Archive for May 2009

African Wedding   1 comment

Sunday, May 17th, 2009
A Church In West Eldoret

After discussing how I missed riding my bicycle in Kenya, Taxi Max and I came up with a plan to buy a bike together.  I would keep it for the remainder of my stay and he would get it once I left.  After purchasing the bike at Ukwala, we took it to a local bike shop to get it tuned up for 100 KSH.  While the bike was being prepared, we walked through the market to get something to drink.  “Hey,” Max yelled, “there’s my Dad!!”  Sitting in on a high wooden stool in the middle of the square was an imposing old man wearing a brown vested suit and blue turban.  A street vendor was busily shining his black leather shoes.  The man warmly embraced his son who introduced me as his friend the doctor.  “Chris, this is my father Waweru.”  With a high pitched belly laugh, Waweru abandoned his shoe shine and stepped forward to embrace me.  He stared at me for a long while with his one good eye then yelled something to Max in Swahili.  With a surprised smile, Max turned to me and translated that Waweru wanted me to attend his daughter’s wedding this Sunday.  The offer was too good to pass up.

Sunday morning found me working in the hospital and I didn’t get away until noon, several hours after the wedding had started.  I was picked up by a car carrying Max’s girlfriend and children.  “Max isn’t coming,” she said.  “He got a job driving some Dutch tourists to Boringo.”  There went my safety net.  I was going to be the only Mizungu at the wedding and not know anyone but Waweru who I had just met.  We arrived at the church to find services still going on.  The final hour of the 5 hour service was clearly taking it’s toll on the bride and groom who looked about ready to pass out.  With an eruption of drums and loud singing, the wedding was over and the celebration began.  Everyone, young and old, leapt to their feet and danced and jumped around the new couple.  They hoisted them up on their shoulders and carried them to the party tent that had been erected just outside the church.  Waweru found me and nearly squeezed the life out of me as he laughed and jumped.  “You came!” he exclaimed in rough English.  He assigned a man named Timothy to introduce me to the family and guests.

Timothy found me a plate of food (rice and beans) and a Fanta and told me to stand by a flower arrangement.  After eating a bit, I looked up and realized that he had made me stand directly in front of the head table!  “Timothy, can I sit somewhere out of the way?”.  He took me by the elbow and sat me behind the bride and groom in the middle of the groomsmen and bridesmaids the oldest of which was at most 12 years old.  30 little eyes were fixed on me trying to figure out who this guy was sitting with them.  One boy sitting next to me was particularly fascinated with my camera.  I showed him how to use it and after a few practice shots, sent him around the wedding to take some candid shots for me.  He did a wonderful job! (The bottom row of pictures are his.)

It came time for me to present my gift to the couple so I joined the line of guests with presents.  The MC spotted me and called me forward.  “Our mizungu doctor friend has joined us from…?”  “Indiana,” I said.  “Ingreeamdah!” he exclaimed.  Close enough.  As I handed my gift over to the bride (who had no clue who I was) a microphone was pushed in front of me.  “I want to congratulate you on a beautiful wedding and wish you a bright future together!”  They clearly wanted me to say more but leaving well enough alone, I handed back the mic and slipped into the crowd.  Max’s girlfriend found me and said it was time to go.  We climbed in the car and headed back to Eldoret.  Weddings in Kenya can last well into the early hours of the morning.  I’ll have to imagine what went on.

  

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Posted May 21, 2009 by chrislux in Travel

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Emily Returns   Leave a comment

(Note: ‘Emily’ and her grandmother have granted me permission to share their story on this site)

In two previous posts (“Sometimes, when there’s nothing to do” and “Rounding With The Pediatrics Team”) I described my interactions with a young patient who I have referred to as Emily.  This week, she returned to the hospital for follow-up of her seizure disorder.  Medically, she is improving dramatically.  Her medications have reduced the frequency of her seizures and with additional adjustments to her dosing, we hope to eliminate them completely.  She again was accompanied by her grandmother who is her sole caretaker since the death of her parents.  Now that Emily’s medical condition was coming under control, my conversations with the grandmother turned to other aspects of her life.  I was surprised to learn that they are currently living in an internally displaced persons (IDP) camp.  These camps were constructed by international aid groups following the political violence referred to here as ‘the clashes’.  Around new years 2008, the current president Mwai Kibaki, announced that he had won an election that he was strongly predicted to lose.  People from his tribe became targets of brutal street violence that lasted over 2 months resulting in the killing of hundreds of people.  The fighting shut down the IU/Kenya partnership for a time.  It also displaced thousands of people from their land including Emily and her grandmother.

