Optometry in Moshi, Tanzania

This morning I was picked up by the Head of Department of the Kilimanjaro Christian Medical Center College of Optometry. His name is Focus Maro, a perfectly appropriate name for an optometrist, and one of the most industrious and motivated optometrists I have met in Africa. Not only does he run the optometry department at this large university, he has a private clinic that is associated with the medical center and helps to train optometrists. He told me that the college was started by Swedish optometrists and they often return to visit, continuing their supportive relationship. I met many of the six full-time optometry faculty at this active institution.

The KCMC College of Optometry offers a three year diplomate program and teaches 15 to 20 students per class. With six faculty it is possible to offer a high quality program. Tanzania has regulated optometry, with optometrists required to register with a state-run authority. This gives the College some leverage to require a high level of competence, and they will fail students who do not show the required level of knowledge and skill. They have a high quality optometry and ophthalmology library with several lecture halls and internet-linked classrooms where each student has a computer. They have the ability to run remote training sessions, with lecturers from all over Africa and the world.

The KCMC College of Optometry is closely linked with the Department of Ophthalmology. They jointly run a busy clinic and I saw perhaps 100 patients waiting for eye exams. One interesting point is that Dr. Maro told me they used to see patients by appointment, but that system did not work very well. Now they accept patients all morning and work through the afternoon to see them all. Unfortunately, I forgot to bring my camera during this part of the morning so I don’t have any photographs to share. I will not make that mistake tomorrow.

KCMC is located in Moshi, Tanzania, on the flank of Mt. Kilimanjaro, the highest peak in Africa. The weather now is warm and dry, and attracts trekkers from all over the world. Moshi is known as the cleanest city in Tanzania. This morning as I was waiting to be picked up, I could see homeowners and businesses cleaning up their properties and the streets. The traffic circles have manicured bushes with flowering plants. The College is no exception, offering a clean and beautiful campus, with workers keeping the place up very nicely.

I met the Head of the Ophthalmology Department and we chatted for 10 minutes. He described the program and the many challenges. One challenge is treating patients with dense corneal scarring leading to blindness in that eye. A corneal transplant could correct the blind eye. But corneal transplants using artificial materials do not work well, and culturally it is difficult to obtain human corneas for transplant. He said it was not for a lack of available donor tissue, as there are many cases of traffic accidents and other casualties. It is almost impossible to convince family members, however, in the midst of emotional trauma and mourning to release tissue to harvest. It is not culturally acceptable to gain release in advance, as is relatively common in the United States.

The optometrists and ophthalmologists work together to treat the patients in the busy clinic. The optometrists work seeing the routine patients that need spectacles and eye drops, while the ophthalmologists treat more complex medical eye issues and surgical cases. They have an optical laboratory to make high quality spectacles. One challenge is contact lens care, because they do not have the instruments and laboratory equipment to fabricate rigid contact lenses. Apparently, soft lenses through international contact lens companies are not readily available either.

Dr. Maro and the Head of Department of Ophthalmology briefly discussed the program I work with at the Masinde Muliro University of Science and Technology (MMUST) in Kakamega, Kenya. The Kenyan program offers a four-year bachelor’s degree with 30 students per class. In contrast, we only have three full-time faculty, whereas the recommended faculty to student ratio should require eight or nine faculty lecturers and professors. As I left our meeting, the Head of Department of Ophthalmology told me that we should hire more Kenyan faculty. I reminded him that the Kenyan system requires a Master’s or Doctoral degree to be a full fledged faculty member, and no one in the entire country met those requirements. It prompted me to concentrate on training the most talented newly graduated Kenyan optometrists to get their advanced degrees, so that they can run their own department in the coming years.

The KCMC College of Optometry and Department of Ophthalmology accept many foreign students including those from surrounding African countries. As I have mentioned, the entire academic setting here offers an exceptionally high level of training. Today’s experience made me question what strategy might be best for training optometrists. Would it be best to develop new programs such as MMUST, where I am teaching and where we face many challenges including the lack of a spectacle fabrication facility, or would it be best to send Kenyan students abroad but close by for training? I see advantages to both scenarios. Even though Kenyan and Tanzanian cultures seem similar, there might be national rivalries and/or barriers to travel that would inhibit Kenyan students from moving here for several years. Clearly, the powers that be have decided that developing a regional hub in Kakamega, Kenya at MMUST, despite the challenges, would be best. I will continue with that goal in mind. Tomorrow I will start the lectures on slit lamp and ophthalmoscopy for the optometrists on the faculty. The Head of Department for Ophthalmology requested a lecture on refraction for the ophthalmology residents and faculty, and I will do that on Wednesday.

Tarangire National Park

All day yesterday I kept thinking how fortunate I had been. I was getting a private tour of Tarangire National Park with my own guide using a modified Toyota Landcruiser. It was fairly ridiculous really, and definitely wasteful, but here I was about 120 kilometers south of Arusha, Tanzania seeing elephants, giraffes, lions, and so many more incredible animals.

The whole trip could have easily fallen apart. In the days leading up to the trip, my hosts had expressed doubts they could organize a classroom and hands on seminar of slit lamp and ophthalmoloscopy skills. My contact at the Brien Holden Vision Institute, Kesi Naidoo, had left it up to me. If I wanted to go, I could take the chance. If I wanted to back out and reschedule, no problem. I decided to go.

When planning the trip the idea was to arrive late on a Saturday and have Sunday off. Monday through Wednesday I would teach the workshop and head out Thursday to Nairobi and back to the United States. If I was going to have a day off in Northern Tanzania I would make the best of it. I researched things to do on Trip Advisor and found the Arusha National Park. But as I looked into it further, I realized that it was a rainforest park similar to the area around Kakamega where I was now living. If I headed a bit further south, I would be in the high plains area with the opportunity to see animals I had never seen before. Tarangire was not one of the more well known national parks like the Serengeti but it was highly rated, and had a large population of elephants living in the wild.

While traveling in Africa, I have found that it is sometimes hard to know what a fair price is for goods and services. It is a two-tiered system. If I use the local buses called matatus, for example, I can travel a 100 kilometers or more for $2 or $3. I often do this and enjoy it. If for some reason I decide to hire a driver, say I have a lot of luggage to carry, the same trip might cost $40 to $60. When in non-tourist regions like Kakamega I can get a fine meal for $3 to $5 but it might cost two or three times the price in a tourist destination. When scheduling this safari without any local knowledge or contacts, I relied on the internet for information. I had determined that $315 to $400 for a full day trip to the Tarangire National Park was the going rate. It’s a lot I know. But the trip included round trip transportation 120 kilometers each way, a guide with knowledge of the region and wildlife, lunch, and park fees which are $60 a day and go toward preserving this beautiful natural resource. Through Trip Advisor I booked the trip for $315, which was the least expensive of the three I had checked. I decided to go all out on my one day off.

Yesterday morning I was greeted by Anthony of Backpacker’s Safari Company. “Where is everyone else?” I asked. I was expecting a tour vehicle full of other people with a free seat or two available. “You are the only one,” he said. “Okay, let’s go,” I said, astonished that this was really happening.


Anthony of Backpacker’s Safari Company in Arusha, Tanzania. By the way, you can see the photograph a little bit larger if you click on them.


In Arusha we stopped and picked up our box lunches. These boys were happy to get their picture taken in downtown Arusha. We headed south about 120 kilometers which took an hour and a half.


The road is excellent from Arusha to Tarangire National Park. We passed through areas with many Maasai settlements, although many Maasai migrate so the settlements can change. We stopped at the Tarangire National Park headquarters where Anthony purchased the permit to enter.


The Love Bird


These giraffes were kind enough to line up for me.


This large bull elephant was digging in the river bed for moisture. This part of the river appeared dry but I could see the ground was quite moist just a few feet down.


Here I am, enjoying my private tour. The top of the extended Toyota Landcruiser lifts up to give an excellent and shaded view of the surroundings. We saw a cheetah but I was not able to get a good picture of it. The cheetah was lounging under a tree, but got up when an elephant approached. Anthony said it was very rare to see a cheetah in that area.


Anthony said, “Look, see how the elephants take care of their baby.” The young elephant was sleeping peacefully.


There was a wide variety of wildlife to see as we trekked around the dirt roads in the park.


I am trying to remember the name of this bird. Anyone have any ideas?


A Baobab tree. They can live up to 500 years, Anthony said, and attract a lot of wildlife.


Part of the river had standing or even running water. I noticed that the wildebeasts and zebras hang out together. Anthony said that the wildebeasts rely on the zebras to find water because they do not remember where it is.


We saw several ostriches.




We stopped around noon to eat our boxed lunch, and this was the view.


The Tanangire National Park is known mostly for its elephant migration. Anthony said that during the rainy season in March, April, and May when water is plentiful, the elephants leave to other areas around Tanzania.


Mother with calf.


There were lots of wildebeasts, which Anthony called wildebeasties.


A pride of lions. It seemed that most of the tour vehicles were looking for lions. We were early and noticed these lions just after lunch. As we left the area we were stopped five or six times as the other guides wanted to deliver on the lion viewing experience.


Lots of flirting going on.


As we left the area, I snapped a photo of this Maasai compound. To the right is a circular area, bounded by a brush fence, where they put their cattle or goats at night.


This hastily snapped photo was on the road leading back to Arusha. These 12 to 14 year old Maasai boys were preparing for circumcision in the coming week. Anthony drove me back to Arusha. I have him a 40,000 Tanzanian Shilling tip, which amounts to $20 and was the recommended amount. He dropped me off at the local transportation center and I caught a matatu to Moshi to begin my work Monday morning.

In fact, it is Monday morning now and I am waiting for a local optometrist to pick me up.

