Mt. Longonot and Lake Naivasha

 This weekend was filled with adventure! On Saturday we climbed Mt. Longonot, a Dormant volcano lying in the center of the Gregory Rift. the climb to the rim was steep, but we were rewarded with views of the crater below and of nearby Lake Naivasha.  Next we hiked around the entire rim and then back down to the parking lot. The hike took 5.5 hours in total and everyone was super tired! To refresh ourselves we visited Sawela Lodge, where we visited the swimming pool and then ate dinner at the lodge restaurant.

Driving toward Mt. Longonot

Looking into the crater

Cheese

Hiking the rim

Looking out onto the savannah

Vervet monkeys at Sawela Lodge

The next day we drove back the same direction to visit Cresent Island Game Reserve, an isolated island in the middle of Lake Naivasha where we could get up close and personal with wildlife. After a quick boat ride across the shallow lake, we walked around the island and had close encounters with impalas, waterbuck, wildebeest, and even giraffes! It was an amazing experience!

Natalya meets an ostrich

Grant's Zebra

Giraffe!

Wildebeest

Impala

Hippos

African Fish Eagle

End of week 1

 Here’s an update after my first week in Kijabe! The jet lag is beginning to fade, and I’ve settled into the routine of working at the hospital. Each day I head in after a hearty breakfast, look over any cases from the previous day, then head to gross in the afternoon. After that the next batch of slides comes and the cycle repeats.

 

Some of the case highlights of this week included a mixed germ cell tumor, a Wilms tumor, and a case of Madura foot. This latter case was a rather unusual one, as the specimen was a tan white mass with numerous gritty black “stones” inside it. Dr Garcia, had never seen anything like it, but when we told our local pathologist colleague Rosemary about it, she immediately suspected Madura Foot. This condition, also known as eumycetoma, is a fungal infection of the skin, most commonly of the foot, and may develop after minor trauma where the wound is inoculated with fungus, which slowly spreads resulting in ulceration, deformity, and loss of function. Diagnosis is by biopsy with identification of fungal forms. Treatment is surgical resection or anti fungal medication. When we looked at our sample under the microscope Mx sure enough, there were numerous brown fungal colonies in the tissue! Brown colonies like the ones we saw are typically created by fungi of the genus Madurella, Pyretochaeta, Exophiala, or others .

Other than the exciting cases, we also visited Rosemary’s house for authentic home cooked Kenyan food as well as visited a global cuisine restaurant called Talisman to bid farewell to Dr Garcias mother, Ginger before she left to return to the US.

I’m looking forward to the weekend! Tomorrow we will climb Mt Longonot, and probably take it easy on Sunday.

Madura foot gross appearance

H&E appearance (not our case, but a similar one found online)

Trying to open a wine bottle without a corkscrew..

Delicious home cooked Kenyan food (clockwise from top): chicken curry, mung beans, irio, chapati, and pilau

Blue monkey on hospital roof

Butterfly, likely of genus Glenotis

Day 1: Exploring Kijabe

 Today we went for a walk along the hills, which were filled with fragrant flowers and lush foliage. We saw eagles, and ibises and even monkeys! After that it was time to finally get to work: we entered Kijabe hospital and surveyed our workload. There was a nice collection of thyroid, gyn, and BST cases, some large cases, some small biopsies. Unfortunately the dictation software stopped working so we had to slow down a bit. We did end up finishing all the specimens though.

Afterward it was time to preview. There was a nice mix of GU, HNL, and GYN cases to look at. Afterward I went back to the house and we all ate dinner; Rochelle had made lentil soup, yum!

We had to send a couple consult cases to UW, which we do via a camera attached to the microscope.  the first one was a brain tumor: a 21 year old male status post surgery for left frontal pilocystic astrocytoma in Feb 2022. MRI 11/28/2023 showed recurrence of cyst with recurrent tumor, with patient undergoing subsequent surgery.  We believed this represented a recurrence of the pilocytic astrocytoma, but were worried that there may be a higher grade process present. 

Worrisome atypia

A worrisome hypercellular area

Our neuropathology colleagues advised that in order to rule out diffuse glioma (more invasive than pilocytic astrocytoma) we should look for high mitotic activity and other high grade features such as microvascular proliferation and necrosis.  We did not end up finding these things, so we signed out the case as "worrisome" for a higher grade process.

