Stopping in Advent

A moment of quiet on this otherwise busy campus - when we had to cancel church services yesterday, Dec. 20, the fourth Sunday of Advent. The snow came through the night and we were covered - the Falmouth police urged folks not to drive on Sunday and when we realized it was as serious as it was, we decided not to hold services. My first snow day from church! It was kind of odd - I love the fourth Sunday of Advent and the week feels strange in a way, now but I know the next few days will be filled to the brim. Meanwhile, the quiet and the beauty that surround us are wonderful. In the photo my two terries, Lulu and Ruby, are wondering if they can get through the deep snow and get to the tree (they couldn't) but today is there is already a path made by someone else anxious to get there. Slowly our world will come back to normal but for a day we all stopped. Isn't that what Advent is all about anyway?

David Nawrocki at Maseno, Kenya - Chapter 6, Final Chapter

Chapter 6   As you read this final chapter, you may continue to find errors in the typing of these journal entries.  The entire three weeks here have been a struggle to access both water and electricity for daily life.  We live each day with the uncertainty of not knowing whether we will have electricity or water and for how long.  Many of the journal entries have been done under a mosquito net at 2:00 am because that seems to be one of the times where the electrical power remains on.  Loss of power makes caring for the patients difficult because we cannot take x-rays and evening treatments in the wards at night must be done by railroad lanterns.  We have collected water in buckets this week along with everyone else with each rain to flush toilets and take bucket showers.    As I write this chapter I find I am already missing the staff, the patients, the laughter and innocence of the children of Maseno, Kenya.  I will miss my daily Swahili lessons with the Reverend James Obura, the hospital chaplain as I have attempted to learn the Lord's Prayer, the 23dr Psalm and the Apostles Creed in Swahili.  I will miss the impact that everyone here has had on my life.  I am asked daily when I will return and why I cannot stay for another few weeks.   This final chapter and this journal would be incomplete without sharing some final experiences of the last three weeks.   The Orphan's Programs   There are two Orphan's Programs that Drs. Nan and Gerry Hardison have helped develop in Maseno since they have been here.  The first program involves free medical care if you are an orphan and have lost both blood parents.  You are eligible to be seen at the Maseno Mission Hospital and Dr. Gerry Hardison will care for you, no questions asked.  Your medical record flags you as an Orphan's Program patient and care is provided.  The Hardisons cover the cost.   The second program involves the 43 parishes in the northern region of the Anglican Church of Kenya.  Thirty-eight of the 43 parishes have approximately 250 to 600 orphans per parish.  These are children spread throughout miles of country side that have lost both parents to HIV, other illnesses or tragedies and are monitored by church elders, extended family members, or the children themselves.  It is not uncommon to have children ages 7, 8, 9, or 10 become heads of households.  The children from each of the parishes walk for miles each Saturday to come to their respective parish for a day of gathering which includes one cup of tea and a meal of beans and corn which is a staple meal in this part of the world.  Education is also provided during the morning for these children by grade levels under the shade of the nearby trees.  The cooking of the tea and food on open campfires begins at 5:30 am – 6:00 am every Saturday by volunteers in the community from each parish.  Education, games, dancing is all provided by the same volunteers for the morning.   The children come in from the surrounding villages between 7am and 8am in the morning.  Many of these children are as young as 3, 4, and 5 years of age.  They walk several kilometers by themselves in some cases to attend the Saturday morning gathering at the church and hopefully have the one major meal they will eat all week.  There are games, singing and dancing for the couple of hours as the children arrive.  When it is time for tea mid morning, the children line up in long lines in front of a make shift table which is really a fallen tree trunk.  Each child carries a small plastic trash bag where they keep their tin cup or plastic cup (recycled margarine containers) that they use to drink their tea from.  Children as young as three stand in line with their cup waiting for their cup of tea which is comprised of tea, milk and lots of sugar.  Once the children finish their tea they sit in small groups under the trees for education by grade level.  Classroom education may include Math, Swahili, English, or basic games for the 3 and 4 year olds.   Dan and I used the opportunity to visit the eighth grade class, to meet the students and to provide a guest lecture with the permission of the instructor.  