Living With Uncertainty

In the post “How Things Work” I detailed two administrative processes I have been completing. One was the work permit application through the Registrar (Admin). I did my part and submitted all that was requested. I was told the Registrar would hand carry the application to Nairobi and submit the application through the Department of Education. This is important because, I have been told, a year or two ago the Kenyan government raised the fees for a work permit from $100 to $2,000. Fortunately, for foreign lecturers working in fields where there is unmet need they would waive the fees, or at least reduce them substantially. I was told they would now accept my official University of California, Berkeley transcripts as evidence of my credentials.

When I asked the Finance Department when I might get paid the administrator reminded me I did not have my work permit. He said, “The Kenyan Immigration people are serious about their jobs. They can be difficult. You don’t want to mess with them.” I nodded my head and left the office. I was starting to think that maybe the University was protecting itself. If I was not paid, then they could say I was not working for them if trouble should arise. I have heard stories about people being incarcerated.

Kesi Naidoo of the Brien Holden Vision Institute told me that he needed a lecturer to give seminars on slit lamp and ophthalmoscopy skills in two or three African countries. He spoke with Dr. Okenwa-Vincent, and they both agreed I would be a good fit for the job. The main issue was that University lectures have started and I would miss three lectures a week for the four weeks I would be gone. I offered to make them up when I returned. In the last days, I have gotten the e-mail addresses of the 2nd, 3rd, and 4th year class representatives and will forward them reading materials, notes, etc to review in pdf or doc format. That won’t take the place of the lectures, but might move them along faster.

The only other issue was getting permission to leave from the Vice Chancellor. I was told that if my Head of Department and the Dean of the College of Public Health, Bioscience, and Technology signed my application, the Vice Chancellor would sign it. It was a rubber stamp, they said.

Unfortunately, that was not the case. The Vice Chancellor put up some resistance my request for leave of absence. I was called into his office, but he was at a meeting. The meetings here normally last at least three hours and there are a lot of them. Some last all day. I asked if I could leave him a note and the administrative assistant said that would be okay. I got out my pen and and asked for some paper. She said that I should complete a typewritten request. I told her that our department did not have a typewriter nor did we have a reliable printer. I reminded her that I was supposed to leave the next day and suggested a neatly handwritten note would be acceptable. Thankfully, she agreed.

I wrote a page and a half, and signed it at the end. I wrote that I am giving lectures, supervising students, and seeing patients. Due to several factors, I did not yet have a work permit yet, and it was technically illegal for me to be working. While unlikely, I could be subject to fines or even imprisonment. By leaving I would be protecting not only myself but the University. While I was gone I would request duplicates of my diplomas, and hopefully the situation would get sorted out in the weeks I was gone. I would return, make up my lectures, and we could put this chapter behind us.

I handed the administrative assistant my hand written note and she attached it to my original paperwork. She then handed the packet back to me. “What should I do with this?” I asked. She said that because of the amended application I needed to get it signed, once again, by the Head of Dept and his boss the Dean. “Oh no,” I said, “They already approved and signed the application for leave. They are in full support of the leave of absence, and besides I will make up the lectures I will miss.” I was on a roll now, but still respectful. “Furthermore,” I said, “You might want to suggest to the Vice Chancellor that he read my note, and then tear it up and put it in the trash. I don’t think anyone, especially the University, wants signed documentation of illegal activity in my file.” I walked away, had lunch, and then gave a lecture from 2 to 4:30 in the afternoon. It was my second lecture to the 2nd year students on Clinical Optometry Procedures.

I have fallen into a morning routine. I sit in the clinic consultation room preparing my lectures. When a patient arrives I do an eye examination, and then go back to preparing lectures. The 3rd and 4th year students have not yet returned from attachment, which is the outside clinic and hospital rotations, so there is no one to teach at the moment.

Most of the patients have been complaining about swollen, red, itchy eyes. I strongly suspect the frequent afternoon rains have promoted mold growth and/or stimulated bushes and trees to bloom in the morning sunshine. I have diagnosed allergic conjunctivitis many, many times in the last week and have recommended topical ophthalmic antihistamine drops.

Today I followed my morning routine but the optometry clinic receptionist, Jennifer, was called into a meeting. Because she was not there, less patients arrived for eye examinations. There has been a steady back log of about ten or twelve patients to be seen, and Jennifer often calls the patients when she knows a daktari will be available. Jennifer returned around two, we chatted, and I left for lunch. I bid her so long for a few weeks, because I decided I was done for the day. I wasn’t supposed to be there anyway, I reasoned. I never did hear back from the Vice Chancellor.

I had lunch at a place in downtown Kakamega called Garden View, which offers a chicken curry plate with rice or ugali for 350 KSh, or $3.50. Ugali is a large mass of white corn meal. It is good, but way too much for me eat so I usually get rice. At Garden View, sometimes the curry tastes like curry and sometimes it is a tomato-based stew with peppers, onion, and garlic. Fortunately, I like both. It depends on the cook and what his or her idea of curry is.

As I was riding my bike back to my place around 3 in the afternoon, I could see the dark clouds rolling in, the wind picking up, and hear thunder. This was a big one brewing. I decided to stop by Golf Hotel bar, an open air but covered bar, to avoid the rain. Fortunately, with my phone acting as a hotspot, I could work almost anywhere. I ordered a Tusker and settled in. While working, I got a message from Kesi on WhatsApp Messenger asking if I could talk. Sure, I responded. A couple minutes later we were talking on Skype.

“There has been a complication,” he said, referring to the upcoming optometry seminar I was supposed to teach in Tanzania. “A few days ago they said it was a go and to make the plans, but today they said it might not work,” he said. He asked if I had made the plane reservations. “Yes,” I said, “Yesterday, I made my plane reservations for Nairobi tomorrow and then to Northern Tanzania near Kilimanjaro Saturday.” “Okay,” he said. I mulled it over for a moment. “Tell you what, Kesi,” I said and I calculated the cost of the trip, “I am going to Tanzania. If they can do the workshop great, we’ll do it and the Institute can reimburse me. If not, I will just make it a vacation. I need to leave Kakamega anyway.” The flights were cheap and and I would stay in an affordable hotel. I had already done the research. “All right,” he said, “I will get back to you tomorrow with more information.” “Thanks, and have a good evening.” I said. “Good evening, Dan,” Kesi said.

So, I am headed to Nairobi tomorrow. I fly to Kilimanjaro Airport Saturday afternoon and have booked a room in Arusha, a mid-sized city in Northern Tanzania. Sunday, I made reservations for an outing at the Tarangire National Park. Monday through Wednesday, I might be teaching optometry slit lamp and ophthalmoscopy skills. If that occurs, it will take a local bus the hour or so over to Moshi, not too far away from the Kilimanjaro Airport. If the seminar falls through I will find a not-too-expensive hotel in Arusha or Moshi and rest for a few days. I can work on my slit lamp and ophthalmoscopy power point presentations because, at one point or another, they will be needed.

I am learning to go with the flow, handle the uncertainty, delays, and changed plans. It seems to happen a lot here. I am definitely not the only one dealing with all this, not by a long shot. The Kenyan people are experts at waiting. They are patient, easy going, and know how to handle adversity. This is just a lesson in doing the same.

A Tribute to Yogi Berra (May 12, 1925 – September 22, 2015)

You come to a fork in the road take it. If you don’t know where you are going, you’ll end up someplace else. We’re lost, but we’re making good time. Nobody comes here anymore, it’s too crowded. We made too many wrong mistakes.

I wish I had an answer to that because I’m tired of answering that question. If you ask me anything I don’t know, I’m not going to answer. It’s tough to make predictions, especially about the future. You can observe a lot just by watching. I never said most of the things I said.

Ninety percent of the game is half mental. Half the lies they tell about me aren’t true. Cut my pie into four pieces, I don’t think I could eat eight. A nickel ain’t worth a dime anymore.

He must have made that before he died. Even Napoleon had his Watergate. If you can’t imitate him, don’t copy him.

In theory, there is no difference between theory and practice. But in practice, there is. If the world were perfect, it wouldn’t be. It ain’t the heat, it’s the humility.

Deja Vu All Over Again. The future ain’t what it used to be.

It ain’t over ’til it’s over.


This morning I dropped off my completed Kenyan work permit application at the Registrar’s (Admin) Office. I have learned that I need to add the “Admin” because there is more than one Registrar’s Office. Last Friday he said he would complete his part of the application and, I believe I heard him right, hand carry the application to Nairobi. Included in the application were 2 passport photos, my Curriculum Vitae, and my official University of California, Berkeley transcript documenting my Doctor of Optometry and Doctor of Philosophy degrees. Apparently, they have backed off of the requirement that I show them my original diplomas. I attribute that change of heart to the face-to-face meeting I had with the administrator.

Most administrators, professors, and lecturers do not have computers on their desks. Definitely, administrative assistants and receptionists do not have computers on their desks. That would be a huge investment. Things are done the old fashioned way using paper and carbon paper, when necessary. Almost everyone has a mobile phone, but texting is uncommon. To communicate and make decisions, a telephone call or face-to-face meeting usually does the trick.

I thought I’d do a photo tour of the Optometry and Vision Science Department, along with other photos of the Masinde Muliro University of Science and Technology. I snapped a few on the way back from lunch. If you want to see the photo a little larger, you can click on it.


The Optometry and Vision Science Department is on the ground floor in the middle. You might be able to make out the rectangular sign. There is a reception desk, the Head of Department’s office, and a slightly larger room with 4 large desks, or should I say, way too large of desks. It’s hard to walk between them.


The small clinic is about 40 yards away. It was completed only two months ago and only serves University staff, professors, faculty, and students. I am not sure what the student population size is at the moment, but we have the potential to see perhaps 5 to 10 patients a day once we get up and running at full speed, maybe more. Right now the clinic volume has been 0 to 5 patients a day, although the receptionist showed me a stack of at least 10 patients waiting for examinations. We have all been busy completing the 4th year student qualifying examinations and grading the last couple of days. This afternoon I was writing a lecture in the clinic conference room and two patients stopped by so I gave them an eye exam.