Day 5: End of Week 1

Woke up in the middle of the night- dreamed about my mother attempting suicide again. I didn't jot down my visions at the time, but I recalled being angry and wondering why she was trying to do it again after promising she wouldn't.

The water is VERY hot in the shower- expect your skin to be burned off every time. I had to start squatting in the shower so the temperature would cool down before it reached my body =(. Someday I'll find a stool in the place to adjust the dial on the water boiler. Also, laundry days here are on Tuesdays and Fridays. You wouldn't think it, but the dirty clothes seem to pile on quicker here compared to the U.S. for some reason.

Rochelle relayed a message via Ginger for me to go ahead to the hospital without her if I want to start work early. I misunderstood or didn't understand the meaning initially because what she wanted to convey is that I can go to the lab, preview and writeup cases before she gets there so that she can review them while I gross with Ginger. That makes SO much more sense!

Last day of the week, and we are finally all caught up! At this hospital, reviewing the path records, they have 3712 surgical pathology cases, 1344 Paps, and 262 non-GYN cytology for the 2023 year. That seems about what we probably get individually during our two AP years at UW. It would be nice if this hospital could open up a residency spot for pathology, but then we have to deal with all this bureaucratic headache, in addition to finding pathology attendings willing to teach/train someone on the job.

Things that also differ here in pathology: formalin goes down the sink?! What about their water supply?? We reuse the same protective gown. It is surprising how far one can go with a sturdy gown. I don't know how long the one I'm using has been hanging in the gross room, but I ended up using that same one all week and probably will for the remainder of my rotation. Another difference is that lead pencil is used for writing on cassettes rather than having a fancy label printer. The caveat of using pencil is that it dissolves in formalin, so you better be sure your labels are etched well onto the block. The ink here is also watered down, as we have been reusing the same bottles for our surgical specimens. Thankfully the volume isn't as high here compared to UW, so it will most likely last them all year long. It also seems that we don't really need our margins inked that often to finalize diagnoses on our cases. So long as you cut and submit the tissue appropriately, you should be able to tell microscopically how close the lesion is to the margin. The ink does help though =).

All week I was putting the finally figured out what to do with this blue strip for the headset, turns out it it a compressed surgical cap to cover my hair haha...

Previewing cases- we finally caught up! The hospital had a total of 3712 surgical pathology cases (excluding cytology), which seems good for one resident to train here. When we've been chatting with each other leading up to boards applications, everyone we asked just guesstimated ~3000 cases total from both AP years of training.

Rochelle left around 3PM, whereas I continued previewing cases (chondroid syringoma was interesting to see- it presented as a firm mobile scalp mass in young patient) until Ginger came by, and pretty much finished all cases not pending consultation or slides. By the time I was done previewing, the new cases from the OR (one colon, one MOAR thyroid) were not accessioned so the both of us decided to go home.

Laundry came FRESH and hot out the presses. They wash and dry your clothes for you. It was raining today (you can tell from just outside the grossing window, which is something I appreciate more here compared to our closed artificially lit gross rooms in Seattle), so I was worried they were hanging in the drizzling rain all day.

Ginger wears nightgowns, nightshirts if you will (of which I have 3, 2 from Christmas gifts). If I had known she was going to wear them I would've brought my own as well.

Changes occurring by the end of the week: I was no longer spraying my scrubs with permethrin, nor myself with picaridin. I will pretty much save those sprays for when I'm traveling in Nairobi or on safari. There really aren't any mosquitoes here!

Things I appreciate during this tenure in Africa: talking to Rochelle and Ginger about their interests and learning more about them, getting advice on my future career path in path (ha), and spilling the tea (lips are sealed).

Dinner was everyone for themself (again)! I had ramen with canned tuna and a whole can of corn, plus yogurt, juice, wine, and diced mango. At the dining table while eating my mango, Rochelle teased me, asking if I was planning on eating all the fruit in my tray (a reference to my possibility of having diarrhea while hiking tomorrow).

Laying in bed around 9PM is when you start receiving work emails from UW. Reminder that PST is 11 hours behind Kenya's time zone. Happy weekend all!

Day 4: In Hell, You Gross Thyroids

Almost getting over the jetlag!

In the mornings now, I hear voices. Is it the TV, are they talking in the living room loudly, or am I going crazy? Who knows...

