Wednesday, August 9, 2017

A Musical Journey from Dilla to Bacharach

J Dilla by Jed Cablao (Deviant Art)

I happened to be on Soundcloud the other day just randomly checking for music, and I came across one of DJ Jazzy Jeff's sets. I'm more familiar with his work as an actor on "The Fresh Prince of Bel Air", but the originator of the Transformer scratch is an actual practising DJ. The set he was playing was a tribute to J Dilla; I believe "Dilla" or "Dillalude" was my original search parameter. The Dillalude was actually my introduction to musician Robert Glasper - accomplished pianist and J Dilla fanboy - who does an interesting interpretation of Common's "TheLonious" (another track produced by J. Dilla). I'm always searching for new interpretations of the Dillalude, in which Glasper manages to sneak in multiple of Dilla's productions.

Anyway, back to DJ Jazzy Jeff's "Dilla Tribute" set. It was touted as containing both his well known, lesser known and even unreleased tracks. Around the quarter mark, DJ Jazzy Jeff starts playing an obviously older track that had a haunting Oboe intro that segued into this rapid keyboard rhythm accompanied by light rapid fire drums. This gave way to the graceful female singer who sings a difficult quick tempo part; shortly after, the rest of the band joins in the singing of the chorus, adding great shades of harmony to the whole effort. And then, it happens: Jeff starts to fade out the track, and appears to be modulating the track as another male voice starts to drop the intro to a rap song. Then the heavy bassline drops and the rap song continues buoyed by the looped modulated chorus motif from the previous band.

With a bit of an assist from the Shazam app, I was able to swiftly pin down both tracks. "Knowing when to Leave" (from The Burt Bacharach Medley) by the Carpenters and "Yum Yum" by Slum Village. Great work by Dilla on the sampling job, but the final product seemed a bit raw because the bass guitar he added to the mix seems a tad overpowering. Also, the vocals seem a bit washed out (probably a recording issue). The Carpenters on the other hand are a whole other story. Karen's vocals are unmatched, and coincidentally she also plays the drums on the track. Richard is light, swift and enchanting on the keys. However, while Dilla samples their track, the Carpenters are actually covering someone else's music. Yep, Burt Bacharach & Hal David to be exact. When they originally made this track, they had frequent collaborator Dionne Warwick doing the singing.

From reading up on some of the comments about the Carpenters' video on Youtube, I found out that President Obama had a night of music at the White House which honoured Burt Bacharach (& Hal David posthumously) with the 2012 Library of Congress Gershwin Prize for Popular Song. Conveniently, the whole performance was on Youtube and was a star-studded affair in which various musicians (Stevie Wonder, Diana Krall, Arturo Sandoval, Sheryl Crow, Mike Meyers? et al) took turns in singing Bacharach/David hits. You have to witness how much virtuosity one person can plug into playing the harmonica when you get to experience Stevie Wonder's extended solo on "Alfie". However, my highlight from the whole event was Sheléa and Arturo Sandoval on "Anyone Who Had a Heart"

I'm surprised I'd never heard of this ballad before because it has done quite the rounds. Originally performed by frequent Bacharach/David alum Dionne Warwick, it has been covered by many an artist, with each artist making the song their own. No proof of this is more evident than in Luther Vandross' rendition of the ballad. To her credit, Sheléa also make this song her own. Her vocals stamp their authority on her beautiful piano playing; starting out as a mere whisper, her singing reaches a crescendo that has her sounding part Whitney Houston, part Tamia. She conveys the full range of emotion from pining to hurt to desperation, and she'll leave you engrossed. A sprinkling of Mr. Sandoval's horn brings the full melancholy into this song. The Bacharach/David team certainly deserved to be feted for just this gem alone.

It certainly proved to be quite the musical marathon in one short evening. It has definitely opened up a wide range of artists and genres for me to explore. Thankfully though, between Youtube and the rest of the net, I think I'll be up to the task.

As you embark on your musical journeys, may God speed you well.  

Tuesday, August 8, 2017

ELECTION DAY


Considering how much ambivalaence I've encountered among my fellow Kenyans when I ask them about voting, I'm still pretty psyched. This happens to the first time I've actually been able to vote out of the 4 times that I've been eligible. Don't count it as a dereliction of civic duty on my part; I've just never been around for the previous elections. So I definitely didn't want to miss my chance. I even got my voter's card way before the deadline hit (a surprise for a typical procrastinator like myself). Wasn't too happy at the Independent Electoral and Boundaries Commission's (IEBC) decision to ask people to report back to their voting stations for verification (as if I didn't provide all the necessary details first time around), but they saved face by making the verification an SMS/Online affair. Thanks to this, I even knew beforehand which line I would be in during the voting exercise: No. 11 at the PCEA Enchorro Emuny Primary School in Ngong!

So all I had to do was bide my time and prepare for the day at hand. So today I was up by 4.30 am, done with preparations and out of the house by 5.45 am. Fearing for the worst with regards to my car, I made arrangements to park it within a family friend's compound, which was a convenient 3 minute walk from the voting station. As I drove, it was quite the sight to behold: cars parked along the roadside in droves, and an amorphous massing of people at the school gate. The IEBC had assured people that it would really be an easy process whereby we would just walk in and we'd be shown into which lines we were supposed to queue, so I thought the process would be easy. I was wrong!

So, I walked into the school compound, under the cover of darkness, and just run into total pandemonium. Lines of people as far as the eye can see, and very little indication as to where I was supposed to go. Started to look for an official, but they were few and far-in-between. I had saved a PDF of my voter details, so I had it on my phone screen for easy reference. By the time I did find an official, he just pointed me off to some far off corner and went on his merry way. So, Plan B: walk up to people in lines and find out what specific line they were in. For reference, the IEBC chose the first letter of the first name appearing in your ID as the signifier for the line that you would queue in.

Casting my gaze further afield, I could just barely make out some numbers on classroom doors; so, I just had to look for the door labelled 11. Trust you me, this had already taken all of 15 minutes. But, it wasn't the end. Lines 11 - 13 were actually located on the upper level of the school building, with, up until that point, no obvious observable staircase leading to the polling stations. After asking around, finally settled into one line that I believed was a combination 11/12/13 line; I was relieved of this notion when one Administration Police Officer (AP) walked by, and told us that Line 11 was actually separate from 12/13, which saw me move ahead.

Once I was sure I was in the right line (knock on wood), I was sure that the only thing I'd have to endure was an appreciable wait....but there was more than that. First off, the upper level of that school building was the things that'd make an Emergency Preparedness Coordinator cringe: only one stairwell packed to the brim by the two lines of individuals ascending; a few stragglers milling through the middle, some genuinely geriatric, invalid or with child, and others lost or trying to skip the queue; and to cap it off, this was also the only exit for people who had cast their votes.

The permutations for all the things that could have gone disastrously wrong within that scenario are baffling. Having just completed some Life Support Training courses, I tried to imagine how that understaffed voting station would have dealt with someone suffering a fainting spell, heart attack, etc. My biggest gripe is with the building design specifically. Even on an ordinary school day, if a fire breaks out or a panic arises because of an "explosion", students will basically be trampled in a stampede through that one narrow stairwell. Sometimes we only ever survive because of God's grace because we fail to plan for the simplest eventualities; and as one of my Surgical Consultants (Dr. Oigara) always used to say,

Failing to plan is planning to fail      

Of course when you've been in a line for a prolonged period of time, the shady Kenyan characters start to crop up. I'm talking blatant line-cutters, ladies using the ruse of carrying the same child so that they can basically rock up to the line ahead of everyone else; and then they're those irritating characters in the back of the line who act like those ahead of them are slowing down the line, as if we ever had any possibility of influencing the events ahead of us. (these are probably the same impatient individuals who cause a fuss during traffic jams).

So it basically took me 3 hours and 50 minutes to complete this simple task. Mind you, many people tell me that conditions were better this time around. If I'm led to believe that the IEBC has actually learned from its mistakes and performed better this time around, then it would be something of a quantum leap to expect them to have a trouble free election anytime soon. I recognize that they have had some unique challenges this time around (being reconstituted afresh, having their IT Manager murdered, constant court challenges), but some logistical issues are not hard to solve.

First off, they've got to view the voters as mere monkeys, Sheep, or Children, if you please. We are basically showing up to an alien environment, and we are definitely bound to be confused. Their main function is to:

  1. get us in line
  2. get us into the voting booth to cast our votes
  3. get us out so we can go on our merry way without making a nuisance of ourselves
And for Heaven's sake, they need to have a dry-run before the election day so that they can test the system out. Hoping for things to fall into place without any practice when 1000+ sheeple rock up to the spot is impossible. Barring any technical difficulties from their biometric system, they could probably shave off at least one hour from everyone's wait time.