As we met with 8th grade students, classrooms with the 7th and 9th grade students emptied out to join us.  Dan and I began asking the students about what they wanted for their own country based on the violence of the recent Kenyan elections.  The students were filled instead with questions about America and President Obama.  They were curious about poverty and homelessness in America.  One student asked about nuclear disarmament and asked if President Obama's efforts to reduce the number of nuclear weapons in the world would make Kenya and countries in Africa a safer place.  The students briefly talked about their own country after a lot of prodding and agreed that one of their greatest assets in Kenya was their natural wildlife and the importance of taking care of it.   Dan then opened the door to questions about HIV.  As visiting clinicians to the country, the teachers in the classroom gave us permission to pursue this line of dialogue.  Dan and I were amazed at the number of questions students had about HIV, vectors of transmission associated with HIV, and the possibility of survival once the virus was contracted.  Many students still thought that a HIV diagnosis was an automatic death sentence if you were diagnosed with the illness.  Many students did not realize that there were medications available that could treat the disease free of charge available in the community.  Our discussion lead into many questions related to sexuality and its implications for HIV transmission.  We held a show of hands to see who knew what their HIV status was, instructors included. Our guest lecture ended with a wish for all of them to find peace and an end to their tribal warfare that plagued their last national election.  Young people in Kenya have told us that they are tired of watching their countrymen and women die of disease, violence and malnutrition.  They are tired of the blatant corruption in local government and they want peace, employment, access to medical care and the opportunity for a better life.   Our guest lecture ended with the shared hope that the students in the class would complete their education and become the future leaders of their country.  We thanked the teacher in charge for the privilege of speaking with his students and returned to the local parish where the children grades 1-6 were completing their class room time.  As 12:00 pm approached, large cooking vats of beans and corn were strategically arranged on the log and nearby table so that lunch could be served to the hundreds of children. They once again formed three very long lines so they could be given their free meal.  Plastic plates were used to serve the luncheon meal.  We served the children one by one.  Once the meal was completed the children quickly returned with their plates for the remaining food.  The plates were then returned for cleaning and use for the following weekend.  I was surprised how quickly the food was consumed and at the same time I was not surprised.  As the children completed their lunch, they played or rested for a brief moment before their journey began back to their homes.  Some children played soccer in the afternoon sun.  Many of the children looked for an adult who was willing to sit on the ground with them and put their arms around them as long as it was possible.  It was not uncommon to see 5 to6 children sitting next to one adult.  The children would just huddle next to you for the opportunity to be touched and sometimes held.  They would say very little.  There were several occasions where I would be taking pictures and felt the warmth of a child leaning up against my leg hoping that I would not move.  I have seen these same children in the pediatric wards of the Maseno Mission Hospital sometimes sitting by themselves when their parents are not there.  Their faces expressed a sense of experience that some Americans never achieve by the time they are in their older years.  Many children in Kenya experience the maturity of a lifetime before they reach the age of 10.  You see it in their eyes and the way they handle themselves when they are in the hospital for illnesses that you and I would simply give into.  They are brave beyond words and rarely let on to the suffering they have already experienced.   The children gradually left one by one.  They all said goodbye as the "mzungu" left for their return trip to the Maseno Mission Hospital.  The sight of 200+ orphan children standing with their tin cups in their hands was humbling and hard to describe.  It is an image I will never forget.  Some parishes have up to 600 children fed on Saturdays in a similar fashion.   Victories and Losses in the Hospital Wards   There have been many victories in the hospital wards as patients have been treated for malaria, tuberculosis, HIV/AIDs, meningitis, pneumonia, malnutrition, cancer, and many other illnesses. We had a child who fell from a tree and broke both arms.  His arms were set in casts and he was sent on his way.  