Solid consistency, almost!

Outside my bedroom door, it became quiet. Rochelle had gone on a run. I slowly got up and out my door to have breakfast. Again, a cereal and sandwich with my atovaquone (antimalarial) and azithromycin (traveler's diarrhea)... wondering if I really need to take the former medication if both Rochelle and Ginger haven't taken them for years now every time they visit.

Today I planned to work without contacts nor sunglasses, though I've never done pathology through the microscope with eyeglasses. Do people typically take off their glasses, peer through the eyepieces, and then put their glasses back on to type out their reports on the computer screen? It feels so cumbersome to press both my face and glasses against the microscope.

The backup of cases from December had finally started to be whittled down, though we still have not hear back from BST consults. Rochelle thought people would be confused by the way I organized the files, but I think if Dan Child and Becky Yoda got back to me quickly, then it shouldn't have been a problem with the BST folks as well. Also learned a new thing during this- Austin Jones added Troy Hutchens to the email thread, so I guess he does BST as well! I've been on the CP side since he joined the AP faculty so I haven't really had a chance to work with him yet. A challenging inflammatory derm case came up, so we consulted Josiah Hanson and Luke Dang (Luke didn't respond -.-). Advice to future residents- my way of organizing the consults was just to shove them onto OneDrive into folders separated by subspecialty with the case clinical history imported into the folder as well. Then you can just easily share it with respective faculty/fellows.

This morning's grossing work consisted mostly of biopsies and replacing decal solution for some pending specimens (they are so rock hard, I don't think those bony specimens will be ready even if we gave it a year) while in the afternoon 15-20 thyroidectomies arrived from an outside institution, along with tonsils and adenoids. This was a lot on its own, compounded with the fact that they stick their thyroid goiters in container with a narrow mouth and strong formalin, where it is impossible to pull out without tearing the specimen. Good luck to those of you with short and/or fat fingers. The formalin from this hospital in northwest Africa, who may or may not have diluted the formalin, will sting your eyes as if you are cutting onions!

Apparently the prevalence of iodine deficiency can be up to 51% in Africa, affecting hundreds of millions. I wonder why salt here hasn't been iodized to counteract something so easily preventable? And to think our preventative medicine in the U.S. is lacking. During grossing I noticed the windows were opened up not only for ventilation but also to prevent TB. That led me to question if that's why they asked me to mask up. OR if it's because of my cough that I caught from my nephews over the break. My partner repeatedly testing negative, who was breathing directly into my face while snoring in bed, so I'm PROBABLY ok.

Back at the apartment, staring at living room, you'll see that there's no TV. One of my friends Nancy Lin, who I stayed with during one college summer, arranged her living room in similar manner "to spark conversation." Rochelle & Ginger actually play scrabble on their phones while sitting next to each other on the loveseat, and I'm at the dinner table or couch writing a blog post with more fervor and conviction than some research projects I'm involved in... (some of which I need to do this weekend! Apologies faculty members!) 

Dinner menu tonight: a rendition of lasagna without pasta, like ratatouille (there's eggplant, cheese, tomatoes, mushrooms <3... side salad, and homemade bread. On my second bowl of the lasagna, Rochelle noticed I had mushrooms leftover, and she asked whether I saved them for last because I liked or hated them. LOVE mushrooms. Can't get enough! Who in their right mind would save the thing they like least for last and have that flavor linger in their mouth?!

It's barely been a week, but it's been fun getting to know more about the people I work with: their interests include jazzercise, wanting to be a dancer in the next life, seeing Elvis in concert in Seattle before he became famous, having their prom song be Everly Brothers' All I Have to do is Dream. I actually like Dr. G's music playlist. Back in the later years of high school and college, I had this sudden motivation to develop this encyclopedic knowledge of American music history, from the roaring 20s, to the soaring 60s, disco, 80s (!), early 90s hiphop, to the present decade. Although I feel like I've reached the stage where I probably don't and won't keep up with current pop as much, which is giving me deja vu of riding in my aunt or uncle's car and wondering why they only listened to old crap. Turns out it isn't crap! Or I'm just getting old =(.

***PICTURES: ONE DAY, I PROMISE***

Some Pics from first week from Rochelle

 This is Rochelle,  Decided to add a brief post with some pics, if I can get them loaded!

