I Built No Schools in Kenya

by Kirsten Drysdale

  Later in the morning I get a text from Suzanne asking if I’d like to visit her clinic today.

  I drive the Peugeot out to Lower Kabete Road, where I find a tiny cement block with a tin roof, on a small grass plot across the road from a post office. Close to a hundred people are sitting around the building, some waiting on the verandah, others resting in the shade of the trees. Some left their homes at dawn, travelling hundreds of kilometres to reach this place they have heard about – the place that helps ‘the troubled’.

  One young woman has brought her older brother with her: she says that every time she cooks the family dinner, he snatches the pot from the jiko and tips it down the toilet, claiming the food is poisoned. Another man has brought his fourteen-year-old daughter, who’s been disappearing in the night, setting off for Nairobi from their village on foot. Friends and neighbours sometimes catch her along the way; at other times she simply turns up again in the morning, refusing to say where she’s been or what she’s been doing. Her father worries about her ending up pregnant – or worse. Yet another has brought his mother. Only sixty-something, she’s becoming very forgetful. ‘She only talks about people from the past,’ he says. ‘I think she is seeing ghosts.’

  Suzanne takes me inside, where the clinic is separated into two rooms: one where patients sit for consultations with a psychiatric nurse, the other a makeshift dispensary, where trainees and counsellors are filling prescriptions and manually counting out pills. She introduces me to Steven, a thirteen-year-old boy with a seemingly permanent smile who is helping her manage the waiting list. He has epilepsy and was kicked out of school because of his fits – the villagers thought he was possessed by demons.

  ‘I know epilepsy isn’t really a “mental health” issue,’ Suzanne tells me. ‘But it’s so poorly understood here, we’re really the only people who can help him.’

  All Steven needs to manage his condition is a one-cent tablet, phenobarbital, taken once a day. Phenobarbital has been used in low doses as an anticonvulsant for epileptics for over a hundred years. Though a number of other drugs have since superseded it, it remains cheap and highly effective, and is endorsed by the World Health Organization, making it a particularly suitable drug for the developing world – where 80 per cent of the globe’s epilepsy sufferers live. The problem is, it’s a narcotic that’s subject to strict international controls and regulations, so not too many pharmacies around here will stock it. Suzanne has sourced all of her medications at cost price or cheaper through pharmaceutical companies and only charges patients here what they can afford.

  Since he’s been medicated, Steven has only had one seizure. If it wasn’t for Suzanne’s clinic, this kid might have been denied an education. But now he’s back at school. ‘I’m going to be an engineer,’ he tells me proudly.

  ‘He probably will be – he gets jolly good marks,’ Suzanne says.

  Over the course of the morning I meet a number of grateful clients – some with great success stories, others still works in progress. There’s a young woman with schizophrenia who hasn’t had an episode since taking her medication but is having troubling side effects: stiffness and cramping in her neck, severe enough that her head rests on a permanent tilt. She’s on a ‘typical antipsychotic’, first used in the 1950s but since mostly out of favour due to this sort of Parkinsonism and similar adverse effects. The clinic has sourced her a newer drug, and are counselling her and her carer – her brother – on how to phase it in.

  There’s a teenage boy with depression who has made great progress – every two weeks he comes for talk therapy. At first he wouldn’t even make eye contact; today, for the first time, he laughed.

  The man with the forgetful mother is told that she most likely has Alzheimer’s. That she is seeing ghosts, in a way, but that there’s no drug they can give her to stop that. The staff tell him to keep her in her village, where she’s surrounded by the people and places she knows best. That as long as she’s safe and supervised, she’ll be okay. The man seems dissatisfied. He leaves saying he will consult a mganga – a witch doctor – instead.

  The nurses count pills and give injections. I help Steven tick names off the list and watch the crowd outside shrink. But there aren’t enough hours in the day; the clinic doesn’t have time to see everybody. There are still a few dozen tortured souls who’ve missed out. They put their names at the top of the list for next time, then shuffle off on their long journeys home, back to the slums, or the townships, or the country.

  Suzanne hates having to turn anyone away. ‘But you can only do what you can,’ she says with a sigh, sweeping the last of the red dirt off the long grey verandah.