We saw another child who was seen by a local healer for spirits (headache).  The local healer placed several cuts on his forehead with a non-sterile blade (to release the spirits) that resulted in a massive infection below the skin on the child's forehead.  The infection was surgically opened and the infection treated.  The child eventually went home with his parents days later.  Klein was a four year old boy with tuberculosis, malaria and HIV and infected ears.  He was treated for all four infections and finally smiled the day he was discharged to go home.  We have had a 12 month old infant and a teenager that accidentally consumed cattle pesticide.  Both children had their stomachs lavaged and eventually discharged to return to their homes.  We have had several children delivered by caesarian-section.  We have also had several children diagnosed with "jiggers".  They were all treated with medications that would draw the insects out from the skin on their feet and legs so that their skin could once again heal.  These children were the lucky ones who were treated in time for a complete recovery and the opportunity to continue life.   Some patients have been seen and then sent on to larger hospitals in Kisumu.  One 5 year old girl named Rebecca came into the hospital barely breathing with pneumonia.  Her lungs were drained of fluid for three consecutive days.  She was eventually transferred to Kisumu to be seen by a thoracic surgeon.  Two weekends ago on a Sunday we had several people brought to the hospital by ambulance from an auto accident that occurred in Luanda.  The father died instantly in the accident.  The mother suffered a fractured leg and pelvis.  The two boys in the car suffered multiple lacerations, broken bones and a fractured skull. The mother was in the operating theater while we were carrying the injured boys in our arms from the outpatient clinic to X-ray and then back to the medical wards for suturing.  The boys involved in the accident had their heads sutured and arms set in casts before they were transferred to Kisumu for further care.   Many other patients have been less fortunate.  We have seen many chronically ill patients with gastro-esophageal cancer, thyroid cancer, congestive heart failure, tuberculosis, leukemia, hemorrhagic fever that could not be saved.  Ann who was our teenage girl we found on our home visits lasted for four days in the hospital.  She had a form of tuberculosis that became fatal because treatment began too late.  In each case several family members would care for the patients each day, feed them, wash them, and eventually carry them home for burial.  In one case last rights were given to a woman who passed away from congestive heart failure three days later while she was in the hospital ward.   There are many other cases too numerous to mention where Dr. Hardison and the medical staff have been able to provide the life saving care that people in Maseno and Luanda would otherwise not see.  Despite everyone's efforts, there are many medical specialties required for critical care that do not exist in Kenya when compared to the United States.  If the medical specialty is present, it is limited to those who can afford the surgery and most people cannot afford it.   Symba and the Holy Eucharist   We have seen patients in the medical wards twice a day, seven days a week. Sunday evenings we have taken dinner with Drs. Nan and Gerry Hardison at their house approximately three kilometers from the hospital.  They have a dog named Symba who is part of the family.  Symba is a middle aged, slightly overweight, male golden brown German Shepherd mix with a gentle personality and eyes for the next free meal or handout.  He can be quite vocal if you have food and you are not sharing or paying attention.   Wednesday mornings, there is an 8:00 church service at St Philips Academy in a small chapel on the grounds where the Hardison's house is located.  This past Wednesday Helen and I made the three kilometer walk from Maseno Mission Hospital to St. Philips Academy to attend the service at the chapel.  The chapel is open to the morning air and the doors in the front are left open during the service.  As I approached the chapel I saw Symba sitting on the walkway just outside the front door of the chapel.  He barked once then recognized who I was, wagged his tail, let me pass, and then reassumed his position sitting by the door to the chapel.   The Holy Eucharist service went as planned until we got to the celebration of communion.  Parishioners lined up in the center aisle to receive communion.  As the last person made their way towards the minister giving communion at the altar, Symba's keen eye caught sight of the morsels of bread on the plate the minister was serving from.  Symba got up and got in line behind the last parishoner.  He patiently made his way to the minister at the alter rail, sat down, began to wag his tail and waited for his communion bread.  The minister ignored him and went to the side of the chapel to give communion to someone on the right who could not come up to the altar.  