Anyway, the day's done and nothing unbecoming has happened. I'm hoping to just be able to sit things out at home, and hope all things turn out peacefully. At the end of the day, come what may, peace and a normal semblance of life is what we crave for. We can sort out the other political stuff later.

God Bless. 

Wednesday, July 26, 2017

Ngong: Is devolution helping?



If you know me well enough by now, you'd know that I am not a fan of devolution as it has taken place in Kenya over the last few years. The idea behind it was noble: development spread over the country, even to those hinterland areas that had been marginalized for the longest time. At its heart, the notion that you could provide a myriad of services to the people within their localities, such that they wouldn't be required to pass through Nairobi seemed like a win-win situation.

However, as with most things Kenyan, the concept is beautiful, but the implementation is a disaster. Too much political finagling has since saddled us with a heavy debt burden; we have too many counties, most of which exist to settle political points. Each of these units has too much political representation taking home massive salaries and delivering nothing in return. And finally, the counties merely devolved a problem that was faced by the central government: weak institutions and poor accountability for the manner in which money is spent. This has exacerbated the "leaky cauldron" syndrome, and thus the country as a whole is just hemorrhaging money that was meant to spur development.

Lest I be labelled as a person who's all about theories, I give you now the example of Ngong Town. Situated approximately 20 kilometres from the city centre, Ngong is one of those areas that seemed poised to take off as a part of "Greater Nairobi". Basically, as space and prices become more prohibitive in Nairobi, Ngong could very easily have morphed into an ideal suburb.

I've basically called Ngong my home since late 1989 when my parents moved us out here (despite much protestation). A staple of the town was its big market located right at its centre; on the periphery of the market was a Bus/Matatu stage/terminus where people could catch a bus onwards to Nairobi via Ngong Road or via Kiserian. I've been informed lately that the spot may actually all have been a terminus, and was encroached on by the market sellers (I still remain unconvinced).

Anyway, not much has gone on in terms of development at the market place for a long time; it remained the same village type installation with little in terms of improvement. When the devolution bug hit us, at least initially, nothing changed either. However, circa early this year, I noted that the market area had been cleared out. Unfortunately for most drivers, who already have a problem driving through that portion of Ngong Rd. surrounding the market, the market stalls ended up being uprooted and deposited on either side of the road's "pavement" area.




It was bad enough driving through before; now, it's a situation akin to driving through Kawangware. The obstacles are plenty: pedestrians, animals, motorcycles and matatus. You are literally moments away from knocking someone down or running into one accident or another; to add insult to injury, this is one of those areas where a rowdy crowd can mushroom at a moment's notice - especially the motorcycle fraternity - and you could be in for a very hefty "shakedown".

This is really a development failure. Granted, I hear people mention that there are plans to relocate the market, or perhaps even build a storeyed building where it will be housed; however, I feel like the market should have been the first priority in this case. As I drive past that parking lot, I see that some matatus have started using the parking areas; but, on the other hand, I still deal with the marked nuisance of the matatus that refuse to use the parking area and willing obstruct traffic along the road as they collect their customers. Apparently without the watchful eye of the law to steer them straight, it's just business as usual.

From a cost-benefit analysis, we would have received much bigger gains from upgrading the market first. Lord knows in this day and age of Cholera, we should prioritize measures that'll safeguard our food safety. I have hoped for the longest time that Kenya would adopt an organized "Farmers Market" model similar to what's done in the US and Europe. We need to prioritize this very basic concept, and try to add more value to this portion of the agricultural supply-demand chain. The matatu industry is a rogue that can only be tamed by concerted political effort (..but then, this is an election year, so no one in their right mind will be trying to needlessly unsettle this particularly big portion of the electorate). So, why spend money so frivolously?

I don't have photographic evidence here, but lately I've come across a board erected at the parking lot which proudly states that this is a World Bank-funded project. Seriously! How can free-thinking independent Kenyans not be ashamed at needing the World Bank to sponsor the construction of a mere parking lot? How can anyone excuse running up a debt (yes, this is indeed debt) for such a simple project? No doubt the project was inflated so that pockets ended up lined in the process, but seriously, this is why we can't have good things.   

Kenya looked at Devolution as a salve for the issue of  skewed development in the country; however, without applying any sort of Discipline to all these efforts, nothing meaningful will really be achieved. I'd dare say that Discipline pegged to our previous non-devolved administration would have brought the change we desire at a much faster rate (and it would have been cheaper too).

Unfortunately, short of a miracle, it seems we're doomed to ride this devolution train until we either get it right, or it bankrupts us enough to have to make a major change. Come what may, even for this realist, it pays to have faith at least once in a while. So my eyes are open, and in my heart I retain some hope that sober minds will eventually prevail and that we will mature as a country and as a people. We just have to.

God Bless

Sunday, July 16, 2017

Spider-Man Homecoming: Spoiler-Free Review



Seems like new movies are creeping up on me a mile a minute these days. Been meaning to watch a whole bunch, but I've just ended up being caught up in a lot of stuff. Just this past Thursday, while walking through Nakumatt Junction, I got wind of the fact that Spider-man: Homecoming was playing in the theaters; with my past luck with missing out on Guardians of the Galaxy: Vol.2, I figured I might as well quit procrastinating and just get over with watching the latest spidey installment.

Truth be told, I would really have loved to watch it at the Nairobi IMAX, but the IMAX has been disappointing me lately. They have perfected the art of unprofessionalism, harkening back more to their days as 20th Century Cinema than actual IMAX. So, until further notice, I will be giving them the widest of berths. I chose to go with the tried and trusted Century Cinemax at the Junction, beating out the characteristic Sunday afternoon Ngong Road traffic, and arriving with some time to spare.

Gotta say that the new Marvel Studios logo intro is astounding. Paired with that famous animated spidey theme set to great brass, you can't help but become nostalgic.

People have sworn that this is the spidey characterization that they've been waiting to see because apparently Tom Holland gives off that true vibe of spidey as a kid with high school struggles getting in the way of the superhero biz. It's not exactly something that I've fancied. In our first introduction to Spidey, we have him geeking out "taped-footage" style about his involvement in the events of Civil War. His frenetic energy came off as a bit irritating, more akin to TV's Ultimate Spider-man (a disgrace to previous animated forays) as opposed to more serious spidey affairs. I am glad to say that things were toned down, and that nervous fanboy energy dissipated very quickly.

I'm also glad that Tony Stark was used very sparingly in this movie. With all his appearances in the trailers, I had the gloomy impression that this movie might have played out like Iron Man 3.5 (in other words, atrocious!) But, as I've mentioned, he is only sprinkled in when he's really needed. They have of course gone with the Ultimate Spiderman type scenario where Spidey is being looked at as a possible fit for this iteration of the Avengers; and all this occurs under the tutelage of Tony Stark (and a much irritated Happy Hogan). Therefore, under the cover of a Stark Enterprises internship, spidey's basically looking for a chance to impress Tony and fast track his way into the Avengers; turns out that he's mostly ignored, and the friendly neighbourhood Spidey gig starts to bore him.

This is where the Vulture and his crew come in. The first 5 minutes of the movie is actually a quick intro to this crew (Adrian Toomes et. al). In another beautiful tying up of the MCU continuity, as occurred in Captain America: Civil War, we are introduced to the working stiffs whose job it is to clear up after the Avengers saved us from the initial otherworldly attack. In a stroke of bad luck, Damage Control (a Tony Stark/Federal Government outfit) pulls the kind of juris-my-diction move that basically takes the food off their table. Therefore, while sitting on a stash of uncatalogued alien-tech, and the skills to retrofit it for some nefarious applications, the crew basically puts together an operation that brings in the money on the black market, and puts the tech in the hands of lowly thugs. This thus becomes Spidey's make-or-break mission to prove that he's a worthy superhero whether he gets the backing or not.

I'm glad to say that you will walk into this movie very surprised; despite all the TV spots that were churned out, a lot of the story is still wrapped up tight such that you'd have to watch the movie to get any true sort of exposition. The movie actually did a lot with its 2 hr 13 min runtime: I was pleasantly surprised at how elaborately we get to follow Peter's progression, mix in a love interest, the Avengers' angle, and twists and turns with the villain. The superhero set pieces are also quite well done. Two standouts, without really giving anything away, are the Washington Monument rescue and the Ship Rescue. Seeing him attempt to hold that ship together echoed Tobey Maguire's Spider-Man 2 train scene; but, it also reminded me of Superman's airplane rescue from Superman Returns. I think those moments really grounded this Spider-Man, because even at these points that he's facing major insurmountable odd (stemming from his own weaknesses) he's still braving the odds to save the bystanders.  