Jennifer is the clinic receptionist, on the left. Pamela (center) and Patricia stopped by to say hi and chat.


There is a frame selection room, but no frames. I am not sure of the reasons why, perhaps the funds ran out. But we still do not have frames or a way to place lenses into the frames. But I am choosing to look on the bright side. We have a clinic we did not have three months ago, with good quality instruments. The rest will be worked out in time.


I believe there are nine clinic rooms, although not all are equipped with the optometry lane as we call it with chair, stand, projector, phoropter, and slit lamp.


Looking down the clinic hallway.


Just outside the clinic there is this beautiful Nandi Flame tree (Spathodea campanulata).


The Nandi Flame tree has orange-red flowers. It is native to the area and grows well. Apparently, it grows so well that it has been listed as one of the world’s top 100 invader species. That reminds me of the fact that in Arizona the mesquite tree is native to Southern Arizona and is a beautiful, hardy tree. In Hawaii, the mesquite tree is an invasive species that is spreading out of control, crowding out the native Hawaiian dry land trees.


This building, right next to the clinic, was just completed last week. It has many classrooms and lecture halls.


Many of the administrative offices are in small tin-roofed shacks. When it starts to rain in the afternoon it can be hard to hear what the person next to you is saying.


There is a lot of open land on the campus. Here students are walking across a field to and from class.


This tree is on the driveway in and out of campus. It has a sign posted that there are bees nesting above and not to disturb them.


This was the scene this afternoon around 1pm just outside the campus main gate. The two lane highway is the main thoroughfare through town. About 50 km (31 miles) to the south lies Kisumu, and 110 km to the north is Kitale, gateway to the Mt. Elgon National Park. Another interesting town not too far away is Eldoret, gateway to the Kerio Valley National Park. Over time I will explore these places, which are the lesser known Kenyan National Parks. Nakuru, to the southeast about 4 hours by car, is well known for a lake with pink flamingos. A bit farther, perhaps 6 hours to the south, lies the famous Maasai Mara National Park, partly in Kenya but mostly in Tanzania.


In an earlier post I mentioned by bewilderment that there were not more bicycles shops given that there are bikes everywhere. Well, I was mistaken. There are bicycle shops all over the place, they just don’t have walls or a roof. m2

The guys at the bike shop helped me pump up my tires. The bike came with a pump but to tell you the truth I can’t figure out how it works. I will buy a small bike pump in the US when I am there in a couple weeks, and bring it back. That’s it for today. I am waiting to find out the details of my optometry teaching tour which might start as early as this Wednesday. I’ll let you know when I know.

How Things Work

Sometimes things work better than expected, and at less cost than you might think. Sometimes things work worse than expected, and at times not at all.


This is the electrical box in my apartment. When I moved in I had over 3 kW-hrs of electricity on the meter. Now, as you can see I have 0.39 kW-hrs left, and it is Saturday evening. While it is clearly true that I am running out of electricity, is not for lack of trying to buy more.

When the team of University housing people toured my apartment, I asked how to get more electricity. “Oh, that’s easy,” one gentleman said, “Just use mPesa and recharge the account.” “Okay,” I said, “How do I do that?” “Just put mPesa money on your mobile phone account and then use that to pay. You can do that anywhere you see a green mPesa sign in town,” he said. “Asante,” I replied.

I went to the Safaricom store and put 1000 Kenyan shillings (Ksh) on my new mPesa account, about $10. They gave me instructions on how to use a SIM tool to pay Kenya Power. I came home and followed the instructions. There are a series of fields to fill out, and one was “account number.” I did not know my account number, but my friend Richard suggested it might be the number on the meter box. Richard also lives in National Housing, but has a different meter box with different instructions. I put the number on the box in. The money transfer failed, and failed again.

The next morning I called Kenya Power and explained my predicament. He said, “You must come down.” “Where are you located?” I asked. He said something like, “Asawana mana place.” “Could you repeat that?” I asked. “Asawana mana place,” he said again. “I am having trouble understanding you. Could you speak more slowly?” I said. “Asawana mana place,” he said exactly as he had said before. “Okay, fine, I will find you,” I said shortly. Kakamega is a small place. Almost everyone knows where everything is and what it is called. It is difficult for them to understand that I would not know where Kenya Power was located or where “Asawana mana place” was. The gentleman on the phone thought he was speaking plainly enough.

While it is true that most of the time I ride my bike, sometimes I walk. At times I take another option. Just outside the gates to National housing there are usually a cadre of piki piki drivers, or motorcycle taxis, just waiting to take customers. It is a 5-7 minute ride downtown for 50 Ksh, or 50 cents. As I approach the security gate, they seem to read my mind, and one pulls up. “Where to?” the driver asks. “Kenya Electric,” I say. “Where?” he asks. “Kenya Electric,” I repeat. “I do not know where that is,” he says. “Kenya Electric Power Company,” I say. “Oh, Kenya Power. Hold on,” he says as we take off.

We arrived, I paid my 50 Ksh, and looked around. There was a large metal blue gate, open, with security guard sitting at the side. Behind the gate was a two story industrial building. There was no sign. “Kenya Power?” I asked. “Yes,” he said. I entered and went to the window that said “Pay Bill.” I waited in line, then asked how to pay my bill. “What is your account number?” she asked. “I don’t know,” I said. I showed her the meter box number I had written down. “You need an account number,” she said. “Talk to that man,” and she pointed to another line of people. I waited in that line and talked to the man.

“I would like to pay for more electricity,” I said. I live at National Housing and that is my meter number,” I said as I handed him the piece of paper with the number written on it. He looked at the number with no recognition of what he was seeing. “I took a picture of of the meter box with my phone,” I said. “Would you like to see that?” I asked. “Yes,” he said. He looked at the image and said, “That is not your meter number, that is your meter box number.” Please go to the meter department and they will explain things to you. He pointed down the hall.

I walked down the hall and found the meter department. Three of the staff were discussing something and I waited for them to finish. I sat down in the empty chair and explained my predicament, and that I had an image on my phone that might help. “Let us see it,” the man said. I handed him my phone with the image of the box. “You must input commands into the meter box to see your meter number. We will show you how to do it,” he said. They handed me a pamphlet with four distinct meter types, each with different instructions. “We do not know what type of meter box you have, as they all look different,” he said. “You will have to try the different instructions until one works, and then it will display your meter number. Then use that number to pay with a token or mPesa.” “Asante,” I said, and left.

I took a piki piki home and followed the instructions. On the second try I keyed in 804# and got a response. “141406” lit up on the screen, and then “10453.” But which was it, or was it both together. I tried paying mPesa with 141406. Failed. I tried with 10453. Failed again. I tried 14140610453 and it worked. I received a confirmation text that Kenya Power had received 500 Ksh from the mPesa system. Awesome, I thought. I waited for the kW-hrs on my meter to increase. Nothing. I wondered how long it might take. That was yesterday, still no increase, and the number continues to steadily decrease.

Yesterday morning Dr. Okenwa-Vincent said that an important administrator wanted to meet with me. This was the man in charge of securing my work permit, the gentleman who said that he needed to see my original O.D. and Ph.D. diplomas, which I did not have. “When?” I asked. “How about now, are you free?” he asked. “Sure, let’s go.” he said. We walked a few buildings away and entered his office. Dr. Okenwa-Vincent asked if the administrator was in. “No, he is in a meeting.” the receptionist said. “When might he be back in?” Dr. Okenwa-Vincent asked. “After lunch at 2pm,” she said. “Thank you, we will try back later.” he said.

After lunch I saw Dr. Okenwa-Vincent, “Would you like to try to see the administrator again?” I asked. “Sure, let’s go,” he said. We walked over. It was 2:30pm. Dr. Okenwa-Vincent asked if the administrator was in. “No, you just missed him. He was here then stepped out.” the receptionist said. “When might he be back?” he asked. “A half-hour,” she said. We walked away. As we were walking, he reminded me that I needed to request for time off to visit Tucson and go to the Academy meeting. “How do I do that?” I asked. I had sent him an e-mail a week earlier requesting the time off. He replied stating that my format was wrong and I would have to fill out some forms. “Go the the University Bookstore,” he said, “And they will give you copies of the forms.”

I went to the University Bookstore and paid 30 Ksh for copies of the university forms. As I walked away, I read the instructions. “Fill out in quadruplicate,” it clearly stated. I did not even know the word quadruplicate existed. I counted my copies and there were only three. I walked back and paid another 10 Ksh for the other copy. I took the forms back to the clinic. Jennifer, the clinic receptionist, saw me looking over the forms. “I can get you carbon paper to put between the pages so that you only have to fill out the form once,” she said. “That would be great,” I responded. She went away for a few minutes and returned with three slips of carbon paper. I had not seen this stuff since elementary school in Cassville, Missouri in the 1970s. In case you don’t know what carbon paper is, it has one shiny side and one dull side with a dark blue tint. To copy what you are writing, put the carbon paper between two slips of regular paper, dull side down. Then whatever you are writing will show up in dark blue ink on the bottom paper. I slipped the three carbon papers between my four forms and started writing.

After I filled out my page I would submit the paperwork to my boss, Dr. Okenwa-Vincent, the Dean of Public Health, Biosciences, and Technology, and then the Vice Chancellor for approval, each in sequence with all four forms. Dr. Okewa-Vincent was in and he filled out his section then signed the forms. Jennifer took the packet to the Dean who filled out his section and signed the forms a few hours later. I carried to packet to the Vice Chancellor’s office. “We cannot accept this from you,” the receptionist said. “What would you suggest?” I said. “You must take the forms to the Registry. They will put it in your file and then walk the forms here to the Vice Chancellor’s office,” she replied. “Where is the Registry?” I asked. “In the Registrar’s office, next building on your left,” she replied. I walked to the Registrar’s office, found the desk with the sign “Registry” and handed the packet to the receptionist. She looked through the packet. “Thank you,” she said, “We will forward this to the Vice Chancellor.”