Symba walked over to that person, sat next to the celebrant and waited once again for his turn for his communion bread.  The chapel was silent but you could see the smiles, silent laughter and surprise on everyone's face.   Celebration of the Eucharist ended and we began to sing our final hymn.  Symba realizing that his serving of communion bread would have to wait until after the service walked back down the aisle and sat beside me in the church pew for a gentle rub on the head until the service was finally over.   God's Presence at Maseno Mission Hospital   God is present in the hospital wards of Maseno Mission Hospital every day.  I have had the privilege of caring for the sick, celebrating the healed and carrying the dead who transitioned to a better life.  The future of Maseno Mission Hospital is uncertain as it struggles to become financially viable amongst the corruption and uncertainty of Kenya's political future.  Volunteers of all kinds will continue to come to Maseno Mission Hospital to care for the sick and forgotten as well as its orphans.  Engineers Without Borders will come in November to attempt to improve the facilities infrastructure for the hospital compound.  Christ's Hope will continue to provide in-home care for people with HIV/AIDS and search for those who have been neglected or forgotten in the community.  Jerod, who is one of Christ's Hope's clients, is with us right now for blood transfusions associated with his HIV/AIDS.  He is a gentle man with a gentle smile who was neglected based on the stigma and isolation of his illness.     There are numerous pictures to share with everyone on my return trip.  Your presence and prayers as a parish have helped the passage and distribution of the many medicines that were donated and found their way through customs.  Fifty percent of the medicine brought was distributed in the last three weeks.  I have told patients and members of the medical staff at Maseno that there are many people in Falmouth at St. Barnabas who hold them in their prayers each week.  You are all in their prayers at Maseno at the 8:00 spiritual devotional service at the hospital each morning.  They are grateful that people half way around the world would want to come to the northwestern province of Kenya to serve and care for the people of Maseno.  They do not know your face but they know your presence.   There is no way to easily end this journal entry except to say that there is much more work to be done here.  There are many untold stories.  There is tremendous need and tremendous opportunity for those of us that have so much to share with those that have so little.  I ask you to keep the people of Maseno in your prayers in the weeks and months to come.

David Nawrocki at Maseno, Kenya - Chapter 5

Chapter 5   Community Health Outreach Work in Maseno and Luanda: HIV, ARVs and AIDS   There continues to be a tremendous stigma associated with HIV in Kenya therefore many people in Maseno and neighboring Luanda do not pursue the healthcare they need to treat the disease.  Family members in some cases abandon children with HIV.  Life is very hard in Kenya with very limited money and a very high unemployment rate.  People make tough choices every day about the little money they have and how to spend it.  Healthcare still costs money in Kenya although it is pennies compared to what we spend in the U.S.  Community Health Outreach Workers from Maseno Mission Hospital travel by foot to the neighboring villages in Maseno and Luanda encouraging people in the community to seek the healthcare they need rather than face the inevitable death sentence that HIV places on them without immediate healthcare.  Many of the Community Health Outreach Workers have HIV themselves; therefore, they can relate to their clients the importance of getting treatment for the virus before it turns into AIDS.  HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Autoimmune Immunodeficiency Disease).  Antiretrovirals (ARVs) are medicines that help lower the amount of virus carried in your body when you are first diagnosed with HIV.   The Walk Through Luanda   Paroxetes Agara is one of Community Outreach Workers who was recently diagnosed with HIV as well as tuberculosis.  Most of the patients we see at the hospital have complications associated with HIV, malaria and tuberculosis.  She had taken a break from her daily community visits where she walks several kilometers while she was being treated for her tuberculosis with regular injections of streptomycin and working from the outpatient clinic.  She agreed to make an exception and take Helen and me out for a day of home visits since she knew the outlying villages so well.    Helen, Paroxetes and I left Maseno Mission Hospital early in the morning. and walked for several kilometers through the jungle back trails of first Maseno and then Luanda.  We left the backroad trails at one point and came back up on the highway just in time to pass through Luanda center.  