wedding stationery, kept us peering and pointing mile after mile. The signs emblazoned in crude letters over these shops were another great discovery. ‘Adorable Wonderful Hairdressing Paradise,’ ‘Glorious Exhibition Boutique and Salon,’ ‘Ice Cream Butcher Parlour.’ It had flashed by so fast I wondered if I really saw that one, or had yesterday’s midday sun fried my brain already?

Before we left the city limits, Nairobi threw one more surprise at us in the guise of the largest slum on the African continent. What looked like a solid shining metal plate that reached to the horizon turned out to be the corrugated roofs of the ‘homes’ of over two million people living inches apart from each other. And, it wasn’t on my map. The inside of the jeep was suddenly quiet and grave; we all had questions but didn’t know where to start. I watched Sister Goretti as she blessed herself and said a silent prayer.

The journey to Sister Goretti’s home in Nuu village took us North from the city on the Thika Road. The landscape changed visibly with each mile. Green fields and small communities gave way to rough, red scrubland where small children, as young as four or five herded humped grey cattle and long-eared Nubian goats. One child I saw wore plastic bags tied around his feet to save his soft skin from the savage thorns of the scrub bushes. Another, a Masai boy, a long way from his tribal home, stood straight with one foot resting on the knee of his other leg and watched over his small skinny herd while leaning on a long stick that once would have been a steel tipped spear. I was later to discover that the Masai are now forbidden to carry weapons in public - as was the tradition of all Masai warriors above the age of thirteen - and instead now carry heavy clubs not unlike the Irish Shillelagh or long un-pointed sticks. He looked out of place here, not as I had imagined. The red check pattern of the cloth draped around him, the pierced ears elongated by ceremonial discs and the straight stature were all familiar from television documentaries I had seen, but his skin, tight on his cheek bones and his yellow eyes didn’t fit my memory of healthy shining men jumping high in the ancient Masai tribal dances. He waved weakly as we passed.

Inside the car, we three new arrivals pointed excitedly to ourselves, and each other at every ‘amazing’ sight. Weaver bird nests hanging like handmade Christmas decorations from the trees, groups of women clearing the ground, swinging in unison with sharp bladed knives called pangas, a village of round mud huts thatched with dried leaves, eagles soaring in circles on the rising morning air currents and giant Marabou storks standing like grey old men in dinner jackets in the tops of the strange upsidedown looking Baobab trees. Sister Goretti had seen it all many times before but didn’t spoil the moment; instead she smiled for us at each new discovery we made.

We left the North bound road at the city of Thika and veered East along the main road to Somalia. Even the sound of the name Somalia somehow made me nervous. Last night on the hotel bar’s television I had watched CNN as the fighting escalated in the capital, Mogadishu. A quick calculation on my map reassured me we were at least two days drive from the Somalia border. The main road was no more than a back road by Irish standards, more potholes, un-signposted speed bumps and police checks. The police checks consist of a plank skewered with deadly six-inch nails and placed at a distance apart across both lanes of the road. Sister told us the checks were there to police overcrowding in the Matatus – the crammed Toyota mini-busses that serve as public transport throughout the country. The name Matatu translates literally, we were told, as ‘room for one more’. To me, in every Matatu I saw there didn’t appear to be room for one more envelope, never mind one more passenger.

By the time we reached the small village of Matuu and the welcoming sign of a service station selling ‘freezing cold water’, our rear ends were numb from the bouncing of the jeep over the uneven road. The air outside the hermetically sealed vehicle assaulted us like a slap in the face. I, foolishly leaned on the car bonnet to rest, a bad mistake. Several weeks later I can still feel the tender area on the backs of my legs where I received skin-reddening burns from the hot metal.

By now people were stopping to stare at our strange group. It’s safe to say that the sight of four very white people - Wazungu, in the Swahili language - caused quite a stir in this rural backwater. An overcrowded school bus drew stares and giggles of laughter from the children, but they smiled widely and waved. Shouts of Karibu , welcome, gushed happily from their lips. Men on bicycles stopped and leaned on their cross bars enjoying the sight of us being enjoyed by the children.

In this rural area the bicycle is king. A bicycle is an expensive thing, almost forty Euros, the equivalent of two months wages. Big, double cross-barred lumps of steel and leather reminiscent of the ‘high nellies’ of my grandfather’s time. But here we noticed a modification made to these means of transport. The bicycles carried an addition, a rectangular metal plate, carefully welded just beneath the rear carrier that acted as a modified registration plate. These plates were hand painted and ornately decorated bearing inscriptions extolling the wonders of Jesus Christ, or the glory of the Bible. One in particular that caught our eye declared, “Jesus is a Winner, He wins EVERY TIME.” All of this painted neatly around the red circle of a horse-race’s winning post.