We had (for us) an uneventful trip here and first day with shopping, etc, for Details (of everything 😏) see Jason's posts, he has taken that assignment seriously!  Not sure I want everyone to see all my secrets, but oh well!  Life is too short to worry about it. 

There were A LOT of cases here waiting for us, both in the gross room and to sign out, including several sarcomas in 1 month old to adults (thanks to the BST folks for consultations), an ependymoma, a meningioma, breast cancer(s), Burkitt's lymphoma (2!), cancers of unknown cell type, cervical carcinoma, LAMN, bone marrow biopsy... etc, etc!  3 days in though we are CAUGHT UP!!!  As Jason pointed out, some of the gross descriptions/sampling left much to be desired and emphasized how important grossing and describing what you've done is!

Garden store on the way to Kijabe where we bought oregano, mint and Rosemary!

View from our living room Window!

The Crew!  Mom keeps saying it's her last year, but then changes her mind :)

Jason's exciting first meal!  Who knows if this was the cause of his dysentery

Jason's getting ready!  There were piles of slides everywhere!

Starting the grossing.  Notice the sunglasses as eye protection from formalin and the sun!  the fan is the replacement for a hood and formalin fumes not so nice, especially when the specimens come in undiluted formalin!  Mom still doing her gross room duties at 83!!

Pic from morning jungle walk

AM sunrise from my bedroom window

More from AM walk

That's all for now.  Will try to update with more pics later!

Day 3: I Have Died of Dysentery

It's only technically the second day I've been in Kenya, but I haven't been sleeping well. Even though I passed out from jetlag, I woke up around 11PM and then 3AM. My ears have just gotten so sensitive after having dogs who needed to go out in the middle of the night that I can hear my roommates walking to the bathroom to pee and then slamming their bedroom doors when they return. Tip: the toilet sometimes doesn't flush well until after you wait a really long time, so either you do all your business before flushing, or press down on the handle multiple times until enough water flows down to wash off most of what has been sitting at the bottom of the toilet.

After being startled by the sound of birds and activity in the living room, and laying in bed since 6am, I finally started getting up around 7-8am, reorganized the kitchen to make things more logical, and googled a recipe so that I can contribute to cooking (I mean, after hearing about how some prior residents cooked here, e.g., Josh and his wife)- I have to show them up somehow, right?? The challenge is to make something with pasta and little seasoning so that Ginger would like it, but lots of seasoning and no pasta so that Rochelle would enjoy it -.-

Morning breakfast consisted of milk and cereal again, after which I showered, sprayed permethrin on my clothes, and scrubbed up. They wore skirts and open-toed sandals while I was in scrubs... everything about PPE and personal safety that they enforce at UW, thrown out the window here!

Because Rochelle has been doing this for so long, orientation the initial day seemed like a whirlwind filled with LOTS of gaps in knowledge. Login information, which software to use, she could not remember. There wasn't a lot of explanation to things, I remember mostly finger pointing to things that I should be aware of but not how to use them properly, such as the grossing area and Dragon dictation setup. I think for future residents it would be good to write up something to help orient them... the only reason I could find to delaying the global health elective until after CP1 is that experience from FileMakerPro on the heme/coag rotation helped me navigate the software without much guidance from Rochelle (in fact, I think I even knew how to use it better than her!) FileMakerPro will be what you log into to enter your diagnoses on Surgical Pathology and Cytology (GYN Paps and non-GYN specimens) cases. The other thing to worry about is when we need to send photos over to UW or to people Rochelle knows for consultation. I was only familiar with the Eos software because I used to think about learning how to use a DSLR camera and purchased a Canon eons ago, which used that same software to download/upload images.

Since I was already there and gowned up after setting up the dictation software, I began grossing, and Ginger was my assistant! Sadly there are no safety goggles available, so I ended up using my sunglasses with the fan on and window open. It only became unbearably hot when the sun shone through the open window. Lots of culture shock grossing in specimens- poor ventilation, and some specimens are thrown into pill bottles (e.g., the prostate TURPs were collected in an empty bottle of antiretroviral meds) with formalin. The challenge was retaining the formalin, filtering the specimens, and making sure specimens are not contaminated by other specimens sitting in opaque containers. At this point I started beginning to feel how spoiled I am at UW with air conditioning, PPE, increased availability of grossing equipment... rather than Q-tips with ink, they reuse paintbrushes. They reuse all the blades- the short blade was chipped in several areas along the sharp edge, and the scalpel was rusting. Vinegar along with formalin is in short supply, so they need to be used sparingly. Several things we take for granted to be able to do our job well we never really think about, but then again there seems to be opportunities where those in a more developed country could shave down on costs. Less tissue blocks submitted, less work for technicians, less glass and stains used, and less time spent at the microscope.