Luanda center is filled with outdoor merchants, bicycles, trucks, small fires with pots of oil cooking fish and samosas (fried dough with lentils).  All along the shops there are small children barely clothed playing amongst the abandoned skeletons of cars that once traveled the roads.  The children make up games from anything they find along the roadside.  Shingles, tin cans, plastic cups, automobile tires all become the objects of a game to be played in the hot late morning sun.  There is no trash pick-up or recycling in Maseno or Luanda.  Everyone burns their trash including plastics.  On many days there are several fires producing their acrid smoke that fills the air as you walk the dirt roads.  Most of the cars and trucks operate with diesel fuel.  The exhaust they produce is dark, black and suffocating especially after the third or fourth truck passes by in tandem.  Walking through the township with dozens of Trans African tractor trailor trucks idling in the town square made the walk almost impossible if you wanted to breathe. There was a sigh of relief as we made it to the outer limits of Luanda township. I stopped for a minute, took a deep breath and renewed myself for the journey into the local villages  As we walked through town, Paroxetes continually met clients she knew who were HIV positive and were continually monitored for consistently taking their ARVs so that the medication would keep the HIV virus in check.  We would stop so she could shake hands with her clients, reaffirm their commitment to their medication regimen and more importantly their commitment to life itself.  "Asante-san" as we continued walking.   The Kisumu to Mombassa Highway & the Kenyan Railway   As we left the town center on the main highway that passes from Kisumu to Mombassa, we passed another one of Paroxetes' clients, a middle aged woman who was HIV positive with her eight year old son in one hand and a live chicken with its legs tied in the other hand.  She said that she was on her way to Luanda township to sell her chicken for 380 Kenyan Schillings.  She would use the money to pay for her son's circumcision at the Maseno Hospital circumcision clinic that morning.  (Maseno Mission Hospital sponsors a circumcision clinic once a week and performs the surgery on eighteen to twenty-two boys per week).  She said that the rest of her money after the surgery would be used to buy food for her son and a ride home in a "mutata" (Kenyan minibus that functions like a local cab/bus service).  We said "Asante-san" after talking for a few minutes and continued on our journey down the long steep hill and back up the crest of the next hill.  All along the highway, people walked with jugs of water balanced on their heads.  Farmers tended their cattle with ropes tied to one of their legs.  Little children played in the fields along the roadside smiling as they hid behind the corn crops atop the many hillsides on the other side of the highway wondering why there were "mzungu" walking along the road.  As we reached the crest of the second hill, we turned left off the main highway and walked behind a closed store front until we came to railway tracks that had been laid down during the occupation of Kenya by the British.  The railroad bed was poorly maintained but still functional.  I am told there is a train that passes on the track three times a week from Nairobi to Mombassa and is extremely unreliable and dangerous to travel on.  The tour guide books tell you it is a safe and romantic ride through the Kenyan country side.  The local people tell us that the train ride is anything but romantic.  The train frequently breaks down in the middle of the country and can take hours or days to be repaired.    The First Home Visit and President Barack Obama   Once we walked over the ancient railway, we were on clay path that meandered into crop fields, lush tropical vegetation and dozens of homes that were dispersed deep amongst the tropical foliage.  After three turns in the path with multiple intersections, I became completely lost and totally dependent on our guide.  There were labyrinths of homes and trails that went deep into the countryside of Kenya.  I had no idea how Paroxetes knew which house to go to.  We would simply leave the path and begin walking down someone's dirt path to their home when we were directed by Paroxetes.   Our first client, Evelyn, was a woman who had just given birth.  Evelyn's mother graciously invited us into their home.  Kenyan rural village homes typically have a few chairs, a table and a couch.  If a house has more than one couch, it is a sign of wealth.  Roofs are made of tin.  Pictures of family members can be seen lining the walls along the inside of the home with a Kenyan calendar, and sometimes a poster that reflects the recent election violence in Kenya.  There is also usually some type of poster that describes the election of President Barack Obama in the U.S.  Everyone asks us during our visits about the work President Obama is doing in the U.S.  We have even heard children quote Obama as their president in Kenya out of frustration with their current political leaders.   