Tom Holland is a great Spidey and a Peter Parker to boot. This is not the down-on-his-luck Spidey that we got from Tobey MaGuire, and neither is it the socially awkward ultra-jokesy Andrew Garfield iteration. We don't get a single mention about Uncle Ben this time around; rather, we only get to see Peter's interaction with his very young  (eye candy) Aunt May. Peter's life is mostly school and geeky shenanigans with his friend, Ned (who very early on learns Peter's secret). He is still amateurish as Spidey; his improved spider suit is a gift from Tony Stark, but it comes with a very elaborate leash which basically has him on "training wheels." This movie is interesting for examining one issue that is unique to our web-slinging hero and wasn't addressed in past versions: basically, how does he get around when you place him in an environment devoid of tall buildings to swing from? It is really hilarious to see how the dynamics turn out.

Marvel gets a bad wrap for having very weak villains. Apart from Loki (and maybe the Red Skull), most of their villains haven't exactly been memorable or insurmountable. Michael Keaton's "Vulture" is definitely a stellar addition. His motives are clear, and even when he's menacing he still retains a kind of likeability. Sure, he is a bad guy, and he does some unforgivable things, but unlike a Joker out for chaos, he's the kind of bad guy who is doing just enough that he gets to achieve his goal and avoids the heavy hit; essentially, staying under the radar. Marvel has finally gotten a villain right.
I have to mention that this movie has multiple villains, but they are really secondary characters; this safely keeps the attention on the Vulture, and prevents any Spider-man 3/Amazing Spider-man 2 missteps. I would absolutely be hyped for a Sinister 6 scenario if they can pay attention to these dynamics.

Ned (Jacob Batalon) was actually a good addition, providing the true support to Spidey's heroing. It could easily have been a cringe worthy gimmick that wrecked Homecoming, but it gives Peter a soundboard for some of his bad decisions, and a genius sidekick to help an amateur out. Jennifer Connelly as Karen, the AI in Spidey's suit, was yet another master stroke. Wonder if it's a coincidence that she's playing a role very similar to her husband's (Paul Bettany aka Jarvis aka Vision). She pokes as much fun at our hero's missteps as a sarcastic Jarvis did with Iron Man; was good to have that back-and-forth in this movie, especially as we get the exposition on how "extra" Tony went when upgrading the suit.

Zendaya's "Michelle" is just a counter-culture kid who is used to poke deadpan fun in various scenarios; but it seems her character was mostly hyped up, because Peter's love interest, Liz (Laura Harrier) has a more prominent role this time around. It remains to be seen what the MCU will do with Michelle's character in upcoming installments in light of the nickname she mentions towards the end of the movie.

I enjoyed the movie, and it flowed seamlessly from start to finish...with one exception. This movie comes after Civil War in the MCU canon, but there seems to be a slight discrepancy with regards to the Avengers' base of operations. This would lead me into spoiler territory, so it might be better for you to explore it yourself when you watch the movie. On another note, if you can watch this at a decent IMAX, I'd recommend that you see it there; if not, you might be better off watching it in 2-D. I really hope James Cameron's glassless 3D takes off, because I have never enjoyed the cumbersome experience of donning a pair of glasses just to watch a movie (totally intrusive).

All in all, I give this movie my highest seal of approval; give it a try and you won't regret it.

God Bless.

Wednesday, July 12, 2017

The Music of Acoustic Alchemy: Red Dust & Spanish Lace

The music of Acoustic Alchemy takes me back to my Messiah College days. I discovered the group sometime in 2003 thanks to Launchcast, a great Yahoo! internet music service that is currently defunct. I run across the service during those late summer nights when I'd get off work and just spend my time online until the sun came up; it basically kept me going till I could eat breakfast, and then get some sleep.

Since my music preferences were mostly set for "Jazz" and "Easy Listening", Acoustic Alchemy eventually popped up one day...and I was hooked. I remember checking out their website, and they had this player which played the full tracks from (as far as I can remember it) two of their last albums: The Beautiful Game and Aart. Aart was my first purchase from them, and, consequently, the album I used to introduce my brothers to the group. It's notable for having one of my favourite Acoustic Alchemy songs - "Passion Play" - and in 2012, during my twin brother's wedding, the groomsmen marched in to the church to the tune of "The Velvet Swing".

Anyway, I continued to follow the group, and later that year they released "Radio Contact", which I also ended up purchasing, in addition to some of their back catalog. As luck would have it, they ended up coming to perform a concert in Pennsylvania (Reading, PA to be exact).  The concert venue was slightly more than an hour away from Messiah, but, luckily, my then-girlfriend (Heather) drove us down and we got to experience Acoustic Alchemy in all their glory. Back then they still had bassist Frank Felix in their lineup; and Eddie M. was the man on sax-duty that night (a role that had been filled by Jeff Kashiwa for the making of Aart). Otherwise, the core was the same: Greg Carmichael (strings), Miles Gilderdale (strings), Fred White (Keys) and Greg Grainger (drums).
Any of their concerts is basically a time for comedy. Anytime you have Miles ad-libbing on the mic, something funny is bound to happen. This concert bookmarks 2004 for me because I remember Miles and Frank poking fun at the whole Janet Jackson/Justin Timberlake debacle during the Superbowl Halftime show.

The tracklist consisted of a diverse bunch of tracks, some from Aart, The Beautiful Game, and of course, Radio Contact. However, towards the end, Greg went into an extended flamenco guitar solo that had me hypnotized. The tune felt somewhat familiar, but I wasn't sure I had actually encountered it. He put on a wonderful show in that solo, with so many emotions explored in the fast/slow ebb and flow of his notes, taking you on along for the ride; and just when I thought he was done, he starts playing double-time, and then they ended up segueing from the guitar solo into a more rapid flamenco infused piece by the whole band; I use the word "infused" because it is flamenco-nuanced. Actually, one of the guitars (Greg's Nylon) starts out in flamenco, but eventually he ends up switching to his more traditional playing style, with the band providing some flamenco riffs here and there. This is actually one of those long-form songs (not typical of their style), which starts out one way and then totally morphs into something unexpectedly new.

I remember that at the end of the concert they asked us if we had any requests that they'd want us to play. It was a free-for-all, and people pretty much shouted their favourites. Wish I could have been more emphatic in asking for "Passion Play", but instead they went with a wonderful version of "Flamoco Loco" that included a solo by drummer Greg Grainger which delved into an interpolation of Michael Jackson's "Billy Jean" before finally climaxing as Flamoco Loco. (In retrospect, maybe I shouldn't have asked for a song that needed a vocalist to hum along; but from a few videos on Youtube, I now see that they've decided to forgo the vocalist and still make an attempt to play it live).

In what must have seemed an injustice to me at that time, by the end of the concert they neglected to announce what the name of the flamenco song that they'd performed was; didn't even leave a hint in terms of which album it was from (and by this point in their careers, they were 13 albums deep). So I was left to track down things the old-fashioned way: listening to the CD track sampler on Amazon.com. Eventually, I found it: the title track from their very first album, Red Dust and Spanish Lace. Listening to the track, even now, brings back that subtle memory of that wintry night in Reading, PA, and the effervescent joy of knowing that beyond the enchanting solo (which is half of the song's length) lies a veritable feast in terms of good music.

The whole album is a masterpiece (and I'll get down to some of the standout tracks in due time), but it is its final track which is a true showstopper.

God Bless





Saturday, July 1, 2017

Memories: One wintry night at Larsen...


The whole time I was a student at Messiah College, I also worked as a custodial assistant (read: janitor). I usually refer to this as my first true job because I didn't really do anything truly "professionally related" to my long and arduous field of study until I started my medical internship in 2014. I loved that I got to work with a lot of great people, that it gave me decent pocket money, and it gave me a sense of responsibility.

By the time my senior year rolled up, part of my duties included cleaning the (then) new building - Larsen Student Union. Each building I've had the experience of cleaning had its own character: Hoffman was old, and had squirrels in its roof, which ended up giving me the occasional "jump scare" on many a night; Boyer Hall was always well lit and had these big hallways; Larsen had a great open plan with a cafeteria with two levels of seating space, and some office space (can't forget the glass on the stair handrail that was impossible to keep clean).

But one thing about Larsen really unnerved me: on the upper seating level, they had these gnarly looking paintings that they had hung on the wall. Far be it from me to imply that the paintings were ugly or anything like that; rather, they were painted in a style slightly reminiscent of the Van Gogh self portrait I included up top. However, with the lights turned down low, those pictures made it seem like I was working under the watchful eye of Vigo the Carpathian (from Ghostbusters II); hence, here I was in another building that gave me "jump scares".

Vigo the Carpathian

One wintry night (prolly in 2004), I was doing my best to finish up cleaning in Larsen so that I could head on back to my apartment. Ironically, I was cleaning that upper seating level when I heard a loud bang that just made my knees turn into jelly. I scanned the "haunted wall" for any signs of dastardly poltergeist activity, but everything seemed to be in place. I can't lie: I did as superficial of a job as could be considered acceptable, and "got the hell out of dodge".