I walked back to the office of the important administrator I was supposed to meet. He was in. I was to sit down and wait until called. Ten minutes later I was called into his office. I had decided to keep things light. This was the first time I had met him, after all, and wanted to make a good first impression. It was not his fault that I had brought the wrong documents because of my ignorance of the Kenyan system. It was not his fault that the Kenyan government did not accept official transcripts. I complemented him on the university and the excellent Kakamega weather. He smiled and was pleased.

“And I just wanted to apologize for not bringing the proper documents,” I said. “I did not know the Kenyan government did not accept official transcripts from the University of California, Berkeley.” “You have official transcripts?” he said. “Why, yes, I ordered them directly from Berkeley.” I showed him the adobe pdf document on my computer. He studied the document. “Where does it say you completed your Ph.D.?” he said. “That’s right here,” I indicated with my finger. “Doctor of Philosophy in Vision Science Degree Conferred December 20, 2001,” it read. “And what is all this?” he asked. “Oh, those are the specific courses with the grades listed, the coursework I completed for the Ph.D.” I answered. “Impressive,” he said. “It was a lot of work, but well worth it to get the Ph.D. and do my work for the last 13 plus years,” I said. “Do you have a CV?” he asked. “Sure I forwarded that two months ago. I have a copy right here,” I said. “Well, in that case,” he continued, “Just make a copy of the transcript along with your CV. On Monday, we’ll make the application. Bring me two passport photos and I will carry the application to Nairobi in a week.” “Thanks,” I said.

“And by the way,” he said, “I simply cannot see with these glasses.” “Let me take a look,” I said as I held out my hand to take the glasses. I held them up and looked through the lenses. “Ah, I see what is going on,” I said, “You have good distance vision but need help with near work. The progressive lenses you had made were set too low so you do not get the reading power you need. I could help you out with that,” I said. “Next week?” he asked. “Yes, next Monday or Tuesday I can check your vision and get you going in the right direction,” I said. I thanked him and said I’d drop off the documents Monday morning. My work was done. It was late Friday afternoon and I could relax.

I woke up this morning concerned about the electricity in my apartment. The reading was down to 0.50 kW-hrs. I have noticed that many offices are open on Saturdays so I had breakfast and completed the hand washing of my dirty clothes. I hung them out to dry, then got ready to go into town. I walked to the gate of the National Housing complex and caught a piki piki downtown. As approached the office, two people were reading a sign posted on the blue security gate. The office was now closed on Saturdays it read. I went to Tuskys, did some shopping, and made the copies of the official transcript and CV. I headed back home around 2pm. I was getting hungry. I got a call from Richard who said there was a soccer game on, and would I like to meet at Golf bar to watch it. “Sure,” I said, and jumped on my bike for the 12 minute ride up the hill.

Golf Hotel, Restaurant, and Bar is a fine establishment with 1970’s architecture, lots of straight lines with a nice pool. The grounds are well kept up, brilliant green grass with bushes and many large trees, some of which I recognized from my rainforest walk last weekend. It is clean, well run, and with an courteous staff. They open up the pool to the community for a 200 Ksh fee on weekends, and there were about 20 children and adults splashing around having fun. The bar is on the second floor, with one side overlooking the pool, the other with a view of the parking lot and grounds.

I ordered a cheeseburger, fries, and a coke and settled in to watch the Chelsae – Arsenal match up. Richard joined me a few minutes later. He was the only person rooting for Chelsae in the place, that was packed with mostly young to middle-aged men. He ordered a beer and I too ordered one after I finished my meal. Chelsae won 2-0.

I said goodbye to Richard and headed down the hill on my bike. A half block past the Kakamega General Hospital on a narrow paved lane, I saw a group of people crowded around a man lying on the ground. His bashed motorcycle laid next to him, leaking oil. I pulled up, parked my bike, and stepped over to see if I could help. He was out cold, with many cuts and abrasions on his arms and shoulders. People were trying to revive him. I could see a large abrasion on his left forehead. It was bleeding slowly and starting to swell.

I said, “He needs to go to the hospital.” While I am not a medical doctor, I am well trained in first aid. Every two years I take a first responder’s course that teaches CPR and other skills. I know that head injuries can be deceptive and deadly. Anyone with a head injury must be seen by a physician. Of course, he could have a broken neck, and moving him could be dangerous also.

I noticed a small sedan stopped 20 feet away. I walked over and saw a woman sitting in the driver’s seat. “If it is possible, could you take him a half block to the hospital?” I did not know if he would regain consciousness or if we should move him, but wanted to check out the possibilities. “Yes,” she replied. As I walked back, I was also thinking about having someone run up to the hospital to get an ambulance. There is no 911 service in Kakamega. I got back to the man and they had him up on his feet. He was dazed and unsteady, wavering back and forth. The crowd kept him up. I noticed he was a very large, muscular man.

Just then a passenger van with a side door pulled up, just feet away. I asked the driver, “Would you take this man to the hospital?” He was silent. “Yes or no?” I asked. He said he would. The group guided him toward the open side door. All of the sudden, the injured man looked back at his motorcycle on the ground and mumbled something. He turned towards the bike, almost falling down. I said firmly, “You need to go to the hospital. We will take care of your piki piki.” A piki piki driver backed his running motorcycle up to us. The injured man sat down on the back, still wavering a bit. I wondered if it was good idea for him ride in his condition. I imagined him falling off, but he was on the motorcycle and holding on. “Okay, go, but go slow,” I said to the driver. They took off slowly and steadily, the injured passenger holding on. Another motorcycle driver started walking his damaged motorcycle up to the hospital. “Will you take it up there?” I asked. He said he would.

As I walked back to my bicycle a crowd of children came up to me. “Hello!” one boy said. “Hello,” I replied. They smiled and seemed very excited about the whole thing. I rode my bike back home and made a cup of coffee. I sat down and thought about what had happened. The group of people seemed most interested in getting the man up and on his feet, while I had insisted that he go to the hospital. At the hospital there would be charges, although I suspected they would be minimal, and a piki piki driver would not have much money. I had a responsibility to follow up, and I wanted to see how he was doing anyway. I grabbed 5000 Ksh that I has stashed away, $50, and headed up the hill.

As I rode past the scene of the accident I could clearly see what had happened.


There was a large speed bump, partly to slow traffic and partly to divert water off the road. It was up where the couple was walking. I knew from experience that that particular speed bump was the largest of the four on that block. I rode up to the speed bump.


The piki piki driver, going down the hill with speed, had hit the speed bump and been launched off his saddle, possible forward onto the handlbars. I could see a gouge mark in the asphalt where perhaps a foot rest had hit. As he tried to control his bike, it skidded side to side but he could not keep it up. He landed 15 to 20 yards past the speed bump down the hill.


I entered the hospital to the right. I was hoping I would not have to visit him at the place the sign indicated on the left. I asked the security guard where he might be. He said, “Casualty Care.” I parked my bike and followed the signs to casualty care. There was a large dark waiting room with examination rooms on the left. A child sat on a exam table with a bandaged foot. I approached a well dressed man sitting at a small desk with a hospital chart in front of him. “Did a piki piki driver come in with a head injury? I was there and wanted to know how he was doing.” I said. “A big man?” he asked. “Yes,” I said. “He was here and we dressed his wounds, but he left,” he said. “He had a pretty bad head injury, and was unconscious when I first saw him,” I said. “Yes, I examined him, but he did not want to stay,” he said. “Okay,” I replied. “Are you the daktari?” I said. “Yes,” he replied. I introduced myself, we shook hands, and walked back to my bike.

When I got home I called the Kenya Power Company. I talked with a man and explained my situation and how I could not pay for more electricity. He said, “I am in my office and will be here until 9pm. Come in.” I grabbed a piki piki downtown, trying not the think about what could happen on a piki piki. As expected the big blue gate was locked. I called the number I had dialed just 15 minutes earlier. It was busy. I waited a few minutes and tried again. Busy. I waited a few minutes and tried again. The phone rang but no one picked up. This continued for another 20 minutes until I decided to leave. It was dark now and there was no way I was going to catch a piki piki. I walked the half hour home, using the flashlight application on my mobile phone. I snapped this photo on my way home of several small roadside shops near the Kakamega General Hospital. The green storefront is one of many mPesa places (you can click on the image so see it in higher resolution).

As you can see, I continue to move forward, trying to get the hang of how things work. I might not have any electricity in my apartment when I wake up in the morning, and then I will see what happens when things don’t work.

Update:  Sunday, 20 September, 2015. I was down to 0.10 kW-hrs when Richard stopped by my place. He recommended that I call Kenya Power again, but this time I called the national number not the Kakamega number. Wow, what a difference! The operators spoke fluent English with a polished British accent. They quickly figured out what had gone wrong. I had sent two mPesa payments of 500 KSh each, and had the confirmation texts with time and date sent. The issue was that there was a 562 KSh back payment due from the previous tenant, so my first 500 was sucked up immediately, and the normal notification did not get sent. The second payment of 500 did generate a “token” number, using the remaining 438 KSh, but the normal text message with instructions did not go out because of the divided payment, part back payment part for my “token.” They gave me the token number which I then entered into my meter an now I have over 36 kW-hrs of electricity. Yay! That should last me a long time, perhaps months.

Settling In, Then Off Again

It has been about five days since I posted an entry. This week, up until now, there did not seem to be much to say. I have been busy preparing my first lecture to the second year students on “Clinical Optometric Procedures.” I have been settling in to a routine, doing my work.