The camps include row upon row of tightly packed tents where food and water are distributed.  Attempts are made to place these people back in their native lands or resettle them to new parts of the country.  Unfortunately, many people are still living in these camps over a year after the clashes.  From what I have learned, some people are there due to an inability to find or afford a new place to live.  Others have become accustomed to the convenience of clean water and food delivered by trucks and have chosen not to leave.  Aid organizations are beginning to cut off supplies to these camps in an effort to discourage the latter group.  Emily’s grandmother is in her 80’s and does not seem thrilled by the notion of starting a new life for herself.  She is, however, intensely interested in seeing her young granddaughter gain access to a stable life.  Emily currently attends a school in the IDP camp that functions more as a day care than a true school.  Before the clashes, she was one of the top students in her class.

I have begun discussions with Emily’s social worker to try and find solutions to some of the many obstacles facing her.  We will travel to the IDP camp soon to access her current situation and discuss the available alternatives.  It may not be possible to solve any major issues for her before I have to leave, but at least we can start the gears in motion.  I will continue this story as additional progress is made.

Posted May 20, 2009 by chrislux in Travel

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AMPATH Week   Leave a comment

May 4-10, 2009

AMPATH (Academic Model Providing Access to Healthcare) is a division of the IU Kenya Partnership dedicated to battling the HIV epidemic.  It is arguably the most successful and impactful aspect of the partnership and certainly receives the most international recognition.  AMPATH functions to both treat existing cases of HIV/AIDS as well as to prevent it’s spread both between adults and from mother to child.  The program has bases in over 19 regions of western Kenya.  These sites provide HIV testing, clinical evaluation, anti-retrovirial drugs, food, and psychological counseling.  The numbers of patients treated in the AMPATH centers is constantly growing and will soon pass the 100,000 mark.  Each site is staffed by clinicians, medical officers, pharmacists, and various support staff.  Program directors, including Dr. Mamlin, travel daily to these sites to see patients and ensure quality control.  AMPATH also maintains a series of farms to provide food security for the ever growing population of patients.  Students who work in the IU/Kenya partnership are given a week to experience the AMPATH program in the community first hand.  My experience occurred the week of May 4, 2009.

AMPATH Farms – Eldoret

Two days working on the AMPATH Farm in Eldoret gave us a significant change from our normal routine in Moi Hospital.  There are several farms throughout Kenya that all produce food solely for the patients of the AMPATH program.  Justina and I were assigned to the farm in Eldoret located directly behind the new Mother Baby Hospital at Moi Hospital.  The farm is a beautifully maintained piece of land that is worked entirely by hand by a dedicated staff, many whom are patients of the program.  Row upon row of carrots, onions, sukuma wiki, managu, and cabbage stretch for several hundred meters.  Each plot is manned by a team of two workers which creates a friendly air of competition.  There are no power tools so all of the work is done by hand.  Justina and I helped with weeding, planting, tilling, harvesting and plot maintenance.  Lunch was a cup of sour uji warmed in a pot in the fire.  The farm currently produces 1,800 kg of vegetables a day and their goal is to soon reach 2,000 kg per day.  The harvested crops are loaded on large trucks for distant distribution and on bicycles for local dispersal.  The vegetables are supplemented at the AMPATH clinics by bags of grains and rice from America provided by USAID.  We came to learn later that this food in no way can support all 100,000 patients but is instead dedicated to those patients who are just starting their drug therapy or who are deteriorating medically.  Working in the sun warmed fields with the AMPATH staff was a welcome change of pace and a highlight of my time in Kenya.