  On the way home, I stop in at the other end of the spectrum of fortune in Nairobi: East Africa’s first-ever KFC, a drive-through and dine-in restaurant at the Junction Mall on Ngong Road, the shopping centre closest to Sarah and Jack’s place. Robert’s been involved with helping get it set up, so I decide to head down for the opening.

  The queue is over a hundred people long. They’ve lined up for hours to sample the Colonel’s secret herbs and spices. The crowd is made up of fashionable teenagers on school holidays, women in business suits, and working dads with children who fill the booths in the diner.

  I strike up a conversation with the man in front of me, Huzefa. He works for a global telco and reckons the huge turnout is the result of ‘major buzz on social networking sites’. There’s been virtually no official advertising for the event, just word-of-mouth gossip and net-savvy Kenyans spewing status updates and tweets in the lead-up.

  The Nairobi store is just the first of dozens planned across Kenya, Uganda, Ethiopia and Tanzania over the next few years. I note the paradox: that the fast-food industry is taking off here while in other parts of the region people starve. Huzefa has a different take. He expresses frustration at being pitied by Westerners for the perceived hopelessness of his homeland. He hates that no one’s covering the country’s own efforts to help those affected by the drought in the north, and tells me that a ‘Kenyans4Kenya’ campaign currently saturating FM airwaves and social media has so far raised more than 240 million shillings. Much of that money’s come in ten-shilling donations transferred by the mobile phone–based transaction service M-Pesa: a Kenyan innovation, and the precursor to Apple Pay. I take Huzefa’s point. His countrymen buy badges and turn out in their thousands to send off truckloads of donated food to Turkana, but all we see on the international pages are pictures of dead cows and thirsty kids.

  That’s the story, I realise, and I successfully pitch it to a news outlet back home.

  It’s a tiny little thing, but it feels like it counts as some sort of an accomplishment.

  Fiona’s back again. She’s staying for two weeks. She wants to do an overall health assessment of Walt, see for herself how he’s handling the Risperidone, and overhaul the caring regime if necessary.

  When she arrives, she notices the new curtains, and that the lion is gone from the wall, and develops a theory: Marguerite is planning to sell the house and move Walt into a local aged care home. She decides that’s what Marguerite’s friend Deborah is all about: she’s a real estate agent. I’ll never find out if she is right about that.

  Two days into her visit, I have an afternoon off. I spend it in the computer room at the Club filing my KFC story. I’ve gone out of my way to be inconspicuous, walking back to the house, so that I can slip in through the gates quietly and not trigger Walt with the sound of a car pulling into the driveway. I creep around to the side of the house, wanting to come in through the sunroom instead of the front door, in an effort not to disturb him. But lunch must have run later than usual – I realise too late that they’re still in the dining room, and the door through to the sunroom is open.

  Walt spots me. I freeze.

  ‘Who the devil is that?’ he demands.

  ‘Hi, Walt – only me!’ I call cheerily, hoping the moment might pass him by.

  Fiona shoots me a filthy look. She jumps up from h
er seat and pulls the door shut.

  I’m livid. My entire being goes white-hot as I quietly, violently rage. I swing my fists, stamp my feet, roar silently at the sky, flip her the bird through the closed door with such force I actually strain a muscle in my hand.

  Then I turn to see Esther and David staring at me from the clothesline outside my window.

  I stare back for a moment, mortified to have been caught in such a childish act. Then we all collapse into laughter.

  ‘These people are fucking crazy!’ I hiss at them from the doorway.

  ‘So are you!’ David points out. Fair call.

  I remain trapped in the sunroom until Fiona has put Walt down for his nap.

  ‘This can’t go on,’ I tell her when she comes back down the hallway. ‘You just cannot treat us like this. We live here. We need to be able to relax when we’re not “on duty” with Walt. You can’t control every little bump and squeak in the house!’

  ‘I know, I know,’ she says, stopping short of actually apologising, ‘but Dad’s comfort is the whole point of you all being here, so we’re going to have to come up with an alternative arrangement.’

  ‘Like what?’

  ‘Can you and Ruby stay with your friends from the High Commission?’