Back on the road this fascination with Religion was dawning on us. Sister Goretti pointed out the various denominations of churches that had sprung up every other mile. Amongst the cracking mud huts a tower of concrete and brick would rise and a sign announcing the presence of the East African Church of the Full Gospel, the Church of the Wonders of Creation, the Second Episcopalian Church of Kenya, The Third Episcopalian Church of Kenya - one was forced to wonder what had happened to the First Episcopalian Church of Kenya? There were Protestants, Catholics, Lutherans, Presbyterians, Hindus, Muslims, Adventists and something that was delightfully called the Wonderful Absolute Truth of the Church of the Creator. By our unscientific reckoning there were more churches per capita in Kenya than anywhere else on the planet.

The nearest large town to our destination at Nuu was the town of Mwingi. Not really a town at all as I understood them, but more like a collection of shops and stalls, bars and truck repair garages lining each side of the road for about half a mile; a thriving market town that today thrived even more as it was in fact market day. Sister Goretti announced we needed potatoes as if we had just pulled up outside of a large Tescos. Bernard was directed to drive down a side lane off the main street; this it appeared was where the real business was done, and judging by the stares of the locals this was where anything could be done. As Sister and I left the car she advised Bernard and Betty to lock the car doors, leaving them like fish in a bowl to be examined by hundreds of curious eyes. For me Africa had just taken a new turn. A map could tell me I had travelled over four thousand miles from Carlow to this point, but it took only a short walk through the crowded stalls, inhaling the new smells, feeling the new gazes on my back in the company of Sister Goretti to show me the real measure of the distance I had travelled.

Beneath the seemingly endless canopy of plastic sheeting that hung above the stalls, my senses were attacked from every angle. Strange and exotic fruits and vegetables vied for table space with the more familiar potatoes, onions and carrots of home. But they were out of place here, not in the neat ordered rows of the supermarket shelves I was used to. Guinea fowl and thin balding chickens hung upside-down by their feet, silent, their eyes followed me suspiciously as I passed. In the darkness of the near distance I could see other eyes following me too, but only eyes, no bodies. Hands reached out from beneath counters to touch me as I passed, a legless beggar sat on a blanket beneath a display of something green resembling cabbage. I stood quietly behind Sister as she tested every potato on display, too small, too rotten, too big, too dear, too dirty, she knew her potatoes for sure. I noticed I was taller than most of the people, suddenly for some strange reason I felt like a bodyguard scouring every inch of the semi-darkness for a sniper or would-be assassin. But there were no assassins and the staring faces soon turned to smiling faces. The touching hands soon turned to shaking hands. Karibu, Karibu, I was welcome again, welcome a thousand times over. Sister found the lady she was looking for; a laughing plump woman with a small boy at her side, he hid smiling from behind his mother’s colourful dress, his white teeth almost glowing. We bought what we needed from her, some potatoes, sukuma weki - a green leaf vegetable not unlike kale - and a big handful of bursting bright-red tomatoes. I shook hands with the stallholder and her son; she laughed at my Swahili pronunciation of thank you, Asante Sana I said, thank you very much. Relaxed now, as we left I could take in the sights and sounds of the market, hand-woven baskets, bows and metal tipped arrows, plastic mineral bottles and chunks of shrivelled meat. The shouts of the sellers extolled the virtues of their products, as they do the world over from Moore Street to Mumbai.

Back outside in the blinding sunlight Sister turned to me and said, “I always go to that woman.” “She seems very nice I replied. Is that her son?” Sister stopped, “yes, that’s her son, God bless him. His mother has AIDS you know.”

I was still quiet when we stopped at the junction on the road leading to Sister’s village. For us the solid tar-macadam road ended here and carried on to Garissa where the Arab traders sell their camels for meat. The signpost announced that ahead of us lay 33 kilometres of red murram soil that acted as a road; when it’s not washed away by the rains that is. And somewhere at the end of that road lay the village of Nuu, it’s people and whatever else we might find there.

"KARIBUNI, KARIBUNI - WELCOME TO NUU"

It was late afternoon when we arrived in the village of Nuu. A square of brick-built shops and workshops surrounded a deserted central market place. The noise and rising dust from our jeep brought people to the roadside waving as they had done along our entire journey. Sister Goretti excitedly waved back giving us a running commentary on the familiar faces. She was home.