            

AMPATH Clinics

I had the opportunity to travel to several AMPATH clinics in the towns of Amukura, Chulaimbo, and Mosoriot.  Many of these sites are accessible only by traveling on some of the worst roads in Kenya.  We often would drive for over 4 hours round trip to work at the clinic for less than 2.  We were exhausted doing this for one week.  The AMPATH program directors sign on for 2 year contracts.  The clinics consist of cinder block buildings with corrugated steel roofs and wooden benches in the waiting areas.  Buildings range from food storage to pharmacy and clinical buildings.  We arrived at each clinic to find close to 100 patients waiting in long lines in the shade to be seen.  Many have traveled for long distances on the same terrible roads we arrived on.  Some patients come to refill their medications which are given in 1 to 2 month supplies both due to availability and also as a means of ensuring compliance.  Many HIV+ pregnant mothers come to the clinics in an attempt to prevent transmission of the virus to their unborn infants.  With proper drug therapy, most will be successful.  In stark contrast to the west, infected mothers in Kenya are encouraged to exclusively breast feed their infants for 6 months.  The risk of dying from malnutrition exceeds that of contracting HIV from the virus laden breast milk.  Adults and children alike come to the clinic to learn the results of their HIV testing.  The patients are often stoic in their reaction, but the results clearly impact them deeply.

The AMPATH clinics have experienced such a high volume of patients that they have the diagnosis and treatment of HIV down to a science.  The vast majority of the patients we see in the clinics have no visible signs of being ill.  Herein lies a bit of a paradox that exists in the success of the clinics.  They are not curing anyone of their disease.  Every person that is treated by the AMPATH centers becomes another carrier of the virus and can live a relatively normal life.  There are a number of reasons why the HIV/AIDS epidemic has hit Kenya particularly hard.  First of all, researchers believe the disease began infecting humans roughly in this part of the world.  The virus has been spreading here longer than anywhere else and the treatment has reached Africa relatively late.  Culture also has a major impact on the dissemination of the virus.  Kenyans are very accepting of a loosely structured polygamy.  The tradition of wife inheritance, where a man is expected to take the wife of his deceased brother into his bed, also creates a problem.  Men traveling for work visit roadside prostitutes (90% of whom are infected) on a regular basis.  These cultural practices fuel an already raging fire that is devastating Africa.  A vaccine (which has been a painfully elusive holy grail of HIV research) or a viable cure are badly needed to stem the tide.

Termite Invasion   1 comment

May 11, 2009  10:00 PM
Student Hostel, Eldoret, Kenya

2009-05-11 Termite Invasion 002The thunder started during dinner and the heavy rains quickly followed.  The rains were much needed as farmers were beginning to dig up their recently planted corn in search of food.  The rains continued into the night.  The rainy season had finally arrived in earnest.  I sat at my desk in the dorm reading and listening to the rain when a winged termite landed on the page in front of me.  Then I heard the buzzing sound.  I looked up and saw over 100 termites crawling on my ceiling and thousands more climbing my windows up to the open vent window I hadn’t noticed was open.  After quickly shutting the small window, I grabbed a grocery bag and began scraping as many of the invaders off my walls and into the bag as possible.  When I was satisfied that I had most of them, I took the bag out into the hall to release them outside.  That’s when I realized that the entire dorm had been over run by hundreds of thousands of the winged insects.  The water from the rains drives them from their underground homes.  Then, they fly towards the lights of the dorms and congregate in vast swarms.  Quickly after landing, their wings fall off and the now wingless insects begin to crawl looking for food.  It was an amazing sight, but there was one thing left to do to make this a truly Kenyan experience.  My friend Benson had showed me these termites before and told me that the Kenyans like to eat them as a delicacy.  To demonstrate, he popped one in his mouth and ate it.  I was standing alone in a giant swarm of termites.  As one flew by, I plucked it from the air by it’s wings and in a quick bite, I ate the live termite.  It crunched.  It was salty.  It wasn’t all that good.  I have heard they are good fried and even cooked into an omelet.  I may have to try that someday, but at least now I am one step closer to knowing what it’s like to be Kenyan.