Making my way out of the exit towards Mellinger Apartments, I came face to face with the cause of the loud bang - a little bird plopped right outside the student union door. Putting 2 and 2 together, I concluded that the bird had probably flown into one of the clear glass windows and stunned itself. Well, the little bird wasn't really moving so I was being more positive than usual and counting on it being more stunned than seriously injured. It struck me as strange that a bird would be gallivanting around at night time; perhaps, if we had the "avian flu" scare around back then, I would have thought twice about my chance encounter with the little bird.

Even if the bird was merely stunned, I figured it wouldn't survive that frigid winter weather on its own that night. So, as gently as I could, I scooped up the little bird and placed in it my jacket pocket, and went home. I really didn't know what I was going to do with the little guy, but I figured I could at least keep him comfortable; I lined up an old shoe box with some waste paper and placed the bird inside. (I might have placed some water for it to drink, but my memory fails me)

Come morning time, I was in a hurry to get to class, so I left without even informing my housemates (Collins and Luke) that I had stowed away the bird in a shoe box within the upper reaches of the wardrobe. I don't even remember checking in on the little fella before I left. Anyway, after class was done, I made me way back to the apartment, hoping to come up with a solution for the little avian visitor; when I got home, I ended up finding a bit of a mess with a scanty trail of feathers scattered on the furniture, and an exasperated looking Luke.

Turns out the little bird had come to, and must have been shocked to find himself in a strange place. So, it panicked! I never found out what the finer details of the escape were, but I just know eventually Luke found a way to let it out. He gave me the kinda look that just screamed, "What the hell, Richard?"; but then he was one to have an eclectic collection of pets, so he knew my heart was in the right place.

My ex-girlfriend, Heather, reminded me about this incident a few years back. She told me that it was an idiosyncrasy that was just "so me." More compliment than actual backhand comment, it lifted my spirits. Who would've thought that the first life that I actually made an attempt at saving wasn't even human at all. I doubt that this one act will place me in that "weird" friend category, y'know, the kind who picks up weird animals, takes them home and fosters them. I just feel like it's something anyone would do if it happened to them.

Now that I'm a bit removed from my college days, I'm really missing school. Life was simpler, and I don't think I've had a boss and colleagues as good as the ones I had while I was on the cleaning crew. Nothing upped the job satisfaction scales like getting the seal of approval from my bosses (Teresa, Chuck, Dwight, Bob or Elick):
You do good work!
Who would've guessed that one of my best formative experiences was being a janitor (ahem, custodial assistant). It's too bad I can't list it on my resume. Lord knows my current life could use some of that simple appreciation from the higher-ups. It really is the simple things in life that you crave for when all is said and done.

Here's to hoping that the road ahead is filled with more positives.

God Bless.
    

Sunday, June 25, 2017

Review: Suave Kenya BP-214





I've been really craving a bag from the company Suave Kenya ever since I learned about its history from a youtube video in a friend's Facebook post. It's a nice little upstart which up-cycles kitenges (a traditional fabric native to East and Central Africa) and denim to create really stylish looking bags. Currently, they offer 2 styles of bags: bag packs and messenger bags.


They put an interesting twist on things, adding little flourishes even when using the same kitenge to make different bags; sadly, though, this has meant that the styles they offer sometimes fly off the shelves real quick while I procrastinate about buying a specific bag. 

Anyway, last month I finally committed to getting one of their bags; the BP-214 to be exact (which according to their page is no longer available). I gravitated towards its dark purple colour scheme with the quaint kitenge highlights for its pockets.


This bag also contains its fair share of denim. The denim forms the inner lining of the bag, and it just makes it a beautiful ensemble of seemingly contrasting elements that fit surprisingly well together.


What struck me from the get-go is that this seems like a very small bag. They don't list its dimensions on the website, but I've measured it at 30 cm by 40 cm by 15 cm. Combine that with the rather small straps, and I initially felt like this bag would serve more as a stylish embellishment rather a good workhorse of a bag.


At least that's how I felt until I actually placed a good sized book in the bag. I usually tote around Creative Home Landscaping, and as the pictures show, it fit in quite snugly with lots of room to spare. The book measures 22 cm by 29 cm by 2 cm, which is probably representative of your typical book.

A spacious stylish interior



Side-by-side comparison
I really love this product. I'd say that my only gripe right now is the straps. My recommendation would be that perhaps when they upscale the company, they could look into making a more rugged version with fuller more padded straps and a little more height. I feel like the current dimensions are more suited to a lady than a gentleman per se; but perhaps that is just a bias from the vast majority of bag packs I've had before that had to be big enough to survive a medical student's books and things.

I will certainly be making a repeat purchase from Suave Kenya (possibly for a friend)...but first, I should probably start by sampling one of their messenger bags for myself. I think I could eventually end up using it as my "doctor's bag". They retail at the same price as the bag packs - sh. 3500 - with free delivery in some parts of Nairobi (best contact them first at 0726352001 to find out if you're eligible for this offer). I'll be making my choice between models ML-71, ML-74 and ML-75.

Note: The messenger bag on offer is the 13'' version. I hear there's a 15'' version that retails at sh. 4500, but I guess I can look into that later.

God Bless



Monday, June 5, 2017

The Things That Medical School Won't Teach You (5) - Being there for your patient


Yeah, that's right! I've got an Amazing Spider-man comic cover up for a medical blog post. It's not going to be something along the lines of a treatise about "with great power comes great responsibility" (that would be too easy!) However, comics, especially the well written ones probably have useful lessons to teach us; maybe even enough to have them regarded as seriously as "literature".

This particular Spider-man adventure is from the Spider Totem story arc. Here we're dealing with a slightly more mature Peter Parker (unlike the one people seem to be pining for so much in Spider-man: Homecoming). Science teacher by day, and superhero extraordinaire when the occasion calls for it. As events begin to unfold, we're given the foreboding news that a big baddie has his sights set on Spidey; but Spidey being Spidey foregoes the advice to lay low and ends up being accosted by this mighty predator, Morlun. 

Soon as he steps on the scene, Morlun knocks the wind (and literal jokes) out of Spidey. He's pretty much Spider-man's worst nightmare: a seemingly unassailable foe that can track him no matter where he goes. A couple of battles are fought, with Spidey having to retreat each time to get a breather; in the end, however, he's worn out, quite practically defeated. So he ends up saying a few goodbyes and prepares himself to "not go so gently into the good night".

This, of course, is where the magic happens: someone miraculously comes to Spidey's aid!
This is the part that has always remained crystal clear in my mind since the first time I read the story. It's heartbreaking to see Spider-man humbled to the levels achieved in this episode, but it's elating to see him get the help he needs. His reflection at this juncture is priceless:

"And in that moment, oddly enough, I finally understand what it feels like for someone else to look up and see me...and it's great..."   

Anyone who's had someone bail them out from dire straits would probably have their own unique way of articulating this very same sentiment; and let's be real - everyone has a little something to offer whenever we find ourselves in need. As someone involved in healthcare, my greatest contribution to this world is definitely medically related.

My mind harkens back to my orientation week in 2001 at Daystar University; Pastor Mwalwa's orientation speech in particular. These were his exact opening words:

Every system in this world will fail you! 

No set of words ever did ring truer; and each time it comes true, it is an utter betrayal of the human condition because it underscores how small we are in this life; so finite, so fallible, for the most part really powerless to change a lot of the circumstances in our lives. All things considered, though, could there possibly be a greater betrayal than that of our own health failing us? Every other systemic failure is external, yet we choose to internalize it; our health, on the other hand, is automatically internal, immediately personal.

This is the backdrop against which we encounter patients every single day, and an issue to take to heart. A lot of medical school work preps you for dealing with a patient's illness, but not the ramifications of that illness on the person's being or integrity. However, just like any task we may be poorly equipped to deal with, on-the-job-learning bridges the gap; even if we were never taught how to be counselors, it becomes an essential skill to pick up. It also helps to pick up some virtues along the way: patience, respect, honesty and humility. Every new patient poses a unique set of experiences, especially bitterness, anger or depression occasioned by their illness. Thus, always exercise patience even when they (and/or their relatives) drive you up the wall; respect the patient enough to be honest about their condition, and the treatment options available, and do all in your power to help them; and, lastly, be humble enough to accept the patient's wishes and your shortcomings.

Come what may, that patient can't help but come out of the experience a little more enlightened. All this is summed up in a great quote:

Pain is a gift. Humanity without pain, would know neither fear nor pity. Without fear, there could be no humility, and every man would be a monster. The recognition of pain and fear in others gives rise in us to pity, and in our pity is our humanity, our redemption (Dean Koontz, Velocity)

As one who gets to behold broken humanity every single day in your line of work, may that spur you to restore that humanity, and alleviate that same pain. Understand that people will look up to you, and you shouldn't be scared to have that responsibility heaped on your shoulders; it will mould you, everyday, into a better human being.