The convent of the Mercy Nuns shares a small gated compound with the Catholic Church, the Priest’s house, the medical clinic and school and is the centre of Sister Goretti’s physical world here in Africa. Single story brick buildings, simple, but nonetheless monuments of architecture in this remote place. The white-painted structures stood in the welcoming shade of well planned trees; bougainvillea blossomed on their walls.

‘Karibuni! Karibuni! Welcome!’ came the shout from the wildly smiling face of Sister Bernadette – a smile we were to discover rarely left her enthusiastic face. This ‘local’ nun shook our hands and embraced us like long lost relatives. In the background stood another ‘local’ Sister Jennifer – wearing a Nun’s white veil even in this terrible heat. Her greeting was solemn and sincere. ‘Thank the Lord you have arrived safely,’ she said, and blessed herself adding a silent prayer.

After we had refreshed ourselves and been given a tour of the nun’s modest accommodation – comfortable enough to allow these women to go about their lives of healing, guiding and educating, but without the luxuries of home – we shared a welcome meal prepared by the ever resourceful cook and convent handyman Philip.

Over the meal we learned of what lay ahead of us, how the notices of our arrival and more importantly of Bernard’s eye clinic had gone out to the surrounding countryside and how people had already started to arrive, walking for miles from the far flung regions. ‘Where will they stay?’ we asked. ‘Comfortably beneath the trees or in the mud huts of friends and relatives,’ we were assured. ‘Someone will feed them, a bowl of maize maybe and something to drink.’We learned of the work of the nuns, their education programmes for the young women of the area, learning skills in dressmaking and tailoring that would assure them of an income. We learned of the work of the clinic and it’s nurses, the lives saved and the ongoing battle against the ever-present scourges of Malaria and AIDS. We learned of the plights of the children orphaned by these and other diseases and the small amounts of money it takes to improve their situation. But mostly we learned that these three Mercy nuns were doing everything they could, unselfishly, to bring about these changes.

After our meal I took a short sticky nap and dozed off beneath the luxury of my mosquito net to the dreamlike sound of African children singing in the distance. In the still air the singing came easily without interference of the modern world, no cars or machinery, no ever present hum of electricity, no aircraft flying overhead, only the sound of singing and birdsong. Despite the poverty I had witnessed on our journey so far, it was good to know that children still found time to sing.

The Sun had already set by the time we emerged rested from our naps, and it was still only six-thirty in the evening. The bright glare of daylight had disappeared and the African sky gave up another of it’s treasures in the shape of a night undiluted by the pollution of electric light. I had never seen so many stars in my life. The Milky Way stretched like a cloud from horizon to horizon, the Southern Cross welcomed my first visit South of the equator. Shooting stars unzipped themselves across the vast theatre of sky. And slowly a creamy full moon lifted itself above the distant hills, extinguishing the stars and again lighting the world. With the full moon came the insects, as numerous as they were different. A beetle the size of my hand allowed me to pick him up where he sat quietly licking the sweating salts from my skin. Bats as big as crows flew in and out between the beams of the verandah. In the distant tree tops the wide-eyed bush babies called out to one another, sounding for all the world like human babies. Each new sight and sound brought gasps of amazement from us. It was a welcome break to enjoy this time but silently we knew that when the Sun rises tomorrow the real reason for our journey will begin.

"AND SO IT BEGINS..."

Bernard’s first morning of eye tests started at 8am. Already the temperature was rising towards thirty degrees. Sisters Goretti, Bernadette and Jennifer had made sure the day started well with a breakfast of fresh fruits and porridge, they filled our water bottles and laid out everything we could possibly need for the day ahead.

‘Wonderful news,’ Sister Bernadette beamed even wider than usual from the kitchen door, ‘thirty maybe forty people are waiting already, and more arriving every minute. Thank God.’

A small room in the medical clinic was to be our testing area for the next few days. Beside it was the labour ward, now empty except for four bare beds and four tiny cots by their side. A small brown lizard scurried across the ceiling as we entered.

Not speaking either Swahili or the local language of the Kamba people Bernard met his assistant, Mendwa – or Boniface as he preferred to be called – who would act as his interpreter. The equipment was arranged in the bare room and a testing chart was hung on the wall. The first problem arose. Most of the people Bernard would be testing could not read so the standard ABC eye charts would be useless. Quickly I used my design skills and set about drawing a crude chart of hopefully recognisable images, a hen, a cross, an elephant, a butterfly, a milking stool and a dog, all in decreasing sizes. Would they work? We’d have to wait and see.