Here on the equator in the highlands of Western Kenya, the sun rises at 6:45, the sun sets at 6:45. The day starts out sunny, clear and cool at around around 16 degrees Celsius (60 degrees F) and warms to about 26 C (80 F) in the afternoon. We are in the late summer rainy season. I wake up, shower, and have a breakfast of instant coffee, oats, and fruit. The local fruits of oranges, banana, and mango are plentiful and cheap. It is also common to see apples and tangerines in the high end grocery stores and they are more expensive. Yesterday, I asked a grocery clerk, “Which of these coffees is the best Kenyan instant coffee?” “Nescafe,” he answered. There is an assumption among locals that the big international companies have higher quality food, but there was no way I was going to buy Nescafe. I vaguely remember an incident that happened years ago where Nescafe initiated an advertising claiming that their baby formula was more nutritious than mother’s milk, leading to infant malnutrition and deaths. I went for Gibson’s brand which is made in Kenya, and I have no details about how ethical Gibson’s has been over the years, but have not tried it yet. I once bought Dorman’s brand and it was good.

I ride my bike to work through the back roads. There is a side entrance at the University, closest to my place, that allows bicyclists and pedestrians to enter. I enjoy greeting the security guard with a “Jambo” or  “Habari?” As I ride, I frequently hear locals say or sometimes yell “Mzungu!” as I ride by. The look at me and laugh, putting an elbow into their neighbor’s side. “Hey, look at that. There’s a mzungu on a bicycle.” As I have mentioned before, bicycles are for poor people here, and they assume that a mzungu is wealthy.  While I have no complaints, and I am still not receiving a salary, I certainly do not perceive myself as wealthy by American standards. I am wealthy by Kenyan standards, however.

As I ride I hear “How are you?,” every few minutes. I am trying to learn Swahili, and will sometimes answer “Mizuri sana,” which means “I am fine.” Oh, they do not like that at all. If someone yells, “How are you?” they want to hear, “Fine, thank you.” So now I say, “Fine, thank you, and you?” as I ride by.

Most mornings I arrive to work and find a place to sit and work. I have no office here and neither does the other full-time faculty member, Richard Donkor, OD, from Ghana. We often sit in the consultation room in the clinic where it is clean, quiet, and there is an electrical outlet to power our laptops, charge our phones. Telecommunications in Kenya are excellent, at least through the company I use called Safaricom. My mobile phone acts as a hotspot, is inexpensive, and reliable. I buy data packages as needed, use it a lot, and have purchased $20 in data so far in my three weeks here.

Lately, I have been working on my lectures. I am partly employed by the Brien Holden Vision Institute out of Australia and have access to their online teaching materials, either in pdf or Powerpoint format. They have extensive teaching materials available and I have enjoyed reviewing their Clinical Optometric Procedures I and II series, which is one of the classes I teach. I have not found any contact lens or visual neurology lectures on their website. For the contacts lectures, I have joined the International Association of Contact Lens Educators (IACLE) group and should have access to their teaching materials soon. I have purchased a neuro-ophthalmology text but it has not yet arrived. That will help me with those lectures.

Lunchtime here is 12:30 to 2:00. Usually, I start getting lightheaded around 11:30 so often reach into my bag for a snack, often peanuts. I always carry my backpack, which contains my laptop, charger, notebook, rain jacket, some cash, and passport. I carry water, and have unfortunately become dependent on bottled water. I must come up with a better solution than buying all that plastic. Sometimes I do not bring my passport, but only a copy of it. It depends on whether or not I might need it for some administrative task. I always carry tissues or toilet paper. The only restroom on campus I have found that has toilet paper is the optometry clinic, so I often use that. The rest, for example, the restroom near the Department of Optometry and Vision Science has no paper products and no way to wash my hands. An individual sized alcohol hand cleaner is helpful.

Most Kenyans bring their lunch, and some seem to not eat lunch at all, as far as I can tell. I get on my bike and ride the 7 minutes off campus to a local restaurant that has a lunch plate with drink for 550 Kenyan Shillings (Ksh), or $5.50. I often get the chicken curry with rice. Another place called Garden View, and a bit further away, maybe 10 minutes, has the same thing for 360 Ksh. I mentioned this to Jennifer, who is the receptionist at the optometry clinic, and she said that was expensive. I have been doing quite well spending about 10,000 KSh a week ($100,) but that includes several items I have needed to purchase but did not have such as an electrical outlet adapter, towel, place mat, and laundry soap. Perhaps by American standards that is reasonable, even frugal, and by Kenyan standards I am wealthy and extravagant. I am living on savings.

I head back after lunch riding my bike on a pedestrian and bicycle path next to the main road. As I ride, I repeat the mantra “Stay left, stay left.” This helps me to remember to ride on the correct side of the road. If I have to ride on the road, as many bicyclists do, I will be passed by motorcycles and cars just inches away. Drivers here are quite good, and used to all sorts of obstacles including cattle and human-drawn carts loaded ridiculously high with all sorts of materials. Today, heading down the pedestrian/bicycle path, I dodged a herd of twenty cattle led by a Maasai caretaker. It seemed perfectly normal to me.

Once back at the department or clinic I work away on one project or another. As the afternoon wears on the skies begin to darken. Usually, around 4 pm, the wind picks up and I hear thunder. It will start raining in about 10 minutes. I continue working until the rain has passed. Today there was half-inch hail mixed in with the rain, which plinked off the metal clinic roof.

For the last couple of days we have enjoyed the company of a visiting optometrist from Ghana, Dr. Angela Amedo. She helped us out with oral qualifying examinations, a right of passage for fourth year students. We spent all day Wednesday as a panel, quizzing the students, one by one, on all things optometry. Drs. Okenwa-Vincent and Donkor, in conjunction with the Brien Holden Vision Institute, have been taking every opportunity to tighten the standards, make the program more rigorous. They have worked tirelessly to increase the quality of instruction and clinical experience, and their work has been nothing short of heroic.

Having said that, currently, the level of optometric knowledge and skill is still fairly basic. For example, while the students attend lectures and gain book knowledge, the clinic volume is very low, between zero to five patients a day. In fact, and more importantly, the clinic construction and outfitting was just completed in July of this year. It has 9 rooms, 8 functioning lanes with instruments. We still don’t have any frames on the frame board or a way to grind lenses. An optometry clinic without a way to fabricate spectacles is like a pharmacy without medicine. As a result, the students have little experience with actual patients. There is something called “attachment” where the students spend time in optometry offices and ophthalmology clinics around the country, but the quality of the experience varies greatly.

The Masinde Muliro University of Science and Technology (MMUST) offers a four year Bachelor’s of Optometry degree and has over 120 students in the program. Despite all of the challenges I have mentioned, this institution offers the highest quality optometry program in Kenya and the Eastern Africa region. I will be the third faculty member, and responsible for teaching, clinic duties, and mentoring Jr. faculty from Kenya that have recently graduated. We are encouraging and mentoring the Kenyan faculty to obtain a higher degree so that they can run their own department in the coming years.

Another important factor is that optometry is not regulated in Kenya. Anyone can open and optician or optometry office. All they would need is some money to buy an autorefractor, some frames, lens blanks and an edger. You see places advertising “Computerized Eye Exams,” and that means using an autorefractor to determine the needed prescription, then making and dispensing spectacles. As a result, whether the student graduates or not, does well or not, they can still open an office. MMUST offers a bachelor’s degree program so they should not call themselves a doctor of optometry, but many do. Even if they do not finish the program, the student will have had much more experience than most. You can imagine, as the head of the department, trying to reign in 30 students per class, many exhibiting the normal arrogance of youth. The head, or faculty member, has very little real influence over the students. If Dr. Okenwa-Vincent, in consultation with Dr. Donkor, decides to fail a student, what real consequence will that have, except for enraging the parents who spent a lot of money to send their child to the University?

Having said that, Kenyans in general show the great respect towards educational systems. The students, for the most part, want to study and do well. The overwhelming majority want to become competent optometrists. The students who work hard often get the best jobs in hospitals, clinics, or working with an ophthalmologist.

For those of you reading this who are not optometrists, it might be helpful to mention the role of optometry and how the profession has developed. Opticians make glasses, and are good at what they do, but have limited knowledge of optics and the human visual system. Say, a hundred years ago, when it became possible to reliably polish glass and put the lenses into metal spectacle frames, opticians had very little idea on how to match the spectacles to the patient. Imagine a table in an open air market or small jewelry shop offering a variety of spectacles. People would try them on, take a look around. If they seemed to help, they paid the requested fee and walked away.

Ophthalmologists specialize in medicine and surgical treatment of eye disease. Many, and there are clear exceptions to this statement, have limited knowledge of optics and vision. They are highly trained, so there are relatively few ophthalmologists. Access to care, especially in rural areas, can be an important limitation.

Optometry has developed to fill a need, an important role in today’s society where vision is so crucial for optimal function. We are primary eye care practitioners, and can handle the majority of the common and routine ocular and visual conditions. We help to educate and prevent eye problems, such as recommending sun protection to prevent cataracts. We can recommend spectacles, fit contact lenses, treat the majority of red and irritated eyes, and remove superficial corneal foreign bodies. Optometrists are trained in providing magnifiers and other optical aids to people with visual impairments, an area we call low vision.

I have no doubt that optometry in Kenya, and the rest of the developing world, will progress as it has in Britain, India, Asia, most of Europe, and the United States. The need has already been recognized, that is why optometry is here. The quality of education will continue to increase. Within the next decade, optometry will be regulated in Kenya as it is currently with medicine and dentistry. It is just a matter of time. The generation that we are training now are the pioneers of Kenyan optometry, and optometry in Africa in general.

As I have settled into my routine here in Kakamega, Kenya, there has been one overlying issue that has not been resolved. Concerning the job appointment, we have run into an important administrative issue. While I have my official transcripts from the University of California, Berkeley that verify my educational credentials, MMUST and the Kenyan government do not recognize transcripts. I do not know why. As I mentioned, they do not recognize optometry licensure in Kenya, so the hard copy of my Arizona license to practice optometry was not recognized. While my colleagues and coworkers know me and know my work, Kenyan government and university officials do not.