I feel I can safely end this with the last words from that orientation speech from Pastor Mwalwa. He didn't set out to scare us that day; just to steep us in a little bit of reality. Thus, like a good teacher, he left us with something positive and hopeful at the end by completing his opening remarks.

Every system in this world will fail you...but God will never fail you!



God Bless

Monday, May 22, 2017

The Music of Pat Metheny: "He's Gone Away"

Nestled in the eclectic works of Pat Metheny (circa 1997) is a collaborative effort between him and the late Charlie Haden (Rest in Peace) entitled "Beyond the Missouri Sky (Short Stories)". The album is a mix of original compositions and covers, and one of the most beautiful covers that they put down is "He's Gone Away".

He's Gone Away probably ranks up there with great American folk classics. I can't think of this classic without my mind gravitating towards "Shenandoah", probably the next best classic. Seeing as it's quite the old song, its history is mired in some confusion. It is probable that multiple versions exist, with new lyrics added as the song traded hands or traversed generations; be that as it may, it still retains its beautiful ballad quality.

This is one of those quiet ballad pieces where Pat excels. It is also really suited to the "plain" playing style typified by Haden. I'm not trying to Christianize Metheny's version of the tune, but this version feels like it pays homage to "Amazing Grace"; at least, my ears pick an Amazing Grace motif just after the preamble. In much the same manner, the beginning of Lyle Mays solo on San Lorenzo is also capped by an Amazing Grace motif. I don't know whose decision this was (Metheny or Haden), but it makes the rendition that much more soulful.

There is so much meditative "space" in this song. It's as if the silence (and the unsaid) in the song evokes as much passion as that which is actually played. Pat's guitar is most prominent throughout the performance. When they're evenly matching it up, it seems like Pat plays at least 2 notes for every deep note churned by Haden's bass; then they eventually segue into all-Pat. The middle portion of the song actually surprised me today. I've listened to it countless times, and only today did I realize that Pat is overdubbing himself - using the same guitar - to give that impression of a guitar duet. I always assumed the accompaniment was from Charlie Haden, but there is nary a bass note to be heard.

Towards the end of the song, with Haden again on bass, the song is more sonically filled as a result of the overdubs of Metheny's guitar (I have no idea which other one he was playing in this case) that seem to carry the same weight/gravitas that a violin and horn would. It all builds up to this beautiful crescendo conveying the full emotional force of the song, and then magically ends with what you first heard as the preamble.

Some people responded negatively to the overdubbing and feel that perhaps it made the performance less pure. It's sad that we will never get to see a live version of this piece performed. Their tour for this was strictly a duet, and I feel like getting this performance down perfectly would probably have required a second guitar player in tow. Sad! In case you do find any live Metheny/Haden versions that are labelled as "He's Gone Away", they are merely mislabelled versions of Farmer's Trust.

I'm not a purist by any stretch, and I offer this as a definitive 'keeper' from the Metheny songbook. This should appeal to anyone, any age, any leaning. A ballad it may be, but it also captivates the soul like a simple lullaby. The beauty is in the music.

God Bless

Friday, May 12, 2017

The Things That Medical School Won't Teach You (4) - Sometimes, you'll end up hating your patients!




Everyone gets a little tired of their job sometimes, it's about as natural a process as it comes. If someone is enjoying their job 100% of the time, they are probably as rare a commodity as a unicorn. I believe job satisfaction probably lies somewhere between maximizing the "ups" and minimizing the "downs" of your typical work routine.

As a medical practitioner, I can attest that medical school, TV shows and even forerunners and mentors at least gave me the impression that the medical field would be hard. The hours are tedious, the life is downright difficult, and your colleagues and their respective idiosyncrasies will prove to be a challenge. But then, no one ever prepares you for how challenging your patients will actually be; I'm not talking about your patients' illnesses because between your training and your superiors you'll have that covered. I'm talking about those little unexpected moments when your patients (and their relatives) set you up for failure.

Scenario 1: No situation rings truer than the one I so optimally used to introduce this post. If you've managed to go through your internship without your patient turning on you during the ward round, you are one lucky person. Tragically, even very recently as a medical officer, I had taken an extensive patient history that lasted about half an hour in preparation for the major ward round. As soon as the consultant shows up to listen to the history, the patient starts to poke so many holes in my retelling of the history such that even I am left in doubt as to whether I clerked that very patient. However, the embarrassment doesn't stop there; if you have a consultant like mine, you will be berated in front of your colleagues, accused of 'confabulating' (aka LYING) and dismissively asked to return to take a proper history. Lord knows I am not a spiteful human being, but whenever I have been privy to such treatment, I usually give such a patient a wide berth.

Scenario 2: There are probably fewer less comfortable conditions than morbidity. Being stuck in a strange bed, having nurses (and nurses aides) interrupting your rest on a regular basis to take care of you, and last, but not least, having to endure the ward rounds. Granted though, patients will put up with this because they understand that we're trying to get them better. I remember once having a patient in the ward who looked so sickly, like he was on his way out of this world; on the cusp of kidney failure, yellowed eyes and just a generally poor disposition. First time I talked to his family, I basically HAD to reassure them that he would get better. Eventually, we basically discover that he's only suffering from an acute infection, and we're sure that he'll recover full kidney function.

Once the relatives discover he's out of the woods, their true colours come out: complaints and demands galore. Suddenly, it's as if my medical knowledge counted for nothing, and they're the ones who were in charge. Mind you, this happened during the healthcare workers' strike, and it was beyond irritating to have a basically stable patient demand more attention than the less stable sicker patients. Can't lie: I thanked God when we discharged that patient!

Scenario 3:



Speaking of demanding, few things will irk you more than the patient who shows up at the most inopportune moments. As a rule of thumb, kind of like Murphy's Law, a patient is likely to show up needing your help when it's time for you to clock out and head home. Even worse, though, is the scenario where someone shows up at the Casualty (A&E) Department at the oddest hour of the night with an easily treatable malady. If you've been unlucky enough to work the late night shift, you'd understand that you're usually working with a skeleton crew, basically the bare minimum. As if that wasn't enough, the late night clientele can sometimes resemble the idiosyncratic late night Walmart shopper: CRAZY!

I understand that you may have your issues, but it does help if you're considerate about the tasks that we juggle in those circumstances. We operate in triage mode in the Casualty Department, meaning that regardless of the time you set foot in the department, I am going to address the needs of the most severe patient first. I pre-assessed you really quickly and I'm 97% sure you have the flu, so I'm pretty sure that between your headache and chills you're not likely to expire within the next hour. Allow me to attend to this head injury patient who's so banged up that he lacks the capacity to even complain about his situation.

Scenario 4: All hospitals are definitely not created equal! Every person working in a hospital is particularly aware of their hospital's degree of competence, and perhaps more critical of the hospital than an outsider might be. Be that as it may, we are sensitive to being criticized by an outsider. It's very much the same way you might feel comfortable calling your sibling an idiot, but God protect the individual who tries to heap such disrespect on the very same sibling.

As an intern, I once had the misfortune of having the uncle of an MCA (Member of County Assembly) admitted to our hospital to undergo prostate surgery. This was tragic on so many fronts:

  1. An MCA is, for the most part, an overpaid but practically useless political post that we've somehow been saddled with since 2013
  2. Many of the individuals chosen as MCAs take it upon themselves to lord the position over individuals in government institutions, like hospitals.
  3. The limited staff we had in the surgical ward ended up being diverted to the VIP patient's beck and call...and he wasn't even thankful in the least.
In my opinion, if you really can pay for admission at a better hospital, why would you feel the need to game the system, and then mistreat the people who are trying to help you?

Scenario 5: The dysfunctional family. There are few experiences more trying than having to deal with a sick patriarch/matriarch who's admitted in your institution, but is pretty much in the middle of a "custody battle" that gets dragged into the hospital. Sometimes it feels like their relatives are already counting the spoils even prior to the patient's demise. Never have I run into a bunch of entitled individuals who will frustrate your management of the patient, and seem ever eager to drag the hospital into a lawsuit at the slightest perception of an insult.
For your sake (and that of the hospital), make sure to DOCUMENT EVERYTHING! Your notes had better be crisp and concise and up to date. Lord knows you don't want to be sucked into the black hole that this debacle will turn into. On many an occasion, don't forget to emphasize how inadequately your institution is equipped to handle any serious emergencies that may befall the patient, and be on hand to provide them a referral to a top-notch medical facility of their choosing.

There are a myriad of other situations, but this is all I can summon up from memory at this juncture. The commonest string that binds them all seems to be "the demanding patient"; thus, it is in your best interest to always be able to pick out those patients that are likely to be the most demanding.

 Take home message: this life can be hard, but the more prepared you are to face the other awkward stresses that come your way, the more bearable your medical experience will be.

Take care and God Bless.
   