Having entered the building from the rear none of us had seen the queue forming outside until the first patient was led in, supported by two young men. Outside the open door a crowd of over fifty people waited in the shade of the verandah. People shook hands and greeted each other amid a low babble of conversation. The patient, and elderly lady was totally blind. Bernard examined her, there would be no need for my eye charts I realised as he nodded slowly, ‘no hope I’m afraid.’ Mendwa explained to the lady who took the news quietly. Her helpers returned and led her back outside into the glaring sunshine she would never see again. The next patient we were told had just arrived but would be seen first as he had been carried here in a wheelbarrow by his two sons. Again, there was no hope for this man’s sight. Four more patients followed in a row, all without hope of saving their sight. Bernard looked depressed. It was too much for each of us to take in having travelled all this distance, is this how it was going to be? We each took a quick break to gather our thoughts.

But then things got better. The next lady, her eyes a milky white, had two mature cataracts. Bernard clapped loudly, ‘two mature cataracts, if we can get her to hospital for an operation she should be ok.’ The news lifted our spirits. More cataracts followed and the list of those we could help grew steadily as the day progressed. Regardless of the news these people received they all accepted their fate with equal measure. No outward sign of joy or sorrow regardless of what they heard. One lady whose sight could be saved was the exception, she burst into song and a dance of sorts as she shuffled her tired old feet in rhythm, her shoulders shaking in the traditional Kamba fashion. This sight alone was reward enough for all of us.

By the end of that sweltering day – well over forty degrees inside the tin-roofed clinic – 75 people had been tested; of those, the most common ailment was the presence of cataracts which at least could be treated. A simple prescription for spectacles would ensure the sights of many more. For some of the younger ones – who, curiously seemed happy at the thought of wearing spectacles – a handshake and congratulations for having such perfect eyesight was good enough, they left with a smile. But for others there would be no hope, a thorn in the eye while searching for a lost goat. A lash from a cow’s tail during milking. A stone thrown in play or anger. All of these could possibly have been treated had they been seen in time. But in this far flung parish hospitals are just a rumour that filter from the mouths of those who have visited Nairobi.

"...THE MOST FRIGHTENED AND WORRIED LOOK I HAD EVER SEEN..."

Good Friday was no excuse for the second day of eye tests to be halted. Again, the queues of people greeted Bernard and the team, they waited patiently without worry of time. A working routine had been established the previous day and the crowds were quickly swallowed up in the heat of the testing room to be replaced outside by others who shuffled in from the bush, leaning heavily on stout walking sticks. It would be another busy day of testing.

As Bernard and Betty continued their work I took time to stroll to the village. As a white man dressed in t-shirt, shorts and sandals I expected some curiosity over my appearance but never imagined what came next. An old man emerged from a mud hut and on seeing me started shouting at the top of voice. Instantly a younger man joined him at his side, quieting him with a reassuring arm around his shoulders. The younger man approached me and spoke in English. “I am sorry to frighten you sir,” he said, “it is my old father. He saw a white man with a beard and wearing sandals and thought it was Jesus Christ coming to take him.” I have been confused with many people before but this really was a first.

I stopped to examine a washed out bridge at the edge of the village and knelt to look deep into the dark concrete pipes that made up the structure. A green monitor lizard, over three feet long, at the same moment decided to investigate the world outside. Which of us got the bigger fright I’ll never know.

In the village people came to their doors to inspect the stranger. My hand was shaken by what seemed like the whole village. A man hearing I was from Ireland sang a verse of ‘Cockles and Mussels’. You really can’t go anywhere! A young girl wearing a Meath GAA jersey posed happily for my camera without understanding my amazement. The old lady who had danced for us the day before came and hugged me like a long-lost son.

Returning to the clinic I was told of a woman who had a thorn in her eye since before Christmas – four months in this condition seemed like a punishment beyond unfair to anyone. She rested in the shade. Her daughter sat by her side, stroking her mother’s head, wearing the most frightened and worried look I had ever seen. She would be an urgent case, but when we went to look for her later she had disappeared back into the bush from where she’d come.

But the list of treatable cases grew longer and still we didn’t know how or where this treatment would come from. Sister Goretti smiling as always never doubted for a moment that it would come. Two more days of clinics followed; one in Nuu, a day of rest on Easter Sunday, and one in the even more remote clinic at Kavindu. One boy at Kavindu arrived with his eyes streaming and red from a spitting cobra snake attack less than an hour earlier. A simple case of moving a sack in a depleted grain store. The folk cure is to break an egg into the eye and wash the poison out, but in this desolate place eggs were as rare as rain.