  For a moment, this seems like an appealing solution. I’m sure they’d be happy to have us stay. Then the reality of the logistics sets in. Nairobi is not a city made for commuting, and my friends’ apartment is on the other side of town.

  ‘But how would we get here for our shifts?’ I ask. ‘And what about when we’re on night duty?’

  ‘You’d obviously have to sleep here on those nights. And maybe we could get you girls a car to share. Or have Peter collect you each day.’

  ‘It’s a good hour away in the morning traffic. And the person who’s on in the morning needs to be here when Walt wakes up. And even if we did have our own car, we’d only get home for a few hours before having to turn around and come back again. And what about driving at night? I thought it wasn’t safe to?’

  In a flash, Fiona has a plan B. ‘I’m going to find a flat for you girls. Somewhere nearby. Somewhere you could walk to if you had to.’

  By the end of the week, Jade, Ruby and I are moving into our own place: a three-bedroom guesthouse at the back of a property a few streets away, backing onto a forest. Fiona had seen it advertised for rent on the noticeboard at the shops.

  The ‘Maharaja flat’, so nicknamed by Marguerite because it’s owned by an Indian-Kenyan artist, is perfect in almost every way. The place looks like something straight out of Vogue Living. The shelves are decorated with beautiful stone carvings and sculptures, much of the furniture is custom-made from reclaimed wood of old dhows and the brass-studded Gujarati doors I saw in Mombasa, the living room features plush rugs and a huge leather couch and armchairs piled high with soft throws and cushions and poufs. A striking series of paintings and photographs, much of it the artist-owner’s work, adorns the walls, while the bathroom – full of light and greenery and scented candles – is like a day spa.

  Here, we have our own kitchen. Sure, it means buying our own groceries and preparing our own meals, but having that level of control over our lives feels more like a privilege than a chore. If we want to have baked beans on toast for dinner, in our underwear, watching TV, we can. There’s no dressing up for dinner at seven, no need to eat politely and make tired conversation with Walt or Marguerite, no tiptoeing around the house to get a glass of water lest you disturb Walt in another room. We only have to stay over at the house with Walt on the nights we’re on duty. We have our own bedrooms. No need for the constant interruption of people coming in to get Walt’s medicine, or to charge the pagers, or to use the shared laptop for Fiona’s regular Skype calls. No having to wear earplugs to block out the Songs of Ireland or the ninety-fifth rendition of Mozart’s The Magic Flute.

  But there is something, which I can’t quite put my finger on, that makes me feel uneasy about the place. When I close the glass doors at the end of the day, and look out through the gardens in the fading light, even with the resident askari patrolling the grounds I somehow feel less safe.

  Ruby and Jade don’t seem to share my concerns, so I push them aside and settle in. We go to work. We come home from work. And we don’t have to think about work when we’re not there. Almost like having a normal job.

  Almost.

  Walt is asleep when his daughter calls me and Ruby into the dining room. He’s having his afternoon nap. I’ve just set his bed at all the right angles, propped up the three pillows just so – the thickest under his left shoulder, the other two cradling his head. He tried to pull me into bed with him, but I wriggled out of his grip and shut his bedroom door behind me in a flurry of flirtatious tsk-tsk-ing.

  Fiona’s flying back to England in a few days and wants to make sure that if he ‘goes’ while she’s not here, he ‘goes well’. She produces a rolled-up woolly green sock. Every time I opened the suitcase to restock Walt’s pills, I saw the green sock in there, and only now do I realise that I’ve always vaguely wondered about it.

  ‘I need to ask something of you girls,’ Fiona says. Calm as ever.

  Ruby and I look at each other, wondering where this is going.

  Fiona unrolls the sock, reaches down into the end of it, and withdraws a small glass ampoule of clear liquid and a sterile syringe sealed in a plastic and wax-paper pouch. ‘I’m taking Dad off the Risperidone. I don’t think it’s helping him at all. Increasing the risk of him having a stroke or heart attack just isn’t worth it. And the reality is that’s already the most likely way Dad will go, when the time comes.’

  She puts the vial on the table. A cough splutters out of the baby monitor in shallow treble tones. I tap the screen on, see Walt hasn’t stirred, tap it off again.