Tuesday, April 18, 2017

Easter 2017

The recently ended season of Easter was quite the enjoyable experience. This time, especially, since I got to spend most of those days away from work. An eclectic bunch of memories from my past cross my mind whenever I think of my past Lents/Easters. In no specific order, I think of

  1. 5-day holidays from being in a Catholic high school (Holy Thursday to Easter Monday)
  2. Easter of 2014, probably the last holiday period I enjoyed before the start of my internship period. (That was an exceptionally hard year)
  3. There was that one Easter in China when the church I used to go to burnt down
  4. Preaching on Psalm 22 one year, only to have someone else preach a totally different (contradictory) message on the same issue a year later.
  5. 2007, my first year in China, when the whole season went by without me even realizing it. 
  6. 2004, Messiah College: choosing an extremely hard challenge in terms of what I gave up for Lent
  7. 2004, Messiah College (redux): having one of my Kenyan colleagues concoct an April Fools' Day joke so hard it rocked the Messiah community to its core. (They were none to pleased with Kenyans for a bit there)
  8. Mr. Creavey (who'd occasionally give me a lift to Elizabeth Ann Seton Church) and his sons playing trumpets during Easter Sunday mass on Patti Drennan's "Sing, O sing a jubilant song."
  9. Cathy Poiesz organizing the small catholic community at Messiah for a lovely night service at a massive church in Harrisburg (possibly Cathedral Parish of Saint Patrick). I remember the choir had balcony seating and sang a haunting rendition of "Remember your love"
Apparently my most vivid memories are associated with my time at school. Seems like I'm itching for the good bit of education 4 years after graduating, but that's a story for another time. Seems like all I do these days is work, and then when I get some time away from work all I want to do is de-stress. I would've loved to indulge myself in all that the season of Lent presents, but with the exception of 2016, my mind can't really be tamed enough to meditate.

I love this season, its sombre tone, the heartfelt music. It is the most appropriate season for me to contemplate "What wondrous love is this" or "God of Mercy and Compassion". Well, in any case, I can't be too hard on myself. This (religion) is more than just the seasons in which I get reminded to reinvest myself in things heavenly. It is an everyday walk that I need to apply myself to. Thank goodness I've got leave coming up in May. I need to find myself some place quiet to just put everything in perspective, and time away from the disillusionment with medicine I've had of late.

I may have barely made anything of myself this season, but I'm hoping to make something of myself starting this week. Feeling doubly blessed after that 3-day weekend (ended up being pulled into work on Good Friday), and this week my boss is at a conference overseas so I get to exercise more control over patient management. Definitely looking forward to shorter ward rounds and more time to myself. This is what dreams are made of.

God Bless.

Thursday, April 6, 2017

The Things That Medical School Won't Teach You (3) - The Giggles



I'd like to start this particular post with a very specific memory: it was circa 1997 and I was in my first year of high school. We were out on the sports field taking part in a class rugby game, and a member of the opposing team tackled me by grabbing me around the waist and swinging me backwards. It was by no means a bad or dangerous tackle (I've taken much worse hits), but unfortunately, I fell awkwardly on my right wrist and experienced excruciating pain.

I dragged myself onto the sidelines and sat out the rest of the game. Despite licking my wounds, the pain had not subsided by the game's end. From there it was off to the high school clinic, then back home, and finally off to the hospital (the former Masaba Hospital, if my memory serves me right). Just as I'd feared, I had fractured my wrist. Was probably a stress fracture because I can recall that, not too far back, one of the poles from a tent had struck that same wrist while we had dismantled a tent at school. At least it wasn't bad enough that it would require an implant; but it did require me to endure a POP cast for a period of 3 months. The worst part of this whole affair was the indignity that I was exposed to at the hospital. I remember the two female nurses taunting me for having the gall to play rugby, me being so spindly and all. Even worse, each of them kept squeezing the wrist to elicit the tenderness. Worst of all was when the doctor showed up and joined in the taunting. I remember that he was a massive fellow, but despite his stature, he claimed that he wouldn't be caught dead trying to play rugby. What on earth made me think I could indulge in the sport? Three taunting medical professionals, a fistful of pain and a dented ego made for one unbearably bad night.

Fast forward to my days as a medical professional, and the experience has been softened in hindsight. This is neither an admission that I have taken up a heavy-handed approach to patient care nor find it acceptable for other practitioners to disregard their patients; it is, rather, an admission that sometimes one person's malady can be another's (comedic) pot of gold.

I've said it once, and I'll say it again: a lot of your friends/family/colleagues who work in the medical field are damaged goods. You can attribute that to years and years of rigorous training, being part of a profession where your superiors have the bedside manner of an army drill sergeant, and impossible situations that everyday practice will throw your way. Like any good professional, we get used to the life....and then we begin to find humour in even the most macabre of situations.

Thus my disclaimer would be, "we're laughing with you, we're not laughing at you!"

Medical personnel's brains are wired a bit different from the rest of the population. In much the same way that firemen (and other first responders) are geared to run towards situations of danger, we actively seek out those situations that we've been trained to handle. A lot of times we're even fascinated by all that strangeness. A lawyer friend of mine was talking about his experiences with helping Key populations (aka people most at risk of contracting HIV - Gay men and IV Drug users). He commented that some gay people feel stigmatized when they show up with anal infections because the nurses start calling each other, "Kujeni muone maajabu!" (come see these wonders!)
Two things are at work here:

  1. Bad PR because sometimes we focus more on the ailment than the person.
  2. Utter fascination at getting to see things that previously we've only ever encountered in our books.
Size, complexity, consistency...really a treasure trove for the senses. If you happen to be at a teaching hospital, you and your "condition" will be celebs for the day.

Thanks to shows like House MD, which exaggerate bits of the medical experience, you can understand that our minds are trained to probe situations, sometimes to extreme lengths. So, for example, when a patient walks into the Emergency Room with a fractured penis, normal minds might stop at merely thinking "Ouch! That must really hurt!" But not your medical friend. His/her mind works a little like this

  1.  "Ouch! That must really hurt!" Let me take care of the patient's discomfort first.
  2. Let me document the patient's account of what happened (Will it be truthful, though? Patients lie, right?)
  3. The likely cause of injury occurred when aforementioned part probably encountered such-and-such in a traumatic clash 
  4. Chances are that the woman that caused this "accident" is not likely to be the man's wife, because statistics show that ...
  5. My colleagues have heard about this case and have come trooping down to see for themselves what's up. Everybody's going to be giving their "2 cents" about this case.
  6. How on earth am I gonna keep a straight face when I have to present this case to my consultant?
If it's a good day, I'd be putting on my stoic face and would succeed in keeping a straight face throughout the whole encounter. If it's a bad day, anything can set you off laughing. Sometimes the patient's voice or demeanor could be a trigger; sometimes the consultant will callously utter such a brash statement that leaves you beside yourself with laughter. At other times, it's just the nature of the situation. I remember getting the giggles when my colleague was presenting a patient history in the ward: this middle aged lady had been walking home in the dark and had, in a stroke of bad luck,  randomly fallen into a pit latrine that was being dug. Don't know what it was about the case, but it left me in stitches. However, God forbid that you should draw attention to yourself by randomly bursting into laughter while you're in a team of 15 conducting a ward round. You suppress that laughter like a boss and ride out the period of mirth.

Sometimes I feel guilty, like I'm headed to hell for finding some of these things funny; but, it is a coping mechanism. I think you'd rather prefer that I find your situation funny and can engage with it 100%, as opposed to fearing it and being overwhelmed by it as most normal folk would. As the disclaimer states, "I'm laughing with you, not at you!" Don't condemn us for our laughter/amusement, but appreciate that it is a joyous part of our day to find amusement in a day's work.

God Bless.    

Saturday, March 4, 2017

Logan Review (spoiler free)


This was an unusual entry into the X-men universe. This finally makes this series a trilogy, which I have thoroughly enjoyed. People give the first entry in the series more grief than it deserves. As I remember it, it had the dubious honour of having a critic review an unfinished leaked copy of the movie, and then it was all downhill from there. Anyway, that's a tangent for another day.

This trilogy has been quite unique; in some ways as unique as the Captain America trilogy. It basically employed the same format, starting with one director, then shifting to a second director(s) who helmed the second and third movies. Despite this being the same director, the 2nd and 3rd movie are stylistically very different. In Captain America, it was because the Russo brothers had morphed "Civil War" into Avengers 2.5; in this case, James Mangold was aiming for a movie straddling multiple genres (Dystopian future/Western/Road Movie).

As you know from all the media hype about this movie, mutantkind has for the most part disappeared. What remains are a few vestiges; what we see of those vestiges are  Wolverine, Caliban and a 90-something Professor X. Logan's invulnerability isn't what it used to be, and the Professor is more liability than saviour at this point in his life, with major repercussions for any humans in his vicinity. Things can only get worse when Laura aka X-23 is introduced into their lives.