Finally the last patient arrived; a woman in her sixties who had walked thirty kilometres to be told she was fine, a few simple drops would relieve her dry eyes. Time and space won’t allow me to summarise on all of the cases we had seen, the hardships, the joy, the poverty and the hope. In four clinics Bernard saw 330 people – 9 with no hope of restored eyesight, 45 mature cataracts, 215 in need of spectacles, 4 spitting cobra attacks and the rest in good health or in need of simple eye drops. Our next job would be to leave Sister Goretti’s beloved Nuu and the village of smiling people, heading instead for the city of Nairobi to locate what help was available for the forty-five cataract cases we had seen.

It was with heavy hearts we left, but hearts filled with a new appreciation of life. This was no road to Damascus, but a road nonetheless impossible not to move and change forever those that had seen it. Just before we left we discovered that the lady with the thorn embedded in her eye for four months had been found and her details added to the list of those needing urgent treatment. Now it was up to us to find that help.

"NAIROBI'S KIKUYU EYE HOSPITAL - A PARTNERSHIP IS FORMED..."

After the remoteness of the eye testing clinics in Nuu and Kavindu, to be back in Nairobi’s rat race felt like landing on another planet. Sisters Goretti and Bernadette had travelled with us on parochial business to the city, Sister Jennifer had stayed behind. Before we left we had made a donation to Sister Jennifer of €600 – money collected from so many charitable friends, relatives and sponsors – Sister Jennifer beamed as she told us how this money will ensure that twenty-six orphan girls will now be able to attend school for the next year. This small sum of money will buy uniforms, bedding, books and food for all twenty-six for a full school year.

Before we left Nairobi for the first time, Bernard had made contact with a fellow optician, the chairman of the Optica group Mr Bharat Bhardwaj who had agreed to provide all of the spectacle prescriptions we would need. True to his word Mr Bhardwaj through his son, the company’s managing director Kush Bhardwaj, received the prescriptions and promised delivery a week later. The forty-five cataract cases we would have to arrange ourselves.

On the outskirts of the city the neat flower beds and freshly painted walls of the Kikuyu eye-unit created a well cared for and well loved feel about the place. Our first piece of luck came in the guise of the hospital administrator’s secretary who hailed from the same part of the country where Bernard had just conducted his clinics. A meeting with Mr. Macharia, the administrator, was hastily arranged. Mr. Macharia pulled out all the stops and in turn arranged a meeting with the Director of Clinical Surgery Dr. Walia. It was more than we had dared hope for. Dr. Walia listened to the story of our journey, the cases we had seen and weighed the situation instantly. He made some rapid telephone calls, using an economy of words to get his message across. We could tell that this was a man used to giving orders and having people act upon them. A young doctor, a doctor Gladys knocked politely and joined our meeting. Dr. Walia briefly summarised the situation for Dr. Gladys who fumbled through her diary almost in awe of her commanding superior. Two days were earmarked for surgery. Dr Gladys noted that one of her colleagues would be on holiday on the days concerned, “he can cancel,” Dr. Walia said, and a line was instantly drawn through a fellow doctors holiday plans.

Outside in the warm sunshine Sister Goretti raised her hands to the sky and announced, “the Lord was watching over us,” she would get no argument from me

Finally; back in Ireland we eagerly tracked the progress of Bernard’s patients. Sister Goretti and Sister Bernadette kept us informed through the crackling telephone lines how Mr Bhardwaj’s spectacles had been delivered on time. How they themselves had secured a bus to transport the patients to the distant city. How they would use the Nuu clinic as a dormitory for the early start required. And eventually, how thirty-five of the initial forty-five had travelled for surgery. The ten that didn’t travel may never have been in a car or bus before, may never been outside of their district, or simply may have been too scared to make that long journey. Three days later the news arrived of the expidition's total success.

Even the woman who endured a thorn in her eye for over four months had been treated allowing her worried daughter to smile once more. An added bonus was the news that a mobile clinic would now travel to Nuu for the post-surgery-care needed by the thirty-five, and the ten that had been missed could be treated there, close to their homes in Nuu without need to travel into the unknown. A new line of communication had been opened between the care givers of Nairobi and this once forgotten backwater of Sister Goretti’s smiling people and small miracles.