Evelyn' son was two weeks old.  The mother was religiously taking her HIV medication and her son had already started his medication from the time of birth.  Both mother and son were doing well as long s they took their medication.  The HIV medications will keep the level of virus in their blood at a low level as long as they continue their ARV medications.   Sounds of Life in the Chair   Our second client was an elderly woman named Florence.  She lived in a dirt floor home that had minimal furniture, tin signs, and dusty pictures of family members along the wall who had long since left home or passed away.  The house was dark, cool and musty with dust many layers thick on the wall. Chickens walked in and out of the house at will as we spoke about the status of her daughter.  The house was not unlike the home of someone in America who had aged to the point that they had difficulty taking care of themselves as well as the house they lived in.  Florence's daughter had missed several appointments at the HIV clinic.  As we spoke with Florence, we noticed the quiet sounds of another two week child wrapped in a blanket sleeping in a chair near the end of the table where we all sat.  It was Florence's granddaughter, Marilyn.  Florence reassured Paroxetes that the child was fine and taking her HIV medication.  Concerns were raised for Evelyn's daughter regarding her possible current level of HIV infection since she had not been seen at the HIV clinic for several weeks. The grandmother promised she would speak to her daughter and reinforce the importance of returning to the HIV clinic for medication monitoring and follow-up.   Sounds of Chickens By Our Feet   As we left Florence's house we passed several men herding their cattle and goats down the dirt path we were walking on.  Most livestock interactions were without incident.  Cattle were usually more interested in the grass they grazed on then the "mzungu" walking by.  Kenyans are very proud of their cattle and goats both for their monetary value and visible sense of pride.  We often waited for them to pass before we continued on our journey.  We made several more turns in the red clay covered paths until we walked along a line of corn fields to the entrance of a home where Michael lived with his two sons.  He was HIV positive and had started his ARV medication until he was attacked one night by a gang of youths, brutally beaten, and had his right leg broken.  He showed us his leg cast and stated that he had become more focused on his pain medications and forgotten about his HIV medications.  Our counselor reviewed with him his HIV status and arranged a time that he could come back to the clinic to restart his HIV medication regimen.  The entire time we were sitting in his home, Helen constantly heard the sound of chickens under a basket by her feet in the chair she was sitting in.  After the HIV counseling was completed, I asked Michael why he had chickens under a basket in his house.  He explained that his bean crops were at a critical stage and that chickens eat the leaves of the immature plants stunting the growth of the mature plant.  I asked if we could see the chickens.  Once he lifted up the edge of the basket, chickens went running everywhere and the chase began for the birds through the front door and out into the fields.  I apologized for creating more work for Michael and his sons.  He graciously said no problem, have a safe journey as he reached and picked up one of his chickens by the tail feathers and feet.   Death of a Brother   As we left Michael's house, we met a local community aid worker who joined us for our continued walk.  Her name was Linda.  She was responsible for supporting HIV infected people in her immediate neighborhood.  She led us down paths that even Paroxetes was not able to find.  The paths we walked on were typically at an angle since the land we walked was always on the side of a hill.  Our walking paths were also the drainage paths for the water running down the hillside when the heavy rains came.  I often imagined being lost on one of the many paths and watching the running flood waters coming at me as I scrambled to find my way out of the fields and onto the highway.  Fortunately the weather was in my favor, lots of sunshine and little rain for the day.   As we turned left onto another red clay path we saw a family sitting on a couch outside in front of their house about 25 yards down the path.  The couch was positioned between two homes on the path.  In front of the couch there was a campfire with the evening meal cooking and the freshly covered grave just past the fire in front of the couch.  As we approached children ran to meet us with their father directly behind them.  His name was Lawrence Mongata.  Lawrence invited us into his house and introduced his wife and six children to us.  He commented on how he had just buried his brother outside his house and was blessed that he had "mzungu" visiting in his home.  He said that this was a positive sign celebrating the memory of his brother.  