In the middle of grossing, I decided to change my overly dirty gloves for a fresh pair, only to notice that my thumb had green ink all over it, likely due to my left glove being nicked at some point. So much for protecting myself from formalin... at least I still had my sunglasses to protect my eyes (I had gotten formalin in them at the VA during my 1st year when I was rotating there with Bitania, and then a 2nd time was a near-mostly miss when prepping a prostate at Montlake with goggles on).

When nature calls (and when Ginger needed a break from grossing), one finally finds it necessary to use the bathroom at the hospital. Multiple issues arose, though: 1) it's a squatty potty?! (where you place your feet between the toilet opening and squat down to do your business) 2) the men's bathroom was out of order 3) there was no toilet paper inside the women's bathroom, so you have to grab however much you think you need before entering. Act 1. Montezuma's revenge. Delhi belly. The Nile runs. Call it what you will, but oh it hurt soooooo much (the title of this post alludes to Oregon Trail, if you haven't played it before or just don't follow the pop culture ephemera :P). The first time I aimed too far away from orifice- had to wipe down everything to get it flushed :'(. The second time I squatted too close to the orifice, and kept water splashing down from tank/pipe and onto my bum -.-! The shocking thing Rochelle told me was that all the time she's been here, she's NEVER had traveler's diarrhea. It's probably because I was greedy and ate everything at the buffet bar and grocery store. Maybe next time I should just wash and peel my own produce rather than purchasing the pre-cut ones...

Another putative culprit are the milk tea and hot chocolate they bring to the lab around 11AM daily. Their version of milk tea I believe is mostly milk and sugar- it curdles on the surface if you leave your cup sitting for too long at the desk. The other option is hot chocolate, which is also mostly milk and no sugar. One of the days this week I forgot to bring my water bottle and relied solely on both for hydration... BIG mistake. In multiple Acts =(!

Since the lab was so backlogged on so many specimens due to whoever rotated before us (Rochelle mentioned that they did all the easy cases and left us with piles of the harder/challending cases), I spent most of my initial day grossing rather than at the microscope diagnosing off slides. Some other things to note about grossing- you realize how IMPORTANT it is to describe your specimen accurately and submit the appropriate tissues in blocks before ever receiving your glass slides. A lot of the trays contained an inappropriate number of slides. For example, 5 slides for appendix or gallbladder when they really should have only put in 1 block of tissue. Excision or resection specimens (bigs) containing margins that don't make sense (e.g., radial margin for colon rather than rectum), or not even submitting/inking margins at all. Please Please Please remember your inking schemes and relevant surgical margins!!! Seeing how others practice pathology makes me really grateful of all that we have been taught at UW, including the importance of being able to gross your own specimen. Another thing about the trays: since they only have the metal trays that we use for slides from frozen specimens, that is how you will organize your workload. Additionally, they won't bother to space out the cases for you, i.e.,  the slides sit back to back and cases will run into each other, so you need to make sure the slide you are grabbing belongs to the appropriate case and not make diagnoses off the wrong slide(s).

Ultimately, we stopped before 4PM, which is nice because they want to get started on cooking to have dinner by 6PM and be in bed by 8PM. They like sleeping early! What do I do with my time then aside from drafting blog posts?! I GUESS boards studying, but the internet is so clunky here, even with the new router. Thank goodness I purchased an unlimited data plan from Holafly ($75 for 30 days)- there's enough decent signal to where I could work off my phone if needed. (I actually spent most of it uploading instagram posts and sending TikToks to Bitania :P)

Before dinner though, we stopped at the local market once more for carrots, english muffins, and pineapple. One of the ladies there makes English muffins that they really love, so we asked for a bag the day before, and came around today to pick it up.