Posted May 17, 2009 by chrislux in Travel

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The Masai Mara   1 comment

May 8-10, 2009

Mara left

Travel to Fig Tree Camp

The Masai Mara is a large wildlife sanctuary at the southern border of Kenya.  Inhabited by the Masai people, the mara is the northern aspect of the massive Serengeti that extends deep into Tanzania.  Joining me on this trip were Chelsea, Marcie, Justina, Ester, Mandy.  Our drivers were named Erick and Victor.  The drive to the Masai Mara is a brutal 7 hour trek over some of the worst roads in Kenya.  We eventually reached the Fig Tree Camp which turned out to be well worth the trip.  Fig Tree is a beautiful compound in the heart of the mara.  The rooms are a mixture of a cabin and a canvas tent with western bathrooms and covered porches.  The canopied beds were hung with mosquito nets and looked out over the river where we could see crocodiles and hippos.  Small monkeys played around the tents and pool and watched to see if we would drop anything for them.  Meals were served in a large open dining room by our wonderful waiter Paul.  A troop of Masai would enter the hall nightly to demonstrate their guttural chanting song and display their jumping prowess which is used to determine the quality of wives they will be granted.  Nights at Fig Tree were peaceful and quiet apart from the grunting of a hippopotamus, the bark of a hyena, and the occasional anti-malarial induced psychotic nightmare (Marcie had a rough night).  Before sunrise each morning, we were awoken by a guard rapping on our tent door so we could explore the mara at first light.

       

The Cats of the Masai Mara

Soon after entering the park on the first day, we came upon a cheetah and her cubs feasting on a freshly killed impala.  While we did not see the kill, we were told that the parents will often wound the animal and slow it down enough to allow the young to practice their hunting skills.  The animals took turns eating pieces of their prey while the others stood guard on the perimeter.  They, like many animals in the park, were accustomed to large trucks and were not frightened despite our close approach.  The young cheetahs had a mane of fluffy fur making them look harmless, but their bloody snouts suggested otherwise.

 

On several occasions, we visited a pride of lions that had taken down a Cape (water) buffalo.  There were several males (brothers of the alpha male), females and cubs gathered around the carcass.  In the matter of two days, the buffalo was reduced to bones and the lions rested lazily in the shade digesting their enormous meal.  The lions were extremely watchful and often had scouts hidden in the bush many meters from their gathering place.  At one point, we turned a corner in the road and passed within 2 meters of a female that none of us had seen until we were right on top of her.  Without the protection of our vehicle, we would have been an easy kill.  100 meters from the group of cats, we found several Masai men crouched in the grass cutting bundles of straw for their roofs.  We warned them of the nearby lions, but they were not in the least bit worried and continued on with their work.  The Masai and the lion share a balance of power on the mara and both seem to have a healthy respect for each other.  Recent poisonings of the lions by the Masai have been harshly condemned and the practice has been largely abandoned.

  

  

 

The most elusive cats in the Masai Mara are leopards.  Many groups travel through the park for a week without seeing one of these secretive animals.  On our last night in the park, Justina spotted a dark shadow in the trees far in the distance that she thought she saw move.  We drove slowly into the wooded grove and saw the female leopard high in a tree protecting a warthog that she had killed.  She seemed skittish and we soon learned why.  A large male leopard bolted up the tree and with teeth bared and claws exposed, challenging the female for her meal.  Before we could take any pictures, our driver slammed the vehicle in reverse and ordered us to close the roof.  “Battling leopards are VERY unpredictable and we can’t be near them when they’re fighting!”  The roar of the engine scared off the large male who slunk into the trees and out of site.  We occasionally saw movement in the distance, but for the time being, he had left the female to her prey.  We cautiously moved back towards the tree and tried to catch another glimpse of the cat.  We briefly opened the roof and by leaning out on the roof of the car, I was able to see her through a break in the leaves.  We counted ourselves fortunate to have seen a leopard and left the grove to explore other parts of the park.

  

The African Elephants

Elephants in the mara travel in troops led by the eldest female.  The Masai Mara was once home to thousands of these massive animals, but their numbers have dwindled to the point where it is a rare site to see more than 10 of them at a time.  After crossing a small river and barely making it up the bank in our vehicle, we came across a small troop of six elephants including a small baby lazily grazing on dried grass.  We stood admiring the peaceful animals for a good while.  The matriarch would frequently blow trunk-fulls of dust onto her back to cool off and brush away flies.  The baby stayed close to its mother occasionally taking drinks of milk to wash down the dry grass.  When our driver changed positions and moved too close for their comfort, the elephants reacted quickly forming a tight ring around the baby.  The largest male moved forward and began to grunt loudly.  The agitated male appeared to be ready to charge and we urged our driver to leave before things got out of hand.  We left the elephants to enjoy their grass lunch in peace.

