Check-Ups in Nairobi - Getting Care in East Africa

Land border crossing between Tanzania and Nairobi - legitimate excuse for
procrastinating an endo appointment right? 

Last week I traveled to Nairobi, Kenya, for my first big check-up since being in Tanzania, and since being diagnosed. Unfortunately the checkups and advice needed for my diabetes care isn't easily accessible in Arusha. I had one appointment with the endocrinologist at the hospital here, but the long queues of forlorn people outside his door made it clear that it would be difficult to get much of time in the face of such overwhelming need. As such, it is necessary to travel to Kenya for what I need.

High security in "Nairobbery." 

I had heard the private health care in Kenya is world-class, and on the advice of colleagues, booked to see the endocrinologist at the Aga Khan University Hospital in Nairobi. The Aga Khan Hospitals are funded by the Aga Khan, the philanthropist leader of Ismaili Muslims. The service funds hospitals in Kenya, Tanzania (Dar es Salaam), Pakistan, India, Uganda and Tajikstan, and aims to support low-middle income earners in developing countries. I was so impressed by the care I received and I have heard expats saying that it surpasses what they would receive in their home countries. My consultation was only $35 and while this unaffordable for most people in the region, it is significantly cheaper than I would face in the private system at home. The hospital had gardens for patients and was very clean and modern, the staff were friendly and all services and appointments efficient. My endocrinologist was thorough, knowledgeable and kind, and she allayed all my fears and nerves about my first big check-up.

While the drive to Nairobi from Arusha is less than 300km, I had been advised to take a shuttle bus to avoid driving in Nairobi's infamous traffic and to save border crossing issues with a private car. This was a good tip given the navigation and terrifying driving in Nairobi. 8 hours travel for 300kms for an endo appointment is longer than I would like... but it is better than many people in the world have access to. While waiting around for tests and appointments I made the most of Nairobis modern shops and food, stocking up on supplies such
 as decent shampoo and cooking ingredients.

So to summarise my first big check-up as a diabetic - terrifying, adventurous, and oh yeah, terrifying again. I was a bundle of nerves, self-judgement and anxiety for weeks leading up to this. Other T1s, do you all find it so nerve-wracking?! At least in the future I know I can reward myself with Nairobi food and shopping, seems only fair right? X

I was pretty happy when we found an Asian
restaurant... #small things. :)

When you have been in Arusha for a year and a half,
even Nairobi is a foodie holiday. 

The "African massage" is not so great for diabetics.
Trying to psyche myself up to jab on bumpy African
roads is always fun, but I am becoming an expert.  

Kutembea. To walk. Hiking in Tanzania.

Injecting for lunch at the summit of Longido. 

Hiking, or tramping as we call it in New Zealand, is such a passion of mine. I love being in the forest and being on your two feet is the best way to explore. I have found this a huge adjustment living here. While people from London are in awe of the outdoor lifestyle that Tanzania has to offer, it is a far cry from what I am used to! That said, it is a goal of mine to make the effort to hike/climb a few more of the mountains here this year.

One of the things I love most about hiking in a new country are the glimpses you get into people's everyday lives. You get to see into homes, and if you are lucky, be invited in. People want to talk to you and the kids chase you. Here in Tanzania people apologise ("pole!") that you have to walk! When I was hiking in the Usambarra mountains my guide told me that the people felt pity for me that I could not afford the bus... A huge cultural difference to be walking as a luxury! 

Hiking is easy in Tanzania if you are organised yet flexible. There are almost no maps, and you nearly always have to take a guide or a ranger and often pay village fees. If you are willing to do this, the country is at your fingertips.

Almost at the top of Longido. 

On Sunday I camped with some friends at Longido, about an hour from Arusha. The camp site was cliche Africa and I only had one scorpion under my tent and a measly 4 thorns straight through my shoe into my foot. After a night of scorpion dreaming we hiked/climbed up Mt Longido. It was 4 1/2 hours straight up with a hands and knees scramble/climb to the summit, and about three hours down. I love imagining the creatures around me in the forest as we trekked past elephant poo and a leopard footprint! It is amazing how much energy hiking uses. I miscalculated my long-acting insulin the night before so had to suck sweets constantly on the climb, and I should have carried much more sugar with me.I  would love to hear from other diabetics how they adjust their insulin for all day exertion?

Here's to this being the first of many 2016 mountain hikes. Let it be the year of Meru, Oldonyo Lengai and fingers and toes crossed for Mt Nyiragongo in Congo.  

Maasai land

Maasai land.

Big trees hiking in Usambarra mountains. 

Shimo la Mungu crater. 

Big mountains in Usambarra. 

Umeme. Electricity.

Umeme = electricity. It is shida kabisa, a complete problem. 

Enjoying candlelight dinners. Love it.  

We are lucky enough to live in a house with electricity, but this of course means dealing with the power-cuts that are routine in this part of the world. There is usually some kind of cut every day, ranging from 1 hour to 15+ hours per day. Candlelight dinners, bucket showers, no TV… can be fun until the novelty wears off!

The longest we went without any power was 8 days. In the 4 months prior to elections there was only a couple of hour’s power per day, usually in the middle of the night. I loved hearing stories of people getting up at 2am to doing their ironing! The real reasons behind power cuts are fairly elusive, and include political control of communication to companies that own hydro-dams wanting to sell more generators!

Power cuts are of course disruptive for everyone, but having the added stress of life-saving medication that must be refrigerated adds another dimension. The first power cut we experienced I rushed around, checked with the neighbours about who to call, asked how long it usually takes to come back… Basically an all-round panic over my insulin. As I realised how common-place these cuts are here, we developed a range of strategies to keep my insulin at a reasonable temperature. Let’s just say my standards for what qualifies as “refrigerated” have undergone quite a transformation.

So tonight, I request that you enjoy your lights on demand for me.

See here for my tips to keep insulin cool with limited electricity.