I have been informed they will only accept hard copies of my optometry and doctorate diplomas, and I did not bring those. To make matters worse, I seem to have lost them. I know that might sound odd to many, but as I progressed through the educational system there were many moves, many boxes to pack and unpack, and timetables to keep. For example, I finished the Ph.D. at UC Berkeley on December 21, 2001, and my diploma was not ready. I moved to Tucson over the holidays, and started work at the University of Arizona on January 4, 2002. I provided the University with an official, stamped and signed piece of paper that stated I had finished the requirements for my degree. They accepted that as proof, and I went to work. That was over thirteen years ago. My friend Carl Jacobsen, O.D., who lives in Berkeley is currently checking to see, if by some miracle, they have my diploma sitting an a file somewhere. If not, the Ph.D. diploma and O.D. diploma will have to be ordered and signed and that takes a couple months.

In the meantime, I cannot be hired here at MMUST, and cannot be paid. Working without a work permit in Kenya is a serious offense, punishable by fine or even jail time. Interestingly, this administrative snafu has opened up an opportunity for me. Kesi Naidoo, from the Brien Holden Vision Institute (BHVI), has arranged a 4 week teaching tour including visits to Malawi, Tanzania, and South Africa to give lectures and an practical training sessions on slit lamp examination and ophthalmoscopy. The BHVI accepted my proof of academic credentials long ago and will be able to pay me a portion of the income stream. I will leave in a week for one of those places, then visit Tucson for a few days to visit friends and take steps to getting the paperwork issue cleared up. There is another issue that has arisen with my mortgage. It seems my mortgage company sold the mortgage to another company and the details of monthly payment need to be worked out. It will be best done from Tucson.

After the Tucson visit I will head to the American Academy of Optometry and Volunteer Optometric Services to Humanity (VOSH) meetings in New Orleans, where I will obtain valuable continuing education credits to maintain my license, as well as see friends and colleagues. Then there will be the long flight back to Nairobi, followed by a continuation of the teaching tour to the remaining two African countries. This means that you, the readers, will have plenty of adventures to follow over the next month or so, provided I have the time to write. And I will make the time.

Kakamega National Forest

The very day I heard I might be teaching at the Masinde Muliro University I looked up the town in which it was located, Kakamega, Kenya. Twenty-one kilometers, or 13 miles, east of the town, there was a huge green patch on the map. It was the Kakamega National Forest, protected by the Kenyan Wildlife Service. The more I read about it the more I was interested. It was the last remnant of true rainforest in Kenya, that once stretched across Central Africa and also known as the Guineo-Congolian forest. Just like most rainforests in the world, it was under pressure by land development and local intrusion.

I read about the forest and found out that I could get there by piki-piki, or motorcycle taxi, for 300 to 500 shillings, or 3 to 5 dollars. The entrance fee was 600 shillings for non-residents, and I could arrange for a guide for 500 shillings for a short walk or 1000 shillings for a long walk. Yesterday afternoon I e-mailed the guide, Abraham Imbai, and he responded the same evening. I went to sleep last night excited that I was going to the rainforest.

I woke up, made some coffee and oatmeal, and as I was having breakfast I got a telephone call from Abraham. We confirmed that I would meet him at the park office at 10 in the morning. I took a piki-piki into town and picked up some water, fruit, and nuts for lunch. When I exited Tusker, a local grocery store, I picked out what looked like a responsible piki-piki driver if he would take me out there and asked how much. The driver seemed hesitant. He called over his buddy, much younger, who said he would do it for 500 shillings. This piki-piki driver was enthusiastic and impetuous. It was me now who was hesitating for a moment. I was not so sure about the driver. “Is there a place I can get a neon green safety jacket?” I asked. I had seen bicyclists and motorcycle drivers wear them. “Yes, I will take you there,” he said. “Okay, let’s go,” I said. He turned to another piki-piki driver and said something in Swahili. The other guy reluctantly handed over his helmet. “Here, take this,” he said. I put it on.

We stopped by a second hand clothing kiosk just down the road. I described what I wanted. The store owner showed me some neon green safety pants. “Yes,” I said, “But the jacket.” He shook his head no. I noticed his neighbor rummaging around in a large nylon bag. He pulled out precisely what I wanted, an ultralight safety vest, designed for bicyclists. I walked over. “How much? I asked, and he replied “200 shillings.” I pulled out 200 shillings and handed it to him. My piki-piki driver saw a heavier safety neon green jacket and said, “450 shillings. Buy it for me.” I handed him his requested fee of 500 shillings for the trip and said, “Here is your fee of 500 shillings. You can buy it for yourself if you want.” He shook is head and we walked back to the motorcycle without the jacket.

I have noticed that some piki-piki drivers, when given the task of driving a mzungu, get very excited. It was as if the driver were a Secret Service agent shuttling around the President of the United States. In a driving culture already on the edge of sanity and safety, the last thing anyone needs is a nineteen year old motorcycle driver in a hurry with a feeling of entitlement. Furthermore, these are small motorcycles in poor repair. When I sit my 200 lbs down on the back, the bike settles a few inches. When we hit a bump, we bottom out. The weight shifts back leaving the front tire with less weight on the road, therefore less traction. I have often wondered if the drivers take this into account, especially with potholes in the asphalt, rutted dirt roads, and large loose or embedded rocks along the way.

“Hey, do you know how to drive a piki-piki? he asked. “Yes, I know,” I said. “Good. Do you want to drive?” he asked excitedly. I thought for a moment. This might solve my concerns about his youth, personality, and driving style. But I did not have a Kenyan license. If stopped, I could face a fine or even arrest. An innocent outing could snowball into losing my job and being deported. No, it was not worth the risk. “You drive,” I said.

Off we went, at top speed. About a mile outside of town the road turned to dirt. My piki-piki driver was a man on a mission. I held on. I said, “You know, I am not in a hurry. We have plenty of time.” He nodded. He hugged the left side of the road where the dirt was more tightly packed, passing inches from people walking. Several miles out of town we approached a T intersection. We simply had to veer left. I saw another piki-piki driver, also with a passenger, coming down the road from our right. My guy showed no signs of slowing. The driver coming fast on our right looked right at me with a spaced out, bewildered look on his face, never even tapping the brakes. We were on collision course. Just a few meters from colliding I grabbed my drivers shoulders and said, “Look!” He braked sharply and we passed a meter behind the speeding motorcycle. My guy said, “I don’t slow down.” I breathed a huge sigh of relief, and was perplexed by my driver’s response because thankfully he did slow down. I said, “No hurry. I want to arrive safely.” We arrived at the Kakamega National Forest office and I was glad to be there.

Once off the back of a speeding motorcycle, I noticed how calm and peaceful it was. A young lady met me at the office. “Abraham told me you were coming,” she said, “Welcome.” She took my 600 shillings entrance fee, and I signed in. I also paid the 1000 shilling fee for a long walk. On the wall it said a short walk was 1-2 hours and a long walk was 3-4 hours. There were other options such as the sunrise walk, night walk, and full day hike. Abraham met me and introduced himself. We headed toward an area called the KEEP Bandas. He introduced me to Emily, who was a local high school student. He explained that he often brought local residents on the walk because very few had an appreciation for the forest, its plants, and animals. He said that most residents rarely left their town. They assumed that all of Kenya was rainforest and had no idea the area was precious and endangered.


The KEEP Bandas are traditional Luyha dwellings made out of a timber structure then packed with mud. The outside is coated with a mud and cow dung mixture that acts as stucco, and they are painted, and a thatched roof is put in place. They are available for rent at 900 shillings a night ($9), or 1800 shillings a night including two meals.


This is the dining area, also a traditional structure.


We began our walk. A couple from Kisumu joined us and they wanted a short walk. Abraham told me we would do a short walk, break for lunch, then go on another walk. That sounded good to me. This was a beautiful iridescent blue-green butterfly.


Abraham talked a lot about the strangler figs and how they are so important to the ecosystem. They surround a tree, and then the original tree dies, leaving a space in the middle. That space is often used by animals and insects as a home.


There were many incredible butterflies.


Abraham knew a lot about how the local plants were used as medicines. He pointed out a 120 year old woody vine, he called it. He said the vines were used by primate mothers as a jungle gym to teach their young ones how to climb, before heading up into the higher canopy. The vines extend up for tens of meters. He said that he caught a local guy cutting one or two meter sections out of the vines, and leaving the rest of the vine to die. He asked why he would do such a thing. The local guy said that the Luhya bullfighters would pay him 15,000 KSh for the woody vine sections. Apparently, they would burn the vine to make charcoal, crush it, and feed it to the bulls. The bulls would then become muscular and grow very large, but would become sterile. I mentioned to Abraham that it sounded like the vines contained anabolic steroids which would increase muscle mass, and were used by body builders. The local guy was arrested for cutting the vines and spent 6 months in jail. They told him if they caught him doing it again it would be a year.


We saw Black-and-White Colobus monkeys in the trees.


A group of Black-and-White Colobus monkeys. For some reason, I was very good at seeing monkeys in the trees. I would see one or a group and point them out. Abraham was impressed.


I was also impressed at their incredibly long tails.


Abraham took the time to smell the flowers. This small bunch of flowers, by the way, was over 5 feet tall. He did not pick them. This glade was one of several large areas, natural and not cleared, in the forest. He said that slowly but surely the forest was moving in.


There were lots of mushrooms. The couple from Kisumu were surprised that the forest had so many downed trees, and wondered why they were not cleared. Abraham explained that when a tree fell it was left where it fell. If it fell in a path, they moved the path around it. He pointed out tiny holes all over the tree. “These dead trees are home to thousands of insects and animals. They are home to mushrooms.”


After a break and lunch, we all took Abraham’s motorbike to the Rondo Retreat Center, a beautiful bed and breakfast lodging. We then walked down a road and climbed a mountain.