     

Mara Wildlife

While the cats and elephants are certainly the highlight of a trip to the Masai Mara, there are many other fantastic things to see.  Giraffes are in abundance and were often seen far in the distance walking in a line on the horizon.  Flocks of impalas are composed of a harem of females led by a single male who, according to our guide Victor, “has to take care of all that.”  Hippos seem clumsy and harmless wading in the rivers or lumbering across the plains, but kill more humans than any other animal in the mara.  Several varieties of vultures sit in dead tree branches waiting for the cats to leave them scraps of meat.   Hot air balloons leave at sunrise every morning taking tourists who can afford the trip on a quiet flight over the mara.  Zebras and exotic birds cover the plains watching for predators.  Throughout the territory, the Masai men and boys walk their territory draped in red or orange cloth.  Sadly, these proud warriors are often reduced to begging for money or rushing towards cars to sell trinkets.  The poor Kenyan economy does not spare even the Masai people.
  

  

 

On our last drive out of the park, we drove through a herd of Cape buffalo lazily grazing in the open fields.  They kept a watchful eye for predators and many of them eyed us intently as we drove through their ranks.  Small birds referred to as ‘buffalo peckers’ jumped from animal to animal cleaning off small insects.  Cape buffalo can also be extremely dangerous to a person walking on the mara and must be approached with caution.

 

All in all, the trip to the Masai Mara was the trip of a lifetime.  The land is beautiful, seeming to stretch forever in all directions.  Despite being almost flat, there are rolling hills that offer the animals plenty of places to hide and hunt.  This place is home to some of the most fascinating animals in the world.  Hopefully the Kenyan and Tanzanian people will continue to keep it safe for generations to come.

Posted May 15, 2009 by chrislux in Photography, Travel

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For you are a Kenyan Child   2 comments

 

Before leaving for Kenya, my mother Donata Lux gave me a children’s book by Kelly Cunnane entitled “For you are a Kenyan Child”.  She thought I might find someone in Kenya who would like to have it.  I flipped through the story and while it was a nice book, I didn’t put much thought into it at the time.  I decided to slide it into my luggage at the last minute.

One of the first places I visited in Moi Hospital was the Sally Test Center for Children.  The center is run by Sarah Ellen Mamlin and is made possible by financial support from a close friend of Sarah Ellen’s named Sally Test.  The center is a wonderful oasis of happiness in the otherwise dreary pediatric wards.  Children who are well enough to join in group activities come to the center every day for teaching sessions, games, songs, food, and an escape from their treatments for a short while.  The staff of the Sally Test Center also help care for children who are orphaned or abandoned by their parents by searching for long term placement.  Even children who cannot leave their beds benefit from the center.  The staff pushes a toy cart down the halls of the wards daily loaning toys and books to the sick children.  I realized that while my mother had never heard of the Sally Test Center, she had sent the book for them.

I spoke with Sarah Ellen and her assistants Patricia and Helen about a possible project to help bring the book to life for the children.  The book, “For you are a Kenyan Child”, repeats the title phrase after describing a typical activity in the life of a Kenyan child.  There are few books specifically about Kenyans and seeing a story about their lives can be empowering for these sick children.  Many of the children we see in the hospital have little or no concept of the world outside of their town or village.  None of them had heard of Indiana (one child thought it was in Japan) although they had all heard of the United States.  I sent a message to my elementary school art teacher and family friend Ruth Simmons who eagerly accepted the challenge to start a collaboration between her children at Mary Castle Elementary School and the Children of Sally Test.  All of the pieces were in place.

Blank pieces of paper were prepared with short phrases written on them leaving room for the children to add something specific to their lives.  A favorite food.  A game they play with their friends.  A family chore.  The children would then color an illustration for their page that could now be added to their books.  Each child was photographed with their work of art and the images were sent electronically between the two groups of children.  The tag lines read either, “For you are a Kenyan Child” or “For you are a Hoosier Child”.