For the above GI problems, I began taking azithromycin (starting with the old prescription from OSU when I had originally planned to go to Vietnam for global health before the Covid pandemic hit), 500mg. The results have been moderately successful with alternating solid to liquid quality. We'll see how it goes by the 3rd day...

Once we were back from the market, I finished blogging in my room while Rochelle slept, snacking on watermelon and wondering which food source led to my bowel's demise (sliced fruit from the store, luncheon meat, milk, hot chocolate or tea from the lab, etc.)

Dinner menu: shredded beef soft tacos with sides of bell pepper, lettuce, cilantro, yogurt (rather than sour cream), tomatoes, cheese, salsa. I must have eaten 3 of them- for now, I've been holding back on how much I can eat partially to not be rude or greedy, but also because I'm trying not to eat all the food in case they wanted to save some for leftovers.

***(REMIND ME TO UPLOAD PHOTOS! If not, catch them on my instagram @jasonjsiu ;)***

Day 2: From Nairobi to Kijabe (grocery shopping!)

The morning after.

Took a shower, arranged my bug sprays neatly in a row to determine which ones to use for spraying clothing (that's permethrin) and which ones to spray on your skin but not your eyes (that's DEET and picaridin). It seems I overpacked because Rochelle and Ginger don't use mosquito repellant while staying in Kenya- apparently it's dry enough most of the time and at a high enough elevation to where mosquitoes aren't around, unless it's after the rain or if you leave your window open at night, which makes me suspicious that what they're saying is actually true... if you look at the malaria prevalence, I believe it is mostly in northwest Kenya rather than where we are.

The breakfast at the hotel buffet bar was quite lovely. I started off with bran flake cereal in milk, with a glass of pineapple juice. Then proceeded to the hot bar where I grabbed a bit of everything- baked beans, bacon, grilled tomato, potatoes, eggs, sausage, sausage roll, arancini, grilled veggies, arrowroot and sweet potato with a glass of tropical juice. This was when Rochelle & Ginger finally arrived to breakfast. After chatting with them, I continued to grab a bowl of fruit salad with a glass of orange juice, and finally had a yogurt parfait because we were waiting for Phillip to call us indicating when he would arrive. Apparently the typical Kenyan habit is to arrive fashionably late just like us Asians (I think the latest I've ever arrived at any social gathering was 3 hours, if you don't count not going at all even after RSVPing yes).

Since we were all waiting anyways for Phillip to arrive, we all went back to our rooms, brushed our teeth and grabbed our luggage to check out of the hotel. 

Driving in Kijabe is something to adjust to. The driver sits on the right side of the car, with the stick shift used by their left hand, and cars drive along the left side of the road. People also walk along and cross the highway! People will try to overtake vehicles, and you feel like you will almost run into the car in the other lane before you can return to your side. On top of that, you're buckled in a waisted seatbelt, so no over-the-shoulder strap is going to protect you from launching forward in case of an accident...

The roads, buildings, and houses varied in quality driving from Nairobi to Karen to Kijabe. It was very reminiscent of when I traveled to China for the first time in 1997 to visit my parents' hometown and tour parts of Asia. Dirt roads, dilapidated houses, with varying income inequality. It seems like these cities in Kenya are on the up and up, catching up with the rest of the world. Also, there are various cute farm animals grazing alongside the highway as well! Goats, sheep, cows, donkeys, chickens, ducks, etc.

I was on edge for some reason the entire time because I assumed we would start work right away after arriving in Kenya. I mean I was only going to be working for 3 weeks so I felt like I needed to make the most of my general pathology experience worthwhile. Surprisingly, today was supposed to be a relaxing day of preparation. Our first stop entailed going to a Westernized shopping center/outlet with your familiar fast food spots like KFC and Burger King. One thing to get accustomed to is security all around town. Whether it was at the hotel or at this shopping center, security guards stood at the entrance with metal detectors ready for you to pass through. I was reading online before this trip that you also really shouldn't take pictures of government buildings and people without their express permission- things to think about to stay out of trouble while in Kenya. At this center, I was able to go to a currency exchange counter. One thing to remember when coming here is that your bills need to be younger than 2009 AND they cannot have any damage to them. They rejected one of my old bills and a new bill with a 5 mm tear in the middle. The exchange rate is currently great, though, at 156 KES (Kenyan shillings) for every $1 USD.

