Who is My Neighbour?

B, our part time cook, has had a very bad few months by anyone’s standards. His wife got typhoid. His part-time jobshare let him go. His house burnt down with all his belongings in it. And now, after the joyful birth of his third grandchild a week ago, the babe is failing to thrive. Has lost weight dramatically. Has lost sucking reflex. Is crying all the time.
Yesterday the dad took the newborn babe to the local district hospital, in Mbale.

‘We can’t treat him here, he needs to go, several hours away, to Kisumu.’

Stressed phonecalls to B, in Nairobi, 8 hours away. B is the only member of the extended family in employment. One wife, 2 adult sons (and their wives and three children), and three daughters in high school, all depending on B’s part time wage in a land without social security.

Last night B’s son was in howling distress on the phone. To check into Kisumu hospital you need to provide a deposit. No one was clear how much. At least 10,000 KSh, £90, B reckoned. No one had that money. Was it worth Dad and stricken babe, in extremis, boarding the overnight bus to travel several hours, without it? So B spelled it all out to me, and hotfoot via the bank, we loaned him the money.

Today, palefaced, B updated the situation. The babe is now on an incubator, with a drip. But the total deposit had been 27,000 KSh, - some £250. Back I go to the bank.

This morning, L, our housekeeper, filled in more of the gaps. Mbale hospital, the district hospital from which they were sent, is in a poor position. Has, for confused reasons - ?failure to pay bills – no water at all, ever. Families of patients must arrive with their own water in tow. And yes, you must first pay a deposit to access treatment in a hospital. You pay your money, receive a receipt, and show the receipt before any test or interaction.

I truly wish the babe and family well. I realize they have no one else with money in their circles. I trust B, our cook, I value his integrity, I want to help out. I can’t walk by on the other side when, without medical knowledge, it seems that a life is at stake.

I know it’s ignoble, but I’ve also totted up how much extra we’ve contributed to our part time employee in the last few months. 3 saucepans, a set of crockery, a duvet, sheets and some towels, a lilo and pump, four sets of clothes, some shoes, and the proceeds of a cash whip-round at the time of the fire. 1000 bob to help towards the doctor’s fees for his wife. 15,000 KSh, £130, towards the term’s fees at high school for the three daughters, after the fire, when it became clear that without extra contribution, at least one of them would have to stay out of school. And now loans of 24,000 Ksh, £230, to help out the grandson, - and a sense that this might just be the beginning. We pay generous wages for what B does and contribute too towards his transport costs each month. But we watch his distress at the claims and the real demands on him, to which without external help he will not be able to rise.

Trying to get the second installment of cash from the cash-point on a Friday afternoon, it all fell apart, as slick transactions often do here. The cash machine spat out the receipt, saying it had issued 20,000 KSh, but gave me not a bean. No handy notice on the machine ‘in case of malfunction please phone..’ Blank-faced security guards. No branch of the bank in the mall. In the end I walked to the nearest branch, tried to lodge a report. Got waved from pillar (the reception) to post (the customer service point) via the priority business counter. No one would take a report. ‘You need to contact your (foreign) bank to sort this out’ though this had been their bank’s ATM, and we have a local account with their branch too. I was hot, I was bothered, I was flustered, and I was trying to get the cash to Kisumu, fast, to help the babe. And in the end I just saw red.

‘This cash is not for myself, nor for my child, nor my employee’s child. It’s to help a sick child in Kisumu hospital, who is nothing to do with me. It’s a charitable donation because I’ve been asked and am stepping up. This isn’t my country. This actually isn’t anything to do with me. And you, who are paid by this bank to sort out problems, this bank which is my bank too, are all refusing to even take a report so one day, this problem, of your ATM’s making, might be sorted out by someone else. I can’t say how angry that makes me.’

B says, heavily, ‘God will manage all. It’s in his hands.’ I respect his acceptance. But I see it more as about what we do, what we are willing to take on, help out with, live up to, with whom we are willing to identify. Yet today I feel sulky, resentful, overburdened, overstretched, a mulish Jonah under the fig tree turning her face from what she’s being asked to do. Who me? Not me Lord. We're surrounded by need all around. Today, I feel we’ve done enough, for now. This is one of our employees, I care for him, but the others are requesting support too, though at lesser levels, - and the wider community. What is realistic? Where can I draw appropriate limits, when today the need is so clear, but I feel overstretched? What would I ask for from my kindly boss in the UK? Maybe a fiver if my purse had been stolen, to help me buy lunch and to pay back next morning.