   
The Children of the Sally Test Center

The Children of Mary Castle Elemen
tary

Children in both Indiana and Eldoret learned a great deal about each other that made them unique but also much that they had in common.  Hoosiers had never heard of uji for breakfast or washed cows to help their families.  Kenyans did not know what a pop tart was or how to play baseball.  Both liked pancakes, although Kenyans call them chapati.  Both liked soccer and swing sets.  Both now had a connection to children half way around the world and knew a bit more about them then they did before.  The pages in Kenya were collected and added to the back of their copy of the book.  The hope is that this project will be repeated in the future as new children enter the Sally Test Center and Ruth Simmons’ art class.

The activities in the Sally Test Center are more than just distractions from time on the wards.  The center is more than day care.  On many occasions on rounds, a child that was struggling with their illness and seemingly losing hope would come join in the play or singing and a new strength would be rekindled in them.  You can see it in their eyes.  This is as much a treatment as anything we prescribe in their charts.

Kakamenga Rainforest   1 comment

Saturday, May 3, 2007
Kakamenga Rainforest, Kenya

Friday was labor day in Kenya giving us a nice long weekend to recover our energy and set out on another quick adventure.  It was agreed that a group of us would take the relatively short journey to the Kakamenga Rainforest for an afternoon hike in the old growth forest.  We were accompanied by our favorite driver, Taxi Max.  After a fairly short drive, we arrived at the gates of the forest, hired a park guide, and set out on our hike.

Kakamenga Rainforest is a small remnant of what was once a mighty expanse of trees ranging as far as the Atlantic Ocean and covering hundreds of thousands of square kilometers.  Now, the remaining forest is a mere 240 sq km.  Unfenced, it is under constant assault from local cattle farmers and villagers in search of free firewood.  Still, what remains is a beautiful example of the diverse life that exists in an old growth rainforest.

Quickly after entering the park, an alarm was sounded by red tailed monkeys alerting the forest of our intrusion.  Blue monkeys seemed less disturbed, but let out loud hooting grunts to mark their territory.

  

Continuing into the forest, we followed signs that lead us to the muddy waters of the Isiukhu Falls.  Legend has it that visitors of the falls hear a woman crying upstream and none that have searched have found her.  We didn’t hear any crying on our visit.  We did find a small opening in the forest where a pool of water fed by the brown rapids of the falls was churning in circles before continuing into the forest.  The rapids served as the fishing grounds for a small crane called a hammercock that searched for a meal in a small eddy current.  Anita and Kalpana clambered out to a rock in the middle of the pool to enjoy the sun while Angeli and I searched the shores for good subjects to photograph.

 

Many of us were surprised to learn that within rainforests exist natural grassy clearings that are home to a variety of animals, birds and insects.  The final category, insects, was by far the best represented on our walk.  Butterflies and moths danced around the grassy fields and through the tree branches of the forest.  Angeli and I stumbled upon a nest of ants that produced a loud rattling sound by vibrating in unison as we stood watching them.  Justina had the unfortunate experience of stepping in a nest of fighting ants wearing her ill-chosen sandals.  She was able to brush them off quickly with no real harm done.  Giant termite mounds the size of many Kenyan houses could be found throughout the forest.  Silk worms hung precariously from a thin strand gleaming in the sun.  Dragon flies landed on any warm rock surface especially those near water.

  

Deep in the forest, we came across an enormous fichus tree.  Kalpana could not resist practicing her climbing skills on the tangled structure and quickly made her way high into twisted branches.  The acrobatics did not stop there as we shortly came upon a massive labyrinth of vines that had long outlived their host trees and served as a perfect natural jungle gym for our group.

  
            
The final portion of our hike again presented us with a new surprising terrain.  Rather than the dense broad leaved trees and vines we had become accustomed to, we were now climbing across bare rock and gravel covered slopes studded with tall cedar trees.  The rock slope was split with gaping chasms and scattered boulders.  The thin trees offered little protection from the afternoon sun.  Thankfully, we had all been living in Kenya long enough that the altitude and heat had little effect on our stamina.  Our guide commented later that we didn’t seem to tire out like typical mizungus.  A final climb put us back in the edge of the forest where we found a winding staircase leading to a watch tower.  We climbed the tower and found it offered a wonderful view across the entire rainforest to the hills on the opposite side which concealed the town of Eldoret to which we would soon return.  While we saw few birds or animals, we all left satisfied with a day spent hiking through the Kakamenga Rainforest.

Posted May 11, 2009 by chrislux in Photography, Travel

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