He said a prayer for all of us and then wished safe passage for the white clinicians back to America when they finished their work in Kenya.  He had one daughter who was HIV positive.   He promised her continued compliance with her HIV medications and shared one last prayer with us before we left.  Before we left his property we walked out to his brother's grave site and said prayers and expressed condolences once again for his loss.   The Value of a Life   We continued our journey into the endless clay paths until we came upon a house set deep into the property with multiple cattle tied on the lawn.  There were several buildings on the property used as shelter for the animals as well as other members of the extended family.  There were children three and four years' old gathering firewood, then carrying it under their arms to the building where the family cooking was done.  We were once again welcomed into someone's home to discuss the health of one their children.  They explained that one of their daughters, Ann, who was HIV positive, had been sick for several weeks, had stopped eating, and could no longer swallow.  Helen and I were allowed to see Ann where she slept and evaluate her condition.  Ann was severely dehydrated, mal-nourished and required immediate medical attention in a hospital.  The family was reluctant to go forward with hospitalization due to their financial condition and concern that Ann was HIV positive and had little chance of surviving as it was.  Community Health Outreach Workers spent most of the day convincing the family to bring Ann to Maseno Mission Hospital.  Ann arrived at the hospital the following morning.               Jiggers and the Bishop's Message on St. Luke's Day   Many of the rural homes in western Kenya have dirt floors where children sleep at night.  There are no beds or mattresses in many cases.  The children often become infected with insects from the dirt and develop a disease called "jiggers".  The insects enter their skin while they sleep on the dirt floors during the night and infect them gradually from head to toe.  The disease is often fatal if not treated in time.  Children are washed in insecticidal soap and treated for chronic skin infection if caught soon enough. The home remedy also involves taking cow manure and covering the floor of the house with it.  The cow manure kills the infective insects and makes sleeping on the dirt floor safe again The Rotary Club International of Maseno is currently sponsoring a community awareness campaign to teach parents how to cover their dirt floors with cow manure to prevent their children from getting "jiggers".  Bishop Orchect's annual message which was given on St. Luke's Day (October 19th) also had references to the tragedy of children dying as a result of "jiggers" in Kenya.  He emphasized the importance of better educating parents regarding the disease as he spoke to a packed audience at Maseno Mission Hospital.   Our Final Visit   Our final home visit was with a young woman named Judith who recently found out she was HIV positive and was reluctant to seek medical care due to the stigma of the disease in her community.  She was a beautiful thin woman with a quiet demeanor and a resigned attitude that her life was over.  Paroxetes shared her life story and the importance of not giving up hope and that life was still possible with proper medication and treatment.   As we sat in Judith's living room children playing outside continually poked their heads just inside the doorway to see who the white strangers were.  They laughed and ran back in forth in the afternoon sun giggling in Swahili.  One two year old boy looked inside the doorway with a beautiful engaging smile over his dirt covered face that made you disregard the fact that he was dressed only in a shirt and no pants.  He did not seem to care nor did his friends.  He was proud and happy.  His smile conveyed his sense of confidence as he ran back out amongst the cattle, goats, chickens and cats roaming the yard.   Judith eventually agreed to come by Maseno Mission Hospital and be treated with ARVs to lower the level of virus in her body and hopefully have a second chance at living once again.  As we walked out the front door, the children were waiting for us.  "Hello mzungu, how are you?" The appropriate response was always the same. "I am fine, how are you?" Most children in Kenya only know the English words "Hello, how are you, I am fine."  You hear these words from children in the country side, along the roads, and along the red clay paths that crisscross the sides of the fields and hills.   The children playing in the yard posed for a few last pictures.  Paroxetes, Helen and I then began our two hour walk home back to Maseno Mission Hospital. Paroxetes said hello to a few more clients as we passed through Luanda center.  The late afternoon sun bore down on us as we passed through Luanda and then turned back into the countryside red clay paths to avoid the exhaust fumes of the passing trucks on the highway.