We could see the rain moving in but it never rained hard. This was looking to the south towards Kisumu.


Abraham spend quite a bit of time talking about this plant. He said it was used to stop the bleeding and provide comfort after the circumcision of young males. He winced as he spoke about it. I asked at what age males were circumcised. He said, “12 to 14 years. If they knew what was coming, they would move away before it happened.”


He called this a Protea plant and said it only grew in this volcanic soil on the hill. I could see lava rocks, large and small, in the red soil, similar to what I have seen in Oregon and Hawaii. My guess is, however, this region’s volcanic activity was a long, long time ago.

We headed down the hill and back to the Rondo Retreat. We sat on their expansive lawn, had juice and sodas, and talked about our day. Abraham then drove Emily and me part way back to Kakamega, and I caught another piki-piki the rest of the way home. I was careful to pick a driver that looked calm and mature, and the ride was uneventful. I am looking forward to my next visit to the Kakamega National Forest, which will almost certainly include an overnight stay in the KEEP Bandas. I want to do a night hike, and/or a sunrise hike, when Abraham said many animals are out and about.

Small Victories

I woke up on Saturday morning happy that it was the weekend. I had one major goal for the day. I wanted to get the door open to my patio. The door had been locked by the tenant before me and the key was lost.

Dr. Okenwa-Vincent had told me many times throughout the week that he wanted me to move to another apartment, one on the fourth floor with a refrigerator, microwave, and television. I said I was happy where I was, but sure I would move. My apartment had none of those amenities. On Thursday I headed over to the housing office of the Masinde Muliro University of Science and Technology. There was team of four people and we packed into a small truck and drove ten minutes to my place. We headed up to my place and the team walked in. “Nice,” one gentleman said, “This is a good apartment.” “I agree, I have been happy here,” I said. They looked around. “Looks good,” another person said.

“The only thing is the door to my patio is locked and there is no key,” I said. “Maybe we can talk with maintenance and they can open if for you. Or maybe we can find the key,” the lead person said, wearing a suit and tie. “Okay, that would be great,” I replied. The team of people filed out of the apartment.

“Um, I thought I was being moved to the apartment on the next floor, and that was why we were here,” I said. “We cannot find the keys to that apartment, and it is not ready yet,” one man said. That had been the problem all along, I thought, and it had been a week. I was supposed to move in to the fourth floor apartment from the very start, but had been offered the third floor apartment because it was clean and there were keys. “How about if we move the refrigerator from the upstairs apartment to your apartment?” one of the team asked. “I like that idea,” I said. “We will look into it,” another said.

On Friday, I saw that someone had moved into the upstairs apartment. It’s one thing to move a refrigerator from an empty apartment. That is possible. It’s entirely another matter to move a refrigerator from a now occupied apartment. The new occupant would be, let’s just say, not happy. It was clear that I would not be moving. It was also clear that if I wanted anything done I would have to do it myself, and that was my Saturday goal.

I took a piki-piki, or motorcyle taxi, into town for 50 shillings. I went to a hardware store and explained my predicament to the man behind the security screen. “That is not a problem,” he said, “I will sell you a key blank for 100 shillings ($1). You take to the locksmith and he will cut the key.” “But how will he know how to cut the key?” I asked. “He will take his tools to your place,” he replied. “Okay, where can I find the locksmith?” I said. “See that white Nissan?” he said as the pointed down the street. “Turn there,” he said, indicating a left turn with his hand. “Go past the lady selling the bras, and down the alley. There you will find the locksmith.” “Asante,” I said and headed down the street.

I followed his directions, found the lady selling the bras, and walked down the alley. I could see no locksmith. I was looking for a grinding wheel and a board of key blanks, similar to what I had seen at the Ace Hardware store near where I live. I heard a lady say, “Hey, mzungu!” I ignored the comment, but walked up to her and said, “I am looking for the locksmith. Is he around here?” “No, he died,” she said. “Is there another locksmith in town?” I asked. “Yes, near the DeNeru building,” she said. “Where can I find that?” I said. “Down the street then this way, then down, that way,” she said as her hand made a left motion then moved straight into the air. “I think I’ve got it,” I said, and walked off in the direction she had indicated.

I made a left, then a right, and walked straight a couple blocks. “Is this the DeNuru Building?” I asked a gentleman on the street. “One more block. On the corner,” he said indicating with his hand. I walked the block, and found another hardware store. “Is this the DeNuru Building?, I asked. “Yes, it is,” a lady replied. “Do you make keys?” I asked. “No, but the locksmith is across the street. Can you show him, Asan?” she said. Asan walked me across the street. A truck had stalled in the street, creating a lot of commotion. Asan made it across just fine but I was dodging pedestrians, bicycles, and motorcycles. Asan looked concerned, but finally I made it across too. “This is the locksmith,” he said. “Asante,” I said.

I explained my predicament. “No problem,” he said. “I will make you a key. I must go to your house.” “How much?” I asked. “Two thousand shillings,” he replied. “Oh, that sounds expensive. I respect your skill but I could not possibly pay two thousand shillings. How about one thousand shillings?” I said. “Fifteen hundred,” he said. “One thousand, two hundred, and I will pay your way there and back,” I said. “Agreed,” he said, and he gathered up his tools. He grabbed a long spring, a screw driver, hack saw blade, and file. “Is that all you need?” I asked. “Yes,” he said, “Let’s go.”

We walked to a piki-piki driver. “How much to National Housing?” I asked. “For both of you?” he asked. “Yes,” I said. “100 bob,” he said, which means 100 shillings. “Let’s go,” I said, and all three of climbed onto the small motorcycle. Ten minutes later we were at my place. I paid the piki-piki driver the 100 shillings.


The locksmith went right to work. The first job was to get the door open.


It took about 10 minutes but he did it!


He took off the lock and disassembled it.


He then moved around the templates inside to create the new key pattern.


He filed the key by hand.


He tested the key, the put the whole thing back together. The whole process took about an hour.


Success! I had access to my patio and a new key for the lock. I thanked him, “Asante!” I said. I gave him the 1200 shillings, with an extra 100 shillings to get back to the center of town. Piki-piki drivers wait just outside the housing complex to give rides to residents and anyone else passing by. It was a good day!

First Weekend in Kakamega

Richard Donkor, OD, and I were tired after two days of performing 4th year optometry student qualifying examinations. As I mentioned in my last post, there were five stations. The three Kenyan optometrists worked the refraction, slit lamp, and ophthalmoscopy stations, Richard did binocular vision and confrontation tests, and I did the history taking, case analysis, diagnosis, and treatment plan station. The first day I devised various clinical scenarios, but I realized that it was difficult to compare between students with cases of varying complexity. It was also a lot of work.

On Friday, I settled on one case which happens to be very similar to my actual case. I will briefly describe the typical interaction. The student would enter the room and introduce themselves. “Hello, I am Dr. Twelker,” I would reply. They would shake my hand while holding their right elbow with the left hand, and a slight bow. The first time this happened on Thursday, I thought the student had a sore elbow. With every student sporting a sore elbow, I asked a student why she held her elbow like that. “It is a sign of respect,” she said. “Oh, how nice,” I said, “Thank you.” The culture is similar enough to America that I feel quite comfortable most of the time, but there are enough significant differences that I am sure I make mistakes all the time without even knowing it. I am glad that the vast majority of Kenyans are good natured, gracious, and forgiving.

“This is an evaluation of history taking, case analysis, diagnosis, and treatment plan. You will be the optometrist and I will take the role of a patient. We have twelve minutes. Do you have any questions?” I said. Usually there were none, and there was a nod of understanding. I would take off my glasses, “Okay, begin,” and I pressed the stopwatch on my phone.

The student would introduce themselves and ask my name and age. “What brings you to our clinic?” the student would ask. “I purchased these reading glasses five years ago. They worked for many years but now they have lost their power while reading. I can see well through them for distance vision, however, which was not the case before.” I said. “How old are you?” the student would ask. “Fifty-five,” I answered, which is not far from the truth. I chose 55 because at that age there should be no ocular accommodation remaining and I did not want that to be a confusing factor. The student would then dutifully and carefully work through the history taking point of general health, ocular health, family history, medications, and allergies. I kept it simple. “Do you have any hobbies?” they were trained to ask. “Reading at night,” I answered. “Do you smoke or drink alcohol?” they asked. I usually said no, or sometimes answered that I had an occasional beer. Once, and perhaps I was bored, I answered that I occasionally smoked marijuana. I was curious what might happen. It did not phase the student one bit. “Very well,” he replied and continued. Marijuana is illegal in Kenya but I hear that it is not that uncommon for some people to use it.

Sometimes there was an awkward pause after the history. I sat there. The student sat there. He or she would quietly say, “I am done with the history.” “What would you do next?” The vast majority of the time the student would respond, “I would take visual acuities, distance and near,” which is the right answer. Occasionally the student would say, “You might have cataracts. I will take you to the slit lamp to look.” I encouraged the student to take a straightforward approach to the exam flow and, at least in the first years of practice, use the same order almost all the time. History, visual acuities, confrontations including cover test, retinoscopy, refraction, tonometry, slit lamp, and ophthalmoscopy. That should be the order. If a practitioner jumps to the slit lamp, for example, then it would be most efficient to do applanation tonometry at that time which means instilling eye drops. The eye drops could interfere with refraction. Thus, it was best to stick to a simple and consistent exam flow, I recommended.

I encouraged every student to become proficient at retinoscopy because it is quick, inexpensive, and provides so much information about the refractive and ocular health status. I was happy to have some input into their education, even if it was in the last days of their four year degree. “The retinoscopy shows significant ‘with motion’,” I would say. “What does that imply?” The vast majority replied, “Hyperopia” and I was glad for that.