  ‘Now, if or when that happens,’ Fiona continues, ‘it could all be over very quickly for him, which would be a blessing. But it could just as easily go the other way and be a horribly prolonged process. If he survives an attack, he will be in a great deal of pain. And that’s what I want to avoid.’

  I sense Ruby shift in her seat. Is this going where I think it’s going?

  Fiona continues, her words careful and clear. ‘This is morphine,’ she says, placing a fingertip down on the table in front of the glass tube. ‘I want you to use it if he is struggling or in distress. You’ll know when. If he has a heart attack and stops breathing, he’ll turn blue. He’s too fragile to be resuscitated – you’ll most likely just break his ribs if you try. He will probably be in pain. If he has a stroke, he may just spasm for a bit. It’ll be like a seizure. It’ll look awful, but he won’t feel any pain at the time. The thing is, in either case he won’t recover well. It’ll be the start of months of decline. It will be awful for him.’

  She looks us each in the eye. ‘If I’m not here and you find yourself faced with one of these scenarios, I’m asking you to inject him with this.’

  She taps the spot on the table. The curve of the meniscus flinches inside the glass tube.

  When Fiona sees that we understand what she is asking, she continues. ‘You’ll need to roll him onto his side to get at his back. Let me show you.’

  Fiona demonstrates on Ruby’s back for me, then on my back for Ruby. She pulls our shirts up and points out where, between the scapula and the spine, we are to push the needle through his skin and inject an amount of liquid morphine. She asks us to inject it a half-inch deep, subcutaneously, then to place several drops under his tongue to give him more immediate relief. Then to sit with him, to comfort him.

  ‘Please,’ she says, ‘I don’t want him to be afraid, and I don’t want him to be alone.’

  Neither Ruby nor I agree to do it.

  But I’m sympathetic.

  From the moment I was first able to fathom death, I’ve been somewhat obsessed by it. I’m terrified of dying slowly – of being diagnosed with terminal cancer or some awful degenerative disease and having to endure
years of pain and indignity. The anxiety of that knowledge seems like it would be even more torturous than the physical suffering itself. I watched my own grandmother take several cruel weeks to die. Starvation and organ collapse claimed her in the end, which is usually how these things go. The experience made me surer than ever that having the ability to manage your own end on your own terms means being able to quell that existential panic – a right everyone should be afforded but never compelled to exercise, nor invoked by anyone but that individual.

  I want to explain all of this to Fiona, but when I begin to she shakes her head and raises a hand to stop me, as though she doesn’t expect a response. I see that she felt she simply had to ask, knowing her request would almost certainly be refused, on the off-chance one of us might agree to carry it out for her.

  My pager starts beeping – Walt is out of bed.

  ‘I’ll go,’ Fiona says, leaving Ruby and I to sit there in shock. We just look at each other in silence.

  Fiona doesn’t ever mention the vial or her request again.

  14

  FUN RUN

  Ruby and I arrive at the Karura Forest at seven, driving the old Peugeot along a dirt road through the trees until we reach a car park full of gleaming Mercedes and BMWs in a grassy clearing marked out with bunting. An officious race warden tells us to follow the lycra-clad queue into a squash court where we register and are issued with competitor numbers to stick to our shirts. As far as I can tell, we’re the only individuals running; everyone else seems to be a member of a corporate or charity team.

  Oddly, the whole scene reminds me of home – it’s like the marshalling area for the City2Surf race in Sydney, full of middle-class health nuts, the kind of people who have to schedule exercise into their otherwise sedentary lives, and who run for the networking opportunities as much as the ‘fun’.

  Ruby and I puff along through the greenery for ten kilometres, birds and monkeys scattering and converging again around us as we jog, overtaken every so often by a trio of long, lean African semi-pros who lap us twice before we’re even halfway through. I remember what a pleasure it is to be outdoors, to be in the thick of dirt and trees and nature, to feel and breathe the rawness of a place. But there’s also something about the forest that makes me uneasy. I wouldn’t want to be here alone, or at night. We reach the finish line in a respectable time, middle of the pack, then lay ourselves out in the shade to recover.