It was hard to watch these 2 X-men brought down to this level. Wolverine has always been the Lone Wolf who is sometimes called upon to be the ever reluctant hero. Despite all the bad that humankind has forced upon him, at least he always had invulnerability to rely on, and the choice to hit the road when he so desired. The pillar that was Prof. X is now also a distant memory; in a change of roles, Logan is now tasked with eking out a living to cater for the Prof. and his many special needs. The antagonism between the two of them gives the movie a lot of heart, sometimes intensely engrossing, and at other times hilarious when the Prof. exhibits petulant outbursts.

However, ever the heroes that they are, Laura's needs are a call to action, and even a chance to earn some redemption.

All things considered, this was a great movie, beautifully shot and well paced. I remember the joy of seeing Wolverine break out into a berserker rage in "X-men: Apocalypse", and this movie managed to one-up even that bit of gruesomeness! The R-rating on this movie is definitely used to good effect, whether it's Wolverine or X-23 doing the eviscerating. Though it's set in the near future, the movie is mostly grounded in the present, with the reavers and minor elements reflecting anything of futuristic proportions.

I have to come out and state that this movie is really its own story. Coming into it, there had been talk about them adopting the "Old Man Logan" storyline (definitely a great read if you come across it), but apart from the "Open Road" element of that comic, there isn't much of similarity worth noting.

This is (somewhat) a Marvel movie, so the complaint may arise that the bad guys are not really captivating. I don't think this will be the movie to change your mind about the dearth of characterization for villains in the Marvel stable. On the plus side, though, reflecting on Logan's tribulations will make you understand that the baddies are just an unfortunate hurdle. It could've been anything really. Anything that pushes against him so hard when he's at his most vulnerable seems downright insurmountable.

Hugh Jackman, Patrick Stewart and Dafne Keen are the heart and soul of this movie. What surprised me most was how many times Prof. X dropped the F-Bomb in this outing; all his typical decorum is thrown out the window, and he must've picked up some Wolverine-isms after being cooped up with him. For the most part, Hugh Jackman is reduced to brooding, but his emotions cover the whole range of the spectrum...with the rare smile chipped in. Even though Logan is even more reluctant to be a hero in this outing (Prof. X seems to be the one more concerned with looking out for X-23), Jackman imbues even the neglect with a true humanity. And Dafne Keen will not be afflicted with the "bad child actor who ruins a good movie" title. She has little dialogue for most of the movie, but her facial expressions and physicality convince you that she's more than a little bundle of joy. I look forward to seeing her take her rightful place in the X-men franchise.

I feel like this movie has emotionally drained me; it will take the love you have for these characters and beat you down with it. But, if ever there was a way for the roles of Prof. X and Wolverine to be retired (by their respective actors), this was it. Five star performance that's definitely worth watching. I still feel like there's more left of this story to tell, but maybe the X-men can give us that in a future installment that involves X-23 and Nathaniel Essex (aka Mr. Sinister), who was teased at the end of X-men: Apocalypse, but sadly didn't make it into this movie. Maybe some other day.

God Bless

Saturday, February 25, 2017

Green Thumb

Seems great to finally have some time to just sit back and chill. The whole rigmarole stemming from this whole medical health workers strike is still dominating my whole work life. Can't change anything about that, but I can find something totally different to do on my downtime. 

I've been fascinated with plants for quite some time, but I don't think I've ever intentionally grown something; so I decided to give it a try. For my first bit, it was actually just a small transplant job. The sitting room plants had gotten worse for the wear, so I decided to switch them out for some Monstera deliciosa which is what my Dad usually had growing in the sitting room while I was growing up.  



So this is what the plant looked like after I transferred it. Most of the leaves were quite old and dusty, but these were the best Monstera specimens I could find down at Dagoretti. Shortly after some watering, the middle stalk began to unfurl a new life









And voila! dead centre, we now have the new leaf (proof that I didn't end up killing the plant).

I've also taking to spritzing the leaves from time to time to give them a nice sheen, and maybe keep them from looking so dessicated.










My second foray is more of a long term project. After spotting the above magnificent bloom from the Purple Orchid tree (Bauhinia purpurea) at the PCEA Kikuyu Hospital, I figured that I would take a stab at growing Bauhinia from scratch. From my time at Wenzhou, I'd encountered it as a common avenue tree. Even retracing my steps back to my primary school, I too found it growing vibrantly in the school compound. Thus, I waited for the blooms to give way to precious pods, and then had to wait for them to dry and time things just right before they scattered their seeds to the ground.


And this is the result. Four out of the seven seeds I planted sprouted, bearing the typical bilobed leaves.












I don't know where I'm going to put these plants in the long term, but I feel the urge to continue with the experimentation. At least, I know I'm going to use the next plants I grow for landscaping at our upcoming house. Have an eye on some Agapanthus seeds with a view towards growing up to 100 Agapanthus seedlings. Also want to do some experimentation with some local bamboo, but I want to make sure I can find the "clumping" variety, as opposed to the the friendship-destroying "running" variety.

Other than that, life is just as it should be right now, I guess. Will keep you posted.

God Bless.




Sunday, February 12, 2017

Feb 2017

Dearest me, Smonday is already upon me!

I've gotta say, since the doctors' strike started, last week had to have been one of the worst weeks I've ever faced. For starters, I pretty much put in 60 hours worth of work during the week (...and none of that comes with any overtime). I think the earliest I actually got home might have been 8.20 pm, which coincidentally happened on Friday, the day most people are like to make their exits before 5.00 pm.

I've been so tired lately that I'm starting to embrace the Kenyan culture of not reading. By the time I'm done with my patients and all such related activity, I just want to get home and de-stress. My mind can't be bothered with fanciful thoughts of reading or even trying to keep up with new advances in the medical field...I'd rather just soak in some sensory deprivation and chill.

Last week, I even had the dubious distinction of being tossed under the bus by my consultant for some shenanigans that went down at the hospital. Of course I can't divulge any of the details, but it has got to be one of the most underhanded things that has happened to me while I've worked as a doctor. People don't understand how much medico-legal detail is involved in dealing with patients, and I think a lot more people would steer clear of the medical profession if the actually found out. We may have come along way scientifically, but there's still a lot that we don't know about medical practice. Sometimes it can actually feel more like practising an Art than a Science.

The patients and their relatives will see things differently though. I think medicine is one of the few careers where people feel like they can question your acumen without having even a basic grasp of the concepts involved. Even a primary school teacher is unlikely to get called out on the pedagogy that they employ to teach their students; but a doctor is fair game to everyone. We have moved away from Paternalistic Medicine to a more shared patient-doctor relationship, which I feel is more ideal; if you can understand the disease process and its respective treatment, then I believe the patient can participate more actively in the treatment. Don't get me wrong, if the situation calls for it and either their patient or caregiver is unable to fathom what needs to be done, it is my duty to go "over their heads" and be paternalistic, for the patient's sake.

There is, however, a third patient-doctor relationship that has developed lately that emphasizes Patient Autonomy. If the patient has the necessary education or understanding of their condition, this may be bearable; however, a lot of times you encounter this from a patient who merely wants to be in-charge without a semblance of a clue as to what they actually require. These are the patients (and relatives) that are likely to haul you court for some good old litigation. Thank God I have an extra card up my sleeve for such patients: I can just "Discharge (them) Against Medical Advice" (DAMA), and let them end up being someone else's problem.

I think I'm just a bit disillusioned by the medical field these days. Job satisfaction is at an all-time low, and I don't have the energy to keep myself afloat. I'm beginning to detest some of my patients and the systematic failure at my workplace is just draining. I hate this government for doing nothing to avert or even alleviate the effects of this strike; I'm annoyed at the general public for not having the guts to even try to keep this government accountable despite the egregious missteps that they have committed.

Lord knows I just need a break. Maybe a change in this 10-month routine will do me some good. Something's got to give.

Sunday, January 22, 2017

Memories: A Bad Day at The Office




It's already been quite the tumultous start to 2017 down here in Kenya. The doctors' strike drags on for yet another week, and now, in much the same manner, university lecturers are also on strike due to  talk of yet another unfulfilled Collective Bargaining Agreement (CBA) from 2013. The writing on the wall is obvious: politicians can't be trusted to fulfil any pledges they make in the wake of an election year. Lord knows what other messes they'll be orchestrating in the remaining 7 months of election campaigning.

I feel like the doctors' strike would have ended earlier if we only had a limited number of people taking part in the negotiations, i.e. the president, his ministers of Health and Labour and the doctors' union. In all honesty, other groups like the SRC (Salary & Remuneration Commission) and the Council of Governors have nothing of importance to add to this issue. Devoid of such organization, we are being treated to trivialities that border on the obscene. Social media was ablaze with #IamNotSewage because the Labour Court judge (Wasilwa) hearing the case openly referred to the collective striking medical body as stinking of sewage. (Apparently judges must be skipping Decorum 101 these days). As if that wasn't enough, just recently a 'nominated' Member of Parliament tried to whittle the strike into an issue of tribalism; this earned the ire of the medical fraternity, and now we have #TribelessDoctor trending.