“The refraction shows +1.00 diopter (D) of refractive error in the distance, both eyes, and the patient holds his material at 50 centimeters. You decide to prescribe bifocals, what add to you prescribe and what to you write on the pad of paper?” “The majority said, “+1.00 D, both eyes, and +2.00 D add,” which is the right answer. Some wanted to calculate the add based on a formula of “Age – 10, divided by a half,” which in this case would be +2.25 D. I told them that was not incorrect, but that at age 55 years there was no accommodation left and suggested they prescribe based on the working distance. Several students forgot to incorporate the distance refraction in the Rx, and answered Plano, +2.00 D add, which is quite incorrect. I told the students kindly but firmly that the distance refraction must be taken into account, and from now on to never forget it.

The clinic volume is somewhere between zero and five patients a day, and the clinic is not open every day. Many of the students have only seen five or six patients their entire third year, and perhaps seven or eight their fourth year. Much of what they have learned is from books and lectures. Despite this challenge, some students were sharp and answered the questions quickly and confidently. One student was excellent. I asked him where he intended to practice and the town is 60 kilometers from Kakamega. “Micah,” I said, “I recommend that you get some experience, then return to the University. You can study to get your master’s and then your doctorate degrees. You could run this program someday.” I hope I planted a seed, much like my mentors did many years ago. Thank you, Drs. Zadnik and Mutti.

“The patient states that he is a farmer and bifocals are too expensive. He wants reading glasses. What do you write as the reading prescription?” I said. Most replied, “+3.00 D,” the right answer. Some said, “+2.00 D,” indicating only the add. I reminded them that bifocals incorporate the distance power through all portions of the lens, including the bottom portion. “+2.00 D, while helpful, would most likely be insufficient for this patient to achieve the best visual acuity. They call it an ‘addition’ for a reason, that is, you add it to the distance power.” A few had an “ah-ha” moment.

Some students, and I did this when I was a fourth year and beginning practitioner, made the case more complex than it needed to be. When I mentioned that the distance was blurry at distance and near, some students immediately jumped to a diagnosis of significant cataract. I reminded them that almost all 55 year old patients have some cataract, and most are not clinically significant, and recommending sunglasses and/or a hat would be a very good idea. I said that as an optometrist, especially an optometrist in Kenya, our main work was to treat refractive conditions through optical means such as spectacles. This happens to be one of the most common causes of unnecessary visual impairment. Keep things simple. Only add complexity when the situation requires it, as it sometimes will. When faced with complex case, as in the patient with a diagnosis of ocular trauma or disease, concentrate on what benefit we might be able to provide, and refer to an ophthalmologist or other specialist.

One student on the first day, when hearing a case of a 19 year old complaining of blur at night, immediately diagnosed night blindness due to Vitamin A deficiency (thankfully, not a common condition in Kenya due to no shortage of affordable fresh fruits and vegetables) and recommended that her patient eat more vegetables. “Eating more veggies will be healthy for the patient,” I said, “But I was trying to get at a diagnosis of low myopia.”

I did this process 24 times on Thursday, and 20 times on Friday. It was exhausting, although streamlining the case the second day was most helpful. Dr. Donkor was tired too. We decided that after work we would rest then meet to go to a club. Fortunately, Richard lived just one floor below me and he had a vehicle. I walked downstairs a 9pm when we had agreed to meet.

Richard drove us to Signature, described as the finest dance club in Kakamega. There was a brief security check at the ground floor and we ascended the stairway. Entering the club there was a bar on the left with perhaps thirty people sitting in a modern, well laid out floor plan. It had many distinct fixed seating modules that might hold six or eight people. It was perfect for small groups and most Kenyans go out with friends.

We headed to the right where there was also a bar, and the area was much larger and dimly lit. The central feature of the club was a perhaps 20′ x 20 lighted dance floor with DJ. Laser light shows illuminated sections of the club. Monitors on the wall showed music videos that the DJ was selecting and mixing. The modular format was on this side too, with many small groups sitting in the periphery of the club, occasionally moving out to the dance floor. Richard and I sat at small, raised circular table with raised seats for four. For awhile the club manager sat with us.

Most songs were from African artists from various countries, and when a Kenyan artist came on, the energy level notched up significantly. There were some American artists selected like Rihanna or hip hop artists, but the majority were from Africa. Of course, being a dance club for mostly young folks, the emphasis was on modern dance music.

The Kenyan music was excellent. For example, there was Gabriel Karegwa, popularly known as Prince Otach. I was told he was currently based in the UK, and credited with popularizing Kenyan music abroad. Emmy Kosgei was a well known Kenyan gospel artist and was becoming better known abroad.  Her music is here.

I have been impressed by the diverse and international nature of African life, especially musical life. Africa is vast, diverse, and full of continental pride. I have been to other countries that seemed to draw their music and entertainment from America. Not so in Kenya. There was a strong emphasis on African music, both traditional and modern, with clear Kenyan pride.

Just like most clubs, things started off pretty mellow. Mostly there were young men dancing together, nicely dressed and showing off their smooth moves. When a woman would join the men on the dance floor, there was some competition for her attention, and eventually she would usually pick one guy and dance with him. When the DJ mixed in the next song, perhaps one that was not as popular, the whole thing would usually break up and the cycle would start anew.

Richard and I sat drinking beer and occasionally chatting, although it was difficult to communicate with the loud music. I enjoyed seeing the various styles of dress and awesome dance moves. I watched the interactions among people. It did not bother me that the club, at least for me the only white guy in the place, was probably not going to be a great place to meet people. For one thing, I was significantly older than most, and as is often the case, most people were having fun with their friends and acquaintances. A few people throughout the evening stopped by the table, acquaintances of Richard, and he introduced me to them.

Most men wore dress shoes, dark pants, and a button down long sleeve shirts. Some men wore very pointy shoes, a style not popular in the US, but perhaps influenced by Middle Eastern culture. Most women wore dresses, but not all. Some wore layered tank tops and jeans or pants, similar to the US. One guy on the dance floor, more than once, unclasped his belt, unbuttoned his trousers, unzipped his pants and slowly tucked in his nicely ironed shirt and then put the whole ensemble back together, all to the music. “Huh, I wonder if that works for him?” I thought.

Another fashion trend I had never seen in Tucson was the Maasai blanket, also called a shuka, draped loosely over the shoulders. Maasai shukas are brightly colored red, blue, or green plaid small blankets. One man and one woman sported this uniquely African style. The man wore a khaki brimmed hat, shuka, and walked around the club as if he were an ancient mystic. The woman seemed much more approachable, although I did not approach, and she sat and chatted with friends as if she were at home on a cool evening.

Richard leaned over and said, “A lot of people here are first year students.” I could see them testing the waters, showing their smooth moves. There were definitely some professors and lecturers there, I thought, and many couples who danced or sat and talked, keeping to themselves. This was a university town, after all, and probably the best paid people in Kakamega worked for the university. They would be able to afford a night out.

To our right, and directly next to us, there were four women, all smartly dressed. They sat and talked, occasionally standing up to dance by themselves or with one another. One woman who almost never stood up or danced, wearing an elaborate lime green dress with fringe, seemed to be the leader. She was closely paired with a muscular, strong woman in a tight dark blue dress with short hair, square jaw. As the night progressed, got louder, the young men began to show interest. They would be firmly rejected with a few words or a palm held straight up, then brushed aside. Once gone, the women would celebrate and dance together more fervently. One guy, moving to the music, moved in toward their table from the dance floor, along with his buddy close behind. He too was asked to move on. He was bolder than the rest, however, and would not take no for an answer. There was more body language stating the obvious, and a few strong words from the women. He persisted. One of the women turned to the club security man, and the intruder was escorted away, his friend following closely behind.

As the night progressed the music got louder, the dance floor more crowded. I could tell when a woman settled on a man, either her partner or perhaps a new acquaintance. She would bend over, dancing to the music, and bump and grind her ass into his crotch. He would move to the music too, either becoming more animated and bend over her, dancing more passionately, or coolly stand straight up and act interested but distant. This was not common behavior in Tucson, I thought, or maybe it was that I did not go to dance clubs often and it would be similar at home. When going out in Tucson, I usually went to live music clubs or brew pubs. The vibe was different there, although I certainly have seen instances of sexy dancing and the occasional drunken make out session, so it wasn’t that different.

Two men talked near the bar, impeccably dressed, wearing identical ironed plaid shirts. Ah, the first obviously homosexual guys, I thought. But then again, I wasn’t sure. For a while, I thought the four women next to me were most likely lesbian. But as the night wore on, two began to flirt and dance with men including the one who seemed most anti-male and had called security. The woman in the lime green dress vigilantly maintained her post at the table, however, accompanied by the woman who resembled Grace Jones.

The night was reaching fever pitch, I had had four beers, and it was one in the morning. Richard was enjoying the company of a woman, an ex-girlfriend he explained, and deeply involved in conversation. I was ready to go. I mentioned to Richard I could catch a taxi home. One nice thing about Kakamega, among many nice things, was that the distances were relatively short and taxis were affordable. I could catch a boda-boda, or motorcycle taxi home for 100 shillings ($1) or, more likely and safer at night, a taxi for 300 shillings. He assured me, however, the he too was ready to leave. I insisted that I was fine on my own, and he insisted that he was truly ready to go. I believed him because a few days earlier while having a pint at the Golf Hotel bar, I had left him to his own devices and he was fine with it.

As we were preparing to leave, the server came up and said something in my ear. I did not understand. “Please write it,” I said. She came back with a piece of paper and handed it to me. “Del Monte, 300 shillings,” it read. She was asking me to buy her a carton of juice, in other words, to give her an extra tip over and above what we had tipped. I felt resigned to my fate. “Sure,” I said, and handed her a 500 shilling note. She brought me back 200 shillings and we left for home. This would be the dynamic, I thought. I would be the mzungu in the crowd, the white guy with money and I would have to get used to it.