But chatting to a school mum friend whom I really respect today, she told me what they have done this week. How a friend in another country, a supplier to their business, but no one to whom they have clear responsibility, had let slip how he had cancer, tumors on major organs. How her husband had phoned the consultant to understand the situation. Had requested a costing of treatment here, and the alternatives. And had stepped in, to fund and arrange chemotherapy, flights and hotel for the friend and his wife in India. Had stepped up to sort out the visas. And made nothing of it. As she said,

‘The cancer is far gone. Most likely this won’t help much. But it matters to my husband that he does what he can for a friend. That he gives it his best shot.’

And that’s really it. B didn’t hesitate when I said we’d give the money as a loan, not a present, though he did gulp and it’s a massive amount for him to pay back. He wants to give his grandson his best shot. It matters to make possible what we can in relationships. It matters to raise the bar. This feeling of feeling overstretched, this is the Kenyan experience. This is to walk in B’s shoes, as he juggles part payments of school fees with trips back home with gradually furnishing his rebuilt house in Kangemi, sole wageearner in the family.

And, as I write, an email pops up on screen. A UK friend has read my facebook status, is offering to pay the check-in charges. And this truly is about being a good neighbour, - going out of her way for a babe and a family she knows not at all - but creating those links of love which make the sun emerge from behind clouds in a sometimes bleak world.

The Bare Necessities

If there's one institution (and in fact there are many) that I've learned to truly appreciate during this time in Kenya, its the UK National Health Service. Free health care at the point of delivery. Treatment for those who need it, without assessment of their ability to pay. Rationed, yes. After a wait, ok. Sometimes a postcode lottery. Not a magic wand. But ambitious in its vision, a testimony to what you can choose to do with taxation, and a miracle of our times, of which to be truly proud and for which to give daily thanks.  The freedom which comes from believing that should I, or mine, be struck down by illness, professional help that we can afford will, most often, be offered.

I've been thinking of blood recently.  When we arrived, we filled out forms at Tom's work to join the Walking Blood Bank.  Gave it no further thought. Assumed, vaguely, it might be about access to pre-screened or better nourished blood.  Gradually I've got wiser.

Now I'm in the networks I get regular texts and emails asking whether I'm a specific blood type to give blood. I''ve been a blood donor in UK, it's surely a good thing. But here, in extemis, the appeals are to give earmarked blood, to donate my O+  for my mate, patient B, or a classmate's dad, or the radio appeal beneficiary, patient C, and her alone.  No man is an island and there aren't the storage facilities, or, I think, enough donors. Here you need your network. You need your employment-based Walking Blood Bank. In case of emergency, you may need your O+ mates, the school mums, and their spouses, and their friends and relations, and the Quaker meeting and the book group, and additional Samaritans, and need them not just to bring grapes, or to bring the children home from school, but to turn out and to donate their blood.

Sanitary towels are another big issue. A hidden issue. An embarrassing issue I'd guess for many Kenyan young women.  They aren't cheap - probably 200 KSh - £1.50 for enough for a monthly period. But lots of poorer families in the slums try to live on 75 KSh for the whole family a day.  So girls, young women, older women have to manage without sanitary towels. Try to make do with  leaves, mud or rags.  Many have to miss a week of school a month. Not good for self esteem, health or education.

An Irish women's group goes to some schools in Nairobi's slums and hands out termly sanitary towels to the pupils. Local women's groups make cheaper ones to generate jobs. But they are a drop in the ocean. A friend passed me another appeal recently. For sanitary towels to work, you need knickers. And those who have no sanitary towels, in general have no knickers either. So this other appeal is to donate pants. Not pants for all the month. Just pants to be worn during a period. Parties for panties they suggest. Instead of bring a bottle, bring a pack of pants to donate. I have to say, it's a form of solidarity which appeals.  But like the peace movement saying that you don't see generals holding cake sales to pay for the latest military hardware, pants, sanitary towels, blood they're such basic needs in this country where you see many with plenty as well as extreme poverty.