Not only did Rochelle forget to pack a lot of things, but I also forgot to pack sunglasses. Luckily, there was a sunglass store right across the supermarket. The lady taking care of me there was very attentive- wiping off every pair of sunglasses before letting me try them on. I ended up purchasing the earliest, and cheapest pair I could find for $14 USD?! Someone could work overseas and live here very comfortably with the great exchange rate. If you have sensitive eyes like mine, you're going to need a pair to avoid these harsh rays right near the equator. It was great finally wearing them so that the dust wasn't hitting my eyes while riding the van with the windows open. I'm very heat intolerant, and it reached around the 80s F that day, so any air in the car would have been helpful. Moreover, I caught some kind of bug from my sweet but germ-infested nephews and didn't want to get anyone in the car sick (more on this later).

I don't understand why people don't love grocery shopping. It combines two of my favorite things: food and shopping. Interesting aspects of the Kenyan grocery stores compared to the U.S.: the variety of color seen with their produce, and the variety of their fruits and vegetables (e.g., bananas and plantains rather than the genetically non-diverse kind we have at the store). The produce here is charged by the kilogram, so you have to bag and weigh them at a central counter where they append a sticker to the bag with the final price on it. There is not only milk in the chilled section but milk sitting on the counter at room temperature. Even the eggs sit on the shelves at room temp. In terms of cereal, corn flakes seem to be the predominant purchase. I think I realize why now after having chosen one cereal that almost looked like Quaker Oatmeal Squares (only $2 at Fred Meyer!). The amount of cereal in my box could last you 5 days if you don't fill your bowl to the brim...

Rochelle and Ginger got hungry, so after making all our purchases and dropping them off in the van, we stopped at Artcaffe. Rochelle ordered a watermelon/pineapple w/ mint and passionfruit salad and sour passionfruit drink w/ an accompanying shot glass on the side containing simple syrup. Phillip ordered a hot chocolate, and Ginger got a roasted red bell pepper soup w/ garlic bread. I only wanted cold water, but everyone offered me some of their food, which I never refuse ;).

Soon after that we departed for Kijabe, which was 50 km away, and took around an hour to get there depending on traffic. Seems like we brought the Seattle rain with us, which was refreshing to have the window open driving up to our lodge, but before we reached our destination we had to drive through dirt roads with potholes and muddy pools of water. There's no elevator to our place, so after laying down some of our carry-on bags, we moved all the grocery bags up first and then moved all the luggage to the bottom of the stairs before transporting all of them up in as few trips as possible up three flights of stairs (there's no elevator :(...).

Something Phillip advised Rochelle and Ginger to do in the past is to wash all our produce with a bleach/water solution for 10 minutes and then rinse them under tap water before setting them aside in these baskets to dry.

There wasn't much else to do today, so we walked 5 minutes down the road to the hospital for a quick tour of the pathology laboratory, said hi to the personnel who were still working there, and walked up the road to get to the local market. It's at this location where several women were sitting around the perimeter inside the building, each with similar but slightly different produce for sale. How this produce ends up in this little flea market is that the women go to a market even higher up on the hill where it is cheaper, purchase it, and resell it down here. Plenty of folks don't go because they know the price is cheaper up top, but for those of us who are lazy and don't want to walk that far to grocery shop (only to have to walk just as long back home), this place will suffice. And who can complain if you're from the U.S.- the total cost of our grocery haul was 1250 KES or around $8. EIGHT DOLLARS for all those fruits and vegetables!?

Rochelle & Ginger love wine (particularly cabernet sauvignon), so it was wine o'clock upon returning to the apartment. Dinner that night was every human for themself, so on night one, since I didn't think to have any easy dinner ingredients, resorted to cereal and milk with a pairing of the Bota Box wine that was already opened. Then I made a meat and cheese sandwich for myself, but honestly, I was so jetlagged and tired from not sleeping on the plane that I could have passed out and been fine not eating.

Shocking things: (1) Rochelle washing her feet in the kitchen sink (she said they were dirty), and (2) they store their bread in the freezer. I thought I was strange for storing my bread in the refrigerator to make it last longer and not mold, but the caveat to that is the bread can get dry. However, they put their bread in the freezer, take out some slices hours beforehand to thaw it, and then eat it. I think I'm too lazy to have the foresight to set bread slices aside for my meals, but to each their own!