All the wrong people are doing the talking, which is driving the doctors irate. Has any of these sanctimonious individuals ever set foot inside a public hospital, apart from occasions for photo-ops? Can they really sympathize with a general public with whom they have nothing in common? Do they even understand the situations that medical staff have to contend with, especially those that go above and beyond the call of duty? It is probably for these reasons (and many others) that another topic has been trending - #MyBadDoctorExperience. I hear that initially the topic was created to highlight patients' bad experiences at the hands of incompetent doctors; but as later stories will attest, the doctors are currently using it to highlight the traumatic experiences they've experienced at the hands of the healthcare system. It is only a glimpse of what doctors experience, but it is enlightening nonetheless; and I guess it's time to add my experience to the fray.

*Friendly Advisory: beyond this point, some of this gets a little graphic! 

It was about mid-December 2014, and I was knee deep into the 2nd rotation of my internship (Obstetrics & Gynaecology). I believe that at that point, of the 3 interns in the department (Fiona, Lucy and myself), I was 'stationed' in the Labour Ward. I use the word stationed lightly because throughout the course of the day, we all converged at the Labour ward to handle whatever business came up. Considering how overwhelming the work could be for 3 interns, it was very typical for the 2 interns who weren't on duty to end up leaving the hospital after 11.00 pm. Only one of us was ever on night-duty, but we figured that it would be better for us to let the intern-on-duty disappear to freshen up at home; that intern would then report back to the hospital around 7.00 pm, but we'd basically have the intern relax in the call room while we cleared every issue in the wards. Some time before 11pm, we'd join our colleague in the call-room and just debrief each other before we set off. Turns out it was a great way to de-stress and keep ourselves sane.

On this particular day, around 4.00 pm, a patient (about 38 years old) showed up to the Labour Ward; (for my convenience, I'll refer to her as "Edna") by all regards, she was a stable patient, obviously in the 3rd trimester of her pregnancy, and had been admitted because she noted reduced fetal movements in the course of that day. I take down her history, and I find out that this is her 5th pregnancy; all prior pregnancies had ended in normal deliveries, but they had yielded only girls! So here she was hoping that this particular pregnancy yielded a boy so that she could call it quits procreation-wise. By all accounts everything's normal, until I dig out the fetoscope to listen for the fetal heartbeat: not a sound, no matter what position I checked for it. Undeterred, figuring that the problem was my technique, I called in one of the senior nurses to assess for the fetal heartbeat. She too couldn't find the fetal heart.

Unfortunately for us, the fetal doppler probe was not available, so the only way we could confirm the presence of a fetal heart was to perform an obstetric ultrasound. As a double misfortune, the sonographers were also not available at the hospital after 4.00 pm, so we basically had to arrange for her to be transported by ambulance to a reputable external radiology centre to have an obstetric ultrasound done. At this point, I'm really hoping that the ultrasound will prove that there's a fetal heartbeat so that I can schedule her for an emergency caesarean section (C/S) as soon as possible; worst case scenario is that she's had an intrauterine fetal demise (IUFD), and in that case I would not need to saddle her with an unnecessary surgical scar.

We arrange for the ultrasound, but end up having to wait for the ambulance to return from another emergency. Theater staff have been informed about a possible C/S being performed, but we've currently hit the magical hour: 5 - 6 pm...shift change-over time. Basically, nothing gets done during that period, and we end up having to pool our surgical cases until the anaesthetist-on-duty shows up. I keep doing the rounds on the other patients, but also take the time to read the nurses' cardex for Edna's case. During that interview, Edna had reported that she had experienced some vaginal bleeding prior to coming to the hospital (a detail she omitted when I queried her about any danger signs that she may have experienced). Around 5.30 pm, the ambulance becomes available and I'm looking forward to having some clarification on the matter. I've already discussed the option of a C/S with Edna and her husband, and they've suggested that a Bilateral Tubal Ligation (BTL) aka "tying her tubes" be performed; I've even joined up as a member of "Team Edna", and I'm really hoping that the baby is a boy and in optimum condition. And then, it happens!

A sizable amount of blood gushes from her vagina, soaking the sheets! I see the colour disappear from her face, and forget all about the ultrasound; by this point it's very clear that I have to get her into theater immediately. The nurses attempt to stabilize the patient, while we hurriedly prepare blood, get consent, alert the theater, the anaesthetist and my immediate superior (a Medical Officer). The Medical Officer gives me the go-ahead to perform the case and tells me he'll be coming in eventually just in case I might need any help. I counsel Edna's husband again about the emergency situation, and let him know it's the only option that we have left.

Under normal circumstances, I would just perform the C/S myself, but Fiona happens to be around at that moment so she makes the decision to step into theater with me for the case, which affords me several advantages; Fiona and Lucy basically taught me how to perform C/Ss. In addition Fiona is left-handed; basic rule of surgery is that the primary surgeon stands on the side of the patient which allows them the most ease to operate - so, a right-handed surgeon would stand to the right of a patient and vice versa for a left-handed surgeon. Working with Fiona thus felt like having two primary surgeons on the table at the same time, and the responsibility could be shifted without us having to reposition ourselves at the operating table.

Everything is ready for us very quickly. We jump into theater, and in a break from the norm, we are scrubbed in and gowned before the patient has even been wheeled into the theater. Soon as she's placed on the table and anaesthetized we get to work. We sacrifice most of the presurgical skin disinfection for the sake of speed, and start hurriedly. I make a wide incision and slice through skin, fat, fascia and muscle, making my way to the uterus; during this time, she barely bleeds. Once I'm through the peritoneum, I come across a pale white uterus! Gone is the pink colour of the vitalized uterine tissue that I encounter during routine surgery; the inside of her is just as pale as her extremeties.

In one swift move, I'm inside the uterus and we visualize the baby's placenta detached from the uterine wall and accompanied by a massive blood clot...Placental Abruption! Quite the atypical case because the bleeding was concealed and Edna did not experience the usual cluster of symptoms. There was nothing that could be done for this BABY BOY. With one life gone, we concentrate on Edna. With the uterus taken care of, it's time to perform the BTL. All things considered, and with the haste needed post-operatively for the patient (including the most important issue of the blood transfusion), I opt not to perform the BTL, and close her up layer by layer. Soon as we're done, the anaesthetist lets the blood run, trying to reperfuse the patient as quickly as the blood can flow.

Our part as surgeons is done, and we step away from the table to assess the patient whose life entirely relies on the anaesthetist's manipulation. Never would I have thought that the patient I met a mere 3 hours earlier would have taken this eventual turn. As if by design, her breathing ceases, and shortly thereafter her heart stops. We're ready for it when it happens and we jump in to resuscitate her.  We aren't able to achieve anything meaningful, and I lament that her husband isn't around to say any sort of goodbye. A 100% fatality rate in an Obstetric procedure.

We clean her body and place her accordingly. We then silently walk out of the operating room into the adjacent corridor, each one of us pondering the experience. We have theater notes to write, and still have more cases to perform; but more than that, we have to inform the father of four of his wife and child's demise. He's not in the reception area when we come out, but undoubtedly, he'll be arriving soon. I try to organize my thoughts so that I can deliver the news in an informative yet sympathetic manner, but I can't lift my gaze from my hands as they lie idle in my lap. In the end, I'm glad when the anaesthetist picks himself up and ends up relaying the information to the bereaved. I was within earshot of the conversation, but I don't remember hearing any wailing or sobbing from Edna's husband. He calmly stepped out of the reception area, and, as with countless cases, I know nothing more of what happened to him or his family.

With every loss you encounter, you're supposed to be able to detach yourself from the situation enough that you can function adequately come what may. After all, the work never ends and though one person's life has been brought to a standstill, the rest of the world need to move on. Even if it may not be required of you, every death is a chance for you to reflect on what you might have missed, what you might have done wrong and what more you could have done; and after that, the harsh lessons inform your practice in regard to subsequent patients.

Every doctor (/medical practitioner) you've ever met probably has a couple of these jarring experiences that they could quote for you if you gave them the chance. We carry many of these scars with us, but rather than break us, these scars make us resolute. We spend a lifetime poring over our mistakes, so that we don't repeat them to your detriment or that of your loved ones. Us asking for you (through the government) to avail us the tools to stave off death for another day is something that we are duty-bound to do. We would love the chance for every one of our patients to have therapeutic options available to them at a rate that they can adequately afford; that they would stand the same rate of survival regardless of their economic endowment.

As with all things in this life, we do our part, but we recognize that in the end God provides the true healing. In the end, He's all we really have.

God Bless.