Living with uncertainty

So we're back in Nairobi after 5 weeks away, more relaxed than pre-departure and more competent than this time last year. And with the greater detachment after absence I'm aware what I'm grappling with is the lesson of living in shades of grey, living in the moment, less worrying about the morrow, being in the here and now, seeking not to focus on the worries at the corner of my eye, but to act justly in the moment.

The month before we left was overshadowed by worrying about illnesses of our house staff. Waking up at 3am worrying. We'd decided when we employed people that we would aim to be good employers subsidising their health and their children's education. After checking with friends here long term we agreed to take on responsibility for paying 80% of their medical costs and to pay it from our pockets rather than paying for individual private medical insurance at £270/per person pa. And over much of the year it was clear that the staff really welcomed this degree of security, and the only health costs had been a gift of £30 when the 3 year old son of the handyman was knocked unconscious and needed rushing to a clinic, a scan and a doctor's consultation. Though school fees for five children and part fees for another two is another matter again.

But then one night I realised that E, the night guard who covers at weekends, had lost alot of weight. About a stone and a half. And he said he'd been diagnosed with diabetes. You buy insulin privately here if you can afford it. $80 a daily dose. But his monthly wage, as sole wage earner in his family, is about $100/month. And though we are the people he has regular contact with, he is employed by a major global firm - which doesn't offer health cover - and contracted by D's employer not by us. On the one hand it is clear he needs access to insulin and would get this, were he in UK. On the other, amidst the many responsibilities we have to others we are employing, the cost, and not creating something which can't be sustainable in the medium term at latest once we've left Kenya, beyond a supply for emergencies this is something we are choosing not to take on. With heavy hearts. And as you dig beneath the surface it becomes clear how pressing an issue this is for many in our lives. L, our homehelp, has adopted her dead sister's two children, alongside her own. But as I discussed E's diagnosis with her, she noted that the sister who died had died from a diabetic coma. And another adult sister who lives intermittently with her is diabetic, attempting to manage the situation by diet.

And so to R, our handyman cum gardener, who always wears a hat, no matter what the weather. I had just assumed he was a fanatical Arsenal fan, never to be seen without his supporter's woolly hat even when unblocking the sewage pipe in full midday sun. But 2 days after the E incident he was looking tired on a Monday morning. What's up? Heavy weekend?

He hadn't been sleeping for the last month. Bad headaches. Whipped off his hat to show a growth the size of a pancake on the side of his face and neck.
'How long have you had that for?'
8 years... but I've only had the headaches for the last month. When I went to the doctor 3 years ago he told me it would cost £60 to operate.
Brain tumour.' I was thinking. 'Thousand dollar bills.' 'And this one IS up to us.'

A friend whose daughter fell this year paid $1000 deposit before seeing a neurosurgeon and a further $1400 for a scan and consult. How much would potential brain surgery cost? But R is in his thirties, and is employed by us, again sole wage earner and has 4 young children. Though we pay generously there is no way he could begin to meet the costs of potential neurosurgery.

So I gave him £60 to go and see a doctor at the local clinic, and he queued for two days to get to the head of the queue. And off we flew on our much needed but by no means cheap holiday, while I checked my phone for a text on the debts we might have run up in our absence.

But praise be, on our return, there is R, weeding in full health, without hat for the first time, with a neat little scar on the side of his head. Its a bit hard to determine what was up from the scrappy note in internationally illegible GP handwriting and our language difficulties and lack of diagnostic skills. But not a brain tumour, only a further £60 owed, and if I understand correctly, possibly a fatty deposit caused by too much heading of the football in his youth. Headaches gone. Beauty restored. And a sound night's sleep for all concerned.

And what am I learning? That there aren't solutions to everything. That what matters more - or maybe not more, but as much - is concern and involvement. That E wasn't expecting or asking for us to pay for insulin for him, - though this IS what we expect from our solutions-focussed perspective. That what matters now to him is that we are willing to enquire, do what we can, and to sit with him in the messiness and anxiety of a life without safety nets and solutions. That he feels he can ask us in an emergency. That in our limited way, with our self imposed restrictions, we don't just walk by on the other side of the road.