After twenty four hours of departure delays, missed flights and mindless people-watching in airports, I finally arrived in Berlin, disoriented and in great need of a toothbrush. Seth in his usual high-energy, unrelenting O.F. focus immediately wanted to get to work. Although obviously exhausted, my adrenaline took over as we walked all over Berlin for last minute items and packed and repacked our gear a million times. That night, over a plate of cow (Seth is a huge carnivore and I am practically Hindu) and spinach artichoke tapas we defined our organizational objectives and flushed out our ever-evolving strategy for the summer.

We left the next day for Nairobi via Doha, the capital of Qatar in the Middle East. Our 12 hour overnight layover exposed us to an antiquated world of Arabic and African cultures that have been mixing for centuries through commerce. The airport was a diverse stage of hundreds of languages, with poor South Asian migrant workers, wealthy oil tycoons, western businessmen, and fully clad Muslims of African and Arab descent. The smells of body order and Indian spices that permeated the air and strange and beautiful faces provoked a sense of curiosity and intrigue to the unknown world we were embarking upon.

Despite months of planning, traveling to Africa on this type of quest is a nebulous affair. We had reached out to surgeons and health professionals all over the region but a solid schedule seemed to elude us. As soon as we hit African soil we were welcomed Dr. Westin Khisa, a fistula surgeon in Nairobi. Dr. Khisa is a short, smiling man with a hundred jokes in his pocket and a warm hospitable heart on his sleeve. Working with AMREF, he has helped build O.F. treatment capacity throughout Kenya. Seth met Dr. Khisa while in Geneva at the World Health Organization and our primary purpose in reconnecting with him was to pick his brain on how he and his team built this capacity. After a short tour of his office, Dr. Khisa invited us to an evening of masala tea (a black pepper and ginger spiced African tea) and fish sticks as we discussed maternal health in Africa and American politics with he and his colleagues (these Kenyans sure love Obama!)

We continued the conversation the following morning for a 7am breakfast. The doctors shared their deep sense of African society at the community, district, and national level. Kenyatta National Hospital (where they all work) is one of the largest hospitals in Africa and they are responsible for even the most remote patients in Kenya. Despite efforts to set up a formal network of referral hospitals, reliance on traditional medicine sometimes keeps populations of people out of the national health scheme. Nairobi doctors are seen by some local people as alien and these people prefer treatment by community health workers who they know and trust, but who sometimes have absolutely no medical training. To build bridges as outsiders, working in this area is a tricky task even for Africans. This discussion over breakfast helped us to understand the intricacies of working within tribal populations in African society and bridging the gap between rural and urban (read modern) medicine.

That night we took the overnight train to Mombasa, an ancient Afro-Arab trade port on the Indian coast. The rhythmic but loud thumping of trains usually keeps me from sleeping but this train was magic. I woke up at 7am, refreshed, ready to go and expecting to arrive in an hour with a full day. But for some reason we were stopped. Five minutes into breakfast, we learned that we had actually been stopped the entire night due to a carriage derailment about a mile up- comforting to know as we traveled in a carriage on the same archaic tracks. To kill time, we walked around Kibwezi, the small village that our waiting train had invaded. But as curious as we were about the villagers, they seemed even more interested in watching us. We made friends with unspoken words and nail polish and were finally on our way again.

Twelve hours later, we were greeted at Mombasa Railway Station by Dr. Jennifer Merry Othigo, a fistula advocate and surgeon from Coast General Hospital. Seth met Dr. Othigo for a few minutes in New York and had mentioned our upcoming trip to Kenya. Without hesitation, Dr. Othigo offered to host us and we were as excited for this experience as we were to discuss her success in treating fistula in the coastal region. Dr. Othigo has a deep understanding of treatment costs and she helped us develop a detailed patient costing analysis so that we could capture and categorize the components of a single vesico-vaginal fistula (VVF) surgery. While we had planned on at most two days of meetings, our delayed arrival and Dr. Othigo’s phenomenal African hospitality extend our stay through the weekend.

With extra time, we had a chance see the real Mombasa and to get to know Dr. Othigo and her friends and family. As Mombasa is a rich blend of Arab Muslim and African Christian societies, Dr. Orthigo transcends religious and cultural divides by working in partnership with the Council of Imams, an organization of Muslim societal leaders. This deep cross culturalism is pronounced in her personal life and we were invited by her close friends Zeitun and Said to a traditional Arab-Swahili meal in their warm and simple home. The magnificent food and Arab generosity highlighted the unceasing African kindness we had experienced since we landed on the continent. Though we were really beginning to grow comfortable in this coastal port, it came time to board the train once more for an overnight (hopefully) return trip to Nairobi.